Who Cares? Unpaid Caregiving by Sexual Identity, Gender, and Partnership Status Among U.S. Adults.

Recent scholarship indicates that sexual minority adults have higher caregiving rates than heterosexuals and that women are more likely to be caregivers than men. However, little research has addressed how gender and sexuality intersect in shaping caregiving status. This study uses data from the Behavioral Risk Factor Surveillance System and aggregates a probability-based sample of adults living in 36 U.S. states between 2015 and 2021. We examine who provides care among adult heterosexual, lesbian, gay, and bisexual men and women. Results reveal that women are more likely to be caregivers than men, but only among heterosexuals. We find little variation in caregiving by sexuality among women, but bisexual men are more likely than heterosexual men to be caregivers; the latter result appears to be driven by unpartnered, bisexual men. Lastly, we contextualize caregivers' experiences and reveal selected descriptive differences in patterns of care recipient-caregiver relationships across gender and sexual identity groups. Our findings advance understanding of caregiving and changing family ties in an era of population aging and increasing diversity in sexual identities.

Healthcare satisfaction at the intersections of sexual orientation and race/ethnicity.

OBJECTIVES: Existing scholarship has consistently demonstrated disparities in healthcare experience based on sexual identity. However, relatively little research has considered intersections with race/ethnicity, despite that intersection with other characteristics may complicate healthcare experiences and satisfaction among sexual minorities. This study aims to address such a gap by examining healthcare satisfaction across the intersections of sexual and racial/ethnic identity. DESIGN: Utilizing data on U.S. adults included in the 2013-2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 372,766), we investigate levels of satisfaction with care among a range of groups simultaneously embodying two identities. RESULTS: Findings from ordered logistic regression models show that among adults who identify as heterosexual, the odds of reporting high satisfaction with care are lower among Blacks, Asians, and Native Americans. Among sexual minority adults, the likelihood of reporting high satisfaction with care is consistently lower among Native American gay and lesbian adults compared to gays and lesbians of other race/ethnicity or Native American and White heterosexuals, indicating heightened vulnerability to poorer healthcare experience among this multiple minority group. CONCLUSION: While levels of satisfaction with care tend to be generally high across groups, future research should endeavor to investigate the driving factors that lower the odds of high healthcare satisfaction among those with intersecting minority identities.

Parenthood, Stress, and Well-Being among Cisgender and Transgender Gay and Lesbian Adults.

OBJECTIVE: This study examines whether and how parenthood status is associated with two key aspects of health- mental well-being and smoking- among sexual minority adults across three gender identity groups: cisgender gay men, cisgender lesbian women, and transgender gay/lesbian adults. BACKGROUND: Parents tend to report worse health than non-parents due to elevated stress associated with parenting. However, most existing scholarship de facto examines parental status and health among cisgender heterosexual adults. Little research has employed an intersectional approach to focus on parenthood and health differences within sexual minority adults across varying gender identities. METHOD: OLS and logistic regression models were used to analyze data from the 2010 Social Justice Sexuality Project (N = 2,803), a survey of racially diverse sexual and gender minority adults residing in all 50 US states and Puerto Rico. RESULTS: In a sample composed predominantly of people of color, parenthood status is related to both mental well-being and smoking status among gay and lesbian adults, but this relationship is inconsistent across cisgender and transgender groups. OLS regression models show that parenthood is positively related to mental well-being among gay and lesbian transgender people, whereas logistic regression results find that parenthood is associated with higher odds of smoking among cisgender gay men. CONCLUSION: These findings suggest that among a sample of sexual and gender minorities composed mostly of people of color, parenthood status is connected with the health and well-being of gay and lesbian adults in ways that depend on gender identity.

"Yes We Can!" The Mental Health Significance for U.S. Black Adults of Barack Obama's 2008 Presidential Election.

This study examines the mental health significance of Barack Obama's 2008 presidential election for black adults. His election was a milestone moment. Hence, we expect black adults would experience improved mental health after the first self-identified black person wins election to the most powerful position in the United States. Using nationally representative survey data from the Behavioral Risk Factor Surveillance System (BRFSS), we address this expectation by predicting poor mental health days that black adults report pre-election and post-election. We find no overall difference in poor mental health days between the time periods. However, a statistical interaction between gender and time period demonstrates black men report 1.01 fewer poor mental health days after the election, whereas black women report .45 more poor mental health days after the election.

Education and health: The joint role of gender and sexual identity.

BACKGROUND: Prior research has found that education's association with health can differ by social positions such as gender. Yet, none of the existing work has tested whether the relationship between education and self-rated health is equivalent across sexual orientation groups, and additionally, if these associations differ for men and women. Deploying the intersectionality perspective, we expand current debates of education as a resource substitution or multiplication to include sexual orientation. METHODS: We answer these questions using data from the Behavioral Risk Factor Surveillance System (BRFSS), a probability-based sample of adults living in 44 US states and territories for selected years between 2011 and 2017 (n = 1,219,382). RESULTS: Supporting resource multiplication, we find that compared to their same-gender heterosexual counterparts, education is less health-protective for bisexual adults, especially bisexual women. Gay men and lesbian women, on the other hand, seem to have similar associations of education with health as their same-gender heterosexual counterparts. Turning to gender comparisons across sexual identity groups, we find that resource substitution may operate only among heterosexual women when compared with heterosexual men. CONCLUSIONS: In sum, this study suggests that the relationship between education and health may depend on the intersection of gender and sexual orientation among U.S. adults.

Does Sexual Orientation Complicate the Relationship Between Marital Status and Gender With Self-rated Health and Cardiovascular Disease?

A substantial body of work has demonstrated the importance of marital status for health, yet the vast majority of this work has studied heterosexual marriages and relationships. To understand the role of marital status in shaping health among heterosexual, lesbian, gay, and bisexual men and women, we examine data from a probability-based sample of adults living in 40 U.S. states for selected years between 2011-2015. We test two physical health outcomes-poor-to-fair self-rated health and cardiovascular disease-and present predicted probabilities and pairwise comparisons from logistic regression models before and after adjustment for demographic characteristics, socioeconomic status, health behaviors, and depression. Overall, findings reveal some important similarities and differences in the relationships between marital status and health by sexual orientation and gender. First, the health benefits of marriage extend to sexual minority adults, relative to adults who are either formerly or never married. Among heterosexual adults, adjusted models also highlight the healthy status of never-married adults. Second, the health benefits associated with intimate relationships appear less dependent on legal marriage among sexual minorities than among heterosexual adults. Third, we document a persistent health disadvantage for bisexual adults compared with heterosexual adults, particularly among women who are formerly married, indicating some elevated health vulnerability among selected sexual minority women. Fourth, associations between sexual orientation and health are more similar across marital status groups for men than women. Altogether, these findings add much needed nuance to our understanding of the association between marital status and health in an era of increasing diversity in adult relationships.

Racial disparities in health and health behaviors among gay, lesbian, bisexual and heterosexual men and women in the BRFSS-SOP.

Objectives: Research on sexual minority health lack examinations of how sexual orientation intersects with other identities, including racial/ethnic identity, to shape health outcomes among U.S. adults. This study examines how health status and health behavior varies for gay, lesbian, and bisexual men and women who identify as non-Hispanic white, non-Hispanic black, Latino, Asian/Pacific Islander, and American Indian/Alaskan Native. By examining health and health behaviors within and across sexual minority subgroups, our study reports on race/ethnic, gender, and sexual orientation specific health risks.Methods: We respond to shortcomings in current data by utilizing aggregated data from fourteen states from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2005 and 2010 (n = 557,773). We investigated the odds of reporting poorer health, current cigarette smoking, and obesity by sexual orientation within race/ethnic and gender subgroups; all statistical analyses were performed in 2016.Results: Results suggest persistent health and behavior disadvantages for lesbian and bisexual women of all racial and ethnic identities, relative to heterosexuals. Some of the heightened odds are extreme. Asian/Pacific Islander lesbian (OR = 3.92) and bisexual (OR = 4.61) women, for example, have 4.0 times higher odds of smoking than heterosexual A/PI women. Results for men are more variable. To illustrate, the odds of obesity for White and A/PI men are indistinguishable between bisexuals and heterosexuals, and Black and American Indian/Alaskan Native bisexuals have lower odds of obesity than their heterosexual counterparts.Conclusion: These findings highlight the need for policy efforts aimed at improving health and health behaviors among lesbian and bisexual women across groups, and more targeted efforts among sexual minority men.

Gender, migration and perceptions of HIV risk in Mexico.

This study examines the role that duty plays in men's and women's perceptions of HIV-related risk in Mexico, and how gender and migration influence these perceptions. We draw on qualitative data from the 2014 Study of Health and Migration in Mexico (SHMM), which included 24 in-depth interviews with migrant men and non-migrant women living in a medium-sized city in Guanajuato, Mexico. While men report migrating out of responsibility to provide for their families, this sense of duty also had implications for their sexual health behaviours. Duty permeates how residents in this migrant-sending community described their perceptions of HIV risk, with men and women drawing consistently on three aspects of duty: fidelity, gendered sexual expectations, and the burden of HIV prevention. We argue that a strong sense of duty can prompt gender role expansion for migrant men and limit gender role expansion for non-migrant women.

State-level climate, anti-discrimination law, and sexual minority health status: An ecological study.

How social and legal climate influence LGB health is an under-studied topic. In response, this study examines whether the lesbian/gay/bisexual (LGB) climate index and presence of anti-discrimination law show population health significance for U.S. sexual minorities. The LGB climate index uses survey data collected between 2012 and 2013 to gauge states' support of lesbian, gay, and bisexual individuals, whereas anti-discrimination law captures any state-level law that makes it illegal to discriminate because of sexual orientation in employment, housing, and public accommodations. We merge these two contextual measures with 2011-2015 Behavioral Risk Factor Surveillance System (BRFSS) aggregated, individual-level survey data, from which we generate three measures of state-level rates: excellent self-rated health, routine health care utilization, and health insurance among self-identified lesbian/gay and bisexual adults. We find that the LGB climate index associates positively with rates of excellent self-rated health, routine health care utilization, and health insurance-but only for states with anti-discrimination laws, and only among lesbian/gay adults. Analyses confirm salubrious synergism between a sexually-minority-friendly climate and anti-discrimination law-together these two contextual measures interact to protect lesbian/gay population health.

The mental well-being of Central American transmigrant men in Mexico.

To understand the mental health status of Central American migrant men travelling through Mexico to the U.S., we analysed the association between migration-related circumstances/stressors and psychological disorders. In-person interviews and a psychiatric assessment were conducted in 2010 and 2014 with 360 primarily Honduran transmigrant young adult males. The interviews were conducted at three Casas del Migrante (or migrant safe houses) in the migration-corridor cities of Monterrey, and Guadalupe, Nuevo Leon; and Saltillo, Coahuila. The results indicated high levels of migration-related stressors including abuse and a high prevalence of major depressive episodes (MDEs), alcohol dependency, and alcohol abuse. Nested logistic regression models were used to separately predict MDEs, alcohol dependency, and alcohol abuse, assessing their association with migration experiences and socio-demographic characteristics. Logistic regression models showed that characteristics surrounding migration (experiencing abuse, migration duration, and attempts) are predictive of depression. Alcohol dependency and abuse were both associated with marital status and having family/friends in the intended U.S. destination, while the number of migration attempts also predicted alcohol dependency. The results provide needed information on the association between transit migration through Mexico to the U.S. among unauthorised Central American men and major depressive disorder and alcohol abuse and dependency.

A New Piece of the Puzzle: Sexual Orientation, Gender, and Physical Health Status.

Although research has long documented the relevance of gender for health, studies that simultaneously incorporate the relevance of disparate sexual orientation groups are sparse. We address these shortcomings by applying an intersectional perspective to evaluate how sexual orientation and gender intersect to pattern self-rated health status among U.S. adults. Our project aggregated probability samples from the Behavioral Risk Factor Surveillance System (BRFSS) across seven U.S. states between 2005 and 2010, resulting in an analytic sample of 10,128 sexual minority (gay, lesbian, and bisexual) and 405,145 heterosexual adults. Logistic regression models and corresponding predicted probabilities examined how poor self-rated health differed across sexual orientation-by-gender groups, before and after adjustment for established health risk factors. Results reveal distinct patterns among sexual minorities. Initially, bisexual men and women reported the highest--and gay and lesbian adults reported the lowest--rates of poor self-rated health, with heterosexuals in between. Distinct socioeconomic status profiles accounted for large portions of these differences. Furthermore, in baseline and fully adjusted regression models, only among heterosexuals did women report significantly different health from men. Importantly, the findings highlight elevated rates of poor health experienced by bisexual men and women, which are partially attributable to their heightened economic, behavioral, and social disadvantages relative to other groups.

Gender, acculturation, and smoking behavior among U.S. Asian and Latino immigrants.

In this paper we examine smoking prevalence and frequency among Asian and Latino U.S. immigrants, focusing on how gender differences in smoking behavior are shaped by aspects of acculturation and the original decision to migrate. We draw on data from 3249 immigrant adults included in the 2002-2003 National Latino and Asian American Study. Findings confirm the gender gap in smoking, which is larger among Asian than Latino immigrants. While regression models reveal that gender differences in smoking prevalence, among both immigrant groups, are not explained with adjustment for measures of acculturation and migration decisions, adjustment for these factors does reduce gender differences in smoking frequency to non-significance. Following, we examine gender-stratified models and test whether aspects of migration decisions and acculturation relate more strongly to smoking behavior among women; we find that patterns are complex and depend upon pan-ethnic group and smoking measure.

Families, resources, and adult health: where do sexual minorities fit?

Extensive research documents the relevance of families and socioeconomic resources to health. This article extends that research to sexual minorities, using 12 years of the National Health Interview Survey (N = 460,459) to examine self-evaluations of health among male and female adults living in same-sex and different-sex relationships. Adjusting for socioeconomic status eliminates differences between same- and different-sex cohabitors so that they have similarly higher odds of poor health relative to married persons. Results by gender reveal that the cohabitation disadvantage for health is more pronounced for different-sex cohabiting women than for men, but little difference exists between same-sex cohabiting men and women. Finally, the presence of children in the home is more protective for women's than men's health, but those protections are specific to married women. In all, the results elucidate the importance of relationship type, gender, and the presence of children when evaluating health.

Language proficiency and health status: are bilingual immigrants healthier?

Bilingual immigrants appear to have a health advantage, and identifying the mechanisms responsible for this is of increasing interest to scholars and policy makers in the United States. Utilizing the National Latino and Asian American Study (NLAAS; n = 3,264), we investigate the associations between English and native-language proficiency and usage and self-rated health for Asian and Latino U.S. immigrants from China, the Philippines, Vietnam, Mexico, Cuba, and Puerto Rico. The findings demonstrate that across immigrant ethnic groups, being bilingual is associated with better self-rated physical and mental health relative to being proficient in only English or only a native language, and moreover, these associations are partially mediated by socioeconomic status and family support but not by acculturation, stress and discrimination, or health access and behaviors.

Is discrimination an equal opportunity risk?: racial experiences, socioeconomic status, and health status among black and white adults.

Using the 2004 Behavioral Risk Factor Surveillance System, we explore the relationship between racial awareness, perceived discrimination, and self-rated health among black (n = 5,902) and white (n = 28,451) adults. We find that adjusting for group differences in racial awareness and discrimination, in addition to socioeconomic status, explains the black-white gap in self-rated health. However, logistic regression models also find evidence for differential vulnerability among black and whites adults, based on socioeconomic status. While both groups are equally harmed by emotional and/or physical reactions to race-based treatment, the negative consequences of discriminatory experiences for black adults are exacerbated by their poorer socioeconomic standing. In contrast, the association between racial awareness and self-rated health is more sensitive to socioeconomic standing among whites. Poorer health is more likely to occur among whites when they reflect at least daily on their own racial status-but only when it happens in tandem with mid-range educational achievement, or among homemakers.

Does multiracial matter? A study of racial disparities in self-rated health.

How do self-identified multiracial adults fit into documented patterns of racial health disparities? We assess whether the health status of adults who view themselves as multiracial is distinctive from that of adults who maintain a single-race identity, by using a seven-year (2001-2007) pooled sample of the Behavioral Risk Factor Surveillance System (BRFSS). We explore racial differences in self-rated health between whites and several single and multiracial adults with binary logistic regression analyses and investigate whether placing these groups into a self-reported "best race" category alters patterns of health disparities. We propose four hypotheses that predict how the self-rated health status of specific multiracial groups compares with their respective component single-race counterparts, and we find substantial complexity in that no one explanatory model applies to all multiracial combinations. We also find that placing multiracial groups into a single "best race" category likely obscures the pattern of health disparities for selected groups because some multiracial adults (e.g., American Indians) tend to identify with single-race groups whose health experience they do not share.

Gender, acculturation, and health among Mexican Americans.

This study examines whether the relationship between acculturation and physical health varies by gender among Mexican Americans, and if the mechanisms that mediate the acculturation-health relationship operate differently by gender. Using the 1998-2007 National Health Interview Study, we construct a composite measure of acculturation and estimate regression models for the total number of health conditions, hypertension, heart disease, and diabetes. Immigrants with the lowest levels of acculturation are the healthiest, but this association is stronger for men. Medical care plays a central role in accounting for gender and acculturation differences across health outcomes-increased access to and utilization of medical care is associated with worse health, which suggests that better health among recent arrivals (particularly men) partially results from their lack of knowledge about their own poor health.

Racial and ethnic differences in adult asthma prevalence, problems, and medical care.

OBJECTIVES: We document the extent to which racial and ethnic differences exist in asthma prevalence among US adults, and among asthmatic adults, we document racial differences in asthma problems and asthma-related medical care. We also explore potential explanations for racial and ethnic disparities in each outcome. DESIGN: Using data on a 24-state sample of white, black, Hispanic, Asian, and Native American adults from the 2004 Behavioral Risk Factor Surveillance System, we examine race/ethnic differences in asthma prevalence, problems (had an asthma attack last year; asthma symptoms; sleep difficulties; activities limited because of asthma), and asthma-related medical care (number of routine doctor visits; medication use; urgent doctor visits; visited an emergency room for asthma-related care last year). We then explore whether any observed disparities are due to differences in demographic characteristics, socioeconomic status, health behavior, and environmental conditions across racial/ethnic groups. RESULTS: Asthma prevalence is lowest among Asian and Hispanic adults, and highest among black and Native American adults. Considerable racial/ethnic differences in asthma-related problems and medical care are also present, with Asians doing as well or better than whites, while blacks, Hispanics, and especially Native Americans report more asthma-related problems and medical care use. For some groups (i.e., Asians and Hispanics), we were mostly unable to explain away observed differences with white adults with adjustment for potential explanatory mechanisms, while for other groups (i.e., blacks and Native Americans) adjusting for socioeconomic status and air quality accounted for much of the observed disparity with whites.

Family structure differences in health care utilization among U.S. children.

This study explores the relationship between family structure and children's access to health care using data from the 2001-2003 waves of the child sample files from the U.S. National Health Interview Survey. Specifically, we investigate the extent to which family structure types predict children's utilization of preventive health care, and barriers to care. We then explore whether observed differences across family structures can be attributed to differences in demographic characteristics, socioeconomic status (SES), and child health status. Using logistic regression models, we document substantial variation in health care usage and barriers to health care across a variety of family structures. Of note is the finding that the children of single mothers demonstrate extremely different patterns of health care access than do the children of single fathers, and the importance of SES as a risk factor for diminished levels of access to health care varies by family type. SES plays a major role in mediating the relationship between access to care for children in single mother and cohabiting families (when contrasted against children in two married parent families), but less of a role for children living with stepparents, a single father, or with parents and other relatives.

Racial/ethnic differences in hypertension and depression among US adult women.

OBJECTIVES: This study assesses racial/ethnic differences in the odds of hypertension among US adult women and examines the degree to which depression, in addition to demographic, socioeconomic status, and health lifestyle characteristics, account for observed differences. METHODS: The most recent iterations of the National Health Interview Survey (2001-2003) were used to examine the odds of hypertension among adult women aged > or =18. The sample consisted of non-Hispanic Whites (n=34,698), non-Hispanic Blacks (n=8,077), and Hispanics (n=9,055). RESULTS: Age-adjusted hypertension rates were significantly higher for Black and Hispanic women than for White women. Sequential logistic regression models demonstrated that health lifestyle accounted for the largest portion of the racial/ethnic gap in hypertension, and depression had little mediating influence. Adjusting for all covariates reduced the gap between Black and White women somewhat, but Black women retained their elevated odds of hypertension (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.60-1.90), while the gap between Hispanic and White women was reduced to nonsignificance (OR .99, 95% CI .90-1.11). Interaction tests revealed that the relationship between depression and hypertension differed across racial/ethnic groups; depression had a much stronger association with hypertension among Black and Hispanic women than among Whites. CONCLUSIONS: After adjusting for age, Black and Hispanic women were more hypertensive than their White counterparts, and depression disproportionately increased their risk. Efforts to improve hypertension treatment and control would benefit from a better understanding of the link between mental and physical health among US minority groups.