Advocates for Evidence-Based Health Policy Speakers
The U.S. is Failing Sexual Minority Citizens
Same-sex marriage was legalized in the United States in 2015. Although legalizing same-sex marriage represented a significant milestone for the LGBTQ community, same-sex couples are still being targeted and discriminated against. For example, just this year, the U.S. Supreme Court decided the case, Masterpiece Cakeshop v. Colorado Civil Rights Commission, ruling in favor of a Colorado baker who refused to bake a wedding cake for a same-sex couple.
A recent study evaluated whether living in a state with a law permitting denial of services to same-sex individuals affected mental distress among sexual minority adults (defined as those who identify as gay, lesbian, bisexual). The study focused on data accumulated from 2014 through 2016 from adults aged 18 to 64 years. The study compared sexual minority adults living in 3 states that passed laws permitting denial of services to same-sex couples with those living in 6 states that had not. The study found that laws permitting denial of services to same-sex couples were associated with adverse mental health outcomes and a 46% increase in mental distress among sexual minority adults.
Several states allow the denial of services to same-sex couples. In 2015, Utah passed a law that permitted government officials to refuse to issue marriage licenses for same-sex couples. Similarly, North Carolina law allows adoption and child welfare agencies to refuse to permit same-sex couples to adopt children.
The U.S. legal system will continue to fail sexual minority individuals and mental distress rates will keep increasing unless lawmakers consider exploring these discriminatory laws. As of today, the U.S. legal system is failing to protect sexual minorities from discrimination. Just this year, the Supreme Court permitted President Donald Trump’s partial ban on transgender individuals serving in the military to take effect while court challenges continue. Due to the uncertainty of the partial ban, hundreds of transgender military recruits remain unsure about whether they can enlist. This is another example of the type of discrimination experienced by sexual minorities that increases mental distress.
The Equality Act is an opportunity for Congress to decrease discrimination against the LGBTQ community by amending the Civil Rights Act to explicitly add sexual orientation and gender identity as protected classes. It would prohibit discrimination in public spaces and services and federally funded programs based on sexual orientation and gender identity. Therefore, passing the Equality Act is a vital step that will likely reduce the stigma and discrimination and thus, ultimately eliminate the health disparities experienced by sexual minorities.
This Health Policy Journal Club review is a collaboration between Policy Prescriptions® and the Satcher Health Leadership Institute. It is written by Chelsea Ukoha, JD. She is a Health Policy Leadership Fellow.
Abstract
IMPORTANCE: Recent evidence suggests that state policies affecting sexual minorities are associated with health disparities. Twelve states have laws permitting the denial of services to same-sex couples, and the US Supreme Court is considering whether states can prohibit the denial of services to same-sex couples.
OBJECTIVE: We investigated whether state laws permitting individuals to refuse services to sexual minorities were associated with changes in the proportion of sexual minority adults reporting mental distress.
DESIGN, SETTING, AND PARTICIPANTS: This difference-in-difference-in-differences linear regression analysis with state fixed effects used Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 through 2016 from adults aged 18 to 64 years in 3 states that implemented laws permitting the denial of services to same-sex couples (Utah, Michigan, and North Carolina) and 6 nearby control states (Idaho and Nevada, Ohio and Indiana, and Virginia and Delaware, respectively). Sexual minority adults were defined as those who identified as gay, lesbian, bisexual, or not sure of their sexual orientation under a module on sexual orientation that BRFSS implemented in 2014 and each state could opt to include. Analysis controlled for year and individual-level sex, race, ethnicity, age group, educational attainment, income, employment, and marital status. A permutation test was conducted to precisely estimate statistical significance.
EXPOSURES: An interaction term indicating whether individuals identified as a sexual minority and lived in a state with a law permitting denial of services to same-sex couples in 2015.
MAIN OUTCOMES AND MEASURES: Mental distress, defined as poor mental health on 14 or more of the past 30 days.
RESULTS:
Of 109?089 participants, 4656 (4.8%; all percentages incorporate survey weights) identified as sexual minorities, 86141 (72.1%) were non-Hispanic white, and ages were uniformly distributed between 18 and 64 years. In 2014, 2038 of 16637 heterosexual adults (12.6%) and 156 of 815 sexual minority adults (21.9%) in the 3 same-sex denial states reported mental distress. The proportion of sexual minority adults reporting mental distress increased by 10.1 percentage points (95% CI, 1.8 to 18.5 percentage points, permutation-adjusted P value?=?.046) between 2014 and 2016 in states that passed laws permitting denial of services to same-sex couples compared with control states, a 46% relative increase in sexual minority adults experiencing mental distress. Laws permitting denial of services to same-sex couples were not associated with significant changes in heterosexual adults experiencing mental distress (-0.36 percentage points, 95% CI, -1.73 to 1.01 percentage points).
CONCLUSIONS AND RELEVANCE: Laws permitting denial of services to same-sex couples, which exist in 12 states and are under consideration by the US Supreme Court, are associated with a 46% increase in sexual minority adults experiencing mental distress.
PMID: 29799924
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