Biosocial Factors Shaping Perceptions of Disease Risk Among a Community-Based Sample of Sexual and Gender Minority People Living in Toronto During the COVID-19 Pandemic

Abstract

Introduction: The COVID-19 pandemic has disproportionately affected vulnerable populations, including sexual and gender minority (SGM) people. Food insecurity, prevalent among this population, may influence perceived vulnerability to infection and related psychological outcomes. This study investigated the association between food insecurity and perceived vulnerability to infection among SGM adults in Toronto, Canada, during the third wave of the COVID-19 pandemic. Methods: A mixed-methods study was conducted with 338 self-identified SGM adults recruited via respondent-driven sampling to complete an internet-based survey between March and July 2021. Measures included food security status, germ aversion, perceived infectability, and COVID-19 worry. Structural equation modeling (SEM) examined pathways linking food insecurity, discrimination, sleep quality, and perceived vulnerability to disease, adjusting for demographic and socioeconomic covariates. Results: The SEM showed that discrimination predicted increased food insecurity (β = 0.30, p < 0.001) and poorer sleep quality (β = 0.26, p < 0.001). Sleep quality mediated the relationship between food insecurity and perceived vulnerability to disease (indirect effect = 0.16, p < 0.001). Discrimination had a significant total effect on perceived vulnerability to disease (β = 0.22, p < 0.001). Discussion: These findings highlight the roles of food insecurity, discrimination, and sleep quality in shaping perceptions of disease vulnerability and risk among SGM people. Interventions addressing food security, mental health, and structural inequities are crucial for mitigating health disparities both during public health crises and in everyday life.