Stigmas are profoundly negative stereotypes of a social group and its members that have diffused and normalized throughout a community. Being marked as a member of a stigmatized group does more than designate someone as different: stigmas denote people as discredited, devalued, and disgraced. Stigmas shape health and risk communication and are considered the leading—but least understood—barrier to health promotion. Communication and stigmas are dynamically connected. Communication is critical to a stigma’s existence, spread, expression, coping, and elimination. Using mediated and interpersonal communication, community members are socialized to recognize and react to stigmatized people. People use communication to enact the devaluation and ostracism of stigmatized people, and stigmatized people use communication to cope with stigmatization. Stigmas also shape communication: stigmas compel non-marked persons to engage in stigmatization and ostracism of marked persons, reduce marked people’s disclosure and encourage secrecy, and shape the characteristics of personal and community networks. Last, campaigns have used communication to attempt to eliminate existing stigmas. The accumulating research, conducted from diverse assumptions about human behavior (cultural determinism, evolutionary, socio-functional), shows how easily and effectively stigmas may be socialized; how challenging they are to manage; how many facets of health and wellbeing are devastated by their existence; and how difficult it is to attenuate them. While much has been uncovered about stigma, health, and risk, many questions remain. Among these include: How can one design messages that effectively alert the general public about imminent health threats and that successfully promote desirable behavioral changes without evoking stigma processes? How do different reactions to stigmatization influence targets and their social networks? What factors increase resistance or vulnerability to messages containing stigma-inducing content? How can one create an effective, reliable means to eliminate existing stigmas?
Rachel A. Smith, Xun Zhu, and Madisen Quesnell
Marla L. Moon
A visual impairment can affect cognitive, emotional, neurological, and physical development. Visual impairment impairs reading speed and comprehension, and is often mistaken for a learning disability. Learning is accomplished through complex and interrelated processes, one of which is vision. As a result, visual impairments limit the range of experiences and kinds of information to which one is exposed. A reliance on visual cues in health and risk messages intensifies these effects with regard to health information. The millions of children and adults who are affected by visual impairments worldwide thus require specific consideration regarding how best to make health information accessible for them. The reliance on caretakers to address the health information needs of those living with visual impairments violates their privacy and threatens their emotional well-being. Technological and modality advances that rely on touchscreens that lack tactile or auditory cues marginalize a broad segment of society that is in need of gateways to overcome barriers to accommodating visual impairment. In designing strategic health and risk messages, consideration should be given to this scope of possible limitation and its implications for access to and processing of health and risk information. Health and risk message designers should understand both the realities of challenges to accessing information for the visually impaired and strategies for addressing these realities and the scope of the issue worldwide and across the lifespan.
Self-disclosure, or revealing information about the self to others, plays an integral role in interpersonal experiences and relationships. It has captivated the interest of scholars of interpersonal communication for decades, to the extent that some have positioned self-disclosure as the elixir of social life. Sharing personal information is the means by which relationships are built and maintained, because effective disclosures contribute to greater intimacy, trust, and closeness in a relationship. Self-disclosure also confers personal benefits, including reduced stress and improved physical and psychological health. Furthermore, disclosing private thoughts and feelings is often a necessary precondition for reaping the benefits of other types of communication, such as supportive communication. Despite the apparent advantages for personal and relational well-being, self-disclosure is not a panacea. Revealing intimate information can be risky, awkward, and incite judgment from close others. People make concerted efforts to avoid self-disclosure when information has the potential to cause harm to themselves, others, and relationships. Research on self-disclosure has primarily focused on dyadic interactions; however, online technologies enable people to share personal information with a large audience and are challenging taken-for-granted understandings about the role of self-disclosure in relating. As social networking sites become indispensable tools for maintaining a large and robust personal network, people are adapting their self-disclosure practices to the features and affordances of these technologies. Taken together, this body of research helps illuminate what is at stake when communicating interpersonally.
Roxanne L. Parrott, Amber K. Worthington, Rachel A. Smith, and Amy E. Chadwick
The public, including lay members who have no personal or familial experience with genetic testing or diagnosis, as well as individuals who have had such experiences, face many intrinsic decisions relating to understanding genetics. With the sequencing of the human genome and genetic science discoveries relating genes to cancer, heart disease, and diabetes, the scope of such decisions broadened from prenatal genetic testing related to reproductive choices to genetic testing for contributors to common causes of morbidity and mortality. The decision about whether to seek genetic testing encompasses concerns about stigma and discrimination. These issues lead some who can afford the cost to seek screening through online direct-to-consumer sites rather than in clinical settings. Many who may benefit from genetic testing lack awareness of family health history that could guide physicians to recommend these diagnostic tests. Families may not discuss health history due to genetic illiteracy, with the public’s genetic illiteracy increasing their illness uncertainty and decreasing the likelihood that physicians will engage in conversations about personalized medicine with their patients. Physicians may nonetheless order genetic tests based on patients’ symptoms, during preoperative workups, or as part of opportunistic screening and assessment associated with a specific genetic workup. Family members who receive positive genetic test results may not disclose them to life partners, other family members, or insurance companies based on worries and anxiety related to their own identity, as well as a lack of understanding about their family members’ risk probability. For many, misguided beliefs that genes absolutely determine health and disease status arise from media translations of genetic science. These essentialist beliefs negatively relate to personal actions to limit genetic expression, including failure to seek medical care, while contributing to stereotypes and stigma communication. As medical science continues to reveal roles for genes in health across a broad spectrum, communicating about the relationships that genes have for health will be increasingly complex. Policy associated with registering, monitoring, and controlling the activities of those with genetic mutations may be coercive and target individuals unable to access health care or technology. Communicating about genes, health, and risk will thus challenge health communicators throughout the 21st century.
Spring Chenoa Cooper and P. Christopher Palmedo
Embarrassment, according to Fischer and Tangney, is an “aversive state of mortification, abashment, and chagrin that follows public social predicaments.” It is usually related to our perceptions of how others perceive us as well as their judgments of us, and it is associated with a loss of self-esteem when we perceive that others have judged us as inadequate or incompetent. However, even mere exposure or attention publicly placed on someone can elicit embarrassment (think of someone pointing at you and laughing). Embarrassment is considered a self-conscious emotion. Self-conscious emotions include those that are evoked by self-reflection and self-evaluation: embarrassment, shame, guilt, and pride. Shame, an intense form of embarrassment, also has structural and larger social contexts, while embarrassment is more individually experienced. Self-conscious emotions play an important role in regulating behavior; they assist us in behaving according to social standards and guide us in responding when those rules are broken. While these emotions provide feedback in social situations, they also provide feedback for anticipated outcomes. Embarrassment can play an important role in health, both in communication and behavior, and occurs through different forms. Primary embarrassment is the first rush of blood to the face and increased heart rate that usually lasts a few moments. Secondary embarrassment is the after-effect that shapes future behavior. Anticipatory embarrassment is the emotion surrounding the potential for embarrassment in an upcoming situation. Solitary embarrassment is the one that no one actually observes. Three stigmatized areas of health—mental health, healthcare, and sexual health—may be assessed as case studies through which to understand the literature around embarrassment, as both an affect and an emotion.
Rebecca Cline and Andrea Meluch
Health consequences and key communication processes that emerge during disasters vary by type of disaster. The types of disasters that researchers have most investigated are rapid-onset natural disasters and slowly-evolving human-caused disasters. Three types of communication processes occur in disasters that have implications for health. The first set of communication processes involves the social dynamics of affected communities. Communities that experience natural disasters tend to exhibit an emergent altruistic community; community members join together to support each other in the immediate aftermath of the disaster. In contrast, community conflict is the hallmark of slowly-evolving environmental disasters. That conflict triggers a cascade of social dynamics that infests close personal relationships with interpersonal conflict, stigmatization of victims and advocates, and pressures to avoid open communication (i.e., social constraints) regarding the disaster and its traumatic effects. These dynamics contribute to elevated mental health problems. The second set of communication processes focuses specifically on social support. Supportive communication processes and networks are important resources for coping with ongoing disasters and for mitigating their longer-term mental health effects. Due to differences in community-level social dynamics, patterns of social support evolve differently in natural versus human-caused disasters. Natural disasters are typified by immediate intra-community social support. Community members support each other in the immediate aftermath of the disaster. Ultimately this social support is overwhelmed by the disaster’s needs and deteriorates. As a result, communities are largely dependent on internal and external institutional sources to meet community members’ needs. In contrast, slowly-evolving human-caused disasters tend to exhibit the emergence of corrosive communities. In these communities, those most affected by the disasters (those whose health is harmed or who claim other harmful or potentially harmful effects, and those who function as advocates) tend to experience failed or diminished social support. Whereas the community may previously have been altruistic, mutual help either fails to emerge or is withdrawn in the disaster context. Failed social support contributes to the relatively worse mental health consequences of slowly-evolving human-caused disasters when compared to natural disasters. The third set of communication processes relate to institutional responses in disasters. In natural disasters, institutional communication is driven largely by widely disseminated and applied models that are intended to prevent harm and to provide resources to address harm and to reduce further negative consequences to health and well-being. Institutions and their agencies provide resources immediately following the disaster to meet basic human needs and, thereafter, to restore normalcy to the community and thereby protect community members’ physical and mental health. These efforts assume that natural disasters unfold in predictable stages (i.e., preparedness, warning, post-disaster, recovery) and that institutions’ responses should vary according to the stage of the disaster. In contrast, no such response models exist for slowly-evolving human-caused disasters. Moreover, community members experiencing such disasters often encounter what they perceive as institutional failures by both community-based and external responding institutions. Often community institutions (e.g., business, government) are perceived as causing the disaster and/or minimizing it, if not denying its existence or covering it up. As a result, communities experiencing this class of disasters tend to develop substantial distrust for local and responding institutions.
Karyn Ogata Jones and Lee Crandall
Intergroup communication adds to the general knowledge about disability by summarizing key areas in research and commentary. Intergroup communication is discussed in terms of how stigma affects identification, perception, and communication. Scholarship examining efforts to measure attitudes these groups have about each other, and the effects of inter-group communication on attitudes, beliefs, and behaviors, is reviewed. Scholarly commentary plays a role in the complicated relationship between identity and disability, and how this relationship impacts intergroup interactions, as well as present a summary of studies examining intergroup communication and disability in interpersonal, group, mediated, and professional settings. Illustrations from social media are provided to show how mediated inter-group communication can impact perceptions and knowledge. Studies are presented from an international perspective, allowing for culturally based comparisons.
Analisa Arroyo and Kristin Andersen
Weight-based stigma is pervasive and is propagated via sociocultural and interpersonal messages that influence individuals’ identity. The ideals communicated in these messages place disproportionate value on appearance and have made weight an important component of attractiveness. Some cultures, particularly Western culture, hold a bias toward thin bodies and promote a bias against those who do not fit cultural ideals of slender or lean body shapes. This bias, judgment, stigma, prejudice, and discrimination toward individuals based on their size, shape, or weight is known as weightism. Most of the research regarding weightism has been conducted on obesity and overweight individuals because of the related public health concerns. However, because weight is a continuum on which individuals are frequently evaluated, stigmatization is experienced by individuals who are either over or under cultural norms for appropriate weight and toward those who engage in deviant weight-control behaviors (e.g., purging). Thus, because individuals with eating disorders are often underweight and have deviant eating behaviors, they also experience weight-based stigma and discrimination. There are a multitude of negative effects associated with being a part of these stigmatized weight groups, including lower self-esteem, less social confidence, greater body dissatisfaction, poorer mental health, and increased substance use and self-harm behaviors. These negative outcomes create a social divide between the stigmatized weight groups and others, wherein stigmatized individuals turn to negative health behaviors (e.g., bingeing and purging) in an effort to cope with their negative social experiences. Subsequently, they perpetuate their affiliation with their stigmatized weight group and the related health conditions.