Fernandez Jessica R, Richmond Jennifer, Nápoles Anna M, Kruglanski Arie W, Forde Allana T
Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
SSM Popul Health. 2021 Dec 18;17:100991. doi: 10.1016/j.ssmph.2021.100991. eCollection 2022 Mar.
Metaphors are often used to describe cancer experiences (e.g., battle, journey). Few studies explore how social threats (e.g., discrimination) shape metaphor preferences. We examined the relationship between discrimination and preferences for cancer metaphors (i.e., concrete, action-based) versus metaphors (i.e., open-ended, reflective) and mediating effects of needs for personal significance and cognitive closure. We also stratified the analysis when discrimination was/was not attributed to race and by racial/ethnic group. Four-hundred twenty-seven U.S. participants completed an online survey. Items included everyday discrimination, need for personal significance, need for cognitive closure, and preference for cancer scenarios using battle or journey metaphors. Multigroup structural equation modeling examined: serial mediation (i.e., discrimination predicting metaphor preference via needs for personal significance and cognitive closure) stratified by discrimination attribution; and single mediation (i.e., discrimination predicting need for cognitive closure via need for personal significance) stratified by racial/ethnic group. Discrimination was associated with metaphor preferences through serial mediation when discrimination was not attributed to race (β = 0.02, 95% CI [0.01,0.05]). Discrimination was directly associated with metaphor preferences (β = -0.20, 95% CI [-0.37,-0.06]) and the serial mediation was nonsignificant when discrimination was attributed to race. The single mediation model varied across racial/ethnic groups and was strongest for Non-Hispanic White participants (β = 0.17, 95% CI [0.07,0.30]). Discrimination may shape cancer metaphor preferences through needs for personal significance and cognitive closure, yet these relationships differ based on whether discrimination is attributed to race and racial/ethnic group. Given that the U.S. health system often focuses on battle metaphors when framing cancer treatment and screenings, individuals who prefer journey metaphors (i.e., those who experienced more frequent racial discrimination in the present study) may experience a systematic disadvantage in cancer communication. A more careful consideration of cultural, racial, and ethnic differences in metaphor use may be a crucial step towards reducing cancer disparities.
隐喻常常被用于描述患癌经历（例如，战斗、旅程）。很少有研究探讨社会威胁（例如，歧视）如何塑造隐喻偏好。我们研究了歧视与癌症隐喻偏好（即具体的、基于行动的隐喻）和隐喻（即开放式的、反思性的隐喻）之间的关系，以及个人意义需求和认知闭合需求的中介作用。我们还根据歧视是否归因于种族以及种族/族裔群体对分析进行了分层。427名美国参与者完成了一项在线调查。调查项目包括日常歧视、个人意义需求、认知闭合需求，以及使用战斗或旅程隐喻对癌症情景的偏好。多组结构方程模型检验了：按歧视归因分层的序列中介作用（即歧视通过个人意义需求和认知闭合需求预测隐喻偏好）；以及按种族/族裔群体分层的单一中介作用（即歧视通过个人意义需求预测认知闭合需求）。当歧视不归因于种族时，歧视通过序列中介作用与隐喻偏好相关（β = 0.02，95%置信区间[0.01,0.05]）。当歧视归因于种族时，歧视与隐喻偏好直接相关（β = -0.20，95%置信区间[-0.37,-0.06]），序列中介作用不显著。单一中介模型在不同种族/族裔群体中有所不同，对非西班牙裔白人参与者最强（β = 0.17，95%置信区间[0.07,0.30]）。歧视可能通过个人意义需求和认知闭合需求塑造癌症隐喻偏好，但这些关系因歧视是否归因于种族和种族/族裔群体而有所不同。鉴于美国医疗系统在构建癌症治疗和筛查框架时通常侧重于战斗隐喻，偏好旅程隐喻的个体（即本研究中经历更频繁种族歧视的个体）在癌症沟通中可能会面临系统性劣势。更仔细地考虑隐喻使用中的文化、种族和族裔差异可能是减少癌症差异的关键一步。
