HIV/AIDS-related stigma and discrimination among health care workers at Tanta University Hospitals, Egypt

HIV/AIDS-related stigma and discrimination among health care professionals is one of the most important factors of this disease expansion. This study aimed to assess the stigmatized attitude among health care providers toward people living with HIV (PLHIV) at Tanta University Hospitals. The study is a cross-sectional survey. Data was gathered from randomly selected 310 health care workers at Tanta University Hospital using a structured questionnaire. Among studied participants, only 24.0 % had previous contact with HIV patients during work and 21.3 % felt worried to touch cloths of HIV patients, 26.4 % were worried to dress the wounds of HIV patients and 27.4 % were afraid to get blood sample from HIV patients. Those who were unwilling to care for HIV patients represented 40 % and only 36 % reported that if discriminating against HIV patients, they may get in trouble. Less than one half (42 %) reported having enough supply for reducing risk of nosocomial infection with HIV and 86 % reported having no guidelines to deal with HIV patients. Out of the participants, 78.7 % reported that HIV patients should be ashamed of themselves. Among the participants, 35, 48, and 43 % preferred not to provide medical services to injecting drug users, men having sex with men and sex workers suspected to have HIV infection, respectively. Infection control is defective in the supplies and procedures. There is absence of policy and protocols with regard to dealing with PLHIV. Health care providers showed high levels of stigma and discrimination against PLHIV.

Rejection and Latina/o mental health: Intragroup marginalization and intragroup separation

Experiencing discrimination or rejection from one's own ethnic group can have adverse effects on mental health above and beyond general ethnic discrimination alone. Intragroup marginalization is a term that involves being marginalized by members of one's own ethnic group for acting in concordance with the mainstream culture (Castillo, Conoley, Brossart, & Quiros, 2007). Minimal research has examined rejection by one's own ethnic group for acting too enculturated to one's home culture, or intragroup separation. In the current study, a community sample of Latina/o adults (N = 233), primarily women of Mexican descent, were recruited and completed self-report surveys. Using 3 hierarchical regressions, results demonstrated that intragroup marginalization and intragroup separation predicted symptoms of depression, anxiety, and alcohol misuse above and beyond that of general ethnic discrimination alone. Moreover, family and ethnic group intragroup marginalization and intragroup separation uniquely predicted different symptoms of mental health. Additional findings suggested that nativity status served as a moderator for intragroup separation and alcohol misuse, such that the relationship strengthened for U.S.-born Latina/os. Theoretical and practical implications are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

African American emerging adults' experiences with racial discrimination and drinking habits: The moderating roles of perceived stress

OBJECTIVES

Despite the abundance of research aimed at quantifying the impact of racism on the mental and physical health of African Americans, results remain inconclusive largely because of challenges with operationalization, as well as conflation with the concept of racial discrimination, which may be more readily assessed. The purpose of the current study was to: (a) determine whether racial discrimination had an impact on the degree of alcohol use and binge drinking among African American emerging adults, and if so, (b) determine whether perceived stress linked to racially discriminatory experiences moderated these associations.

METHOD

We used a series of hierarchical regressions to examine associations among racial discrimination, perceived stress, and degree of alcohol consumption in a sample of African American emerging adults in the southeast (n = 235).

RESULTS

We found that the association between racial discrimination and degree of alcohol consumption (alcohol use and binge drinking) was strongest among individuals who reported greater levels of perceived stress linked to racial discrimination experiences. This association, however, was not significant for individuals who reported lower levels of perceived stress in response to racial discrimination.

CONCLUSIONS

African Americans who experience a high degree of perceived stress in response to experiences with racial discrimination may be at greater risk for problem drinking than their peers with less perceived stress. These findings highlight the need for novel intervention efforts aimed at mitigating the effects of stress and racial discrimination on health outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Too big to be seen: Weight-based discrimination among nursing students

An educational intervention was conducted to determine the efficacy of an obesity sensitivity program to determine nursing students' attitudes toward obese clients. As part of the clinical curriculum, nursing students (N = 103) received weekly obesity sensitivity education on weight-based discrimination. Students' completed a preproject and postproject attitudes toward obese persons scale (Barra, 2015) to evaluate discriminatory beliefs and actions. All clinical groups had a significant positive change in their own weight prejudices postobesity education intervention. Chi-square analysis was utilized as a measure of association between pre- and postobesity education with clinical application concerning obesity size, body odor, appearance, and lifestyle, along with provider fear of a back injury. Promoting nursing student awareness of obese client bias can dissipate negative stigmas to promote a therapeutic patient-provider relationship.

[Use of the theory of the social representations to understand discriminatory attitudes towards HIV/AIDS]

OBJECTIVE

The Theory of Social Representation (TSR) is a widely used approach to understanding attitudes towards HIV/AIDS in diverse cultures and contexts. However, there are few studies that offer a articulate view of the problem, and that also focus on the role of future educators. This research aimed to understand the extent to which knowledge and social representations about HIV/AIDS determine attitudes towards HIV/AIDS in a population of educators in training.

METHODS

This research is based on the contribution of 613 university students from Huelva, Spain. For that, TRS has been used and the hypothesis has been formulated according to its assumptions. A test about HIV, representation scales and attitude scales towards HIV are the instruments that have used for data collection. These help to obtain information about some social representations and exclusive attitudes. As an analythical method, the reproduction of structural equations was into use.

RESULTS

The data have proved that the knowledge degree about HIV has a negative (β=-0,36) influence on negative representations. And these have a positive effect (β=0,80) on exclusive attitudes. Similarly, the knowledge degree determined both in an indirect and negative (β=-0,26) way the discriminatory attitudes.

CONCLUSIONS

The results show that student teachers`attitudes, whether discriminatory or tolerant towards people with HIV/AIDS, are determined by their social representations, and these by the level of knowledge about HIV/AIDS, highlighting the importance of education.

The association of perceived discrimination and depressive symptoms among Chinese, Korean, and Vietnamese Americans

OBJECTIVES

Few studies have investigated ethnic differences in discrimination and depressive symptoms, and the link between them among foreign-born Asian Americans. This study identifies if depressive symptoms and perceived discrimination differ by Asian ethnicity, and if perceived discrimination is associated with depressive symptoms among foreign-born Chinese, Korean, and Vietnamese Americans.

METHODS

This study uses data from the Asian American Liver Cancer Prevention Program (N = 600). Using nonprobability sampling, foreign-born Asian American adults (58% female, Mage = 47.3 years, SD = 11.82) were recruited from the community in the Baltimore-Washington Metropolitan Area. Perceived discrimination was defined using everyday and major discrimination scales; the Centers for Epidemiological Studies-Depression Scale defined the outcome of depressive symptoms. Multiple logistic regressions were conducted to determine if this association exists.

RESULTS

A high prevalence of depressive symptoms (one third to one fifth per ethnicity) and ethnic differences between foreign-born Chinese, Korean, and Vietnamese Americans were found; increased perceived discrimination was associated with worse depressive symptomology. Those with "high" and "mild discrimination" had greater odds of being depressed than those who had never experienced discrimination; those with "unfair treatment" had greater odds of being depressed than those who had none. Major experiences of discrimination were less common and less likely associated with depressive symptoms than everyday experiences.

CONCLUSIONS

Foreign-born Asian Americans experience substantial discrimination and depressive symptoms. Future studies should stratify by Asian ethnicity and examine the differences between minor and major experiences of discrimination to provide appropriate mental health prevention and treatment for this population. (PsycINFO Database Record

Experiences of Discrimination, Harassment, and Violence in a Sample of Italian Transsexuals Who Have Undergone Sex-Reassignment Surgery

The present study aims to provide an overview of experiences of discrimination, harassment, and violence in a sample of Italian transsexuals who have undergone sex-reassignment surgery (SRS). Lack of support for gender transition from family members was also assessed, before and after SRS. Data were collected in the context of a multicentric study (Milan, Florence, and Bari) on SRS outcome. Patients who underwent SRS were contacted and asked to fill out a questionnaire concerning experiences of discrimination, harassment, violence, and crime they might have experienced in previous years. Seventy-two participants took part in the research: 46 were male-to-female (MtF; 64%) and 26 were female-to-male (FtM; 36%). Thirty-six percent of the total sample (with no differences between MtF and FtM) experienced at least one episode of harassment, violence, or discrimination. The workplace was reported to be the social area with the highest risk of discrimination and harassment (22% of participants). Reports of more than one incident of discrimination, harassment, and violence characterized the majority of participants in the MtF sample. Compared with previous studies carried out in other countries, a much larger proportion of participants could count on a supportive family environment before and after transition. Our results show that Italian society at large is prejudiced against transsexuals, but at a more "micro" level, having a trans person as a family member might result in a protective and tolerant attitude.

The mediating effect of self-esteem on the relationship between perceived discrimination and psychological well-being in immigrants

The aim of the study is to analyze the mediating effect of self-esteem on the relationship between perceived discrimination and psychological well-being in South American immigrants in Chile. An analytical, cross sectional, non-experimental design was used. We evaluated 853 Peruvians and Colombians living in the northern cities of Arica, Antofagasta, and Santiago de Chile, the capital located in the center of the country. The instruments used were the Ryff Psychological Well-being Scale, the Rosenberg Self-Esteem Scale and the Perceived Discrimination Scale by Basabe, Paez, Aierdi and Jiménez-Aristizabal. We used the estimation method (RWLS) and polychoric correlation matrices, to estimate the effect size and overall fit of the direct effect models of discrimination and self-esteem on psychological well-being, and indirect and total effects of discrimination mediated by self-esteem. While both populations reported similar levels of perceived discrimination, it was found that the means in psychological well-being and self-esteem of the Colombian population were significantly higher than that of the Peruvian population. Regarding self-esteem, the results provided evidence for the possible mediating effect on the relationship between perceived discrimination and psychological well-being. This research aims to contribute to the development of interventions seeking to strengthen self-esteem in order to circumvent possible negative consequences of perceived discrimination, as a consequent, improving immigrants´ personal resources to successfully cope with the diverse demands of their new context.

A scoping review of the role of HIV-related stigma and discrimination in noncommunicable disease care

Background

People living with HIV are increasingly burdened by noncommunicable diseases (NCDs) as a result of the NCD susceptibility that accompanies increased life expectancy and the rising global prevalence of NCDs. Health systems are being strengthened and programs are being developed to address this burden, often building on HIV care strategies and infrastructure or through integrated care models. HIV remains a stigmatized condition and the role of HIV stigma in the provision of NCD care is not well understood.

Methods

We conducted a scoping literature review of both peer reviewed and grey literature to identify evidence of the role of HIV stigma in the NCD-care continuum (prevention, diagnosis, care seeking, retention in care, and adherence to treatment of NCDs). We searched PsychInfo and Pubmed and conducted additional searches of programmatic reports and conference abstracts. Included studies were published in English within the past decade and examined HIV-related stigma as it relates to NCD-care or to integrated NCD-and HIV-care programs.

Results

Sixteen articles met the inclusion criteria. Findings suggest: fear of disclosure, internalized shame and embarrassment, and negative past experiences with or negative perceptions of health care providers negatively influence engagement with NCD care; HIV stigma can adversely affect not only people living with HIV in need of NCD care, but all NCD patients; some NCDs are stigmatized in their own right or because of their association with HIV; integrating NCD and HIV care can both reduce stigma for people living with HIV and a present a barrier to access for NCD care.

Conclusion

Due to the dearth of available research and the variability in initial findings, further research on the role of HIV stigma in the NCD-care continuum for people living with HIV is necessary. Lessons from the field of HIV-stigma research can serve as a guide for these efforts.

Is disability exclusion associated with psychological distress? Australian evidence from a national cross-sectional survey

OBJECTIVE

To examine the association between disability exclusion and psychological distress.

DESIGN

Cross-sectional study.

SETTING

Population-based study of individuals living in households across Australia.

PARTICIPANTS

Respondents were persons aged 15 and over living with a disability.

PRIMARY OUTCOME MEASURES

Reporting an experience of discrimination or avoidance behaviour due to a respondent's disability. High or very high levels of psychological distress measured using the Kessler K10 instrument.

METHODOLOGY

Using the Survey of Disability, Ageing and Carers, we calculated the prevalence of persons with a disability experiencing psychological distress, disaggregated by experiences of disability exclusion, including discrimination and avoidance. Logistic regression models were fitted to examine the association between disability exclusion and psychological distress, once extensive controls and adjustments for survey design and presence of psychosocial disabilities were considered.

RESULTS

About 62% of persons citing an experience of disability discrimination were in psychological distress, compared with 27% of those citing no discrimination. Furthermore, 53% of those who actively avoided social, familial or economic activities because of their disability experienced psychological distress, compared with 19% of those who did not avoid these situations. After controlling for demographic characteristics and disabling conditions, reporting an experience of disability discrimination or disability avoidance increased the odds of psychological distress by 2.2 (95% CI 1.74 to 2.26) and 2.6 (95% CI 2.28 to 2.97) times, respectively. Those who experienced both avoidance and discrimination were 3.7 (95% CI 2.95 to 4.72) times more likely to be in psychological distress than those experiencing neither. Avoidance and discrimination in healthcare settings were also found to be strongly associated with experiencing psychological distress.

CONCLUSIONS

Given new policy initiatives to improve disability care, coupled with the increasing speed of population ageing, the onus is on governments and its citizenry to address disability exclusion to offset potential mental health impacts.

[Stigma and discrimination experienced by people living with HIV in Togo, in 2013]

BACKGROUND

Stigma and discrimination experienced by people living with HIV (PLWHA) prevent and delay access to prevention and treatment services. The aim of this study was to describe the patterns of stigma and discrimination experienced by PLWHA in Togo and to identify the associated factors.

METHODS

A cross-sectional study was conducted in 2013 among PLWHA in Togo in order to collect data on stigma or discrimination experiences. Univariate and multivariate analyses were performed to identify associated factors.

RESULTS

A total of 891 PLWHA were interviewed, including 848 (95.2%) receiving antiretroviral therapy. External stigma (37.9%) was the major form of stigmatization followed by internalized stigma (35.4%). The main features of external stigma were gossip (36.5%) and issues to access education (36.0%). Internalized stigma mainly consisted of a feeling of guilt (37.6%) and self-devaluation (36.0%). In univariate and multivariate analysis, female gender was significantly associated with stigma (aOR = 1.73, 95% CI [1.08-2.77]). Of the 891 PLWHA, 75 (8.4%) reported a violation of their rights. Finally 27 (4.1%) were discouraged from having children by a health professional because of their HIV status.

CONCLUSION

Stigma affects more than one-third of PLWHA in Togo, more particularly females. It appears necessary to design new interventions and integrate psychosocial care in the management of PLWHA, in addition to antiretroviral therapy.

Discrimination, harassment and non-reporting in UK medical education

CONTEXT

Discrimination and harassment create a hostile environment with deleterious effects on student well-being and education. In this study, we aimed to: (i) measure prevalences and types of discrimination and harassment in one UK medical school, and (ii) understand how and why students report them.

METHODS

The study used a mixed-methods design. A medical school population survey of 1318 students was carried out in March 2014. Students were asked whether they had experienced, witnessed or reported discrimination or harassment and were given space for free-text comments. Two focus group sessions were conducted to elicit information on types of harassment and the factors that influenced reporting. Proportions were analysed using the Wilson score method and associations tested using chi-squared and regression analyses. Qualitative data were subjected to framework analysis. Degrees of convergence between data were analysed.

RESULTS

A total of 259 (19.7%) students responded to the survey. Most participants had experienced (63.3%, 95% confidence interval [CI]: 57.3-69.0) or witnessed (56.4%, 95% CI: 50.3-62.3) at least one type of discrimination or harassment. Stereotyping was the form most commonly witnessed (43.2%, 95% CI: 37.4-49.3). In the qualitative data, reports of inappropriate joking and invasion of personal space were common. Black and minority ethnic students had witnessed and religious students had experienced a greater lack of provision (χ²  = 4.73, p = 0.03 and χ²  = 4.38, p = 0.04, respectively). Non-heterosexual students had experienced greater joking (χ²  = 3.99, p = 0.04). Students with disabilities had experienced more stereotyping (χ²  = 13.5, p < 0.01). Female students and students in clinical years had 2.6 (95% CI: 1.3-5.3) and 3.6 (95% CI: 1.9-7.0) greater odds, respectively, of experiencing or witnessing any type of discrimination or harassment. Seven of 140 survey respondents had reported incidents (5.0%, 95% CI: 2.4-10.0). Reporting was perceived as ineffective and as potentially victimising of the reporter.

CONCLUSIONS

Harassment and discrimination are prevalent in this sample and associated with gender, ethnicity, sexuality, disability and year group. Reporting is rare and perceived as ineffective. These findings have informed local developments, future strategies and the development of a national prevention policy.

Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan

INTRODUCTION

Respectful and dignified healthcare is a fundamental right for every woman. However, many women seeking childbirth services, especially those in low-income countries such as Pakistan, are mistreated by their birth attendants. The aim of this epidemiological study was to estimate the prevalence of mistreatment and types of mistreatment among women giving birth in facility- and home-based settings in Pakistan in order to address the lack of empirical evidence on this topic. The study also examined the association between demographics (socio-demographic, reproductive history and empowerment status) and mistreatment, both in general and according to birth setting (whether home- or facility-based).

MATERIAL AND METHODS

In phase one, we identified 24 mistreatment indicators through an extensive literature review. We then pre-tested these indicators and classified them into seven behavioural types. During phase two, the survey was conducted (April-May 2013) in 14 districts across Pakistan. A total of 1,334 women who had given birth at home or in a healthcare facility over the past 12 months were interviewed. Linear regression analysis was employed for the full data set, and for facility- and home-based births separately, using Stata version 14.1.

RESULTS

There were no significant differences in manifestations of mistreatment between facility- and home-based childbirths. Approximately 97% of women reported experiencing at least one disrespectful and abusive behaviour. Experiences of mistreatment by type were as follows: non-consented care (81%); right to information (72%); non-confidential care (69%); verbal abuse (35%); abandonment of care (32%); discriminatory care (15%); and physical abuse (15%). In overall analysis, experience of mistreatment was lower among women who were unemployed (β = -1.17, 95% CI -1.81, -0.53); and higher among less empowered women (β = 0.11, 95% CI 0.06, 0.16); and those assisted by a traditional birth attendant as opposed to a general physician (β = 0.94, 95% CI 0.13, 1.75). Sub-group analyses for home-based births identified the same significant associations with mistreatment, with ethnicity included. In facility-based births, there was a significant relationship between women's employment and empowerment status and mistreatment. Women with prior education on birth preparedness were less likely to experience mistreatment compared to those who had received no previous birth preparedness education.

CONCLUSION

In order to promote care that is woman-centred and provided in a respectful and culturally appropriate manner, service providers should be cognisant of the current situation and ensure provision of quality antenatal care. At the community level, women should seek antenatal care for improved birth preparedness, while at the interpersonal level strategies should be devised to leverage women's ability to participate in key household decisions.

Association Between Perceived Discrimination and Emergency Department Use Among Safety-Net Patients in the Southwestern United States

OBJECTIVES

Patients' perceptions of how they are treated in their interactions with the healthcare system represent important and valid measures of healthcare quality that may influence health utilization, outcomes, and costs. Perceived discrimination or the sense of being treated unfairly is an important patient perception known to adversely affect health, but the relation of such perceptions to health-seeking behaviors related to low-acuity emergency department (ED) use is unclear. The objectives of this exploratory study were to describe the prevalence and nature of perceived discrimination or perceived unfair treatment (PD/PUT), and to examine the association of PD/PUT with healthcare utilization among adult safety-net patients in the southwestern United States who sought ED treatment for low-acuity conditions.

METHODS

Cross-sectional survey data were collected via self-administered questionnaires completed by adult safety-net patients who were uninsured or covered by Medicaid and who sought ED treatment for low-acuity conditions (N = 310). We used descriptive statistics to describe PD/PUT in the healthcare experiences reported by study participants. We used logistic regression to examine the association between PD/PUT and participants' likelihood to seek health care from ED and non-ED settings.

RESULTS

Thirty-eight percent of study participants reported PD/PUT, most frequently attributed to insurance status (being uninsured or covered by Medicaid). Participants who reported PD/PUT in their ability to access medical care or to obtain health insurance were significantly more likely to be frequent (vs nonfrequent) ED users (odds ratio [OR] 3.80, P < 0.001) and to use multiple (vs 1) EDs (OR 3.79, P < 0.001) during a 12-month period. Participants who reported PD/PUT while receiving medical care were more likely to have received care in ED and non-ED settings, as compared with EDs only (OR 2.02, P = 0.012).

CONCLUSIONS

A substantial proportion of this sample of adult safety-net patients in the Southwest reported experiencing PD/PUT in their healthcare interactions and most frequently attributed such perceptions to their insurance status. Although this study does not establish a causal link between PD/PUT and utilization of care in specific settings, it highlights the need to better understand the underlying causes of PD/PUT across multiple delivery settings and to clarify the extent to which such experiences may influence patients' healthcare-seeking behaviors. Federal and state policies that aim to maintain or expand health insurance coverage for safety-net populations should consider the role of health insurance status in driving perceptions of being discriminated against or treated unfairly.

The Mediating Roles of Rejection Sensitivity and Proximal Stress in the Association Between Discrimination and Internalizing Symptoms Among Sexual Minority Women

The negative impact of discrimination on mental health among lesbian, gay, and bisexual populations has been well documented. However, the possible mediating roles of sexual orientation rejection sensitivity and rejection-based proximal stress in the association between discrimination and internalizing symptoms remain unclear. Rejection-based proximal stress is a subset of proximal stressors that are theorized to arise from concerns about and expectations of sexual orientation-based rejection and discrimination. Drawing on minority stress theory, we tested potential mediating effects using indirect effects structural equation modeling in a sample of 300 sexual minority women. Results indicated that the indirect effect of discrimination on internalizing symptoms (a latent variable indicated by depression and anxiety symptoms) through sexual orientation rejection sensitivity and rejection-based proximal stress (a latent variable indicated by preoccupation with stigma, concealment motivation, and difficulty developing a positive sexual identity) was significant. Additionally, the indirect effects of discrimination on rejection-based proximal stress through sexual orientation rejection sensitivity and of sexual orientation rejection sensitivity on internalizing symptoms through rejection-based proximal stress were also significant. These findings indicate that sexual orientation rejection sensitivity plays an important role in contributing to rejection-based proximal stress and internalizing symptoms among sexual minority women.

Addressing patient biases toward physicians

[Full article available at http://rimed.org/rimedicaljournal-2017-12.asp].

Experiences of Discrimination and Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis (MESA)

Experiences of discrimination are associated with increased risk of adverse health outcomes; however, it is unknown whether discrimination is related to incident type 2 diabetes mellitus (diabetes). We investigated the associations of major experiences of discrimination (unfair treatment in 6 situations) and everyday discrimination (frequency of day-to-day experiences of unfair treatment) with incident diabetes among 5,310 participants from the Multi-Ethnic Study of Atherosclerosis, enrolled in 2000-2002. Using Cox proportional hazards models, we estimated hazard ratios and confidence intervals, adjusting for demographic factors, depressive symptoms, stress, smoking, alcohol, physical activity, diet, waist circumference, and body mass index. Over a median follow-up of 9.4 years, 654 diabetes cases were accrued. Major experiences of discrimination were associated with greater risk of incident diabetes when modeled continuously (for each additional experience of discrimination, hazard ratio = 1.09, 95% confidence interval: 1.01, 1.17) or categorically (for ≥2 experiences vs. 0, hazard ratio = 1.34, 95% confidence interval: 1.08, 1.66). Similar patterns were observed when evaluating discrimination attributed to race/ethnicity or to a combination of other sources. Everyday discrimination was not associated with incident diabetes. In conclusion, major experiences of discrimination were associated with increased risk of incident diabetes, independent of obesity or behavioral and psychosocial factors. Future research is needed to explore the mechanisms of the discrimination-diabetes relationship.

Intergroup Contact: Using Storytelling to Increase Awareness of Lesbian and Gay Older Adults in Long-Term Care Settings

Due to societally imposed stigmatization, lesbian and gay (LG) older adults fear and prolong accessing long-term care (LTC) even though they need LTC at higher rates. Interventions that decrease negative attitudes toward LG older adults among LTC staff are a first step in addressing this problem. In this study, the influence of intergroup contact (IGC) on LTC staff members' attitudes toward LG was explored through the use of storytelling as a training mechanism. An embedded mixed-method approach was employed to collect and analyze responses of 60 LTC staff who participated in a storytelling event. Participants completed pretests, posttests, and participated in audio-recorded group discussions. The findings showed that storytelling had a significant (p =0.001) and positive effect (d =0.57) on participants attitudes toward LG. Qualitative analysis revealed 90 codes, 13 process codes, and 4 themes: making meaning of stories, seeking understanding, application to LTC setting, and debating. When guided by IGC theory, storytelling has potential for positively influencing attitudes of LTC staff members toward LG older adults. There is a need for longitudinal work to further test this model.

Not just sticks and stones: Indirect ethnic discrimination leads to greater physiological reactivity

OBJECTIVES

We examined the effect of indirect ethnic discrimination on physiological reactivity (i.e., cortisol, blood pressure, heart rate) in Latino emerging adults.

METHOD

Participants (N = 32) were randomly assigned to be exposed to indirect ethnic discrimination (experimental condition) or not (control condition) while undergoing a cognitive stress task.

RESULTS

Greater total cortisol output was observed in participants in the experimental condition, relative to those in the control condition. No significant differences in heart rate or blood pressure were noted.

CONCLUSIONS

Results suggest that witnessing ethnic discrimination affects cortisol recovery responses, but not cardiovascular reactivity. Words that are not intentionally hurtful or directed at a specific person may still "hurt"-affecting biological processes associated with hypothalamic-pituitary-adrenocortical (HPA) axis and potentially leading to long-term health consequences. (PsycINFO Database Record

Linking parental socialization about discrimination to intergroup attitudes: The role of social dominance orientation and cultural identification

OBJECTIVES

This study investigated the interaction of parental socialization about discrimination and social dominance orientation (SDO) in predicting the cultural identity and intergroup attitudes of the Minnanese, an ethnic group in Taiwan that faced systematic discrimination during the early decades of Chinese Nationalist rule. Because high SDO individuals tend to support group-based dominance, we hypothesized that under high preparation for bias, which may reinforce narratives that place the historically disadvantaged Taiwanese in a subordinate position, Minnanese high in SDO would identify less with Taiwanese and more with Chinese (the historically high-status outgroup) compared with their low SDO counterparts.

METHOD

We examined our hypotheses using a sample of Minnanese (N = 365; 183 women, 182 men; average age = 44.35) who participated in a nationally representative survey of Taiwanese adults.

RESULTS

As predicted, among Minnanese exposed to high levels of preparation for bias, those with high SDO expressed greater levels of Chinese identification and more favorable attitudes toward Chinese than their low SDO counterparts (no difference was found in attitudes toward Taiwanese). Among Minnanese exposed to low levels of preparation for bias, SDO predicted neither Chinese nor Taiwanese identity. Moreover, the interaction effect of preparation for bias and SDO on attitudes toward Chinese was mediated by Chinese identity.

CONCLUSION

Using a unique, non-Western sample, this study demonstrated the role that parental socialization about past discrimination, in combination with belief in group-based dominance, plays in the construction of group identity and intergroup attitudes among members of historically disadvantaged ethnic groups. (PsycINFO Database Record

Perceived distress tolerance accounts for the covariance between discrimination experiences and anxiety symptoms among sexual minority adults

Sexual orientation-related discrimination experiences have been implicated in elevated rates of anxiety symptoms within sexual minority groups. Theory suggests that chronic discrimination experiences may dampen the ability to tolerate distress, increasing vulnerability for anxiety. This study examined the role of distress tolerance, or the capacity to withstand negative emotions, as a construct underlying associations between discriminatory experiences and anxiety among sexual minority adults. Participants (N=119;M_age=36.4±14.8; 50% cisgender male, 31% cisgender female, 19% transgender; 37% non-Latino white) were recruited from Houston, Texas. Measures administered included the Heterosexist Harassment, Rejection, and Discrimination Scale (discrimination experiences), Distress Tolerance Scale (distress tolerance), and the State-Trait Inventory for Cognitive and Somatic Anxiety (anxiety). The association of discrimination experiences and anxiety through distress tolerance was assessed using covariate-adjusted mediation modeling. Results indicated that sexual orientation-related discrimination experiences were significantly and positively associated with anxiety and that this association was mediated through lower distress tolerance. Significant indirect effects were specific to cognitive (versus somatic) anxiety symptoms. Results suggest that distress tolerance may be an explanatory mechanism in the association between discriminatory experiences and cognitive symptoms of anxiety and a potentially relevant target within clinical interventions to address anxiety-related health disparities among sexual minority adults. However, more sophisticated designs are needed to delineate causal associations.

Perceived Discrimination and Cardiovascular Outcomes in Older African Americans: Insights From the Jackson Heart Study

OBJECTIVE

To assess the associations of perceived discrimination and cardiovascular (CV) outcomes in African Americans (AAs) in the Jackson Heart Study.

PATIENTS AND METHODS

In 5085 AAs free of clinical CV disease at baseline enrolled in the Jackson Heart Study from September 26, 2000, through March 31, 2004, and followed through 2012, associations of everyday discrimination (frequency of occurrences of perceived unfair treatment) and lifetime discrimination (perceived unfair treatment in 9 life domains) with CV outcomes (all-cause mortality, incident coronary heart disease [CHD], incident stroke, and heart failure [HF] hospitalization) were examined using Cox proportional hazards regression models.

RESULTS

Higher levels of everyday and lifetime discrimination were more common in participants who were younger and male and had higher education and income, lower perceived standing in the community, worse perceived health care access, and fewer comorbidities. Before adjustment, higher levels of everyday and lifetime discrimination were associated with a lower risk of all-cause mortality, incident CHD, stroke, and HF hospitalization. After adjustment for potential confounders, we found no association of everyday and lifetime discrimination with incident CHD, incident stroke, or HF hospitalization; however, a decrease in all-cause mortality with progressively higher levels of everyday discrimination persisted (hazard ratio per point increase in discrimination measure, 0.90; 95% CI, 0.82-0.99; P=.02). The unexpected association of everyday discrimination and all-cause mortality was partially mediated by perceived stress.

CONCLUSION

We found no independent association of perceived discrimination with risk of incident CV disease or HF hospitalization in this AA population. An observed paradoxical negative association of everyday discrimination and all-cause mortality was partially mediated by perceived stress.

Association between perceived weight discrimination and physical activity: a population-based study among English middle-aged and older adults

OBJECTIVE

To examine the association between perceived weight discrimination and physical activity in a large population-based sample.

DESIGN

Data were from 2423 men and 3057 women aged ≥50 years participating in Wave 5 (2010/11) of the English Longitudinal Study of Ageing. Participants reported experiences of weight discrimination in everyday life and frequency of light, moderate and vigorous physical activities. We used logistic regression to test associations between perceived weight discrimination and physical activity, controlling for age, sex, socioeconomic status and body mass index (BMI).

RESULTS

Perceived weight discrimination was associated with almost 60% higher odds of being inactive (OR 1.59, 95% CI 1.05 to 2.40, p=.028) and 30% lower odds of engaging in moderate or vigorous activity at least once a week (OR 0.70, 95% CI 0.53 to 0.94, p=.017).

CONCLUSIONS

Independent of BMI, individuals who perceive unfair treatment on the basis of their weight are less physically active than those who do not perceive discrimination. This has important implications for the health and well-being of individuals who experience weight-based discrimination, and may also contribute to a cycle of weight gain and further mistreatment.

Stigma toward psychosis and its formulation process: prejudice and discrimination against early stages of schizophrenia

BACKGROUND

Stigma toward psychosis can prevent social attendance and help-seeking behavior. Early detection and intervention has been shown to improve patient outcome in schizophrenia. The aim of this study was to reveal the characteristics and formulation process of stigma toward each clinical stage of schizophrenia, taking people's backgrounds into consideration.

METHODS

The participants consisted of three groups: general public, patients with mental illness, and psychiatric professionals. We performed a survey examining stigmas toward people with psychotic-like-experiences (PLE), at-risk mental state for psychosis (ARMS), schizophrenia, or depression. Prejudice was measured using a 21-item questionnaire, and discrimination was measured using the Social Distance Scale.

RESULTS

The participants consisted of 149 people from the general public, 97 patients, and 119 psychiatric professionals. Generally, a similar pattern was observed among the groups in which prejudice and discrimination against PLE was mildest, followed by that against ARMS and depression, and finally schizophrenia. When the stigma of the general public was compared with that of psychiatric professionals, the prejudice and discrimination against PLE of the general public were both lower than those of the psychiatric professionals. However, the prejudice of the general public was stronger than that of the professionals for ARMS. Furthermore, the discrimination of the general public was stronger than that of the professionals for schizophrenia.

CONCLUSIONS

The stigmas of mental illness differed according to the clinical stage, although the pattern of severity was similar among the three groups. A formulation process is suggested in which stigma toward schizophrenia develops from an attitudinal property (prejudice) against ARMS and a behavioral property (discrimination) against schizophrenia.