Understanding multilevel predictors affecting family formation among sexual and gender minority couples

PROJECT SUMMARY Family formation plans (e.g., whether/when to have children) vary by micro-level factors like sociodemographics (age, race/ethnicity) and individual- and couple-level influences like finances and job security. These micro-level influences do not fully account for variations in reproductive life plans, which are

also influenced by macro-level factors like state and local laws and structural inequities. Sexual and gender minority (SGM) people's health and wellbeing may be particularly affected by these macro-level factors. Our research and that of others demonstrate that structural stigma (macro-social conditions like anti-LGBT

legislation that negatively impact wellbeing) worsens SGM people's mental and physical health. Given current high levels of structural stigma in the US, there is an urgent need to understand the potential health and wellbeing impacts to halt the widening of already gaping health disparities. One aspect of health and wellbeing

potentially impacted by anti-LGBT legislation and other forms of structural stigma is having children. Almost 40% of SGM people are interested in parenting but may face unique barriers in doing so. Being unable to freely plan when, whether, and how to have children excludes SGM people from a health-promoting life stage,

which may drive some SGM-related health disparities (e.g., alcohol use, cardiovascular health, depression). The proposed mixed-methods study will prospectively examine multi-level impacts on SGM couples' family formation plans. Aim 1. Quantitatively test multi-level influences on family formation plans through a large-scale

survey of SGM couples. We hypothesize that couples living in states with higher levels of structural stigma will be less likely to plan to have children and more likely to report that state-level policies influence their decision- making. These associations will be moderated by the racial/ethnic and gender composition of the couple, as

well as by SES. Aim 2. Qualitatively describe multi-level factors influencing SGM couples' family formation planning. From the Aim 1 sample, we will recruit couples from states with high and low structural stigma for in- depth dyadic interviews (N=120). We will describe multi-level influences on family formation planning. Aim 3.

Given the dynamic sociopolitical landscape for marginalized populations, we will quantify changes in impacts of multi-level factors on family formation plans and well-being over time. We will follow the Aim 2 subsample with dyadic pulse surveys (i.e., brief/regular surveys across three years) and a final in-depth dyadic interview. Using

qualitative trajectory methods and prospective analyses of dyadic pulse surveys, we will test our hypotheses that changes (or lack thereof) in couples' contexts (e.g., moving to another state, legislation changes) will influence decision-making, mental health, relationship quality, and family formation. This project will produce

the first investigation of how multi-level factors prospectively influence SGM couples' family formation plans. This work will have a positive impact by revealing for the first time the multi-level needs of LGBTQ couples as they form families, thereby informing interventions to reduce entrenched inequities.