Contextual Determinants of Sexual Minority Health in the United States
R01 Application Summary/Abstract
Kara Joyner (PI) and Wendy Manning (Co-I)
Researchers have long documented health disparities for sexual minority populations (or sexual diverse
populations) and they are beginning to document them for gender minority populations (or gender diverse
populations). These health disparities remain largely intractable because researchers have not been able to
rigorously capture the putative mechanism behind them: stigma. The minority stress perspective posits that
sexual minority populations, like racial/ethnic minority populations, experience a higher prevalence of adverse
health outcomes than heterosexual populations due to their stigmatized status in society. Researchers testing
this perspective have increasingly measured stigma at the societal level or “structural stigma,” a concept that
captures both social climate (public attitudes towards sexual/gender minorities) and legal climate (laws and
policies relevant to sexual/gender minorities). Researchers have been hampered in their ability to adequately
assess the effects of structural stigma due to the design of most population-based surveys that include questions
on sexual minority status and health. Few of these surveys permit researchers to measure stigma at multiple
levels. Another limitation of these surveys is that they are cross-sectional, precluding a consideration of how
exposure to structural stigma changes over the life course. The National Longitudinal Study of Adolescent to
Adult Health (Add Health) has the necessary criteria to rigorously investigate the effects of structural stigma on
the health outcomes of sexual minority respondents, including a formal and regulated mechanism for producing
and disseminating contextual data. Add Health users interested in testing minority stress and intersectionality
perspectives will have unprecedented opportunities to examine how various outcomes are associated with
structural stigma for sexual minority respondents and how the associations differ across subgroups. Aim 1 of
this project is to create a contextual database that researchers can use to better study the effects of structural
stigma. Specifically, this database will include measures of social and legal climate relevant to sexual minorities
that correspond to the tract, county, and state levels before or around the time of Waves 3, 4, and 5. This
database will also include measures of structural racism since many sexual minorities are also racial/ethnic
minorities. We will convene an advisory team to ensure we have the best measures of structural stigma and
racism. Aim 2 will examine with this contextual database how state-level measures of legal climate are
associated with self-rated health and health biomarkers among Add Health respondents and consider how these
associations differ by key factors (e.g., gender, socioeconomic status, and race/ethnicity). This database will
promote research on health disparities for sexual and racial minority populations that is both rigorous and
innovative. Research made possible by the creation of this contextual database has the potential to inform
policies and interventions that improve the health of sexual and racial minority populations, including subgroups
of these populations, ensuring all populations have equal opportunities for long, healthy, and productive lives.