Suchergebnisse

AbstractThe association between stigma and adverse interpersonal outcomes is well established. However, the mechanisms underlying this association have yet to be comprehensively conceptualized and tested, in part because research has neglected to evaluate stigma across multiple levels. To address this gap, we examined whether stigma—measured at individual, interpersonal, and structural levels—prospectively affects loneliness and social support by thwarting fundamental belonging needs, using a longitudinal sample of 315 gay men. Results indicated that thwarted belonging needs prospectively mediated the association between interpersonal discrimination, internalized homonegativity, and concealment motivation and changes in loneliness and lack of social support. When indirect pathways were tested simultaneously, discrimination was uniquely associated with reductions in social support via thwarted belonging needs. In addition, the prospective association between objectively‐measured structural stigma (at the state and county levels) and loneliness and lack of social support was serially mediated by perceptions of structural stigma and thwarted belonging needs. To guide future work, we propose a model outlining pathways by which stigma, across multiple levels, may lead to adverse interpersonal outcomes by increasing relationally‐oriented biological, motivational, cognitive, affective, and behavioral mechanisms that affect belonging needs.

POLICY POINTS: Stigma is an established driver of population‐level health outcomes. Antidiscrimination laws can generate or alleviate stigma and, thus, are a critical component in the study of improving population health. Currently, antidiscrimination laws are often underenforced and are sometimes conceptualized by courts and lawmakers in ways that are too narrow to fully reach all forms of stigma and all individuals who are stigmatized. To remedy these limitations, we propose the creation of a new population‐level surveillance system of antidiscrimination law and its enforcement, a central body to enforce antidiscrimination laws, as well as a collaborative research initiative to enhance the study of the linkages between health and antidiscrimination law in the future. CONTEXT: Stigma is conceptualized as a fundamental cause of population health inequalities. Antidiscrimination law is one important lever that can influence stigma‐based health inequities, and yet several challenges currently limit the law's potential to address them. METHODS: To determine whether antidiscrimination law adequately addresses stigma, we compared antidiscrimination law for its applicability to the domains and statuses where stigma is experienced according to the social science literature. To further examine whether law is a sufficient remedy for stigma, we reviewed law literature and government sources for the adequacy of antidiscrimination law enforcement. We also reviewed the law literature for critiques of antidiscrimination law, which revealed conceptual limits of antidiscrimination law that we applied to the context of stigma. FINDINGS: In this article, we explored the importance of antidiscrimination law in addressing the population‐level health consequences of stigma and found two key challenges—conceptualization and enforcement—that currently limit its potential. We identified several practical solutions to make antidiscrimination law a more available tool to tackle the health inequities caused by stigma, including (1) the ...

AbstractThis study examined the health consequences for lesbian, gay, bisexual, and transgender (LGBT) populations of exposure to communities with relatively high versus low levels of support for same‐sex marriage. We used data from the Gallup Daily tracking survey, the largest probability‐based sample of LGBT‐identified adults in the United States (N= 11,949 LGBT respondents;N= 352,343 non‐LGBT respondents), which was linked to attitudinal responses on same‐sex marriage obtained from the 2012 Cooperative Congressional Election Survey (N= 54,535). Controlling for potential confounders, higher levels of local approval of same‐sex marriage lowered the probability that LGBT (and non‐LGBT) individuals reported smoking and fair/poor self‐rated health; further, LGBT disparities in smoking were lower in communities where residents were most likely to support same‐sex marriage. Findings suggest that local attitudes may be related to the health of LGBT individuals and contribute to sexual orientation health disparities, providing further evidence for the role of structural stigma in shaping LGBT health.

There has been a great deal of state-level legislative activity focused on immigration and immigrants over the past decade in the United States. Some policies aim to improve access to education, transportation, benefits, and additional services while others constrain such access. From a social determinants of health perspective, social and economic policies are intrinsically health policies, but research on the relationship between state-level immigration-related policies and Latino health remains scarce. This paper summarizes the existing evidence about the range of state-level immigration policies that affect Latino health, indicates conceptually plausible but under-explored relationships between policy domains and Latino health, traces the mechanisms through which immigration policies might shape Latino health, and points to key areas for future research. We examined peer-reviewed publications from 1986–2016 and assessed 838 based on inclusion criteria; 40 were included for final review. These 40 articles identified four pathways through which state-level immigration policies may influence Latino health: through stress related to structural racism; by affecting access to beneficial social institutions, particularly education; by affecting access to healthcare and related services; and through constraining access to material conditions such as food, wages, working conditions, and housing. Our review demonstrates that the field of immigration policy and health is currently dominated by a "one-policy, one-level, one-outcome" approach. We argue that pursuing multi-sectoral, multi-level, and multi-outcome research will strengthen and advance the existing evidence base on immigration policy and Latino health.

This article explicates a vision for social change throughout multiple levels of society necessary to eliminate sexual orientation health disparities in youths. We utilized the framework of Bronfenbrenner's ecological theory of development, a multisystemic model of development that considers direct and indirect influences of multiple levels of the environment. Within this multisystem model we discuss societal and political influences, educational systems, neighborhoods and communities, romantic relationships, families, and individuals. We stress that continued change toward equity in the treatment of lesbian, gay, and bisexual youths across these levels will break down the barriers for these youths to achieve healthy development on par with their heterosexual peers.

IMPORTANCE: Bullying is the most widespread form of peer aggression in schools. In an effort to address school bullying, 49 states have passed antibullying statutes. Despite the ubiquity of these policies, there has been limited empirical examination of their effectiveness in reducing students' risk of being bullied. OBJECTIVE: To evaluate the effectiveness of antibullying legislation in reducing students' risk of being bullied and cyberbullied, using data from 25 states in the United States. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional observational study was conducted using a population-based survey of 63 635 adolescents in grades 9 to 12 from 25 states participating in the 2011 Youth Risk Behavior Surveillance System study (September 2010-December 2011). Data on antibullying legislation were obtained from the US Department of Education (DOE), which commissioned a systematic review of state laws in 2011. The report identified 16 key components that were divided into the following 4 broad categories: purpose and definition of the law, district policy development and review, school district policy components (eg, responsibilities for reporting bullying incidents), and additional components (eg, how policies are communicated). Policy variables from 25 states were linked to individual-level data from the Youth Risk Behavior Surveillance System on experiencing bullying and cyberbullying. Analyses were conducted between March 1, 2014, and December 1, 2014. EXPOSURE: State antibullying legislation. MAIN OUTCOMES AND MEASURES: Exposure to bullying and cyberbullying in the past 12 months. RESULTS: There was substantial variation in the rates of bullying and cyberbullying across states. After controlling for relevant state-level confounders, students in states with at least 1 DOE legislative component in the antibullying law had a 24%(95%CI, 15%−32%) reduced odds of reporting bullying and 20%(95%CI, 9%−29%) reduced odds of reporting cyberbullying compared with students in states whose laws had no DOE legislative ...

AbstractIntroductionMore than 70% of new HIV diagnoses in the United States were among men who have sex with men (MSM) in 2019. Pre‐exposure prophylaxis (PrEP) is a transformative innovation for reducing human immunodeficiency virus (HIV) infections. Structural stigma against sexual minorities, including in the form of state‐level policies, may affect PrEP implementation. We evaluated whether lower structural stigma reflected by earlier year of state same‐sex marriage legalization was associated with increased male PrEP prescriptions and male PrEP‐to‐need ratio (PnR), a ratio of PrEP prescriptions to new HIV diagnoses.MethodsWe used 2012−2019 AIDSVu data on male PrEP prescriptions and male PnR in each US state and year. We used generalized estimating equations to evaluate the relationship between the timing of implementing state same‐sex marriage policies and the outcomes of male PrEP prescriptions per 100,000 people and the male PnR. We adjusted for calendar year, Medicaid expansion and the political party of the governor in each state.ResultsState implementation of same‐sex marriage policies in earlier, relative to later, periods was associated with increases in the rate of male PrEP prescriptions and in the male PnR. Specifically, implementing state same‐sex marriage policies between 2004 and 2011 and between 2012 and 2013 were each associated with greater rates of male PrEP prescriptions relative to implementing same‐sex marriage policies between 2014 and 2015. Implementing state same‐sex marriage policies between 2004 and 2011 as well as between 2012 and 2013 were both significantly associated with a greater male PnR relative to implementing same‐sex marriage policies between 2014 and 2015. By 2019, the difference in male PrEP prescriptions was 137.9 (97.3−175.5) per 100,000 in states that implemented same‐sex marriage in 2004−2011 and 27.2 (23.3−30.5) per 100,000 in states that implemented same‐sex marriage from 2012 to 2013, relative to states that implemented same‐sex marriage in 2014−2015.ConclusionsEarlier implementation of state same‐sex marriage policies was associated with greater rates of male PrEP prescriptions. Reducing state‐level structural stigma may improve HIV prevention among MSM in the United States.