Racial and Ethnic Disparities in the Prescribing of Pain Medication in US Primary Care Settings, 1999-2019: Where Are We Now?

BACKGROUND: Policy initiatives have attempted to reduce healthcare inequalities in the USA, but evidence on whether these initiatives have reduced racial and ethnic disparities in pain treatment in primary care is lacking. OBJECTIVE: To determine whether racial and ethnic disparities in medication prescribed for pain in primary care settings have diminished over a 21-year period from 1999 to 2019. DESIGN: An annual, representative cross-sectional probability sample of visits to US primary care physicians, taken from the National Ambulatory Medical Care Survey. PATIENTS: Pain-related visits to primary care physicians. MAIN MEASURES: Prescriptions for opioid and non-opioid analgesics. KEY RESULTS: Of 599,293 (16%) sampled visits, 94,422 were pain-related, representing a population-weighted estimate of 143 million visits made annually to primary care physicians for pain. Relative risk analysis controlling for insurance, pain type, and other potential confounds showed no difference in pain medication prescribed between Black and White patients (p = .121). However, White patients were 1.61 (95% CI 1.32-1.97) and Black patients 1.57 (95% CI 1.26-1.95) times more likely to be prescribed opioids than a more underrepresented group consisting of Asian, Native-Hawaiian/Pacific-Islander, and American-Indian/Alaska-Natives (ps < .001). Non-Hispanic/Latino patients were 1.32 (95% CI 1.18-1.45) times more likely to receive opioids for pain than Hispanic/Latino patients (p < .001). Penalized cubic spline regression found no substantive narrowing of disparities over time. CONCLUSIONS: These findings suggest that additional intervention strategies, or better implementation of existing strategies, are needed to eliminate ethnic and racial disparities in pain treatment towards the goal of equitable healthcare.

Trends in Racial Inequalities in the Administration of Opioid and Non-opioid Pain Medication in US Emergency Departments Across 1999-2020.

BACKGROUND: Despite initiatives to eradicate racial inequalities in pain treatment, there is no clear picture on whether this has translated to changes in clinical practice. OBJECTIVE: To determine whether racial disparities in the receipt of pain medication in the emergency department have diminished over a 22-year period from 1999 to 2020. DESIGN: We used data from the National Hospital Ambulatory Medical Care Survey, an annual, cross-sectional probability sample of visits to emergency departments of non-federal general and short-stay hospitals in the USA. PATIENTS: Pain-related visits to the ED by Black or White patients. MAIN MEASURES: Prescriptions for opioid and non-opioid analgesics. KEY RESULTS: A total of 203,854 of all sampled 625,433 ED visits (35%) by Black or White patients were pain-related, translating to a population-weighted estimate of over 42 million actual visits to US emergency departments for pain annually across 1999-2020. Relative risk regression found visits by White patients were 1.26 (95% CI, 1.22-1.30; p<0.001) times more likely to result in an opioid prescription for pain compared to Black patients (40% vs. 32%). Visits by Black patients were also 1.25 (95% CI, 1.21-1.30; p<0.001) times more likely to result in non-opioid analgesics only being prescribed. Results were not substantively altered after adjusting for insurance status, type and severity of pain, geographical region, and other potential confounders. Spline regression found no evidence of meaningful change in the magnitude of racial disparities in prescribed pain medication over 22 years. CONCLUSIONS: Initiatives to create equitable healthcare do not appear to have resulted in meaningful alleviation of racial disparities in pain treatment in the emergency department.

Mobilizing or Sedative Effects? A Narrative Review of the Association Between Intergroup Contact and Collective Action Among Advantaged and Disadvantaged Groups.

ACADEMIC ABSTRACT: In this narrative review, we examined 134 studies of the relationship between intergroup contact and collective action benefiting disadvantaged groups. We aimed to identify whether, when, and why contact has mobilizing effects (promoting collective action) or sedative effects (inhibiting collective action). For both moderators and mediators, factors associated with the intergroup situation (compared with those associated with the out-group or the in-group) emerged as the most important. Group status had important effects. For members of socially advantaged groups (examined in 98 studies, 100 samples), contact had a general mobilizing effect, which was stronger when contact increased awareness of experiences of injustice among members of disadvantaged groups. For members of disadvantaged groups (examined in 49 studies, 58 samples), contact had mixed effects. Contact that increased awareness of injustice mobilized collection action; contact that made the legitimacy of group hierarchy or threat of retaliation more salient produced sedative effects. PUBLIC ABSTRACT: We present a review of existing studies that have investigated the relationship between intergroup contact and collective action aimed at promoting equity for disadvantaged groups. We further consider the influence of contact that is positive or negative and face-to-face or indirect (e.g., through mass or social media), and we distinguish between collective action that involves socially acceptable behaviors or is destructive and violent. We identified 134 studies, considering both advantaged (100 samples) and disadvantaged groups (58 samples). We found that intergroup contact impacts collective action differently depending on group status. Contact generally leads advantaged groups to mobilize in favor of disadvantaged groups. However, contact has variable effects on members of disadvantaged groups: It sometimes promotes their collective action in support of their own group; in other cases, it leads them to be less likely to engage in such action. We examine when and why contact can have these different effects.

Nostalgic intergroup contact and intergroup relations:Theoretical, empirical, and applied dimensions.

Recent research has highlighted the potential of nostalgic recall of intergroup contact as a means of enhancing intergroup relationships and tackling prejudice. In this article, we review the scarce but promising literature that integrates research on nostalgia and intergroup contact. We outline the mechanisms that explain the link between nostalgic intergroup encounters and improved intergroup attitudes and behavior. We further highlight the benefits that nostalgic contact reverie may have for intergroup relations - and beyond. We then discuss the potential of nostalgic intergroup contact as a strategy for real-world, prejudice reduction interventions. Finally, we draw on current research from the fields of nostalgia and intergroup contact to make suggestions for future research. "… nostalgic memories … lead to a vivid sense of commonality [which] accelerates the process of acquaintance in a community where formerly only barriers may have existed." [1, p. 454].

Social identity threat across group status: Links to psychological well-being and intergroup bias through collective narcissism and ingroup satisfaction.

OBJECTIVE: Through two correlational studies (Study 1: Turkish majority, Kurdish minority; Study 2: White British majority; Black minority), we examined the implications of social identity threat for majority and minority ethnic group members' psychological well-being and intergroup bias, using a social identity framework that incorporates the recently highlighted distinction between narcissistic and non-narcissistic positive evaluation of the ingroup (i.e., collective narcissism and ingroup satisfaction, respectively). METHOD: Online questionnaires were completed by 397 Turkish nationals (265 ethnic Turks and 132 ethnic Kurds, Mage = 32.81, SD = 11.67) in Study 1 and 351 British individuals (163 White and 188 Black British; Mage = 31.47, SD = 10.84) in Study 2. RESULTS: Social identity threat was consistently associated with collective narcissism among all ethnic groups, whereas it was either unrelated or related negatively to ingroup satisfaction. Collective narcissism was positively associated with intergroup bias among both majority and minority groups. Unexpectedly, ingroup satisfaction was also related to greater bias particularly among majority members. In all groups, ingroup satisfaction (but not collective narcissism) was directly associated with greater psychological well-being. CONCLUSIONS: Findings highlight the importance of exploring the narcissistic component of positive ingroup evaluation to provide a more nuanced understanding of the relationships between social identity threat and personal well-being, as well as intergroup bias. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Where to draw the line? The influence of prior relationship, perpetrator-target sex and perpetrator motivation on the point at which behavior 'crosses the line' and becomes stalking.

The present study examines the influence of prior relationship (intimate, non-intimate), perpetrator-target sex (male-female, female-male) and perpetrator motivation (romance, upset) on (1) the point at which behavior crosses the line and becomes stalking, and (2) the likelihood of offering five forms of advice to the target (formal support, informal support, protective measures, avoidance measures, threatening action). The study used a 2 × 2 × 2 between-participants experimental design. Four-hundred and sixty-one UK students read one of eight versions of a hypothetical scenario that they were informed may or may not depict a stalking situation. Analyses revealed that 97.8% (n = 451) of participants believed the perpetrator's behavior constituted stalking, and that behavior was perceived to cross the line earlier in the scenario when the perpetrator's motivation was to upset the target in the context of a non-intimate prior relationship only. Prior relationship, perpetrator-target sex and perpetrator motivation also influenced the likelihood of offering various forms of advice to the target. These findings further demonstrate the impact of situational characteristics on perceptions of stalking and highlight the importance of educational campaigns and programs to increase people's understanding of stalking.

Social dominance orientation, belief in a just world and intergroup contact as predictors of homeless stigmatisation.

The purpose of this study was to explore individual and situational predictors of homeless stigmatization. The aim was to test if individual differences in Belief in a Just World (BJW) and Social Dominance Orientation (SDO) moderate the effect of quantity and quality of contact on stigmatization of the homeless. One hundred and eighty-seven participants completed measures of BJW, SDO, quality, and quantity of contact, as well as a measure of homeless stigmatization. Results showed that BJW and SDO correlated positively with stigmatization, while both quantity and quality of contact were negatively correlated with stigmatization. SDO was found to moderate the relationship between quantity of contact and stigmatization; more contact with the homeless was related to lower stigmatization for participants with low and moderate SDO scores but not those with high SDO. BJW did not moderate the relationship between contact and stigmatization. Implications regarding the interaction between SDO and contact are discussed.

I (dis)like the way you (dis)like them: The role of extended contact on social distance and attitudes towards the ingroup.

While extended intergroup contact has been commonly studied in the context of prejudice reduction, less is known about its implications for processes related to the ingroup. Through three correlational and one experimental studies (total N = 897) conducted in two different intergroup contexts (Turkey and United Kingdom), we investigated whether extended intergroup contact relates to social distance and attitudes towards ingroup members as a function of outgroup attitudes. We also investigated ingroup identification and perceived ingroup morality as potential mediators in these associations. Correlational studies demonstrated that especially when outgroup attitudes were more negative, participants' positive (but not negative) extended contact was related to a more negative evaluation of the ingroup; whereas when outgroup attitudes were more positive, extended contact was associated with positive attitudes towards the ingroup. We found experimental evidence for the suggested relationships in relation to ingroup social distance. Findings are discussed in the light of vicarious dissonance theory and deprovincialization hypothesis.

Reducing prejudice toward Syrian refugee children: A vicarious contact intervention among Turkish elementary school children.

We conducted an experimental intervention to test the effectiveness of vicarious contact in the relationship between Turkish and Syrian elementary school children; the participants were Turkish children. We used a mixed-methods approach, investigating effects by using both quantitative and qualitative methodologies. Participants in the experimental condition were asked to read stories on positive contact between Turkish and Syrian children over the course of six weekly sessions. The results revealed that vicarious contact, compared to a control condition where participants did not engage in any activity, led to greater intentions to help outgroup members. Importantly, effects only emerged among children who reported higher initial negative outgroup attitudes. Results from qualitative data revealed that vicarious contact produced richer, more positive, and complex representations of the relationships and friendships between groups. We discuss the theoretical and practical implications of these findings.

Comparing story reading and video watching as two distinct forms of vicarious contact: An experimental intervention among elementary school children.

Research has shown that vicarious contact, that is observing an interaction between ingroup and outgroup members, can improve intergroup relations. Although vicarious contact has been operationalized in different ways, mainly via story reading or video watching, an experimental comparison of these different strategies is still missing. We conducted a school intervention with the aim of comparing the two most used forms of vicarious contact, namely story reading and video watching. Elementary schoolchildren without disabilities (N = 292) were assigned to one of three different conditions: reading a story; watching a video; control. In the two vicarious contact conditions, participants read or watched the story of a child with disability becoming friends with children without disabilities; in the control condition, participants only completed the dependent measures. Results revealed that, in general, both vicarious contact conditions were equally effective in improving outgroup attitudes and behavioural intentions. In addition, they operated with the same strength through the same underlying processes (IOS, ingroup norms). We discuss theoretical and practical implications in the context of vicarious contact as a prejudice-reduction intervention.

Meta-humanization reduces prejudice, even under high intergroup threat.

Meta-dehumanization, the perception your group has been given less than human qualities, contributes to a vicious cycle of outgroup dehumanization and hostility, such as hate crimes and support for discriminatory policies. Minimal research has investigated potential benefits of meta-humanization, or perceiving your group has been given dignified qualities. Across 7 studies (N = 1,261) in Canada and the United Kingdom, we focus on Muslim-non-Muslim relations and provide the first empirical evidence to suggest that (a) there is an indirect effect of meta-humanization through outgroup humanization that reduces prejudice and (b) that perceived high intergroup threat moderates the indirect effect of meta-humanization. Studies 1a and 1b reveal that humanization mediates the indirect effect of meta-humanization on prejudice. Studies 2a and 2b replicate these results as well as demonstrate that perceived threat moderates the indirect effect, and Study 2c extends this by testing the perspective of Muslims. Studies 3a and 3b further demonstrate an interaction between high threat and meta-humanization on prejudice and interest in intergroup contact. We conclude by discussing the implications of our results for the growing literature on meta-dehumanization, meta-humanization, and intergroup relations more broadly. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intergroup fears and concerns among minority and majority groups: Implications for contact and attitudes.

AIMS: Driven by the literature on pluralistic ignorance, our research investigates fear of appearing racist, being rejected, discriminated, and disinterest in intergroup contact as antecedents of contact and outgroup attitudes, focusing on attributional differences between the majority and minority group perspectives. METHODS: Questionnaires were distributed in schools in Northern Italy. Participants were 400 Italian and 141 immigrant high-school students. RESULTS: The results showed that the lack of interest in contact was the strongest predictor of contact for the majority group. For the minority group, fear of rejection emerged as the strongest predictor. The majority group attributed the minority to avoid contact most strongly due to the fear that they would be rejected, and the minority group perceived it was due to the majority not being interested in contact. CONCLUSION: Our research contributes to understanding the divergent concerns the majority and minority groups have in relation to intergroup contact and discusses the importance of tackling these concerns.

The impact of feminist stereotypes and sexual identity on feminist self-identification and collective action.

The present study sought to examine the role of sexual identity and exposure to stereotypes of feminism on women's self-identification as a feminist, endorsement of feminist attitudes, and intention to engage in collective action. Participants (N = 312; all women) disclosed their sexual identity as either heterosexual or non-heterosexual (sexual minority) and were randomly assigned to one of three conditions: exposure to positive stereotypes of feminists, to negative stereotypes of feminists, control condition (no exposure to stereotypes). Results showed stark differences between heterosexual and sexual minority women, with sexual minority women scoring significantly higher on self-identification as feminist, feminist attitudes, and collective action intentions. Exposure to positive stereotypes of feminists increased feminist self-identification regardless of sexual identity. Exposure to negative stereotypes reduced self-identification with feminism, and lower identification mediated the path between negative stereotyping and collective action. Implications of these findings for the advancement of women's rights movements are discussed.

Imagined contact facilitates acculturation, Sometimes: Contradicting evidence from two sociocultural contexts.

OBJECTIVE: Imagined intergroup contact has been shown to be an effective tool to improve intergroup relationships in various settings, yet the application of the strategy among minority group members and across cultures has been scarce. The current research aimed to test imagined contact effects on minority group members' acculturation strategies (contact participation and culture maintenance), perceived discrimination, feelings of belongingness, and social acceptance across three studies conducted in the United Kingdom (Study 1) and Turkey (Studies 2 and 3). METHOD: The sample consisted of Eastern Europeans in Study 1 (N = 63) and Kurds in Study 2 and 3 (N = 66 and 210, respectively). Participants were randomly assigned to 1 of 2 conditions (control vs. imagined contact) and completed measures of acculturation, perceived discrimination, general belongingness, and social acceptance. RESULTS: Findings showed that while imagined contact significantly reduced perceived discrimination and culture maintenance, and increased contact participation and social acceptance among Eastern Europeans (Study 1), it reduced social acceptance and contact participation among Kurds recruited from a conflict-ridden homogeneous setting (Study 2). With a larger and more heterogeneous sample of Kurds (Study 3), these effects occurred only among those with higher ingroup identification. Moreover, in all studies social acceptance mediated the effects of imagined contact on contact participation and perceived discrimination. DISCUSSION: Findings offer important insights about the use of the imagined contact strategy among minority group members and imply the need to take into account the context-dependent nature of contact strategies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Secondary transfer effect among children: The role of social dominance orientation and outgroup attitudes.

Research has provided evidence that the effects of intergroup contact on prejudice reduction are not limited to the outgroup one has contact with (primary outgroup). Rather, they extend to secondary outgroups uninvolved in the contact situation (secondary transfer effect; Pettigrew, 2009, Social Psychology, 40, 55). We aimed to provide the first empirical evidence for the emergence of the secondary transfer effect among children. Majority (Italian) and minority (with an immigrant background) elementary schoolchildren were administered a questionnaire including measures of contact with the primary outgroup (minority children for the majority, majority children for the minority), prejudice towards the primary outgroup and towards a dissimilar secondary outgroup (disabled children), and social dominance orientation. Results revealed that among the majority group, contact with the primary outgroup had indirect associations with reduced prejudice towards the secondary outgroup. Specifically, we found evidence for sequential mediation by social dominance orientation and prejudice towards the primary outgroup. No secondary transfer effects emerged among minority group members. We discuss theoretical and practical implications of the findings, arguing for the importance of identifying the core processes driving the secondary transfer effect.

'And the best essay is ': Extended contact and cross-group friendships at school.

We conducted one experimental intervention based on extended contact principles aimed at fostering the formation of cross-group friendships within educational settings. Italian school children took part in a school competition for the best essay on personal experiences of cross-group friendships with immigrants, to be written in small groups. This manipulation was intended to favour the exchange of personal positive cross-group experiences, thus capitalizing on the benefits of extended contact. In the control condition, participants wrote an essay on friendship, without reference to cross-group relations. Results revealed that children who took part in the intervention reported a higher number of outgroup friends 3 months later. This indirect effect was sequentially mediated by pro-contact ingroup and outgroup norms and by outgroup contact behavioural intentions. This study provides experimental evidence that interventions based on extended contact can foster cross-group friendship formation. Theoretical and practical implications of the findings are discussed.

Imagining intergroup contact can combat mental health stigma by reducing anxiety, avoidance and negative stereotyping.

Research has demonstrated widespread negative attitudes held toward people with mental health problems. Our study investigated whether a new prejudice reduction technique, imagined intergroup contact (Crisp & Turner, 2009), could combat stigma against people with mental illness, and the mediating processes through which it may exert this beneficial effect. We found that compared to a control condition, participants who imagined a positive encounter with a schizophrenic person reported weakened stereotypes and formed stronger intentions to engage in future social interactions with schizophrenic people in general. Importantly, these intentions were formed due to reduced feelings of anxiety about future interactions. We discuss the implications of these findings for improving the social inclusion of people with mental health problems.

Justice for whom, exactly? Beliefs in justice for the self and various others.

The present studies examine why people think the world is more just to themselves than to others generally. Beliefs in justice for the self were uniquely associated with psychological adjustment, consistent with the theoretical motive to believe in justice for the self (Studies 1 and 2). However, this "justice motive" did not appear to affect the relative strength of justice beliefs. Instead, self-other differences in justice beliefs appeared to reflect objective assessments of the justice received by various demographics. Undergraduates believed the world to be more just to themselves than to others but not their undergraduate peers specifically (Study 1). Participants of both genders believed the world to be more just to men, and to themselves, than to women (Study 2). Women did not exempt themselves individually from injustice but believed, similar to men, that undergraduate women receive as much justice as men (Study 3).