Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


College of Education and Human Services


Family Science and Human Development

Thesis Sponsor/Dissertation Chair/Project Chair

Brad van Eeden-Moorefield

Committee Member

Eva Goldfarb

Committee Member

Soyoung Lee


This research focuses on identifying how heteronormativity moderates links between individual and interpersonal processes (i.e., communication self-efficacy, safe sex behaviors) that influence comprehensive sexual health (CSH) disparities among queer and heterosexual cisgender women. The World Health Organization (2019) defines CSH as well-being across physical, emotional, and social domains; yet, the extant literature often fails to consider determinants of, or disparities in, CSH. The first aim was to validate a measure of CSH and test its validity across online survey samples of queer and heterosexual women (N = 246) using a multi-group confirmatory factor analysis in MPLUS. Data fit the model (RMSEA= 0.06, CFI= 0.93) and some moderation was present. The second and third aims examined how heteronormativity moderates the links between communication self-efficacy, safe sex behaviors, and CSH in queer and heterosexual women, respectively. Among queer women, results suggested strong model fit (n=110; TLI=.96, CFI=.97, RMSEA=.04) and moderated, partial mediation was present. This also held true for heterosexual women (n=188, TLI=.96, CFI=.98, RMSEA=.04). Taken together, the latent construct of CSH can be measured parsimoniously, and it appears that the individual process of communication self-efficacy has a stronger direct effect on CSH compared to interpersonal processes. Heteronormativity moderated this relationship, particularly for women with high internalized heteronormativity. Thus, results provide a level of evidence explaining some impact of heteronormativity on CSH disparities among diverse women.

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