Research ArticleInnovations in Dental Hygiene Education

Color-Blind Racial Attitudes in Entry-Level Dental Hygiene Students in Virginia

Emily A. Ludwig and Jessica R. Suedbeck
American Dental Hygienists' Association October 2023, 97 (5) 79-90;

Abstract

Purpose Subscribing to color-blind racial attitudes may contribute to inequities in the delivery of oral care and affect treatment of diverse patients. The purpose of this study was to survey all entry-level dental hygiene students in one state to determine color-blind racial attitudes.

Methods After IRB approval, a convenience sample of 220 dental hygiene students in all entry-level programs in Virginia were invited to participate in this cross-sectional study. The Color-Blind Racial Attitudes Scale (CoBRAS), an effective, validated measuring instrument, was used to quantify unawareness of contemporary racist ideals. Three subscales (Racial Privilege, Institutional Discrimination, and Blatant Racial Issues) were also measured by the survey. Descriptive statistics, separate one-way between-subjects ANOVA, and independent samples t-tests were used to analyze the data.

Results One hundred and sixty (n=160) dental hygiene students completed the survey. Independent samples t-tests revealed statistically significant differences when comparing year in program and program type. Participants in their second year of dental hygiene education had significantly lower overall CoBRAS scores compared to those in their first year of education (M=50.76, M=59.13, respectively; p=0.004). Participants enrolled in a baccalaureate dental hygiene (B.S.) program had significantly lower overall CoBRAS scores compared to those enrolled in an associate (A.S.) program (M=50.53, M=59.54, respectively; p=0.002).

Conclusion Participants possessed moderate levels of color-blindness suggesting a need for more awareness and training early in dental hygiene education to increase delivery of culturally competent oral healthcare.

Keywords

INTRODUCTION

Racial inequities in healthcare due to bias, prejudice, and stereotyping were highlighted in the 2003 report from the Institute of Medicine (IOM) where minorities received fewer procedures and poorer healthcare compared to the majority.1 This is a continual trend with the 2022 National Healthcare Quality and Disparities Report finding Black populations received worse care for 45% of quality measures, American Indian/Alaska Native received worse care for 43% of quality measures, and Hispanic populations received worse care for 38% of quality measures compared to White populations.2 While the causes of these minority disparities in quality care measures are multifactorial, they may persist because White populations continue to experience improving care due to possible provider biases towards minority populations.2 The Commission on Dental Accreditation (CODA) highlights the importance of cultural competence in providing care with the intent of dental hygienists recognizing cultural influences impacting the delivery of health services to individuals and communities.3 As the population of the United States (US) rapidly diversifies, it is important for dental hygienists, starting at the student level, to be prepared to meet the oral health needs of culturally diverse patients and have an awareness of racism and racist attitudes which may affect delivery of care.

Racism is defined as an organized system within a society in which policies, institutional practices, cultural representations, and others’ norms cause inequities in power across racial or ethnic groups.4 Racism can be classified as internal (integration of racist attitudes and beliefs into an individual’s viewpoint), interpersonal (interactions between individuals), and systemic (control over access to resources such as labor, material, and symbolic resources within a society).5-9 Moreover, groups who are racialized as inferior are devalued, disempowered, and may be subject to differential treatment in various sectors of society, including healthcare and healthcare outcomes.8 These inequities exist in a wide variety of health conditions including poorer access to healthcare, earlier onset of illness, increased severity and progression of illness, and higher levels of comorbidity.8,9 The National Institute of Health’s 2021 Oral Health in America Report also highlights racism as a contributing factor to oral health disparities in the United States.10 As racism in healthcare persists, this creates barriers to access to care and obstacles to working towards more equitable care for minority populations.10,11

Importantly, contemporary racism has also evolved to become more subtle forms of discrimination and prejudice not revolving around obvious discriminatory behavior which has become more socially and morally unacceptable.12,13 As a result, color-blind racial ideology has emerged as a dominant form of racism/bias and may explain some of the persistence of inequities in healthcare delivery.12,14-16 Racial color-blindness embodies two dimensions: color-evasion, which emphasizes sameness among individuals to reject the idea of White racial superiority, and power-evasion, the belief everyone has equal opportunities for success in life and failure therefore falls on the individual.17 Research indicates subscribing to color-blind ideology often leads to denial, minimization, and/or unawareness of racism or racist policies.14-16 This is often because those who are color-blind assume ignoring race helps promote racial equality.15 In a healthcare setting, where egalitarian ideals are highlighted, color-blind ideology could erroneously be seen as ideal for these reasons. However, research has indicated healthcare providers with higher color-blindness may engage in racially insensitive behavior, have an increase in negative emotions when providing care to diverse patients, and have decreased ethnocultural empathy ultimately leading to an impairment in the quality of healthcare interactions and poorer patient treatment decisions and outcomes.15,18-20 Additionally, individuals exhibiting color-blindness may also display higher levels of bias on other implicit and explicit measures of racism such as implicit attitudes tests (IATs) which may further disparities in receipt of quality healthcare.21

Dental hygienists should be competent in adhering to the standard of care and providing equitable and impartial care to all patients. However, they may not be aware of their own implicit biases, such as color-blind racial attitudes, which could affect optimal delivery of oral care. Color-blind levels can be easily assessed using the validated Color-Blind Racial Attitudes Scale (CoBRAS) which scores a participant’s level of unawareness of the implications of racism as low, moderate, or high.22 Lower scores represent more awareness of the implications of racism while higher scores represent more unawareness of the implications of racism. Levels of color-blind racial attitudes were first assessed by Ludwig et al. in first and second-year dental hygiene students at one university in Virginia and dental hygiene students were found to possess moderate levels of color-blindness.23 Ultimately, the research by Ludwig et al. recommended expanding the population starting at the student level, early in dental hygiene education, as awareness of color-blind levels is an important first step in combatting biases in the delivery of care.23 A larger cohort of dental hygiene student participants may provide information about the type of cultural competence development needed or how cultural competence should be delivered to dental hygiene students. Based on the findings of moderate levels of unawareness of racism in dental hygiene students, there is a need for more development at the student dental hygiene level in color consciousness to increase cultural competence in the delivery of oral healthcare. Therefore, the purpose of the present study was to examine color-blind racial attitudes in dental hygiene students in all five entry-level dental hygiene programs in Virginia. Additionally, this study sought to investigate differences in color-blindness between age, ethnic groups, year in dental hygiene education and program type.

METHODS

This cross-sectional survey was considered exempt (871649-3) by the Old Dominion University Institutional Review Board (IRB). A convenience sample of 220 (n=220) dental hygiene students in all five entry-level dental hygiene programs in Virginia were invited to participate in the survey. An open survey link via Qualtrics (Provo, UT, USA) was sent to the five Virginia entry-level dental hygiene program directors via email who agreed to share the study link with their student populations. With the link, directions were distributed to the target population of dental hygiene students. In an introductory statement, participants were informed of the identity of the investigators, the survey would take approximately 15 minutes to complete, that participation was anonymous and confidential, and that voluntary informed consent was understood upon return of the survey. No incentives were offered for survey completion. The survey was available electronically via Qualtrics for one month during the Spring semester.

Survey Instrument

The validated Color-Blind Racial Attitudes Scale (CoBRAS) was used to quantify contemporary racial attitudes and stereotyping.22 The 20-item scale is designed to measure participants’ lack of awareness or denial of racism in the US. Items are rated on a six-point Likert-type scale ranging from 1 (strongly disagree) to 6 (strongly disagree). The total scale is composed of three subscales. The first subscale assesses unawareness of White racial privilege and includes 7 items (e.g., “Everyone who works hard, no matter what race they are, has an equal chance to become rich”). The second subscale measures unawareness of institutional racism and has 7 items (e.g., “Social policies, such as affirmative action, discriminate unfairly against White people”). The third subscale, which has 6 items, assesses unawareness of blatant racial issues (e.g., “Racial problems in the US are rare, isolated situations”). Half of the questions are scored in reverse and item scores are added to obtain subscale scores and a total score. Overall scores may range from 20-120 and subscale scores may range from 7-42. Overall scores ranging from 20-53.3 indicate low unawareness, 53.4-83.7 moderate unawareness, and 83.8-120 high unawareness. Subscales ranging from 7-18.6 indicate low unawareness, 18.7-30.3 moderate unawareness, and 30.4-42 high unawareness. The first page of the survey included five demographic questions to determine age, gender, ethnicity, year in program, and program type; the second page included the twenty CoBRAS questions. Participants were able to review and change answers to the survey prior to completion.

Statistical Analyses

The sample size was determined based on previous research on color-blind racial attitudes in dental hygiene students which demonstrated significant differences between groups could be identified with seventy-one participants (n=71).23 Descriptive statistics were used to evaluate the means between groups. Separate one-way between subject’s ANOVA and Tukey post hoc tests were used to determine statistically significant differences (p<0.05) among dental hygiene students based on age and ethnicity. If Levene’s statistic was significant and violated the assumption of homogeneity of variance, the F-statistic was adjusted and reported using Welch’s F and Games-Howell post hoc test was utilized to identify significant differences between the groups. Independent samples t-tests were utilized to examine for statistically significant differences (p<0.05) in year in program (1st or 2nd), and program type, associate (AS) or baccalaureate (BS).

RESULTS

Two hundred and twenty entry-level dental hygiene students from Virginia were invited to participate in the study. One-hundred and sixty students completed the survey yielding a 73% participation rate (n=160). Surveys partially completed were not used for analyses. Most respondents were female (n=155, 97%) and between the ages of 18-29 (n=125, 78%). Approximately one-half of participants were in the first and second year of their entry-level associate dental hygiene education, (n=85, ≈53%), and one-half were in the first and second year of their entry-level baccalaureate dental hygiene education (n=75, ≈47%). Additionally, most respondents were White (n=101, 63%). Demographic characteristics are displayed in Table I.

View this table:
Table I.

Demographics of dental hygiene student participants

Results revealed an overall average CoBRAS score of 55.21 (Table II). While on the lower end of the range, this score indicated moderate levels of color-blindness and moderate unawareness of racism among the entry-level dental hygiene participants. When comparing overall CoBRAS means among group demographics of age and ethnicity, no statistically significant differences were found (p’s>0.05). When comparing year in program, independent samples t-test revealed participants in their second year of dental hygiene education had significantly lower overall CoBRAS scores (M=50.76) compared to participants in their first year of dental hygiene education (M=59.13) (t(158) = 2.942, p=0.004). Additionally, when comparing program types, a significant difference was found. Participants enrolled in BS programs had significantly lower overall CoBRAS scores (M=50.53) compared to those in AS programs (M=59.54) (t(158)=−3.186, p=0.002) (Table III).

View this table:
Table II.

Mean overall, subscale, and subscale question scores for all groups

View this table:
Table III.

t-test results comparing overall CoBRAS scores for program type (BS and AS) and year in program (1st or 2nd)

Additionally, CoBRAS subscale scores were compared among groups based on demographics of age, ethnicity, year in dental hygiene program, and program type. Overall participant average on the unawareness of racial privilege subscale was 25.71, indicating moderate unawareness of White racial privilege. When comparing means among group demographics of age and year in dental hygiene, no statistically significant differences were found (p>0.05). When comparing ethnicities, statistically significant differences were found between groups (F(5, 17.553) = 6.893, p=0.001). Games-Howell post hoc test found White participants had significantly lower racial privilege subscale scores (M=24.10) than Black (M=30.27) (p<0.001) and Asian participants (M=29.74) (p=0.048). Additionally, Black participants had significantly higher (M=30.27) racial privilege subscale scores compared to participants in the Other ethnicity category (M=22.67) (p=0.045). Additionally, when comparing program type, independent samples t-test revealed a statistically significant difference. Participants enrolled in BS programs had significantly higher racial privilege subscale scores (M=27.10) compared to those in AS programs (M=24.43) (t(158)=2.529, p=0.012) (Table IV).

View this table:
Table IV.

t-test results comparing racial privilege subscale scores for program type (BS and AS)

The overall average score on the institutional racism subscale was 20.90, indicating moderate unawareness of institutional types of discrimination. When comparing means among group demographics of age, ethnicity, and year in program, no statistically significant differences were found (p’s>0.05). When comparing program type, however, independent samples t-test revealed a statistically significant difference. Participants enrolled in BS programs had significantly lower institutional discrimination subscale scores (M=19.56) compared to those in AS programs (M=22.14) (t(158)=−2.884, p=0.004).

Lastly, the overall average score on the blatant racial issues subscale was 22.44, indicating moderate unawareness of more overt racial racism. When comparing means among group demographics of age, ethnicity, year in dental hygiene program, and program type, no significant differences were found (p’s>0.05).

DISCUSSION

Racial biases in healthcare providers may influence decision-making, judgement, communication, and treatment decisions, thus perpetuating inequities in minority patient care.24-27 Unconscious or implicit types of biases such as color-blind racial attitudes may be harder to navigate and recognize as they are typically deep-seated in the subconscious.28,29 It is important for clinicians to mitigate implicit bias which may impact patient oral care outcomes. This study sought to identify prevalence of color-blind racial attitudes in all five entry-level dental hygiene programs in one state.

Results of the CoBRAS questionnaire indicate a moderate level of unawareness of denial of racism among study participants. These results support recent previous research findings in dental hygiene students, dental students, and practicing dental hygienist providers.23,30-32 In the present study, overall mean scores and average scores for all subscale measures indicated moderate levels of unawareness of racism, White privilege, institutional discrimination, and more overt racist acts among the dental hygiene student participants. However, the overall CoBRAS score was on the lower end of the moderate range indicating an increase in cultural competence education at the student level may assist in achieving scores in the low range and maintaining awareness of racism in the future.

In contrast, separate research studies by Ludwig et al. found dental hygiene students in one program surveyed and practicing dental hygienists had low levels of unawareness of blatant racial issues.23,32 This study indicates that dental hygiene student participants are more unaware of overt types of racism. Explicit (overt) racist actions and expressions are often most severe for indigenous, Black, and other minority Americans in everyday instances, and since this study population was largely White, perhaps they have not been subject to racist attitudes or acts which led to their unawareness.33 Additionally, these findings may be related to participant peer interaction during their education. One study on college student interaction with other races found White students were least likely to have one of their four closest friends from a different race and tended to have close friends from the same race.34 It is possible the participants in this student population have not had extensive interracial peer experience during their dental hygiene education which may have exposed them to racial biases or conflict thus resulting in the moderate unawareness of more pervasive racial actions. This points to a need for increased diversity in student populations to allow more opportunities for students to form interracial peer relationships which may expand experiences and awareness of explicit racial actions and behaviors.

Year in dental hygiene education was significant in overall measures of color-blind attitudes. Participants in their second year of dental hygiene education had significantly lower overall CoBRAS scores than participants in their first year of dental hygiene education indicating more awareness of the overall implications of racism. Previous research by Ludwig et al. on dental hygiene students in one program found no significant differences between first- and second-year students on CoBRAS overall or subscale scores.23 This may be due to the expanded sample size or participants in their second year of baccalaureate education may have completed more coursework and possibly been exposed to more curricula focused on treating diverse patient populations. Being further along in their education, participants may have also had more clinical experiences with varying cultures while providing dental hygiene care which may have led to more awareness of the overall implications of racism. Also, recent media focus on implicit and explicit types of biases and racist acts may have increased awareness of racial inequalities.35

The type of program also affected levels of color-blindness in participants. Participants currently enrolled in baccalaureate dental hygiene programs had significantly lower overall CoBRAS scores compared to those in an associate degree program. It is possible a university environment may offer more opportunities to attend events, join student organizations, or learn about different cultures which may have contributed to this finding. Also, additional curriculum and patient experiences provided during baccalaureate education may have influenced the lower overall CoBRAS scores. On the institutional discrimination subscale, participants enrolled in BS programs were more aware of institutional types of racism or racial inequalities that exist at a societal, political, and economic level.36,37 Importantly, low levels of institutional discrimination may assist in understanding unfair policies and racial institutional culture which creates barriers for underserved and minority groups in obtaining goods and services such as oral healthcare.38,39 For the racial privilege subscale, which assesses awareness of racial privilege, participants in an AS program were more aware of the implications of White racial privilege. Since the ethnicities of the dental hygiene participants in this study were relatively similar whether in a baccalaureate or associate program, these findings highlight a need for further exploration of unconscious attitudes and recognition of racial privilege in baccalaureate degree education. Additionally, associate-level dental hygiene curricula may consider more training and coursework on institutional types of discrimination to increase awareness of these types of constructs to improve outcomes of delivery of dental hygiene care to minority populations. Case and vignette studies including these subscale CoBRAS constructs may assist in increasing awareness in both baccalaureate and associate education.

Moreover, over half of participants in the present study were White, and the racial and ethnic makeup of dental hygiene students remains predominantly White. Sixty percent of dental hygiene students enrolled in programs in the US in the 2021-2022 academic year identified as White.40 Importantly, a lack of diversity in oral health care providers may contribute to inequities in access to care. Additionally, racially concordant healthcare interactions are associated with more positive outcomes related to communication as well as utilization of healthcare services.41-43 Importantly, increasing diversity in dental hygiene student populations may expose students to more culturally diverse peers and situations thereby increasing their cultural competence and awareness of the implications of racism.

Finally, the overall finding was moderate levels of unconscious biases related to racism in overall and all subscale measures regardless of age, ethnicity, year in program, or program type. Multicultural competence is critical for dental hygiene curricula as patient populations are rapidly diversifying. Furthermore, CODA standards require program evidence of cultural competence in dental hygiene.3 Dental hygiene curriculum aimed at eliminating health disparities, especially related to race, should include education about color-blind ideology and constructs, stereotypes, and how to recognize implicit bias. The Color-Blind Racial Attitudes Scale is an excellent tool for discovering unconscious bias as it relates to racism; identification of implicit biases is the first step in combatting the effects these biases may have on providing culturally competent oral care. Dental hygiene educators may consider incorporation of implicit bias training, such as administering the CoBRAS early in dental hygiene education and repetitively throughout the curriculum. These biases exist in dental hygiene students, as demonstrated by the findings in the present study and previous research.23,30-32 Increasing awareness of these unconscious types of biases early and continually in dental hygiene education may assist in improving delivery of oral healthcare to increasingly diverse populations in the future.

Limitations and Future Research

Several limitations may have influenced this study. This study consisted of a convenience sample of entry-level dental hygiene students in one state which limits the generalizability of results. A lack of diversity in ages and ethnicities may have influenced results as well. There may be bias in response to CoBRAS questions as participants may have chosen answers based on what they thought was morally or socially acceptable. Future studies should examine educational interventions focused on identifying implicit and explicit biases and decreasing racial inequities. Future studies may consider varying cultural experiences and the effects on color-blind racial attitudes. Examining the current curriculum to assess where changes may be needed to increase cultural competence may make students more effective at providing equitable care. Finally, expanding the sample population to include dental hygiene students across the US may provide more insight into the prevalence of implicit biases such as color-blind racial attitudes as well as the mediating variables which may be contributing.

CONCLUSION

Dental hygiene student participants were moderately unaware of the implications of color-blind racial ideology and the constructs of racism. Participants further along in their education and enrolled in BS programs had significantly lower overall CoBRAS scores compared to those in their first year of dental hygiene education or enrolled in an AS program. Findings highlight a need for more research to understand the implications of color-blindness in delivery of dental hygiene care. Curriculum to combat and recognize implicit types of biases early in dental hygiene education may increase ethnocultural empathy and competence and facilitate better oral healthcare treatment to diverse populations later in the career. Lastly, efforts to recruit diverse dental hygiene student applicants may increase peer-to-peer cultural experiences and increase the number of culturally diverse dental hygiene providers to meet the needs of the rapidly diversifying population.

Footnotes

  • NDHRA priority area: Professional development: Education (educational models).

  • DISCLOSURES

    The authors have no conflicts of interests to disclose. No outside funding was received for this research.

  • Received April 29, 2023.
  • Accepted August 5, 2023.

REFERENCES

  1. 1.↵
    1. Smedley BD,
    2. Stith AY,
    3. Nelson AR.
    Unequal treatment: confronting racial and ethnic disparities in health care [Internet]. Washington, DC: The National Academies Press; 2003 [cited 2023 Apr 17]. Available from: https://www.nap.edu/read/12875/chapter/1
  2. 2.↵
    2022 National Healthcare Quality and Disparities Report. Rockville (MD): Agency for Healthcare Research and Quality; October 2022. AHRQ Pub. No. 22(23)-0030.
  3. 3.↵
    1. Commission on Dental Accreditation
    . Accreditation standards for dental hygiene education programs [Internet]. Chicago, IL: American Dental Association; 2022 [cited 2023 Apr 2]. Avaialble from: https://coda.ada.org/-/media/project/ada-organization/ada/coda/files/dental_hygiene_standards.pdf?rev=aa609ad18b504e9f9cc63f0b3715a5fd&hash=67CB76127017AD98CF8D62088168EA58
  4. 4.↵
    1. Paradies Y,
    2. Ben J,
    3. Denson N, et al.
    Racism as a determinant of health: a systematic review and meta analysis. PLoS One. 2015 Sep;10(9):e0138511.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Paradies Y.
    Defining, conceptualizing and characterizing racism in health research. Crit Public Health. 2006 Jun;16(2):143-57.
    OpenUrl
  6. 6.
    1. Berman G,
    2. Paradies Y.
    Racism, disadvantage and multiculturalism: towards effective anti-racist praxis. Ethn Racial Stud. 2010 Feb;33(2):214-32.
    OpenUrlCrossRef
  7. 7.
    1. Hamilton C,
    2. Carmichael S.
    Black power. New York: Random House; 1967. 256 p.
  8. 8.↵
    1. Williams DR,
    2. Lawrence JA,
    3. Davis BA.
    Racism and health: evidence and needed research. Annu Rev Public Health. 2019 Apr;40(1):105-25.
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Major B,
    2. Dovido JF,
    3. Link BG
    1. Priest N,
    2. Williams DR.
    Racial discrimination and racial disparities in health. In Major B, Dovido JF, Link BG, editors, The Oxford handbook of stigma, discrimination and health. Oxford: Oxford University Press; 2018. p. 163-65.
  10. 10.↵
    1. National Institutes of Health
    . Oral health in America: Advances and challenges. [Internet]. Bethesda (MD): US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021 [cited 2023 Apr 1]. Available from: https://www.nidcr.nih.gov/research/oralhealthinamerica
  11. 11.↵
    1. Yearby R,
    2. Clark B,
    3. Figueroa J.
    Structural racism in historical and modern US health care Policy. Health Affairs. 2022 Feb;41(2):187-94.
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. Bonilla-Silva E.
    Racism without racists: color-blind racism and the persistence of racial inequality in America. Lanham, MD: Rowman & Littlefield; 2003. 363 p.
  13. 13.↵
    1. Bobo LD,
    2. Fox C.
    Race, racism, and discrimination: Bridging problems, methods, and theory in social psychological research. Soc Psychol Q. 2003 Dec;66:319-32.
    OpenUrlCrossRef
  14. 14.↵
    1. Bonilla-Silva E.
    Rethinking racism: toward a structural interpretation. Am Sociol Rev. 1997 Jun;62(3):465–80.
    OpenUrlCrossRef
  15. 15.↵
    1. Neville HA,
    2. Awad GH,
    3. Brooks JE, et al.
    Color-blind racial ideology: theory, training, and measurement implications in psychology. Am Psychol 2013 Sep;68(6):455-66.
    OpenUrlCrossRefPubMed
  16. 16.↵
    1. Neville HA,
    2. Coleman MN,
    3. Falconer JW,
    4. Holmes D.
    Color-blind racial ideology and psychological false consciousness among African Americans. J Black Psychol. 2005 Feb;31:27-45.
    OpenUrlCrossRef
  17. 17.↵
    1. Frankenberg R.
    White women, race matters: the social construction of whiteness. Minneapolis (MN): University of Minnesota Press; 2003. 304p
  18. 18.↵
    1. Holoien DS,
    2. Shelton JN.
    You deplete me: The cognitive costs of colorblindness on ethnic minorities. J Exp Soc Psychol. 2012 Mar;48(2):562-65.
    OpenUrlCrossRef
  19. 19.
    1. Bukard AW,
    2. Knox S.
    Effect of therapist color-blindness on empathy and attributions in cross-cultural counseling. J Couns Psychol. 2004 Oct;51(4):387-97.
    OpenUrlCrossRef
  20. 20.↵
    1. Neville, HA,
    2. Gallardo, ME,
    3. Sue DW
    1. Penner LA,
    2. Dovidio JF.
    Racial color blindness and Black-White health care disparities. In: Neville, HA, Gallardo, ME, Sue DW, editors. The myth of racial color blindness: Manifestations, dynamics and impact. American Psychological Association; 2016. p. 275-293.
  21. 21.↵
    1. Richeson JA,
    2. Nussbaum RJ.
    The impact of multiculturalism versus colorblindness on racial bias. J Exp Soc Psychol. 2004 May;40(3):417-23.
    OpenUrlCrossRef
  22. 22.↵
    1. Neville H,
    2. Lilly R,
    3. Duran G, et al.
    Construction and initial validation of the color-blind racial attitudes scale (CoBRAS). J Couns Psychol. 2000 Jan;47(1):59-70.
    OpenUrlCrossRef
  23. 23.↵
    1. Ludwig E,
    2. Tolle S,
    3. Suedbeck J.
    Color-blind racial attitudes in dental hygiene students: A pilot study. J Dent Hyg. 2019 Oct;93(5):15-22.
    OpenUrlFREE Full Text
  24. 24.↵
    1. Cooper LA,
    2. Roter DL,
    3. Carson KA, et al.
    The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012 May;102(5):979-87.
    OpenUrlCrossRefPubMed
  25. 25.
    1. Johnson RL,
    2. Roter D,
    3. Powe NR, et al.
    Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004 Dec; 94(12):2084-90.
    OpenUrlCrossRefPubMed
  26. 26.
    1. Green AR,
    2. Carney DR,
    3. Pallin DJ, et al.
    Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007 Apr;22(9):1231-8.
    OpenUrlCrossRefPubMed
  27. 27.↵
    1. van Ryn M,
    2. Burgess DJ,
    3. Dovidio JF, et al.
    The impact of racism on clinician cognition, behavior, and clinical decision making. Du Bois Rev. 2011 Apr;8(1):199-218
    OpenUrlCrossRefPubMed
  28. 28.↵
    1. Blair IV,
    2. Banaji MR.
    Automatic and controlled processes in stereotype priming. J Pers Soc Psychol. 1996 Jun;70:1142-63.
    OpenUrlCrossRef
  29. 29.↵
    1. Devine PG.
    Stereotypes and prejudice: their automatic and controlled components. J Pers Soc Psychol. 1989 Jan; 56(1):5-18.
    OpenUrlCrossRefPubMed
  30. 30.↵
    1. Su Y,
    2. Behar-Horenstien LS.
    Color-blind racial beliefs among dental students and faculty. J Dent Educ. 2017 Sep;81(9):1098-1107.
    OpenUrlAbstract/FREE Full Text
  31. 31.
    1. Behar-Horenstein LS,
    2. Garvan C.
    Relationships among knowledge, efficacy, and practices instrument, color-blind racial attitudes scale, Deamonte Driver survey, and defining issues test 2. J Dent Educ. 2016 Apr;80(3):355-64.
    OpenUrlAbstract/FREE Full Text
  32. 32.↵
    1. Ludwig EA,
    2. Tolle SL,
    3. Suedbeck J.
    Color-Blind Racial Attitudes in Practicing Dental hygienists. J Dent Hyg. 2022 Apr;96(2):25-34.
    OpenUrlFREE Full Text
  33. 33.↵
    1. Lavalley R,
    2. Robinson Johnson, K.
    Occupation, injustice, and anti-Black racism in the United States of America. J Occ Sci. 2020 Sep;27(1):487-99.
    OpenUrl
  34. 34.↵
    1. Park J.
    Clubs and the campus racial climate: student organizations and interracial friendship in college. J Coll Stud Dev. 2014 Oct;55(7):641-60.
    OpenUrl
  35. 35.↵
    1. Roberts SO,
    2. Rizzo MT.
    The psychology of American racism. Am Psychol. 2020 Jun;76(3):475-87.
    OpenUrl
  36. 36.↵
    1. Hardeman RR,
    2. Medina EM,
    3. Kozhimannil, KB.
    Structural racism and supporting black lives: the role of health professionals. New Eng J Med. 2016 Dec;375(22):2113-15
    OpenUrlCrossRefPubMed
  37. 37.↵
    1. King CJ,
    2. Redwood Y.
    The health care institution, population health and black lives. J Nat Med Assoc. 2016 Jun;108(2):131-36.
    OpenUrl
  38. 38.↵
    1. Sabbah W,
    2. Gireesh A,
    3. Chari M, et al.
    Racial discrimination and uptake of dental services among American adults. Int J Environ Res Public Health. 2019 May;16(9):1558-66.
    OpenUrl
  39. 39.↵
    1. Yearby R.
    Racial disparities in health status and access to healthcare: The continuation of inequality in the United States due to structural racism. Am J Econ Sociol. 2018 Oct;77(3):1113-1152.
    OpenUrlCrossRef
  40. 40.↵
    1. Commission on Dental Accreditation
    . 2021-2022 Survey of dental hygiene education programs [Internet]. Chicago (IL): American Dental Association Health Policy Institute; 2022 Dec [cited 2023 Apr 17]. Available from: https://coda.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/sall_dh_2021-22.xlsx?rev=30fb9e0ee89544f4a8901c751a61bf71&hash=399C88BE2D44012071267E6F2D68785B
  41. 41.↵
    1. Shen MJ,
    2. Peterson MB,
    3. Costas-Muniz R, et al.
    The effects of race and racial concordance on patient-physician communication: a systematic review of literature. J Racial Ethn Health Disparities 2018 Feb;5(1):117-40.
    OpenUrl
  42. 42.
    1. Safran DG,
    2. Taira DA.
    3. Rogers WH, et al.
    Linking primary care performance to outcomes of care. J Fam Pract. 1998 Sep; 47(3):213-20.
    OpenUrlPubMed
  43. 43.↵
    1. Strumpf, E.C.
    Racial/ethnic disparities in primary care: the role of physician-patient concordance. Med Care. 2011 May;49(5):496-503.
    OpenUrlCrossRefPubMed
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Color-Blind Racial Attitudes in Entry-Level Dental Hygiene Students in Virginia
Emily A. Ludwig, Jessica R. Suedbeck
American Dental Hygienists' Association Oct 2023, 97 (5) 79-90;
del.icio.us logo Twitter logo Facebook logo Mendeley logo

Jump to section

Keywords