What Do Teenagers and Young Adults Think and Feel About Their Peers with Cancer? A Quantitative and Qualitative Analysis of Explicit and Implicit Prejudices

Keywords: cancer, teenager/young adult, stigma, explicit/implicit stereotype and prejudice

Abstract

The social stigma of cancer is a powerful source of stereotyping and prejudice against people affected by oncological disorders. Two cross-sectional studies attempted to (1) provide a formal and content characteristic of the stereotype of teenage cancer patient and (2) analyze explicit and implicit prejudice against them. In the first study, 2,370 middle school students proposed open-ended descriptions and quantified 50 attributes representing physical appearance, cognitive, task-oriented, social, and emotional functioning of the teenage cancer patient. In the second study, 207 undergraduate students of education completed the Implicit Association Test, which contrasted the teenage cancer patient with a teenager as a reference category. Content analysis of 11,191 open-ended descriptions and exploratory factor analysis of 50 attributes showed that teenage cancer patients were characterized in the emotional, social, and physical appearance domain. The IAT revealed that teenagers with cancer automatically induced moderate negative prejudice not linked with similarly negative explicit prejudice. Negative explicit and implicit prejudice suggests that teenagers with cancer may be omitted or disfavored by classmates and teachers, therefore they require special treatment in school and out-of-school environments. The findings and their practical implications were discussed in light of theories of stigmatization, stereotyping, and prejudice against cancer patients.

References

Armstrong, F. D., & Reaman, G. H. (2005). Psychological research in childhood cancer: The children’s oncology group perspective. Journal of Pediatric Psychology, 30(1), 89–97. https://doi.org/10.1093/jpepsy/jsi020

Beggan, J. K. (1992). On the social nature of nonsocial perception: The mere ownership effect. Journal of Personality and Social Psychology, 62(2), 229–237. https://doi.org/10.1037/0022-3514.62.2.229

Berrenberg, J. L, Finlay, K. A., Stephan, W. G., & Stephan, C. (2007). Prejudice toward people with cancer or AIDS: Applying the integrated threat model. Journal of Applied Biobehavioral Research, 7(2), 75–86. https://doi.org/10.1111/j.1751-9861.2002.tb00078.x

Bosson, J. K., Swann, W. B., & Pennebaker, J. W. (2000). Stalking the perfect measure of implicit self-esteem: The blind men and the elephant revisited? Journal of Personality and Social Psychology, 79(4), 631–643. https://doi.org/10.1037/0022-3514.79.4.631

Chambers, S. K., Dunn, J., Occhipinti, S., Hughes, S., Baade, P., Sinclair, S., Aitken, J., Youl, P., & O’Connell, D. L. (2012). A systematic review of the impact of stigma and nihilism on lung cancer outcomes. BMC Cancer, 12, 184. https://doi.org/10.1186/1471-2407-12-184

Christov-Moore, L., Simpson, E. A., Coudé, G., Grigaityte, K., Iacoboni, M., & Ferrari, P. F. (2014). Empathy: Gender effects in brain and behavior. Neuroscience & Biobehavioral Reviews, 46(Pt 4), 604–627. https://doi.org/10.1016/j.neubiorev.2014.09.001

Cunningham, W. A., Preacher, K. J., & Banaji, M. R. (2001). Implicit attitude measure: Consistency, stability, and convergent validity. Psychological Science, 12(2), 163–170. https://doi.org/10.1111/1467-9280.00328

Daher, M. (2012). Cultural beliefs and values in cancer patients. Annals of Oncology, 23(3), 66–69. https://doi.org/10.1093/annonc/mds091

de Boer, H., Timmermans, A. C., & van der Werf, M. P. C. (2018). The effects of teacher expectation interventions on teachers’ expectations and student achievement: Narrative review and meta-analysis. Educational Research and Evaluation, 24(3–5), 180–200. https://doi.org/10.1080/13803611.2018.1550834

Devine, P. G., & Sharp, L. B. (2009). Automaticity and control in stereotyping and prejudice. In T. D. Nelson (Ed.), Handbook of prejudice, stereotyping, and discrimination (pp. 61–87). Psychology Press.

Donnan, B. M., & Webster, T. (2015). What about school? Education challenges for children and adolescents with cancer. Educational and Developmental Psychologist, 32(1), 23–40. https://doi.org/10.1017/edp.2015.9

Donovan, T. (2001). The stigma of terminal cancer. In C. Carlisle, T. Mason, C. Watkins, & E. Whitehead (Eds.), Stigma and social exclusion in healthcare (pp. 246–254). Routledge.

Dovidio, J. F., Brigham, J.C., Johnson, B.T., & Gaertner, S. L. (1996). Stereotyping, prejudice and discrimination: Another look. In C. N. Macrae, C. Stangor, & M. Hewstone (Eds.), Stereotypes and stereotyping (pp. 276–319). Guilford Press.

Drury, A. M., Lehmkuhl, H. D., Nabors, L. A., & Jiang, D. (2005). Adults’ attitudes toward children with cancer. Journal of Psychosocial Oncology, 23(1), 41–54. https://doi.org/10.1300/J077v23n01_03

Dunn, D. S. (2015). The psychology of disability. Oxford University Press.

Dusek, J. B., Flaherty, J. F., & Hill, J. P. (1981). The development of the self-concept during the adolescent years. Monographs of Society for Research in Child Development, 46(4), 1–67. https://doi.org/10.2307/1166004

Esses, V. M., Haddock, G., & Zanna, M. P. (1993). Values, stereotypes, and emotions as determinants of intergroup attitude. In D. M. Mackie & D. L. Hamilton (Eds.), Affect, cognition, and stereotyping: Interactive processes in group perception (pp. 137–166). Academic Press.

Fiske, S. T. (2018). Stereotype content: Warmth and competence endure. Current Directions in Psychological Science, 27(2), 67–73. https://doi.org/10.1177/0963721417738825

Fujisawa, D., & Hagiwara, N. (2015). Cancer stigma and its health consequences. Current Breast Cancer Reports, 7, 143–150. https://doi.org/10.1007/s12609-015-0185-0

Gravetter, F. J., & Forzano, L. (2016). Research methods for the behavioral sciences. Cengage Learning.

Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74(6), 1464–1480. https://doi.org/10.1037/0022-3514.74.6.1464

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. https://doi.org/10.1037/0022-3514.85.2.197

Gross, E. F., & Hardin, C. D. (2007). Implicit and explicit stereotyping of adolescents. Social Justice Research, 20(2), 140–160. https://doi.org/10.1007/s11211-007-0037-9

Hofmann, W., Gawronski, B., Gschwendner, T., Le, H., & Schmitt, M. (2005). A meta-analysis on the correlation between the Implicit Association Test and explicit self-report measures. Personality and Social Psychology Bulletin, 31(10), 1369-1385. https://doi.org/10.1177/0146167205275613

Holmbeck, G. N., & Hill, J. P. (1988). Storm and stress beliefs about adolescence: Prevalence, self-reported antecedents, and effects of an undergraduate course. Journal of Youth and Adolescence, 17(4), 285–306. https://doi.org/10.1007/BF01537671

Johnson, C. G. B., Brodsky, J. L., & Cataldo, J. K. (2014). Lung cancer stigma, anxiety, depression, and quality of life. Journal of Psychosocial Oncology, 32(1), 59–73. https://doi.org/10.1080/07347332.2013.855963

Kreitler, S. (2019). Psycho-oncology for the clinician. The patient behind the disease. Springer.

Kolańczyk, A., Fila-Jankowska, A., Pawłowska-Fusiara, M., & Sterczyński, R. (2004). Serce w rozumie: afektywne podstawy orientacji w otoczeniu [The heart in the mind: The affective basis of orientation in the environment]. Gdańskie Wydawnictwo Psychologiczne.

Kolańczyk, A., & Wojciszke, B. (2010). Motywacje umysłu [Motivations of the mind]. Wydawnictwo Smak Słowa.

Kopera, M., Suszek, H., Bonar E., Myszka, M., Gmaj, B., Ilgen, M., & Wojnar, M. (2015). Evaluating explicit and implicit stigma of mental illness in mental health professionals and medical students. Community Ment Health Journal, 51(5), 628–34. https://doi: 10.1007/s10597-014-9796-6

Kurtek, P. (2016). Schematy i atrybucje osób znaczących w regulacji aktywności zaradczej młodzieży z lekką niepełnosprawnością intelektualną w społecznych sytuacjach trudnych: wybrane koszty pro- i antyspołecznego radzenia sobie [Schemas and attributions of the significant persons in the regulation of remedial activity of adolescents with mild intellectual disabilities in socially difficult situations: selected costs of pro- and anti-social coping]. Wydawnictwo Akademickie “Żak”.

Liang, J., Wolsiefer, K., Zestcott, C. A., Chase, D., & Stone, J. (2019). Implicit bias toward cervical cancer: Provider and training differences. Gynecologic Oncology, 153(1), 80–86. https://doi.org/10.1016/j.ygyno.2019.01.013

Maitner, A. T., Smith, E. R., & Mackie, D. M. (2016). Intergroup emotions theory: Prejudice and differentiated emotional reactions toward outgroups. In C. G. Sibley & F. K. Barlow (Eds.), The Cambridge handbook of the psychology of prejudice (pp. 111–130). Cambridge University Press.

Marlow, L. A., Waller, J., & Wardle, J. (2015). Does lung cancer attract greater stigma than other cancer types? Lung Cancer, 88(1), 104–107. https://doi.org/10.1016/j.lungcan.2015.01.024

Martinez, L. R., White, C. D., Shapiro, J. R., & Hebl, M. R. (2016). Selection BIAS: Stereotypes and discrimination related to having a history of cancer. Journal of Applied Psychology, 101(1), 122–128. https://doi.org/10.1037/apl0000036

Nosek, B. A., & Smyth, F. L. (2007). A multitrait-multimethod validation of the implicit association test. Experimental Psychology, 54(1), 14–29.

Romer, D., Reyna, V. F., & Satterthwaite, T. D. (2017). Beyond stereotypes of adolescent risk taking: Placing the adolescent brain in developmental context. Developmental Cognitive Neuroscience, 27, 19–34. https://doi.org/10.1016/j.dcn.2017.07.007

Rosenthal, R. (1991). Meta-analytic procedures for social research. Sage Publications.

Santrock, J. (2013). Adolescence. McGraw-Hill Education.

Schiller, J. H., Bowden, C. J., Mills, J., Lang, E., Dickson, H., Hamann, H. A., & Sriram, N. (2013). Explicit and implicit associations toward lung cancer (LC) relative to breast cancer (BC). Journal of Clinical Oncology, 31(15), S1321. https://doi.org/10.1200/jco.2013.31.15_suppl.8017

Simon, A. E., Wardle, J., & Miles, A. (2011). Is it time to change the stereotype of cancer: The expert view. Cancer Causes Control, 22(1),135–140. https://doi.org/10.1007/s10552-010-9683-6

Sriram, N., Mills, J., Lang, E., Dickson, H. K., Hamann, H.A., Nosek, B. A., & Schiller, J. H. (2015). Attitudes and stereotypes in lung cancer versus breast cancer. PLoS ONE, 10(12), e0145715. https://doi.org/10.1371/journal.pone.0145715

Steliarova-Foucher, E., Fidler, M. M., Colombet, M., Lacour, B., Kaatsch, P., Piňeros, M., & Persi-Bonet, R. (2018). Changing geographical patterns and trends in cancer incidence in children and adolescents in Europe, 1991-2010. Lancet Oncology, 19(9), 1159–1169. https://doi.org/10.1016/S1470-2045(18)30423-6

Stern, M., & Arenson, E. (1989). Childhood cancer stereotype: Impact on adult perception of children. Journal of Pediatric Psychology, 14(4), 593–605. https://doi.org/10.1093/jpepsy/14.4.593

Stewart, B. W., & Wild, C. P. (2014). World cancer report. International Agency for Research on Cancer.

Threader, J., & McCormack, L. (2016). Cancer-related trauma, stigma and growth: The ‘lived’ experience of head and neck cancer. European Journal of Cancer Care, 25(1), 157–169. https://doi.org/10.1111/ecc.12320

Wakefield, C. E., McLoone, J., Goodenough, B., Lenthen, K., Cairns, D. R., & Cohn, R. J. (2010). The psychosocial impact of completing childhood cancer treatment: A systematic review of literature. Journal of Pediatric Psychology, 35(3), 262–274. https://doi.org/10.1093/jpepsy/jsp056

Whitley, B. E., & Kite, M. E. (2010). The psychology of prejudice and discrimination. Wadsworth.

Wiener, L. S., Hersh, S. P., & Alderfer, M. A. (2016). Psychiatric and psychosocial support for the child and family. In Ph. A. Pizzo, & D. G. Poplack (Eds.), Principles and practice of pediatric oncology (pp. 1322–1346). Wolters Kluwer.

Wiens, B. A., & Gilbert, B. O. (2000). A reexamination of a childhood cancer stereotype. Journal of Pediatric Psychology, 25(3), 151–159. https://doi.org/10.1093/jpepsy/25.3.151

Wojciszke, B. (1986). Teoria schematów społecznych: struktura i funkcjonowanie jednostkowej wiedzy o otoczeniu społecznym [Social schema theory: The structure and functioning of individual knowledge in the social environment]. Zakład Narodowy im. Ossolińskich.

Wojciszke, B. (1991). Proces oceniania ludzi [The process of evaluating people]. Wydawnictwo Nakom.

Zajonc, R. B. (1980). Feeling and thinking: Preferences need no inferences. American Psychologist, 35(2), 151–175. https://doi.org/10.1037/0003-066X.35.2.151

Published
2021-11-26
Section
Articles