Effects Of Stigma Research Articles

Physicians' Stigma Towards Ethnicity of Patients with Cancer and Its Effects on the Health Outcomes: The Moderating Effect of Ethnic Dissimilar Medical Encounters.

This study aimed to examine the moderating effect of ethnic patient-physician similarity versus dissimilarity on the relationship between physicians' stigma towards ethnicity and physicians' communication behaviors during medical encounters and patients' post-meeting anxiety. A prospective nested study design with 146 encounters, including 146 patients with cancer and 32 oncology/surgery physicians, was conducted between November 2019 and July 2022 in two medical centers. Before the medical encounters, physicians were asked to complete sociodemographic, professional and the Perceived Ethnic Discrimination Questionnaires (PEDQ-CV). Patients completed sociodemographic, clinical characteristics and State-Trait Anxiety Inventory (STAI) questionnaires before and following the encounters. During the medical encounters, structured "real-time" observations of the physicians' behaviors were assessed using the Four Habits Coding Scheme (4HCS). The mixed linear analysis model revealed that the two-way interaction effects between physicians' stigma toward ethnicity and the ethnic similarity between the physician and patient on physician communication behaviors (b = - .822, p < .05) and patients' post-meeting anxiety (b = .580, p < .05) were significant. In ethnic dissimilar medical encounters, physician stigma towards ethnicity was associated with poor communication behaviors and higher post meeting patients' anxiety. However, in ethnic similar medical encounters, physician ethnic stigma was associated with improve communication behaviors and stable levels of anxiety. Our study highlights the significant role of similar versus dissimilar ethnic medical encounters on the effect of ethnic stigma on health outcomes. These findings call for implementing a climate of diversity management to limit the additive effect of stigma towards ethnicity and to provide fair and equal care.

The effect of an emotional support training program on weight self-stigma and body image among women with polycystic ovary syndrome

Purpose This study aims to investigate the impact of an emotional support training program on weight self-stigma and body image among women with polycystic ovary syndrome (PCOS). Design/methodology/approach A randomized controlled trial was conducted with 200 women diagnosed with PCOS employing a pretest-posttest design. The experimental group, consisting of 100 women, participated in an emotional support training program and received an informational booklet, while the control group (100 women) received only the booklet. Pre- and post-intervention assessments were conducted using weight self-esteem and body shape questionnaires. Findings The results demonstrated a statistically significant difference in weight self-stigma and body shape scores between the experimental and control groups following the intervention. For both the immediate post-intervention test [t(198) = 31.1, p = 0.01] [t(198) = 31.1, p = 0.01] [t(198) = 31.1, p = 0.01] and [t(198) = 60.7, p = 0.01] [t(198) = 60.7, p = 0.01] [t(198) = 60.7, p =0.01], as well as the delayed post-intervention test [t(198) = 32.3, p = 0.01] [t(198) = 32.3, p = 0.01] [t(198) = 32.3, p = 0.01] and [t(198) = 70.9, p = 0.01] [t(198) = 70.9, p = 0.01] [t(198) = 70.9, p = 0.01], the experimental group exhibited lower mean scores. Specifically, the experimental group scored 20.3 ± 9.2 for immediate and 20.4 ± 9.3 for delayed assessments on weight self-stigma, and 101.2 ± 7.2 for immediate and 86.5 ± 7.6 for delayed assessments on body shape. In contrast, the control group scored 159.8 ± 6.3 for immediate and 157.6 ± 6.4 for delayed assessments, respectively. Practical implications Nurses should be aware of the adverse effects of PCOS and associated obesity on weight self-stigma and body image. They are encouraged to develop targeted emotional support training programs specifically designed to address weight self-stigma and body image concerns in women with PCOS. Originality/value This study confirms the effectiveness of an emotional support training program in mitigating the negative effects of weight-related stigma and improving body image perception.

How does organizational stigma damage employees’ innovative performance? An emotional labor perspective

In this rapidly developing and technologically advancing business environment, innovation has become crucial to an organization’s success. However, very few studies have explored the effect of organizational stigma, a negative label that becomes prevalent and situational in nature, on employees’ innovative performance. Using survey data from 151 employees in the overseas business departments of five Chinese multinational enterprises blacklisted by the U.S. government, along with one-on-one follow-up interviews with 17 participants, this study uncovers a psychological mechanism behind the negative relationship between organizational stigma and employees’ innovative performance. Specifically, organizational stigma prompts employees to engage in surface acting, which further leads to emotional exhaustion as employees are unable to replenish their emotional resources due to the negative experience of organizational stigma. This emotional exhaustion, in turn, diminishes the emotional resources employees can devote to innovative behaviors, resulting in a decline in their innovative performance. Moreover, this study identifies stigma attribution as a moderating factor, where employees who attribute stigma to positive appraisal-related causes experience a lesser decrease in their innovative performance. By combining quantitative surveys with qualitative interviews, this study not only helps bridge the gap in understanding the impact of organizational stigma at the relatively unexplored employee level, including its underlying mechanisms and boundary conditions, but also offers practical insights for managers on how to mitigate the negative effects of organizational stigma on employees’ innovative performance.

Analysis of the Psychosocial and Cognitive Effects of Stigma on Bipolar Disorder-A Literature Review

Abstract: Beyond the distress of the disorder, individuals with bipolar disorder also endure long-term stigma. Stigma reflects attitudes towards specific groups without objective evaluation. Certain groups are perceived as unable to meet societal norms due to their limitations. It stems from misconceptions and fear, leading to discrimination, exclusion, and deep shame. Stigma has long posed a significant barrier to the survival and recovery of individuals with mental disorders, including bipolar disorder. Therefore, addressing and reducing the stigma these patients face should be a key focus of our research. Stigma further marginalizes individuals with bipolar disorder, delaying care, damaging relationships, and eventually lowering quality of life. Modern society should adopt a more supportive attitude and work to improve bipolar disorder treatment outcomes. The key approach is eliminating misunderstandings, promoting awareness, and building an inclusive society with the necessary resources. Above all, the most important thing is to correct people's long-held misconceptions about bipolar disorder.

“When you provide abortion services, you are looked upon as a bad guy”: experiences of abortion stigma by health providers in Nigeria

ABSTRACT Background Abortion stigma as reported globally has been inadequately documented empirically in Nigeria, Africa’s most populous country with a restrictive abortion law and a high rate of unsafe abortions. Objective The objectives of this study were to investigate the ways in which abortion stigma is experienced by Nigerian health professionals and how such experiences influence health professionals’ practice of safe abortion and post-abortion care. Methods The study utilized qualitative research consisting of in-depth interviews with 10 abortion providers. We elicited information with an open-ended interview guide that investigated the understanding of participants’ experiences of abortion stigma in Nigeria. The data were analysed qualitatively and thematically using Atlas.ti. Results The themes centred on perceptions and experiences of stigma among the providers interviewed. Participants’ experiences of abortion stigma included the following: being treated differently to other health professionals; experiencing disapproval and disrespect; name-calling and societal judgement; tagging and profiling of clinics by anti-abortionists; and social isolation. Participants attributed stigma to cultural and religious beliefs, the restrictive national abortion law, and pointed to hypocrisy. Some reported effects of stigma on providers included a feeling of insecurity, social exclusion, secrecy, and insincerity in clinical practice, discouragement, and guilt feelings. Despite the negative impacts, many respondents reported a sense of satisfaction stemming from their views that they were saving lives. Conclusion Systematic efforts to address these adverse factors could reduce the level of stigma experienced by providers, with a potential follow-through effect of improving women’s access to safe abortion care in Nigeria.

Multilevel Sexual Minority Stigma-Based Experiences and Mental Health Among U.S. Sexual Minority Adults: A Socio-Ecological Longitudinal Moderated Mediation Analysis

Abstract Background The current study aimed to longitudinally examine whether intrapersonal stigma (i.e., internalized stigma; identity concealment) mediates the associations between interpersonal stigma (i.e., adulthood and childhood victimization; everyday discrimination; perceived external stigma) and mental health outcomes among sexual minority adults, and as a function of two moderators: structural climate and generation. Methods Data from 600 sexual minorities across three generations (i.e., ages 18-25, 34-42, 48-55) who completed all three waves of the 2016-2019 Generations Study were merged with census division data on legal climate (2016 Human Rights Campaign State Equality Index). A series of three-wave time-lagged simplex moderated mediation models were estimated for each independent and dependent variable combination through two parallel mediators, with both moderators included on each independent-mediator variable pathway. Results Greater identity concealment partially explained the effects of perceived external stigma on greater psychological distress and suicidal ideation, but most strongly among older generations. Other mediation was not supported. Reversed sensitivity analyses revealed how identity concealment’s positive effect on suicidal ideation may be suppressed through lower adulthood victimization and, only among younger generations in higher stigma climates, how it’s positive effects on psychological distress and suicidal ideation may be suppressed through lower everyday discrimination. Conclusions Identity concealment may represent a salient mechanism through which sexual minorities navigate structural climates and the harmful effects of interpersonal stigma on distress and suicidal ideation. While the longitudinal findings provide some support for the cross-level effects of sexual minority stigma on mental health outcomes, further advanced time-lagged examinations are warranted.

The mediating effect of stigma on the relationship between fear of disease progression and social alienation in patients with haematological malignancies

ABSTRACT Objective: To explore the mediating effect of shame in patients with malignant haematological diseases between fear of disease progression and social alienation. Methods: Recruiting 310 patients with haematological malignancies as the research population, the convenience sampling method was used to investigate the general information questionnaire, the fear of disease progression scale, the social influence scale and the general alienation scale. Results: The patients with haematological malignancies scored (36.02 ± 9.74) points for fear of disease progression, (58.02 ± 9.52) points for stigma and (31.31 ± 5.85) points for social alienation. Social alienation in patients with haematologic malignancies was positively correlated with stigma (r = 0.500, P < 0.01) and fear of disease progression (r = 0.424, P < 0.01), and fear of disease progression was also positively correlated with stigma (r = 0.405, P < 0.01). Bootstrap test results showed that the mediating effect of stigma on the relationship between fear of disease progression and social alienation in patients with haematological malignancies was 0.159, accounting for 37.5% of the total effect. Conclusion: The sense of shame plays an intermediary role between fear of disease progression and social alienation in patients with malignant haematological diseases. Clinical nurses should pay attention to the current situation of fear and shame in patients with such diseases and take appropriate intervention measures to reduce the occurrence of negative emotions such as social alienation.

Analysing the Impact of Socioeconomic Factors on Mental Health Differences in Chinese Society: Integrating Cultural, Psychological and Technological Perspectives.

Mental health (MH) differences remain an issue in contemporary Chinese society, with various factors influencing individuals' well-being. This study investigates the complex connection between results related to psychological wellness and social issues, integrating cultural, psychological and technological perspectives. Through a quantitative research methodology, data were collected from 1000 individuals using a questionnaire survey and analysed using SPSS software. The study's findings shed light on the impact of socioeconomic status (SES) on MH stigma, help-seeking behaviour and overall well-being. The findings identify that lower SES was associated with heightened levels of MH stigma and decreased the search for assistance actions. Cultural beliefs emphasising MH stigma and societal expectations were identified as mediators in the connection involve SES and MH outcomes. Digital technology use emerged as a moderator, indicating that higher levels of technology utilisation were linked to reduced disparities in accessing MH resources. The novelty of this study lies in its comprehensive examination of the multifaceted factors influencing MH disparities within Chinese society. Additionally, psychological factors such as resilience and social support were observed to mitigate the negative lower SES's effect on MH consequences. The interaction between SES and cultural factors was found to predict MH outcomes, with lower SES exacerbating the effects of MH stigma and cultural barriers.

Flexibility stigma, supervisory support, and the use of flexible work arrangements in the public sector: distinguishing flextime and flexplace

ABSTRACT This study examines the relationship between flexible work arrangements (FWAs) in the public sector and flexibility stigma, focusing on two types of FWAs based on work schedule and work location. Using data from the 2017 Federal Work-Life Survey of U.S. federal employees, the study analyzes how supervisory and organizational support influence the relationship between flexibility stigma and FWA use. Results show a negative relationship between flexibility stigma and flextime use, while flextime use varies by type of flextime. Supervisor and organizational support mitigated the negative effects of flexibility stigma, particularly for flextime and remote work. The findings suggest that enhancing supervisory support can reduce the effects of flexibility stigma and promote effective use of FWA in the public sector. This study provides new insights into how supervisory and organizational support systems can mitigate flexibility stigma and promote the adoption of various FWAs in the public sector.

The mindful resiliency in recovery model: empowering the transcendence of stigma.

Mindfulness-based interventions show unique promise in treating substance use disorders among marginalized populations who face heightened stigma. The Mindful Resiliency in Recovery Model is introduced as a novel theoretical framework articulating how mindfulness training can mitigate the adverse effects of stigma, enhance psychological resilience, and facilitate sustained recovery from addiction. The current manuscript synthesizes various models of mindfulness processes, stigma, and substance use disorder recovery to propose an integrated theoretical framework on the promise of mindfulness-based interventions in supporting recovery. Further, the current manuscript draws upon empirical literature to establish preliminary support for the premises and hypotheses of the Mindful Resiliency in Recovery Model concerning the mechanisms influencing the efficacy of mindfulness-based interventions among marginalized individuals. Preliminary evidence supports the premises of the proposed model. There is evidence to suggest that specific processes like increased present-moment awareness, acceptance, decentering, reappraisal, and savoring may be especially salient in mitigating internalized stigma and fostering resiliency in recovery. There is a need for additional research on these processes, and contextual factors that may moderate their efficacy. The Mindful Resiliency in Recovery Model has significant implications for optimizing mindfulness-based interventions to empower marginalized individuals to transcend stigma and actualize their capacity for wellbeing in substance use disorder recovery. It provides a roadmap for future research on the mechanisms and contextual factors affecting the efficacy of mindfulness-based interventions for marginalized and stigmatized communities. It further offers guidance to clinicians utilizing mindfulness-based interventions to support individuals experiencing stigma.

The Effect of Stigmatization on Diabetes Health Promotion Self-Care Behaviours and Predictors of Stigma and Self-Care Behaviours in Individuals With Type 2 Diabetes.

Individuals with type 2 diabetes are at risk of delaying or not performing diabetes health promotion self-care behaviours because of their social or self-stigmatization. The study aimed to reveal the effect of stigmatization on diabetes health promotion self-care behaviours and predictors of stigma and diabetes health promotion self-care behaviours in individuals with type 2 diabetes. This cross-sectional study included 235 individuals with type 2 diabetes. The Diabetes Stigma Assessment Scale (DSAS) and Diabetes Health Promotion Self-Care Scale (DHPSCS) were used for data collection. There was a significant, negative correlation between the DSAS and DHPSCS scores. High mean scores on the DSAS and its subscales treated differently, blame/judgement and self-stigma were predictors of a negative effect on diabetes self-care behaviours. Poor health status, alcohol intake and diabetes complications are predictive of stigma. Insulin use and self-monitoring blood glucose are predictors of self-care behaviours. Stigma negatively affects diabetes self-care behaviours in individuals with type 2 diabetes. Nurses could provide education on improvement of health status, harms of alcohol intake and management of diabetes complications. Counselling for coping with stigma and performing self-care could be provided. Nurses could organize interventions to raise awareness about diabetes in society.

The Impact of Stigma, Impacting Factors, and Measures to Reduce Stigma

This review illustrates definitions of stigma, types, effects of different aspects, factors contributing to different effects and ways to reduce stigma. There are three types of stigmas amongst mental illness stigma, physical deformation stigma, and stigma associated with broader social identities. Moreover, it shows two different effects of stigma, it then explains the consequences of different factors, including psychoglogical consequences and social practical consequences. At the end of the article,it shows the factors that influence stigma and measures to reduce it,and also have summary for the article and future development direction. To sum up, this review tells us a stigma is a negative attitude or idea about a mental, physical, or social feature of a person or group of people that involves social disapproval. We can know that stigma is the dynamic process by which one group imposes human inferiority on another group and maintains it. It is the stereotyping of the group's negative characteristics and thus the masking of other characteristics. Despite the negative effects of stigma, there are strategies to help cope with and overcome these challenges.

Development, validity and reliability of the “Multiple sclerosis stigma scale”

BackgroundStigma in multiple sclerosis (MS) refers to the negative attitudes, beliefs, and behaviors that patients may encounter as a result of their diagnosis. Patients who hold stigmatizing beliefs are more prone to experiencing anxiety and depression, social isolation, and poor treatment adherence. To mitigate the adverse effects of stigma, it is crucial to assess stigmatizing beliefs; however, there is currently no specific stigma scale available for MS. ObjectiveThe aim of this study was to develop and validate “Multiple Sclerosis Stigma Scale (MSSS)”. MethodsThis methodological study was conducted in three phases. In the first phase, the concept of stigma in MS was defined. In the second phase, an item pool was generated based on the findings from the first phase. In the third phase, psychometric properties of the scale were evaluated, including face and content validity, construct validity, convergent validity and reliability. ResultsAfter evaluating the validity (face, content, and construct validity) and reliability, the initial item pool of 276 items was reduced to 12 items. Factor analysis revealed two factors: discrimination and disclosure. The developed questionnaire had excellent reliability, with an internal consistency coefficient of 0.88 and a stability coefficient of 0.87. ConclusionThe 12-item MSSS is valid and reliable for assessing the level of stigma in Turkish people with MS.

Lesbian and Gay Population, Work Experience, and Well-Being: A Ten-Year Systematic Review.

Despite an increase in the promotion of equal opportunities at work, there is still persistent discrimination against lesbian and gay (LG) workers. In this vein, this study aimed to systematically review the research investigating the peculiarities of the work experience of LG people, particularly considering the theoretical frameworks in the approach to sexual minorities' work-related issues, as well as individual and contextual variables influencing the work experience and the impact they may have on health and well-being. We explored the PsycArticles, EMBASE, Scopus, and Web of Science electronic databases and the EBSCOHost (PsycInfo, Psychology and Behavioral Sciences Collection) scholarly search engine, between 01/01/2013 to 01/03/2023, with regards to the search terms "lgb*", "gay*", "lesbian*", "homosexual*", and "sexual minorit*", associated with "employee*", "personnel", "worker*", and "staff", and with "workplace", "work", "job", "occupation", "employment", and "career". Data were narratively synthesized and critically discussed. Of the 1584 potentially eligible articles, 140 papers contributed to this systematic review. Five main theoretical frameworks were identified: (a) minority stress, (b) sexual prejudice and stigma, (c) queer and Foucauldian paradigms, (d) social identity theories, and (e) intersectionality. Furthermore, significant individual (e.g., outness, disclosure, and work-family conflict) and contextual (e.g., heterosexist and heteronormative workplace climate and culture) variables influencing LG people's work experience were identified. This review highlights the need to develop a unified theoretical model for the construction of specific measurement tools to assess the work experience of LG people and for the implementation of interventions aimed at minimizing the effects of stigma in work contexts.

Associations Between PrEP Stigma, PrEP Confidence, and PrEP Adherence: Conditional Indirect Effects of Anticipated HIV Stigma.

Research has linked stigma surrounding preexposure prophylaxis (PrEP) to poor HIV prevention outcomes, including PrEP adherence. However, there remains a limited understanding of the mechanisms through which PrEP stigma affects PrEP adherence, specifically among sexual and gender minority (SGM) youth. In this study, we aimed to investigate the indirect effect of PrEP stigma on PrEP adherence through PrEP confidence and the moderating role of anticipated HIV stigma. Participants included 235 SGM youth, assigned male sex at birth, aged 16-24, and self-reported HIV-negative, with an active PrEP prescription from the Prepared, Protected, emPowered randomized controlled trial. Participants were recruited from 9 clinics in the United States between 2019 and 2021. Using baseline data, we tested cross-sectional indirect and conditional indirect effects using the Statistical Package for the Social Sciences Process with confidence intervals and 2000 resamples. We found significant indirect effects, suggesting that PrEP stigma was negatively associated with PrEP confidence, which in turn resulted in both monthly and weekly optimal PrEP adherence (Indirect effects: B = -0.11, Standard Error [SE] = 0.05, CI: [-0.244 to -0.032]; B = -0.09, SE = 0.04, CI: [-0.191 to -0.014], respectively). Anticipated HIV stigma moderated these indirect effects (B = -0.11, SE = 0.08, CI: [-0.315 to -0.001]; B = -0.09, SE = 0.06, CI: [-0.245 to -0.001], respectively), suggesting that the conditional indirect effects were significant at high but not low levels of anticipated HIV stigma. Results suggest that SGM youth who are on PrEP anticipating HIV stigma experience a compounding effect of PrEP stigma on PrEP confidence, consequently leading to suboptimal adherence. Interventions addressing the intersectionality of PrEP and HIV stigmas and enhancing confidence could improve PrEP adherence, particularly among SGM youth.

Clinical observations of weight stigma among nursing students: A descriptive approach.

Mistreatment of individuals due to their body size or weight stigma has been described as a source of stress and as a deterrent for engagement in the healthcare system. Efforts to reduce weight stigma have included curricular interventions to reduce weight bias among future healthcare professionals. However, few studies have examined students' observations of weight stigma and subsequent socialization to healthcare environmental norms. The purpose of this study is to evaluate observed weight stigma among pre-licensure nursing students and recent graduates during clinical rotations and its effect on the perceived ability to provide respectful care to people in larger bodies. A cross-sectional, descriptive study was conducted from February to March 2023. Participants answered questions related to personal weight bias (Fat Phobia Scale), observations of weight stigma, and perceived ability to provide respectful care. Ninety-one participants completed the survey, of whom half (n = 48) held a high level of weight bias. A quarter of participants (n = 23) reported that they engaged in weight stigma behaviors and a quarter (n = 24) of participants observed weight stigma behaviors from two or more healthcare professional roles. Almost one-third (n = 10) of participants who observed weight stigma behaviors perceived that it impacted their ability to provide respectful care to patients in larger bodies. These findings describe that weight stigma enacted by multiple healthcare professional roles is observed by nursing students during clinical rotations and is perceived to impact their ability to provide respectful care. Efforts to improve healthcare professionals' sensitivity to the effects of weight bias and weight stigma should include addressing the role of socialized norms on weight bias among future healthcare professionals.

Bisexual minority stress as a risk factor for sexual violence-related posttraumatic stress disorder symptoms among bisexual+ women: A multilevel analysis.

Bisexual+ (e.g., bisexual, pansexual, queer) women experience higher rates of sexual violence (SV) and posttraumatic stress disorder (PTSD) than heterosexual and lesbian women, as well as unique identity-related minority stress. We examined between- and within-person associations between bisexual minority stress and PTSD symptoms related to SV in a sample of young bisexual+ women (N = 133) who reported adult SV (Mage = 22.0 years, range: 18-25 years; 85.0% White; 99.3% cisgender). We analyzed data from four waves of data collection (baseline to 3-month follow-up) using multilevel models. Controlling for SV severity, there was a significant within-person effect of antibisexual stigma from lesbian/gay people on PTSD, β =.17, p =.010, suggesting that at waves when women experienced more stigma, they also reported higher PTSD symptom levels. At the between-person level, women who reported higher levels of antibisexual stigma from heterosexual people, β =.26, p =.043, and anticipated binegativity, β =.29, p =.005, on average across study waves also reported higher average levels of PTSD. Additionally, anticipated binegativity explained the association between average antibisexual stigma and PTSD, β =.15, p =.014, 95% CI [0.45, 4.61]. Bisexual minority stress may be associated with higher PTSD symptom severity following SV among young bisexual+ women, and the anticipation of binegativity may be a target mechanism in this association. Study findings highlight the importance of examining the joint contributions of SV and minority stress to identify novel targets for future research and practice to address PTSD symptoms.

Resistance to anti-smoking messages related to the higher smoking stigma of Korean female smokers.

The degree of perceived smoking stigma can differ, based on various factors such as gender; this may influence the effect of smoking cessation interventions, including denormalization. This study investigates the gender differences in smoking stigma recognized by Korean smokers and explores the effect of these differences on the success of smoking cessation messages that aim to initiate an identity crisis among smokers. It aims to contribute to effective smoking cessation intervention strategies for female smokers. The smoker-gender Implicit Association Test (IAT) was used to measure gender-based smoking stigma; the test comprised photos of people smoking, with positive and negative descriptors. Participants were 120 smokers aged 19-35 years (60 males and 60 females). Participants' cognitive attitudes toward smoking and cessation intentions were assessed at baseline. To investigate the effect of social stigmatization on smokers, participants were asked to watch anti-smoking campaigns that stigmatized either smoking behavior or smokers' self-identity. Cognitive attitudes and cessations intention were used to show differences in gender and message conditions. The IAT D-score showed that female smokers perceived other female smokers significantly more negatively than they did male smokers, suggesting a higher level of smoking stigma. Female smokers in the socially stigmatizing condition reduced their negativity toward smoking less than those who were not stigmatized. Moreover, cessation intentions did not improve when female smokers received identity-threatening messages, indicating that female smokers tended to resist stigmatizing messages. These findings provide empirical evidence that the gender of Korean smokers is significantly related to differences in smoking stigma. The negative perception and resistance responses of female smokers shown in this study are consistent with the findings of previous studies on the stigma of substance use disorders and addiction. High smoking stigma can also be a risk factor in anti-smoking interventions, including health communication; therefore, these findings should be interpreted with caution.

Development and Preliminary Validation of Stigma Measures for Care Partners of Persons Who Are d/Deaf or Hard of Hearing.

A great deal of literature documents the significant demands, both physical and psychosocial, that care partners experience when providing care to persons with a range of health conditions. There is, however, far less research available on care partners of adult persons who are d/Deaf or hard of hearing (d/DHH). In response to this gap, the authors developed measures of d/DHH stigma among care partners as part of the work of the Lancet Commission on Hearing Loss' Measures, Models, and Stigma Reduction Subgroup. The measures examined in this article are part of a larger set of parallel measures to enable comparison of stigma measurement across groups. The present study describes the preliminary validation of five stigma scales specifically tailored for use to assess the prevalence and effect of stigma on the care partners of adult people who are d/DHH in the United States. Care partners in this context are defined broadly and can include spouses, partners, adult children, siblings, and friends of persons who are d/DHH. The scales describe the care partner's own assessment of how the person who is d/DHH experiences and perceives stigma as well as the care partner's own internalized, experienced, and perceived stigma as a result of their association with a person who is d/DHH. This latter set of three scales describes secondary stigma, or the stigma a person experiences related to their association with a member of a stigmatized group. Measures were developed through a process that included a literature review, Delphi groups with people who became d/DHH after they developed spoken language, cognitive interviews, and a pretest. An online, self-administered preliminary validation survey was conducted with 151 care partners. Results support the internal reliability of each of the five stigma scales (ordinal α's all greater than 0.9) and that each scale is assessing a single factor. Additional testing is needed to confirm the validity of these measures. After further validation, they can be used to assess the prevalence and effect of stigma on care partners of persons who are d/DHH and to evaluate the success of interventions developed to address stigma and its effects both on the care partner and the person who is d/DHH and receiving the care.

Preliminary Validation of Hearing Device-Related Stigma Measures in Four United States Populations.

Although hearing devices such as cochlear implants and hearing aids often improve communication, many people who are d/Deaf or hard of hearing (d/DHH) choose not to use them. Hearing device-related stigma, or negative societal beliefs about people who use hearing devices, often drives this decision. Although much research has documented the negative effects of hearing device-related stigma, no widely accepted, validated measure to quantify such stigma across populations currently exists. In this article, we describe the preliminary validation of four distinct but related scales measuring hearing device-related stigma in different populations, including people who use hearing devices and those close to them. We preliminarily validated four measures for quantifying hearing device-related stigma in different populations that were previously developed and refined through a literature review, Delphi interviews, cognitive interviews, and a pretest. We preliminarily validated these measures through self-administered online surveys in a convenience sample in the United States. Among participants who use a hearing device and who either (a) self-identified as being d/DHH before they developed language (lifelong; n = 78) or (b) those who self-identified as having acquired a d/DHH identity after they developed language (acquired n = 71), we validated an anticipated hearing device-related stigma scale (d/DHHS-LE-HDA). We validated three scales that measure perceived hearing device-related stigma observed by parents of children who are d/DHH and who use a hearing device (n = 79) (d/DHHS-P-HDPO), care partners of adults who are d/DHH and use a hearing device (n = 108) (d/DHHS-CP-HDPO), and health care providers (n = 203) (d/DHHS-HCP-HDSH). Exploratory factor analysis assessed the reliability of each measure. Each of the four scales loaded onto one factor. Factor loadings for the eight-item scale measuring anticipated hearing device-related stigma among the two populations with lived experience ranged from 0.635 to 0.910, with an ordinal α of 0.93 in the lifelong d/DHH participants and 0.94 among the acquired d/DHH participants. The six-item scale of perceived stigma observed by parents had item loadings from 0.630 to 0.920 (α = 0.91). The nine-item scale of hearing device-related stigma observed by care partners had item loadings from 0.554 to 0.922 (α = 0.95). The eight-item scale of hearing device-related stigma reported by health care providers had item loadings from 0.647 to 0.941 (α = 0.89). Preliminary validation results show that the four stigma measures perform well in their respective populations. The anticipated stigma scale performed similarly well for both lifelong d/DHH and acquired d/DHH, which suggests that it could perform well in different contexts. Future research should further validate the scales described here as well as measure hearing device-related stigma in different populations-including people who live in different geographic regions and people using different kinds of hearing devices-and evaluate the success of interventions developed to reduce hearing device-related stigma.