Experiences Of Discrimination Research Articles

Medical Mistrust Among Black Patients with Serious Illness: A Mixed Methods Study.

Medical mistrust among Black patients has been used to explain the existence of well-documented racial inequities at the end of life that negatively impact this group. However, there are few studies that describe patient perspectives around the impact of racism and discriminatory experiences on mistrust within the context of serious illness. To better characterize experiences of racism and discrimination among patients with serious illness and its association with medical mistrust. Seventy-two Black participants with serious illness hospitalized at an academic county hospital. This is a convergent mixed methods study using data from participant-completed surveys and existing semi-structured interviews eliciting participants' perspectives around their experiences with medical racism, communication, and decision-making. The experience of medical racism and its association with Group-Based Medical Mistrust (GBMM) scale scores, a validated measure of medical mistrust. Of the 72 Black participants, 35% participated in interviews. Participants were mostly men who had significant socioeconomic disadvantage, including low levels of wealth, income, and educational attainment. There were reported high levels of race-based mistrust in the overall GBMM scale score (mean [SD], 36.6 [9.9]), as well as high scores within the suspicion (14.2 [5.0]), group disparities in healthcare (9.9 [2.8]), and lack of support (9.1 [2.7]) subscales. Three qualitative themes aligned with the GBMM subscales. Participants expressed skepticism of healthcare workers (HCWs) and modern medicine, recounted personal experiences of discrimination in the medical setting, and were frustrated with poor communication from HCWs. This study found high levels of mistrust among Black patients with serious illness. Suspicion of HCWs, disparities in healthcare by race, and a lack of support from HCWs were overarching themes that influenced medical mistrust. Critical, race-conscious approaches are needed to create strategies and frameworks to improve the trustworthiness of healthcare institutions and workers.

“I was told that people might hurt me”: Experiences of religious discrimination among Jewish, Christian, and Alevi youth in Turkey

AbstractThis study investigates the experiences of young members of Alevi, Christian, and Jewish religious minorities in Turkey, a secular country with a Sunni Muslim majority. Data was collected through semi structured interviews with 29 participants aged from 17 to 24. A thematic analysis was employed to explore patterns of discrimination and exclusion in their everyday lives. The experiences of Jewish and Christian participants are characterized by ostracism, increased vulnerability to injury, and passing as a member of the majority. Alevi participants report being subjected to intense pressure to become assimilated into majority Sunni practices, as well as frequent exposure to harshly unfavourable stereotypes, and ongoing rejection of Alevi theology as a ‘true’ belief system. The discussion centres on the issue of misrecognition and, particularly, denial of identity, contextualizes the findings into broader dynamics of nation‐state politics, and focuses attention on the agency of minorities and majorities. Limitations of the study and recommendations for future research have also been presented. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Joy Beyond the Gender Binary: Experiences, Constructions, and Barriers of Joy in Nonbinary Lives

ABSTRACT Sociologists have increasingly begun exploring the experiences of gender-expansive populations; however, these studies are oversaturated with negative experiences of prejudice and discrimination and do not accurately portray the joy that accompanies identifying outside of the gender binary. This omission of joy prevents a comprehensive exploration of gender-expansive lives, potentially reinforcing stereotypes and contributing to the marginalization of their diverse narratives. To address the growing concern about the “joy deficit” in sociology and trans studies, I conducted in-depth interviews with 28 nonbinary people in which they discussed their experiences of joy. This study identifies four key dimensions of nonbinary joy: 1) discovery of gender identity; 2) authentic expression of gender; 3) external affirmation of identity and expression; and 4) engagement with validating communities. However, interviewees also discussed individual and social factors that frequently created barriers to experiencing these forms of joy. By examining both the sources of nonbinary joy and obstacles to its realization, this research contributes to a more nuanced understanding of gender-expansive identities. Furthermore, this project reveals joy as a social constructed phenomenon, influenced by structural factors that govern its accessibility and manifestation, rather than an individual state of being.

Health and Well-Being Among College Students in the United States During the COVID-19 Pandemic: Daily Diary Study.

There is evidence that anxiety and stress increased among college students during the COVID-19 pandemic. However, less is known about daily experiences of affect, worry, substance use behaviors, experiences of pleasure, concern over food security, experiences of bias or discrimination, feelings of belongingness, and other indicators of well-being and how they vary across days in this population. This study surveyed a wide range of indicators of health and well-being in daily life over 21 days with a sample of college students in a large university system in the United States during the pandemic. The overall variance in each daily measure was partitioned to reflect the proportion due to (1) between-person differences versus (2) within-person, day-to-day variability. This is important because measures that vary primarily due to between-person differences may be more amenable to interventions that target particular students, whereas measures that vary more due to day-to-day variability may be more amenable to interventions that target day-level contextual factors. A sample of 2068 young adult college students (aged 18-24, mean 19.8, SD 1.3 years; 66.6% women) completed a baseline survey; 97.3% (n=2012) then completed up to 21 consecutive daily surveys that assessed a comprehensive set of daily markers of health, behavior, and well-being. The daily diary study produced a total of 33,722 person-days. Among all person-days, a minority were substance use days (eg, 14.5% of days involved alcohol use, 5.6% vaping, and 5.5% cannabis). Experiences of pleasure were reported on most (73.5%) days. Between-person differences explained more than 50% of the variance in numerous indicators of health and well-being, including daily vaping, cannabis use, other illicit substance use, experiences of bias or discrimination, positive affect, negative affect, worry, food insecurity, and feelings of belonging at the university. In contrast, within-person differences explained more than 50% of the variance in daily alcohol use, cigarette use, stress, experiences of pleasure, where the student slept last night, and physical activity. College student health and well-being are multifaceted, with some aspects likely driven by person-level characteristics and experiences and other aspects by more dynamic, contextual risk factors that occur in daily life. These findings implicate services and interventions that should target individual students versus those that should target days on which students are at high risk for poor experiences or behaviors.

Relationships Among Internalized Stigma, Readiness to Change and Treatment Eagerness, and Recovery Among Individuals With Substance Use Disorder in Turkey.

To investigate relationships among internalized stigma, readiness to change and treatment eagerness, and recovery among people with substance use disorder (SUD) (N = 131). This study used a cross-sectional and correlational research design. Multiple linear regression was used for analysis. A 1-unit increase in alienation and discrimination experiences led to 0.220- and 0.337-unit increases in readiness to change and treatment eagerness, respectively (p = 0.001); however, a 1-unit increase in stigma resistance led to a 0.306-unit decrease in recovery (p < 0.001). There was a negative correlation between internalized stigma and recovery and positive correlations between internalized stigma and readiness to change and treatment eagerness; however, there was no significant relationship between recovery and readiness to change and treatment eagerness. Early intervention programs targeting internalized stigma in individuals with SUD may improve readiness to change and treatment eagerness and recovery attitudes. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Exploring cumulative identity-based discrimination, distress, and traumatic exposure among Muslims living in the United States.

Muslims living in the United States (MLUS), a highly heterogeneous group, experience high rates of discrimination that may cumulatively contribute to traumatic stress. This study explored whether identity-based discrimination (i.e., due to religion, gender, race) was individually and cumulatively associated with psychological distress and exposure to trauma among MLUS. Fifty-nine MLUS completed the survey at two time points (~1 year apart). We administered measures of discrimination (at Time 1), distress (at Times 1 and 2), and trauma exposure (at Time 2). Multiple linear regressions determined whether discrimination at Time 1 was associated with traumatic exposure or distress at Time 2, after controlling for covariates. Mediation analyses determined whether the relationship between cumulative discrimination and distress at Time 2 occurred via distress at Time 1. MLUS who reported experiencing both religious and racial discrimination also reported greater exposure to traumatic events, after controlling for covariates. All three forms of identity-based discrimination (religion, race, gender) were individually and cumulatively (i.e., experiencing all three) associated with distress at Time 1, but not Time 2. However, the relationships between cumulative discrimination at Time 1 and distress at Time 2 were mediated by distress at Time 1. U.S.-born Muslims were particularly at risk for experiencing discrimination, distress, and traumatic exposure. Experiences of discrimination may have a cumulative impact on trauma and psychological distress among MLUS. This study underscores the need for targeted interventions that assess MLUS clients' discriminatory experiences to develop a more holistic conceptualization, better support systems, and the most effective approaches. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Considerations to Optimize Structurally Responsive Work Environments for U.S. Military Specialty Physicians.

Recruitment, training, and retention of wartime critical specialty physicians may be stymied by discrimination and abuse. It is unclear to what extent the US combat specialty physicians witness or experience discrimination and abuse, whether they or others intervene, and if they would subsequently discourage people from entering their field. The present study surveyed US active duty anesthesiologists, emergency medicine physicians, and orthopedic surgeons (N = 243; 21% response rate). A generalized linear model evaluated the extent to which gender, specialty, service, and number of witnessed/experienced negative/stigmatizing comment/event types were associated with burnout. A bootstrapped mediation analysis evaluated whether gender and burnout were mediated by the number of comment/event types. The sample was majority non-Latine White (87%) and men (66%) with tri-service and specialty representation. The most commonly reported negative/stigmatizing comment/event types were related to pregnancy (62%) and parental leave (61%), followed by gender and assigned sex (42%), lactation (37%), and sexual harassment (35%). Of the respondents who witnessed/experienced such comments/events, self-intervention was reported after comments regarding lactation (43%), assigned sex and gender (42%), race and ethnicity (41%), pregnancy (41%), parental leave (37%), and sexual harassment (24%). Witnessing another person intervene was reported after sexual harassment (25%) and comments/events regarding race and ethnicity (24%), pregnancy (20%), assigned sex and gender (19%), lactation (19%), and parental leave (18%). Nonintervention was reported after comments/events related to parental leave (42%), pregnancy (38%), sexual harassment (26%), lactation (26%), assigned sex and gender (26%), and race and ethnicity (22%). Respondents reported moderate-to-high intervening likelihood, importance, and confidence. Respondents reporting neutral to extremely agree on prompts indicating that pregnant active duty physicians are trying to avoid deployment (P = .002) and expect special treatment that burdens the department (P = .007) were disproportionately men (36% and 38%, respectively) compared to women (14% and 18%, respectively). The highest proportion of neutral to extremely agree responses regarding discouraging specialty selection were reported in relation to transgender and gender diverse students (21%), followed by cisgender female students (18%); gay, lesbian, or bisexual+ students (17%); cisgender male students (13%); and racial and ethnic minoritized students (12%). In the primary model, the number of witnessed/experienced comment/event types was associated with greater burnout (0.13, 95% CI 0.06-0.20, P = .001), but women did not report significantly different levels of burnout than men (0.20, 95% CI -0.10 to 0.51, P = 0.20). The number of comment/event types mediated the relationship between gender and burnout (0.18, 95% CI 0.06, 0.34; P < .001). Although reported intervening confidence, likelihood, and importance were high, it is unclear whether perceptions correspond to awareness of intervention need and behaviors. Bivariate differences in burnout levels between men and women were fully explained by the number of comment types in the mediation model. Annual trainings may not effectively address workplace climate optimization; institutions should consider targeted policy and programmatic efforts to ensure effective, structurally responsive approaches.

A Multistakeholder Qualitative Study to Inform Sexual Orientation and Gender Identity Data Collection in the Cancer Care Setting.

Purpose: Sexual and gender minoritized (SGM) populations face health disparities along the cancer care continuum, although attempts to define these disparities are limited by a lack of comprehensive sexual orientation and gender identity (SOGI) data collection. The objective of this study was to interview a diverse group of stakeholders to understand attitudes, barriers, and facilitators to inform data collection approaches in a cancer care setting. Methods: This was a qualitative study conducted from March to July 2023 with paired surveys of stakeholders including patients, caregivers, providers, and cancer registry staff. Twenty participants across these categories, including half who identified as SGM, completed surveys and interviews. Qualitative data were reduced to themes with exemplar quotations using rapid qualitative analysis methods and compared to survey data. Results: Themes revealed general support for SOGI data collection as part of holistic cancer care, and all participants acknowledged that specific SOGI-related information, particularly correct pronoun usage, was essential to inform patient-centered care. Themes revealed tensions around optimal SOGI data collection methods, mixed opinions on the relevance of sexual orientation, experiences of discrimination and discomfort related to SOGI, and limited acknowledgment of population benefits of SOGI data collection. Conclusion: Themes demonstrated overall support for SOGI data collection but also revealed several barriers, such as a lack of recognition of population benefits and experiences of discrimination and discomfort, that will need to be addressed to comprehensively collect these data. Based on diverse preferences and limitations of all methods of collection, a multimodal approach may be needed to optimize completion.

The Association Between Experienced Discrimination and Pain in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

The relationship between experienced discrimination and its effects on pain interference and management among racial disparities is not well explored. This research investigated these associations among Black and White U.S. adults. The analysis involved 9369 Black and White adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS), assessing experiences of discrimination, pain interference (SF-12), and pain treatment, incorporating factors like demographics, comorbidities, and stress. Black participants experiencing moderate discrimination were found to have a 41% increased likelihood of pain interference (aOR 1.41, 95% CI 1.02-1.95), similaritythose facing high levels of discriminationalso showed a 41% increase (aOR 1.41, 95% CI 1.06-1.86) compared to those without such experiences. White individuals reporting moderate discrimination also faced a heightened risk, with a 21% greater chance of pain interference (aOR 1.21, 95% CI 1.01-1.45). Notably, the presence of moderate discrimination among Black participants correlated with a 12% reduced probability of receiving pain treatment (aOR 0.88, 95% CI 0.56-1.37). Furthermore, Black, and White individuals who reported discrimination when seeking employment had a 33% (aOR 0.67, 95% CI 0.45-0.98) and 32% (aOR 0.68, 95% CI 0.48-0.96) lower likelihood, respectively, of receiving treated pain. The study elucidates how discrimination exacerbates pain interference and restricts access to treatment, affecting Black and White individuals differently. These findings underscore an urgent need for strategies to counteract discrimination's negative effects on healthcare outcomes. Addressing these disparities is crucial for advancing health equity and improving the overall quality of care.

Perceived leader inclusion and employee work-to-family conflict: a daily diary study

PurposeEmployees’ perceived inclusion has been shown to have beneficial effects on their effective functioning at work (e.g. engagement, creativity, and task performance); however, workplace inclusion is also believed to have a profound impact on employees’ functioning beyond the work domain, such as on their family domain. The primary goal of our study thus is to explore how perceptions of workplace inclusion influence employees’ family lives.Design/methodology/approachWe tested our hypotheses by surveying 125 employees from a cotton textile manufacturing company in China over 10 consecutive workdays.FindingsDaily perceived leader inclusion was negatively related to employees’ daily resource depletion at work, which in turn was positively related to employees’ daily work-to-family conflict. The direct effect of daily perceived leader inclusion on resource depletion and the indirect effect of daily perceived leader inclusion on work-to-family conflict were stronger for employees with more discrimination experience in their lives.Practical implicationsLeaders should be aware of their unique roles they play in shaping individual inclusion perceptions and should enact actions that satisfy employees’ desires for both belongingness and uniqueness. Moreover, leaders should also be attentive to those who are susceptible to discrimination when promoting inclusion initiatives.Originality/valueOur study proposes an important facet of workplace inclusion—perceived leader inclusion—and offers a resource perspective to understand how leader inclusion may impact employees’ functioning beyond the work domain to affect their family lives.

An Exploration of LGBTQA+ Young People’s Coping Strategies When Navigating Suicidal Thoughts and Behaviors

ABSTRACT LGBTQA+ young people experience suicidal thoughts and behaviors at a much greater rate than their heterosexual and cisgender peers. This study explored firsthand accounts of the coping strategies employed by LGBTQA+ young people when experiencing suicidal thoughts and behaviors. LGBTQA+ young people (N = 27; ages 14–25) in Australia with a history of suicidal thoughts and/or attempts participated in semi-structured interviews. Using reflexive thematic analysis, four major themes were developed: (1) It’s about the journey, not the destination, (2) Connecting with others, (3) When I knew better, I coped better, and (4) Doing the best I can with what I have. LGBTQA+ young people reported utilizing a range of coping strategies, however these were limited by a lack of knowledge around mental health, gender and sexuality diversity, and available resources. Experiences of discrimination within support settings and limited access to clinicians with knowledge of sexuality and gender diversity were cited as significant barriers. Interventions to increase mental health literacy in LGBTQA+ young people and improvements to clinician knowledge of sexuality and gender diversity are needed to enhance LGBTQA+ young people’s access to effective coping strategies when experiencing suicidal thoughts and behaviors.

Youth With Specific Learning Disorders: Attitudes and Clinical Decision-Making Among Mental Health Trainees

Individuals with disabilities often face discrimination due to negative attitudes from others around them. This is true for youth with specific learning disorders (SLD), whose experiences of discrimination can increase the risk for developing mental health concerns. The current study explored whether the presence of an SLD comorbid with mental health concerns and attitudes toward SLD may have an association with clinical decision-making in counselor trainees. The study additionally investigated the role of contact and experience in attitudes and decision-making patterns. Seventy graduate students enrolled in mental health-related programs at a public university in the southern United States participated in the survey study. Findings showed that SLD had an association with clinical decision-making, with counselor trainees rating a vignette depicting a youth with SLD as having more severe mental health concerns than a vignette without an SLD.

Associations Between Experiences of Discrimination, Socioeconomic and Racial Polarization, and Birth Outcomes in the Atlanta African American Maternal Child Cohort

Associations Between Experiences of Discrimination, Socioeconomic and Racial Polarization, and Birth Outcomes in the Atlanta African American Maternal Child Cohort

Perceived Weight Discrimination and General Coping Strategies.

Perceived weight discrimination is associated consistently with worse health outcomes. Coping strategies may be one mechanism of this association. The present research examined the association between perceived weight discrimination and strategies used to cope with general stress (not weight-specific) and whether these strategies accounted for part of the association with markers of health. Participants (N = 1882) completed a cross-sectional survey with a comprehensive measure of coping strategies and reported on their perceived experience of weight discrimination and markers of physical, mental, and social health. Perceived weight discrimination was associated with greater use of disengaged coping strategies (β = .19, p < .01) and was unrelated to active and support coping strategies. Disengaged coping mediated the association between weight discrimination and worse physical, mental, and social health (proportion of mediation ranged from 14 to 47%). This pathway was independent of body mass index (BMI). Individuals in the obesity weight category (BMI ≥ 30kg/m2) were less likely to use active (β = - .11, p < .01) and support (β = - .09, p < .01) coping strategies, which did not consistently mediate the association with health. Perceived experiences of weight discrimination are associated with disengaged coping strategies to manage stressful experiences, and these strategies are one mechanism that may contribute to the worse health associated with unfair treatment due to weight.

“So, You’re Not Doing This Right”: Faculty and Transgender Students’ University Classroom Experiences

Transgender people in the United States experience mistreatment and discrimination, as well as harassment and violence, at much higher rates than the general population. In university classrooms specifically, less conspicuous forms of prejudice-based behavior are even more common. This study aimed to gain an accurate understanding of cisgender faculty and transgender student perceptions and attitudes regarding the issues transgender students face in the classroom. Semi-structured, one-on-one interviews were conducted with cisgender faculty (n = 7) as well as two transgender students (n = 2) at a mid-sized U.S. university. Thematic analysis was conducted to identify and describe interviewees’ understanding of and concerns about transgender students’ experiences in the classroom. The interviewed cisgender faculty were aware of inappropriate comments among student peers that they viewed as requiring intervention. At the same time, they also described awareness of their own improper name or pronoun usage. The two transgender students described feelings of being separated from other students by virtue of their transgender identity, experiences of being tokenized, and being positioned by their professors in classrooms to represent all transgender students. Implications for positively and proactively addressing transgender students’ experiences of prejudice in higher education classrooms are presented.

Experiences of Prejudice and Discrimination from the Perspective of Syrian Migrants: A Qualitative Study in Türkiye

This study examines Syrian immigrants’ experiences of prejudice and discrimination, their causes, and solutions based on their own experiences. The findings obtained from in-depth interviews with the 20 participants selected using the snowball sampling method are as follows. There are experiences of prejudice and discrimination in business life, such as late employment, wage inequality, and marginalizing labels. Experiences of exclusion, such as marginalizing discourses and being treated differently, are evident in social life. The reasons for these phenomena are economic, social, and media factors. Social policies and education regulations are needed to prevent prejudice and discrimination. Among these suggestions, steps such as facilitating services for Syrians and improving Turkish language skills stand. This research makes an important contribution to the field in terms of addressing the causes and solutions of prejudice and discrimination against migrants based on their own experiences. Therefore, we argue that it is important to include the voices of migrants in future research on the causes and prevention of prejudice and discrimination.

Eliminating persistent racism from the workplace

PurposeThe purpose of this paper is to share learning about practical steps that can be taken to eliminate persistent racism from the workplace, including racism by people who have cognitive impairments who do not understand the impact of their behaviours.Design/methodology/approachThis paper is informed by qualitative research. An independent researcher was commissioned to recruit 45 black British, black African and black Caribbean women living in Norfolk and working for a range of employers. Parameters were agreed in advance (aims, consent, data protection). A list of questions was provided to the researcher. The questions covered experiences of prejudice and discrimination. Data collection included face to face/online/telephone interviews, focus groups and questionnaires. The researcher recorded the women’s views and compiled them in a findings report. The report was shared with the women to confirm that their views had been recorded accurately. The author has also convened conversations with over 100 professionals representing providers of public services, including social and domiciliary care.FindingsThe author identified that it will be impossible for employers to eliminate persistent racism from their workplaces until all managers consistently and diligently address every report of racism effectively, in line with the steps set out in this paper. The purpose is to establish, over time, a workplace culture where racism is never tolerated or allowed to persist, and workers and managers learn – and become more confident – to recognise, address and eliminate racism at work. Until this is embedded, racism affecting workers will continue to go unchecked and unacknowledged in the workplace.Research limitations/implicationsThe data gathered to inform this paper (specifically the research commissioned and described in this abstract, in addition to other data, such as conversations convened with professionals) is qualitative data. It cannot be assumed that the experiences of the people interviewed reflect the experiences of all people. However, the voices of participants have highlighted issues to inform future planning.Practical implicationsThe author must be clear that, so far there has been no definitive solution to persistent racism in the workplace. The learning so far is being shared with the hope that this assists others with developing strategies to eliminate persistent racism.Social implicationsWorkplaces across the UK are committed to eradicating racism. However, the rate of change is glacial. This research paper shares learning about how to address this, to increase the pace of change, to begin to genuinely eliminate persistent racism from the workplace.Originality/valueTo the author’s knowledge, the learning from this research is original and not replicated elsewhere.

Racial Socialization and Black Adolescent Mental Health and Developmental Outcomes: A Critical Review and Future Directions

ABSTRACT Objective Black American adolescents are beleaguered with the most frequent and severe experiences of racial discrimination (RD) among their peers. To protect Black adolescents’ mental health and developmental outcomes from the pernicious impact of discrimination, parents and other proximal adults and peers often utilize racial socialization (RS), or communications and behaviors emphasizing the importance of race and the harms of racism. While several recent RS reviews have been conducted across ethnicity, a modern review investigating RS practices related to and predictive of Black adolescent psychosocial outcomes is needed. Method To ground our critical systematic review of 45 articles, we first highlighted the ways RD impacts the lives of Black adolescents. Then, drawing from integrative models for Black youth development, we synthesized recent psychological, academic, and sociocultural literatures to describe the role of RS in Black adolescents’ wellness. Results The impact of various tenets of RS was seen most clearly as a protective factor against RD with respect to adolescents’ mental health (e.g. depression), academic achievement (e.g. GPA), and sociocultural identity (e.g. public and private racial regard) development. Cultural socialization, a strategy related to extolling pride for one’s race, was the most consistent RS protective factor, with novel RS constructs (e.g. parental competency) emerging as a method to buffer youth internalizing and externalizing problems. Conclusions Recommendations are made for future research on understudied components of RS and multiple methods and reporters to capture a more holistic depiction of RS practices. We emphasize preventative and intervening approaches to reduce the impetus for RS and its impact, including burgeoning clinical and community-level programs and the importance for provider training to yield positive mental health outcomes for Black adolescents.

Associations Between Weight Discrimination, Eating-Disorder-Related Psychiatric Impairment, and Eating-Disorder Treatment Interest Across the Weight Spectrum.

Only approximately 20% of college students with an eating disorder (ED) seek treatment. One barrier to seeking treatment is weight discrimination. Past research demonstrates that experiencing weight discrimination is associated with increased ED risk and decreased in-person treatment engagement. Weight discrimination may be a particularly relevant treatment barrier for students who have a higher body weight given their higher likelihood of experiencing weight discrimination. College students with a probable ED diagnosis (N = 372; Mage = 23.94; 73.12% women, 18.55% men, 6.18% another gender; 11.29% Asian, 4.57% Black, 12.63% Hispanic, 83.60% White, 4.84% Native American, and 0.54% another race) completed an online self-report survey that included the Clinical Impairment Assessment (CIA), Experience of Weight Discrimination (EWD) Scale, and a 0-100 scale to indicate interest in participating in virtual guided self-help ED treatment. Linear regression showed significant positive relationships between weight discrimination and ED-related psychiatric impairment and treatment interest. Elevations in CIA scores corroborate past literature that suggested that weight discrimination was positively related to ED psychopathology. Contrary to past research, college students who experienced weight discrimination had greater treatment interest. Students who experience weight discrimination may view virtual self-guided treatment as less weight-stigmatizing due to the "do-it-yourself" approach and no in-person interactions. Findings highlight the potential impacts of weight discrimination on acceptability of ED-related care. Future research is needed to identify ways to reduce weight discrimination and promote weight-inclusive practices in the medical system.

A person-reported cumulative social risk measure does not show bias by income and education

BackgroundSocial risk such as housing instability, trouble affording medical care and food insecurity are a downstream effect of social determinants of health (SDOHs) and are frequently associated with worse health. SDOHs include experiences of racism, sexism and other discrimination as well as differences in income and education. The collective effects of each social risk a person reports are called cumulative social risk. Cumulative social risk has traditionally been measured through counts or sum scores that treat each social risk as equivalent. We have proposed to use item response theory (IRT) as an alternative measure of person-reported cumulative social risk as IRT accounts for the severity in each risk and allows for more efficient screening with computerized adaptive testing.MethodsWe conducted a differential item functioning (DIF) analysis comparing IRT-based person-reported cumulative social risk scores by income and education in a population-based sample (n = 2122). Six social risk items were analyzed using the two-parameter logistic model and graded response model.ResultsAnalyses showed no DIF on an IRT-based cumulative social risk score by education level for the six items examined. Statistically significant DIF was found on three items by income level but the ultimate effect on the scores was negligible.ConclusionsResults suggest an IRT-based cumulative social risk score is not biased by education and income level and can be used for comparisons between groups. An IRT-based cumulative social risk score will be useful for combining datasets to examine policy factors affecting social risk and for more efficient screening of patients for social risk using computerized adaptive testing.