answer my 9 qs

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ComSDis 245 Dr. John Heilmann https://youtu.be/izuD30Cp5Ao?t=149    Life experiences Clinical experience Research     I know some things… My thoughts influenced by my perspective… I may upset you… We are working together to be our best selves and improve health   Explicit – known by you and others Implicit – present, but not necessarily conscious     Generalizations May be superficial and inaccurate May have some truth Problem when make assumptions with an individual    Low income & reading to kids Obesity and physical fitness Teen pregnancy in minority populations   How may they affect the provider? How may the provider discriminate?    Often over-simplification What happens when an individual violates group expectations (i.e., role incongruity)? When there is accuracy to a stereotype, what is the underlying cause?  What is the cause of healthcare disparities? ◦ Outright discrimination ◦ Stereotype threat (point of this paper)  “Threat of being personally reduced to a group stereotype”   Large scale, epidemiological study (20,000 people) Subset of 2,000 people   When you visit the doctor, do you worry that they will make judgments about you because of your x, y, or z? If yes, ◦ Do you worry that the provider will act in ways that justify those judgments? ◦ Do you think the judgments affect the quality of care you receive?    Self-rated overall health Hypertension Depression    Physician distrust Dissatisfaction with healthcare Preventative health (have you gotten the flu shot in the past 2 years?)   Using stereotype threat to predict health outcomes Control for all demographic variables  Using stereotype threat to predict perceptions of health   Stereotype threat exists and goes beyond race/culture Stereotype threat affects health outcomes  https://www.fiercehealthcare.com/healthcare /healthcare-stereotyping-can-negativelyaffect-patient-outcomes  Should public health campaigns stop directly targeting those most affected by a certain disease?    In a “colorblind” world, we would treat all patients with the upmost respect. All patients would be treated the same. Based on this article, how could our patients’ health still be affected by demographic variables? Should we modify the way we practice based on this type of information? Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study Cleopatra M. Abdou, PhD,1 Adam W. Fingerhut, PhD,2 James S. Jackson, PhD,3 Felicia Wheaton, PhD4 Introduction: Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care. Methods: Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n¼2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use. Results: Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorer mental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine. Conclusions: The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups. (Am J Prev Med 2016;50(2):191–198) & 2016 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine Introduction H ealth disparities exist on the basis of many aspects of identity, including racial/ethnic background,1–3 SES,4,5 gender,6,7 age,8,9 as well From the 1Davis School of Gerontology and Department of Psychology, University of Southern California, Los Angeles, California; 2Department of Psychology, Loyola Marymount University, Los Angeles, California; 3 Institute for Social Research, Department of Psychology, and School of Public Health, University of Michigan, Ann Arbor, Michigan; and 4Davis School of Gerontology, University of Southern California, Los Angeles, California Address correspondence to: Cleopatra M. Abdou, PhD, Davis School of Gerontology and Department of Psychology, University of Southern California, 3715 McClintock Avenue, Suite 238, Los Angeles CA 900890191. E-mail: cabdou@usc.edu. 0749-3797/$36.00 http://dx.doi.org/10.1016/j.amepre.2015.07.034 as indicators of healthy versus nonhealthy body weight.10,11 Recently, it has been suggested that healthcare stereotype threat (HCST) might be one of the overlooked pathways whereby minority and stigmatized identities contribute to health disparities.12–15 Stereotype threat is the threat of being personally reduced to a group stereotype,16–19 which can lead individuals to avoid stereotype-relevant domains. HCST, as a more specific form of stereotype threat, is the threat of being personally reduced to group stereotypes that commonly operate within the domain of health care, such as stereotypes regarding unhealthy lifestyles and inferior intelligence. The experience of HCST—although stemming from social cues and interpersonal experiences that result from group-level stereotypes—is a situational, psychosocial phenomenon that the authors propose contributes to & 2016 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine Am J Prev Med 2016;50(2):191–198 191 192 Abdou et al / Am J Prev Med 2016;50(2):191–198 population-level health disparities. Specifically, the authors propose that stereotypes: (1) are salient in healthcare settings for ethnic minorities and members of other socially stigmatized groups; (2) can serve as a form of identity threat; and (3) ultimately contribute to proximal and distal health disparities. HCST may affect the care one receives by impairing working memory20 or creating anxiety,21 which could lead a patient to forget or intentionally withhold important information or mistrust medical recommendations, and even lead to the avoidance or underutilization of care.13,14 Importantly, unlike discrimination and other established social determinants of health disparities that can be difficult to address or modify, a vast literature shows that stereotype threat can be prevented or reduced, such as by emphasizing that a stereotyped trait (e.g., intelligence) is malleable,22,23 creating identity-safe environments,24 reframing threat as a challenge,25 and utilizing selfaffirmation,26–28 among other methods. Stereotype threat can also be prevented and reduced from a societal standpoint (discussed in Inzlicht et al.29) and within the healthcare domain13,14 via changes in social and health policies that do more to promote equality. The application of stereotype threat to health care is a new phenomenon, with only a handful of papers addressing the topic.13,14 In the first published experimental study of HCST, Abdou and Fingerhut12 assessed black and white women’s anxiety levels while waiting to ostensibly see a physician in a virtual healthcare setting. Those in the HCST condition were primed by being asked about their race and ethnic identification at the beginning of the study as opposed to at the end and by being exposed to images that were stereotypical (e.g., a poster of a young black pregnant woman) or neutral with respect to the reproductive health of black women, thus invoking threat or not. As predicted, highly identified black women reported higher levels of anxiety under threat than did their white counterparts, a difference that disappeared when threat was not present. Thus far, the work on HCST has been limited in at least two ways. Among these is the singular focus, to date, on racial/ethnic identity as the source of HCST.12–15 Second, existing work has yet to empirically demonstrate the link between HCST and downstream health outcomes and larger health disparities. The objective of the present study was to begin remedying these limitations by assessing the extent to which people fear being judged in healthcare contexts on a variety of characteristics, not just race/ethnicity, and to connect these threats to larger health outcomes. To the extent that stereotype threat theory is applicable to the healthcare domain, people who possess a particular stigmatized identity should be more likely to report HCST, or the fear of being judged by that identity when seeking health care, and the people who are reporting fear of being judged should be more likely to experience disparities in health care and broader health outcomes. Methods Data Source Data were collected as part of the 2012 wave of the Health and Retirement Study (HRS), including a module on HCST, which was designed by the research team. The HRS is a longitudinal study that began in 1992 and surveys approximately 26,000 Americans aged Z50 years and their spouses every 2 years. The HRS collects extensive data on demographic, social, economic, and health characteristics. A random subsample (n=2,048) of the 20,555 individuals participating in the 2012 wave of HRS was administered the HCST module. A total of 1,746 answered preliminary questions, and, of those, 1,479 had seen a doctor in the previous 2 years and were asked HCST-related questions. In comparison to those who had seen a physician in the past 2 years, those who had not were more likely to report poor self-rated health and dissatisfaction with health care; they were also far less likely to have had the influenza vaccine. Given this, the sample may have been relatively healthier than the larger HRS and overall population. Measures HCST was measured with three questions across six different aspects of identity. Participants were asked: (1) When you visit the doctor, do you worry that the doctor or other medical staff make judgments about you because of your [race/ethnic background, gender, age, weight, money, other reason]?” and could respond yes or no. The “other reason” question was not included in this analysis because, ultimately, it was unclear whether individuals had identity-related concepts in mind when they chose this option and, therefore, whether the reasons were relevant in the context of HCST. The individuals who reported HCST with respect to a particular identity were then asked (2) if they worry that they might act in ways that justify such judgments and (3) whether they think that judgments affect the quality of health care they receive. Health outcomes were selected to reflect global physical and mental health status. These included self-rated health, diagnosed hypertension, and depressive symptoms. Respondents were asked whether their health was excellent, very good, good, fair, or poor. Those who reported fair or poor health were considered to have poor self-rated health. Respondents were considered to have hypertension if they had ever been told by a doctor that they had high blood pressure or hypertension. Depressive symptoms were defined as feeling sad, blue, or depressed for Z2 weeks in a row in the last 12 months. Perceptions of health care were assessed as physician distrust and dissatisfaction with health care. Responses to three dichotomous items were averaged to calculate physician distrust, including disagreement with the statement (1) you completely trust the doctor’s judgment about your medical care and agreement with the statements (2) you worry that the doctor is judging you based on the private information you discussed and (3) you worry that the doctor is testing you for things that you don’t know about. Dissatisfaction www.ajpmonline.org Abdou et al / Am J Prev Med 2016;50(2):191–198 with health care was defined as being somewhat or very dissatisfied overall about the quality, cost, or convenience of health care. Finally, preventative health care was indicated by whether or not in the past 2 years the respondent had received the influenza vaccine. Control variables included age in years, gender, race/ethnicity, education, household income, and lack of health insurance. Race/ ethnicity was defined as black, Latino, white, or other. Education was categorized as no degree, high school diploma or General Educational Development test, some college or college degree, and master’s or other professional degree. Household income was the sum of all income reported by the respondent and their spouse (if applicable) in dollars. This measure was natural log transformed because of its skewed distribution. Lack of health insurance was defined as not having any type of public (e.g., Medicare, Medicaid) or private health insurance. Statistical Analysis First, the authors examined the demographic and health-related characteristics of the sample and examined the prevalence of HCSTs. Second, logistic regression was used to test whether each type of HCST was associated with the specific stigmatized social identity (e.g., race predicts race-related HCST). Third, the association between HCST and each health outcome (poor self-rated health, diagnosed hypertension, and depressive symptoms) was tested in logistic regression models controlling for sociodemographic characteristics. Fourth, logistic regression was used to test whether HCST was associated with dissatisfaction with health care and use of preventative care, controlling for sociodemographic characteristics and also health status (poor self-rated health, six chronic health conditions, and an index of symptoms experienced in the past 2 years), as health is likely to influence one’s utilization of health care (or contact with the healthcare system). Ordinary least squares regression was employed for the model of physician distrust, a continuous measure that was converted to z-score for analysis. Finally, logistic regression was used to identify sociodemographic and health characteristics associated with belief that one acts in ways that justify judgments and that judgments affect care among those who reported one or more threats. All analyses were performed using the SVY command, which accounts for complex sampling design in Stata, version 13.1. Results Table 1 summarizes the sociodemographic characteristics of the sample as well as descriptive statistics for the HCST measures and dependent variables. Mean age was 65.9 (SD¼10.1) years, and 56% were female. Approximately 10% were black, 5% were Latino, 82% were white, and 3% were other. The majority of respondents (56%) had a high school diploma or General Educational Development test. Median household income was $47,000 and about 5% lacked health insurance. Seventeen percent of respondents reported HCST with respect to one or more aspect of their identities, with the prevalence of specific types of HCST ranging from just 42% for race/ethnicity and gender to 8.3% for age and weight (Table 1). Logistic regression results indicated February 2016 193 that age was positively associated with age-related HCST (OR¼1.03, p¼0.005). Compared with whites, blacks (OR¼7.44, po0.001) and Latinos (OR¼11.05, po0.001), but not those of other race, had higher odds of reporting race-related HCST. Household income and level of education were not significantly associated with money-related HCST, except that relative to those with no degree, those with a master’s or professional degree had marginally statistically significant lower odds of reporting HCST (OR¼0.18, p¼0.053). Gender was not significantly associated with gender-related HCST; however, the OR was in the predicted direction (with women reporting higher levels of HCST than men). Finally, compared with normal-weight individuals, those who were overweight (OR¼3.58, p¼0.004) or obese (OR¼25.40, po0.001) had significantly higher odds of reporting weight-related HCST. Regarding health outcomes (Table 2), logistic regression analyses showed that those who reported experiencing HCST on the basis of one or more aspects of identity had higher odds of poor self-rated health, hypertension, and depressive symptoms compared with those who experienced no HCST, holding sociodemographic characteristics constant. Findings for healthcare perceptions and use of preventative care are summarized in Table 3. Ordinary least squares regression results for physician distrust indicated that those who experienced one or more types of HCST reported higher average physician distrust, with a greater effect size among those who perceived two or more types of HCST. Similarly, those who reported two or more types of HCST had higher odds of being dissatisfied with health care and had lower odds of receiving the influenza vaccine compared with those who reported no threat. Finally, among those who reported one or more types of HCST, those who reported two or more types of HCST had 3.8 times greater odds of worrying that they acted in ways that justified judgment(s) by healthcare providers and 8.3 times greater odds of thinking that judgment(s) by healthcare providers affect the quality of care they receive (Table 4). Discussion This naturalistic observation of older adults is an important demonstration of the existence of HCST. In addition to corroborating the first set of experimental findings to exist on the topic of HCST (i.e., Abdou and Fingerhut12), this study demonstrates that HCST exists in relation to aspects of social identity beyond race/ethnicity (e.g., age, gender). Additionally, these data are the first to show that the experience of HCST is associated with important proximal and distal health consequences. Specifically, 194 Abdou et al / Am J Prev Med 2016;50(2):191–198 Table 1. Characteristics of the Sample (n¼1,479) Characteristics Age (years; M [SD]) Female (%) Table 1. (continued) Values 65.9 (9.5) 56.4 Race Caucasian 81.8 African American 9.9 Latino 5.4 Other 2.9 Education No degree 10.5 High school diploma/GED 55.8 2- or 4-year college degree or some college 22.9 Master or professional degree 10.8 Median household income ($) No health insurance (%) 47,000 4.7 Stereotype threat Types of stereotype threat Race/ethnicity 2.1 Gender 2.3 Age 8.3 Weight 8.3 Money 3.0 Number of stereotype threats 0 82.7 1 12.4 2 3.1 3 1.6 4 0.2 5 0.1 1þ Threats 17.3 2þ Threats 4.9 Among those who report 1þ threats Act in ways that justify judgment(s) (n¼254) 34.2 Believe judgment(s) affects care (n¼261) 41.1 Health outcomes Poor self-rated health 24.1 Hypertension 58.8 Depressive symptoms 13.1 (continued) Characteristics Values Healthcare outcomes Physician distrust (M [SD]) 0.21 (0.27) Dissatisfied with healthcare (%) 7.9 Influenza vaccine 66.3 GED, General Educational Development test. those reporting one or more types of HCST were more likely to ...
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lecturernewt
School: University of Virginia

Attached.

QN. 1
Implicit bias
QN. 2
Explicit bias
QN. 3
To determine the impact of provider discrimination on healthcare outcomes.
QN. 4
A patient may think that the provider holds certain stereotypical beliefs about them, and is so nervous
about that potential stereotype, that he doesn’t tell his provider everything.
Qn. 5

Attached.

Surname1
Name
Professor
Course Number
Submission Date
QN. 1
Explicit bias
QN. 2
Implicit bias
QN. 3
To document if certain people feel a threat of a stereotype ( that may not be acted upon by the
provider), and if the stereotype threat affects health outcomes.
QN. 4
A patient may think that the provider holds certain stereotypical beliefs about them, and is so nervous
about that potential stereotype, that he doesn’t tell his provider everything.
Qn. 5
True
QN. 6
True
QN. 7
Making it clear that the clinic will not discriminate against any patient (e.g., put up a sign saying the
office does not discriminate)
QN. 8
A campaign to improve literacy encourages young African American mothers to read to their children.
An African American mother thinks the healthcare provider will assume she doesn’t read with her child.
QN. 9
Generally, when people are sick, they desperately look for any good health care facility to heal them.
Althou...

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