Julia M. Przedworski

Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People among Heterosexual First-Year Medical Students? A Report from the Medical Student CHANGE Study

Purpose A recent Institute of Medicine report concluded that lesbian and gay individuals face discrimination from health care providers and called for research on provider attitudes. Medical school is a critical juncture for improving future providers’ treatment of sexual minorities. This study examined both explicit bias and implicit bias against lesbian women and gay men among first-year medical students, focusing on two predictors of such bias, contact and empathy. Method This study included the 4,441 heterosexual first-year medical students who participated in the baseline survey of the Medical Student Cognitive Habits and Growth Evaluation Study, which employed a stratified random sample of 49 U.S. medical schools in fall 2010. The researchers measured explicit attitudes toward gay and lesbian people using feeling thermometer self-assessments, implicit attitudes using the Implicit Association Test, amount and favorability of contact using self-report items, and empathy using subscales of the Interpersonal Reactivity Index. Results Nearly half (45.79%; 956/2,088) of respondents with complete data on both bias measures expressed at least some explicit bias, and most (81.51%; 1,702/2,088) exhibited at least some implicit bias against gay and lesbian individuals. Both amount and favorability of contact predicted positive implicit and explicit attitudes. Both cognitive and emotional empathy predicted positive explicit attitudes, but not implicit attitudes. Conclusions The prevalence of negative attitudes presents an important challenge for medical education, highlighting the need for more research on possible causes of bias. Findings on contact and empathy point to possible curriculum-based interventions aimed at ensuring high-quality care for sexual minorities.

Comparison of Health and Health Risk Factors Between Lesbian, Gay, and Bisexual Adults and Heterosexual Adults in the United States: Results From the National Health Interview Survey

IMPORTANCE Previous studies identified disparities in health and health risk factors among lesbian, gay, and bisexual (LGB) adults, but prior investigations have been confined to samples not representative of the US adult population or have been limited in size or geographic scope. For the first time in its long history, the 2013 and 2014 National Health Interview Survey included a question on sexual orientation, providing health information on sexual minorities from one of the nations leading health surveys. OBJECTIVE To compare health and health risk factors between LGB adults and heterosexual adults in the United States. DESIGN, SETTING, AND PARTICIPANTS Data from the nationally representative 2013 and 2014 National Health Interview Survey were used to compare health outcomes among lesbian (n = 525), gay (n = 624), and bisexual (n = 515) adults who were 18 years or older and their heterosexual peers (n = 67 150) using logistic regression. MAIN OUTCOMES AND MEASURES Self-rated health, functional status, chronic conditions, psychological distress, alcohol consumption, and cigarette use. RESULTS The study cohort comprised 68 814 participants. Their mean (SD) age was 46.8 (11.8) years, and 51.8% (38 063 of 68 814) were female. After controlling for sociodemographic characteristics, gay men were more likely to report severe psychological distress (odds ratio [OR], 2.82; 95% CI, 1.55-5.14), heavy drinking (OR, 1.97; 95% CI, 1.08-3.58), and moderate smoking (OR, 1.98; 95% CI, 1.39-2.81) than heterosexual men; bisexual men were more likely to report severe psychological distress (OR, 4.70; 95% CI, 1.77-12.52), heavy drinking (OR, 3.15; 95% CI, 1.22-8.16), and heavy smoking (OR, 2.10; 95% CI, 1.08-4.10) than heterosexual men; lesbian women were more likely to report moderate psychological distress (OR, 1.34; 95% CI, 1.02-1.76), poor or fair health (OR, 1.91; 95% CI, 1.24-2.95), multiple chronic conditions (OR, 1.58; 95% CI, 1.12-2.22), heavy drinking (OR, 2.63; 95% CI, 1.54-4.50), and heavy smoking (OR, 2.29; 95% CI, 1.36-3.88) than heterosexual women; and bisexual women were more likely to report multiple chronic conditions (OR, 2.07; 95% CI, 1.34-3.20), severe psychological distress (OR, 3.69; 95% CI, 2.19-6.22), heavy drinking (OR, 2.07; 95% CI, 1.20-3.59), and moderate smoking (OR, 1.60; 95% CI, 1.05-2.44) than heterosexual women. CONCLUSIONS AND RELEVANCE This study supports prior research finding substantial health disparities for LGB adults in the United States, potentially due to the stressors that LGB people experience as a result of interpersonal and structural discrimination. In screening for health issues, clinicians should be sensitive to the needs of sexual minority patients.

The mixed impact of medical school on medical students’ implicit and explicit weight bias

Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians.

Health and Health Risks Among Sexual Minority Women: An Examination of 3 Subgroups

We used 2001-2010 National Health and Nutrition Examination Survey data to examine insurance status, source of routine care, cigarette and alcohol use, and self-rated health among lesbian, bisexual, and heterosexual women who have sex with women, compared with heterosexual women who do not have sex with women. We found higher risks of being uninsured among lesbian and bisexual women, worse self-rated health among bisexual women, higher alcohol use among bisexual and heterosexual women who have sex with women, and higher smoking across all subgroups.

A Comparison of the Mental Health and Well-Being of Sexual Minority and Heterosexual First-Year Medical Students: A Report From the Medical Student CHANGE Study.

Purpose Research is lacking on psychological distress and disorder among sexual minority medical students (students who identify as nonheterosexual). If left unaddressed, distress may result in academic and professional difficulties and undermine workforce diversity goals. The authors compared depression, anxiety, and self-rated health among sexual minority and heterosexual medical students. Method This study included 4,673 first-year students who self-reported sexual orientation in the fall 2010 baseline survey of the Medical Student Cognitive Habits and Growth Evaluation Study, a national longitudinal cohort study. The authors used items from published scales to measure depression, anxiety, self-rated health, and social stressors. They conducted bivariate and multivariate analyses to estimate the association between sexual identity and depression, anxiety, and self-rated health. Results Of 4,673 students, 232 (5.0%) identified as a sexual minority. Compared with heterosexual students, after adjusting for relevant covariates, sexual minority students had greater risk of depressive symptoms (adjusted relative risk [ARR] = 1.59 [95% confidence interval, 1.24–2.04]), anxiety symptoms (ARR = 1.64 [1.08–2.49]), and low self-rated health (ARR = 1.77 [1.15–2.60]). Sexual minority students were more likely to report social stressors, including harassment (22.7% versus 12.7%, P < .001) and isolation (53.7% versus 42.8%, P = .001). Exposure to social stressors attenuated but did not eliminate the observed associations between minority sexual identity and mental and self-reported health measures. Conclusions First-year sexual minority students experience significantly greater risk of depression, anxiety, and low self-rated health than heterosexual students. Targeted interventions are needed to improve mental health and well-being.

The Adverse Effect of Weight Stigma on the Well-Being of Medical Students with Overweight or Obesity: Findings from a National Survey

ABSTRACTBACKGROUNDThe stigma of obesity is a common and overt social bias. Negative attitudes and derogatory humor about overweight/obese individuals are commonplace among health care providers and medical students. As such, medical school may be particularly threatening for students who are overweight or obese.OBJECTIVEThe purpose of our study was to assess the frequency that obese/overweight students report being stigmatized, the degree to which stigma is internalized, and the impact of these factors on their well-being.DESIGNWe performed cross-sectional analysis of data from the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES) survey.PARTICIPANTSA total of 4,687 first-year medical students (1,146 overweight/obese) from a stratified random sample of 49 medical schools participated in the study.MAIN MEASURESImplicit and explicit self-stigma were measured with the Implicit Association Test and Anti-Fat Attitudes Questionnaire. Overall health, anxiety, depression, fatigue, self-esteem, sense of mastery, social support, loneliness, and use of alcohol/drugs to cope with stress were measured using previously validated scales.KEY RESULTSAmong obese and overweight students, perceived stigma was associated with each measured component of well-being, including anxiety (beta coefficient [b] = 0.18; standard error [SE] = 0.03; p < 0.001) and depression (b = 0.20; SE = 0.03; p < 0.001). Among the subscales of the explicit self-stigma measure, dislike of obese people was associated with several factors, including depression (b = 0.07; SE = 0.01; p < 0.001), a lower sense of mastery (b = −0.10; SE = 0.02; p < 0.001), and greater likelihood of using drugs or alcohol to cope with stress (b = 0.05; SE = 0.01; p < 0.001). Fear of becoming fat was associated with each measured component of well-being, including lower body esteem (b = −0.25; SE = 0.01; p < 0.001) and less social support (b = −0.06; SE = 0.01; p < 0.001). Implicit self-stigma was not consistently associated with well-being factors. Compared to normal-weight/underweight peers, overweight/obese medical students had worse overall health (b = −0.33; SE = 0.03; p < 0.001) and body esteem (b = −0.70; SE = 0.02; p < 0.001), and overweight/obese female students reported less social support (b = −0.12; SE = 0.03; p < 0.001) and more loneliness (b = 0.22; SE = 0.04; p < 0.001).CONCLUSIONSPerceived and internalized weight stigma may contribute to worse well-being among overweight/obese medical students.

Beliefs about the causes of obesity in a national sample of 4th year medical students.

OBJECTIVE Physician knowledge of the complex contributors to obesity varies. We do not know whether todays medical students are graduating with deep understanding of the causes of obesity. Our objective was to assess beliefs about causes of obesity in a national sample of 4th year medical students. METHOD We randomly selected 2000 4th year students from a random sample of 50 U.S. medical schools and asked them to rate the importance of several factors as causes of obesity. Of those invited, 1244 (62%) responded. We conducted latent class analysis to identify groups with similar response patterns. RESULTS Most students demonstrated knowledge that obesity has multiple contributors. Students fell into 1 of 4 classes: (1) more likely to endorse all contributors (28%), (2) more likely to endorse physiological contributors (27%), (3) more likely to endorse behavioral or social contributors (24%), and (4) unlikely to endorse contributors outside of overeating and physical activity (22%). CONCLUSION Though students were generally aware of multiple causes, there were 4 distinct patterns of beliefs, with implications for patient care. PRACTICE IMPLICATIONS Targeted interventions may help to improve depth of knowledge about the causes of obesity and lead to more effective care for obese patients.

Informal Training Experiences and Explicit Bias against African Americans among Medical Students

Despite the widespread inclusion of diversity-related curricula in U.S. medical training, racial disparities in the quality of care and physician bias in medical treatment persist. The present study examined the effects of both formal and informal experiences on non-African American medical students’ (N = 2,922) attitudes toward African Americans in a longitudinal study of 49 randomly selected U.S. medical schools. We assessed the effects of experiences related to medical training, accounting for prior experiences and attitudes. Contact with African Americans predicted positive attitudes toward African Americans relative to white people, even beyond the effects of prior attitudes. Furthermore, students who reported having witnessed instructors make negative racial comments or jokes were significantly more willing to express racial bias themselves, even after accounting for the effects of contact. Examining the effects of informal experiences on racial attitudes may help develop a more effective medical training environment and reduce racial disparities in healthcare.

Beyond generalized sexual prejudice: Need for closure predicts negative attitudes toward bisexual people relative to gay/lesbian people

Increasing evidence suggests that bisexual people are sometimes evaluated more negatively than heterosexual and gay/lesbian people. A common theoretical account for this discrepancy argues that bisexuality is perceived by some as introducing ambiguity into a binary model of sexuality. The present brief report tests a single key prediction of this theory, that evaluations of bisexual people have a unique relationship with Need for Closure (NFC), a dispositional preference for simple ways of structuring information. Participants (n=3406) were heterosexual medical students from a stratified random sample of 49 U.S. medical schools. As in prior research, bisexual targets were evaluated slightly more negatively than gay/lesbian targets overall. More importantly for the present investigation, higher levels of NFC predicted negative evaluations of bisexual people after accounting for negative evaluations of gay/lesbian people, and higher levels of NFC also predicted an explicit evaluative preference for gay/lesbian people over bisexual people. These results suggest that differences in evaluations of sexual minority groups partially reflect different psychological processes, and that NFC may have a special relevance for bisexual targets even beyond its general association with prejudice. The practical value of testing this theory on new physicians is also discussed.

Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study

PurposeDiversification of the physician workforce continues to be a national priority; however, a paucity of knowledge about the medical school experience for African American medical students limits our ability to achieve this goal. Previous studies document that African American medical students are at greater risk for depression and anxiety. This study moves beyond these findings to explore the role of racial identity (the extent to which a person normatively defines her/himself with regard to race) and its relationship to well-being for African American medical students in their first year of training.MethodsThis study used baseline data from the Medical Student Cognitive Habits and Growth Evaluation (CHANGE) Study; a large national longitudinal cohort study of 4732 medical students at 49 medical schools in the US racial identity for African American students (n = 301) was assessed using the centrality sub-scale of the Multidimensional Inventory of Black Identity. Generalized linear regression models with a Poisson regression family distribution were used to estimate the relative risks of depression, anxiety, and perceived stress.ResultsFirst year African American medical students who had lower levels of racial identity were less likely to experience depressive and anxiety symptoms in their first year of medical school. After controlling for other important social predictors of poor mental health (gender and SES), this finding remained significant.ConclusionsResults increase knowledge about the role of race as a core part of an individual’s self-concept. These findings provide new insight into the relationship between racial identity and psychological distress, particularly with respect to a group of high-achieving young adults.