Advancing Intersectional Discrimination Measures for Health Disparities Research: Protocol for a Bilingual Mixed Methods Measurement Study

Background Guided by intersectionality frameworks, researchers have documented health disparities at the intersection of multiple axes of social status and position, particularly race and ethnicity, gender, and sexual orientation. To advance from identifying to intervening in such intersectional health disparities, studies that examine the underlying mechanisms are required. Although much research demonstrates the negative health impacts of perceived discrimination along single axes, quantitative approaches to assessing the role of discrimination in generating intersectional health disparities remain in their infancy. Members of our team recently introduced the Intersectional Discrimination Index (InDI) to address this gap. The InDI comprises three measures of enacted (day-to-day and major) and anticipated discrimination. These attribution-free measures ask about experiences of mistreatment because of who you are. These measures show promise for intersectional health disparities research but require further validation across intersectional groups and languages. In addition, the proposal to remove attributions is controversial, and no direct comparison has ever been conducted. Objective This study aims to cognitively and psychometrically evaluate the InDI in English and Spanish and determine whether attributions should be included. Methods The study will draw on a preliminary validation data set and three original sequentially collected sources of data: qualitative cognitive interviews in English and Spanish with a sample purposively recruited across intersecting social status and position (gender, sexual orientation, race and ethnicity, socioeconomic status, age, and nativity); a Spanish quantitative survey (n=500; 250/500, 50% sexual and gender minorities); and an English quantitative survey (n=3000), with quota sampling by race and ethnicity (Black, Latino/a/x, and White), sexual or gender minority status, and gender. Results The study was funded by the National Institute on Minority Health and Health Disparities in May 2021, and data collection began in July 2021. Conclusions The key deliverables of the study will be bilingual measures of anticipated, day-to-day, and major discrimination validated for multiple health disparity populations using qualitative, quantitative, and mixed methods. International Registered Report Identifier (IRRID) PRR1-10.2196/30987

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Advancing Intersectional Discrimination Measures for Health Disparities Research: Protocol for a Bilingual Mixed Methods Measurement Study (Preprint)

10.2196/preprints.30987 ◽

2021 ◽

Author(s):

Ayden I Scheim ◽

Greta R Bauer ◽

João L Bastos ◽

Tonia Poteat

Keyword(s):

Health Disparities ◽

Sexual Orientation ◽

Mixed Methods ◽

Social Status ◽

Race And Ethnicity ◽

Validation Data ◽

Data Set ◽

Quantitative Survey ◽

And Gender ◽

Underlying Mechanisms

BACKGROUND Guided by intersectionality frameworks, researchers have documented health disparities at the intersection of multiple axes of social status and position, particularly race and ethnicity, gender, and sexual orientation. To advance from identifying to intervening in such intersectional health disparities, studies that examine the underlying mechanisms are required. Although much research demonstrates the negative health impacts of perceived discrimination along single axes, quantitative approaches to assessing the role of discrimination in generating intersectional health disparities remain in their infancy. Members of our team recently introduced the Intersectional Discrimination Index (InDI) to address this gap. The InDI comprises three measures of enacted (day-to-day and major) and anticipated discrimination. These attribution-free measures ask about experiences of mistreatment <i>because of who you are</i>. These measures show promise for intersectional health disparities research but require further validation across intersectional groups and languages. In addition, the proposal to remove attributions is controversial, and no direct comparison has ever been conducted. OBJECTIVE This study aims to cognitively and psychometrically evaluate the InDI in English and Spanish and determine whether attributions should be included. METHODS The study will draw on a preliminary validation data set and three original sequentially collected sources of data: qualitative cognitive interviews in English and Spanish with a sample purposively recruited across intersecting social status and position (gender, sexual orientation, race and ethnicity, socioeconomic status, age, and nativity); a Spanish quantitative survey (n=500; 250/500, 50% sexual and gender minorities); and an English quantitative survey (n=3000), with quota sampling by race and ethnicity (Black, Latino/a/x, and White), sexual or gender minority status, and gender. RESULTS The study was funded by the National Institute on Minority Health and Health Disparities in May 2021, and data collection began in July 2021. CONCLUSIONS The key deliverables of the study will be bilingual measures of anticipated, day-to-day, and major discrimination validated for multiple health disparity populations using qualitative, quantitative, and mixed methods. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT PRR1-10.2196/30987

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Power Dynamics at College Parties

10.1093/oso/9780190268503.003.0004 ◽

2017 ◽

Author(s):

Jennifer Beste

Keyword(s):

Sexual Orientation ◽

Social Factors ◽

Race And Ethnicity ◽

Social Groups ◽

Power Dynamics ◽

Gender Inequalities ◽

Gender Based ◽

Social Scientific ◽

And Gender ◽

Powerful Group

Undergraduate ethnographers analyzed the power dynamics among different social groups at parties, attending to race and ethnicity, sexual orientation, and gender. Based on their observations, they sought to identify dominant and subordinate social groups. Most ethnographers who addressed power dynamics in regard to ethnicity and sexual orientation (many did not) perceived that white heterosexual males had the most power and dominance. Regarding power dynamics among the genders, 66% of students claimed that heterosexual males were the most powerful group; 7% argued that females had more power; 24% perceived that both men and women exercise different forms of power or that social factors unrelated to gender determined which individuals were most powerful; and 3% did not directly answer the question about power. After analyzing ethnographers’ reasoning for their perspectives, Beste draws on social scientific research to analyze the power dynamics and gender inequalities manifest in college social and sexual culture.

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Sexual minority adolescents and mental health

Oxford Textbook of Public Mental Health ◽

10.1093/med/9780198792994.003.0027 ◽

2018 ◽

pp. 235-246

Author(s):

Richard Montoro

Keyword(s):

Mental Health ◽

Health Disparities ◽

Sexual Orientation ◽

Identity Formation ◽

Sexual Minority ◽

Coming Out ◽

Minority Youth ◽

Sexual Minority Youth ◽

Mental Health Disparities ◽

And Gender

Sexual minority youth is a broad term that includes adolescents from both sexual orientation and gender minorities. As a major task of adolescence is identity formation, sexual minority youth are particularly vulnerable during this period of self-definition (‘coming out’) both because of societal stigma and traditionally poor parental support. This chapter will start by defining the common terms used by the diverse identities in this population and outlining basic concepts in sexual orientation and gender identity. The literature demonstrating the central role of stigma in creating the mental health disparities of sexual minority youth will be reviewed. As stigma is present at individual, interpersonal, and structural levels, the chapter will conclude with a discussion of the multiple multi-level interventions necessary to have an impact on these disparities. Policymakers and clinicians are uniquely positioned to have a powerful impact on the mental health disparities of sexual minority youth.

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A Mixed-Methods Examination of the Unique Associations of Gender-Sexuality Alliance Involvement and Family Support on Bravery in Sexual and Gender Minority Youth

Journal of Adolescent Research ◽

10.1177/0743558420933226 ◽

2020 ◽

pp. 074355842093322

Author(s):

Christopher J. Ceccolini ◽

V. Paul Poteat ◽

Jerel P. Calzo ◽

Hirokazu Yoshikawa ◽

Kasey Meyer

Keyword(s):

Sexual Orientation ◽

Mixed Methods ◽

Gender Identity ◽

Family Support ◽

Well Being ◽

Minority Youth ◽

Gender Minority ◽

Sexual And Gender Minority ◽

And Gender ◽

Heterosexual Youth

Research among sexual and gender minority (SGM) youth has suggested associations between Gender-Sexuality Alliance (GSA) involvement and better health. Emergent research has similarly demonstrated associations between family support and general well-being among SGM youth. However, the trait of bravery has received little attention in this literature, despite its relevance for youth in marginalized positions. We examined the association between level of GSA involvement, family support, and bravery among GSA members ( n = 295; Mage = 16.07), and whether those associations differed based on sexual orientation or gender identity. We then conducted one-on-one interviews with SGM youth ( n = 10), to understand how they understood bravery and experienced support in both GSA and family contexts. Greater GSA involvement significantly predicted greater bravery for all youth, whereas greater family support predicted greater bravery only for heterosexual youth. No significant moderation was found for gender minority youth. Our qualitative findings clarified how SGM youth conceptualized bravery and how they experienced it within their GSA and family settings. GSAs were associated with more frequent displays of explicit support for SGM identity, while families were perceived as providing less explicit support.

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The Challenges Presented Around Collection of Patient Sexual Orientation and Gender Identity Information For Reduction of Health Disparities

Medical Care ◽

10.1097/mlr.0000000000001219 ◽

2019 ◽

Vol 57 (12) ◽

pp. 945-948

Author(s):

Melissa E. Dichter ◽

Shannon N. Ogden

Keyword(s):

Health Disparities ◽

Sexual Orientation ◽

Gender Identity ◽

Identity Information ◽

And Gender

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Sexual Orientation and Gender Identity Data Collection in Clinical Settings and in Electronic Health Records: A Key to Ending LGBT Health Disparities

LGBT Health ◽

10.1089/lgbt.2013.0001 ◽

2014 ◽

Vol 1 (1) ◽

pp. 34-41 ◽

Cited By ~ 111

Author(s):

Sean Cahill ◽

Harvey Makadon

Keyword(s):

Health Disparities ◽

Sexual Orientation ◽

Data Collection ◽

Gender Identity ◽

Electronic Health Records ◽

Clinical Settings ◽

Lgbt Health ◽

Health Records ◽

Electronic Health ◽

And Gender

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Stigma and Sexual and Gender Minority Mental Health

The Oxford Handbook of Sexual and Gender Minority Mental Health ◽

10.1093/oxfordhb/9780190067991.013.37 ◽

2020 ◽

pp. 417-428

Author(s):

Joanne DiPlacido ◽

Carolyn R. Fallahi

Keyword(s):

Mental Health ◽

Race And Ethnicity ◽

Minority Stress ◽

Treatment Interventions ◽

Minority Mental Health ◽

And Bisexual ◽

And Gender ◽

Underlying Mechanisms ◽

Mental Health Effects

Minority stress and stigma among LGBTQ individuals as a result of oppression from discrimination, heterosexism, and homonegativity has consistently led to poorer mental health outcomes. This chapter outlines the research linking minority stress and stigma to mental health. The authors review Hatzenbuehler’s mediational framework to understand the underlying mechanisms to explain why minority stress predicts psychiatric distress. The authors also discuss the role of intersectionality on mental health, recognizing that many LGBTQ individuals deal with multiple oppressions due to not only their sexual orientation or gender identity or expression but also race and ethnicity. This chapter covers minority stress and stigma among more vulnerable populations at higher risk of mental distress, such as transgender, older, and bisexual communities and those living in the Global South. The authors discuss how coping and social support can buffer the negative mental health effects of minority stress and stigma. Methodological issues and future directions are reviewed and suggestions for prevention and treatment interventions are offered.

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What Oncologists Should Know About Treating Sexual and Gender Minority Patients With Cancer

JCO Oncology Practice ◽

10.1200/op.20.00036 ◽

2020 ◽

Vol 16 (6) ◽

pp. 309-316

Author(s):

Gwendolyn P. Quinn ◽

Ash B. Alpert ◽

Megan Sutter ◽

Matthew B. Schabath

Keyword(s):

Health Disparities ◽

Sexual Orientation ◽

Gender Identity ◽

Clinical Encounter ◽

Gender Minority ◽

Patients With Cancer ◽

Sexual Orientations ◽

Sexual And Gender Minority ◽

And Gender

Sexual and gender minority (SGM) individuals encompass a broad spectrum of sexual orientations and gender identities. Although SGM is a research term, this population is often known as lesbian, gay, bisexual, transgender, queer (LGBTQ). Typically, LGB refers to sexual orientation, T refers to gender identity, and Q may refer to either. Although each group is distinct, they share the common bond of experiencing health disparities that may be caused, in part, by stigma and discrimination, as well as by the oncology provider’s lack of knowledge and, therefore, lack of comfort in treating this population. One challenge in improving the quality of care for SGM patients with cancer is the lack of collection of sexual orientation and gender identity (SOGI) data in the medical record. Furthermore, national studies suggest that many oncologists are unsure of what to do with this information, even when it is collected, and some are uncertain as to why they would need to know the SOGI of their patients. This clinical review offers insight into the health disparities experienced by SGM individuals and strategies for improving the clinical encounter and creating a welcoming environment.

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