Ning Hsieh

Drawing on 40 interviews with LGBTQ+ people about their health experiences, we examine the consequences of identity nonrecognition—which occurs when mutual recognition of the situationally relevant identities for self and other in an encounter cannot be established—and discordance in the definition of the situation. We found that respondents experienced identity nonrecognition in two ways: (1) identity reductionism, or moments when providers leaned on medical authority, heteronormativity, and essentialist ideas to reduce their LGBTQ+ patients to biological entities, and (2) identity rejection, or interactional moments between patient and provider outside of medical decision-making when respondents asserted their gender and/or sexual identities mattered in the health encounter but found that providers rejected these identities. This work contributes to social psychological theories of identities and medical sociology scholarship by situating identity nonrecognition as an overlooked but important identity-relevant stressor, examining the importance of power differentials in defining the situation, and offering new conceptual tools for understanding the perpetuation of inequality.

Not all U.S. populations have equal access to a primary care provider (PCP). This study presents one of the first population-based evidence of inequities in access to PCPs at the intersection of race/ethnicity, sexual orientation, and gender. We analyzed pooled data from the Behavioral Risk Factor Surveillance System from 2016 to 2021 across 42 states and 1 territory in the United States. The final sample encompassed 1,142,344 respondents aged 18 and older. Logistic regression models, stratified by gender spectrum, were estimated to compare predicted probabilities of having a PCP across 20 sexual and racial/ethnic identity groups. Among those on the feminine spectrum, most sexual minorities of color exhibited lower rates of having a PCP compared to heterosexual White individuals. Even when sociodemographic and health factors were accounted for, PCP access disadvantages remained significant in some groups of Native and Hispanic sexual minorities. Among sexual minorities of color on the masculine spectrum, inequities were less prominent, and sociodemographic and health factors nearly explained all their disadvantages. Sexual orientation, gender, and race/ethnicity intersect to shape the access to PCPs. Future research, policy designs, and clinical practices should adopt an intersectional approach to achieve a better understanding of healthcare inequities and to reduce inequities.

Objectives: Recent studies have found that perceived discrimination as a chronic stressor predicts poorer cognitive health. However, little research has investigated how social relationships as potential intervening mechanisms may mitigate or exacerbate this association. Using a nationally representative sample of U.S. older adults, this study examined how the existence and quality of 4 types of relationships—with a partner, children, other family members, and friends—may modify the impact of perceived discrimination on incident dementia. Methods: We analyzed data from the 2006 to 2016 Health and Retirement Study (N = 12,236) using discrete-time event history models with competing risks. We used perceived discrimination, social relationships, and their interactions at the baseline to predict the risk of incident dementia in the follow-ups. Results: Perceived discrimination predicted a higher risk of incident dementia in the follow-ups. Although having a partner or not did not modify this association, partnership support attenuated the negative effects of discrimination on incident dementia. Neither the existence nor quality of relationships with children, other family members, or friends modified the association. Discussion: Our findings imply that intimate partnership plays a critical role in coping with discrimination and, consequently, influencing the cognitive health of older adults. Although perceived discrimination is a significant risk factor for the incidence of dementia, better partnership quality may attenuate this association. Policies that eliminate discrimination and interventions that strengthen intimate partnerships may facilitate better cognitive health in late life.

Midlife is a pivotal stage shaping healthy aging, and sexual minorities may face more challenges in midlife than heterosexual individuals, due to cumulative social, economic, and health disadvantages. Yet, few studies have examined how life satisfaction in midlife varies by sexual identity. Using data from the 2016 Health and Retirement Study (N = 3,630), we conducted logit regressions and Karlson-Holm-Breen (KHB) decomposition analysis to examine how health-related, socioeconomic, and sociopsychological factors contribute to disparities in life satisfaction across sexual orientation groups in middle adulthood. The results show that bisexual individuals, but not gay or lesbian individuals, reported significantly lower life satisfaction than their heterosexual peers because of their poorer health status and behaviors, fewer social resources, and lower socioeconomic status. Our findings suggest that public policies should target continuing the reduction in sexuality-based stigma, particularly biphobia, to mitigate the health, social, and economic disparities linked to diminished well-being among middle-aged bisexual individuals.

Objective: This study examines the long‐observed marital advantage in happiness during the COVID‐19 pandemic.Background: The COVID‐19 pandemic may have altered the marital advantage in happiness due to changes in social integration processes. However, this has not been explored in previous studies.Method: Data were from the COVID‐19 substudy of the National Social Life, Health, and Aging Project (N = 2622). A series of regressions were estimated to understand marital status differences in pandemic happiness and changes in relationships with nonresident family and friends. Karlson–Holm–Breen mediation analysis was conducted to examine whether relationships with nonresident family and friends explained the marital association with pandemic happiness.Results: From pre‐pandemic to pandemic, married respondents experienced a greater increase in unhappiness than unmarried counterparts, narrowing happiness gaps. However, unmarried individuals, including cohabiting, divorced, widowed, and never married individuals, continued to report higher levels of unhappiness during the pandemic than married peers. These differences primarily stemmed from pre‐pandemic happiness. After controlling for pre‐pandemic happiness, cohabiting, widowed, and never married older adults did not significantly differ from their married counterparts in reporting unhappiness during the pandemic. In contrast, divorced individuals remained consistently more unhappy than married individuals during the pandemic, mainly due to deteriorated relationship quality with nonresident family.Conclusion: During a global crisis, it is crucial for policymakers, healthcare providers, and researchers to develop innovative interventions to promote happiness and healthy aging among all older adults, paying special attention to those who are divorced.

Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.

Marital and intimate partner relationships are some of the most important social ties that shape older adults’ health and well-being. This paper provides analytic guidelines for the couple data in Round 2 (2010–2011) and Round 3 (2015–2016) of the National Social Life, Health, and Aging Project (NSHAP) to encourage more research on marriage and partnership in late life. First, we describe the recruitment of couples and outline how to identify partners in the data sets. Second, we provide descriptive information about the couple sample. Third, we offer guidance for analyzing the dyadic data cross-sectionally and longitudinally. Round 2 interviewed all primary respondents and a sample of their current cohabiting partners and spouses (n = 955 couples). In Round 3, NSHAP reinterviewed the primary respondents and partners who participated in Round 2 (Cohort 1; n = 621 couples) and recruited a new sample of age-eligible adults along with any cohabiting romantic partners (Cohort 2; n = 766 couples). Couples can be identified using a household ID variable in Round 2 and a partner ID variable in Round 3. Demographic characteristics of the couple sample vary by round and cohort. Researchers can use data from either round to conduct cross-sectional dyadic analyses to examine issues faced by older couples. A common strategy for couple analysis is the actor–partner interdependence model. With 2 rounds of couple-level data, researchers may consider using cross-lagged models in their research.

Research on the social dimensions of health and health care among sexual and gender minorities (SGMs) has grown rapidly in the last two decades. However, a comprehensive review of the extant interdisciplinary scholarship on SGM health has yet to be written. In response, we offer a synthesis of recent scholarship. We discuss major empirical findings and theoretical implications of health care utilization, barriers to care, health behaviors, and health outcomes, which demonstrate how SGMs continue to experience structural- and interactional-level inequalities across health and medicine. Within this synthesis, we also consider the conceptual and methodological limitations that continue to beleaguer the field and offer suggestions for several promising directions for future research and theory building. SGM health bridges the scholarly interests in social and health sciences and contributes to broader sociological concerns regarding the persistence of sexuality- and gender-based inequalities.