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      Sexual orientation, gender expression and socioeconomic status in the National Longitudinal Study of Adolescent to Adult Health

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          Abstract

          Background

          Socioeconomic status (SES) is a fundamental contributor to health, yet it is rarely examined relative to gender expression, particularly gender non-conformity and sexual orientation.

          Methods

          We use data from 11 242 Wave V respondents (aged 33–44) in the National Longitudinal Study of Adolescent to Adult Health (2016–2018) to examine associations between socially assigned gender expression, sexual orientation and SES, in logistic and multinomial regression models stratified by sex assigned at birth.

          Results

          Among both women and men a general pattern of heightened risk for lower SES among gender non-conforming sexual minorities relative to gender conforming heterosexuals was observed. Gender non-conforming heterosexuals were also at elevated risk of lower SES compared with their conforming heterosexual peers.

          Conclusion

          Socioeconomic differences by sexual orientation and gender expression have important implications for understanding health disparities among gender non-conforming sexual minorities and their gender conforming heterosexual counterparts.

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          Most cited references30

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          Social Conditions As Fundamental Causes of Disease

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            Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications.

            Link and Phelan (1995) developed the theory of fundamental causes to explain why the association between socioeconomic status (SES) and mortality has persisted despite radical changes in the diseases and risk factors that are presumed to explain it. They proposed that the enduring association results because SES embodies an array of resources, such as money, knowledge, prestige, power, and beneficial social connections that protect health no matter what mechanisms are relevant at any given time. In this article, we explicate the theory, review key findings, discuss refinements and limits to the theory, and discuss implications for health policies that might reduce health inequalities. We advocate policies that encourage medical and other health-promoting advances while at the same time breaking or weakening the link between these advances and socioeconomic resources. This can be accomplished either by reducing disparities in socioeconomic resources themselves or by developing interventions that, by their nature, are more equally distributed across SES groups.
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              U.S. disparities in health: descriptions, causes, and mechanisms.

              Eliminating health disparities is a fundamental, though not always explicit, goal of public health research and practice. There is a burgeoning literature in this area, but a number of unresolved issues remain. These include the definition of what constitutes a disparity, the relationship of different bases of disadvantage, the ability to attribute cause from association, and the establishment of the mechanisms by which social disadvantage affects biological processes that get into the body, resulting in disease. We examine current definitions and empirical research on health disparities, particularly disparities associated with race/ethnicity and socioeconomic status, and discuss data structures and analytic strategies that allow causal inference about the health impacts of these and associated factors. We show that although health is consistently worse for individuals with few resources and for blacks as compared with whites, the extent of health disparities varies by outcome, time, and geographic location within the United States. Empirical work also demonstrates the importance of a joint consideration of race/ethnicity and social class. Finally, we discuss potential pathways, including exposure to chronic stress and resulting psychosocial and physiological responses to stress, that serve as mechanisms by which social disadvantage results in health disparities.
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                Author and article information

                Journal
                J Epidemiol Community Health
                J Epidemiol Community Health
                jech
                jech
                Journal of Epidemiology and Community Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0143-005X
                1470-2738
                February 2024
                28 November 2023
                : 78
                : 2
                : 121-128
                Affiliations
                [1 ] departmentDepartment of Epidemiology and Biostatistics , Dornsife School of Public Health, Drexel University , Philadelphia, PA, USA
                [2 ] departmentDepartment of Maternal & Child Health , Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
                [3 ] departmentThe Williams Institute , Ringgold_33785University of California School of Law , Los Angeles, California, USA
                Author notes
                [Correspondence to ] Dr Stephanie M. Hernandez, Epidemiology and Biostatistics, Drexel University, Philadelphia, PA 19104-2816, USA; smh483@ 123456drexel.edu
                Author information
                http://orcid.org/0000-0003-4571-1191
                Article
                jech-2022-220164
                10.1136/jech-2022-220164
                10850725
                38053260
                7904649e-36f0-43f1-86c2-e0ba0d1a7f33
                © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 02 December 2022
                : 17 October 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100009633, Eunice Kennedy Shriver National Institute of Child Health and Human Development;
                Award ID: P2CHD050924
                Award ID: R01HD087365
                Award ID: T32HD091058
                Funded by: FundRef http://dx.doi.org/10.13039/100006545, National Institute on Minority Health and Health Disparities;
                Award ID: R01HD087365
                Funded by: Office of the Director, National Institutes of Health;
                Award ID: U54CA267735-02
                Categories
                Original Research
                1506
                Custom metadata
                unlocked

                Public health
                health,gender identity,cohort studies,economics,education
                Public health
                health, gender identity, cohort studies, economics, education

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