Health and Wellness Across Sexual Identities

Health and Wellness Across Sexual Identities
LGBTQ+ Americans have unique perspectives, needs, and experiences related to healthcare that brands must understand. Keep reading for key insights, a downloadable deck, and webinar replay that will help your brand or organization better understand and connect with these segments.

Read on and fill out the form for an excerpt from our Health and Wellness Across Sexual Identities presentation.

Rapid changes in societal norms over the past several years are continuing to pave the way for a more inclusive and welcoming America. The greater acceptance many young people now experience affords an opportunity to openly identify as LGBTQ+ with less risk for social stigma and discrimination. As a result, we continue to see growth in the number of Americans who identify as LGBTQ+. To win in this constantly evolving space, brands and organizations must understand LGBTQ+ Americans’ unique health-related needs and how these impact their engagement with health insurers and providers.

Collage Group’s 2021/2022 Health & Wellness Study leverages data captured from more than 3,500 Americans to help brands understand how health-related attitudes and behaviors differ by sexual identity. Our research reveals how an emerging consumer mindset impacts Americans engagement with both the health insurance and health care provider space. We explore barriers to insurance coverage, drivers and barriers to trust and satisfaction, provider preferences, receptivity to provider advice, and more.

To read and watch the full study, download the attached presentations and watch the webinar replay below. In the meantime, take a look at a few key insights and implications:

#1. The LGBTQ+ population is less likely to have health insurance than others. Affordability issues and distrust in health care have led to lower insurance rates among LGBTQ+ Americans. Position yourself as a partner in their health journey and prove yourself trustworthy by offering targeted services to address their unique needs.

27% of Surveyed LGBTQ+ Americans Say They are Uninsured

Best Practice: Blue Cross Blue Shield of Rhode Island is addressing LGBTQ+ Americans’ barriers to coverage with an easy to find resource page on their website to connect patients with providers that are inclusive and LGBTQ+ friendly.

BCBSRI Has Its Own LGBTQ+ Safe Zones Where Providers and Facilities Can Be Certified as LGBTQ+ Friendly

#2: LGBTQ+ Americans are less satisfied with their current medical care in part because of past negative experiences. More poor interactions with health care providers leads to avoiding care in the future and, ultimately, poorer health outcomes (see the full presentation for supporting data and details on the LGBTQ+ experience with health care).

They Are More Likely to Have Negative Experiences with Doctors and Staff

LGBTQ+ Patient Have Especially Felt Judged and Pressured to Make Decisions

Which of the following, if any, have you experiences while receiving medical care? The doctor or staff…

Total Pop. LGBTQ+ Non-LGBTQ+
Rushed through my visit
Did not listen to me
Did not explain things clearly
Talked to me like I wasn't smart enough to understand
Judged my lifestyle

18% ▲

Pressured me to make a decision before I was ready

15% ▲

I have not experienced any of the above

39% ▼


#3: LGBTQ+ Americans want affirming care that is sensitive to their unique needs, but they don’t need to see LGBTQ+ providers to get that level of care. Make sure your providers and staff are trained in culturally competent care for the LGBTQ+ community.

Wanting Understanding Providers Does Not Require LGBTQ+ Providers

Please indicate which statement best reflect your views about the doctors you interact with, even if neither is exactly correct.

Best Practice: In addition to providing various resources – like an LGBTQ+ friendly provider list – OutCare offers online training to help health care providers develop cultural competency for the segment. Trainings like these are a great way to increase the quality of care provided to LGBTQ+ individuals.

Outcare Provides Online Trainings to Help Health Care Providers Become Culturally Competent When Treating the LGBTQ+ Community

OutCare – a non-profit that provides numerous resources related to LGBTQ+ health care – has an online course for providers to develop cultural competency.

Contact us at the form below to learn more about how you can gain access to these diverse consumer insights and much more in our cultural intelligence platform.

Get In Touch.

There's a world of just for you


How Multicultural and Youth Consumers are Reshaping the Video Game Industry

, , ,
How Multicultural and Youth Consumers are Reshaping the Video Game Industry
Share on facebook
Share on twitter
Share on linkedin

The stunning growth of video games and virtual reality within the entertainment industry is attributable to two core segments: youth and multicultural consumers. Brands need to understand how to leverage this passion point to activate these key segments as gamer culture continues to blend with the mainstream.

By 2023, U.S. revenue from video games, eSports, and virtual reality entertainment will exceed that of either traditional cinema or over-the-top (OTT) video streaming. A massive portion of this spend will be due to multicultural consumers, the segment responsible for 94 percent of growth in video game expenditures between 2010 and 2017. But it’s not just multicultural America—81 percent of U.S. consumers play video games!

Here’s what this opportunity means for marketing strategies:

1. Representations of video games and gaming culture are increasingly important in advertisements portraying multicultural and youth segments.

2. Gaming-focused social media platforms, like Twitch and Mixer, offer new channels to communicate with a growing share of your target consumers

3. Gaming conventions and eSports tournaments, such as E3 and PAX, provide new opportunities to demonstrate a shared passion for this growing source of entertainment.

4. Gaming influencers can speak authentically and directly with tens of millions of online followers across both mainstream and gaming-specific media channels

Games and gaming devices present unlimited potential for branded content, in-game activations, advertising, and marketing innovation

As gaming rapidly becomes a mainstream form of entertainment media, it’s becoming increasingly important for brands to understand consumers as gamers—their video game related attitudes, preferences, and behaviors.

The first thing brands need to know is that video games present multiple opportunities to connect with and activate consumers. Much like OTT streaming, there’s an ever-growing list of titles and genres of games available across a variety of devices. And like traditional sports, individuals will sometimes play video games by themselves, and sometimes watch others play. And even when consumers aren’t engaging with video games directly, they follow gaming influencers, share gaming memes, and attend gaming conventions.

Brands also need to understand how to activate consumers through video games. From real-world influencer partnerships and eSports sponsorships to in-game branded content and “avatar activations,” getting video game marketing right requires knowing where your brand has permission to play, and which consumers you are likely to reach.

To provide Collage Group members with an introduction to video games and the consumers who enjoy them, in July 2019 we conducted a nationally representative survey of 1097 respondents, oversampling Gen Z, Millennial, Black, Asian, and Hispanic consumers across acculturation levels for precision within these segments.

Strategic takeaways from our research include:

  1. Gen Z gamers are more likely to watch casual streaming than eSports. Partner with the online/social media streamers delivering casual entertainment to this emerging consumer segment.
  2. Hispanic gamers are most likely to make gaming part of their social lives. Prioritize multiplayer and “party” games, as well as activations at gaming conventions, to reach Hispanic consumers.
  3. Younger gamers are more comfortable with branded content in their games. Think outside of the box! Look out for the opportunities virtual worlds present to show off your brand’s personality.

Understanding how multicultural and youth consumers approach entertainment media is essential for marketing to these already powerful and ever-growing segments.  If you are interested in having an initial conversation with our consulting team about methods to deal with this topic, please contact us directly.

Explore the Archive

Investors loved the Pinterest IPO but is it just a refuge for Gen X white women?

The IPO of Pinterest last week could only be described as good news for its shareholders, making its co-founder and CEO Ben Silbermann an overnight billionaire.  If you don’t know Pinterest that well, you might think of it as the ad sales platform dominated by female users, as aptly described in the company’s IPO filinghere and elsewhere. On most platforms, ads are interspersed with user content, essentially competing for user attention.  But in Pinterest, ads are described in their filing documents as “native content,” whose imagery is associated with content collected by Pinterest users (Pinners) on their boards.  Additionally Pinners build community around the positive inspiration that arises from imagery, and in this respect the platform is notably free of the polarizing content and negative emotion that can place brands in the cross-fire.

In other words, Pinterest appeals to a collectivist mindset, building community around shared inspiration that is notably free from a shared “dislike” of something “other.”  Given that collectivism is a dominant trait of multicultural, younger-skewing audiences, how does Pinterest user adoption look in these segments?   And furthermore, do we see any evidence that Pinterest can appeal to men?

Our 2018 research into the social media usage produced for both our genYZ and Latinum platforms offers some interesting insights to marketers thinking of advertising on the Pinterest platform. Our research incorporated a representative sample of 2782 consumers across both race and ethnicity, and generation.  Firstly, let’s take a look at the following chart showing consumers’ top three platforms, by gender and by Gen Z and Millennial.   Overall, the data show how platform preference can vary significantly when it comes to gender and generation.  Zooming into Pinterest, note that the percentage of Millennial Males (dark gray) including Pinterest in their top three is about the same as for Reddit, Whatsapp and even Twitch – that bastion of video game-obsessed Gen Z men.

The second chart below shows the percentage of respondents saying Pinterest was their favorite platform overall.  We like this chart because it reveals early adoption patterns that may imply opportunities to grow adoption for certain segments.  Overall, we can indeed see how female dominate Pinterest is across every single segment.   But there are some interesting opportunities for Pinterest to expand within each generation that in turn reveal opportunities and risks for advertisers.  Let’s go through them by generation:

Gen Z: Pinterest’s most obvious opportunity is to increase the appeal of the platform to Gen Z males for every demographic. The immediate question might be to ask what lessons can be learned from Twitch. If so, perhaps we should think laterally: it may not be the obvious opportunity to, for example, foster the collection of video snippets of gamers, but rather to connect to the resurgent interest in Dungeons and Dragons or MCU collectibles.   For advertisers set on reaching Gen Z males, the second tier priority (after Snapchat and Instagram) remains Twitch, but keep your ear to the ground.

Millennials: Where are Asian Millennials?  Penetration is notably weak for Asian Millennial females and non-existent for males. While this is certainly a red flag for advertisers (and an opportunity for Pinterest), take note also of interest among African American Millennial males despite lower interest among African American Millennial females.

Gen X:  No news here among females: women across race & ethnicity are confirmed as the core of Pinterest’s user base, but there are interesting variations.  Note the disparity between African American vs Hispanic women.  As revealed in our Essentials research, these two demographics drive significant influence across the social media universe in general. But advertisers should not conflate the two groups as they are respectively the demographics that Pinterest has most and least penetrated. By contrast, take a look at Gen X White males and then look across to Boomer males.  Does adoption of Pinterest among Boomer+ African American and Hispanic males imply that the Gen X adoption by White males could be broadened?  Advertisers take note of the opportunity to reach older males across all race/ethnicity segments.

Boomer+:  Newsflash: Boomer+ Multicultural women show surprisingly weak interest in Pinterest, while Boomer+ White women are the single most dominant segment.  Pinterest has a “just do it” opportunity to expand here, but advertisers looking to appeal to older Multicultural women using Pinterest may wish to ask for more evidence of adoption from Pinterest sales reps.  The Boomer+ Asian segment is also surprisingly weak.

Use these insights to optimize digital channels strategy for select segments.

  • Lead with older-resonant content when advertising on Pinterest, focusing on women across race and ethnicity.
  • While Gen X White men are the dominant male segment, the data suggest you consider advertising to attract older African American  and Hispanic men.
  • Find another platform to reach your Asian consumers.

To place these insights into context, be sure to attend our upcoming webinar on the Essentials of Gen Z and Millennial Marketing or review our recent work on the Essentials of Multicultural Marketing. Contact your Client Services representative to learn more about how Collage Group can help you better appeal to Multicultural and Generational segments by  using our CultureRate:Ad technology, participating in our benchmarking initiative and commissions custom engagements.

Must-Have for Marketers: The Essentials of Multicultural and Generational Marketing

The winning impact of cross-cultural and Hispanic themes in advertising


How does advertising work?  The dominant model for ad success today is based on “salesmanship,” where ads capture conscious attention, communicate benefits, and drive recall. The salesmanship model views the human mind as a calculator, making decisions based on the rational evaluation of costs and benefits. Marketing legend Philip Kotler sums up this perspective well, arguing that ads should “inform, persuade, or remind.”

Of course, marketers have always known that an appeal to reason and logic only gets you so far.  Indeed, advertisers have relied heavily on emotion and psychology since the end of the 19th century.  But until recently, the assumption remained that the point of advertising, whether rational or emotional, was to motivate a conscious process enabling evaluation and recall.

But over the past decade, our understanding of human decision-making has radically changed.  In popular consciousness, the decision-making that precipitated the Great Recession, as well as the rise of social and political bubbles powered by “alternative facts,” are clear indicators that the human mind is by no means a purely rational calculator. And in academia, theories depending on rational choice models and conscious processes have been buried under new evidence for the power of precognitive emotions.

According to the dual system model made famous by Daniel Kahneman, human beings make choices in two ways.  The first stage is the precognitive “System 1” process, formed via innate characteristics, gut feelings, and early experience, as well as sustained or repeated behavior. The second stage uses the intentional “System 2” process, requiring conscious application, logic and evidence.  In some interpretations of dual process theory, System 1 makes all the decisions, with System 2 merely providing ex post facto rationalization. But even if System 2 does some of the work, we now know that the brain can make a decision seven seconds before you know it.

As a marketer, shouldn’t your job be easier armed with these powerful scientific insights? If only: the problem is that if you want to target System 1, marketers must appeal to audiences with multiple, and often opposed, ways of seeing the world that are hard wired into their decision-making processes.

In other words, we are shifting from an advertising paradigm dominated by universal appeals to conscious thought, evidence and logic, towards one where messages resonating with one segment’s precognitive emotions may backfire for another. To make matters worse, conventional metrics and norms focused on awareness and recall appeal to the System 2 processes and thereby provide an incomplete picture.

To help members better market to diverse America, we decided to weigh in with our own proprietary approach which we call CultureRate:Ad.  In our inaugural CultureRate:Ad initiative, we incorporated facial tracking technology and machine learning techniques into a survey of almost 4000 consumers.  Using this approach, we can model what works and what does not for different demographics.  We also developed dashboards incorporating innovative “Groundswell,” “Backlash” and “Net Groundswell” metrics that directly measure how consumers’ minds are changed.

For this analysis, we identified what works and what doesn’t across 30 recent ads in two studies. In the first study, we compared the effects of socially inclusive messages, diverse casting, and appeals to traditional American themes, as well as the applications of other content and structural factors.  We found found distinctly different responses for African American and bicultural Hispanics as reported here.

In the second study, we evaluated different strategies for reaching Hispanic audiences, including Spanish functional ads, Spanish-language ads with Hispanic cues, English ads with Hispanic cues and English total market ads.

Findings are in the attached, and our Spanish language findings will be separately detailed in a forthcoming study.

Topline findings from the study are below:

Win with “peak sentimentality”

This emotion represents a mix of sadness and surprise associated with a sudden pang of longing, nostalgia and wistfulness.  We found that across all segments, peak sentimentality is the emotion most predictive of the desire to share an ad with others, the perception that the message is important, and an improvement in the opinion of the brand. Marketers succeed in capturing viewers’ hearts and minds (and wallets) when the ad tells a story that elicits this emotion and ties it to the brand effectively.

Fuse brand and message in the close

We found that ads win with consumer when successfully interweave branding moments and the narrative, especially in the close.  We performed a paired comparison of ads from Honeymade and Tylenol that particularly exemplify the power of the close to make or break an ad.

Take some risks with messages of inclusion and diverse casting

We found that overall, cross-cultural messages, specifically inclusion messaging and diverse casting, drive the highest groundswell for the Total Market, versus functional ads and ads with American themes. Backlash does increase for some audiences, but not enough to offset the benefit for the majority of the total market.

Cultural cues deeply resonate for all Hispanics

In our Hispanic-focused test, we found that Hispanic cues drive positive response across all levels of acculturation.  And as long as ads in Spanish are simple and convey universal themes like love of family, they will likely do well with English-dominant Hispanics as well.

Take Action Now

Contact us now to explore an innovative approach to ad testing, measure groundswell and backlash and to discover what works and what doesn’t


Is What You Think of Trump’s Fan Base Fake News?

Election results are rolling in as we go to print, but in all likelihood you are reading this in the wake of the historic midterm election results. Our stock in trade is Multicultural, Gen Z and Millennial research, but in this post we take a Total Market view to anticipate the election results, with a focus on white ethnocentrism.

The appeal to that segment could not be more clear. Donald Trump continued to reinforce the threat of immigration right up until the last day of campaigning for the midterms, a message he’s been perpetuating since the very inception of his campaign for president. Despite increasing polarization, it’s undeniable that Trump’s fan base is steadfast in their support of him. Loyal to the “make America great again” slogan, the president’s supporters are typically understood to be older voters who hail from white, rural, small-town America.  As if to confirm this exact scenario, the president has spent most of his time campaigning away from urban cores, strongholds of the Democrats.

Data from our recent America in 2018 research, however contradict prevalent assumption that white people in urban areas (which we defined as counties with populations greater than 50,000 and with 90% or more living in high density urban environments) are less likely to respond Trump’s anti-immigrant rhetoric. Yet again, the prevailing assumptions about  Trump’s fan base may not hold water.

In our study we asked, “to what degree are you concerned about the loss of majority status for European Americans?” We asked survey participants to rank their answer on a 5-point scale, where 5 indicated highest concern and categorized respondents as “ethnocentric” if they answer 4 or 5.  Of the 1421 survey respondents identifying as white, 22% were “ethnocentric” using this measure.

We identified four major takeaways:

No surprise: ethnocentricity in Gen Z is uniformly low.

All Gen Z segments report lower ethnocentricity than older generations.

Aging and urbanicity are strongly correlated with ethnocentricity.

We found that ethnocentricism among whites peaks among older Millennials and gen Xers, but declines among Boomers. In addition, we found that higher urbanicity is correlated with higher ethnocentricism among whites.

Older Millennial and Gen X males living in urban areas are the most concerned about losing majority status.

Ethnocentricity among women peaks in Gen X

Recent academic research confirms that exposure to diversity in urban environments can increase ethnocentricity among whites. In this Harvard study, researchers focused on attitudinal changes towards immigration by analyzing the reactions of white commuter rail riders after seeing Mexican immigrants at their train platform. The data shows that initially, people responded negatively to outsiders. While those negative feelings were ultimately reduced during the course of the study, they never completely subsided. This confirms the theory that urbanicity doesn’t necessarily make you more open to a diverse population, even if it means being at the center of a multicultural and vibrant melting pot.

As we go to print we don’t yet know whether the results in key swing districts in urban areas will reveal that white individuals voted in favor of Trump’s anti-immigrant agenda, or that they voted to break with that appeal to instinct. For marketers, the challenge could not be more clear, that the increase in polarization across the media creates major opportunities to appeal to a diverse consumer base even as it increases the risk of backlash.  In this climate, Collage Group provides the tools marketers need to navigate the Total Market through the turbulence of consumer sentiment and behavior.

Blame Gen Z: why shopping experiences are becoming easier by the click, touch and tap.

, ,

2017 American Community Survey: First Look

The U.S. Census Bureau recently released preliminary estimates from the 2017 American Community Survey. We’ve been digging through the data to identify and analyze demographic changes likely to impact your markets, and uncovered a few interesting nuggets. Key takeaways include:

• The US population grew by 2.6 million people in 2017
• Asians and Hispanics accounted for almost 80% of 2017’s population growth, but less than 25% of the total population
• The Asian Indian sub-population grew by 7.4% this year
• Asians replaced Latin Americans as the largest portion of foreign born residents entering the U.S. since 2010
• 63% of all Asians residing in the US—almost 12 million—are foreign born


Asians and Hispanics Drove 2017 Population Growth
The U.S. population grew by almost 2.6 million people in 2017, bringing the annual growth rate back in line with the decade-long trend of greater than 2% annual growth. As the table below shows, most of the 2017 growth is due to the Asian and Hispanic populations. When combined, these two groups account for 81% of total population growth, despite the fact they constitute less than one quarter of the total U.S population in 2017.

A closer look reveals that the 2017 growth rate for both of these populations exceeded the previous 5-year average. As the graph below illustrates, the growth rate for Asians was more than 1.4 percentage points higher in 2017 (3.8%), while the growth rate for Hispanics was 0.9 percentage points higher (2.5%). Let’s look at what’s driving growth in these population.

Central and South Americans Driving Hispanic Growth 
The Central American and South American sub-populations are the major drivers of growth in the Hispanic population this year. The rate of growth for both of these sub-populations exploded in 2017, while growth in the Mexican Hispanic sub-population continued its steady decline.

The Central American sub-population grew by 240,000 people—mostly Guatemalans and Salvadorans. The South American sub-population grew by 260,000 people—more than 50% of this growth is due to the Colombian and Venezuelan sub-population. Despite its comparatively low growth rate, the Mexican Hispanic population added 412,000 people in 2017. And the Dominican Republic sub-population grew by almost 160,000 people.

Indian, Filipino, and Chinese Drove Asian Growth
Though the Asian population is comprised of 22 sub-populations, Indians, Filipinos, and Chinese drove most of the growth in 2017. This isn’t terribly surprising given the size of these sub-populations—together they account for 60% of the Asian population—about 11.2 million people. The most stunning finding is that the Indian subgroup grew at 7.4% in 2017. In the past five years, this group has grown by more than 25%—roughly 900,000 thousand people.

Asians Outpacing Hispanics on Immigration
2017’s explosive Asian growth rate is related to two other findings. First, foreign-born residents arriving in the U.S after 2009 are now more likely to be from an Asian country than a Latin American country. This finding, first reported by the New York Times, is based on an analysis conducted by William H. Frey of the Brookings Institute. Frey’s analysis found that 41% of all immigrants arriving in the U.S. between 2010 and 2017 were Asian, while only 39% came from Latin America. Despite this shift towards more Asian immigrants, about half of all foreign-born residents are Hispanic.

Second, the Asian portion of the foreign born population grew by 2 percent—from 26.6% to 27.1%—between 2016 and 2017. Presently, 63% of the entire Asian population in the US—about 12 million people—is foreign born. The Hispanic population, in comparison, only has 19.8 million foreign-born residents, roughly 33.5% of the Hispanic population.


The U.S. Census Bureau will continue releasing data from the 2017 survey over the next few weeks, and we’ll be doing deeper dives to understand how the U.S. population is changing. We’ll make sure to update you as we learn more!

Read more about America’s changing demographics:

The Big Shift 2017

2016 ACS at a Glance 

2015 ACS at a Glance


gen-Z “Family Values” offers new ground for marketers tapping into cultural themes

, ,

In Taking a Stance: Examining millennial and gen-Z political issue positions, we established that despite being more likely than millennials to self-identify as conservative, gen-Z is decidedly progressive in its political leanings. It is possible, however, that gen-Z’s flavor of conservatism is distinct from that of millennials, and it will be important for brands to understand the nuances of gen-Z’s social divides.

Collage Group has sought to explain these differential outcomes, making them a core focus of our Ad Rating Survey. As part of the survey, we asked respondents to take an unambiguous stance on 13 selected social trends, in four categories:

After analyzing the results for both generations and race and ethnicity we found several interesting takeaways:

Rather than featuring a strict divide between liberals and conservatives, the generational ideological battleground has three categories.

The largest group is Social Liberal (44% of the population), which tends to approve of trends across all four categories, followed by Social Conservative, with 29% of the population tending to disapprove of all the mentioned trends. A third group, however, responded positively to trends regarding race, youth, and activism, but negatively on non-traditional family trends.

gen-Z consumers are substantially more likely to feature Family Values than Social Conservatism

While gen-Z is more comfortable with same-sex parents and interracial couples than millennials, they are more wary towards single mothers, stay-at-home dads, and unmarried partners. This implies that for gen-Z, Family Values is more concerned with family structure than family membership.

Women are at the center of youth Social Liberalism

Given the salience of the 2016 Women’s March, the 2017 #MeToo movement, and the surge of women running for political office in 2018, the importance of gender in discussions of social ideology cannot be ignored. Among gen-Z and millennial panelists, a strong majority of women are Social Liberal (58%), while only 45% of men fall into that category. Millennial and gen-Z women are more united in their liberal social leanings than men of the same age.

Understanding how Family Values shapes generational social views is essential for marketing to these fast growing and influential consumer segments. To learn more about how you can leverage these preferences to produce valuable brand outcomes, please complete the form below.


Marketers Need to Rethink How to Mix Multicultural Themes and American Cues in Advertising

, , , ,

As advertising approaches a tipping point in the need to appeal across multiple demographics, marketers are asking “what really works across the wide spectrum of identity that is America today?” Our analysis of ads unpacks the conundrum and reveals some startling insights.