Minority Stress, Structural Stigma, and Physical Health Among Sexual and Gender Minority Individuals: Examining the Relative Strength of the Relationships

Flentje, Annesa; Clark, Kristen D.; Cicero, Ethan C.; Capriotti, Matthew R.; Lubensky, Micah E.; Sauceda, John A; Neilands, Torsten B.; Lunn, Mitchell R.; Obedin‐Maliver, Juno

doi:10.1093/abm/kaab051

Cited by 53 publications

(38 citation statements)

References 59 publications

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“…Structural stigma is conceptualized as the social conditions, cultural norms, and institutional policies that detract from the wellbeing of marginalized communities, including SGM people [21]. Research has primarily examined structural stigma as directly impacting SGM people's health [22][23][24][25][26], but structural stigma also limits access to high-quality social resources [27], such as healthcare. SGM people living in areas with high structural stigma (i.e., U.S. Census regions with more anti-SGM policies) are less likely to access healthcare [28] and more likely to report lower-quality care [29].…”

Section: Structural Stigma and Government Funding As Structural Deter...mentioning

confidence: 99%

Structural determinants of tailored behavioral health services for sexual and gender minorities in the United States, 2010 to 2020: a panel analysis

et al. 2022

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Background Research indicates that tailored programming for sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender, queer) people, compared to non-tailored programming, is effective for reducing the disproportionate health burden SGM people experience relative to the general population. However, the availability of SGM-tailored programming is often over-reported and inconsistent across behavioral health (i.e., substance use and mental health) facilities in the United States (U.S.). Methods Using panel analysis, the National Survey of Substance Abuse Treatment Services (N-SSATS), and the National Mental Health Services Survey (N-MHSS), this study examines structural stigma and government funding as two structural determinants affecting the availability of SGM-tailored programming in the U.S. Results Results indicated that from 2010 to 2020, reductions in structural stigma (i.e., increases in state-level supportive SGM policies) were positively associated with increases in the proportion of substance use treatment facilities offering SGM-tailored programming. This effect was significant after controlling for over-reporting of SGM-tailored programming and time- and state-specific heterogeneity. On average, the effect of reduced structural stigma resulted in approximately two new SGM-tailored programs in the short term and about 31 new SGM-tailored programs in the long term across U.S. substance use treatment facilities. Structural stigma did not predict the availability of SGM-tailored programming in mental health treatment facilities. Government funding was not significant in either data set. However, without correcting for over-reporting, government funding became a significant predictor of the availability of SGM-tailored programming at substance use treatment facilities. Conclusions Because SGM-tailored programming facilitates access to healthcare and the current study found longitudinal associations between structural stigma and the availability of SGM-tailored programming in substance use treatment facilities, our findings support claims that reducing structural stigma increases access to behavioral health treatment specifically and healthcare generally among SGM people. This study’s findings also indicate the importance of correcting for over-reporting of SGM-tailored programming, raising concerns about how respondents perceive the N-SSATS and N-MHSS questions about SGM-tailored programming. Implications for future research using the N-SSATS and N-MHSS data and for public health policy are discussed.

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Section: Structural Stigma and Government Funding As Structural Deter...mentioning

confidence: 99%

Structural determinants of tailored behavioral health services for sexual and gender minorities in the United States, 2010 to 2020: a panel analysis

et al. 2022

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“…Our findings show that more protective policy environments are associated with greater reports of past-year discrimination and victimization among cisgender SM people and gender expansive GM people. Discrimination is associated with a wide range of disparities, including poor mental [ 58 , 59 ] and physical health outcomes [ 60 , 61 ] and with delays in seeking healthcare services [ 11 , 62 ]. Further research should examine whether policy environments moderate the relationship between reported discrimination and victimization and the health of SGM people.…”

Section: Discussionmentioning

confidence: 99%

State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People

Clark

Lunn

Lev

et al. 2022

IJERPH

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Legislation has been passed in some states to reduce discrimination and victimization toward sexual and gender minority people (SGM; people who are not solely heterosexual and/or whose gender identity is not equal to what is socially associated with sex assigned at birth). The purpose of these analyses is to test whether state-level policy environments are associated with past-year discrimination and victimization among SGM people. Cross-sectional data from The Population Research in Identity and Disparities for Equality (PRIDE) Study annual questionnaire (collected 2018–2019), a national study of the health of SGM adults in the USA, were used for these analyses. Measures included related to discrimination, victimization, and demographic characteristics. State-level policy environments were measured using data from the Movement Advancement Project. Logistic regression analyses evaluated state-level policy environment scores and past-year discrimination and victimization among gender identity categories. In this sample, 7044 people (gender minority n = 2530) were included. Cisgender sexual minority (odds ratio [OR] = 1.007, p = 0.041) and the gender expansive subgroup of gender minority people (OR = 1.010, p = 0.047) in states with more protective policy environments had greater odds of discrimination. The gender expansive subgroup was found to have greater odds of victimization in states with more protective policy environments (OR = 1.003, p < 0.05). There was no relationship between state-level policy environments and victimization among any other study groups. SGM people may experience increased risk for discrimination and victimization despite legislative protections, posing continued risks for poor health outcomes and marginalization. Evaluation of factors (e.g., implementation strategies, systems of accountability) that influence the effectiveness of state-level polices on the reported experiences of discrimination and victimization among SGM people is needed.

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“…Social acceptance of MSM is variable across nations and cultures. [ 7 8 9 ] In America, social marketing has played a major role in social acceptance of gay, lesbian, bisexual and transgender people. Compared to a decade earlier, 60% of Americans are more likely to accept gay relationships and marriages.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 ] Social and family acceptance and safe community environment have strong association with improved health conditions. [ 8 9 ] Fear of anticipated discrimination and disparity in access to health facilities is an universal phenomenon. [ 10 11 12 13 ] The ongoing COVID-19 pandemic has made the gender minority population more vulnerable.…”

Section: Introductionmentioning

confidence: 99%

Transgenders are the most vulnerable amongst individuals engaging in receptive anal intercourse

Wadhwa

Arora

Pandhi

et al. 2021

Journal of Family Medicine and Primary Care

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Background: In India, sexuality not confirming to hetero-conjugal and peno-vaginal norm is abhorred and discriminated against. Individuals engaging in Receptive Anal Intercourse (RAI) are marginalized. Reappraisal of their sexual health conditions is likely to promote inclusive health care. Methods: Eighty-five consenting adults with RAI history were recruited from a tertiary care hospital in Delhi. Clinico-demographic data was noted and anal cytology samples were reported by Bethesda 2014 terminology. Results: There were 29 transgenders (TGs), 51 males (31 bisexual) and five females. Fifty-four subjects were Human Immunodeficiency Virus (HIV) infected (22 TGs, 31 males (17 bisexual) and one female) and 52 were receiving anti-retroviral treatment (ART). Thirty-one subjects had anal warts (6 TGs, 20 males, five females). Anal cytology revealed squamous intra-epithelial lesions (SIL) in 20 (5 TGs, 13 males, two females). TGs had significantly risker sexual practices than homosexual males, bisexual males and females, with consistently earlier age of first RAI exposure and frequent childhood (≤16 years) RAI experience compared to homosexual males, bisexual males and females, even after stratification by HIV status, warts and SIL. Conclusions: TGs had the highest sexual health risk profile including higher frequency of HIV infection compared to other subjects with RAI history. Bisexuality was common; their risk profile was variably lower than homosexual males. Mindfulness of above is likely to help overcome barriers to health care access and promote compassionate approach at all levels including primary care physicians.

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Minority Stress, Structural Stigma, and Physical Health Among Sexual and Gender Minority Individuals: Examining the Relative Strength of the Relationships

Cited by 53 publications

References 59 publications

Structural determinants of tailored behavioral health services for sexual and gender minorities in the United States, 2010 to 2020: a panel analysis

Structural determinants of tailored behavioral health services for sexual and gender minorities in the United States, 2010 to 2020: a panel analysis

State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People

Transgenders are the most vulnerable amongst individuals engaging in receptive anal intercourse

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