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Kim, Sookyung, et al. "The recent trends in discrimination and health among ethnic minority adolescents: an integrative review." BMC Public Health 25.1 (2025): 861.

https://doi.org/10.1186/s12889-025-21729-0

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BMC Public Health 25, Article number: 861 (2025) Cite this article

Abstract

Background

Experiences of racial discrimination during adolescence can negatively affect lifelong health. Although many ethnic minority adolescents face discrimination in common worldwide, there are few updated review studies that explored how discrimination affected health status and behavior among ethnic minority adolescents.

Methods

Comprehensive searches of the PubMed, Embase, PsycINFO, and CINAHL were conducted, integrating keywords about adolescent, ethnic groups, discrimination, and health. The search encompassed articles published between January 2016 and March 2021, following Whittemore and Knafl's integrative literature review method. Quality appraisal was evaluated by the Risk of Bias Assessment Tool.

Results

After conducting the initial screening of 167 studies, eleven studies met the inclusion criteria and were included in the review. More than 80% of the studies were conducted African-American/Black adolescents in the United States. There were clear associations between group discrimination and mental health problems. Discrimination was also linked to the low overall health, high substance use, high emotional eating, and high behavioral problems, and low ethnic identity. Of the six studies investigating gender differences, two each reported that discrimination was linked to higher substance use in boys and stronger internalizing symptoms in girls.

Conclusion

This integrative review provides insights into the discrimination experiences of ethnic minority adolescents, with particular implications for mental health, overall health, substance use, and behavioral problems. This review contributes evidence for need of integrative health promotion programs to mitigate racial discrimination against ethnic minority adolescents for health equity.

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Background

Although non-discrimination is being emphasized as the principle of the 2030 Agenda for Sustainable Development Goals [ 6], adolescents who still experience discrimination are common around the world. In the United States, nearly one-third of adolescents experience discrimination [ 7]. In Australia, over 30% of adolescents reported on experiences of discrimination including skin colour, language accent, and cultural background [ 8]. This may be particularly problematic during the critical period of adolescence, in which individuals gain personal independence, forge social relationships, and learn behaviors that will endure the course of life [ 9]. Moreover, ethnic minority adolescents are at a particularly high risk for health-related challenges, including those pertaining to social exclusion, rejection by [ 9] community members, and discrimination [ 9]. This is a serious issue globally, as experiences of discrimination during adolescence can negatively affect health throughout the life cycle [ 10].

Acknowledging the crucial role of discrimination in the health of ethnic minority groups, professional organizations and institutions have been implementing strategies to improve health care and practice. For example, the National Institutes of Health (NIH) in the United States has formed the UNITE initiative to eradicate racism within biomedical research enterprises [ 11]. The International Council of Nurses (ICN) expects nursing professionals to be aware of health vulnerabilities that are related to physical, psychosocial, spiritual issues experienced by ethnic minority groups; as such, working to improve the delivery of health care by increasing their cultural competencies and incorporating those elements into practice [ 12].

According to previous research, a literature review of studies published through the end of 2016 showed that discrimination targeted at adolescents was related to well-being in terms of socioemotional, behavioral, and academic issues [ 13]. Further, a review of longitudinal studies conducted between 2003 and 2017 showed that adolescents who experienced discrimination during adolescence tended to have a variety of behavioral problems, including increased risk-taking behaviors, substance use, and poor mental health outcomes [ 14]. In 2022, the World Health Organization emphasized that ethnicminorities' experiences of discrimination increase their vulnerability to health risk factors, leading to poor health outcomes [ 15]. This prompted the need to update our knowledge with a review of research conducted in the last five years since 2016. Particularly, while gender differences are a significant in discrimination and health behavior/outcomes [ 16, 17], and a review [ 13] revealed significant differences in the race-by-gender moderate effect in the academic aspect on discrimination and well-being among adolescents. Moreover, a systematic review [ 14] did not address gender differences, leading to limited conclusions concerning the relationship between adolescents' experiences of discrimination and health according to gender. Therefore, this study needs to explore gender differences in health based on discrimination experiences.

Aims

This study conducted an integrative review of research from the past five years on adolescent discrimination, its impact on health status and health behaviors, and the gender differences in discrimination on the health of ethnic minority adolescents.

Methods

Following the integrative review method proposed by Whittemore and Knafl [ 21], this study searched for and evaluated articles according to five steps: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis, and (5) presentation.

Problem identification

The research question was "How do experiences of discrimination influence health and health behaviors in ethnic minority adolescents?" To address this, the specific approaches were employed: (a) explore relevant study characteristics, (b) identify the influences of discrimination on health status and health behaviors, and (c) explore any gender differences in these health and health behaviors. Health status encompasses both physical and mental well-being including conditions such as depression and anxiety [ 22]. Health behaviors were defined as behavior patterns and habits related to health maintenance, health improvement, and healeth restoration such as smoking, alcohol use, physical activity [ 23, 24].

Literature search

We conducted literature searches in four databases (PubMed, Embase, PsycINFO, and CINAHL) using the following keywords: 1) "adolescent," "ethnic groups," "discrimination," and "health". The search query in PubMed was as follows: ((teen* OR adolescen* OR child* OR youth* OR student*) AND (ethnic groups OR minority groups OR multicultural)) AND ((discrimination OR discrimination, psychological OR social discrimination) AND (health OR health behavior)). Studies were limited to those published between January 2016 and March 2021 and search scope were limited by title/abstract. The keywords were adapted for each database. The search, screening and reporting were guided by the Preferred Reporting Items for Systematic Reviews And Meta- Analysis (PRISMA) framework [ 25]. The inclusion criteria were as follows: (1) peer-reviewed articles, (2) written in the English language, (3) cross-sectional, retrospective, prospective designs, and (4) topics related to discrimination and health/health behaviors in ethnic minority adolescents. This initially resulted in a total of 167 articles. After removing duplicate articles using EndNote X9 and a manual search, we were left with 118 articles. After further reviewing the titles and abstracts, we excluded 105 articles due to non-applicable populations, including specific groups such as LGBTQ adolescents, adolescents with diseases (e.g., Human Immunodeficiency Virus, Diabetes Mellitus, Attention Deficit Hyperactivity Disorder, Obsessive Compulsive Disorder), and college students. Finally, after reviewing the full texts of the 13 remaining articles, we selected 11 for the analysis. Fig. 1 demonstrates the detailed flow diagram of the literature selection.

Data evaluation

We investigated the quality of the returned literature via the Risk of Bias Assessment Tool for Non-Randomized Studies (RoBANS) version 2.0. In this context, there were six areas of potential risk, including the selection of participants, confounding variables, measurements of exposure, blindness to outcome assessments, incomplete data, and the reporting of selective results [ 26]. RoBANS returns three categories of risk ratings, including low risk, high risk, and unclear. In this study, two researchers independently conducted quality appraisals, then reconciled their results to reach a consensus.

Data analysis

We used a framework for data extraction in which two researchers extracted data from the selected studies based on the following categories: author, year, country, population, age, sample size, study design, data source or sampling, survey respondent, measurements type of discrimination, outcomes and key findings. The extracted data from the two authors were compared, and where discrepancies existed, the third author was consulted. Differences were resolved through consensus.

Results

Study characteristics

Of the 11 selected studies, the publication year distribution was as follows: eight studies from 2018 to 2019, two studies from 2020 to 2021 (ending in March), and one study from 2016 to 2017. The majority of studies were conducted in the United States (81.8%), followed by the Netherlands (18.2%). Further, the majority of studies were conducted among African-American/Black adolescents (81.8%), followed by Latino/Hispanic adolescents (45.5%), and biracial/multiracial adolescents (27.3%). As for the research designs, eight studies were cross-sectional (72.7%) and three were longitudinal (27.3%). While the study populations varied in age (range of 6-19 years), most were conducted among individuals aged 13-17 years. Looking at the data types, six studies investigated primary data (54.5%), with sample sizes ranging from 118 to 612 individuals, while fives studies investigated secondary data (45.5%) (e.g., National Survey of Children's Health), with sample sizes ranging from 1,170 to 95,677 individuals (Table 1). Four studies (36.4%) were sampled from several schools (range of 5-159), one study (9.1%) recruited adolescents who were on probation, and the other study (9.1%) used referral sampling. Two studies (18.2%) using National Survey of Children's Health data had parent or guardian responses, while the remaining nine studies (81.8%) had adolescent self-report or interview responses (Table 2).

Table 1 Characteristics of studies on discrimination and health among ethnic minority adolescents

Table 2 Summary of studies regarding discrimination and health among ethnic minority adolescents

Influences of discrimination on health and health behavior

Most studies measured discrimination using the widely implemented Everyday Discrimination Scale (EDS; n = 4, 36.4%) developed by Williams et al. [ 27], followed by the Discrimination Questionnaire ( n = 2, 18.2%) developed by Stevens et al. [ 28]. One study each used the Racial Ethnic Discrimination Index ( n = 1, 9.1%) and Adolescent Discrimination Distress Index ( n = 1, 9.1%). Finally, three studies (27.3%) used single items to assess experiences of unfair treatment and discrimination. In terms of the type of discrimination, there have been many studies that measure whether people have been discriminated against because of his or her skin, color, origin, or religion; whether they have been treated less fairly than others in schools, stores, etc., whether they have been criticized by a particular ethnic group (Table 2).

In categorizing the health-related dependent variables, six studies (54.5%) measured mental health as an outcome affected by discrimination (e.g., psychiatric symptoms, the prevalence of psychotic experiences, depression, and anxiety). Overall health was measured as an outcome in two studies (18.2%), followed by substance use in two studies (18.2%), obesity (9.1%), behavioral problems (e.g., oppositional defiant disorder and conduct disorder) (9.1%), and ethic/racial identity in each study (9.1%).

All six studies that analyzed the effects of discrimination on mental health in adolescents reported that higher perceived discrimination was associated with worse mental health [ 29, 30, 31, 32, 33, 34]. In one study among Moroccan-Dutch adolescents, personal discrimination (e.g., negative treatment based on their skin color, origin, and/or religion) was positively associated with psychiatric symptoms (odds ratio [OR], 2.69; 95% confidence interval [CI] [1.13, 6.41]) [ 29]. Looking at ethnic minorities in the Netherlands, El Bouhaddani et al. [ 31] similarly reported that personal discrimination was a predictor for psychotic experiences, including delusional and hallucinatory events (OR, 2.30; 95% CI: [1.22, 4.34]). Moreover, Adriaanse et al. [ 29] reported that psychiatric symptoms were associated with an increased odds of experiencing group discrimination, referring to whether adolescents felt that their ethnic groups were discriminated against in particular situations (e.g., stores, school, street locations, or during interactions with the police) (OR, 2.82; 95% CI: [1.57, 5.06]). Loyd et al. [ 32] investigated a sample of recently arrested ethnic minority adolescents and found that participants, who experienced episodes of interpersonal discrimination that were similar to group discrimination, reported higher internalizing symptoms (OR, 7.09; 95% CI: [3.95, 10.2]) and externalizing behaviors (OR, 7.87; 95% CI: [4.39, 11.3]). In sum, the investigated studies showed a clear association between group discrimination and mental health problems among ethnic minority adolescents.

Three studies (27.3%) reported that discrimination experience was a predictor for depression and anxiety among ethnic minority adolescents [ 30, 33, 34]. Even further, Pachter et al. [ 33] found that such experiences were significantly associated with higher levels of both 12-month major depression (OR, 1.21; 95% CI: [1.06, 1.39]) and 12-month anxiety (OR, 1.15; 95% CI: [1.00, 1.33]) in African-American and Afro-Caribbean adolescents. Similarly, Zapolski et al. [ 35] reported that discrimination had significant effects on symptoms of depression (\(\:{\upbeta\:}=\) 0.22, p < 0.001) and anxiety (\(\:{\upbeta\:}=\) 0.20, p  < 0.001) in African-American adolescents.

Anderson et al. [ 35] identified that propensity score analysis shows that, unlike their white counterparts, experiences of discrimination are associated with poorer overall health outcomes for low-income Black and Hispanic adolescents group. As for long-term longitudinal research, Colen et al. [ 36] investigated a sample of upwardly mobile individuals from various racial/ethnic groups, finding that African-Americans and Latinos had significantly lower health outcomes than Whites despite being at the higher end of the socioeconomic spectrum. Moreover, upwardly mobile African-Americans and Latinos were surprisingly more likely to experience discrimination than their counterparts with lower socioeconomic status.

Some researchers also established that discrimination experiences were risk factors for substance use among ethnic minority adolescents [ 34, 37]. In Black Caribbean adolescents, Assari et al. [ 37] reported that higher discrimination was associated with higher substance use (OR, 1.15; 95% CI: [1.02, 1.29]), although there was no association between the level of discrimination exposure and smoking. Zapolski et al. [ 34] similarly reported that discrimination was a predictor of substance use (\(\:{\upbeta\:}=\) 0.15, p < 0.001). Another study found that African-American fathers and their sons engaged in emotional eating in response to discrimination, which may degrade overall quality of life due to the risk of obesity [ 38]. Finally, Weeks and Sullivan [ 39] found that adolescents who were treated unfairly due to their ethnicity had a significant tendency for increased behavioral problems, regardless of the specific ethnicity (OR, 2.94; 95% CI: [1.30, 6.66]). Cheon et al. [ 30] conducted a latent profile analysis showing that ethnic/racial minority adolescents with prior discrimination experiences were more likely to have low levels of ethnic/racial identity and U.S. American identity (F = 3.57, p  < 0.05).

Gender differences in health/health behavior discrimination

Quality appraisal

The majority of reviewed studies were well-designed and made appropriate efforts to reduce the risk of bias. As for the greatest concerns, the measurement of exposure appeared to pose a high risk of bias in three studies, while the blinding of outcome assessments showed an unclear risk of bias in all studies. Supplementary material 1 lists the results of the quality appraisal.

Discussion

Of particular note, most of the investigated studies reported that adolescents with discrimination experiences tended to have worse mental health such as psychiatric problems, psychotic experiences, anxiety, and depression. This suggests that racial discrimination is a major social determinant of health [ 40, 43], described as "where people live and grow" [ 9, 44]. According to the conceptualization of the social determinants of mental health, discrimination can lead to poor choices and adverse health behaviors, thus leading to risk factors such as substance use, poor dietary habits, and stress. In turn, exposure to adverse social conditions increases the risk of poor mental health [ 43]. Further, negative health impacts stemming from discrimination result in health disparities. As the unequal distributions of opportunities, resources, and healthcare access are driven by social norms and public policies [ 43], public health professionals should establish and implement interventions designed to help ethnic minority adolescents who have experienced discrimination. Colen et al. [ 36] analyzed longitudinal data of adolescents, finding that despite African Americans and Hispanics being higher on the socioeconomic status, their health status were substantially poorer than those of Whites. This aligns with research from 1999 to 2018 showing that, regardless of income, the health status of Black people was consistently lower than that of White people [ 45]. The results affirm the notion that race or ethnicity exerts a more significant influence on health inequalities than socioeconomic status. As race and ethnicity are inherent traits, it underscores the necessity of policy-driven initiatives aimed at enhancing healthcare access for these communities to alleviate such disparities.

We also identified a relationship between discrimination and low-level health perceptions. This is consistent with the results of a previous systematic review showing a significant and consistent relationship between racism and ill health [ 4]. As Colen et al. [ 36] found that Black adolescents were more vulnerable than Hispanic adolescents when recovering from discrimination experiences, interventions designed to alleviate racial disparity may require tailored approaches.

A comparison of studies on adolescent discrimination and health, conducted before [ 13] and after 2016 (as reported in this study), shows consistent trends. Most studies were conducted in the United States, followed by Europe. Studies prior to 2016 found strong links between discrimination and depression, internalizing symptoms, and externalizing behaviors. Similarly, six of 11 studies since 2016 reported that discrimination was associated with increased depression, anxiety, and, in severe cases, psychiatric symptoms and psychotic experiences, emphasizing its harmful effects on mental health. Prior to 2016, the association between discrimination and substance use was weak, and similarly, only two studies found a significant association after 2016. Gender differences in the impact of discrimination on socioemotional well-being were not significant before 2016, and only two post-2016 studies reported differences: one linked higher depression and anxiety to females, while the other connected higher substance use to male adolescents. These results highlight the need for further research on gender-specific health outcomes and meta-analytical reviews. Notably, studies since 2016 identified increased relations of oppositional defiant disorder, conduct disorder, and emotional eating among adolescents exposed to discrimination-findings not reported in earlier research, highlighting the evolving understanding of the broader health impacts of discrimination on adolescents.

Future studies should have public health professionals, proactively implement strategies to provide professional education; moreover, research should be conducted for reducing the negative health effects of structural, personally mediated, and internalized racism and improving the well-being of adolescents [ 50]. This is especially important for improved health and health care in minority groups [ 12].

Implications for practice

This article will contribute to providing evidence-based practice for public health professionals, as advocacy may be critical for ethnic minority adolescents. Although discrimination was found to have the greatest effect on mental health in this study, it was also identified to have an impact on a variety of health behaviors including substance use and emotional eating. Therefore, it is necessary to develop and provide an integrative health prevention program for ethnic minority adolescents in the community setting. School health professionals in particular can play an important role in alleviating the experiences of discrimination among ethnic minority adolescents and preventing negative impact on health status and behaviors. Learning from the experience of COVID-19, where inaccurate information led to discriminatory attitudes toward certain ethnicities [ 18], school health professionals should communicate accurate information about the issue to mitigate racial and ethnic discrimination. Policymakers should increase public awareness about discrimination through educational programs and campaigns, thus preventing its widespread occurrence. Moreover, Gender differences in the effects of discrimination on health status and health behavior have been identified in only few studies and should be continued in future studies. It is expected to apply gender specific intervention considering these study findings that male adolescents who have experienced discrimination revealed have higher substance use than female adolescents, and that female adolescents who have experienced discrimination are higher internal symptoms than male adolescents.

Limitations

All studies selected for this integrative review were observational studies, of which 8 studies (72.7%) were cross sectional studies, with limited research design. As we reviewed publications published within the last 5 years, ethnic backgrounds may have been limited, so caution should be taken in generalizing the results. In addition, all of the Blinding of Outcome Assessment in the Quality Appraisal have been assessed as unclear risk of bias, meaning that it has been studied only in cross-sectional studies among quantitative research in the last five years. The results of this study have strength that provides evidence in the needs to perform experimental and longitudinal studies about ethnic minority adolescents' discrimination on health and health behavior. The possibility that studies other than four databases and written in English were excluded is the limitation of this study.

Conclusion

This integrative review provides insights into the discrimination experiences of ethnic minority adolescents, with particular implications for mental health, overall health, substance use, behavioral problems, and important gender differences. In turn, this underscores the need for public health professionals to recognize the health vulnerabilities of adolescents due to their racial and ethnic identity and to be concerned with protecting them from factors associated with experiences of discrimination. The findings emphasize that discrimination during adolescence has a particularly strong impact on the health of ethnic minorities with lower socioeconomic status. The fact that economic success does not moderate the impact on health underscores the importance of prioritizing research on discrimination during this critical developmental period. Because efforts to identify gender disparities in the impact of discrimination on health and risky behaviors have yielded limited results, these findings are inconclusive and further research is needed to examine gender-specific effects.

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Funding

The authors declare that this study received supported by Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (NRF-2020R11A2069894). The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.

Author information

Authors and Affiliations

1. School of Nursing, Soonchunhyang University, Cheonan, Republic of Korea

Sookyung Kim

2. Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

Hyeonkyeong Lee & Kennedy Diema Konlan

3. Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana

Kennedy Diema Konlan

Contributions

The study was conceived by SK and HL. SK developed the eligibility criteria, search strategy, quality appraisals plan, and data extraction plan with guidance from HL. Search and screening were conducted by SK. SK, and KK conducted data extraction and quality appraisals. SK wrote the initial draft of the manuscript. SK, HL, and KK contributed to the manuscript and approved the submitted version.

Corresponding author

Correspondence to Hyeonkyeong Lee.

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Kim, S., Lee, H. & Konlan, K.D. The recent trends in discrimination and health among ethnic minority adolescents: an integrative review. BMC Public Health 25, 861 (2025). https://doi.org/10.1186/s12889-025-21729-0
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# data[].attributes.attachment_link.title
The recent trends in discrimination and health among ethnic minority adolescents: an integrative review - BMC Public Health

# data[].attributes.attachment_link.description
Background Experiences of racial discrimination during adolescence can negatively affect lifelong health. Although many ethnic minority adolescents face discrimination in common worldwide, there are few updated review studies that explored how discrimination affected health status and behavior among ethnic minority adolescents.

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Racial discrimination experienced by ethnic minority adolescents significantly affects their mental health, overall well-being and leads to substance abuse, behavioural problems and reduced ethnic identity

# data[].attributes.headline
Discrimination directly correlates with mental health issues

# data[].attributes.subject
Discrimination directly correlates with mental health issues

# data[].attributes.body
Pachter et al. (2018) found discrimination was significantly associated with 12-month major depression (OR=1.21) and anxiety (OR=1.15) in African-American adolescents. Page 5, Table 2

# data[].attributes.body
El Bouhaddani et al. (2019) reported personal discrimination increased the risk of psychotic experiences (OR=2.30) in Moroccan-Dutch adolescents. Page 5, Table 2

# data[].attributes.headline
Gender differences significantly affect health outcomes

# data[].attributes.subject
Gender differences significantly affect health outcomes

# data[].attributes.body
Males are more likely to turn to substance abuse due to discrimination (OR=1.32). Page 6, Table 2

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Females showed more internalized symptoms (depression OR=3.75). Page 8, Table 2

# data[].attributes.headline
Con “Subjective measurement of discrimination may overestimate its effects.”

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Con “Subjective measurement of discrimination may overestimate its effects.”

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Studies used validated tools (e.g., Everyday Discrimination Scale) and combined parent/self-reports to reduce bias. Page 4 (Main Text).

# data[].attributes.headline
Con "Overrepresentation of U.S. African-American samples limits generalizability."

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Con "Overrepresentation of U.S. African-American samples limits generalizability."

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Dutch studies (e.g., Adriaanse et al., 2016) replicated findings in Moroccan-Dutch youth, supporting cross-cultural validity. Page 5 (Main Text).

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This article, published in BMC Public Health (2025) by a team from the School of Nursing, Yonsei University, South Korea, is based on an integrative analysis of 11 studies from 2016-2021 and makes the core claim that racial discrimination experienced by ethnic minority adolescents significantly impairs their mental health, exacerbates risky behaviors such as substance abuse, and weakens ethnic identity, and that there are gender differences in these effects. Through an integrative review, the article explores the impact of discrimination on the health of minority adolescents and emphasizes the need for public health interventions during this critical developmental period. Covering groups such as African Americans, Latinos, and Dutch-Moroccan, the study combines standardized scales (e.g., the Everyday Discrimination Scale) with demographic analyses. The importance of this claim lies in the revelation of a global paradox: despite the inclusion of anti-discrimination in the United Nations Sustainable Development Goals (SDGs), discrimination among adolescent populations remains pervasive.

The article notes that experiences of discrimination are significantly associated with mental health problems (such as depression, anxiety, and psychotic symptoms), lower general health, higher substance use, emotional eating, and behavioral problems among ethnic minority adolescents. In addition, the study found that experiences of discrimination were associated with lower ethnic identity, and in terms of gender differences, discrimination was associated with increased substance use in boys and stronger internalizing symptoms in girls.

To visualize the complex causal relationships, the argument map constructs a multi-layered logical framework. The core claim sits at the center and extends into four major branches: mental health, risk behaviors, ethnic identity, and gender differences. For example, the mental health branch cites Dutch research (El Bouhaddani et al., 2019) showing that discrimination increases the risk of hallucinations or delusions by 2.3 times (OR = 2.30) among adolescents of Moroccan origin. The gender differences branch, on the other hand, was analyzed through an interaction term, revealing that males were more likely to cope with external stressors through substance abuse (OR=1.32), while females internalized depressive symptoms more often (OR=3.75). These pieces of evidence form visual correlations through arrows that ultimately point to the overarching point. This hierarchical design not only helps to reinforce logical relationships, it allows the reader to quickly grasp the core of the article.

The argument map is like a simplified way that quickly shows you the direct relationship between “how discrimination harms mental health” and “how discrimination harms mental health”. But there is a downside: it's too simplified. For example, it shows that discrimination causes depression, but it doesn't tell you the more complex reasons behind it, such as how big environmental issues like fewer hospitals in certain neighborhoods and poorer school resources can be combined with discrimination. The color coding makes the information neat, but it can also make people lose sight of the details. For example, the data on Moroccan youth in the Netherlands is labeled “mental health,” but their stories of identity struggles and language barriers as second-generation immigrants are not visible in the graphic. In addition, the figure of “15% increased risk” (OR=1.15) may seem serious to the general public, but experts know that the impact is actually very small, and it is easy for people to misunderstand it if it is not clearly explained in the guide.