• Emily M Yette and Jennifer Ahern.
• Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California. Electronic address: eyette@berkeley.edu.
• Am J Prev Med. 2018 Sep 1; 55 (3): 281289281-289.

IntroductionIt is well established that socially marginalized groups experience worse health than dominant groups. However, many questions remain about the health of members of multiple marginalized groups, such as black sexual minority women. The purpose of this study was to examine the relationship between health-related quality of life (HRQOL), race, and sexual orientation identity among a general population sample of black and white women and to assess additive interaction between sexual orientation identity and race.MethodsThis study used cross-sectional 2014 and 2015 Behavioral Risk Factor Surveillance System data from 154,995 women residing in 20 U.S. states. G-computation was used to estimate age-adjusted prevalence differences for nine dichotomized measures of HRQOL. The HRQOL of black sexual minority women was compared with the HRQOL of black heterosexual women, white sexual minority women, and white heterosexual women. Analyses were conducted in 2017.ResultsAge-adjusted prevalence differences for all measures suggested worse HRQOL among black sexual minority women, compared with most of the other groups (e.g., frequent poor mental health comparing black lesbian and heterosexual women: 0.083, 95% CI= -0.017, 0.183); HRQOL among black bisexual women was often similar to or worse than white bisexual women. Most prevalence differences comparing black sexual minority women with white heterosexual women suggested additive interaction that led to stronger or weaker associations than expected. Although many point estimates suggested meaningful differences, many 95% CIs for prevalence differences, and when assessing for interaction, included 0.ConclusionsHaving two marginalized identities compared with one is often associated with worse HRQOL. In addition, race and sexual orientation identity may interact in their relationship to HRQOL, such that black sexual minority women have worse or better HRQOL than expected.Copyright © 2018 Elsevier Ltd. All rights reserved.

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