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Janoušková M, Pekara J, Kučera M, Kearns PB, Šeblová J, Wolfová K, Kuklová M, Šeblová D. Experiences of stigma, discrimination and violence and their impact on the mental health of health care workers during the COVID-19 pandemic. Sci Rep 2024; 14:10534. [PMID: 38720009 PMCID: PMC11078939 DOI: 10.1038/s41598-024-59700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Health care workers have been exposed to COVID-19 more than people in other professions, which may have led to stigmatization, discrimination, and violence toward them, possibly impacting their mental health. We investigated (1) factors associated with stigma, discrimination, and violence, (2) the association of stigma, discrimination, and violence with mental health, (3) everyday experiences of stigmatization, discrimination, and violence. We chose a combination of a quantitative approach and qualitative content analysis to analyze data collected at three time points: in 2020, 2021 and 2022. A higher age was associated with lower odds of experiencing stigma, discrimination, and violence, whereas female gender was related to more negative experiences. The intensity of exposure to COVID-19 was associated with greater experience with stigmatization, discrimination, and violence across all three years (for example in 2022: odds ratio, 95% confidence interval: 1.74, 1.18-2.55 for mild exposure; 2.82, 1.95-4.09 for moderate exposure; and 5.74, 3.55-9.26 for severe exposure, when compared to no exposure). Stigma, discrimination, and violence were most strongly associated with psychological distress in 2020 (odds ratio = 2.97, 95% confidence interval 2.27-3.88) and with depressive symptoms in 2021 (odds ratio = 2.78, 95% confidence interval 2.12-3.64). Attention should be given to the destigmatization of contagious diseases and the prevention of discrimination, violence, and mental health problems, both within workplaces and among the public.
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Affiliation(s)
- Miroslava Janoušková
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia.
- Division of Medical Psychology, Third Faculty of Medicine, Charles University, Prague, Czechia.
| | - Jaroslav Pekara
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia.
- Medical College, Prague, Czechia.
| | - Matěj Kučera
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
- National Institute of Mental Health, Klecany, Czechia
- Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pavla Brennan Kearns
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Jana Šeblová
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
- Paediatric Emergency Department, Motol University Hospital, Prague, Czechia
| | - Katrin Wolfová
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Marie Kuklová
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
- Faculty of Science, Charles University, Prague, Czechia
| | - Dominika Šeblová
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, Czechia
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Burns PA, Klukas E, Sims-Gomillia C, Omondi A, Bender M, Poteat T. As Much As I Can - Utilizing Immersive Theatre to Reduce HIV-Related Stigma and Discrimination Toward Black Sexual Minority Men. Community Health Equity Res Policy 2024; 44:151-163. [PMID: 36189845 DOI: 10.1177/0272684x221115920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Despite advances in biomedical HIV prevention modalities such as pre-exposure prophylaxis to prevent the transmission of HIV, racial/ethnic and sexual/gender minority populations are disproportionately impacted by HIV epidemic. Alarming rates of HIV have persisted among Black gay and bisexual men, particularly in Southern states. METHODS Utilizing data from the ViiV ACCELERATE! initiative, we explored the impact of As Much As I Can, an immersive theatre production, on HIV-related stigma behaviors. A self-administered post-performance survey was conducted with a cohort (n = 322) of randomly selected audience members. RESULTS Overall, the results showed participants had a highly favorable experience, rating the performance with a mean score of 9.77/10. Respondents indicated they intended to change behaviors to promote HIV prevention education and to reduce stigma and discrimination including: (1) Say something if I hear stigmatizing language against people living with HIV (75.4%), (2) Say something if I hear anti-gay language (69.7%) and (3) Tell others about HIV prevention options (e.g., PrEP, PEP, condoms (64.1%). The findings show there is an association between HIV-related behavior intention and linkage to HIV care. Respondents who reported they were more likely to say something about HIV stigma were almost three times (O.R. 2.77; 95% C.I. 0.98-7.8) more likely to indicate they would follow up with a healthcare professional. CONCLUSIONS This study suggests that immersive theatre is an effective method for communicating HIV prevention education and reducing HIV-related structural stigma and discrimination that increases HIV vulnerability for Black sexual minority men.
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Affiliation(s)
- Paul A Burns
- John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Courtney Sims-Gomillia
- John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Angela Omondi
- John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Melverta Bender
- Mississippi State Department of Health/Office of STD/HIV, Jackson, MS, USA
| | - Tonia Poteat
- School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Barreras JL, Bogart LM, MacCarthy S, Klein DJ, Pantalone DW. Discrimination and adherence in a cross-sectional study of Latino sexual minority men with HIV: Coping with discrimination as a mediator and coping self-efficacy as a moderator. J Behav Med 2023; 46:1057-1067. [PMID: 37392342 PMCID: PMC10577103 DOI: 10.1007/s10865-023-00426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/25/2023] [Indexed: 07/03/2023]
Abstract
Discrimination is associated with antiretroviral therapy non-adherence and reduced well-being among people with HIV. We examined the potential for coping to mediate the associations between intersectional discrimination and non-adherence and coping self-efficacy (confidence in one's ability to cope with discrimination) as a moderator that may buffer the negative effects of discrimination on non-adherence in a cross-sectional convenience sample of 82 Latino sexual minority men with HIV. In bivariate linear regressions, discrimination targeting Latino ethnic origin, undocumented residency status, and sexual orientation were each significantly associated with lower self-reported antiretroviral therapy non-adherence (percentage of prescribed doses taken in the last month) and greater use of disengagement coping (denial, substance use, venting, self-blame, behavioral disengagement). Associations between discrimination targeting Latino ethnicity and non-adherence, and discrimination targeting undocumented residency status and non-adherence, were each mediated by disengagement coping responses. Moderation analyses highlighted significant discrimination by coping self-efficacy interaction effects-both coping self-efficacy for problem solving and stopping unpleasant emotions/thoughts each moderated the associations between Latino discrimination and adherence, between undocumented residency status discrimination and adherence, and between HIV discrimination and adherence. Coping self-efficacy for getting social support moderated the association between undocumented residency status discrimination and adherence. Further, the interaction coefficients across models indicated that the negative effects of discrimination on adherence were attenuated at higher levels of coping self-efficacy. Findings highlight the need for structural interventions that reduce-and ultimately eliminate-discrimination, and interventions that address the harmful effects of discrimination and adherence improvement interventions to enhance coping skills among people faced with intersectional discrimination.
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Affiliation(s)
- Joanna L Barreras
- School of Social Work, California State University Long Beach, 1250 Bellflower Boulevard, Long Beach, CA, 90840, USA.
- Bienestar Human Services, Inc, 5326 East Beverly Blvd, Los Angeles, CA, 90022, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
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Rodriguez VE, Enriquez LE, Ro A, Ayón C. Immigration-Related Discrimination and Mental Health among Latino Undocumented Students and U.S. Citizen Students with Undocumented Parents: A Mixed-Methods Investigation. J Health Soc Behav 2023; 64:593-609. [PMID: 37222500 PMCID: PMC10683331 DOI: 10.1177/00221465231168912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Research has consistently linked discrimination and poorer health; however, fewer studies have focused on immigration-related discrimination and mental health outcomes. Drawing on quantitative surveys (N = 1,131) and qualitative interviews (N = 63) with Latino undergraduate students who are undocumented or U.S. citizens with undocumented parents, we examine the association between perceived immigration-related discrimination and mental health outcomes and the process through which they are linked. Regression analyses identify an association between immigration-related discrimination and increased levels of depression and anxiety; this relationship did not vary by self and parental immigration status. Interview data shed light on this result as immigration-related discrimination manifested as individual discrimination as well as vicarious discrimination through family and community members. We contend that immigration-related discrimination is not limited to individual experiences but rather is shared within the family and community, with negative implications for the mental health of undocumented immigrants and mixed-status family members.
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Affiliation(s)
| | | | - Annie Ro
- University of California, Irvine, Irvine, CA, USA
| | - Cecilia Ayón
- University of California, Riverside, Riverside, CA, USA
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Roy S, Hassan S, Kanaya AM, Kandula NR, Desai MM. Associations of Discrimination, Low Social Support, and Limited English Proficiency with Depression in South Asian Immigrants. J Immigr Minor Health 2023; 25:990-998. [PMID: 36940078 PMCID: PMC11070655 DOI: 10.1007/s10903-023-01467-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/21/2023]
Abstract
South Asians face stressors as a growing immigrant group in America. Work is needed to understand how these stressors impact mental health to identify those at risk of depression and design interventions. This study examined associations of three stressors (discrimination, low social support, limited English proficiency) with depressive symptoms in South Asians. Using cross-sectional data from the Mediators of Atherosclerosis in South Asians Living in America study (N = 887), we fit logistic regression models to evaluate independent/joint effects of three stressors on depression. Overall prevalence of depression was 14.8%; 69.2% of those with all three stressors had depression. The combined effect of high discrimination/low social support was significantly greater than the sum of the individual factors. Experiences of discrimination, low social support, or limited English proficiency, as well as a combination of these factors, should be considered when diagnosing/treating South Asian immigrants in a culturally appropriate manner.
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Affiliation(s)
- Shireen Roy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
| | - Saria Hassan
- School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Namratha R Kandula
- Departments of Medicine and Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Diaz AA, Thakur N, Celedón JC. Lessons Learned from Health Disparities in Coronavirus Disease-2019 in the United States. Clin Chest Med 2023; 44:425-434. [PMID: 37085230 PMCID: PMC9678822 DOI: 10.1016/j.ccm.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the United States, the coronavirus disease-2019 (COVID-19) pandemic has disproportionally affected Black, Latinx, and Indigenous populations, immigrants, and economically disadvantaged individuals. Such historically marginalized groups are more often employed in low-wage jobs without health insurance and have higher rates of infection, hospitalization, and death from COVID-19 than non-Latinx White individuals. Mistrust in the health care system, language barriers, and limited health literacy have hindered vaccination rates in minorities, further exacerbating health disparities rooted in structural, institutional, and socioeconomic inequities. In this article, we discuss the lessons learned over the last 2 years and how to mitigate health disparities moving forward.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Neeta Thakur
- Department of Medicine, University of California at San Francisco, 505 Parnassus Avenue, Box 0841, San Francisco, CA 94143, USA
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Suite 9130, Rangos Building, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Muruthi JR, Muruthi BA, Thompson Cañas RE, Romero L, Taiwo A, Ehlinger PP. Daily discrimination, church support, personal mastery, and psychological distress in black people in the United States. Ethn Health 2023; 28:503-521. [PMID: 35733281 DOI: 10.1080/13557858.2022.2078481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study used the stress process model to test the mediating effects of personal mastery and moderating effects of church-based social support on the relationship between daily discrimination and psychological distress across three age groups of African American and Afro-Caribbean adults. METHODS Using a national sample of 5008 African Americans and Afro-Caribbean adults from the National Survey of American Life Study, this study employs structural equation modeling to investigate the relationships between daily discrimination, personal mastery, church-based social support, and psychological distress. RESULTS Daily discrimination was an independent predictor of psychological distress across all groups. Group- and age-specific comparisons revealed significant differences in the experience of daily discrimination and psychological distress. Mastery was a partial mediator of the relationship between discrimination and psychological distress among Afro-Caribbeans while church support was a significant moderator only among the young and older African Americans. IMPLICATIONS Together, our study findings provide useful first steps towards developing interventions to reduce the adverse psychological impacts of daily discrimination on African Americans and Afro-Caribbeans. Intervention efforts such as individual psychotherapy aimed to improve Afro-Caribbean individuals' sense of mastery would be a partial solution to alleviating the adverse effects of discrimination on their psychological health.
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Affiliation(s)
- James R Muruthi
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Bertranna A Muruthi
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Reid E Thompson Cañas
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Lindsey Romero
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Abiola Taiwo
- Department of School Psychology, University of Oregon, Eugene, USA
| | - Peter P Ehlinger
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
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Freeman M, Mulutsi NE. Law and policy are essential but insufficient to end stigma and discrimination in mental health. Lancet 2022; 400:1387-1389. [PMID: 36223801 DOI: 10.1016/s0140-6736(22)01743-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Melvyn Freeman
- Department of Psychology, University of Stellenbosch, Matieland 7602, Stellenbosch, South Africa.
| | - Nkeng Evah Mulutsi
- District Specialist Mental Health Team, Tshwane District Health Services, Pretoria, South Africa
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Atinga RA, Alhassan NMI, Ayawine A. Recovered but Constrained: Narratives of Ghanaian COVID-19 Survivors Experiences and Coping Pathways of Stigma, Discrimination, Social Exclusion and Their Sequels. Int J Health Policy Manag 2022; 11:1801-1813. [PMID: 34634884 PMCID: PMC9808237 DOI: 10.34172/ijhpm.2021.81] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Research about the coronavirus disease 2019 (COVID-19), its epidemiology and socio-economic impact on populations worldwide has gained attention. However, there is dearth of empirical knowledge in low- and middle-income settings about the pandemic's impact on survivors, particularly the tension of their everyday life arising from the experiences and consequences of stigma, discrimination and social exclusion, and how they cope with these behavioral adversities. METHODS Realist qualitative approach drawing data from people clinically diagnosed positive of COVID-19, admitted into therapy in a designated treatment facility, and subsequently recovered and discharged for or without follow-up domiciliary care. In-depth interviews were conducted by maintaining a code book for identifying and documenting thematic categories in a progression leading to thematic saturation with 45 participants. Data were transcribed and coded deductively for broad themes at the start before systematically nesting emerging themes into the broad ones with the aid of NVivo 12 software. RESULTS Everyday lived experiences of the participants were disrupted with acts of indirect stigmatization (against relatives and family members), direct stigmatization (labeling, prejudices and stereotyping), barriers to realizing full social life and discriminatory behaviors across socio-ecological structures (workplace, community, family, and social institutions). These behavioral adversities were associated with self-reported poor health, anxiety and psychological disorders, and frustrations among others. Consequently, supplicatory prayers, societal and organizational withdrawal, aggressive behaviors, supportive counseling, and self-assertive behaviors were adopted to cope and modify the adverse behaviors driven by misinformation and fearful perceptions of the COVID-19 and its contagious proportions. CONCLUSION In the face of the analysis, social campaigns and dissemination of toolkits that can trigger behavior change and responsible behaviors toward COVID-19 survivors are proposed to be implemented by health stakeholders, policy and decision makers in partnership with social influencers, the media, and telecoms.
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Affiliation(s)
- Roger A. Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | | | - Alice Ayawine
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Sunyani, Ghana
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Velin L, Chew MS, Pompermaier L. Discrimination in an "equal country"-a survey amongst Swedish final-year medical students. BMC Med Educ 2022; 22:503. [PMID: 35761244 PMCID: PMC9238226 DOI: 10.1186/s12909-022-03558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Discrimination due to gender and ethnicity has been found to be widespread in medicine and healthcare. Swedish and European legislation list seven discrimination grounds (age, sex, ethnicity, religion, sexuality, non-binary gender identity, and disability) which may intersect with each other; yet these have only been sparsely researched. The aim of this study was to assess the extent of discrimination, based on these seven discrimination grounds, amongst final-year medical students in Sweden. METHODS A web-based survey, based on the CHERRIES-checklist, was disseminated to course coordinators and program directors in charge of final year medical students at all seven medical schools in Sweden. Quantitative data were analyzed using descriptive statistics, Fisher's exact test, and logistic regression. Free-text answers were analyzed thematically using the "Master Suppression techniques" conceptual framework. RESULTS Of the 1298 medical students contacted, 247 (19%) took part in the survey. Almost half (n = 103, 42%) had experienced some form of discrimination, and this difference was statistically significant by gender (p = 0.012), self-perceived ethnicity (p < 0.001), country of birth other than Scandinavia (p < 0.001) and visible religious signs (p = 0.037). The most common type of discrimination was gender-based (in 83% of students who had experienced discrimination), followed by age (48%), and ethnicity (42%). In the logistic regression, women/non-binary gender (p = 0.001, OR 2.44 [95% CI 1.41-4.22]), country of birth not in Scandinavia (p < 0.001, OR 8.05 [2.69-24.03]), non-Caucasian ethnicity (p = 0.04, OR 2.70 [1.39-5.27]), and disability (p = 0.02, OR 13.8 [1.58-12040]) were independently associated with discrimination. Half of those who had experienced religion-based discrimination and nearly one-third of victims of ethnicity-based discrimination reported "large" or "extreme" impact of this. Clinical staff or supervisors were the most common offenders (34%), closely followed by patients and their relatives (30%), with non-Caucasian respondents significantly more likely to experience discrimination by patients (p < 0.001). CONCLUSIONS Discrimination appears to be frequent in medical school, even in one of the world's "most equal countries". Discrimination is most commonly gender- or ethnicity-based, with ethnicity- and religion-based discrimination appearing to have the largest impact. Future research should continue to evaluate discrimination from an intersectional perspective, adapted for local contexts and legislations.
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Affiliation(s)
- Lotta Velin
- Centre for Teaching & Research in Disaster Medicine and Traumatology (KMC), Department of Biomedical and Clinical Sciences, Linköping University, Johannes Magnus väg 11, 583 30, Linköping, Sweden.
| | - Michelle S Chew
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- ANOPIVA US, Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Linköping, Sweden
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Abuhammad S, Hatamleh R, Alrawashdeh M, Alrabadi N, Mukattash T, Abuhammad M, Howard K. Personal attributes and attitudes to substance use disorder: A study among Jordanian undergraduate medical majors students. PLoS One 2022; 17:e0263442. [PMID: 35192667 PMCID: PMC8863271 DOI: 10.1371/journal.pone.0263442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Emerging health professionals in undergraduate programs should be equipped to provide care to people with substance use disorder (SUD). The students’ personal attributes may impact their attitude toward those with SUD. This study aims to evaluate the impact of personal attributes of Jordanian undergraduate health students on their attitudes toward SUD and examine the relationship between the personal attributes and their devaluation and discriminatory (stigmatory) behaviour toward those with SUD. Method A cross-sectional descriptive design was used to examine the attitudes and stigmatory behaviours. The data were collected between May to October 2017 with a structured questionnaire that consisted of three parts: 1) a data sheet to collect the socio-demographic characteristics of the participants, 2) the Acute Mental Health Scale (ATAMHS), and 3) the Devaluation-Discrimination Scale (DDS). Findings Younger and females demonstrated a positive attitude toward those with SUD compared to older or male students. Age, gender, and previous experience with SUD are significant factors that affect their attitude. Conclusion Identifying the attitude to people with SUD and personal attributes of emerging health professionals in Jordan will help identify the need to educate them prior to their entry into practice.
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Affiliation(s)
- Sawsan Abuhammad
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
- * E-mail:
| | - Reem Hatamleh
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Alrawashdeh
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Nasr Alrabadi
- Department of Pharmacy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mai Abuhammad
- Health Center, Department of Emergency, Jordan University of Science and Technology, Irbid, Jordan
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Miconi D, Frounfelker RL, Whiteley T, Mekki-Berrada A, Rousseau C. Discrimination and Sympathy for Violent Radicalization Among College Students in Quebec (Canada): The Protective Role of Intrinsic and Extrinsic Religiosity. J Nerv Ment Dis 2021; 209:773-776. [PMID: 34582404 DOI: 10.1097/nmd.0000000000001405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The present study examines the moderating role of total, intrinsic, and extrinsic religiosity in the relation between perceived discrimination and sympathy for violent radicalization (VR) among college students in Quebec, Canada. A total of 931 students responded to an online questionnaire and were included in this study. Linear mixed-effects models were conducted to account for the clustered nature of the data, and moderation was assessed via interaction analysis using cross-product terms in the models. Findings indicated that both intrinsic and extrinsic religiosity had a protective role in the link between perceived discrimination and sympathy for VR and buffered the effects of sadness in response to discrimination on sympathy for VR, but not the effects of anger in response to discrimination. These results provide evidence of the protective role of religiosity in Canada, a social context characterized by an increase in religious discrimination, but which also supports religious diversity.
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Affiliation(s)
- Diana Miconi
- Division of Social and Cultural Psychiatry, McGill University, Montréal, Quebec, Canada
| | | | | | | | - Cécile Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montréal, Quebec, Canada
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Sukhera J, Kulkarni C, Taylor T. Structural distress: experiences of moral distress related to structural stigma during the COVID-19 pandemic. Perspect Med Educ 2021; 10:222-229. [PMID: 33914288 PMCID: PMC8082743 DOI: 10.1007/s40037-021-00663-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has taken a significant toll on the health of structurally vulnerable patient populations as well as healthcare workers. The concepts of structural stigma and moral distress are important and interrelated, yet rarely explored or researched in medical education. Structural stigma refers to how discrimination towards certain groups is enacted through policy and practice. Moral distress describes the tension and conflict that health workers experience when they are unable to fulfil their duties due to circumstances outside of their control. In this study, the authors explored how resident physicians perceive moral distress in relation to structural stigma. An improved understanding of such experiences may provide insights into how to prepare future physicians to improve health equity. METHODS Utilizing constructivist grounded theory methodology, 22 participants from across Canada including 17 resident physicians from diverse specialties and 5 faculty members were recruited for semi-structured interviews from April-June 2020. Data were analyzed using constant comparative analysis. RESULTS Results describe a distinctive form of moral distress called structural distress, which centers upon the experience of powerlessness leading resident physicians to go above and beyond the call of duty, potentially worsening their psychological well-being. Faculty play a buffering role in mitigating the impact of structural distress by role modeling vulnerability and involving residents in policy decisions. CONCLUSION These findings provide unique insights into teaching and learning about the care of structurally vulnerable populations and faculty's role related to resident advocacy and decision-making. The concept of structural distress may provide the foundation for future research into the intersection between resident well-being and training related to health equity.
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Affiliation(s)
- Javeed Sukhera
- Departments of Psychiatry/Paediatrics and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Chetana Kulkarni
- Hospital for Sick Children (SickKids), Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Taryn Taylor
- Department of Obstetrics and Gynecology and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Weiss J, Balasuriya L, Cramer LD, Nunez-Smith M, Genao I, Gonzalez-Colaso R, Wong AH, Samuels EA, Latimore D, Boatright D, Sharifi M. Medical Students' Demographic Characteristics and Their Perceptions of Faculty Role Modeling of Respect for Diversity. JAMA Netw Open 2021; 4:e2112795. [PMID: 34086032 PMCID: PMC8178710 DOI: 10.1001/jamanetworkopen.2021.12795] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Faculty role modeling is critical to medical students' professional development to provide culturally adept, patient-centered care. However, little is known about students' perceptions of faculty role modeling of respect for diversity. OBJECTIVE To examine whether variation exists in medical students' perceptions of faculty role modeling of respect for diversity by student demographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from the Association of American Medical Colleges' 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 accredited allopathic US medical schools. Data were analyzed from January 1 to November 1, 2020. MAIN OUTCOMES AND MEASURES Students' perceptions of faculty role modeling of respect for diversity by the independent variables sex, race/ethnicity, sexual orientation, and age. Multivariable logistic regression was used to examine the extent to which student-reported perceptions of faculty respect for diversity varied by demographic characteristics, and logistic regression models were sequentially adjusted first for demographic characteristics and then for marital status and financial variables. RESULTS Of 30 651 students who completed the survey, the final study sample consisted of 28 778 respondents, representing 75.4% of the 38 160 total US medical school graduates in 2016 and 2017. Of the respondents, 14 804 (51.4%) were male participants and 1506 (5.2%) identified as lesbian, gay, or bisexual (LGB); a total of 11 926 respondents (41.4%) were 26 years or younger. A total of 17 159 respondents (59.6%) identified as White, 5958 (20.7%) as Asian, 1469 (5.1%) as Black/African American, 2431 (8.4%) as Hispanic/Latinx, and 87 (0.3%) as American Indian/Alaska Native/Native Hawaiian/Pacific Islander individuals. Overall, 5101 students (17.7%) reported perceiving that faculty showed a lack of respect for diversity. Of those who identified as Black/African American students, 540 (36.8%) reported perceiving a lack of faculty respect for diversity compared with 2468 White students (14.4%), with an OR of perceived lack of respect of 3.24 (95% CI, 2.86-3.66) after adjusting for other demographic characteristics and covariates. American Indian/Alaska Native/Native Hawaiian/Pacific Islander (OR, 1.73; 95% CI, 1.03-2.92), Asian (OR, 1.62; 95% CI, 1.49-1.75), or Hispanic/Latinx (OR, 1.43; 95% CI, 1.26-1.75) students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students (OR, 1.17; 95% CI, 1.10-1.25), and students who identified as LGB (OR, 1.96; 95% CI, 1.74-2.22) or unknown sexual orientation (OR, 1.79; 95% CI, 1.29-2.47) had greater odds compared with heterosexual students. Students aged 33 years or older had greater odds of reporting a perceived lack of respect compared with students aged 26 years or younger (OR, 1.81; 95% CI, 1.58-2.08). CONCLUSIONS AND RELEVANCE In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.
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Affiliation(s)
- Jasmine Weiss
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Lilanthi Balasuriya
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Laura D. Cramer
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Inginia Genao
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mona Sharifi
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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15
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Beatty Moody DL, Waldstein SR, Leibel DK, Hoggard LS, Gee GC, Ashe JJ, Brondolo E, Al-Najjar E, Evans MK, Zonderman AB. Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research. PLoS One 2021; 16:e0251174. [PMID: 34010303 PMCID: PMC8133471 DOI: 10.1371/journal.pone.0251174] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/21/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives To examine whether intersections of race with other key sociodemographic categories contribute to variations in multiple dimensions of race- and non-race-related, interpersonal-level discrimination and burden in urban-dwelling African Americans and Whites. Methods Data from 2,958 participants aged 30–64 in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to estimate up to four-way interactions of race, age, gender, and poverty status with reports of racial and everyday discrimination, discrimination across multiple social statuses, and related lifetime discrimination burden in multiple regression models. Results We observed that: 1) African Americans experienced all forms of discrimination more frequently than Whites, but this finding was qualified by interactions of race with age, gender, and/or poverty status; 2) older African Americans, particularly African American men, and African American men living in poverty reported the greatest lifetime discrimination burden; 3) older African Americans reported greater racial discrimination and greater frequency of multiple social status-based discrimination than younger African Americans; 4) African American men reported greater racial and everyday discrimination and a greater frequency of social status discrimination than African American women; and, 5) White women reported greater frequency of discrimination than White men. All p’s < .05. Conclusions Within African Americans, older, male individuals with lower SES experienced greater racial, lifetime, and multiple social status-based discrimination, but this pattern was not observed in Whites. Among Whites, women reported greater frequency of discrimination across multiple social statuses and other factors (i.e., gender, income, appearance, and health status) than men. Efforts to reduce discrimination-related health disparities should concurrently assess dimensions of interpersonal-level discrimination across multiple sociodemographic categories, while simultaneously considering the broader socioecological context shaping these factors.
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Affiliation(s)
- Danielle L. Beatty Moody
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
- * E-mail:
| | - Shari R. Waldstein
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland, United States of America
| | - Daniel K. Leibel
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
| | - Lori S. Hoggard
- Department of Psychology, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Gilbert C. Gee
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Jason J. Ashe
- Department of Human Services Psychology, University of Maryland, Baltimore, Maryland, United States of America
| | - Elizabeth Brondolo
- Department of Psychology, St. John’s University, Queens, New York, New York, United States of America
| | - Elias Al-Najjar
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, Maryland, United States of America
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
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16
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Flores J, Caqueo-Urízar A, Quintana L, Urzúa A, Irarrázaval M. Perceived discrimination and contextual problems among children and adolescents in northern Chile. PLoS One 2021; 16:e0246998. [PMID: 33606801 PMCID: PMC7894936 DOI: 10.1371/journal.pone.0246998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 01/30/2021] [Indexed: 12/24/2022] Open
Abstract
Discriminatory behaviors among inter-ethnic relations in schools have long been noted and studied, but there are several correlations between discriminatory behaviors and other constructs that need further investigation. As an example, the relation between perceived discrimination and contextual problems-which include family, school and peer problems-among children and adolescents in Latin America has received little attention from previous studies. Further, the mediating role of ethnic identification and collective self-esteem in this relation also needs to be considered as they could be proven as protective factors for discriminatory behavior and its outcomes. Therefore, this study aimed to, first, establish the relationship between perceived discrimination and contextual problems in inter-ethnic students aged 8-19 years living in Arica, Chile; and second, to identify the role that ethnic identification and collective self-esteem play within this relation. In order to investigate this matter, a cross-sectional study was carried out with 3700 students in 29 schools between the fourth year of primary education and the last year of secondary education, aged between 9-18 years, with 48.4% men and 51.6% women. The sample was divided into primary and secondary school groups. The scales utilized were the Everyday Discrimination Scale, Multi-Group Ethnic Identity Measure-Revised Scale, Collective Self-Esteem Scale and the dimensions of contextual family, school and peer problems, as well as the general index of contextual problems of the Child and Adolescent Assessment System. For data analysis, we tested a path analytic model at both the within and between levels to account for the relations between variables. In each group the models obtained an optimal fit. We found that perceived discrimination and ethnic identification were directly related to contextual problems (.23-.39), and collective self-esteem had only a mediating role. This study showed that strategized interventions focusing on ethnic identification and perceived discrimination should be utilized by schools to create a better developing environment.
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Affiliation(s)
- Jerome Flores
- Centro de Justicia Educacional y Escuela de Psicología y Filosofía, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile
- * E-mail:
| | | | - Lirna Quintana
- Centro de Justicia Educacional y Escuela de Psicología y Filosofía, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile
| | - Alfonso Urzúa
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Antofagasta, Chile
| | - Matías Irarrázaval
- Departamento de Psiquiatría, Facultad de Medicina, Hospital Clínico Universidad de Chile, Santiago, Región Metropolitana, Chile
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Largent EA, Bhardwaj T, Abera M, Stites SD, Harkins K, Lerner AJ, Bradbury AR, Karlawish J. Disclosing Genetic Risk of Alzheimer's Disease to Cognitively Unimpaired Older Adults: Findings from the Study of Knowledge and Reactions to APOE Testing (SOKRATES II). J Alzheimers Dis 2021; 84:1015-1028. [PMID: 34602479 PMCID: PMC8629880 DOI: 10.3233/jad-210675] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current practice guidelines recommend against Apolipoprotein E (APOE) testing. However, advances in Alzheimer's disease (AD) research and care may soon change this. OBJECTIVE To examine longitudinally the experience of learning an APOE result and, if an ɛ4 carrier, taking a disease-specific treatment to reduce one's risk of AD. METHODS Fifty ɛ4 carriers and 20 non-carriers completed semi-structured interviews 3 months and 15 months after APOE disclosure. RESULTS Individuals generally understand their APOE results. While non-carriers felt relief, ɛ4 carriers often described themselves as disappointed by their result but nevertheless glad to know. Carriers expressed concerns about stigma and discrimination, including in the workplace. Carriers adopted new health behaviors at higher rates than non-carriers and revised their future plans to account for their increased risk of AD. Individuals participating in research were hopeful that their participation would help them or others; individuals who learned they were at increased risk for AD but who could not participate in research were disappointed. CONCLUSION Providers disclosing APOE results should be sensitive to how APOE results shape emotions, self-perceptions, and attitudes about memory; raise concerns about stigma and discrimination in personal and professional relationships; influence health behaviors and decision-making; and can have follow-on effects on family members.
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Affiliation(s)
- Emily A Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Maramawit Abera
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shana D Stites
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin Harkins
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alan J Lerner
- Brain Health and Memory Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Angela R Bradbury
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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18
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Saiz J, Muñoz M, Ausín B, González-Sanguino C, Ángel Castellanos M, Vaquero C, Ugidos C, López-Gómez A. Effects of COVID-19 lockdown on perceived discrimination and internalized stigma in people with previous mental disorder diagnoses in Spain. Am J Orthopsychiatry 2021; 91:407-411. [PMID: 34138629 DOI: 10.1037/ort0000542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
COVID-19 disease control efforts and consequences are likely to be complicated by the impact of fear and stigmatization of the novel coronavirus. These complications may also worsen due to the potential compounding of COVID-19 related stigma with stigmatization associated with previously diagnosed conditions. This exploratory study analyzes the experiences of the stigma associated with COVID-19 lockdown in people with different previous diagnoses 2 and 5 weeks after the beginning of the state of emergency in Spain. Gender and age were controlled as covariables and 1,052 people participated in the study. The diagnosis groups were: Psychiatry and mental health (n = 71), Cardiovascular disease (n = 42), Neurological disease (n = 23), Lung disease (n = 53), and No diagnosis (n = 863). The instruments used to measure the stigma were the Intersectional Day-to-Day Discrimination Index and two items of the Internalized Stigma of Mental Illness scale. Analysis of covariance of repeated measures and analysis of variance, including Scheffe's post hoc test, were performed. We found significant differences in stigma among the first and second evaluation. Regarding the previous diagnosis, no differences were found at Time 1, but significant differences were found at Time 2, with those having a previous psychiatric or mental health diagnosis reporting higher levels of perceived discrimination and internalized stigmatization. Our results suggest that people with previous stigmatizing conditions might be more vulnerable to experiencing stigma in a confinement situation. In order to reduce the burden of the COVID-19 stigma, health interventions should also consider the resulting intersection of effects on internalized stigma and perceived discrimination. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jesús Saiz
- Department of Social, Work and Differential Psychology, School of Psychology, Complutense University of Madrid
| | - Manuel Muñoz
- Personality, Evaluation and Clinical Psychology Department, School of Psychology, Complutense University of Madrid
| | - Berta Ausín
- Department of Social, Work and Differential Psychology, School of Psychology, Complutense University of Madrid
| | - Clara González-Sanguino
- Department of Social, Work and Differential Psychology, School of Psychology, Complutense University of Madrid
| | - Miguel Ángel Castellanos
- Psychobiology and Methodology in Behavioral Sciences Department, School of Psychology, Complutense University of Madrid
| | - Carlos Vaquero
- Chair Against Stigma Grupo 5-Complutense University of Madrid
| | - Carolina Ugidos
- Chair Against Stigma Grupo 5-Complutense University of Madrid
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Farfel JM, Barnes LL, Capuano A, de Moraes Sampaio MC, Wilson RS, Bennett DA. Informant-Reported Discrimination, Dementia, and Cognitive Impairment in Older Brazilians. J Alzheimers Dis 2021; 84:973-981. [PMID: 33935076 PMCID: PMC9113828 DOI: 10.3233/jad-201436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Self-reported discrimination is a source of psychosocial stress that has been previously associated with poor cognitive function in older African Americans without dementia. OBJECTIVE Here, we examine the association of discrimination with dementia and cognitive impairment in racially diverse older Brazilians. METHODS We included 899 participants 65 years or older (34.3% Black) from the Pathology, Alzheimer's and Related Dementias Study (PARDoS), a community-based study of aging and dementia. A structured interview with informants of the deceased was conducted. The interview included the Clinical Dementia Rating (CDR) Scale for the diagnosis of dementia and cognitive impairment proximate to death and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a second measure of cognitive impairment. Informant-reported discrimination was assessed using modified items from the Major and Everyday Discrimination Scales. RESULTS Discrimination was reported by informants of 182 (20.2%) decedents and was more likely reported by informants of Blacks than Whites (25.3% versus 17.6%, p = 0.006). Using the CDR, a higher level of informant-reported discrimination was associated with higher odds of dementia (OR: 1.24, 95% CI 1.08 -1.42, p = 0.002) and cognitive impairment (OR: 1.21, 95% CI: 1.06 -1.39, p = 0.004). Similar results were observed using the IQCODE (estimate: 0.07, SE: 0.02, p = 0.003). The effects were independent of race, sex, education, socioeconomic status, major depression, neuroticism, or comorbidities. CONCLUSION Higher level of informant-reported discrimination was associated with higher odds of dementia and cognitive impairment in racially diverse older Brazilians.
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Affiliation(s)
- Jose M. Farfel
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - Ana Capuano
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | | | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Health Sciences Program, Instituto de Assistência Medica ao Servidor Público do Estado (IAMSPE), São Paulo, Brazil
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
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20
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Naidenova I, Nesseler C, Parshakov P, Chusovliankin A. After the Crimea crisis: Employee discrimination in Russia and Ukraine. PLoS One 2020; 15:e0240811. [PMID: 33112927 PMCID: PMC7592748 DOI: 10.1371/journal.pone.0240811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
This paper examines the issue of employee discrimination after a political crisis: the annexation of Crimea. The annexation, which resulted in a political crisis in Russian-Ukrainian relations, is a setting which allows us to test if a bilateral political issue caused employee discrimination. We use a quasi-experimental approach to examine how the political crisis influenced participation in major sports leagues in Russia and Ukraine. The results show that the employment conditions significantly worsened since the Crimea crisis started.
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Affiliation(s)
| | - Cornel Nesseler
- Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
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21
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Liu Y, Finch BK, Brenneke SG, Thomas K, Le PD. Perceived Discrimination and Mental Distress Amid the COVID-19 Pandemic: Evidence From the Understanding America Study. Am J Prev Med 2020; 59:481-492. [PMID: 32829968 PMCID: PMC7336127 DOI: 10.1016/j.amepre.2020.06.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/09/2020] [Accepted: 06/21/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION This study examines COVID-19-associated discrimination regardless of infection status. It evaluates the contribution of various risk factors (e.g., race/ethnicity and wearing a face mask) and the relationship with mental distress among U.S. adults in March and April 2020, when the pandemic escalated across the country. METHODS Participants consisted of a probability-based, nationally representative sample of U.S. residents aged ≥18 years who completed COVID-19-related surveys online in March and April (n=3,665). Multivariable logistic regression was used to predict the probability of a person perceiving COVID-19-associated discrimination. Linear regression was used to analyze the association between discrimination and mental distress. Analyses were conducted in May 2020. RESULTS Perception of COVID-19-associated discrimination increased from March (4%) to April (10%). Non-Hispanic Black (absolute risk from 0.09 to 0.15 across months) and Asians (absolute risk from 0.11 to 0.17) were more likely to perceive discrimination than other racial/ethnic groups (absolute risk from 0.03 to 0.11). Individuals who wore face masks (absolute risk from 0.11 to 0.14) also perceived more discrimination than those who did not (absolute risk from 0.04 to 0.11). Perceiving discrimination was subsequently associated with increased mental distress (from 0.77 to 1.01 points on the 4-item Patient Health Questionnaire score). CONCLUSIONS Perception of COVID-19-associated discrimination was relatively low but increased with time. Perceived discrimination was associated with race/ethnicity and wearing face masks and may contribute to greater mental distress during early stages of the pandemic. The long-term implications of this novel form of discrimination should be monitored.
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Affiliation(s)
- Ying Liu
- Center for Economic and Social Research, University of Southern California, Los Angeles, California.
| | - Brian Karl Finch
- Center for Economic and Social Research, University of Southern California, Los Angeles, California; Department of Sociology and Spatial Sciences, University of Southern California, Los Angeles, California
| | - Savannah G Brenneke
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kyla Thomas
- Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | - PhuongThao D Le
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Lee S, Chang AM, Buxton OM, Jackson CL. Various Types of Perceived Job Discrimination and Sleep Health Among Working Women: Findings From the Sister Study. Am J Epidemiol 2020; 189:1143-1153. [PMID: 32406503 DOI: 10.1093/aje/kwaa075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 04/29/2020] [Indexed: 12/27/2022] Open
Abstract
Job discrimination, a social stressor, may lead to sleep health disparities among workers; yet, limited research has examined this relationship and specific sources of job discrimination. We used a US sample of working women (n = 26,085), participants in the Sister Study (2008-2016), to examine the associations of perceived job discrimination due to sex, race, age, health conditions, and/or sexual orientation with sleep health. Cross-sectionally, linear or logistic regression models revealed that each source of job discrimination was independently associated with different sleep problems after controlling for other sources of job discrimination. Longitudinally, among participants without short sleep (<7 hours/night) at time 1 (2012-2014), age-specific job discrimination was associated with 21% increased odds of new-onset short sleep (odds ratio = 1.21, 95% confidence interval: 1.03, 1.43) at time 2 (2014-2016). Among those without insomnia symptoms at time 1, race-specific job discrimination was associated with 37% increased odds of new-onset insomnia symptoms (odds ratio = 1.37, 95% confidence interval: 1.07, 1.75) at time 2. Sex- and health-specific job discrimination also predicted new-onset sleepiness. There were dose-response relationships such that a greater number of sources of job discrimination (≥3) was associated with greater odds of prevalent and incident sleep problems. Perceived job discrimination may contribute to working women's poor sleep health over time, raising concerns about sleep health disparities emanating from the workplace.
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Singh R, Subedi M. COVID-19 and stigma: Social discrimination towards frontline healthcare providers and COVID-19 recovered patients in Nepal. Asian J Psychiatr 2020; 53:102222. [PMID: 32570096 PMCID: PMC7293527 DOI: 10.1016/j.ajp.2020.102222] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Rakesh Singh
- Department of Community Health Sciences, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal; School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal.
| | - Madhusudan Subedi
- Department of Community Health Sciences, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal; School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
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Kricheli Katz T, Regev T, Lavie S, Porat H, Avraham R. Those who tan and those who don't: A natural experiment on colorism. PLoS One 2020; 15:e0235438. [PMID: 32706822 PMCID: PMC7380621 DOI: 10.1371/journal.pone.0235438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022] Open
Abstract
Are darker-skinned workers discriminated against in the labor market? Studies using survey data have shown that darker skin tone is associated with increased labor market disadvantages. However, it is hard to refute the possibility that other factors correlated with skin tones might affect employment outcomes. To overcome this inherent limitation, we use a natural experiment: we utilize changes in one's own skin tone, generated by exposure to the sun, to explore the effect of skin tone on the tendency to be employed. We find that those people whose skin tone becomes darker by exposure to the sun (but not others) are less likely to be employed when the UV radiation in the previous three weeks in the area in which they reside is greater. These within-person findings hold even when controlling for the week, the year, the region, demographic characteristics and the occupation and industry one is employed in.
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Affiliation(s)
| | - Tali Regev
- The Interdisciplinary Center Herzelyia, Tel Aviv, Israel
| | - Shay Lavie
- Buchmann Faculty of Law, Tel Aviv University, Tel Aviv, Israel
| | - Haggai Porat
- Harvard University, Cambridge, Massachusetts, United States of America
| | - Ronen Avraham
- Buchmann Faculty of Law, Tel Aviv University, Tel Aviv, Israel
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Ogunbajo A, Iwuagwu S, Williams R, Biello KB, Kahler CW, Sandfort TGM, Mimiaga MJ. Validation of depressive symptoms, social support, and minority stress scales among gay, bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: a mixed methods approach. BMC Public Health 2020; 20:1023. [PMID: 32600303 PMCID: PMC7325044 DOI: 10.1186/s12889-020-09127-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Global North. The validity and reliability of these instruments-to our knowledge-have never been thoroughly investigated among GBMSM in Nigeria. The aim of the current study was to determine the validity and reliability of the English versions of the Center for Epidemiologic Studies Depression Scale (CESD-R), Multidimensional Scale of Perceived Social Support (MSPSS), and LGBT Minority Stress Measure among a large multi-state sample of GBMSM Nigeria. METHODS Between January and June 2019, we conducted cognitive interviews (N = 30) and quantitative assessments (N = 406) with GBMSM in Nigeria. The cognitive interviews assessed comprehension of scale items and elicited suggestions for scale modifications. The quantitative assessment was used to gather psychosocial health data and to evaluate psychometric properties and construct validity of the modified scales. We utilized confirmatory factor analysis to assess factor structure, correlation coefficients, and Cronbach's alpha to examine scale validity and internal consistency. RESULTS Based on participant feedback from the cognitive interviews, we made slight modifications (i.e., culturally appropriate word substitutions) to all three scales. Results of quantitative analyses indicated good psychometric properties including high factor loadings, internal consistency and construct validity among the CESD-R, MSPSS, and LGBT Minority Stress Measure among GBMSM in Nigeria. CONCLUSION These results suggests that modifying research scales to be more culturally relevant likely do not jeopardize their validity and reliability. We found that modified scales measuring depressive symptoms, perceived social support, and minority stress among GBMSM in Nigeria remained valid. More research is needed to explore whether the psychometric properties remain if the scales are translated into broken English (Pidgin) and other traditional Nigerian languages (Yoruba, Igbo and Hausa).
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Affiliation(s)
- Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI 02912 USA
- Center for Health Equity, Brown School of Public Health, Providence, RI USA
| | | | - Rashidi Williams
- Equality Triangle for Health and Peoples Development Initiative, Warri, Delta Nigeria
| | - Katie B. Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI 02912 USA
- Center for Health Equity, Brown School of Public Health, Providence, RI USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
| | - Christopher W. Kahler
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI 02912 USA
| | - Theodorus G. M. Sandfort
- HIV Center for Clinical and Behavioral Studies New York State Psychiatric Institute and Columbia University, New York, USA
| | - Matthew J. Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI 02912 USA
- Center for Health Equity, Brown School of Public Health, Providence, RI USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI USA
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Eick SM, Goin DE, Izano MA, Cushing L, DeMicco E, Padula AM, Woodruff TJ, Morello-Frosch R. Relationships between psychosocial stressors among pregnant women in San Francisco: A path analysis. PLoS One 2020; 15:e0234579. [PMID: 32530956 PMCID: PMC7292353 DOI: 10.1371/journal.pone.0234579] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022] Open
Abstract
Pregnant women who experience psychosocial stressors, such as stressful life events, poor neighborhood quality, and financial hardship, are at an increased risk for adverse pregnancy outcomes. Yet, few studies have examined associations between multiple stressors from different sources, which may be helpful to better inform causal pathways leading to adverse birth outcomes. Using path analysis, we examined associations between multiple self-reported stressor exposures during and before pregnancy in the Chemicals in Our Bodies-2 study (N = 510), a demographically diverse cohort of pregnant women in San Francisco. We examined associations between eight self-reported exposures to stressors and three responses to stress which were assessed via interview questionnaire at the 2nd trimester. Stressors included: neighborhood quality, stressful life events, caregiving, discrimination, financial strain, job strain, food insecurity, and unplanned pregnancy. Perceived stress, depression, and perceived community status were included as indicators of self-reported stress response. Our model indicated that women who experienced discrimination and food insecurity had a 3.76 (95% confidence interval [CI] = 1.60, 5.85) and 2.67 (95% CI = 1.31, 4.04) increase in depression scale scores compared to women who did not experience discrimination and food insecurity, respectively. We additionally identified job strain and caregiving for an ill family member as strong predictors of increased depressive symptoms (β = 1.63, 95% CI = 0.29, 3.07; β = 1.48, 95% CI = 0.19, 2.70, respectively). Discrimination, food insecurity, and job strain also influenced depression indirectly through the mediating pathway of increasing perceived stress, although indirect effects were less precise. In our study population, women who experienced discrimination, food insecurity, job strain and caregiving for an ill family member had an increased number of depressive symptoms compared to women who did not experience these stressors. Results from our study highlight the complex relationships between stressors and stress responses and may help to identify possible mediating pathways leading to adverse pregnancy outcomes.
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Affiliation(s)
- Stephanie M. Eick
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail: (SME); (RM)
| | - Dana E. Goin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
| | - Monika A. Izano
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
| | - Lara Cushing
- Department of Health Education, San Francisco State University, San Francisco, California, United States of America
| | - Erin DeMicco
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
| | - Tracey J. Woodruff
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
| | - Rachel Morello-Frosch
- Department of Obstetrics, Gynecology and Reproductive Sciences, Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, United States of America
- Department of Environmental Science, Policy and Management and School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
- * E-mail: (SME); (RM)
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Hessou SPH, Glele-Ahanhanzo Y, Adekpedjou R, Ahoussinou C, Djade CD, Biaou A, Johnson CR, Boko M, Alary M. HIV incidence and risk contributing factors among men who have sex with men in Benin: A prospective cohort study. PLoS One 2020; 15:e0233624. [PMID: 32516307 PMCID: PMC7282649 DOI: 10.1371/journal.pone.0233624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/08/2020] [Indexed: 12/18/2022] Open
Abstract
Men who have sex with Men (MSM) are a key population in the transmission of Human Immunodeficiency Virus (HIV) infection. In Benin, there is a lack of strategic information to offer appropriate interventions for these populations who live hidden due to their stigmatization and discrimination. The objective is to identify contributing factors that affect HIV incidence in the MSM population. Study of a prospective cohort of 358 HIV-negative MSM, aged 18 years and over, reporting having had at least one oral or anal relationship with another man during the last 12 months, prior to recruitment. The monitoring lasted 30 months with a follow-up visit every six months. Univariate analyses and a Cox proportional hazards multivariate regression were used to examine the association between bio-behavioral, socio-demographic and knowledge-related characteristics with HIV incidence. The retention rate for the follow-up of the 358 participants was 94.5%. On the 813.5 person-years of follow-up, 48 seroconversions with an HIV incidence of 5.91 per 100 person-years were observed (95% CI: 4.46–7.85). Factors associated with the high risk of HIV were age (HR = 0.4; 95% CI: 0.2–0.8), living in couple (HR = 0.5 95% CI: 0.2–0.96) and the lack of condom systematic use with a male partner during high-risk sex (HR = 3.9; 95% CI: 1.4–11.1). HIV incidence is high within MSM population and particularly among young people. Targeted, suitable and cost-effective interventions for the delivery of the combination prevention package in an environment free of stigma and discrimination are necessary and vital for reaching the 90x90x90 target.
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Affiliation(s)
- Septime P. H. Hessou
- National Reference Centre for AIDS Research and Care (CNRRPEC-CNHU/Bénin), Cotonou, Bénin
- Population Health and Best Practices in Health Axis Quebec City University Hospital Research Center Laval University, Hôpital du Saint-Sacrement, Québec, Canada
- Inter-faculty Centre for Training and Research in Environment for Development (CIFRED), Abomey-Calavi University (UAC), Calavi, Bénin
- * E-mail:
| | - Yolaine Glele-Ahanhanzo
- Regional Institute of Public Health (IRSP), University of Abomey-Calavi (UAC), Ouidah, Bénin
| | - Rhéda Adekpedjou
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Université de Montréal, Quebec, Canada
| | - Clement Ahoussinou
- Institute for the Analysis of Communication and Social Groups, Missereté, Bénin
| | - Codjo D. Djade
- Population Health and Best Practices in Health Axis Quebec City University Hospital Research Center Laval University, Hôpital du Saint-Sacrement, Québec, Canada
| | | | - Christian R. Johnson
- Inter-faculty Centre for Training and Research in Environment for Development (CIFRED), Abomey-Calavi University (UAC), Calavi, Bénin
| | - Michel Boko
- Inter-faculty Centre for Training and Research in Environment for Development (CIFRED), Abomey-Calavi University (UAC), Calavi, Bénin
| | - Michel Alary
- Population Health and Best Practices in Health Axis Quebec City University Hospital Research Center Laval University, Hôpital du Saint-Sacrement, Québec, Canada
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Baker NA, Halford WK. Assessment of Couple Relationships Standards in Same-Sex Attracted Adults. Fam Process 2020; 59:537-555. [PMID: 30921472 DOI: 10.1111/famp.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Relationship standards are beliefs about what makes a good romantic relationship. To date, no research on relationship standards in same-sex relationships has been conducted. This paper describes development of the Rainbow Couples Relationship Standards Scale (Rainbow CRSS). In common with measures of relationship standards developed with heterosexuals, the Rainbow CRSS assesses the importance people attach to Couple Bond standards (expression of love, caring, intimacy), Family Responsibility standards (extended family relations, maintenance of face and harmony), Religion, and Relationship Effort standards. The Rainbow CRSS also assesses three standards hypothesized to be of particular importance to same-sex couples: Relationship Outness (public disclosure of the relationship), Sexual Openness (acceptance of open sexual relationship), and Dyadic Coping with Homophobic discrimination. Participants were 414 same-sex attracted men and women who completed the Rainbow CRSS online, plus some validation scales. The Rainbow CRSS showed a coherent two-level factor structure that was similar to that in heterosexual couples for the Couple Bond and Family Responsibility Scales. Same-sex attracted people's standards were similar for men and women, and for singles versus those in a relationship. Same-sex attracted people's standards were very similar in endorsement of Couple Bond, Family Responsibility, Religion, and Relationship Effort standards to those of heterosexuals. The Relationship Outness and Dyadic Coping with Homophobia scales assessed potentially important standards that reflect some distinctive challenges for same-sex couple relationships.
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Affiliation(s)
- Nicholas A Baker
- School of Psychology, University of Queensland, St. Lucia, Queensland, Australia
| | - W Kim Halford
- School of Psychology, University of Queensland, St. Lucia, Queensland, Australia
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Novara C, Serio C, Lavanco G, Schirinzi M, Moscato G. Identity, Couple and Intergroup Dynamics in Intercultural Families: Implications on Life Satisfaction of Partners. Fam Process 2020; 59:709-724. [PMID: 30888685 DOI: 10.1111/famp.12437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The current study analyzed how identity, couple, and intergroup dynamics are related to life satisfaction among 210 intercultural partners living in Italy. Three levels of analysis were considered: a micro level, taking into account the identity aspect of each partner in terms of self- or hetero-ethnic identification; a meso level, examining the passion, commitment, and intimacy of the couple sphere of the partners; a macro level investigating the discrimination that partners can perceive by the community as an effect of the relationship between dominant and minority groups. The results show that for both partners, foreign and Italian, the variables that have a predictive value on life satisfaction bring into play the couple and the intergroup dynamics, leaving out the identitary one. Specifically, increased perceived discrimination as a member of a mixed couple leads to decreased life satisfaction by partners. In turn, we can see that a strong intimacy between partners enhances their life satisfaction. These results introduce a reflection on the role of the differences about the ethnic identity, considered erroneously the main cause of dissatisfaction in the mixed couple. The implications of the study are described and suggestions for future research discussed.
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Affiliation(s)
- Cinzia Novara
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Consuelo Serio
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Gioacchino Lavanco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Massimiliano Schirinzi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Gianluigi Moscato
- Department of Social Psychology, University of Malaga, Malaga, Spain
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Neumark-Sztainer D, Wall MM, Choi J, Barr-Anderson DJ, Telke S, Mason SM. Exposure to Adverse Events and Associations with Stress Levels and the Practice of Yoga: Survey Findings from a Population-Based Study of Diverse Emerging Young Adults. J Altern Complement Med 2020; 26:482-490. [PMID: 32354223 PMCID: PMC7310310 DOI: 10.1089/acm.2020.0077] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: This study examines the prevalence of exposure to adverse events and associations with stress levels among a diverse population-based sample of young people. The study further explores whether these vulnerable populations, who have the potential to benefit from the mind-body practice of yoga, engage in a regular yoga practice. Design: EAT 2018 (Eating and Activity over Time) is a population-based study in which survey data were collected from 1568 ethnically/racially diverse (81.2% nonwhite) emerging young adults (mean age: 22.0 ± 2.0 years). Results: Exposure to adverse events was highly prevalent. For example, 43.9% reported at least one adverse childhood experience (ACE) (e.g., physical, emotional, or sexual abuse before age 18), whereas 40.1% reported experiencing discrimination. Exposure to adverse events was associated with higher stress levels. Practicing yoga at least 30 min/week was reported by 12.7% of the population, with variation across sociodemographic characteristics. Young adults exposed to adverse events were either more or similarly likely to practice yoga than young adults not reporting adverse events. Conclusions: The high prevalence of exposure to adverse events and associations with higher levels of stress points to a need for public health interventions. Thus, it was promising to find that young people exposed to adverse events, who may have greater emotional burdens, practice yoga at equal or greater proportions to those without these exposures. Given the potential benefits of yoga for populations living with high stress, it is important to develop further outreach efforts and provide accessible, acceptable, and affordable opportunities for practicing yoga.
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Affiliation(s)
- Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Jongwoo Choi
- Department of Statistics, Columbia University, New York City, NY, USA
| | | | - Susan Telke
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Susan M Mason
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Hagiwara N, Kron FW, Scerbo MW, Watson GS. A call for grounding implicit bias training in clinical and translational frameworks. Lancet 2020; 395:1457-1460. [PMID: 32359460 PMCID: PMC7265967 DOI: 10.1016/s0140-6736(20)30846-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/30/2020] [Accepted: 02/18/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Frederick W Kron
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mark W Scerbo
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | - Ginger S Watson
- Curry School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
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Chernilo D. The dialectics of universality: The heterodox critical social theory of Robert Fine. Br J Sociol 2020; 71:403-415. [PMID: 32077501 DOI: 10.1111/1468-4446.12744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 06/10/2023]
Abstract
Robert Fine was among the most original social theorists in Britain of the past 30 years, and the aim of this paper is to offer a first systematic assessment of his intellectual contribution. There are sound intellectual reasons to explore Fine's scholarship. He maintained a problematic relation with mainstream sociology and, against the reduction of sociology to questions of method, culture, or class, he argued that sociologists must continue to ask difficult normative questions as part of the social world they ought to explain. And there are also pressing political concerns that justify a reconsideration of his writings. Global politics is currently marked by a populist wave that decries the very ideas and values that were central to Fine's social theory: the need to uphold the rule of law at home and abroad, the politics of cosmopolitan solidarity, and the significance of antisemitism and its relationships with different forms of authoritarian politics. My main argument is that there is a dialectics of universality that drives forward Fine's intellectual project. By this, I mean that a universalistic idea of humanity-an all-inclusive conception of all human beings-is the most important normative intuition of modern times. This idea of humanity moves forward in history through a dual process of emancipation and domination: successful forms of social, legal, and political inclusion help make visible previous dynamics of exclusion but may also create or recreate discriminatory practices. Building on the work of French historian Michael Löwy on heterodox Jewish thinkers, I explain the three main tenets of Fine's work: (a) his reconstruction of critical social theory; (b) the notion of cosmopolitan solidarity; and (c) the significance and main features of modern antisemitism.
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Affiliation(s)
- Daniel Chernilo
- School of Government, Universidad Adolfo Ibáñez, Santiago, Chile
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Chang ES, Kannoth S, Levy S, Wang SY, Lee JE, Levy BR. Global reach of ageism on older persons' health: A systematic review. PLoS One 2020; 15:e0220857. [PMID: 31940338 PMCID: PMC6961830 DOI: 10.1371/journal.pone.0220857] [Citation(s) in RCA: 241] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Although there is anecdotal evidence of ageism occurring at both the structural level (in which societal institutions reinforce systematic bias against older persons) and individual level (in which older persons take in the negative views of aging of their culture), previous systematic reviews have not examined how both levels simultaneously influence health. Thus, the impact of ageism may be underestimated. We hypothesized that a comprehensive systematic review would reveal that these ageism levels adversely impact the health of older persons across geography, health outcomes, and time. Method A literature search was performed using 14 databases with no restrictions on region, language, and publication type. The systematic search yielded 13,691 papers for screening, 638 for full review, and 422 studies for analyses. Sensitivity analyses that adjusted for sample size and study quality were conducted using standardized tools. The study protocol is registered (PROSPERO CRD42018090857). Results Ageism led to significantly worse health outcomes in 95.5% of the studies and 74.0% of the 1,159 ageism-health associations examined. The studies reported ageism effects in all 45 countries, 11 health domains, and 25 years studied, with the prevalence of significant findings increasing over time (p < .0001). A greater prevalence of significant ageism-health findings was found in less-developed countries than more-developed countries (p = .0002). Older persons who were less educated were particularly likely to experience adverse health effects of ageism. Evidence of ageism was found across the age, sex, and race/ethnicity of the targeters (i.e., persons perpetrating ageism). Conclusion The current analysis which included over 7 million participants is the most comprehensive review of health consequences of ageism to date. Considering that the analysis revealed that the detrimental impact of ageism on older persons’ health has been occurring simultaneously at the structural and individual level in five continents, our systematic review demonstrates the pernicious reach of ageism.
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Affiliation(s)
- E-Shien Chang
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Sneha Kannoth
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Samantha Levy
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - John E. Lee
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Becca R. Levy
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Psychology, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
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34
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Fang L. The well-being of China's rural to urban migrant children: Dual impact of discriminatory abuse and poverty. Child Abuse Negl 2020; 99:104265. [PMID: 31756636 DOI: 10.1016/j.chiabu.2019.104265] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/24/2019] [Accepted: 11/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Post-migration experiences of discriminatory abuse and poverty have been recognized as key risk factors for psychopathology and health problems among children. However, little research has explored these associations among children participating in the internal migration process. Building on the stress and coping framework (Lazarus & Folkman, 1984), this study investigated the influence of discriminatory abuse and poverty on depressive symptoms and health problems in a group of Chinese migrant children. It also examined how a culturally based meaning-focused coping, as measured by Chinese beliefs about adversity scale, moderates the stress-distress associations. PARTICIPANTS A cross-sectional study was conducted among 1714 migrant youth (Mean Age = 13; Range = 10-16; 45.6 % Female). METHODS The latent variable interaction structural equation modeling was conducted to explore the main and interaction effects among studied variables. RESULTS High prevalence of depressive symptoms (49.6 %) was found for this sample. More than 90% of respondents reported on an average of 0-2 days as being sick over the past 30 days. Migrant youth were found to experience moderate levels of discriminatory abuse (M = 1.29, SD = 0.51; Range = 1-4) and economic stress (M = 1.38, SD = 1.25; Range = 1-4). The findings further revealed that discriminatory abuse and economic stress possessed severe consequences on their mental and physical health. The meaning-focused coping strategy weakened the relationship between discriminatory abuse and depressive symptoms (β=-0.07, p<.001). Among migrant youth who encountered discriminatory abuse those who adhered more to meaning-focused coping reported less depressive symptoms. CONCLUSION Findings shed light on the protective role of cultural factors in stress management for young people from migrant backgrounds.
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Affiliation(s)
- Lue Fang
- Asia Research Institute, Office 7.39, National University of Singapore, 10 Kent Ridge Crescent, #07-01 AS8, 119260, Singapore.
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Rad MS, Shackleford C, Lee KA, Jassin K, Ginges J. Folk theories of gender and anti-transgender attitudes: Gender differences and policy preferences. PLoS One 2019; 14:e0226967. [PMID: 31887173 PMCID: PMC6936834 DOI: 10.1371/journal.pone.0226967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022] Open
Abstract
Transgender rights and discrimination against transgender people are growing public policy issues. Theorizing from social, cognitive, and evolutionary psychology suggests that beyond attitudes, discrimination against transgender people may derive from folk theories about what gender is and where it comes from. Transgender identity is met with hostility, in part, because it poses a challenge to the lay view that gender is determined at birth, and based on observable physical and behavioral characteristics. Here, in two pre-registered studies (N = 1323), we asked American adults to indicate the gender of a transgender target who either altered their biology through surgical interventions or altered their outward appearance: to what extent is it their birth-assigned gender or their self-identified gender? Responses correlate strongly with affect toward transgender people, measured by feeling thermometers, yet predict views on transgender people’s right to use their preferred bathrooms above and beyond feelings. Compared to male participants, female participants judge the person’s gender more in line with the self-identified gender than the birth-assigned gender. This is consistent with social and psychological theories that posit high status (e.g., men) and low status (e.g., women) members of social classification systems view group hierarchies in more and less essentialist ways respectively. Gender differences in gender category beliefs decrease with religiosity and conservatism, and are smaller in higher age groups. These results suggest that folk theories of gender, or beliefs about what gender is and how it is determined have a unique role in how transgender people are viewed and treated. Moreover, as evident by the demographic variability of gender category beliefs, folk theories are shaped by social and cultural forces and are amenable to interventions. They offer an alternative pathway to measure policy support and possibly change attitude toward transgender people.
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Affiliation(s)
- Mostafa Salari Rad
- Kahneman-Treisman Center for Behavioral Science & Public Policy, Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America
- Department of Psychology, Princeton University, Princeton, New Jersey, United States of America
- Department of Psychology, New School for Social Research, The New School, New York City, New York, United States of America
- * E-mail:
| | - Crystal Shackleford
- Department of Psychology, New School for Social Research, The New School, New York City, New York, United States of America
| | - Kelli Ann Lee
- Department of Psychology, New School for Social Research, The New School, New York City, New York, United States of America
| | - Kate Jassin
- Department of Psychology, New School for Social Research, The New School, New York City, New York, United States of America
| | - Jeremy Ginges
- Department of Psychology, New School for Social Research, The New School, New York City, New York, United States of America
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Abstract
INTRODUCTION Mistreatment of physicians by patients is a long-standing phenomenon that has garnered increased attention recently. Medical students and residents also experience mistreatment, and many supervising physicians do not know how to recognize it or respond appropriately. Little guidance exists as to how faculty should best address these situations. We developed, taught, and evaluated a stepwise approach to help faculty physicians manage patient mistreatment of trainees (residents and students). METHODS Our approach is summarized by the acronym ERASE: (1) Expect that mistreatment will occur. (2) Recognize episodes of mistreatment. (3) Address the situation in real time. (4) Support the learner after the event. (5) Establish/encourage a positive culture. We designed an interactive, case-based educator development session to teach ERASE and surveyed participants before and after to evaluate the session. Sixty-nine participants attended one of four workshops between November 2017 and January 2018. RESULTS Nearly 80% of attendees reported having received no prior training in managing mistreatment of trainees by patients. Participants noted significant changes in their confidence in recognizing and responding to episodes of mistreatment after the session compared with just prior to it. DISCUSSION ERASE fills an important void in medical education by introducing a novel, easy-to-understand approach that faculty can employ to manage mistreatment of trainees. We have continued to disseminate this model to faculty and residents in various departments around our medical center and at national conferences. This resource will allow educators to disseminate the ERASE model at their home institutions.
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Affiliation(s)
- Kirsten M. Wilkins
- Associate Professor, Department of Psychiatry, Yale University School of Medicine
| | | | - Kali D. Cyrus
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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Koerting A, Polo R, Vázquez MC, del Amo J. [The Social Pact for the Non-discrimination and Equal Treatment Associated with HIV development]. Rev Esp Salud Publica 2019; 93:e201912115. [PMID: 31782757 PMCID: PMC10308823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023] Open
Abstract
Advances in treatment and care have improved the life expectancy and quality of life for people living with HIV. However, those infected with HIV remain exposed to the social stigma that continues to be associated with this condition and sometimes experience discriminatory treatment in areas such as health, education, the judiciary or the workplace, and in access to benefits and insurance. There is a lot of evidence that the discrimination and stigma associated with HIV alienate people from prevention, diagnosis, treatment and quality of life services. This situation is exacerbated by social, economic and cultural status, as social and structural inequity facilitates increased discrimination and unfair treatment in the daily lives of people living with HIV. In response to this situation arises the need to establish a Social Pact for Non-Discrimination and Equal Treatment Associated with HIV, agreed and signed by social and institutional agents key in the response to HIV. Its aim is to eliminate the stigma and discrimination associated with HIV and AIDS, ensuring equal treatment and opportunities, non-discrimination, respect for fundamental rights and diversity of those affected. Reducing discrimination against people living with HIV is one of the priority objectives of the Ministry of Health, Consumer Affairs and Social Welfare's Strategic Plan for the Prevention and Control of HIV and other STIs, currently extended to 2020. It is aligned with the UNAIDS cross-cutting objective of zero discrimination and with the fourth objective of the 90-90-90-90 strategy, which should ensure that 90% of people with HIV and viral load suppression have a good health-related quality of life.
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Affiliation(s)
- Ana Koerting
- Técnica Superior Externa TRAGSATEC (Plan Nacional sobre el Sida). Madrid. España.Spain
| | - Rosa Polo
- Plan Nacional sobre el Sida. Jefa de Área Asistencial y de Investigación. Madrid. España.Spain
| | - María-C. Vázquez
- Plan Nacional sobre el Sida. Jefa de Área de Prevención y Coordinación Multisectorial y Autonómica. Madrid. España.Spain
| | - Julia del Amo
- Plan Nacional sobre el Sida. Directora. Madrid. España.Spain
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Abstract
PURPOSE The data for this paper were collected as part of a larger project exploring how the medical profession conceptualizes the task of supporting physicians struggling with clinical competency issues. In this paper, the authors focus on a topic that has been absent in the literature thus far-how physicians requiring remediation are perceived by those responsible for organizing remediation and by their peers in general. METHOD Using a constructivist grounded theory approach, the authors conducted semistructured interviews with 17 remediation stakeholders across Canada. Given that in Canada health is a provincial responsibility, the authors purposively sampled stakeholders from across provincial and language borders and across the full range of organizations that could be considered as participating in the remediation of practicing physicians. RESULTS Interviewees expressed mixed, sometimes contradictory, emotions toward and perceptions of physicians requiring remediation. They also noted that their colleagues, including physicians in training, were not always sympathetic to their struggling peers. CONCLUSIONS The medical profession's attitude toward those who struggle with clinical competency-as individuals and as a whole-is ambivalent at best. This ambivalence grows out of psychological and cultural factors and may be an undiscussed factor in the profession's struggle to deal adequately with underperforming members. To contend with the challenge of remediating practicing physicians, the profession needs to address this ambivalence and its underlying causes.
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Affiliation(s)
- Gisèle Bourgeois-Law
- G. Bourgeois-Law is clinical associate professor, Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and PhD candidate, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-4726-3663. P.W. Teunissen is professor of medical education, School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands, and gynecologist, Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; ORCID: https://orcid.org/0000-0002-0930-0048. L. Varpio is professor, Department of Medicine, and associate director of research, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-1412-4341. G. Regehr is professor, Department of Surgery, and associate director for research, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002- 3144-331
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Hu YY, Ellis RJ, Hewitt DB, Yang AD, Cheung EO, Moskowitz JT, Potts JR, Buyske J, Hoyt DB, Nasca TJ, Bilimoria KY. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med 2019; 381:1741-1752. [PMID: 31657887 PMCID: PMC6907686 DOI: 10.1056/nejmsa1903759] [Citation(s) in RCA: 486] [Impact Index Per Article: 97.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender. RESULTS Among 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients' families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00). CONCLUSIONS Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.
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Affiliation(s)
- Yue-Yung Hu
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Ryan J Ellis
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - D Brock Hewitt
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Anthony D Yang
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Elaine Ooi Cheung
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Judith T Moskowitz
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - John R Potts
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Jo Buyske
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - David B Hoyt
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Thomas J Nasca
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
| | - Karl Y Bilimoria
- From the Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern Medicine (Y.-Y.H., R.J.E., D.B. Hewitt, A.D.Y., K.Y.B.), the Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital (Y.-Y.H.), the American College of Surgeons (R.J.E., D.B. Hoyt, K.Y.B.), the Department of Medical Social Sciences, Northwestern University (E.O.C., J.T.M.), and the Accreditation Council for Graduate Medical Education (J.R.P., T.J.N.) - all in Chicago; and the Department of Surgery, Thomas Jefferson University Hospital (D.B. Hewitt), and the American Board of Surgery (J.B.) - both in Philadelphia
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Hoggard LS, Powell W, Upton R, Seaton E, Neblett EW. Racial discrimination, personal growth initiative, and African American men's depressive symptomatology: A moderated mediation model. Cultur Divers Ethnic Minor Psychol 2019; 25:472-482. [PMID: 30816753 DOI: 10.1037/cdp0000264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Mounting evidence indicates that racial discrimination is a risk factor for depression among African American men. However, the mechanisms underlying the association between racial discrimination and depressive symptomatology remain unclear. The present study investigated the mediating capacity of personal growth initiative (PGI) in the relation between racial discrimination experiences and depressive symptomatology, as well as whether the proposed mediating relation was moderated by age, education, and income. METHOD Participants included 649 African American men recruited from barbershops in the North, South, West, and Midwest regions of the United States and from academic institutions-events. RESULTS Results revealed significant associations between racial discrimination and a combined latent factor representing depressed affect, interpersonal problems, and somatic complaints but not the latent factor representing positive affect. PGI mediated the association between racial discrimination and depressive symptomatology; however, the mediational pathway was not moderated by age, education, and income. CONCLUSIONS Interventions designed to mitigate the mental health consequences of racial discrimination among African American men might focus on enhancing PGI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Lori S Hoggard
- Department of Psychology, Rutgers University-New Brunswick
| | - Wizdom Powell
- Health Disparities Institute, University of Connecticut
| | | | | | - Enrique W Neblett
- Department of Psychology, The University of North Carolina at Chapel Hill
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Hayashi T, Odagiri Y, Takamiya T, Kikuchi H, Fukushima N, Inoue S. Exposure to organisational injustice and serious psychological distress: longitudinal analysis of details of exposure from a private Japanese company. BMJ Open 2019; 9:e029556. [PMID: 31558453 PMCID: PMC6773284 DOI: 10.1136/bmjopen-2019-029556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Studies have shown that organisational injustice (OIJ) is associated with mental disorders. However, there is little research regarding details on OIJ exposure. We examined the effect of OIJ on serious psychological distress (SPD) by considering the exposure frequency, the exposure duration and the OIJ-free period after the disappearance of exposure. METHODS We used a prospective cohort design. OIJ exposure was assessed three times with 1-year intervals between assessments, and the subjects were grouped according to the exposure histories. The outcome assessment for SPD by scores of 13 or higher on the K6 questionnaire was carried out 3 years after the baseline scores were obtained. Participants were all full-time regular employees of one office of a manufacturing company in Japan. Participants who were being treated for mental disorders, those with SPD and those with missing data on the K6 questionnaire in the baseline survey were excluded from the prospective cohort. Self-reported questionnaire data from 1087 employees who participated in all surveys and answered all questions were analysed. Logistic regression analysis was used to explore the effect of OIJ on SPD. RESULTS SPD developed in 35 participants. Frequent OIJ exposure was associated with a higher risk for SPD (p for trend=0.002). Of the 1087 participants, 319 (29.3%) experienced a change in OIJ exposure at least once, and 8.6% of subjects experienced such a change twice. These changes in OIJ exposure were more strongly related to SPD than was the frequency of OIJ exposure. CONCLUSIONS OIJ was associated with SPD onset particularly when the workers were more frequently exposed to it. Moreover, frequent changes in the OIJ exposure were associated with a higher risk for SPD. Because OIJ exposure can change in a relatively short time, considering exposure histories may provide useful information for preventing mental disorders.
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Affiliation(s)
- Toshio Hayashi
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku-ku, Japan
| | - Yuko Odagiri
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku-ku, Japan
| | - Tomoko Takamiya
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku-ku, Japan
| | - Hiroyuki Kikuchi
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku-ku, Japan
| | - Noritoshi Fukushima
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku-ku, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku-ku, Japan
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Price M, Polk W, Hill NE, Liang B, Perella J. The intersectionality of identity-based victimization in Adolescence:A person-centered examination of mental health and academic achievement in a U.S. high school. J Adolesc 2019; 76:185-196. [PMID: 31539764 DOI: 10.1016/j.adolescence.2019.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Growing evidence indicates that identity-based victimization (IBV; e.g., discrimination) is traumatic, and associated with mental health and academic concerns. Youth with multiple stigmatized identities face a higher risk of both victimization and poor mental health. The current study enhances a growing research base on intersectional IBV by examining 1) identity, rather than attribution, 2) a range of IBV experiences, 3) both mental health and academic achievement, 4) the mediating role of discrimination across multiple social identities, and 5) including gender expansive youth within a diverse sample representative of a high school population in the U.S. METHODS A cluster analysis was conducted to provide a nuanced depiction of intersectionality in a diverse sample of high school students (N = 946; ages 14-20, 44% cisgender boys, 53% cisgender girls, 3% gender expansive youth). Outcome and IBV differences across clusters were examined, in addition to the mediation of cluster membership and outcomes by discrimination. RESULTS Three distinct profiles of identity emerged: LGBTQ Youth (24%), Heterosexual Youth of Color (37%), and Heterosexual White Youth (39%). LGBTQ Youth and Heterosexual Youth of Color experienced the most IBV, and had higher levels of depression, lower wellbeing, and lower GPAs. Finally, discrimination partially mediated the association between identity and outcomes for LGBTQ youth, and fully mediated this association for Heterosexual Youth of Color. CONCLUSIONS The disproportionately of IBV, poor mental health, and lower academic achievement faced by LGBTQ youth and youth with intersecting stigmatized identities suggests that they may benefit from tailored and targeted treatments.
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Affiliation(s)
- Maggi Price
- Harvard University, United States; Boston College, United States.
| | | | | | | | - John Perella
- Medford Public Schools, Revere Public Schools, United States
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Kidd JD, Levin FR, Dolezal C, Hughes TL, Bockting WO. Understanding predictors of improvement in risky drinking in a U.S. multi-site, longitudinal cohort study of transgender individuals: Implications for culturally-tailored prevention and treatment efforts. Addict Behav 2019; 96:68-75. [PMID: 31039507 DOI: 10.1016/j.addbeh.2019.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE While transgender people report higher rates of risky drinking than the general population, no studies have examined transgender alcohol use longitudinally. This study investigated minority stress and identity development predictors of improvement in risky drinking among transgender individuals. METHODS Data come from a multi-site, longitudinal cohort study of U.S. transgender individuals (N = 330) and include measures of enacted stigma, felt stigma, identity development, and risky alcohol use. Theory-driven, hierarchical multivariable logistic regression was used to investigate the hypothesis that minority stress and identity development factors are related to improvement in risky drinking between baseline and 1-year follow-up. RESULTS Baseline risky drinkers (n = 106; 37.1%) were younger and more likely to have female sex assigned at birth. At 1-year follow-up, 68 baseline risky drinkers (64.2%) reported persistent risky drinking, while 38 (35.8%) reported improved drinking. Controlling for demographics and study site, female sex assigned at birth and enacted stigma were associated with lower odds of improved drinking. Non-white/Hispanic race/ethnicity, felt stigma, change in gender role/expression for 1-5 years, and diffuse-avoidant identity style were associated with higher odds of improvement. CONCLUSIONS/IMPORTANCE This is the first study to identity predictors of improvement in risky drinking among transgender individuals. Compared to trans-feminine individuals (assigned male at birth), trans-masculine individuals (assigned female at birth) were more likely to report risky drinking at baseline and had lower odds of improvement at 1-year follow-up. Improved drinking may be facilitated by preventing anti-transgender discrimination. Felt stigma and diffuse-avoidant identity style may lower alcohol risk via avoidance of drinking venues. Further research is needed to explicate these relationships and to inform culturally-tailored alcohol interventions for this at-risk population.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Frances R Levin
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Curtis Dolezal
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, United States of America.
| | - Walter O Bockting
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, United States of America.
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Gottert A, Friedland B, Geibel S, Nyblade L, Baral SD, Kentutsi S, Mallouris C, Sprague L, Hows J, Anam F, Amanyeiwe U, Pulerwitz J. The People Living with HIV (PLHIV) Resilience Scale: Development and Validation in Three Countries in the Context of the PLHIV Stigma Index. AIDS Behav 2019; 23:172-182. [PMID: 31350712 PMCID: PMC6773670 DOI: 10.1007/s10461-019-02594-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Supporting resilience among people living with HIV (PLHIV) is crucial to their sustained uptake of HIV services as well as psychological and social wellbeing. However, no measures exist to assess resilience specifically in relation to living with HIV. We developed the PLHIV Resilience Scale and evaluated its performance in surveys with 1207 PLHIV in Cameroon, Senegal and Uganda as part of the PLHIV Stigma Index-the most widely used tool to track stigma and discrimination among PLHIV worldwide. Factor analyses demonstrated satisfactory psychometric properties and reliability (alphas = 0.81-0.92). Levels of resilience (e.g., whether one's self-respect has been positively, negatively, or not affected by one's HIV status) varied substantially within and across countries. Higher resilience was associated with less depression in each country (all p < 0.001), and, in Cameroon and Uganda, better self-rated health and less experience of stigma/discrimination (all p < 0.001). The final 10-item PLHIV Resilience Scale can help inform interventions and policies.
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Affiliation(s)
- A Gottert
- Population Council HIV and AIDS Program, Washington, DC, USA.
| | - B Friedland
- Population Council HIV and AIDS Program, New York, NY, USA
| | - S Geibel
- Population Council HIV and AIDS Program, Washington, DC, USA
| | - L Nyblade
- RTI International, Washington, DC, USA
| | - S D Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - S Kentutsi
- National Forum of PLHIV Networks in Uganda (NAFOPHANU), Kampala, Uganda
| | | | - L Sprague
- UNAIDS, Geneva, Switzerland
- The Global Network of People Living with HIV (GNP +), Amsterdam, The Netherlands
| | - J Hows
- The Global Network of People Living with HIV (GNP +), Amsterdam, The Netherlands
| | - F Anam
- International Community of WLHIV (ICW), Nairobi, Kenya
| | - U Amanyeiwe
- Prevention, Care and Treatment (PCT) Division, USAID Office of HIV/AIDS, Washington, DC, USA
| | - J Pulerwitz
- Population Council HIV and AIDS Program, Washington, DC, USA
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Aasprang A, Våge V, Flølo TN, Hegland PA, Kolotkin R, Natvig GK, Andersen JR. Patient-reported quality of life with obesity - development of a new measurement scale. Tidsskr Nor Laegeforen 2019; 139:18-0493. [PMID: 31429227 DOI: 10.4045/tidsskr.18.0493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Many questionnaires for measuring the quality of life for patients with obesity require comprehensive calculation before they are used. There is a need for questionnaires that permit simple assessment of the responses during a patient consultation. We have developed the questionnaire Patient-Reported Outcomes in Obesity (PROS). The objective of the study was to test the reliability and validity of the questionnaire. MATERIAL AND METHOD The questionnaire was used to ask patients about the extent to which they perceived their weight or body shape as bothersome. A group of patients with an average body mass index (BMI) of 42 (n = 109) completed the PROS questionnaire and The Impact of Weight Quality of Life questionnaire (IWQOL-Lite) before undergoing obesity surgery. Another group with an average body mass index of 29 (n = 95) completed the PROS questionnaire 1-5 years after having undergone obesity surgery. 67,7 % of the patients were > 40 years and 79 % were women. For the statistical analysis we used Cronbach's alpha, factor analysis, Spearman's rank test and independent t-test. RESULTS Cronbach's alpha for the total PROS score was 0.90, and the factor analysis showed a significant factor (eigenvalue = 4.7) that explained 58.4 % of the variance. The test-retest correlation was 0.93 (p < 0.001). The correlation coefficients between the PROS score, the total IWQOL-Lite score (rs = -0.91) and body mass index (rs = 0.60) were all significant (p < 0.001). The t-test showed an effect size (difference in standard deviation) between the non-surgery and the surgery groups of 1.9 (95 % CI 1.6-2.5) for the PROS questionnaire and 2.1 (95 % CI 1.7-2.5 for the total IWQOL-Lite score. INTERPRETATION The PROS questionnaire is a reliable and valid questionnaire for measurement of obesity-specific quality of life.
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Fox RS, Carnethon MR, Gallo LC, Wiley JF, Isasi CR, Daviglus ML, Cai J, Davis SM, Giachello AL, Gonzalez P, McCurley JL, Schneiderman N, Penedo FJ. Perceived Discrimination and Cardiometabolic Risk Among US Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study. Int J Behav Med 2019; 26:331-342. [PMID: 31236872 PMCID: PMC7294575 DOI: 10.1007/s12529-019-09782-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is a group of cardiovascular risk factors including elevated blood pressure, elevated triglycerides, decreased high-density lipoprotein cholesterol, impaired fasting glucose, and abdominal obesity, which disproportionately affects Hispanics/Latinos. The present study examined associations between perceived discrimination and MetS in Hispanic/Latino adults from various background groups (i.e., Dominican, Central American, Cuban, Mexican, Puerto Rican, South American). METHODS Data were obtained from 5174 Hispanics/Latinos who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. MetS components and covariates were measured at a baseline examination, and perceived discrimination was assessed within 9 months of baseline. Path analysis modeled associations of perceived discrimination with MetS prevalence and each of the six components of MetS, controlling for age, sex, income, acculturation, physical activity, diet, smoking, and alcohol use. RESULTS Among the full cohort, perceived discrimination was not associated with MetS prevalence in any of the models evaluated. Higher perceived discrimination at work/school was associated with larger waist circumference. When examining background groups separately, higher perceived ethnicity-associated threat was related to increased MetS prevalence only among individuals of Central American background. Differential patterns of association between perceived discrimination and MetS components were found for different background groups. CONCLUSIONS Overall results suggested that perceived discrimination was not strongly or consistently associated with MetS among Hispanics/Latinos.
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Affiliation(s)
- Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Joshua F Wiley
- Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sonia M Davis
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aida L Giachello
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jessica L McCurley
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Frank J Penedo
- Department of Psychology, University of Miami, Miami, FL, USA.
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Vernby K, Dancygier R. Can immigrants counteract employer discrimination? A factorial field experiment reveals the immutability of ethnic hierarchies. PLoS One 2019; 14:e0218044. [PMID: 31339894 PMCID: PMC6655538 DOI: 10.1371/journal.pone.0218044] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/24/2019] [Indexed: 11/19/2022] Open
Abstract
How pervasive is labor market discrimination against immigrants and what options do policymakers and migrants have to reduce it? To answer these questions, we conducted a field experiment on employer discrimination in Sweden. Going beyond existing work, we test for a large range of applicant characteristics using a factorial design. We examine whether migrants can affect their employment chances—by adopting citizenship, acquiring work experience, or signaling religious practice—or whether fixed traits such as country of birth or gender are more consequential. We find little systematic evidence that immigrants can do much to reduce discrimination. Rather, ethnic hierarchies are critical: callback rates decline precipitously with the degree of ethno-cultural distance, leaving Iraqis and Somalis, especially if they are male, with much reduced employment chances. These findings highlight that immigrants have few tools at their disposal to escape ethnic penalties and that efforts to reduce discrimination must address employer prejudice.
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Affiliation(s)
- Kåre Vernby
- Department of Political Science, Stockholm University, Stockholm, Sweden
- * E-mail:
| | - Rafaela Dancygier
- Department of Politics and Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America
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Hall T, Kakuma R, Palmer L, Minas H, Martins J, Kermode M. Social inclusion and exclusion of people with mental illness in Timor-Leste: a qualitative investigation with multiple stakeholders. BMC Public Health 2019; 19:702. [PMID: 31174504 PMCID: PMC6554932 DOI: 10.1186/s12889-019-7042-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social inclusion is a human right for all people, including people with mental illness. It is also an important part of recovery from mental illness. In Timor-Leste, no research has investigated the social experiences of people with mental illness and their families. To fill this knowledge gap and inform ongoing mental health system strengthening, we investigated the experiences of social inclusion and exclusion of people with mental illness and their families in Timor-Leste. METHODS Eighty-five participants from the following stakeholder groups across multiple locations in Timor-Leste were interviewed: (1) people with mental illness and their families; (2) mental health and social service providers; (3) government decision makers; (4) civil society members; and (5) other community members. Framework analysis was used to analyse interview transcripts. RESULTS People with mental illness in Timor-Leste were found to face widespread, multi-faceted sociocultural, economic and political exclusion. People with mental illness were stigmatised as a consequence of beliefs that they were dangerous and lacked capacity, and experienced instances of bullying, physical and sexual violence, and confinement. Several barriers to formal employment, educational, social protection and legal systems were identified. Experiences of social inclusion for people with mental illness were also described at family and community levels. People with mental illness were included through family and community structures that promoted unity and acceptance. They also had opportunities to participate in activities surrounding family life and livelihoods that contributed to intergenerational well-being. Some, but not all, Timorese people with mental illness benefited from disability-inclusive programming and policies, including the disability pension, training programs and peer support. CONCLUSIONS These findings highlight the need to combat social exclusion of people with mental illness and their families by harnessing local Timorese sociocultural strengths. Such an approach could centre around people with mental illness and their families to: increase population mental health awareness; bolster rights-based and culturally-grounded mental health services; and promote inclusive and accessible services and systems across sectors.
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Affiliation(s)
- Teresa Hall
- Nossal Institute for Global Health, University of Melbourne, 333 Exhibition St, Melbourne, Victoria, 3004, Australia.
| | - Ritsuko Kakuma
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - Lisa Palmer
- School of Geography, University of Melbourne, Melbourne, Australia
| | - Harry Minas
- Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - João Martins
- Faculty of Medicine and Health Sciences, National University of Timor-Leste, Díli, Timor-Leste
| | - Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, 333 Exhibition St, Melbourne, Victoria, 3004, Australia
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Abstract
Faces are among the most salient and relevant visual and social stimuli that humans encounter. Attractive faces are associated with positive character traits and social skills and automatically evoke larger neural responses than faces of average attractiveness in ventral occipito-temporal cortical areas. Little is known about the behavioral and neural responses to disfigured faces. In two experiments, we tested the hypotheses that people harbor a disfigured is bad bias and that ventral visual neural responses, known to be amplified to attractive faces, represent an attentional effect to facial salience rather than to their rewarding properties. In our behavioral study (N = 79), we confirmed the existence of an implicit 'disfigured is bad' bias. In our functional MRI experiment (N = 31), neural responses to photographs of disfigured faces before treatment evoked greater neural responses within ventral occipito-temporal cortex and diminished responses within anterior cingulate cortex. The occipito-temporal activity supports the hypothesis that these areas are sensitive to attentional, rather than reward properties of faces. The relative deactivation in anterior cingulate cortex, informed by our behavioral study, may reflect suppressed empathy and social cognition and indicate evidence of a possible neural mechanism underlying dehumanization.
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Affiliation(s)
- Franziska Hartung
- Center for Cognitive Neuroscience Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA.
- Penn Center for Neuroaesthetics Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA.
| | - Anja Jamrozik
- Center for Cognitive Neuroscience Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA
| | - Miriam E Rosen
- Center for Cognitive Neuroscience Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA
| | - Geoffrey Aguirre
- Center for Cognitive Neuroscience Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA
| | - David B Sarwer
- Center for Obesity Research and Education College of Public Health, Department of Social and Behavioral Sciences, Temple University 1301 Cecil B. Moore Avenue, 19122, Philadelphia, PA, USA
| | - Anjan Chatterjee
- Center for Cognitive Neuroscience Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA
- Penn Center for Neuroaesthetics Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA
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Affiliation(s)
| | | | - Mala Rao
- Imperial College London, London, UK
| | - Sarah Salway
- Health Equity and Inclusion Research Group, Faculty of Social Sciences, University of Sheffield, Sheffield, UK
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