Mark L Hatzenbuehler's research while affiliated with Harvard University and other places

Publications (176)

Article
Research into correlates and predictors of emotion regulation has focused almost exclusively on individual differences and the immediate situation. Here, we consider whether features of macro-social contexts may also shape emotion regulation. To test this hypothesis, we conducted a longitudinal study of 502 gay and bisexual men living in 269 U.S. c...
Article
We evaluated the hypothesis that neural responses to racial out-group members vary systematically based on the level of racial prejudice in the surrounding community. To do so, we conducted a spatial meta-analysis, which included a comprehensive set of studies (k=22; N=481). Specifically, we tested whether community-level racial prejudice moderated...
Article
Objective: Transgender adolescents experience adversity accessing mental healthcare, which is exacerbated by transgender-specific mental health provider shortages in the United States. Factors associated with variability in transgender-specific mental health provider availability across states – especially at the macro-social level – have yet to be...
Article
Full-text available
Background Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). However, there is limited data on whet...
Article
The association between stigma and adverse interpersonal outcomes is well established. However, the mechanisms underlying this association have yet to be comprehensively conceptualized and tested, in part because research has neglected to evaluate stigma across multiple levels. To address this gap, we examined whether stigma—measured at individual,...
Article
Objective The adolescent health consequences of the school-to-prison pipeline remain underexplored. We test whether initiating components of the school-to-prison pipeline—suspensions, expulsions, and school policing—are associated with higher school-average levels of student substance use, depressed feelings, and developmental risk in the following...
Preprint
Full-text available
Hypervigilance is often theoretically invoked as a psychological mechanism linking stigma to internalizing psychopathology among sexual minority young adults. Empirically, however, hypervigilance is rarely explicitly assessed among sexual minorities but instead commonly conflated with putatively related constructs, such as sexual orientation-relate...
Article
Objective: Gay and bisexual men have significantly higher rates of depression than heterosexual men. The minority stress theory (Meyer, 2003) proposed that distal minority stressors, like interpersonal discrimination, contribute to this disparity. The psychological mediation framework (Hatzenbuehler, 2009) posited several psychosocial mechanisms t...
Article
Purpose: We assessed sexual orientation-related patterns in the 1-year longitudinal course (i.e., onset, remittance, persistence) and severity of suicidality. Method: Data were obtained from a prospective, population-based cohort representing nearly 2.4 million Swedish young adults. Results: A higher proportion of sexual minorities remitted (1...
Article
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Researchers are increasingly recognizing the importance of studying and addressing intersectional stigma within the field of HIV. Yet, researchers have, arguably, struggled to operationalize intersectional stigma. To ensure that future research and methodological innovation is guided by frameworks from which this area of inquiry has arisen, we prop...
Preprint
Full-text available
Objective: Transgender adolescents experience adversity accessing mental healthcare, which is exacerbated by transgender-specific mental health provider shortages in the United States. Factors associated with variability in transgender-specific mental health provider availability across states—especially at the macro-social level—have yet to be ide...
Article
Objective: Effective Skills to Empower Effective Men (ESTEEM) represents the first intervention to address the psychological pathways through which minority stress undermines young sexual minority men's (SMM's) mental and sexual health using transdiagnostic cognitive-behavioral therapy. This study compared the efficacy of ESTEEM against two existi...
Article
Objectives: We leverage state-level variability in social policies that confer legal protections for sexual minorities (e.g., employment non-discrimination acts) and examine their association with birth outcomes among sexual minority women. Methods: We link measures of structural protections (i.e., social policies) to a prospective, population-b...
Preprint
A persistent question in social neuroscience is whether the amygdala underlies racial prejudice. Despite decades of research, evidence for a stronger amygdala response to racial out-group versus in-group members has been mixed. Here, we consider a potential explanation for these conflicting results: that neural responses to racial out-group members...
Preprint
Low socioeconomic status (SES) in childhood is associated with altered neural development and elevated risk for psychopathology. Can public policies that increase financial resources for families with low income—including cash assistance programs and the presence of Medicaid expansion—reduce these socioeconomic disparities in brain development and...
Article
In this article, we argue that stigma may be an important, but heretofore underrecognized, source of heterogeneity in treatment effects of mental- and behavioral-health interventions. To support this hypothesis, we review recent evidence from randomized controlled trials and spatial meta-analyses suggesting that stigma may predict not only who resp...
Article
Purpose The purpose of the study is to establish prospective relationships among school mean levels of substance use, developmental risk and resilience factors, and school discipline. Methods We linked 2003–2014 data from the California Healthy Kids Survey and the Civil Rights Data Collection, from more than 4,800 schools and 4,950,000 students. W...
Article
Importance: Homophobic bullying-which is motivated by actual or perceived sexual orientation-is a common experience among youth and is more strongly associated with adverse outcomes than bullying unrelated to bias. Yet current approaches to reducing homophobic bullying either lack empirical evidence or encounter significant obstacles. Thus, the fi...
Article
Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). Although the literature on stigma and mental heal...
Article
Psychological theories of identity concealment locate the ultimate source of concealment decisions within the social environment, yet most studies have not explicitly assessed stigmatizing environments beyond the immediate situation. We advanced the identity-concealment literature by objectively measuring structural forms of stigma related to sexua...
Article
Objectives. To examine the relationship between city-level structural stigma pertaining to sexual orientation and gender identity (SOGI) and completeness of patient SOGI data collection at US federally qualified health centers (FQHCs). Methods. We used the Human Rights Campaign's Municipal Equality Index to quantify city-level structural stigma aga...
Article
Objectives. To examine the relationship between city-level structural stigma pertaining to sexual orientation and gender identity (SOGI) and completeness of patient SOGI data collection at US federally qualified health centers (FQHCs). Methods. We used the Human Rights Campaign’s Municipal Equality Index to quantify city-level structural stigma aga...
Article
Objective To determine whether structural and individual forms of stigma are associated with neurodevelopment in children. Method Stigma related to gender, race, and Latinx ethnicity was measured at the structural level using objective state-level indicators of social policies and prejudicial attitudes, and at the individual level using self-repor...
Preprint
We examined whether cultural sexism (county- and state-level gender attitudes) moderates the efficacy of psychotherapies by re-analyzing data from a previous meta-analysis of randomized controlled trials of youth psychotherapy for the most commonly targeted problems (depression, anxiety, conduct, attention-deficit hyperactivity disorder; 2,698 effe...
Article
Objective We examined whether anti-Black cultural racism moderates the efficacy of psychotherapy interventions among youth. Method We analyzed a subset of studies from a previous meta-analysis of five decades of youth psychotherapy randomized controlled trials. Studies were published in English between 1963 and 2017 and identified through a system...
Poster
Full-text available
Research consistently links internalizing/externalizing symptomatology in Black youth to discrimination (Benner et al., 2018), with a near exclusive focus on interpersonal racism (Williams, 2018). Despite recent calls (Trent et al., 2019), few studies have explored anti-Black racism at the macro level, including if and how cultural racism (i.e., a...
Chapter
Part 1 of this first-of-its-kind 3-part series can help show how to break down the cycles of ignorance, shame, and toxic stress that harm children who identify as LGBTQ+ and improve their chances of leading happy, healthy adult lives. https://shop.aap.org/pediatric-collections-lgbtq-support-and-care-part-1-combatting-stigma-and-discrimination/
Chapter
Part 1 of this first-of-its-kind 3-part series can help show how to break down the cycles of ignorance, shame, and toxic stress that harm children who identify as LGBTQ+ and improve their chances of leading happy, healthy adult lives. https://shop.aap.org/pediatric-collections-lgbtq-support-and-care-part-1-combatting-stigma-and-discrimination/
Chapter
In this chapter, we introduce readers to emerging research on sexual and gender minority (SGM) health disparities. First, we provide a brief background on SGM populations, including how SGM populations are defined, the different measures that have been used to operationalize sexual orientation and gender identity, and what is currently known and un...
Preprint
Objective: The study examined whether cultural racism moderates the efficacy of psychotherapy interventions among youth.Method: We analyzed a subset of studies from a previous meta-analysis of five decades of youth psychotherapy randomized controlled trials. Studies were published in English between 1963 and 2017 and identified through a systematic...
Preprint
Full-text available
Background To determine whether being raised in a stigmatizing context influences neurodevelopment in children. Methods We drew data from one of the first national, multi-site neuroimaging studies with substantial variability in sociopolitical contexts: the Adolescent Brain and Cognitive Development study (N=11,534; M =9.9 years). We measured stru...
Article
Background: To examine trends in state-level policy support for sexual minorities and HIV outcomes among MSM. Methods: This longitudinal analysis linked state-level policy support for sexual minorities (N=94 Metropolitan Statistical Areas [MSAs] in 38 states) to 7 years of data (2008-2014) from CDC on HIV outcomes among MSM. Using latent growth...
Article
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Background: While gay and bisexual men (GBM) represent the largest group of HIV-infected individuals in the United States (U.S.), nearly all evidence on their HIV risk and prevention outcomes derive from non-probability samples. Setting: A probability-based cohort of GBM (N=502) from 45 states and Washington, D.C. Methods: Cross-sectional surv...
Article
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Background: Young gay and bisexual men disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in young gay and bisexual men's exposure to minority stress. In fact, minority stress, psychiatric morb...
Article
Using updated data from the General Social Survey/National Death Index (GSS/NDI) study, we examined whether the relationship between structural stigma-measured by aggregating 4 items assessing prejudice towards homosexuality to the community level-and all-cause mortality is present among gay men/lesbian women. Our hypothesis is based on emerging ev...
Article
Introduction: Sexual minority female adolescents have worse reproductive health than heterosexual peers; research into the origins of these disparities is limited. Our objective was to examine whether exposure to structural stigma (e.g., societal-level conditions, cultural norms, institutional policies/practices that constrain the lives of the sti...
Article
Background: Bias-based bullying is associated with negative outcomes for youth, but its contextual predictors are largely unknown. Voter referenda that target lesbian, gay, bisexual, and transgender groups may be 1 contextual factor contributing to homophobic bullying. Methods: Data come from 14 consecutive waves (2001-2014) of cross-sectional s...
Article
Policy Points • Stigma is an established driver of population‐level health outcomes. Antidiscrimination laws can generate or alleviate stigma and, thus, are a critical component in the study of improving population health. • Currently, antidiscrimination laws are often underenforced and are sometimes conceptualized by courts and lawmakers in ways...
Article
Stigma may strain the heart health of lesbian, gay, and bisexual (LGB) individuals. To date, however, LGB-related differences in cardiovascular diagnosis, risk factors, and basal biomarkers are inconsistently reported. Using a laboratory-based stress paradigm, the current study assessed whether cardiovascular stress reactivity differs as a function...
Article
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Background Researchers have long recognized that stigma is a global, multi-level phenomenon requiring intervention approaches that target multiple levels including individual, interpersonal, community, and structural levels. While existing interventions have produced modest reductions in stigma, their full reach and impact remain limited by a nearl...
Chapter
The articles included in this collection on bullying provide a wide lens through which to view this complexity.
Article
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This ecologic cohort study explores the relationship between state minimum wage laws and rates of HIV diagnoses among heterosexual black residents of U.S metropolitan areas over an 8-year span. Specifically, we applied hierarchical linear modeling to investigate whether state-level variations in minimum wage laws, adjusted for cost-of-living and in...
Article
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Sexual orientation related health disparities are well documented. Sexual minority men appear to be at risk for mental health problems due to the stress they experience in establishing and maintaining a minority sexual identity. These mental health issues may combine synergistically and lead to higher medical costs to society. We examine whether se...
Article
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In the past two decades, population-based health surveys have begun including measures of sexual orientation, permitting estimates of sexual orientation disparities in psychiatric morbidity and differences in treatment utilization. The present study takes advantage of the high-quality, comprehensive nationwide health registry data available in Swed...
Article
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...
Article
Significance Voter initiatives and referendums concerning the rights of marginalized groups are utilized in 27 states, but research on the psychosocial consequences of these initiatives is underdeveloped. This research combines official records of televised advertisements from same-sex marriage campaigns with psychological outcomes among a probabil...
Article
This study assesses whether anti-immigrant prejudice at the community level is prospectively associated with mortality. We used 10 waves of data from the General Social Survey (GSS) that were linked to mortality data via the National Death Index (NDI) for the period between 1993 and 2014 (n = 13,242). The 2014 GSS-NDI dataset is a nationally repres...
Article
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This is a critical and perhaps unprecedented time for the social sciences in public health. While there are many opportunities for the social sciences to continue making transformative contributions to improve population health, there are significant challenges in doing so, particularly in a rapidly changing political landscape. Such challenges are...
Article
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Most individuals are stigmatized at some point. However, research often examines stigmas separately, thus underestimating the overall impact of stigma and precluding comparisons across stigmatized identities and conditions. In their classic text, Social Stigma: The Psychology of Marked Relationships, Edward Jones and colleagues laid the groundwork...
Article
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth experience significant bullying that undermines their mental and physical health. National health organizations have called for the development of innovative strategies to address LGBTQ bullying. Pediatricians and other clinicians, medical and public health students, interdisciplinary res...
Article
This study examined the health consequences for lesbian, gay, bisexual, and transgender (LGBT) populations of exposure to communities with relatively high versus low levels of support for same-sex marriage. We used data from the Gallup Daily tracking survey, the largest probability-based sample of LGBT-identified adults in the United States (N = 11...
Article
Purpose: The purpose of this study was to examine rates of substance use between transgender and nontransgender youth using a representative population-based sample and to examine mediating risk factors. Methods: A statewide cross-sectional sample of California middle and high schools collected between 2013 and 2015. This representative sample o...
Article
Objective: Gay, bisexual, and other men who have sex with men (MSM) might be particularly likely to migrate to experience freedoms unavailable in their home countries. Structural stigma (e.g., laws and policies promoting the unequal treatment of oppressed populations) in MSM migrants' sending and receiving countries represent potential barriers to...
Article
Full-text available
While the prevalence of sexual identities and behaviors of men who have sex with men (MSM) varies across countries, no study has examined country-level structural stigma toward sexual minorities as a correlate of this variation. Drawing on emerging support for the context-dependent nature of MSM’s open sexual self-identification cross-nationally, w...
Article
Objective No representative population-based studies of youth in the US exist on gender identity-related disparities in suicidal ideation or on factors that underlie this disparity. To address this, we: (1) examined gender identity-related disparities in the prevalence of suicidal ideation; (2) evaluated whether established psychosocial factors exp...
Article
Purpose: Racism, whether defined at individual, interpersonal, or structural levels, is associated with poor health among Blacks. This association may arise because exposure to racism causes poor health, but geographic mobility patterns pose an alternative explanation-namely, Black individuals with better health and resources can move away from ra...
Article
Background Alcohol use among underage youth is a significant public health concern. According to the National Institute on Alcohol Abuse and Alcoholism, alcohol is the “drug of choice” among adolescents, meaning more youth use and abuse alcohol than any other substance. Prevalence of alcohol use is disproportionately higher among sexual minority yo...
Article
There is increasing evidence that racism is a cause of poor health outcomes in the United States, including adverse birth outcomes among Blacks. However, research on the health consequences of racism has faced measurement challenges due to the more subtle nature of contemporary racism, which is not necessarily amenable to assessment through traditi...
Article
There has been a great deal of state-level legislative activity focused on immigration and immigrants over the past decade in the United States. Some policies aim to improve access to education, transportation, benefits, and additional services while others constrain such access. From a social determinants of health perspective, social and economic...
Article
Introduction: Recent research suggests that anti-bullying laws may be effective in reducing risk of bullying victimization among youth, but no research has determined whether these laws are also effective in reducing disparities in bullying. The aim of this paper was to evaluate the effectiveness of anti-bullying legislation in reducing disparitie...
Article
Suicide is the second leading cause of death among adolescents aged 15 to 24 years.¹ Youth who are sexual minorities (ie, those who identify as lesbian, gay, or bisexual [LGB]; report persistent same-sex attractions; or engage in same-sex sexual behavior) represent one of the groups at highest risk for suicidal ideation and attempts. A review of mo...
Article
Psychological research on stigma has focused largely on the perceptions of stigmatized individuals and their interpersonal interactions with the nonstigmatized. This work has been critical in documenting many of the ways in which stigma operates to harm those who are targeted. However, this research has also tended to overlook broader structural fo...
Article
Health disparities related to stigmatized characteristics, including sexual orientation, have been well-documented. However, it is largely unknown whether temporal declines in stigma at a structural level contribute to concomitant reductions in health disparities between stigmatized and nonstigmatized groups. The objective of this study was to (a)...
Article
Rationale: Despite abundant state-level policy activity in the U.S. related to immigration, no research has examined the mental health impact of the overall policy climate for Latinos, taking into account both inclusionary and exclusionary legislation. Objective: To examine associations between the state-level policy climate related to immigrati...
Article
Psychological research has provided essential insights into how stigma operates to disadvantage those who are targeted by it. At the same time, stigma research has been criticized for being too focused on the perceptions of stigmatized individuals and on microlevel interactions, rather than attending to structural forms of stigma. This article desc...
Article
Rationale: A small but growing body of research documents associations between structural forms of stigma (e.g., same-sex marriage bans) and sexual minority health. These studies, however, have focused on a limited number of outcomes and have not examined whether sociodemographic characteristics, such as race/ethnicity and education, influence the...
Article
Long tolerated as a rite of passage into adulthood, bullying is now recognized as a major and preventable public health problem. The consequences of bullying—for those who are bullied, the perpetrators of bullying, and the witnesses—include poor physical health, anxiety, depression, increased risk for suicide, poor school performance, and future de...
Article
In this article, we review theory and evidence on stigma and minority stress as social/structural determinants of health among lesbian, gay, bisexual, and transgender (LGBT) youth. We discuss different forms of stigma at individual (eg, identity concealment), interpersonal (eg, victimization), and structural (eg, laws and social norms) levels, as w...
Article
Stigma processes play an underrecognized role in the distribution of life chances, influencing health through the production of disadvantage and the induction of stress. Policies enact stigma processes, mitigate them, or ignore them. If each of these two statements is correct, the intersection of stigma and policy demands our attention. We propose...
Article
Objectives: To determine whether fundamental cause theory (which posits that, in societal conditions of unequal power and resources, members of higher-status groups experience better health than members of lower-status groups because of their disproportionate access to health-protective factors) might be relevant in explaining health disparities r...
Article
Laws and policies can affect the HIV risk of key populations through a number of direct and indirect pathways. We investigated the association between HIV prevalence among men who engage in transactional sex and language in the penal code protecting sexual minorities, including men who have sex with men (MSM), and sex workers. HIV prevalence among...
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The extent to which socially-assigned and culturally mediated social identity affects health depends on contingencies of social identity that vary across and within populations in day-to-day life. These contingencies are structurally rooted and health damaging inasmuch as they activate physiological stress responses. They also have adverse effects...
Article
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Background: We investigated whether adolescents drank alcohol less frequently if they lived in jurisdictions with school climates that were more affirmative of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals. Methods: Data from the 2010 School Health Profile survey, which measured LGBTQ school climate (e.g., percentage o...
Article
Importance: Bullying is the most widespread form of peer aggression in schools. In an effort to address school bullying, 49 states have passed antibullying statutes. Despite the ubiquity of these policies, there has been limited empirical examination of their effectiveness in reducing students' risk of being bullied. Objective: To evaluate the e...
Article
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Objectives: We examined whether and how racial prejudice at both the individual and community levels contributes to mortality risk among majority as well as minority group members. Methods: We used data on racial attitudes from the General Social Survey (1993-2002) prospectively linked to mortality data from the National Death Index through 2008...
Article
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Recent studies have identified substantial health disparities between lesbian, gay, and bisexual (LGB) individuals compared to heterosexuals. However, possible variation in sexual orientation health disparities by age and according to gender remains largely unexplored. To examine physical health disparities between LGB and heterosexual individuals...
Article
This study assessed individual (ie, internalized transphobia) and structural forms of stigma as risk factors for suicide attempts among transgender adults. Internalized transphobia was assessed through a 26-item scale including four dimensions: pride, passing, alienation, and shame. State-level structural stigma was operationalized as a composite i...
Article
The goal of this study was to evaluate a novel measure of environmental risk factors for bullying among sexual minority youths. Data on lesbian, gay, bisexual, and transgender (LGBT) assault hate crimes were obtained from police records, geocoded, and then linked to individual-level data on bullying and sexual orientation from the 2008 Boston Youth...
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We tested the preliminary efficacy of a transdiagnostic cognitive-behavioral treatment adapted to improve depression, anxiety, and co-occurring health risks (i.e., alcohol use, sexual compulsivity, condomless sex) among young adult gay and bisexual men. Treatment adaptations focused on reducing minority stress processes that underlie sexual orienta...
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Substantial country-level variation exists in prejudiced attitudes towards male homosexuality and in the extent to which countries promote the unequal treatment of MSM through discriminatory laws. The impact and underlying mechanisms of country-level stigma on odds of diagnosed HIV, sexual opportunities, and experience of HIV-prevention services, n...
Article
Research is just beginning to explore the intersection of bullying and relationship violence. The relationship between these forms of youth aggression has yet to be examined in diverse urban centers, including New York City (NYC). This study seeks to identify intersections of joint victimization from bullying and electronic bullying (e-bullying) wi...