Structural Determinants of Health across Race, Sexual Orientation, and Gender: A Mixed Methods Application of Public Health Critical Race Praxis

Abstract

Purpose: This dissertation uses Public Health Critical Race Praxis (PHCRP) to understand how structural determinants (including structural racism and discrimination (SRD) and community cultural wealth (CCW)) impact the health of U.S. adults across race, sexual orientation, and gender. The purpose of this research is to effect positive structural change to promote the health and wellbeing of queer and transgender Black, Indigenous, and other people of color (QTBIPOC). Specific Aims: The aims of the dissertation are as follows: (1) Conduct a systematic scoping review to describe how PHCRP is applied methodologically in published health literature and summarize strategies for applying anti-racist principles in health research; (2) Examine individual and joint associations between structural racism, structural cisheterosexism, and QTBIPOC status on measures of health-related quality of life (HRQoL) and health services outcomes among U.S. adults; and (3) Identify how QTBIPOC community members describe the ways in which structural determinants impact the health of their community through a content analysis of QTBIPOC-authored independently-published print media. Methods: This mixed methods study utilizes three unique data sources to answer its research questions. Aim 1 is a qualitative systematic scoping review of four major health databases. Aim 2 is a quantitative analysis of national Behavioral Risk Factor Surveillance System (BRFSS) data, linked with state-level indices of structural racism and structural LGBTQ+ discrimination. Aim 3 is a qualitative analysis of QTBIPOC-authored independently-published print media from the Zine Archive & Publishing Project (ZAPP) Collection at the Seattle Public Library. Importance: This dissertation is innovative in approach, population, methodology, and impact. The use of PHCRP, focus on multiply marginalized populations, examination of structural-level factors, novel datasets, and applicability to a variety of stakeholders distinguishes this study. This study will serve as a model for anti-racist and intersectional public health research.