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