Folk theories of gender and anti-transgender attitudes: Gender differences and policy preferences

Transgender rights and discrimination against transgender people are growing public policy issues. Theorizing from social, cognitive, and evolutionary psychology suggests that beyond attitudes, discrimination against transgender people may derive from folk theories about what gender is and where it comes from. Transgender identity is met with hostility, in part, because it poses a challenge to the lay view that gender is determined at birth, and based on observable physical and behavioral characteristics. Here, in two pre-registered studies (N = 1323), we asked American adults to indicate the gender of a transgender target who either altered their biology through surgical interventions or altered their outward appearance: to what extent is it their birth-assigned gender or their self-identified gender? Responses correlate strongly with affect toward transgender people, measured by feeling thermometers, yet predict views on transgender people’s right to use their preferred bathrooms above and beyond feelings. Compared to male participants, female participants judge the person’s gender more in line with the self-identified gender than the birth-assigned gender. This is consistent with social and psychological theories that posit high status (e.g., men) and low status (e.g., women) members of social classification systems view group hierarchies in more and less essentialist ways respectively. Gender differences in gender category beliefs decrease with religiosity and conservatism, and are smaller in higher age groups. These results suggest that folk theories of gender, or beliefs about what gender is and how it is determined have a unique role in how transgender people are viewed and treated. Moreover, as evident by the demographic variability of gender category beliefs, folk theories are shaped by social and cultural forces and are amenable to interventions. They offer an alternative pathway to measure policy support and possibly change attitude toward transgender people.

ERASE-ing Patient Mistreatment of Trainees: Faculty Workshop

INTRODUCTION

Mistreatment of physicians by patients is a long-standing phenomenon that has garnered increased attention recently. Medical students and residents also experience mistreatment, and many supervising physicians do not know how to recognize it or respond appropriately. Little guidance exists as to how faculty should best address these situations. We developed, taught, and evaluated a stepwise approach to help faculty physicians manage patient mistreatment of trainees (residents and students).

METHODS

Our approach is summarized by the acronym ERASE: (1) Expect that mistreatment will occur. (2) Recognize episodes of mistreatment. (3) Address the situation in real time. (4) Support the learner after the event. (5) Establish/encourage a positive culture. We designed an interactive, case-based educator development session to teach ERASE and surveyed participants before and after to evaluate the session. Sixty-nine participants attended one of four workshops between November 2017 and January 2018.

RESULTS

Nearly 80% of attendees reported having received no prior training in managing mistreatment of trainees by patients. Participants noted significant changes in their confidence in recognizing and responding to episodes of mistreatment after the session compared with just prior to it.

DISCUSSION

ERASE fills an important void in medical education by introducing a novel, easy-to-understand approach that faculty can employ to manage mistreatment of trainees. We have continued to disseminate this model to faculty and residents in various departments around our medical center and at national conferences. This resource will allow educators to disseminate the ERASE model at their home institutions.

[The Social Pact for the Non-discrimination and Equal Treatment Associated with HIV development]

Advances in treatment and care have improved the life expectancy and quality of life for people living with HIV. However, those infected with HIV remain exposed to the social stigma that continues to be associated with this condition and sometimes experience discriminatory treatment in areas such as health, education, the judiciary or the workplace, and in access to benefits and insurance. There is a lot of evidence that the discrimination and stigma associated with HIV alienate people from prevention, diagnosis, treatment and quality of life services. This situation is exacerbated by social, economic and cultural status, as social and structural inequity facilitates increased discrimination and unfair treatment in the daily lives of people living with HIV. In response to this situation arises the need to establish a Social Pact for Non-Discrimination and Equal Treatment Associated with HIV, agreed and signed by social and institutional agents key in the response to HIV. Its aim is to eliminate the stigma and discrimination associated with HIV and AIDS, ensuring equal treatment and opportunities, non-discrimination, respect for fundamental rights and diversity of those affected. Reducing discrimination against people living with HIV is one of the priority objectives of the Ministry of Health, Consumer Affairs and Social Welfare's Strategic Plan for the Prevention and Control of HIV and other STIs, currently extended to 2020. It is aligned with the UNAIDS cross-cutting objective of zero discrimination and with the fourth objective of the 90-90-90-90 strategy, which should ensure that 90% of people with HIV and viral load suppression have a good health-related quality of life.

Attitudes Towards Physicians Requiring Remediation: One-of-Us or Not-Like-Us?

PURPOSE

The data for this paper were collected as part of a larger project exploring how the medical profession conceptualizes the task of supporting physicians struggling with clinical competency issues. In this paper, the authors focus on a topic that has been absent in the literature thus far-how physicians requiring remediation are perceived by those responsible for organizing remediation and by their peers in general.

METHOD

Using a constructivist grounded theory approach, the authors conducted semistructured interviews with 17 remediation stakeholders across Canada. Given that in Canada health is a provincial responsibility, the authors purposively sampled stakeholders from across provincial and language borders and across the full range of organizations that could be considered as participating in the remediation of practicing physicians.

RESULTS

Interviewees expressed mixed, sometimes contradictory, emotions toward and perceptions of physicians requiring remediation. They also noted that their colleagues, including physicians in training, were not always sympathetic to their struggling peers.

CONCLUSIONS

The medical profession's attitude toward those who struggle with clinical competency-as individuals and as a whole-is ambivalent at best. This ambivalence grows out of psychological and cultural factors and may be an undiscussed factor in the profession's struggle to deal adequately with underperforming members. To contend with the challenge of remediating practicing physicians, the profession needs to address this ambivalence and its underlying causes.

Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training

BACKGROUND

Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts.

METHODS

A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender.

RESULTS

Among 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients' families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00).

CONCLUSIONS

Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.

Racial discrimination, personal growth initiative, and African American men's depressive symptomatology: A moderated mediation model

OBJECTIVES

Mounting evidence indicates that racial discrimination is a risk factor for depression among African American men. However, the mechanisms underlying the association between racial discrimination and depressive symptomatology remain unclear. The present study investigated the mediating capacity of personal growth initiative (PGI) in the relation between racial discrimination experiences and depressive symptomatology, as well as whether the proposed mediating relation was moderated by age, education, and income.

METHOD

Participants included 649 African American men recruited from barbershops in the North, South, West, and Midwest regions of the United States and from academic institutions-events.

RESULTS

Results revealed significant associations between racial discrimination and a combined latent factor representing depressed affect, interpersonal problems, and somatic complaints but not the latent factor representing positive affect. PGI mediated the association between racial discrimination and depressive symptomatology; however, the mediational pathway was not moderated by age, education, and income.

CONCLUSIONS

Interventions designed to mitigate the mental health consequences of racial discrimination among African American men might focus on enhancing PGI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exposure to organisational injustice and serious psychological distress: longitudinal analysis of details of exposure from a private Japanese company

OBJECTIVES

Studies have shown that organisational injustice (OIJ) is associated with mental disorders. However, there is little research regarding details on OIJ exposure. We examined the effect of OIJ on serious psychological distress (SPD) by considering the exposure frequency, the exposure duration and the OIJ-free period after the disappearance of exposure.

METHODS

We used a prospective cohort design. OIJ exposure was assessed three times with 1-year intervals between assessments, and the subjects were grouped according to the exposure histories. The outcome assessment for SPD by scores of 13 or higher on the K6 questionnaire was carried out 3 years after the baseline scores were obtained. Participants were all full-time regular employees of one office of a manufacturing company in Japan. Participants who were being treated for mental disorders, those with SPD and those with missing data on the K6 questionnaire in the baseline survey were excluded from the prospective cohort. Self-reported questionnaire data from 1087 employees who participated in all surveys and answered all questions were analysed. Logistic regression analysis was used to explore the effect of OIJ on SPD.

RESULTS

SPD developed in 35 participants. Frequent OIJ exposure was associated with a higher risk for SPD (p for trend=0.002). Of the 1087 participants, 319 (29.3%) experienced a change in OIJ exposure at least once, and 8.6% of subjects experienced such a change twice. These changes in OIJ exposure were more strongly related to SPD than was the frequency of OIJ exposure.

CONCLUSIONS

OIJ was associated with SPD onset particularly when the workers were more frequently exposed to it. Moreover, frequent changes in the OIJ exposure were associated with a higher risk for SPD. Because OIJ exposure can change in a relatively short time, considering exposure histories may provide useful information for preventing mental disorders.

The intersectionality of identity-based victimization in Adolescence:A person-centered examination of mental health and academic achievement in a U.S. high school

INTRODUCTION

Growing evidence indicates that identity-based victimization (IBV; e.g., discrimination) is traumatic, and associated with mental health and academic concerns. Youth with multiple stigmatized identities face a higher risk of both victimization and poor mental health. The current study enhances a growing research base on intersectional IBV by examining 1) identity, rather than attribution, 2) a range of IBV experiences, 3) both mental health and academic achievement, 4) the mediating role of discrimination across multiple social identities, and 5) including gender expansive youth within a diverse sample representative of a high school population in the U.S.

METHODS

A cluster analysis was conducted to provide a nuanced depiction of intersectionality in a diverse sample of high school students (N = 946; ages 14-20, 44% cisgender boys, 53% cisgender girls, 3% gender expansive youth). Outcome and IBV differences across clusters were examined, in addition to the mediation of cluster membership and outcomes by discrimination.

RESULTS

Three distinct profiles of identity emerged: LGBTQ Youth (24%), Heterosexual Youth of Color (37%), and Heterosexual White Youth (39%). LGBTQ Youth and Heterosexual Youth of Color experienced the most IBV, and had higher levels of depression, lower wellbeing, and lower GPAs. Finally, discrimination partially mediated the association between identity and outcomes for LGBTQ youth, and fully mediated this association for Heterosexual Youth of Color.

CONCLUSIONS

The disproportionately of IBV, poor mental health, and lower academic achievement faced by LGBTQ youth and youth with intersecting stigmatized identities suggests that they may benefit from tailored and targeted treatments.

Understanding predictors of improvement in risky drinking in a U.S. multi-site, longitudinal cohort study of transgender individuals: Implications for culturally-tailored prevention and treatment efforts

OBJECTIVE

While transgender people report higher rates of risky drinking than the general population, no studies have examined transgender alcohol use longitudinally. This study investigated minority stress and identity development predictors of improvement in risky drinking among transgender individuals.

METHODS

Data come from a multi-site, longitudinal cohort study of U.S. transgender individuals (N = 330) and include measures of enacted stigma, felt stigma, identity development, and risky alcohol use. Theory-driven, hierarchical multivariable logistic regression was used to investigate the hypothesis that minority stress and identity development factors are related to improvement in risky drinking between baseline and 1-year follow-up.

RESULTS

Baseline risky drinkers (n = 106; 37.1%) were younger and more likely to have female sex assigned at birth. At 1-year follow-up, 68 baseline risky drinkers (64.2%) reported persistent risky drinking, while 38 (35.8%) reported improved drinking. Controlling for demographics and study site, female sex assigned at birth and enacted stigma were associated with lower odds of improved drinking. Non-white/Hispanic race/ethnicity, felt stigma, change in gender role/expression for 1-5 years, and diffuse-avoidant identity style were associated with higher odds of improvement.

CONCLUSIONS/IMPORTANCE

This is the first study to identity predictors of improvement in risky drinking among transgender individuals. Compared to trans-feminine individuals (assigned male at birth), trans-masculine individuals (assigned female at birth) were more likely to report risky drinking at baseline and had lower odds of improvement at 1-year follow-up. Improved drinking may be facilitated by preventing anti-transgender discrimination. Felt stigma and diffuse-avoidant identity style may lower alcohol risk via avoidance of drinking venues. Further research is needed to explicate these relationships and to inform culturally-tailored alcohol interventions for this at-risk population.

The People Living with HIV (PLHIV) Resilience Scale: Development and Validation in Three Countries in the Context of the PLHIV Stigma Index

Supporting resilience among people living with HIV (PLHIV) is crucial to their sustained uptake of HIV services as well as psychological and social wellbeing. However, no measures exist to assess resilience specifically in relation to living with HIV. We developed the PLHIV Resilience Scale and evaluated its performance in surveys with 1207 PLHIV in Cameroon, Senegal and Uganda as part of the PLHIV Stigma Index-the most widely used tool to track stigma and discrimination among PLHIV worldwide. Factor analyses demonstrated satisfactory psychometric properties and reliability (alphas = 0.81-0.92). Levels of resilience (e.g., whether one's self-respect has been positively, negatively, or not affected by one's HIV status) varied substantially within and across countries. Higher resilience was associated with less depression in each country (all p < 0.001), and, in Cameroon and Uganda, better self-rated health and less experience of stigma/discrimination (all p < 0.001). The final 10-item PLHIV Resilience Scale can help inform interventions and policies.

Patient-reported quality of life with obesity - development of a new measurement scale

BACKGROUND

Many questionnaires for measuring the quality of life for patients with obesity require comprehensive calculation before they are used. There is a need for questionnaires that permit simple assessment of the responses during a patient consultation. We have developed the questionnaire Patient-Reported Outcomes in Obesity (PROS). The objective of the study was to test the reliability and validity of the questionnaire.

MATERIAL AND METHOD

The questionnaire was used to ask patients about the extent to which they perceived their weight or body shape as bothersome. A group of patients with an average body mass index (BMI) of 42 (n = 109) completed the PROS questionnaire and The Impact of Weight Quality of Life questionnaire (IWQOL-Lite) before undergoing obesity surgery. Another group with an average body mass index of 29 (n = 95) completed the PROS questionnaire 1-5 years after having undergone obesity surgery. 67,7 % of the patients were > 40 years and 79 % were women. For the statistical analysis we used Cronbach's alpha, factor analysis, Spearman's rank test and independent t-test.

RESULTS

Cronbach's alpha for the total PROS score was 0.90, and the factor analysis showed a significant factor (eigenvalue = 4.7) that explained 58.4 % of the variance. The test-retest correlation was 0.93 (p < 0.001). The correlation coefficients between the PROS score, the total IWQOL-Lite score (rs = -0.91) and body mass index (rs = 0.60) were all significant (p < 0.001). The t-test showed an effect size (difference in standard deviation) between the non-surgery and the surgery groups of 1.9 (95 % CI 1.6-2.5) for the PROS questionnaire and 2.1 (95 % CI 1.7-2.5 for the total IWQOL-Lite score.

INTERPRETATION

The PROS questionnaire is a reliable and valid questionnaire for measurement of obesity-specific quality of life.

Perceived Discrimination and Cardiometabolic Risk Among US Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study

BACKGROUND

Metabolic syndrome (MetS) is a group of cardiovascular risk factors including elevated blood pressure, elevated triglycerides, decreased high-density lipoprotein cholesterol, impaired fasting glucose, and abdominal obesity, which disproportionately affects Hispanics/Latinos. The present study examined associations between perceived discrimination and MetS in Hispanic/Latino adults from various background groups (i.e., Dominican, Central American, Cuban, Mexican, Puerto Rican, South American).

METHODS

Data were obtained from 5174 Hispanics/Latinos who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. MetS components and covariates were measured at a baseline examination, and perceived discrimination was assessed within 9 months of baseline. Path analysis modeled associations of perceived discrimination with MetS prevalence and each of the six components of MetS, controlling for age, sex, income, acculturation, physical activity, diet, smoking, and alcohol use.

RESULTS

Among the full cohort, perceived discrimination was not associated with MetS prevalence in any of the models evaluated. Higher perceived discrimination at work/school was associated with larger waist circumference. When examining background groups separately, higher perceived ethnicity-associated threat was related to increased MetS prevalence only among individuals of Central American background. Differential patterns of association between perceived discrimination and MetS components were found for different background groups.

CONCLUSIONS

Overall results suggested that perceived discrimination was not strongly or consistently associated with MetS among Hispanics/Latinos.

Can immigrants counteract employer discrimination? A factorial field experiment reveals the immutability of ethnic hierarchies

How pervasive is labor market discrimination against immigrants and what options do policymakers and migrants have to reduce it? To answer these questions, we conducted a field experiment on employer discrimination in Sweden. Going beyond existing work, we test for a large range of applicant characteristics using a factorial design. We examine whether migrants can affect their employment chances—by adopting citizenship, acquiring work experience, or signaling religious practice—or whether fixed traits such as country of birth or gender are more consequential. We find little systematic evidence that immigrants can do much to reduce discrimination. Rather, ethnic hierarchies are critical: callback rates decline precipitously with the degree of ethno-cultural distance, leaving Iraqis and Somalis, especially if they are male, with much reduced employment chances. These findings highlight that immigrants have few tools at their disposal to escape ethnic penalties and that efforts to reduce discrimination must address employer prejudice.

Social inclusion and exclusion of people with mental illness in Timor-Leste: a qualitative investigation with multiple stakeholders

BACKGROUND

Social inclusion is a human right for all people, including people with mental illness. It is also an important part of recovery from mental illness. In Timor-Leste, no research has investigated the social experiences of people with mental illness and their families. To fill this knowledge gap and inform ongoing mental health system strengthening, we investigated the experiences of social inclusion and exclusion of people with mental illness and their families in Timor-Leste.

METHODS

Eighty-five participants from the following stakeholder groups across multiple locations in Timor-Leste were interviewed: (1) people with mental illness and their families; (2) mental health and social service providers; (3) government decision makers; (4) civil society members; and (5) other community members. Framework analysis was used to analyse interview transcripts.

RESULTS

People with mental illness in Timor-Leste were found to face widespread, multi-faceted sociocultural, economic and political exclusion. People with mental illness were stigmatised as a consequence of beliefs that they were dangerous and lacked capacity, and experienced instances of bullying, physical and sexual violence, and confinement. Several barriers to formal employment, educational, social protection and legal systems were identified. Experiences of social inclusion for people with mental illness were also described at family and community levels. People with mental illness were included through family and community structures that promoted unity and acceptance. They also had opportunities to participate in activities surrounding family life and livelihoods that contributed to intergenerational well-being. Some, but not all, Timorese people with mental illness benefited from disability-inclusive programming and policies, including the disability pension, training programs and peer support.

CONCLUSIONS

These findings highlight the need to combat social exclusion of people with mental illness and their families by harnessing local Timorese sociocultural strengths. Such an approach could centre around people with mental illness and their families to: increase population mental health awareness; bolster rights-based and culturally-grounded mental health services; and promote inclusive and accessible services and systems across sectors.

Behavioural and Neural Responses to Facial Disfigurement

Faces are among the most salient and relevant visual and social stimuli that humans encounter. Attractive faces are associated with positive character traits and social skills and automatically evoke larger neural responses than faces of average attractiveness in ventral occipito-temporal cortical areas. Little is known about the behavioral and neural responses to disfigured faces. In two experiments, we tested the hypotheses that people harbor a disfigured is bad bias and that ventral visual neural responses, known to be amplified to attractive faces, represent an attentional effect to facial salience rather than to their rewarding properties. In our behavioral study (N = 79), we confirmed the existence of an implicit 'disfigured is bad' bias. In our functional MRI experiment (N = 31), neural responses to photographs of disfigured faces before treatment evoked greater neural responses within ventral occipito-temporal cortex and diminished responses within anterior cingulate cortex. The occipito-temporal activity supports the hypothesis that these areas are sensitive to attentional, rather than reward properties of faces. The relative deactivation in anterior cingulate cortex, informed by our behavioral study, may reflect suppressed empathy and social cognition and indicate evidence of a possible neural mechanism underlying dehumanization.

A non-discriminatory response to disability related problem behaviour at Australian universities

When students with a psychological disorder study at university, there are competing goals and challenges faced by administrators, teaching staff and students. Positive goals such as inclusion, self-determination and respect for diversity are sometimes counterbalanced by problem behaviour associated with mental illness. The challenge for tertiary institutions is to accommodate the educational needs of students with a psychological disorder, without undermining the inherent requirements of a course of academic study, or the duties that a university owes to staff and students with respect to safe and healthy learning environments. This article considers how the Australian legal system has attempted to find balance between these competing needs and duties, in a way that is respectful to those who study with a psychological disorder.

Maternal experiences of ethnic discrimination and child cardiometabolic outcomes in the Study of Latino Youth

PURPOSE

Limited research has examined maternal experiences of racial/ethnic discrimination in relation to child cardiometabolic health. In this study, we investigated whether maternal experiences of ethnic discrimination were associated with cardiometabolic risk in Hispanic/Latino youth several years later.

METHODS

Our sample included 1146 youth (8-16 years) from the Study of Latino Youth (2012-2014), who were children of the Hispanic Community Health Study/Study of Latinos participants (2008-2011). We used regression models to examine the prospective associations between maternal report of ethnic discrimination in relation to her child's body mass index (BMI) z-score, metabolic syndrome score (MetS), and high sensitivity C-reactive protein (hsCRP) levels 2 years later.

RESULTS

Maternal ethnic discrimination was associated with youth hsCRP, but not BMI or MetS (P-values >.05). Adjusting for age, nativity, and national background, maternal ethnic discrimination was associated with higher (log) hsCRP levels (β = 0.18, 95% CI = 0.04 to 0.32) in children. This association was robust to adjustment for maternal and household characteristics (β = 0.17, 95% CI = 0.04 to 0.31), as well as maternal depression and maternal BMI.

CONCLUSIONS

Maternal ethnic discrimination is associated with inflammation among Hispanic/Latino youth, and not BMI z-score or MetS. Studies are needed to address temporality and pathways.

DSM-5 Alcohol Use Disorder Severity as a Function of Sexual Orientation Discrimination: A National Study

BACKGROUND

Sexual minorities are more likely than their heterosexual counterparts to develop alcohol use disorder (AUD), and understanding the underlying reasons for this heightened risk is a public health priority. This study examined relationships between sexual orientation discrimination and DSM-5 AUD severity.

METHODS

The 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions III conducted in-person interviews with a nationally representative sample of U.S. adults (N = 36,309). Approximately 2.8% of the target population self-identified as lesbian, gay, or bisexual, 3.1% had at least 1 past-year same-sex sexual partner, and 8.3% reported same-sex sexual attraction.

RESULTS

Adults who identified as lesbian, gay, bisexual, heterosexual with same-sex attraction and/or current same-sex sexual partners, and those not sure of their sexual identity, had higher rates of individual DSM-5 AUD criteria than heterosexual-identified adults with only opposite-sex attraction and sexual partners. Respondents who were bisexual or unsure of their sexual identity consistently had the highest probabilities of endorsing each of these AUD criteria relative to the other subgroups. Differences in AUD severity across sexual orientation subgroups were much larger among women than among men. Sexual minorities who experienced higher levels of sexual orientation discrimination had significantly higher levels of AUD severity than sexual minorities who experienced lower levels or no discrimination. In particular, greater levels of sexual orientation discrimination increased the odds of impaired control criteria and pharmacologic criteria. Associations between prior-to-past-year sexual orientation discrimination and AUD severity were not as robust as those involving past-year discrimination.

CONCLUSIONS

Sexual minorities are at substantially greater risk of severe DSM-5 AUD, and this is particularly true among those who experience high levels of sexual orientation discrimination. Findings indicate that proximal experiences of discrimination are more salient than distal experiences. AUD treatment should address recent sexual orientation discrimination given that such experiences are associated with more severe AUD.

Narrative Intersectionality in Caring for Marginalized or Disadvantaged Patients: Thinking Beyond Categories in Medical Education and Care

Categories are essential to doctors' thinking and reasoning about their patients. Much of the clinical categorization learned in medical school serves useful purposes, but an extensive literature exists on students' reliance on broad systems of social categorization. In this article, the authors challenge some of the orthodoxies of categorization by combining narrative approaches to medical practice with the theoretical term "intersectionality" to draw students' attention to the important intersecting, but often overlooked, identities of their patients. Although intersectionality applies for all patients, the focus here is on its importance in understanding and caring for marginalized or disadvantaged persons.Intersectionality posits that understanding individual lives requires looking beyond categories of identity in isolation and instead considering them at their intersection, where interrelated systems of power and oppression, advantage and discrimination are at play and determine access to social and material necessities of life. Combined with narrative approaches that emphasize the singularity of a person's story, narrative intersectionality can enable a more robust understanding of how injustice and inequality interrelate multidimensionally to produce social disadvantage.The authors apply this framework to two films that present characters whose lives are made up of numerous and often-contradictory identities to highlight what physicians may be overlooking in the care of patients. If the education of physicians encourages synthesis and categorization aimed at the critically useful process of making clinical "assessments" and "plans," then there must also be emphasis in their education on what might be missing from that process.

Reducing Social Judgment Biases May Require Identifying the Potential Source of Bias

Social judgment is shaped by multiple biases operating simultaneously, but most bias-reduction interventions target only a single social category. In seven preregistered studies (total N > 7,000), we investigated whether asking participants to avoid one social bias affected that and other social biases. Participants selected honor society applicants based on academic credentials. Applicants also differed on social categories irrelevant for selection: attractiveness and ingroup status. Participants asked to avoid potential bias in one social category showed small but reliable reductions in bias for that category (r = .095), but showed near-zero bias reduction on the unmentioned social category (r = .006). Asking participants to avoid many possible social biases or alerting them to bias without specifically identifying a category did not consistently reduce bias. The effectiveness of interventions for reducing social biases may be highly specific, perhaps even contingent on explicitly and narrowly identifying the potential source of bias.

Family factors mediate discrimination related stress and externalizing symptoms in rural Latino adolescents

INTRODUCTION

Externalizing disorders are more prevalent in rural than urban settings and account for disproportionately high mental health service costs for rural adolescents. Although cultural stressors such as discrimination have been associated with externalizing problems in ethnic minority youth broadly, this relationship is understudied in Latinos, particularly those in rural settings. Further, though the associations of family processes such as familism and family conflict have been studied in relation to youth externalizing symptoms, whether these processes change in the face of adolescent discrimination stress remains unknown.

METHODS

A moderated multiple mediation model was used to examine the association between perceived discrimination, externalizing symptoms, and the indirect effect of family factors (familism, and family conflict) in a large sample (n = 455) of rural Latino youth. We also evaluated whether indirect and direct effects of discrimination on externalizing symptoms differed in boys versus girls.

RESULTS

Familism and family conflict each independently mediated the relationship between discrimination related stress and externalizing symptoms. However, discrimination had a direct effect on externalizing symptoms for boys only. In girls, this association held only when family factors were accounted for. Post-hoc analyses reveal that the moderating effect of sex on discrimination is driven by differences in rule-breaking behavior, as opposed to aggressive behavior.

CONCLUSION

Findings suggest that discrimination is associated with changes in the family environment which in turn invoke elevated risk for externalizing problems. Further, family-focused interventions that address externalizing problems may be especially effective for adolescent girls.

Discrimination exposure and DNA methylation of stress-related genes in Latina mothers

Latina mothers, who have the highest fertility rate among all ethnic groups in the US, are often exposed to discrimination. The epigenetic changes related to this discrimination are largely unknown. This study is the first to explore the relationship between discrimination and DNA methylation of stress regulatory genes in Latinas. Our sample was Latina women (n = 147) with a mean age of 27.6 years who were assessed at 24-32 weeks' gestation (T1) and 4-6 weeks postpartum (T2) and reside in the U.S. Blood was collected at T1, and the Everyday Discrimination Scale (EDS) was administered at T1 and T2. DNA Methylation at candidate gene regions was determined by bisulphite pyrosequencing. Associations between EDS and DNA methylation were assessed via zero-inflated Poisson models, adjusting for covariates and multiple-test comparisons. Discrimination was negatively associated with methylation at CpG sites within the glucocorticoid receptor (NR3C1) and brain-derived neurotrophic factor (BDNF) genes that were consistent over time. In addition, discrimination was negatively associated with methylation of a CpG in the glucocorticoid binding protein (FKBP5) at T1 but not at T2. This study underscores associations between discrimination and epigenetic markers of DNA methylation in Latinas that warrant further investigation to better understand the biological pathways and psychopathological effects of discrimination on Latina mothers and their families.

Hearing "That's So Gay" and "No Homo" on Campus and Substance Use Among Sexual Minority College Students

Sexual orientation microaggressions are common on college campuses and can contribute to negative outcomes; yet little is known about their relationship with substance use outcomes. Among a convenience sample of cisgender sexual minority college students (n= 574; 57.0% female, 24.9% people of color, 50.7% gay/lesbian; 72.4% public school) from 37 states (67.8% Midwest), this analysis investigates the association between hearing "that's so gay" and "no homo" on campus and hazardous alcohol use and the frequency of illicit drug use. Using multivariable regression analyses, the commonly heard phrases "that's so gay" and "no homo" were each found to significantly increase the risk for hazardous drinking and the frequency of drug use among students. Efforts should be made to create more welcoming campus climates for sexual minority students by reducing the use of these microaggressions and, in the meantime, offering supports to mitigate their harmful effects.

Is More Always Merrier? Intersectionality as an Antecedent of Job Insecurity

As modern workplace environments are becoming increasingly diverse, the experiences of disenfranchised employees have become a topic of great interest to scholars and business professionals alike. While the experiences of individuals with singular stigmatized identities have been well-established, a dearth of research has assessed how intersectionality, i.e., holding multiple stigmatized identities, combine and intertwine to shape workplace experiences. We contribute to a growing literature on intersectionality by assessing the extent to which employees identifying with multiple stigmatized identities may constitute a risk factor for the experience of job insecurity, a prevalent and potent economic stressor. Additionally, we propose that job insecurity will partially mediate the relationship between intersectionality and a variety of adverse workplace outcomes associated with increased job insecurity perceptions. In order to test these hypotheses, we collected survey data from 449 employed individuals within the United States over two timepoints. Results of the tests of our direct and indirect hypotheses revealed that individuals with more stigmatized identities reported greater perceptions of job insecurity, and intersectionality indirectly affected workplace outcomes via this heightened job insecurity. Our results highlight a new antecedent of job insecurity for consideration and is meant to motivate others to approach diversity-related research questions with multiple identities in mind, in an effort to encapsulate the full spectrum of one’s experience based on their identity makeup.