License to Discriminate: Structural Stigma and Lesbian, Gay, and Bisexual Health
A growing body of research suggests that a lesbian, gay, and bisexual (LGB) persons’ stigmatized status impacts their health relative to heterosexuals. However, less research has examined how differences in stigma towards LGB people across geographic locales influences these health differentials. This dissertation draws upon structural stigma theory to examine whether or not a LGB person living in a state with marriage equality, anti-discrimination protections, or with high acceptance of LGB people can influence how healthy they are, in addition to whether they have insurance and can go to the doctor. In the first empirical chapter, I test different operationalizations of structural stigma to predict health outcomes, including health insurance status, access to medical care, and self-rated health. I find that measures of cultural acceptance for lesbian and gay people is important in predicting self-rated health, while both legal and cultural measures are important predictors of health insurance and health care for gay/lesbians and bisexuals. Furthermore, results show that these operationalizations of structural stigma work similarly for both men and women sexual minorities. The second empirical chapter tests whether structural stigma is associated with health insurance and health care access over and above individual characteristics (including demographic characteristics, socioeconomic status, and health behaviors). Overall, I find that group level differences in marital status and socioeconomic status explain state-level variations in health insurance and medical care access. The third empirical chapter tests whether structural stigma is associated with self-rated health over and above individual characteristics, and I find that in states with high levels of structural stigma (or low acceptance of LGB people), gay and lesbian adults experience worse health than heterosexuals, with no health disparities in states with low levels of structural stigma. Step-wise regressions show income mediated much of the relationship between structural stigma and self-rated health. These findings point to the importance of context in influencing health-related outcomes for gay and lesbian adults, as well as the role that income plays in creating health disparities.
LGBT health, population health, sexuality, structural stigma
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