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Genetic Counselors’ and Genetic Counseling Students’ Implicit and Explicit Attitudes toward Homosexuality

  • Original Research
  • Published:
Journal of Genetic Counseling

Abstract

Members of the lesbian, gay, and bisexual (LGB) community experience significant health disparities. Widespread preferences for heterosexual over homosexual people among healthcare providers are believed to contribute to this inequity, making recognition (and ultimately reduction) of healthcare providers’ sexual prejudices of import. The present study sought to characterize North American genetic counselors’ and genetic counseling students’ implicit and explicit attitudes toward homosexuality. During January 2017, 575 participants completed a Web-based survey and Sexuality Implicit Association Test (SIAT). A majority of participants (60.2%) harbored implicit preferences for heterosexual over homosexual people. Mean implicit attitude score (0.24) indicated a slight automatic preference for heterosexual over homosexual people, while mean explicit attitude score (0.033) indicated no preference for either group. Although participants’ implicit and explicit attitudes were positively correlated (p < 0.001), there was greater implicit bias for heterosexual over homosexual people than suggested by explicit attitude scores (p < 0.001). Implicit attitudes differed across self-reported sexual orientation (p < 0.001), but not across gender, race, or genetic counseling specialty. Education has been demonstrated to be moderately effective at reducing sexual prejudices, and almost all participants (95.8%) indicated that they would support the implementation of genetic counseling curricula addressing lesbian, gay, bisexual, and transgender (LGBT) issues. The study’s combined findings suggest that North American genetic counselors and genetic counseling students support, and may benefit from, the implementation of genetic counseling curricula addressing LGBT issues.

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Notes

  1. Comparisons of the sample’s mean D score to the implicit attitude scores of additional groups previously reported in the literature were complicated by differences in methodologies, data reporting, and/or sample sizes (Burke et al. 2015; Cochran et al. 2007; Sabin et al. 2015).

References

  • Accreditation Council of Genetic Counseling (2015). Practice based competencies for genetic counselors. Retrieved from http://www.gceducation.org/Documents/ACGC%20Core%20Competencies%20Brochure_15_Web.pdf.

  • Bartoş, S. E., Berger, I., & Hegarty, P. (2014). Interventions to reduce sexual prejudice: A study-space analysis and meta-analytic review. The Journal of Sex Research, 51(4), 363–382.

    Article  PubMed  Google Scholar 

  • Berkman, C. S., & Zinberg, G. (1997). Homophobia and heterosexism in social workers. Social Work, 42(4), 319–332.

    Article  PubMed  CAS  Google Scholar 

  • Blair, I. V., Steiner, J. F., Fairclough, D. L., Hanratty, R., Price, D. W., Hirsh, H. K., et al. (2013). Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. The Annals of Family Medicine, 11(1), 43–52.

    Article  PubMed  Google Scholar 

  • Blair, I. V., Steiner, J. F., Hanratty, R., Price, D. W., Fairclough, D. L., Daugherty, S. L., 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brotman, S., Ryan, B., Jalbert, Y., & Rowe, B. (2002). The impact of coming out on health and health care access: The experiences of gay, lesbian, bisexual and two-spirit people. Journal of Health & Social Policy, 15(1), 1–29.

    Article  Google Scholar 

  • Brown, J. P., & Tracy, J. K. (2008). Lesbians and cancer: An overlooked health disparity. Cancer Causes & Control, 19(10), 1009–1020.

    Article  Google Scholar 

  • Burke, S. E., Dovidio, J. F., Przedworski, J. M., Hardeman, R. R., Perry, S. P., Phelan, S. M., et al. (2015). Do contact and empathy mitigate bias against gay and lesbian people among heterosexual medical students? A report from medical student CHANGES. Academic Medicine: Journal of the Association of American Medical Colleges, 90(5), 645–651.

    Article  Google Scholar 

  • Cameron, C. D., Brown-Iannuzzi, J. L., & Payne, B. K. (2012). Sequential priming measures of implicit social cognition: A meta-analysis of associations with behavior and explicit attitudes. Personality and Social Psychology Review, 16(4), 330–350.

    Article  PubMed  Google Scholar 

  • Cochran, B. N., Peavy, K. M., & Cauce, A. M. (2007). Substance abuse treatment providers' explicit and implicit attitudes regarding sexual minorities. Journal of Homosexuality, 53(3), 181–207.

    Article  PubMed  Google Scholar 

  • Cooper, L. A., Roter, D. L., Carson, K. A., Beach, M. C., Sabin, J. A., Greenwald, A. G., 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(5), 979–987.

    Article  PubMed  PubMed Central  Google Scholar 

  • Corrigan, P. W. (2005). Changing stigma through contact. Advances in Schizophrenia and Clinical Psychiatry, 1, 614–625.

    Google Scholar 

  • Dardick, L., & Grady, K. E. (1980). Openness between gay persons and health professionals. Annals of Internal Medicine, 93(1_Part_1), 115–119.

    Article  PubMed  CAS  Google Scholar 

  • Gates, G. J., & Newport, F. (2016). Special report: 3.4% of US adults identify as LGBT. Gallup. October 18, 2012.

  • Glessner, H. D., VandenLangenberg, E., Veach, P. M., & LeRoy, B. S. (2012). Are genetic counselors and GLBT patients “on the same page”? An investigation of attitudes, practices, and genetic counseling experiences. Journal of Genetic Counseling, 21(2), 326–336.

    Article  PubMed  Google Scholar 

  • Green, A. R., Carney, D. R., Pallin, D. J., Ngo, L. H., Raymond, K. L., Iezzoni, L. I., 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.

    Article  PubMed  PubMed Central  Google 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(2), 197–216.

    Article  PubMed  Google Scholar 

  • Greenwald, A. G., Poehlman, T. A., Uhlmann, E. L., & Banaji, M. R. (2009). Understanding and using the Implicit Association Test: III. Meta-analysis of predictive validity. Journal of Personality and Social Psychology, 97(1), 17–41.

    Article  PubMed  Google Scholar 

  • Haider, A. H., Schneider, E. B., Sriram, N., Dossick, D. S., Scott, V. K., Swoboda, S. M., et al. (2015). Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions. JAMA Surgery, 150(5), 457–464.

    Article  PubMed  Google Scholar 

  • Hayes, J. A., & Erkis, A. J. (2000). Therapist homophobia, client sexual orientation, and source of client HIV infection as predictors of therapist reactions to clients with HIV. Journal of Counseling Psychology, 47(1), 71–78.

    Article  Google Scholar 

  • Herek, G. M. (2000). The psychology of sexual prejudice. Current Directions in Psychological Science, 9(1), 19–22.

    Article  Google Scholar 

  • Institute of Medicine (US) (2011) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington (DC): National Academies Press (US). Available from: https://www.ncbi.nlm.nih.gov/books/NBK64806/, https://doi.org/10.17226/13128.

  • King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., et al. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8(1), 1.

    Article  Google Scholar 

  • Lee, J. G., Griffin, G. K., & Melvin, C. L. (2009). Tobacco use among sexual minorities, USA, 1987-2007 (May): A systematic review. Tobacco Control, tc-2008, 18, 275–282.

    Article  PubMed  CAS  Google Scholar 

  • Lim, F., & Levitt, N. (2011). Lesbian, gay, bisexual, and transgender health. AJN The American Journal of Nursing, 111(11), 11.

    Article  PubMed  Google Scholar 

  • Logie, C., Bridge, T. J., & Bridge, P. D. (2007). Evaluating the phobias, attitudes, and cultural competence of master of social work students toward the LGBT populations. Journal of Homosexuality, 53(4), 201–221.

    Article  PubMed  Google Scholar 

  • McCabe, S. E., Bostwick, W. B., Hughes, T. L., West, B. T., & Boyd, C. J. (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 100(10), 1946–1952.

    Article  PubMed  PubMed Central  Google Scholar 

  • Neville, S., & Henrickson, M. (2006). Perceptions of lesbian, gay and bisexual people of primary healthcare services. Journal of Advanced Nursing, 55(4), 407–415.

    Article  PubMed  Google Scholar 

  • Nosek, B. A., Greenwald, A. G., & Banaji, M. R. (2005). Understanding and using the Implicit Association Test: II. Method variables and construct validity. Personality and Social Psychology Bulletin, 31(2), 166–180.

    Article  PubMed  Google Scholar 

  • Nosek, B. A., Greenwald, A. G., & Banaji, M. R. (2007a). The Implicit Association Test at age 7: A methodological and conceptual review. Automatic processes in social thinking and behavior, 265–292.

  • Nosek, B. A., Smyth, F. L., Hansen, J. J., Devos, T., Lindner, N. M., Ranganath, K. A., et al. (2007b). Pervasiveness and correlates of implicit attitudes and stereotypes. European Review of Social Psychology, 18(1), 36–88.

    Article  Google Scholar 

  • NSGC (2016). 2016 Professional status survey. Retrieved: 3/9/17. https://www.nsgc.org/p/cm/ld/fid=68.

  • Penner, L. A., Dovidio, J. F., West, T. V., Gaertner, S. L., Albrecht, T. L., Dailey, R. K., et al. (2010). Aversive racism and medical interactions with Black patients: A field study. Journal of Experimental Social Psychology, 46(2), 436–440.

    Article  PubMed  PubMed Central  Google Scholar 

  • Peris, T. S., Teachman, B. A., & Nosek, B. A. (2008). Implicit and explicit stigma of mental illness: Links to clinical care. The Journal of Nervous and Mental Disease, 196(10), 752–760.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sabin, J. A., Nosek, B. A., Greenwald, A. G., & Rivara, F. P. (2009). Physicians’ implicit and explicit attitudes about race by MD race, ethnicity, and gender. Journal of Health Care for the Poor and Underserved, 20(3), 896–913.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sabin, J. A., Riskind, R. G., & Nosek, B. A. (2015). Health care providers’ implicit and explicit attitudes toward lesbian women and gay men. American Journal of Public Health, 105(9), 1831–1841.

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith, G. B. (1993). Homophobia and attitudes toward gay men and lesbians by psychiatric nurses. Archives of Psychiatric Nursing, 7(6), 377–384.

    Article  PubMed  CAS  Google Scholar 

  • Sukhera, J., Milne, A., Teunissen, P. W., Lingard, L., & Watling, C. (2018). The actual versus idealized self: Exploring responses to feedback about implicit bias in health professionals. Academic Medicine, 93(4), 623–629.

    Article  PubMed  Google Scholar 

  • Téllez, C., Ramos, M., Umland, B., Palley, T., & Skipper, B. (1999). Attitudes of physicians in New Mexico toward gay men and lesbians. Journal of the Gay and Lesbian Medical Association, 3(3), 83–89.

    Article  Google Scholar 

  • VandenLangenberg, E., Veach, P. M., LeRoy, B. S., & Glessner, H. D. (2012). Gay, lesbian, and bisexual patients’ recommendations for genetic counselors: A qualitative investigation. Journal of Genetic Counseling, 21(5), 741–747.

    Article  PubMed  Google Scholar 

  • Wolitski, R. J., & Fenton, K. A. (2011). Sexual health, HIV, and sexually transmitted infections among gay, bisexual, and other men who have sex with men in the United States. AIDS and Behavior, 15(1), 9–17.

    Article  Google Scholar 

  • Yancey, A. K., Cochran, S. D., Corliss, H. L., & Mays, V. M. (2003). Correlates of overweight and obesity among lesbian and bisexual women. Preventive Medicine, 36(6), 676–683.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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 & Intergroup Relations, 19(4), 528–542.

    Article  Google Scholar 

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Acknowledgements

This study was conducted to fulfill a degree requirement for the Stanford University Master’s Program in Human Genetics and Genetic Counseling.

Funding

Funding for this study was provided by the Stanford University (as part of the first author’s degree requirements) and the NSGC Membership Committee. M.L.N. received financial support from Invitae laboratory to attend the 2017 NSGC Annual Education Conference (AEC) to present the study results.

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Authors and Affiliations

  1. Cancer Center Genetics Department, Providence St. Joseph Health, Anchorage, AK, USA

    Megan L. Nathan

  2. Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA

    Megan L. Nathan & Kelly E. Ormond

  3. Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA

    Kelly E. Ormond

  4. Department of Psychology, Harvard University, Cambridge, MA, USA

    Christopher M. Dial

  5. Division of Medical Genetics, Northwell Health, Great Neck, NY, USA

    Amber Gamma

  6. Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Mitchell R. Lunn

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  1. Megan L. Nathan
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  5. Mitchell R. Lunn
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Contributions

The study was conceived by M.L.N. with assistance from K.E.O., M.R.L., and A.G.. Measures were developed by M.L.N., M.R.L., and C.M.D.. Analysis was performed by M.L.N. and C.M.D.. M.L.N. wrote the primary drafts of the manuscript and all authors provided critical review and revisions. K.E.O. provided oversight of all aspects of the research study. All authors provided final approval of the version to be published and certify that they have participated in the study sufficiently to take public responsibility for its content.

Corresponding author

Correspondence to Kelly E. Ormond.

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Conflict of Interest

K.E.O., C.M.D., A.G., and M.R.L. declare that they have no conflicts of interest.

Informed Consent

Informed consent was obtained from all participants for being included in the study.

Human Studies and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Animal Studies

No animal studies were carried out by the authors for this article.

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Nathan, M.L., Ormond, K.E., Dial, C.M. et al. Genetic Counselors’ and Genetic Counseling Students’ Implicit and Explicit Attitudes toward Homosexuality. J Genet Counsel (2018). https://doi.org/10.1007/s10897-018-0295-8

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  • DOI: https://doi.org/10.1007/s10897-018-0295-8

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