Does Implicit Racial Bias Affect Auditory-Perceptual Evaluations of Dysphonic Voices?

Implicit racial bias has been well studied in adults, including among orthopaedic surgeons, through the Implicit Association Test (IAT). Recent studies suggest implicit race bias is also present among children. Explicit racial preference has been studied in children through The Clark Doll Test since the 1930s. The purpose of this study was to determine whether implicit and explicit racial biases are present among pediatric orthopaedic patients. A prospective, cross-sectional survey was administered to pediatric orthopaedic patients aged 7 to 18 years at clinics in a tertiary pediatric hospital setting. The survey included a Clark Doll Test to determine whether pediatric patients expressed explicit bias, followed by a race IAT to determine whether pediatric patients expressed implicit bias. Preference and magnitude of implicit bias as demonstrated on the IAT was calculated using standard D-scores. A total of 96 patients were consented and included in this study. Overall, pediatric patients demonstrated a slight pro-White implicit bias (M = 0.22) on IAT testing. Pediatric patients who identified as White or European American and Hispanic or Latinx both had the strongest pro-White implicit bias (M = 0.35). Patients who identified as Black or African American demonstrated no implicit racial bias (M = -0.13) on IAT testing. No notable explicit bias was observed in participants of any racial background. This study contributes evidence that pediatric orthopaedic patients express implicit racial bias on IAT testing, with an overall slight pro-White bias. It also provides insight into the dissociation of implicit and explicit racial bias in childhood and adolescence. We encourage future research on implicit bias among pediatric patients in the orthopaedic community to provide a better understanding and possible solutions to bias-related challenges in health care.

The purpose of this study was to investigate implicit racial bias in auditory-perceptual evaluations of dysphonic voices completed by experienced voice-focused speech-language pathologists (SLPs). Thirty SLPs specializing in voice disorders listened to audio files of 20 Black speakers and 20 White speakers of General American English with voice disorders. The SLPs rated the overall severity of dysphonia (OS) of each voice heard using a 100-unit visual analog scale and then completed the Harvard Implicit Association Test (IAT) to estimate their implicit racial bias. There were no significant main effects of speaker race or labeled race on OS ratings; however, there was a small but significant interaction effect between them: Race labeling resulted in a minimizing effect for Black speakers, but not White speakers. No significant relationship was found between Harvard IAT scores and differences in OS ratings by race-labeling condition. These findings suggest that experienced, voice-focused SLPs demonstrated a minimizing bias in their auditory-perceptual ratings of dysphonia of Black speakers. This bias is small and may not be clinically significant but, in some cases, could contribute to worse clinical care of Black people with voice disorders.

This study is to (1) assess implicit racial bias among pediatric providers and (2) use virtual patient (VP) vignettes to determine the impact of implicit racial bias on clinical decision-making in pediatric sickle cell disease (SCD) pain care. This cross-sectional study was conducted at a mid-sized, freestanding children's hospital in the northeast. Participants (N = 52) were pediatric SCD providers (87% cisgender female, 90% White, M age = 38.78). Providers completed a demographic questionnaire, the race Implicit Association Test (IAT) with adult and child faces, and a measure of SCD explicit bias (5-point Likert scale). Providers also made clinical decisions for four VP vignettes depicting Black and White youth in the emergency department (ED) with either SCD or cancer pain. Frequency tables were calculated. On the race IAT, providers demonstrated a pro-White implicit bias for both adult (81%) and child (89%) faces. Responses to the explicit bias measure reflected low levels of agreement with negative stereotypes about SCD patients. No significant differences emerged in providers' pain treatment decisions for Black vs. White, or SCD vs. cancer VPs. Findings indicate pediatric providers harbor implicit racial bias similar to the general population. Findings from VP vignettes did not demonstrate that pain treatment decision-making differed based on race or diagnosis. This may be due to standardized protocols and procedures in the pediatric emergency setting. Future research is needed to clarify the role of implicit bias in clinical decision-making and the potential efficacy of treatment protocols in preventing biases from interfering with pediatric SCD pain care.

Disparities between Black and White Americans persist in medical treatment and health outcomes. One reason is that physicians sometimes hold implicit racial biases that favor White (over Black) patients. Thus, disrupting the effects of physicians' implicit bias is one route to promoting equitable health outcomes. In the present research, we tested a potential mechanism to short-circuit the effects of doctors' implicit bias: patient activation, i.e., having patients ask questions and advocate for themselves. Specifically, we trained Black and White standardized patients (SPs) to be "activated" or "typical" during appointments with unsuspecting oncologists and primary care physicians in which SPs claimed to have stage IV lung cancer. Supporting the idea that patient activation can promote equitable doctor-patient interactions, results showed that physicians' implicit racial bias (as measured by an implicit association test) predicted racially biased interpersonal treatment among typical SPs (but not among activated SPs) across SP ratings of interaction quality and ratings from independent coders who read the interaction transcripts. This research supports prior work showing that implicit attitudes can undermine interpersonal treatment in medical settings and provides a strategy for ensuring equitable doctor-patient interactions.

This is a study about the phenomena of implicit racial bias (IRB) in higher education, as it relates to a student conduct disciplinary system at a 4-year public university, a system that requires that student conduct cases be handled in a fair, just, and expedient manner. Given the automaticity and pervasiveness of IRB, this study examines how IRB held by student conduct professionals may negatively influence the outcome of student conduct cases, how the process itself and its regulatory landscape has allowed for this practice to continue, and what can be done to prevent and mitigate its impact on students of color, particularly Black students. The following questions guided the study: How can IRB be identified and diagnosed in a university disciplinary system? What is the association between IRB, the hearing officers, and conduct case outcomes? What has been the experience with IRB in other fields of study besides higher education such as Health, Criminal Justice, Housing, and K-12 Education? Three methods to identify IRB were used in this study: Checking for significant disparities in the handling of cases on account of race, using case vignettes to observe behaviors indicative of IRB, and using the results of a reaction-time instrument (The Implicit Association Test) to assess racial bias that is automatically activated. The site selected was the Student Conduct Office in a public university where the researcher had the most knowledge and in-depth understanding of its conduct procedures and practices. A review of the office’s caseload for two years (2016-2018)revealed evidence suggestive of disparate treatment on account of race. Subjects who reacted to a set of case vignettes designed by the researcher and took the Implicit Association Test also displayed implicit racial bias.

Two studies examined the construct validity of valuing diversity in relation to both explicit and implicit racial bias. In the first study, participants completed three measures: the Miville-Guzman Universality-Diversity Scale to measure valuing diversity; the Implicit Association Test to assess implicit racial bias; and the Symbolic Racism 2000 Scale to assess explicit racial bias. Results indicated there was a significant relationship between the valuing diversity and implicit racial bias measures as well as between the valuing diversity and explicit racial bias measures. The explicit and implicit racial bias measures accounted for unique variance in the valuing diversity construct. There was not a significant relationship between explicit and implicit racial bias. The second study assessed how priming with counter-stereotypical exemplars affected responses to the same measures. Although it was expected that exposure to counter-stereotypical exemplars would produce decrements in implicit racial bias, the manipulation did not directly affect responses to any of the measures. Together these studies clarify the fundamental nature of valuing diversity and provide further insight into the relationship between explicit and implicit racial attitudes.

Racial inequality persists in modern American society and permeates domains ranging from healthcare to education. Scientists typically trace such racial inequality to implicit (rather than explicit) racial bias, and some argue that implicit racial bias is better understood as a contextual or cultural variable rather than as an individual difference variable. Here, this body of work is expanded by highlighting a method—cultural snapshots—for identifying contextual patterns of information that explain and facilitate socially situated implicit racial bias. Cultural snapshots enable scientists to (a) characterize the cultural information commonly and frequently encountered by a collective, (b) examine how such cultural information influences the cognitions of individuals, and (c) draw conclusions about the emergence of shared cognition. The chapter concludes with a discussion of some ways this approach could be applied to other types of cultural patterns and the benefits of examining implicit racial bias at a cultural level more broadly.

The present study investigated the effects of immersive exposure to other-race individuals on racial bias. In Study 1, we tracked African students ( N = 85) who went to study at a Chinese university and thus experienced daily contact with Chinese individuals en masse for the first time. Using a cohort-sequential longitudinal design, we found that an implicit pro-Chinese racial bias emerged within 3 months after these students arrived in China, and that this bias remained stable for at least a year. In contrast, their explicit racial bias did not change. In Study 2, we assessed another group of African students ( N = 47) at 1 month and at 3 months after their arrival in China, looking at not only their implicit and explicit racial bias, but also their intergroup contact quantity, intergroup contact quality, and intergroup friendship. We found that intergroup contact quantity and intergroup friendship predicted implicit but not explicit racial bias 2 months later. The findings suggest that immersive experiences with racial out-groups can have early and lasting effects on implicit racial bias.

A lesson in bias: The relationship between implicit racial bias and performance in pedagogical contexts

Researchers and theorists studying intergroup relations have been interested in the impact of alcohol on interracial responding. Theories predict that alcohol will exacerbate expressions of racial bias by increasing reliance on stereotypes and/or by decreasing controlled processing and self-monitoring. Prior studies testing these theories have often examined alcohol's effects on implicit (i.e., indirect) measures of racial bias with inconsistent results. However, previous research in this area has suffered from several methodological limitations, including small sample sizes and doses of alcohol that may have been too low to induce substantial intoxication. Here, in more than triple the number of alcohol participants than the largest prior study, we tested whether an intoxicating dose of alcohol (target breath alcohol concentration of .08%) exacerbated implicit racial bias. Young adults who identified as races other than Black or African American (N = 207) were randomly assigned to consume an alcoholic or placebo beverage and completed the race-based Implicit Association Test (race IAT) testing implicit preference for White (vs. Black) individuals [or, conversely, bias against Black (vs. White) individuals]. All participants demonstrated an implicit racial bias (i.e., linking traditionally Black names with negative/unpleasant words), with no difference in this implicit racial bias across beverage conditions. Specifically, there were no differences between alcohol participants' race IAT D scores (M = 0.55, SD = 0.39), and placebo participants' race IAT D scores (M = 0.59, SD = 0.35), b = 0.05, 95%CI [-0.07, 0.18], p = .422. These findings challenge theories and prior studies suggesting that alcohol increases implicit racial bias. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

People of color generally, and Blacks specifically, are underrepresented in the US Army's officer corps, especially in the general officer grades. Studies show that Black officers have both a lower promotion rate and a higher attrition rate when compared to White officers. Underrepresentation exacerbates Black officer accessions, employment, promotion, and retention. This quantitative study explored implicit racial bias among a diverse group of US Army officers to determine if a negative racial bias exists against Black US Army officers. The study used a Racial Implicit Association Test (IAT) to measure the strength of racial preference. Findings from the data indicate there is a strong implicit preference for Whites and a less favorable preference for Blacks among US Army officers. The presence of implicit racial bias in military decision-making, specifically in employment, promotions, and retention, raises concerns about achieving equality within all military branches. The study concluded that there is a need for a more stringent Equal Employment Opportunity policy within the military. Cultural and policy changes, diversity training, bias mitigation techniques, and application of Title VII are needed to decrease the adverse effects of continued implicit racial bias. Such changes would improve the current policy, increase equality, and decrease the harm caused to the careers of Black officers--Author's abstract

Although the medical profession strives for equal treatment of all patients, disparities in health care are prevalent. Cultural stereotypes may not be consciously endorsed, but their mere existence influences how information about an individual is processed and leads to unintended biases in decision-making, so called "implicit bias". All of society is susceptible to these biases, including physicians. Research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics. We review the origins of implicit bias, cite research documenting the existence of implicit bias among physicians, and describe studies that demonstrate implicit bias in clinical decision-making. We then present the bias-reducing strategies of consciously taking patients' perspectives and intentionally focusing on individual patients' information apart from their social group. We conclude that the contribution of implicit bias to health care disparities could decrease if all physicians acknowledged their susceptibility to it, and deliberately practiced perspective-taking and individuation when providing patient care. We further conclude that increasing the number of African American/Black physicians could reduce the impact of implicit bias on health care disparities because they exhibit significantly less implicit race bias.

ContextStudies documenting racial/ethnic disparities in health care frequently implicate physicians’ unconscious biases. No study to date has measured physicians’ unconscious racial bias to test whether this predicts physicians’ clinical decisions.ObjectiveTo test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes.Design, Setting, and ParticipantsAn internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient.Main Outcome MeasuresIAT scores (normal continuous variable) measuring physicians’ implicit race preference and perceptions of cooperativeness. Physicians’ attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians’ explicit racial biases by questionnaire.ResultsPhysicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians’ prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009).ConclusionsThis study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians’ unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.

Age-related differences in explicit and implicit racial biases in Black Cameroonians (N = 187, 94 females) were investigated using a cross-sectional design. Participants ranged in age from 3 to 30 years, and were from middle-to-high income families in Yaoundé, Cameroon. Biases were assessed by comparing attitudes toward Blacks with those toward Whites and Chinese. Implicit pro-Black/anti-other-race (White and Chinese) biases were present at age 4, in contrast to anti-Black/pro-other-race biases, which were observed among 9- to 30-year-olds. In addition, explicit pro-Black/anti-other-race biases that were present at age 4 were no longer evident by age 7. These findings provide a detailed picture of age-related differences in racial biases in an understudied part of the world that can inform theories regarding the development of racial biases, as well as efforts to reduce such biases. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The association between physicians' and patients' racial attitudes and poorer patient-physician communication in racially discordant medical interactions is well-documented. However, it is unclear how physicians' and patients' racial attitudes independently and jointly affect their behaviors during these interactions. In a secondary analysis of video-recorded medical interactions between non-Black physicians and Black patients, we examined how physicians' explicit and implicit racial bias and patients' perceived past discrimination influenced their own as well as one another's affect and level of engagement. Affect and engagement were assessed with a "thin slice" method. For physicians, the major findings were significant three-way interactions: physicians' affect and engagement were influenced by their implicit and explicit racial bias (i.e., aversive racism), but only when they interacted with patients who reported any incidence of prior discrimination. In contrast, patients' affect was influenced only by perceived discrimination. Theoretical and clinical implications of current findings are discussed.