
==== Front
Saf Health Work
Saf Health Work
Safety and Health at Work
2093-7911
2093-7997
Occupational Safety and Health Research Institute

S2093-7911(24)00034-9
10.1016/j.shaw.2024.05.002
Review Article
Prevalence of Workplace Microaggressions and Racial Discrimination: A Systematic Review and Meta-analysis
Salari Nader n_s_514@yahoo.com
12
Fattah Ahoura ahoura.fattah@gmail.com
3
Hosseinian-Far Amin a.hosseinian-far@herts.ac.uk
4
Larti Mojdeh nurselarti@gmail.com
2
Sharifi Sina SharifiII_SIi1@gmail.com
5
Mohammadi Masoud Masoud.mohammadi1989@yahoo.com
6⁎
1 Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
2 Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
3 Medical Biology Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
4 Department of Business Analytics & Systems, University of Hertfordshire, Hatfield, AL10 9EU, UK
5 Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
6 Research Center for NonCommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
⁎ Corresponding author. Masoud.mohammadi1989@yahoo.com
15 5 2024
9 2024
15 5 2024
15 3 245254
6 12 2023
2 5 2024
11 5 2024
© 2024 The Authors. Published by Elsevier B.V. on behalf of Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency.
2024
Occupational Safety and Health Research Institute
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Background

In recent years, the rise of workplace racial discrimination and microaggressions has decreased the efficiency and productivity of organizations and institutions, and realization of organizational goals globally. Accordingly, it was decided to conduct a systematic review and meta-analysis in the present study with the aim of investigating the prevalence of microaggression and racial discrimination in the workplace.

Methods

The PubMed, Scopus, Web of Science, ScienceDirect and Google Scholar databases were systematically searched for studies that had reported the effects of work stress among managers. The search did include a lower time limit and was conducted in June 2023. The heterogeneity of the studies was investigated using the I2 index, and accordingly random effects method was adopted for meta-analysis. Data analysis was conducted with the Comprehensive Meta-Analysis (v.2) software.

Results

In the review of seven studies with a sample size of 2998 people, the overall prevalence of microaggression and racial discrimination in the workplace was found to be 73.6% and 18.8%, respectively. Publication bias within the selected studies was examined with the Egger's test, which indicated the absence of publication bias for the pooled prevalence of workplace microaggression (p: 0.264) and for the pooled prevalence of workplace racial discrimination (p: 0.061).

Conclusion

The results obtained from this report indicate the high impact of micro-aggression and racial discrimination in the workplace. Considering the negative effects of such behaviours, the findings from this study will be helpful to managers and health policymakers.

Keywords

Microaggression
Prevalence
Racial discrimination
Workplace
==== Body
pmc1 Background

While racial discrimination is a well-known occurrence in the workplace [1], microaggression is a comparatively recent concept in research [2]. It can be argued that microaggression is a new moral category that refers to subtle yet harmful forms of discriminatory behavior that it is experienced by members of marginalized groups [3]. Accordingly, implicit bias often underlies such behavior, indicating aggressors are insensible to the harm they have inflicted [3].

Microaggression can be defined as communicative slights or actions, verbal, non-verbal, impacting a marginalized individual's emotional and mental well-being, and degrades the victim's identity [4,5]. It is an atypical offensive action, which is typically subtle in nature, and can play a disproportionately harmful role in affecting the victim [2]. Moreover, microaggressions can often be unintentional behaviors based on implicit prejudices, however, they are considered harmful by marginalized groups [6].

Apart from microaggression, there are other concepts and associated acts that are also discussed. Racism is one of the most significant terms in contemporary sociological culture, however, defining it proves to be challenging [7]. In the sociology of race and ethnicity, the concept of racism entails a wide range of social phenomena such as systemic inequality, institutional discrimination, internalized stereotypes, and racial attitudes [7].

Microaggressions present some key theoretical challenges about the nature of intention as well as evidence for the meanings of actions that speakers can or should be responsible for [4]. Considering that micro-aggressions are not immediately evident, and may have occurred unintentionally, it can be challenging for the victim to cognize whether what was faced was a micro-aggression or not [4]. Therefore, an individual's assessment of the level of discrimination is based on their own perception, and this is also related to inherent inclination to create impressions of others [8].

Organizations attempt to create inclusive working environments with high levels of employee participation as well as social interaction among work groups, to benefit from the diversity and the full potential of workforce [9]. Nonetheless, despite all the efforts, organizations often face pertinent challenges of unwanted acts or behaviors that result in the reduction of organizational productivity [10].

In the United States, racial, ethnic, and linguistic minority workers experience elevated rates of work-related injuries and illnesses compared to their white counterparts. Reasons associated with this include potential socioeconomic factors e.g., education, income, and wealth, and their segregation into more hazardous jobs [10].

In the discourse revolving around microaggressions, a key focus is on whether or not the individuals responsible for the microaggression behaviors are morally responsible for the harm they cause [2]. Perpetrators of microaggressions can claim that these actions are nothing more than misunderstandings and the intentions of the speaker have been misconstrued, which is both theoretically and practically valid [4]. Nonetheless, even if the person responsible claims no offensive intentions, labeling an unintentional microaggression as “just a misunderstanding” minimizes the detrimental effects on the victims, and also reinforces underlying unconscious attitudes in society [4,10].

Existing research indicates that racial discrimination increases the psychological stress of employees. This is particularly evident among marginalized groups, such as racial minorities, leading to a negative impact on their organizational commitment, overall productivity, and performance [[10], [11], [12], [13], [14], [15]]. This can also have destructive effects on reducing the probability of being hired [1], decreasing job security, and declining employee job satisfaction [8,10]. Furthermore, it is crucial to acknowledge that racial discrimination is an important obstacle to the development and advancement of inclusive working environments [16,17].

In human service organizations (HSOs), microaggressions can lead to reduced therapeutic alliance, and high staff turnover, which ultimately lead to negative outcomes [5]. Similarly, microaggression can result in a degree of disorganization within the work environment that may lead to reduced productivity, negative work atmosphere, high staff turnover, and organizational costs related to internal and external investigations [6]. Job satisfaction and job security are among the vital aspects of adults' daily lives [8] Therefore, it is essential to give special attention to the factors related to job dissatisfaction within organizations.

In recent years, there has been a significant attention and focus on the rising prevalence of microaggressions and racial discrimination. Such behaviours result in destructive effects within the work environment, the negative consequences of which not only make it difficult for organizations to achieve their goals, but also affect the employees' lives within the wider societal context [[12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22]]. Considering the heterogeneity presented in the studies that have dealt with these concepts, the main question of this research is, what is the prevalence of microaggressions in the workplace and racial discrimination? Accordingly, considering the importance of this topic, it was decided to conduct a systematic review and meta-analysis on relevant studies in the field.

2 Methods

To obtain relevant studies through a systematic review, the PubMed, Web of Science, Google Scholar, Scopus, and ScienceDirect databases and repositories were searched in June 2023. The keywords used for the searches include Burden, Outbreak, Prevalence, Workplace, Microaggression, Worksite, Jobsite, Racial Prejudice, Racial Discrimination, and Microassault. To maintain the comprehensiveness of the search, no restrictions were considered in choosing the year of publication of the articles. The information of all identified studies was then transferred into the EndNote reference management software. In order to maximize the number of relevant studies, the lists of references used within the identified articles were manually searched and reviewed for grey literature. The searches were last updated within the same month, i.e., June 2023.

The research was conducted to answer the research question based on the PICO framework, including population, intervention, comparison, and results: The study population (Population) includes: Workers in the workplace, Intervention: Without intervention, but among workers in the workplace who have faced microaggressions and racial discrimination in the workplace, Comparison: Compared with workers who have not faced microaggressions and racial discrimination at work, Outcomes: The overall prevalence of workplace microaggressions and racial discrimination.

3 Inclusion and exclusion criteria

The selected articles within this study had reported the prevalence of micro-aggressions and racial discrimination in the workplace. Furthermore, we only included studies for which we had full-text access and that were written in English. Non-English language articles with English abstracts were also included in the study, cross-sectional studies, mixed methods and pilot studies.

In terms of exclusion, firstly, duplicates and irrelevant studied were skipped. Studies that had not provided sufficient evidence were also omitted. Lastly, case-control, cohort studies and case-series studies were omitted from the systemic review.

4 Study selection

The study selection was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. As the first step, identified studies that were duplicates in various databases and repositories were removed, and only a copy of each was retained. Subsequently, the review of titles and abstracts of the remaining articles identified a number of irrelevant studies which were then removed based on the inclusion and exclusion criteria. In the eligibility evaluation stage, the full text of the remaining articles was evaluated in accordance with the inclusion and exclusion criteria, and at this stage, a number of further unrelated studies were omitted. To eliminate bias, all the steps of reviewing sources and data extraction were completed by two researchers independently. Cases of disagreement were then resolved with the assistance of a third reviewer to reach consensus.

5 Quality evaluation

The remaining articles underwent a round of quality assessment. In order to evaluate the quality of the articles, a checklist suitable for observational studies was adopted. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist includes six scales: title, abstract, introduction, methods, results, and discussion. In total, this checklist contains 32 items/subscales. The 32 items denote different methodological aspects of a study e.g., title, statement of the problem, type of study, methods of statistical analysis and findings, determination of the appropriate sample size, sampling method, statistical population of study, definition of variables and procedures, means of data collection, and study objectives. Consider fulfilling any of the 32 items gets a point, then the maximum score that can be awarded would be 32. Accordingly, articles that scored 16 or higher are classed as medium or high-quality articles. Articles that scored below 16 were considered to be of lower methodological quality, and were therefore omitted.

6 Data extraction

Data extraction was completed by two researchers through a different pre-prepared checklist. The fields within the checklist include first author's name, year of publication, location of study, prevalence, sample size, age group of participants, and study instrument.

7 Statistical analysis

The extracted quantitative evidence was entered into the Comprehensive Meta-Analysis (v.2) software, and the heterogeneity of studies was examined using the I2 test. The Egger's test was used at a significance level of 0.05 to assess existence of publication bias, and corresponding Funnel plots were drawn.

8 Results

On the whole, 460 articles were found after searching the specified repositories and databases, and the identifying information of the articles were transferred into the EndNote reference management software. A total of 119 duplicate articles were removed. In the screening phase, the titles and abstracts of the remaining studies were reviewed, and 155 further articles were excluded based on the inclusion and exclusion criteria. In the eligibility evaluation phase, 179 articles were omitted following the full text review, and in accordance with the inclusion and exclusion criteria. In the quality evaluation phase, based on the scores obtained from the STROBE checklist, studies with poor methodological quality were removed, and finally, seven studies were retained for final evaluation. The information of these seven studies is reported in Fig. 1, Table 1, Table 2.Fig. 1 PRISMA flow diagram for study selection.

Fig. 1

Table 1 Summary of characteristics of included studies of prevalence of microaggression

Table 1Author	Year	Location	Age	Type of study	Sample size	Prevalence of microaggression	Instrument	
Nadal [20]	2011	United States	24.83	cross-sectional	443	%31.1	(REMS-I)∗	
Samora et al [21]	2020	United States	≤21	cross-sectional	264	74%	32-item survey	
Sudol et al [18]	2021	United States	≤20	cross-sectional	259	94%	Anonymous electronic survey	
∗ Racial and Ethnic Microaggression Scale-Initial Version.

Table 2 Summary of characteristics of included studies of prevalence of racial discrimination

Table 2Author	Year	Location	Age	Type of study	Sample size	Prevalence of racial discrimination	Instrument	
Avery et al [19]	2008	United States	41	cross-sectional	763	3.30%	Single question (Yes & No)	
Enoksen [23]	2016	Norway	42.5	pilot study	224	15%	“He or she likes to spoil himself/herself,” questionnaire	
Kim et al [24]	2013	United States	≤30	cross-sectional	502	34%	Questionnaire analyzed with STATA 11	
Zambrana et al [25]	2017	United States	42.8	mixed methods study	543	44%	Web-based/individual and group interviews/and survey comments	

According to the study characteristics outlined in Table 1, Table 2, 6 cross-sectional studies, an experimental, and a mixed methods study were included. The highest prevalence (microaggression) was related to the study of Sudol et al, in which among 259 participants with an average age of ≤20 years, 245 (94%) reported microaggression at work [18]. Additionally, the lowest prevalence (racial discrimination) was reported in the study of Avery et al, where 3.3% of all 763 participants, with an average age of 41 years, reported racial discrimination at work [19].

9 The prevalence of workplace microaggressions

In the review of three studies with a sample size of 966 people, the I2 heterogeneity test showed high heterogeneity (I2: 99.1), thus, random effects method was adopted to conduct the meta-analysis. Accordingly, the pooled prevalence of workplace microaggression was found to be 73.6% (95%CI: 30.7%–94.6%) (Fig. 2). Publication bias assessment using the Egger's test shows the absence of publication bias in the studies (p: 0.264) (Fig. 3).Fig. 2 Forest plot of the prevalence of workplace microaggressions based on random effects method.

Fig. 2

Fig. 3 Funnel plot of publication bias in reviewed studies related to microaggression in the workplace.

Fig. 3

Based on the findings of a meta-regression analysis, it was observed that as the sample size increased, there was a decline in the overall occurrence of microaggressions in the workplace (p < 0.05) (Fig. 4). Moreover, with the increase in the year of publication of studies, the prevalence workplace microaggression increased (p < 0.05) (Fig. 5).Fig. 4 Meta-regression of the effect of sample size on the prevalence of workplace microaggressions.

Fig. 4

Fig. 5 Meta-regression of the effect of year of study on the prevalence of workplace microaggressions.

Fig. 5

9.1 The prevalence of racial discrimination in the workplace

A meta-analysis of four other studies with a sample size of 2032 that provided the necessary information for analysis was performed, the examination of the I2 heterogeneity test showed high heterogeneity (I2: 98.6). Thus, random effects method was adopted to analyze the results. Accordingly, the pooled prevalence of racial discrimination in the workplace was found as 18.8% (95%CI: 7.4–40.1%) (Fig. 6). The Egger's test result indicates the absence of publication bias in the studies (p: 0.061) (Fig. 7).Fig. 6 Forest plot of the prevalence of racial discrimination in user location based on random effects method.

Fig. 6

Fig. 7 Funnel plot of publication bias in reviewed studies related to racial discrimination in the workplace.

Fig. 7

Similarly, based on the findings from the meta-regression analysis, with the increase in the sample size, a decline in the prevalence of racial discrimination in the workplace was observed (p < 0.05) (Fig. 8). Moreover, with the increase in the year of publication, the prevalence racial discrimination in the workplace increased (p < 0.05) (Fig. 9).Fig. 8 Meta-regression of sample size effect on the prevalence of racial discrimination in the workplace.

Fig. 8

Fig. 9 Meta-regression of the effect of the study year on the prevalence of racial discrimination in the workplace.

Fig. 9

10 Discussion

This systematic review and meta-analysis aimed to find the pooled prevalence of racial discrimination and microaggression in the workplace. Based on the findings in our meta-analysis, the overall pooled prevalence of microaggression and racial discrimination in the workplace was found to be 73.6% and 18.8%, respectively.

Considering existing literature, Krieger et al reported racial discrimination as 37% [26], whilst Vecormak et al found the rate of racial discrimination, considered in the study as the most common type of discrimination, as 40.6% [27]. Nonetheless, Kim et al, reported racial discrimination as the third most common source of discrimination from management, and found its prevalence to be 31.4% [24]. Donavan et al reported the prevalence of microaggression at 69% [28], whilst Hong et al reported this as 30.9% [29]. Similarly, Samura et al found in their research that 74% of the participants had experienced some form of microaggression [21].

Microaggressions are often subtle insults that appear verbally, non-verbally or visually [[30], [31], [32]]. Microaggressions can be directed intentionally or unconsciously towards members of a marginalized group [33]. Accordingly, microaggression includes behaviors that arise from implicit bias and occur at the interpersonal level [34]. In other words, microaggressions are humiliation or destructive insults that are manifested towards individuals or groups of individuals who are members of a marginalized community [35]. These obstinacies in behaviours essentially demonstrate the dominance of the privileged group and reaffirm the subordinate status of the marginalized community [33].

Racial discrimination can be faced on day-to-day basis and can be both in the form of overt behaviors, for instance, being called by derogatory names, and in the form of subtle behaviors, e.g., being stared at by a retailer security while shopping [[36], [37], [38], [39]]. In addition to changes in racial attitudes, changes in the political and legal landscape are likely to reduce overt forms of discrimination in the workplace and create more subtle manifestations of prejudice [40].

While racial discrimination appears to be a common experience for many ethnic minorities, there are likely individual differences in the extent to which individuals rate any negative incident as discriminatory [41]. Some individuals are vigilant in paying attention to instances of discrimination and are likely to highlight the incidents even in the absence of much evidence, while others may not be so attentive and are likely to overlook the discriminatory actions despite existence of clear evidence [42,43]. Research has shown that racism is not fading away but has been replaced by less obvious actions [44]. It is worth noting that other titles that are applied to racial discrimination include “modern racism” [45], “abhorrent racism” [46] and “double-sided racism” [47].

Employment discrimination can affect an employer's ability to recruit qualified employees, retain top talent, improve performance, and market products or services to consumers [48]. Survey studies show that during the recruitment process, African Americans and Hispanics are less likely to be invited for interviews or receive job compared to their White counterparts [[49], [50], [51]].

Microaggressions negatively impacts the receiver, and this can disrupt existing structures and hierarchies [52]. Additionally, discrimination in the workplace leads to widespread destructive effects [53]. The effects of discrimination can also have a negative impact on individual's attitude around their jobs [54]. In addition, the intangible costs associated with the effects of racial discrimination are significant [55].

Racial discrimination also extends beyond interpersonal interactions and is manifested at the institutional level in discriminatory policies, regulations and practices. This is also referred to as structural or institutional racism [[56], [57], [58], [59], [60]]. In addition, studies show that exposure to occupational, ethnic, and racial discrimination leads to severe mental health consequences, including psychological distress [61], depression [62], and trauma [63]. Furthermore, some studies have linked discrimination to a range of adverse negative health outcomes, including respiratory conditions, diabetes [64], complaints of physical conditions [65], and chronic health diseases [66,67]. Discrimination also leads to unequal access to social, educational and material resources, which has a direct and indirect effect on health status [[68], [69], [70]].

The economic consequences of racial discriminatory experiences extend beyond the individuals who have been discriminated against [71] and even include the perpetrators themselves [[72], [73], [74]]. Accordingly, research finds racial discrimination as a persistent source of labor market disadvantage for minorities and marginalized groups [75].

In line with the results obtained from the existing literature, and considering the findings of this study, there is a high prevalence of racial discrimination and microaggression in the workplace.

11 Limitations

One of the key limitations of this study was related to the exclusion of possible other related literature published in a language other than English. Moreover, a number of studies were excluded due to their lower methodological quality. It should also be noted that racial discrimination and microaggressions in the workplace can have factors beyond what was discussed within this article. The occurrences of workplace racial discrimination and microaggressions were not examined regarding factors such as the childhood experiences of both the individuals facing discrimination and those engaging in discriminatory behavior, variations in how anger is manifested in different individuals, as well as the presence of mental disorders and their potential influence.

12 Conclusion

Based on the findings of our meta-analysis, the overall pooled prevalence of microaggression and racial discrimination in the workplace was 73.6% and 18.8%, respectively. Microaggression and racial discrimination directly affect the physical and mental health of employees, which can leave long-term and at the same time irreparable consequences for the individuals involved. Additionally, such behaviours reduce workplace productivity and can negatively affect the realization of organizational goals. Therefore, managers may find the results of our meta-analysis useful for devising appropriate mechanism and techniques for prevention, management, and/or response to incidence of microaggression and racial discrimination in the workplace. Moreover, health policymakers and mental health researchers may find the study useful, in terms of causal tracing of related negative health outcomes.

Abbreviation

PRISMA: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses

STROBE: The Strengthening the Reporting of Observational Studies in Epidemiology

Funding

Not applicable.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and materials

Datasets are available through the corresponding author upon reasonable request.

CRediT authorship contribution statement

Nader Salari: Conceptualization. Ahoura Fattah: Writing – review & editing, Writing – original draft, Investigation. Amin Hosseinian-Far: Writing – review & editing, Supervision, Investigation. Mojdeh Larti: Writing – review & editing, Supervision. Sina Sharifi: Writing – original draft, Supervision, Conceptualization. Masoud Mohammadi: Writing – review & editing, Writing – original draft, Supervision, Software, Methodology, Investigation, Formal analysis, Conceptualization.

Conflicts of interest

The authors declare that they have no conflict of interest.

Acknowledgments

By Student Research Committee of Kermanshah University of Medical Sciences.
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References

1 Whitaker T.R. Banging on a locked door: the persistent role of racial discrimination in the workplace Social Work in Public Health 34 1 2019 22 27 30700222
2 Rini R. How to take offense: responding to microaggression Journal of the American Philosophical Association 4 3 2018 332 351
3 Friedlaender C. On microaggressions: cumulative harm and individual responsibility Hypatia 33 1 2018 5 21
4 Elder C.-H. Microaggression or misunderstanding? Implicatures, inferences and accountability Journal of Pragmatics 179 2021 37 43
5 Bryant L.S. Godsay S. Nnawulezi N. Envisioning human service organizations free of microaggressions New Ideas in Psychology 63 2021 100893
6 Green M.A. Sounds insignificant, feels harmful: mitigating the impact of microaggressions in US based workplaces 2021 University of Maryland University College
7 Shiao J. Woody A. The meaning of “racism” Sociological Perspectives 64 4 2021 495 517
8 Tabor F. Dalton P. Perception of racial discrimination in the workplace and its impact on job satisfaction and job security Journal of Graduate Education Research 2 1 2021 9
9 Lee H. Perceived racial discrimination in the workplace: considering minority supervisory representation and inter-minority relations Public Management Review 24 4 2022 512 535
10 Schaufeli W.B. Bakker A.B. Van Rhenen W. How changes in job demands and resources predict burnout, work engagement, and sickness absenteeism Journal of Organizational Behavior 30 2009 893 917
11 Dhanani L.Y. Beus J.M. Joseph D.L. Workplace discrimination: a meta-analytic extension, critique, and future research agenda Personnel Psychology 71 2 2018 147 179
12 Hosler A.S. Kammer J.R. Cong X. Everyday discrimination experience and depressive symptoms in urban black, guyanese, hispanic, and white adults Journal of the American Psychiatric Nurses Association 25 6 2019 445 452 30569835
13 McCord M.A. Joseph D.L. Dhanani L.Y. Beus J.M. A meta-analysis of sex and race differences in perceived workplace mistreatment Journal of Applied Psychology 103 2 2018 137 29016163
14 Stone A.L. Carlisle S.E. Examining race/ethnicity differences in the association between the experience of workplace racial discrimination and depression or negative emotions Journal of Racial and Ethnic Health Disparities 6 2019 874 882 30264336
15 Williams D.R. Lawrence J.A. Davis B.A. Racism and health: evidence and needed research Annual Review of Public Health 40 2019 105 125
16 Board U.M.S.P. Update on sexual harassment in the federal workplace 2018
17 Rubin E.V. Alteri A.M. Discrimination complaints in the US federal government: reviewing progress under the no FEAR act Review of Public Personnel Administration 39 4 2019 511 522
18 Sudol N.T. Guaderrama N.M. Honsberger P. Weiss J. Li Q.W. Whitcomb E.L. Prevalence and nature of sexist and racial/ethnic microaggressions against surgeons and anesthesiologists JAMA Surgery 156 5 2021
19 Avery D.R. McKay P.F. Wilson D.C. What are the odds? How demographic similarity affects the prevalence of perceived employment discrimination The Journal of Applied Psychology 93 2 2008 235 249 18361629
20 Nadal K.L. The racial and ethnic microaggressions scale (REMS): construction, reliability, and validity Journal of Counseling Psychology 58 4 2011 470 480 21875180
21 Samora J.B. Denning J. Haralabatos S. Luong M. Poon S. Do women experience microaggressions in orthopaedic surgery? Current state and future directions from a survey of women orthopaedists Current Orthopaedic Practice 31 5 2020 503 507
22 Agudelo-Suárez A.A. Ronda-Pérez E. Gil-González D. Vives-Cases C. García A.M. Ruiz-Frutos C. Felt E. Benavides S.G. The effect of perceived discrimination on the health of immigrant workers in Spain BMC Public Health 11 2011 652 21849020
23 Enoksen E. Perceived discrimination against immigrants in the workplace: influence of personal values and organizational justice Equality, Diversity and Inclusion 35 2 2016 66 80
24 Kim H. Jayaraman S. Landsbergis P. Markowitz S. Kim S. Dropkin J. Perceived discrimination from management and musculoskeletal symptoms among New York City restaurant workers International Journal of Occupational and Environmental Health 19 3 2013 196 206 23816262
25 Zambrana R.E. Wingfield A.H. Lapeyrouse L.M. Davila B.A. Hoagland T.L. Valdez R.B. Blatant, subtle, and insidious: URM faculty perceptions of discriminatory practices in predominantly white institutions Sociological Inquiry 87 2 2017 207 232
26 Krieger N. Waterman P.D. Hartman C. Bates L.M. Stoddard A.M. Quinn M.M. Sorensen G. Barbeau E.M. Social hazards on the job: workplace abuse, sexual harassment, and racial discrimination—a study of Black, Latino, and White low-income women and men workers in the United States International Journal of Health Services 36 1 2006 51 85 16524165
27 Cormack D. Harris R. Stanley J. Māori experiences of multiple forms of discrimination: findings from Te Kupenga 2013 Kōtuitui: New Zealand Journal of Social Sciences Online 15 1 2020 106 122
28 Donovan R.A. Galban D.J. Grace R.K. Bennett J.K. Felicié S.Z. Impact of racial macro-and microaggressions in black women’s lives: a preliminary analysis Journal of Black Psychology 39 2 2013 185 196
29 Hong L. Rubinsak L. Benoit M. Chandavarkar U. Brockmeyer A. Teoh D. Stevens E. Ioffe Y. Temkin S. Workplace bullying, harassment and microaggressions: the results of a Women of Gynecologic Oncology (WGO) survey Gynecologic Oncology 162 2021 S6 S7
30 Nadal K.L. Griffin K.E. Wong Y. Hamit S. Rasmus M. The impact of racial microaggressions on mental health: counseling implications for clients of color Journal of Counseling & Development 92 1 2014 57 66
31 Sue D.W. Nadal K.L. Capodilupo C.M. Lin A.I. Torino G.C. Rivera D.P. Racial microaggressions against black Americans: implications for counseling Journal of Counseling & Development 86 3 2008 330 338
32 Solorzano D. Ceja M. Yosso T. Critical race theory, racial microaggressions, and campus racial climate: the experiences of African American college students Journal of Negro Education 2000 60 73
33 Shoshana A. The language of everyday racism and microaggression in the workplace: Palestinian professionals in Israel Ethnic and Racial Studies 39 6 2016 1052 1069
34 Feaster B. McKinley-Grant L. McMichael A.J. Microaggressions in medicine Cutis. 107 5 2021 235 237 34288848
35 Torino G.C. Rivera D.P. Capodilupo C.M. Nadal K.L. Sue D.W. Everything you wanted to know about microaggressions but didn't get a chance to ask Microaggression Theory: Influence and Implications 2018 1 15
36 Essed P. Understanding everyday racism: an interdisciplinary theory 1991 Sage
37 Feagin J.R. The continuing significance of race: antiblack discrimination in public places American Sociological Review 1991 101 116
38 Sikes M.P. Living with racism: the black middle-class experience 1994 Beacon Press
39 Swim J.K. Cohen L.L. Hyers L.L. Experiencing everyday prejudice and discrimination 1998 Elsevier Prejudice 37 60
40 Dovidio J.F. Gaertner S.L. Bachman B.A. Racial bias in organizations: the role of group processes in its causes and cures Turner M.E. Groups at work: Theory and research 2001 Lawrence Erlbaum Associates Publishers 415 444
41 Sellers R.M. Shelton J.N. The role of racial identity in perceived racial discrimination Journal of Personality and Social Psychology 84 5 2003 1079 12757150
42 Barrett L.F. Swim J.K. Appraisals of prejudice and discrimination 1998 Elsevier Prejudice 11 36
43 Crosby F. The denial of personal discrimination American Behavioral Scientist 27 3 1984 371 386
44 Deitch E.A. Barsky A. Butz R.M. Chan S. Brief A.P. Bradley J.C. Subtle yet significant: the existence and impact of everyday racial discrimination in the workplace Human Relations 56 11 2003 1299 1324
45 McConahay J.B. Modern racism, ambivalence, and the modern racism scale Dovidio J.F. Gaertner S.L. Prejudice, discrimination, and racism 1986 Academic Press 91 125
46 Gaertner S.L. Dovidio J.F. The aversive form of racism Dovidio J.F. Gaertner S.L. Prejudice, discrimination, and racism 1986 Academic Press New York 61 89
47 Katz I. Hass R.G. Racial ambivalence and American value conflict: correlational and priming studies of dual cognitive structures Journal of Personality and Social Psychology 55 6 1988 893
48 Triana MdC. Jayasinghe M. Pieper J.R. Perceived workplace racial discrimination and its correlates: a meta-analysis Journal of Organizational Behavior 36 4 2015 491 513
49 Bertrand M. Mullainathan S. Are Emily and Greg more employable than Lakisha and Jamal? A field experiment on labor market discrimination American Economic Review 94 4 2004 991 1013
50 Fix M. Struyk R. Clear and convincing evidence: measurement of discrimination in America (natural field experiments No. 0049) 1993 The Field Experiments Website
51 Pager D. The mark of a criminal record American Journal of Sociology 108 5 2003 937 975
52 Smith-Oka V. Microaggressions and the reproduction of social inequalities in medical encounters in Mexico Social Science & Medicine 143 2015 9 16 26331863
53 Goldman B.M. Gutek B.A. Stein J.H. Lewis K. Employment discrimination in organizations: antecedents and consequences Journal of Management 32 6 2006 786 830
54 Velez B.L. Moradi B. Brewster M.E. Testing the tenets of minority stress theory in workplace contexts Journal of Counseling Psychology 60 4 2013 532 23815632
55 Elias A. Paradies Y. Estimating the mental health costs of racial discrimination BMC Public Health 16 2016 1 13 26728978
56 Bailey Z.D. Krieger N. Agénor M. Graves J. Linos N. Bassett M.T. Structural racism and health inequities in the USA: evidence and interventions The Lancet 389 10077 2017 1453 1463
57 Lee R.T. Perez A.D. Boykin C.M. Mendoza-Denton R. On the prevalence of racial discrimination in the United States PloS One 14 1 2019 e0210698
58 Seaton E.K. Caldwell C.H. Sellers R.M. Jackson J.S. The prevalence of perceived discrimination among African American and Caribbean Black youth Developmental Psychology 44 5 2008 1288 18793063
59 Taylor R.J. Forsythe-Brown I. Mouzon D.M. Keith V.M. Chae D.H. Chatters L.M. Prevalence and correlates of everyday discrimination among black Caribbeans in the United States: the impact of nativity and country of origin Ethnicity & Health 24 5 2019 463 483 28669197
60 Umaña-Taylor A.J. A post-racial society in which ethnic-racial discrimination still exists and has significant consequences for youths’ adjustment Current Directions in Psychological Science 25 2 2016 111 118
61 Krieger N. Kaddour A. Koenen K. Kosheleva A. Chen J.T. Waterman P.D. Barbeau E.M. Occupational, social, and relationship hazards and psychological distress among low-income workers: implications of the ‘inverse hazard law’ Journal of Epidemiology & Community Health 65 3 2011 260 272 20713372
62 Raver J.L. Nishii L.H. Once, twice, or three times as harmful? Ethnic harassment, gender harassment, and generalized workplace harassment Journal of Applied Psychology 95 2 2010 236 20230066
63 Alleyne A. Black identity and workplace oppression Counselling and Psychotherapy Research 4 1 2004 4 8
64 Karlsen S. Nazroo J.Y. Relation between racial discrimination, social class, and health among ethnic minority groups American Journal of Public Health 92 4 2002 624 631 11919063
65 Bowen-Reid T.L. Harrell J.P. Racist experiences and health outcomes: an examination of spirituality as a buffer Journal of Black Psychology 28 1 2002 18 36
66 Finch B.K. Kolody B. Vega W.A. Perceived discrimination and depression among Mexican-origin adults in California Journal of Health and Social Behavior 2000 295 313 11011506
67 Gee G.C. Spencer M.S. Chen J. Takeuchi D. A nationwide study of discrimination and chronic health conditions among Asian Americans American Journal of Public Health 97 7 2007 1275 1282 17538055
68 Adler N.E. Rehkopf D.H. US disparities in health: descriptions, causes, and mechanisms Annual Review of Public Health 29 2008 235 252
69 Adler N.E. Snibbe A.C. The role of psychosocial processes in explaining the gradient between socioeconomic status and health Current Directions in Psychological Science 12 4 2003 119 123
70 Gallo L.C. Matthews K.A. Understanding the association between socioeconomic status and physical health: do negative emotions play a role? Psychological Bulletin 129 1 2003 10 12555793
71 Chrobot-Mason D. Rose Ragins B. Linnehan F. Second hand smoke: ambient racial harassment at work Journal of Managerial Psychology 28 5 2013 470 491
72 Grigg K. Manderson L. Is there a relationship between psychopathic traits and racism? Current Psychology 34 2015 702 712
73 Samson F.L. Racial resentment and smoking Social Science & Medicine 126 2015 164 168 25562312
74 Kwate N.O.A. Goodman M.S. An empirical analysis of White privilege, social position and health Social Science & Medicine 116 2014 150 160 25014267
75 Hirsh E. Lyons C.J. Perceiving discrimination on the job: legal consciousness, workplace context, and the construction of race discrimination Law & Society Review 44 2 2010 269 298
