Ning Hsieh’s research while affiliated with Michigan State University and other places

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Publications (33)


Flowchart of sample selection process.
Weighted Descriptive Statistics for Analytic Variables
Sexual Identity Differences in Self-Rated Health from Ordinal Logit Regression Models, Health and Retirement Study 2016 (N = 3623)
Sexual Identity and Self-Rated Health in Midlife: Evidence from the Health and Retirement Study
  • Article
  • Full-text available

September 2021

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14 Reads

Hui Liu

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Ning Hsieh

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Wen-hua Lai

Purpose: This study examined health disparities among U.S. sexual minority people in midlife—a critical life course stage that is largely overlooked in the sexual minority health literature. Methods: Data were drawn from the 2016 Health and Retirement Study. We restricted the analysis to respondents aged 50–65. The final sample consisted of 3623 respondents, including 3418 self-identified heterosexual individuals, 99 self-identified gay/lesbian individuals, 38 self-identified bisexual individuals, and 68 respondents who identified as “something else.” Ordinal logistic regression models were estimated to predict the odds of reporting better health. Results: Bisexual midlifers reported significantly worse health than their heterosexual counterparts after age, gender, and race-ethnicity are controlled for (OR=0.43, 95% CI=0.25–0.76); this health disparity is mostly explained by marital status, socioeconomic status, and health behaviors (in particular smoking and exercising). We did not find evidence of a self-rated health disadvantage among gay and lesbian midlifers relative to their heterosexual counterparts. Conclusion: These findings highlight the diversity of the sexual minority population in midlife. Public policies and programs should be designed and implemented at the interpersonal and institutional levels to eliminate health and other social disadvantages among sexual minority people, in particular bisexual people, in midlife.

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Health and Health Care of Sexual and Gender Minorities

September 2021

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75 Reads

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76 Citations

Journal of Health and Social Behavior

Research on the social dimensions of health and health care among sexual and gender minorities (SGMs) has grown rapidly in the last two decades. However, a comprehensive review of the extant interdisciplinary scholarship on SGM health has yet to be written. In response, we offer a synthesis of recent scholarship. We discuss major empirical findings and theoretical implications of health care utilization, barriers to care, health behaviors, and health outcomes, which demonstrate how SGMs continue to experience structural- and interactional-level inequalities across health and medicine. Within this synthesis, we also consider the conceptual and methodological limitations that continue to beleaguer the field and offer suggestions for several promising directions for future research and theory building. SGM health bridges the scholarly interests in social and health sciences and contributes to broader sociological concerns regarding the persistence of sexuality- and gender-based inequalities.


Percentage of old-old respondents (age 80 and above) who remained in the study since 1998
Percentage of young-old respondents (age 65–79) who remained in the study since 2002.* Difference between respondents with and without children is statistically significant at p < 0.05 level
Childlessness and Social Support in Old Age in China

June 2021

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55 Reads

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8 Citations

Journal of Cross-Cultural Gerontology

Although previous studies showed that children are the primary source of old-age support in China, much less is known about the availability and sources of social support among childless elders. Also, little research has explored how older adults’ social support transitions over time by childless status. Using the 2005 and 2011 Chinese Longitudinal Healthy Longevity Survey (N = 14,575), this study examined the transition of living arrangement and sources of social support by childless status among adults aged 65 and older. A series of multinomial logistic and linear regression models were used to analyze the data. Results show that compared to elders with children, childless elders were more likely to live alone or in an institution at baseline, but their probability of living alone decreased substantially while that of living in an institution increased modestly in the 6-year follow-up. Moreover, childless elders generally had fewer support sources, but this disadvantage became smaller over time. Although childless elders were significantly more likely to depend on nobody, the spouse, grandchildren (or other relatives), or nonrelatives for support at baseline, this pattern disappeared in the follow-up likely due to mortality selection. Findings imply that although the risk of social isolation among childless elders becomes lower as age progresses, garnering more social resources at younger ages may help reduce their premature mortality.


Disparities in Experience with Culturally Competent Care and Satisfaction with Care by Sexual Orientation

March 2021

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26 Reads

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9 Citations

LGBT Health

Purpose: Prior studies have identified health care providers' lack of cultural competency as a major barrier to care among sexual minority individuals. However, little is known about disparities in experience with culturally competent care by sexual orientation at the population level. This study assessed experiences with culturally competent care and satisfaction with care across sexual orientation groups in the United States. Methods: We analyzed nationally representative data from the 2017 National Health Interview Survey (n = 21,620) with ordinal logit regression models and compared six aspects of health care experiences across sexual orientation groups. These were: preferences for and frequencies of seeing health care providers who understand or share their culture; perceived experiences of being treated with respect by providers and providers asking about their beliefs and opinions; access to easily understood health information from providers; and satisfaction with received care. Results: Relative to heterosexual men, gay men were more likely to consider it important for providers to understand or share their culture (odds ratio [OR] = 1.4, p < 0.05) and to have providers who ask for their opinions or beliefs about care (OR = 1.5, p < 0.01). Relative to heterosexual women, bisexual- and something else-identified women were less likely to report being treated with respect (ORs = 0.4-0.6, p's < 0.01) and satisfaction with care (ORs = 0.5-0.6, p's < 0.05). No statistical differences in health care experiences were found between other sexual minority groups and their heterosexual counterparts. Conclusions: Access to culturally competent care and satisfaction with care varied by sexual orientation and gender. Clinical practices should address the unique health care barriers faced by bisexual- and something else-identified women.


Social Networks in Later Life: Similarities and Differences between Sexual-Minority and Heterosexual Older Adults

December 2020

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28 Reads

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11 Citations

Socius Sociological Research for a Dynamic World

Community-based research suggests that lesbian, gay, and bisexual (LGB) older adults are more socially isolated than their heterosexual counterparts. However, little is known about how social networks in late adulthood differ between LGB and heterosexual people at the population level. Using data from the 2015–2016 National Social Life, Health, and Aging Project ( n = 3,929), the authors compare the size, frequency of contact, composition, diversity, and density of core discussion networks as well as family and friend support across sexual-orientation groups. The authors find that LGB people share a few network characteristics with their heterosexual counterparts, including network size, frequency of contact with network members, and proportion of nonspousal kin members in the network. However, their networks are less likely to include intimate partners, are more likely to include friends, and have lower diversity and density. LGB people also report lower family support but higher friend support than heterosexual people.


Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study

November 2020

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174 Reads

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25 Citations

The Journals of Gerontology Series B Psychological Sciences and Social Sciences

Hui Liu

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Ning Hsieh

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[...]

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Kenneth M Langa

Objectives We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States. Method We analyzed data from the Health and Retirement Study (2000-2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status (TICS). Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment. Results The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (OR = 1.53, p < .001). Discussion The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.


Elevated Risk of Cognitive Impairment Among Older Sexual Minorities: Do Health Conditions, Health Behaviors, and Social Connections Matter?

September 2020

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13 Reads

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44 Citations

The Gerontologist

Background and objectives: Little research has examined cognitive health disparities between sexual minority and heterosexual populations. Further, most extant studies rely on subjective measures of cognitive functioning and non-probability samples. This study uses a performance-based cognitive screening tool and a nationally representative sample of older Americans to examine the disparity in cognitive impairment by sexual orientation and the potential mechanisms producing this disparity. Research design and methods: Using data from the 2015-16 National Social Life, Health, and Aging Project (N=3,567), we analyzed respondents' scores on the survey-adapted Montreal Cognitive Assessment (MoCA-SA). We estimated ordinal logit regressions to examine the relationship between sexual orientation and cognitive impairment and used the Karlson-Holm-Breen method to assess how mental and physical conditions, health behaviors, and social connections mediate this relationship. Results: The prevalence of cognitive impairment is significantly higher among sexual minority older adults than among heterosexual older adults when sociodemographic factors are adjusted for. Depressive symptoms explain some of this prevalence gap. Although anxiety symptoms, physical comorbidity, health behaviors, and social connections may contribute to cognitive impairment, they do not explain the cognitive disparity by sexual orientation. Discussion and implications: The findings indicate that depressive symptoms are an important link between minority sexual orientation and cognitive impairment and highlight the importance of studying other potential mechanisms that we could not explore in this study. Future research should further investigate how minority stress processes may unfold to accelerate cognitive decline among sexual minorities over the life course.


Social Relationships and Loneliness in Late Adulthood: Disparities by Sexual Orientation

April 2020

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206 Reads

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56 Citations

Journal of Marriage and Family

Objective This is the first national study to examine disparities in loneliness and social relationships by sexual orientation in late adulthood in the United States. Background Prior studies have shown that lesbian, gay, and bisexual (LGB) individuals often struggle with social relationships across the life course, likely because of stigma related to sexual orientation. However, little is known about whether loneliness is more prevalent among LGB people than among other groups in late adulthood, and if so, which relationships contribute to the loneliness gap. Method We analyzed data from a nationally representative sample of older adults from the 2015–2016 National Social Life, Health, and Aging Project (N = 3,567) to examine the disparity in loneliness by sexual orientation and identify links between this disparity and multiple dimensions of social relationships, including partner, family, friend, and community relationships. Results Older LGB adults were significantly lonelier than their heterosexual counterparts, primarily due to a lower likelihood of having a partner and, to a lesser extent, lower levels of family support and greater friend strain. While they were also disadvantaged in the size of close family and frequency of community participation, these factors were less relevant to their loneliness. Overall, the conventionally defined inner layers of relationships (partnership and family) contributed more to the loneliness disparity than the outer layers of relationships (friends and community). Conclusion These findings suggest that strengthening the partnerships and family relationships of sexual minorities is essential to reducing the loneliness gap.




Citations (26)


... Underlying causes of these disparities remain poorly understood but are likely due to multifactorial and multilevel factors that occur over the life-course. For example, differences in cognitive performance and dementia risk in AA may in part be caused by racial disparities in education (amount and quality) [52,53], availability of material and social resources [54], access to favorable food and physical activity environments [55], exposure to discrimination [56], and neurotoxicants [57,58]. A previous study in Atherosclerosis Risk in Communities (ARIC) found that reducing hypertension, obesity, and physical inactivity through targeted interventions could significantly lower dementia rates among Black individuals, particularly by addressing structural barriers to health [59]. ...

Reference:

Neighborhood environment associations with cognitive function and structural brain measures in older African Americans
Perceived discrimination and incident dementia among older adults in the U.S.: The buffering role of social relationships

The Journals of Gerontology Series B Psychological Sciences and Social Sciences

... Marriage is one of the social factors that has gained considerable attention across the disciplines in well-being studies. While some scholars value marriage as a means for happiness [1], others believe marriage undermines happiness and life satisfaction [2,3]. As sociologists acknowledge the significance of marriage, they are concerned about what undermines the happiness of couples in marriage. ...

Marital Status and Happiness During the COVID-19 Pandemic
  • Citing Article
  • November 2023

Journal of Marriage and Family

... Relative to heterosexual individuals, lesbian, gay, and bisexual individuals have poorer access to healthcare due in part to a lack of financial security and health coverage and in part to provider insensitivity, prejudice, or discrimination against nonnormative sexuality (Badgett et al., 2019;Hsieh & Shuster, 2021;Sabin et al., 2015). Moreover, although masculinity garners more economic privilege than femininity, it is associated with fewer health-promoting beliefs and behaviors such as healthcare utilization, which explains why men tend to underutilize health services (Courtenay, 2000;Hsieh, 2024;Springer & Mouzon, 2011). However, the intersection of racial/ethnic, sexual orientation, and gender inequalities in healthcare is often overlooked despite the fact that individuals experiencing two or more forms of inequality may face compounded barriers to care (Bowleg, 2012;Hsieh & Ruther, 2017;Tan et al., 2017). ...

Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States
  • Citing Article
  • September 2023

Journal of Health and Social Behavior

... Participant characteristics are reported in Table 1. The sample consisted of older adults, as diabetes prevalence increases in later life, with research considering those aged 50 and older as representing this period of the lifespan (Zhang et al., 2023). PWD were 66.36 years old, on average, reported an average of 1.36 chronic health conditions other than diabetes, and a majority were Non-Hispanic White (68.2%) and had a bachelor's degree or higher (52%). ...

Social relationships in later life: Does marital status matter?

... Several findings emerged from this investigation. First, consistent with prior research in the United States, [10][11][12][13][14] it was observed that bisexual men and women reported poorer selfrated mental and general health, lower life satisfaction, and higher depressive symptoms compared to their heterosexual counterparts. This supports the minority stress perspective, suggesting that due to their stigmatized sexual identity, sexual minority individuals experience more adverse health and wellbeing outcomes. ...

A National Study on Religiosity and Suicide Risk by Sexual Orientation
  • Citing Article
  • October 2022

American Journal of Preventive Medicine

... We used longitudinal dyadic data from the National Social Life, Health, and Aging Project (NSHAP; Waite et al., 2007. 1 The NSHAP is a restricted-publicly available dataset and is a nationally representative sample of community-dwelling US older adults ages 57 The current study relied on Rounds 2 and 3 of NSHAP (Wong & Hsieh, 2021). Round 2 was the first round in which all primary respondents and their current coresidential partner were also interviewed, thus allowing for a couple-level LCA analysis. ...

Couple Analysis in the National Social Life, Health, and Aging Project
  • Citing Article
  • December 2021

The Journals of Gerontology Series B Psychological Sciences and Social Sciences

... 12,13 However, there remains limited evidence in the differential physical health outcomes between these groups, largely due to the heterogenous methods employed between studies, and limited collection of data around sexual and gender minority identity within physical health studies. 3,5,[14][15][16][17] Intersectional minority identities can also compound poor outcomes; for instance, ethnic minority SGM groups report greater experiences of discrimination and harassment than white counterparts. 18,19 The United Kingdom's (UK) SM population is estimated to be at least 3.2% (1.5 million people), 20 and gender minority (GM) population at least 0.5% (262,000 people); 21 hence, the health inequities experienced by these groups represents a significant public health concern. ...

Health and Health Care of Sexual and Gender Minorities
  • Citing Article
  • September 2021

Journal of Health and Social Behavior

... In literature, a call for concordant care is not universally expressed. For instance, in research on the patient's perspective of diversity-sensitive care focussing on gender and sexual identity, patients' reports lack desire for concordance [78]. Some patients believe that the same level of understanding can be attained even without concordance, through principles such as equality and mutual respect [69]. ...

Disparities in Experience with Culturally Competent Care and Satisfaction with Care by Sexual Orientation
  • Citing Article
  • March 2021

LGBT Health

... Due to the unique circumstances of older childless women, they encounter distinct challenges in many aspects in their old age. Socially, according to studies, older adults without children have a limited social network compared to those with children [6,16]. The main areas of assistance that the family should provide are emotional support, instrumental help, and contact with health, welfare, and economic institutions. ...

Childlessness and Social Support in Old Age in China

Journal of Cross-Cultural Gerontology

... A key strategy to manage stress is via emotional support. For the LGBTQ+ population, it is important to account for sources of emotional support because individuals with sexual minoritized identities report higher levels of emotional support from friends and lower levels of family support (Gustafson et al. 2023;Hsieh and Wong 2020). We examine whether emotional support was especially important for individuals that do not identify as heterosexual during the pandemic, and we examine support from family, friends, and partners. ...

Social Networks in Later Life: Similarities and Differences between Sexual-Minority and Heterosexual Older Adults

Socius Sociological Research for a Dynamic World