Original Research ARTICLE
Challenges to Identity Integration Indirectly Link Experiences of Heterosexist and Racist Discrimination to Lower Waking Salivary Cortisol in Sexually Diverse Latinx Emerging Adults
- 1Department of Human Ecology, University of California, Davis, Davis, CA, United States
- 2Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- 3Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
- 4Department of Psychology, University of California, Davis, Davis, CA, United States
Heterosexist and racist discrimination may adversely impact neurobiological processes implicated in the physical and psychosocial well-being of sexually diverse Latinx people. Yet, little is known about how experiences of both heterosexist and racist discrimination are associated with adrenocortical and psychological functioning in groups of people with multiply marginalized social group identities. Through the application of the intersectionality, minority stress, and allostatic load frameworks, it was hypothesized that experiences of heterosexist and racist discrimination would be associated with disruptions to diurnal salivary cortisol patterns and challenges to identity integration. A group of sexually diverse (self-identified lesbian, gay, bisexual, and queer) Latinx emerging adults (N = 51; ages 18–29, M = 24.06 years; SD = 2.73) provided saliva samples and completed a series of questionnaires during a four-day testing protocol. Heterosexist and racist discrimination were both positively associated with challenges to identity integration. Challenges to identity integration, in turn, were associated with lower intercepts of diurnal cortisol slopes, and heterosexist and racist discrimination were indirectly associated with lower cortisol intercepts via challenges to identity integration. These findings suggest that experiences of heterosexist and racist discrimination may interconnect by challenging sexual and ethnic/racial identity integration and disrupting adaptive adrenocortical regulation among sexually diverse Latinx emerging adults.
Sexually diverse (i.e., people who self-identify as lesbian, gay, bisexual, pansexual, or queer) Latinx people experience heterosexist and racist discrimination which negatively impacts their well-being (Rhodes et al., 2020). Social environments that are not accepting or embracing of sexual and ethnic/racial diversity are pervasive stressors which may compromise multiply marginalized people’s ability to physiologically and psychosocially adjust healthfully (Parra and Hastings, 2018). The effects of pervasive social stressors are particularly concerning during emerging adulthood because this developmental period is characterized by uncertainty, heightened self-awareness (Arnett, 2000, 2001, 2004, 2006), sexual identity exploration and formation (Patterson, 2008; Morgan, 2013), and ethnic/racial identity exploration and formation (Erikson, 1968; Phinney, 2006; Kroger et al., 2010). Although most individuals navigate this developmental period successfully (Arnett, 2007), emerging adulthood also is a period of escalating mental health challenges (de Girolamo et al., 2012), particularly for vulnerable and marginalized groups of people. The role of stress physiology in the links between discrimination and identity formation during emerging adulthood for sexually diverse people of color has received little empirical attention (Parra and Hastings, 2018).
In stress frameworks applied to marginalized people, experiences of heterosexist (Meyer, 2003) and racist (Myers, 2009) discrimination constitute sources of social stress. Less adaptive adrenocortical functioning is associated with heterosexist discrimination experienced by sexually diverse people (Lick et al., 2013; Parra et al., 2016) and with racist discrimination experienced by ethnically/racially diverse people (Busse et al., 2017); both may contribute to diminished physical and mental health (McEwen, 1998; McEwen and Seeman, 1999). Heterosexist and racist discrimination also have been linked to challenges with identity integration in sexually and ethnically/racially diverse groups of people (Patterson, 2008; Umaña-Taylor et al., 2015, respectively). Sexually diverse Latinx people who have experienced both heterosexist and racist discrimination report a need to keep their sexual and ethnic/racial identities separate (Morales, 1989; Shramko et al., 2018), and this barrier to identity integration is a form of social stress associated with poor psychosocial adjustment (Sarno et al., 2015; Santos and VanDaalen, 2016; Shramko et al., 2018).
Most studies on adrenocortical functioning and identity integration in sexually and ethnically/racially diverse people have focused on single social categorical identities. These approaches rarely account for how systems and processes of racism and heterosexism are interconnected through an intersectionality framework to affect the lives of multiply marginalized people at their social locations (Crenshaw, 1989; Collins, 2015). Thus, it remains unclear how sexually diverse Latinx people internalize institutional and societal stressors and how these sources of stress may intersect and affect their physical and psychosocial adjustment. This lack of informed perspective underscores the important need for studies that examine the complexity of within-group heterogeneity of identities and experiences, using a critical application of an intersectionality lens in quantitative research (McCall, 2005; Cole, 2009; DeBlaere et al., 2010; Parent et al., 2013; Else-Quest and Hyde, 2016a, b). The overarching goal of this study was to assess associations among heterosexist and racist discrimination, adrenocortical functioning via diurnal patterns of salivary cortisol, and identity integration in a group of sexually diverse Latinx emerging adults through the integration of intersectionality, minority stress, and allostatic load frameworks.
Heterosexism and Racism in Sexually and Ethnically/Racially Diverse Groups of People
Models of minority stress (e.g., Meyer, 1995, 2003) applied to sexually diverse groups of people suggest that heterosexism, a systemic form of oppression often expressed through acts of discrimination, constitutes a source of severe and pervasive social stress. Heterosexism is an ideology perpetuating the notion that being sexually attracted exclusively to people of the opposite biological sex assigned at birth, within a female/male binary, is superior to being sexually attracted to members of the same biological sex assigned at birth (Herek, 1996). Pervasive heterosexist discrimination has been associated with disruptions to diurnal adrenocortical activity (Parra et al., 2016). In the allostatic load (AL) framework (McEwen, 1998; McEwen and Seeman, 1999), pervasive social stressors can repeatedly evoke and tax neurobiological stress responses and thereby confer risk for poor health. Moreover, heterosexist discrimination also is associated with poor psychosocial adjustment, such as challenges to sexual identity integration (Patterson, 2008; Morgan, 2013). Sexual identity integration is a dynamic process of empowerment through the adoption of positive attitudes and beliefs about one’s marginalized sexual identities and the disclosure of one’s sexual identities to others (i.e., outness; Rosario et al., 2001). Challenges to sexual identity integration are associated with negative self-perceptions such as internalized homonegativity (faulting oneself for being non-heterosexual) (Igartua et al., 2003; Herek and Garnets, 2007; Herek et al., 2009).
Models of minority stress applied to ethnically/racially diverse groups of people (Myers, 2009) also posit that racism is a systemic form of oppression that can be enacted through discrimination and constitutes a severe and pervasive form of social stress (Paradies et al., 2015). Racism refers to beliefs and actions that evaluate a person’s non-majority cultural heritage or a person’s non-majority external social classification based on phenotype, language, or membership in an ethnic/racial group as inferior to, or less than, that of a majority group member (Jones, 2001). Pervasive racist discrimination has been associated with challenges to ethnic/racial identity integration (Pahl and Way, 2006; Umaña-Taylor et al., 2015) and with alterations to typical daily patterns of salivary cortisol (Busse et al., 2017). Ethnic/racial identity integration refers to an ethnically/racially diverse person’s sense of belonging to their cultural heritage (Phinney and Ong, 2007; Quintana, 2007) and ethnic/racial group (Umaña-Taylor, 2004). Both challenges to ethnic/racial identity integration (Umaña-Taylor et al., 2015) and dysregulated daily patterns of salivary cortisol production (Busse et al., 2017) in the context of racism are associated with health disparities in groups of Latinx people.
Models of minority stress applied to the study of sexual and ethnic/racial group membership often examine people who identify with these social groups as if their memberships are based on discrete and separable marginalized social categorical identities (Parra and Hastings, 2018). For example, a queer Latinx person typically would be examined as queer or Latinx, in the context of heterosexism or racism, respectively, but not at their different locations of an intersection (e.g., queer Latinx in the context of interacting systems of oppression). Systems and institutions, including science, often use these single categorical identity-focused approaches, which render invisible the comprehensive lived experiences of people who belong to multiply marginalized social groups affected by multiple systems and forms of oppression (Crenshaw, 1989).
Scientists have called for a broader intersectional perspective to accommodate quantitative methods across scientific disciplines (McCall, 2005; Bowleg, 2008; Cole, 2009; Else-Quest and Hyde, 2016a, b) and have emphasized a critical distinction between additive and multiplicative approaches and effects (see Else-Quest and Hyde, 2016a, b for full review). Additive and multiplicative approaches assume that multiply marginalized people’s experiences of various forms of oppression can be captured by treating each marginalized social categorical identity and/or experience independently (single-axis; e.g., being queer or Latinx), additively (e.g., being queer and Latinx), or multiplicatively (e.g., being queer x Latinx). These approaches have been called “antithetical to intersectionality” (Else-Quest and Hyde, 2016a, p.162; also see McCall, 2005; Collins, 2015) because they assume that each social categorical identity is discrete and independent of social structures that perpetuate power and privilege. Yet, additive and multiplicative effects (as statistical main and interaction effects, respectively) are inherent to quantitative analyses (Bowleg, 2008; Else-Quest and Hyde, 2016a, b). Additive and multiplicative effects are presumed to measure the unique and complex contributions of specific and intertwined marginalized social categories to help explain social inequalities and inequities, within nested systems of power and privilege, at varying social locations (e.g., health disparities specific to queer Latinx people) (McCall, 2005; Bowleg, 2008; Else-Quest and Hyde, 2016a, b). Additive and multiplicative statistical effects are considered viable when integrating an intersectionality lens with quantitative methods because they may effectively measure how two or more systems of oppression intersect and structurally, institutionally, and interpersonally disempower and confer risk to multiply marginalized people (Bowleg, 2008; Cole, 2009).
Discrimination and Identity in Sexually Diverse Latinx Emerging Adults
Identity integration is an essential task during emerging adulthood that is critical for psychosocial adjustment (Erikson, 1968; Marcia, 1987; Arnett, 2000, 2001, 2004, 2006). Sexual identity integration (Rosario et al., 2001) and ethnic/racial identity integration (Phinney, 2003, 2006; Sellers et al., 2003) promote well-being and protect against discrimination. Navigating multiply marginalized social group categorical identities is considered an exploratory and challenging process of identity integration for many people and may be particularly complex and stressful for sexually diverse people of color (Morales, 1989; Espín, 1993). Sexual and ethnic/racial identity integration for sexually diverse people of color may encompass consolidating opposing cultural beliefs and expectations as well as managing the effects from experiences of heterosexist discrimination within their majority-heterosexual ethnically/racially diverse communities and racist discrimination within the mainstream majority-White sexually diverse community (Morales, 1989; Espín, 1993; Meyer, 2010; Balsam et al., 2011; Morales, 2013). Difficulties with or challenges to multiple identity integration may be a mechanism by which heterosexist and racist discrimination marginalize sexually diverse Latinx people to affect their adrenocortical stress responses. Processes specific to multiple identity exploration and formation are particularly salient during emerging adulthood (Arnett, 2004) and integrating multiple marginalized social group memberships in heteronormative and racist social contexts can be an ongoing challenging process (Morales, 1989; Espín, 1993) which has been implicated with health inequities (e.g., Shramko et al., 2018). Thus, emerging adulthood may be marked by particular stressors for sexually diverse Latinx individuals that disrupts integration of their multiple marginalized identities.
Although the minority stress model predominantly focuses on single categorical social identities specific to sexual diversity (e.g., lesbian, gay, bisexual; Meyer, 2003), it also acknowledges that sexually diverse people of color may further experience unique stressors associated with their ethnicity/race (i.e., sexually diverse people of color experience both heterosexism and racism; Meyer, 2010). Sexually diverse Latinx people experience heterosexist discrimination based on their sexual orientation within Latinx communities (Espín, 1993; Díaz et al., 2001, 2006; Ryan et al., 2009) and racist discrimination based on their ethnicity/race within majority-White sexually diverse communities (Morales, 1989; Balsam et al., 2011). Sexually diverse Latinx emerging adults who face discrimination based on their marginalized sexual and ethnic/racial identities report feeling less supported by others, have lower self-esteem, have more depression and anxiety symptoms, and are at elevated risk for suicide (see Rhodes et al., 2020 for full review). The intersectionality framework provides a comprehensive lens by which to examine the lived experiences of multiply marginalized people (Crenshaw, 1989). Thus, the integration of an intersectionality framework and the minority stress model can bring visibility to and a richer contextualization of how heterosexism intersects with racism to disadvantage sexually diverse Latinx people (Parra and Hastings, 2018).
Adrenocortical Markers of Stress Regulation in Response to Heterosexist and Racist Discrimination
Adrenocortical functioning may be adversely affected by heterosexist and racist discrimination that is targeted toward sexually diverse Latinx people. The allostatic load (AL) framework suggests that chronic or extreme stressors undermine the neurobiological systems that support individual and social adaptation through flexible allocation of physiological resources (allostasis; McEwen, 1998; Goldstein and McEwen, 2002), leading to AL (McEwen and Stellar, 1993). The hypothalamic-pituitary-adrenal (HPA) axis is one of the body’s primary stress response and regulation systems (Gunnar and Adam, 2012) and often is used as a marker of AL (Hastings et al., 2011). The HPA axis is active throughout the circadian cycle; the normative diurnal pattern of cortisol production is established early in life and is characterized by high cortisol concentrations at waking, followed by a brief increase in HPA activity for approximately 30–45 min, then decreasing cortisol levels throughout the day to their lowest levels in the evening (Gunnar and Adam, 2012). This diurnal pattern is typically quantified across multiple saliva samples collected over one or more days to derive a salivary cortisol intercept (baseline waking cortisol) and slope (changes in cortisol from waking to evening) (Hruschka et al., 2005).
High waking cortisol levels, or higher cortisol intercepts, have been associated with more life satisfaction and self-acceptance, and with less anxious arousal, anticipatory stress, and depression (Vargas and Lopez-Duran, 2014; Rector et al., 2019). Exposure to pervasive stress has been associated with lower cortisol intercepts (Adam and Kumari, 2009). Steeper or more negative diurnal cortisol slopes are considered normative, allowing the body to readily allocate resources for self-regulation (Gunnar and Adam, 2012). Flatter or less negative diurnal slopes, which are associated with chronic or pervasive exposure to stressors, also have been implicated with poorer health and psychosocial adjustment (Juster et al., 2010; Guerry and Hastings, 2011; Lick et al., 2013). Whether a flatter slope reflects hypercortisolism (elevated HPA activity producing maladaptively high circulating cortisol) or hypocortisolism (diminished HPA activity producing maladaptively low circulating cortisol) depends in part on whether the cortisol intercept is higher or lower, respectively.
Pervasive and severe social stressors have been associated with both HPA axis hyperactivity (Busse et al., 2017) and HPA axis hypoactivity (Adam, 2012). Experiences of heterosexist discrimination have been associated with higher and flatter diurnal cortisol slopes, with flatter diurnal slopes mediating the link between heterosexist discrimination and depressive symptoms in a group of LGB emerging adults (Parra et al., 2016). Conversely, the association between discrimination and lower cortisol intercepts (waking cortisol) has been documented in studies of ethnically/racially diverse groups of people. In a study of ethnically and racially diverse late adolescents, which included Latinx people, experiences of racist discrimination were associated with lower waking cortisol and flatter salivary cortisol slopes (Huynh et al., 2016). Discrimination and flattened diurnal cortisol slopes also were associated in a sample that included Latinx emerging adults (Zeiders et al., 2014). These studies of discrimination and diurnal cortisol patterns suggest that experiences of ethnic/racial and heterosexist discrimination during emerging adulthood may be associated with either atypically elevated or diminished adrenocortical activity, as evidenced by either high or low cortisol intercepts paired with flattened diurnal slopes.
In our review of the literature, there is only one published study on diurnal adrenocortical functioning at the intersection of sexual orientation and racial identities. Cook et al. (2017) reported that Black bisexual and gay men had flatter diurnal cortisol output, reflecting less decline (i.e., shallower diurnal slope) and higher evening cortisol levels when compared to White bisexual and gay men. Our current study builds on Cook et al. (2017) by assessing actual measurement of heterosexist and racist discrimination instead of only using marginalized social categorical identities. Although it has been important and informative for researchers to apply psychosocial and neurobiological methods to studies with multiply marginalized populations, intersectionality scholars have critiqued the use of social categorical identifiers as proxies for experiences of oppression without assessing actual experiences (e.g., Bowleg, 2008; Cole, 2009; Parent et al., 2013). A comparative or between-group approach that does not consider within-group heterogeneity presumes similar or identical life experiences for all individuals who share those social group memberships and social locations, which may limit our understanding of how complex and multi-faceted contexts of discrimination are linked with physiology (Parra and Hastings, 2018).
The Impacts of Heterosexist and Racist Discrimination on Sexual and Ethnic/Racial Identity Integration in Sexually Diverse Latinx Emerging Adults
The integration of sexual orientation and ethnic/racial identities is a process unique to sexually diverse people of color, involving the experience and resolution of tensions between their marginalized sexual and ethnic/racial identities, which Morales (1989) referred to as conflicts in allegiances (CIA). Morales argued that sexually diverse people of color’s awareness of their social belonging to both a marginalized sexually diverse group and a marginalized ethnically/racially diverse group was associated with a need for these identities to remain separate. Both heterosexist and racist discrimination have been shown to engender challenges to identity integration as measured through CIA (Morales, 1989; Sarno et al., 2015; Santos and VanDaalen, 2016). Sexually diverse people of color with strong ethnic/racial group orientation report more group identity conflict and less engagement in sexually diverse communities (Sarno et al., 2015) and high group identity conflict has been associated with poor psychosocial adjustment (Santos and VanDaalen, 2016). Shramko et al. (2018) showed that sexually diverse Latinx emerging adults who reported more heterosexist and racist discrimination struggled with integrating their sexual and ethnic/racial identities when compared to sexually diverse Latinx emerging adults who reported less heterosexist and racist discrimination. Thus, assessing challenges to integration of sexual and ethnic/racial identities using an inherently intersectional approach may reveal how heterosexist and racist discrimination concurrently shape the adrenocortical and psychosocial adjustment of sexually diverse Latinx emerging adults.
In the current study, we tested the associations between single-axis measures assessing heterosexist and racist discrimination, an inherently intersectional measure of challenges to identity integration, and diurnal salivary cortisol intercepts and slopes in a sample of sexually diverse Latinx emerging adults. We hypothesized that more experiences of heterosexist and racist discrimination (additive effects), including the statistical interaction between the two (i.e., heterosexist X racist discrimination; multiplicative effects) would be associated with (1) lower salivary cortisol intercepts and/or flatter slopes and (2) more challenges to identity integration. These first two hypotheses were important to establish whether single-axis measures of discrimination, as additive and multiplicative effects, were associated with identity integration and adrenocortical functioning of sexually diverse Latinx people. Further, we hypothesized that more challenges to identity integration (3) would be associated with lower cortisol intercepts and/or with flatter cortisol slopes and (4) would function as a mechanism accounting for the associations of heterosexist and racist discrimination with cortisol intercepts and slopes.
Materials and Methods
Two hundred and two emerging adults (N = 202) (n = 101 sex-assigned female at birth) between the ages of 18–29 (M = 23.13 years, SD = 2.59) and self-identifying as sexually diverse Latinx (n = 51), sexually diverse White (n = 51), straight Latinx (n = 49) or straight White (n = 51) were recruited in Northern California through free and paid advertisements on social media, including flyers distributed at information booths during Pride events. To test the specific hypotheses of the current study, only the sexually diverse Latinx group (N = 51; n = 27 sex-assigned female at birth; M = 24.06 years; SD = 2.73) were included. Sexually diverse Latinx participants self-identified as bisexual/pansexual (33.3%) (n = 17), gay (35.3%) (n = 18), lesbian (5.9%) (n = 3), and queer (25.5%) (n = 13); and as monoethnic/racial Latinx (82.4%) (n = 44) and biracial Latinx-White1 (17.6%) (n = 9). Participants reported their gender as cisgender female (43.1%) (n = 22), cisgender male (45.1%) (n = 23), transgender female-to-male (5.9%) (n = 3), and as genderqueer or non-binary (5.9%) (n = 3). The sample consisted of employed (57%) and unemployed (6%) community members, college students (27%), and people who reported being both employed and a college student (10%). Education levels included having a college degree attained (45%) or in progress (45%), vocational training certificate attained (4%), and high school completed (6%). Most of the sample reported an annual income less than $20k (57%), with the balance reporting $20 to $30k (8%), $30 to $40k (22%), and more than $40k (13%).
Participants completed a 4-day testing protocol after being phone screened for eligibility based on the following criteria: self-identification as lesbian, gay, bisexual, queer, or straight; monoethnic/racial Latinx, monoethnic/racial White, or biracial Latinx-White; fluent in English; and between the ages of 18–29 years. Participants who reported taking antidepressants known to normalize salivary cortisol levels were invited to participate because one of the overarching goals of the larger study focused on mental health, and including participants using antidepressants would make these analyses more generalizable (see Deuschle et al., 2003, for a review). Participants who reported the use of hormones (e.g., birth control, estradiol, and testosterone), glucocorticoids2, and other medications also were enrolled in the study. The use of these medications was tested for their associations with raw salivary cortisol concentrations prior to log transformations and computing intercepts and slopes for the main analyses (see section “Results”).
After the phone screen, participants met with research staff. During the first visit, participants gave informed consent and completed a questionnaire. Participants practiced saliva sampling and were instructed to collect three saliva samples per day over two consecutive weekdays (for a total of 6 samples) using absorbent oral swabs (SalivettesTM, Salimetrics Inc., State College, PA, United States). Participants reported their usual times of waking and going to bed on weekdays, which also were their expected times of waking and going to bed on the two specific weekdays they selected for in-home data collection. Research staff programmed automated text messages to participants’ phones and automated email reminders synchronized to their reported wake time, 30 min post waking, and at bedtime. This approach was used to capture each participant’s own circadian rhythm indexed by their self-reported waking and bedtimes (the 30-min post waking samples were not included in the current analyses of diurnal cortisol intercept and slope). Participants received printed instructions, a freezer ice pack, and a second questionnaire packet that included daily diaries for the saliva collection protocol. Participants received a $25 cash payment at the end of the visit.
Self-Administered Procedures at Home
Participants were instructed to not brush their teeth for 2 h before, and to not consume food, drinks, tobacco, or caffeine for 1 h before, collecting each saliva sample. To help participants adhere to the sampling protocol, participants received text messages and email reminders. Participants recorded the specific time and date when each sample was taken. Saliva samples were kept in freezer ice packs at the participants’ home freezers. Participants used daily diaries to log whether they had experienced unusual events, or had consumed food, drinks, tobacco, or caffeine 1 h prior to completing each sample. The exact sampling collection times varied across participants in order to conform with each participant’s circadian cycle (Adam and Gunnar, 2001). Participants completed a second questionnaire packet.
Participants returned their frozen saliva samples in the icepacks and their second questionnaire to research staff. At this time, research staff checked the questionnaire packet and daily diaries for completion. Participants were thanked for their work, debriefed, and received a $75 cash payment. In sum, participants were compensated $100 in cash for their time and efforts.
Diurnal Cortisol Assays
Diurnal cortisol was assayed from the saliva samples. Saliva samples were stored in a medical freezer at −30°C for 2 months in the laboratory until all data were collected to assay cortisol in one batch. Samples were shipped to Salimetrics Saliva Lab (Salimetrics, Carlsbad, CA, United States) for salivary cortisol assay, in duplicate, using a highly sensitive enzyme immunoassay (Salimetrics, State College, PA, United States). The minimum detection ranged from 0.007 to 1.8 μg/dL, and the intra- and interassay variabilities were 8.31 and 7.69%, respectively. The averages of the duplicate cortisol values were used in all subsequent analyses.
Participants reported demographic information including their age, biological sex assigned at birth, gender, sexual orientation, ethnicity/race, education, employment status, and household income.
The Revised Gay-related Stressful Life Events scale (Rosario et al., 2002) is a 12-item measure used to assess heterosexist discrimination, for example, “being physically assaulted in a gay-bashing incident”; “getting in trouble with the police because of your sexual orientation.” Response options were binary, Yes = 1, No = 0. Two items were removed due to zero variability across responses. Hence, the possible range for this scale was 0–10, with higher summed scores suggesting more stressful events related to heterosexist discrimination. Tetrachoric inter-item correlations were computed to derive an ordinal alpha (Gadermann et al., 2012) an index of internal consistency of the binary response options, Ordinal alpha α = 0.80.
The Brief Perceived Ethnic Discrimination Questionnaire – Community Version (Brondolo et al., 2005) is a 17-item scale used to assess racist discrimination3. All items in the scale were used to compute racist discrimination (Brondolo et al., 2005), for example, “Have others actually hurt you and tried to hurt you (e.g., kicked or hit you)?”; “Have policemen or security officers been unfair to you?” Response options for each item ranged from 1 = Never to 5 = Very often. Higher averaged scores suggested more experiences with racist discrimination, Cronbach’s alpha α = 0.93.
Challenges to Identity Integration
The Conflicts in Allegiances (CIA; Sarno et al., 2015) questionnaire is an inherently intersectional measure of a unique form of social stress experienced by sexually diverse people of color. The six-item CIA scale captures the degree to which people who hold memberships and allegiances to multiple marginalized social groups experience challenges to integrating their sexual and ethnic/racial identities, for example, “I have not yet found a way to integrate being LGBQ with being a member of my cultural group”; “I feel as if my sense of cultural identity is at odds with my LGBQ identity.” Response options for each item ranged from 1 = Strongly disagree to 7 = Strongly agree. Two items were reverse coded. Higher averaged scores suggested more challenges to identity integration, Cronbach’s alpha α = 0.82.
Cortisol Intercepts and Slopes
Raw biomarker hormone values were log10 transformed to correct for positive skewness.
Use of medications, reported experiences of unusual events, and consumption of food, caffeine, or tobacco 60 min before each sample were dummy coded (No = 0, Yes = 1) and tested for their respective associations with raw cortisol values4. Using multilevel linear modeling, the individual log10-transformed biomarker values for the four saliva samples (waking and bedtime samples on each of two days) were combined and used to compute participants’ diurnal cortisol intercepts (baseline cortisol at waking) and slopes (degree of change). Each participant’s cortisol intercept and slope were derived by fitting a linear regression line predicted from that person’s four cortisol values, accounting for variation in collection times and sampling days (see Adam and Gunnar, 2001; Hruschka et al., 2005; Adam, 2006; Saxbe et al., 2008). Given log10-transformed values, higher diurnal cortisol intercepts were indexed by less negative or more positive coefficients. Lower diurnal cortisol intercepts, indexed by more negative coefficients, were interpreted as representing a hypoactive HPA axis associated with decreased well-being (Rector et al., 2019) and greater stress (Vargas and Lopez-Duran, 2014). Diurnal cortisol slopes with more negative values (more steeply decreasing) were interpreted as representing more adaptive regulation of daily cortisol secretion (greater decreases in cortisol production from waking to bedtime), whereas flatter slopes with smaller negative values, or with zero or positive values, reflected less adaptive HPA axis functioning (Juster et al., 2010; Gunnar and Adam, 2012).
The Sexual Orientation Developmental Milestones questionnaire (Floyd and Stein, 2002) was used to assess participants’ degree of “outness” or sexual orientation disclosure. A single item “Currently you are out to” prompted participants to respond with options 1 = No one to 5 = Most or all the significant people in your life. This single item was used as a continuous variable with higher scores suggesting more outness.
After examining zero-order correlations, we tested the total and direct associations of heterosexist and racist discrimination, and their interaction, with challenges to identity integration and salivary cortisol intercepts and slopes, as well as the indirect associations of discrimination with cortisol intercepts and slopes through challenges to identity integration (Hayes, 2015). We calculated six indirect effects by multiplying the effects of heterosexist discrimination and racist discrimination, and their interaction term on challenges to identity integration by the effect of challenges to identity integration on salivary cortisol intercepts and slopes. The indirect associations of heterosexist discrimination and racist discrimination, and their interaction term with salivary cortisol intercepts and slopes through challenges to identity integration were interpreted as meeting mediation criteria if the Bias-Corrected accelerated Confidence Intervals (BCa CIs) of the tested indirect effect, above and beyond the direct and total effects, did not include zero (Hayes, 2015) whether or not the direct and total effects were significant (Zhao et al., 2010; Rucker et al., 2011). The degree of model fit was assessed using the chi-square (χ2) goodness of fit statistic, comparative fit index (CFI, Bentler, 1990), Tucker-Lewis index (TLI, Tucker and Lewis, 1973), normed-fit index (NFI, Bentler and Bonnet, 1980), root mean square error of approximation (RMSEA; Browne and Cudeck, 1992), and standardized root mean square residual (SRMR). Model fit was acceptable if the χ2 statistic was non-significant (p > 0.05, Barrett, 2007), CFI, TLI, and NFI values were >0.95, and RMSEA and SRMR values were <0.06 and 0.08, respectively (Hu and Bentler, 1999).
The multiple mediation analysis was fitted as a path model in the lavaan package (Rosseel, 2012) in R, adjusting for all associated covariates in the model. We obtained 95% BCa CIs for the model’s estimates using bootstrapping (Preacher and Hayes, 2008; Mackinnon et al., 2010). We used bootstrapping because Shapiro–Wilk tests of normality showed that our main predictor variables, heterosexist and racist discrimination, were not normally distributed, all ps < 0.05, and because bootstrapping is robust against non-normality of the sampling distribution of the indirect effect (Montoya et al., 2017).
Missing data occurred at a low frequency, with 3.9% of data missing overall.5 Little’s MCAR test was not statistically significant, χ2(423) = 51.80, p > 0.05, thus, data were assumed to be at least missing at random. Considering the small amount of missing data and the small sample size, full information maximum likelihood was used to estimate missing data.
Table 1 displays the means (M), standard deviations (SD), and zero-order correlations for all measures. Both heterosexist discrimination and racist discrimination were positively associated with challenges to identity integration. Challenges to identity integration was marginally negatively associated with salivary cortisol intercepts. Age was positively associated with outness and salivary cortisol intercepts. Outness was negatively associated with racist discrimination and challenges to identity integration.
Table 1. Descriptive statistics and zero-order correlations among main predictor, outcome, and control variables.
Participants who were assigned female at birth were younger (M = 23.27, SD = 2.85), t(49) = −2.28, p < 0.05, were less out (M = 3.78, SD = 1.31), t(49) = −2.58, p < 0.05, reported more heterosexist discrimination (M = 1.56, SD = 1.28), t(49) = 2.27, p < 0.05, and reported more challenges to identity integration (M = 4.37, SD = 1.51), t(48) = 2.32, p < 0.05 when compared to participants who were assigned male at birth (Ms = 24.95, 4.58, 0.79, 3.45; SDs = 2.34, 0.83, 1.10, 1.62, respectively). Analyses of variance with Bonferroni-corrected post hoc tests showed that self-identified bisexual/pansexual participants were marginally younger, F(3,47) = 2.98, p < 0.05 (M = 23.05, SD = 3.12), less out, F(3,47) = 7.25, p < 0.001 (M = 3.29, SD = 1.26), and reported greater challenges to identity integration, F(3,46) = 3.16, p < 0.05 (M = 4.68, SD = 1.25) than self-identified gay participants (Ms = 25.35, 4.83, 3.23; SDs = 2.03, 0.51, 1.62). There were no other significant differences among the sexual orientation groups. Participants’ age, sex assigned at birth, ethnicity/race (monoethnic/racial or biracial), and outness were included as covariates in the subsequent analyses. The zero-order correlations between heterosexist discrimination and racist discrimination, and between salivary cortisol intercepts and slopes, were both non-significant, and the study did not have a goal of examining such associations; therefore, these associations were not covaried in the model.
Associations Between Heterosexist and Racist Discrimination, Challenges to Identity Integration, and Salivary Diurnal Cortisol Intercepts and Slopes
The unstandardized regression coefficients for total, direct, and indirect effects for the full model are reported in Table 2, and to aid interpretation, standardized coefficients are presented in Figure 1. Overall, the model showed good fit to the data (χ2 = 2.07, df = 2, p > 0.05; χ2/df = 1.04; CFI = 0.999; TLI = 0.969; NFI = 0.978 RMSEA = 0.026, 90% BCa CIs = [0.000,0.280], SRMR = 0.032), accounting for 18.1, 11.3, and 18.3% of the variability in salivary cortisol intercepts, diurnal slopes, and challenges to identity integration, respectively. Contrary to the first hypothesis, the total and direct effects of heterosexist discrimination (c1), racist discrimination (c2) and the interaction term between heterosexist and racist discrimination (c3) on salivary cortisol intercepts and diurnal cortisol slopes were non-significant. Supporting the second hypothesis, heterosexist discrimination (a1) and racist discrimination (a2) were both positively associated with challenges to identity integration. Partially supporting the third hypothesis, challenges to identity integration was significantly negatively associated with salivary cortisol intercepts (b1) but was not associated with diurnal cortisol slopes (b2) (see Figure 2).
Figure 1. Mediation path analysis. Solid lines represent statistically significant paths. Dashed lines represent non-significant paths. β represents standardized coefficients. Unstandardized coefficients are provided in Table 2.
Figure 2. Averaged waking and bedtime salivary cortisol at low and high (±1 SD) Challenges to identity integration.
Tests of indirect effects were used to evaluate the fourth hypothesis. As predicted, both the specific indirect effect of heterosexist discrimination on salivary cortisol intercepts through challenges to identity integration (a1∗b1) and the specific indirect effect of racist discrimination on salivary cortisol intercepts through challenges to identity integration (a2∗b1) were significant. The corresponding indirect effects for diurnal cortisol slopes were non-significant, nor were there significant indirect effects of the interaction term between heterosexist and racist discrimination on salivary cortisol intercepts or diurnal cortisol slopes through challenges to identity integration. Thus, sexually diverse Latinx emerging adults’ experiences of greater heterosexist and racist discrimination were associated with lower salivary cortisol intercepts through their having more challenges to identity integration.
Studies of neurobiological functioning have yet to consider how two or more forms of oppression, such as heterosexist and racist discrimination, interconnect to marginalize social groups like sexually diverse Latinx emerging adults, undermining their physiological and psychosocial adjustment and conferring health risks. At the same time, few studies of intersectionality have considered the neurobiological impacts of experiencing complexly intertwined discrimination targeted toward multiple social categorical identities within social groups at various social locations. We sought to bridge these gaps through the application of an intersectional lens (Crenshaw, 1989) to models of minority stress (e.g., Meyer, 2003; Myers, 2009) and allostatic load (McEwen and Stellar, 1993) to further understand the lived experiences of sexually diverse Latinx people during emerging adulthood, which is a developmental period associated with sexual and ethnic/racial identity exploration, formation, and consolidation processes implicated with people’s ability to healthfully adjust (Arnett, 2004). Experiences of heterosexist and racist discrimination in sexually diverse Latinx people during emerging adulthood are associated with a host of social inequalities and inequities that perpetuate health disparities (Rhodes et al., 2020). Moreover, heterosexist and racist social contexts can challenge sexually diverse Latinx emerging adults from integrating their multiple marginalized social group identities, and these challenges are associated with psychological distress and depressive symptoms (Morales, 1989; Espín, 1993; Santos and VanDaalen, 2016; Shramko et al., 2018).
In the current study, we specifically examined the additive and multiplicative effects of heterosexist and racist discrimination on sexually diverse Latinx emerging adults’ diurnal adrenocortical functioning and challenges with integrating their multiple marginalized social identities. Heterosexist discrimination and racist discrimination were each positively associated with challenges to identity integration, suggesting that single-axis measures of discrimination independently and additively associate with challenges to identity integration among sexual diverse Latinx emerging adults. Healthy sexual and ethnic/racial identity integration is a developmental process crucial for the well-being of sexually and ethnically/racially diverse emerging adults (Shramko et al., 2018). Heterosexist discrimination is associated with hesitation to identify as a sexually diverse group member (Herek and Garnets, 2007) and with developing negative attitudes and beliefs of the self (i.e., internalized homonegativity) (Igartua et al., 2003; Herek et al., 2009). Racist discrimination has been associated with confusion about and lack of sense of belonging with a Latinx ethnic/racial group membership (Umaña-Taylor et al., 2008). In parallel with our findings, Shramko et al. (2018) also reported that sexually diverse Latinx emerging adults experience more challenges to the integration of their sexual and ethnic/racial social group identities when they report more heterosexist and racist discrimination (Shramko et al., 2018).
For sexually diverse Latinx emerging adults, cultural factors such as the importance of family, traditional gender roles, conservative religious values, and widespread heterosexism within Latinx culture are described as potential stressors associated with challenges to the healthy integration of their sexually diverse and Latinx social group identities (Espín, 1993; Rodriguez, 1996; Díaz, 2013). Moreover, experiences of racist discrimination within mainstream sexually diverse White communities have also been associated with challenges to sexual and ethnic/racial identity integration in sexually diverse Latinx people (Savin-Williams, 1996). Thus, it is likely that discriminatory heterosexist and racist contexts challenge sexually diverse Latinx emerging adults’ capacity to navigate and integrate their multiple marginalized social group identities, and these challenges have been associated with diminished well-being and poor health in sexually diverse people of color (Sarno et al., 2015; Santos and VanDaalen, 2016; Shramko et al., 2018).
Yet, heterosexist and racist discrimination were not directly associated with adrenocortical diurnal functioning, neither additively nor multiplicatively (their interaction term). The statistically non-significant total and direct effects for heterosexist and racist discrimination on adrenocortical patterns in this study suggest that single-axis (i.e., assessing multiple marginalized social identities and/or experiences independently), additive (i.e., the sum of multiple marginalized social identities and/or experiences), and multiplicative (interactions among multiple marginalized social identities and/or experiences) effects may not always capture the complex processes by which two or more systems of oppression, specifically heterosexist and racist discrimination, intersect (Bowleg, 2008) and “get under the skin” to confer elevated risk for health disparities. Rather, it was the individuals’ internalized, subjective and personally relevant processing of these multi-faceted discriminatory and oppressive experiences that accounted for their compromised adrenocortical activity (Parra and Hastings, 2018).
More specifically, we found significant indirect effects suggesting that challenges to identity integration is a plausible intersectional mechanism by which heterosexist and racist discrimination create social disparities in physical health. Sexually diverse Latinx emerging adults’ feelings of being more challenged with identity integration significantly linked the associations of both more heterosexist discrimination and more racist discrimination with hypoactive adrenocortical activity, as indicated by reduced salivary cortisol intercepts. Thus, challenges to identity integration may be a form of internalized social distress that compromises adaptive adrenocortical regulation. Lower cortisol intercepts, indicative of less circulating cortisol at waking, have been associated with diminished psychological health (Rector et al., 2019) and are considered an index of dysregulated adrenocortical functioning associated with exposure to severe and pervasive stress (Adam and Kumari, 2009; Vargas and Lopez-Duran, 2014). This interpretation suggests that experiences at the intersections of heterosexist and racist discrimination may influence sexually diverse Latinx emerging adults to keep their sexual and ethnic/racial marginalized social group identities separate from each other, and that this experience of one’s self living between divided social worlds (Morales, 1989) carries a physical, biological toll.
It is important to note that challenges to identity integration should not be considered a proxy for the intersection of racist and heterosexist discrimination. Rather, challenges to identity integration reflects a psychological, intrapersonal identity process that may be exacerbated by experiences of discrimination related to sexually diverse Latinx people’s multiply marginalized social locations. This perspective reinforces the necessity of examining within-group heterogeneity of social group memberships, which is critical for the application of an intersectionality lens in quantitative research (McCall, 2005; Cole, 2009; DeBlaere et al., 2010; Parent et al., 2013; Else-Quest and Hyde, 2016a, b). Doing so requires the development and use of inherently intersectional measures (Cole, 2009; DeBlaere et al., 2010; Balsam et al., 2011; Sarno et al., 2015; Else-Quest and Hyde, 2016b) of multifaceted identity processes in order to gain deeper insights into the links between complex experiences of specific and systemic oppression within systems of power and privilege and individual manifestations of compromised health and well-being in quantitative studies.
Unexpectedly, heterosexist discrimination, racist discrimination, and challenges to identity integration were not associated with diurnal salivary cortisol slopes. Previous studies have documented associations between experiencing more heterosexist discrimination and manifesting flatter diurnal slopes in sexually diverse White Canadian emerging adults (Parra et al., 2016) and shown that Black U.S. gay and bisexual men have flattened and less variable diurnal cortisol output than White U.S. gay and bisexual men (Cook et al., 2017). In addition to the differences in sample demographics, these prior studies also differed from the current study in both the number of samples used to measure diurnal slopes and the analytical approach used to calculate diurnal slopes, which can affect findings (Stewart and Seeman, 2000; Stalder et al., 2016). Whether these methodological differences may account for the current study’s lack of direct and total significant associations with diurnal cortisol slopes, or whether this may be specific to the links between adrenocortical functioning, identity integration, and discrimination experiences for sexually diverse Latinx emerging adults is unclear. It would be advantageous for future studies to collect more salivary samples over multiple points of two or more days while collecting more objective measures of waking and bedtime sampling times (Granger et al., 2012), including quality of sleep (Backhaus et al., 2004), in order to have greater opportunity to capture the dynamic fluctuations and degree of change of daily salivary cortisol output.
The interpretation of these findings should be taken with caution. Causality and directionality of associations cannot be proven because this study used a non-experimental and cross-sectional design. Additionally, the study included a convenience sample of participants from a particular social categorical community such that findings should not be assumed to be generalizable to other multiply marginalized social categorical groups. Although comparably sized samples have been sufficient for detecting direct associations between discrimination and biological measures in prior studies (e.g., Parra et al., 2016), the sample size may have precluded our ability to detect total and direct associations of discrimination on cortisol slopes and intercepts. It is important to note that although the current study may have been underpowered to detect direct and total effects, the reported indirect effects were robust after accounting for participants’ age, sex assigned at birth, monoethnic/racial and biracial identities, and outness.
Additionally, prospective studies would substantially help to advance research in this area. Longitudinal designs may potentially reveal the directionality or temporal order of effects between experiences of heterosexist and racist discrimination on adrenocortical functioning through challenges to identity integration, particularly during emerging adulthood as it is a developmental period associated with identity confusion, exploration, and integration (Arnett, 2000, 2001, 2006). Indeed, prospective research has shown enduring effects of racist discrimination on adrenocortical functioning (Adam et al., 2015) and of heterosexist and racist discrimination on developing positive sexual and ethnic/racial identities, respectively (Pahl and Way, 2006; Patterson, 2008; Umaña-Taylor et al., 2008). Whether there are lasting effects of heterosexist and racist discrimination on identity integration and adrenocortical functioning in sexually diverse Latinx emerging adults, or other sexually diverse people of color, remains to be seen.
Sexually diverse Latinx emerging adults are tasked with consolidating a clear sense of self that integrates their multiple intersecting social group memberships (Espín, 1993; Morales, 1989) during an important development period of both opportunity and vulnerability (Arnett, 2007; Morgan, 2013). Yet, sexually diverse Latinx people experience considerable amounts of discrimination based on their marginalized social group memberships (Rhodes et al., 2020) that negatively impacts their healthy neurobiological and psychosocial adjustment (Parra and Hastings, 2018). The complex associations between systems and processes of oppression and aspects of sexuality (attraction, behavior, and identity) and ethnicity/race (language, culture, and identity) are not sufficiently well understood to help explain health and psychosocial disparities in sexually diverse people of color. Drawing from the available adrenocortical and identity integration literature in both sexually diverse and Latinx groups of people, it is likely that the lived experiences of discrimination faced by sexually diverse Latinx emerging adults, which are situated within multiple systems of power and privilege, adversely impacts their adrenocortical stress responses and their ability to integrate their marginalized social identities. Challenges to identity integration may represent one way in which heterosexism and racism intersect to socially and biologically disadvantage sexually diverse people of color by tasking them to integrate their divided social worlds.
Our work showed that measures that are inherently intersectional (i.e., assessing how sexually diverse people of color integrate their sexual and ethnic/racial identities in the context of heterosexism and racism) are necessary to identify processes unique to the intersections of multiple forms of oppression that constitute health disparities in sexually diverse Latinx emerging adults. Experiences of heterosexist and racist discrimination were indirectly associated with atypical daily cortisol patterns through challenges with identity integration through additive, but not multiplicative, processes. Conceptualizing the intersection of two forms of oppression via statistical interactions did not directly capture how sexually diverse Latinx people are physiologically and psychologically impacted by heterosexism and racism, whereas an inherently intersectional measure, the challenges in allegiances scale (Sarno et al., 2015), did capture these effects (Parra and Hastings, 2018). Thus, heterosexist and racist discrimination may intertwine to disenfranchise sexually diverse Latinx emerging adults from thriving both within and across their marginalized social groups, as evidenced through dysregulated patterns in salivary cortisol production and challenges to identity integration, both of which are essential socio-biological processes for healthy physical and social adaptation.
Data Availability Statement
The raw data supporting the conclusions of this article will be made available by the authors to any qualified researcher upon request.
This study was carried out in accordance with the recommendations of and approved by the UC Davis Institutional Review Board. All participants gave written informed consent.
LP conceptualized the study design and analyses, executed data collection, cleaning, scoring, and statistical analyses, interpreted the results, drafted and revised the manuscript, provided final approval of the version to be published, and takes accountability for all aspects of the work, including accuracy and validity of the contents. PH conceptualized the study design and analyses, provided interpretation of the results, drafted and revised the manuscript, provided final approval of the version to be published, and takes accountability for all aspects of the work, including accuracy and validity of the contents.
This research was supported by funding from the National Science Foundation (NSF) Rapid Response Research program (RAPID Grant No. 1649566) awarded to PH and LP; and from generous funding awarded to LP by the American Psychological Association Psi Chi Junior Scientist Fellowship, the American Psychological Foundation Wayne F. Placek Grant, the Council of Graduate Departments of Psychology– Dr. Judy Kuriansky Scholarship, the University of California Office of the President (UCOP) Consortium on the Developmental Science of Adolescence, the UC Eugene Cota-Robles Fellowship, and the Human Development Graduate Group at UC Davis, the NSF Graduate Research Fellowship Program (Grant No. 1650042), the National Academies of Sciences, Engineering, and Medicine’s Ford Foundation Dissertation Year Fellowship, and the UCOP Dissertation Year Fellowship. Any opinions, findings, conclusions, and recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the NSF, or other funding agencies.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
We thank the participants of the Sexual Orientation and Psychosocial Adjustment Study (SOPAS) for their time and efforts. We also thank Diego D. Barragan, Alice Hsu, Paige Richards, Andre Sillas, Nava Ratna, Harpreet Singh, Kevin Dihn, Ryan Hodge, Alex Huerta, Jasmine Palustra, and Marissa Rodriguez for assisting with data collection and preparation.
- ^ Although biracial Latinx-White people are known to experience unique forms of discrimination and challenges to their ethnic and/or racial identity integration (Jackson et al., 2012; Soliz et al., 2017), t-tests showed no mean differences between monoethnic Latinx and biracial Latinx-White people among measures of sexual and ethnic discrimination, identity integration, and salivary cortisol indices (all ps > 0.05). Given the small number of biracial Latinx-White people in this study, in an effort to yield more precise estimates, participants’ monoethnic and biracial identities were included as a covariate in the main analyses.
- ^ The frequent use of glucocorticoids for asthmatic patients has been shown to decrease morning cortisol (Masharani et al., 2005), yet more recent evidence suggests that glucocorticoid dosage does not affect cortisol concentrations for asthmatic patients who adhere to their prescribed glucocorticoid doses (Shin et al., 2014). In the present study, participants were asked to refrain from using their glucocorticol steroids two days before and during the two days of data collection. The use of all medications, including hormones, was tested for their associations with raw waking and evening salivary cortisol samples prior to computing salivary cortisol intercepts and slopes, all ps > 0.05; please see section “Measures.”
- ^ The term “racist discrimination” encompasses discrimination based on a person’s cultural heritage, phenotype, language, and/or membership to an ethnic group, all which fall within the broader definition of racism (Jones, 2001).
- ^ Independent sample t-tests showed no mean differences in salivary cortisol between participants who endorsed the use of medication (M = 0.24, SD = 0.23), t(196) = −0.197, p > 0.05; experienced unusual events (M = 0.25, SD = 0.22), t(196) = −0.401, p > 0.05, and who reported consuming food (M = 0.18, SD = 0.16), t(195) = 0.78, p > 0.05, or tobacco (M = 0.20, SD = 0.02), t(196) = 0.257, p > 0.05, when compared to participants who did not (M = 0.23, 0.23, 0.23, 0.23; SD = 0.22, 0.21, 0.22, 0.22, respectively). All participants reported that they did not consume caffeine 1 h prior to sampling.
- ^ Participants returned six frozen saliva samples, which included two waking and two bedtime samples that were used to compute cortisol intercepts and slopes for this study. Of the 204 total waking and bedtimes samples (four samples per participant), 2.9% (n = 6) of oral swabs did not have sufficient saliva for assay; and four of these six oral swabs with insufficient saliva belonged to a single participant. The participant was retained in the study and their missing cortisol intercepts and slopes were estimated using full information maximum likelihood.
Adam, E. K. (2006). Transactions among adolescent trait and state emotion and diurnal and momentary cortisol activity in naturalistic settings. Psychoneuroendocrinology 31, 664–679. doi: 10.1016/j.psyneuen.2006.01.010
Adam, E. K. (2012). Emotion-Cortisol transactions occur over multiple times scale in development: implications for research on emotion and the development of emotional disorders. Monogr. Soc. Res. Child Dev. 77, 17–27. doi: 10.1111/j.1540-5834.2012.00657.x
Adam, E. K., and Gunnar, M. R. (2001). Relationship functioning and home and work demands predict individual differences in diurnal cortisol patterns in women. Psychoneuroendocrinology 26, 189–208. doi: 10.1016/s0306-4530(00)00045-7
Adam, E. K., Heissel, J. A., Zeiders, K. H., Richeson, J. A., Ross, E. C., Ehrlich, K. B., et al. (2015). Developmental histories of perceived racial discrimination and diurnal cortisol profiles in adulthood: a 20-year prospective study. Psychoneuroendocrinology 62, 279–291. doi: 10.1016/j.psyneuen.2015.08.018
Arnett, J. (2006). “Emerging adulthood: understanding the new way of coming of age,” in Emerging Adults in America: Coming of Age in the 21st Century, eds J. Arnett and J. Tanner (Washington, DC: American Psychological Association, 3–19. doi: 10.1037/11381-001
Backhaus, J., Junghanns, K., and Hohagen, F. (2004). Sleep disturbances are correlated with decreased morning awakening salivary cortisol. Psychoneuroendocrinology 29, 1184–1191. doi: 10.1016/j.psyneuen.2004.01.010
Balsam, K. F., Molina, Y., Beadnell, B., Simoni, J., and Walters, K. (2011). Measuring multiple minority stress: the LGBT people of color microaggressions scale. Cultur. Divers. Ethnic. Minor. Psychol. 17, 163–174. doi: 10.1037/a0023244
Bowleg, L. (2008). When black + lesbian + woman ≠ black lesbian woman: the methodological challenges of qualitative and quantitative intersectionality research. Sex Roles 59, 312–325. doi: 10.1007/s11199-008-9400-z
Brondolo, E., Kelly, K. P., Coakley, V., Gordon, T., Thompson, S., Levy, E., et al. (2005). The perceived ethnic discrimination questionnaire: development and preliminary validation of a community version. J. Appl. Soc. Psychol. 35, 335–365. doi: 10.1111/j.1559-1816.2005.tb02124.x
Cook, S. H., Juster, R.-P., Calebs, B. J., Heinze, J., and Miller, A. L. (2017). Cortisol profiles differ by race/ethnicity among young sexual minority men. Psychoneuroendocrinology 75, 1–4. doi: 10.1016/j.psyneuen.2016.10.006
Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ. Chic. Leg. Forum 140, 139–167.
de Girolamo, G., Dagani, J., Purcell, R., Cocchi, A., and McGorry, P. D. (2012). Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles. Epidemiol. Psychiatr. Sci. 21, 47–57. doi: 10.1017/s2045796011000746
DeBlaere, C., Brewster, M. E., Sarkees, A., and Moradi, B. (2010). Conducting research with LGB people of color: methodological challenges and strategies. Couns. Psychol. 38, 331–362. doi: 10.1177/0011000009335257
Deuschle, M., Hamann, B., Meichel, C., Krumm, B., Lederbogen, F., Kniest, A., et al. (2003). Antidepressive treatment with amitriptyline and paroxetine: effects on saliva cortisol concentrations. J. Clin. Psychopharmacol. 23, 201–205. doi: 10.1097/00004714-200304000-00014
Díaz, R. M., Ayala, G., Bein, E., Henne, J., and Marin, B. V. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual latino men: findings from 3 US cities. Am. J. Public Health 91, 927–932. doi: 10.2105/ajph.91.6.927
Díaz, R. M., Bein, E., and Ayala, G. (2006). “Homophobia, poverty, and racism: triple oppression and mental health outcomes in Latino gay men,” in Sexual Orientation and Mental Health, eds A. M. Omoto and H. S. Kurtzman, (Washington, DC: American Psychological Association), 207–224. doi: 10.1037/11261-010
Else-Quest, N. M., and Hyde, J. S. (2016a). Intersectionality in quantitative psychological research: I. theoretical and epistemological issues. Psychol. Women Q. 40, 155–170. doi: 10.1177/0361684316629797
Espín, O. M. (1993). “Issues of identity in the psychology of Latina lesbians,” in Between Men—between Women: Lesbian and gay Studies. Psychological Perspectives on Lesbian and gay Male Experiences, eds L. D. Garnets, and D. C. Kimmel, (New York, NY: Columbia University Press), 348–363.
Floyd, F. J., and Stein, T. S. (2002). Sexual orientation identity formation among gay, lesbian, and bisexual youths: multiple patterns of milestone experiences. J. Res. Adolesc. 12, 167–191. doi: 10.1111/1532-7795.00030
Gadermann, A. M., Guhn, M., and Zumbo, B. D. (2012). Estimating ordinal reliability for likert-type and ordinal item response data: a conceptual, empirical, and practical guide. Pract. Assess. Res. Eval. 17:3.
Granger, D. A., Johnson, S. B., Szanton, S. L., Out, D., and Schumann, L. L. (2012). Incorporating salivary biomarkers into nursing research: an overview and review of best practices. Biol. Res. Nurs. 14, 347–356. doi: 10.1177/1099800412443892
Gunnar, M. R., and Adam, E. K. (2012). The hypothalamic–pituitary–adrenocortical system and emotion: current wisdom and future directions. Monogr. Soc. Res. Child Dev. 77, 109–119. doi: 10.1111/j.1540-5834.2011.00669.x
Hastings, P. D., Shirtcliff, E. A., Klimes-Dougan, B., Allison, A. L., Derose, L., Kendziora, K. T., et al. (2011). Allostasis and the development of internalizing and externalizing problems: changing relations with physiological systems across adolescence. Dev. Psychopathol. 23, 1149–1165. doi: 10.1017/S0954579411000538
Herek, G. M., Gillis, J. R., and Cogan, J. C. (2009). Internalized stigma among sexual minority adults: insights from a social psychological perspective. J. Couns. Psychol. 56, 32–43. doi: 10.1037/a0014672
Hruschka, D. J., Kohrt, B. A., and Worthman, C. M. (2005). Estimating between-and within-individual variation in cortisol levels using multilevel models. Psychoneuroendocrinology 30, 698–714. doi: 10.1016/j.psyneuen.2005.03.002
Hu, L.-T., and Bentler, P. M. (1999). Structural equation modeling: a multidisciplinary journal cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Multidiscip. J. 6, 1–55. doi: 10.1080/10705519909540118
Huynh, V. W., Guan, S.-S. A., Almeida, D. M., McCreath, H., and Fuligni, A. J. (2016). Everyday discrimination and diurnal cortisol during adolescence. Horm. Behav. 80, 76–81. doi: 10.1016/j.yhbeh.2016.01.009
Igartua, K. J., Gill, K., and Montoro, R. (2003). Internalized homophobia: a factor in depression, anxiety, and suicide in the gay and lesbian population. Can. J. Commun. Mental Health 22, 15–30. doi: 10.7870/cjcmh-2003-0011
Jackson, K. F., Yoo, H. C. B., Guevarra, R., and Harrington, B. A. (2012). Role of identity integration on the relationship between perceived racial discrimination and psychological adjustment of multiracial people. J. Couns. Psychol. 59, 240–250. doi: 10.1037/a0027639
Juster, R. P., McEwen, B. S., and Lupien, S. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci. Biobehav. Rev. 35, 2–16. doi: 10.1016/j.neubiorev.2009.10.002
Mackinnon, D. P., Lockwood, C. M., and Williams, J. (2010). Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behav. Res. 39, 99–128. doi: 10.1207/s15327906mbr3901_4
Marcia, J. E. (1987). “The identity status approach to the study of ego identity development,” in Self and Identity: Perspectives Across the Lifespan, eds T. Honess, and K. Yardley, (Boston: Routledge and Kegan Paul), 161–171.
Masharani, U., Shiboski, S., Eisner, M. D., Katz, P. P., Janson, S. L., Granger, D. A., et al. (2005). Impact of exogenous glucocorticoid use on salivary cortisol measurements among adults with asthma and rhinitis. Psychoneuroendocrinology 30, 744–752. doi: 10.1016/j.psyneuen.2005.03.003
McEwen, B. S., and Seeman, T. (1999). Protective and damaging effects of mediators of stress. Elaborating and testing the concepts of allostasis and allostatic load. Ann N. Y. Acad. Sci. 896, 30–47. doi: 10.1111/j.1749-6632.1999.tb08103.x
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol. Bull. 129, 674–697. doi: 10.1037/0033-2909.129.5.674
Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., et al. (2015). Racism as a determinant of health: a systematic review and meta-analysis. PLoS One 10:e0138511. doi: 10.1371/journal.pone.0138511
Parent, M. C., DeBlaere, C., and Moradi, B. (2013). Approaches to research on intersectionality: perspectives on gender, LGBT, and racial/ethnic identities. Sex Roles 68, 639–645. doi: 10.1007/s11199-013-0283-2
Parra, L. A., Benibgui, M., Helm, J. L., and Hastings, P. D. (2016). Minority stress predicts depression in lesbian, gay, and bisexual emerging adults via elevated diurnal cortisol. Emerg. Adulthood 4, 365–372. doi: 10.3390/ijerph14111365
Parra, L. A., and Hastings, P. D. (2018). Integrating the neurobiology of minority stress with an intersectionality framework for LGBTQ-latinx populations. New Dir. Child Adolesc. Dev. 161, 91–108. doi: 10.1002/cad.20244
Phinney, J. S. (2003). “Ethnic identity and acculturation,” in Acculturation: Advances in Theory, Measurement, and Applied Research, eds K. Organista, P. Chun, and G. Marin, (Washington, DC: American Psychological Association), 63–81.
Phinney, J. S. (2006). “Ethnic identity exploration in emerging adulthood,” in Emerging adults in America: Coming of Age in the 21st Century, eds J. Arnett, and J. Tanner, (Washington, DC: American Psychological Association), 117–134. doi: 10.1037/11381-005
Preacher, K. J., and Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav. Res. Methods 40, 879–891. doi: 10.3758/brm.40.3.879
Rector, J. L., Tay, L., Wiese, C. W., and Friedman, E. M. (2019). Relative sensitivity of cortisol indices to psychosocial and physical health factors. PLoS One 14:e0213513. doi: 10.1371/journal.pone.0213513
Rhodes, S. D., Mann-Jackson, L., Alonzo, J., Bell, J. C., Tanner, A. E., Martínez, O., et al. (2020). “The health and well-being of latinx sexual and gender minorities in the USA: a call to action,” in New and Emerging Issues in Latinx Health, eds A. D. Martínez and S. D. Rhodes (Cham: Springer International Publishing), 217–236. doi: 10.1007/978-3-030-24043-1_10
Rodriguez, R. A. (1996). “Clinical issues in identity development in gay Latino men,” in Gay and Lesbian Mental Health: A Sourcebook for Practitioners, ed. C. J. Alexander, (Binghamton, NY: Haworth), 127–157.
Rosario, M., Hunter, J., Maguen, S., Gwadz, M., and Smith, R. (2001). The coming-out process and its adaptational and health-related associations among gay, lesbian, and bisexual youths: stipulation and exploration of a model. Am. J. Community Psychol. 29, 133–160. doi: 10.1023/a:1005205630978
Rosario, M., Schrimshaw, E. W., Hunter, J., and Gwadz, M. (2002). Gay-related stress and emotional distress among gay, lesbian and bisexual youths: a longitudinal examination. J. Consult. Clin. Psychol. 70, 967–975. doi: 10.1037/0022-006x.70.4.967
Rucker, D. D., Preacher, K. J., Tormala, Z. L., and Petty, R. E. (2011). Mediation analysis in social psychology: current practices and new recommendations. Soc. Personal Psychol. Compass 5, 359–371. doi: 10.1111/j.1751-9004.2011.00355.x
Ryan, C., Huebner, D., Díaz, R. M., and Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics 123, 346–352. doi: 10.1542/peds.2007-3524
Santos, C. E., and VanDaalen, R. A. (2016). The associations of sexual and ethnic-racial identity commitment, conflicts in allegiances, and mental health among lesbian, gay, and bisexual racial and ethnic minority adults. J. Couns. Psychol. 63, 668–676. doi: 10.1037/cou0000170
Sarno, E., Mohr, J. J., Jackson, S. D., and Fassinger, R. (2015). When identities collide: conflicts in allegiances among LGB people of color. Cultur. Divers. Ethnic. Minor. Psychol 21, 550–559. doi: 10.1037/cdp0000026
Savin-Williams, R. C. (1996). Ethnic- and Sexual-Minority Youth. In r. C. Savin-Williams and k. M. Cohen, the Lives of Lesbians, Gays, and Bisexuals: Children to Adults. Orlando, FL: Harcourt Brace College Publishers, 152–165.
Sellers, R. M., Caldwell, H., Schmeelk-Cone, K. H., and Zimmerman, M. A. (2003). Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. J. Health Soc. Behav. 44, 302–317.
Shin, Y. S., Liu, J. N., Kim, J. H., Nam, Y. H., Choi, G. S., Park, H. S., et al. (2014). The impact of asthma control on salivary cortisol level in adult asthmatics. Allergy Asthma Immunol. Res. 6, 463–466. doi: 10.4168/aair.2014.6.5.463
Shramko, M., Toomey, R. B., and Anhalt, K. (2018). Profiles of minority stressors and identity centrality among sexual minority Latinx youth. Am. J. Orthopsychiatry 88, 471–482. doi: 10.1037/ort0000298
Soliz, J., Cronan, S., Bergquist, G., Nuru, A. K., and Rittenour, C. E. (2017). Perceived benefits and challenges of a multiethnic-racial identity: insight from adults with mixed heritage. Identity 17, 267–281. doi: 10.1080/15283488.2017.1379907
Stalder, T., Kirschbaum, C., Kudielka, B. M., Adam, E. K., Pruessner, J. C., Wüst, S., et al. (2016). Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology 63, 414–432. doi: 10.1016/j.psyneuen.2015.10.010
Stewart, J., and Seeman, T. (2000). Salivary Cortisol Measurement. Available at: https://macses.ucsf.edu/research/allostatic/salivarycort.php#techniques (accessed August 6, 2019).
Umaña-Taylor, A. J., Tynes, B. M., Toomey, R. B., Williams, D. R., and Mitchell, K. J. (2015). Latino adolescents’ perceived discrimination in online and offline settings: an examination of cultural risk and protective factors. Dev. Psychol. 51, 87–100. doi: 10.1037/a0038432
Umaña-Taylor, A. J., Vargas-Chanes, D., Garcia, C. D., and Gonzales-Backen, M. (2008). A longitudinal examination of latino adolescents’ ethnic identity, coping with discrimination, and self-esteem. J. Early Adolesc. 28, 16–50. doi: 10.1016/j.physbeh.2016.04.024
Vargas, I., and Lopez-Duran, N. (2014). Dissecting the impact of sleep and stress on the cortisol awakening response in young adults. Psychoneuroendocrinology 40, 10–16. doi: 10.1016/j.psyneuen.2013.10.009
Zeiders, K. H., Hoyt, L. T., and Adam, E. K. (2014). Associations between self-reported discrimination and diurnal cortisol rhythms among young adults: the moderating role of racial–ethnic minority status. Psychoneuroendocrinology 50, 280–288. doi: 10.1016/j.psyneuen.2014.08.023
Keywords: sexual diversity, Latinx, intersectionality, heterosexist discrimination, racist discrimination, identity integration, cortisol and stress
Citation: Parra LA and Hastings PD (2020) Challenges to Identity Integration Indirectly Link Experiences of Heterosexist and Racist Discrimination to Lower Waking Salivary Cortisol in Sexually Diverse Latinx Emerging Adults. Front. Psychol. 11:228. doi: 10.3389/fpsyg.2020.00228
Received: 03 September 2019; Accepted: 31 January 2020;
Published: 25 February 2020.
Edited by:Margarita Azmitia, University of California, Santa Cruz, United States
Reviewed by:Stephanie H. Cook, New York University, United States
Nathan Grant Smith, University of Houston, United States
Emma Kristine Adam, Northwestern University, United States
Copyright © 2020 Parra and Hastings. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.