Racialized heteropatriarchy, sexual minority status, and cardiometabolic risk among Black and White young adult women

Increasingly, population health literature recognizes that structural racism and structural heteropatriarchy each pattern women's population health, and acknowledges their mutually constitutive nature, yet few studies explicitly integrate measures from each of these systems of oppression into one construct. I develop a composite measure of racialized heteropatriarchy, or the reinforcing systems of race-, gender-, and sexuality-based discrimination, using contextual indicators of reproductive care access, LGB civil rights policies, gendered racism, and family welfare policy. Using Waves I, III, and IV of Add Health (N = 4,633), I explore its relationship and cardiometabolic risk-an indicator of stress-related physiological dysregulation-among Non-Hispanic Black and Non-Hispanic White young adult females by race/ethnicity (a social construct that exists to justify racial stratification) and sexual minority status (self-identification as heterosexual vs. self-identification as non-heterosexual and/or attracted to females). Findings from race-stratified negative binomial regressions suggest that exposure to racialized heteropatriarchy is positively associated with cardiometabolic risk among Black heterosexual women (count ratio = 1.055, 95 % CI = [1.006, 1.106]), Black sexual minority women (1.059 [0.958, 1.170]), White sexual minority women (1.078 [1.000, 1.163]), and to lesser extent White heterosexual women (1.026 [0.987, 1.067]). This study enhances our understanding of women's population health by underscoring the joint roles of structural racism and structural heteropatriarchy in patterning the health of multiply-marginalized women, and adds further evidence that racial inequity in women's health cannot be eliminated without policies that address race-, gender- and sexuality-based discrimination.