Research

In keeping with the Inequality Center's goal of producing superior work in the area of social inequalities and health, we will convene a monthly working group focused on grant proposals, research papers, and student dissertations. The idea of the working group will be to provide feedback on ongoing research that is being undertaken by affiliated faculty and students.

Projects and Proposals

Please see the items below for detailed information on the Center’s research projects and proposals.

Stigma
 

Mental Illness Stigma and Status Processes in Interpersonal Interactions

PI – Jo Phelan, NIMH

Interventions to reduce mental illness stigma will be most effective if based on solid scientific understanding of the social processes involved. The proposed research involves three features that hold significant promise for the construction of well-grounded interventions.

First, rather than focusing on attitudes of stigmatizers or adaptations of the stigmatized, we focus directly on an area that has been under-represented in existing research - interpersonal interactions between stigmatized and non-stigmatized individuals. Second, existing research on interactions has not been conducted within a general theoretical framework nor has it led to interventions. We therefore translate a well developed program of theory, research and intervention - expectation states theory (EST) – to the problem of stigma. EST research shows how status hierarchies based on characteristics such as gender and race are reproduced in social interactions, as well as how those hierarchies can be altered. Third, the rapidly expanding literature on mental illness stigma is based largely on survey methods and self-report outcome measures. As useful as this research has been, an experimental approach that includes behavioral assessments can be highly effective in adding to knowledge about stigma. Here we proposed the first steps in a program of research aimed at investigating whether EST and its interventions can be applied to stigma and whether stigma entails additional components to which interventions must attend.

We propose two experiments in which participants interact with a partner who has been labeled with psychiatric hospitalization (stigma), not having finished high school (low status) or neither. We address the following aims: (1) EST research shows that a low-status label reduces one’s influence in cooperative goal oriented interactions. Is this also true for a label of mental illness? (2) A label of mental illness increases interaction strain and social distance. Is this also true for a low-status label? (3) Assess whether mental illness combines additively or multiplicatively with other status characteristics. (4) Assess whether being labeled with mental illness or low educational attainment before an interaction affects mood, self-esteem and social withdrawal after the interaction, and assess the extent to which strain and negativity in the interaction mediate such labeling effects. Results from these studies will inform intervention efforts that seek the best ways to harness the power of interpersonal contact in reducing mental illness stigma.

Collaborative Research: A Multi-method Approach to Stigma and Status Processes

PI - Jo Phelan, NSF

Stigma and status are the major concepts in two important traditions of theory and research in social psychology. Work in the stigma tradition focuses on us-them distinctions between normal and deviant individuals. Work on status processes focuses on vertical hierarchies of influence and prestige in task groups. Although these programs have produced tremendous knowledge growth in the past 40 years, both would benefit from attention to the other.

Despite considerable research on whether various attributes act as status characteristics, the status literature does not include investigations of characteristics considered to be stigmatizing, particularly mental illness. Work in this tradition has also been nearly exclusively experimental, with little research directly on the implications of status characteristics in natural settings. Stigma research has not been systematized within an explicit theoretical framework and also largely studies stigmatization processes with the stimgatizer or the stigmatized rather than in interactions between stigmatized and non-stigmatized individuals. The investigators seek to build on both traditions by proposing three studies that address areas of convergence and departure between stigma and status processes. The three proposed studies include:

  1. An experiment that follows a standard protocol in the status characteristics tradition to examine behavioral outcomes and explicit self-report attitudes toward stigmatizing attributes and status characteristics, using common outcome variables from each tradition

  2. A study designed to measure implicit attitudes toward a status characteristic (educational attainment) and a stigmatizing attribute (mental illness) on outcome variables representing both the stigma and status literatures.

  3. An audit study to test for status (competency expectations) and stigma (social distance) effects of mental illness in natural settings.

  4. The proposed studies will be carried out at the University of Maryland and Columbia University. The investigators represent the two traditions under study in the proposed work: Lucas has published widely on status processes in groups and Phelan has done the same on the stigma of mental illness.

Intellectual Merit of the Proposed Work

The proposed work has the potential to significantly inform the extensive literatures on stigma and status processes. The status characteristics literature, despite impressive knowledge growth, has not attended to mental illness nor been the subject of more than a handful of investigations outside of the experimental laboratory. The proposed research will examine the status implications of mental illness and other characteristics in experimental and natural settings. The stigma literature has identified a number of outcomes of stigmatization and tends to focus on natural settings, but it has not been systemized within an explicit framework nor regularly studied as it occurs in interactions between stigmatized and non-stigmatized individuals. The proposed work will study mental illness within the successful theoretical framework of expectation states and status characteristics theories and will focus on how stigma and status processes emerge in interpersonal interactions. By including behavioral, explicit self report, and implicit attitude measures, the proposed research is also well-suited to investigate how status and stigmatization processes converge and depart. The proposed work has the potential to be “transformative”: It integrates and juxtaposes concepts and measures from two well established fields of study and attempts to understand whether the fields can be merged to create a new conceptual and empirical area of study.

Broader Impacts

There have been several recent calls for interventions designed to reduce the stigma of mental illness. These interventions are unlikely to be successful if not grounded in basic understanding of the processes that give rise to stigma and its outcomes. The proposed research has the potential to significantly inform efforts to combat the stigma of mental illness by studying it within a framework that has led to successful interventions in the past and by studying its outcomes in diverse settings.

Genetics and Stigma: The Role of Mass Media

PI – Jo Phelan, NH6RI

New information about the human genome has the potential to significantly alter the way we view and react to individuals and groups. At the same time, our reactions to this new information will be shaped by the way it is presented to and understood by the public and by existing attitudes about the groups to whom the information applies. We propose to examine the impact of human genomic research on existing forms of stigma. Because of the importance of the mass media in communicating genomic research to the public, we formed a collaboration between experts in stigma and communications to examine not only the content of information disseminated to the public but also how the public understands and responds to that information.

We focus on three stigma-related characteristics (schizophrenia, obesity, and race), and one lower-stigma characteristic as a comparison group (heart disease). From previous research, we identify stigma-relevant themes that have been prominent in the media, e.g. high vs. low genetic determinism and benefit vs. harm of genetic research. These may be supplemented by themes we identify in recent media reports.

Our aims are to:

  1. examine the prevalence of these themes in recent newspaper and news magazine coverage;

  2. compare the prevalence of these themes in coverage of schizophrenia, obesity, racial differences, and heart disease;

  3. examine how the public comprehends, interprets, and reacts to stories reflecting themes such as determinism and harm;

  4. assess variations in these reactions depending on the characteristic in question (e.g., obesity vs. heart disease);

  5. assess variations in reactions depending on respondents’ characteristics.

We address these aims in two phases: Phase 1 is a content analysis of 300 news stories, published between 2003 and 2007, about the causes of one of our four characteristics. In Phase 2, we construct synthetic news stories in which we vary the characteristic described and themes such as determinism and harm. Then, using a nationally representative sample of 700 people, we conduct an online experiment in which respondents are randomly assigned to read one version of the story. Respondents will answer open- and closed-ended questions assessing comprehension, interpretation, attitudes, beliefs and behavioral orientations in response to the story. Open-ended responses will be coded quantitatively to assess deviations in recall from the content of the article as well as attitudinal reactions.

A school-based intervention to address mental illness stigma

Research shows that stigma and discrimination are painfully present in the lives of people with mental illnesses and their families, blocking opportunities, compromising self-esteem and keeping people from accessing helpful treatments. Efforts designed to address these critical issues have produced only limited success, suggesting the need for new approaches that address these problems in a comprehensive fashion. We propose a school-based field experiment to evaluate a comprehensive multifaceted intervention designed to change attitudes and behaviors regarding mental illnesses during the critical period of early adolescence.

Structural Stigma and Population Health
 

Minority Health

Childhood adversity and cardiovascular health indices among Puerto Rican youth

Over the past decade there has been increasing recognition that many adult diseases begin in childhood.  Cardiovascular disease, which remains the leading cause of death in the U.S., and a source of disparities in mortality, is a particularly compelling example. Recently, the American Academy of Pediatrics modified its practice guideline that focuses on the prevention of cardiovascular disease in childhood and adolescence, emphasizing the need for greater prevention efforts and screening for cardiovascular risk. Childhood adversity presents a pathway through which childhood SES can impact cardiovascular risk, however the potential mechanisms driving these associations have not been fully explored.  

Latinos, the largest minority group in the United States, carry a disproportionate burden of cardiovascular disease compared to other ethnic groups. Puerto Ricans in particular have higher rates of obesity than other Latino subgroups, Puerto Rican women in particular have higher rates of hypertension, hypercholesterolemia, obesity and diabetes than any other Latino group. Furthermore Latinos experience childhood adversity at higher proportions than White, non-Latino populations. 

Supported by an NHLBIK01 award, the Robert Wood Johnson HSS Seed Award and Columbia University’s   Provost’s Grant Program for Junior Faculty Who Contribute to the Diversity Goals of the University, Dr. Suglia is examining the feasibility of conducting a cardiovascular healthassessment among Puerto Rican young adults living in two different social contexts, the South Bronx, NY and San Juan Puerto Rico. The overall project goal is to examine the relation between childhood adversity and cardiovascular health indices among Puerto Rican youth and examine the role ofsocial context and level of as potential modifiers of the child adversity and cardiovascular risk association.

Disparities Research
 

A Lifecourse Approach to Emerging Health Disparities in a US Birth Cohort

PI – Bruce Link, NICHD

The proposed research brings novel data to bear on the emergence of racial and socioeconomic disparities in health over the life course. We examine the intersection and mutual influence of three factors, socioeconomic status (SES), cognitive ability, and health itself. Extant research has demonstrated amply that indicators of SES predict health outcomes, that health affects socioeconomic attainment, and that cognitive ability predicts both educational attainment and health. But how do such associations between SES, cognitive ability, and health arise over the life course? And what role does racial discrimination play in influencing each of these factors to create disparities by race?

A theory of dynamic interplay of these factors across the life course is posited to explain the emergence of racial and socioeconomic disparities in general health, obesity, respiratory function, and depression. A California-based cohort, the Child Health and Development Study. Adolescent Sample (CHDS-A) (n=2020), born 1959-1966, provides the novel data to evaluate this theory. Detailed information was collected at multiple time points from before birth until age 15-17 years for black and white offspring and their families. Sufficient numbers of black and white offspring from both high and low SES families were included in the sample. The data already collected include assessments during childhood and adolescence of SES, cognitive ability, and the selected domains of health. This project will add assessments at age 42-49 years. Analysis of the accumulated data will elucidate the relationships among fundamental sources of health disparities and inform the construction of policies and interventions designed to reduce such inequalities.

Fundamental Causes of Social Disparities in Cancer Survival

Parisa Tehranifar - Lance Armstrong Young Investigator Grant Award

In the last several decades, remarkable improvements in cancer survival have been made through advances in early detection and treatment of many cancers. However, all segments of the population have not benefited equally and the burden of cancer is being disproportionately borne by socially disadvantaged racial/ethnic minorities and persons with low socioeconomic status (SES). Numerous investigations have produced important knowledge about specific pathways by which social disparities may occur for a limited number of cancers within specific time periods, but fall short of answering a fundamental question: why do social disparities in cancer vary across cancer sites and time periods?

In this young investigator application, I propose to investigate whether variations in effectiveness of screening and treatment capacities across cancer sites and time periods are associated with socioeconomic, racial and age-related disparities in cancer survival. I will test several hypotheses based on the theory that socially advantaged groups effectively use their greater access to adaptable social resources (e.g., knowledge, power, and beneficial social connections), in different or changing situations, to avoid disease or death. The usefulness of these resources for extending survival from a particular disease depends on the availability of knowledge, technology, and effective tools for treating that disease. Accordingly, we would expect to observe significant social disparities for cancers with greater screening and treatment capacities (e.g., breast, colon) and relatively smaller social disparities for cancers with more limited screening and treatment capacities (e.g., pancreas, lung). Furthermore, social disparities in cancer survival may be larger in young adults (< 40 years) who, similar to low SES and racial minority groups, have fewer adaptable resources relevant to health promotion, and have experienced the slowest improvement in cancer survival. I hypothesize that differences in survival between racial and socioeconomic groups are larger for: 1) cancers with more effective screening and treatment services than for cancers with less effective screening and treatment services; 2) cancers with greater progress in cancer screening and treatment services than cancers with minimal progress over time; and 3) young adults with cancer than middle-aged and elderly cancer patients.

This project will fill a gap in our understanding of why social disparities in cancer emerge, endure or change thereby informing policy and practice to overcome the unequal burden of cancer in our society. Support for the study hypotheses will show that advances in cancer screening and treatment will not only fail to narrow, but will exacerbate social disparities in cancer survival through greater uptake and utilization of these services by socially advantaged groups. These findings will endorse interventions that reduce the relevance of personal resources to obtaining cancer care or target population groups experiencing survival disparities.