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Hate-Motivated Behavior: Impacts, Risk Factors, And Interventions

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Hate-Motivated Behavior: Impacts, Risk Factors, And Interventions

KEY POINTS:

  • The last several years have seen discrimination, hate, and White supremacist ideology shift from the fringes of society to mainstream social media and political and social discourse.
  • Hate-motivated behavior, which is highly prevalent and likely underreported, comprises a continuum of behavior from subtle discrimination to violent crime. Targeted groups are heterogeneous.
  • Documented factors associated with the commission of hate-motivated behavior are largely demographic or other individual-level characteristics.
  • Legal and law enforcement solutions include hate crime laws, community-based policing, and federal tracking. Psychological and other health-focused interventions include education and training programs, public awareness campaigns, measurement development, perspective taking, counterfactual thinking, intergroup contact approaches, and social-emotional learning. With few exceptions such as intergroup contact, hate-motivated behavior reduction efforts are largely unproven to date.
  • Moving forward, public health efforts addressing hate-motivated behavior should tackle intervention across structural, interpersonal, and individual levels. Academic-community partnerships and statewide task forces represent solid starting points for the development of strategic, comprehensive planning.
  • Greater use of experimental research design and application of existing public health approaches (for example, bystander interventions) represent promising next steps in hate-motivated behavior prevention.

Discrimination is a social determinant of health disparities often experienced by members of vulnerable communities as a series of unique stressors. Discrimination, hate, and White supremacist ideology have increasingly shifted from the fringes of society to mainstream social media, political, and social discourse. This shift in social norms is a contributing factor to the rise of hate groups and notable hate-based events such as those in Charlottesville, Virginia, in 2017. Further evidence of shifting social norms can be seen in the rise of other hate-motivated behavior, described in this brief.

Hate-motivated behavior can be thought of as verbal or nonverbal expressions of discrimination. For instance, hate speech comprises the verbal or written expression of prejudice aimed at harming another group. Hate crimes are commonly defined as harmful acts toward a person or group based on actual or perceived group membership. Acts of hate are thought to be effortful or intentional.

Hate-motivated behavior poses a threat to the population’s well-being, especially for vulnerable populations. Targeted communities are heterogenous—in its cataloging of hate crime statistics, the Federal Bureau of Investigation recognizes myriad groups targeted on the basis of race, ethnicity, sexual orientation, gender, religion, and disability.

The negative health consequences for victims are numerous, with much of the literature focused on the victimization of people on the basis of race, sexual orientation, and gender minority status. Experiences of hate are associated with poor emotional well-being such as feelings of anger, shame, and fear. Moreover, victims tend to experience poor mental health, including depression, anxiety, posttraumatic stress, and suicidal behavior. Medically, impacts include poor overall physical health, physical injury, stress, and difficulty accessing medical care. Victimization is also associated with poor health behaviors such as alcohol or drug use and unhealthy coping strategies such as emotion suppression. The experience of hate-motivated behavior can result in blaming of and lower empathy toward fellow victims.

Entire communities can feel the impacts of victimization. Members of the targeted community may experience vicarious trauma symptoms resulting from witnessing others being victimized. In addition, a review of structural discrimination shows that for a targeted vulnerable group, long-standing, systemic inequalities can be seen in economic, housing, and educational disparities.

Increasing Prevalence Of Hate-Motivated Behavior

Hate-motivated behavior may be on the rise. In 2018 the Federal Bureau of Investigation recorded more than 7,000 hate crime incidents reported by law enforcement—an increase of approximately 30 percent since 2014. These include hate crimes targeting individual people, groups, or property. Likewise, rates of hate crimes toward specific stigmatized groups have remained elevated since 9/11. All signs point to a continuation of this trend through 2020 as attacks against Asians have risen during the coronavirus disease 2019 (COVID-19) pandemic. Another troubling recent trend is the proliferation of hate on the internet, with a recent survey of eighteen- to twenty-five-year-olds in six countries finding that a majority had been exposed to online hate in the preceding three months. Microaggressions and other subtle expressions of hate are also prevalent. Indeed, research from 2017 suggests that over the course of twelve months, up to one in four Black and Latinx students were victims of racial microaggressions, depending on contextual factors. All these data likely underestimate prevalence, given underreporting by both victims and law enforcement.

A Social-Ecological Model For Understanding Hate-Motivated Behavior

A social-ecological model of violence provides an easy-to-follow way to organize what we know about hate-motivated behavior. The social-ecological model categorizes the impacts and causes of and solutions to any public health crisis on three levels: structural (for example, social norms, laws), interpersonal (for example, peer groups, family support), and individual (for example, demographics, attitudes). The levels interact with and can affect one another. Accordingly, prevention efforts should address more than one level of the model.

Supplemental exhibit 1 presents a social-ecological summary of hate-motivated behavior impacts and causes, risk factors for commission, and potential solutions. We focus on commission rather than victimization because most preventive strategies thus far have addressed victimization. Although victimization-focused research and prevention are certainly important, the lack of strategies for reducing offending forms a notable gap in the literature. Moreover, future research and prevention design should focus equally on protective factor enhancement, an idea expanded on later in this brief.

Causes And Risk Factors

Hateful acts, especially hate crimes, are rooted in biases or even the simple preferences all people possess. For some people, these biases may manifest as prejudicial or stigmatizing beliefs. Prejudicial processes happen when people engage in cognitive shortcuts via stereotypes, which are exaggerated beliefs about a group or evaluations of an object, person, or group. Prejudicial beliefs also stem from negative emotional reactions to members of a targeted group. Prejudice ultimately shows up as discriminatory behaviors directed toward another person on the basis of group membership.

Unfortunately, most of the literature on risk factors for hate-motivated behavior suffers from two limitations: it is separated by discipline and is primarily theoretical or descriptive, and therefore lacks rigorous testing and empirical support. As our goal with this review is to be as informative as possible, we include both empirically and theoretically derived risk factors drawing on psychological, public health, sociological, criminological, and political science literatures. As such, supplemental exhibit 1 is intended to be representative, not exhaustive. Further research is necessary to validate the risk factors summarized in the exhibit.

Research demonstrates that perpetrators of hate crimes tend to be of younger age, male sex, and White race. Personality traits such as high emotional instability have been shown to be background risk factors for discrimination. Potential drivers of hate-motivated behavior include a range of attitudes (for example, high social dominance orientation) and prejudices, mental shortcuts (for example, dichotomous thinking), and disinhibiting behaviors (for example, alcohol use). The same prejudices and attitudes (for example, social dominance orientation) that drive hate are also empirically linked to support of far-right political figures and movements, such as President Donald Trump, Brexit, and the UK Independence Party. Interpersonal risk factor research highlights the impact of both negative family and peer group influences on subtle discrimination and far-right extremist behavior, respectively. A variety of perceptions of outgroup members (for example, as a threat) may also precipitate hateful acts. Lack of exposure to diversity may also be associated with sexist behavior.

Structurally, individual events such as terrorist attacks are associated with spikes in hate crimes. Upticks in immigration and the expansion of civil rights of minority groups also offer contextual explanations for hate-motivated behavior. In terms of big picture influences, social norms as expressed through laws and political discourse tend to be markers associated with the continuum of discrimination from subtle to violent forms. For instance, implementation of hate crime laws is often seen as a symbolic gesture supporting minority or vulnerable populations. In contrast, expressions of extreme far-right nationalism or White supremacist ideologies may be associated with increased hate-motivated beliefs and behavior. Finally, large-scale intergroup dynamics such as segregation and perceived or actual competition for resources may be important in understanding hate-motivated behavior.

Possible Interventions

As with risk factors, there are few thorough scientific evaluations of the effectiveness of strategies to reduce hate-motivated behavior. Supplemental exhibit 1 provides a representative set of possible interventions by social-ecological level.

Hate-motivated behavior interventions tend to fall under one of the following domains: legal and law enforcement strategies, educational approaches, public health programming, and psychological strategies.

LEGAL AND LAW ENFORCEMENT STRATEGIES

Signed into federal law in 2009, the Matthew Shepard and James Byrd, Jr., Hate Crimes Prevention Act increased funds to prosecute hate crimes and enhance victim services and added gender and sexual orientation to the federally protected set of groups. A variety of state hate crime laws also exists, each varying in prosecution approach, protected groups, and other details. In general, hate crime laws punish offenders either through an additional criminal charge or an aggravating factor at sentencing. However, hate crimes are notoriously difficult to prosecute, given that hate-motivated intent is difficult to prove. These limitations notwithstanding, some experts argue for the preventive value of hate crime laws, as they may deter commission and symbolize the value of protecting vulnerable groups. Notably, the Hate Crimes Prevention Act has been used infrequently since its passage, and the limited examination of hate law impacts to date shows these laws to be only modestly effective with regard to deterrence or reduction in hate crime incidents.

An alternative approach is community-based policing. A group of Australian scholars has recommended such policing strategies to address hate crimes, including implementing community needs surveys, commissioning joint training for community leaders and law enforcement members, and training to raise awareness concerning implicit bias. Such strategies seek to reduce both intergroup tension and bias-based violence.

Finally, federal hate crime reporting in the United States is aimed at understanding the scope of the problem and identifying US regions requiring increased law enforcement attention. Unfortunately, the literature has shown that law enforcement agency participation in the

federal reporting program is tragically low in many states.

EDUCATIONAL APPROACHES

A recent review of school-based interventions demonstrated that programs such as bullying interventions and social and emotional learning techniques can reduce both subtle and overt prejudice in youth. The former approach often features peer support, counseling, and other interactive techniques, and the latter seeks to develop youth’s skills such as emotion regulation, goal setting, and social awareness. These social and emotional strategies are in part based on basic science demonstrating that self-regulation processes or skills may be of value to reduce prejudice. There is some evidence supporting their effectiveness.

Other educational strategies seek to train adults in hate crime–specific content. For example, Phyllis Gerstenfeld has articulated a formal semester-long course in hate crimes designed for undergraduate students. In addition, expert organizations currently train law enforcement and attorneys on factual content including hate crime laws, geography and types of incidents, and reporting. Rigorous evaluation of educational programs for adult professionals is currently absent.

PUBLIC HEATH PROGRAMMING

 

Advocacy and civil rights organizations often take a social equality–based public health approach to preventing hate crimes. Such organizations often focus on research, legislative action, education and awareness, and service provision (for example, legal services). Two prominent US examples are the Southern Poverty Law Center and the Human Rights Campaign. Nonpartisan evaluation of the impact of such organizations is admittedly difficult because of the unclear metrics of success and subjective goals inherent in the nature of advocacy.

Public awareness campaigns and public health surveillance are more traditional approaches that have been applied widely to other public health challenges. Prominent public awareness campaigns addressing prejudice and victimization of vulnerable groups include “It Gets Better” and “Stand Up, Speak Up.” Such exemplars are designed to target forms of hate-motivated behavior such as bullying, property damage, or verbal insults. A review of publicly available web, television, and radio campaigns directed at the reduction of racism found that such campaigns target persons of all ages using a variety of methods ranging from general emotional and other appeals to practical steps one can take to reduce discrimination. However, no formal evaluation of the efficacy of these strategies has been conducted.

Population-level surveillance and measurement of hate-motivated behavior have emerged largely in response to law enforcement underreporting. A well-
regarded example can be seen in questions included in the National Crime Victimization Survey, which has been employed in several secondary analyses of victimization reporting and subgroup patterns. Likewise, widely used self-report measures exist in the literature for general hate crime victimization experiences and group-specific experiences of microaggressions or discrimination. Although not a prevention strategy in and of itself, public health measurement and surveillance of hate-motivated behavior are important areas of growth to support prevention.

PSYCHOLOGICAL INTERVENTIONS

Several interpersonal- and individual-level psychological interventions aim to reduce prejudice, discrimination, or hate via differing processes. Intergroup contact-based interventions involve direct contact with members of the stigmatized group, sometimes in the form of a person who may not necessarily fit well-established stereotypical characteristics. Empirical evidence highlights the positive impacts of contact interventions on reduction of noncriminal forms of hate in contexts such as schools and workplace settings.

Cognitively based tasks such as perspective taking, self-reflection exercises, and counterfactual thinking may also be helpful. Perspective taking is an approach requiring one to adopt the perspective of the member of the targeted group to develop a sense of empathy or understanding. Thus, it is potentially useful in raising awareness regarding microassaults and aggressions. A variety of self-reflection exercises promote self-awareness and consideration of one’s degree of implicit or explicit prejudice (see, for example, Project Implicit). Interventions based on counterfactual thinking provide an individual with the opportunity to consider alternative actions or behaviors in their past or present to promote shifts in beliefs or behavior.

Evidence on the impacts of psychological interventions is mixed and largely insufficiently tested to date. Although evidence for intergroup contact is robust, one review concluded that perspective-taking interventions are likely ineffective in tackling prejudice and that thorough evaluation of these interventions is absent from the literature. However, early evidence does support the promise of counterfactual interventions.

Future Directions

Hate-motivated behavior is a major public health concern. The impacts of hateful acts are fairly well-documented and inclusive of blunted affective well-being, poor mental and physical health, early mortality, loss of social support, and inadequate health care. These impacts extend beyond an individual victim in forms such as vicarious trauma, barriers to health care use, and structural inequalities. Although the evidence of public health impacts is strong, support is far weaker for research regarding hate-motivated behavior commission risk factors and interventions. The best evidence about risk factors points toward individual demographic, attitudinal, and other characteristics. Although the roles of intergroup perceptions and familial or peer influence cannot be ignored, emerging evidence also implicates historical and current changes in demography, social norms, and laws as factors promoting an atmosphere ripe for discrimination. Generally speaking, legal, criminal justice, and public health solutions thus far lack sufficient rigorous evaluation, whereas there is modest evidence for a few psychological interventions, and one study on hate crime laws shows some promise.

Our use of a social-ecological model to organize the health impacts, commission risk factors, and potential solutions to hate-motivated behavior is intentional. To date, hate-motivated behavior is primarily addressed as a legal matter or social science concept. The evidence we present here suggests the need to design prevention programming by targeting the reduction of risk factors across social-ecological levels, seek to enhance community- and individual-level protective factors, and provide needed infrastructure to bring about systematic equality for vulnerable groups. Doing so will require understanding causes and interventions for specific subpopulations. A recent conceptual outlining of the social-ecological of transgender-based discrimination and health provides a sample road map. This model shows structural (for example, disparate health care policies), interpersonal (for example, antitransgender hate crimes), and individual (for example, identity concealment) sources of discrimination, as well as sample multilevel intervention strategies such as transgender and family or partner support groups, health care provider training, and refinement of access-to-care policies.

Drawing on the social-ecological laid out in supplemental exhibit 1, we recommend a public health approach that starts with scaled-up research to improve the empirical base for understanding risk and protective factor pathways to hate-motivated behavior commission. Prevention strategies crossing structural, interpersonal, and individual levels may follow. For example:

  • Policy and funding to support enhanced public health surveillance and interdisciplinary training for legal, health care, political, and education professionals. Ideally, such training would take place in interprofessional groups to foster better communication and processes among professionals handling hateful behavior. Training should also address the full continuum of behaviors.
  • Interdisciplinary academic-community partnerships or statewide task forces comprising criminal justice, political, public health, nonprofit, and other expert teams. One of the primary functions of these teams would be the development of a regional, statewide, or national hate-motivated behavior prevention strategic plan.
  • Rigorous evaluation research of existing prevention and intervention programming. Areas of particular need are policy evaluations of state and national hate crime laws, psychometric studies to improve outcome assessment and uniform measurement of hate-motivated behavior, and comparative quasi-experimental and experimental investigations of joint or selected individual, interpersonal, and structural approaches.
  • Large-scale development and testing of interventions shown to be effective in other areas of public health. A logical starting point may be the design of bystander interventions for hate-motivated behavior. Moreover, research should be designed to focus on protective factor identification and enhancement to provide alternative behaviors for potential hate-motivated behavior actors.

Redefining hate as a public health issue entails a shift in how we think about, study, and try to prevent such behavior. Existing empirical support for hate-motivated behavior interventions is modest at best. Interdisciplinary, multilevel research and prevention programming design are clearly needed moving forward.

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Vermont Health Connect had 10 data breaches last winter

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Vermont Health Connect had 10 data breaches last winter
Vermont Health Connect has set up a special enrollment period in response to the coronavirus outbreak. VHC photo

In mid-December, a Vermont Health Connect user was logging in when the names of two strangers popped up in the newly created account.

The individual, who was trying to sign up for health insurance, deleted the information that had suddenly appeared.

“It was super unsettling to think that someone is filing in my account with my information,” the person, whose name is redacted in records, wrote in a complaint to the Department of Vermont Health Access. “Just seems like the whole thing needs a big overhaul.”

It was one of 10 instances between November and February when Vermont Health Connect users reported logging to find someone else’s information on their account.

The data breaches included names of other applicants and, in some cases, their children’s names, birth dates, citizenship information, annual income, health care plans, and once, the last four digits of a Social Security number, according to nearly 900 pages of public records obtained by VTDigger. On Dec. 22, the department’s staff shut down the site to try to diagnose the problem.

While officials say the glitches have been resolved, it’s the most recent mishap for a system that has historically been plagued by security and technical issues. The breaches could be even more widespread: Administrators of Vermont Health Connect can’t tell if other, similar breaches went unreported.

“We don’t know what we don’t know,” said Jon Rajewski, a managing director at the cybersecurity response company Stroz Friedberg. Regardless of whether there are legal ramifications for the incidents, they should be taken “very seriously,” he said.

“If my data was being stored on a website that was personal, — maybe it contains names or my Social Security number, like my status of insurance… — I would expect that website to secure it and keep it safe,” he said.

“I wouldn’t want someone else to access my personal information.”

Andrea De La Bruere, executive director of the Agency of Human Services, called the data breaches “unfortunate.” But she downplayed the severity of the issues. Between November and December, 75,000 people visited the Vermont Health Connect website for a total of 330,000 page views, she said. The 10 incidents? “It’s a very uncommon thing to have happen,” she said.

De La Bruere said the issue was fixed on Feb. 17, and users had reported no similar problems since. The information that was shared was not protected health information, she added, and the breaches didn’t violate the Health Insurance Portability and Accountability Act, or HIPAA.

“No matter what the law says technically, whether it’s HIPAA-related or just one’s personal information, it’s really concerning,” said Health Care Advocate Mike Fisher.

The timing of the issue is less than ideal, he added. Thousands of Vermonters will be logging into Vermont Health Connect in the coming weeks to take advantage of discounts granted by the American Rescue Plan. “It’s super important that people can access the system, and that it’s safe and secure,” Fisher said.

A ‘major issue

The issues first arose on Nov, 12, when at least two Vermonters logged in and found information about another user, according to records obtained by VTDigger.

Department of Vermont Health Access workers flagged it as a “major issue” for their boss, Kristine Fortier, a business application support specialist for the department.

Similar incidents also occurred on Nov. 17 and 18, and later on multiple days in December.

Department of Vermont Health Access staff members appeared alarmed at the issues, and IT staff escalated the tickets to “URGENT.”

“YIKES,” wrote a staff member Brittney Richardson. While the people affected were notified, the data breaches were never made public.

State workers pressed OptumInsights, a national health care tech company that hosts and manages Vermont Health Connect, for answers. The state has contracted with the company since 2014. It has paid about $11 million a year for the past four years for maintenance and operations, with more added in “discretionary funds.”

Optum appeared unable to figure out the glitch. “It is hard to find root cause of issue,” wrote Yogi Singh, service delivery manager for Optum on Dec. 10. Optum representatives referred comments on the issues to the state.

By Dec. 14, Grant Steffens, IT manager for the department, raised the alarm. “I’m concerned on the growing number of these reports,” he wrote in an email to Optum.

The company halted the creation of new accounts on Dec, 14, and shut down the site entirely on Dec, 22 to install a temporary fix. “It’s a very complex interplay of many many pieces of software on the back end,” said Darin Prail, agency director of digital services. The complexity made it challenging to identify the problem, and to fix it without introducing any new issues, he said.

In spite of the fixes, a caller reported a similar incident on Jan. 13.

On Feb. 8, a mother logged in to find that she could see her daughter’s information. When she logged into her daughter’s account, the insurance information had been replaced by her own.

“Very weird,” the mother wrote in an emailed complaint.

Optum completed a permanent fix on Feb. 17, according to Prail. Vermont Health Connect has not had a problem since, he said.

Prail said the state had reported the issues to the Centers for Medicaid and Medicare Services as required, and had undergone a regular audit in February that had no findings. The state “persistently pressured Optum to determine the root cause and correct the issue expeditiously but at the same time, cautiously, so as to not introduce additional issues/problems,” he wrote in an email to VTDigger.

“We take reported issues like this very seriously,” he said.

A history of glitches

The state’s health exchange has been replete with problems, including significant security issues and privacy violations, since it was built in 2012 at a cost of $200 million.

The state fired its first contractor, CGI Technology Systems, in 2014. A subcontractor, Exeter, went out of business in 2015. Optum took over for CGI, and continued to provide maintenance and tech support for the system.

Don Turner
Don Turner, right, then the House minority leader, speaks in 2016 about the need to fix the state’s glitch-ridden Vermont Health Connect website. With him are Phil Scott, left, then the lieutenant governor, and Sen. Joe Benning. Photo by Erin Mansfield/VTDigger

In 2018, when Vermont Health Connect was less than 6 years old, a report dubbed the exchange outdated and “obsolete.”

Officials reported similar privacy breaches in 2013, when Vermonters saw other people’s information.

An auditor’s report in 2016 found a slew of cybersecurity flaws, and officials raised concerns again during a  2018 email breach.

It wasn’t the first time that Vermont Health Connect users had been able to view other people’s personal information. Three times since October 2019, individuals had logged in to see another individual’s insurance documents. Prail attributed those incidents to human error, not to system glitch; a staff member uploaded documents to the wrong site, he said.

In spite of the issues, Prail said he and other state officials have been happy with Optum. After years of technical challenges with Vermont Health Connect, “Optum has really picked up the ball and improved it and been running it pretty well,” he said.

Glitches are inevitable, he added, and Optum has addressed them quickly. “They took a really difficult-to-manage site and made it work pretty well,” he said. “Optum is generally quite responsive to any issues we have.”

“I find any privacy breach to be concerning,” said Scott Carbee, chief information security officer for the state. He noted that the state uses “hundreds of software systems.” “While the scope of the breaches can be mitigated, true prevention is a difficult task,” he wrote in an email to VTDigger.

Optum spokesperson Gwen Moore Holliday referred comments to the state, but said the company was “honored” to work with Vermont Health Connect “to support the health care needs of Vermont residents.”

Prail said the Agency of Human Services had no plans to halt its contract with the company. “I don’t have a complaint about Optum,” he said. “They took a really difficult-to-manage site and made it work pretty well.”

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Health Care

Tags: data breaches, Optum, Vermont Health Connect

Katie Jickling

About Katie

Katie Jickling covers health care for VTDigger. She previously reported on Burlington city politics for Seven Days. She has freelanced and interned for half a dozen news organizations, including Vermont Public Radio, the Valley News, Northern Woodlands, Eating Well magazine and the Herald of Randolph. She is a graduate of Hamilton College and a native of Brookfield.