Cumulative consequences of stigma: Possessing multiple concealable stigmatized identities is associated with worse quality of life

Large health disparities exist between stigmatized and nonstigmatized groups. In addition to experiencing and anticipating greater discrimination, members of stigmatized groups also tend to demonstrate greater ruminative tendencies in response, which may lead to these poor health outcomes. Even among stigmatized groups, differences in the visibility of stigma lead to different mechanisms through which stigma takes its toll. Previous work has primarily focused on the impact of belonging to a single marginalized group; however, people often belong to multiple marginalized groups, and this likely affects both their health outcomes and their anticipation of stigma. In the current study, we focused on individuals with concealable stigmatized identities (CSIs)—socially stigmatized identities that are not immediately apparent to others—and created a measure of concealable marginalization that captures multiple group memberships. We predicted that those possessing a greater number of CSIs would anticipate more stigma from others, and, in turn, ruminate more about the stigma, which would negatively impact the health. Surveying N = 288 adults with CSIs, we found that possessing a greater number of marginalized concealable identities predicted worse self-reported physical quality of life. These relationships were partially mediated by greater anticipated stigma and brooding rumination in regard to their CSI. This work illuminates a more complete picture of how living with CSIs can take its toll on health.     

Adult-child interaction during invasive medical procedures.

Adult-child interactions during stressful medical procedures were investigated in 43 pediatric patients videotaped during a venipuncture procedure in the course of cancer treatment. Relations among six adult behavior categories (explain, distract, command to engage in coping behavior, give control to the child, praise, and criticize/threat/bargain) and three child behavior categories (momentary distress, cry/scream, and cope) were examined using correlational and sequential analysis. Results indicated that adult distraction resulted in increased child coping and reduced momentary distress and crying. Adult explanations, although a likely response to child distress and crying, did not result in a reduction of these behaviors. Attempts to give the child control reduced child crying. Implications for clinical interventions during painful medical procedures are discussed.     

Psychometric properties and measurement invariance of Depression,Anxiety and Stress Scales (DASS-21) across cultures

Cross-culturally measurement invariant instruments are useful for the assessment of mental symptoms across cultures. The current study aimed to investigate the psychometric properties and measurement invariance of the Depression, Anxiety and Stress Scales (DASS-21) (DASS) across Pakistan and Germany. German participants were recruited through an online survey (N = 1323), while Pakistani participants were recruited through online survey or paper-and-pencil survey (N = 1841). The DASS-21 showed good reliability, construct and structure validity in both countries. The DASS-21 indicated partial weak (stress subscale) and partial strong measurement invariance (depression and anxiety subscales) between both countries. Latent mean comparison of depression and anxiety symptoms between Pakistani and German students indicated that Pakistani university students experience more symptoms of depression and anxiety. Results suggest that the DASS-21 could be used in Pakistan and Germany, but caution should be taken when making direct comparisons between the two countries.     

Motivation and anxiety for dental treatment and dental attendance: The roles of the locus of causality personality and treatment styles

The purpose of the present study was to test a self-determination theory model with the following hypotheses: (1) Patients’ autonomous causality personality orientation and oral health care professionals’ autonomy-supportive treatment styles, as perceived by patients, would both be positively indirectly associated with dental attendance through patients’ autonomous motivation for dental treatment. (2) Patients’ controlled causality personality orientation and oral health care professionals’ controlling treatment styles, as perceived by patients, would both be positively indirectly associated with avoidance of making a dental clinic appointment through patients’ anxiety for dental treatment. A sample size of about 200 patients was estimated to be acceptable in detecting moderate effect sizes (independent variables: 5–6; power: .80; p < .05). Student patients (N = 226) responded to a survey with validated questionnaires. Using LISREL, both hypotheses were supported. In addition, patients’ perception of a controlling treatment style moderated the controlled personality—dental anxiety relation, so that a lower controlling treatment style mitigated dental anxiety substantially among patients with a high control orientation. Effect sizes were moderate to large. Analyses (Z-scores) also revealed that the autonomous personality is more strongly linked to situational autonomous motivation than situational autonomy support, whereas a controlled personality and a perceived controlling treatment style are equally and significantly associated to dental anxiety. Both patient personalities and oral health care professionals’ treatment styles are substantially linked to autonomous motivation and anxiety for dental treatment, which are relatively strongly associated with dental attendance and avoiding dental clinic appointments, respectively.     

The problem of creating habits: establishing health-protective dental behaviors.

We describe three experiments testing treatments to promote the performance of health-protective dental behaviors. Subjects included 55 women from an introductory psychology course (Experiment 1), 45 men and women (Experiment 2), and 81 older-than-average students identified as at risk for gum disease (Experiment 3). The interventions, derived from social cognitive theory, included health education, skills training, and self-monitoring. In each study, we examined the contribution of additional treatment components, including social support (Experiment 1), intensive contact (Experiment 2), and flexible goal setting (Experiment 3). Across experiments, the behavioral results were remarkably similar: Subjects exhibited excellent adherence while in the study but, at follow-up, reported behavior that differed little from baseline. We discuss parallels between attempts to promote health-protective dental behaviors and other health-promotion programs, and we describe different perspectives from which to address the problem of creating healthy habits.     

Evaluating preference for and reinforcing efficacy of fruits and vegetables compared with salty and sweet foods

Children diagnosed with autism spectrum disorder are often more selective in their food preferences than their typically developing peers. Additionally, many preferred food selections have minimal nutritional value. We evaluated the preference for, and reinforcing efficacy of, fruits and vegetables compared with salty and sweet foods, which are often used as edible reinforcers. Multiple-stimulus preference assessments were conducted to identify preferred foods, and reinforcer assessments were conducted to determine the reinforcing efficacy of more preferred foods. Fruits and vegetables were sometimes preferred over salty or sweet foods and often functioned as reinforcers. Future research should incorporate fruits and vegetables into preference assessments when identifying putative reinforcers.