Author Type

Graduate Student

Date of Award

Spring 4-1-2026

Document Type

Dissertation

Publication Status

Version of Record

Submission Date

April 2026

Department

Counselor Education

College Granting Degree

College of Education

Department Granting Degree

Counselor Education

Degree Name

Doctor of Philosophy (PhD)

Thesis/Dissertation Advisor [Chair]

Hannah Bowers Parker

Abstract

The current study examined whether neighborhood-based social determinants of health (SDOH) were associated with emotional health outcomes among sexual minority young adults ages 18–29, and whether perceived social support mediated this relationship. SDOH refers to the conditions in which individuals are born, grow, live, work, and age, including neighborhood and built environment characteristics that shape access to resources, safety, and well-being. Emotional health in this study was operationalized through self-reported symptoms of depression and anxiety, while social support represented perceived availability and quality of interpersonal resources that may buffer the impact of structural disadvantage. This study utilized a non-experimental, cross-sectional secondary data analysis of the NIH All of Us Research Program. The final analytic sample consisted of N = 384 sexual minority young adults with complete data across key measures, including the General Anxiety Disorder (GAD-7) screener for anxiety, the Patient Health Questionnaire (PHQ-9) for depression, the Rand MOS Social Support Scale (Rand MOS-SSS), Social Cohesion and Neighborhood Safety (SCNS), and Neighborhood Disorder Scale (NDS). A reliability-corrected structural equation modeling (SEM) approach was employed, using standardized total scores as single-indicator latent variables with fixed error variances based on Cronbach’s alpha. The emotional health construct was modeled as a latent factor indicated by PHQ-9 and GAD-7 scores. Mediation was tested using maximum likelihood estimation with 5,000 bootstrapped resamples to generate bias-corrected confidence intervals for indirect effects. Results indicated that social support was a robust and statistically significant predictor of emotional health, such that higher perceived support was associated with lower levels of depression and anxiety symptoms. In contrast, neighborhood disadvantage, measured through the SCNS and NDS, did not demonstrate a stable or unique association with social support when both indicators were included simultaneously in the model. Consequently, the hypothesized mediation pathway was not supported. Social support did not mediate the relationship between neighborhood disadvantage and emotional health, due to a weak neighborhood-to-support pathway. Global model fit indices indicated poor overall fit, suggesting potential measurement overlap among neighborhood indicators and the need for alternative model specifications in future research. Findings suggest that while neighborhood context remains an important structural determinant of lived experience, social support appears to function as a more proximal and meaningful correlate of emotional well-being for sexual minority young adults. The study highlights the importance of strengthening social support networks as a potential avenue for mental health promotion, while underscoring the need to improve measurement of neighborhood disadvantage in future SDOH research.

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