Stigmatization in the context of the COVID-19 pandemic: a survey experiment using attribution theory and the familiarity hypothesis.

BACKGROUND: The COVID-19 pandemic has created a global health crisis, leading to stigmatization and discriminatory behaviors against people who have contracted or are suspected of having contracted the virus. Yet the causes of stigmatization in the context of COVID-19 remain only partially understood. Using attribution theory, we examine to what extent attributes of a fictitious person affect the formation of stigmatizing attitudes towards this person, and whether suspected COVID-19 infection (vs. flu) intensifies such attitudes. We also use the familiarity hypothesis to explore whether familiarity with COVID-19 reduces stigma and whether it moderates the effect of a COVID-19 infection on stigmatization. METHODS: We conducted a multifactorial vignette survey experiment (28-design, i.e., NVignettes = 256) in Germany (NRespondents = 4,059) in which we experimentally varied signals and signaling events (i.e., information that may trigger stigma) concerning a fictitious person in the context of COVID-19. We assessed respondents' cognitive (e.g., blameworthiness) and affective (e.g., anger) responses as well as their discriminatory inclinations (e.g., avoidance) towards the character. Furthermore, we measured different indicators of respondents' familiarity with COVID-19. RESULTS: Results revealed higher levels of stigma towards people who were diagnosed with COVID-19 versus a regular flu. In addition, stigma was higher towards those who were considered responsible for their infection due to irresponsible behavior. Knowing someone who died from a COVID infection increased stigma. While higher self-reported knowledge about COVID-19 was associated with more stigma, higher factual knowledge was associated with less. CONCLUSION: Attribution theory and to a lesser extent the familiarity hypothesis can help better understand stigma in the context of COVID-19. This study provides insights about who is at risk of stigmatization and stigmatizing others in this context. It thereby allows identifying the groups that require more support in accessing healthcare services and suggests that basic, factually oriented public health interventions would be promising for reducing stigma.

Free Will and the Brain Disease Model of Addiction: The Not So Seductive Allure of Neuroscience and Its Modest Impact on the Attribution of Free Will to People with an Addiction.

Free will has been the object of debate in the context of addiction given that addiction could compromise an individual's ability to choose freely between alternative courses of action. Proponents of the brain-disease model of addiction have argued that a neuroscience perspective on addiction reduces the attribution of free will because it relocates the cause of the disorder to the brain rather than to the person, thereby diminishing the blame attributed to the person with an addiction. Others have worried that such displacement of free will attribution would make the person with a drug addiction less responsible. Using the paradigmatic literature on the seductive allure of neuroscience explanations, we tested whether neuroscience information diminishes attributions of free will in the context of addiction and whether respondent characteristics influence these attributions and modulate the effect of neuroscience information. We performed a large-scale, web-based experiment with 2,378 German participants to explore how attributions of free will in the context of addiction to either alcohol or cocaine are affected by: (1) a text with a neurobiological explanation of addiction, (2) a neuroimage showing effects of addiction on the brain, and (3) a combination of a text and a neuroimage, in comparison to a control group that received no information. Belief in free will was measured using the FAD-Plus scale and was, subsequent to factor analysis, separated into two factors: responsibility and volition. The investigated respondent characteristics included gender, age, education, self-reported knowledge of neuroscience, substance-use disorder (SUD), and having a friend with SUD. We found that attributions of volition (in the cocaine-subsample) were reduced in the text and neuroimage-treatment compared to the control group. However, respondent characteristics such as education and self-reported knowledge of neuroscience were associated with lower attributions of responsibility for both substances, and education was associated with lower attribution of volition for the alcohol sub-sample. Interaction analyses showed that knowledge of neuroscience was found to generally decrease attribution of responsibility. Further research on attribution of free will should consider the effects of context and respondent characteristics, which appeared surprisingly larger than those induced by experimental treatments.

Public Stigma Toward People With Drug Addiction: A Factorial Survey.

OBJECTIVE: Stigmatizing attitudes toward people with a drug addiction have detrimental effects on the lives of these people. However, the factors that influence stigma toward people with a drug addiction have not yet been thoroughly investigated, compared with the stigma of other mental illnesses. Based on attribution theory, our experiment examined to what extent individual and contextual characteristics of people with a drug addiction influence stigmatizing attitudes toward people with a drug addiction. Moreover, we explored whether respondent characteristics indicative of familiarity with addiction decrease stigma toward people with a drug addiction. METHOD: We conducted a full factorial survey of 2,857 respondents from a German online access panel who were from all walks of life. We experimentally varied vignettes (29-design) that featured a fictional person with an addiction. Stigmatizing beliefs, such as blame or fear, were assessed using the Attribution Questionnaire (AQ-9). RESULTS: Different attributes of people with a drug addiction and of the characteristics of their addiction modulated stigma in ways that are mostly consistent with attribution theory and related research. For example, female gender and younger age of people with a drug addiction diminished several stigmatizing attitudes; greater duration of addiction and social influence to use drugs increased them. Furthermore, characteristics of respondents modulated stigma: women, younger respondents, and those with higher education expressed less-stigmatizing responses than others. CONCLUSIONS: The stigmatization of people with a drug addiction is influenced by several factors, including characteristics of the stigmatized person, the addiction, and the person holding stigmatizing attitudes. A better understanding of the underlying mechanisms of these effects is needed to develop evidence-based antistigma measures.