On sin versus sickness. A theory of perceived responsibility and social motivation

Polarized Perspectives on Health Equity: Results from a Nationally Representative Survey on US Public Perceptions of COVID-19 Disparities in 2023

Republicans and Democrats responded to the COVID-19 pandemic in starkly different ways, from their attitudes in 2020 about whether the virus posed a threat to whether the pandemic ended in 2023. The consequences of COVID-19 for health equity have been a central concern in public health, and the concept of health equity has also been beset by partisan polarization. In this article, the authors present and discuss nationally representative survey data from 2023 on US public perceptions of disparities in COVID-19 mortality (building on a previous multiwave survey effort) as well as causal attributions for racial disparities, the contribution of structural racism, and broader attitudes about public health authority. The authors find anticipated gulfs in perspectives between Democrats on the one hand and independents and Republicans on the other. The results offer a somewhat pessimistic view of the likelihood of finding common ground in how the general public understands health inequities or the role of structural racism in perpetuating them. However, the authors show that those who acknowledge racial disparities in COVID-19 are more likely to support state public health authority to act in response to other infectious disease threats. The authors explore the implications of these public opinion data for advocacy, communication, and future needed research.

Increasing Social Support for Women via Humanizing Postpartum Depression

Women experiencing postpartum depression (PPD) often face the debilitating symptoms of depression as well as the stigmatization associated with having a mental health crisis during motherhood. Accordingly, there have been numerous calls for theoretical-based approaches to reduce the stigma and promote social support for women with PPD. Guided by stigma research, anthropomorphism literature, and attribution theory, this research explored the effect of PPD anthropomorphism (i.e., imbuing humanlike intentions and characteristics to PPD) on perceived controllability, sympathy, anger toward PPD, and willingness to provide social support (WPSS). Results of three studies revealed that humanizing PPD led to decreased perceived controllability attributed to women with PPD, resulting in increased sympathy, more anger toward PPD, and consequently, greater WPSS. This research contributes to the extant health communication literature, particularly in the realm of mental health stigma, by addressing how humanizing risk-bearing entities affects individuals' mental health related perceptions and decisions.

Teaching gene-environment interaction concepts with narrative vignettes: Effects on knowledge, stigma, and behavior motivation

Gene-environment interaction (GxE) concepts underlie a proper understanding of complex disease risk and risk-reducing behavior. Communicating GxE concepts is a challenge. This study designed an educational intervention that communicated GxE concepts in the context of eating behavior and its impact on weight, and tested its efficacy in changing knowledge, stigma, and behavior motivation. The study also explored whether different framings of GxE education and matching frames with individual eating tendencies would result in stronger intervention impact. The experiment included four GxE education conditions and a control condition unrelated to GxE concepts. In the education conditions, participants watched a video introducing GxE concepts then one of four narrative vignettes depicting how a character's experience with eating hyperpalatable or bitter tasting food (reward-based eating drive vs. bitter taste perception scenario) is influenced by genetic or environmental variations (genetic vs. environmental framings). The education intervention increased GxE knowledge, genetic causal attributions, and empathetic concern. Mediation analyses suggest that causal attributions, particularly to genetics and willpower, are key factors that drive downstream stigma and eating behavior outcomes and could be targeted in future interventions. Tailoring GxE education frames to individual traits may lead to more meaningful outcomes. For example, genetic (vs. environmental) framed GxE education may reduce stigma toward individuals with certain eating tendencies among individuals without such tendencies. GxE education interventions would be most likely to achieve desired outcomes such as reducing stigma if they target certain causal beliefs and are strategically tailored to individual attributes.

Time to level up: A systematic review of interventions aiming to reduce stigma toward autistic people

LAY ABSTRACT

How non-autistic people think about autistic people impacts autistic people negatively. Many studies developed trainings to reduce autism stigma. The existing trainings vary a lot in terms of study design, content, and reported effectiveness. This means that a review studying how the studies have been conducted is needed. We also looked at the quality of these studies. We collected and studied 26 studies that tried to reduce stigma toward autistic people. The studies often targeted White K-12 students and college students. Most trainings were implemented once. Trainings frequently used video or computer. Especially, recent studies tended to use online platforms. The study quality was poor for most studies. Some studies made inaccurate claims about the intervention effectiveness. Studies did not sufficiently address study limitations. Future trainings should aim to figure out why and how interventions work. How intervention changes people's behavior and thoughts should be studied. Researchers should study whether the training can change the societal stigma. Also, researchers should use a better study design.

Protective behaviors against COVID-19 and their association with psychological factors in China and South Korea during the Omicron wave: a comparative study

OBJECTIVES

We aimed to explore the level of protective behaviors against COVID-19 and its association with psychological factors in China and South Korea during the Omicron wave.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted a population-based cross-sectional survey from March 15 to 30, 2023 in China and South Korea. Demographic characteristics, health status, protective behaviors, and psychological factors (including perceived risks, efficacy belief, attribution of disease, fear of COVID-19, trust and evaluation, fatalism, resilience, and pandemic fatigue) were investigated. After adjusting for sociodemographic and health-related factors, multivariable regression models were constructed to explore the psychological influencing factors of protective behavior.

RESULTS

A total of 3000 participants from China and 1000 participants from Korea were included in the final analysis. The mean performance score for protective behaviors among all respondents was 2.885 in China and 3.139 in Korea, with scores ranging from 1 to 4. In China, performance scores were higher in those who were female, aged 30-39, employed, married, living in urban areas, having the highest income level, having the best subjective health status, and having a history of chronic disease (P-value <0.05). In Korea, performance scores were higher for individuals who were female, over 50 years old, educated to high school or below, unemployed, married, had a history of chronic disease, and had never been infected with SARS-CoV-2 (P-value <0.05). In the multivariable regression model, perceived severity (β = 0.067), attribution of disease (β = 0.121), fear of COVID-19 (β = 0.128), trust and evaluation (β = 0.097), psychological resilience (β = 0.068), and efficacy belief (β = 0.216) were positively associated with the performance scores, pandemic fatigue (β = -0.089) was negatively associated with performance scores in China (P-value <0.05). However, in Korea, perceived susceptibility (β = 0.075), fear of COVID-19 (β = 0.107), and efficacy belief (β = 0.357) were positively associated with protective behaviors (P-value <0.05), trust and evaluation (β = -0.078) and pandemic fatigue (β = -0.063) were negatively associated with performance scores (P-value <0.05).

CONCLUSIONS

Populations in both China and Korea demonstrated great compliance with protective behaviors during the Omicron wave. Because of the sociocultural, economic, and political differences, there were differences in the association between psychological factors and protective behaviors in the two countries. This study, from the perspective of psychological factors in different cultural contexts, would provide references for increasing adherence to protective guidelines in future outbreaks of emerging infectious diseases.

Media Framing of Causes, Risks, and Policy Solutions for Cannabis-Impaired Driving: Does Medical vs. Non-Medical Cannabis Context Matter?

Driving under the influence of cannabis (DUIC) is a major cause of preventable death and a growing public health concern. News media coverage of DUIC may influence public perceptions of causal factors for DUIC, risks of DUIC, and potential policy solutions. This study examines Israeli news media coverage of DUIC, and contrasts media coverage according to whether news items refer to cannabis use for medical vs. non-medical purposes. We conducted a quantitative content analysis of news articles related to driving accidents and cannabis use (N = 299) from eleven of the highest circulation newspapers in Israel between 2008 and 2020. We apply attribution theory to analyze media coverage of accidents that were linked to medical cannabis, use compared with non-medical use. News items describing DUIC in the context of non-medical (vs. medical) cannabis use were more likely to: (a) emphasize individual causes (vs. social and political); (b) describe drivers in negative terms (vs. neutral or positive); (c) refer to an increased accident risk due to cannabis use (vs. inconclusive or low risk); and (d) call for increased enforcement rather than education. Results show that Israeli news media coverage of cannabis-impaired driving varied significantly depending on whether it referred to cannabis use for medical purposes, or non-medical purposes. News media coverage may influence public perceptions of the risks of DUIC, the factors that are associated with this issue, and potential policy solutions that may reduce the prevalence of DUIC in Israel.

The effect of autism phenotype and diagnosis disclosure on students' desire for social distance from autistic peers

LAY ABSTRACT

Autistic students experience loneliness, rejection from peers, which might negatively affect both their well-being, as well as academic results. Others have studied this topic, however, the existing research does not analyze the desire for social distance from autistic female students in higher education. The goal of this study was to evaluate whether the way autism is expressed and disclosing the autism diagnosis had an effect on students' willingness to interact with autistic male and female students. We also analyzed participants' knowledge about autism, contact with autistic people in the past and its pleasantness in relation to their willingness to interact with autistic students described in the scenarios of the present study. We found that students were less willing to interact with autistic male students compared to autistic female students, as well as with autistic students whose diagnosis was not disclosed compared to autistic students whose diagnosis was disclosed to the raters. In addition, students who reported more pleasant contact with autistic individuals in the past were more willing to socially interact with autistic students if their diagnosis was disclosed. Students with higher knowledge of autism expressed greater willingness to interact with autistic males and autistic students regardless of diagnosis disclosure. Findings suggest that autistic males and individuals who prefer not to disclose their diagnosis are more vulnerable to social exclusion. More subtle expressions of autism need to be researched further.

Effects of Health Responsibility Frames on Attributions, Emotions, and Social Support Intentions in the Context of Dementias

When news stories cover health and diseases, they often address issues of responsibility. These responsibility frames can affect recipients' responsibility beliefs (i.e., attributions) and thereby affect emotions and motivations to support people affected by health problems. To date, it is not fully understood how responsibility frames affect these attributions, emotions, and social support intentions in the context of dementia. In an online experiment with N = 1,059 German participants, we tested the effects of different responsibility frames (individual vs. contextual) on social support intentions through responsibility attributions and emotional reactions in the context of dementia. Results show that responsibility frames affect responsibility attributions and social support intentions. Mediation analysis shows that the effect of contextual responsibility frames on social support intention is partially mediated by responsibility attribution and emotions (sympathy and anger). We discuss these findings considering framing effects research and media coverage.

Actual and counterfactual effort contribute to responsibility attributions in collaborative tasks

How do people judge responsibility in collaborative tasks? Past work has proposed a number of metrics that people may use to attribute blame and credit to others, such as effort, competence, and force. Some theories consider only the actual effort or force (individuals are more responsible if they put forth more effort or force), whereas others consider counterfactuals (individuals are more responsible if some alternative behavior on their or their collaborator's part could have altered the outcome). Across four experiments (N=717), we found that participants' judgments are best described by a model that considers both actual and counterfactual effort. This finding generalized to an independent validation data set (N=99). Our results thus support a dual-factor theory of responsibility attribution in collaborative tasks.

(De)Stigmatizing Depression on Social Media: The Role of Responsibility Frames

Responsibility frames on social media could shape recipients' responses toward people with depression, which is crucial for the public (de)stigmatization of the mental disorder. Thus, the present study examines the effects of different responsibility frames (individual, social, combination) in Instagram-posts about depression on respondents' related attributions as well as their emotional and behavioral reactions toward people suffering from the illness. Our online-experiment (N = 1,015) revealed that frames emphasizing the responsibility of one's social network (e.g. family, friends and professionals) for depression, i.e. social frames, strengthened participants' attributions to the social network, i.e. social attributions, most effectively. Individual frames, however, primarily intensified individual attributions to those affected by depression. Contrary to previous findings, a combination frame did not prove to increase recipients' social attributions more than a one-sided social frame. For emotional and behavioral responses, we did not find any effects of responsibility frames compared to the control group-possibly due to buffering effects of the narrative structure of the Instagram posts.

Do Autistic People's Support Needs and Non-Autistic People's Support for the Neurodiversity Movement Contribute to Heightened Autism Stigma in South Korea vs. the US?

We examined stigma towards vignette characters representing diverse autistic characteristics (social, non-speaking, or repetitive interests or restricted behaviors; RIRB) among 259 South Korean and 240 American participants (age range = 18 ~ 74). Within each domain, participants were randomized to read a vignette depicting low or high support needs. Koreans reported greater stigma towards autistic characteristics and less awareness of and support for the neurodiversity movement than Americans. Autistic characters' support needs and rater characteristics (autism knowledge, neurodiversity endorsement, and contact quantity) predicted stigma in at least one domain, and after accounting for these variables, participants' nationality was suggestively associated only with stigma towards social characteristics and RIRB. Findings highlight the need for culturally adapted-training that provides contact with diverse autistic people.

Cluster Randomized Pragmatic Clinical Trial Testing Behavioral Economic Implementation Strategies to Improve Tobacco Treatment for Patients With Cancer Who Smoke

PURPOSE

Few cancer centers systematically engage patients with evidence-based tobacco treatment despite its positive effect on quality of life and survival. Implementation strategies directed at patients, clinicians, or both may increase tobacco use treatment (TUT) within oncology.

METHODS

We conducted a four-arm cluster-randomized pragmatic trial across 11 clinical sites comparing the effect of strategies informed by behavioral economics on TUT engagement during oncology encounters with cancer patients. We delivered electronic health record (EHR)-based nudges promoting TUT across four nudge conditions: patient only, clinician only, patient and clinician, or usual care. Nudges were designed to counteract cognitive biases that reduce TUT engagement. The primary outcome was TUT penetration, defined as the proportion of patients with documented TUT referral or a medication prescription in the EHR. Generalized estimating equations were used to estimate the parameters of a linear model.

RESULTS

From June 2021 to July 2022, we randomly assigned 246 clinicians in 95 clusters, and collected TUT penetration data from their encounters with 2,146 eligible patients who smoke receiving oncologic care. Intent-to-treat (ITT) analysis showed that the clinician nudge led to a significant increase in TUT penetration versus usual care (35.6% v 13.5%; OR = 3.64; 95% CI, 2.52 to 5.24; P < .0001). Completer-only analysis (N = 1,795) showed similar impact (37.7% clinician nudge v 13.5% usual care; OR = 3.77; 95% CI, 2.73 to 5.19; P < .0001). Clinician type affected TUT penetration, with physicians less likely to provide TUT than advanced practice providers (ITT OR = 0.67; 95% CI, 0.51 to 0.88; P = .004).

CONCLUSION

EHR nudges, informed by behavioral economics and aimed at oncology clinicians, appear to substantially increase TUT penetration. Adding patient nudges to the implementation strategy did not affect TUT penetration rates.

Provider Implicit Bias in Prescribing HIV Pre-exposure Prophylaxis (PrEP) to People Who Inject Drugs

BACKGROUND

Multiple HIV outbreaks among people who inject drugs (PWIDs) have occurred in the USA since 2015, highlighting the need for additional HIV prevention tools. Despite high levels of need, pre-exposure prophylaxis (PrEP) is drastically underutilized among PWIDs. Implicit bias toward PWID held by clinicians may impede PrEP scale-up among these underserved patients. This study examined how primary care providers' (PCPs) clinical decisions related to PrEP can be impacted by biases when the patient has a history of substance use.

METHODS

We conducted an online survey of PCPs (n = 208). The survey included the implicit association test (IAT) to assess unconscious attitudes toward PWIDs, direct questions regarding clinicians' explicit PWID attitudes, and an embedded experiment in which we systematically varied the risk behavior of a hypothetical patient and asked PCPs to make clinical judgments.

RESULTS

A minority (32%) of PCPs reported explicit PWID bias. The IAT indicated strong implicit PWID bias (meant IAT score = 0.59, p < .0001) among 88% of the sample. Only 9% of PCPs had no implicit or explicit PWID bias. PWID patients were judged as less likely to adhere to a PrEP regimen, less responsible, and less HIV safety conscious than heterosexual or gay male patients. Anticipated lack of adherence mediated PCPs' intent to prescribe PrEP to PWID.

CONCLUSIONS

PCPs' bias may contribute to PrEP being under-prescribed to PWID. Implicit and explicit PWID biases were common in our sample. This study illustrates the need to develop and test tailored interventions to decrease biases against PWID in primary care settings.

Effects of Health Responsibility Frames: Testing a Mediation Model of Attributions, Emotions, and Social Support Intentions

When news stories cover health and illness, they often address issues of responsibility. These responsibility frames can affect recipients' responsibility beliefs (i.e. attributions) and thereby indirectly affect emotions and motivation to support people affected by health problems. To date, it is not fully understood how responsibility frames affect social support intentions, and if attributions and emotions mediate this effect. In an online experiment with N = 1,088 German participants, we tested the effects of responsibility frames (individually controllable vs. non-controllable) for type 2 diabetes and depression on social support intentions through responsibility attributions and emotional reactions. Mediation analyses show that responsibility frames indirectly affect social support intentions through social-societal attributions and sympathy. This mediation effect was observed in both depression and type 2 diabetes, despite issue-specific differences in attributions, emotions, and social support intentions. We discuss these findings considering framing effects research and health reporting.

Brain-computer interfaces, disability, and the stigma of refusal: A factorial vignette study

As brain-computer interfaces are promoted as assistive devices, some researchers worry that this promise to "restore" individuals worsens stigma toward disabled people and fosters unrealistic expectations. In three web-based survey experiments with vignettes, we tested how refusing a brain-computer interface in the context of disability affects cognitive (blame), emotional (anger), and behavioral (coercion) stigmatizing attitudes (Experiment 1, N = 222) and whether the effect of a refusal is affected by the level of brain-computer interface functioning (Experiment 2, N = 620) or the risk of malfunctioning (Experiment 3, N = 620). We found that refusing a brain-computer interface increased blame and anger, while brain-computer interface functioning did change the effect of a refusal. Higher risks of device malfunctioning partially reduced stigmatizing attitudes and moderated the effect of refusal. This suggests that information about disabled people who refuse a technology can increase stigma toward them. This finding has serious implications for brain-computer interface regulation, media coverage, and the prevention of ableism.

Association between self-compassion and cyber aggression in the COVID-19 context: roles of attribution and public stigma

Self-compassion is negatively associated with aggressive behaviors. However, the association between self-compassion and cyber aggression toward stigmatized people (e.g., people infected with COVID-19) has not been investigated in the COVID-19 context and the mechanism underlying this association remains underexplored. On the basis of emotion regulation theory and attribution theory, this study examined the indirect effects of self-compassion on cyber aggression toward people infected with COVID-19 through attribution and public stigma of COVID-19. Data were collected from 1162 Chinese college students (415 male, mean age = 21.61 years). Participants completed an online questionnaire including measurement of the key variables and basic demographic information. Results indicated that self-compassion was negatively associated with cyber aggression through the lower attribution of COVID-19 and lower public stigma of COVID-19. A sequential pathway from the attribution of COVID-19 to public stigma of COVID-19 was identified in the relationship between self-compassion and cyber aggression. Our findings are consistent with emotion regulation theory and attribution theory, which posit that emotion regulation strategies are associated with interpersonal mistreatment through cognitive pathways. These findings suggest that emotional self-regulation strategies can be used to reduce cyber aggression toward stigmatized people by reducing attribution and public stigma in the COVID-19 context. Self-compassion improvement could be target for the interventions aiming at alleviating public stigma and interpersonal mistreatment toward stigmatized people.

Who attributes what to whom? Moral values and relational context shape causal attribution to the person or the situation

Eight preregistered studies (total N = 3,758) investigate the role of values and relational context in attributions for moral violations, focusing on the following questions: (1) Do people's values influence their attributions? (2) Do people's relationships with the violator (self, close other, distant other) influence their attributions? (3) Do the principles intrinsic to the violated values (e.g., loyalty to close others) further influence their attributions? We found that participants were more likely to attribute violations by distant others to the person committing the violation, rather than the situation in which the violation occurred, when participants endorsed the violated values themselves. The tendency to make dispositional attributions did not obtain for violations of participants' less highly endorsed moral values or non-moral values. Relationship with the violator also influenced participants' attributions-participants were more likely to attribute their own and close others' moral violations to situational factors, relative to distant others' violations. This relational pattern was pronounced for violations of "binding" moral values, in which protection of personal relationships and groups is primary. Collectively, these results support a relational-values account of causal attribution for moral violations, whereby attributions systematically vary based on (1) the relevance of the violated values to the attributor's moral values, (2) the attributor's personal relationship to the violator, and (3) an interaction between (1) and (2) such that the principles intrinsic to the violated values influence the effects of one's relationship to the violator.

A systematic review and meta-analysis of associations between primarily non-autistic people's characteristics and attitudes toward autistic people

This systematic review includes a narrative synthesis and meta-analysis of research on the associations between primarily non-autistic people's characteristics and their attitudes toward autistic people. Of 47 studies included in the narrative synthesis, White undergraduate students were surveyed most frequently. Demographic characteristics were the factors most frequently tested for associations with attitudes, followed by contact-related factors (i.e., quantity and quality), knowledge about autism, trait and personality factors, and other factors that did not fit into a single category. Internal consistency was not reported for some instruments assessing raters' characteristics; some instruments had alpha levels lower than 0.70, and many characteristics of raters were measured using one-item measures. Moreover, theoretical motivations for investigating the raters' characteristics were rarely provided. A total of 36 studies were included in the meta-analysis, which showed that attitudes toward autistic people were significantly associated with participants' gender, knowledge about autism, and quality and quantity of their previous contact with autistic people, but not with their age or autistic traits. These findings indicate a need for more studies that focus on context-related characteristics (e.g., institutional variables such as support/commitment to inclusion), use reliable instruments to measure non-autistic people's characteristics, and situate their investigation in a theoretical framework.

Distributive justice criteria and social categorization processes predict healthcare allocation bias

OBJECTIVES

Drawing on theories of distributive justice and intergroup discrimination, we examined how much distributive justice criterion and racial group membership contribute to bias in healthcare allocation decisions, by testing a theoretical model that specifies perceived stereotypicality and individual responsibility as a serial mediation process in the relationship between disease's contraction controllability (controllable vs. non-controllable) and bias in medical decision-making.

METHOD

White Portuguese medical students (N = 213) participated in an online experimental study conducted in two phases. In phase 1, we manipulated the cause of disease contagion and the salience of patient's racial categorization, and measured the stereotypicality of behaviour. In phase 2, we assessed perceived responsibility and likelihood of recommending medical treatment.

RESULTS

Controllable (vs. non-controllable) contraction behaviours in phase 1 were perceived as more stereotypic. As a spillover effect, more stereotypical behaviours in phase 1 predicted more patient's responsibility for their disease in phase 2. Importantly, controllable behaviours of disease contraction in phase 1 negatively affected recommendations for medical treatment in phase 2; and this negative effect was serially mediated by the stereotypicality of behaviour and patient responsibility. Furthermore, patients' skin colour moderated this process, meaning that perceptions of controllable behaviour as more stereotypic were stronger for Black than for White patients.

CONCLUSIONS

This research shows how stereotyping and social categorization bias allocation decisions through the patient's level of responsibility in decision-making processes. The findings are discussed in light of principles of distributive justice and the literature on intergroup relations with respect to racial disparities in health care.

Predictors of the Public’s Aversion to Patients Infected with COVID-19 in China: The Mediating Role of Negative Physiology

COVID-19 has had a lasting impact on the public’s mental health. Understanding the mechanism of the formation of the public’s aversion to COVID-19-infected people can not only help eliminate the irrational stigma, rejection, and aversion of the public but also promote the creation of a harmonious and healthy social atmosphere. Based on stimulus–organism–response theory, this study explored the relationships between environmental stimuli, public negative physiology, and aversion responses. A cross-sectional, online-based survey study was conducted in April 2022. A total of 1863 effective questionnaires from respondents of various ages, genders, incomes, and education levels were acquired. Structural equation modeling was used to test the proposed model. The environmental stimuli including the use of social media and the perception of risk communication aggravated the negative physiology of the public, while the public’s perception of prevention measures reduced the public’s negative physiology during the epidemic. The negative physiology of the public increases the public’s aversion responses, including disgust, stigma, and avoidance, toward patients infected with COVID-19. The negative physiology of the public plays a mediating role in the relationship between the environmental stimuli and the public’s aversion to patients infected with COVID-19. The emergence of excessive information in social media and strict prevention measures in daily life, as well as the dissemination of a large amount of risk information in pseudo-environments and realistic environments, have all exerted an impact on public sentiment and cognition. In the case of the prolonged spread of the epidemic, the accumulation of negative physiology, such as anxiety, panic, and depression, is more likely to lead to the public’s aversion to people with COVID-19.

Multilevel causal attributions on transboundary risk: Effects on attributions of responsibility, psychological distance, and policy support

This study used two randomized experiments in a prospective design (Study 1 N = 297, Study 2 N = 296) to examine how multilevel causal attribution dimensions (internal vs. external to an individual or a country) shape domestic and foreign policy support to counter transboundary risk. Results from Study 1 and 2 showed that external-country (vs. internal-country) causal attribution reduced perceptions of internal-country attributions of responsibility, which had a cross-lagged effect on support for domestic-industry policies to mitigate the risk. In contrast, perceptions of external-country attributions of responsibility increased support for foreign policies in a 2-week follow up. This study offers theoretical insights into the demarcation of multilevel causal attribution dimensions in studying media framing effects. It also highlights some important causal mechanisms of how media frames shape public support for policies aimed at transboundary risk mitigation.

Morally excused but socially excluded: Denying agency through the defense of mental impairment

Defendants can deny they have agency, and thus responsibility, for a crime by using a defense of mental impairment. We argue that although this strategy may help defendants evade blame, it may carry longer-term social costs, as lay people’s perceptions of a person’s agency might determine some of the moral rights they grant them. Three randomized between-group experiments (N = 1601) used online vignettes to examine lay perceptions of a hypothetical defendant using a defense of mental impairment (versus a guilty plea). We find that using a defense of mental impairment significantly reduces responsibility, blame, and punitiveness relative to a guilty plea, and these judgments are mediated by perceptions of reduced moral agency. However, after serving their respective sentences, those using the defense are sometimes conferred fewer rights, as reduced agency corresponds to an increase in perceived dangerousness. Our findings were found to be robust across different types of mental impairment, offences/sentences, and using both manipulated and measured agency. The findings have implications for defendants claiming reduced agency through legal defenses, as well as for the broader study of moral rights and mind perception.

Advances on Self-Regulation Models: A New Research Agenda Through the SR vs ER Behavior Theory in Different Psychology Contexts

The aim of this paper is to demonstrate how Bandura's Social Cognitive Theory (1986) influenced the development of several complementary models of the construct of Self-Regulation. Building on the foundation of Self-Determination Theory, SDT (2000), and Zimmerman's Self-Regulation Theory, SR (2001), with their assumptions, contributions, goddesses, and limitations, we come to the Self- vs. External Regulatory Theory, SR-ER (2021). Finally, we integrate recent evidence demonstrating the explanatory adequacy of the SR vs. ER model for different psychological constructions in different settings related to education, health, clinical practice and social work. Complementary, a new theoretical and empirical research agenda is presented, to continue testing the adequacy of SR vs. ER assumptions, and to better understand the behavioral variability of the different constructs studied.

The role of moral explanations and structural inequalities in experiences of mental illness stigma in Northern Minas Gerais, Brazil

The process of stigmatization within different cultural contexts has long been viewed as essential in understanding the course and outcomes of mental illness. However, little research has examined which cultural constructs and categories are used to explain mental illness, and how they contribute to the way people with mental illness experience stigma and social exclusion, as well as how these beliefs affect healthcare practices. This study examines meanings ascribed to mental illness and experiences of stigma among four groups in urban settings of Minas Gerais, Brazil: persons with mental illness; their families; members of the lay public; and health professionals working at an alternative community-based psychosocial treatment service or a local university hospital. Qualitative methods, including semi-structured interviews and participant observation, were conducted with a purposive sample of 72 participants. Data were analyzed through content analysis. The findings suggest that stigma and discrimination are intrinsically rooted in a systemic process of social exclusion generated by meanings ascribed to mental illness and the structural vulnerabilities of the mental healthcare system. The findings further suggest that structural inequality is a powerful factor behind lay concepts of mental illness and that this is particularly harmful because it reinforces personal blame attributions instead of addressing the hidden structural forces that contribute to mental illness. The study highlights the subtle interrelations between cultural beliefs and structural vulnerabilities that should be addressed in mental health policy in order to diminish the effects of stigma on people with mental illnesses.

Latent Patterns of Posttraumatic Stress Symptoms, Depression, and Posttraumatic Growth Among Adolescents During the COVID-19 Pandemic

Researchhas shown that posttraumatic reactions can co-occur in trauma-exposed individuals. Many studies have assessed the co-occurring patterns of two types of reactions, but few have assessed the patterns of multiple reactions. To build on existing knowledge, the present study examined co-occurring patterns of posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and posttraumatic growth (PTG) among adolescents during the COVID-19 pandemic. Participants (N = 683) were adolescents selected from an area in China severely affected by COVID-19 who completed the PTSD Checklist, a measure of depression, a PTG inventory, and a cognitive emotional regulation questionnaire. Latent profile analysis and multinomial logistic regression were used for the data analyses. The results showed three heterogeneous patterns characterized by growth (n = 248, 36.3%), distress (n = 101, 14.8%), and struggle (n = 334, 48.9%). Positive refocusing and reappraisal were associated with membership in the growth group compared with distress group, OR = 0.83, 95% CI [0.75, 0.93] and OR = 0.78, 95% CI [0.68, 0.90], whereas rumination, catastrophizing, and "putting into perspective" were associated with membership in the distress group compared with growth group, ORs = 1.15-1.44. These findings suggest that posttraumatic reactions show heterogeneous characteristics: struggle, rather than growth or distress, is common among adolescents during COVID-19; and distinct cognitive emotional regulation strategies have distinguishing roles in the three patterns of posttraumatic reactions.

Intersecting Stigma and HIV/AIDS Community Participation Among Young Chinese Men Who Have Sex with Men Living with HIV

Community participation is vital for the recovery and empowerment of men who have sex with men (MSM) living with HIV. Intersectionality also provides an important lens that inequalities operate in an intersectional manner and pose compound challenges to the lives of minority individuals. However, the association between intersecting stigma toward HIV-positive MSM and their community participation is underexplored. The study drew on a sample of young Chinese MSM living with HIV from a community-based online survey that recruited respondents using nonprobability purposive sampling (n = 1004). Structural equation modeling was performed to investigate the associations among perceived stigma against sexual minorities and people living with HIV, HIV-related self-stigma, and HIV/AIDS community participation. The indirect effect of self-stigma and the statistical interaction between perceived homosexual stigma and perceived HIV-related stigma were further examined. Results show that total direct effect was significant [B (SE) = 0.859 (0.233); confidence interval (95% CI) = 0.402-1.316]. Perceived HIV-related stigma was positively correlated with HIV/AIDS community participation, while HIV-related self-stigma was negatively correlated. The mediating role of HIV-related self-stigma was significant in both types of perceived stigma [total indirect effect: B (SE) = -0.935 (0.175); 95% CI = -1.277 to -0.593]. The interaction effect was also significant and negative [B (SE) = -0.117 (0.056), p < 0.001], showing that perceived homosexual stigma could offset the effect of perceived HIV-related stigma on HIV-related self-stigma. The findings illustrate how intersecting stigma is involved in HIV-related self-stigma and community participation and highlight the importance of applying an intersectionality perspective to investigate stigma toward MSM living with HIV and their community participation.

Intergroup helping during the COVID-19 crisis: A moderated mediation with effects of ingroup identification, ingroup blame, and perceived global common fate

Strong identification with the national ingroup encourages acts of ingroup solidarity and helping of ingroup members, but it is less well understood how ingroup identification affects willingness to help outgroup members in need. This was tested in the context of the COVID-19 crisis, asking British nationals about their willingness to donate money to help those suffering from the coronavirus crisis in China. It was hypothesized that ingroup identification would have an indirect negative effect on willingness to help outgroup members, mediated by ingroup blame, i.e. preparedness to attribute blame for the worldwide problems caused by the coronavirus crisis to the British national ingroup. Identification was expected to be negatively associated with ingroup blame, and ingroup blame was expected to be positively associated with outgroup helping. Moreover, it was hypothesized that the link between ingroup blame and outgroup helping would be attenuated if perceived global common fate in terms of managing the pandemic was high. Support for these predictions was found in a survey of British participants (N = 210).

Association of public explanations of why children struggle and support for policy solutions using a national sample

Purpose

Despite evidence showing the importance of structural determinants for child well-being and the existence of policies that can promote child well-being, many communities are not adopting these policies. Limited awareness of structural determinants may explain this gap. This study establishes the public's recognition of structural determinants and their associations with support for policies that promote child well-being.

Methods

Secondary analyses of survey data collected in 2019 from a random sample of 2496 adults in the United States. This survey asked why some children "struggle" (e.g., do poorly in school, use drugs, or get involved in crime). Respondents could select individual (e.g., lack of effort) and structural (e.g., low wages) explanations. Respondents were also asked about their support for policies that are supportive of children and families.

Results

Stronger beliefs of structural explanations were associated with greater support for policies that strengthen family economics, family-friendly work, and afford access to high-quality early childcare and education. Beliefs in individual explanations were inversely associated with support for these policies.

Conclusions

These findings suggest increasing recognition of the structural determinants that hinder child development may help increase support for policies that are effective in improving children's outcomes.

Public Stigma of COVID-19 and Its Correlates in the General Population of China

This study aimed to examine the profile of COVID-19-related public stigma and its correlates in the general population of China. A cross-sectional online survey was conducted in China from 7 May to 25 May in 2020. A total of 1212 participants from the general population completed the survey measuring their stigmatizing attitudes towards COVID-19, as well as knowledge and causal attributions of COVID-19. Univariate and multivariate analyses were performed to examine the correlates of COVID-19-related public stigma. A total of 31.8% of participants endorsed stigmatization towards people with COVID-19. Those who were of older age (t = -3.97, p < 0.001), married (F = 3.04, p < 0.05), had a lower level of education (F = 8.11, p < 0.001), and a serious psychological response (F = 3.76, p < 0.05) reported significantly higher scores of public stigma. Dangerousness (B = 0.047, p < 0.001), fear (B = 0.059, p < 0.001), anger (B = 0.038, p < 0.01), and responsibility (B = 0.041, p < 0.001) were positively associated with public stigma. This study shows that public stigma related to COVID-19 is prevalent in the general population of China. Actions against public stigma need to contain the spread of misinformation about COVID-19, alter inappropriate attributions, alleviate unfavorable reactions, and provide psychosocial support for the public.

Moral identity and empathy promote prosocial behavior only toward blameless AIDS patients

Moral identity and empathy are two important contributors of charitable donation. But there are also inconsistent findings which suggest the existence of moderating variables. This research investigated their effects on charitable donation when the fictional recipients have or have not responsibility for HIV infection. Through four between-subjects experiments, we respectively explored the effect of responsibility of AIDS patients (blameless vs. blameful; manipulated by different ways of HIV infection) on donation, and its interaction with trait moral identity (study 1a, n = 313, Mage = 19.37, 70% females), primed moral identity (study 1b, n = 392, Mage = 19.43, 72% females), trait empathy (study 2a, n = 310, Mage = 19.34, 67% females), and primed empathy (study 2b, n = 366, Mage = 19.39, 55% females). Measures of moral identity and empathy, and a priming technique with moral identity and empathy words as stimuli were used research tools. The results demonstrated that when AIDS patients were not responsible for their plight (blameless), moral identity and empathy (regardless of trait or activated) showed positive effects on donation. When AIDS patients were responsible for their plight (blameful), however, all positive effects disappeared. Trait moral identity even showed a negative effect on donation. These results indicated that the prosocial effects of moral identity and empathy are conditioned by characteristics of the beneficiaries.

Effectiveness of Narrative Messaging Styles about the Social Determinants of Health and Health Inequities in Ontario, Canada

Health inequities are systemic, avoidable, and unjust differences in health between populations. These differences are often determined by social and structural factors, such as income and social status, employment and working conditions, or race/racism, which are referred to as the social determinants of health (SDOH). According to public opinion, health is considered to be largely determined by the choices and behaviours of individuals. However, evidence suggests that social and structural factors are the key determinants of health. There is likely a lack of public understanding of the role that social and structural factors play in determining health and producing health inequities. Public opinion and priorities can drive governmental action, so the aim of this work was to determine the most impactful way to increase knowledge and awareness about the social determinants of health (SDOH) and health inequities in the province of Ontario, Canada. A study to test the effectiveness of four different messaging styles about health inequities and the SDOH was conducted with a sample of 805 adult residents of Ontario. Findings show that messages highlighting the challenges faced by those experiencing the negative effects of the SDOH, while still acknowledging individual responsibility for health, were the most effective for eliciting an empathetic response from Ontarians. These findings can be used to inform public awareness campaigns focused on changing the current public narrative about the SDOH toward a more empathetic response, with the goal of increasing political will to enact policies to address health inequities in Ontario.

Seven (weak and strong) helping effects systematically tested in separate evaluation, joint evaluation and forced choice

In ten studies (N = 9187), I systematically investigated the direction and size of seven helping effects (the identifiable-victim effect, proportion dominance effect, ingroup effect, existence effect, innocence effect, age effect and gender effect). All effects were tested in three decision modes (separate evaluation, joint evaluation and forced choice), and in their weak form (equal efficiency), or strong form (unequal efficiency). Participants read about one, or two, medical help projects and rated the attractiveness of and allocated resources to the project/projects, or choose which project to implement. The results show that the included help-situation attributes vary in their: (1) Evaluability – e.g., rescue proportion is the easiest to evaluate in separate evaluation. (2) Justifiability – e.g., people prefer to save fewer lives now rather than more lives in the future, but not fewer identified lives rather than more statistical lives. (3) Prominence – e.g., people express a preference to help females, but only when forced to choose.

Rationale and protocol for a cluster randomized pragmatic clinical trial testing behavioral economic implementation strategies to improve tobacco treatment rates for cancer patients who smoke

BACKGROUND

Routine evidence-based tobacco use treatment minimizes cancer-specific and all-cause mortality, reduces treatment-related toxicity, and improves quality of life among patients receiving cancer care. Few cancer centers employ mechanisms to systematically refer patients to evidence-based tobacco cessation services. Implementation strategies informed by behavioral economics can increase tobacco use treatment engagement within oncology care.

METHODS

A four-arm cluster-randomized pragmatic trial will be conducted across nine clinical sites within the Implementation Science Center in Cancer Control Implementation Lab to compare the effect of behavioral economic implementation strategies delivered through embedded messages (or "nudges") promoting patient engagement with the Tobacco Use Treatment Service (TUTS). Nudges are electronic medical record (EMR)-based messages delivered to patients, clinicians, or both, designed to counteract known patient and clinician biases that reduce treatment engagement. We used rapid cycle approaches (RCA) informed by relevant stakeholder experiences to refine and optimize our implementation strategies and methods prior to trial initiation. Data will be obtained via the EMR, clinician survey, and semi-structured interviews with a subset of clinicians and patients. The primary measure of implementation is penetration, defined as the TUTS referral rate. Secondary outcome measures of implementation include patient treatment engagement (defined as the number of patients who receive FDA-approved medication or behavioral counseling), quit attempts, and abstinence rates. The semi-structured interviews, guided by the Consolidated Framework for Implementation Research, will assess contextual factors and patient and clinician experiences with the nudges.

DISCUSSION

This study will be the first in the oncology setting to compare the effectiveness of nudges to clinicians and patients, both head-to-head and in combination, as implementation strategies to improve TUTS referral and engagement. We expect the study to (1) yield insights into the effectiveness of nudges as an implementation strategy to improve uptake of evidence-based tobacco use treatment within cancer care, and (2) advance our understanding of the multilevel contextual factors that drive response to these strategies. These results will lay the foundation for how patients with cancer who smoke are best engaged in tobacco use treatment and may lead to future research focused on scaling this approach across diverse centers.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT04737031 . Registered 3 February 2021.

Social Identities of Persons With Schizophrenia and Social Functioning: Individual and Family Caregiver Perspectives

ABSTRACT

We apply social identity theory and self-categorization theory to examine the role of social identities in relation to the recovery of persons with schizophrenia. We assess whether illness-based and non-illness-based identities held by both those with schizophrenia and their caregivers explain additional variance in social functioning in persons with schizophrenia beyond the previously established predictors of negative symptoms and theory of mind. Sixty Mexican-origin adults diagnosed with schizophrenia and their family caregivers were obtained through an outpatient mental health clinic located in either Los Angeles, CA, or in Puebla, Mexico. A three-step hierarchical regression indicated that identity endorsements, from both the perspective of the person with schizophrenia and their caregiver, and negative symptomatology are significant independent predictors of social functioning. Specifically, greater endorsement of nonillness identities both for the person with schizophrenia and also their caregiver is associated with higher social functioning. Illness identity plays an important role in the path to recovery.

Precautionary Behavior Practices and Psychological Characteristics of COVID-19 Patients and Quarantined Persons

Background: since the coronavirus disease (COVID-19) was first reported in 2019, South Korea has enforced isolation of patients with confirmed cases of COVID-19, as well as quarantine for close contacts of individuals diagnosed with COVID-19 and persons traveling from abroad, in order to contain its spread. Precautionary behavior practices and psychological characteristics of confirmed and quarantined persons were investigated for planning pandemic recovery and preparedness. Methods: this study was conducted with 1716 confirmed patients and quarantined persons in Daegu and Busan, regions where a high number of cases were confirmed during the early stage of the COVID-19 outbreak in South Korea. We collected online survey data from 23 April to 20 May 2020, in Daegu, and 28 April to 27 May 2020, in Busan, in cooperation with Daegu and Busan Infectious Disease Control Centers and public health centers in the regions. COVID-19 symptoms, pre-cautionary behavior practices, psychological states, and the need for improvement in isolation/quarantine environments were examined using an online survey. Results: compared to patients infected with coronavirus, quarantined persons engaged in more hygiene-related behaviors (e.g., hand washing, cough etiquette, and proper mask-wearing) and social distancing. COVID-19 patients had a strong fear of stigma, while quarantined persons had a strong fear of contracting COVID-19. Study participants responded that it was necessary to provide financial support and adequate information during isolation/quarantine. Conclusions: the study highlights the importance of precautionary behavior to prevent COVID-19 infection and the need to provide support (both psychological and financial) to patients and quarantined persons, to reinforce effective communication, social solidarity, and public health emergency preparedness (PHEP) in a pandemic situation.

Who or what is to blame? Examining sociodemographic relationships to beliefs about causes, control, and responsibility for cancer and chronic disease prevention in Alberta, Canada

BACKGROUND

Beliefs about causes and responsibility for chronic diseases can affect personal behaviour and support for healthy policies. In this research we examined relationships between socio-demographics (sex, age, education, employment, political alignment, perceived health, household income, household size) and perceptions of causes and responsibility for health behaviour, chronic disease correlates, and attitudes about cancer prevention and causes.

METHODS

Using data from the 2016 Chronic Disease Prevention survey in which participants (N = 1200) from Alberta, Canada responded to items regarding how much they believed personal health behaviours, prevention beliefs, and environmental factors (i.e., healthy eating, physical activity, alcohol, smoking, and where a person lives or works) are linked to getting cancer. Participants also responded to questions about causes and responsibility for obesity, alcohol, and tobacco (i.e., individual or societal). Relationships were examined using multinomial logistic regression on socio-demographics and survey items of interest.

RESULTS

Men (compared to women) were less likely to link regular exercise, or drinking excessive alcohol, to reducing or increasing cancer risk. Similarly, men were less likely to link environmental factors to cancer risk, and more likely to agree that cancer was not preventable, and that treatment is more important than prevention. Finally, men were more likely to believe that alcohol problems are an individual's fault. Left and central voters were more likely to believe that society was responsible for addressing alcohol, tobacco, and obesity problems compared to right voters. Those with less than post-secondary education were less likely to believe that regular exercise, maintaining a healthy body weight, or eating sufficient fruits and vegetables were linked to cancer - or that society should address obesity - compared to those with more education. Households making above the median income (versus below) were more likely to link a balanced diet with cancer and were less likely to think that tobacco problems were caused by external circumstances.

CONCLUSIONS

These results provide insight into the importance of health literacy, message framing, and how socio-demographic factors may impact healthy policy. Men, those with less education, and those with less income are important target groups when promoting health literacy and chronic disease prevention initiatives.

Public Stigma Toward Female and Male Opium and Heroin Users. An Experimental Test of Attribution Theory and the Familiarity Hypothesis

Drug abuse and addiction exist around the world. People addicted to drugs such as opium or heroin often encounter dehumanizing discriminatory behaviors and health-care systems that are reluctant to provide services. Experiencing discrimination often serves as a barrier to receiving help or finding a home or work. Therefore, it is important to better understand the mechanisms that lead to the stigmatization of drug addiction and who is more prone to stigmatizing behaviors. There is also a dearth of research on whether different patterns of stigma exist in men and women. Therefore, this study investigated factors affecting gender-specific stigmatization in the context of drug addiction. In our vignette study (N _Mensample = 320 and N _Womensample = 320) in Iran, we experimentally varied signals and signaling events regarding a person with drug addiction (i.e., N _Vignettes = 32 per sample), based on Attribution Theory, before assessing stigmatizing cognitions (e.g., blameworthiness), affective responses (e.g., anger), and discriminatory inclinations (e.g., segregation) with the Attribution Questionnaire. We also tested assumptions from the Familiarity Hypothesis by assessing indicators of respondents' familiarity with drug addiction (e.g., knowledge about addiction). Results, for example, show higher stigma if the person used "harder" drugs, displayed aggressive behavior, or had a less controllable drug urge. Self-attributed knowledge about addiction or prior drug use increased some forms of stigma, but diminished others. These findings only partially converged between men and women. We suggest that anti-stigma initiatives should consider information about the stigmatized person, conditions of the addiction, and characteristics of stigmatizers.

The Influence of Weight Bias on Processes and Outcomes in Negotiation

In two studies, using a mix of samples, we examined the influence of weight bias on behaviors in competitive, potentially high stakes situations. As predicted, weight bias directed focal actors' treatment of counterparts in a negotiation. Negotiators made lower value offers to overweight counterparts relative to average-weight counterparts. In addition, overweight counterparts also received more negative messages over the course of their negotiation and were evaluated less favorably after the negotiation than average-weight counterparts.

Searching for Evidence-Based Public Policy and Practice: Analysis of the Determinants of Personal/Public Adaptation and Mitigation Behavior against Particulate Matter by Focusing on the Roles of Risk Perception, Communication, and Attribution Factors

In recent years, awareness about the risk of particulate matter (PM) has increased both domestically and internationally; consequently, various policies have been implemented to reduce PM. Since citizens are both victim and cause of this risk, PM cannot be successfully decreased only through government policies. Therefore, citizens' active participation is required to reduce PM and prevent its risks. However, a theoretical model about public behavior against PM has not been established. Therefore, we suggest the public behavior model about individuals' response against PM, in which response actions are classified into four types based on the combinations of the public-personal domains and mitigation-adaptation actions: Personal or public adaptations, and personal or public mitigations. We analyze how risk perception, risk communication, blame attribution factors influence the four types of responses against PM. The analysis results reveal that the receiver's ability, negative emotion, trust in government, and age influence personal mitigation behavior, personal adaptation, public mitigation, and public adaptation, respectively. As this study demonstrates the differences in the factors influencing each type of response actions against PM, evidence-based policy is needed that considers the differences in these influencing factors.

Representation of Mental Illness in Leading Ugandan Daily Newspapers: A Content Analysis

Media are a major purveyor of information about mental health. Recognizing what messages media are disseminating about mental illness, therefore, is a step toward raising mental health literacy in a population. Most research about media coverage of mental illness, however, has taken place in Western nations. Differences in cultural views of mental illness and severely strained mental health-care resources in sub-Saharan African make it likely that media coverage of mental illness there will differ substantially from Western contexts. This study investigated the coverage of mental illness in the two largest circulation newspapers in Uganda: The Monitor and The New Vision. Analysis of the entire contents of every issue of both papers from January 1, 2017 to June 30, 2019 revealed just 53 articles addressing mental illness. Although types of mental illness addressed did not differ greatly from coverage in Western newspapers, causes to which mental illness was attributed included war, poverty, and witchcraft, none of which appears in content analyses in other contexts. Also, different than Western media, most articles were thematically rather than episodically framed, especially in the government-owned paper, and individuals with mental illness themselves were regularly cited.

Parents' Experiences of Affiliate Stigma when Caring for a Child with Autism Spectrum Disorder (ASD): A Meta-Synthesis of Qualitative Studies

PROBLEM

Stigma affects not only children diagnosed with autism spectrum disorder (ASD) themselves, but also people connected with them (i.e., parents, siblings). The capacity of parents to provide care is affected by the stigma they perceive. This meta-synthesis encompasses the experiences of affiliate stigma among parents of children with ASD.

ELIGIBILITY CRITERIA

Articles were limited to the English language, those reported on stigma experienced by parents of children with ASD aged 2-18 years, published between 1940 and 2019.

SAMPLE

PubMed, CINAHL, PsycINFO, EMBASE, Scopus and The Cochrane Library databases were searched for eligible studies. Titles and abstracts were reviewed, and twelve articles fitted the selection criteria. The texts of the selected research papers were reviewed by two independent reviewers.

RESULTS

Four common themes across parental experiences included felt stigma, enacted stigma, variations in stigma, and contributors to stigmatizing experiences.

CONCLUSIONS

Highlighting the differences in parents' views on affiliate stigma is necessary to create awareness about ASD and the stigma linked with this disorder.

IMPLICATIONS

The findings asserted that healthcare professionals, especially those in pediatric settings, and society need to have a greater awareness of the stigma and challenges that these parents encounter as this has implications on their mental and physical health. This awareness will lead to more compassionate health care delivery which will support them and create a better environment for families and children with ASD.

COVID-19-related stigma profiles and risk factors among people who are at high risk of contagion

Rationale

COVID-19 is likely to be stigmatized. The people of Hubei province perceived courtesy and affiliate stigma due to the geographic linkage to COVID-19. Perceived courtesy stigma refers to the perception of stigma of people who are associated with COVID-19 (e.g., the geographic linkage). Affiliate stigma is the internalization and psychological responses of perceived courtesy stigma among the associates.

Objective

The current study aims to reveal different patterns of perceived courtesy and affiliate stigma among people who are at high risk of contagion of COVID-19, and to examine the possible risk factors.

Method

A sample including 2813 adults who located in Hubei Province, China (female: n = 2,184, 77.64%; male: n = 629, 22.36%; mean age = 37.85 years, SD = 6.61 years, range = 18–63 years) were employed in the current study, using latent profile analysis for searching stigma profiles.

Results

Three profiles of stigma were found: the “Denier” (35.98%), “Confused moderate” (48.13%) and “Perceiver” (15.89%) displaying the low, moderate and high level of perceived courtesy and affiliate stigma, respectively. Multinomial logistic regression analyses revealed that generally people with a high level of education, perceived threats, anxiety symptoms, and familiarity with quarantined cases have a high likelihood to be distributed into the “Perceiver”.

Discussion and Conclusions

Our findings highlight the issues of COVID-19-related stigma and provide evidence for launching effective health actions to promote a cohesive society and culture of health. The media can transmit scientific knowledge, promote positive interactions and social cohesion between the stigmatized group and the dominant group, and create spaces for stories that nurture group identification among the implicated people. Future studies should use more representative sample and improve the measures.

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People at high risk of contagion of COVID-19 may experience stigma.

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Stigma may concern perceived courtesy and/or affiliate stigma.

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Three distinct profiles of stigma were identified.

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Risk factors were measured at the interface of individuals and the community.

Preferred level of categorization as strategy to manage chronic illness-related identity among individuals with type 1 versus type 2 diabetes

The present investigation examined social identification management among individuals affected by chronic illness. Because diabetes is a chronic medical condition that consists of a broad superordinate group with two nested subgroups of differing relative status (type 1 versus type 2), it is well-suited to an examination of positive identity management strategies used by individuals with chronic illness. A cross-sectional survey was conducted on individuals with diabetes (N = 399) to assess diabetes-related identity. Results indicated that individuals with type 1 diabetes reported greater identity centrality and greater preference for subgroup self-categorization ("individual affected by type 1 diabetes") over superordinate group categorization ("individual affected by diabetes") than did individuals with type 2 diabetes. The relationship between diabetes type and preferred categorization level was moderated by perceived intractability of their condition and perceived stigmatization of the lower status subgroup (i.e., type 2), suggesting that categorization level functions to maintain a positive self-concept. Further, categorization level moderated the negative relationship between identity centrality and feelings of depression and anger, suggesting that self-categorization might function to protect against self-concept threat. The present findings highlight the roles of group status, group boundary permeability, and perceived stigma on identity management strategies used by individuals with a chronic illness.

Perceptions of Responsibility for Antibiotic Resistance: Implications for Stewardship Campaigns

Widespread public engagement with antibiotic stewardship is essential to stem the rising incidence of antibiotic-resistant infections; however, campaigns that focus on increasing knowledge have not been effective. Beliefs about who is responsible for causing and solving antibiotic resistance (AR) likely influences engagement in antibiotic stewardship behaviors. This study assesses the U.S. public's AR causal and solution responsibility attributions and the capacity for changing these attributions to inform future antibiotic stewardship campaigns. U.S. participants (N= 1,014) diverse across race, education, and geographic region were surveyed on their beliefs about responsibility for AR for themselves, the general public, healthcare providers, scientists, and drug companies. Substantial percentages of participants held causal and solution beliefs about antibiotic resistance that likely inhibit antibiotic stewardship behaviors. Participants' beliefs that they and the general public are responsible for causing and solving AR were lower than their beliefs that healthcare providers, scientists, and drug companies are responsible. Beliefs about causal responsibility for any given person or group were significantly and positively associated with beliefs about solution responsibility for that same person or group. Responsibility beliefs differed by age, education level, and racial/ethnic background. Results highlight the need for antibiotic stewardship campaigns to incorporate responsibility attribution messaging to motivate stewardship.

Closeness or compassion? Relatedness and causal control influence helping via distinct pathways

Why do people feel compassion? Two largely separate research literatures - one driven by evolutionary psychology and one driven by attribution theory - have shown that feelings of compassion for needy individuals and subsequent helping are predicted by both genetic relatedness and causal control. Research also suggests that emotional closeness, rather than compassion, motivates help for family. In two studies, we tested the role of genetic relatedness and control on cognitive and emotional mediators of helping. Results revealed that relatedness and control had distinct and independent effects on willingness to help needy individuals that were mediated by emotional closeness and compassion, respectively. These results provide a unique bridging of disparate literatures and suggest that emotional closeness and compassion serve distinct functions in facilitating prosocial behavior.

Opioid Addiction Stigma: The Intersection of Race, Social Class, and Gender

Objectives: To investigate whether public stigma toward people addicted to opioids varies according to the race, social class, and gender of the person who uses opioids, the social class and gender of the individual evaluating them, and their attributions of the cause of opioid addiction. Methods: An online survey was sent to White undergraduate students at a public university. Participants were randomly assigned to one of eight vignettes depicting an individual addicted to opioids as either Black or White, male or female, and working- or middle-class. The vignettes were followed by measures of reactions to the vignette character including stigma, attributions, and preferred consequences, i.e. criminal prosecution or medical care. ANOVAs and mediation analyses were conducted to assess the direct and indirect effects of race, class, and gender on stigma, criminalization, and medicalization. Results: Participants tended to judge working-class opioid users more harshly than middle-class users, and participants who were middle- to upper-class themselves tended to judge all opioid users more harshly than participants who were working class. Expressed stigma was greater toward White than Black opioid users. Attributing addiction to bad character partially mediated the relationships between opioid user social class and the dependent variables. There were few effects of user or participant gender on attitudes. Conclusions: Efforts to shift public opinion toward supporting funding to address the opioid epidemic should be informed by awareness of biases against working-class users on the part of middle- and upper-class members of the public and the consequences of blaming addiction on opioid users' character.

An examination of stigmatising attributions about mental illness amongst police custody staff

Individuals who enter police custody may experience mental illness, making it highly imperative for custody staff to be knowledgeable and competent in this area- however, reports suggest this is not always the case (Leese & Russell, 2017). The present study examined the differences in casual attributions and stereotypes of individuals experiencing mental illnesses, mainly, schizophrenia between police custody staff (n = 77) and members of the general population (n = 85). Using the Attribution Questionnaire (AQ-27; Corrigan, 2004), the current study found that the general population held more negative attitudes towards individuals experiencing mental illnesses than police custody staff. In particular they endorsed the attributions anger, avoidance, dangerousness and fear. Custody staff were found to help vulnerable adults more than the general population. In addition, people who knew a family member or friend experiencing a mental illness scored higher on the help and pity attributions. Furthermore, police custody staff highlighted that additional training around mental health would be beneficial to their job role. Further development of an adequate measurement of attitudes of police custody staff towards mental health needs developing in order to put in place effective training.

Is disclosing an autism spectrum disorder in school associated with reduced stigmatization?

Evidence suggests disclosing an autism diagnosis is associated with reduced stigmatization for autistic adults. However, it is unknown whether this is true for autistic adolescents. We used a vignette-and-questionnaire design to study stigmatizing attitudes with adolescents (aged 11-12 and 14-16 years, total N = 250) in a UK school. We investigated the effect of disclosing that a fictional adolescent had an autism diagnosis on stigmatizing attitudes of peers by testing the effect of disclosure of diagnosis on the social and emotional distance pupils wanted to maintain from the autistic adolescent. We also tested the effect of disclosure on peers' assessment of the adolescent's responsibility for their own behaviour. We checked to see if the effects were moderated by gender and age-group. Disclosing autism did not affect the social and emotional distance peers wanted to maintain from the autistic adolescent, but was associated with significant reduction in personal responsibility attributed to the adolescent's behaviour. Boys attributed more personal responsibility to the autistic adolescent than girls, but this gender effect was reduced when autism was disclosed. These findings suggest that disclosing autism to other pupils may be of limited use in reducing stigmatization by peers in UK schools.