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Objective: To examine reported experiences of gender discrimination and harassment among US women. Data Source and Study Design: Data come from a nationally representative, probability-based telephone survey of 1596 women, conducted January-April 2017. Methods: We calculated the percentages of women reporting gender discrimination and harassment in several domains, including health care. We used logistic regression to examine variation in experiences among women by race/ethnicity and sexual orientation/gender identity. Principal Findings: Sizable fractions of women experience discrimination and harassment, including discrimination in health care (18 percent), equal pay/promotions (41 percent), and higher education (20 percent). In adjusted models, Native American, black, and Latina women had higher odds than white women of reporting gender discrimination in several domains, including health care. Latinas' odds of health care avoidance versus whites was (OR [95% CI]) 3.69 (1.59, 8.58), while blacks' odds of discrimination in health care visits versus whites was 2.00 [1.06, 3.74]. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) women had higher odds of reporting sexual harassment (2.16 [1.06, 4.40]) and violence (2.71 [1.43, 5.16]) against themselves or female family members than non-LGBTQ women. Conclusions: Results suggest that discrimination and harassment are widely experienced by women across multiple domains of their lives, particularly those who are a racial/ethnic minority or LGBTQ. Further policy and programmatic efforts beyond current legal protections for women are needed to meaningfully reduce these negative experiences, as they impact women's health care and their lives overall. KEYWORDS discrimination, gender and health, LGBTQ health, racial/ethnic differences in health and health care, social determinants of health, survey research and questionnaire design, women's health, 1 | INTRODUCTION The prominence of the #MeToo and #TimesUp movements have heightened public awareness of discrimination, sexual assault, and harassment against women in the United States. (1) While this [...]

Objective: To examine reported experiences of discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly contribute to poor health outcomes. Data Source and Study Design: Data came from a national, probability-based telephone survey of US adults, including 489 LGBTQ adults (282 non-Hispanic whites and 201 racial/ethnic minorities), conducted January-April 2017. Methods: We calculated the percentages of LGBTQ adults reporting experiences of discrimination in health care and several other domains related to their sexual orientation and, for transgender adults, gender identity. We report these results overall, by race/ethnicity, and among transgender adults only. We used multivariable models to estimate adjusted odds of discrimination between racial/ethnic minority and white LGBTQ respondents. Principal Findings: Experiences of interpersonal discrimination were common for LGBTQ adults, including slurs (57 percent), microaggressions (53 percent), sexual harassment (51 percent), violence (51 percent), and harassment regarding bathroom use (34 percent). More than one in six LGBTQ adults also reported avoiding health care due to anticipated discrimination (18 percent), including 22 percent of transgender adults, while 16 percent of LGBTQ adults reported discrimination in health care encounters. LGBTQ racial/ethnic minorities had statistically significantly higher odds than whites in reporting discrimination based on their LGBTQ identity when applying for jobs, when trying to vote or participate in politics, and interacting with the legal system. Conclusions: Discrimination is widely experienced by LGBTQ adults across health care and other domains, especially among racial/ethnic minorities. Policy and programmatic efforts are needed to reduce these negative experiences and their health impact on sexual and/or gender minority adults, particularly those who experience compounded forms of discrimination. KEYWORDS discrimination, gender identity, Lesbian, gay, bisexual, trangender, queer (LGBTQ) health, Racial/ethnic differences in health and health care, sexual orientation, Social determinants of health, Survey research, 1 | INTRODUCTION Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in the United States have experienced a long history of discrimination, including criminalization and classifications as mentally ill, attempts [...]

Objective: To summarize findings from this Special Issue, which examine reported experiences of discrimination among six underrepresented groups in public opinion research--blacks, Latinos, Native Americans, Asian Americans, lesbian, gay, bisexual, transgender, or queer (LGBTQ) adults, and women. Data Source and Study Design: Data come from a nationally representative, probability-based telephone survey of 3453 US adults, conducted January--April 2017. Methods: We calculated the percent of adults reporting discrimination in several domains, including health care. Principal Findings: In health care encounters, 32 percent of black adults reported discrimination, as did 23 percent of Native Americans, 20 percent of Latinos, 18 percent of women, 16 percent of LGBTQ adults, and 13 percent of Asian Americans. Significant shares also reported experiencing racial, gender, or LGBTQ identity-based violence against themselves or family members, including 51 percent of LGBTQ adults, 42 percent of blacks, 38 percent of Native Americans, and 21 percent of women. At least one in seven blacks (22 percent), LGBTQ adults (18 percent), Latinos (17 percent), and Native Americans (15 percent) reported avoiding health care for themselves or family members over concerns of anticipated discrimination or unfair treatment. Conclusions: Taken together, this polling effort illustrates the significant and widespread level of discrimination against many groups in America today, as well as the complex manifestation of these experiences across different groups and different areas of life. While it is beyond the scope of these results to make specific recommendations for how to end discrimination in each area of life we studied, this Special Issue provides important evidence that more research and practice on discrimination are sorely needed in health services research. KEYWORDS Determinants of Health/Population Health/Socioeconomic Causes of Health, Racial/Ethnic Differences in Health and Health Care, Social Determinants of Health, Survey Research and Questionnaire Design, 1 | INTRODUCTION In 2014, a national coalition representing 200 US civil and human rights groups released a report, Falling Further Behind: Combating Racial Discrimination in America. (1) This report [...]

Objective: To examine reported racial discrimination and harassment against Native Americans, which broadly contribute to poor health outcomes. Data Source and Study Design: Data come from a nationally representative, probability-based telephone survey including 342 Native American and 902 white US adults, conducted January-April 2017. Methods: We calculated the percent of Native Americans reporting discrimination in several domains, including health care. We used logistic regression to compare the Native American-white difference in odds of discrimination and conducted exploratory analyses among Native Americans only to examine variation by socioeconomic and geographic/neighborhood characteristics. Principal Findings: More than one in five Native Americans (23 percent) reported experiencing discrimination in clinical encounters, while 15 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Native Americans also reported they or family members have experienced violence (38 percent) or have been threatened or harassed (34 percent). In adjusted models, Native Americans had higher odds than whites of reporting discrimination across several domains, including health care and interactions with the police/courts. In exploratory analyses, the association between geographic/neighborhood characteristics and discrimination among Native Americans was mixed. Conclusions: Discrimination and harassment are widely reported by Native Americans across multiple domains of their lives, regardless of geographic or neighborhood context. Native Americans report major disparities compared to whites in fair treatment by institutions, particularly with health care and police/courts. Results suggest modern forms of discrimination and harassment against Native Americans are systemic and untreated problems. KEYWORDS American Indian and Alaska Natives, discrimination, Native Americans, racial/ethnic disparities in health and health care, racism, social determinants of health, survey research, 1 | INTRODUCTION Native Americans have experienced worse health outcomes than whites since Europeans first arrived in the Americas more than 500 years ago. (1) Centuries of massive trauma, genocide, [...]

Objective: To examine experiences of racial discrimination among Asian Americans, which broadly contribute to poor health outcomes. Data Source and Study Design: Data come from a nationally representative, probability-based telephone survey, including 500 Asian and a comparison group of 902 white US adults, conducted January to April 2017. Methods: We calculated the percent of Asian Americans reporting discrimination in several domains, including health care. We used logistic regression to compare the Asian-white difference in odds of discrimination, and among Asians only to examine variation by geographic heritage group (South Asian versus East Asian) and gender. Principal Findings: 13 percent of Asians reported discrimination in healthcare encounters. At least one in four adults reported experiencing discrimination in employment (27 percent job applications, 25 percent equal pay/promotions); housing (25 percent); and interpersonal interactions (35 percent microaggressions, 32 percent racial slurs). In unadjusted models, East and South Asians were more likely than whites to report experiences of institutional discrimination, and South Asians were more likely than whites to report microaggressions. In adjusted models, Asians had higher odds than whites of reporting avoiding health care due to discrimination concerns and also when obtaining housing. Conclusions: Asians in the United States experience discrimination interpersonally and across many institutional settings, including housing and health care. South Asians may be especially vulnerable to forms of institutional discrimination and microaggressions. These results illustrate a need for greater investigation into the unique experiences of Asian subgroups and greater protections for groups at higher risk of discrimination, within health care and beyond. KEYWORDS Asian Americans, discrimination, racial disparities in health and health care, racism, social determinants of health, survey research, 1 | INTRODUCTION Despite a legacy of exclusionary immigration laws, (1,2) periods of forced migration and internment, (3) and multiple high-profile hate crimes against Asians in recent years, (4,5) patterns [...]

Objective: To examine experiences of racial/ethnic discrimination among Latinos in the United States, which broadly contribute to their poor health outcomes. Data Source and Study Design: Data come from a nationally representative, probability-based telephone survey including 803 Latinos and a comparison group of 902 non-Hispanic white US adults, conducted January--April 2017. Methods: We calculated the percent of Latinos reporting discrimination in several domains, including health care. We used logistic regression to compare the Latino-white difference in odds of discrimination, and among Latinos only to examine variation by socioeconomic status and country of birth. Principal Findings: One in five Latinos (20 percent) reported experiencing discrimination in clinical encounters, while 17 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Latinos also reported experiencing discrimination with employment (33 percent applying for jobs; 32 percent obtaining equal pay/promotions), housing (31 percent), and police interactions (27 percent). In adjusted models, Latinos had significantly higher odds than whites for reporting discrimination in health care visits (OR: 3.18, 95% CI: 1.61, 6.26) and across several other domains. Latinos with college degrees had significantly higher odds of reporting discrimination in multiple domains than those without college degrees, with few differences between foreign-born and US-born Latinos. Conclusions: Latinos in the United States report experiencing widespread discrimination in health care and other areas of their lives, at significantly higher levels than whites. Being born in the United States and earning a college degree are not protective against discrimination, suggesting that further health and social policy efforts to eliminate discrimination are needed. KEYWORDS discrimination, Hispanic, Latinos, racial/ethnic differences in health and health care, racism, social determinants of health, survey research, 1 | INTRODUCTION In recent years, there has been a growing national debate about the seriousness of racial and ethnic discrimination in the United States. (1) Despite this increased national [...]

Objective: To examine experiences of racial discrimination among black adults in the United States, which broadly contribute to their poor health outcomes. Data Source and Study Design: Data come from a nationally representative, probability-based telephone survey including 802 non-Hispanic black and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017. Methods: We calculated the percent of blacks reporting discrimination in several domains, including health care. We used logistic regression to compare the black-white difference in odds of discrimination, and among blacks only to examine variation by socioeconomic status, gender, and neighborhood racial composition. Principal Findings: About one-third of blacks (32 percent) reported experiencing discrimination in clinical encounters, while 22 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A majority of black adults reported experiencing discrimination in employment (57 percent in obtaining equal pay/promotions; 56 percent in applying for jobs), police interactions (60 percent reported being stopped/unfairly treated by police), and hearing microaggressions (52 percent) and racial slurs (51 percent). In adjusted models, blacks had significantly higher odds than whites of reporting discrimination in every domain. Among blacks, having a college degree was associated with higher odds of experiencing overall institutional discrimination. Conclusions: The extent of reported discrimination across several areas of life suggests a broad pattern of discrimination against blacks in America, beyond isolated experiences. Black-white disparities exist on nearly all dimensions of experiences with public and private institutions, including health care and the police. Evidence of systemic discrimination suggests a need for more active institutional interventions to address racism in policy and practice. KEYWORDS African Americans, black Americans, discrimination, racial disparities in health and health care, racism, social determinants of health, survey research, 1 | INTRODUCTION From 2009 to 2016, the Obama administration established several policies aimed at reducing institutional discrimination against racial/ethnic minorities in the United States, including policies in health care, [...]

This Special Issue of Health Services Research on discrimination in America was conducted in the midst of a national debate on the extent of discrimination in the lives of Americans, [...]