The primary focus of the current study was to identify health disparities between sexual minority subgroups by examining differences of health indicators in lesbians, gay men, and bisexual individuals, and compare these to their heterosexual counterparts. Data was drawn from the National Health and Nutrition Examination Survey (NHANES), and variables examined in sexual minorities were related to health care access and utilization, risky health behaviors, and overall disease prevalence and outcomes. Findings suggest there are still some current health disparities in terms of insurance coverage, access to medical care, substance use, and prevalence of certain health conditions. However, a trend analysis conducted to examine three NHANES panels, suggests a mild improvement in some of these areas. Further findings, discussion, limitations of the study, current implications, and future directions are addressed.

Gender and sexual minorities (GSM) experience considerably worse health outcomes than heterosexual and cisgender people, yet no comprehensive understanding of GSM health exists due to a dearth of research. GSM leaders in Dallas expressed need for a community needs assessment of GSM health. In response to this call, the Center for Psychosocial Health Research conducted a needs assessment of gender and sexual minority health in Dallas (35 interviews, 6 focus groups). Competency was one area highlighted and shared across existing research. Thus, the current study explored how competency impacts gender and sexual minorities' experience of health care in Dallas. We utilized a consensual qualitative research approach to analyze competency-related contents. The meaning and implications of emerging core ideas were explored. These findings were also used to develop a survey instrument.

Cardiovascular disease (e.g., myocardial infarction, stroke, coronary artery disease) is the leading cause of death and disability worldwide. There is a growing body of literature that indicates sexual minority (e.g., gay, lesbian, bisexual, queer) adults are at a higher risk of cardiovascular disease than their heterosexual counterparts. The aim of this dissertation was to identify factors that contribute to the cardiovascular health (CVH) disparities that have been observed among sexual minority individuals. Guided by an adaptation of the minority stress model of CVH among sexual minority individuals, this dissertation includes three studies. In the first study (i.e., Chapter 2), we conducted a scoping review of the literature that investigated social determinants of cardiovascular health among sexual minority adults. Although findings were mixed, several social determinants of health were found to influence the CVH of sexual minority adults. For instance, sexual minority adults who lived in environments that were more supportive of sexual and gender minority people had lower odds of being overweight or obese. In the second study (i.e., Chapter 3), we used data from a racially and ethnically diverse sample of sexual minority women to examine the associations of family-related factors (i.e., sexual identity disclosure and family social support) with self-reported incident hypertension. Additionally, we examined whether these associations were moderated by race/ethnicity and sexual identity, or mediated by depressive symptoms. We found that higher levels of family social support were associated with lower levels of depressive symptoms among sexual minority women. However, family-related factors were not associated with self-reported incident hypertension. Further, race/ethnicity and sexual identity did not moderate the associations between family-related factors and reported incident hypertension. In the third study (i.e., Chapter 4), we used data from a nationally representative sample of adults to investigate sexual identity differences in ideal CVH (as defined by the American Heart Association’s Life Simple 7) and whether these associations were mediated by depressive symptoms. Compared to exclusively heterosexual women, mostly heterosexual and lesbian women were less likely to meet ideal criteria for tobacco use. In contrast, lesbian women were more likely to meet ideal criteria for glycosylated hemoglobin than exclusively heterosexual women. Among men, relative to exclusively heterosexual men, mostly heterosexual men were less likely to meet ideal criteria for tobacco use. Gay and bisexual men were less likely to meet ideal criteria for physical activity, whereas gay men were more likely to meet ideal criteria for body mass index compared to exclusively heterosexual men. Bisexual men were less likely to meet ideal criteria for blood pressure relative to exclusively heterosexual men. Depressive symptoms were found to partially mediate the association between sexual identity and physical activity only among mostly heterosexual women. Overall, these dissertation findings highlight CVH disparities among sexual minority adults. Clinicians should be educated about the CVH disparities that have been documented among sexual minority adults to provide personalized and culturally competent care. Results also indicate there is a need to develop behavioral interventions tailored specifically to the needs of sexual minority adults to improve their CVH outcomes and reduce CVH-related disparities.

Background: Sexual minority women (SMW; e.g., lesbian, bisexual women) are at substantially higher risk for hazardous drinking (HD) than their heterosexual, cisgender counterparts. There is considerable evidence that minority stressors at the individual (e.g., internalized stigma) and interpersonal (e.g., discrimination) levels are associated with HD among SMW, but minority stressors at the structural level (e.g., structural stigma) are understudied. Further, there is a wide gap in the literature on the relationships between multilevel minority stressors and HD. Additionally, there is evidence that these associations may differ by race/ethnicity and sexual identity, but relatively little is known about these differences, particularly in a multilevel context. Methods: This dissertation includes three studies that were guided by an adaptation of the minority stress model and the social ecological model. In the first study we conducted a systematic review of quantitative research studies that examined associations between structural stigma and alcohol-related outcomes among sexual and gender minority (SGM) adults in the United States. In the second study we used data from a diverse sample of SMW enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study to determine whether structural stigma at Wave 4 (2017-2019) was prospectively associated with HD at Wave 5 (2019-2022), and whether this association was attenuated when accounting for individual- (i.e., internalized stigma, stigma consciousness) and interpersonal- (i.e., discrimination, sexual identity concealment) level minority stressors. In the third study we used data from Waves 4 and 5 of the CHLEW study to examine whether associations between multilevel minority stressors (i.e., internalized stigma, stigma consciousness, discrimination, sexual identity concealment, structural stigma) and HD varied by race/ethnicity and sexual identity. Results: The systematic review included 11 studies. There was moderate to strong support for a positive association between structural stigma and poor alcohol-related outcomes among SGM people, with differences by gender, sexual identity, race, and ethnicity. All studies used cross-sectional designs, and nearly half utilized non-probability samples. Transgender and nonbinary people, SGM people of color, and sexual identity subgroups beyond gay, lesbian, and heterosexual were underrepresented. Multilevel stigma and resiliency factors were understudied. In the second study, structural stigma was positively associated with HD alone, and when combined with interpersonal-level minority stressors. With the addition of individual-level minority stressors, the association between structural stigma and HD was attenuated, with partial attenuation (i.e., structural stigma was still significant) in the model combining all three levels, and full attenuation (i.e., structural stigma was no longer significant) in the model with only structural stigma and individual-level stressors. Discrimination was negatively associated with HD in the fully combined model and was not associated with HD in any other models. In the third study, we found that associations between structural stigma and HD did not vary by race/ethnicity or sexual identity. However, the associations between individual-level minority stressors (i.e., internalized stigma, stigma consciousness) and interpersonal-level minority stressors (i.e., sexual identity concealment) with HD varied somewhat by race/ethnicity and sexual identity. Conclusions: Findings from this dissertation highlight the importance of structural stigma in SMW’s HD and underscore the importance of both structural-level and multilevel minority stressors in designing interventions to effectively address HD drinking disparities and inequities among SMW. Future research is needed using intersectional approaches with probability samples, longitudinal designs, expanded measures of structural stigma, and samples that reflect the diversity of SGM people.

This dissertation aims to fill important gaps in the weight discrimination literature by applying a non-pathologizing, intersectional approach and by focusing on previously understudied groups (i.e., sexual and gender minority (SGM) people, racial and ethnic minoritized people, and early adolescents). Chapter 1 is an introduction to weight discrimination, including its origins in anti-fatness, its intersections with other systems of oppression, and the necessity to de-pathologize fatness to confront anti-fat oppression. Chapter 2 describes a scoping review of weight stigma/discrimination and its relationship with mental and emotional health among SGM people across the lifespan. Across 23 included studies, findings include consistent relationships between weight stigma and worse mental and emotional health and a scarcity of research focused on gender minority people, racial and ethnic minoritized people, early adolescents, and important outcomes such as self-injurious thoughts and behaviors (SITBs). Aiming to address these gaps, Chapters 3 and 4 both describe cross-sectional analyses of data from a large national sample of 10- to 14-year-old adolescents from the Adolescent Brain Cognitive Development Study. Chapter 3 reports analyses of prevalence of weight discrimination among early adolescents with minoritized sexual, gender, racial, and ethnic identities and those who are gender nonconforming, as well as those at the intersections of these identities. Minoritized adolescents, including intersectionally minoritized adolescents, were significantly more likely to report weight discrimination compared to their peers. Chapter 4 reports analyses of weight discrimination in association with SITBs, and includes testing of sexual identity, gender identity, gender nonconformity, race/ethnicity, sex assigned at birth, and social support as potential moderators. It also includes analysis of intersectional discrimination (based on weight plus sexual identity and/or race/ethnicity) in association with SITBs. Findings indicate that weight discrimination is associated with higher odds of SITBs; none of the proposed moderators had a significant effect. Intersectional discrimination was associated with heightened odds of SITBs. Finally, Chapter 5 presents a synthesis of results and discusses overall strengths, limitations, and implications. This includes implications for future research to fill identified gaps, policy changes to confront anti-fatness and protect adolescents from weight discrimination, and clinical interventions to make healthcare safe and affirming for fat and intersectionally minoritized adolescents.

The purpose of this study was to explore the religion – health link in a sample of adults and undergraduate students (N = 555) that identified as lesbian, gay, or bisexual (LGB), and to explore how perceptions of cultural humility of religious individuals and groups toward LGB individuals affect the relationship between religion and health. First, I found religious commitment among LGB individuals was positively correlated with satisfaction in life, but it was negatively correlated with physical health. Second, I found that cultural humility moderated the relationship between religious commitment and satisfaction in life for LGB individuals involved in a religious community. The lowest levels of satisfaction with life were found for individuals with low religious commitment and perceived the cultural humility of their religious community to be low. However, cultural humility did not moderate the relationship between religious commitment and mental and physical health outcomes. Third, I found cultural humility did not moderate the relationship between religious commitment and minority stress (i.e., internalized homophobia). Fourth, I found that cultural humility was a significant positive predictor of motivations to forgive a hurt caused by a religious individual. I conclude by discussing limitations, areas for future research, and implications for counseling.