Advertisement

Prevalence of Social Determinants of Health Among Sexual Minority Women and Men in 2017

      Introduction

      Inequities in social determinants of health are plausible contributors to worse health of sexual minorities relative to heterosexuals. Sexual minorities may have higher rates of housing, food, and financial insecurity as adults owing to adverse childhood experiences or policies that induce social disadvantage. This study compares the prevalence of 3 types of social determinants of health among sexual minority and heterosexual adults.

      Methods

      Data were from the Behavioral Risk Factor Surveillance System 2017 survey of U.S. states that administered the optional Social Determinants of Health module and Sexual Orientation and Gender Identity modules. In August 2019, authors estimated the odds of food, housing, and financial insecurity among sexual minority men and women, compared with heterosexuals.

      Results

      Sexual minority women and men had higher odds of housing insecurity, housing instability, and food insecurity, but no differences were observed for perceived neighborhood safety. Sexual minority women had higher odds of financial insecurity than their heterosexual peers.

      Conclusions

      Sexual minorities have more housing and food insecurity than heterosexuals, which may contribute to their risk for poorer health. Future research should address the causes and consequences of these differences.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Blosnich JR
        • Farmer GW
        • Lee JG
        • Silenzio VM
        • Bowen DJ
        Health inequalities among sexual minority adults: evidence from ten U.S. states, 2010.
        Am J Prev Med. 2014; 46: 337-349
        • Hsieh N
        • Ruther M
        Sexual minority health and health risk factors: intersection effects of gender, race, and sexual identity.
        Am J Prev Med. 2016; 50: 746-755
        • Alderwick H
        • Gottlieb LM
        Meanings and misunderstandings: a social determinants of health lexicon for health care systems.
        Milbank Q. 2019; 97: 407-419
        • Pollack CE
        • Griffin BA
        • Lynch J
        Housing affordability and health among homeowners and renters.
        Am J Prev Med. 2010; 39: 515-521
        • Downing J
        The health effects of the foreclosure crisis and unaffordable housing: a systematic review and explanation of evidence.
        Soc Sci Med. 2016; 162: 88-96
        • Corliss HL
        • Goodenow CS
        • Nichols L
        • Austin SB
        High burden of homelessness among sexual-minority adolescents: findings from a representative Massachusetts high school sample.
        Am J Public Health. 2011; 101: 1683-1689
        • McLaughlin KA
        • Hatzenbuehler ML
        • Xuan Z
        • Conron KJ
        Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity.
        Child Abuse Negl. 2012; 36: 645-655
        • Flentje A
        • Shumway M
        • Wong LH
        • Riley ED
        Psychiatric risk in unstably housed sexual minority women: relationship between sexual and racial minority status and human immunodeficiency virus and psychiatric diagnoses.
        Womens Health Issues. 2017; 27: 294-301
        • Gundersen C
        • Ziliak JP
        Food insecurity and health outcomes.
        Health Aff (Millwood). 2015; 34: 1830-1839
        • Gates G
        LGBT people are disproportionately food insecure.
        Published 2014
        • Szanton SL
        • Thorpe RJ
        • Whitfield K
        Life-course financial strain and health in African-Americans.
        Soc Sci Med. 2010; 71: 259-265
        • Klawitter M
        Meta‐analysis of the effects of sexual orientation on earnings.
        Ind Relat J Econ Soc. 2015; 54: 4-32
        • Mason TB
        • Lewis RJ
        Minority stress and binge eating among lesbian and bisexual women.
        J Homosex. 2015; 62: 971-992
        • Wiseman MC
        • Moradi B
        Body image and eating disorder symptoms in sexual minority men: a test and extension of objectification theory.
        J Couns Psychol. 2010; 57: 154-166
        • Tester JM
        • Lang TC
        • Laraia BA
        Disordered eating behaviours and food insecurity: a qualitative study about children with obesity in low-income households.
        Obes Res Clin Pract. 2016; 10: 544-552
        • Becker CB
        • Middlemass K
        • Taylor B
        • Johnson C
        • Gomez F
        Food insecurity and eating disorder pathology.
        Int J Eat Disord. 2017; 50: 1031-1040
        • Austin A
        • Herrick H
        • Proescholdbell S
        Adverse childhood experiences related to poor adult health among lesbian, gay, and bisexual individuals.
        Am J Public Health. 2016; 106: 314-320
        • Edwards KM
        • Sylaska KM
        • Neal AM
        Intimate partner violence among sexual minority populations: a critical review of the literature and agenda for future research.
        Psychol Violence. 2015; 5: 112-121
        • Hong JS
        • Garbarino J
        Risk and protective factors for homophobic bullying in schools: an application of the social–ecological framework.
        Educ Psychol Rev. 2012; 24: 271-285
        • Herek GM
        Hate crimes and stigma-related experiences among sexual minority adults in the United States: prevalence estimates from a national probability sample.
        J Interpers Violence. 2009; 24: 54-74
        • Nadal KL
        That's So Gay! Microaggressions and the Lesbian, Gay, Bisexual, and Transgender Community.
        American Psychological Association, Washington, DC2013
      1. Obergefell v. Hodges, 576 U.S. ___ (2015).

      2. Centers for Medicare & Medicaid Services. Obergefell v. Hodges and Eligibility for Medicaid/CHIP.
        Published 2015
        • Social Security Administration
        Introduction to same-sex marriage claims. Program Operations Manual System (POMS).
        Published 2017
        • U.S. Department of Agriculture
        Same sex marriage and SNAP mandatory household states memo.
        Published 2015
        • Dillbary JS
        • Edwards G
        An empirical analysis of sexual orientation discrimination.
        Univ Chic Law Rev. 2019; 86: 1-76
        • Department of Housing and Urban Development
        Equal Access to housing in HUD programs regardless of sexual orientation or gender identity. Vol 24 CFR Parts 5, 200, 203, 236, 570, 574, and 982.
        2011
        • Schwegman D
        Rental market discrimination against same-sex couples: evidence from a pairwise-matched email correspondence test.
        Hous Policy Debate. 2019; 29: 250-272
        • Denton M
        • Walters V
        Gender differences in structural and behavioral determinants of health: an analysis of the social production of health.
        Soc Sci Med. 1999; 48: 1221-1235
        • Gonzales G
        • Przedworski J
        • Henning-Smith C
        Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States: results from the National Health Interview Survey.
        JAMA Intern Med. 2016; 176: 1344-1351
        • Sun H
        • Gao L
        Lending practices to same-sex borrowers.
        Proc Natl Acad Sci U S A. 2019; 116: 9293-9302
        • Friedman S
        • Reynolds A
        • Scovill S
        • Brassier FR
        • Campbell R
        • Ballou M
        An estimate of housing discrimination against same-sex couples.
        SSRN Journal. 2013;
        • Desmond M
        • Perkins KL
        Housing and household instability.
        Urban Aff Rev. 2016; 52: 421-436
        • Manning WD
        • Brown SL
        • Stykes JB
        Same-sex and different-sex cohabiting couple relationship stability.
        Demography. 2016; 53: 937-953
        • Andersen JP
        • Blosnich J
        Disparities in adverse childhood experiences among sexual minority and heterosexual adults: results from a multi-state probability-based sample.
        PloS One. 2013; 8: e54691
        • Brown MJ
        • Masho SW
        • Perera RA
        • Mezuk B
        • Cohen SA
        Sex and sexual orientation disparities in adverse childhood experiences and early age at sexual debut in the United States: results from a nationally representative sample.
        Child Abuse Negl. 2015; 46: 89-102
        • Marshal MP
        • Dietz LJ
        • Friedman MS
        • et al.
        Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review.
        J Adolesc Health. 2011; 49: 115-123
        • Henning-Smith C
        • Gonzales G
        Differences by sexual orientation in perceptions of neighborhood cohesion: implications for health.
        J Commun Health. 2018; 43: 578-585