Brenda Major, Ph.D. Distinguished Professor, Psychological and Brain Sciences University of California, Santa Barbara

◦  Self-esteem ◦  Self-concept ◦  Intellectual performance ◦  Coping ◦  Behavior ◦  Stress physiology ◦  Mental and physical health

Approach: Experimental Social Psychology

}  An

attribute that discredits and reduces a person to less than a whole person in the eyes of others Goffman

}  Stigmatization 2001)

involves (Link & Phelan,

◦  Labeling ◦  Negative stereotypes ◦  Exclusion/avoidance ◦  Status loss ◦  Discrimination ◦  Occurs in a context of power

} 

Growing recognition across variety of disciplines that social stigma undermines mental and physical health and contributes to health disparities in society. ◦  Hatzenbuehler, Phelan & Link (2013)

}  Structural

Discrimination

◦  Diminished Resources

}  Discrimination

in health care

◦  Access and delivery

}  Interpersonal

Discrimination

◦  Stress ◦  Social isolation ◦  Psychological and behavioral responses

} 

Increased incidence of:

} 

Decreases in health over time.

} 

} 

◦  Depression, psychiatric distress, general anxiety disorder, PTSD symptoms ◦  Hypertension, cardiovascular disease, diabetes, respiratory problems, self-reported ill health, low birth weight, cancer.

The PD-Health relationship is reliable controlling for potential confounding variables. Increased stress responses in experimental studies

Anticipated Stigma

“Enacted” Stigma

“Felt” Stigma Internalized Stigma

} 

Features of felt stigma:

◦  Awareness of social devaluation of ones social identity ◦  Knowledge of negative stereotypes ◦  Awareness of potential for discrimination

} 

Social Identity Threat:

A psychological state caused by concern that one’s social identity puts one at risk of being judged in light of negative stereotypes, or becoming a target of prejudice, discrimination (Steele, 1992).

Stress Responses

Situational cues

Enacted Stigma

Felt Stigma

Personal Characteristics

Health Outcomes

Social Identity Threat

Mental Physical

HealthRelated Behaviors

} 

Decreases performance in negatively stereotyped domains ◦  (Steele & Aronson, 1992)

} 

Depletes cognitive resources necessary for self-control and performance on intellectual tasks ◦  Inzlicht, McKay & Aronson, 2006; Major et al., 2012; Inzlicht & Kang

} 

Increases stress responses (CVR, cortisol)

◦  Major, Eliezer & Rieck, 2012; Townsend, Major & Mendes, 2012

Social identity threat can occur in the absence of discrimination experiences – no one else need even be present. }  Social identity threat can influence emotions, cognition, behavior, and physiology in the absence of awareness. }  Social identity threat is contextual triggered by features of situations. }  People differ in their chronic sensitivity to experiencing social identity threat } 

}  Racism

}  Sexism

}  Sizeism

People who are overweight or obese are profoundly stigmatized in the U.S. }  In Irving Goffman’s terms, they are “doubly stigmatized”. They have } 

◦  An “abomination of the body” AND ◦  A “blemish of individual character”

} 

Lazy, weak-willed, sloppy, self-indulgent, gluttonous, unintelligent

} 

They are discriminated against by ◦  Health care workers ◦  Co-workers and managers ◦  Family members ◦  Peers ◦  Teachers ◦  Even by others who are themselves overweight.

§ 

.”

§  even

though 95% of people who lose weight regain it within 3 years. §  Overweight people are blamed for being overweight. §  Prejudice against overweight is seen as justified, “for their own good

}  The

social identity of “fat” is undesired

–  Overweight do not identify with the “group” overweight or express pride in this group –  Overweight are prejudiced against others who are overweight. –  Overweight often blame themselves for being fat and internalize negative stereotypes of overweight

}  Only

just beginning to be addressed. }  Most studies are correlational and cross-sectional.

} 

Self-reported experiences of weight discrimination (e.g., being teased, excluded, discriminated against) are correlated with ◦  Disordered eating among adolescents ◦  Poor body image ◦  Intention to avoid exercise ◦  Substance use disorders ◦  Perceived stress ◦  Poorer psychological functioning (e.g., depression; anxiety disorder)

◦  These effects are observed controlling for BMI

} 

Self-reported experiences of weight discrimination

◦  prospectively predicted a decline in self-rated functionality of obese people over 10 years (Schaefer & Ferraro, 2011)

◦  exacerbated the positive relationship between waist-to-hip ratio and physiologic predictors of diabetes and heart disease (e.g., Tsenkova et al. 2010) ◦  Prospectively predicted weight gain over 4 year period } 

Desire to lose weight predicts weightrelated morbidity even when BMI is held constant.

(Hunger & Major, Health Psychology, in press) } 

194 Ps participated on Mturk

} 

Completed measures of:

◦  (63% female; 72% White; mean age= 33 yrs; mean BMI = 26.51(SD = 6.45, range = 14.92-48.46).

◦  height and weight, demographics ◦  Weight-based discrimination - enacted stigma

–  (5 items, α = .94); (e.g., “During your lifetime, how often other people treated you unfairly because of your weight?)

◦  Weight stigma concerns – felt stigma

–  (5 items, α = .96); e.g., I am concerned that other people’s opinion of me will be based on my weight

◦  Mental Health (study 1) Physical health (study 2) –  (5-items, general health scale, α = .85)

} 

Enacted and Felt Weight Stigma Mediate the Relationship between BMI and Health Enacted Stigma

.31**

.61**

Felt Stigma

Weight Stigma Concerns

Perceived Discrimination

-.46**

-.00

.34**

Body Mass Index

-.15 (-.30**)

Physical Health



} 

} 

Could the mere fear or concern that one might be stigmatized because of one’s weight increase stress? Does weight stigma identity threat deplete individual’s capacity for self-regulation?

◦  Does it diminish cognitive resources necessary to override impulses? ◦  Does it lead to reduced self-efficacy for controlling one’s weight? ◦  Does it lead to increased eating?

} 

Design:

} 

Participants:

} 

Procedures:

◦  Weight (BMI) x Visibility (Seen vs. Unseen) ◦  97 college women, BMI ranged from 19.6 to 44.22 ◦  All asked to give speech about “Why I would make a good dating partner” ◦  Half thought speech was videotaped (camera present); half thought it was just audiotaped (camera absent) ◦  After speech, all completed a measure of cognitive depletion – the Stroop Task.

} 

Blood pressure reactivity

} 

Cognitive depletion

◦  BP during speech minus BP during 5 min baseline ◦  Performance on Stroop task ◦  Measure of executive control

} 

You will see a series of words or xxx’s, each preceeded by a +. Say aloud, as quickly as you can, the color in which the word or nonword is printed.

RED  

XXX  

RED  

XXX  

YELLOW  

GREEN  

YELLOW  

XXX  

GREEN  

XXX  

Latency to respond correctly on incompatible trials is a measure of depletion of cognitive resources. }  When people are stressed, distracted, under “cognitive load” they respond more slowly to the incompatible trials – show cognitive interference } 

When weight is visible in a weight-relevant situation, overweight women will experience WS identity threat. }  When weight is invisible, impact of weight will be attenuated or absent }  Thus, overweight women in videotape condition should experience greatest stress and cognitive interference. } 

Impact of Visibility and Weight on Stroop Interference 160 Audio

Video

Stroop  interference  (ms)

140

β = .32*

120

100 80

β = -.15

60 40 20

0

Low  BMI

High  BMI

Impact of Visibility and Weight on Blood Pressure Reactivity 30

Audio

Mean  arterial   pressure  (mmHg)

Video 25

β = .29* 20

β = -.21 15

10

5

0 Low  BMI

High  BMI

} 

Situations that are appearance-relevant (e.g., dating situation where weight is visible) are identity threatening for overweight women.

◦  Lead to increased stress on both physiological and self-report measures, ◦  Lead to cognitive depletion, assessed by poorer performance on Stroop Task

} 

Can the media trigger WS identity threat?

} 

Can experiencing WS identity threat lead to ◦  Reduced sense of control over food intake? ◦  Increased eating of snack foods?

2 (Article Content) x Perceived Weight }  93 college women read and described (while videotaped) an article titled either “Lose weight or lose your job” or “Quit smoking or lose your job” }  Assessed eating of snack foods during subsequent 10 min waiting period }  Self-efficacy for dietary control assessed } 

Calories Consumed

220

200

Control

180

WS Threat

160

140

120

100

Low Perceived Weight

High Perceived Weight

Self-Efficacy for Dietary Control

70

65

60

55

Control

50

WS Threat

45

40

35

Low Perceived Weight

High Perceived Weight

} 

Health messages that are intended to motivate overweight individuals to lose weight but that stigmatize them may backfire.

Latinas anticipated interacting with a samesex White peer who they were led to believe had prejudiced or nonprejudiced attitudes about minorities. }  Threat cognitions, Threat emotions, and Physiological reactivity (BP) assessed prior to the interaction } 

} 

.

White women who varied in chronic perceptions of sexism engaged in job interview with a White male evaluator. }  Prior to interview, led to believe he might reject them for either sexist or merit-based reasons }  Assessed changes in the stress hormone cortisol from baseline 20 min and 40 min post rejection } 

I experience discrimination because of my gender }  My gender group is discriminated against }  I have been unfairly treated because of my gender }  Member of my gender group face a good deal of gender discrimination }  In general, others respect the gender group I am a member of ® alpha = .86 } 

6

7

Merit

Sexist

5

β = .667**

4 3 2

β = -.034

1

5

β = .603**

4 3 2

β = -.190

1

0

Low -1

Merit

6

Sexist Cortisol (nmol/L)

Cortisol (nmol/L)

7

High

Chronic Perceived Sexism (+/- 1SD)

20 min Post Stressor Onset

0 Low -1

High

Chronic Perceived Sexism (+/- 1SD)

40 min Post Stressor Onset

Townsend, Major, Gangi & Mendes, 2011

} 

} 

White females completed measure of gender identity. Later, randomly assigned to summarize one of two articles describing results of a study: ◦  Female UC alums faced pervasive sexism or ◦  Female UC alums faced rare sexism

} 

Cardiovascular reactivity assessed

◦  during speech and during recovery (10 min post-speech)

} 

Self-reported anxiety assessed

◦  immediately post-speech and again post-recovery

Identification of additional mediators of the stigma-health relationship }  Identification of moderators. } 

◦  What factors increase risk? ◦  What factors increase resilience?

} 

Testing Interventions to reduce effects of enacted and felt stigma

◦  Contributions of person and environment need to be acknowledged to design most effective interventions

} 

Collaborators

◦  Wendy Mendes ◦  Sarah Townsend ◦  Jeff Hunger ◦  Dina Eliezer ◦  Pam Sawyer ◦  Heather Reick ◦  Carol Miller ◦  Debra Bunyan

} 

Funding from National Institutes of Health, National Science Foundation