Midlife Satisfaction Disparities by Sexual Orientation: Findings from the Health and Retirement Study.

Midlife is a pivotal stage shaping healthy aging, and sexual minorities may face more challenges in midlife than heterosexual individuals, due to cumulative social, economic, and health disadvantages. Yet, few studies have examined how life satisfaction in midlife varies by sexual identity. Using data from the 2016 Health and Retirement Study (N=3,630), we conducted logit regressions and Karlson-Holm-Breen (KHB) decomposition analysis to examine how health-related, socioeconomic, and sociopsychological factors contribute to disparities in life satisfaction across sexual orientation groups in middle adulthood. The results show that bisexual individuals, but not gay or lesbian individuals, reported significantly lower life satisfaction than their heterosexual peers because of their poorer health status and behaviors, fewer social resources, and lower socioeconomic status. Our findings suggest that public policies should target continuing the reduction in sexuality-based stigma, particularly biphobia, to mitigate the health, social, and economic disparities linked to diminished well-being among middle-aged bisexual individuals.

Marital Status and Happiness During the COVID-19 Pandemic.

Objective: This study examines the long-observed marital advantage in happiness during the COVID-19 pandemic. Background: The COVID-19 pandemic may have altered the marital advantage in happiness due to changes in social integration processes. However, this has not been explored in previous studies. Method: Data were from the COVID-19 substudy of the National Social Life, Health, and Aging Project (N=2622). A series of regressions were estimated to understand marital status differences in pandemic happiness and changes in relationships with non-resident family and friends. Karlson-Holm-Breen mediation analysis was conducted to examine whether relationships with non-resident family and friends explained the marital association with pandemic happiness. Results: From pre-pandemic to pandemic, married respondents experienced a greater increase in unhappiness than unmarried counterparts, narrowing happiness gaps. However, unmarried individuals, including cohabiting, divorced, widowed, and never married individuals, continued to report higher levels of unhappiness during the pandemic than married peers. These differences primarily stemmed from pre-pandemic happiness. After controlling for pre-pandemic happiness, cohabiting, widowed, and never married older adults did not significantly differ from their married counterparts in reporting unhappiness during the pandemic. In contrast, divorced individuals remained consistently more unhappy than married individuals during the pandemic, mainly due to deteriorated relationship quality with non-resident family. Conclusion: During a global crisis, it is crucial for policymakers, healthcare providers, and researchers to develop innovative interventions to promote happiness and healthy aging among all older adults, paying special attention to those who are divorced.

Perceived Discrimination and Incident Dementia Among Older Adults in the United States: The Buffering Role of Social Relationships.

OBJECTIVES: Recent studies have found that perceived discrimination as a chronic stressor predicts poorer cognitive health. However, little research has investigated how social relationships as potential intervening mechanisms may mitigate or exacerbate this association. Using a nationally representative sample of U.S. older adults, this study examined how the existence and quality of 4 types of relationships-with a partner, children, other family members, and friends-may modify the impact of perceived discrimination on incident dementia. METHODS: We analyzed data from the 2006 to 2016 Health and Retirement Study (N = 12,236) using discrete-time event history models with competing risks. We used perceived discrimination, social relationships, and their interactions at the baseline to predict the risk of incident dementia in the follow-ups. RESULTS: Perceived discrimination predicted a higher risk of incident dementia in the follow-ups. Although having a partner or not did not modify this association, partnership support attenuated the negative effects of discrimination on incident dementia. Neither the existence nor quality of relationships with children, other family members, or friends modified the association. DISCUSSION: Our findings imply that intimate partnership plays a critical role in coping with discrimination and, consequently, influencing the cognitive health of older adults. Although perceived discrimination is a significant risk factor for the incidence of dementia, better partnership quality may attenuate this association. Policies that eliminate discrimination and interventions that strengthen intimate partnerships may facilitate better cognitive health in late life.

Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States.

Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.

Explaining Health Disparities in the Sexual Minority Population: The Role of Neighborhood Effects.

Individual health is affected not only by characteristics and behaviors of the individual, but also by the environment in which the individual lives. Although neighborhood effects are well-established in the health literature, whether these effects are different for sexual minority populations is unknown. There is evidence that the neighborhoods in which sexual minorities reside are distinct from those in which heterosexuals reside, which could give rise to differential neighborhood effects. This research uses restricted data from the National Center for Health Statistics Research Data Center-which include neighborhood identifiers-to investigate health-relevant differences between the neighborhoods in which heterosexuals and sexual minorities reside. We also provide preliminary evidence on whether neighborhood effects explain any or all the disparities in health behaviors or health outcomes between sexual minority and heterosexual populations or mediate or moderate the effects of other covariates in explaining these disparities.

A National Study on Religiosity and Suicide Risk by Sexual Orientation.

INTRODUCTION: Although religiosity is known to predict lower suicide risk among the general population, it is unclear how different aspects of religiosity such as religious beliefs and attendance are associated with suicide risk among sexual minorities relative to heterosexual populations. METHODS: Analyzing nationally representative data from the 2016-2019 National Survey on Drug Use and Health in 2022 (N=163,995), this study conducted logistic regressions to link suicidal ideation, plans, and attempts with religious beliefs and attendance. Moderation analyses were used to assess how religiosity is differentially linked to suicide risk among heterosexual, gay/lesbian, and bisexual males and females. RESULTS: Although higher religiosity is consistently associated with lower suicide risk among heterosexual people, the effects of religiosity may be less beneficial or even harmful among sexual minorities. Specifically, religious attendance is associated with lower odds of suicidal ideation, plans, and attempts among heterosexual people, but it is also related to higher odds among gay/lesbian and bisexual people. In addition, religious beliefs are associated with lower odds of suicidal plans and attempts among heterosexual people, but this association is significantly weaker for bisexual people. These findings are more pronounced among gay males and bisexual females. CONCLUSIONS: Using population-based data, this study shows that the relationships between religiosity and suicide risk vary by sexual orientation and gender and that religious beliefs and religious attendance are differentially associated with suicide risk among sexual minorities. Future research should continue to explore how various aspects of religious participation may influence the mental health of diverse sexual minority communities.

Sexual Identity and Self-Rated Health in Midlife: Evidence from the Health and Retirement Study.

Purpose: This study examined health disparities among U.S. sexual minority people in midlife-a critical life course stage that is largely overlooked in the sexual minority health literature. Methods: Data were drawn from the 2016 Health and Retirement Study. We restricted the analysis to respondents aged 50-65. The final sample consisted of 3623 respondents, including 3418 self-identified heterosexual individuals, 99 self-identified gay/lesbian individuals, 38 self-identified bisexual individuals, and 68 respondents who identified as "something else." Ordinal logistic regression models were estimated to predict the odds of reporting better health. Results: Bisexual midlifers reported significantly worse health than their heterosexual counterparts after age, gender, and race-ethnicity are controlled for (OR=0.43, 95% CI=0.25-0.76); this health disparity is mostly explained by marital status, socioeconomic status, and health behaviors (in particular smoking and exercising). We did not find evidence of a self-rated health disadvantage among gay and lesbian midlifers relative to their heterosexual counterparts. Conclusion: These findings highlight the diversity of the sexual minority population in midlife. Public policies and programs should be designed and implemented at the interpersonal and institutional levels to eliminate health and other social disadvantages among sexual minority people, in particular bisexual people, in midlife.

Couple Analysis in the National Social Life, Health, and Aging Project.

OBJECTIVES: Marital and intimate partner relationships are some of the most important social ties that shape older adults' health and well-being. This paper provides analytic guidelines for the couple data in Round 2 (2010-2011) and Round 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP) to encourage more research on marriage and partnership in late life. METHOD: First, we describe the recruitment of couples and outline how to identify partners in the data sets. Second, we provide descriptive information about the couple sample. Third, we offer guidance for analyzing the dyadic data cross-sectionally and longitudinally. RESULTS: Round 2 interviewed all primary respondents and a sample of their current cohabiting partners and spouses (n = 955 couples). In Round 3, NSHAP reinterviewed the primary respondents and partners who participated in Round 2 (Cohort 1; n = 621 couples) and recruited a new sample of age-eligible adults along with any cohabiting romantic partners (Cohort 2; n = 766 couples). Couples can be identified using a household ID variable in Round 2 and a partner ID variable in Round 3. Demographic characteristics of the couple sample vary by round and cohort. DISCUSSION: Researchers can use data from either round to conduct cross-sectional dyadic analyses to examine issues faced by older couples. A common strategy for couple analysis is the actor-partner interdependence model. With 2 rounds of couple-level data, researchers may consider using cross-lagged models in their research.

Health and Health Care of Sexual and Gender Minorities.

Research on the social dimensions of health and health care among sexual and gender minorities (SGMs) has grown rapidly in the last two decades. However, a comprehensive review of the extant interdisciplinary scholarship on SGM health has yet to be written. In response, we offer a synthesis of recent scholarship. We discuss major empirical findings and theoretical implications of health care utilization, barriers to care, health behaviors, and health outcomes, which demonstrate how SGMs continue to experience structural- and interactional-level inequalities across health and medicine. Within this synthesis, we also consider the conceptual and methodological limitations that continue to beleaguer the field and offer suggestions for several promising directions for future research and theory building. SGM health bridges the scholarly interests in social and health sciences and contributes to broader sociological concerns regarding the persistence of sexuality- and gender-based inequalities.

Social Relationships and Loneliness in Late Adulthood: Disparities by Sexual Orientation.

OBJECTIVE: This is the first national study to examine disparities in loneliness and social relationships by sexual orientation in late adulthood in the United States. BACKGROUND: Prior studies have shown that lesbian, gay, and bisexual (LGB) individuals often struggle with social relationships across the life course, likely because of stigma related to sexual orientation. However, little is known about whether loneliness is more prevalent among LGB people than among other groups in late adulthood, and if so, which relationships contribute to the loneliness gap. METHOD: We analyzed data from a nationally representative sample of older adults from the 2015-2016 National Social Life, Health, and Aging Project (N = 3,567) to examine the disparity in loneliness by sexual orientation and identify links between this disparity and multiple dimensions of social relationships, including partner, family, friend, and community relationships. RESULTS: Older LGB adults were significantly lonelier than their heterosexual counterparts, primarily due to a lower likelihood of having a partner and, to a lesser extent, lower levels of family support and greater friend strain. While they were also disadvantaged in the size of close family and frequency of community participation, these factors were less relevant to their loneliness. Overall, the conventionally defined inner layers of relationships (partnership and family) contributed more to the loneliness disparity than the outer layers of relationships (friends and community). CONCLUSION: These findings suggest that strengthening the partnerships and family relationships of sexual minorities is essential to reducing the loneliness gap.

Disparities in Experience with Culturally Competent Care and Satisfaction with Care by Sexual Orientation.

Purpose: Prior studies have identified health care providers' lack of cultural competency as a major barrier to care among sexual minority individuals. However, little is known about disparities in experience with culturally competent care by sexual orientation at the population level. This study assessed experiences with culturally competent care and satisfaction with care across sexual orientation groups in the United States. Methods: We analyzed nationally representative data from the 2017 National Health Interview Survey (n = 21,620) with ordinal logit regression models and compared six aspects of health care experiences across sexual orientation groups. These were: preferences for and frequencies of seeing health care providers who understand or share their culture; perceived experiences of being treated with respect by providers and providers asking about their beliefs and opinions; access to easily understood health information from providers; and satisfaction with received care. Results: Relative to heterosexual men, gay men were more likely to consider it important for providers to understand or share their culture (odds ratio [OR] = 1.4, p < 0.05) and to have providers who ask for their opinions or beliefs about care (OR = 1.5, p < 0.01). Relative to heterosexual women, bisexual- and something else-identified women were less likely to report being treated with respect (ORs = 0.4-0.6, p's < 0.01) and satisfaction with care (ORs = 0.5-0.6, p's < 0.05). No statistical differences in health care experiences were found between other sexual minority groups and their heterosexual counterparts. Conclusions: Access to culturally competent care and satisfaction with care varied by sexual orientation and gender. Clinical practices should address the unique health care barriers faced by bisexual- and something else-identified women.

Childlessness and Social Support in Old Age in China.

Although previous studies showed that children are the primary source of old-age support in China, much less is known about the availability and sources of social support among childless elders. Also, little research has explored how older adults' social support transitions over time by childless status. Using the 2005 and 2011 Chinese Longitudinal Healthy Longevity Survey (N = 14,575), this study examined the transition of living arrangement and sources of social support by childless status among adults aged 65 and older. A series of multinomial logistic and linear regression models were used to analyze the data. Results show that compared to elders with children, childless elders were more likely to live alone or in an institution at baseline, but their probability of living alone decreased substantially while that of living in an institution increased modestly in the 6-year follow-up. Moreover, childless elders generally had fewer support sources, but this disadvantage became smaller over time. Although childless elders were significantly more likely to depend on nobody, the spouse, grandchildren (or other relatives), or nonrelatives for support at baseline, this pattern disappeared in the follow-up likely due to mortality selection. Findings imply that although the risk of social isolation among childless elders becomes lower as age progresses, garnering more social resources at younger ages may help reduce their premature mortality.

Elevated Risk of Cognitive Impairment Among Older Sexual Minorities: Do Health Conditions, Health Behaviors, and Social Connections Matter?

BACKGROUND AND OBJECTIVES: Little research has examined cognitive health disparities between sexual minority and heterosexual populations. Further, most extant studies rely on subjective measures of cognitive functioning and non-probability samples. This study uses a performance-based cognitive screening tool and a nationally representative sample of older Americans to examine the disparity in cognitive impairment by sexual orientation and the potential mechanisms producing this disparity. RESEARCH DESIGN AND METHODS: Using data from the 2015-2016 National Social Life, Health, and Aging Project (N = 3,567), we analyzed respondents' scores on the survey-adapted Montreal Cognitive Assessment. We estimated ordinal logit regressions to examine the relationship between sexual orientation and cognitive impairment and used the Karlson-Holm-Breen method to assess how mental and physical conditions, health behaviors, and social connections mediate this relationship. RESULTS: The prevalence of cognitive impairment is significantly higher among sexual minority older adults than among heterosexual older adults when sociodemographic factors are adjusted for. Depressive symptoms explain some of this prevalence gap. Although anxiety symptoms, physical comorbidity, health behaviors, and social connections may contribute to cognitive impairment, they do not explain the cognitive disparity by sexual orientation. DISCUSSION AND IMPLICATIONS: The findings indicate that depressive symptoms are an important link between minority sexual orientation and cognitive impairment and highlight the importance of studying other potential mechanisms that we could not explore in this study. Future research should further investigate how minority stress processes may unfold to accelerate cognitive decline among sexual minorities over the life course.

Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study.

OBJECTIVES: We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States. METHODS: We analyzed data from the Health and Retirement Study (2000-2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment. RESULTS: The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (odds ratio = 1.53, p < .001). DISCUSSION: The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.

Social Networks in Later Life: Similarities and Differences between Sexual-Minority and Heterosexual Older Adults.

Community-based research suggests that lesbian, gay and bisexual (LGB) older adults are more socially isolated than their heterosexual counterparts. However, little is known about how social networks in late adulthood differ between LGB and heterosexual people at the population level. Using data from the 2015-16 National Social Life, Health and Aging Project (N=3,929), we compare the size, frequency of contact, composition, diversity, and density of core discussion networks as well as family and friend support across sexual orientation groups. We find that LGB people share a few network characteristics with their heterosexual counterparts, including network size, frequency of contact with network members, and proportion of non-spousal kin members in the network. However, their networks are less likely to include an intimate partner, are more likely to include friends, and have lower diversity and density. LGB people also report lower family support but higher friend support than heterosexual people.

Bisexuality, Union Status, and Gender Composition of the Couple: Reexamining Marital Advantage in Health.

It has long been documented that married individuals have better health outcomes than unmarried individuals. However, this marital advantage paradigm has been developed primarily based on heterosexual populations. No studies to date have examined the health effects of marriage among bisexuals, one of the most disadvantaged but understudied sexual minority groups, although a few have shown mixed results for gays and lesbians. Similarly, no research has examined how the gender composition of a couple may shape bisexuals' health outcomes above and beyond the effects of sexual orientation. We analyzed pooled data from the 2013-2017 National Health Interview Survey (n = 154,485) and found that the health advantage of marriage applied only to heterosexuals and, to a lesser extent, gays and lesbians. Married bisexuals, however, exhibited poorer health than unmarried bisexuals when socioeconomic status and health behaviors were adjusted for. Moreover, bisexuals in same-gender unions were healthier than bisexuals in different-gender unions primarily because of their socioeconomic advantages and healthier behaviors. Together, our findings suggest that bisexuals, particularly those in different-gender unions, face unique challenges in their relationships that may reduce the health advantage associated with marriage.

Disability, Psychological Well-Being, and Social Interaction in Later Life in China.

Many studies show that disability predicts lower social participation and poorer psychological well-being. However, few have examined how disability, social interaction, and psychological well-being interrelate with one another. We use diary data from World Health Organization's Study on Global AGEing and Adult Health, 2007-2010 ( N = 8,771) and mediation analysis to examine the links between disability, daily social interaction, and the momentary and global well-being of older adults in China. We find suggestive support for the hypothesis that psychological well-being predicts social interaction in the context of disablement, but little evidence for the converse. Specifically, in a cross-sectional analysis, disability predicts lower levels of momentary affect, happiness, and life satisfaction, which are linked to spending more time alone and participating in fewer activities with grandchildren, friends, and coworkers. These findings are consistent with the hypothesis that a less active social life is explained by poor functional performance and compromised psychological vibrancy.

Functional Status, Cognition, and Social Relationships in Dyadic Perspective.

OBJECTIVES: Health limitations can change older adults' social relationships and social engagement. Yet, researchers rarely examine how the disability of one's spouse might affect one's social relationships, even though such life strains are often experienced as a couple. This study investigates the association between functional and cognitive limitations and social experience in a dyadic context. METHOD: We use actor-partner interdependence models to analyze the partner data from 953 heterosexual couples in Wave II (2010-2011) of the National Social Life, Health, and Aging Project. RESULTS: One spouse's functional and cognitive health is associated with the other's relationship quality, but the pattern varies by gender. Husbands' functional limitations are associated with lower marital support and higher marital strain in wives, but wives' functional limitations are related to lower family and friendship strain in husbands. Husbands' cognitive impairment also predicts higher family and friend support in wives. DISCUSSION: Findings support a gendered dyadic relationship between health and social life and highlight women's caregiver role and better connection with family and friends. There are also differences between experiencing cognitive and physical limitations in couples. Finally, mild health impairment sometimes shows stronger effects on social relationships than severe impairment, suggesting adaptation to health transition.

A National Dyadic Study of Oral Sex, Relationship Quality, and Well-Being among Older Couples.

Objectives: We examine how giving versus receiving oral sex, 2 processes that are linked to relationship quality, are associated with older men's and women's well-being. Method: We analyzed 884 heterosexual couples from the National Social Life, Health, and Aging Project (2010-2011). We estimate Actor-Partner Interdependence Models using the SEM approach to assess three well-being outcomes: general happiness, psychological distress, and self-reported mental health. Results: Older adults with better relationship quality gave oral sex to their partner more often than those with worse relationship quality; this association was stronger for men than for women. While receiving oral sex was positively related to both men's, and women's perceptions of relationship quality, women's relationship quality was more strongly linked to their partners' well-being than men's. Correspondingly, men's giving of oral sex (and thus their female partner's receiving of oral sex) was positively related to their own well-being through increasing their female partner's perceived relationship quality. Discussion: Given the high prevalence of sexual dysfunctions among older adults, oral sex may play an important but overlooked role in maintaining an active sexual life, a high-quality relationship, and psychological vibrancy in late life.

Loneliness in the older adult marriage: Associations with dyadic aversion, indifference, and ambivalence.

Marriage protects against loneliness, but not all marriages are equally protective. While marriage is a highly interdependent relationship, loneliness in marital dyads has received very little research attention. Unlike most studies proposing that positive and negative marital qualities independently affect loneliness at the individual level, we used a contextual approach to characterize each partner's ratings of the marriage as supportive (high support, low strain), ambivalent (high support, high strain), indifferent (low support, low strain), or aversive (low support, high strain), and examined how these qualities associate with own and partner's loneliness. Using couple data from the Wave II National Social Life, Health and Aging Project (N=953 couples), we found that more than half of the older adults live in an ambivalent, indifferent, or aversive marriage. Actor-partner interdependence models showed that positive and negative marital qualities synergistically predict couple loneliness. Spouses in aversive marriages are lonelier than their supportively married counterparts (actor effect), and that marital aversion increases the loneliness of their partners (partner effect). In addition, wives (but not husbands) in indifferent marriages are lonelier than their supportively married counterparts. These effects of poor marital quality on loneliness were not ameliorated by good relationships with friends and relatives. Results highlight the prominent role of the marriage relationship for imbuing a sense of connectedness among older adults, and underscore the need for additional research to identify strategies to help older adults optimize their marital relationship.