Drug Addiction Stigma in the Context of Methadone Maintenance Therapy: An Investigation into Understudied Sources of Stigma

Peer Victimization, Depressive Symptoms, and Substance Use: A Longitudinal Analysis

By Katie Tarantowicz

It is no secret that bullying experiences in youth can affect people’s lives. They may lead to poor mental health, emotionally scaring people who are targeted by bullying. We’ve all experienced a few bullying assemblies in grade school where they teach us to “treat others how you would want to be treated” and “step in when you see something wrong!” However, these assemblies often don’t touch on what will happen to targets of bullying if these messages are ignored and bullying continues. A small, but growing body of research is starting to examine the long-term consequences of being targeted by bullying. Dr. Earnshaw and her colleagues sought to examine associations between bullying, mental health, and substance use over time.

How did they conduct the research?

There were several key aspects of the study:

  • It was executed longitudinally, or over time.
  • It explored whether certain youth were more vulnerable to bullying.
  • It examined depressive symptoms as a mediator.
  • It tested several substance use outcomes, including alcohol, marijuana, and tobacco.

In other words

  • Longitudinal– This study included the same participants over several years. They worked with participants from 5th to 10th grade, and were able to measure the long-term of peer victimization. Previous studies that have been done on this topic often worked with participants at one point in time.
  • Vulnerable- The authors examined whether certain youth experience more frequent bullying, including boys, sexual minority youth, and youth with chronic illnesses.
  • Mediator– They focused not only on peer victimization’s associations with future substance use, but on the possibility of peer victimization being associated with depressive symptoms, which may then be associated with substance use. They interviewed people about their experiences of peer victimization in 5th grade, then followed up with them in 7th grade to discover signs of depressive symptoms, and finally interviewed them about their substance use in 10th grade. Depressive symptoms were examined as the middle point of this chain reaction.

Peer Victimization -> Depressive Symptoms -> Substance Use

  • Outcomes– Each participant reported whether they used alcohol, marijuana, and tobacco in the past 30 days.


They found that alcohol was the most used, marijuana was the second most used, and tobacco was the least used by youth in 10th grade. They also found that more frequent 5th grade peer victimization was associated with more 7th grade depressive symptoms. And, more 7th grade depressive symptoms were associated with greater likelihood of 10th grade alcohol, marijuana, and tobacco use. They also found that boys, youth with chronic illnesses, and sexual minorities all experienced more peer victimization in 5th grade. Overall, their findings suggest that youth may use substances to ease painful emotions resulting from bullying.

The big idea

Their findings suggest that youth who have been bullied in elementary school may experience distress by middle school and turn to substance use by high school, perhaps to cope with feelings of distress. Also, some youth are more vulnerable to bullying, including boys, youth with chronic illnesses, and sexual minority youth.

Limitations of this study and looking onward

There is the possibility that other variables that were not examined in the study may have an effect on these findings, such as traumatic stress, low academic achievement, and social and school-driven support. Additionally, the authors did not look at the possible substance use of the bullies themselves. Further research on this topic is needed to continue to understand other aspects of this topic.

Looking onward, Dr. Earnshaw and her colleagues recommend that teams of pediatricians, parents, and teachers come together to spread awareness about bullying and work on interventions to prevent the development of depressive symptoms and substance use disorders due to peer victimization.

You can also read about this study in: UDaily, Reuters, Mashable, Newsworks, DrugRehab.com, and other sites.

Reference: Earnshaw, V. A., Elliott, M. N., Reisner, S. L., Mrug, S., Windle, M., Tortolero Emery, S., Peskin, M. F., Schuster, M. A. (in press). Peer victimization, depressive symptoms, and substance use among youth: A longitudinal analysis. Pediatrics.


Weight and race-based bullying: Health associations among urban adolescents

Weight and race-based bullying: Health associations among urban adolescents

By Julie Bender

What did we already know?

Since our first day of preschool, teachers have been pounding the same saying into our brains. My elementary school even had these words written in huge letters in the cafeteria:

“Treat others the way you would like to be treated.”

We sat through countless assemblies lecturing us on the importance of being an ally instead of a bully and why we should always stick up for people if they are being victimized. Teachers endlessly reminded us of this because “you wouldn’t want to be sad so don’t make other people feel sad.” But what we didn’t really understand was that bullying has the power do much more than just make someone sad.

What else is there to know?

Drs. Lisa Rosenthal, Valerie Earnshaw, Jeannette Ickovics, and several other researchers from Yale University and New Haven Public Schools wanted to find out if kids who are bullied experience negative health effects. They used data from a longitudinal study, meaning that they recruited participants and collected data from the same participants at multiple time points. The study began in 2009 when they recruited 644 fifth and sixth graders from 12 public schools in New Haven, Connecticut. Students were asked to rate their emotional symptoms and their health in general. In addition to survey questions, physical measurements such as height, weight, and blood pressure were also taken. Two years later, when the students were in 7th and 8th grade, they completed the same procedure. This time, they also answered questions about bullying, including “How often have you been teased or bullied about your weight?” and “How often have you been teased or bullied about your race/ethnicity?”

What did they find?

The researchers used regression analyses to analyze their data. This is what they found:

  • Students who were bullied more frequently due to their weight or race also reported increases in negative emotional symptoms (such as unhappiness, depression, and nervousness) over the two years.
  • Students who were bullied more frequently due to their weight or race also reported worse physical health over time, including a higher BMI, higher blood pressure, and worse overall self-rated health.
  • Weight- and race-based bullying led to negative emotional symptoms, which in turn led to worse physical health.

Why does this matter?

This research shows us that bullying due to race and weight could have consequences for emotional and physical health. We’ve always known that bullying is bad, however, we didn’t know that there were such strong associations between bullying and worse physical health outcomes. This data shows us that we need to continue to study this phenomenon to see what else we can find about the effects of bullying. It also makes it clear that we need to step-up our game when it comes to bullying prevention in schools. We might be trying to prevent it, but we clearly aren’t doing a good enough job.

This study shows that bullying might be doing more than just making kids “upset” and professionals need to take action to prevent more students from experiencing both the negative emotional and physical health outcomes that are associated with being bullied.

Reference: Rosenthal, L., Earnshaw, V. A., Carroll-Scott, A., Henderson, K. E., Peters, S. M., McCaslin, C., Ickovics, J. R. (2015). Weight- and race-based bullying: Health associations among urban adolescents. Journal of Health Psychology, 20, 401-412. PMC3995896

Intended responses to rape as functions of attitudes, attributions of fault, and emotions


Intended responses to rape as functions of attitudes, attributions of fault, and emotions

-By Jacque Buck

We’ve all heard the stories – Brock Turner, Ben Roethlisberger, Bill Cosby. Sexual assault or rape cases covered and picked apart by the media that caused outrage throughout the nation. In response to publicized cases like these, it appears that more and more women are speaking out about these injustices (thank you feminism), including women in college. A generation of strong women with fire in their bellies, ambition to continue to pave the way for equality, and reject the misogynistic, garbage narrative is something that I can get behind. Our responses to rape matter, including both speaking out against rape and showing support for individual survivors of rape. But, we know that there’s a lot of variability in people’s responses. Some people speak out against rape and some people don’t; some people offer social support to survivors of rape and some people don’t. Can we get a more precise idea of why people respond to rape in different ways? How do their attitudes, attributions of fault, and emotions matter in these responses? To answer that question, I turned to Drs. Valerie Earnshaw, Eileen Pitpitan, and Stephenie Chaudoir’s article.

Wait – what do you mean by attitudes, attributions of fault, and emotions?

Attitudes are how a person thinks or feels about a particular subject and, in this study, are participants’ feelings about feminism and beliefs about rape. Feminism and rape myth acceptance likely impacted student responses to rape including likelihood of speaking out and/or taking action.

Attributions to fault are the people, norms, or other things that participants blame for rape and are likely related to how they responded to rape, as well. College students in the U.S. may blame society, the perpetrator, and/or the survivor.

Emotions are feelings that play a role in student responses to rape. The main emotions examined in the study were fear, anger and pity. Feeling fear is a common response to people’s increased awareness of rape culture, whereas feeling anger is a response to realizing someone’s personal freedom and privacy have been invaded. Pity is not felt for rape itself, but for the survivor of rape as his or her physical, psychological, and emotional well-being has been damaged for reasons out of their control.

Got it, so what happened in this study?

This study examined college students’ perceptions of and reactions to a description of a female student’s rape experience. All participants were pre-screened, read a scenario online about a female college student’s rape experience, and answered questions about their reactions, including their attitudes, attributions of fault, and emotions. 105 female and 74 male college students participated. Many of these types of studies are divided by gender, but this one included both males and females simultaneously because in the real world we aren’t awkwardly standing around on opposites sides of the gym like 6th graders at a school dance.

The Bottom Line

Women held more positive attitudes toward feminism and disagreed more with rape myth acceptance attitudes than men. Women also attributed more blame to society than men did, but women and men attributed similar amounts of fault to the survivor. Women experienced greater fear and anger than men after reading about the scenario, and women and men experienced similar amounts of pity. Women agreed more strongly than men that they would engage in anti-rape action, but women and men agreed that they would help survivors of rape to a similar extent.

Participants who had more positive attitudes toward feminism, disagreed with rape myth acceptance attitudes, attributed fault for rape to society, and felt fear after reading the scenario agreed more strongly that they would engage in anti-rape action. Participants who disagreed with rape myth acceptance attitudes, attributed fault for rape to the male perpetrator, and felt anger after reading the scenario agreed more strongly that they would help the survivor of rape. These associations were similar for women and men.

So interestingly, college students’ attitudes, attributions of fault, and emotions played different roles in predicting engagement in anti-rape action and responding to an individual survivor of rape. Attitudes, including attitudes towards feminism and rape myth acceptance attitudes, were more strongly associated with engagement in anti-rape action but were not associated with helping individual survivors. Attributions of fault to society were associated with breaking down society and rape culture itself, whereas attributions of fault to men were associated with likelihood of helping an individual survivor. As far as emotional reactions go, feelings of anger were related to reported likelihood of helping a survivor but fear was more consistent with intent to engage in anti-rape action. Pity ended up being unrelated to responses to rape in this study.

Any Limitations?

Yes, and these are good to keep in mind when thinking about how these results might matter in the real world. There were a few:

  1. The rape scenario that participants read is not the same as every rape case that’s ever occurred – they’re all different, ya feel? So, students could have responded in a different way if they were given a different situation to read.
  2. This study measures intended behavior and we don’t know if these participants would actually engage in anti-rape action or help a survivor.
  3. The sample of students used for this study were mainly white kids in New England and, it turns out, not everyone is white and from New England. The results may not generalizable to everyone, but may still be useful and a reason for further research.


The awesome thing about this study is that it’s about rape on college campuses and, as I hope you know, that’s a huge problem. If you haven’t watched The Hunting Ground, go watch it right now. Also, if we can get a stronger understanding of predictors of college students’ desire to help and take action, efforts to stop rape on campus in the long run have a higher likelihood of being improved. Just imagine not feeling weird about walking home alone one day. Crazy, right? Dream big. Peace out.

Reference: Earnshaw, V. A., Pitpitan, E. V., & Chaudoir, S. R. (2011). Intended responses to rape as functions of attitudes, attributions of fault, and emotions. Sex Roles, 64, 382-393.

The Impact of Stigma in Healthcare on People Living with Chronic Illnesses

By Carly Hill

Over half of adults in the United States live with a chronic illness like diabetes or asthma. If you’re one of the lucky few that doesn’t have a chronic illness, odds are you know someone who does. You probably also know that adults with chronic illnesses usually spend a lot of time visiting different doctors and health care facilities trying to manage their symptoms. But what you might not know is that these patients are sometimes stigmatized in healthcare settings. This can have a negative impact on their quality of life. If you felt like your doctor had negative feelings about your illness, how likely would you be to seek treatment? And if you don’t seek treatment, would that harm your quality of life? Well, Valerie Earnshaw and Diane Quinn wanted to study just that: Does stigma in healthcare settings impact people living with a chronic illness? They thought that if a person experiences more stigma, they would be less likely to access healthcare. And as a result, this would lead to worse quality of life.   If we can understand exactly how stigma affects people, we can work towards forming strategies to ensure that people with chronic illness access healthcare and have the best quality of life possible.

Unlike other studies on chronic illness stigma, Earnshaw and Quinn defined three distinct types of stigma and looked to identify which type of stigma had the worst impact on individuals. Internalized stigma occurs when people absorb or “internalize” negative attitudes about their stigmatized attribute. Experienced stigma is pretty self-explanatory: It’s just when someone perceives that they’ve been discriminated against in a healthcare setting. Internalized and experienced stigma could lead to anticipated stigma. That is, if someone has experienced stigma or internalizes stigma, they’ll probably expect this stigma in healthcare settings in the future as well. All three types of stigma may be related to each other and are all connected to care access and quality of life. Earnshaw and Quinn thought that the more someone internalizes stigma about their illness or experiences stigma, the more likely they’d be to think others will do the same in the future. As a result, they would anticipate that they will experience stigma in the future. They also thought that people who anticipate stigma would access less care, and then have a lower quality of life. So, all 3 types of stigma have an impact on care access and quality of life for the chronically ill community.

The Study

Earnshaw and Quinn recruited 184 participants through an online survey. The majority of these participants were white/European females who had either asthma, some type of inflammatory bowel disease (like Crohn’s or ulcerative colitis), diabetes, or some type of chronic pain disorder. The participants were then asked some questions about internalized, experienced, and anticipated stigma and whether they’d experienced any of these forms of stigma in healthcare settings.


Here’s the big picture: Earnshaw and Quinn were right. But just in case you actually DID want to see the numbers, look at the figure below. Just like they thought, the data showed that internalized stigma and experienced stigma were related; the more a person experienced stigma, the more they internalized stigma. Both internalized stigma and experienced stigma in healthcare settings lead to anticipation of stigma in healthcare settings. So, the more you experience stigma or internalize stigma, the more likely you are to think you’ll be stigmatized in the future. Internalizing stigma was found to be directly related to care access and quality of life. The more someone internalizes stigma, the less likely they are to access health care. And if you’re not accessing healthcare when you have a chronic illness, your quality of life is lower. The same went for those that anticipated stigma. People that anticipated stigma accessed less care. Interestingly, the data also suggested that the relationship between anticipated stigma and care access was stronger than the relationship between internalized stigma and care access. This means that people may be more influenced by the stigma they anticipate in the future rather than the stigma they internalize.

But, there were some limitations to keep in mind. First, this sample doesn’t represent the whole population of people living with chronic illnesses. Most participants were females and in their early 20s. The chronic illnesses they reported didn’t include some of the illnesses more prevalent among older adults such as heart disease and cancer. We need to look at more research to see if Earnshaw and Quinn’s findings are true for the rest of the population.

So why should we care?

Well, chronic illness is on the rise among Americans and over half of adults are currently coping with at least one. This research is really important to help understand what influence stigma has on the quality of life for this population. When these individuals seek out care and experience, anticipate, or internalize stigma about their illness, they may not be comfortable reaching out to get treatment. And without medical care, the symptoms of chronic illness may take a serious toll on their overall quality of life. If we can begin to eliminate stigma in the healthcare setting, we can ensure that living with a chronic illness doesn’t have to mean that someone will live an unsatisfactory life.

What do we do about it?

Earnshaw and Quinn think that early intervention can help to take away the internalized stigma these people deal with and that way, they won’t hesitate to access health care resources and improve their quality of life overall. Providing information and tools to make healthcare workers more aware of the negative impacts of stigma would also be a useful way to ensure that stigma won’t have such negative consequences for people with chronic illnesses. Earnshaw and Quinn think that by encouraging self-efficacy, patients will be more likely to keep up with their healthcare visits. Because the number of people diagnosed with a chronic illness increases everyday, a better understanding of how stigma impacts quality of life is necessary to ensure that the needs of this growing population are served.

Reference: Earnshaw, V. A., & Quinn, D. M. (2012). The impact of stigma in healthcare on people living with chronic illnesses. Journal of Health Psychology, 17, 157-168. PMC21799078

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