Disease avoidance as a functional basis for stigmatization

The psychological distress and mental health disorders from COVID-19 stigmatization in Ghana

The emergence of the COVID-19 global pandemic in Ghana has resulted in various degrees of stigmatization. Previous studies have stressed the need for developing policies to curb the stigma towards COVID-19 survivors and healthcare workers. Some have investigated the knowledge and willingness of people to accept COVID-19 survivors. Others have also explored the experiences of health workers who have been victims of stigma from COVID-19. There is a need for further studies to understand COVID-19 related stigma and related psychological distress. The purpose of this study was to investigate the cases of COVID-19 related stigma and discrimination against healthcare workers, COVID-19 recovered patients, suspected persons of COVID-19, Asians, and persons with travel history from COVID-19 hotspot countries. The study was undertaken using the phenomenology approach to qualitative research. Purposive and snowball sampling techniques were used in recruiting the twenty-eight study participants. Data were garnered using interviews and focus group discussions. Data were analyzed using interpretative phenomenological analysis. The findings revealed that COVID-19 victims have faced various forms of stigma such as stereotyping, social exclusion, mockery, finger-pointing, and insults. The study recommends that the COVID-19 National Response Team in Ghana must put in place a robust psychosocial intervention plan for stigmatized persons to help them cope with the stigma and help in its prevention.

Stigmatization of Chinese and Asian-looking people during the COVID-19 pandemic in Germany

BACKGROUND

The outbreak and global spread of COVID-19 was accompanied by an increase in reports of stigmatization of Chinese and Asian-looking people. The behavioral immune system provides a framework for stigmatization in response to infectious disease threats. Specifically, stigmatization might increase with rising levels of infectious disease threat. The present study aimed to examine this hypothesis during the early phase of the COVID-19 pandemic.

METHODS

As part of the "EUCLID" project ( https://euclid.dbvis.de ), a total of 5011 persons from Germany were surveyed via an online-questionnaire between February 2^nd and April 3^rd, 2020, covering the progression of the COVID-19 pandemic over three time periods which were defined by critical events.

RESULTS

There was no evidence for an increase in the stigmatization of Chinese and Asian-looking people across three topics, that is personal proximity, air travel, and medical measures upon arrival from China.

CONCLUSIONS

The present findings provide good news in that participants showed an adaptive response to the infectious disease threat rather than displaying increased stigmatization. Further research is necessary to specify the conditions that increase the risk of stigmatization in response to infectious disease threats.

Considerations of the proximate mechanisms and ultimate functions of disgust will improve our understanding of cleansing effects

To understand the consequences of cleansing, Lee and Schwarz favor a grounded procedures perspective over recently developed disgust theory. We believe that this position stems from three errors: (1) interpreting cleansing effects as broader than they are; (2) not detailing the proximate mechanisms underlying disgust; and (3) not detailing adaptive function versus system byproducts when developing the grounded procedures perspective.

Differential effects of progesterone on social recognition and the avoidance of pathogen threat by female mice

Although pathogen threat affects social and sexual responses across species, relatively little is known about the underlying neuroendocrine mechanisms. Progesterone has been speculated to be involved in the mediation of pathogen disgust in women, though with mixed experimental support. Here we considered the effects of acute progesterone on the disgust-like avoidance responses of female mice to pathogen threat. Estrous female mice discriminated and avoided the urinary and associated odors of males subclinically infected with the murine nematode parasite, Heligmosomoides polygyrus. These avoidance responses were not significantly affected by pre-treatment with progesterone. Likewise, brief (1 min) exposure to the odors of infected males attenuated the subsequent responses of females to the odors of the normally preferred unfamiliar males and enhanced their preferences for familiar males. Neither progesterone nor allopregnanolone, a central neurosteroid metabolite of progesterone, had any significant effects on the avoidance of unfamiliar males elicited by pre-exposure to a parasitized male. Progesterone and allopregnanolone, did, however, significantly attenuate the typical preferences of estrous females for unfamiliar uninfected males, suggestive of effects on social recognition. These findings with mice indicate that progesterone may have minimal effects on the responses to specific parasite threat and the expression of pathogen disgust but may influence more general social recognition and preferences.

Identifying female phenotypes that promote behavioral isolation in a sexually dimorphic species of fish Etheostoma zonale

In sexually dimorphic species characterized by exaggerated male ornamentation, behavioral isolation is often attributed to female preferences for conspecific male signals. Yet, in a number of sexually dimorphic species, male mate choice also results in behavioral isolation. In many of these cases, the female traits that mediate species boundaries are unclear. Females in sexually dimorphic species typically lack many of the elaborate traits that are present in males and that are often used for taxonomic classification of species. In a diverse and largely sexually dimorphic group of fishes called darters (Percidae: Etheostoma), male mate choice contributes to behavioral isolation between a number of species; however, studies addressing which female traits males prefer are lacking. In this study, we identified the dominant female pattern for two sympatric species, Etheostoma zonale and Etheostoma barrenense, using pattern energy analysis, and we used discriminate function analysis to identify which aspects of female patterning can reliably classify species. We then tested the role of female features in male mate choice for E. zonale, by measuring male preference for computer animations displaying the identified (species-specific) conspecific features. We found that the region above the lateral line is important in mediating male mate preferences, with males spending a significantly greater proportion of time with animations exhibiting conspecific female patterning in this region than with animations exhibiting heterospecific female patterning. Our results suggest that the aspects of female phenotypes that are the target of male mate choice are different from the conspicuous male phenotypes that traditionally characterize species.

Pathogens, odors, and disgust in rodents

All animals are under the constant threat of attack by parasites. The mere presence of parasite threat can alter behavior before infection takes place. These effects involve pathogen disgust, an evolutionarily conserved affective/emotional system that functions to detect cues associated with parasites and infection and facilitate avoidance behaviors. Animals gauge the infection status of conspecific and the salience of the threat they represent on the basis of various sensory cues. Odors in particular are a major source of social information about conspecifics and the infection threat they present. Here we briefly consider the origins, expression, and regulation of the fundamental features of odor mediated pathogen disgust in rodents. We briefly review aspects of: (1) the expression of affective states and emotions and in particular, disgust, in rodents; (2) olfactory mediated recognition and avoidance of potentially infected conspecifics and the impact of pathogen disgust and its' fundamental features on behavior; (3) pathogen disgust associated trade-offs; (4) the neurobiological mechanisms, and in particular the roles of the nonapeptide, oxytocin, and steroidal hormones, in the expression of pathogen disgust and the regulation of avoidance behaviors and concomitant trade-offs. Understanding the roles of pathogen disgust in rodents can provide insights into the regulation and expression of responses to pathogens and infection in humans.

Strangers look sicker (with implications in times of COVID-19)

We animals have evolved a variety of mechanisms to avoid conspecifics who might be infected. It is currently unclear whether and why this "behavioral immune system" targets unfamiliar individuals more than familiar ones. Here I answer this question in humans, using publicly available data of a recent study on 1969 participants from India and 1615 from the USA. The apparent health of a male stranger, as estimated from his face, and the comfort with contact with him were a direct function of his similarity to the men in the local community. This held true regardless of whether the face carried overt signs of infection. I conclude that our behavioral immune system is finely tuned to degrees of outgroupness - and that cues of outgroupness are partly processed as cues of infectiousness. These findings, which were consistent across the two cultures, support the notion that the pathogens of strangers are perceived as more dangerous.

Employee norm-violations in the service encounter during the corona pandemic and their impact on customer satisfaction

In this study, an experiment was used to examine the effects of employee norm-violations in the service encounter with respect to what was considered appropriate behavior (e.g., social distancing) during the 2020 corona pandemic. The participants were exposed to a grocery store employee whose behavior was manipulated (norm-violating vs. norm-confirming). Norm-violating behavior resulted in lower perceived employee warmth, lower perceived employee competence, higher disgust, and more dehumanization of the employee. These responses mediated the impact of employee behavior on customer satisfaction, so that satisfaction was attenuated when norms were violated. The mediators, however, typically also instill a hostile, avoidance-seeking mindset for those who are subject to norm-violations, which is likely to result in problems when transgressors are to be persuaded to change their behaviors.

Behavioral Immune Trade-Offs: Interpersonal Value Relaxes Social Pathogen Avoidance

Behavioral-immune-system research has illuminated how people detect and avoid signs of infectious disease. But how do we regulate exposure to pathogens that produce no symptoms in their hosts? This research tested the proposition that estimates of interpersonal value are used for this task. The results of three studies (N = 1,694), each conducted using U.S. samples, are consistent with this proposition: People are less averse to engaging in infection-risky acts not only with friends relative to foes but also with honest and agreeable strangers relative to dishonest and disagreeable ones. Further, a continuous measure of how much a person values a target covaries with comfort with infection-risky acts with that target, even within relationship categories. Findings indicate that social prophylactic motivations arise not only from cues to infectiousness but also from interpersonal value. Consequently, pathogen transmission within social networks might be exacerbated by relaxed contamination aversions with highly valued social partners.

Disgust Toward Interracial Couples: Mixed Feelings About Black–White Race Mixing

Three studies further explored Skinner and Hudac's (2017) hypothesis that interracial couples elicit disgust. Using verbal and face emotion measures (Study 1), some participants reported more disgust toward interracial couples than same-race White and Black couples. In Study 2, only people higher in disgust sensitivity tended to “guess” that rapidly presented images of interracial (vs. White) couples were disgusting. Study 3 used a novel image classification paradigm that presented couples side-by-side with neutral or disgusting images. Participants took longer to decide whether target images were disgusting only when interracial (vs. White) couples appeared next to neutral images. Greater sexual disgust heightened this difference. Mixed evidence suggesting an association of disgust with Black couples also emerged in Studies 2 and 3. Thus, the disgust–interracial romance association may only emerge under certain conditions, and the current research offers limited support for the hypothesis that disgust response is exclusively linked to interracial unions.

Addressing Disease-Related Stigma During Infectious Disease Outbreaks

Outbreaks of emerging infectious disease are a constant threat. In the last 10 years, there have been outbreaks of 2009 influenza A (H1N1), Ebola virus disease, and Zika virus. Stigma associated with infectious disease can be a barrier to adopting healthy behaviors, leading to more severe health problems, ongoing disease transmission, and difficulty controlling infectious disease outbreaks. Much has been learned about infectious disease and stigma in the context of nearly 4 decades of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome pandemic. In this paper, we define stigma, discuss its relevance to infectious disease outbreaks, including how individuals and communities can be affected. Adapting lessons learned from the rich literature on HIV-related stigma, we propose a strategy for reducing stigma during infectious disease outbreaks such as Ebola virus disease and Zika virus. The implementation of brief, practical strategies such as the ones proposed here might help reduce stigma and facilitate more effective control of emerging infectious diseases.

COVID-19 Prevention and Control Public Health Strategies in Shanghai, China

CONTEXT

COVID-19 was characterized as a pandemic by the World Health Organization on March 11, 2020. This research aims to analyze the public health strategies to prevent and control COVID-19 in Shanghai, China, and provide recommendations for public health policy and interventions in the United States.

PROGRAM

Based on the Social-Ecological Model, this research collected information for public health strategies from the Shanghai Municipal Health Commission and various Chinese websites.

EVALUATION

The daily confirmed new cases of COVID-19 decreased from 27 to 0 in 53 days since the first case of COVID-19 was confirmed in Shanghai on January 20, 2020.

DISCUSSION

The pattern of daily confirmed new cases suggests the effectiveness of public health strategies. This research also provides recommendations on the development and improvements of public health strategies in the U.S. by acknowledging the differences in political and social systems between the two countries.

Disgust propensity has a causal link to the stigmatization of people with cancer

Disgust-driven stigma may be motivated by an assumption that a stigmatized target presents a disease threat, even in the absence of objective proof. Accordingly, even non-contagious diseases, such as cancer, can become stigmatized by eliciting disgust. This study had two parts: a survey (n = 272), assessing the association between disgust traits and cancer stigma; and an experiment, in which participants were exposed to a cancer surgery (n = 73) or neutral video (n = 68), in order to test a causal mechanism for the abovementioned association. Having a higher proneness to disgust was associated with an increased tendency to stigmatize people with cancer. Further, a significant causal pathway was observed between disgust propensity and awkwardness- and avoidance-based cancer stigma via elevated disgust following cancer surgery exposure. In contrast, those exposed to cancer surgery not experiencing elevated disgust reported less stigma than controls. Exposure-based interventions, which do not elicit disgust, may be profitable in reducing cancer stigma.

In sickness and in filth: Developing a disdain for dirty people

Cleanliness is universally valued, and people who are dirty are routinely marginalized. In this research, we measured the roots of negative attitudes toward physically unclean individuals and examined the differences that exist in these attitudes between childhood and adulthood. We presented 5- to 9-year-old children and adults (total N = 260) with paired photographs of a dirty person and a clean person, and we measured biases with a selective trust task and an explicit evaluation task. In Study 1, where images of adults were evaluated, both children and adults demonstrated clear biases, but adults were more likely to selectively trust the clean informant. Study 2 instead used images of children and included several additional tasks measuring implicit attitudes (e.g., an implicit association task) and overt behaviors (a resource distribution task) and also manipulated the cause of dirtiness to include illness, enjoyment of filth, and accidental spillage. Children and adults again revealed strong biases regardless of the cause of dirtiness, but only children exhibited a bias on the explicit evaluation task. Study 3 replicated these findings in India, a country that has historically endorsed strong purity norms. Overall, this research indicates that dirty people are targets of discrimination from early in development, that this is not merely a Western phenomenon, and that this pervasive bias is most strongly directed at individuals of similar ages.

An Overprotective Nose? Implicit Bias Is Positively Related to Individual Differences in Body Odor Disgust Sensitivity

Body odors are universal elicitors of disgust, a core emotion that plays a key role in the behavioral immune system (BIS) - a set of psychological functions working to avoid disease. Recent studies showed that body odor disgust sensitivity (BODS) is associated with explicit xenophobia and authoritarianism. In the current experimental pre-registered study (https://osf.io/6jkp2/), we investigated the association between olfactory pathogen cues, BODS and implicit bias toward an outgroup (tested by an implicit association test). Results show that BODS is positively related to implicit bias toward an outgroup, suggesting that social attitudes may be linked to basic chemosensory processes. These attitudes were not influenced by background odors. Additionally, BODS was related to social, but not economic conservatism. This study extends the BIS framework to an experimental context by focusing on the role of disgust and body odors in shaping implicit bias.

The "Labeled" Side of COVID-19 in India: Psychosocial Perspectives on Islamophobia During the Pandemic

The Coronavirus disease 2019 (COVID-19) has emerged as a global public health threat over the last few months. Historically, infectious disease outbreaks like the plague, Influenza, cholera, HIV, etc. have generated stigma, prejudice, "othering" and xenophobia, against certain communities. One such prevalent form of xenophobia, is Islamophobia or "fear and discrimination against the Muslims." Though debated over its various facets and definitions, it is on the rise worldwide. India, being a socio-politically diverse and populous nation, has been facing unique challenges during COVID-19. Considering Hinduism and Islam are the two major religious communities, the subcontinent has witnessed complex dynamics in their relationship throughout history. The pandemic has further instigated Islamophobia, and consequent discrimination, as well as unrest. This can have significant effect of public behavior and health. In the recent past, few legislations in India were interpreted to be Islamophobic and generated nation-wide protest, which provided a fertile backdrop against the discriminative effects of the pandemic. Keeping this in background, this commentary highlights the social contexts of increase in Islamophobia in India during the pandemic, discusses the possible psychological explanations and public health impact, as well as outlines some ways to mitigate it focusing on collectivism.

A Narrative Review of Stigma Related to Infectious Disease Outbreaks: What Can Be Learned in the Face of the Covid-19 Pandemic?

Infectious disease pandemics are associated with social consequences and stigma that are noticeably similar in various health conditions, health systems, and cultures. Stigma impacts health-related outcomes, not only as a barrier to receiving the timely diagnosis and appropriate treatment but also as an important variable that increases mental health issues such as anxiety and depression. The COVID-19 outbreak has been associated with stigma too. Studying similarities as well as differences in the features of stigma observed in each outbreak can provide us with the knowledge and deeper understanding of the situation, which is necessary for approaching the issue comprehensively. The stigma needs to be addressed rigorously by professionals and health care providers as well as authorities. Here, we narratively review stigma due to some well-known infectious diseases and how it parallels to the current COVID-19 situation. After discussing its effects on both individuals and societies, we provide solutions to manage this important issue.

Pathogens and Immigrants: A Critical Appraisal of the Behavioral Immune System as an Explanation of Prejudice Against Ethnic Outgroups

The last two decades have seen the development of a body of literature in evolutionary psychology that seeks to attribute negative attitudes to ethnic and racial minorities and other outgroups to an evolved behavioral immune system (BIS). It hypothesizes that disgust sensitivity, which evolved as protection against pathogen threats, also triggers reactions to cues that are not viscerally disgusting, such as people with unfamiliar features, and thus can explain prejudice toward members of these groups. Such an explanation seems to limit the influence of education, public policy, and rhetoric on those attitudes. Our conceptual analysis shows that this is not the case. Existing hypotheses about why the BIS would be triggered even in the absence of visceral disgust elicitors suggest that general unfamiliarity or atypicality act as cues for this hypersensitive threat detection system. This implies that the impact of the BIS must depend on the cultural and societal context in which people learn not only what is disgusting but also what is typical. The social context of personal interaction with mass media representation of and political debate about immigrants consequently needs to be considered as a decisive factor for any effect of the BIS on attitudes and behavior toward ethnic and racial outgroups. The BIS is therefore not a separate or even superordinate explanation of prejudice, compared to those coming from the social sciences. We conclude that it can offer valuable insights into processes of stigmatization and prejudice, once the role of social learning in the developmental unfolding and activation of psychological mechanisms is taken seriously.

Conspecific infection threat rapidly biases the social responses of female mice: Involvement of oxytocin

Pathogen threat affects social preferences and responses across species. Here we examined the effects of social context and the infection status of conspecific females and males on the social and mate responses of female mice. The responses of female mice to males were rapidly affected by the presence of infected female conspecifics and infected males. In mice odor cues drive appetitive and aversive social and mate responses. Brief (1 min) exposure to the fresh urinary odors of females infected with the murine nematode parasite, Heligmosomoides polygyrus, attenuated the responses of other uninfected females to the odors of naturally preferred unfamiliar males and enhanced their preferences for familiar males. Likewise exposure to the odors of a male either infected with H. polygyrus or treated with the bacterial endotoxin, lipopolysaccharide, reduced the responses of females to the odors of unfamiliar males. In addition, females displayed an avoidance of, and discrimination against, male mice whose odors had been associated with that of an infected female ("guilt by association") and a preference for the odors associated with an uninfected female ("mate copying"). These shifts in preferences for female associated male odors were attenuated in a dose-related manner by pre-treatment with the oxytocin receptor antagonist, L-368,899. These findings show that social information associated with the infection status of conspecifics can rapidly bias the mate preferences of female mice in an oxytocin receptor dependent manner.

Dynamic and game theory of infectious disease stigmas

Stigmas are a primal phenomena, ubiquitous in human societies past and present. Some evolutionary anthropologists have argued that stigmatization in response to disease is an adaptive behavior because stigmatization may help people and communities reduce the risks they face from infectious diseases and increase reproductive success. On the other hand, some cultural anthropologists and social critics argue that stigmatization has strong negative impacts on community health. One recent analysis resolved this conflict by hypothesizing that stigmas had individual and group-evolutionary benefits in the past but are now maladaptive because of intervening societal transitions. Here, we present a quantitative theory of infectious disease stigmatization. Using a four-compartment model of stigmatization against a chronic disease, we show a stigma ratio, being the ratio of net transmissions by stigmatized people to net transmissions by unstigmatized people, predicts the impact of stigmatization on lifetime infection risk. When stigmatized people are segregated from the rest of the population and there are no alternative interventions that reduce transmission, stigmatization can reduce prevalence and infection risk. When stigmas do not lead to segregation but do discourage behavior change and reduce access to medical interventions, stigmatization acts to increases the lifetime risk of infection in the community. We further show that fear of stigmas can create policy resistance to healthcare access. The societal consequences of fear are worse when effective medical treatment is available. We conclude that stigma's can be adaptive, but good healthcare and leaky ostracism can make stigmas against chronic infectious disease maladaptive, and that the deprecation of stigmas is a natural transition in the modern urban societies.

The role of social cognition in parasite and pathogen avoidance

The acquisition and use of social information are integral to social behaviour and parasite/pathogen avoidance. This involves social cognition which encompasses mechanisms for acquiring, processing, retaining and acting on social information. Social cognition entails the acquisition of social information about others (i.e. social recognition) and from others (i.e. social learning). Social cognition involves assessing other individuals and their infection status and the pathogen and parasite threat they pose and deciding about when and how to interact with them. Social cognition provides a framework for examining pathogen and parasite avoidance behaviours and their associated neurobiological mechanisms. Here, we briefly consider the relationships between social cognition and olfactory-mediated pathogen and parasite avoidance behaviours. We briefly discuss aspects of (i) social recognition of actual and potentially infected individuals and the impact of parasite/pathogen threat on mate and social partner choice; (ii) the roles of 'out-groups' (strangers, unfamiliar individuals) and 'in-groups' (familiar individuals) in the expression of parasite/pathogen avoidance behaviours; (iii) individual and social learning, i.e. the utilization of the pathogen recognition and avoidance responses of others; and (iv) the neurobiological mechanisms, in particular the roles of the nonapeptide, oxytocin and steroid hormones (oestrogens) associated with social cognition and parasite/pathogen avoidance.This article is part of the Theo Murphy meeting issue 'Evolution of pathogen and parasite avoidance behaviours'.

Prosthesis use is associated with reduced physical self-disgust in limb amputees

Self-disgust is an emotion schema negatively affecting people's body image and is triggered by bodily imperfections and deviations from the "normal" body envelope. In this study, we explore the idea that "normalising" the body in those with limb amputations via the prosthesis would be linked to reduced self-directed disgust. An international clinical community sample (N = 83) with mostly lower limb amputations completed measures about their demographics, prosthesis, adjustment, body image disturbance, psychological distress, and self-directed disgust in a survey design. Consistent with the "normalising" hypothesis, correlation and bootstrapped regression models revealed, first, that frequency of prosthesis use was significantly and negatively associated with physical self-disgust. Second, prosthesis use significantly mediated the exogenous effect of time since amputation on physical self-disgust. These results emphasise the psychological value of the prosthesis beyond its functional use, and stress its importance in normalising the body envelope in those with limb amputations, which may in turn promote psychological well-being.

Exogenous attention and memory for faces following contextual behavioral immune system activation

The behavioral immune system (BIS) is characterized by affective, cognitive and behavioral processes that work in an articulated manner to prevent the occurrence of infections. Attention and memory evolved to enhance the organism's chances of survival and have been proposed to play an important role in the BIS. The present study investigated the effects of attention and memory for neutral faces after a contextual activation of the BIS. Participants were primed, by the use of film clips, either with infectious disease concerns or non-infectious disease concerns. They performed an exogenous attentional task involving the discrimination of target letters, with face stimuli presented as distractors, which was then followed by a surprise recognition task for the faces. The results showed that participants in the infectious disease condition were more accurate in the attentional task than participants in the control condition. No significant difference between groups was found in the response times during the attention task nor in memory performance. Overall, these results suggest that the BIS might be associated with a hypervigilant state towards cues in general and that BIS activation through this type of priming may not be sufficient to clearly activate mnemonic mechanisms.

Body odour disgust sensitivity predicts authoritarian attitudes

Authoritarianism has resurfaced as a research topic in political psychology, as it appears relevant to explain current political trends. Authoritarian attitudes have been consistently linked to feelings of disgust, an emotion that is thought to have evolved to protect the organism from contamination. We hypothesized that body odour disgust sensitivity (BODS) might be associated with authoritarianism, as chemo-signalling is a primitive system for regulating interpersonal contact and disease avoidance, which are key features also in authoritarianism. We used well-validated scales for measuring BODS, authoritarianism and related constructs. Across two studies, we found that BODS is positively related to authoritarianism. In a third study, we showed a positive association between BODS scores and support for Donald Trump, who, at the time of data collection, was a presidential candidate with an agenda described as resonating with authoritarian attitudes. Authoritarianism fully explained the positive association between BODS and support for Donald Trump. Our findings highlight body odour disgust as a new and promising domain in political psychology research. Authoritarianism and BODS might be part of the same disease avoidance framework, and our results contribute to the growing evidence that contemporary social attitudes might be rooted in basic sensory functions.

Applying Mental Model Methods to Characterize Understanding of Gene-Environment Influences: The Case of Podoconiosis in Ethiopia

The rapid pace of genomic discovery has raised public expectation and concerns about the utility of new discoveries and their potential to exacerbate health disparities. Improving literacy concerning gene and environmental (GxE) contributors to disease is needed to avoid commonly observed deterministic misconceptions about genomics. Mental models approaches that incorporate community engagement processes could be used to inform GxE literacy-building interventions. We used a mental models approach to describe and systematically compare expert and lay understanding of GxE interactions, using the example of podoconiosis, a non-infectious lymphedema endemic in highland Ethiopia. Methods included: (1) specifying elicitation questions for a literature review, (2) eliciting an expert model, (3) eliciting a lay model, and (4) comparing the two models. We used a coding scheme to identify lay participants' knowledge gaps, misunderstandings and extra knowledge relative to the expert standard. Results indicated that lay participants' viewed poverty as an important susceptibility factor and considered heredity and contagion to have a joint causal influence. Experts did not endorse either of these viewpoints. Conventional expert-based interventions aimed to correct misconceptions about behaviors important for prevention may be stymied by lay views that social environmental factors have more important influences on health outcomes. GxE literacy interventions that consider multiple levels of influence including social determinants of health and personal resilience to augment health education strategies are needed in diverse settings. Novel communication approaches will be needed to help target audiences disentangle long-held conceptions of heredity and contagion.

Reframing the science and policy of nicotine, illegal drugs and alcohol - conclusions of the ALICE RAP Project

In 2013, illegal drug use was responsible for 1.8% of years of life lost in the European Union, alcohol was responsible for 8.2% and tobacco for 18.2%, imposing economic burdens in excess of 2.5% of GDP. No single European country has optimal governance structures for reducing the harm done by nicotine, illegal drugs and alcohol, and existing ones are poorly designed, fragmented, and sometimes cause harm. Reporting the main science and policy conclusions of a transdisciplinary five-year analysis of the place of addictions in Europe, researchers from 67 scientific institutions addressed these problems by reframing an understanding of addictions.  A new paradigm needs to account for evolutionary evidence which suggests that humans are biologically predisposed to seek out drugs, and that, today, individuals face availability of high drug doses, consequently increasing the risk of harm.  New definitions need to acknowledge that the defining element of addictive drugs is 'heavy use over time', a concept that could replace the diagnostic artefact captured by the clinical term 'substance use disorder', thus opening the door for new substances to be considered such as sugar. Tools of quantitative risk assessment that recognize drugs as toxins could be further deployed to assess regulatory approaches to reducing harm. Re-designed governance of drugs requires embedding policy within a comprehensive societal well-being frame that encompasses a range of domains of well-being, including quality of life, material living conditions and sustainability over time; such a frame adds arguments to the inappropriateness of policies that criminalize individuals for using drugs and that continue to categorize certain drugs as illegal. A health footprint, modelled on the carbon footprint, and using quantitative measures such as years of life lost due to death or disability, could serve as the accountability tool that apportions responsibility for who and what causes drug-related harm.

Out-Group Threat Responses, In-Group Bias, and Nonapeptide Involvement Are Conserved across Vertebrates: (A Comment on Bruintjes et al., "Out-Group Threat Promotes Within-Group Affiliation in a Cooperative Fish")

The challenges and threats posed by out-groups have major effects on human social behavior and how individuals interact with one another. We briefly review evidence here that out-group threat similarly affects nonhuman animal behavior. Actual and potential threats posed by out-group individuals (unfamiliar and genetically nonrelated individuals of the same species) affect social behavior promoting "out-group" avoidance and "in-group" bias and enhancing in-group (familiar and/or genetically related individuals) affiliation and interactions. Individuals from out-groups present risks of pathogen exposure as well as being threats to resources, territory, and offspring. All of these threats function to promote in-group bias in humans and nonhumans. There are also striking similarities in the underlying neurobiological mechanisms mediating the responses to out-group threat and the expression of in-group bias. In particular, the evolutionarily conserved, hormone-regulated nonapeptide systems (oxytocin, arginine-vasopressin, and homologous neuropeptides and their receptors) are involved in the mediation of the detection and avoidance of out-groups and response to in-groups and facilitation of in-group responses across multiple vertebrate species. Consequently, comparative investigations of both the behavioral expression of and the mechanism underlying out-group avoidance and in-group bias are necessary for a full understanding of the evolution of social behavior and responses to in- and out-groups.

Do Customers Flee From HIV? A Survey of HIV Stigma and Its Potential Economic Consequences on Small Businesses in Tshwane (Pretoria), South Africa

HIV stigma and discrimination affect care-seeking behavior and may also affect entrepreneurial activity. We interview 2382 individuals in Pretoria, South Africa, and show that respondents believe that businesses with known HIV+ workers may lose up to half of their customers, although the impact depends on the type of business. Survey respondents' fear of getting HIV from consuming everyday products sold by the business-despite a real infection risk of zero-was a major factor driving perceived decline in customers, especially among food businesses. Respondents' perceptions of the decline in overall life satisfaction when one gets sick from HIV and the respondent's dislike of people with HIV were also important predictors of potential customer exit. We suggest policy mechanisms that could improve the earnings potential of HIV+ workers: reducing public health scare tactics that exacerbate irrational fear of HIV infection risk and enriching public health education about HIV and ARVs to improve perceptions about people with HIV.

An investigation of the emotion of disgust as an affective barrier to intention to screen for colorectal cancer

Colorectal cancer (CRC) screening participation remains unacceptably low. This study investigated the emotion of disgust as a potential deterrent to intention to screen for CRC. The study utilised a convenience sample of individuals' 40-70 years of age to complete an online survey. Participants included 30 men and 118 women recruited between December 1, 2013 and March 31, 2014. Data on socio-demographics, health status, screening intentions and emotional barriers to bowel screening were collected via an on-line survey. Logistic regression analysis was utilised to investigate predictors of screening intention. Individuals were more likely to report intention to screen if they had prior screening experience, and reported fewer emotional concerns to screening for CRC. Results implicate disgust as a predictor of screening avoidance among participants. Specifically, higher reported faecal disgust was predictive of a 3% decrease in screening intention. This study was the first to empirically position disgust alongside other negative emotional states as an affective barrier to screening for CRC. Trait disgust sensitivity was not a reliable predictor of screening intention. This research suggests that anticipated faecal disgust may contribute to avoidance of screening for CRC.

The Link Between Everyday Discrimination, Healthcare Utilization, and Health Status Among a National Sample of Women

BACKGROUND

Research has not adequately examined the potential negative effects of perceiving routine discrimination on general healthcare utilization or health status, especially among reproductive-aged women. We sought to evaluate the association between everyday discrimination, health service use, and perceived health among a national sample of women in the United States.

MATERIALS AND METHODS

Data were drawn from the Women's Healthcare Experiences and Preferences survey, a randomly selected, national probability sample of 1078 U.S. women aged 18-55 years. We examined associations between everyday discrimination (via a standardized scale) on frequency of health service utilization and perceived general health status using chi-square and multivariable logistic regression modeling.

RESULTS

Compared with women who reported healthcare visits every 3 years or less (reference group), each one-point increase in discrimination score was associated with higher odds of having healthcare visits annually or more often (odds ratio [OR] = 1.36, confidence interval [95% CI] = 1.01-1.83). Additionally, each one-point increase in discrimination score was significantly associated with lower odds of having excellent/very good perceived health (OR = 0.65; 95% CI = 0.54-0.80).

CONCLUSION

Perceived discrimination was associated with increased exposure to the healthcare setting among this national sample of women. Perceived discrimination was also inversely associated with excellent/very good perceived health status.

Homosexuality and Pro-Gay Ideology as Pathogens? Implications of a Disease-Spread Lay Model for Understanding Anti-Gay Behaviors

Negative behaviors targeting gay men and lesbians range from violent physical assault to casting a vote against gay marriage, with very different implications for those targeted. Existing accounts of such actions, however, are unable to differentially predict specific anti-gay behaviors, leaving a large theoretical hole in the literature and hindering the design of effective interventions. We propose (a) that many sexually prejudiced laypersons conceptualize homosexuality and pro-gay ideology as “contaminants” analogous to infectious pathogens and (b) that anti-gay behaviors can thus be viewed as strategic attempts to prevent, contain, treat, or eradicate the “pathogens” of homosexuality and pro-gay ideology. By considering analogues to disease-spread processes (e.g., susceptibility of specific subpopulations, inoculation procedures, prevalence in the local environment, interconnections among community members), we derive novel predictions regarding the incidence and nature of anti-gay behaviors and provide leverage for creating more tailored interventions to reduce such discrimination.

[The influence of pathogen threat on ageism in Japan: The role of living with older adults]

Previous research has suggested that Western European individuals exhibit negative attitudes toward older adults under pathogen threat. The present study investigated whether Japanese individuals exhibited ageism when pathogen threat was salient. Additionally, the study determined whether pathogen threat would have less of an impact on ageism among individuals with experience living with older adults. Study 1 showed that when pathogen threat was chronically and contextually salient, Japanese university students who had no experience living with older adults exhibited ageism, while those with such experience did not. Study 2 showed similar findings among Japanese nursing students. We argue that familiarity with older adults is essential for diminishing ageism in the event of a pathogen threat.

Self-affirming trait kindness regulates disgust toward one's physical appearance

In two studies, self-affirming the behavioral trait of kindness was examined as a method of regulating state disgust toward one's physical appearance. In Study 1, 56 participants (37 women, 19 men, Mage=33.16 years) completed either a questionnaire designed to self-affirm kindness or a control equivalent and rated their disgust, anger, sadness, and happiness toward their appearance and behavior. In Study 2, 116 individuals (83 women, 33 men, Mage=24.90 years) participated in the same experiment over the internet in an ecologically valid context. When controlling for trait self-disgust, the self-affirmed in Study 1 reported significantly less disgust toward their appearance (ηp(2)=.12, p=.011). This effect was replicated in Study 2, but driven by lower state disgust levels in those higher in trait self-disgust (f(2)=.10, p=.001). Affirming valued traits, like kindness, may be a useful tool for regulating disgust toward body image.

Does a brief state mindfulness induction moderate disgust-driven social avoidance and decision-making? An experimental investigation

In this experimental study, we evaluated whether manipulated disgust and mindfulness predicted social avoidance in bowel health contexts. Community participants (n = 101) were randomised to conditions in which disgust and/or state mindfulness were experimentally induced. Tasks assessing social avoidance and perceptions of available social networks in the context of bowel/health problems were conducted. Manipulation checks confirmed the elicitation of disgust and state mindfulness in the applicable conditions. As expected, persons in the disgust condition were more likely to exhibit immediate social avoidance (rejecting a glass of water). State disgust predicted greater socially avoidant decision-making, less decisional conflict, and smaller social network maps. State mindfulness predicted fewer names on inner network circles and amplified the effect of disgust on creating smaller social network maps. This report furthers understanding of disgust and avoidance in bowel health contexts, and suggests the need for caution in mindfulness interventions that raise awareness of emotion without also providing skills in emotional regulation.

The relationship between physical appearance concerns, disgust, and anti-fat prejudice

This study examined relationships between physical appearance concerns (fear of fat, body image disturbance; BIDQ), disgust, and anti-fat prejudice (dislike, blame), and tested whether disgust mediates relationships between physical appearance concerns and anti-fat prejudice. Participants (N=1649; age=28 years) provided demographic data and completed measures of anti-fat prejudice, tendency to feel disgust, and physical appearance concerns. Univariate, multivariate, and mediation analyses were conducted. Univariate and multivariate associations were found between fear of fat, BIDQ, disgust, and anti-fat prejudice for women. For women only, mediation analyses showed that disgust partially mediated relationships between physical appearance concerns and dislike of fat people. For men, univariate and multivariate relationships were found between fear of fat, and dislike and blame of fat people, but disgust was not related to anti-fat prejudice. Newer constructs centering on physical appearance concerns and disgust appear promising candidates for understanding anti-fat prejudice.

The social life of 'eugh': disgust as assessment in family mealtimes

Disgust is a complex phenomenon that pervades a number of social situations. To date, disgust has primarily been understood as an individually experienced emotion or as a way of defining boundaries between people or objects; the detailed social practices through which disgust is choreographed, however, have yet to be fully explored. The social implications of disgust are particularly apparent when food and eating are involved, as it is in such settings that individuals, objects, and social boundaries coincide. In this paper, I argue that the enactment of disgust is an inherently social event, and that we can evidence it as such through the way in which it is produced and oriented to in everyday interaction. The setting for this paper is family mealtimes, as a situation in which children and parents explore the boundaries of what is, and what is not, disgusting. A large corpus of video and audio recordings of mealtimes in England and Scotland were analysed using a discursive psychological approach, with a focus on explicating the sequential and prosodic features of disgust markers (DMs), such as 'eugh' and 'yuck'. The analysis demonstrates that DMs are typically preceded by a 'noticing' by speakers and that 'eugh' is usually uttered alone and at the start of a turn in talk. It is argued that, regardless of their putative status as emotions or cultural concepts, DMs work as assessments of food and eating practices in everyday interaction. They orient others to a trouble source and attend to people's entitlements to 'know' disgust. The implications for our understanding of disgust as a social psychological concept are further explored.

Proactive strategies to avoid infectious disease

Infectious disease exerts a large selective pressure on all organisms. One response to this has been for animals to evolve energetically costly immune systems to counter infection, while another--the focus of this theme issue--has been the evolution of proactive strategies primarily to avoid infection. These strategies can be grouped into three types, all of which demonstrate varying levels of interaction with the immune system. The first concerns maternal strategies that function to promote the immunocompetence of their offspring. The second type of strategy influences mate selection, guiding the selection of a healthy mate and one who differs maximally from the self in their complement of antigen-coding genes. The third strategy involves two classes of behaviour. One relates to the capacity of the organisms to learn associations between cues indicative of pathogen threat and immune responses. The other relates to prevention and even treatment of infection through behaviours such as avoidance, grooming, quarantine, medicine and care of the sick. In humans, disease avoidance is based upon cognition and especially the emotion of disgust. Human disease avoidance is not without its costs. There is a propensity to reject healthy individuals who just appear sick--stigmatization--and the system may malfunction, resulting in various forms of psychopathology. Pathogen threat also appears to have been a highly significant and unrecognized force in shaping human culture so as to minimize infection threats. This cultural shaping process--moralization--can be co-opted to promote human health.