Explanations for Social Hierarchies & Health Race, SES, Sexual Orientation, Gender

1. Explanations for Social Hierarchies & Health Race, SES, Sexual Orientation, Gender Group 3 Aayesha Siddiqui, Allison Fels, Ashley LeClerc, Casey Mulligan, Emily Carroll, Emily Wong, Hailey Tipton, Kindra Lansburg, Meagan Beasley, Sarah Reinstein, and Sonia Nixon

2. Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence Meyer 2003 Emily Carroll, Hailey Tipton, Meagan Beasley, and Allison Fels

3. LGB Disparities • Evidence shows that compared with their heterosexual counterparts, gay men and lesbians suffer from more mental health problems including substance use disorders, affective disorders and suicide. • Stigma, prejudice, and discrimination create a stressful social environment that can lead to mental health problems in people who belong to stigmatized minority groups.

4. Stress Theory • External Events or Conditions that are taxing to individuals and exceed their capacity to endure • Stress: Physical, mental or emotional pressure, strain, or tension • Somatic or mental illness

5. Social Stress • Conditions in social environment (not only personal events) • Ex.) Prejudice and discrimination-related and low SES, racism, sexism or homophobia • Leads to stress -> Mental and physical ill effects

6. Minority Stress • Elaboration of Social Stress Theory: Minority Stress • Unique • Chronic • Socially based

7. Minority Stress Relevant to LGB Individuals • Distal Proximal External object Expectations of Internalization of (-) Stressful events & events & the societal attitudes conditions vigilance this (chronic & acute) expectation Concealment of requires sexual orientation Identity stressors

8. Additional Stressors • Minority Identity • Group-Identity • Self-Identity • Identity & Health Outcomes

9. Empirical Review Results for Minority Stress • Evidence from within Group Processes & Mental Health Impact • Prejudice events • Concealment vs. disclosure • Stigma • Internalized homophopia • Minority Between Groups vs. Majority in Prevalence of Mental Disorders • Suicide

10. Future Applications • Researchers, policymakers and public health practitioners should use the stress model to decrease disparate mental health outcomes in the LGBT population.

11. (h) Coping and Social Support (community and individual) • Circumstances in the • Environment (c) General Stressors • (d) Minority Stress • Processes (distal) • Prejudice events • (discrimination, violence) • Mental Health Outcomes • Negative • Positive • (b) Minority Status • Sexual orientation • Race/ethnicity • Gender • (f) Minority Stress Processes • (proximal) • Expectations of rejection • Concealment • Internalized homophobia • (g) Characteristics of Minority Identity • Prominence • Valence • Integration • (e) Minority Identity • (gay, lesbian, bisexual) Minority stress processes in lesbian, gay, and bisexual populations Meyer, 2003

12. References Cochran SD. Emerging issues in research on lesbians’ and gay men’s mental health: Does sexual orientation really matter? American Psychologist. 2001;56:931-947. Meyer, IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull. 2003;129(5):674-697. Ouellette, SC. The value and limitations of stress models in HIV/AIDS. In: Dohrenwend, BP., editor. Adversity, stress, and psychopathology. New York: Oxford University Press; 1998. p. 142-160.

13. Social Conditions as Fundamental Causes of Disease Link & Phelan 1995 Sonia Nixon, Kindra Lansburg, and Emily Wong

14. Proximal Causes of Disease • Individually-based conditions that lead to disease • Diet • Exercise • Smoking • Epidemiologists focus on these causes

15. Contextualizing Risk Factors • “Attempting to understand how people come to be exposed to individually-based risk factors” (Link 1995)

16. Fundamental Cause • “Involves access to resources, resources that help individuals avoid diseases and their negative consequences through a variety of mechanisms” (Link 1995) • Linked to multiple disease outcomes through multiple risk factor mechanisms

17. Social Conditions • Factors that involve a person’s relationships to others • Relationships with intimates • Positions occupied within the social and economic structures of society • Race • Gender • Socioeconomic Status • Stressful life events • Stress-process variables

18. What is happening? Some fundamental causes surrounding an individual Proximal causes Outcome Poor Diet Race Little Exercise Gender SES Disease(s) Smoking Position Events Stress Relationships Electromagnetic fields

19. Support for Theory • Association between social conditions and illness • Gender, race and stress studies • Men higher rate of mortality at all ages • African Americans higher rate of overall mortality and infant mortality • Stressful life events linked to heart disease, diabetes, cancer, etc.

20. Support for Theory • Causal Direction – which came first? The chicken or the egg? • Illness condition of workers cannot be thought of as having caused the plant closing, so cause must have occurred in the other direction: plant closing causes illness condition of workers

21. What can we do? • Analyze the factors that put people “at risk of risk” to include in intervention • Focus on the social factors that affect the fundamental causes of disease to potentially affect many diseases • Health policy makers should be wary of effective interventions that only focus on one risk factor

22. References • Hamilton, V. L., Broman, C. L., Hoffman, W. S., & Renner, D. S. (1990). Hard times and vulnerable people: Initial effects of plant closing on autoworkers' mental health. Journal of Health and Social Behavior, 31(2), 123-140. • Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, Spec No, 80-94. • Shrout, P. E., Link, B. G., Dohrenwend, B. P., Skodol, A. E., Stueve, A., & Mirotznik, J. (1989). Characterizing life events as risk factors for depression: The role of fateful loss events. Journal of Abnormal Psychology, 98(4), 460-467.

23. Theory of Gender and Power: Constructs, Variables, and Implications for Developing HIV Interventions for Women Wingood, et al. 2009 Ashley LeClerc, Casey Mulligan, Sarah Reinstein, and Aayesha Siddiqui

24. How do we define gender? Gender is “better understood as a verb than as a noun.” (Bohan, 1993 and Crawford, 1995) Gendered “social interactions often elicit gendered health beliefs and health behaviors.”

25. Theory of Gender and Power Sexual division of power Physical exposures Behavioral risk factors Sexual division of labor Economic exposures Socioeconomic risk factors Structure of cathexis Social exposures Personal risk factors

26. Theory of Gender and Power • Societal level: • Allocation of women and men to certain occupations, e.g. “women’s work” • Institutional level: • Social mechanisms that perpetuate economic imbalance, e.g. unpaid “nurturing work” • Economic exposure • e.g. limited health insurance • Socioeconomic risk factors • e.g. ethnic minorities Sexual division of labor Economic exposures Socioeconomic risk factors

27. Theory of Gender and Power Sexual division of power Physical exposures Behavioral risk factors Sexual division of labor Economic exposures Socioeconomic risk factors Structure of cathexis Social exposures Personal risk factors

28. Theory of Gender and Power Sexual division of power Physical exposures Behavioral risk factors • Societal level: • Gender negotiated through relationships of power, e.g. hegemonic masculinity • Institutional level: • Social mechanisms perpetuate power imbalances, impede empowerment, e.g. abuse of authority and control/dependence in relationships • Physical exposure • e.g. high-risk steady partner • Behavioral risk factors • e.g. poor condom use skills

29. Theory of Gender and Power Sexual division of power Physical exposures Behavioral risk factors Sexual division of labor Economic exposures Socioeconomic risk factors Structure of social norms and affective attachments Structure of cathexis Social exposures Personal risk factors Structure of cathexis Social exposures Personal risk factors

30. Theory of Gender and Power • Societal level: • Dictates appropriate, normative, stereotypical sexual behavior • Institutional level: • Mainly through social and sexual relationships, the family, and faith-based institutions, e.g. biases about how men/women should express sexuality • Social exposures • e.g. religious affiliation that forbids the use of contraception • Personal risk factors • e.g. perceived invulnerability to HIV/AIDS Structure of social norms and affective attachments Structure of cathexis Social exposures Personal risk factors

31. Theory of Gender and Power Sexual division of power Physical exposures Behavioral risk factors Sexual division of labor Economic exposures Socioeconomic risk factors Structure of cathexis Social exposures Personal risk factors

32. Application of Theory

33. Going Forward… • Impact vs. Outcome • To change outcome, we have to involve men • Power vs. Empowerment • Provide the tools, strategies, and self-efficacy to enable change of the existence of the established power dynamic

34. References Bohan, J. S. (1993). Regarding gender: Essentialism, constructionism and feminist pyschology. Psychology of Women Quarterly, 17, 5-21. Crawford, M. (1995). Talking Difference: On gender and language. Thousand Oaks, CA: Sage. Wingood, G. M., Camp, C., Dunkle, K., Cooper, H., DiClemente, R. J. (2009). The theory of gender and power: Constructs, variables, and implications for developing HIV interventions for women. Emerging theories in health promotion practice and research, 2nd edition. Hoboken, NJ: Jossey-Bass.