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115 2 the gradient copy Terry Trussler
- 1. Pride, Prejudice & Determinants of Health Terry TrusslerEdD Community Based Research Centre For Gay Men’s Health
- 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. Minority Stress Meyer et al. (2010) Mental Disorders Contextual Stressors Structural Disadvantage
- 4. Gay Health @ Work • Workplace prejudice lore • Social context of “gender order” • Origins of Canada’s Health Policy • Whitehall Study gradient social status health status What do disparities reveal?
- 5. Whitehall Study Marmot et al. 2004 0 0.5 1 1.5 2 2.5 3 Distress & Disease High Control Intermediate Low Control
- 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. National Sample 72% of all FSA postal codes
- 9. Privacy @ work Importance Very Important 38% Important 16% Not that important 21% Not important 22% Indefinite 3%
- 10. Out @ Work Who knows your sexuality @ work? No one 39% Almost none 10% Some 21% Everyone 31%
- 11. Employment Discrimination dismissed, rejected, restricted Definitely yes 5% Probably yes 12% Probably no 26% Definitely no 57%
- 13. Grouping for Analysis by “social location”… • Gay • Bisexual • MSM (married/partnered with a woman) 85% bisexual 10% gay 5% straight
- 14. Privacy @ Work 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Privacy Important Gay Bisexual MSM
- 15. Out @ work 0 10 20 30 40 50 60 70 Some to almost everyone Gay Bisexual MSM
- 16. Employment Discrimination 0 5 10 15 20 25 Dismissed, Rejected, Restricted Gay Bisexual MSM
- 17. Career Damage (status loss) 0 1 2 3 4 5 6 7 8 9 10 56% endured discrimination Gay Bisexual MSM
- 18. Annual Income 0% 10% 20% 30% 40% 50% 60% 70% 80% More than $50,000 Gay Bisexual MSM
- 21. Outcome Analysis
- 22. Health Effects of Prejudice Outcomes 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. Health Effects of Prejudice Intersections: “axes of (dis)advantage” • Age (<30: depression) • Class ($100K+: UAIU) • Race/Ethnicity (min: UAIU) • HIV status (HIV+: suicidality) • Orientation (bisexual: suicidality, UAIU)
- 24. More Gradients
- 26. Sex Now n=8,494 0 2 4 6 8 10 12 14 Self-reported HIV+ Gay Bisexual MSM
- 28. Sex Now n=8,494 0 5 10 15 20 25 30 35 Sexual Risk UAIU Gay Bisexual Married MSM
- 34. Discussion
- 35. Global Fund Adam, B. (2011) 0 5 10 15 20 25 30 35 US $ Millions Gay Sex Workers IDU
- 36. Acknowledgements Vancouver Foundation Public Health Agency of Canada Province of British Columbia
- 37. acknowledgements CBRC Olivier Ferlatte, Travis SalwayHottes, Rick Marchand, Craig Phillips, David Ham & the CBRC Board Investigaytors Alex Chen, JoshunDulai, Daren Ho, Trevor Hodges, David Le, Daniel McGraw, Keith Reynolds, Jordan Sang, Jaedyn Starr Dialogue Moffat Clarke, Jeff Dodds, Mark Gilbert, OlenaHankivsky, Ilan Meyer, aaronpoirier… and many more
Hinweis der Redaktion
- Going beyond behaviours in gay men’s health is a venture beyond field boundaries, along trails less traveled, without many affirming signposts…
- The survey’s recruitment achieved widespread coverage of Canada, including all provinces and territories and a diverse mix of urban, suburban and rural men.
- Within group analysis looks at the whole population and divisions in experience…
- The largest group were keeping their sexuality a secret but another large group seemed to be out to everyone in their environment.
- The idea of between group analysis is to uncover inequities that remain concealed by the within group analysis.
- Here again we see the gradient show up as a disparity among men who feel their career was damaged by discrimination in the workplace.
- We don’t see the same gradient pattern with education, but as shown in SN 2010, on average, gay men were more highly educated than bisexual men or MSM.And, on average, they also earned substantially less annual income with their education than bisexual or married MSM.
- So… what happens to men who suffer discrimination at work due to their sexuality? Is there a health impact that can be measured? That’s what we want to know in Outcome Analysis. We will use Logistic Regression to model the multiple factors that may be involved in answering this question.