The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma

Am J Public Health. 2012 May;102(5):988-95. doi: 10.2105/AJPH.2011.300621. Epub 2012 Mar 15.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Asthma / diagnosis
  • Asthma / therapy*
  • Attention Deficit Disorder with Hyperactivity / diagnosis
  • Attention Deficit Disorder with Hyperactivity / drug therapy*
  • Attitude of Health Personnel*
  • Black or African American
  • Central Nervous System Stimulants / therapeutic use
  • Counseling
  • Female
  • Health Services Research
  • Healthcare Disparities / ethnology*
  • Humans
  • Male
  • Pain Management / methods*
  • Pediatrics*
  • Prejudice
  • Referral and Consultation
  • Stereotyping
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / drug therapy*
  • White People


  • Analgesics, Opioid
  • Central Nervous System Stimulants