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The Relative Understanding of Stigma About Health (RUSH) Study: The Role of Controllability and Knowledge in

Charlotte S Zell1, Steven R Thorp2, Kenneth J Thompson3

  • 1University of Houston, Houston, TX, USA.

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|October 28, 2025
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Health stigma is driven by perceived controllability and lack of knowledge. Mental health conditions and obesity face significant public stigma, informing targeted public health interventions.

Keywords:
DiscriminationMental healthPhysical healthPrejudiceStereotypes

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Area of Science:

  • Social Psychology
  • Public Health
  • Health Communication

Background:

  • Publics often hold negative stereotypes, prejudice, and discrimination towards individuals with various health conditions.
  • Understanding the drivers of health-related stigma is crucial for effective public health interventions.

Purpose of the Study:

  • To identify the most stigmatized health conditions and behaviors in the U.S. public.
  • To examine the factors, such as perceived controllability and knowledge, that influence variations in health stigma.
  • To investigate the relationship between knowledge and stigma at both individual and condition levels.

Main Methods:

  • A nationally representative sample of 1,096 U.S. adults completed the Relative Understanding of Stigma about Health Index (RUSH-I) online survey.
  • The RUSH-I instrument assessed perceptions of controllability, knowledge, and public stigma for 36 health conditions and behaviors.
  • Statistical analyses explored relationships between controllability, knowledge, and stigma.

Main Results:

  • Health conditions and behaviors perceived as more controllable and less known were associated with substantially higher stigma.
  • Perceived controllability and knowledge explained over two-thirds of the variance in stigma across health issues.
  • Mental health conditions were generally more stigmatized than physical health conditions, with obesity being the most stigmatized condition overall.
  • Individual-level analysis revealed a positive relationship between knowledge and perceived stigma.

Conclusions:

  • Perceived controllability and knowledge are key determinants of health stigma.
  • Public health messaging should address conditions with high stigma, particularly obesity and mental health issues.
  • Further research is needed to understand the complex relationship between knowledge and stigma.