Prior studies of the utilization of mental health professionals by sexual minority populations have relied on data that are now dated or not nationally representative. These studies have also provided mixed findings regarding gender differences in the utilization of mental health professionals among sexual minority individuals. Using data from the 2013-2015 National Health Interview Surveys, this study investigates (1) how sexual minority individuals compare to heterosexual participants in their utilization of mental health professionals; and (2) gender differences in that utilization. The results indicate sexual minority individuals utilize mental health care professionals at higher rates than heterosexual individuals even after controlling for measures of mental health and other demographic characteristics; this is true for both men and women. However, gender moderates the sexual minority effect on utilization rates. Sexual minority men utilize mental health professionals at a high rate, such that their utilization rates are similar to sexual minority women, contrary to the gender gap seen among heterosexuals.

We examined the relationship between race-specific rural mortality and the health infrastructure of rural counties in light of America’s recent emergence of a rural mortality penalty. Using the Compressed Mortality File from National Center for Health Statistics (2008–2012) and county-level demographic, socioeconomic, and health care indicators from the Area Health Resource File and the US Census, we created a rural public health infrastructure index which encompasses four types of health care access (public health employees, critical access hospital/rural referral centers, rural health clinics, and emergency departments) within counties. We found that each unit increase in the index is associated with a decline in rural Black mortality, but is associated with an increase in rural White mortality. Policymakers could benefit from focusing on the declining rate of mortality improvement in many rural regions, specifically by trying to better understand how decisions concerning public health spending may influence mortality differently for Black and White residents.

BACKGROUNDGeographic disparities in mortality have been analyzed by place in myriad ways. Although the people who live in a place continuously change, the health characteristics of those places tend to stay the same; they are persistent. Our work analyzes persistence of mortality across various geographic designations and uncovers the wide-ranging disparities in death across the United States. METHODSUsing 48 years of county-level mortality data, we analyze trends over time and disparities across places using rural-urban distinctions and census-based region and division classifications. Trends in death rates, excess deaths, and rates of mortality improvement are provided. RESULTSFindings support the hypothesis that persistently high mortality places are disproportionately concentrated in the rural South, particularly the East South Central division of Kentucky, Tennessee, Mississippi, and Alabama. The disparity between this division and urban America is wide and getting wider, and the disparity between this area of the South and the Midwest is alarming. CONTRIBUTIONOur research moves forward the literature on place-based mortality disparities in two important areas by testing the notion of persistence of poor health in place, and by identifying geographic disparities based on classifications not previously tested.

Research has shown that cross-sectional estimates of sexual identities overlook fluidity in those identities. Research has also shown that social factors, such as competing identities, can influence sexual identity fluidity. We contributed to this literature in two ways. First, we utilized a representative panel of US adults (N = 1034) surveyed in 2010, 2012, and 2014 by the General Social Survey. The addition of a third observation allowed us to examine more complexity in sexual identity fluidity. We found that 2.40% of US adults reported at least one change in sexual identity across the 4 years, with 1.59% reporting one change and 0.81% reporting two changes. Our second contribution came from examining the role of religion, as past research has suggested that religion can destabilize and prolong sexual identity development. We found that lesbian or gay individuals (N = 17), bisexuals (N = 15), and females (N = 585) showed more sexual identity fluidity compared to heterosexuals (N = 1003) and males (N = 450), respectively. Marital status, age, race, and education did not have significant associations with sexual identity fluidity. Regarding the role of religion, we found that participants identifying as more religious in Wave 1 showed more fluidity in sexual identity across later observations. Further analysis showed that higher levels of religiosity make it more likely that lesbian or gay individuals will be fluid in sexual identity, but this is not the case for heterosexual individuals. This finding reinforces past qualitative research that has suggested that religion can extend or complicate sexual minorities' identity development.

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