Do We Belong? Examining the Associations Between Adolescents' Perceptions of School Belonging, Teacher Discrimination, Peer Prejudice and Suicide

In the USA, suicide is a leading cause of death for adolescents ages 12 to 18 (National Institute of Mental Health (NIMH), 2019). Given the urgency of this public health crisis, this paper aims to explore the impact of a sense of school belonging and teacher-based discrimination and peer-based prejudice on suicidal ideation and attempts among Black youth. This secondary analysis used a sample of Black youth (N = 4229; Mage = 16) from the National Longitudinal Study of Adolescents to Adult Health data. Independent variables included a sense of school belonging, school-based teacher discrimination, and school-based peer prejudice; the dependent variable was suicidal thoughts and behaviors. The results of multinomial regression analyses revealed that as Black adolescents' sense of school belonging decreased, they were 35% more likely to be at risk for suicidal ideation and attempts. Findings from our study support the assertion that the school microsystem plays a substantial role in modifying the risk of suicidal behavior among Black youth.

Interpersonal Transphobia Within Nursing: A Critical Concept Exploration

Transphobic perceptions negatively impact health care access and outcomes among transgender and gender-diverse people and challenge nurses' capacity to maintain ethical practice standards. The concept of transphobia has not been well defined in the literature or nursing. Using a critical realist lens, this concept exploration sought to define interpersonal transphobia through a review of purposefully selected literature. Attributes included discrimination and prejudice, while antecedents were cisnormativity, erasure, and stigma. Nurses can help reduce transphobia by seeking education and practicing gender-affirming care, including transgender people in research, and advocating for equitable policies and procedures.

Historical narratives about the COVID-19 pandemic are motivationally biased

How people recall the SARS-CoV-2 pandemic is likely to prove crucial in future societal debates on pandemic preparedness and appropriate political action. Beyond simple forgetting, previous research suggests that recall may be distorted by strong motivations and anchoring perceptions on the current situation1-6. Here, using 4 studies across 11 countries (total n = 10,776), we show that recall of perceived risk, trust in institutions and protective behaviours depended strongly on current evaluations. Although both vaccinated and unvaccinated individuals were affected by this bias, people who identified strongly with their vaccination status-whether vaccinated or unvaccinated-tended to exhibit greater and, notably, opposite distortions of recall. Biased recall was not reduced by providing information about common recall errors or small monetary incentives for accurate recall, but was partially reduced by high incentives. Thus, it seems that motivation and identity influence the direction in which the recall of the past is distorted. Biased recall was further related to the evaluation of past political action and future behavioural intent, including adhering to regulations during a future pandemic or punishing politicians and scientists. Together, the findings indicate that historical narratives about the COVID-19 pandemic are motivationally biased, sustain societal polarization and affect preparation for future pandemics. Consequently, future measures must look beyond immediate public-health implications to the longer-term consequences for societal cohesion and trust.

Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine

Importance

The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender).

Objective

To evaluate academic medical culture, faculty mental health, and their relationship.

Design, Setting, and Participants

A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health.

Exposures

Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status.

Main Outcomes and Measures

Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health.

Results

Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis.

Conclusions and Relevance

High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.

Barriers to COVID-19 Vaccine Uptake in the LGBTQIA Community

Objectives. To report findings from qualitative research that describe sources of hesitancy and barriers to vaccine uptake among lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) populations. Methods. In March 2021, we conducted focus groups with members of the Los Angeles, California LGBTQIA community to identify barriers to becoming vaccinated. Semistructured interviews were conducted with 32 individuals in 5 focus groups. Thematic analysis was conducted to identify themes. Results. Historical and ongoing medical trauma, including misgendering, and perceived emotional violence emerged as significant barriers to LGBTQIA individuals becoming vaccinated. Fear of violence was found to be a major barrier among transgender individuals, whereas fear of an unwelcoming vaccination site was a barrier for seniors. Finally, surviving was a higher priority than becoming vaccinated. Conclusions. Participants reported vaccine hesitancy and barriers that are unique to the life experiences of LGBTQIA individuals; these include medical trauma, violence, stigma, and discrimination. Our findings highlight the need to include LGBTQIA leaders and trusted individuals in the development of vaccination education and the delivery of vaccination services. (Am J Public Health. 2022;112(3):405-407. https://doi.org/10.2105/AJPH.2021.306599).

'Us-Versus-Them': Othering in COVID-19 public health behavior compliance

Objective

We explored public perceptions about the COVID-19 pandemic to learn how those attitudes may affect compliance with health behaviors.

Methods

Participants were Central Pennsylvania adults from diverse backgrounds purposively sampled (based on race, gender, educational attainment, and healthcare worker status) who responded to a mixed methods survey, completed between March 25–31, 2020. Four open-ended questions were analyzed, including: “What worries you most about the COVID-19 pandemic?” We applied a pragmatic, inductive coding process to conduct a qualitative, descriptive content analysis of responses.

Results

Of the 5,948 respondents, 538 were sampled for this qualitative analysis. Participants were 58% female, 56% with ≥ bachelor’s degree, and 50% from minority racial backgrounds. Qualitative descriptive analysis revealed four themes related to respondents’ health and societal concerns: lack of faith in others; fears of illness or death; frustration at perceived slow societal response; and a desire for transparency in communicating local COVID-19 information. An “us-versus-them” subtext emerged; participants attributed non-compliance with COVID-19 behaviors to other groups, setting themselves apart from those Others.

Conclusion

Our study uncovered Othering undertones in the context of the COVID-19 pandemic, occurring between groups of like-minded individuals with behavioral differences in ‘compliance’ versus ‘non-compliance’ with public health recommendations. Addressing the ‘us-versus-them’ mentality may be important for boosting compliance with recommended health behaviors.

Effect of a Brief Social Contact Video on Transphobia and Depression-Related Stigma Among Adolescents: A Randomized Clinical Trial

IMPORTANCE

Transphobia and stigma remain barriers to seeking mental health care for gender-diverse adolescents.

OBJECTIVE

To examine the utility of brief social contact-based video interventions of transgender protagonists with depression to reduce transphobia and depression-related stigma and increase treatment-seeking intentions among adolescents in the general population.

DESIGN, SETTING, AND PARTICIPANTS

During August 2021, a total of 1437 participants were recruited and randomly assigned to 1 of 4 video-based conditions in a 2:2:1:1 ratio: (1) transgender adolescent girls, (2) transgender adolescent boys, (3) cisgender adolescent girls, or (4) cisgender adolescent boys.

INTERVENTIONS

In each of the approximately 110-second videos, an empowered presenter shared their personal story about coping with depression and reaching out for help.

MAIN OUTCOMES AND MEASURES

The primary outcome was the score on the Attitudes Toward Transgender Men and Women (ATTMW) scale. Secondary outcomes were (1) a "gender thermometer" rating for warmth in transgender perception, (2) the Depression Stigma Scale (DSS) score, and (3) the General Health-Seeking Questionnaire (GHSQ) score.

RESULTS

Of the 1437 randomized participants, 1098 (76%) completed the postintervention assessment and passed all the validity tests (mean [SD] age, 16.9 [1.2] years; 481 [44%] male; 640 [58%] White). A significant change in attitudes toward transgender youth was found within the intervention group only (mean [SD] ATTMW scores: intervention group, 34.6 [23.1] at baseline to 32.8 [24.2] after intervention; P < .001; control group, 33.5 [23.4] at baseline to 32.4 [24.1] after intervention; P = .01). The mean (SD) total DSS scores decreased significantly across study groups (intervention: 1.3 [3.3]; control: 1.7 [3.3]; P < .001). A significant increase in intention to seek help from a parent was found in the intervention (mean [SD] GHSQ score, 0.2 [1.1]) and control (mean [SD] GHSQ score, 0.3 [1.2]) groups (P < .001), as was a decrease in those not wanting to seek help from anyone (mean [SD] GHSQ score: intervention, 0.2 [1.6], P = .009; control, 0.3 [1.2], P < .001) Secondary analyses revealed significant differences in baseline ATTMW scores and intervention effects between transgender and gender-diverse and cisgender participants and between lesbian, gay, bisexual, or queer (LGBQ) and straight participants (F = 36.7, P < .001) and heterosexual participants (F = 37.0, P < .001). A significant difference was also found in mean (SD) transgender warmth scores from baseline to after intervention between groups (2.6° [13.1°] in the intervention group vs 0.4° [8.3°] in the control group; P < .001).

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, brief social contact-based videos proved efficacious in reducing transphobia and depression-related stigma and in increasing treatment-seeking intentions among adolescents in the general population. By personifying, individualizing, and providing face and voice to the experience of transgender youth, other adolescents, especially those who are cisgender and/or of a heterosexual orientation, can gain empathetic insights into the lives of their often marginalized and stigmatized fellow youth.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04969003.

Nursing students' experience of learning cultural competence

INTRODUCTION

European societies are rapidly becoming multicultural. Cultural diversity presents new challenges and opportunities to communities that receive immigrants and migrants, and highlights the need for culturally safe healthcare. Universities share a responsibility to build a fair and equitable society by integrating cultural content in the nursing curricula. This paper aims to analyze European student nurses´ experience of learning cultural competence and of working with patients from diverse cultural backgrounds.

MATERIALS AND METHODS

A phenomenological approach was selected through a qualitative research method. 7 semi-structured focus groups with 5-7 students took place at the participants' respective universities in Spain, Belgium, Turkey and Portugal.

RESULTS

5 themes and 16 subthemes emerged from thematic analysis. Theme 1, concept of culture/cultural diversity, describes the participants' concept of culture; ethnocentricity emerged as a frequent element in the students' discourse. Theme 2, personal awareness, integrates the students' self-perception of cultural competence and their learning needs. Theme 3, impact of culture, delves on the participants' perceived impact of cultural on both nursing care and patient outcomes. Theme 4, learning cultural competence, integrates the participants' learning experiences as part of their nursing curricula, as part of other academic learning opportunities and as part of extra-academic activities. Theme 5, learning cultural competence during practice placements, addresses some important issues including witnessing unequal care, racism, prejudice and conflict, communication and language barriers, tools and resources and positive attitudes and behaviors witnesses or displayed during clinical practice.

CONCLUSION

The participants' perceived level of cultural competence was variable. All the participants agreed that transcultural nursing content should be integrated in the nursing curricula, and suggested different strategies to improve their knowledge, skills and attitudes. It is important to listen to the students and take their opinion into account when designing cultural teaching and learning activities.

Angry facial expressions bias towards aversive actions

Social interaction requires fast and efficient processing of another person's intentions. In face-to-face interactions, aversive or appetitive actions typically co-occur with emotional expressions, allowing an observer to anticipate action intentions. In the present study, we investigated the influence of facial emotions on the processing of action intentions. Thirty-two participants were presented with video clips showing virtual agents displaying a facial emotion (angry vs. happy) while performing an action (punch vs. fist-bump) directed towards the observer. During each trial, video clips stopped at varying durations of the unfolding action, and participants had to recognize the presented action. Naturally, participants' recognition accuracy improved with increasing duration of the unfolding actions. Interestingly, while facial emotions did not influence accuracy, there was a significant influence on participants' action judgements. Participants were more likely to judge a presented action as a punch when agents showed an angry compared to a happy facial emotion. This effect was more pronounced in short video clips, showing only the beginning of an unfolding action, than in long video clips, showing near-complete actions. These results suggest that facial emotions influence anticipatory processing of action intentions allowing for fast and adaptive responses in social interactions.

A Matter of Justice: "Fat" Is Not Necessarily a Bad Word

This essay argues that the discrimination that fat patients face is an issue of health justice. Insofar as this is the case, bioethicists and health care providers should not only care about it but also work to dismantle the systematic, institutional, social, and individual factors that are contributing to it to ensure that fat patients receive high-quality health care, free of stigma and discrimination. The essay discusses a variety of ways in which fat patients are discriminated against and considers the false assumptions that fuel such discrimination. It concludes by considering the structural and social issues that contribute to fatness and pushes health care providers to abandon the assumption that being fat is an individual moral failing. Ultimately, the paper argues, "fat" is not necessarily a bad word, nor one that health care providers should avoid.

Bayesian analysis of home advantage in North American professional sports before and during COVID-19

Home advantage in professional sports is a widely accepted phenomenon despite the lack of any controlled experiments at the professional level. The return to play of professional sports during the COVID-19 pandemic presents a unique opportunity to analyze the hypothesized effect of home advantage in neutral settings. While recent work has examined the effect of COVID-19 restrictions on home advantage in European football, comparatively few studies have examined the effect of restrictions in the North American professional sports leagues. In this work, we infer the effect of and changes in home advantage prior to and during COVID-19 in the professional North American leagues for hockey, basketball, baseball, and American football. We propose a Bayesian multi-level regression model that infers the effect of home advantage while accounting for relative team strengths. We also demonstrate that the Negative Binomial distribution is the most appropriate likelihood to use in modelling North American sports leagues as they are prone to overdispersion in their points scored. Our model gives strong evidence that home advantage was negatively impacted in the NHL and NBA during their strongly restricted COVID-19 playoffs, while the MLB and NFL showed little to no change during their weakly restricted COVID-19 seasons.

VR Disability Simulation Reduces Implicit Bias Towards Persons With Disabilities

This article investigates how experiencing Virtual Reality (VR) Disability Simulation (DS) affects information recall and participants' implicit association towards people with disabilities (PwD). Implicit attitudes are our actions or judgments towards various concepts or stereotypes (e.g., race) which we may or may not be aware of. Previous research has shown that experiencing ownership over a dark-skinned body reduces implicit racial bias. We hypothesized that a DS with a tracked Head Mounted Display (HMD) and a wheelchair interface would have a significantly larger effect on participants' information recall and their implicit association towards PwD than a desktop monitor and gamepad. We conducted a 2 x 2 between-subjects experiment in which participants experienced a VR DS that teaches them facts about Multiple Sclerosis (MS) with factors of display (HMD, a desktop monitor) and interface (gamepad, wheelchair). Participants took two Implicit Association Tests before and after experiencing the DS. Our study results show that the participants in an immersive HMD condition performed better than the participants in the non-immersive Desktop condition in their information recall task. Moreover, a tracked HMD and a wheelchair interface had significantly larger effects on participants' implicit association towards PwD than a desktop monitor and a gamepad.

Comparing the effect of cross-group friendship on generalized trust to its effect on prejudice: The mediating role of threat perceptions and negative affect

Intergroup relations theory posits that cross-group friendship reduces threat perceptions and negative emotions about outgroups. This has been argued to mitigate the negative effects of ethnic diversity on generalized trust. Yet, direct tests of this friendship-trust relation, especially including perceptions of threat and negative affect as mediators, have remained rare at the individual level. In this article, we bridge this research gap using representative data from eight European countries (Group-Focused Enmity). We employ structural equation modelling (SEM) to model mediated paths of cross-group friendship on generalized trust via perceptions of threat and negative affect. We find that both the total effect as well as the (mediated) total indirect effect of cross-group friendship on generalized trust are weak when compared with similar paths estimated for prejudice.

A qualitative study of barriers to employment experienced by people living with HIV in Toronto and Ottawa

BACKGROUND

Effective treatment has extended the life expectancy and reduced disability in people living with HIV (PLWH). However, previous research has found 45-65% of working-age PLWH were unemployed compared to 5-10% in the general public of North America and Europe. We examined the barriers to gaining employment among PLWH.

METHODS

Thirty-five in-depth interviews were conducted in person or over the phone with PLWH living in Toronto or Ottawa. This included PLWH who were unemployed but actively seeking employment, as well as PLWH who had successfully gained employment through an agency that specifically supported PLWH funded by the AIDS Committee of Toronto. Interviews were conducted between February 2019 and March 2020. All interviews were audio-recorded, transcribed and analyzed using thematic analysis.

RESULTS

The majority of participants were between the ages of 40-55 and identified as male. Participants shared many common barriers when describing their attempts to attain or maintain employment. Although varying in employment status at the time of the study, consistent barriers included experiencing HIV stigma in workplaces, challenges overcoming mental health illnesses, and difficulties in navigating social assistance and unemployment insurance programs when pursuing a return to work.

CONCLUSIONS

PLWH face significant barriers when attempting to engage with employment opportunities. Health providers and organizations can do more to support campaigns to end HIV stigma, to support individuals in pursuing employment, and to advocate for policy change that supports reentry into the workforce for PLHA.

Stigma and Discrimination During COVID-19 Pandemic

The COVID-19 pandemic has been instrumental in creating a dramatic shift from people's need to live in mutual association toward a desire to stigmatize distinctive others. Pandemic seems to be causing othering. Stated simply, stigmatization is a social process set to exclude those who are perceived to be a potential source of disease and may pose threat to the effective social living in the society. Based on the secondary evidence collected from news published online or in print, the present article delves into stigma associated with the COVID-19 pandemic among different social groups in the Indian society and the mounting cases of prejudice based on race, class, and religion. It also presents insights into the varied manifestations, and the deleterious consequences of COVID-19 inspired othering brought to its potential targets in India.

Association between maternity harassment and depression during pregnancy amid the COVID-19 state of emergency

OBJECTIVES

Maternity harassment, known in English as pregnancy discrimination, remains prevalent in developed countries. However, research examining the mental health effects of maternity harassment is lacking. We aimed to examine the association between maternity harassment and depression during pregnancy in Japan.

METHODS

A cross-sectional Internet survey was conducted on 359 pregnant employees (including women who were working at the time their pregnancy was confirmed) from May 22 to May 31, 2020, during which time a COVID-19 state of emergency was declared. Maternity harassment was defined as being subjected to any of the 16 adverse treatments prohibited by national guidelines. Depression was defined as a score of ≥9 on the Edinburgh Postnatal Depression Scale (Japanese version). Logistic regression analysis was performed.

RESULTS

Overall, 24.8% of the pregnant employees had experienced maternity harassment by supervisors and/or colleagues. After adjusting for demographics, pregnancy status, work status, and fear of COVID-19, pregnant employees who experienced maternity harassment were more likely to have depression than those who did not (odds ratio 2.48, 95% confidential interval 1.34-4.60). This association was not influenced by whether they were teleworking or not as a COVID-19 measure.

CONCLUSIONS

One quarter of pregnant employees experienced maternity harassment and had a higher prevalence of depression than those who did not. Being physically away from the office through teleworking may not reduce the effect of maternal harassment on depression. To protect the mental health and employment of pregnant women, employers should comply with the laws and take measures to prevent maternity harassment.

Controlling social desirability bias: An experimental investigation of the extended crosswise model

Indirect questioning techniques such as the crosswise model aim to control for socially desirable responding in surveys on sensitive personal attributes. Recently, the extended crosswise model has been proposed as an improvement over the original crosswise model. It offers all of the advantages of the original crosswise model while also enabling the detection of systematic response biases. We applied the extended crosswise model to a new sensitive attribute, campus islamophobia, and present the first experimental investigation including an extended crosswise model, and a direct questioning control condition, respectively. In a paper-pencil questionnaire, we surveyed 1,361 German university students using either a direct question or the extended crosswise model. We found that the extended crosswise model provided a good model fit, indicating no systematic response bias and allowing for a pooling of the data of both groups of the extended crosswise model. Moreover, the extended crosswise model yielded significantly higher estimates of campus Islamophobia than a direct question. This result could either indicate that the extended crosswise model was successful in controlling for social desirability, or that response biases such as false positives or careless responding have inflated the estimate, which cannot be decided on the basis of the available data. Our findings highlight the importance of detecting response biases in surveys implementing indirect questioning techniques.

It Can Be Done! A Skills-Based Elective in Implicit Bias Recognition and Management for Preclinical Medical Students

PURPOSE

Students perceive bias in learning environments. Curricula targeting implicit bias recognition and management increase student awareness and achieve strategy identification, but fall short of actual skill development to address bias. In light of this gap, the authors developed and evaluated a skills-based elective to recognize and manage implicit bias in the learning environment.

METHOD

Nine 1.5-hour sessions were delivered to 15 first-year medical students from 2017 to 2019. An evidence-based conceptual framework and transformative learning theory informed the instructional design; it incorporated active learning exercises. Skills assessment occurred through direct observation of student performances in role-play exercises. Using thematic analysis, the authors conducted a program evaluation based on focus groups with students and data from notes taken by the investigative team.

RESULTS

Students engaged with all aspects of instruction, including role-plays. Authors identified 3 themes from the program evaluation: (1) Student engagement can be enhanced, (2) Instruction is empowering, and (3) It (addressing bias in one's own and witnessed encounters) can be done! Analysis additionally highlighted opportunities for improvement and lessons learned.

CONCLUSIONS

This innovative course achieved skill development and practice for medical students in implicit bias recognition and management as it pertains to 3 facets of clinical care present at every stage of a health professional's career. These include interpersonal encounters, advocating for patients when bias is perceived in witnessed encounters with peers and supervisors, and addressing comments made by others within the learning environment. Outcomes could inform novel, skills-based curricula across the spectrum of health professions training and practice.

The Muslimah Project: A Collaborative Inquiry into Discrimination and Muslim Women's Mental Health in a Canadian Context

Prior research in Europe and North America demonstrates that religious discrimination against Muslim people, commonly known as Islamophobia, results in many negative mental health impacts, including depression, anxiety, isolation, and feelings of exclusion (Awan & Zempi, 2015). In Canada, Muslim women face a unique form of discrimination based on their religious, racial, and gender identities (Helly, 2012; Zine, 2008). Grounded in feminist intersectional theory and practice (Hill Collins & Bilge, 2016), the present manuscript emerges from a community-based project centered on Muslim women's experiences of discrimination and resulting adverse mental health impacts. Through a series of five focus groups (N = 55), the research team engaged with Muslim women from diverse backgrounds in order to gain a more complete understanding of mental health inequities in Canada. Thematic analyses of focus group data revealed that Muslim women participants regularly experience Islamophobic discrimination and face multiple barriers when attempting to access culturally relevant and responsive supports. Results illuminate the potential of reciprocal, community-based research to investigate and respond to mental health disparities experienced by Muslim women in Canada.

Resident Physician Experiences With and Responses to Biased Patients

IMPORTANCE

Biased patient behavior negatively impacts resident well-being. Data on the prevalence and frequency of these encounters are lacking and are needed to guide the creation of institutional trainings and policies to support trainees.

OBJECTIVE

To evaluate the frequency of resident experiences with and responses to a range of biased patient behaviors.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective survey was sent via email to 331 second- and third-year internal medicine residents from 3 academic medical centers in California and North Carolina. First-year residents were excluded owing to their limited interactions with patients at the time of participant recruitment. Data were collected from August 21 to November 25, 2019.

MAIN OUTCOMES AND MEASURES

Descriptive statistics were used to report the frequency of experience of various types of biased patient behavior, residents' responses, the factors impeding residents' responses, and residents' experiences and beliefs regarding training and policies.

RESULTS

Overall, 232 of 331 residents (70%) participated; 116 (50%) were women; 116 of 247 (47%) were White (participants had the option of selecting >1 race/ethnicity); and 23 (10%) identified as lesbian, gay, bisexual, transgender, or queer. The frequency of resident-reported experience of types of biased patient behaviors varied. The most common behaviors-belittling comments and assumption of nonphysician status-were reported to be experienced 1 or more times per week by 14% of residents (32 of 231) and 17% of residents (38 of 230), respectively. Women, Black or Latinx, and Asian residents reported experiencing biased behavior more frequently. Forty-five percent of Black or Latinx residents (17 of 38) encountered instances of explicit epithets or rejection of care. All 70 Asian residents reported experiencing inquiries into their ethnic origins. Most women residents (110 of 115 [96%]) experienced role questioning behaviors, and 87% (100 of 115) experienced sexual harassment. The need to prioritize clinical care and a sense of futility in responding were the most common factors (cited by 34% of residents [76 of 227] and 25% of residents [56 of 227], respectively) significantly impeding responses to biased behaviors. Eighty-five percent of residents (191 of 226) never reported incidents to their institution. Eighty-nine percent of residents (206 of 232) identified training and policies as necessary or very necessary.

CONCLUSIONS AND RELEVANCE

This survey study suggests that biased patient behavior is experienced frequently by internal medicine residents. Non-White and women residents reported experiencing a disproportionate burden of these incidents. Residents' responses rarely included institutional involvement. Residency programs and health care systems should prioritize training and policies to address biased patient behavior and support affected residents.

Effects of genetic information on memory for severity of depressive symptoms

The general public is increasingly aware of the role of genes in causing depression. Recent studies have begun uncovering unintended negative consequences of learning about a person’s genetic susceptibility to disorders. Because people tend to believe that genes determine one’s identity, having genes related to a disorder can be misinterpreted as equivalent to having the disorder. Consequently, learning that a person is genetically predisposed to depression can make people misremember mild depression as more severe. Participants across three experiments read a target vignette about a character displaying mild depressive symptoms, while descriptions of the character’s genetic susceptibility to depression were experimentally manipulated. Participants then read a foil vignette describing a character with more severe depressive symptoms. Afterwards, participants who had learned that the target character was genetically predisposed to depression were comparatively more likely to misremember the target symptoms as being severe, when in fact they were mild. This pattern of results was obtained among both laypeople (Experiments 1 and 2) and practicing master’s-level, but not doctoral-level, mental health clinicians (Experiment 3). Given that depression is diagnosed primarily based on a person’s memory of depressive symptoms, the current findings suggest that genetic information about depression may lead to over-diagnosis of depression.

Bias in bias recognition: People view others but not themselves as biased by preexisting beliefs and social stigmas

Biases perpetuate when people think that they are innocent whereas others are guilty of biases. We examined whether people would detect biased thinking and behavior in others but not themselves as influenced by preexisting beliefs (myside bias) and social stigmas (social biases). The results of three large studies showed that, across demographic groups, participants attributed more biases to others than to themselves, and that this self-other asymmetry was particularly salient among those who hold strong beliefs about the existence of biases (Study 1 and Study 2). The self-other asymmetry in bias recognition dissipated when participants made simultaneous predictions about others' and their own thoughts and behaviors (Study 3). People thus exhibit bias in bias recognition, and this metacognitive bias may be remedied when it is highlighted to people that we are all susceptible to biasing influences.

Discrimination as a social determinant of stress and health among New York City taxi drivers

Discrimination is associated with poorer mental and physical health outcomes. Taxi drivers have a higher risk of exposure to discrimination and higher rates of chronic conditions. A cross-sectional needs assessment was conducted with a multilingual group of 535 male taxi drivers in New York City. Drivers reporting higher discrimination were more likely to have higher perceived stress and were more likely to have anxiety/depression and chronic pain, adjusting for confounders. Workplace-based interventions designed to help drivers cope with discrimination, stress, and chronic health conditions, interventions to educate the taxi-riding public, and greater attention to these issues from administrative agencies are warranted.

A matter of flexibility: Changing outgroup attitudes through messages with negations

Attitudes toward outgroups are an important determinant of peaceful coexistence in diverse societies, but it is difficult to improve them. The current research studies the impact of messages with negations on outgroup attitudes, more specifically on outgroup trust. All studies were preregistered. Using different target groups, Studies 1 and 2 provide evidence for the prediction that communicating negations (e.g., "they are not deceptive") enhances outgroup trust (more so than affirmations, such as "they are reliable," and no messages) among people who are initially low in outgroup trust. Three additional studies (Studies 3a, 3b, and 4), using both a causal chain approach and (moderated) mediation analysis, demonstrate that negations promote cognitive flexibility which in turn enhances outgroup trust among those initially low in outgroup trust. One final study suggests that these findings generalize to outgroup attitude change per se by showing that communicating negations also results in more moderate attitudes when the dominant initial attitude is positive (Study 5: high warmth) rather than negative (Studies 1-4: low trustworthiness). As such, communication that negates people's initial outgroup attitudes could be an effective (previously discounted) intervention to reduce prejudice in intergroup settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Personality traits are directly associated with anti-black prejudice in the United States

Modern psychological theories postulate that individual differences in prejudice are determined by social and ideological attitudes instead of personality. For example, the dual-process motivational (DPM) model argues that personality does not directly associate with prejudice when controlling for the attitudinal variables that capture the authoritarian-conservatism motivation and the dominance motivation. Previous studies testing the DPM model largely relied on convenience samples and/or European samples, and have produced inconsistent results. Here we examined the extent to which anti-black prejudice was associated with the Big Five personality traits and social and ideological attitudes (authoritarianism, social dominance orientation, political party affiliation) in two large probability samples of the general population (N1 = 3,132; N2 = 2,483) from the American National Election Studies (ANES). We performed structural equation modeling (SEM) to test the causal assumptions between the latent variables and used survey weights to generate estimates that were representative of the population. Different from prior theories, across both datasets we found that two personality traits, agreeableness and conscientiousness, were directly associated with anti-black prejudice when controlling for authoritarianism, social dominance orientation, and political party affiliation. We also found that a substantial part of the associations between personality traits and anti-black prejudice were mediated through those social and ideological attitudes, which might serve as candidates for prejudice-reduction interventions in the real world.

Is Essentialism Essential? Reducing Homonegative Prejudice by Targeting Diverse Sexual Orientation Beliefs

We conducted an experiment to assess whether targeting multiple beliefs about sexual orientation (SO) may be more effective in reducing homonegativity than focusing only on beliefs about its biogenetic origins. Participants (116 women, 85 men) were randomly assigned to one of three treatment conditions or a control condition. Those in the treatment conditions read essays summarizing: (1) research suggesting SO has biogenetic origins, (2) research suggesting SO is socially constructed and refuting beliefs about the discreteness, homogeneity, and informativeness of SO categories; or (3) research suggesting SO is biogenetic and research suggesting SO categories are socially constructed and not necessarily discrete, homogenous, or informative. We predicted participants in the conditions that targeted multiple beliefs related to the social construction of SO, not just its biogenetic origins, would exhibit the strongest reductions in beliefs about the discreteness, homogeneity, and informativeness of SO categories, and in homonegativity. We also predicted these participants would exhibit the greatest increases in support for gay and lesbian civil rights. We observed hypothesized shifts in SO beliefs across all experimental conditions. While there was a small main effect of time on homonegative prejudice, there was no main effect of condition and no changes in support for gay and lesbian civil rights. However, post hoc analyses suggested the two conditions addressing social constructionist beliefs accounted for most of the observed prejudice reduction. Implications for more comprehensive educational and social interventions designed to promote social justice for sexual minorities are discussed.

Social consequences of assisted dying: a case study

AIM

To consider the possibility of consequences beyond the alleviation of perceived individual suffering, for families left behind, communities and society as a whole should the End of Life Choice Act gain public support in the September 2020 referendum in New Zealand.

METHOD

This study used the Yin case study approach to undertake a single semi-structured in-depth interview with a participant who self-identified as having first-hand experience of assisted dying from a relative's perspective (in a country where this is legal). Thematic analysis was used to identify themes and trends from the interview transcript.

RESULTS

Three key themes emerged from the interview: the potential for assisted dying becoming an expectation for others to pursue when unwell and possibly facing a life-threatening illness; the notion of stigma being associated with the individual using assisted dying legislation and the family left behind; and that there may be the potential for such legislation to produce a contagion effect.

CONCLUSION

The introduction of assisted dying legislation into New Zealand culture provides a potential hotspot for family, community and social discord that may not be easily remedied. Further study in New Zealand is required to investigate whether a contagion effect of assisted dying is possible, and how as a society, we negotiate what could become a conflicted pathway potentially complicated by prejudice, judgement and stigma.

Racial Colorblindness and Confidence in and Likelihood of Action to Address Prejudice

In this study, we examined the association between racial colorblindness and inaction to address prejudice. Conceptualized as a type of legitimizing ideology that maintains societal inequality, we hypothesized that colorblindness would be associated with less confidence in and lower likelihood of engaging in action to address prejudice. Our study examined the role of affective variables in explaining the link between colorblindness and inaction, as well as explored potential racial group differences. We used multigroup structural equation modeling analysis to test for measurement and structural invariance of our hypothesized model across White, Asian American, and Underrepresented racial minority (i.e., African American, Latinx American, Hawaiian/Pacific Islander, Native American, and Multiracial students from Underrepresented groups) college students. In Study 1 (n = 1,125), we found that greater colorblindness was indirectly associated with less confidence in action through affective variables (e.g., intergroup empathy, and positive and negative emotions during intergroup interactions). In Study 2 (n = 1,356), we found that greater colorblindness was indirectly related to less likelihood of action through intergroup empathy. In both studies, we demonstrated measurement and structural invariance across racial groups, indicating that our hypothesized model functioned similarly across White, Underrepresented, and Asian American students. Our findings have implications for future research and practice to challenge colorblindness and to promote engagement in actions to reduce prejudice.

Marginalized Identities, Trump-Related Distress, and the Mental Health of Underrepresented College Students

The current study sought to determine whether holding targeted marginalized identities was associated with greater experiences of distress related to Trump's presidency and whether participants' level of Trump-related distress predicted decrements in mental health. Participants in the current longitudinal study included 338 underrepresented college students attending a predominantly White institution. Results indicated that individuals who held targeted marginalized identities reported greater Trump-related distress compared to their non-targeted counterparts, and that holding multiple targeted marginalized identities was associated with greater levels of Trump-related distress. Findings also indicated that Trump-related distress was associated with increases (relative to previous trajectories) in anxious but not depressive symptoms. Overall, our results suggest that a shift in sociopolitical circumstances that promulgates bigotry may be harmful to those who possess targeted marginalized identities.

COVID-19-related prejudice toward Asian medical students: A consequence of SARS-CoV-2 fears in Poland

The coronavirus disease 2019 (COVID-19) outbreak caused by SARS-CoV-2 has triggered global panic. We have conducted an anonymous online survey of Asian medical students in Poland to assess whether they experience any form of prejudice related to the ongoing pandemic. As demonstrated, the COVID-19 outbreak had triggered xenophobic reactions toward students of Asian-origin (n=85) before the first SARS-CoV-2 case was confirmed in Poland. Facing prejudice, including discrimination related to COVID-19, may add to feelings of isolation of students of Asian origin who study abroad, and affect career development, especially for students. We recommend that universities should proactively develop policies that support students, faculty, and staff affected by discriminatory behavior both during the current outbreak and in the future. However, preventing such behaviors should also be enforced by national authorities.

The Psychological Consequences of Disability over the Life Course: Assessing the Mediating Role of Perceived Interpersonal Discrimination

We examine whether perceived interpersonal discrimination mediates the association between disability and psychological well-being (depression, negative and positive affect) and how these processes differ across the life course. Data are from two waves (2004-2006; 2013-2014) of the Midlife in the United States (MIDUS; N = 2,503). Perceived discrimination accounts for 5% to 8% of the association between disability and the three mental health outcomes. Moderated mediation analyses reveal significant age differences; perceived discrimination is a stronger explanatory mechanism among midlife (ages 40-64) relative to older (age 65+) adults. Disability stigma takes a heightened psychological toll at midlife, a life stage when adults are expected to be able-bodied and interact with a diverse social network, which may be a source of interpersonal mistreatment. Among older adults, for whom impairment is expected and common, the psychological impact of disability may operate through other pathways. We discuss implications for research and practice.

Don't get it twisted: Untangling the psychology of hair discrimination within Black communities

Systems of oppression have shaped the prejudicial treatment of Black people based on the appearance of their hair, from the era of chattel enslavement to present-day America. Hair discrimination is a social injustice characterized by unfairly regulating and insulting people based on the appearance of their hair. A sampling of 90 African American community members narrated memories of hair discrimination using the guided hair autobiography method. While the hair narratives revealed texture, length, and style were the most common entry points into discriminatory behaviors, color, hair augmentation, density, and product choice were also tools of "othering" within a Eurocentric aesthetic value system. The narratives suggested that men and women experience interpersonal rejections early in their development in both emotionally intimate (at home with family) and public settings (at school with teachers and classmates). Sadness was the most frequently reported emotional response to these rejections. These findings extend the current literature on the psychological significance of hair within Black lives and pleads for policies of hair protection at work, hair-based professional development for teachers in schools, hair-influenced educational curriculum for students, community-based programming in hair care settings, and family interventions during hair combing interactions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Contributors to posttraumatic stress symptoms in women sex workers

Previous research has demonstrated that women who sell sex (women sex workers [WSWs]) consistently report high levels of posttraumatic stress symptoms. The present study explores multiple factors that may contribute to the variation in WSWs' experiences of posttraumatic stress symptoms, including workers' racial identity, experiences of discrimination and control over their working conditions, the site of selling sex, and their clients' perceived sexual entitlement and violence. The study sample consisted of 314 self-identified WSWs. Online invitations to participate in a 30-min survey were sent to WSWs in the United States and Canada who advertise their services online on sites such as Facebook, the Erotic Review, and Backpages. The hypothesized structure of associations between the variables was tested using structural equation modeling. The model accounted for 68% of the variation in the traumatic stress reported, with direct and indirect effects for workers' racial identity, the site where they sell sex, and experiences of discrimination, especially by police. Clients' violence, on the contrary, was indirectly associated with traumatic stress, as violent clients were also significantly more likely to be perceived as sexually entitled, which, in turn, was the strongest predictor of higher traumatic stress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Attitudes Towards Seeking Psychological Help: An Integrative Model Based on Contact, Essentialist Beliefs About Mental Illness, and Stigma

Based on intergroup contact theory, a proposed comprehensive model of attitudes towards seeking professional psychological help was tested, including both potential barriers to mental health help-seeking (i.e., public stigma and self-stigma of seeking help, prejudicial and essentialist beliefs about mental illness, intergroup anxiety) and potential facilitators (i.e., direct and extended contact with persons with mental illness). Relevant measures were completed by 119 community-dwelling participants. Path analysis showed that direct (but not extended) contact with mental illness, by reducing intergroup anxiety, led to less negative beliefs about mental illness and weaker essentialist beliefs about mental illness (the latter being directly and positively associated with negative beliefs about mental illness). Moreover, less negative beliefs about mental illness, by reducing perceptions of self (but not public) stigma of seeking psychological help, were related to more positive attitudes towards help-seeking. Results are discussed in the context of the (unintentional) adverse effects of biogenetic (essentialist) explanations of mental disorders, and the clinical implications regarding interventions that aim at improving help-seeking attitudes.

Religiousness and Rape Myth Acceptance: Risk and Protective Effects

This study addressed the lack of research simultaneously examining multiple dimensions of religiousness when predicting rape myth acceptance, and extended prior findings of a mediating role for right-wing authoritarianism (i.e., uncritical submission to authority and aggressive attitude toward those who do not conform to social norms) in the association between religiousness and prejudice. The sample consisted of 99 undergraduate and graduate students (M age = 31.87 years, 66.7% female, 80.82% White, and 93% Christian affiliated) from a religiously affiliated university in the Midwest United States. As hypothesized, dimensions of religiousness exhibited differential associations with rape myth acceptance. Religious motivation characterized by openness and exploration (i.e., quest religiousness) was a significant negative predictor of rape myth acceptance, directly, and indirectly through right-wing authoritarianism. In contrast, rigid adherence to religious beliefs, assumed to be "right" and absolutely true (i.e., religious fundamentalism), and extrinsically motivated religiousness each exhibited a positive association with rape myth acceptance through right-wing authoritarianism. In addition, internally motivated religiousness and religious fundamentalism each moderated the nonlinear effect for quest predicting rape myth acceptance. Findings suggest that uncritical religious and secular submission to external authorities or uncommitted and nonexploring religiousness may have increased the extent to which persons adhered to rape myths, whereas religious exploration was protective. Practical implications center on the need for socioculturally relevant prevention and intervention efforts with religious identifying college students.

Association of Viewing the Films Joker or Terminator: Dark Fate With Prejudice Toward Individuals With Mental Illness

This survey study assesses the association of viewing the film Joker with level of prejudice toward individuals with mental illness.

How people with disabilities experience programs to prevent intimate partner violence across four countries

Women with disabilities are more vulnerable to violence, including intimate partner violence (IPV), yet the majority of emerging IPV prevention programs fail to explicitly consider the needs of participants with disabilities. Women and men living with disabilities engaged with IPV prevention programs in four countries were interviewed to explore how disability shaped their experiences of gender, violence, IPV, and whether the programs met their disability related needs. In-depth interviews were conducted with 16 women and 15 men living with disabilities in Ghana, Rwanda, Tajikistan and South Africa. The data were analysed thematically and compared across the settings. Participants described experiencing disability-related stigma, discrimination, exclusion, and for women, increased vulnerability to IPV. Barriers to full participation in programs included limited accessibility, and lack of disability-specific materials, recruitment or outreach. Enablers of inclusion included recruitment and monitoring strategies aimed at people with disabilities, partnering with a local disabled people's organization, training staff in disability inclusion, and raising awareness of disability rights. The data encouragingly suggests that inclusion of women and men with disabilities in IPV prevention programs designed for the general population has beneficial outcomes. Inclusion can prevent violence, promote their wellbeing, support economic empowerment, and challenge disability-related stigma and discrimination.

Young adults' BMI and changes in romantic relationship status during the first semester of college

Purpose

Identify how higher Body Mass Index (BMI) and weight discrimination are associated with romantic relationship formation and termination in young adults, and if the association was consistent for males and females.

Methods

First-year students (N = 1096) at entry to university (Time 1) provided BMI and self-reports of weight discrimination and romantic relationship status (in a relationship vs single); 550 were successfully resampled four months later (Time 2). Logistic generalized estimating equations (GEEs) examined if Time 1 relationship status was predicted by BMI and weight discrimination. Logistic GEEs were used to determine if Time 1 BMI and weight discrimination predicted Time 2 relationship status for the strata of students in, and out, of a relationship at Time 1.

Results

At baseline, students were less likely to be in a relationship if they had a higher BMI (OR = 0.94, 95% CI = 0.92, 0.96) or reported weight discrimination (OR = 0.69, 95% CI = 0.53, 0.90). When stratified by gender, the association between higher BMI and weight discrimination with relationship status was only observed for females. Longitudinally, a BMI-based selection effect was observed for romantic relationship formation, but not termination. Of the students who were single at Time 1, each one unit higher baseline BMI decreased the odds of the student transitioning to a relationship by 9% at Time 2 (OR = 0.91, 95% CI = 0.85, 0.96). When stratified by gender the association of higher BMI decreased odds of relationship formation was only significant for females. No weight discrimination differences for selection in or out of a romantic relationship were observed.

Conclusions

These findings suggest a weight-related selection effect for romantic relationship initiation, but not termination, in young female adults with lower BMIs. Weight discrimination was not associated with romantic relationship initiation or termination in this sample.

The role of emotional intelligence in attitudes towards elderly patients - Comparative study of medical students from rural and urban areas

INTRODUCTION

Medical care in geriatrics has its own specificity, and in order to build a successful doctor-patient relationship it is important while studying medicine to learn some functioning aspects of this age group.

OBJECTIVE

The aim of this study is to explore and describe the role of emotional intelligence in the attitudes of medical students towards elderly patients, taking into account their the place of residence. The place of residence has an impact on social relations and socialization, which could effect with disparities in behaviour towards elderly patients.

MATERIAL AND METHODS

Medical University of Lublin students from rural (N=71; M=23.44 SD=1.80) and urban (N=87; M=23.34; SD=1.38) areas took part in the study. Emotional Intelligence Questionnaire (INTE) and Attitude Towards Elderly Patients Questionnaire (ATEP) were used.

RESULTS

There are statistically significant differences between medical students from rural and urban areas in their attitude towards elderly patients (p=0.001), but no differences were observed between rural and urban residents in terms of emotional intelligence (general result, action factor and cognitive factor). Positive correlations were observed between action factor (r=0.322), cognitive factor (r=0.311) and general INTE result (r=0.358) and attitude towards elderly patients in the group of medical students from rural area.

CONCLUSIONS

Medical students from rural areas are characterized by a more positive attitude towards elderly patients than medical students from urban areas. The predictors of attitudes towards elderly patients are the cognitive factor of emotional intelligence and the place of residence of medical students. The results give the opportunity to design a well-developed programme of a geriatric course which could be matched to the personal predispositions of students.

Common Types of Gender-Based Microaggressions in Medicine

PURPOSE

Microaggressions are subtle verbal or nonverbal everyday behaviors that arise from unconscious bias, covert prejudice, or hostility. They may contribute to the persistent disparities faced by women in medicine. In this study, the authors sought to identify common microaggressions experienced by women faculty in medicine and to determine if specific demographic characteristics affect the reported frequencies of these microaggressions.

METHOD

The authors used chain referral sampling to collect real-life anecdotes about microaggressions from women faculty across the nation. Thirty-four unique experiences from those reported were identified and scripted then reenacted using professional actors to create 34 videos of the real-life microaggressions and 34 corresponding fictional "control" versions of the same situations. The videos, presented in a random order, were evaluated by faculty from 4 academic medical centers from 2016 to 2018.

RESULTS

A total of 124 faculty (79 women, 45 men) participated. Women reported higher frequencies of microaggressions than men in 33 of the 34 videos depicting microaggressions (P value range: < .001 to .042, area under the curve range: 0.60-0.69). No such differences were seen with the control videos. Women identified 21 microaggressions as occurring frequently. No significant differences were found with respect to participants' age, race/ethnicity, academic rank, or years in medicine. Post hoc analyses showed that the microaggressions fell into 6 themes: encountering sexism, encountering pregnancy- and child care-related bias, having abilities underestimated, encountering sexually inappropriate comments, being relegated to mundane tasks, and feeling excluded/marginalized.

CONCLUSIONS

Privilege is often invisible to those who have it, whereas bias and discrimination are readily apparent to those who experience it. Knowledge of common microaggressions will allow for targeted individual, interpersonal, and institutional solutions to mitigate disparities in medicine.

Knowledge, attitudes and prejudices of nursing students about the provision of transcultural nursing care to refugees: A comparative descriptive study

OBJECTIVES

The aim of this study was to determine the knowledge, attitudes, and prejudices of nursing students regarding the provision of transcultural nursing care to refugees.

METHODS

The sample of this comparative descriptive study was composed of 317 volunteering nursing students living in Ankara, Turkey. Descriptive statistics were presented as number, percentage, and mean ± standard deviation. The relationships among dependent and independent variables were analyzed with Pearson chi-square test. p ≤ 0.05 was accepted as statistically significant.

RESULTS

The mean age of the students was 21.19 ± 1.66 years; 88.6% were female. Only 30.0% (n = 95) of students (predominantly seniors) were educated on transcultural nursing. Statistically significant differences were found among grades of nursing students on the answers to the items, "Refugees are under coverage of general medical insurance system," "The concept of 'Health' differs from culture to culture," "Cultural features of the patient are important for caring nurse," "In order to provide care to only refugees and foreign patients, nurses from other cultures should be employed in hospitals," "Interpreters should be employed in hospitals 24 hours for services for refugees," and "According to my observations, refugees and their relatives admitted to the hospital are not respecting the healthcare workers and hospital rules." In addition, there was a statistically significant difference in students' comfort level with nursing care activities between those students who were literate in a foreign language and those who were not literate in a foreign language.

CONCLUSIONS

Our findings show that attending lectures on transcultural nursing in a curriculum of seniors and being literate in a foreign language had a positive impact on the attitudes of students in terms of the provision of medical care to refugees. It is recommended that nursing programs integrate lectures on transcultural nursing into the curricula of all four grades of nursing education and encourage students in language learning to better serve our disadvantageous guests.

Parallel Changes in Ethnic/Racial Discrimination and Identity in High School

Research has yet to understand how ethnic/racial discrimination and ethnic/racial identity change simultaneously in adolescence. In a multiethnic sample of 211 adolescents (58% female; 41% Asian American, 10% Black, 24% Latinx, 22% White, 4% other), this study used latent change modeling to examine parallel changes in adolescents' discrimination experiences (frequency and distress) and ethnic/racial identity (private regard, centrality) from 9th to 11th grade. The year immediately following the transition into high school, from 9th to 10th grade, emerged as a challenging period with higher levels of discrimination and accompanying declines in adolescents' private regard. In contrast, from 10th to 11th grade, discrimination distress declined, and adolescents' private regard remained relatively stable. Across both time periods, parallel changes were observed for discrimination (frequency, distress) and adolescents' private regard. Implications for considering the importance of school transition, as well as individual differences by adolescent characteristics and school contexts, are discussed.

Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory?

Advocates of physician-assisted suicide (PAS) often argue that, although the provision of PAS is morally permissible for persons with terminal, somatic illnesses, it is impermissible for patients suffering from psychiatric conditions. This claim is justified on the basis that psychiatric illnesses have certain morally relevant characteristics and/or implications that distinguish them from their somatic counterparts. In this paper, I address three arguments of this sort. First, that psychiatric conditions compromise a person's decision-making capacity. Second, that we cannot have sufficient certainty that a person's psychiatric condition is untreatable. Third, that the institutionalisation of PAS for mental illnesses presents morally unacceptable risks. I argue that, if we accept that PAS is permissible for patients with somatic conditions, then none of these three arguments are strong enough to demonstrate that the exclusion of psychiatric patients from access to PAS is justifiable.