Pride, Prejudice & Determinants of Health

Gay Health @ Work

Terry Trussler EdD

Community Based Research CentreFor Gay Men’s Health

Why Gay Health @ Work?

• Social location of “gender order”• Workplace prejudice lore• Population Health Policy • Whitehall Study-social determinants

gradient social status health status

Supporting Theories

• Population Health Marmot et al.

• Minority Stress Meyer et al.

• Intersectionality Hankivsky et al.

• Syndemic Production Stall et al.

Sex Now 2011

• September 2011- February 2012• Men seeking men online• n=8,607 participants• All provinces/territories FSA• Average age: 43 • Range: 13-84

• Dialogue• Questionnaire• Focus Groups• SFU Institutes• Survey Promotion• Recruitment Drive• Statistics Boot Camp• Individual Analysis

unofficial census

Minority StressMeyer et al. (2010)

Mental Disorders

Stress

Structural Disadvantage

Minority StressMeyer et al. (2010)

Social Disparity Hypothesis

“disadvantaged fare worse”

Analytical Strategy 1. Within group analysis

2. Between group analysis 3. Outcome analysis

Measurement Challenges

• Event recall• Nonevents potent but difficult • Covert discrimination• Systemic prejudice• Accepting professions• Living “the life”

Within Group Analysis

Pride, Prejudice & Determinants of Health

Workplace Perceptions

Supportive

Agree 61%Disagree 20%Uncertain 19%

Privacy @ Work

Importance

Very Important 38%Important 16%Not that important 21%Not important 22%Indefinite 3%

Did your sexuality channel your career?

Channeled?

Very Likely 8%Likely 12%Somewhat unlikely 16%Totally unlikely 54%Uncertain 10%

Sexuality Helped or Hurt?

Impact

Helped 8%Hurt 8%Helped/Hurt 12%Neutral 71%

Out @ Work

Who knows your sexuality @ work?

No one 39%Everyone 31%Some 21%Almost none 10%

Dismissed, rejected, restricted

Employment Discrimination

Definitely yes 5%Probably yes 12%Probably no 26%Definitely no 57%

Between Group Analysis

Pride, Prejudice & Determinants of Health

Whitehall Gradient Marmot et al. 2004

Mental Distress0

0.5

1

1.5

2

2.5

3

High ControlIntermediateLow Control

Between Group Analysis

• Gay Orientation• Bisexual Orientation• MSM (married/partnered with a woman)

MSM model85% bisexual10% gay5% straight

Property Owner

SN 20100

10

20

30

40

50

60

70

80

Gay MSM

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

Privacy @ Work

Privacy Important0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Gay BisexualMSM

Perceived Supportive

Supportive workplace0

10

20

30

40

50

60

70

80

Gay BisexualMSM

Did your sexuality channel your career?

Likely to very likely0

10

20

30

40

50

60

Gay BisexualMSM

Ever attended an event with a woman to blend in?

Gender Cover0

10

20

30

40

50

60

Gay BisexualMSM

How out are you @ work?

Some to almost everyone0

10

20

30

40

50

60

70

Gay BisexualMSM

Turned down, rejected or restricted by sexuality?

Employment Discrimination0

5

10

15

20

25

Gay BisexualMSM

Sexuality hurt career

56% endured discrimination0

1

2

3

4

5

6

7

8

9

10

Gay BisexualMSM

Outcome Analysis

Pride, Prejudice & Determinants of Health

Axes of Social (dis)Advantage

• Gender (in-gender status)

• Age• Ethnicity• Education• Income• Sexual Orientation

Axes of social (dis)advantage

significance odds ratio confidence

Age < 30 <.001 1.783 1.488-2.136

Age 30-44 <.001 1.786 1.494-2.092

Higher Ed .002 1.224 1.079-1.390

Income <$50K <.001 1.311 1.154-1.491

Gay Orientation <.001 4.408 3.738-5.198

employment discrimination vs no discrimination

Stress Factors

• Orientation Disclosure (Out/Not)

• Body Type (BMI, self image)

• Prior prejudice (bashed, bullied)

• Gender presentation (piercings, tattoos)

• Work environment (supportive, cover)

Mediating (stress) Factors

significance odds ratio confidence

Out @ work <.001 2.845 2.384-3.395

Cover <.001 1.881 1.650-2.144

Unsupportive <.001 1.515 1.299-1.767

Body Type BMI .995 1.002 .588-1.707

employment discrimination vs no discrimination

Health Outcomes

• Suicidality (thoughts & attempts)

• Anxiety + Rx (care seeking)

• Depression + Rx (care seeking)

• Sad, lonely (design questions)

• Sexual risk (UAI)

• STI (last 12 months)

Health Outcomes

significance odds ratio confidence

Hurt Career <.001 7.310 6.098-8.763

Suicidal 23% <.001 1.872 1.576-2.223

Depression .123 .904 .796-1.028

Sexual Risk .002 1.252 1.095-1.431

Gonorrhea <.001 1.635 1.210-2.210

employment discrimination vs no discrimination

Intersectional Difference

Gay Bisexual

BMI II .810 .008

Suicidal <.001 .095

Hurt <.001 <.001

UAI <.001 .755

Gonorrhea .010 .466

employment discrimination vs no discrimination

Discussion

Pride, Prejudice & Determinants of Health

Global Fund

US $ Millions0

5

10

15

20

25

30

35

Gay Sex WorkersIDU

Intersections

• Age• Income, education/class• Ethnicities/race• HIV status

Limitations

• Cross sectional survey• No population sample (structural)• Internet sampling• Self report• Unmeasurables• Good Questions

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, Darren 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