Fall 2020 Newsletter

Influences of stigma on health outcomes and interventions

woman sits in the shadows at train station, people walking by

Determining where stigma exists and what effect it’s having on our communities is vital to learning what we can do to counteract its harmful consequences.

Allecia Reid
Allecia Reid

Allecia Reid, social psychologist at UMass Amherst, is studying the impact of stigma on the health of communities, as well as how to improve the efficacy of health-related interventions. Her work also considers how the social connections we make affect the health behaviors we choose, and how our thoughts and attitudes may incite changes in this behavior.

Stigma can be thought of as a “mark” possessed by an individual or group, such as skin color or gender, that is socially devalued. This mark can be connected to a stereotype—the unjust beliefs that someone has adopted about the group. Discrimination is a behavior; and reflects treating a person or group differently due to their membership in a socially devalued group.

Stigma can be measured at multiple levels including individual or self-stigma, interpersonal, and structural. Individual stigma can present itself as internalizing negative views about one’s membership in a group. Interpersonal stigma is the face to face or group context when an individual says something or does something that is discriminatory towards another group outside of their own.

When we experience stigma and discrimination our body’s stress response activates the same fight or flight mechanism that engages when we are in real physical danger. Repeated occurrences of this stress response take a toll on our health.

“The other thing that is especially detrimental about stigma and discrimination is that we as humans ruminate on things, we revisit these experiences over and over again in our minds, so even if it’s not happening on a daily, monthly basis we might go back to that experience and reactivate it,” Reid describes.

As a postdoc at Yale, Reid was a member of a research team conducting a large intervention that measured reports of pregnant women (ages 14-21) experiencing discrimination at different points throughout their pregnancy. The team’s results showed that women who experienced more discrimination early in pregnancy were more likely to exceed weight gain recommendations.

The same women were also more likely to have a low birthweight baby at the end of their pregnancy. Long-term health outcomes of low birthweight such as growth stunting set the child up on a negative health trajectory from the start.

Reid notes, “These women are also more likely to have increased depression during pregnancy and postpartum. We have seen that discrimination has the potential to impact mental health, physical health, and the child’s health outcomes as well.”

Interpersonal stigma is perpetuated by structural stigma. “The way people have defined structural stigma includes the cultural norms of a society, the conditions of a society, and institutional policies that can affect or alter outcomes of people that belong to these stigmatized groups,” Reid explains. 

“A lot of the research on structural stigma has looked at residential segregation, to what extent you see for example blacks and whites are very segregated in the neighborhoods where they live, in a given geographic area. We would say that is structural stigma because it’s very easy when people are in different communities to do things that disadvantage one group and advantage the other.”

In a separate study, Reid evaluated the success rates of HIV prevention interventions in different communities depending upon their level of stigma. She examined county-level estimates of community attitudes towards stigmatized groups as well as the prevalence of residential segregation. Ultimately, she found that the interventions were less successful when conducted in the most stigmatized communities. The worst outcomes arose in places where White Americans had negative attitudes toward African Americans and there were high levels of African American segregation from the majority group.

Reid’s research team learned that intervention designs were more successful when they took into account the views of the stigmatized groups it was addressing. Collecting the greatest needs of a community through focus groups, performing pilot testing, and establishing greater trust through in-person dialogue were all important steps in reducing the effect of stigma on intervention outcomes and developing more successful interventions. 

A portion of Reid’s present work is exploring whether alcohol use, smoking, or being obese are negatively affected by structural stigma as well. Other examples of this type of stigma include bans on same-sex marriage, or employment and housing discrimination of minority groups. Today more than ever, people are recognizing that unjust policies exist in our society that intentionally restrict the opportunities of a specific group.

What are some of the techniques that have been used to reduce stigma and discrimination? One method analyzed by social psychologists is to adopt new strategies when interacting with individuals.

“A thing you commonly see in that literature is that people shouldn’t just think ‘well I’m going to tell myself don’t be discriminatory’ because that’s actually a bad strategy. Instead, using very specific things like ‘when I meet someone I’m going to try to put myself into the other person’s shoes’ or ‘I’m going to try to find points of contact, or ways in which we are similar’ so we can move ahead with a shared sense of similarity. Basically trying to make that person a friend instead of seeing them as part of this particular stigmatized group,” says Reid.

One challenge facing psychologists who want to implement these types of interpersonal interventions across large populations is how to scale them up on a very broad scale.

Reid states, “[When considering] segregated communities, the more we are integrated and have more contact with different people on a day-to-day basis, the more likely you are to reduce those stigmas. You come to see that ‘this person that’s my neighbor is just like anyone else, they’re not different from my group in any particular way.’”