Kelly M. Hoffman

Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

Significance The present work examines beliefs associated with racial bias in pain management, a critical health care domain with well-documented racial disparities. Specifically, this work reveals that a substantial number of white laypeople and medical students and residents hold false beliefs about biological differences between blacks and whites and demonstrates that these beliefs predict racial bias in pain perception and treatment recommendation accuracy. It also provides the first evidence that racial bias in pain perception is associated with racial bias in pain treatment recommendations. Taken together, this work provides evidence that false beliefs about biological differences between blacks and whites continue to shape the way we perceive and treat black people—they are associated with racial disparities in pain assessment and treatment recommendations. Black Americans are systematically undertreated for pain relative to white Americans. We examine whether this racial bias is related to false beliefs about biological differences between blacks and whites (e.g., “black people’s skin is thicker than white people’s skin”). Study 1 documented these beliefs among white laypersons and revealed that participants who more strongly endorsed false beliefs about biological differences reported lower pain ratings for a black (vs. white) target. Study 2 extended these findings to the medical context and found that half of a sample of white medical students and residents endorsed these beliefs. Moreover, participants who endorsed these beliefs rated the black (vs. white) patient’s pain as lower and made less accurate treatment recommendations. Participants who did not endorse these beliefs rated the black (vs. white) patient’s pain as higher, but showed no bias in treatment recommendations. These findings suggest that individuals with at least some medical training hold and may use false beliefs about biological differences between blacks and whites to inform medical judgments, which may contribute to racial disparities in pain assessment and treatment.

Racial bias in perceptions of others' pain.

The present work provides evidence that people assume a priori that Blacks feel less pain than do Whites. It also demonstrates that this bias is rooted in perceptions of status and the privilege (or hardship) status confers, not race per se. Archival data from the National Football League injury reports reveal that, relative to injured White players, injured Black players are deemed more likely to play in a subsequent game, possibly because people assume they feel less pain. Experiments 1–4 show that White and Black Americans–including registered nurses and nursing students–assume that Black people feel less pain than do White people. Finally, Experiments 5 and 6 provide evidence that this bias is rooted in perceptions of status, not race per se. Taken together, these data have important implications for understanding race-related biases and healthcare disparities.

A Superhumanization Bias in Whites’ Perceptions of Blacks

The present research provides the first systematic empirical investigation into superhumanization, the attribution of supernatural, extrasensory, and magical mental and physical qualities to humans. Five studies test and support the hypothesis that White Americans superhumanize Black people relative to White people. Studies 1–2b demonstrate this phenomenon at an implicit level, showing that Whites preferentially associate Blacks versus Whites with superhuman versus human words on an implicit association test and on a categorization task. Studies 3–4 demonstrate this phenomenon at an explicit level, showing that Whites preferentially attribute superhuman capacities to Blacks versus Whites, and Study 4 specifically shows that superhumanization of Blacks predicts denial of pain to Black versus White targets. Together, these studies demonstrate a novel and potentially detrimental process through which Whites perceive Blacks.

Children's racial bias in perceptions of others' pain

Previous research indicates that American adults, both Black and White, assume a priori that Black people feel less pain than do White people (Trawalter, Hoffman, & Waytz, 2012, PLoS One, 7[11], 1-8). The present work investigates when in development this bias emerges. Five-, 7-, and 10-year-olds first rated the amount of pain they themselves would feel in 10 situations such as biting their tongue or hitting their head. They then rated the amount of pain they believed two other children - a Black child and a White child, matched to the childs gender - would feel in response to the same events. We found that by age 7, children show a weak racial bias and that by age 10, they show a strong and reliable racial bias. Consistent with research on adults, this bias was not moderated by race-related attitudes or interracial contact. This finding is important because knowing the age of emergence can inform the timing of interventions to prevent this bias.

The invisible man: Interpersonal goals moderate inattentional blindness to african americans

Research on inattentional blindness demonstrates that when attending to 1 set of stimuli, people often fail to consciously perceive a task-irrelevant object. In this experiment, we tested for selective inattentional blindness to racial outgroup members. We reasoned that some racial groups would be perceived as more relevant than others, depending on the interpersonal goal that was active. White participants were primed with interpersonal goals that ranged from psychologically distant (searching for a coworker) to psychologically close (searching for a romantic partner). In the control condition, no goal was explicitly activated. Then, participants watched a video of 2 teams passing a ball and were asked to count the ball passes of one of the teams. In the middle of the video, a Caucasian or an African American man walked through the scene. Participants were then asked to report whether they had seen the interloper. Results revealed that as interpersonal goals became closer to the self, participants were less likely to see the African American man. This research demonstrates a new form of social exclusion based on early attention processes that may perpetuate racial bias.

Assumptions about life hardship and pain perception

The present work examines whether people assume that those who have faced hardship feel less pain than those who have not, and whether this belief contributes to the perception that Blacks feel less pain than Whites. In Experiments 1 and 2, participants received information about a Black and/or White target person’s life hardship and then rated the target person’s pain. Participants reported that the target individual would feel less pain if s/he had experienced greater hardship. Importantly, racial bias emerged but only when hardship information was consistent with expectations about race and life hardship; that is, participants reported that the Black (vs. White) target individual would feel less pain only if s/he had experienced greater hardship. In Experiment 3, participants read that hardship either toughens or weakens the body, and then rated a Black or White target person’s pain. Racial bias emerged but only when supported by lay beliefs. Specifically, participants reported that the Black (vs. White) target individual would feel less pain but only if they endorsed the belief that hardship leads to toughness. Taken together, these findings suggest that perceptions of hardship shape perceptions of pain and contribute to racial bias in pain perception. These findings also suggest that eliminating this racial bias will require challenging lay beliefs; it will require the recognition that people who have faced great hardship feel just as much, if not more, pain.

Correction: Racial Bias in Perceptions of Others' Pain

There are errors in the Participants subsection of the Methods section of Experiment 2. The correct subsection is: We recruited 32 Black participants from the UVA Psychology pool (N = 12) and via Mechanical Turk (N = 20). UVA participants received course credit for their participation. Mechanical Turk participants received

Reducing Implicit Prejudice

0.50 for their participation. We excluded 5 participants from the primary analyses for not being native-English speakers and/or US-born. Including these participants in our analyses does not change the pattern of results. Our final sample of 27 varied in age (M = 31.74, SD = 14.18) and gender (70% female). There are errors in the last two sentences of the Results and Discussion section of Experiment 2. The correct sentences are: Participants’ ratings were marginally lower for a Black vs. White target and sizeable, F (1, 22) = 3.01, p = .097, η_p^2 = .12. Of note, among the full sample of 32 participants, participants’ ratings were significantly lower for a Black vs. White target and even more sizeable, F (1, 27) = 7.89, p = .009, η_p^2 = .27. There are errors in the Participants subsection of the Methods section of Experiment 3. The correct subsection is: We recruited 65 participants with the help of faculty members and administrators at a school of nursing. Participants were mailed a

Reducing Implicit Prejudice: Reducing Implicit Prejudice

10 gift certificate for their participation. We excluded 7 participants from the analyses for not being native-English speakers and/or US-born, and 14 more who identified the main hypothesis. It is worth noting that most of these participants completed the study toward the end of data collection, suggesting that they had heard about the study from someone else. Including these participants in our analyses did change the results—the pattern did not change but the difference between target race conditions was no longer statistically significant. The final sample of 43 included 29 registered nurses and 14 nursing students. The sample varied in age (M = 32.57, SD = 12.83) and ethnicity (88% White, 5% Black, and 7% other). All participants except one were women. There is an error in the first sentence of the Participants subsection of the Methods section of Experiment 5. The correct sentence is: We recruited 127 participants via Mechanical Turk (N = 57) and via the UVA Psychology Department participant pool (N = 70). There is an error in the last sentence of the Procedure subsection of the Methods section of Experiment 5. The correct sentence is: We averaged the privilege, hardship, and adversity items to form a privilege composite (=). A composite using all 4 items yields similar results, however. There are errors in the second and third sentences of the Participants subsection of the Methods section of Experiment 6. The correct sentences are: We excluded 23 participants for not being native English-speakers and/or American and 34 for failing the manipulation checks (not remembering the target’s status or race, and one participant whose pain rating was more than 4 standard deviations below the grand mean). Including these participants in our analyses changed the results below—the difference between status conditions on pain ratings became non-significant; the difference between status conditions and perceptions of status/power remained highly significant and the relationship between perceptions of status/power and pain also remained highly significant. There is an error in the fifth sentence of the Results and Discussion section of Experiment 6. The correct sentence is: Our a priori (linear) contrast comparing lower- to higher-status targets (-1 0 1) was not significant; however, a post-hoc contrast comparing the lower-status and equal-status target to the higher-status target (-1 -1 2) was significant, F (1, 230) = 5.91, p = .02. There is an error in the fourth sentence of the Secondary Analyses subsection of the Results and Discussion section of Experiment 6. The correct sentence is: And, in fact, perceptions of the target’s power over their outcomes mediates the relationship between condition and perceptions of the target’s pain; a bootstrap analysis yields a 95% confidence interval that does not include 0, (95% CI [.0077, .094], p = .031).