The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma.

OBJECTIVES: We examined the association between pediatricians' attitudes about race and treatment recommendations by patients' race. METHODS: We conducted an online survey of academic pediatricians (n = 86). We used 3 Implicit Association Tests to measure implicit attitudes and stereotypes about race. Dependent variables were recommendations for pain management, urinary tract infections, attention deficit hyperactivity disorder, and asthma, measured by case vignettes. We used correlational analysis to assess associations among measures and hierarchical multiple regression to measure the interactive effect of the attitude measures and patients' race on treatment recommendations. RESULTS: Pediatricians' implicit (unconscious) attitudes and stereotypes were associated with treatment recommendations. The association between unconscious bias and patient's race was statistically significant for prescribing a narcotic medication for pain following surgery. As pediatricians' implicit pro-White bias increased, prescribing narcotic medication decreased for African American patients but not for the White patients. Self-reported attitudes about race were associated with some treatment recommendations. CONCLUSIONS: Pediatricians' implicit attitudes about race affect pain management. There is a need to better understand the influence of physicians' unconscious beliefs about race on pain and other areas of care.

Using the Implicit Association Test to Assess Children's Implicit Attitudes toward Smoking.

The development and psychometric properties of an Implicit Association Test (IAT) measuring implicit attitude toward smoking among fifth grade children were described. The IAT with "sweets" as the contrast category resulted in higher correlations with explicit attitudes than did the IAT with "healthy foods" as the contrast category. Children with family members who smoked (versus non-smoking) and children who were high in sensation seeking (versus low) had a significantly more favorable implicit attitude toward smoking. Further, implicit attitudes became less favorable after engaging in tobacco prevention activities targeting risk perceptions of addiction. Results support the reliability and validity of this version of the IAT and illustrate its usefulness in assessing young children's implicit attitude toward smoking.