Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-25T05:26:00.446Z Has data issue: false hasContentIssue false

6 - The Impact of Implicit Racial Bias in Racial Health Disparities: A Practical Problem with Theoretical Implications

from Section II - Do Measures of Implicit Bias Predict Cognition and Behavior?

Published online by Cambridge University Press:  21 December 2024

By
Louis A. Penner ,
John F. Dovidio ,
Nao Hagiwara  and
Terrance L. Albrecht
Edited by
Jon A. Krosnick ,
Tobias H. Stark  and
Amanda L. Scott
Jon A. Krosnick
Affiliation:
Stanford University, California
Tobias H. Stark
Affiliation:
Utrecht University, The Netherlands
Amanda L. Scott
Affiliation:
The Strategy Team, Columbus, Ohio
Get access

Summary

On average, Black Americans’ health is poorer than that of White Americans. We examine three pathways by which implicit racial bias may contribute to racial health disparities. First, implicit and explicit racial bias cause racial discrimination, producing chronic stress and limited access to resources among Black targets of discrimination. This directly and negatively affects their health. This pathway has substantial empirical support. Second, physician implicit racial bias negatively affects treatment recommendations to Black patients, causing racial health disparities. Although intuitively appealing, currently there is little empirical support for this pathway. Third, physician implicit racial bias negatively influences the quality of healthcare interactions with Black patients, causing racial health disparities. This pathway has substantial empirical support. We conclude by highlighting differences in the ways social cognition and applied health disparity researchers study implicit racial bias, and make an argument for the benefits of dialogue and mutual collaborations between these two groups.

Keywords

applied disparity researchdiscriminationImplicit Association Testimplicit racial biasracial attitudesracial health disparitiesracial healthcare disparities
Type
Chapter
Information
The Cambridge Handbook of Implicit Bias and Racism , pp. 173 - 221
Publisher: Cambridge University Press
Print publication year: 2025

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aiken, L., & West, S. (1991). Multiple Regression: Testing and Interpreting Interactions. Thousand Oaks, CA: SAGE Publications.Google Scholar
American Cancer Society. (2020). Cancer Facts & Figures 2020. Atlanta, GA: American Cancer Society. www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020.htmlGoogle Scholar
Apfelbaum, E. P., Norton, M. I., & Sommers, S. R. (2012). Racial color blindness: Emergence, practice, and implications. Current Directions in Psychological Science, 21I(3), 205–209.CrossRefGoogle Scholar
Arber, S., McKinlay, J., Adams, A., et al. (2006). Patient characteristics and inequalities in doctors’ diagnostic and management strategies relating to CHD: A video-simulation experiment. Social Science and Medicine, 62(1), 103–115.CrossRefGoogle ScholarPubMed
Arkes, H. R., & Tetlock, P. E. (2004). Attributions of implicit prejudice, or ‘Would Jesse Jackson ‘Fail’ the Implicit Association Test?’. Psychological Inquiry, 15(4), 257–278. https://doi.org/10.1207/s15327965pli1504_01CrossRefGoogle Scholar
Bailey, Z., Krieger, N. Agenor, M., et al. (2017). Structural racism and health inequities in the USA: Evidence and interventions Lancet, 389, 1453–1463.CrossRefGoogle ScholarPubMed
Bandera, E. V., Lee, V. S., Rodriguez-Rodriguez, L., et al. (2016). Racial/ethnic disparities in ovarian cancer treatment and survival. Clinical Cancer Research, 22, 5909–5914.CrossRefGoogle ScholarPubMed
Bergsieker, H. B., Shelton, J. N., & Richeson, J. A. (2010). To be liked versus respected: Divergent goals in interracial interactions. Journal of Personality and Social Psychology, 99, 248–264. https://doi.org/10.1037/a0018474CrossRefGoogle ScholarPubMed
Bertakis, K. D., & Azari, R. (2011). Patient centered care is associated with decreased healthcare. American Board of Family Medicine, 24(3) 229–239. https://doi.org/10.3122/jabfm.2011.03.110084CrossRefGoogle Scholar
Birkhäuer, J., Gaab, J., Kossowsky, J., et al. (2017). Trust in the health care professional and health outcome: A meta-analysis. PLOS One (online). https://doi.org/10.1371/journal.pone.0170988CrossRefGoogle Scholar
Black, P. H., & Garbutt, L. D. (2002). Stress, inflammation and cardiovascular disease. Journal of Psychosomatic Research, 52(1), 1–23CrossRefGoogle ScholarPubMed
Blair, I. V., & Brondolo, E. (2017). Moving beyond the individual: Community-level prejudice and health. Social Science and Medicine, 183, 169–172.CrossRefGoogle ScholarPubMed
Blair, I. V., Steiner, J. F., Fairclough, D. L., et al. (2013). Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Annals of Family Medicine, 11, 43–52. https://doi.org/10.1370/afm.1442CrossRefGoogle ScholarPubMed
Blair, I. V., Steiner, J. F., Hanratty, R., et al. (2014). An investigation of associations between clinicians’ ethnic or racial bias and hypertension treatment, medication adherence and blood pressure control. Journal Of General Internal Medicine, 29(7), 987–995. https://doi.org/10.1007/s11606-014-2795-zCrossRefGoogle ScholarPubMed
Bleser, W. K., Miranda, P. Y., & Jean-Jacques, M. (2016). Racial/ethnic disparities in influenza vaccination of chronically ill us adults: The mediating role of perceived discrimination in health care. Medical Care 54, 570–577.CrossRefGoogle ScholarPubMed
Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health, 27, 167–194.CrossRefGoogle ScholarPubMed
Brody, G. H., Miller, G. E., Yu, T., et al. (2016). Supportive family environments ameliorate the link between racial discrimination and epigenetic aging: A replication across two longitudinal cohorts. Psychological Science, 27, 530–541.CrossRefGoogle ScholarPubMed
Burgess, D. J. (2010). Are providers more likely to contribute to healthcare disparities under high levels of cognitive load? How features of the healthcare setting may lead to biases in medical decision making. Medical Decision Making, 30(2), 246–257.CrossRefGoogle ScholarPubMed
Byrd, W. M., & Clayton, L. A. (2015). An American Health Dilemma: Race, Medicine, and Health Care in the United States 1900–2000 (Vol. 2). New York, NY: Routledge.Google Scholar
Calabrese, S. K., Earnshaw, V. A., Underhill, K., et al. (2014). The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PREP): Assumptions about sexual risk compensation and implications for access. AIDS And Behavior, 18(2), 226–240. https://doi.org/10.1007/s10461-013-0675-xCrossRefGoogle ScholarPubMed
Carter, R.T., Johnson, V., Kirkinis, K., et al. (2019). A meta-analytic review of racial discrimination: Relationships to health and culture. Race and Social Problems, 11, 15–32.CrossRefGoogle Scholar
Chae, D. H., Clouston, S., Hatzenbuehler, M. L., et al. (2015). Association between an internet-based measure of area racism and Black mortality. PLoS ONE, 10(4).CrossRefGoogle ScholarPubMed
Chae, D. H., Epel, E. S., Nuru-Jeter, A. M., et al. (2016). Discrimination, mental health, and leukocyte telomere length among African American men. Psychoneuroendocrinology, 6, 310–316. https://doi.org/10.1016/j.psyneuen.2015.09.001Google Scholar
Clark, R., Anderson, N. B., Clark, V. R., et al. (1999). Racism as a stressor for African Americans: A biosocial model. American Psychologist, 54, 805–816.CrossRefGoogle Scholar
Cochran, S. D., Björkenstam, C., & Mays, V. M. (2016). Sexual orientation and all-cause mortality among US adults aged 18 to 59 years, 2001–2011. American Journal of Public Health, 106(5), 918–920.CrossRefGoogle ScholarPubMed
Cooper, L. A., & Roter, D. L. (2003). Patient-provider communication: the effect of race and ethnicity on process and outcomes of healthcare. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 552–93.Google Scholar
Cooper, L. A., Roter, D. L., Carson, K. A., et al. (2012). The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. American Journal of Public Health, 102, 979–987. https://doi.org/10.2105/AJPH.2011.300558CrossRefGoogle ScholarPubMed
Cooper, L. A., Roter, D. L., Johnson, R. L., et al. (2003). Patient-centered communication, ratings of care, and concordance of patient and physician race. Annals of Internal Medicine, 139, 907–915.CrossRefGoogle ScholarPubMed
Curtis, J. R., McClure, L. A., Deizell, E., et al. (2009). Population-based fracture risk assessment and osteoporosis treatment disparities by race and gender. Journal of General Internal Medicine, 24(8), 956–962.CrossRefGoogle ScholarPubMed
Data USA. (2016). https://datausa.io/profile/soc/291060/#demographicsGoogle Scholar
Dehon, E., Weiss, N., Jones, J., et al. (2017). A systematic review of the impact of physician implicit racial bias on clinical decision making. Academic Emergency Medicine, 24, 895–904.CrossRefGoogle ScholarPubMed
Dovidio, J. F., & Gaertner, S. L. (2004). Aversive racism. In Zanna, M. P. (Ed.), Advances in Experimental Social Psychology (Vol. 36, pp. 1–51). San Diego, CA: Academic Press.Google Scholar
Dovidio, J. F., Gaertner, S. E, Kawakami, K., et al. (2002). Why can’t we just get along? Interpersonal biases and interracial distrust. Cultural Diversity and Ethnic Minority Psychology, 8(2), 88–102. https://doi.org/10.1037/1099-9809.8.2.88CrossRefGoogle ScholarPubMed
Dovidio, J. F., Gaertner, S. L., & Pearson, A. R. (2017). Aversive racism and contemporary bias. In Barlow, F. K. & Sibley, C. G. (Eds.), The Cambridge Handbook of the Psychology of Prejudice. Cambridge: Cambridge University Press, 267–294.Google Scholar
Dovidio, J. F., Kawakami, K., Smoak, N., et al. (2009). The nature of contemporary racial prejudice: Insights from implicit and explicit measures of attitudes. In Petty, R. E., Fazio, R. H., & Brinol, P. (Eds.), Attitudes: Insights from the New Implicit Measures. New York, NY: Psychology Press, pp. 165–192.Google Scholar
Dovidio, J. F., & LaFrance, M. (2013). Race, ethnicity, and nonverbal behavior. In Hall, J. A. & Knapp, M. (Eds.), Nonverbal Communication. The Hague, The Netherlands: DeGruyter-Mouton, pp. 671–696.CrossRefGoogle Scholar
Dovidio, J. F., Pearson, A. R., Schellhass, F. M. H., et al. (2023). Aversive racism and implicit bias. In Krosnick, J. A., Stark, T. H., & Scott, A. L. (Eds.), The Cambridge Handbook of Implicit Bias. Cambridge: Cambridge University Press.Google Scholar
Dovidio, J. F., Penner, L. A., Albrecht, T. L., et al. (2008). Disparities and distrust: The implications of psychological processes for understanding racial disparities in health and health care. Social Science and Medicine, 67, 478–486.CrossRefGoogle ScholarPubMed
Dugan, E., Trachtenberg, F., & Hall, M. A. (2005). Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession. BMC Health Services Research, 5, 64.CrossRefGoogle Scholar
Eggly, S., Barton, E., Winckles, A., et al. (2015). A disparity of words: Racial differences in oncologist-patient communication about clinical trials. Health Expectations, 18, 1316–1326. https://doi.org/10.1111/hex.12108CrossRefGoogle ScholarPubMed
Eggly, S., Hamel, L. M., Foster, T. S., et al. (2017a). Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists. Patient Education & Counseling, 100, 818–826.CrossRefGoogle ScholarPubMed
Eggly, S., Hamel, L. M., Heath, E., et al. (2017b). Partnering around cancer clinical trials: Study protocol for a randomized trial of a patient and physician communication intervention to increase minority accrual to prostate cancer clinical trials. BMC Cancer, 807, 3804–3805. https://doi.org/10.1186%2Fs12885-017-3804-5Google Scholar
Epstein, R. M., & Street, R. L. Jr. (2007). Patient-centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. Bethesda, MD: National Cancer Institute, NIH Publication No. 07-6225.Google Scholar
Fazio, R. H., & Olson, M. A. (2003). Implicit measures in social cognition research: Their meaning and use. Annual Review of Psychology 54, 297–327.CrossRefGoogle ScholarPubMed
Fiscella, K., Epstein, R. M., Griggs, J. J., et al. (2021). Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain? PLoS ONE, 16(10), e0257794. https://doi.org/10.1371/journal.pone.0257794CrossRefGoogle ScholarPubMed
Fiscella, K., & Sanders, M. R. (2016). Racial and ethnic disparities in the quality of health care. Annual Review of Public Health, 37, 375–394.CrossRefGoogle ScholarPubMed
Fitzgerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics, 18(1), 19.CrossRefGoogle ScholarPubMed
Forscher, P. S., & Devine, P. G. (2017). Controlling implicit bias: Insights from a public health perspective. PsyArXiv Preprints.CrossRefGoogle Scholar
Gaertner, S. L., & Dovidio, J. F. (1986). The aversive form of racism. In Dovidio, J. F. & Gaertner, S. L. (Eds.), Prejudice, Discrimination, and Racism. Orlando, FL: Academic Press, pp. 61–89.Google Scholar
Gawronski, B., & Brannon, S. M. (2019). Attitudes and the implicit-explicit dualism. In Albarrracin, D. & Johnson, B. (Eds.) Handbook of Attitudes (2nd ed., Vol. 1). New York, NY: Taylor and Francis.Google Scholar
Gibbons, F. X., Gerrard, M., Cleveland, M. J., et al. (2004). Perceived discrimination and substance use in African American parents and their children: A panel study. Journal of Personality and Social Psychology, 86, 517–529.CrossRefGoogle ScholarPubMed
Green, A. R., Carney, D. R., Pallin, D. J., et al. (2007). Implicit bias among physicians and its prediction of thrombolysis decisions for Black and White patients. Journal of General Internal Medicine, 22(9), 1231–1238. https://doi.org/10.1007/s11606-007-0258-5CrossRefGoogle ScholarPubMed
Greenwald, A. G., & Banaji, M. R. (2017). The implicit revolution: Reconceiving the relation between conscious and unconscious. American Psychologist, 72(9), 861–871. https://doi.org/10.1037/amp0000238CrossRefGoogle ScholarPubMed
Greenwald, A. G., & Krieger, L. H. (2006). Implicit bias: Scientific foundation. California Law Review, 94, 945–967.CrossRefGoogle Scholar
Greenwald, A. G., Nosek, B. A., & Banaji, M. R. (2003). Understanding and using the Implicit Association Test: I. An improved scoring algorithm. Journal of Personality and Social Psychology, 85, 197–216.CrossRefGoogle ScholarPubMed
Greenwald, A. G., & Pettigrew, T. F. (2014). With malice toward none and charity for some: Ingroup favoritism enables discrimination. American Psychologist, 69, 669–684.CrossRefGoogle ScholarPubMed
Greenwald, A. G., Poehlman, T. A., Uhlmann, E. L., et al. (2009). Understanding and using the Implicit Association Test. Journal of Personality and Social Psychology, 97(1), 17–41.CrossRefGoogle ScholarPubMed
Hagiwara, N., & Dent, R. (2016). Patient-physician communication during racially discordant medical interactions: Limitations with the current coding systems. Testing, Psychometrics, Methodology in Applied Psychology, 23, 511–529.Google Scholar
Hagiwara, N., Dovidio, J. F., Eggly, S., et al. (2016). The effects of racial attitudes on affect and engagement in racially discordant medical interactions between non-Black physicians and Black patients. Group Processes and Intergroup Relations, 19, 509–527. https://doi.org/10.1177/1368430216641306CrossRefGoogle ScholarPubMed
Hagiwara, N., Dovidio, J. F., Stone, J., et al. (2020). Applied racial/ethnic healthcare disparities research using implicit measures. Social Cognition, 38, S68–97.CrossRefGoogle ScholarPubMed
Hagiwara, N., Eggly, S. Slatcher, R., et al. (2017). Physician racial bias and word use during racially discordant medical interactions. Health Communication, 32, 401–408. https:/?doi.org/10.1080%2F10410236.2016.1138389CrossRefGoogle ScholarPubMed
Hagiwara, N., Elston-Lafata, J., Mezuk, B., et al. (2019). Detecting implicit racial bias in provider communication behaviors to reduce disparities in healthcare: Challenges, solutions, and future directions for provider communication training. Patient Education and Counseling, 102(9), 1738–1743. https://doi-org.proxy.lib.wayne.edu/10.1016/j.pec.2019.04.023CrossRefGoogle ScholarPubMed
Hagiwara, N., Kashy, D., & Penner, L. A. (2014). A novel analytical strategy for patient-physician communication: the one-with-many design. Patient Education and Counseling, 95, 325–331.CrossRefGoogle ScholarPubMed
Hagiwara, N., Penner, L. A. Gonzalez, R., et al. (2013). Racial attitudes, physician-patient talk time ratio, and adherence in racially discordant medical interactions. Social Science and Medicine, 87, 123–131.CrossRefGoogle ScholarPubMed
Haider, A. H., Schneider, E. B., Sriram, N., et al. (2015a). Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions. Journal of the American Medical Association Surgery, 150(5), 457–464.Google ScholarPubMed
Haider, A. H., Schneider, E. B., Sriram, N., et al. (2015b). Unconscious race and class biases among registered nurses: Vignette-based study using implicit association testing. Journal of American College of Surgeons, 220(6), 1077–1086.CrossRefGoogle ScholarPubMed
Hall, W. J., Chapman, M. V., Lee, K. M., et al. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. American Journal of Public Health, 105, 60–76. https://doi.org/10.2105/AJPH.2015.302903CrossRefGoogle ScholarPubMed
Hamel, L. M., Chapman, R., Malloy, M., et al. (2015). Critical shortage of African American medical oncologists in the United States. Journal of Clinical Oncology, 33, 3697–3700. https://doi.org/10.1200/JCO.2014.59.2493CrossRefGoogle ScholarPubMed
Hamel, L. M., Moulder, R., Harper, F.W.K., et al. (2020). Examining the dynamic nature of nonverbal communication between Black patients with cancer and their oncologists. Cancer, 127(7), 1080–1090.CrossRefGoogle ScholarPubMed
Hausmann, L. R., Kwoh, C. K., Hannon, M. J., et al. (2013). Perceived racial discrimination in health care and race differences in physician trust. Race and Social Problems, 5(2), 113–120.CrossRefGoogle Scholar
Hehman, E., Calanchini, J., Flake, J. K., et al. (2019). Establishing construct validity evidence for regional measures of explicit and implicit racial bias. Journal of Experimental Psychology: General, 148(6), 1022–1040.CrossRefGoogle ScholarPubMed
Hertz, R. P., Unger, A. N., Cornell, J. A., et al. (2005). Racial disparities in hypertension prevalence, awareness, and management. Archives of Internal Medicine, 165(18), 2098–2104.CrossRefGoogle Scholar
Hirsh, A.T., Hollingshead, N. A., Ashburn-Nardo, L., et al. (2015). The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions. Journal of Pain, 16, 558–568.CrossRefGoogle ScholarPubMed
Jacoby-Senghor, D. S., Sinclair, S., & Shelton, J. N. (2016). A lesson in bias: The relationship between implicit racial bias and performance in pedagogical contexts. Journal Of Experimental Social Psychology, 63, 50–55. https://doi.org/10.1016/j.jesp.2015.10.010CrossRefGoogle Scholar
Jones, J. H. (1993). Bad Blood. New York, NY: Simon & Schuster.Google Scholar
Kahneman, D. (2011). Thinking, Fast and Slow. New York, NY: Macmillan.Google Scholar
Kurdi, B., & Banaji, M. R. (2017). Reports of the death of the individual difference approach to implicit social cognition may be greatly exaggerated: A commentary on Payne, Vuletich, and Lundberg. Psychological Inquiry, 28(4), 281–287. https://doi.org/10.1080/1047840X.2017.1373555CrossRefGoogle Scholar
Kurdi, B., Seitchik, A. E., Axt, J. R., et al. (2019). Relationship between the Implicit Association Test and intergroup behavior: A meta-analysis. American Psychologist, 74, 569–586.CrossRefGoogle ScholarPubMed
Landovitz, R. J., Desmond, K. A., & Leibowitz, A. A. (2017). Antiretroviral therapy: Racial disparities among publicly insured Californians with HIV. Journal of Health Care for the Poor and Underserved, 28(1), 406–429.CrossRefGoogle ScholarPubMed
Lee, A. K., Corneille, M. A., Hall, N. M., et al. (2016). The stressors of being young and Black: Cardiovascular health and Black young adults. Psychology & Health, 31(5), 578–591. https://doi.org/10.1080/08870446.2015.1127373CrossRefGoogle Scholar
Lee, D. B., Peckins, M. K., Heinze, J. E., et al. (2017). Psychological pathways from racial discrimination to cortisol in African American males and females. Journal of Behavioral Medicine, 41, 208–220. https://doi.org/10.1007/s10865-017-9887-2CrossRefGoogle ScholarPubMed
Lee, Y., Muennig, P., Kawachi, I., et al. (2015). Effects of racial prejudice on the health of communities: A multilevel survival analysis. American. Journal of Public Health, 105(11), 2349–2355.CrossRefGoogle ScholarPubMed
Leitner, J. B., Hehman, E., Ayduk, O., et al. (2016a). Blacks’ death rate due to circulatory diseases is positively related to Whites’ explicit racial bias: A nationwide investigation using project implicit. Psychological Science, 27(10), 1299–1311. https://doi.org/10.1177/0956797616658450%2016aCrossRefGoogle Scholar
Leitner, J. B., Hehman, E., Ayduk, O., et al. (2016b). Racial bias is associated with ingroup death rate for Blacks and Whites: Insights from Project Implicit. Social Science & Medicine, 170, 220–227. https://doi.org/10.1016/j.socscimed.2016.10.007CrossRefGoogle Scholar
Lewis, T. T., Cogburn, C. D., & Williams, D. R. (2015). Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annual Review of Clinical Psychology, 11, 407–440.CrossRefGoogle ScholarPubMed
Lowe, C., Beach, M. C., & Roter, D. L. (2020). Individuation and implicit racial bias in genetic counseling communication. Patient Education and Counseling, 103(4), 804–810. www.sciencedirect.com/science/article/abs/pii/S0738399119304732CrossRefGoogle ScholarPubMed
Maina, I. W., Belton, T. D., Ginzberg, S., et al. (2017). A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Social Science and Medicine, 199, 218-229.Google ScholarPubMed
Mays, V. M., Cochran, S. D., & Barnes, N. W. (2007). Race, race-based discrimination, and health outcomes among African Americans. Annual Review of Psychology, 58, 201–225. https://doi.org/10.1146/annurev.psych.57.102904.190212CrossRefGoogle ScholarPubMed
Mays, V. M., Jones, A. L., Delany-Brumsey, A., et al. (2017). Perceived discrimination in health care and mental health/substance abuse treatment among Blacks, Latinos, and Whites. Medical Care 55, 173–181.CrossRefGoogle ScholarPubMed
Mendes, W. B., Gray, H. M., Mendoza-Denton, R., et al. (2007). Why egalitarianism might be good for your health. Psychological Science. 18(11), 991–998. https://doi.org/10.1111/j.1467-9280.2007.02014.xCrossRefGoogle Scholar
Michaels, E., K., Board, C., Mujahid, M. S., et al. (2022). Area-level prejudice and health: A systematic review. Health Psychology, 41(3), 211–224 www.ncbi.nlm.nih.gov/pmc/articles/PMC8930473/CrossRefGoogle ScholarPubMed
Miller, C. T., Varni, S. E., Solomon, S. E., et al. (2016). Macro-level implicit HIV prejudice and the health of community residents with HIV. Health Psychology, 35(8), 807–815. https://doi.org/10.1037/hea0000314CrossRefGoogle ScholarPubMed
Moses, K. A., Orom, H., Brasel, A., et al. (2017). Racial/ethnic disparity in treatment for prostate cancer: Does cancer severity matter? Urology, 99, 76–83. https://doi.org/10.1016/j.urology.2016.07.045CrossRefGoogle ScholarPubMed
Moskowitz, G. B., Stone, J., & Childs, A. (2012). Implicit stereotyping and medical decisions: Unconscious stereotype activation in practitioners’ thoughts about African Americans. American Journal of Public Health, 102, 996–1001.CrossRefGoogle ScholarPubMed
National Center for Health Statistics (2022). Health, United States, 2022: Hyattsville, MD. US, Department of Health and Human Services.Google Scholar
National Healthcare Quality and Disparities Report. (2018). Rockville, MD: Agency for Healthcare Research and Quality; October 2019. AHRQ Pub. No. 19-0001.Google Scholar
National Healthcare Quality and Disparities Report (2022). Rockville, MD: Agency for Healthcare Research and Quality October 2022, AHRQ Pub. No. 22(23)-0330.Google Scholar
Nosek, B. A. (2007). Implicit-explicit relations. Current Directions in Psychological Science, 16(2), 65–69.CrossRefGoogle Scholar
Oliver, M. N., Wells, K. M., Joy-Gaba, J. A., et al. (2014). Do physicians’ implicit views of African Americans affect clinical decision making? Journal of American Board of Family Medicine, 27, 177–188.CrossRefGoogle ScholarPubMed
Onyeador, I. N., Wittlin, N. M., Burke, S. E., et al. (2020). The value of interracial contact for reducing anti-Black bias among non-Black physicians: A CHANGE Study report. Psychological Science, 31(1), 18–30. https://doi.org/10.1177/0956797619879139CrossRefGoogle ScholarPubMed
Orchard, J., & Price, J. (2017). County-level racial prejudice and the Black–White gap in infant health outcomes. Social Science and Medicine, 181, 191–198. https://doi.org/10.1016/j.socscimed.2017.03.036CrossRefGoogle ScholarPubMed
Oswald, F. L., Mitchell, G., Blanton, H., et al. (2013). Predicting ethnic and racial discrimination: A meta-analysis of IAT criterion studies. Journal of Personality and Social Psychology, 105, 171–192. http://dx.doi.org/10.1037/pspa0000023CrossRefGoogle ScholarPubMed
Payne, B. K., Vuletich, H. A., & Lundberg, K. B. (2017). The bias of crowds: How implicit bias bridges personal and systemic prejudice, Psychological Inquiry, 28, 233–248. https://doi.org/10.1080/1047840X.2017.1335568CrossRefGoogle Scholar
Pearson, A. R., Dovidio, J. F., & Gaertner, S. L. (2009). The nature of contemporary prejudice: Insights from aversive racism. Social and Personality Psychology Compass, 3, 314–338.CrossRefGoogle Scholar
Pennebaker, J. W., Booth, R. J., & Francis, M. E. (2007). Linguistic Inquiry and Word Count (LIWC2007): A computer-based text analysis program [Computer software]. Austin, TX: LIWC.net.Google Scholar
Penner, L. A. (September, 2018b). Stigmatized patients with cancer: The impact of providers and patients’ attitudes on clinical interactions. Symposium, International Conference on Communication in Healthcare, Porto, Portugal.Google Scholar
Penner, L. A., Blair, I. V., Albrecht, T. L., et al. (2014). Reducing racial health care disparities: A social psychological analysis. Policy Insights from the Behavioral and Brain Sciences, 1(1), 204–212.CrossRefGoogle ScholarPubMed
Penner, L. A., & Dovidio, J. F. (2016). Colorblindness and Black–White health disparities. In Neville, H., Gallardo, M., & Sue, D. (Eds.), The Myth of Racial Colorblindness: Manifestation, Dynamics, and Impact Washington, DC: APA Press, pp. 275–294.CrossRefGoogle Scholar
Penner, L. A., & Dovidio, J. F. (May, 2018). The great divide: Laboratory versus healthcare research on implicit bias. Symposium: Annual Meeting of Association for Psychological Science. San Francisco, CA.Google Scholar
Penner, L. A., Dovidio, J. F., Albrecht, T. L., et al. (2019). Doing harm to some: Patient and provider attitudes and healthcare disparities. In Albarrracin, D. & Johnson, B. (Eds.), Handbook of Attitudes (2nd ed., Vol. 2, pp. 152–196). New York, NY: Routledge.Google Scholar
Penner, L. A., Dovidio, J. F., Gonzalez, R., et al. (2016a). The effects of oncologist implicit racial bias in racially discordant oncology interactions. Journal of Clinical Oncology, 34(24), 2874–2880.CrossRefGoogle ScholarPubMed
Penner, L. A., Dovidio, J. F., Hagiwara, N., et al. (2016b). An analysis of race-related attitudes and beliefs in black cancer patients: Implications for health care disparities. Journal of Healthcare for Poor and Underserved, 27, 1503–1520.CrossRefGoogle ScholarPubMed
Penner, L. A., Dovidio, J. F., West, T. W., et al. (2010). Aversive racism and medical interactions with Black patients: A field study. Journal of Experimental Social Psychology, 46, 436–440. https://doi.org/10.1016/j.jesp.2009.11.004CrossRefGoogle ScholarPubMed
Penner, L. A., Eggly, S., Griggs, J. J., et al. (2012). Life-threatening disparities: The treatment of Black and White cancer patients. Journal of Social Issues, 68(2), 328–357. https://doi.org/10.1111/j.1540-CrossRefGoogle ScholarPubMed
Penner, L. A., Gaertner, S., Dovidio, J. F., et al. (2013b). A social psychological approach to improving the outcomes of racially discordant medical interactions. Journal of General Internal Medicine, 28, 1143–1149. https://doi.org/10.1007/s11606-013-2339-yCrossRefGoogle ScholarPubMed
Penner, L. A., Hagiwara, N., Eggly, S., et al. (2013a). Racial healthcare disparities: A social psychological analysis. European Review of Social Psychology, 24(1), 77–122. https://doi.org/10.1080/10463283.2013.840973CrossRefGoogle ScholarPubMed
Penner, L. A., Harper, F. W. K., Dovidio, J. F., et al. (2017). The impact of Black cancer patients’ race-related beliefs and attitudes on racially-discordant oncology interactions: A field study. Social Science and Medicine, 191, 99–108.Google ScholarPubMed
Penner, L. A., Phelan, S. M., Earnshaw, V., et al. (2018). Patient stigma, medical interactions, and healthcare disparities: A selective review. In Major, B., Dovidio, J., & Link, B. (Eds.), Stigma, Discrimination, and Health. New York, NY: Oxford University Press, pp. 183–210.Google Scholar
Pew Research Center. (2015). Exploring Racial Bias Among Biracial and Single-Race Adults: The IAT. Retrieved from: www.pewsocialtrends.org/2015/08/19/exploring-racial-bias-among-biracial-and-single-race-adults-the-iatGoogle Scholar
Phelan, S. M., Burgess, D. J., Yeazel, M. W., et al. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Review, 16(4), 319–326. https://doi.org/10.1111/obr.12266CrossRefGoogle ScholarPubMed
Phelan, S. M., Dovidio, J. F., & van Ryn, M. (2013). Implicit and explicit weight bias in a national sample of 4,732 medical students: The medical student CHANGES study. Obesity Review, 22(4), 1201–1208.CrossRefGoogle Scholar
Phelan, S., Puhl, R, Burgess, D., et al. (2021). The role of weight bias and role-modeling in medical students’ patient-centered communication with higher weight standardized patients. Patient Education and Counseling, 104(8), 1962–1969. Available from: www.sciencedirect.com/science/article/abs/pii/S0738399121000033#!1CrossRefGoogle ScholarPubMed
Plant, E. A., & Devine, P. G. (1998). Internal and external motivation to respond without prejudice. Journal of Personality and Social Psychology, 75, 811–832.Google Scholar
Priest, N., & Williams, D. R. (2018). Racial discrimination and racial disparities in health. In Major, B., Dovidio, J., & Link, B. (Eds.), Stigma, Discrimination, and Health. New York, NY: Oxford University Press, pp. 163–183.Google Scholar
Prunas, A., Sacchi, S., & Brambilla, M. (2018). The insidious effects of sexual stereotypes in clinical practice. Journal of Sex Research, 55(4–5), 642–653. https://doi.org/10.1080/00224499.2017.1337866CrossRefGoogle ScholarPubMed
Puhl, R., Phelan, S. M., Nadglowski, J. et al. (2016). Overcoming weight bias in the management of patients with diabetes and obesity. Clinical Diabetes, 34, 44–50.CrossRefGoogle ScholarPubMed
Puumala, S. L., Burgess, K.M., Kharbanda, A. B., et al. (2016). The role of bias by emergency department providers in care for American Indian children. Medical Care, 54, 562–569.CrossRefGoogle ScholarPubMed
Rae, J. R., & Greenwald, A. G. (2017). Persons or situations? Individual differences explain variance in aggregated implicit race attitudes. Psychological Inquiry, 28(4), 297–300. https://doi.org/10.1080/1047840X.2017.1373548CrossRefGoogle Scholar
Richman, L., Pascoe, E., & Lattaner, M. (2018). Interpersonal discrimination and health. In Major, B., Dovidio, J., & Link, B. (Eds.), Stigma, Discrimination, and Health. New York, NY: Oxford University Press, pp. 203–218.Google Scholar
Rintamaki, L. S., Scott, A. M., Kosenko, K. A., et al. (2007). Male patient perceptions of HIV stigma in health care contexts. AIDS Patient Care and STDs, 21(12), 956–969.CrossRefGoogle ScholarPubMed
Rudman, L. A., & Ashmore, R. D. (2007). Discrimination and the Implicit Association Test. Group Processes & Intergroup Relations, 10(3), 359–372. https://doi.org/10.1177/1368430207078696CrossRefGoogle Scholar
Sabin, J. A., & Greenwald, A. G. (2012). The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: Pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. American Journal of Public Health, 102(5), 988–995. https://doi.org/10.2105/AJPH.2011.300621CrossRefGoogle ScholarPubMed
Sabin, J. A., Marini, M., & Nosek, B. A. (2012). Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS ONE, 7(11).CrossRefGoogle ScholarPubMed
Sabin, J. A., Riskind, R. G., & Nosek, B. A. (2016). Health care providers’ implicit and explicit attitudes toward lesbian women and gay men. Urological Nursing, 36(6)), 308.Google Scholar
Sabin, J. A., Rivara, F. P., & Greenwald, A. G. (2008). Physician implicit attitudes and stereotypes about race and quality of medical care. Medical Care, 46(7), 678–685.CrossRefGoogle ScholarPubMed
Saha, S., Freeman, M., Toure, J., et al. (2008). Racial and ethnic disparities in the VA health care system: A systematic review. Journal of General Internal Medicine, 23(5), 654–671.CrossRefGoogle ScholarPubMed
Schaa, K. L., Roter, D. L., Biesecker, B. B., et al. (2015). Genetic counselors’ implicit racial attitudes and their relationship to communication. Health Psychology, 34, 111–119.CrossRefGoogle ScholarPubMed
Schulman, K. A., Berlin, J., Harless, W., et al., (1999). The effect of race and sex on physicians’ recommendations for cardiac catheterization. New England Journal of Medicine, 340, 618–626.CrossRefGoogle ScholarPubMed
Shelton, J. N., & Richeson, J. A. (2015). Interacting across racial lines. In Mikulincer, M., Shaver, P. R., Dovidio, J. F., & Simpson, J. A. (Eds.), APA Handbook of Personality and Social Psychology, Vol. 2: Group Processes. Washington, DC: American Psychological Association, pp. 395–422.CrossRefGoogle Scholar
Shelton, J. N., Richeson, J. A., Salvatore, J., et al. (2005). Ironic effects of racial bias during interracial interactions. Psychological Science, 16(5), 397–402. https://doi.org/10.1111/j.0956-7976.2005.01547CrossRefGoogle ScholarPubMed
Shelton, J. N., West, T.V., & Trail, T.E. (2010). Concerns about appearing prejudiced: Implications for anxiety during daily interracial interactions. Group Processes & Intergroup Relations, 13(3), 329–344. https://doi.org/10.1177/1368430209344869CrossRefGoogle Scholar
Shen, M. J., Peterson, E. B., Costas-Muñiz, R., et al. (2018). The effects of race and racial concordance on patient–physician communication: A systematic review of the literature. Journal of Racial and Ethnic Health Disparities, 5, 117–140.CrossRefGoogle ScholarPubMed
Siminoff, L. A., Graham, G. C., & Gordon, N. H. (2006). Cancer communication patterns and the influence of patient characteristics: Disparities in information-giving and affective behaviors. Patient Education and Counseling, 62, 355–360.CrossRefGoogle ScholarPubMed
Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press.Google Scholar
Stepanikova, I. (2012). Racial-ethnic biases, time pressure, and medical decisions. Journal of Health and Social Behavior, 53(3), 329–343.CrossRefGoogle ScholarPubMed
Stepanikova, I., & Oates, G. R. (2017). Perceived discrimination and privilege in health care: The role of socioeconomic status and race. American Journal of Preventive Medicine. 2 (1S1), 84–86.Google Scholar
Stewart, M., Brown, J. B., Donner, A., et al. (2000). The impact of patient-centered care on patient outcomes. Journal of Family Practice, 49, 796–804.Google Scholar
Street, R. J., Gordon, H., & Haidet, P. (2007). Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor? Social Science & Medicine, 65(3), 586–598. https://doi.org/10.1016/j.socscimed.2007.03.036CrossRefGoogle ScholarPubMed
Sukhera, J., Wodzinski, M., Rehman, M., et al. (2019). The Implicit Association Test in health professions education: A meta-narrative review, Perspectives on Medical Education, 8, 267–275.CrossRefGoogle ScholarPubMed
Tehranifar, P., Neugut, A. I., Phelan, J. C., et al. (2009). Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiology Biomarkers & Prevention, 18(10), 2701–2708.CrossRefGoogle ScholarPubMed
Teige-Mocigemba, S., Klauer, K. C., & Sherman, J. W. (2010). A practical guide to Implicit Association Tests and related tasks. In Gawronski, B. & Payne, B. K. (Eds.), Handbook of Implicit Social Cognition: Measurement, Theory, and Applications. New York, NY: Guilford Press, pp. 117–139.Google Scholar
Thompson, H. S., Valdimarsdottir, H. B., Winkel, G., et al. (2004). The group-based medical mistrust scale: Psychometric properties and association with breast cancer screening. Preventive Medicine, 38(2), 209–218. https://doi.org/10.1016/j.ypmed.2003.09.041CrossRefGoogle ScholarPubMed
van Ryn, M., Burgess, D., Malat, J., et al. (2006). Physicians’ perceptions of patients’ social and behavioral characteristics and race disparities in treatment recommendations for men with coronary artery disease. American Journal of Public Health, 96(2), 351–357.CrossRefGoogle ScholarPubMed
van Ryn, M., Hardeman, R., Phelan, S. M., et al. (2015). Medical school experiences associated with change in implicit racial bias among 3547 students: A medical student CHANGES study report. Journal Of General Internal Medicine, 30(12), 1748–1756. https://doi.org/10.1007/s11606-015-3447-7CrossRefGoogle Scholar
Vorauer, J. D., Gagnon, A., & Sasaki, S. J. (2009). Salient intergroup ideology and intergroup interaction. Psychological Science, 20, 838–845.CrossRefGoogle ScholarPubMed
Vorauer, J. D., & Sasaki, S. J. (2009). Helpful only in the abstract? Ironic effects of empathy in intergroup interaction. Psychological Science, 20, 191–197.CrossRefGoogle Scholar
Vuletich, H. A., & Payne, B. K. (2019). Stability and change in implicit bias. Psychological Science, 30(6), 854–862. https://doi.org/10.1177/0956797619844270CrossRefGoogle ScholarPubMed
Wheeler, S. M., & Bryant, A. S. (2017). Racial and ethnic disparities in health and health care. Obstetrics and Gynecology Clinics of North America, 44(1), 1–11.CrossRefGoogle ScholarPubMed
Williams, D. R., Lawrence, J.A., & Davis, B. A. (2019). Racism and health: Evidence and needed research. Annual Review of Public Health, 40, 105–125. https://doi.org/10.1177/0956797619844270CrossRefGoogle ScholarPubMed
Williams, D. R., Neighbors, H. W., & Jackson, J. S. (2003). Racial/ethnic discrimination and health: Findings from community studies. American Journal of Public Health, 93(2), 200–208.CrossRefGoogle ScholarPubMed
Wilson, T. D., Aronson, E., & Carlsmith, K. (2010). The art of laboratory experimentation. In Fiske, S. T., Gilbert, D. T., & Lindzey, G. (Eds.), Handbook of Social Psychology . Hoboken, NJ: John Wiley & Sons Inc., pp. 51–81. http://dx.doi.org/10.1002/9780470561119.socpsy001002Google Scholar
Yang, T., & Chen, D. (2018). A multi-group path analysis of the relationship between perceived racial discrimination and self-rated stress: How does it vary across racial/ethnic groups? Ethnicity & Health, 23(3), 249–275. https://doi.org/10.1080/13557858.2016.1258042CrossRefGoogle ScholarPubMed
Zestcott, C. A., Blair, I. V., & Stone, J. (2016). Examining the presence, consequences, and reduction of implicit bias in health care: A narrative review. Group Processes and Intergroup Relations, 19, 528–542.https://doi.org/10.1177/1368430216642029CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×