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Job Satisfaction in the United States

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APRIL 17, 2007, 12:01 A.M.Most American adults are employed and their job is not only their main source of income, but also an important life domain in other ways. Work occupies a large part of each worker’s day, is one’s main source of social standing, helps to define who a person is, and affects one’s health both physically and mentally. Because of work’s central role in many people’s lives, satisfaction with one’s job is an important component in overall well-being. For example, job satisfaction and general happiness are positively related (Pearson’s r=.286, prob.=.000) with those saying they are very happy in general rising from 15.7 % for those very dissatisfied with their job to 45.3 % very happy among those very satisfied with their job. Job satisfaction is not evenly distributed across occupations or workers. In general, job satisfaction increases with the prestige or social standing of occupations. 1 As Table 1 shows, for all workers 47.0 % are very satisfied with their jobs and that increases from 33.6 % very satisfied among the unskilled and entry-level occupations lowest in prestige to 55.8 % very satisfied among professionals and others in jobs with the highest occupational prestige. Similarly, general happiness among the employed averages 33.3%
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Job Satisfaction in the United States
Tom W. Smith
NORC/University of Chicago
EMBARGOED FOR RELEASE
APRIL 17, 2007, 12:01 A.M.
1
Most American adults are employed and their job is not only their main source of
income, but also an important life domain in other ways. Work occupies a large part of
each worker’s day, is one’s main source of social standing, helps to define who a person
is, and affects one’s health both physically and mentally. Because of work’s central role
in many people’s lives, satisfaction with one’s job is an important component in overall
well-being. For example, job satisfaction and general happiness are positively related
(Pearson’s r=.286, prob.=.000) with those saying they are very happy in general rising
from 15.7% for those very dissatisfied with their job to 45.3% very happy among those
very satisfied with their job.
Job satisfaction is not evenly distributed across occupations or workers. In
general, job satisfaction increases with the prestige or social standing of occupations.
1
As
Table 1 shows, for all workers 47.0% are very satisfied with their jobs and that increases
from 33.6% very satisfied among the unskilled and entry-level occupations lowest in
prestige to 55.8% very satisfied among professionals and others in jobs with the highest
occupational prestige. Similarly, general happiness among the employed averages 33.3%
very happy and also rises with occupational prestige. The % very happy climbs from
25.5% to those in occupations with the lowest social standing to 40.2% very happy for
those with jobs of the top social standing.
But there is even more variation in job satisfaction and well-being across
occupations than shows up by looking at the 10 deciles of occupational prestige. The US
Census Classification of Occupation (1980 edition) distinguished over 500 categories of
jobs. Of these 198 have enough people employed in the jobs for measures of job
satisfaction and/or general happiness to be reported on from NORC’s General Social
Surveys (GSS).
2
The remaining occupations have too few workers for reliable reporting.
Table 2 lists the top and bottom 12 occupations in terms of job satisfaction. The
most satisfying jobs are mostly professions, especially those involving caring for,
teaching, and protecting others and creative pursuits. Heading the list are members of the
clergy with a mean score of 3.79 and 87.3% very satisfied.
3
Second are the first of two
healing professions, physical therapists with 78.1% very satisfied. They are followed in
8
th
place by psychologists with 66.9% very satisfied. Third are firefighters with 80.1%
very satisfied. Fourth, comes the first of three educational occupations: educational
administrators (e.g. deans, principals, and superintendents) with 68.4% very satisfied,
teachers in 6
th
place with 69.2% very satisfied, and special education teachers in 9
th
place
with 70.1%. Fifth is the first of two creative professions, painters, sculptors, and related
with 67.3% very satisfied and then authors in 7
th
place with 74.2% very satisfied. Next
comes operating engineers in 10
th
place with 64.1% very satisfied, office supervisors in
11
th
position with 80.6% very satisfied, and in 12
th
place those in security and financial
sells positions such as stock brokers, bond sellers, and financial advisors.
The least satisfying dozen jobs are mostly low-skill, manual and service
occupations, especially involving customer service and food/beverage preparation and
1
Occupational prestige is measured by the NORC-General Social Survey Occupational Prestige scale. For
details see Davis, Smith, and Marsden, 2007 and Nakao and Treas, 1994.
2
See Appendix for details on the GSS.
3
The mean score best reflects the overall position of an occupation since it takes into consideration all
responses. The % very satisfied is a more limited measure and does not perfectly follow the overall mean
score. However, the % very satisfied has more intuitive meaning and will be primarily used in this report.
The same applies to the measure of general happiness.
2
serving. Roofers have the least job satisfaction with only 25.3% very satisfied. Second
comes the first of several food and beverage occupations, waiters and servers, with 27.0%
very satisfied. Other food/drink occupations near the bottom include bartenders in 4
th
place with 26.3% very satisfied, food preparers at 9
th
with 23.6% very satisfied, and
butchers and meat cutters in 11
th
position with 31.8% very satisfied. Third from the
bottom is another manual trade, laborers outside of construction, with 21.4% very
satisfied. In fifth and sixth position are handpackers/packagers with 23.7% very satisfied
and freight, stock, and material handlers with 23.9% very satisfied. Next in 7
th
and 8
th
place are apparel clothing salepersons and cashiers with respectively 23.9% and 25.0%
very satisfied. At 10
th
place are expediters which includes customer service clerks and
complaint desk clerks with 37.0% very satisfied.
4
In 12
th
position are furniture/home
furnishing salespersons with 25.2% very satisfied.
Table 3 shows the top and bottom 12 occupations in general happiness. Unlike job
satisfaction, general happiness does not explicitly refer to work and occupations. Most of
the occupations ranking high in general happiness are professions involving helping
others, technical and scientific expertise, or creativity. The occupation with the happiest
people is the clergy with 67.2% very happy. Second are firefighters with 57.2% very
happy. Third come transportation, ticket, and reservation agents such as travel agents
with 56.5% very happy. Fourth are architects with 53.5% very happy. Fifth are special
education teachers with 52.6% very happy. Other scientific and technical occupations
scoring near the top are science technicians in 7
th
place with 51.0% very happy, industrial
engineers in 9
th
place with 48.4% very happy, and airline pilots and navigators in 10
th
position with 49.1% very happy Sixth come actors and directors with 51.0% very happy.
In 8
th
position are those in miscellaneous mechanical and repairing occupations with
53.6% very happy. In 11
th
position are hardware and building supply salespersons with
55.9% very happy. 12
th
position is held by housekeepers and butlers with 57.7% very
happy.
The occupations with the least happy people are mostly unskilled manual and
service positions. At the bottom are garage and service station attendants with 13.2%
very happy. Second are roofers with 14.2% very happy. Third are molding and casting
machine operators with 11.1% very happy. Next, in fourth and fifth place are two lower-
level, construction trades, construction laborers with 18.8% very happy and
miscellaneous construction workers with 22.1% very happy. Sixth are welfare service
aides with 18.4% very happy. Seventh are amusement and recreation attendants with
15.7% very happy. Eighth are maids and housemen with 22.8% very happy. Ninth come
pressing machine operators with 23.5% very happy. Tenth are electronic repairers with
15.7% very happy. Eleventh are food-preparation, kitchen workers (not including cooks
and chefs) with 20.8% very happy. In 12
th
position are miscellaneous machine operators
with 17.3% very happy.
Three occupations finish in the top dozen on both job satisfaction and general
happiness. The clergy distinguishes itself from all other occupations by ranking first in
both job satisfaction and general happiness. Firefighters do almost as well being third on
4
Expediters have a higher proportion in the very satisfied category than is typical for occupations ranked
near the bottom. They also have high levels in the dissatisfied categories that bring their overall average
down. There is more internal variation in satisfaction among expediters than for most occupations.
3
job satisfaction and second on general happiness. Special education teachers are the third
doubly-top-ranked occupation, being 9
th
in job satisfaction and 5
th
in general happiness.
Only one occupation, roofers, scores in the bottom on both scales, being lowest in
job satisfaction and next to the bottom on general happiness.
It is also instructive to note that a number of very high prestige occupations do not
finish at the top of either list. Physicians are first overall in occupational prestige and do
score well-above average in both job satisfaction (mean score 3.47; 57.9% very satisfied)
and general happiness (mean score 2.39; 43.9% very happy), but not in to top 12 on
either measure. Similarly, lawyers, who are number two in occupational prestige, also
score above average on job satisfaction (mean score 3.33; 52.4% very satisfied) and
general (mean score 2.37; 43.0% very happy), but outside the top dozen positions.
The scorings of some other occupations that do not fall in the top or bottom 12 are
as follows:
Job Satisfaction General Happiness
Mean Score % Very Satisfied Mean Score % Very Happy
Police and Detectives 3.45 59.3 2.41 44.0
Registered Nurses 3.42 53.1 2.31 36.3
Editors & Reporters 3.39 52.9 2.23 35.7
Accountants 3.37 49.7 2.38 41.8
4
Table 1
Job Satisfaction and General Happiness by Occupational Prestige
Deciles of
Occupational Job Satisfaction General Happiness
Prestige Mean Score % Very Satisfied Mean Score % Very Happy
Lowest 3.05 33.6 2.12 25.5
2
nd
3.10 34.6 2.15 28.4
3
rd
3.25 43.4 2.20 31.3
4t 3.28 46.1 2.16 29.4
5
th
3.25 44.3 2.21 31.8
6
th
3.37 51.5 2.28 36.0
7
th
3.36 49.2 2.28 35.9
8
th
3.40 53.9 2.27 36.0
9
th
3.45 57.3 2.31 38.6
Highest 3.44 55.8 2.35 40.2
Overall Average 3.30 47.0 2.23 33.3
N=27,587
Source: General Social Surveys, 1988-2006, See Appendix
Job Satisfaction: On the whole, how satisfied are you with the work you do—would you
say you are very satisfied, moderately satisfied, a little dissatisfied, or very dissatisfied?
Mean Score runs from 1 for someone who is Very Dissatisfied to 4 for someone who is
Very Satisfied.
General Happiness: Taken all together, how would you say things are these days—would
you say you are very happy, pretty happy, or not too happy?
Mean Score runs from 1 for someone who is Not Too Happy to 3 for someone who is
Very Happy.
5
Table 2
Top Occupations in Job Satisfaction
Rank Occupations Mean Score % Very
Satisfied
1 Clergy 3.79 87.2
2 Physical Therapists 3.72 78.1
3 Firefighters 3.67 80.1
4 Education Administrators 3.62 68.4
5 Painter, Sculptors, Related 3.62 67.3
6 Teachers 3.61 69.2
7 Authors 3.61 74.2
8 Psychologists 3.59 66.9
9 Special Education Teachers 3.59 70.1
10 Operating Engineers 3.56 64.1
11 Office Supervisors 3.55 60.8
12 Security & Financial Services Salespersons 3.55 65.4
Bottom Occupations in Job Satisfaction
1 Roofers 2.84 25.3
2 Waiters/Servers 2.85 27.0
3 Laborers, Except Construction 2.86 21.4
4 Bartenders 2.88 26.4
5 Hand Packers and Packagers 2.88 23.7
6 Freight, Stock, & Material Handlers 2.91 25.8
7 Apparel Clothing Salespersons 2.93 23.9
8 Cashiers 2.94 25.0
9 Food Preparers, Misc. 2.95 23.6
10 Expediters 2.97 37.0
11 Butchers & Meat Cutters 2.97 31.8
12 Furniture/Home Furnishing Salespersons 2.99 25.2
Job Satisfaction: On the whole, how satisfied are you with the work you do—would you
say you are very satisfied, moderately satisfied, a little dissatisfied, or very dissatisfied?
Mean Score runs from 1 for someone who is Very Dissatisfied to 4 for someone who is
Very Satisfied.
6
Table 3
Top Occupations in General Happiness
Rank Occupations Mean Score % Very
Happy
1 Clergy 2.61 67.2
2 Firefighters 2.57 57.2
3 Transportation Ticket & Reservation Agents 2.55 56.5
4 Architects 2.52 53.5
5 Special Education Teachers 2.51 52.6
6 Actors & Directors 2.49 51.0
7 Science Technicians 2.47 51.0
8 Mechanics & Repairers, Misc. 2.47 53.6
9 Industrial Engineers 2.47 48.4
10 Airline Pilots & Navigators 2.45 49.1
11 Hardware/Building Supplies Salesperson 2.45 55.9
12 Housekeepers & Butlers 2.45 57.7
Bottom Occupations in General Happiness
1 Garage & Service Station Attendants 1.78 13.2
2 Roofers 1.88 14.2
3 Molding & Casting Machine Operators 1.92 11.1
4 Construction Laborers 1.94 18.8
5 Construction Trades, Misc. 1.97 22.1
6 Welfare Service Aides 1.98 18.4
7 Amusement & Recreation Attendants 1.98 15.7
8 Maids & Housemen 1.99 22.8
9 Pressing Machine Operators 1.99 23.5
10 Electronic Repairers 2.00 15.7
11 Kitchen Workers, Food Preparations 2.00 20.8
12 Machine Operators, Misc. 2.02 17.3
General Happiness: Taken all together, how would you say things are these days—would
you say you are very happy, pretty happy, or not too happy?
Mean Score runs from 1 for someone who is Not Too Happy to 3 for someone who is
Very Happy.
7
Appendix: General Social Surveys (GSS)
The GSS are conducted by the National Opinion Research Center at the
University of Chicago. James A. Davis, Tom W. Smith, and Peter V. Marsden are the
principal investigators. The GSS are full-probability samples of adults living in
households in the United States. Interviews are conducted in-person. Not including the
oversamples in 1982 and 1987, sample size across 1972-2006 totals 50,313 respondents
(1972=1613, 1973=1504, 1974=1484, 1975=1490, 1976=1499, 1977=1530, 1978=1532,
1980=1468, 1982=1506, 1983=1599, 1984=1473, 1985=1534, 1986=1470, 1987=1466,
1988=1481, 1989=1537, 1990=1372, 1991=1517, 1993=1606, 1994=2992, 1996=2904,
1998=2832, 2000=2817; 2002=2765; 2004=2812; 2006=4510). Full technical details on
the sample, response rates, and other methodological matters are presented in James A.
Davis, Tom W. Smith, and Peter V. Marsden, General Social Surveys, 1972-2006:
Cumulative Codebook. Chicago: NORC, 2007.
For more information of the GSS: www.gss.norc.org
8
References
Davis, James A.; Smith, Tom W.; and Marsden, James A., General Social Surveys Cumulative
Codebook: 1972-2006. Chicago: NORC, 2007.
Nakao, Keiko and Treas, Judith, Updating Occupational Prestige and Socioeconomic Scores:
How the New Measures Measure Up,” Sociological Methodology, 24 (1994), 1-72.
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... Specific demographic characteristics have been identified to contribute to overall job satisfaction rates. Key studies evaluate hours worked per week, salary, work-home conflicts, independence at work, student loan debt, clinical environment, and social capital (Ouedraogo et al., 2017;Smith, 2007;Starkel et al., 2015). For physicians, dentists, and veterinarians, there is a difference in job satisfaction between independent or individual practice owners vs. employed practitioners. ...
... For physicians, dentists, and veterinarians, there is a difference in job satisfaction between independent or individual practice owners vs. employed practitioners. This is irrespective of practice or group size but correlated to management being governed by the practitioners or a management/administrative company (Ouedraogo et al., 2017;Smith, 2007;Starkel et al., 2015). Satisfaction is higher among professionals who work in individual practice than those who work in larger systems due to higher levels of professional autonomy that accompanies working in a small privately-owned practice. ...
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... e Physical erapy profession has historically ranked in the top 20% of the 100 best jobs in the United States by various sources. [1][2][3] According to news sources such as US News and World Report, physical therapists (PTs) have a positive job market, strong future growth, high worklife balance, low stress, and moderate-to-high salary. 1 However, literature examining job and career satisfaction of PTs in the United States were largely conducted when the certificate, bachelor's, and master's degree were the primary entry-level professional degree. [3][4][5][6][7][8] us, the results from these studies may not be as relevant and informative in today's education and workforce environments. ...
... [1][2][3] According to news sources such as US News and World Report, physical therapists (PTs) have a positive job market, strong future growth, high worklife balance, low stress, and moderate-to-high salary. 1 However, literature examining job and career satisfaction of PTs in the United States were largely conducted when the certificate, bachelor's, and master's degree were the primary entry-level professional degree. [3][4][5][6][7][8] us, the results from these studies may not be as relevant and informative in today's education and workforce environments. e current changing and unique educational system (eg, professional, residency training, fellowship training), health care environment, and other US societal factors necessitate the examination of job and career satisfaction of PTs in those contexts. ...
... In general, results of this study support previous literature that PTs have high job and career satisfaction. [2][3][4][5][6][11][12][13][14] When examining the "levels of agreement," our results compliment those of Speakman et al 6 who demonstrated that PTs: 1) perceive their jobs to be positively challenging; 2) are given enough freedom/autonomy to do their work; 3) are enabled to use their abilities; 4) have sufficient independence in decision making; 5) perceive their work to be interesting; and 6) are learning and improving in their work. Our results generally suggest that residency-and/ or fellowship-trained PTs agree with these statements more than non-residency-trained or non-fellowship-trained PTs ( Table 2). ...
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Introduction Mentoring and professional development opportunities influence job and career satisfaction. Review of the Literature Job and career satisfaction are multifactorial. The purpose of this study was to compare job and career satisfaction between physical therapists (PTs) who were residency trained and PTs who were neither residency nor fellowship trained and between PTs who were fellowship trained and PTs who were neither residency nor fellowship trained. Subjects Licensed PTs in the United States. Methods An online survey was distributed asking questions regarding job satisfaction and career satisfaction. Respondents were categorized as completing a residency, fellowship, both, or neither. Responses were respectively summed, then compared between groups: residency versus nonresidency/nonfellowship and fellowship versus nonresidency/nonfellowship. Frequency analyses and Mann–Whitney U tests were performed. Results A total of 3,080 survey responses were analyzed. Residency-trained PTs had an overall higher job satisfaction score ( P = .03) and higher career satisfaction score ( P = .05) when compared with non–residency-trained or non–fellowship-trained PTs. Fellowship-trained PTs reported higher job satisfaction ( P < .001) and career satisfaction ( P = .001) compared with non–residency-trained or non–fellowship-trained PTs. Residency-trained PTs rated the importance of their work being interesting and learning/improving in their work of greater importance to their job satisfaction compared with non–residency-trained or non–fellowship-trained PTs ( P < .05). Whereas, fellowship-trained PTs rated factors such as their jobs being positively challenging, fulfilling, and interesting, having sufficient independence, and were learning/improving in their work of greater importance than non–residency-trained and non–fellowship-trained PTs ( P ≤ .004). Discussion and Conclusion Results from the study support previous evidence that PTs overall have high job/career satisfaction and residency/fellowship training may further enhance job and career satisfaction. Findings provide valuable insight and are relevant to all PTs as well as stakeholders involved in professional and postprofessional physical therapy education and those making hiring decisions and potential employment opportunities.
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... Because of work's central role in many people's lives, satisfaction with one's job is an important component in overall well-being. 1 Job satisfaction varies across professions. The physical therapy profession enjoys a perception as one of the better jobs in healthcare based on its ranking of the #10 Best "Health Care" jobs and rated #28 for all vocations in 2022. 2 In 2007, a survey of employment fulfillment rated physical therapists as the second highest profession for occupational prestige and satisfaction, only trailing members of the clergy. 1 However, two recent surveys have shown that job satisfaction may be declining for licensed physical therapists in the United States and that high vacancy rates allow dissatisfied physical therapists to "shop" their skills. ...
... The physical therapy profession enjoys a perception as one of the better jobs in healthcare based on its ranking of the #10 Best "Health Care" jobs and rated #28 for all vocations in 2022. 2 In 2007, a survey of employment fulfillment rated physical therapists as the second highest profession for occupational prestige and satisfaction, only trailing members of the clergy. 1 However, two recent surveys have shown that job satisfaction may be declining for licensed physical therapists in the United States and that high vacancy rates allow dissatisfied physical therapists to "shop" their skills. [3][4] These surveys suggest there may be an increasing level of burnout and declining levels of employee retention secondary to incongruent job responsibility perspectives between employers and employees. ...
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Full-text available
  • Nov 2022
Higher education knowledge management has three goals: improving task quality and efficiency, training human resources at all operational levels, and expanding an organization’s field knowledge base to enhance the organization’s knowledge or intellectual investment. This research aimed to elucidate the effect of knowledge management on teaching motivation and academic staff satisfaction in Vietnamese universities. The purpose of this study is to establish a clear relationship between knowledge management and teaching motivation and academic staff satisfaction; three dimensions of knowledge management systems, namely knowledge acquisition, knowledge dissemination, and knowledge utilization, all of which contribute to increased teaching motivation and academic staff satisfaction when knowledge management systems are implemented. The quantitative research technique was utilized to gather data in this study by surveying 381 professors using a questionnaire. SPSS 22.0 and SmartPLS software were used to process data obtained via survey professors engaged in teaching. Managerial implications for knowledge management systems have been suggested to increase academic staff satisfaction and teaching motivation.
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... Similarly, countering popular perceptions of a clergy crisis is difficult in the absence of more thorough, consistent, and recent data on departures. Higher quality evidence on attrition rates would significantly strengthen recent studies showing that priests and pastors are generally satisfied with their work and are some of the happiest professionals overall (Adams et al., 2017;Smith, 2007). Second, for both Protestant and Catholic clergy, the decision to leave ministry involves a combination of both push and pull factors. ...
Clergy Who Leave Congregational Ministry: A Review of the Literature
Article
  • May 2021
Since its inception in the 1960s, research on premature (i.e., pre-retirement) clergy attrition from congregational ministry has focused on identifying the factors that precipitate and mitigate ministry exits, while the rates at which clergy leave the ministry have been inconsistently tracked. The literature on clergy attrition is peppered with claims of alarmingly high rates of departure; however, these studies lack strong empirical support. The evidence, while fragmentary, consistently shows that pastors do not leave congregational ministry in large numbers. Incidence of attrition of about 1%–2% per year is typical across Protestant denominations and among Roman Catholic priests. In addition, contrary to popular conceptions, there is little evidence attrition is particularly high in the first 5 years of congregational ministry. In terms of the reasons for leaving, among Protestants, the most common factor named is conflict with the congregation or denominational system; a smaller number leave to pursue personal goals or to care for family. Among Catholics, loneliness and isolation, tied in major part to the celibacy requirement, are the most significant reasons cited for leaving. Finances or a loss of faith are rarely cited as reasons for leaving among either Catholics or Protestants.
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A STUDY ON JOB SATISFACTION AMONG THE ARTS AND SCIENCE COLLEGE WOMEN'S FACULTIES MEMBERS IN TRICHY
Article
Full-text available
  • Jul 2023
This study was conducted to the overall job satisfaction among the Arts and science college women's faculties. A well-structured questionnaire based on job study about satisfaction index was applied to obtain required data from job satisfaction of Arts and Science college women's faculties. To study relationship of women's faculties with other.100 women's faculties members from participated in the survey the majority of the respondents was female, M.Phil, 20-30 years of age, single and had job experience of 3-5 years. The simple percentage analysis and chi-square was applied to find out the underlying variance among the variables. The analysis has found five new components of the job satisfaction. The results showed that overall job satisfaction among the college women's faculties members was neutral. The satisfied with the superior and colleagues and management and improve the satisfaction level. The researchers and scholars may conduct further studies on the factors identified through factor analysis. Keyword-Job satisfaction-problems in the arts college faculties.
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The Gap in Mental Health Service Utilization Among United Methodist Clergy with Anxiety and Depressive Symptoms
Article
Full-text available
  • Dec 2022
  • J RELIG HEALTH
Clergy are tasked with multiple interpersonal administrative, organizational, and religious responsibilities, such as preaching, teaching, counseling, administering sacraments, developing lay leader skills, and providing leadership and vision for the congregation and community. The high expectations and demands placed on them put them at an increased risk for mental distress such as depression and anxiety. Little is known about whether and how clergy, helpers themselves, receive care when they experience mental distress. All active United Methodist Church (UMC) clergy in North Carolina were recruited to take a survey in 2019 comprising validated depression and anxiety screeners and questions about mental health service utilization. Bivariate and Poisson regression analyses were conducted on the subset of participants with elevated depressive and anxiety symptoms to determine the extent of mental health service use during four different timeframes and the relationship between service use and sociodemographic variables. A total of 1,489 clergy participated. Of the 222 (15%) who had elevated anxiety or depressive symptoms or both, 49.1% had not ever or recently (in the past two years) seen a mental health professional. Participants were more likely to report using services currently or recently (in the past two years) if they were younger, had depression before age 21, or "very often" felt loved and cared for by their congregation. The rate of mental health service use among UMC clergy is comparable to the national average of service use by US adults with mental distress. However, it is concerning that 49% of clergy with elevated symptoms were not engaged in care. This study points to clergy subgroups to target for an increase in mental health service use. Strategies to support clergy and minimize mental health stigma are needed.
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