The DOI matches its Crossref record; 5 of the 5 references it cites were found in a registry or an index.
The Influence of Implicit Bias on Treatment Recommendations for 4 Common Pediatric Conditions: Pain, Urinary Tract Infection, Attention Deficit Hyperactivity Disorder, and Asthma
Open accessAbstract
Objectives. We examined the association between pediatricians’ attitudes about race and treatment recommendations by patients’ race. Methods. We conducted an online survey of academic pediatricians (n = 86). We used 3 Implicit Association Tests to measure implicit attitudes and stereotypes about race. Dependent variables were recommendations for pain management, urinary tract infections, attention deficit hyperactivity disorder, and asthma, measured by case vignettes. We used correlational analysis to assess associations among measures and hierarchical multiple regression to measure the interactive effect of the attitude measures and patients’ race on treatment recommendations. Results. Pediatricians’ implicit (unconscious) attitudes and stereotypes were associated with treatment recommendations. The association between unconscious bias and patient’s race was statistically significant for prescribing a narcotic medication for pain following surgery. As pediatricians’ implicit pro-White bias increased, prescribing narcotic medication decreased for African American patients but not for the White patients. Self-reported attitudes about race were associated with some treatment recommendations. Conclusions. Pediatricians’ implicit attitudes about race affect pain management. There is a need to better understand the influence of physicians’ unconscious beliefs about race on pain and other areas of care.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source doesn’t support the claim as written.
In the citing paper
“eight articles appeared to refer to the same data collected in a single cross-country comparison study [27–32, 34, 35] and a further two articles analysed the same data [45, 47].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [45]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Four studies examining the correlation between IAT scores and responses to clinical vignettes found a significant correlation between high levels of pro-white implicit bias and treatment responses that favoured patients specified as white [42, 45–47].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [45]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Tversky, A., & Kahneman, D. (1974) · Science · doi:10.1126/science.185.4157.1124 · Cited by 28,810
Implicit social cognition: Attitudes, self-esteem, and stereotypes
Greenwald, A. G., & Banaji, M. R. (1995) · Psychological Review · doi:10.1037/0033-295x.102.1.4 · Cited by 6,682
Self-citationImplicit and explicit prejudice and interracial interaction.
Dovidio, J. F., Kawakami, K., & Gaertner, S. L. (2002) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.82.1.62 · Cited by 1,567
Prevalence of Urinary Tract Infection in Childhood: A Meta-Analysis
Shaikh, N., Morone, N. E., Bost, J. E., & Farrell, M. H. (2008) · Pediatric Infectious Disease Journal · doi:10.1097/inf.0b013e31815e4122 · Cited by 943
Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology
Burgess, D., van Ryn, M., Dovidio, J., & Saha, S. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0160-1 · Cited by 495
Flagged first, then by citations
Research works printed but not linked: 42
- Bloom B, 2010, Vital Health Stat 10, 247, 1
- 10.1542/peds.2010-0188 · DOI · Paper page
- 10.1177/1087054705280413 · DOI · Paper page
- Smedley BD, 2003, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
- 10.1367/A04-203R1.1 · DOI
- 10.1353/hpu.0.0236 · DOI
- 10.1001/jama.2007.64 · DOI
- 10.1001/archpediatrics.2010.100 · DOI
- 10.1542/peds.108.2.432 · DOI
- 10.1089/cap.2005.15.88 · DOI
- 10.1353/hpu.0.0255 · DOI
- 10.1111/j.1526-4637.2008.00527.x · DOI
- 10.1097/01.mlr.0000215901.37144.94 · DOI
- 10.1353/hpu.2008.0005 · DOI
- 10.1097/MLR.0b013e3181792562 · DOI
- 10.1007/s11606-006-0057-4 · DOI
- 10.1016/j.socscimed.2007.03.036 · DOI
- 10.1353/hpu.0.0063 · DOI
- 10.2105/AJPH.94.12.2084 · DOI · Paper page
- 10.2105/AJPH.93.2.248 · DOI
- 10.1111/1467-9280.00262 · DOI
- 10.1080/10463280701489053 · DOI · Paper page
- 10.1016/j.jesp.2009.11.004 · DOI · Paper page
- 10.1353/hpu.0.0185 · DOI · Paper page
- Nosek BA, 2007, Automatic Processes in Social Thinking and Behavior, 265
- 10.1037/0022-3514.81.5.800 · DOI
- 10.1177/0146167205275613 · DOI · Paper page
- 10.1037/a0015575 · DOI · Paper page
- 10.1097/MLR.0b013e3181653d58 · DOI · Paper page
- 10.7326/0003-4819-141-10-200411160-00008 · DOI
- 10.1001/jama.283.13.1715 · DOI
- Chapman GB, 2000, Decision Making in Health Care: Theory, Psychology and Applications
- 10.1037/0022-3514.74.6.1464 · DOI · Paper page
- 10.2307/20439056 · DOI
- 10.1037/0022-3514.85.2.197 · DOI · Paper page
- Cohen J, 1988, Statistical Power Analysis for the Behavioral Sciences
- 10.1542/peds.108.4.1033 · DOI
- 10.1007/s11606-007-0258-5 · DOI · Paper page
- 10.1007/s11606-010-1555-y · DOI
- 10.1197/aemj.9.11.1184 · DOI · Paper page
- 10.1111/j.1526-4637.2006.00105.x · DOI
- 10.1370/afm.282 · DOI
Cited by
Sorted by citations
Items 401–449 of 449
The arc of racial stereotyping, prejudice and discrimination: social psychological perspectives
Fein, S. (2018) · Edward Elgar Publishing eBooks · doi:10.4337/9781788112857.00008 · Cited by 1
Conscientious Refusal and Access to Abortion and Contraception
Fitzgerald, C., & McLeod, C. (2014) · Scholarship@Western (Western University) · doi:10.4324/9780203804971.ch26 · Cited by 1
“(For further studies, see Sabin & Greenwald 2012 and von Hippel et al. 2008.)”
BackgroundEthical Issues in Pediatric Nephrology
Wightman, A., & Freeman, M. (2021) · Springer eBooks · doi:10.1007/978-3-642-27843-3_140-1 · Cited by 1
Health Disparities in Allergic Diseases: An Evidence-Based Look at Causes, Conditions, and Outcomes
Mahdavinia, M. (2020) · doi:10.1007/978-3-030-31222-0 · Cited by 1
The Importance of Social Identity in Feedback Seeking: A Race Perspective
Flores, C., Elicker, J. D., & Cubrich, M. (2019) · Springer eBooks · doi:10.1007/978-3-030-30915-2_8 · Cited by 3
Roloff, K., Okekpe, C., Stowe, R., & Valenzuela, G. J. (2026) · Cureus · doi:10.7759/cureus.118804
Racial, Ethnic, and Socioeconomic Disparities in Cardio-Obstetrics.
Young, O. M., Smith, G., Skowronski, J., Mapatano, S. H., Wade, M., & Mallampati, D. P. (2026) · Clinical obstetrics and gynecology · doi:10.1097/grf.0000000000001060
Nuñez-Gallegos, F., Maskatia, S., Zhang, Y., Zampi, J. D., Nicholson, G. T., McCracken, C. E., Mascio, C., Petit, C. J., Romano, J. C., Zanaboni, D., et al. (2026) · JACC: Advances · doi:10.1016/j.jacadv.2026.103161
Physician Implicit Racial Bias and Guideline-Concordant Vascular Care
Beidelman, E. T., Witrick, B., Howard, K. A., Clark, A., McGinigle, K. L., Minc, S. D., Alabi, O., Hicks, C. W., Gonzalez, A. A., Cené, C. W., et al. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.29779
The Role of Implicit Bias in Shaping Medication Prescribing Practices: A Scoping Review
Edwards, A., Tikare, O., Dulo, N., Coe, A. B., Erickson, S. R., & Dorsch, M. P. (2026) · Journal of the American College of Clinical Pharmacy · doi:10.1002/jac5.70241
“Pediatricians ( M = 0.18, SD = 0.44) in a study who had higher race IAT indicating pro-White bias were less likely to prescribe oxycodone (optimal treatment) for pain relief in Black patients in comparison with White patients ( r = − 0.38, p = 0.05) [25].”
InfluentialMeidert, U., Candolfi, L., Gazzotto, A., Wieber, F., & Gerber-Grote, A. (2026) · BMC Medical Education · doi:10.1186/s12909-026-09461-8
“Documented consequences or effects include disparities in pain medication prescription [21], diagnostic procedures [22, 23], consultation or treat-ment delays [24, 25], consultation length, clinical decision-making [26], specialist referrals [22], and under-or over-treatment [27].”
Negative Descriptors of Patients With Sickle Cell Disease in the Electronic Health Record
Wesevich, A., Vangelatos, A., Sun, M., Tung, E. L., & Peek, M. E. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.6458
Pilot investigation into the influence of racial implicit bias on physician clinical reasoning
González, C. M., Deno, M. L., Ark, T. K., Helft, M., Connor, D. M., Kalet, A. L., Burgess, D. J., Samuel, M. T., Fisher, M. R., & Durning, S. J. (2026) · Diagnosis · doi:10.1515/dx-2025-0123
“All three scenarios were iteratively developed with community member, SPs, members of the investigative team, and clinical experts.”
Social Determinants of Health and Symptomatic Recovery from Pediatric Concussion
Liu, B. C., Yeates, K. O., Tang, K., Beauchamp, M. H., Craig, W. R., Doan, Q. H., Gravel, J., Mikami, A. Y., Ramsay, S., Zemek, R. L., et al. (2026) · Journal of Neurotrauma · doi:10.1177/08977151251407651
“87,88 The parent study ’ s exclusion criteria may have also impacted the representation of certain groups within the sample.”
Advancing Birth Equity Through Quality Improvement Education: The SPEAK UP Champion Course
Byfield, R., & Bingham, D. (2026) · Health Equity · doi:10.1177/24731242261449035
“29,30 Figure 1 depicts both the conceptual progression from knowledge acquisition to equity-oriented outcomes (Fig.”
Kissi, A., Ryckeghem, D. V. V., Mende-Siedlecki, P., Hirsh, A. T., Alboom, I. V., Debeer, D., & Vervoort, T. (2025) · PeerJ · doi:10.7717/peerj.19969
Ebong, I. M., Eads, P., & Charles, G. (2025) · Epilepsy Research · doi:10.1016/j.eplepsyres.2025.107637
Sabin, J., Guenther, G. A., Ma, K. P. K., York, B., Barrington, W., & Frogner, B. K. (2025) · MedEdPublish · doi:10.12688/mep.20799.1
“Healthcare professionals’ implicit bias contributes to poor clinician-patient communication, disparities in pain management, prescribing lipid-lowering medication for women, treatment of coronary heart disease, and other areas 1,7,8 .”
Self-citationTreptow, R. L., Browne, J. V., Feder, J. D., Glovinsky, I., & Skotko, B. (2025) · American Journal of Medical Genetics. Part A · doi:10.1002/ajmg.a.64166
“…et al. 2018; Teal et al. 2012) as well as practicing physicians (Johnson et al. 2017; Penner et al. 2010; Puumala et al. 2016; Rosales et al. 2017; Sabin and Greenwald 2012), on recommended treatments and decision-making (Chapman et al. 2018; Dehon et al. 2017; Harris et al. 2018; Rosales et al.…”
InfluentialAnadria, D., Dobbe, R., Giachanou, A., Kuiper, R., Bartels, R., van Amsterdam, W. V., de Troya, Í. M. D. R., Zurcher, C., & Oberski, D. (2025) · arXiv.org · doi:10.48550/arxiv.2506.13584
“For instance, Black children in the United States receive fewer pain management medications after surgery compared to White children [36], and women receive worse treatment for coronary heart disease than men [37, 33] Patient data samples tend to disproportionately represent wealthier population…”
Racial and Ethnic Differences in ED Analgesia Among Injured Children Transported Via EMS.
Kerolle, S., Browne, L., Brazauskas, R., Adelgais, K., Chadha, K., Chang, T. P., Harris, M. I., Lerner, E., Leonard, J. C., Lowe, G. S., et al. (2025) · Pediatric emergency care · doi:10.1097/pec.0000000000003389
The Impact of Race and Ethnicity on Location and Delivery of Palliative Radiotherapy.
Heng, A. K., Gooley, T., Lo, S. S., Yang, J. T., Gillespie, E. F., Halasz, L. M., & Tseng, Y. D. (2025) · American Journal of Clinical Oncology · doi:10.1097/coc.0000000000001202
Identifying characteristics associated with genetic testing in the NICU
Rumsey, M., Malone-Jenkins, S., Palmquist, R. N., Torre, M. P., Sdano, M. R., Baca, A., Ling, C. Y., & Andoni, L. (2025) · Journal of Community Genetics · doi:10.1007/s12687-025-00780-9
“In addition, provider implicit bias may impact care or treatment provided as well as communication quality and information conveyed in an appointment (Sabin et al. 2012, Green et al. 2007; Cooper et al. 2012; Browner et al. 1999).”
Confronting racism as a healthcare challenge: A teaching and learning approach
Dada, T., Lowe, S., & Whybrow, P. (2024) · Discover Education · doi:10.1007/s44217-024-00279-4
Mizel, M., Haas, A., Adams, J., Martino, S. C., Haviland, A. M., Ghosh-Dastidar, B., Dembosky, J. W., Williams, M., Abel, G. A., Maksut, J., et al. (2024) · BMJ Quality & Safety · doi:10.1136/bmjqs-2024-017430
Treating black patients as “knowers”
Thomas, J. J., Johnson, S. M., Holden, K. B., & Hutchins, S. S. (2023) · Journal of the National Medical Association · doi:10.1016/j.jnma.2023.09.012 · Cited by 1
Trends in repeat opioid analgesic prescription utilization for acute pain in children: 2013-2018.
Nair, A., Placencia, J. L., Farber, H. J., Aparasu, R., Johnson, M. L., & Chen, H. (2023) · Academic pediatrics · doi:10.1016/j.acap.2023.09.020
DeClouette, B., Hulbert, M. A., Nalbandian, D., & Fischer, C. R. (2023) · Operative Techniques in Orthopaedics · doi:10.1016/j.oto.2023.101069
Guarino, S., Wright, C., Pachter, L., & Lanzkron, S. (2022) · Delaware journal of public health · doi:10.32481/djph.2022.10.004
Black Matrilineage, Photography, and Representation
Lopez-Diago, Z., & Deschler Canossi, L. (2022) · Leuven University Press eBooks · doi:10.11116/9789461664631 · Cited by 1
Mittal, D. A. R., Kahlam, A., Le, A., Ahlawat, S., & Monteiro, I. M. (2022) · Cureus · doi:10.7759/cureus.24726
“Finally, while the role of implicit bias has not been studied in biliary atresia, it has been studied in the pediatric population overall [25-27].”
BackgroundNair, A., Farber, H., & Chen, H. (2021) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.5336
“”(45) A recent survey of academic pediatricians found that the presence of pro-White implicit bias was associated with decrease in prescribing narcotic medications for post-surgical pain to African Americans, without affecting the White patients.(46) Prior studies have also shown that caregivers from various racial/ e…”
BackgroundThe impact of socioeconomic risk factors and mental health on asthma
Le, T. P., Sutherlin, T. K., Teverbaugh, L. A., Gleason, M. M., & Carlson, J. C. (2021) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2021.02.014 · Cited by 1
Tjia, J., Pugnaire, M., Calista, J., Esparza, N., Valdman, O., Garcia, M. M., Yazdani, M., Hale, J., Terrien, J., Eisdorfer, E., et al. (2020) · doi:10.21203/rs.3.rs-39615/v2
Self-citationPrejudice and Stereotyping in Healthcare
Focella, E. S. (2020) · The Wiley Encyclopedia of Health Psychology · doi:10.1002/9781119057840.ch101
Aronson, B., Keister, L., & Moody, J. (2020) · doi:10.21203/rs.3.rs-20738/v1
“For example, doctors often mistakenly assume that African Americans have more pain tolerance and have more illicit motivations for seeking pain treatment than do whites (15-19).”
Pain in Daily Surgical Practice; Opioid Use and the Surgeon
Nomikos, I. (2018) · Hellenic Journal of Surgery · doi:10.1007/s13126-018-0454-2
Implicit attitudes among trainee and qualified clinical psychologists in the UK
Blencowe, A. (2017) · UEL Research Repository (University of East London) · doi:10.15123/pub.6464 · Cited by 1
“For example, Green et al. (2007) and Sabin and Greenwald (2012) found that health care providers implicitly associated African American patients with being less cooperative and compliant in medical settings than European American patients.”
BackgroundThe Many Uses of Legitimacy in Medical Ethics
Smith, W. R. (2017) · The AMA Journal of Ethic · doi:10.1001/journalofethics.2017.19.2.fred1-1702
Clinical Toxicology and Its Relevance to Asthma and Atopy.
Joks, R., & Bluth, M. (2016) · Clinics in Laboratory Medicine · doi:10.1016/j.cll.2016.07.005
“Differences in physician gender and perception may bias referral to a pulmonologist compared with maintenance in a primary care setting as well as opioid prescribing habits for pediatric asthma and pain management.(15) Further, in a study of patients’ opioid misuse, providers were more likely to assess African America…”
BackgroundDon'T forget palliative patients--reply.
Schechter, N. (2015) · JAMA pediatrics · doi:10.1001/jamapediatrics.2014.3049
A Circle of Unintended Effects: A Comment on Persky et al.
Blair, I. V. (2013) · Annals of Behavioral Medicine · doi:10.1007/s12160-013-9488-4
“All indicators suggest that physicians are largely unaware of differences in their communication or decisions regarding African American patients[1-7].”
BackgroundAeronautical journal (London, England : 1897): Bibliography
Carmody, K. (2022) · A Country Strange and Far · doi:10.2307/j.ctv22wtqzt.18
Clinician Unconscious Bias and Its Impact on Trauma Patients
Udyavar, N. R., Salim, A., & Haider, A. (2020) · Springer eBooks · doi:10.1007/978-3-030-31246-6_19
Mitigating Implicit Racial Bias Among Criminal Court Jurors: Intervention Through Instruction
Bolotin, H. (2019) · doi:10.14418/wes01.1.1586
“One such study, conducted by Sabin and Greenwald (2012), provided pediatricians (N = 86, 82% White, 65% female) with pediatric case vignettes (e.g., “Pain”) and asked them to respond to a number of explicit attitude/stereotype items (e.g., “My feelings toward African Americans are…”; 0 = cold to 10…”
BackgroundHealthcare Disparities and Noncompliance in Children and Young Adults with Crohn’s Disease
McLoughlin, R. (2019) · doi:10.13028/4p6g-z981
“Implicit bias has been demonstrated in the management of common pediatric disease states[39], and its impact in the present study cannot be excluded.”
BackgroundThe Shock of Charlottesville: Unmasking Racism in Healthcare.
Dossey, L. (2018) · Explore · doi:10.1016/j.explore.2017.10.001
Revisiting Unequal Treatment: Disparities in Access to and Quality of Care for Arthritis
Armbrister, A. N., & Abraído‐Lanza, A. F. (2015) · Springer eBooks · doi:10.1007/978-3-319-22858-7_11
Metadata
- Authors
- Sabin, J. A., & Greenwald, A. G.
- Affiliations
- University of Washington (US)
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 2012-05
- Volume
- 102
- Issue
- 5
- Pages
- 988-995
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- PMC
- PMC3483921
- OpenAlex
- W2078029714
- Cited by
- 525
- References
- 0
- Citations by year
- 2026: 21 · 2025: 32 · 2024: 46 · 2023: 48 · 2022: 78 · 2021: 54 · 2020: 53 · 2019: 37 · 2018: 37 · 2017: 34 · 2016: 25 · 2015: 26 · 2014: 19 · 2013: 11 · 2012: 2
- FWCI
- 61.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- American Journal of Public Health
- Funders
- University of Washington
- Agency for Healthcare Research and Quality (R36 HS015676, 1-R36HS1576-01)
- National Institute of Mental Health (T32MH20010, T32MH020010)
- Topics
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Cultural Competency in Health Care
- Keywords
- implicit bias, racial bias in medicine, pediatricians, treatment guidelines, pain management, urinary tract infection, attention deficit hyperactivity disorder, asthma, racial disparities, African American patients, opioid prescribing, Implicit Association Test, racial stereotypes
- MeSH terms
- Central Nervous System Stimulants, Analgesics, Opioid, Asthma, Attention Deficit Disorder with Hyperactivity, Attitude of Health Personnel, Black or African American, Counseling, Female, Health Services Research, Humans, Male, Pediatrics, Prejudice, Referral and Consultation, Stereotyping, Urinary Tract Infections, White People, Healthcare Disparities, Pain Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
