Stigma and Health最新文献

Prior research has linked stigma associated with substance use (e.g., encounters with and anticipation of discrimination, internalization of negative stereotypes) to increased drug use problems, yet little work has examined protective factors that mitigate this association. The current study examined expressive flexibility (i.e., the ability to flexibly enhance and suppress one's emotional expression in accordance with situational demands), an important component of emotion regulation and psychological flexibility, as a buffer in the relation between substance use stigma and drug use problems among individuals with depression, a population disproportionately impacted by substance use disorder. A community sample of U.S. adults diagnosed with major depressive disorder (N = 112) completed self-report measures of substance use stigma, expressive flexibility, and drug use problems. Moderation analyses showed that substance use stigma was significantly associated with drug use problems, but the association was attenuated for participants with high levels of expressive flexibility. These findings underscored the potential utility of fostering expressive flexibility as a stigma coping resource in substance use prevention and treatment interventions.

Experiences of prejudice and discrimination contribute to heightened risk for alcohol use-related harm among sexual minority (SM) individuals. Discrimination in health care settings can also reduce help-seeking and treatment engagement. However, most research has focused on only one form of discrimination in isolation. This study used an intersectional stigma lens to examine associations between interpersonal health care discrimination and delayed alcohol use treatment among SM adults with multiple stigmatized identities. Interpersonal health care discrimination-based on one's sexual orientation, race-ethnicity, or both-and delayed treatment for alcohol use were examined among a nationally representative sample of SM adults from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 3,201), the only nationally representative survey that assesses multiple domains of sexual orientation, experiences of health care discrimination, and treatment intentions and utilization. Multivariable logistic regression was used to identify factors associated with delayed treatment for alcohol use. Approximately one in five (18.9%) SM adults experienced interpersonal health care discrimination and 9.2% delayed treatment for alcohol use. Delayed treatment was more prevalent among SM adults than the general population of adults with lifetime alcohol use. Those reporting both sexual orientation and racial-ethnic discrimination had more than double the odds of delayed treatment than those reporting neither (adjusted odds ratio = 2.38, 95% confidence interval [1.17, 4.85]). Findings highlight the compounding effect of intersectional stigma on treatment delay. Interventions are needed to address intersectional stigma in health care settings and engage particularly marginalized subpopulations of SM adults in alcohol use treatment.

While adverse childhood experiences (ACEs) and mental health (MH) may significantly influence internalized substance use stigma (ISUS), these relationships remain underexplored. This study addresses this gap by: (1) examining bivariate relationships between ACEs, MH, and ISUS, and (2) investigating the mediating role of MH-specifically anxiety, depression, and post-traumatic stress disorder (PTSD)-in this relationship. As part of the ongoing NIDA-funded Kentucky Justice Community Opioid Innovation Network (JCOIN) trial, 900 women with a history of opioid use disorder were randomly selected from nine Kentucky jails, consented, and interviewed on their substance use histories and related stigma, ACEs, and MH. Linear regression with mediation was used to analyze data. Women were an average age of 37 years and were predominantly non-Hispanic white (92.4%). ACEs and all MH variables were significantly associated with ISUS (p<.001). Mediation models indicated that anxiety and depression partially mediated the relationship between ACEs and ISUS, each explaining about a third (anxiety=38%, depression=32%) of the total effect of this relationship. Additionally, PTSD fully mediated this relationship, highlighting that PTSD is a significant explanatory factor and accounts for about 69% of the relationship. Results suggest that ACEs among women who have been incarcerated are linked to MH issues, which may contribute to ISUS. Addressing MH may help mitigate ISUS, underscoring the need for integrated, trauma-informed treatment interventions targeting ACEs, MH, and ISUS to improve recovery outcomes.

Parents are influential gatekeepers to mental health services for children struggling with mental health issues, and their stigmatizing attitudes and behaviors towards mental illness may hinder help-seeking. Parents' gendered expectations throughout the help-seeking process may influence whether they pursue formal or informal support for their children. We advance stigma research by examining how stigma affects a parent's decision to seek formal and informal mental health support for their child depending on the child's gender. Using longitudinal data from a school-based anti-stigma intervention study among sixth-grade students, we analyzed the subsample of children who reported high mental health symptoms (n=217). Regression models assessed the role of parental stigmatizing attitudes and behaviors and child gender on parental formal and informal help-seeking, including the child's use of psychiatric medications. To examine gendered patterns to stigma and help-seeking, we tested interactions between parental stigmatizing attitudes and the child's self-reported gender on help-seeking behaviors. Mental health labeling and literacy were associated with proactive parental help-seeking behaviors, while discriminatory stigma dimensions like social distance decreased help-seeking. These stigma effects varied by child gender, particularly when it came to formal avenues of care: Labeling enhanced parental help-seeking for girls in formal settings, while social distance deterred medication use among girls. The results of the study suggest that effective interventions targeting mental illness and help-seeking must actively incorporate parental perspectives, address gender biases in mental health, and consider the nuanced ways in which gender may complicate stigma processes when it comes to help-seeking decisions.

Female genital fistula, a debilitating birth injury frequently caused by prolonged obstructed labor or surgery in lower resource settings, leads to stigma and poor health, social, and economic outcomes. Fistula-related stigma evidence is lacking, including the nature, dimensions, sources, and influences on health and well-being. This systematic scoping review aimed to (a) examine fistula-related stigma experiences, (b) assess stigma and discrimination consequences, and (c) compare how stigma, its severity, and related stigma coping and resistance differ across contexts. We searched 10 scientific databases for original research on fistula-related stigma through June 8, 2021. Findings were thematically analyzed and summarized in table and narrative format. We calculated pooled prevalence for divorce/separation, anxiety, and depression. A total of 199 unique articles were identified across 41 countries, predominantly from sub-Saharan Africa. Findings highlight multiple manifestations of fistula stigma including enacted, internalized, anticipated, caregiver, and structural stigma. Fistula stigma intersected with infertility, gender, disability, and poverty stigma. Stigma consequences included mental health and psychological distress, lost employment/income, and limited social engagement. Pooled prevalence of divorce/separation was 35% (95% CI [30%, 41%]), depression 65% (95% CI [56%, 74%]), and anxiety 52% (95% CI [27%, 75%]). Common coping strategies included self-isolation or social withdrawal and keeping oneself clean; stigma resistance was rarely reported. Social support was protective of stigma. Few stigma interventions were identified; none evaluated implementation context or strategies to inform adoption and sustainability. Clinical interventions (e.g., counseling) addressed psychosocial and mental health consequences, and community-level interventions addressed community stigma. Assets-based or strengths-based framing was uncommon. Knowledge gaps impede theory- and evidence-based optimization of clinical and social services for fistula-related stigma prevention and mitigation, impacting quality of life.

Mpox emerged on the global scale in 2022 and predominately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma related to mpox is a potential harm for individuals experiencing multiple levels of marginalization who may already be discriminated against in family, healthcare, and other social domains. To understand perceived mpox stigma among cisgender GBMSM in the United States (US), we conducted a study within the American Men's Internet Survey (AMIS) with 824 cisgender GBMSM ≥15 years from August 5-15, 2022. Perceived mpox stigma was most prevalent among non-Hispanic Black individuals (13.9%) compared to non-Hispanic white individuals (6.0%) and particularly among men aged 25-29 (15.1%) compared to men aged 40+ (5.6%). In adjusted logistic regression models, mpox stigma was significantly associated with knowing someone who tested for mpox (aOR=4.3 95% CI=2.1, 9.0), knowing someone who was vaccinated for mpox (aOR=2.1; 95% CI= 1.2, 3.7), or having an unexplained rash in the three months prior to survey completion (aOR=3.6; 95% CI= 1.9, 7.0). These initial findings suggested people who were more connected to mpox-affected social networks and also those who had symptoms consistent with mpox were more likely to experience stigma. Taken together, these data suggest the potential harmful impact of mpox-related stigma by affecting those who would most benefit from services. Moreover, these data suggest the importance of real-time stigma measurement and mitigation for both rapidly emergent and chronic infectious diseases to improve equity, reduce fear and misinformation, and optimize the impact of public health responses.

Research on caregivers suggests interpersonal contact with persons with Alzheimer's disease (AD) and higher disease-oriented knowledge may heighten AD stigma, though these same mechanisms are often employed in anti-stigma campaigns. If we better understand associations among caregiver experience, interpersonal contact, AD knowledge and AD stigma, we can develop improved ways of reducing stigma and avoid unintended consequences. In a factorial design experiment, 2,371 participants read a vignette describing a fictional person; the vignette varied on clinical symptom stage, AD biomarker result, and treatment availability. Multivariable analyses assessed effects of caregiver experience, interpersonal contact, and different domains of disease-oriented knowledge on modified Family Stigma in Alzheimer's Disease Scale (FS-ADS) outcomes. Interaction analyses tested how clinical features may modify those associations. AD caregiver experience was associated with higher reactions on 6 of 7 FS-ADS domains. Disease-oriented knowledge, independent of content domain, did not substantially affect those associations. However, knowledge of caregiving, treatment, and life impact associated with lower FS-ADS scores, and knowledge about disease course and risk factors associated with higher reactions on FS-ADS domains. Knowledge of treatment modified reactions to symptoms and treatment availability. Knowledge of disease course modified reactions to a biomarker result. AD caregiver experience and interpersonal contact did not modify associations between clinical characteristics and FS-ADS domains. Distinct associations among different domains of AD knowledge and stigma outcomes should be considered when developing anti-stigma campaigns. Failure to do so risks worsening rather than alleviating AD stigma.

Nonsuicidal self-injury (NSSI) is highly stigmatized and increasingly prevalent among young adults. Perceived public NSSI stigma may hamper help-seeking, decrease social support, and impede development of effective public health interventions to address NSSI. Research has been limited, however, by the lack of validated measures of perceived public NSSI stigma, which may be less prone to social desirability biases than other self-report measures of stigma. Thus, we adapted an existing measure of suicide attempt stigma (Scocco et al., 2012) to develop a measure of perceived public NSSI stigma (Stigma of Nonsuicidal Self-Injury [STONSI] Scale). In two samples of young adult university students (one not screened and one prescreened for elevated depressive symptoms), we found support for a two-factor structure of the STONSI (one factor with reverse coded items and one factor with non-reverse coded items), which is used to create an average of all items, consistent with that identified for the suicide attempt stigma measure from which it was adapted. The STONSI exhibited strong internal consistency, as well as within-person stability over a six-week follow-up period. STONSI scores did not differ by lifetime history of NSSI; however, perceived public NSSI stigma was associated with indicators of NSSI severity. Future work is needed to test the validity and reliability of the STONSI in diverse samples with respect to age, clinical setting, and cultural context. If results are replicated, the STONSI may be a valuable tool for future research on NSSI stigma, its correlates, and the development of NSSI stigma interventions.

Out-of-date HIV knowledge among healthcare workers (HCW) can hinder the quality of care for people with HIV (PWH) and contribute to stigmatizing attitudes and behaviors. However, the role of HIV knowledge on stigma and mechanisms underlying HCWs' attitudes and behaviors remain understudied. This study examined empathy and social distance as mediators in the relationship between HIV knowledge and stigma toward PWH among HCWs. Cross-sectional data from 219 HCWs were collected at two clinics in the Dominican Republic. Serial mediation analyses examined the indirect effects of HIV knowledge on stigmas (i.e., worry related to contracting HIV, taking additional infection precautions, and moralizing opinions about PWH's behaviors) through empathy and social distance, adjusting for age and sexual orientation. Mean age was 42.16 years (SD=11.97). Most participants identified as female (79.9%), heterosexual 68.9%, and multi-racial (71.7%). The serial mediation models revealed significant indirect effects, suggesting that insufficient HIV knowledge was associated with less empathy toward PWH (B=1.92, β=.33, SE=.37, p<.001). Lower empathy, in turn, was associated with greater desire for social distance (B=.15, β=.18, SE=.06, p=.009). Greater social distance was subsequently linked to increased worry related to contracting HIV (B=.13, β=.21, SE=.04, p=.001), taking additional infection precautions (B=.06, β=.14, SE=.03, p=.035), and more moralizing opinions about PWH (B=.11, β=.13, SE=.05, p=.027). Interventions that improve HIV knowledge and foster empathy, thereby possibly reducing the desire for social distance from PWH among HCWs, should be explored to test their potential to mitigate HIV stigma and enhance care outcomes for PWH.

Latino and Black sexual minority men are at elevated risk of cigarette use compared to their heterosexual and White SMM counterparts. Internalized homophobia may affect substance use disparities. However, the research linking internalized homophobia and substance use has been inconsistent. The purpose of the present study was to clarify the association between internalized homophobia and daily cigarette use by testing the roles of internalized racism and ethnic identity acceptance as potential moderators of this link. This study collected data from 165 Black and/or Latino SMMs across the United States (M age = 23.72, SD = 3.85) as part of a larger study. Data were collected from December 2020 to February 2021 via Qualtrics Panels. Zero-inflated Poisson regression was conducted to examine the association between internalized homophobia and daily cigarette use and whether internalized racism and/or ethnic identity acceptance would moderate the association between internalized homophobia and daily cigarette use. Internalized homophobia was negatively associated with daily cigarette use; however, this association was significantly moderated by internalized racism and ethnic identity acceptance. Simple slope analyses revealed that low levels of internalized racism and high levels of ethnic identity acceptance attenuated the positive association between internalized homophobia and daily cigarette use. At low levels of ethnic identity acceptance, the positive association between internalized homophobia and daily cigarette use was strengthened. This research aids in contextualizing the association between internalized homophobia and daily cigarette use among Latino and Black SMM. Implications for smoking treatment and prevention programs are discussed.