Reducing Transgender Stigma via an E-contact Intervention

A Descriptive Account of the Nature and Extent of Transgender Homicide in America, 2010 to 2021

There is a growing acknowledgment of transgender homicide as a serious social and public health issue; indeed, the American Medical Association has even referred to violence against transgender people as an "epidemic." Addressing this issue, however, requires understanding the patterns associated with this violence. Yet, reliable data for doing so does not currently exist, especially in recent years. As such, the prevalence of these incidents and their key features are not easily understood. The current study addresses this issue using a comprehensive nationwide database on 305 instances of homicide directed against transgender people between 2010 and 2021, collected through extensive open-source data collection methods. The descriptive analyses of these incidents demonstrate pronounced increases in homicide victimization over time, and clear geographic clustering by state, such that roughly one in four incidents occurred in just three states: Texas, Florida, and California. After accounting for the estimated size of the transgender population, Louisiana, Mississippi, and Missouri emerge as the most dangerous states with the highest risk of homicide victimization. The results also clearly demonstrate the intersectional nature of transgender homicide, in finding that most homicide victims are young Black or Hispanic transgender women. We conclude by emphasizing the need for multipronged policy responses to this issue that recognize the uniquely dangerous intersection of social problems that contribute to the vulnerable social position of many transgender people, including their vulnerability to homicide victimization.

Developing medical professionalism in care of gender nonconforming patients: Reflections of second-year medical students after a curricular experience with gender nonconforming people and allies

INTRODUCTION

Negative healthcare experiences persist for gender nonconforming individuals. Clinician-related factors, including lack of comfort with gender nonconforming persons and unexamined personal biases, present barriers to equitable and affirming healthcare. We explored the effects of contact with gender nonconforming individuals in preclinical medical education through a structured curricular intervention designed to build medical and humanistic knowledge and stimulate the development of medical professionalism surrounding the care of gender nonconforming individuals.

METHODS

A curricular module (didactic prework, time-synchronous online panel discussion, and post-event written reflection) was implemented in a second-year preclinical course in a large multi-campus Midwestern medical school. The module was based on pedagogical foundations of contact theory and reflective writing. Post-event written reflections were investigated using thematic analysis.

RESULTS

Analysis of 355 written reflections revealed three major themes (moments of insight, topics of confusion, connections to professional identity formation) and eight sub-themes. The findings demonstrated emerging gender professionalism and the importance of contact in professional development.

DISCUSSION

Contact with gender nonconforming people and the use of written reflections can encourage self-examination and foster professional identity formation among preclinical medical students. Modeling gender-affirming approaches may help counteract negative cultural messages about gender nonconforming people, aiding development of inclusive future physicians.

Advancing E-contact to Reduce Intergroup Anxiety and Increase Positive Attitudes Towards Individuals Who Identify as Bisexual

Bisexual individuals are invisible sexual minorities, who face prejudice and "double discrimination" from both heterosexual and sexual minority communities. Despite this, little empirical research has examined bisexual prejudice reduction. To address this, the current study tested an E-contact intervention - a highly structured, text-based, online interaction tool - to reduce bisexual prejudice. Heterosexual participants (N = 170) were randomly allocated to an intergroup (E-contact) or intragroup (control) interaction, with either a male or female interaction partner. Findings indicated that intergroup E-contact resulted in less intergroup anxiety compared to an intragroup interaction, and that this effect was more pronounced when the bisexual interaction partner was male for heterosexual men, but not for heterosexual women. Although E-contact had no direct effect on tolerance toward bisexual individuals or the perceived stability of bisexuality as a sexual orientation, findings revealed that reduced intergroup anxiety mediated the effect of E-contact on these outcome variables. This result was found in the intergroup dynamic of heterosexual men interacting with bisexual men, providing an important experimental demonstration of the potential for harnessing an E-contact intervention to reduce affective prejudice toward bisexual individuals.

"Invisible in the Most Tragic of Ways": Exploring Internalized Transphobia and Coping Through Photovoice

Transgender and gender diverse (TGD) individuals experience minority stress that includes internalizing the negative attitudes that exist in society about those whose identities rest outside of the gender binary. The purpose of this study was to gain a better understanding of the experience of internalized stigma and associated coping methods among six TGD adults utilizing photovoice. Thematic and iconographic analysis of 35 works produced by the participants revealed themes involving metaphors for internalized transphobia, internalized social messages, the psychological debt or emotional cost of internalized transphobia, and a range of coping strategies. Specifically, invisibility was a common metaphor used to suggest that a TGD person's experience may be associated with actively hiding, masking their identity, or failing to be seen as their true self. Participants expressed concern with being accepted by others and noted anxiety about outward expressions of their gender and personal characteristics. The results also revealed that participants experienced loneliness, fear of rejection, and low self-esteem related to internalized transphobia and their TGD identities. Participants reported receiving messages that TGD individuals are often viewed negatively and generally lack support from society and close relations. Coping strategies utilized by participants included withdrawing from others, hiding their TGD identity to avoid rejection or violence, self-exploration, accepting self and others, and connecting to a community of TGD persons and/or allies. Focus group feedback revealed benefits to participants, including an enhanced sense of community and self-esteem, as well as recommendations for future group structure. Implications and future research directions are discussed.

Online interventions for reducing hate speech and cyberhate: A systematic review

BACKGROUND

The unique feature of the Internet is that individual negative attitudes toward minoritized and racialized groups and more extreme, hateful ideologies can find their way onto specific platforms and instantly connect people sharing similar prejudices. The enormous frequency of hate speech/cyberhate within online environments creates a sense of normalcy about hatred and the potential for acts of intergroup violence or political radicalization. While there is some evidence of effective interventions to counter hate speech through television, radio, youth conferences, and text messaging campaigns, interventions for online hate speech have only recently emerged.

OBJECTIVES

This review aimed to assess the effects of online interventions to reduce online hate speech/cyberhate.

SEARCH METHODS

We systematically searched 2 database aggregators, 36 individual databases, 6 individual journals, and 34 websites, as well as bibliographies of published reviews of related literature, and scrutiny of annotated bibliographies of related literature.

INCLUSION CRITERIA

We included randomized and rigorous quasi-experimental studies of online hate speech/cyberhate interventions that measured the creation and/or consumption of hateful content online and included a control group. Eligible populations included youth (10-17 years) and adult (18+ years) participants of any racial/ethnic background, religious affiliation, gender identity, sexual orientation, nationality, or citizenship status.

DATA COLLECTION AND ANALYSIS

The systematic search covered January 1, 1990 to December 31, 2020, with searches conducted between August 19, 2020 and December 31, 2020, and supplementary searches undertaken between March 17 and 24, 2022. We coded characteristics of the intervention, sample, outcomes, and research methods. We extracted quantitative findings in the form of a standardized mean difference effect size. We computed a meta-analysis on two independent effect sizes.

MAIN RESULTS

Two studies were included in the meta-analysis, one of which had three treatment arms. For the purposes of the meta-analysis we chose the treatment arm from the Álvarez-Benjumea and Winter (2018) study that most closely aligned with the treatment condition in the Bodine-Baron et al. (2020) study. However, we also present additional single effect sizes for the other treatment arms from the Álvarez-Benjumea and Winter (2018) study. Both studies evaluated the effectiveness of an online intervention for reducing online hate speech/cyberhate. The Bodine-Baron et al. (2020) study had a sample size of 1570 subjects, while the Álvarez-Benjumea and Winter (2018) study had a sample size of 1469 tweets (nested in 180 subjects). The mean effect was small (g = -0.134, 95% confidence interval [-0.321, -0.054]). Each study was assessed for risk of bias on the following domains: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported results. Both studies were rated as "low risk" on the randomization process, deviations from intended interventions, and measurement of the outcome domains. We assessed the Bodine-Baron et al. (2020) study as "some" risk of bias regarding missing outcome data and "high risk" for selective outcome reporting bias. The Álvarez-Benjumea and Winter (2018) study was rated as "some concern" for the selective outcome reporting bias domain.

AUTHORS' CONCLUSIONS

The evidence is insufficient to determine the effectiveness of online hate speech/cyberhate interventions for reducing the creation and/or consumption of hateful content online. Gaps in the evaluation literature include the lack of experimental (random assignment) and quasi-experimental evaluations of online hate speech/cyberhate interventions, addressing the creation and/or consumption of hate speech as opposed to the accuracy of detection/classification software, and assessing heterogeneity among subjects by including both extremist and non-extremist individuals in future intervention studies. We provide suggestions for how future research on online hate speech/cyberhate interventions can fill these gaps moving forward.

Can Intergroup Contact in Virtual Reality (VR) Reduce Stigmatization Against People with Schizophrenia?

People with mental disorders such as schizophrenia do not only suffer from the symptoms of their disorders but also from the stigma attached to it. Although direct intergroup contact is an effective tool to reduce stigmatization, it is rare in real life and costly to be established in interventions, and the success of traditional media campaigns is debatable. We propose Virtual Reality (VR) as a low-threshold alternative for establishing contact since it involves less barriers for affected and unaffected persons. In a 2 + 1 experiment (n = 114), we compared the effects of encounters with a person with schizophrenia through a VR video with contact through a regular video and no contact at all on anxiety, empathy, social proximity, and benevolence towards people with schizophrenia. We found that contact via VR reduced stigmatization only for participants who liked the person encountered. Our data suggest that it is crucial how participants evaluate the person that they encounter and that stronger perception of spatial presence during reception plays an important role, too. Therefore, we discussvarious boundary conditions that need to be considered in VR interventions and future research on destigmatization towards mental disorders, especially schizophrenia.

Controlled Study of the Impact of a Virtual Program to Reduce Stigma Among University Students Toward People With Mental Disorders

Stigma toward mental disorders is one of today's most pressing global issues. The Covid-19 pandemic has exacerbated the barriers to social inclusion faced by individuals with mental disorders. Concurrently, stigma reduction interventions, especially those aimed at university students, have been more difficult to implement given social distancing and campus closures. As a result, alternative delivery for programs contributing to stigma reduction is required, such as online implementation. This paper reports the results of a controlled study focused on an online multi-component program on reducing stigma toward mental illness that included project-based learning, clinical simulations with standardized patients and E-Contact with real patients. A total of 40 undergraduate students from the Universidad del Desarrollo in Santiago, Chile, participated in the study. They were randomly divided between an intervention and control group. The intervention group participated in the online multi-component program, while the control group participated in an online educational program on cardiovascular health. We assessed the impact of the program by using the validated Spanish-language versions of the Attribution Questionnaire AQ-27 and the Questionnaire on Student Attitudes toward Schizophrenia with both groups, before and after the intervention. In addition, an ad hoc Likert scale ranging from 0 to 5 was used with the intervention group in order to assess the learning strategies implemented. Following the intervention, the participants belonging to the intervention group displayed significantly lower levels of stereotypes, perception of dangerousness, and global score toward people with schizophrenia (p < 0.001). In addition, participants presented lower levels of dangerousness-fear, avoidance, coercion, lack of solidarity, and global score (p < 0.001). The control group displayed no statistically significant differences in the level of stigma before and after the evaluation, for all of the items assessed. Finally, the overall assessment of each of the components of the program was highly positive. In conclusion, the study shows that online programs can contribute to reducing stigma toward mental disorders. The program assessed in this study had a positive impact on all the dimensions of stigma and all of the components of the program itself were positively evaluated by the participants.