Implicit Racial Bias in Evaluation of Neonatal Opioid Withdrawal Syndrome

Overview

Journal J Racial Ethn Health Disparities

Specialties Public Health
Social Sciences

Date 2023 Dec 19

PMID 38110799

Authors

Katherine Nyman

Francesca Okolie

Natalie L Davis

Erin Hager

Dina El-Metwally

Affiliations

Soon will be listed here.

Abstract

Objective: To assess implicit bias by administrating the Modified Finnegan Score (MFS) for quantifying neonatal opioid withdrawal and to evaluate risk of decreased opioid treatment of Black versus White infants.

Study Design: Study participants were nurses recruited from a large tertiary care center who received three clinical vignettes portraying withdrawing infants and were randomized to receive an accompanying photo of either a Black or White infant. MFS results were compared for identical vignettes based on race of infant photo.

Results: Out of 275 nurses, 70 completed the survey. In vignette 2, nurses aged ≤35 years scored Black infants lower than White infants (MFS=8.3 ± 2 vs. 9.5 ± 1.2, p=0.012). Nurses with <5 years of experience and ≤10 years of experience also scored Black infants lower for the same vignette (8.2 ± 2.3 vs. 9.6 ± 1.2, p=0.032 and 8.3 ± 2 vs. 9.5 ± 1.2, p=0.0083).

Conclusion: Implicit bias may contribute to the difference in opioid treatment.

References

Beck A, Edwards E, Horbar J, Howell E, McCormick M, Pursley D . The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res. 2019; 87(2):227-234. PMC: 6960093. DOI: 10.1038/s41390-019-0513-6. View

Phelan S, Dovidio J, Puhl R, Burgess D, Nelson D, Yeazel M . Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. Obesity (Silver Spring). 2013; 22(4):1201-8. PMC: 3968216. DOI: 10.1002/oby.20687. View

GREENWALD A, Banaji M . Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychol Rev. 1995; 102(1):4-27. DOI: 10.1037/0033-295x.102.1.4. View

Vela M, Erondu A, Smith N, Peek M, Woodruff J, Chin M . Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs. Annu Rev Public Health. 2022; 43:477-501. PMC: 9172268. DOI: 10.1146/annurev-publhealth-052620-103528. View

Hall W, Chapman M, Lee K, Merino Y, Thomas T, Payne B . Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. Am J Public Health. 2015; 105(12):e60-76. PMC: 4638275. DOI: 10.2105/AJPH.2015.302903. View

Hoffman K, Trawalter S, Axt J, Oliver M . Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016; 113(16):4296-301. PMC: 4843483. DOI: 10.1073/pnas.1516047113. View

Benzing A, Bell C, Derazin M, Mack R, MacIntosh T . Disparities in Opioid Pain Management for Long Bone Fractures. J Racial Ethn Health Disparities. 2020; 7(4):740-745. DOI: 10.1007/s40615-020-00701-1. View

Kennel J, Withers E, Parsons N, Woo H . Racial/Ethnic Disparities in Pain Treatment: Evidence From Oregon Emergency Medical Services Agencies. Med Care. 2019; 57(12):924-929. DOI: 10.1097/MLR.0000000000001208. View

Goyal M, Kuppermann N, Cleary S, Teach S, Chamberlain J . Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments. JAMA Pediatr. 2015; 169(11):996-1002. PMC: 4829078. DOI: 10.1001/jamapediatrics.2015.1915. View

10.

Nafiu O, Chimbira W, Stewart M, Gibbons K, Porter L, Reynolds P . Racial differences in the pain management of children recovering from anesthesia. Paediatr Anaesth. 2017; 27(7):760-767. PMC: 5474946. DOI: 10.1111/pan.13163. View

11.

Wing E, Saadat S, Bhargava R, Yun H, Chakravarthy B . Racial disparities in opioid prescriptions for fractures in the pediatric population. Am J Emerg Med. 2021; 51:210-213. DOI: 10.1016/j.ajem.2021.10.017. View

12.

Jilani S, Jones H, Grossman M, Jansson L, Terplan M, Faherty L . Standardizing the Clinical Definition of Opioid Withdrawal in the Neonate. J Pediatr. 2021; 243:33-39.e1. DOI: 10.1016/j.jpeds.2021.12.021. View

13.

Sarkar S, Donn S . Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey. J Perinatol. 2005; 26(1):15-7. DOI: 10.1038/sj.jp.7211427. View

14.

Parikh A, Gopalakrishnan M, Azeem A, Booth A, El-Metwally D . Racial association and pharmacotherapy in neonatal opioid withdrawal syndrome. J Perinatol. 2019; 39(10):1370-1376. DOI: 10.1038/s41372-019-0440-8. View

15.

Grossman M, Berkwitt A, Osborn R . Racial association and pharmacotherapy in neonatal opioid withdrawal syndrome: thinking beyond genetics. J Perinatol. 2020; 40(4):689-690. DOI: 10.1038/s41372-020-0607-3. View

16.

GREENWALD A, McGhee D, Schwartz J . Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998; 74(6):1464-80. DOI: 10.1037//0022-3514.74.6.1464. View

17.

Smedley A, Smedley B . Race as biology is fiction, racism as a social problem is real: Anthropological and historical perspectives on the social construction of race. Am Psychol. 2005; 60(1):16-26. DOI: 10.1037/0003-066X.60.1.16. View

18.

Blair I, Steiner J, Havranek E . Unconscious (implicit) bias and health disparities: where do we go from here?. Perm J. 2011; 15(2):71-8. PMC: 3140753. DOI: 10.7812/TPP/11.979. View

19.

Audet L, Bourgault P, Rochefort C . Associations between nurse education and experience and the risk of mortality and adverse events in acute care hospitals: A systematic review of observational studies. Int J Nurs Stud. 2018; 80:128-146. DOI: 10.1016/j.ijnurstu.2018.01.007. View

20.

Cheung R, Aiken L, Clarke S, Sloane D . Nursing care and patient outcomes: international evidence. Enferm Clin. 2008; 18(1):35-40. PMC: 2856593. DOI: 10.1016/s1130-8621(08)70691-0. View