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(Commonwealth News Service) Twenty years after Massachusetts became the first state to permit marriage equality, a majority of same-sex married couples say it had a profound positive impact on their lives. A new report finds it strengthened couples' relationships, provided legal protections, financial security and greater acceptance among family and friends.

Abbie Goldberg, Clark University psychology professor, said marriage equality is part of a public health agenda.

"They have access to health insurance. They are physically and mentally healthier. They're able to share the sort of challenges and work of raising children," Goldberg said.

Still, Goldberg noted nearly 80 percent of couples surveyed worry about the future of marriage equality. Supreme Court Justices Samuel Alito and Clarence Thomas have both suggested the high court revisit Obergefell v. Hodges - the decision that legalized same-sex marriage in 2015.

The report reveals same-sex married couples are also concerned about what they consider to be an increasingly hostile environment in the United States. More than 500 anti-LGBTQ+ bills have been introduced since last year - including bans on classroom conversations or books about LGBTQ+ people.

Concerns are forcing couples nationwide to consider relocating to more-friendly states, including Massachusetts, or even out of the country, Goldberg said.

"It's creating not just legal uncertainty but propelling them to think about the future in ways that require time, money, planning," she continued.

Goldberg added marriage equality created families, and the report reveals the positives to ensuring people are protected. Almost 60 percent of participants said marriage provided more stability or security for their children, and often created new in-laws, who could help.