142nd APHA Annual Meeting and Exposition

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Public Fear, Sympathy, and Discrimination towards Persons with Alzheimer's Disease: The Forward-Looking Nature of Stigma and Implications for Anti-Stigma Interventions

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 10:54 AM - 11:06 AM

Rebecca Johnson, M.A. , Department of Bioethics, National Institutes of Health, Bethesda, MD
Kristin Harkins, B.A. , Perelman School of Medicine, Division of Geriatrics, University of Pennsylvania, Philadelphia, PA
Mark Cary, Ph.D. , Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Pamela Sankar, Ph.D. , Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
Jason Karlawish, M.D. , Perelman School of Medicine, Division of Geriatrics; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
Background:Understanding the stigma that Alzheimer’s disease (AD) invokes can help inform public health interventions aimed at mitigating stigmatizing reactions. The present study asked: Do people form stigmatizing reactions from the label “Alzheimer’s disease” itself or the condition’s observable impairments? How does the condition’s prognosis modify these reactions?

Methods: Data were collected through a web-based experiment with N= 789 adult members of the U.S. general population (median age = 49, interquartile range, 32-60, range = 18-90). Participants were randomized through a 3X3 design to read one of 9 vignettes depicting signs and symptoms of mild stage dementia that varied the disease label (“Alzheimer’s” vs. “traumatic brain injury” vs. no label) and prognosis (improve vs. static vs. worsen symptoms). Three types of stigma outcomes were assessed: stereotypes, emotions, and behaviors.

Results: Stigma surrounding cognitive impairment is largely caused by the prognosis of the impairment rather than the label “Alzheimer’s disease.” Depicting symptoms as likely to get worse results in higher levels of anticipated structural discrimination, F(2, 777) = 20.35, p < .001; higher pity, F(2, 778) = 6.15, p < .01; and greater social distance, F(2, 778) = 4.08, p < .05.

Conclusions: Models of AD-directed stigma and anti-stigma interventions should account not only for present symptoms but also concerns about future decline. As Alzheimer’s disease begins to include a “pre-clinical” stage based on biomarker assessment, and as demographic shifts lead to a rise in the condition’s prevalence, understanding the forward-looking nature of Alzheimer’s disease stigma is increasingly important.

Learning Areas:

Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Define a social-cognitive model of disease stigma as it relates to Alzheimer's disease Compare the role that the disease label given to cognitive impairment plays in increasing stigma versus the role that observable symptoms play in increasing stigma Describe the connection between models of Alzheimer's disease stigma and potential anti-stigma interventions Formulate ideas for how to incorporate attention to stigma in public health awareness campaigns for Alzheimer's disease and other diseases of aging

Keyword(s): Aging, Dementia

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator, co-investigator, or key personnel on multiple studies related to disease stigma. I was awarded the Firestone Medal for Excellence in Research from Stanford University for past work on the link between perceptions of a disease’s attributes and stigmatizing reactions. Among my scientific interests is theory-informed anti-stigma interventions, stigma that dementia and other diseases of aging provoke, and intersections between social psychology and public health disease awareness campaigns.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.