Background: Structural cisheteropatriarchy operates through laws/policies, institutionalized practices, and cultural norms to maintain the dominance and normalization of compulsory cisheterosexuality and patriarchy. This system of oppression subordinates women, queer people, and trans/nonbinary people, while advantaging cisheterosexual men – thereby contributing to health inequities. To enable further study, we developed and evaluated the psychometric properties of the first measure of structural cisheteropatriarchy.

Methods: We conducted exploratory factor analysis (EFA) to assess construct validity and develop an index comprised of 30 indicators of protective/harmful state laws across five domains in 2023: economic, youth/education, healthcare/reproductive justice, political, and violence. We generated descriptive statistics and heat maps to visualize overall and indicator-specific patterns.

Results: Inter-item correlations ranged from 0.01 to 0.80 (with 40% 0.40), and Cronbach’s alpha and coefficient omega (both=0.95) indicated good internal consistency reliability. EFA supported a single underlying latent factor. Structural cisheteropatriarchy scores were lowest in the West and Northeast, and highest in the South, with substantial heterogeneity across states (range=-24 to 30, mean=3.7). Notably, even states with generally protective legal climates enacted harmful laws.

Conclusions: This measure demonstrates strong construct validity and addresses critical gaps in structural discrimination research. Future studies should examine how structural cisheteropatriarchy shapes population health and inequities.