Nondiscrimination Protections Research Articles

Understanding Labor Market Discrimination Against Transgender People: Evidence from a Double List Experiment and a Survey

Using a double list experiment designed to elicit views free from social desirability bias, we find that support in the United States for transgender people in the labor market is significantly overreported by 8%–10%. After correcting for this overreporting, we still find that over two-thirds of respondents would be comfortable with a transgender manager and support employment nondiscrimination protection for transgender people. However, respondents severely underestimate this level of support. We also show that stated labor market support for transgender people is lower than support for gay, lesbian, and bisexual people. Our results advance our understanding of employment discrimination against transgender people. This paper was accepted by Marie Claire Villeval, behavioral economics and decision analysis. Funding: Financial support from The Vanderbilt LGBTQ+ Policy Lab. is gratefully acknowledged. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2023.02567 .

Associations Between Structural Stigma and Allostatic Load Among Sexual Minorities: Results From a Population-Based Study.

Structural forms of stigma and discrimination are associated with adverse health outcomes across numerous stigmatized groups, including lesbian, gay, and bisexual (LGB) individuals. However, the biological consequences of structural stigma among LGB populations are understudied. To begin to address this gap, we assessed associations between indicators of structural stigma (i.e., state-level policies) targeting LGB individuals and allostatic load (AL) indices representing physiological dysregulations. Pooled data from the continuous 2001-2014 National Health and Nutritional Examination Survey were analyzed (LGB: n = 864; heterosexual: n = 20,310). Ten state-level LGB-related policies (e.g., employment nondiscrimination protections, same-sex marriage) were used to operationalize structural stigma. A sex-specific AL index representing 11 immune, metabolic, and cardiovascular biomarkers was estimated. Multilevel models were used to examine associations between structural stigma and AL, net of nine individual-level characteristics (e.g., education, race/ethnicity, age, and health behaviors). Sexual minority men living in states with low levels of structural stigma experienced significantly lower AL ( β = -0.45, p = .02) compared with sexual minority men living in states with high structural stigma (i.e., fewer protective policies). There was no significant association between structural stigma and AL among sexual minority women. By demonstrating direct associations between structural stigma and indices of physiological dysregulation, our findings provide a mechanistic understanding of how the social environment can "get under the skin and skull" for sexual minority men in the United States. Future research should explore whether these mechanisms generalize to other marginalized groups exposed to structural stigma.

Nondiscrimination Protections in Gender-affirming Surgery: US Government's Proposed Update to Section 1557 of the Affordable Care Act.

Nondiscrimination Protections in Gender-affirming Surgery: US Government's Proposed Update to Section 1557 of the Affordable Care Act.

The Influence of Anti-LGBTQIA+ Legislation on Graduate Medical Education

The Influence of Anti-LGBTQIA+ Legislation on Graduate Medical Education

Knowledge about Federal Employment Nondiscrimination Protections on the Basis of Sexual Orientation

Using a US nationally representative online sample, we measure the level of knowledge on employment nondiscrimination laws. Although Americans are well informed about sex, race, and disability being protected characteristics, only about 71 percent think that sexual orientation is a protected characteristic. Sexual minorities are as uninformed as heterosexual individuals that sexual orientation is legally protected from employment discrimination. Furthermore, sexual minorities living in states that did not previously have statewide employment nondiscrimination protections prior to the 2020 Supreme Court ruling in Bostock v. Clayton County are less likely to think that sexual orientation is a protected characteristic.

Down but not defeated: Clinicians can harness the power of policy for LGBTQ+ rights

The legal and medical rights of lesbian, gay, bisexual, transgender, queer (LGBTQ+) and other gender and sexual minority (GSM) youth are under attack in the United States. Approximately 160 anti-LGBTQ+ bills were proposed across the United States during the 2021 legislative session, with 70% of states considering at least one anti-LGBTQ+ bill. Over one hundred of the proposed bills specifically target transgender youth and have already resulted in the prohibition of nearly 85,000 13–17-year-old trans youth from participating in sports as their affirmed gender. Such legislation directly impacts the health of youth including in Arkansas and Tennessee which passed bills that limit youth access to evidenced-based, gender-affirming care; in February 2022, the governor of Texas directed state agencies to investigate gender-affirming care for trans youths as ‘child abuse’. Despite these anti-LGBTQ+ proposed and passed laws, 22 states have full non-discrimination protections for LQBTQ+ individuals, and 24 states have laws that protect LGBTQ+ students from bullying on the basis of their sexual orientation and/or gender identity. Civil rights policies have the power to grant protections to LGBTQ+ youth under the law. Conversely, the rollback of those liberties may lead to irreparable harm and preventable deaths. The consequences of anti-LGBTQ+ legislation can additionally deleteriously affect local and state economies as companies and organizations move to supportive communities. Clinicians can, and should, play an important role to engage stakeholders and advocate for LGBTQ+ inclusive policies at the institutional, local, state, and national policy level.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

Discounting Females, Denying Sex, and Disregarding Dangers from Self-ID—A Reply and a Defense of Open Debate

In this article, I reply to comments on my 2020 article “Scrutinizing the Equality Act,” where I express support for the aims of the US Equality Act—providing federal non-discrimination protections to LGBT+ individuals—but opposition to its form. As currently formulated, the US Equality Act would extend federal non-discrimination protections to LGBT+ individuals by redefining “sex” to “include sexual orientation and gender identity” and thereby eliminate sex-based provisions and the protected nature of women’s spaces. My article aimed to stimulate a more balanced discussion around gender self-identification policies that considers both females and transgender people. Here, I reply to published critiques with the goal of correcting misunderstandings and clarifying the complex, contested sociopolitical arguments presented in my article. Framing this issue within the broader creeping illiberal campaign of conformism and censorship in the academy, I, following others, emphasize the crucial role of open, critical dialogue in advancing science and promoting democracy. In that spirit, I echo calls for feminists and others to push back against censorship and engage with sensitive, controversial issues, including but not limited to deficiencies in the US Equality Act.

TAXPAYERS PERCEPTION ON THE IMPLEMENTATION OF INDONESIA TAX TREATIES

Tax treaties or P3B have been recognized for their important role to attract Foreign Direct Investment (FDI), giving legal certainty, providing tax relief, creating non-discrimination protection, and providing dispute mechanism in international tax. Nevertheless, the existing research that has been available so far yielded varied results with none of those examining the perspective of investors. This research aims to evaluate the state of the treaty as well as identify reasons to negotiate from the perspective of the investors. The data used are primary or first-hand data which is generated from the list of questions. This paper uses exploratory and explanatory methods to define the factors to renegotiate based on the survey and examine the effect of the variables determined from the survey results. The object of this research is the investors and potential investors that are represented by their tax consultant whose they possess the necessary knowledge to answer the questions. This study shows that their perception of tax treaties has a significant effect on their participation. However, a more thorough examination is necessary to explain how tax treaty policy should be formulated.

LGBTQ+ Structural Stigma and College Counseling Center Website Friendliness

We examined whether the “friendliness” of college counseling center websites to students with lesbian, gay, bisexual, transgender, and queer, plus other identities (LGBTQ+) varied by state‐level structural policies on hate crime, employment nondiscrimination, and religious exemption. Results from our analyses of variance showed that website friendliness was significantly higher in states that offered hate‐crime and employment nondiscrimination protections to LGBTQ+ individuals. Our findings highlight the need to intervene at multiple ecological levels to build inclusive college communities.

Privately Insured Transgender People Are At Elevated Risk For Chronic Conditions Compared With Cisgender Counterparts.

The burden of morbidity among privately insured transgender people is largely unknown. We identified transgender people enrolled in private insurance (using claims from 2001-19) and compared their rates of selected chronic conditions, using the Elixhauser Comorbidity Index, with claims for a matched cisgender cohort. We documented disparities between transgender and cisgender people across most conditions and found that transgender people were at elevated risk for nearly all chronic conditions compared with their cisgender counterparts. We also found that trans masculine and nonbinary people had the highest predicted average number of chronic conditions compared with all other gender groups. Our findings highlight key gender differences in morbidity between and within transgender and cisgender populations, and they underscore the importance of collecting gender identity information in national surveillance efforts to increase understanding of the health disparities among transgender and cisgender populations. In addition, these findings underscore the need for nondiscrimination protections for transgender people in the US.

Exploring the relationship between the alcohol policy environment and nondiscrimination laws: Implications for binge drinking disparities among LGB adults in the United States

BackgroundAlcohol policies reduce population-level binge drinking; however, they may not reduce binge drinking disparities between different populations. We examined the association between the alcohol policy environment and binge drinking among Lesbian, Gay and Bisexual (LGB) and heterosexual adults in the presence and absence of state laws protecting LGB people from discrimination. MethodsThe 2015–2018 Behavioral Risk Factor Surveillance System (BRFSS) provided information about individual-level binge drinking, sexual identity, and individual-level covariates. The Alcohol Policy Scale (APS) score measures the strength of the alcohol policy environment. Presence of state-level nondiscrimination protections based on sexual orientation came from the Movement Advancement Project. Logistic regression models were used to test whether nondiscrimination statutes modified the association between the alcohol policy environment and binge drinking and whether this interaction differed for LGB and heterosexual adults. ResultsAmong women, a 10 percentage-point increase in APS score was significantly associated with 7% lower odds of binge drinking in states with inclusive nondiscrimination laws (aOR: 0.93 [95% CI: 0.89–0.97; p = 0.0003]) but was not associated with binge drinking in states without inclusive laws (aOR: 0.98 [95% CI: 0.93–1.03] p = 0.4781). Moreover, binge drinking disparities comparing lesbian/bisexual women with heterosexual women were narrower in states with inclusive nondiscrimination laws. No significant association was found among men. ConclusionsBinge drinking disparities between lesbian and heterosexual women are negligible in states with inclusive laws and strong alcohol policy environments. Inclusive nondiscrimination laws are an indicator of less structural stigma directed at lesbian and bisexual women.

Health Disparities among Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults in Nashville, Tennessee.

Health disparities for lesbian, gay, bisexual, and transgender (LGBT) adults are well documented, but LGBT health data at the municipal and county levels are lacking, especially in the southern United States. The objective of this study was to compare access to care, health outcomes, and behavioral risk factors between LGBT and non-LGBT adults in Nashville and Davidson County, Tennessee. Data for this study came from a randomly selected, population-based sample of LGBT (n = 128) and non-LGBT (n = 1583) adults in Nashville. Multivariable logistic regression models were used to compare health outcomes between LGBT and non-LGBT Nashvillians while adjusting for demographic characteristics and socioeconomic status. LGBT Nashvillians were more likely to be uninsured (odds ratio [OR] 3.96, 95% confidence interval [CI] 1.72-9.10), report unmet medical care needs because of cost (OR 2.20, 95% CI 1.14-4.25), exhibit worse mental health outcomes (eg, frequent mental distress; OR 4.53, 95% CI 2.33-8.80), and report high-risk behaviors for human immunodeficiency virus (OR 9.47, 95% CI 3.96-22.62) compared with non-LGBT Nashvillians. To achieve health equity for LGBT individuals at the municipal level, Nashville and Tennessee should consider multifaceted approaches to expanding health insurance coverage and nondiscrimination protections and address mental health and human immunodeficiency virus risks among vulnerable populations.

A Comparative Overview of Disability-Related Employment Laws and Policies in 193 Countries

People with disabilities experience significantly worse employment outcomes than individuals without disabilities. In a study of 91 countries, employment-to-population ratios were significantly lower for people with disabilities. Moreover, studies find clear evidence of discrimination in wages, training, and promotions. The United Nations (UN) Convention on the Rights of People with Disabilities (CRPD) commits countries to enact legislation prohibiting discrimination and guaranteeing reasonable accommodation. However, there has yet to be a global systematic analysis of the extent to which countries are upholding their CRPD commitments. We built the first global database to document employment-related legislative provisions in all countries for persons with disabilities. We report on non-discrimination protections and reasonable accommodation across all 193 UN member states. We found progress and ongoing gaps. Sixty-two percent of countries broadly prohibit disability-based employment discrimination, but far fewer prohibit indirect discrimination (33%) and harassment (30%). Just over half (52%) of countries guarantee reasonable accommodation to workers with disabilities. Similarly, just over half of countries (53%) do not prohibit pay discrimination or discrimination in promotion/demotion. In conclusion, we discuss the need to address gaps in national legislation and to enhance efforts to implement and enforce existing legal rights.

A atuação da Corte Interamericana de Direitos Humanos no que tange a grupos em situação de vulnerabilidade: Análise da Opinião Consultiva 24/2017

O Sistema Interamericano de Proteção aos Direitos Humanos está inserido em um contexto de busca pela máxima proteção e garantia de direitos humanos. Assim, além de uma Constituição Federal que traz no seu bojo a vontade de concretizar direitos humanos e fundamentais, tem-se ainda um Sistema Global e um Sistema Regional de Proteção, o que evidencia a relevância e atualidade do tema. Partindo-se dessa premissa, trabalha-se neste artigo com os conteúdos que abarcam o direito à não-discriminação e à igual proteção perante a lei, especialmente a partir da lógica da função consultiva exercida pela Corte Interamericana de Direitos Humanos. Nesse sentido, tem-se como problema o seguinte questionamento: qual o posicionamento adotado na Opinião Consultiva 24/2017 pela Corte Interamericana de Direitos Humanos, no que tange aos direitos da comunidade LGBT, enquanto grupo em situação de vulnerabilidade? Para tanto, utiliza-se o método de abordagem dedutivo, e objetiva-se, num primeiro momento, abordar a lógica de atuação da Corte Interamericana de Direitos Humanos, com foco na sua função consultiva; verificar os principais aspectos no que tange à proteção dos grupos em situação de vulnerabilidade sob a ótica da Convenção Americana; e, por fim, analisar criticamente a Opinião Consultiva 24/2017, emitida pela Corte, que versa sobre a proteção que deve ser conferida pelos Estados à comunidade LGBT. Conclui-se, ao final, que a Corte compreende que os Estados devem adotar medidas de proteção a esse grupo, evitando qualquer tipo de discriminação e erradicando, ou ao menos reduzindo, as violências que decorrem da identidade de gênero e sexual.

State-Level Transgender-Specific Policies, Race/Ethnicity, and Use of Medical Gender Affirmation Services among Transgender and Other Gender-Diverse People in the United States.

In the 2010s, the number of federal, state, and local transgender-specific policies increased. Some of these policies advanced protections for transgender and other gender-diverse (TGGD) people, and others were restrictive. Little is known about the relationships between these policies and use of medical gender affirmation services (eg, hormone treatment, therapy/counseling), or about how these associations may vary among different racial and ethnic groups. Multilevel modeling was used to examine the associations between state-level transgender-specific policies and the use of medical gender affirmation services among TGGD people in the United States. Data are from the 2015 U.S. Trans Survey of nearly 28,000 TGGD people. The medical gender affirmation services examined in this study were hormone treatment and therapy/counseling. The state policies we analyzed addressed discrimination, health insurance coverage, and changing legal documents; these policies were measured individually and as a composite index. Race/ethnicity was included in the multilevel regression models as a random slope to determine whether the relationship between race/ethnicity and the use of medical gender affirmation services varied by state. Individual policies and the policy index were associated with both outcomes (use of therapy/counseling and hormone treatment services), indicating that protective policies were associated with increased care. Broad religious exemption laws and Medicaid policies that excluded transgender-specific care were both associated with less use of therapy/counseling, whereas transgender-care-inclusive Medicaid policies were associated with more use of therapy/counseling. Nondiscrimination protections that include gender identity were associated with increased use of hormone treatment services. The relationship between race/ethnicity and medical gender affirmation services varied across states. State-level transgender-specific policies influence medical gender affirmation service use and seem to affect use by non-Hispanic white TGGD people and TGGD people of color differently. Advocacy is needed to repeal restrictive policies and promote protective policies in order to reduce health inequities among TGGD people, especially people of color.

Scrutinizing the U.S. Equality Act 2019: A Feminist Examination of Definitional Changes and Sociolegal Ramifications

The U.S. Equality Act, which amends civil rights statutes to explicitly prohibit discrimination on the basis of sexual orientation and gender identity, passed the House in May 2019 with unanimous Democratic support. Adopting a feminist perspective, I scrutinize the act from a largely neglected position, one that supports both LGBTQ and sex-based rights. Although laudable in its aims, the Equality Act is objectionable in form. The Act extends non-discrimination protections to LGBTQ individuals not by creating new protected classes but by redefining sex to include gender identity and sexual orientation, which is not only terminologically imprecise but also creates a clash between sex-based and gender identity-based rights. By defining gender identity as something that exists to be protected “regardless of sex,” the act undermines sex-based provisions, replacing them with provisions based on gender self-identification. Recognizing confusion over terminology, I describe key terms (sex, gender, gender identity, and sexual orientation) and consider various usages. I conclude by discussing ways the bill might be modified so as to protect LGBTQ people without undermining women’s (sex-based) rights.

The LGBT Equality Gap and Federalism

LGBT people in the United States live with an Equality Gap that seems to grow wider with each legislative session. The majority of states do not have non-discrimination protections in place for LGBT people. In the absence of blanket federal non-discrimination protections, a same-sex couple can be denied service by bakers, catering halls, and photographers while trying to exercise their constitutionally protected right to marry. A transgender person can be denied access to a public bathroom that matches their gender identity. A federally funded adoption agency can refuse to work with LGBT persons who wish to adopt. In addition, many states have enacted explicitly anti-LGBT measures and prohibitions that exacerbate the Equality Gap and further underscore regional disparities. Even states with non-discrimination protections for LGBT people have considered expanding religious exemptions in a way that could greatly undercut the effectiveness and scope of existing non-discrimination protections. As a result of this mismatch of laws, the lived experience of LGBT people varies wildly depending on where they reside. For example, LGBT people living in New York enjoy many more protections and suffer none of the disabilities that are imposed on LGBT people living in Mississippi. The regional disparities are so extreme that some countries have issued travel advisories for their citizens visiting certain parts of the United States. This article examines the role federalism has played in the trajectory of LGBT rights and the creation of the Equality Gap. The first section of this article explores federalism as an institutional choice that strikes a balance between state and national power. The second section reviews the instrumental use of federalism by LGBT advocates to advance the legal strategy that ultimately led to nationwide marriage equality. It also provides an overview of corresponding and complementary visions of federalism expressed in both Windsor and Obergefell. The last section reviews the current Equality Gap and the most recent anti-LGBT initiatives that are being considered on the state and local levels in light of Bostock v. Clayton County, the 2020 US Supreme County case that extended Title VII non-discrimination protections to sexual orientation and gender identity. A brief conclusion closes with the observation that federalism has proven to be a pragmatic, but also imperfect, institutional choice for LGBT rights advocates because state level civil rights protections are, by their nature, partial, not portable, and especially vulnerable to majoritarian bias. This observation has particular salience for both our understanding of federalism and the future of LGBT advocacy.

Perceptions of Protection under Nondiscrimination Law

Nondiscrimination rules-statutes, regulations, and soft law protections-are critical for reducing health and health care disparities. Although scholarship has interrogated how nondiscrimination rules affect behavior by discriminators, comparatively little has considered how protections can affect choices made by members of protected groups. A number of states and some interpretations of federal law protect people from discrimination on the basis of sexual orientation. This Article seeks to identify relationships between actual state law, perceived state law, and experiences of discrimination and medical mistrust. This Article reports the results of a national cross-sectional survey of over 3,000 men using Grindr to meet male partners. Participants scored comparable to chance in knowledge about state nondiscrimination protections, with "optimistic errors" (erroneous beliefs that one was protected) significantly more common than pessimistic errors. Perceptions of protection were significantly correlated with lower medical mistrust and greater uptake of care, as well as lower perceived barriers to disclosure and care-seeking. Actual state law protections, however, were significant predictors of having had discussions with providers that depended on disclosure of sexual behavior or orientation. Building on these results, this Article considers pathways by which nondiscrimination law may exert welcome mat (and "unwelcome mat") effects.

Chris Vargas's Consciousness Razing

Abstract Chris Vargas's exhibition Consciousness Razing: The Stonewall Re-Memorialization Project commemorates the fiftieth anniversary of the Stonewall rebellion by smashing pervasive mythologies that erase transgender people from most retellings of the uprising and showcasing multiple artists' proposals for monuments that at least address if not remedy this absence. Stories of gay and lesbian civil rights victories that came out of Stonewall—like the dissolution of sodomy laws, the creation of employment nondiscrimination protections, and gay marriage—all tend to trace back to the rebellion, while the critical role that transgender women, many of color, played in these advances has slipped deep into unseen corners of historical memory. This forgetting is both a symptom and cause of the continued erasure of transgender people, especially transgender women of color, from contemporary LGBT activism, community, and discourse. As a gesture of amelioration, this monument implores us to reconstruct memories of Stonewall as a way of not merely supporting celebrating contemporary trans existence but ultimately shaping trans futurity.