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

While public health practitioners and scholars have long theorized that structural forms of stigma shape the health of disadvantaged groups, they have frequently bemoaned the lack of research on this topic. A unique opportunity to address this lacuna occurred in the past two decades, with the advent of dramatic changes in laws, social attitudes, and other structural manifestations of stigma surrounding LGBTQ+ individuals. In a review of this literature, we conducted a meta-analysis of LGBTQ+ structural stigma and health, finding an effect size comparable to several other well-established macrolevel risk factors for poor health (e.g., income inequality, racial residential segregation, neighborhood socioeconomic status). In addition, we enumerated a range of established methodological strategies that studies have used to strengthen inferences; these strategies include documenting result specificity (i.e., structural stigma is unrelated to the health of cisgender heterosexuals), addressing alternative explanations (e.g., social selection), and triangulating evidence across multiple methods, measures, and health outcomes. We offer suggestions for future research to advance this rapidly expanding field, including identifying sources of unexplained heterogeneity in the structural stigma–health association. Finally, we discuss implications for other marginalized groups and for public health interventions and policies to reduce LGBTQ+ health disparities.

Black and Latinx youth experience advanced pubertal development relative to their same-aged, non-stigmatized peers. Research on determinants of this increased risk has focused almost exclusively on aspects of individuals (e.g., body-mass index) or their proximal environment (e.g., socioeconomic status), to the exclusion of broader macro-social factors. Using two years of Adolescent Brain Cognitive Development Study® data, we examined whether structural stigma (e.g., state-level policies, aggregated prejudicial attitudes) was associated with hormonal and perceived physical indicators of pubertal development. Baseline results documented more advanced pubertal development among Black girls (hormones) and Latinx youth (youth and/or caregiver report) in states characterized by higher (vs. lower) structural stigma. Observed associations were comparable in effect size to a well-established correlate of pubertal development, BMI, and remained or strengthened one year later among these stigmatized (vs. non-stigmatized) groups. Findings suggest the need to broaden the study of determinants of pubertal development to include macro-social factors.

A growing body of evidence has documented the adverse health consequences of structural stigma across multiple marginalized groups, including sexual minority people. In light of these advancements, scholars have urged the field to refine conceptualizations of structural stigma to guide future empirical work. We heed this charge by analyzing two sets of qualitative data among gay and bisexual men obtained from a probability-based panel: (a) responses to an open-ended survey question about structural stigma (n = 385) and (b) in-depth interviews about their subjective experiences of structural stigma (n = 60). Our findings revealed three key dimensions underlying structural stigma. First, participants described structural stigma using metaphors conveying that their freedom had been severely constrained; structural stigma was variously portrayed as a “cage,” a “prison,” and a “net” where “there is no exit.” Second, structural stigma communicated a lack of recognition by others, whereby participants were treated as “sub-human” and “a second-class citizen.” Third, in contexts with high levels of structural stigma, participants reported a lack of social safety, including that their sense of belonging had been threatened; for one participant, structural stigma felt “like knocking on a door and being able to see people on the other side laughing at you for trying to get in.” Based on these themes, we offer a revised definition: Structural stigma is manifested when institutional policies, practices, and cultural norms produce societal conditions that create unfreedom, engender failures of recognition, or undermine social safety. Implications for structural stigma measurement and for research with other stigmatized groups are discussed.

Objective: Self-guided digital mental health interventions (DMHIs) teaching empirically supported skills (e.g. behavioral activation) have demonstrated efficacy for improving youth mental health, but we lack evidence for the complex skill of cognitive restructuring (CR). Method: We conducted the first-ever RCT testing a CR DMHI ("Project Think") against an active control (supportive therapy; "Project Share") in collaboration with public schools. Pre-registered outcomes were DMHI acceptability and helpfulness post-intervention, as well as internalizing symptoms and CR skills use from baseline to seven-month follow-up, in the full sample and the subsample with elevated symptoms. Results: Participants (N = 597; MAge = 11.99; 48% female; 68% White) rated both programs highly on acceptability and helpfulness. Both conditions were associated with significant internalizing symptom reductions across time in both samples, with no significant condition differences. CR skills use declined significantly across time for Project Share youths but held steady across time for Project Think youths in both samples; this pattern produced a significant condition difference favoring Project Think within the elevated sample at seven-month follow-up. Conclusion: Internalizing symptoms declined comparably for Think and Share participants. Consequently, future research should examine whether encouraging youths to share their feelings produces symptom improvements, and whether a single-session, self-guided CR DMHI produces beneficial effects relative to more inert control conditions. Further, the decline in CR skills use for Project Share youths versus sustained CR use by Project Think youths raises questions about the natural time course of youths' CR use and the impact of these DMHIs on that course. ClinicalTrials.gov Registration: NCT04806321.

Today, many social groups face negative stereotypes. Is such negativity a stable feature of society and, if so, what mechanisms maintain stability both within and across group targets? Answering these theoretically and practically important questions requires data on dozens of group stereotypes examined simultaneously over historical and societal scales, which is only possible through recent advances in Natural Language Processing. Across two studies, we use word embeddings from millions of English-language books over 100 years (1900–2000) and extract stereotypes for 58 stigmatized groups. Study 1 examines aggregate, societal-level trends in stereotype negativity by averaging across these groups. Results reveal striking persistence in aggregate negativity (no meaningful slope), suggesting that society maintains a stable level of negative stereotypes. Study 2 introduces and tests a new framework identifying potential mechanisms upholding stereotype negativity over time. We find evidence of two key sources of this aggregate persistence: within-group “reproducibility” (e.g., stereotype negativity can be maintained by using different traits with the same underlying meaning) and across-group “replacement” (e.g., negativity from one group is transferred to other related groups). These findings provide novel historical evidence of mechanisms upholding stigmatization in society and raise new questions regarding the possibility of future stigma change.

Objective Structural forms of stigma and discrimination are associated with adverse health outcomes across numerous stigmatized groups, including lesbian, gay, and bisexual (LGB) individuals. Yet, the biological consequences of structural stigma among LGB populations are understudied. To begin to address this gap, we assessed associations between indicators of structural stigma (i.e., state-level policies) targeting LGB individuals and allostatic load (AL) indices representing physiological dysregulations. Methods Pooled data from the continuous 2001-2014 National Health and Nutritional Examination Survey were analyzed (LGB: n = 864; heterosexual: n = 20,310). Ten state-level LGB-related policies (e.g., employment non-discrimination protections, same-sex marriage) were used to operationalize structural stigma. A sex-specific AL index representing 11 immune, metabolic, and cardiovascular biomarkers was estimated. Multi-level models were used to examine associations between structural stigma and AL, net of 9 individual-level characteristics (e.g., education, race/ethnicity, age, and health behaviors). Results Sexual minority men living in states with low levels of structural stigma experienced significantly lower AL (β = -.45, p = .02) compared to sexual minority men living in states with high structural stigma (i.e., fewer protective policies). There was no significant association between structural stigma and AL among sexual minority women. Conclusions By demonstrating direct associations between structural stigma and indices of physiological dysregulation, our findings provide a mechanistic understanding of how the social environment can “get under the skin and skull” for sexual minority men in the United States. Future research should explore whether these mechanisms generalize to other marginalized groups exposed to structural stigma.

Consistent evidence documents powerful effects of social inequality on health, well-being and academic achievement. Yet research on whether social inequality may also be linked to brain structure and function has, until recently, been rare. Here we describe three methodological approaches that can be used to study this question-single site, single study; multi-site, single study; and spatial meta-analysis. We review empirical work that, using these approaches, has observed associations between neural outcomes and structural measures of social inequality-including structural stigma, community-level prejudice, gender inequality, neighbourhood disadvantage and the generosity of the social safety net for low-income families. We evaluate the relative strengths and limitations of these approaches, discuss ethical considerations and outline directions for future research. In doing so, we advocate for a paradigm shift in cognitive neuroscience that explicitly incorporates upstream structural and contextual factors, which we argue holds promise for uncovering the neural correlates of social inequality.