Post on 09-Jun-2015
Pride, Prejudice & Determinants of Health
The GradientTerry Trussler EdD
Community Based Research CentreFor Gay Men’s Health
Health & Social Theory
• Social Determinants (SDOH) Marmot et al.
• Minority Stress Meyer et al.
• Intersectionality Hankivsky et al.
• Syndemic Production Stall et al.
See: US Institute of Medicine Report on LGBT Health (2011)
Minority StressMeyer et al. (2010)
Gay Health @ Work
• Workplace prejudice lore • Social context of “gender order”• Origins of Canada’s Health Policy • Whitehall Study
gradient social status health status
What do disparities reveal?
Whitehall Study Marmot et al. 2004
Distress & Disease0
0.5
1
1.5
2
2.5
3
High ControlIntermediateLow Control
Sex Now 2011
• September 2011- February 2012• Men seeking men online• n=8,607 participants• All provinces/territories• Average age 43, Range 13-84• Gay 65% Bisexual 32% Straight 2% • Married MSM 21%
National Sample
72% of all FSA postal codes
Within Group Analysis
The Gradient
Privacy @ work
Importance
Very Important 38%Important 16%Not that important 21%Not important 22%Indefinite 3%
Out @ Work
Who knows your sexuality @ work?
No one 39%Almost none 10%Some 21%Everyone 31%
Employment Discrimination
dismissed, rejected, restricted
Definitely yes 5%Probably yes 12%Probably no 26%Definitely no 57%
Between Group Analysis
The Gradient
Grouping for Analysis
by “social location”…• Gay• Bisexual• MSM (married/partnered with a woman)
85% bisexual10% gay5% straight
Privacy @ Work
Privacy Important0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Gay BisexualMSM
Out @ work
Some to almost everyone0
10
20
30
40
50
60
70
Gay BisexualMSM
Employment Discrimination
Dismissed, Rejected, Restricted
0
5
10
15
20
25
Gay BisexualMSM
Career Damage (status loss)
56% endured discrimination0
1
2
3
4
5
6
7
8
9
10
Gay BisexualMSM
Annual Income
More than $50,0000%
10%
20%
30%
40%
50%
60%
70%
80%
Gay BisexualMSM
Higher Education
College-University0
10
20
30
40
50
60
70
Gay BisexualMSM
Property
Unstable Housing 0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Gay BisexualMSM
Outcome Analysis
The Gradient
Health Effects of Prejudice
Outcomes COR (95%CI) AOR (95%CI)Career damage - status loss 8.272 (6.982-9.801) 7.382 (6.014-9.061)
Suicidality 2.460 (2.177-2.781) 1.672 (1.405-1.885)
Depression .934 ( .831-1.049) .913 ( .797-1.046)
Emotional care seeking 2.753 (2.420-3.132) 1.667 (1.431-1.943)
HIV sexual risk (UAIU) 1.535 (1.359-1.733) 1.249 (1.084-1.439)
STI (gonorrhea) 1.998 (1.517-2.633) 1.595 (1.158-2.197)
Age adjusted logistic regression: employment discrimination vs. no discrimination
Health Effects of Prejudice
Intersections: “axes of (dis)advantage”
• Age (<30: depression)• Class ($100K+: UAIU)• Race/Ethnicity (min: UAIU)• HIV status (HIV+: suicidality)• Orientation (bisexual: suicidality, UAIU)
More Gradients
The Gradient
ManCount
HIV+ Blood Sample 0
2
4
6
8
10
12
14
16
18
20
GayBisexual Straight
Sex Now n=8,494
Self-reported HIV+0
2
4
6
8
10
12
14
Gay Bisexual MSM
ManCount
Sexual risk UAIU0
5
10
15
20
25
Gay BisexualStraight
Sex Now n=8,494
Sexual Risk UAIU0
5
10
15
20
25
30
35
Gay Bisexual Married MSM
ManCount
Physician Disclosure0
10
20
30
40
50
60
70
80
90
GayBisexualStraight
Sex Now
Physician Disclosure0
10
20
30
40
50
60
70
80
90
100
Gay Bisexual MSM
Exposure to Violence
Series10
10
20
30
40
50
60
70
Gay BisexualMSM
Suicidality
Suicidality0
10
20
30
40
50
60
Gay BisexualMSM
Resilience
Healthy, Happy, Optimistic0
5
10
15
20
25
30
35
40
45
50
Gay BisexualMSM
Discussion
The Gradient
Global FundAdam, B. (2011)
US $ Millions0
5
10
15
20
25
30
35
Gay Sex WorkersIDU
Acknowledgements
Vancouver FoundationPublic Health Agency of Canada
Province of British Columbia
acknowledgements
CBRC Olivier Ferlatte, Travis Salway Hottes, Rick Marchand, Craig Phillips, David Ham & the CBRC Board
Investigaytors Alex Chen, Joshun Dulai, Daren Ho, Trevor Hodges, David Le, Daniel McGraw, Keith Reynolds, Jordan Sang, Jaedyn Starr
DialogueMoffat Clarke, Jeff Dodds, Mark Gilbert, Olena Hankivsky, Ilan Meyer, aaron poirier… and many more