Stigma Communication Research Articles

Exploring Stigma Communication About Urinary Tract Infections in the United States

ABSTRACT Urinary tract infections (UTIs) have steadily increased in prevalence and severity among women in the United States and can lead to serious complications if left untreated. Yet, women are often reluctant to discuss such infections due to potential stigmatization. Indeed, UTI treatment and prevention often involves communication with intimate partners and physicians, and this communication can require stigma management. Further, stigma communication can influence women’s experiences with UTI symptoms and treatment. The theory of stigma management communication is well-suited to explore how stigma-related communication unfolds about the experience, diagnosis, and treatment of UTIs. The current study uses in-depth interviews conducted in 2022 to learn about experiences with stigma communication surrounding UTIs. Findings reveal that participants perceived UTIs as stigmatized due to associations between UTIs and female gender, sexual behavior, genital health, and hygiene. Participants described using stigma management strategies to accept, ignore, avoid, reduce responsibility for, and challenge stigmas related to UTIs. This analysis has implications for theorizing choice in stigma management research and for provider-patient interactions surrounding UTIs.

The Disparate Prosocial Implications of Ongoing Entertainment Health Media Exposure: A Multi-Malady Stigma Communication Comparison

ABSTRACT Entertainment media is observed to influence perceptions toward those managing major health conditions. In this study, a U.S. representative sample Qualtrics survey (N = 599) is conducted to how routine exposure to illnesses of notable public health concern is comparatively associated with potentially disparate mediated contact outcomes on stereotype content model and reasoned-action approach-related social perceptions and inclinations. Supporting mediated contact premises, evidence suggests largely prosocial outcomes related to routine entertainment health media exposure (e.g. enhanced attitudes, warmth, and social distance perceptions), though health identities stereotypically linked with stigma communication cues (e.g. peril, etiology) were least associated with prosocial attributions.

The Effect of Information Exposure on Stigma Toward the COVID-19 Patient Mediated by Perceived Risk, Attribution of Blame and Protection Norm Conformity

ABSTRACT This study employed the model of stigma communication (MSC) to analyze how exposure to COVID-19-related information affected stigma-related information sharing about people who contracted COVID-19 during the pandemic and examined the cognitive process of the MSC in a collectivist culture. Based on a survey of 526 social media users during the COVID-19 pandemic in China, the study found that exposure to contact tracing information and pandemic control information had different impact on stigma-related information sharing through a series of cognitive variables. A dual-path model showed that perceived personal risk influenced stigma-related information sharing through attribution of blame toward the infected (the personal path), while perceived social risk influenced stigma-related information sharing through protection norm conformity (the social path). Compared to the personal path, the social path is more salient in shaping stigmatized attitudes and behaviors. The findings and discussions added to our understanding of the intricate stigma communication process in a collectivist culture.

Veterans’ Exposure to News Portrayals of Military-Related Posttraumatic Stress and Support for Government Health Interventions: Influences of Stigma and Halo Communication

This study interrogates the nature by which media perpetuates and potentially preempts stigma about military-related posttraumatic stress. Indeed, addressing the stigma of mental illness is critical to facilitating veteran comfort in seeking needed mental health care. Therefore, the authors explored how media messages about veterans experiencing posttraumatic stress (PTS) influenced how veterans viewed themselves, other veterans experiencing PTS and overall support for government policy and intervention. An experimental design was used to assess how veterans’ perceptions are affected by messages adhering to the principles of the model of stigma communication, as well as its more prosocial counterpart, what the authors coin as halo communication. Findings reveal evidence that stigma messages more potently influence outcome perceptions relative to comparable halo messages in the current context. Additionally, interactive effects of message exposure (i.e. conditioned by perceived association with PTS identity) were observed on views that government health intervention is warranted for veterans managing PTS. Practical and theoretical implications are discussed.

A sentiment and content analysis of tweets on monkeypox stigma among the LGBTQ+ community: A cue to risk communication plan.

The stigma associated with monkeypox (mpox) may prevent people from following recommended guidelines. Using a "model of stigma communication," this study maps and determines the mpox stigma on Twitter among LGBTQ+ (Lesbian, gay, bisexual, transgender, queer and more) community. The tweets that contained the terms '#monkeypox', '#MPVS', '#stigma', and '#LGBTQ+' and were published between May 01, 2022 and Sept 07, 2022 were extracted. For sentiment analysis, the VADER, Text Blob, and Flair analysers were implemented. This study evaluated the dynamics of stigma communication based on the "model of stigma communication". A total of 70,832 tweets were extracted, from which 66,387 tweets were passed to the sentiment analyser and 3100 tweets were randomly selected for manual coding. Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria was adopted to report this study. This research provided insight on the cause, communication, and patterns of mpox stigma in the LGBTQ+ community. In the community, stigmatisation was influenced by the group's labelling as the source of monkeypox. Some users believed that mpox resembled previously observed diseases such as HIV/AIDS, and COVID-19. Despite officials and media outlets disseminating information about preventing mpox and stigmatisation, a number of individuals failed to comply. The LGBTQ+ community faced peril in the form of violence due to escalating stigma. Misinformation and misinterpretation spread further stigmatisation. This study indicates that authorities must address misinformation, stigmatization of the LGBTQ+ community, and the absence of a comprehensive risk-communication plan to improve the system. The effects of stigmatization on the vulnerable population must be handled in conjunction with a well-developed risk communication plan, without jeopardizing their wellbeing.

Weight Stigma in Online News Images: A Visual Content Analysis of Stigma Communication in the Depictions of Individuals with Obesity in U.S. and U.K. News

Weight stigma is a pervasive form of discrimination worldwide. News media, and news images in particular, can reinforce weight stigma by portraying persons with obesity in a negative, stereotypical manner. Informed by the model of stigma communication, this study conducted a content analysis of images accompanying obesity-related news articles from the U.S. and U.K. to determine and compare the prevalence of stigmatizing images. Images (N = 445) in obesity-focused news articles obtained from the top four most viewed online news in the U.S. (n = 244) and U.K. (n = 201) during August 2018–August 2019 were systematically coded. These 445 images featured 228 individuals. Of these 228 individuals, 35% were identified as higher weight and 44% as lower weight. Overall, 70% of persons of higher weight in these news images were depicted in a stigmatizing manner. Further, 46% of individuals with higher weight were depicted with their head partially or fully removed from the image, compared to 25% of individuals with lower weight. Additionally, U.K. news were 2.5 times more likely to contain stigmatizing images than U.S. news. These findings highlight the prevalence of weight stigma in news images and suggest that broader systemic efforts are needed by the news media industry to eliminate the use of negative imagery that marginalizes persons of higher weight.

Health stigma on Twitter: investigating the prevalence and type of stigma communication in tweets about different conditions and disorders

BackgroundHealth-related stigma can act as a barrier to seeking treatment and can negatively impact wellbeing. Comparing stigma communication across different conditions may generate insights previously lacking from condition-specific approaches and help to broaden our understanding of health stigma as a whole.MethodA sequential explanatory mixed-methods approach was used to investigate the prevalence and type of health-related stigma on Twitter by extracting 1.8 million tweets referring to five potentially stigmatized health conditions and disorders (PSHCDs): Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS), Diabetes, Eating Disorders, Alcoholism, and Substance Use Disorders (SUD). Firstly, 1,500 tweets were manually coded by stigma communication type, followed by a larger sentiment analysis (n = 250,000). Finally, the most prevalent category of tweets, “Anti-Stigma and Advice” (n = 273), was thematically analyzed to contextualize and explain its prevalence.ResultsWe found differences in stigma communication between PSHCDs. Tweets referring to substance use disorders were frequently accompanied by messages of societal peril. Whereas, HIV/AIDS related tweets were most associated with potential labels of stigma communication. We found consistencies between automatic tools for sentiment analysis and manual coding of stigma communication. Finally, the themes identified by our thematic analysis of anti-stigma and advice were Social Understanding, Need for Change, Encouragement and Support, and Information and Advice.ConclusionsDespite one third of health-related tweets being manually coded as potentially stigmatizing, the notable presence of anti-stigma suggests that efforts are being made by users to counter online health stigma. The negative sentiment and societal peril associated with substance use disorders reflects recent suggestions that, though attitudes have improved toward physical diseases in recent years, stigma around addiction has seen little decline. Finally, consistencies between our manual coding and automatic tools for identifying language features of harmful content, suggest that machine learning approaches may be a reasonable next step for identifying general health-related stigma online.

How do people tweet about gay and bisexual people surrounding the 2022 monkeypox outbreak? An NLP-based text analysis of tweets in the U.S.

ABSTRACT Despite the United States government agencies’ efforts, inconsistent messaging about the causes of the 2022 monkeypox outbreak in the U.S. facilitates the potential stigmatization of gay and bisexual communities. Grounded in the model of stigma communication, this research describes how Twitter users communicate about the monkeypox outbreak and sexual minorities by analyzing US-based tweets containing the following search strings: “gay,” “bisexual,” or “monkeypox.” Using natural language processing (i.e. n-gram and sentiment analyses), this study uncovered that among tweets mentioning “gay” or “bisexual” with “monkeypox” together, stigmatizing phrases such as “gay disease” and negatively valenced words were common. Results were discussed in terms of the model of stigma communication and the potential influences of such communication on Twitter to a broader society.

Communicating Stigma About Invisible Illness: U.S. Military Veterans’ Descriptions of Stigma Communication About Posttraumatic Stress

ABSTRACT Due to mental illness stigma, veterans experiencing posttraumatic stress (PTS) may attempt to cope without seeking professional treatment. This can lead to detrimental consequences, including substance abuse, depression, and suicide. In an attempt to learn more about the stigma surrounding military-related PTS, this study used interviews to explore how veterans with PTS describe stigma communication in two different contexts: within the military organization and from members of society. All four of Smith’s (2007) model of stigma communication content cues (labels, marks, personal responsibility, and social peril) were present when veterans described military stigma about veterans experiencing PTS. Three content cues (labels, marks, and social peril) were present when veterans described public stigma surrounding veterans experiencing PTS. Theoretically, this study presents unique experiences related to how stigma is communicated about individuals experiencing an invisible illness, or what Goffman (1963) describes as “discreditable” individuals. Practically, the results can aid in developing destigmatizing campaigns and interventions.

Alcohol and other drug use: A qualitative exploration of staff and patient's experiences of language use as a means of stigma communication in hospital and primary care settings

IntroductionHospital and primary care settings present opportunities to interact, initiate conversations, and instigate referrals for patients experiencing harm from their alcohol and other drug use. Using a stigma communication model, our qualitative study explored whether stigma communication materialized in staff's language in the hospital and primary care settings, and if so, whether this had any impact on staff's and patients' experiences. MethodThe study conducted thematic analysis on 39 semi-structured interviews comprising both male and female adults (n = 20) who had experienced or were currently experiencing problematic alcohol or other drug use; and staff (n = 19) from either alcohol and other drug specialist services, or other broader health care services. ResultsThe study identified three themes where language use materialized as a means of stigma communication: (i) language that positioned a patient as undeserving; (ii) language that separated a patient from other patients; and (iii) language that blamed a patient. Where language use materialized as a means of stigma communication, this appeared to influence staff's decision-making, or potential avoidance of staff's obligations related to health care. Where language use materialized as a means of stigma communication for patients, poor experiences occurred for both staff and patients, that potentially influenced health care provision or future treatment-seeking intentions. ConclusionsThe use of language as a means of stigma communication was present in staff/patient interactions. Although a number of targeted interventions exist that address language and stigma toward people who use alcohol and other drugs, our findings indicate that change may be inhibited if staff do not realize that their own use of language may contribute to the perpetuation of stigma. The findings also suggest that aspects of language that materialize as a means of stigma communication may impact the “no wrong door” approach, which intends that people, regardless of which service they attend, receive appropriate support.

Culpability Framing Influences on Community Support for Those Managing Illness: A Multi-Malady Comparison of Mediated Health Stigma

ABSTRACT Prior research demonstrates an influence of culpability framing on news consumers’ perceptions about, and willingness to provide support for, those managing illness. Framing research of this sort has typically focused on the effect of frames on a particular health context (e.g. cancer). It is necessary to examine how three health frames which are overwhelmingly represented in health news could be uniquely influencing perceptions about those managing illness in a number of disparate health contexts. Specifically, we explore the nature of health frame influence as it relates to news reports regarding alcoholism, morbid obesity, and cancer. These illnesses represent the three of the most prominent health concerns for Americans that also vary in terms of how they relate to four chief cues for stigma communication. Experimental findings reveal unique ways in which culpability framing influences social support dispositions for those managing illness, as a function of intergroup anxiety perceptions.

Stigma Communication Surrounding Nonmedical Opioid Use Among Affected Family Members

ABSTRACT A growing body of research demonstrates the role of language in stigma toward nonmedical opioid use (NMOU). Terms like “substance abuser” perpetuate stereotypes and evoke punitive judgments. This study examines how affected family members (AFMs) communicate stigma when discussing their loved one’s NMOU. Semi-structured interviews were conducted with 34 adults with a close family member with a history of NMOU. An iterative approach was used to analyze instances when stigmatizing terms or messages were used. AFMs described people engaged in NMOU as underweight, “dirty,” or “nodding off,” and often labeled these individuals “addicts” or opioid “abusers.” Responsibility for the NMOU was attributed to both internal (e.g. choice) and external (e.g. brain disease) factors. People engaged in NMOU were linked to physical danger, resource threats, and threats to the family members’ reputation and relationships. While most stigma messages related to the person engaged in NMOU, stigmatizing messages directed toward AFMs also emerged; family members labeled “enablers” were judged, blamed, and described as a threat to the person engaged in NMOU. Although AFMs expressed care and desire to support their loved ones, they often conveyed stigma in their language choices. This language among AFMs may reflect internalized stigma. Increased efforts are needed to help AFMs cope with the challenges of a loved one’s NMOU and identify effective ways to support their loved one. One way AFMs can support their loved one is by using more inclusive, person-first language.

Twitter and Communicating Stigma about Medications to Treat Obesity

ABSTRACT In North America, stigma remains a significant barrier to treating obesity. Many candidates for medical weight management do not seek treatment, possibly related to anticipated and internalized stigma and weight bias. Pharmacologic treatment of obesity remains highly stigmatized, despite advances in drug development and medical weight management programs. People contemplating medical weight management are likely to see information about “diet pills” on social media sites, such as Twitter. However, Twitter has been found to contain false and stigmatizing information. This study examines a sample of 2170 Tweets to better understand the content through the lens of obesity stigma. Tweets were collected over a seven-day period containing general terms such as “diet pills,” “weight loss pills,” or “fat burner” using the Twitter advanced search option. The analysis revealed that almost 50% of Tweets containing “diet pills” contained stigmatizing language. The most common elements of stigma communication were taking personal blame for obesity and the perils associated with taking medications for weight loss. Further analysis revealed sub-themes such as profiting from social pressures to lose weight, distrust of physicians and the practice of obesity medicine, lack of efficacy of medications, and the use of social media to disseminate stigma. Most Tweets were from personal accounts followed by direct sales of weight loss supplements. The findings have potential implications for medically supervised weight management programs and may drive the need for more evidence-based social media messaging around obesity related healthcare.

Factors affecting stigma communication towards people living with HIV/AIDS

Purpose: This study aims to identify factors influencing the stigma communication concerning HIV (Human Immunodeficiency Virus)/AIDS (Acquired Immune Deficiency Syndrome) patients between health and medical college students. Methods: In this descriptive study, the participants were 158 college students from a certain university. Data were collected from September 18 to September 30, 2018. Self-reported questionnaires were used to measure AIDS-related knowledge, homosexual awareness, fear of HIV/AIDS patients and stigma communication. The collected data were analyzed with descriptive statistics, an independent t-test, one way analysis of variance, Pearson’s correlation and a stepwise multiple regression analysis using the SPSS 23.0 program.Results: The factors influencing the stigma communication between health and medical college students were a fear of HIV/AIDS patients (<i>β</i>=.47, <i>p</i>＜.001) and homosexual awareness (<i>β</i>=-.15, <i>p</i>=.040), which together explained 28.0% of the variance in the model. Conclusion: The study findings suggest that an education program for health and medical college students should be developed. Additionally, when designing the education program, it is recommended that the contents for inducing attitude changes should include affective areas as well as knowledge-oriented contents. The study suggests that it is necessary to provide a systematic education program to decrease the stigma for HIV/AIDS patients before health care providers enter clinical practice.

The Influence of Stigmatizing Messages on Danger Appraisal: Examining the Model of Stigma Communication for Opioid-Related Stigma, Policy Support, and Related Outcomes

ABSTRACT Drug overdose is a leading cause of injury and death in the United States, and opioids are among the most significant of causes. For people with opioid use disorders (OUDs), opioid stigma can lead to devastating consequences, including anxiety and depression. Still, mass media may stigmatize people with OUDs by ascribing stigmatizing labels (e.g., “opioid addict”) and other stigma features to those individuals. However, it is unclear how these stigmatizing messages influence public perceptions of people with OUDs and public support for rehabilitation and Naloxone administration policies. The model of stigma communication (MSC) provides a framework for understanding these relationships. This study used the MSC in two online factorial experiments, the first among college undergraduates (N = 231) and the second among Amazon Mechanical Turk workers (N = 245), to examine how stigmatizing messages about people with OUDs influence stigma-related outcomes. Results reveal that opioid stigma messages influence different outcomes depending on the content of those messages. Classification messages with a stigmatizing mark (e.g., “Alex appears unkempt”) and label (e.g., “opioid addict”) led to greater perceptions of dangerousness and threat in both studies. High stigma classification messages also led to an increased desire for behavioral regulation and social distance in Study 2. Structural equation modeling in Study 1 also supported the applicability of the MSC in the opioid context. Implications for health communication theory development and practice are discussed.

Social stigma and cultural beliefs associated with cleft lip and/or palate: parental perceptions of their experience in Kenya

Cleft lip with or without cleft palate (CL/P)—a condition associated with speech, hearing, feeding, and dental problems, as well as anomalies of the bone and soft tissue around the mouth—is a common birth defect around the globe. The prevalence of this condition varies widely across different countries and regions, and is apparently highest among Asians and lowest among Africans. A review of literature reveals that there exists a dearth of information on experiences of parents of children with CL/P and stigma communication, as well as cultural beliefs associated with CL/P in Africa. To fill this gap, we conducted a descriptive qualitative study examining the experiences of parents of children with CL/P, stigma communication, and cultural beliefs associated with CL/P in Kenya. Twenty four in-depth interviews were done involving purposefully sampled parents of children born with CL/P at AIC CURE International Hospital in Nairobi, Kenya. Five overarching themes emerged under the lived experiences of parents of children with CL/P: Emotional experiences; relational experiences; burden of care and concerns; reaction by the public and friends; and source of social support. The stigma messages and beliefs associated with CL/P further exacerbated the stigma. The study revealed that stigma communication associated with CL/P remains a significant source of social and psychological anguish to parents and guardians of children with CL/P. These findings have critical implications for the management of stigma communication associated with CL/P. They point to the need for public awareness campaigns on CL/P to demystify the condition, its causes and treatment. The study shows that raising public awareness of CL/P would go a long way towards addressing the stigma associated with the condition. It underscores the need for open communication and engagement with all stakeholders to manage stigma communication associated with CL/P through culturally appropriate anti-stigma campaigns.

Constructing and Communicating COVID-19 Stigma on Twitter: A Content Analysis of Tweets during the Early Stage of the COVID-19 Outbreak.

This study focuses on stigma communication about COVID-19 on Twitter in the early stage of the outbreak, given the lack of information and rapid global expansion of new cases during this period. Guided by the model of stigma communication, we examine four types of message content, namely mark, group labeling, responsibility, and peril, that are instrumental in forming stigma beliefs and sharing stigma messages. We also explore whether the presence of misinformation and conspiracy theories in COVID-19-related tweets is associated with the presence of COVID-19 stigma content. A total of 155,353 unique COVID-19-related tweets posted between December 31, 2019, and March 13, 2020, were identified, from which 7000 tweets were randomly selected for manual coding. Results showed that the peril of COVID-19 was mentioned the most often, followed by mark, responsibility, and group labeling content. Tweets with conspiracy theories were more likely to include group labeling and responsibility information, but less likely to mention COVID-19 peril. Public health agencies should be aware of the unintentional stigmatization of COVID-19 in public health messages and the urgency to engage and educate the public about the facts of COVID-19.

Stigma Communication and Adverse Ramifications of Stigmas Associated with Sex Work

Stigma Communication and Adverse Ramifications of Stigmas Associated with Sex Work

Autism stigma in communication classrooms: exploring peer attitudes and motivations toward interacting with atypical students

ABSTRACTCollege students with autism spectrum disorder (ASD) face unique social barriers and are often stigmatized by their peers. Communication and instruction researchers are uniquely positioned to foster an inclusive communication climate in the classroom that minimizes stigma and promotes peer acceptance. To do so, instructors must understand how stigma operates in the classroom—including the features, reactions, and effects of peer stigma communication. The present study utilizes the model of stigma communication (MSC; Smith, [2007]. Language of the lost: An explication of stigma communication. Communication Theory, 17, 462–485. doi: 10.1111/j.1468-2885.2007.00307.x) to explore those three facets of the stigma communication process using a mixed methods design. Results showed that attitudes significantly predicted both social distance and openness toward interaction with atypical students. Though participants expressed generally positive attitudes toward classroom inclusion, open-ended feedback revealed stigmatized beliefs and desired social distance from peers with ASD. Based on these results, we provide implications for and strategies to promote an inclusive classroom climate for students with ASD.

Obesity Stigmas in News Stories and the Role of Sources in Two Leading Newspapers in the United States and South Korea

Regardless of the gap in the number of countries with low versus high obesity rates, a similar degree of negative perceptions about obesity and obese individuals is pervasive throughout the world. Despite the inevitable negative social conception of obesity and obese individuals regardless of their country origins, little research has explored (a) the likelihood that newspapers contributed to the obesity stigmatization in societies and (b) how different, if at all, newspapers in those countries depicted obesity and obese individuals in news stories. Undergirded by the attribution theory and the model of stigma communication, a content analysis of two leading newspapers—one in the United States and one in South Korea—found that the American newspaper produced more stories with obesity stigmas than the Korean newspaper. Unlike the assumption of the attribution theory, news stories with an obesity stigma included not only personal, but also social levels of attributions of obesity in both countries’ newspapers. However, health expert sources might cancel out the potential harms of situating obesity-related stigmas in news stories in both newspapers. Implications of stigma communication are discussed to understand the possibility of biased, unhealthy news production.