Across four studies, we investigated whether perceptions of children’s pain are influenced by their socioeconomic status (SES). We found evidence that children with low SES were believed to feel less pain than children with high SES (Study 1), and this effect was not moderated by child’s age (Study 2). Next, we examined life hardship as a mediator of this effect among children, finding that children with low SES were rated as having lived a harder life and thus as feeling less pain (Study 3). Finally, we examined downstream consequences for hypothetical treatment recommendations. We found that participants perceived children with low SES as less sensitive to pain and therefore as requiring less pain treatment than children with high SES (Study 4). Thus, we consistently observe that stereotypes of low-SES individuals as insensitive to pain may manifest in judgments of children and their recommended pain care. Implications of this work for theory and medical practice are discussed.
AdlerN. E.BoyceT.ChesneyM. A.CohenS.FolkmanS.KahnR. L.SymeS. L. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49, 15–24.
2.
BakerE. H. (2014). Socioeconomic status, definition. In W. C. Cockerham, R. Dingwall & S. Quah (Eds.), The Wiley Blackwell encyclopedia of health, illness, behavior, and society (pp 2210–2214) https://doi.org/10.1002/9781118410868.wbehibs395.
3.
BrekkeM.HjortdahlP.KvienT. K. (2002). Severity of musculoskeletal pain: Relations to socioeconomic inequality. Social Science & Medicine, 54(2), 221–228.
BristowR. E.PowellM. A.Al-HammadiN.ChenL.MillerJ. P.RolandP. Y.. . . ClibyW. A. (2013). Disparities in ovarian cancer care quality and survival according to race and socioeconomic status. JNCI: Journal of the National Cancer Institute, 105(11), 823–832.
6.
ChaikenS.TropeY. (Eds.). (1999). Dual-process theories in social psychology. Guilford Press.
7.
ChenE.MartinA. D.MatthewsK. A. (2006). Socioeconomic status and health: Do gradients differ within childhood and adolescence?Social Science & Medicine, 62(9), 2161–2170.
8.
ChenE.MatthewsK. A.BoyceW. T. (2002). Socioeconomic differences in children’s health: How and why do these relationships change with age?Psychological Bulletin, 128(2), 295–329.
9.
ChzhenY.HowarthC.MainG. (2022). Deprivation and intra-family conflict: Children as agents in the Family Stress Model. Journal of Marriage and Family, 84(1), 121–140.
10.
CohenL. L.CobbJ.MartinS. R. (2014). Gender biases in adult ratings of pediatric pain. Children’s Health Care, 43(2), 87–95.
11.
CohenL. L.LemanekK.BlountR. L.DahlquistL. M.LimC. S.PalermoT. M.. .. WeissK. E. (2008). Evidence-based assessment of pediatric pain. Journal of Pediatric Psychology, 33(9), 939–955.
12.
CozzarelliC.WilkinsonA. V.TaglerM. J. (2001). Attitudes toward the poor and attributions for poverty. Journal of Social Issues, 57(2), 207–227.
13.
CuddyA. J.FiskeS. T.GlickP. (2008). Warmth and competence as universal dimensions of social perception: The stereotype content model and the BIAS map. Advances in Experimental Social Psychology, 40, 61–149.
14.
DavidaiS.GilovichT. (2015). Building a more mobile America—One income quintile at a time. Perspectives on Psychological Science, 10(1), 60–71.
15.
DavidaiS.GilovichT. (2018). How should we think about Americans’ beliefs about economic mobility?Judgment & Decision Making, 13(3), 297–304.
16.
DevineP. G. (1989). Stereotypes and prejudice: Their automatic and controlled components. Journal of Personality and Social Psychology, 56(1), 5–18.
17.
EarpB. D.MonradJ. T.LaFranceM.BarghJ. A.CohenL. L.RichesonJ. A. (2019). Featured article: Gender bias in pediatric pain assessment. Journal of Pediatric Psychology, 44(4), 403–414.
18.
EvansD. A.HebertL. E.BeckettL. A.ScherrP. A.AlbertM. S.ChownM. J.. . . TaylorJ. O. (1997). Education and other measures of socioeconomic status and risk of incident Alzheimer disease in a defined population of older persons. Archives of Neurology, 54, 1399–1405.
19.
FabesR. A.MartinC. L. (1991). Gender and age stereotypes of emotionality. Personality and Social Psychology Bulletin, 17(5), 532–540.
20.
FaulF.ErdfelderE.LangA. G.BuchnerA. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.
21.
FinleyG. A.McGrathP. J.ForwardS. P.McNeillG.FitzgeraldP. (1996). Parents’ management of children’s pain following “minor” surgery. Pain, 64(1), 83–87.
22.
FiskeS. T.CuddyA. J. C.GlickP.XuJ. (2002). A model of stereotype content as often mixed: Separate dimensions of competence and warmth respectively follow from status and competition. Journal of Personality and Social Psychology, 82(6), 878–902.
23.
GebauerS.SalasJ.ScherrerJ. F. (2017). Neighborhood socioeconomic status and receipt of opioid medication for new back pain diagnosis. The Journal of the American Board of Family Medicine, 30(6), 775–783.
24.
GilbertD. T.HixonJ. G. (1991). The trouble of thinking: Activation and application of stereotypic beliefs. Journal of Personality and Social Psychology, 60(4), 509–517.
25.
GoffP. A.JacksonM. C.Di LeoneB. A.CulottaC. M.DiTomassoN. A. (2014). The essence of innocence: Consequences of dehumanizing Black children. Journal of Personality and Social Psychology, 106(4), 526–545.
26.
GriffinR. A.PolitD. F.ByrneM. W. (2007). Stereotyping and nurses’ recommendations for treating pain in hospitalized children. Research in Nursing & Health, 30(6), 655–666.
27.
HaasJ. S.ClearyP. D.GuadagnoliE.FantaC.EpsteinA. M. (1994). The impact of socioeconomic status on the intensity of ambulatory treatment and health outcomes after hospital discharge for adults with asthma. Journal of General Internal Medicine, 9(3), 121–126.
28.
HoffmanD. E.TarzianA. J. (2007). The role and legal status of health care ethics committees in the United States. In A. S. Iltis, S. H. Johnson, & B. A. Hinze (Eds.), Legal Perspectives in Bioethics, 56–77. Routlege Taylor and Francis.
29.
HoffmanK. M.TrawalterS. (2016). Assumptions about life hardship and pain perception. Group Processes & Intergroup Relations, 19, 493–508.
30.
JacobsJ. E.EcclesJ. S. (1992). The impact of mothers’ gender-role stereotypic beliefs on mothers’ and children’s ability perceptions. Journal of Personality and Social Psychology, 63(6), 932–944.
31.
JoyntM.TrainM. K.RobbinsB. W.HaltermanJ. S.CaiolaE.FortunaR. J. (2013). The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. Journal of General Internal Medicine, 28, 1604–1610.
32.
KahnemanD. (2003). A perspective on judgment and choice: mapping bounded rationality. American Psychologist, 58(9), 697–720.
33.
KahnemanD.FrederickS. (2005). A model of heuristic judgment. In HolyoakK. J.MorrisonR. G. (Eds.), The Cambridge handbook of thinking and reasoning (pp. 267–294). Cambridge University Press.
34.
KingS.ChambersC. T.HuguetA.MacNevinR. C.McGrathP. J.ParkerL.MacDonaldA. J. (2011). The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain, 152(12), 2729–2738.
KrausM. W.TanJ. J. (2015). Americans overestimate social class mobility. Journal of Experimental Social Psychology, 58, 101–111.
37.
LeH.ZiogasA.LipkinS. M.ZellJ. A. (2008). Effects of socioeconomic status and treatment disparities in colorectal cancer survival. Cancer Epidemiology and Prevention Biomarkers, 17(8), 1950–1962.
38.
LitmanL.RobinsonJ.AbberbockT. (2016). TurkPrime.com: A versatile crowdsourcing data acquisition platform for the behavioral sciences. Behavior Research Methods, 49(2), 433–442.
39.
LloydE. P.LloydA. R.McConnellA. R.HugenbergK. (2021). Race deficits in pain detection: Medical providers and laypersons fail to accurately perceive pain authenticity among Black people (Invited Rev.). Social Psychological and Personality Science.
40.
LloydE. P.PaganiniG. A.ten BrinkeL. (2020). Gender stereotypes explain disparities in pain care and inform equitable policies. Policy Insights from the Behavioral and Brain Sciences, 7(2), 198–204.
LoBueV.ThrasherC. (2015). The Child Affective Facial Expression (CAFE) set: Validity and reliability from untrained adults. Frontiers in Psychology, 5, Article 1532.
43.
LuoY.WaiteL. J. (2005). The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(2), S93–S101.
44.
MasarikA. S.CongerR. D. (2017). Stress and child development: A review of the Family Stress Model. Current Opinion in Psychology, 13, 85–90.
45.
MazzellaR.FeingoldA. (1994). The effects of physical attractiveness, race, socioeconomic status, and gender of defendants and victims on judgments of mock jurors: A meta-analysis 1. Journal of Applied Social Psychology, 24(15), 1315–1338.
46.
McGrawK. O.WongS. P. (1992). A common language effect size statistic. Psychological Bulletin, 111(2), 361–365.
47.
MolinaE.Del RinconI.RestrepoJ. F.BattafaranoD. F.EscalanteA. (2015). Association of socioeconomic status with treatment delays, disease activity, joint damage, and disability in rheumatoid arthritis. Arthritis Care & Research, 67(7), 940–946.
48.
MontepareJ. M.ZebrowitzL. A. (1998). Person perception comes of age: The salience and significance of age in social judgments. Advances in Experimental Social Psychology, 30, 93–161.
49.
MontoyaA. K.HayesA. F. (2017). Two-condition within-participant statistical mediation analysis: A path-analytic framework. Psychological Methods, 22, 6–27.
50.
PetskoC. D.BodenhausenG. V. (2020). Multifarious person perception: How social perceivers manage the complexity of intersectional targets. Social and Personality Psychology Compass, 14(2), Article e12518.
51.
SchechterN. L.ZempskyW. T.CohenL. L.McGrathP. J.McMurtryC. M.BrightN. S. (2007). Pain reduction during pediatric immunizations: Evidence-based review and recommendations. Pediatrics, 119(5), e1184–e1198.
52.
SmallD. A.PopeD. G.NortonM. I. (2012). An age penalty in racial preferences. Social Psychological and Personality Science, 3(6), 730–737.
53.
StarfieldB.RobertsonJ.RileyA. W. (2002). Social class gradients and health in childhood. Ambulatory Pediatrics, 2(4), 238–246.
54.
SummersK. M.DeskaJ. C.AlmarazS. M.HugenbergK.LloydE. P. (2021). Poverty and pain: Low-SES people are believed to be insensitive to pain. Journal of Experimental Social Psychology, 95, 104116.
55.
TiggemannM.AnesburyT. (2000). Negative stereotyping of obesity in children: The role of controllability beliefs. Journal of Applied Social Psychology, 30(9), 1977–1993.
56.
ToddA. R.ThiemK. C.NeelR. (2016). Does seeing faces of young black boys facilitate the identification of threatening stimuli?Psychological Science, 27(3), 384–393.
57.
TrawalterS.HoffmanK. M.WaytzA. (2012). Racial bias in perceptions of others’ pain. PLOS ONE, 7, Article e48546.
58.
WalpoleM. (2003). Socioeconomic status and college: How SES affects college experiences and outcomes. The Review of Higher Education, 27(1), 45–73.
ZhangL.LosinE. A. R.AsharY. K.KobanL.WagerT. D. (2021). Gender biases in estimation of others’ pain. The Journal of Pain, 22 (9), 1048–1059.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
