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Population Health Trends among Hetrosexual and Sexual Minority Adults

Jessica N. Fish, Family Science, investigates sexual-orientation-related disparities in mental, behavioral, and physical health

Lesbian, gay, bisexual, (LGB) and non-heterosexual people (i.e., sexual minorities) evidence vexing mental, behavioral, and physical health disparities when compared to their heterosexual peers. LGB adults are 3.5 times as likely as their heterosexual counterparts to meet the criteria for an alcohol use or mood disorder and evidence greater incidence of stress-related health conditions such as cardiovascular disease, hypertension, and cancer. These health inequities are theoretically attributed to experiences of minority stress such as stigma, discrimination, and victimization, which occur as a result of having a marginalized sexual identity. At the same time, there have been dramatic changes in the social awareness of and protections for LGB people in the United States. Yet, there remains little empirical understanding of how sexual minority health has changed amid such rapid social progress. The proposed surveillance study directly addresses priorities set by the NIH and Healthy People 2020 by documenting sexual orientation trends in mental, behavioral, and physical health disparities from the early 2000s to 2018. We are at a critical juncture in the sexual minority health field. Social factors such as stigma and discrimination are implicated in sexual minority health vulnerabilities. Documenting population-level health trends among sexual minorities is therefore imperative to understand how sexual minority population health has changed, thus illuminating public health priorities moving forward. The goal of this proposal is to conduct the preliminary data analysis necessary to craft a competitive R03 application to the NIH. This seed grant will provide the PI time to conduct preliminary data analysis with three population-based secondary data sources. The information gleaned from these efforts will lay the foundation for an R03 submission that seeks to:

(1) estimate the extent to which sexual-orientation-related disparities in mental, behavioral, and physical health have changed from the early 2000s to 2018;

(2) examine the extent to which changes in sexual orientation-related health disparities vary by sex, sexual identity, age, and racial/ethnic subgroups; and (3) test the degree to which state and national variability in pro-LGB attitudes and policies are associated with trends in sexual minority health. Each of the three data sources – The National Epidemiologic Survey of Alcohol and Related Conditions, the National Health and Nutrition Examination Survey, and the National Health Interview Survey – are designed to capture the health of the US population, and each offers unique advantages to documenting changes in the health of sexual minority people since in the early 2000s. Together, findings will inform national health and research priorities for sexual minority people. The pilot will provide the PI protected time to (1) analyze preliminary data; (2) publish two initial studies

(3) explore the feasibility of linking contextual data through the Maryland Federal Statistical Research Data Center (RDC) to assess variability in health trends across various social contexts; (4) draft and submit an R03 proposal to NIH; and (5) strategize with international collaborators (i.e., Canada and the EU) on how data may be leveraged to estimate cross-national comparisons. This foundational work will help situate the PI to make the best decisions for a competitive R03 application and (potential) international funding application to support this work.