Structural stigma and LGBTQ+ health: a narrative review of quantitative studies

Hatzenbuehler, Mark L; Lattanner, Micah R; McKetta, Sarah; Pachankis, John E

doi:10.1016/s2468-2667(23)00312-2

Cited by 21 publications

(2 citation statements)

References 122 publications

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“…At the structural level, discriminatory laws cause dramatic increases in suicidality, adverse health behaviors, adverse physical health, and experiences of discrimination. 4 In its Declaration of Professional Responsibility, the American Medical Association calls for physicians to "advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being." 63…”

Section: Disparities In Mortality Bymentioning

confidence: 99%

“…L esbian, gay, and bisexual (LGB) women have systematically worse physical, 1 mental, 1,2 and behavioral health 2,3 than heterosexual women. These disparities are due to chronic and cumulative exposure to stressors (including interpersonal and structural stigma 4 ) that propagates and magnifies ill health throughout the life course, manifesting in disparities across a breadth of adverse health outcomes that tend to become more pronounced as individuals age (ie, weathering). 5 National surveys started enumerating sexual orientation only within the past decade, and very few longitudinal cohort studies collect sexual orientation data.…”

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confidence: 99%

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Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses

McKetta,

Hoatson,

Hughes

et al. 2024

JAMA

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ImportanceExtensive evidence documents health disparities for lesbian, gay, and bisexual (LGB) women, including worse physical, mental, and behavioral health than heterosexual women. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among LGB women and whether they differ by lesbian or bisexual identity.ObjectiveTo examine differences in mortality by sexual orientation.Design, Setting, and ParticipantsThis prospective cohort study examined differences in time to mortality across sexual orientation, adjusting for birth cohort. Participants were female nurses born between 1945 and 1964, initially recruited in the US in 1989 for the Nurses’ Health Study II, and followed up through April 2022.ExposuresSexual orientation (lesbian, bisexual, or heterosexual) assessed in 1995.Main Outcome and MeasureTime to all-cause mortality from assessment of exposure analyzed using accelerated failure time models.ResultsAmong 116 149 eligible participants, 90 833 (78%) had valid sexual orientation data. Of these 90 833 participants, 89 821 (98.9%) identified as heterosexual, 694 (0.8%) identified as lesbian, and 318 (0.4%) identified as bisexual. Of the 4227 deaths reported, the majority were among heterosexual participants (n = 4146; cumulative mortality of 4.6%), followed by lesbian participants (n = 49; cumulative mortality of 7.0%) and bisexual participants (n = 32; cumulative mortality of 10.1%). Compared with heterosexual participants, LGB participants had earlier mortality (adjusted acceleration factor, 0.74 [95% CI, 0.64-0.84]). These differences were greatest among bisexual participants (adjusted acceleration factor, 0.63 [95% CI, 0.51-0.78]) followed by lesbian participants (adjusted acceleration factor, 0.80 [95% CI, 0.68-0.95]).Conclusions and RelevanceIn an otherwise largely homogeneous sample of female nurses, participants identifying as lesbian or bisexual had markedly earlier mortality during the study period compared with heterosexual women. These differences in mortality timing highlight the urgency of addressing modifiable risks and upstream social forces that propagate and perpetuate disparities.

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Section: Disparities In Mortality Bymentioning

confidence: 99%

mentioning

confidence: 99%

Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses

McKetta,

Hoatson,

Hughes

et al. 2024

JAMA

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Real-Time Exposure to Negative News Media and Suicidal Ideation Intensity Among LGBTQ+ Young Adults

Clark,

Kellerman,

Argiros

et al. 2024

JAMA Pediatr

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ImportanceWith a recent surge in anti–lesbian, gay, bisexual, transgender, or queer (LGBTQ+) policies and associated news and media coverage, there is a need to study the association of LGBTQ+ focused news or media exposure and short-term changes in suicidal ideation (SI) among LGBTQ+ youth.ObjectiveTo examine within-person direct and indirect associations between exposure to general and LGBTQ+ negative news or media and SI intensity through expectations of rejection.Design, Setting, and ParticipantsThis intensive longitudinal cohort study used a smartphone-based ecological momentary assessment (EMA) protocol wherein participants responded to EMAs 3 times per day for 28 consecutive days. Young adults aged 18 to 24 years who self-identified as LGBTQ+, resided in Tennessee, and had past-year SI and at least mild depression (defined as a score ≥5 on the Patient Health Questionnaire-9) were eligible for inclusion. Participants were recruited through social media advertisements, LGBTQ+ community organizations, and mental and behavioral health clinics. Participants were recruited between March 30, 2023, and August 23, 2023, and data analyses were conducted from August 28, 2023, through April 20, 2024.ExposuresAt each EMA, participants reported on recent exposure to negative news or media. A 3-level categorical exposure variable denoted (1) no news or media exposure (reference); (2) exposure to general negative news or media; and (3) exposure to LGBTQ+ negative news or media. Each EMA also assessed expectations of rejection due to LGBTQ+ identity on a scale of 0 (not at all) through 10 (very much).Main Outcomes and MeasuresThree primary outcomes assessed current (ie, “right now”) intensity of active SI, passive SI, and self-harm ideation, each measured on a scale from 0 (not at all) to 10 (very strong). Multilevel modeling approaches were used to account for the hierarchical structure of EMA data, with assessments (level 1) nested within people (level 2). Linear mixed models and multilevel mediation models were used to examine within-person associations between exposure to negative news or media and the 3 primary outcomes, as well as the mediating role of expectations of rejection.ResultsOf 31 total participants, 22 were assigned female sex at birth (71%), and 16 (52%) self-identified as transgender or gender diverse. The median (IQR) participant age was 21 (18-22) years, and a total of 2189 EMAs were completed, with a median (range) compliance of 90.5% (41.7%-100%). At the within-person level, recent exposure to LGBTQ+ negative news or media was significantly associated with increased active SI (estimate [b], 0.14; 95% CI, 0.04-0.25; P = .009), passive SI (b, 0.23; 95% CI, 0.04-0.41; P = .02), and self-harm ideation (b, 0.13; 95% CI, 0.02-0.23; P = .02). No statistically significant associations were detected for exposure to general negative news or media. In multilevel mediation models, heightened expectations of rejection explained some of the total effect of exposure to LGBTQ+ negative news or media on active SI (23%) and passive SI (37%).Conclusions and RelevanceThis intensive longitudinal cohort study found that SI intensity modestly increased in the hours immediately following exposure to LGBTQ+ negative news or media among LGBTQ+ young adults. These findings have timely implications for research and intervention, particularly within sociopolitical and geographic contexts where news or media coverage about LGBTQ+ topics is intensified.

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State LGBTQ policy environments and the cancer burden in sexual and gender minoritized communities in the United States

Weideman,

McAlpine

2024

Cancer Medicine

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PurposeOur objective was to assess the association between state policies related to sexual orientation and gender identity (SOGI) and cancer prevalence and survivorship indicators in a sexual and gender minoritized (SGM) population in the United States.MethodsData from the 2017–2021 Behavioral Risk Factor Surveillance System were used to measure cancer diagnosis, physical and mental health, and substance use for SGM adult cancer survivors. A state policy Z‐score, ranging from most restrictive to most protective state policies related to SOGI, was computed from data available from the Movement Advancement Project. Survey‐weighted logistic regression was used to test the relationship between state policies and cancer‐related outcomes for SGM people.ResultsMore protective state policies were associated with lower odds of a cancer diagnosis (adjusted odds ratio [AOR]: 0.92; 95% confidence interval [CI]: 0.87–0.97). Among SGM cancer survivors, increasing protective state policies were associated with lower odds of poor physical health (AOR: 0.83; 95% CI: 0.74–0.94), lower odds of difficulty walking or climbing stairs (AOR: 0.90; 95% CI: 0.80–1.00), and lower odds of difficulty concentrating or remembering (AOR: 0.87; 95% CI: 0.78–0.98). No significant associations were found between state policies and mental health, depression, substance use, diabetes, or cardiovascular disease among SGM cancer survivors.ConclusionSGM people diagnosed with cancer are more likely to live in restrictive policy states, and survivors in those states have worse physical health and cognitive disability. Additional research should investigate potential causal relationships between state policies and SGM cancer outcomes.

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Structural stigma and LGBTQ+ health: a narrative review of quantitative studies

Cited by 21 publications

References 122 publications

Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses

Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses

Real-Time Exposure to Negative News Media and Suicidal Ideation Intensity Among LGBTQ+ Young Adults

State LGBTQ policy environments and the cancer burden in sexual and gender minoritized communities in the United States

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