Stigma and Health最新文献

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.

Latine sexual minority adults report discrimination related to their minoritized identities (racism, heterosexism) and at the intersection of those identities (racism in the LGBTQ+ community, heterosexism in one's racial/ethnic community). Much research has supported the additive effects of single-identity discrimination (racism and heterosexism) on mental health problems; however, less research has examined the role of intersectional discrimination in physical health symptoms and how psychological distress may account for that association. The current study examined the associations between intersectional discrimination with physical symptom severity and tested psychological distress as a potential underlying mechanism. Using cross-sectional data from 320 Latine sexual minority adults (age range 18-70; M = 30.5, SD = 9.6), a structural equation model estimated the association between two intersectional discrimination variables (i.e., racism in the LGBTQ+ community and heterosexism in one's racial/ethnic community) with physical symptom severity and tested their indirect effects via psychological distress. Results revealed that greater heterosexism in one's racial/ethnic community was associated with higher physical symptom severity; there was a significant indirect effect via psychological distress. Racism in the LGBTQ+ community was not a significant predictor in the model. These results highlight the importance of applying an intersectional framework to measuring stigma and discrimination. Findings also provide initial support for psychological distress as a potential underlying mechanism through which discrimination contributes to poorer physical health among Latine sexual minority adults. These results can inform interventions that aim to promote psychological and physical health among this population by mitigating the detrimental effects of intersectional discrimination.

Internalized cancer stigma is high among cancer patients who smoke, but it is unknown whether the experience of stigma changes after quitting smoking post-diagnosis. Using data from an RCT of tobacco treatment, we conducted a secondary data analysis and hypothesized that 1) cancer patients who quit smoking would report greater reductions in internalized cancer stigma, compared to patients who did not quit and that 2) greater reductions in stigma would significantly mediate the relationship between smoking abstinence and subsequent decreases in anxiety and depressive symptoms. Participants (n=303; 56.1% female) were adults recruited from two comprehensive cancer centers who had smoked in the past 30 days, spoke English or Spanish, and were being treated for a recent diagnosis of cancer. Participants completed questionnaires at baseline, 3-month follow-up, and 6-month follow-up, and biochemically verified smoking abstinence was determined by participants' salivary cotinine or carbon monoxide levels. Smoking abstinence at 3-month follow-up was significantly associated with reductions in cancer-related stigma from baseline to 3-month follow-up (b = -1.50, p < .001), controlling for sociodemographic and medical covariates. Additionally, reductions in stigma were associated with reductions in anxiety at 6-month follow-up (b = 0.28, p < .05), but not depressive symptoms. Reductions in stigma significantly mediated the relationship between smoking abstinence and decreased anxiety (indirect effect = -0.42, p < .05), but not depressive symptoms. Smoking cessation may be associated with reduction in internalized cancer stigma. Thus, in addition to benefits for medical outcomes, quitting smoking post-diagnosis may improve psychosocial well-being.

Stigma of mental illness is a significant barrier to mental health service use and recovery. Yet, few studies have examined stigma among marginalized young adults with serious mental illnesses (SMI). This convergent mixed methods study builds knowledge surrounding stigma among a sample of young adults of color with SMI (n=113). The study progressed in two phases. First, a multivariable regression model was estimated to identify factors associated with anticipated stigma. Results indicated that (1) more severe depression symptoms were associated with higher levels of anticipated stigma and (2) more positive treatment beliefs were associated with lower levels of anticipated stigma. Level of education was trending toward significance, suggesting that young adults with higher levels of education experience more anticipated stigma. The second phase focused on qualitative interview data from a subset of young adults (n=57). Analysts used grounded theory coding techniques and constant comparison to evolve a set of themes that describe stigma experiences. Three themes emerged, namely perceptions of the self, societal views of people with SMI, and the impact of stigma on life. Analytic matrices were developed to merge quantitative data on education, depression symptoms, and treatment beliefs with qualitative data to examine convergence and divergence. The density and content of statements on stigma differed by education and depression, further validating quantitative results. These findings suggest that young adults with more severe depression symptoms and negative treatment beliefs may be more likely to experience stigma as they navigate adult systems of care.

Objectives: Sexual and gender minority (SGM) older adults report poorer mental health than their cisgender-heterosexual peers. Age discrimination may be a mechanism underlying these disparities. The current study examined whether SGM older adults reported more age discrimination and, in turn, higher depression and anxiety, compared to cisgender-heterosexual older adults.

Methods: As part of a larger study, 744 older adults (aged ≥ 50; M = 58.4, SD = 6.23) completed an online survey in September 2021. The survey included measures of depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7), and age discrimination (an adapted version of the Everyday Discrimination Scale). The sample included five sexual orientation and gender identity (SOGI) groups: cisgender sexual minority men (25.3%), cisgender sexual minority women (21.6%), cisgender-heterosexual men (19.8%), cisgender-heterosexual women (18.5%), and gender minorities (14.8%). We tested the indirect effects of SOGI group on depression and anxiety through age discrimination.

Results: Compared to cisgender-heterosexual men and women, all three SGM groups reported more age discrimination which, in turn, was associated with higher depression and anxiety. Further, compared to cisgender-heterosexual women, cisgender-heterosexual men reported more age discrimination which, in turn, was associated with higher depression and anxiety. All indirect effects were significant.

Conclusion: Age discrimination may be a mechanism underlying the mental health disparities affecting SGM older adults and a promising intervention target.

Introduction: The mental health of gay and bisexual men (GBM) who use pre-exposure prophylaxis (PrEP) may be negatively impacted by experiences of stigma.

Methods: To assess the relationship between stigma and mental health among GBM who use PrEP in Guatemala, we conducted a survey with 162 PrEP users recruited in a community-based PrEP clinic.

Results: In multiple linear regression analyses, greater internalized (ß=1.94, SE=0.85, p=0.023) and enacted sexual orientation stigma (ß=0.50, SE=0.12, p<0.001) were associated with greater depressive symptoms. Greater internalized (ß=1.82, SE=0.80, p=0.023) and enacted sexual orientation stigma (ß=1.33, SE=0.11, p=0.003) were also associated with greater anxiety symptoms. Additionally, individuals with high social support and high anticipated PrEP stigma had fewer depressive symptoms than individuals with low social support and high anticipated PrEP stigma (ß=-3.25, SE=1.40, p=0.022). This relationship was marginally significant for anxiety (ß=-2.54, SE=1.31, p=0.055).

Conclusion: Sexual orientation and PrEP stigma may affect PrEP users' mental health. Interventions addressing stigma are needed to support uptake and sustained PrEP use in this population.

The purpose of this study was to examine the experiences of discrimination during prostate cancer treatment and assess the association with health-related quality of life (HRQOL) in a cohort of gay and bisexual men (GBM) prostate cancer survivors. This is a cross-sectional analysis of the 24-month follow-up survey from the Restore-2 clinical trial that tested the effectiveness of an online rehabilitation program tailored for GBM prostate cancer survivors in the U.S. This analysis uses data from the 347 participants who completed all items of the Everyday Discrimination Scale (EDS) at the 24-month follow-up. A log-binomial regression model estimated the risk of experiencing discrimination across treatment received and demographic characteristics. Multivariable linear regression models estimated mean differences in HRQOL measures with discrimination as a binary variable after adjustment for relevant covariates. Nearly half (49.3%) of participants endorsed at least one experience of discrimination during prostate cancer treatment. About half (52%) of these rated the discrimination as "rare" (total EDS = 1-3), while 48% reported it as more common (total EDS ≥ 4). Most attributed the discrimination to their sexual orientation (35.5%) or to their provider's attributes (29.6%). Those who underwent systemic/combined treatment (vs. either surgery or radiation only) and those with less than a bachelor's or graduate-level degree (vs. bachelor's degree) were more likely to report discrimination. Experiencing any discrimination was associated with significantly worse HRQOL outcomes. Discrimination during prostate cancer treatment appears to be a common experience for GBM patients and may result in poorer treatment outcomes.

"Religious conscience" or "healthcare denial" policies allow healthcare providers and institutions to refuse to provide services in the name of religious freedom. Denial policies are a form of structural stigma that could impede access to healthcare for sexual and gender minority (SGM) populations, particularly SGM young adults. This study describes SGM university students' response to policies permitting healthcare providers to deny care based on their religious beliefs. Data were obtained from 8,322 SGM students at 38 colleges and universities who participated in the spring 2020 Healthy Minds Study. Descriptive statistics are reported for the level of distress due to the denial policies and likelihood to avoid identity disclosure. Over 90% of SGM students report distress knowing about denial policies (sexual minority: 6.95/10; gender minority: 8.05/10). Students also reported similarly high distress imagining that they had been denied care (sexual minority: 8.05/10; gender minority: 8.57/10). The majority of sexual (69.2%) and gender minority (82.2%) students agreed the policy would make them less likely to disclose their identity to a new provider. Experiencing, or even anticipating, discrimination in healthcare settings through denial policies has negative impacts on the health of SGM populations and has the potential to exacerbate existing mental health disparities for SGM young adults.

Transgender (trans) and nonbinary youth (TNY) and, by extension, their family members, are currently facing widespread and virulent anti-trans stigma and discrimination in the United States (US), which have been associated with negative impacts on health. While research focused on families of TNY has increased in recent years, siblings' perspectives are rarely included. This qualitative analysis sought to address this gap and learn more about how adolescent and young adult TNY and their siblings experienced and managed anti-trans stigma across different settings and over time. Using a reflexive thematic analysis and template organizing approach, we analyzed one-on-one, semi-structured, separate interviews (N=88) with 10 TNY and their 10 siblings (N=20) who completed at least four of five waves of the Trans Teen and Family Narratives Project, a mixed-methods, longitudinal study of TNY and their families in the New England region of the US, conducted from 2016-2019. TNY and their siblings engaged in meaning making about the TNY's (and for some siblings, their own) susceptibility to anti-trans stigma within their families, communities, and nation and with respect to a shifting sociopolitical climate and the TNY's gender affirmation trajectory. Four themes were generated: exercising agency, schemas for understanding stigma, "passing," and awareness of their spatio-temporal and relational positionality. Recommendations for interventions to support TNY and their siblings include fostering access to other TNB/siblings facing anti-trans stigma; advocating for safe and affirming school environments; increasing/restoring access to gender-affirming medical care for those who want it; and conducting explicitly trans liberatory research.

Weight stigma is widely recognized as a significant concern in healthcare. Studies indicate that as medical trainees advance through their training, their levels of weight bias may intensify. Such prejudices can lead to inferior care for higher-weight patients, underscoring the urgency for research that identifies factors that are protective against the development of weight bias. Prior findings have shown that the motivation to respond without prejudice is a key determinant of explicit bias across various contexts, yet its role concerning weight bias remains underexplored. In a one-year longitudinal study of U.S. resident physicians (N = 3,507), we examined the associations between participants' internal motivation (i.e., based on personal values) and external motivation (i.e., based on social pressures) to respond without weight-based prejudice on self-reported explicit weight bias, self-rated preparedness to treat higher-weight patients, and participation in bias-related training. We found that internal motivation predicted lower weight bias (across three measures) and greater self-rated preparedness to treat higher-weight patients (ps ≤ 0.001), whereas external motivation predicted higher weight bias (ps < 0.001). Participants' internal motivation also predicted their participation in bias-related training during the following year (ps ≤ 0.01). Each of these findings held when controlling for demographic variables and BMI. Participants were young and predominantly white, so further research will be needed to generalize these findings to the broader population of healthcare providers. Taken together, these findings suggest that internal motivation to respond without weight-based prejudice may be a useful target for future bias-reduction intervention efforts.