Health Care AI, Intended To Save Money, Turns Out To Require a Lot of Expensive Humans
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Preparing cancer patients for difficult decisions is an oncologist’s job. They don’t always remember to do it, however. At the University of Pennsylvania Health System, doctors are nudged to talk about a patient’s treatment and end-of-life preferences by an artificially intelligent algorithm that predicts the chances of death.
But it’s far from being a set-it-and-forget-it tool. A routine tech checkup revealed the algorithm decayed during the covid-19 pandemic, getting 7 percentage points worse at predicting who would die, according to a 2022 study.
There were likely real-life impacts. Ravi Parikh, an Emory University oncologist who was the study’s lead author, told KFF Health News the tool failed hundreds of times to prompt doctors to initiate that important discussion — possibly heading off unnecessary chemotherapy — with patients who needed it.
He believes several algorithms designed to enhance medical care weakened during the pandemic, not just the one at Penn Medicine. “Many institutions are not routinely monitoring the performance” of their products, Parikh said.
Algorithm glitches are one facet of a dilemma that computer scientists and doctors have long acknowledged but that is starting to puzzle hospital executives and researchers: Artificial intelligence systems require consistent monitoring and staffing to put in place and to keep them working well.
In essence: You need people, and more machines, to make sure the new tools don’t mess up.
“Everybody thinks that AI will help us with our access and capacity and improve care and so on,” said Nigam Shah, chief data scientist at Stanford Health Care. “All of that is nice and good, but if it increases the cost of care by 20%, is that viable?”
Government officials worry hospitals lack the resources to put these technologies through their paces. “I have looked far and wide,” FDA Commissioner Robert Califf said at a recent agency panel on AI. “I do not believe there’s a single health system, in the United States, that’s capable of validating an AI algorithm that’s put into place in a clinical care system.”
AI is already widespread in health care. Algorithms are used to predict patients’ risk of death or deterioration, to suggest diagnoses or triage patients, to record and summarize visits to save doctors work, and to approve insurance claims.
If tech evangelists are right, the technology will become ubiquitous — and profitable. The investment firm Bessemer Venture Partners has identified some 20 health-focused AI startups on track to make $10 million in revenue each in a year. The FDA has approved nearly a thousand artificially intelligent products.
Evaluating whether these products work is challenging. Evaluating whether they continue to work — or have developed the software equivalent of a blown gasket or leaky engine — is even trickier.
Take a recent study at Yale Medicine evaluating six “early warning systems,” which alert clinicians when patients are likely to deteriorate rapidly. A supercomputer ran the data for several days, said Dana Edelson, a doctor at the University of Chicago and co-founder of a company that provided one algorithm for the study. The process was fruitful, showing huge differences in performance among the six products.
It’s not easy for hospitals and providers to select the best algorithms for their needs. The average doctor doesn’t have a supercomputer sitting around, and there is no Consumer Reports for AI.
“We have no standards,” said Jesse Ehrenfeld, immediate past president of the American Medical Association. “There is nothing I can point you to today that is a standard around how you evaluate, monitor, look at the performance of a model of an algorithm, AI-enabled or not, when it’s deployed.”
Perhaps the most common AI product in doctors’ offices is called ambient documentation, a tech-enabled assistant that listens to and summarizes patient visits. Last year, investors at Rock Health tracked $353 million flowing into these documentation companies. But, Ehrenfeld said, “There is no standard right now for comparing the output of these tools.”
And that’s a problem, when even small errors can be devastating. A team at Stanford University tried using large language models — the technology underlying popular AI tools like ChatGPT — to summarize patients’ medical history. They compared the results with what a physician would write.
“Even in the best case, the models had a 35% error rate,” said Stanford’s Shah. In medicine, “when you’re writing a summary and you forget one word, like ‘fever’ — I mean, that’s a problem, right?”
Sometimes the reasons algorithms fail are fairly logical. For example, changes to underlying data can erode their effectiveness, like when hospitals switch lab providers.
Sometimes, however, the pitfalls yawn open for no apparent reason.
Sandy Aronson, a tech executive at Mass General Brigham’s personalized medicine program in Boston, said that when his team tested one application meant to help genetic counselors locate relevant literature about DNA variants, the product suffered “nondeterminism” — that is, when asked the same question multiple times in a short period, it gave different results.
Aronson is excited about the potential for large language models to summarize knowledge for overburdened genetic counselors, but “the technology needs to improve.”
If metrics and standards are sparse and errors can crop up for strange reasons, what are institutions to do? Invest lots of resources. At Stanford, Shah said, it took eight to 10 months and 115 man-hours just to audit two models for fairness and reliability.
Experts interviewed by KFF Health News floated the idea of artificial intelligence monitoring artificial intelligence, with some (human) data whiz monitoring both. All acknowledged that would require organizations to spend even more money — a tough ask given the realities of hospital budgets and the limited supply of AI tech specialists.
“It’s great to have a vision where we’re melting icebergs in order to have a model monitoring their model,” Shah said. “But is that really what I wanted? How many more people are we going to need?”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Pasteurization: What It Does And Doesn’t Do
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Pasteurization’s Effect On Risks & Nutrients
In Wednesday’s newsletter, we asked you for your health-related opinions of raw (cow’s) milk, and got the above-depicted, below-described, set of responses:
- About 47% said “raw milk is dangerous to consume, whereas pasteurization makes it safer”
- About 31% said “raw milk is a good source of vital nutrients which pasteurization would destroy”
- About 14% said “both raw milk and pasteurized milk are equally unhealthy”
- About 9% said “both raw milk and pasteurized milk are equally healthy”
Quite polarizing! So, what does the science say?
“Raw milk is dangerous to consume, whereas pasteurization makes it safer: True or False?”
True! Coincidentally, the 47% who voted for this are mirrored by the 47% of the general US population in a similar poll, deciding between the options of whether raw milk is less safe to drink (47%), just as safe to drink (15%), safer to drink (9%), or not sure (30%):
Public Fails to Appreciate Risk of Consuming Raw Milk, Survey Finds
As for what those risks are, by the way, unpasteurized dairy products are estimated to cause 840x more illness and 45x more hospitalizations than pasteurized products.
This is because unpasteurized milk can (and often does) contain E. coli, Listeria, Salmonella, Cryptosporidium, and other such unpleasantries, which pasteurization kills.
Source for both of the above claims:
(we know the title sounds vague, but all this information is easily visible in the abstract, specifically, the first two paragraphs)
Raw milk is a good source of vital nutrients which pasteurization would destroy: True or False?
False! Whether it’s a “good” source can be debated depending on other factors (e.g., if we considered milk’s inflammatory qualities against its positive nutritional content), but it’s undeniably a rich source. However, pasteurization doesn’t destroy or damage those nutrients.
Incidentally, in the same survey we linked up top, 16% of the general US public believed that pasteurization destroys nutrients, while 41% were not sure (and 43% knew that it doesn’t).
Note: for our confidence here, we are skipping over studies published by, for example, dairy farming lobbies and so forth. Those do agree, by the way, but nevertheless we like sources to be as unbiased as possible. The FDA, which is not completely unbiased, has produced a good list of references for this, about half of which we would consider biased, and half unbiased; the clue is generally in the journal names. For example, Food Chemistry and the Journal of Food Science and Journal of Nutrition are probably less biased than the International Dairy Association and the Journal of Dairy Science:
FDA | Raw Milk Misconceptions and the Danger of Raw Milk Consumption
this page covers a lot of other myths too, more than we have room to “bust” here, but it’s very interesting reading and we recommend to check it out!
Notably, we also weren’t able to find any refutation by counterexample on PubMed, with the very slight exception that some studies sometimes found that in the case of milks that were of low quality, pasteurization can reduce the vitamin E content while increasing the vitamin A content. For most milks however, no significant change was found, and in all cases we looked at, B-vitamins were comparable and vitamin D, popularly touted as a benefit of cow’s milk, is actually added later in any case. And, importantly, because this is a common argument, no change in lipid profiles appears to be findable either.
In science, when something has been well-studied and there aren’t clear refutations by counterexample, and the weight of evidence is clearly very much tipped into one camp, that usually means that camp has it right.
Milk generally is good/bad for the health: True or False?
True or False, depending on what we want to look at. It’s definitely not good for inflammation, but the whole it seems to be cancer-neutral and only increases heart disease risk very slightly:
- Keep Inflammation At Bay ← short version is milk is bad, fermented milk products are fine in moderation
- Is Dairy Scary? ← short version is that milk is neither good nor terrible; fermented dairy products however are health-positive in numerous ways when consumed in moderation
You may be wondering…
…how this goes for the safety of dairy products when it comes to the bird flu currently affecting dairy cows, so:
Take care!
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How Your Brain Chooses What To Remember
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During the day, your brain is simply too busy to encode memories without interfering with normal processing. At night, however…
The filing system
The brain decides which memories to keep based on significance, using sharp brain wave ripples as an internal bookmarking system. Everyday memories fade, while important events are tagged in this manner for consolidation during sleep.
How does it do this? It starts in the hippocampus, which records experiences during wakefulness and replays them repeatedly at high speed during sleep, preparing them for transfer to the neocortex.
How do we know? Uniform Manifold Approximation & Projection (UMAP) for dimension reduction is a tool that condenses 400-dimensional neural activity data into 3D for visualization. Mice navigating a maze showed hippocampal activity encoding location and learning progression; it also showed neural patterns reflecting maze layout and task mastery.
What this means in practical terms: you need to get good sleep if you don’t want to lose your memories!
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How To Boost Your Memory Immediately (Without Supplements)
Take care!
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52 Weeks to Better Mental Health – by Dr. Tina Tessina
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We’ve written before about the health benefits of journaling, but how to get started, and how to make it a habit, and what even to write about?
Dr. Tessina presents a year’s worth of journaling prompts with explanations and exercises, and no, they’re not your standard CBT flowchart things, either. Rather, they not only prompt genuine introspection, but also are crafted to be consistently uplifting—yes, even if you are usually the most disinclined to such positivity, and approach such exercises with cynicism.
There’s an element of guidance beyond that, too, and as such, this book is as much a therapist-in-a-book as you might find. Of course, no book can ever replace a competent and compatible therapist, but then, competent and compatible therapists are often harder to find and can’t usually be ordered for a few dollars with next-day shipping.
Bottom line: if undertaken with seriousness, this book will be an excellent investment in your mental health and general wellbeing.
Click here to check out 52 Weeks to Better Mental Health, and get on the best path for you!
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Eat All You Want (But Wisely)
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Some Surprising Truths About Hunger And Satiety
This is Dr. Barbara Rolls. She’s Professor and Guthrie Chair in Nutritional Sciences, and Director of the Laboratory for the Study of Human Ingestive Behavior at Pennsylvania State University, after graduating herself from Oxford and Cambridge (yes, both). Her “awards and honors” take up four A4 pages, so we won’t list them all here.
Most importantly, she’s an expert on hunger, satiety, and eating behavior in general.
What does she want us to know?
First and foremost: you cannot starve yourself thin, unless you literally starve yourself to death.
What this is about: any weight lost due to malnutrition (“not eating enough” is malnutrition) will always go back on once food becomes available. So unless you die first (not a great health plan), merely restricting good will always result in “yo-yo dieting”.
So, to avoid putting the weight back on and feeling miserable every day along the way… You need to eat as much as you feel you need.
But, there’s a trick here (it’s about making you genuinely feel you need less)!
Your body is an instrument—so play it
Your body is the tool you use to accomplish pretty much anything you do. It is, in large part, at your command. Then there are other parts you can’t control directly.
Dr. Rolls advises taking advantage of the fact that much of your body is a mindless machine that will simply follow instructions given.
That includes instructions like “feel hungry” or “feel full”. But how to choose those?
Volume matters
An important part of our satiety signalling is based on a physical sensation of fullness. This, by the way, is why bariatric surgery (making a stomach a small fraction of the size it was before) works. It’s not that people can’t eat more (the stomach is stretchy and can also be filled repeatedly), it’s that they don’t want to eat more because the pressure sensors around the stomach feel full, and signal the hormone leptin to tell the brain we’re full now.
Now consider:
- On the one hand, 20 grapes, fresh and bursting with flavor
- On the other hand, 20 raisins (so, dried grapes), containing the same calories
Which do you think will get the leptin flowing sooner? Of course, the fresh grapes, because of the volume.
So if you’ve ever seen those photos that show two foods side by side with the same number of calories but one is much larger (say, a small slice of pizza or a big salad), it’s not quite the cheap trick that it might have appeared.
Or rather… It is a cheap trick; it’s just a cheap trick that works because your stomach is quite a simple organ.
So, Dr. Rolls’ advice: generally speaking, go for voluminous food. Fruit is great from this, because there’s so much water. Air-popped popcorn also works great. Vegetables, too.
Water matters, but differently than you might think
A well-known trick is to drink water before and with a meal. That’s good, it’s good to be hydrated. However, it can be better. Dr. Rolls did an experiment:
The design:
❝Subjects received 1 of 3 isoenergetic (1128 kJ) preloads 17 min before lunch on 3 d and no preload on 1 d.
The preloads consisted of 1) chicken rice casserole, 2) chicken rice casserole served with a glass of water (356 g), and 3) chicken rice soup.
The soup contained the same ingredients (type and amount) as the casserole that was served with water.❞
The results:
❝Decreasing the energy density of and increasing the volume of the preload by adding water to it significantly increased fullness and reduced hunger and subsequent energy intake at lunch.
The equivalent amount of water served as a beverage with a food did not affect satiety.❞
The conclusion:
❝Consuming foods with a high water content more effectively reduced subsequent energy intake than did drinking water with food.❞
You can read the study in full (it’s a worthwhile read!) here:
Water incorporated into a food but not served with a food decreases energy intake in lean women
Protein matters
With all those fruits and vegetables and water, you may be wondering Dr. Rolls’ stance on proteins. It’s simple: protein is an appetite suppressant.
However, it takes about 20 minutes to signal the brain about that, so having some protein in a starter (if like this writer, you’re the cook of the household, a great option is to enjoy a small portion of nuts while cooking!) gets that clock ticking, to signal satiety sooner.
It may also help in other ways:
Clinical Evidence and Mechanisms of High-Protein Diet-Induced Weight Loss
As for other foods that can suppress appetite, by the way, you might like;
25 Foods That Act As Natural Appetite Suppressants
Variety matters, and in ways other than you might think
A wide variety of foods (especially: a wide variety of plants) in one’s diet is well recognized as a key to a good balanced diet.
However…
A wide variety of dishes at the table, meanwhile, promotes greater consumption of food.
Dr. Rolls did a study on this too, a while ago now (you’ll see how old it is) but the science seems robust:
Variety in a Meal Enhances Food Intake in Man
Notwithstanding the title, it wasnot about a man (that was just how scientists wrote in ye ancient times of 1981). The test subjects were, in order: rats, cats, a mixed group of men and women, the same group again, and then a different group of all women.
So, Dr. Rolls’ advice is: it’s better to have one 20-ingredient dish, than 10 dishes with 20 ingredients between them.
Sorry! We love tapas and buffets too, but that’s the science!
So, “one-pot” meals are king in this regard; even if you serve it with one side (reasonable), that’s still only two dishes, which is pretty good going.
Note that the most delicious many-ingredient stir-fries and similar dishes from around the world also fall into this category!
Want to know more?
If you have the time (it’s an hour), you can enjoy a class of hers for free:
Want to watch it, but not right now? Bookmark it for later
Enjoy!
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Getting Things Done – by David Allen
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Our “to-do” lists are usually hopelessly tangled:
“To do thing x needs thing y doing first but that can only be done with information that I must get by doing thing z”, and so on.
Suddenly that two-minute task is looking like half an hour, which is making our overall to-do list look gargantuan. Tackling tiny parts of tasks seems useless; tackling large tasks seems overwhelming. What a headache!
Getting Things Done (“GTD”, to its friends) shows us how to gather all our to-dos, and then use the quickest ways to break down a task (in reality, often a mini-project) into its constituent parts and which things can be done next, and what order to do them in (or defer, or delegate, or ditch).
In a nutshell: The GTD system aims to make all your tasks comprehensible and manageable, for stress-free productivity. No need to strategize everything every time; you have a system now, and always know where to begin.
And by popular accounts, it delivers—many put this book in the “life-changing” category.
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Hope: A research-based explainer
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This year, more than 60 countries, representing more than 4 billion people, will hold major elections. News headlines already are reporting that voters are hanging on to hope. When things get tough or don’t go our way, we’re told to hang on to hope. HOPE was the only word printed on President Barack Obama’s iconic campaign poster in 2008.
Research on hope has flourished only in recent decades. There’s now a growing recognition that hope has a role in physical, social, and mental health outcomes, including promoting resilience. As we embark on a challenging year of news, it’s important for journalists to learn about hope.
So what is hope? And what does the research say about it?
Merriam-Webster defines hope as a “desire accompanied by expectation of or belief in fulfillment.” This definition highlights the two basic dimensions of hope: a desire and a belief in the possibility of attaining that desire.
Hope is not Pollyannaish optimism, writes psychologist Everett Worthington in a 2020 article for The Conversation. “Instead, hope is a motivation to persevere toward a goal or end state, even if we’re skeptical that a positive outcome is likely.”
There are several scientific theories about hope.
One of the first, and most well-known, theories on hope was introduced in 1991 by American psychologist Charles R. Snyder.
In a paper published in the Journal of Personality and Social Psychology, Snyder defined hope as a cognitive trait centered on the pursuit of goals and built on two components: a sense of agency in achieving a goal, and a perceived ability to create pathways to achieve that goal. He defined hope as something individualistic.
Snyder also introduced the Hope Scale, which continues to be used today, as a way to measure hope. He suggested that some people have higher levels of hope than others and there seem to be benefits to being more hopeful.
“For example, we would expect that higher as compared with lower hope people are more likely to have a healthy lifestyle, to avoid life crises, and to cope better with stressors when they are encountered,” they write.
Others have suggested broader definitions.
In 1992, Kaye Herth, a professor of nursing and a scholar on hope, defined hope as “a multidimensional dynamic life force characterized by a confident yet uncertain expectation of achieving good, which to the hoping person, is realistically possible and personally significant.” Herth also developed the Herth Hope Index, which is used in various settings, including clinical practice and research.
More recently, others have offered an even broader definition of hope.
Anthony Scioli, a clinical psychologist and author of several books on hope, defines hope “as an emotion with spiritual dimensions,” in a 2023 review published in Current Opinion in Psychology. “Hope is best viewed as an ameliorating emotion, designed to fill the liminal space between need and reality.”
Hope is also nuanced.
“Our hopes may be active or passive, patient or critical, private or collective, grounded in the evidence or resolute in spite of it, socially conservative or socially transformative,” writes Darren Webb in a 2007 study published in History of the Human Sciences. “We all hope, but we experience this most human of all mental feelings in a variety of modes.”
To be sure, a few studies have shown that hope can have negative outcomes in certain populations and situations. For example, one study highlighted in the research roundup below finds that Black college students who had higher levels of hope experienced more stress due to racial discrimination compared with Black students who had lower levels of hope.
Today, hope is one of the most well-studied constructs within the field of positive psychology, according to the journal Current Opinion in Psychology, which dedicated its August 2023 issue to the subject. (Positive psychology is a branch of psychology focused on characters and behaviors that allow people to flourish.)
We’ve gathered several studies below to help you think more deeply about hope and recognize its role in your everyday lives.
Research roundup
The Role of Hope in Subsequent Health and Well-Being For Older Adults: An Outcome-Wide Longitudinal Approach
Katelyn N.G. Long, et al. Global Epidemiology, November 2020.The study: To explore the potential public health implications of hope, researchers examine the relationship between hope and physical, behavioral and psychosocial outcomes in 12,998 older adults in the U.S. with a mean age of 66.
Researchers note that most investigations on hope have focused on psychological and social well-being outcomes and less attention has been paid to its impact on physical and behavioral health, particularly among older adults.
The findings: Results show a positive association between an increased sense of hope and a variety of behavioral and psychosocial outcomes, such as fewer sleep problems, more physical activity, optimism and satisfaction with life. However, there wasn’t a clear association between hope and all physical health outcomes. For instance, hope was associated with a reduced number of chronic conditions, but not with stroke, diabetes and hypertension.
The takeaway: “The later stages of life are often defined by loss: the loss of health, loved ones, social support networks, independence, and (eventually) loss of life itself,” the authors write. “Our results suggest that standard public health promotion activities, which often focus solely on physical health, might be expanded to include a wider range of factors that may lead to gains in hope. For example, alongside community-based health and nutrition programs aimed at reducing chronic conditions like hypertension, programs that help strengthen marital relations (e.g., closeness with a spouse), provide opportunities to volunteer, help lower anxiety, or increase connection with friends may potentially increase levels of hope, which in turn, may improve levels of health and well-being in a variety of domains.”
Associated Factors of Hope in Cancer Patients During Treatment: A Systematic Literature Review
Corine Nierop-van Baalen, Maria Grypdonck, Ann van Hecke and Sofie Verhaeghe. Journal of Advanced Nursing, March 2020.The study: The authors review 33 studies, written in English or Dutch and published in the past decade, on the relationship between hope and the quality of life and well-being of patients with cancer. Studies have shown that many cancer patients respond to their diagnosis by nurturing hope, while many health professionals feel uneasy when patients’ hopes go far beyond their prognosis, the authors write.
The findings: Quality of life, social support and spiritual well-being were positively associated with hope, as measured with various scales. Whereas symptoms, psychological distress and depression had a negative association with hope. Hope didn’t seem to be affected by the type or stage of cancer or the patient’s demographics.
The takeaway: “Hope seems to be a process that is determined by a person’s inner being rather than influenced from the outside,” the authors write. “These factors are typically given meaning by the patients themselves. Social support, for example, is not about how many patients experience support, but that this support has real meaning for them.”
Characterizing Hope: An Interdisciplinary Overview of the Characteristics of Hope
Emma Pleeging, Job van Exel and Martijn Burger. Applied Research in Quality of Life, September 2021.The study: This systematic review provides an overview of the concept of hope based on 66 academic papers in ten academic fields, including economics and business studies, environmental studies, health studies, history, humanities, philosophy, political science, psychology, social science, theology and youth studies, resulting in seven themes and 41 sub-themes.
The findings: The authors boil down their findings to seven components: internal and external sources, the individual and social experience of hope, internal and external effects, and the object of hope, which can be “just about anything we can imagine,” the authors write.
The takeaway: “An important implication of these results lies in the way hope is measured in applied and scientific research,” researchers write. “When measuring hope or developing instruments to measure it, researchers could be well-advised to take note of the broader understanding of the topic, to prevent that important characteristics might be overlooked.”
Revisiting the Paradox of Hope: The Role of Discrimination Among First-Year Black College Students
Ryon C. McDermott, et al. Journal of Counseling Psychology, March 2020.The study: Researchers examine the moderating effects of hope on the association between experiencing racial discrimination, stress and academic well-being among 203 first-year U.S. Black college students. They build on a small body of evidence that suggests high levels of hope might have a negative effect on Black college students who experience racial discrimination.
The authors use data gathered as part of an annual paper-and-pencil survey of first-year college students at a university on the Gulf Coast, which the study doesn’t identify.
The findings: Researchers find that Black students who had higher levels of hope experienced more stress due to racial discrimination compared with students who had lower levels of hope. On the other hand, Black students with low levels of hope may be less likely to experience stress when they encounter discrimination.
Meanwhile, Black students who had high levels of hope were more successful in academic integration — which researchers define as satisfaction with and integration into the academic aspects of college life — despite facing discrimination. But low levels of hope had a negative impact on students’ academic well-being.
“The present study found evidence that a core construct in positive psychology, hope, may not always protect Black students from experiencing the psychological sting of discrimination, but it was still beneficial to their academic well-being,” the authors write.
The takeaway: “Our findings also highlight an urgent need to reduce discrimination on college campuses,” the researchers write. “Reducing discrimination could help Black students (and other racial minorities) avoid additional stress, as well as help them realize the full psychological and academic benefits of having high levels of hope.”
Additional reading
Hope Across Cultural Groups Lisa M. Edwards and Kat McConnell. Current Opinion in Psychology, February 2023.
The Psychology of Hope: A Diagnostic and Prescriptive Account Anthony Scioli. “Historical and Multidisciplinary Perspectives on Hope,” July 2020.
Hope Theory: Rainbows in the Mind C.R. Snyder. Psychological Inquiry, 2002
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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