218925 A linear structural model of legislation on homosexuality and high-risk sexual behavior

Monday, November 8, 2010

Derek Smolenski, PhD, MPH , Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
J. Michael Wilkerson Jr., PhD, CHES , Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
Anne Cain-Nielsen , Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
B. R. Simon Rosser, PhD, MPH , Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
Background: The study of sexual risk behavior among men who have sex with men (MSM) has focused largely on individual-level variables. In contrast, macrosocial factors, such as laws, remain largely unstudied.

Methods: The Structural Interventions to Lower Alcohol-related HIV/STI Risk (SILAS) is a five-year study of men who reside in sixteen US cities. We selected eight cities with favorable legislation on gay marriage, adoption, and anti-discrimination, and matched these on census demographics with eight cities with unfavorable legislation. We used data from 1,725 respondents to the Year 1 survey to estimate a path model of the hypothesized indirect effects of legislation on unprotected anal intercourse with male partners in the last 90 days (UAIMP).

Results: Though we did not identify a direct effect, we identified a pathway from legislation through the following sequence of intermediates: (1) perceived hostility towards gay men, (2) internalized homonegativity, (3) depression, (4) substance use (alcohol, poppers, and erectile enhancement drugs over the past 90 days), and (5) UAIMP.

Conclusion: The lack of a direct effect may indicate that it was too distal a determinant to be detected. However, the observed indirect effect indicates that legislation may indeed play a role in risk behavior. While we cannot argue causality, we can continue to work with the variables in the path model to conceive of future analytic and intervention studies.

Learning Areas:
Biostatistics, economics
Epidemiology
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Distinguish between individual-level determinants and macrosocial factors. 2. Define a direct and an indirect effect. 3. Describe a theoretical model of sexual risk behavior as a function of legislation on homosexuality.

Keywords: Condom Use, Risk Behavior

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I hold a PhD in Epidemiology, I specialize in the development and application of latent variable models, and the senior author/mentor is a leading researcher on interventions for men who have sex with men.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3271.0: Special Topics in LGBT Public Health (II)