title: Sexual Minority Women's Satisfaction with Health Care Providers and State-level Structural Support: Investigating the Impact of Lesbian, Gay, Bisexual, and Transgender Nondiscrimination Legislation.
abstract: Structural discrimination is associated with negative health outcomes among sexual minority populations. Recent changes to state-level and national legislation provide both the opportunity and the need to further explore the impact of legislation on the health indicators of sexual minorities. Using an ecosocial theory lens, the present research addresses the relationship between structural support or discrimination and satisfaction with one's health care provider among sexual minority women.
  
  
  
  Data were drawn from an online survey of sexual minority women's health care experiences. Using the Andersen Behavioral Model of Health Services Utilization to operationalize the variables in our model, we examined the relationship between state-level nondiscrimination legislation and satisfaction with provider-a widely used measure of health care quality-through regression analysis.
  
  
  
  Participants in structurally supportive states (i.e., those with nondiscrimination legislation) were more likely to disclose their sexual identity to their providers and to report higher satisfaction with their providers. The absence of nondiscrimination legislation was associated negatively with satisfaction with providers.
  
  
  
  Results of our study show that the external environment in which sexual minority women seek health care, characterized by structural support or lack thereof, is related to perceived quality of health care.
authors.affiliation: Department of Kinesiology, California State University, Stanislaus, Turlock, California. Electronic address: abaldwin1@csustan.edu.
authors.forename: Aleta M
authors.initials: AM
authors.lastname: Baldwin
authors.affiliation: Department of Applied Health Science, Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana.
authors.forename: Brian
authors.initials: B
authors.lastname: Dodge
authors.affiliation: Department of Management, Policy & Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Schick
authors.affiliation: The Kinsey Institute for Research in Sex, Gender & Reproduction, Indiana University, Bloomington, Indiana.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Sanders
authors.affiliation: Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: J Dennis
authors.initials: JD
authors.lastname: Fortenberry
mesh_terms: D000328:Adult; D001727:Bisexuality / Q000523:psychology*; D003695:Delivery of Health Care / Q000331:legislation & jurisprudence*; D004192:Discrimination, Psychological; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D054625:Healthcare Disparities / Q000331:legislation & jurisprudence*; D018452:Homosexuality, Female / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D010549:Personal Satisfaction; D063508:Social Discrimination; D063106:Transgender Persons; D014189:Transsexualism / Q000523:psychology*; D055815:Young Adult; D008297:Male