{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T20:58:26Z","timestamp":1763585906868,"version":"3.45.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"University of California-Davis, Center for Healthcare Policy and Research"},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["R33AA028073"],"award-info":[{"award-number":["R33AA028073"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Washington Department of Psychiatry and Behavioral Sciences, and Kaiser Permanente Washington Health Research Institute"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In a sample of patients with diagnosed alcohol use disorder (AUD), we examined the prevalence of both stigmatizing (eg, \u201calcohol abuse\u201d) and highly stigmatizing, non-medical descriptors (eg, \u201calcoholic\u201d) documented in electronic health records (EHRs). We also assessed whether the use of these terms\u2014entered by clinicians when documenting AUD using search tools and picklists\u2014varied across patient subgroups within a regional health system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>This study used EHR data from AUD diagnoses documented (January 3, 2015-May 5, 2023) for adult primary care patients identified as Asian, Black, Latine, or White. Four researchers classified AUD descriptors used to diagnose AUD as \u201cstigmatizing\u201d or \u201chighly stigmatizing.\u201d Stigmatizing AUD descriptors were terms that carry negative connotations, imply blame, moral failing, or character flaws. Highly stigmatizing AUD descriptors were non-standard medical terms with strong negative connotations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 61\u2009886 AUD diagnoses (18\u2009068 patients: 3.5% Asian, 5.0% Black, 5.9% Latine, 85.6% White; 40.5% women), stigmatizing descriptors were used in 88.5% and highly stigmatizing in 18.6% of diagnoses. Differences across intersectional subgroups were minimal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most AUD descriptors were stigmatizing (1 in 5 highly stigmatizing), with men showing slightly higher prevalence than women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamiaopen\/ooaf150","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T20:55:22Z","timestamp":1763585722000},"source":"Crossref","is-referenced-by-count":0,"title":["Proportion of alcohol use disorder diagnoses in electronic health records documented with stigmatized descriptors: a comparison across race, ethnicity, and sex"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1606-4661","authenticated-orcid":false,"given":"Robert L","family":"Ellis","sequence":"first","affiliation":[{"name":"Center for Healthcare Policy and Research, University of California, Davis , Sacramento, CA 95820,","place":["United States"]},{"name":"Kaiser Permanente Washington Health Research Institute , Seattle, WA 98101,","place":["United States"]},{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, WA 98195,","place":["United States"]},{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health , Seattle, WA 98195,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin A","family":"Hallgren","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute , Seattle, WA 98101,","place":["United States"]},{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, WA 98195,","place":["United States"]},{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health , Seattle, WA 98195,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily C","family":"Williams","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute , Seattle, WA 98101,","place":["United States"]},{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health , Seattle, WA 98195,","place":["United States"]},{"name":"Health Services Research & Development (HSR&D) Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System , Seattle, WA 98101,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Courtney R","family":"Lyles","sequence":"additional","affiliation":[{"name":"Center for Healthcare Policy and Research, University of California, Davis , Sacramento, CA 95820,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph E","family":"Glass","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute , Seattle, WA 98101,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaac C","family":"Rhew","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, WA 98195,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malia M","family":"Oliver","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute , Seattle, WA 98101,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharine A","family":"Bradley","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute , Seattle, WA 98101,","place":["United States"]},{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, WA 98195,","place":["United States"]},{"name":"Department of Medicine, University of Washington School of Medicine , Seattle, WA 98195,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"2025111915551946200_ooaf150-B1","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.2105\/AJPH.89.9.1339","article-title":"The public\u2019s view of the competence, dangerousness, and need for legal coercion of persons with mental health problems","volume":"89","author":"Pescosolido","year":"1999","journal-title":"Am J Public Health"},{"key":"2025111915551946200_ooaf150-B2","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1111\/acer.14598","article-title":"Stigmatization of people with alcohol use disorders: an updated systematic review of population studies","volume":"45","author":"Kilian","year":"2021","journal-title":"Alcohol Clin Exp Res"},{"key":"2025111915551946200_ooaf150-B3","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1146\/annurev.soc.27.1.363","article-title":"Conceptualizing stigma","volume":"27","author":"Link","year":"2001","journal-title":"Annu Rev Sociol"},{"key":"2025111915551946200_ooaf150-B4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12910-017-0179-8","article-title":"Implicit bias in healthcare professionals: a systematic review","volume":"18","author":"FitzGerald","year":"2017","journal-title":"BMC Med Ethics"},{"key":"2025111915551946200_ooaf150-B5","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1007\/s11606-013-2441-1","article-title":"Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities","volume":"28","author":"Chapman","year":"2013","journal-title":"J Gen Intern Med"},{"key":"2025111915551946200_ooaf150-B6","volume-title":"The New Jim Crow: Mass Incarceration in the Age of Colorblindness","author":"Alexander","year":"2012"},{"key":"2025111915551946200_ooaf150-B7","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(17)30569-X","article-title":"Structural racism and health inequities in the USA: evidence and interventions","volume":"389","author":"Bailey","year":"2017","journal-title":"Lancet"},{"key":"2025111915551946200_ooaf150-B8","doi-asserted-by":"crossref","first-page":"813","DOI":"10.2105\/AJPH.2012.301069","article-title":"Stigma as a fundamental cause of population health inequalities","volume":"103","author":"Hatzenbuehler","year":"2013","journal-title":"Am J Public Health"},{"key":"2025111915551946200_ooaf150-B9","doi-asserted-by":"crossref","first-page":"48","DOI":"10.15288\/jsad.2007.68.48","article-title":"Alcohol and environmental justice: the density of liquor stores and bars in urban neighborhoods in the United States","volume":"68","author":"Romley","year":"2007","journal-title":"J Stud Alcohol Drugs"},{"key":"2025111915551946200_ooaf150-B10","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12916-018-1246-9","article-title":"Challenges and opportunities in examining and addressing intersectional stigma and health","volume":"17","author":"Turan","year":"2019","journal-title":"BMC Med"},{"key":"2025111915551946200_ooaf150-B11","volume-title":"Workable Sisterhood: The Political Journey of Stigmatized Women with HIV\/AIDS","author":"Berger","year":"2004"},{"key":"2025111915551946200_ooaf150-B12","doi-asserted-by":"crossref","first-page":"442","DOI":"10.5325\/jspecphil.26.2.0442","article-title":"Intersectionality and American pragmatism in dialogue social inequality, power, and politics","volume":"26","author":"Collins","year":"2012","journal-title":"J Speculative Philos"},{"key":"2025111915551946200_ooaf150-B13","first-page":"139","article-title":"Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics","volume":"140","author":"Crenshaw","year":"1989","journal-title":"Univ Chic Leg Forum"},{"key":"2025111915551946200_ooaf150-B14","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/S0140-6736(06)68189-0","article-title":"Stigma interventions and research for international health","volume":"367","author":"Weiss","year":"2006","journal-title":"Lancet"},{"key":"2025111915551946200_ooaf150-B15","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1176\/appi.ajp.21111097","article-title":"Racial and ethnic bias in the diagnosis of alcohol use disorder in veterans","volume":"180","author":"Vickers-Smith","year":"2023","journal-title":"Am J Psychiatry"},{"key":"2025111915551946200_ooaf150-B16","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/acer.12950","article-title":"Racial\/ethnic differences in the prevalence of clinically recognized alcohol use disorders among patients from the U.S. Veterans Health Administration","volume":"40","author":"Williams","year":"2016","journal-title":"Alcohol Clin Exp Res"},{"key":"2025111915551946200_ooaf150-B17","doi-asserted-by":"crossref","first-page":"108706","DOI":"10.1016\/j.drugalcdep.2021.108706","article-title":"The intersection of gender and drug use-related stigma: a mixed methods systematic review and synthesis of the literature","volume":"223","author":"Meyers","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2025111915551946200_ooaf150-B18","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1377\/hlthaff.2021.01423","article-title":"Negative patient descriptors: documenting racial bias In the electronic health record","volume":"41","author":"Sun","year":"2022","journal-title":"Health Aff (Millwood)"},{"key":"2025111915551946200_ooaf150-B19","doi-asserted-by":"crossref","first-page":"560","DOI":"10.2307\/2669264","article-title":"Prime suspects: the influence of local television news on the viewing public","volume":"44","author":"Gilliam","year":"2000","journal-title":"Am J Pol Sci"},{"key":"2025111915551946200_ooaf150-B20","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/jcom.12133","article-title":"The changing misrepresentation of race and crime on network and cable news","volume":"65","author":"Dixon","year":"2015","journal-title":"J Commun"},{"key":"2025111915551946200_ooaf150-B21","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/08897077.2014.930372","article-title":"Confronting inadvertent stigma and pejorative language in addiction scholarship: a recognition and response","volume":"35","author":"Broyles","year":"2014","journal-title":"Subst Abus"},{"key":"2025111915551946200_ooaf150-B22","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1001\/jama.2014.2147","article-title":"Confronting the stigma of opioid use disorder\u2014and its treatment","volume":"311","author":"Olsen","year":"2014","journal-title":"JAMA"},{"key":"2025111915551946200_ooaf150-B23","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1057\/biosoc.2015.46","article-title":"White opioids: pharmaceutical race and the war on drugs that wasn\u2019t","volume":"12","author":"Netherland","year":"2017","journal-title":"Biosocieties"},{"key":"2025111915551946200_ooaf150-B24","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.drugpo.2009.10.010","article-title":"Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms","volume":"21","author":"Kelly","year":"2010","journal-title":"Int J Drug Policy"},{"key":"2025111915551946200_ooaf150-B25","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.amjmed.2014.07.043","article-title":"Stop talking 'dirty\u2019: clinicians, language, and quality of care for the leading cause of preventable death in the United States","volume":"128","author":"Kelly","year":"2015","journal-title":"Am J Med"},{"key":"2025111915551946200_ooaf150-B26","doi-asserted-by":"crossref","first-page":"2230","DOI":"10.1038\/s41386-021-01069-4","article-title":"Choosing appropriate language to reduce the stigma around mental illness and substance use disorders","volume":"46","author":"Volkow","year":"2021","journal-title":"Neuropsychopharmacology"},{"key":"2025111915551946200_ooaf150-B27","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.3390\/ijerph14091030","article-title":"Evaluation of a pilot implementation to integrate alcohol-related care within primary care","volume":"14","author":"Bobb","year":"2017","journal-title":"Int J Environ Res Public Health"},{"key":"2025111915551946200_ooaf150-B28","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/1475-6773.00091","article-title":"Methodologic implications of allocating multiple-race data to single-race categories","volume":"37","author":"Parker","year":"2002","journal-title":"Health Serv Res"},{"key":"2025111915551946200_ooaf150-B29","first-page":"146","article-title":"Assessing the impact of different Race-Bridging algorithms on the reported rate of birth defects","volume":"44","author":"Rutkowski","year":"2017","journal-title":"J Registry Manag"},{"issue":"Suppl 1","key":"2025111915551946200_ooaf150-B30","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.2105\/AJPH.2009.171058","article-title":"Critical race theory, race equity, and public health: toward antiracism praxis","volume":"100","author":"Ford","year":"2010","journal-title":"Am J Public Health"},{"key":"2025111915551946200_ooaf150-B31","author":"National Institute on Drug Abuse","year":"2021."},{"key":"2025111915551946200_ooaf150-B32","author":"Shatterproof","year":"2021"},{"key":"2025111915551946200_ooaf150-B33","volume-title":"Diagnostic and Statistical Manual of Mental Disorders: DSM-IV","author":"American Psychiatric Association","year":"1994"},{"key":"2025111915551946200_ooaf150-B34","doi-asserted-by":"crossref","first-page":"e53510","DOI":"10.2196\/53510","article-title":"Occurrence of stigmatizing documentation among hospital medicine encounters with opioid-related diagnosis codes: Cohort study","volume":"8","author":"Bradford","year":"2024","journal-title":"JMIR Form Res"},{"key":"2025111915551946200_ooaf150-B35","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1093\/aje\/kwq304","article-title":"Stigma and treatment for alcohol disorders in the United States","volume":"172","author":"Keyes","year":"2010","journal-title":"Am J Epidemiol"},{"key":"2025111915551946200_ooaf150-B36","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/COH.0b013e3283536ab2","article-title":"Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer","volume":"7","author":"El-Bassel","year":"2012","journal-title":"Curr Opin HIV AIDS"},{"key":"2025111915551946200_ooaf150-B37","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1177\/0886109914531957","article-title":"A qualitative study of black women\u2019s experiences in drug abuse and mental health services","volume":"30","author":"Jones","year":"2015","journal-title":"Affilia"},{"key":"2025111915551946200_ooaf150-B38","doi-asserted-by":"crossref","first-page":"E702","DOI":"10.1001\/amajethics.2020.702","article-title":"Ethical imperatives to overcome stigma against people with substance use disorders","volume":"22","author":"Adams","year":"2020","journal-title":"AMA J Ethics"},{"key":"2025111915551946200_ooaf150-B39","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1111\/add.15333","article-title":"A US national randomized study to guide how best to reduce stigma when describing drug-related impairment in practice and policy","volume":"116","author":"Kelly","year":"2021","journal-title":"Addiction"},{"key":"2025111915551946200_ooaf150-B40","author":"NIAAA","year":"2022"},{"key":"2025111915551946200_ooaf150-B41","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1001\/jama.2016.11874","article-title":"Changing the language of addiction","volume":"316","author":"Botticelli","year":"2016","journal-title":"JAMA"},{"key":"2025111915551946200_ooaf150-B42","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1097\/HEP.0000000000000520","article-title":"A multisociety Delphi consensus statement on new fatty liver disease nomenclature","volume":"78","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"2025111915551946200_ooaf150-B43","author":"National Institute on Drug Abuse","year":"2021"}],"container-title":["JAMIA Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jamiaopen\/article-pdf\/8\/6\/ooaf150\/65397268\/ooaf150.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jamiaopen\/article-pdf\/8\/6\/ooaf150\/65397268\/ooaf150.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T20:55:26Z","timestamp":1763585726000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamiaopen\/article\/doi\/10.1093\/jamiaopen\/ooaf150\/8328334"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,3]]},"references-count":43,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11,3]]}},"URL":"https:\/\/doi.org\/10.1093\/jamiaopen\/ooaf150","relation":{},"ISSN":["2574-2531"],"issn-type":[{"value":"2574-2531","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,11,3]]},"article-number":"ooaf150"}}