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115 2 the gradient copy Terry Trussler

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115 2 the gradient copy Terry Trussler

  1. 1. Pride, Prejudice & Determinants of HealthTerry TrusslerEdDCommunity Based Research CentreFor Gay Men’s Health
  2. 2. Health & Social Theory• Social Determinants (SDOH) Marmot et al.• Minority Stress Meyer et al.• IntersectionalityHankivsky et al.• Syndemic Production Stall et al.See: US Institute of Medicine Report on LGBT Health (2011)
  3. 3. Minority StressMeyer et al. (2010)MentalDisordersContextualStressorsStructuralDisadvantage
  4. 4. Gay Health @ Work• Workplace prejudice lore• Social context of “gender order”• Origins of Canada’s Health Policy• Whitehall Studygradientsocial status health statusWhat do disparities reveal?
  5. 5. Whitehall StudyMarmot et al. 200400.511.522.53Distress & DiseaseHigh ControlIntermediateLow Control
  6. 6. 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%
  7. 7. National Sample72% of all FSA postal codes
  8. 8. Within Group Analysis
  9. 9. Privacy @ workImportanceVery Important 38%Important 16%Not that important 21%Not important 22%Indefinite 3%
  10. 10. Out @ WorkWho knows your sexuality @ work?No one 39%Almost none 10%Some 21%Everyone 31%
  11. 11. Employment Discriminationdismissed, rejected, restrictedDefinitely yes 5%Probably yes 12%Probably no 26%Definitely no 57%
  12. 12. Between Group Analysis
  13. 13. Grouping for Analysisby “social location”…• Gay• Bisexual• MSM (married/partnered with a woman)85% bisexual10% gay5% straight
  14. 14. Privacy @ Work0%10%20%30%40%50%60%70%80%90%Privacy ImportantGayBisexualMSM
  15. 15. Out @ work010203040506070Some to almost everyoneGayBisexualMSM
  16. 16. Employment Discrimination0510152025Dismissed, Rejected, RestrictedGayBisexualMSM
  17. 17. Career Damage (status loss)01234567891056% endured discriminationGayBisexualMSM
  18. 18. Annual Income0%10%20%30%40%50%60%70%80%More than $50,000GayBisexualMSM
  19. 19. Higher Education010203040506070College-UniversityGayBisexualMSM
  20. 20. Property00.511.522.533.544.5Unstable HousingGayBisexualMSM
  21. 21. Outcome Analysis
  22. 22. Health Effects of PrejudiceOutcomes 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
  23. 23. Health Effects of PrejudiceIntersections: “axes of(dis)advantage”• Age (<30: depression)• Class ($100K+: UAIU)• Race/Ethnicity (min: UAIU)• HIV status (HIV+: suicidality)• Orientation (bisexual: suicidality, UAIU)
  24. 24. More Gradients
  25. 25. ManCount02468101214161820HIV+ Blood SampleGayBisexualStraight
  26. 26. Sex Now n=8,49402468101214Self-reported HIV+GayBisexualMSM
  27. 27. ManCount0510152025Sexual risk UAIUGayBisexualStraight
  28. 28. Sex Now n=8,49405101520253035Sexual Risk UAIUGayBisexualMarried MSM
  29. 29. ManCount0102030405060708090Physician DisclosureGayBisexualStraight
  30. 30. Sex Now0102030405060708090100Physician DisclosureGayBisexualMSM
  31. 31. Exposure to Violence010203040506070GayBisexualMSM
  32. 32. Suicidality0102030405060SuicidalityGayBisexualMSM
  33. 33. Resilience05101520253035404550Healthy, Happy, OptimisticGayBisexualMSM
  34. 34. Discussion
  35. 35. Global FundAdam, B. (2011)05101520253035US $ MillionsGaySex WorkersIDU
  36. 36. AcknowledgementsVancouver FoundationPublic Health Agency of CanadaProvince of British Columbia
  37. 37. acknowledgementsCBRCOlivier Ferlatte, Travis SalwayHottes, Rick Marchand,Craig Phillips, David Ham & the CBRC BoardInvestigaytorsAlex Chen, JoshunDulai, Daren Ho, Trevor Hodges, David Le,Daniel McGraw, Keith Reynolds, Jordan Sang, Jaedyn StarrDialogueMoffat Clarke, Jeff Dodds, Mark Gilbert, OlenaHankivsky,Ilan Meyer, aaronpoirier… and many more

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