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"Dovidio, John"
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The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas
Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.
Journal Article
Science faculty’s subtle gender biases favor male students
Despite efforts to recruit and retain more women, a stark gender disparity persists within academic science. Abundant research has demonstrated gender bias in many demographic groups, but has yet to experimentally investigate whether science faculty exhibit a bias against female students that could contribute to the gender disparity in academic science. In a randomized double-blind study (n = 127), science faculty from research-intensive universities rated the application materials of a student—who was randomly assigned either a male or female name—for a laboratory manager position. Faculty participants rated the male applicant as significantly more competent and hireable than the (identical) female applicant. These participants also selected a higher starting salary and offered more career mentoring to the male applicant. The gender of the faculty participants did not affect responses, such that female and male faculty were equally likely to exhibit bias against the female student. Mediation analyses indicated that the female student was less likely to be hired because she was viewed as less competent. We also assessed faculty participants’ preexisting subtle bias against women using a standard instrument and found that preexisting subtle bias against women played a moderating role, such that subtle bias against women was associated with less support for the female student, but was unrelated to reactions to the male student. These results suggest that interventions addressing faculty gender bias might advance the goal of increasing the participation of women in science.
Journal Article
Under the Radar: How Unexamined Biases in Decision-Making Processes in Clinical Interactions Can Contribute to Health Care Disparities
Several aspects of social psychological science shed light on how unexamined racial/ethnic biases contribute to health care disparities. Biases are complex but systematic, differing by racial/ethnic group and not limited to love–hate polarities. Group images on the universal social cognitive dimensions of competence and warmth determine the content of each group's overall stereotype, distinct emotional prejudices (pity, envy, disgust, pride), and discriminatory tendencies. These biases are often unconscious and occur despite the best intentions. Such ambivalent and automatic biases can influence medical decisions and interactions, systematically producing discrimination in health care and ultimately disparities in health. Understanding how these processes may contribute to bias in health care can help guide interventions to address racial and ethnic disparities in health.
Journal Article
Putting PrEP into Practice: Lessons Learned from Early-Adopting U.S. Providers’ Firsthand Experiences Providing HIV Pre-Exposure Prophylaxis and Associated Care
Optimizing access to HIV pre-exposure prophylaxis (PrEP), an evidence-based HIV prevention resource, requires expanding healthcare providers' adoption of PrEP into clinical practice. This qualitative study explored PrEP providers' firsthand experiences relative to six commonly-cited barriers to prescription-financial coverage, implementation logistics, eligibility determination, adherence concerns, side effects, and anticipated behavior change (risk compensation)-as well as their recommendations for training PrEP-inexperienced providers. U.S.-based PrEP providers were recruited via direct outreach and referral from colleagues and other participants (2014-2015). One-on-one interviews were conducted in person or by phone, transcribed, and analyzed. The sample (n = 18) primarily practiced in the Northeastern (67%) or Southern (22%) U.S. Nearly all (94%) were medical doctors (MDs), most of whom self-identified as infectious disease specialists. Prior experience prescribing PrEP ranged from 2 to 325 patients. Overall, providers reported favorable experiences with PrEP implementation and indicated that commonly anticipated problems were minimal or manageable. PrEP was covered via insurance or other programs for most patients; however, pre-authorization requirements, laboratory/service provision costs, and high deductibles sometimes presented challenges. Various models of PrEP care and coordination with other providers were utilized, with several providers highlighting the value of clinical staff support. Eligibility was determined through joint decision-making with patients; CDC guidelines were commonly referenced but not considered absolute. Patient adherence was variable, with particularly strong adherence noted among patients who had actively sought PrEP (self-referred). Providers observed minimal adverse effects or increases in risk behavior. However, they identified several barriers with respect to accessing and engaging PrEP candidates. Providers offered a wide range of suggestions regarding content, strategy, and logistics surrounding PrEP training, highlighting sexual history-taking and sexual minority competence as areas to prioritize. These insights from early-adopting PrEP providers may facilitate adoption of PrEP into clinical practice by PrEP-inexperienced providers, thereby improving access for individuals at risk for HIV.
Journal Article
Ingroup love, outgroup hate, and the gateway group effect: Comparing the direct and indirect impact of dual versus single identification
Decades of research in social identity have shown that people instinctively hold positive attitudes towards ingroup members and negative attitudes towards outgroup members. However, it remains unclear how people respond to individuals explicitly identified with both one’s ingroup and outgroup. We propose that when people are exposed to dual-identified individuals and groups (e.g., Muslim-Americans explicitly identifying with both their Muslim and American identities), intergroup attitudes will improve, driven more by the ingroup component (American), despite the presence of the outgroup component (Muslim). Moreover, we suggest exposure to dual-identification can also improve attitudes toward the broader outgroup (Muslims more generally), a phenomenon called the gateway-group effect. To test these hypotheses, we created a new measure of dual-identification and conducted three studies involving both Muslim-Americans and Mexican-Americans. Results confirmed that exposure to explicitly dual-identified groups improved attitudes towards the dual-identified group (e.g., Mexican-Americans) as well as toward the respective outgroup (e.g., Mexicans).
Journal Article
Targeted social marketing of PrEP and the stigmatization of black sexual minority men
Disparities in HIV incidence and PrEP uptake suggest a need to prioritize Black sexual minority men (SMM) in PrEP social marketing initiatives. However, images linking Black SMM to HIV and PrEP may inadvertently reinforce stigma. We examined HIV-negative/status-unknown Black SMM’s responses to targeted PrEP advertisements using mixed methods, including an experiment embedded in a longitudinal online survey (Time 1: n = 96; Time 2 [eight weeks]: n = 73) and four focus groups ( n = 18). The full factorial experiment included between-groups and within-subjects comparisons. For between-groups comparisons, each participant was randomly assigned to view one of 12 advertisements, which varied by couple composition (Black SMM couple/Black heterosexual couple/multiple diverse couples/no couples) and campaign ( PrEPare for the Possibilities/PlaySure/PrEP4Love ). We examined couple composition, campaign, and interaction effects on: advertisement judgments (Time 1), PrEP stigma (Time 1), PrEP motivation (Times 1 and 2), and PrEP behavior (Time 2). For within-subjects comparisons, each participant viewed all 12 advertisements, and we examined couple composition, campaign, and interaction effects on advertisement judgments (Time 2). Focus group participants discussed advertising preferences and responded to the same set of advertisements. For between-groups and within-subjects comparisons, we found significant couple composition effects but no or limited campaign and interaction effects on advertisement judgments. Advertisements featuring Black SMM exclusively were judged as more stigmatizing than advertisements without couples. Advertisements with diverse (vs. no) couples were considered more eye-catching and motivating. There were minimal effects of couple composition and campaign on PrEP stigma, motivation, and behavior. Focus group participants corroborated concerns about the potential for PrEP advertisements to be stigmatizing, suggesting advertisements featuring Black SMM exclusively could be alienating and fuel conspiracy theories. Focus group participants generally favored diverse and less sexualized advertisements, particularly for public spaces. Findings collectively highlight the potential for targeted PrEP advertisements to stigmatize Black SMM and support diverse representation.
Journal Article
The Irony of Harmony: Intergroup Contact Can Produce False Expectations for Equality
Positive intergroup contact has been a guiding framework for research on reducing intergroup tension and for interventions aimed at that goal. We propose that beyond improving attitudes toward the out-group, positive contact affects disadvantaged-group members' perceptions of intergroup inequality in ways that can undermine their support for social change toward equality. In Study 1, participants were assigned to either high- or low-power experimental groups and then brought together to discuss either commonalities between the groups or inter-group differences. Commonality-focused contact, relative to difference-focused contact, produced heightened expectations for fair (i.e., egalitarian) out-group behavior among members of disadvantaged groups. These expectations, however, proved unrealistic when compared against the actions of members of the advantaged groups. Participants in Study 2 were Israeli Arabs (a disadvantaged minority) who reported the amount of positive contact they experienced with Jews. More positive intergroup contact was associated with increased perceptions of Jews as fair, which in turn predicted decreased support for social change. Implications for social change are considered.
Journal Article
Interacting Like a Body: Objectification Can Lead Women to Narrow Their Presence in Social Interactions
The present experiment tested the impact of sexual objectification on women's behavior in social interactions. We predicted that when objectified, women would narrow their social presence by spending little time talking, particularly when interacting with men. Participants (males and females) gave an oral introduction of themselves to an alleged interaction partner (male or female). Objectification was manipulated by having participants believe their bodies were either visually inspected or not inspected during this introduction. Specifically, participants introduced themselves through a closed-circuit device in one of three conditions: body (videotaped from the neck down), face (videotaped from the neck up), or audio (no videotaping). Women who were in the body condition and thought they were interacting with men spent less time talking than participants in all other groups. In addition, the majority of women disliked the body condition, indicating that they found having their bodies gazed at aversive. Implications for women's behavior in mixed-sex contexts are discussed.
Journal Article
The Scope of Racial Bias in Policing: Behavioral Science's Role in a Systemic Problem
There are substantial and persistent racial disparities in policing in the United States. Although disparities do not necessarily indicate discrimination, there is significant evidence that racism, operating in various forms, is a major factor. We adopt a multilevel perspective in our review and analysis of the empirical literature. We consider five levels of processes relating to racial biases in policing and public safety to identify ways of achieving equity. These levels are the nano-level (intrapersonal), the micro-level (interpersonal), the meso-level (organizational), the macro-level (pan-organizational, institutional, or systemic), and the mega-level (cultural, societal, or narrative). We conclude by discussing the theoretical and practical promise of adopting a multilevel perspective and highlighting the pressing need to reconceive policing in the United States to meet the needs of contemporary society.
Journal Article