self-disclosure of sexuality to physician, durable power of attorney for health care completion

219 Pages·2004·1.5 MB·English

by  J. Mostade

COMPONENTS OF INTERNALIZED HOMOPHOBIA,
SELF-DISCLOSURE OF SEXUAL ORIENTATION TO PHYSICIAN, AND
DURABLE POWER OF ATTORNEY FOR HEALTH CARE COMPLETION
IN OLDER GAY MEN

A dissertation submitted to the
Kent State University Graduate School of Education
in partial fulfillment of the requirements for the
degree of Doctor of Philosophy

by
S. Jeffrey Mostade
December 2004
© Copyright by S. Jeffrey Mostade 2004
All Right Reserved
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A dissertation written by
S. Jeffrey Mostade
B.A., Kent State University, 1990
M.A., John Carroll University, 1995
Ph.D., Kent State University, 2004

Approved by
_______________________________, Co-Director, Doctoral Dissertation Committee
John D. West

_______________________________, Co-Director, Doctoral Dissertation Committee
Cynthia J. Osborn

_______________________________, Member, Doctoral Dissertation Committee
Dianne L. Kerr

Accepted by

_______________________________, Chairperson, Department of Adult Counseling,
Donald A. Bubenzer Health, and Vocational Education

_______________________________, Dean, Graduate School of Education
David England
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ACKNOWLEDGMENTS
It has been an honor to work with each person involved in the completion of this
project. Most significantly, I would like to thank the 116 men who elected to complete a
survey and provide this research project with vitality and meaning. A participant said, “I
answered the questions, but you only asked the boring ones.” His words will guide my
future research.
Academic gratitude is owed to my two co-advisors—Dr. John D. West and Dr.
Cynthia J. Osborn. I appreciate their willingness to help me complete this study. Dr.
Dianne Kerr has been a great support—particularly in the area of diversity and public
health.
I want to thank Dr. Georgia Anetzberger, my inspiration in social service with
older adults, effective advocate for the disenfranchised, and a great friend, for her
valuable perspective on early drafts. I thank Karen Ishler for her patient guidance in the
realm of statistics—a consummate teacher and friend. I am grateful to Dr. Jimmie Moe, a
friend of 27 years, for introducing me to 20 of the fascinating men of this study.
I have been selfish with my time while bringing this project to fruition. I thank my
lover of 22 years, Eric John Nilson, for his support and constancy, expressed when he
said, “It’s not important to me whether you finish, I love you for the choices you make.”
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TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS.................................................................................................iv
LIST OF TABLES...............................................................................................................x
CHAPTER
I. INTRODUCTION TO THE PROBLEM......................................................................1
Statement of the Problem........................................................................................3
Research Question and Hypotheses........................................................................6
Definition of Terms.................................................................................................7
Review of the Literature.......................................................................................10
Gay Men and Aging........................................................................................11
Definition and Prevalence...........................................................................11
Social Aging Theories.................................................................................18
Methodological Issues in the Study of Older Gay Men..............................24
Stigma Management.......................................................................................28
Stigma..........................................................................................................28
Internalized Homophobia............................................................................31
Identity Development..................................................................................35
Population Challenges.................................................................................40
Population Resources..................................................................................49
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TABLE OF CONTENTS (continued)
CHAPTER Page
Health Care Choices and Gay Men.................................................................53
Self-Disclosure of Sexual Orientation to Physician....................................59
Durable Power of Attorney for Health Care...............................................62
Rationale for the Study.........................................................................................67
Significance of the Study......................................................................................69
Summary...............................................................................................................70
II. METHODOLOGY......................................................................................................72
Research Question and Hypotheses......................................................................72
Participant Recruitment and Procedures...............................................................74
Procedures.......................................................................................................75
Advertising......................................................................................................76
Cultural and Social Networks.........................................................................77
Snowball Sampling.........................................................................................78
Senior Luncheon.............................................................................................79
Instrumentation.....................................................................................................81
Participant Characteristics Form.....................................................................81
Health Care Choices.......................................................................................82
Reactions to Homosexuality Scale (RHS)......................................................82
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TABLE OF CONTENTS (continued)
CHAPTER Page
Decision to Create Components..................................................................87
Participant Characteristics....................................................................................88
Methods for Statistical Analysis...........................................................................93
Missing Data...................................................................................................93
Analysis...........................................................................................................94
Summary...............................................................................................................96
III. RESULTS...................................................................................................................97
Treatment of the Data...........................................................................................97
Statistical Analyses...............................................................................................98
Hypothesis 1....................................................................................................98
Hypothesis 2....................................................................................................98
Principal Components Analysis of the RHS.......................................................100
RHS Derived Components............................................................................108
Hypothesis 3..................................................................................................113
Hypothesis 4..................................................................................................114
Hypothesis 5..................................................................................................116
Hypothesis 6..................................................................................................119
Exploratory Analysis..........................................................................................123
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TABLE OF CONTENTS (continued)
CHAPTER Page
Durable Power of Attorney for Health Care.................................................123
Self-Disclosure of Sexual Orientation to Physician......................................125
Summary.............................................................................................................127
IV. DISCUSSION...........................................................................................................129
Findings of the Study..........................................................................................130
Age Cohort and Sexual Orientation Disclosure............................................130
DPAHC Completion and Sexual Orientation Disclosure.............................132
Two Components of Internalized Homophobia............................................133
Models of Multiple Variables Affecting DPAHC and SDSOP....................136
DPAHC Completion.................................................................................137
Self-Disclosure of Sexual Orientation to Physician..................................139
Limitations and Strengths...................................................................................143
Sampling.......................................................................................................143
Statistics and Measures.................................................................................145
Research Methods.........................................................................................146
Research Implications.........................................................................................147
Gay and Lesbian Aging Studies....................................................................148
Research With Internalized Homophobia.....................................................150
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TABLE OF CONTENTS (continued)
CHAPTER Page
Measurement of Internalized Homophobia Using the RHS......................151
Summary.............................................................................................................152
APPENDICES................................................................................................................154
APPENDIX A: HUMAN SUBJECTS REVIEW APPROVAL.........................155
APPENDIX B: PARTICIPANT CONSENT FORM.........................................157
APPENDIX C: GAY AGING SURVEY PACKET...........................................159
APPENDIX D: ADVERTISING TEXT.............................................................165
APPENDIX E: PERMISSION TO USE RHS SCALE......................................167
APPENDIX F: PERMISSION TO CONDUCT PCA WITH THE RHS
SCALE..........................................................................................................169
APPENDIX G: QUALITATIVE RESPONSE TO SURVEY QUESTIONS....171
REFERENCES...............................................................................................................174

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LIST OF TABLES
Table Page
1. Participant Characteristics by Age Cohort for Older Gay Men (N = 105)................89
2. Chi-Square Analysis of Age Cohort and SDSOP......................................................99
3. Chi Square Comparison of SDSOP to DPAHC Completion.....................................99
4. RHS Item Frequencies and Descriptors...................................................................101
5. Number of Items, Average Inter-Item Correlations, and Cronbach’s Alpha
Reliability Estimates for the RHS Using 1-, 3-, 4-, and 5-Component
Solutions Principal Components Analyses With Varimax Rotation......................107
6. Component Loadings and Shared Variances for the 5-Component Solution
Derived From a Principal Components Analysis With Varimax Rotation to
the RHS...................................................................................................................109
7. Independent t-Test for Components of Internalized Homophobia and
SDSOP....................................................................................................................114
8. Independent t–Test for Components of Internalized Homophobia and
Disclosure for Gay Men 75 years of Age and Older (n = 39).................................115
9. Summary of Logistic Regression Analysis for Variables Predicting Durable
Power of Attorney for Health Care Completion.....................................................117
10. Summary of Logistic Regression Analysis for Variables Predicting SDSOP.........121

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