Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Kathrin Boerner

Second Advisor

Kyungmin Kim

Third Advisor

Ilan Meyer


Aging lesbian, gay, bisexual, and transgender (LGBT) middle-aged and older adults are a health disparate population with unique healthcare challenges. Using data from the Aging with Pride: National Health, Aging, Sexuality/Gender Study (NHAS; N = 2,560), the objective was to examine contextual factors that influence the healthcare utilization of LGBT middle-aged and older adults. One-way analysis of variance (ANOVA) and ordinary least squares (OLS) regressions were used to examine access to social resources according to LGBT identity (main effects) and additional sociodemographic variations (interaction effects). Findings suggested that lesbian and transgender respondents had larger social networks than gay respondents. Gay respondents had less social support than lesbians and both groups had more than transgender respondents. Lesbians had more community belonging than all other groups. Education and age moderated the association between LGBT identity and social support. College-level education had a buffering effect on social support among bisexual females, but a negative effect among gay respondents. Older age had a buffering effect on social support among bisexual female and transgender respondents. Multiple logistic regression was used to assess the main effects of disclosure and internalized stigma on healthcare utilization and the interaction effects between disclosure and internalized stigma and social resources on healthcare utilization. Findings indicated associations between disclosure and health screenings, and having a regular provider, and an association between internalized stigma and routine checkups. Higher levels of social support and disclosure in tandem, increased the likelihood of health screenings.

Causal indirect, direct, and total causal effects based on counterfactuals were computed to assess mediational links between discrimination/victimization and healthcare utilization via healthcare barriers. Discrimination/victimization had an indirect effect on health screenings via fear accessing health services both inside and outside of the LGBT community, financial barriers to care or medication, and being uninsured. Discrimination/victimization also had an effect on routine checkups and having a regular provider, via fear seeking health services outside of the LGBT community, financial barriers and being uninsured. Findings from this dissertation can be utilized in LGBT cultural competency trainings for health and human service providers serving aging LGBT people.


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