Featured Findings

Want to share your thoughts with us on the findings below? Please email us at fenway@icpsr.umich.edu.

2000 US Census: Same-Sex Couples in 93% of US Counties

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The 2000 Census identified nearly 600,000 households headed by same-sex couples in nearly all (93%) U.S. counties. This represents a sizeable increase in the number and geographic distribution of same-sex headed households identified in 1990. (more) Data from the 2005 American Community Survey suggest yet another large increase in the number of same-sex couples identified in American households with their estimate of 770,000. (Sources: Bradford J and Mayer K, 2008, "Demography and the LGBT Population: What We Know, Don't Know, and How the Information Helps to Inform Clinical Practice," in The Fenway Guide to Lesbian, Gay, Bisexual and Transgender Health, edited by H. Makadon et al. and published by the American College of Physicians; Simmons T; O'Connell M., 2003, "Married-couple and unmarried-partner households: 2000," US Department of Commerce Economics and Statistics Administration, published online in Census 2000 Special Reports; Gates, G, 2006, "Same-Sex Couples and the Gay, Lesbian, Bisexual Population: New Estimates from the American Community Survey", published online by The Williams Institute.)

For Further Thought

How do you think the health and wellness needs of same-sex couples might differ geographically across these counties?
What can this measurement tell us about the total population of lesbian, gay and bisexual people in the United States? What are the limitations of this measure?

Gay Men Smoke Cigarettes at Higher Rates

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In a 1992 sample of 2593 adult gay men in two cities, 48% reported currently smoking cigarettes. This was close to double the percentage of all men who report currently smoking nationwide (28.6%). Among gay men, frequent attendance at gay bars, HIV seropositivity, and lower socioeconomic status were positively correlated with tobacco use. (more) While this sample has limitations in generalizeability, it confirms a pattern of findings of several other studies that show gay men smoking at higher rates than the general population of men. (Source: Stall, RD, et al., 1999, "Cigarette Smoking Among Gay and Bisexual Men," American Journal of Public Health, Volume 89, pp. 1875-1878).

For Further Thought

What factors might encourage gay men to smoke?
What are the implications of this study for the allocation of smoking cessation resources and the design of interventions?

Gay and Bisexual Men Have Higher Rates of Disordered Eating

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Confirming results of several other studies, this recent study showed that gay/bisexual men have significantly higher symptoms indicative of eating disorders as compared to heterosexual men. In this study, no significant differences were observed between rates of eating disorders in lesbian/bisexual women and heterosexual women, or between diverse ethnic minorities. (more) The study compared 388 racially diverse LGB men and women with a reference group of 128 white heterosexuals. Participants were sampled from a variety of venues in New York City between February 2004 and January 2005.

Full syndrome and subclinical evaluation of eating disorders included: anorexia, bulimia, and binge eating
Data was stratified into racial categories, including: white, black, and Latino

The study results found:

Gay and bisexual men were 3.8 times (1.1 to 13; 95% CI) more likely to have had any clinical or subclinical symptoms of eating disorders compared to heterosexual men
A higher percentage of lesbian and bisexual women reported clinical or subclinical symptoms of eating disorders compared to heterosexual women, but the observed difference was not significant (OR 1.2 (0.4 to 3.5; 95% CI)).
Significantly higher rates of bulimia and subclinical bulimia in gay/bisexual men compared to heterosexual men

(Source: Feldman, Matthew & Ilan Meyer, 2007, "Eating Disorders in Diverse Lesbian, Gay, and Bisexual Populations," International Journal of Eating Disorders, Volume 40, Issue 3, pp. 218-226).

For Further Thought

What might be some causes of the higher rates of disordered eating among gay and bisexual men? What can be done to address this health disparity?
How can we train primary care providers to recognize and address eating disorders in gay and bisexual men?
What might be some possible protective factors that explain the lack of disparity in eating for lesbian/bisexual women?

HIV+ Transgender Women Less Likely to Receive Anti-Retroviral Therapy

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A study comparing 59 HIV-positive male-to-female (MTF) transgender persons with a control group of 300 non-transgender HIV positive persons found that fewer in the MTF sample were receiving highly active anti-retroviral therapy (HAART). Only 59% of the MTF sample reported current use of HAART compared with 82% of the control group. (more) Both groups had similar HIV-related health status (i.e., CD4 count, viral load, and AIDS-related symptoms). (Source: Melendez, RM, et al., 2006, "Health and Health Care among Male-to-Female Transgender Persons Who Are HIV Positive," American Journal of Public Health, Volume 96, pp.1034-1037.)

For Further Thought

What factors might explain the lower rate of use of anti-retroviral therapy among MTF transgender persons in this sample?
Given that a significantly smaller percentage of the MTF study group used HAART, what might explain the similarity in HIV-related health status in the study and control groups?
What other health disparities might this HIV-positive MTF transgender sample experience aside from decreased anti-retroviral therapy utilization?

Sexual Minority Women More Likely to Binge Drink

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A recent analysis of the California Women's Health Survey compared alcohol use in homosexually experienced and exclusively heterosexually experienced women. Women with at least one lifetime female sexual partner reported drinking alcohol with greater frequency and in greater quantity than women who exclusively had male sexual partners. (more) Homosexually experienced women were also more likely to report binge drinking. (Source: Burgard, SA, Cochran, SD, & Mays, VM, 2005, "Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women," Drug and Alcohol Dependence, Volume 77, pp. 61-70.)

For Further Thought

What factors might contribute to a higher rate of binge drinking in sexual minority women?
How would you design a study to determine the causal factors behind these observed differences in drinking patterns?

Age of First Anal Intercourse Dropping Among MSM

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Recent evidence suggests that men who have sex with men (MSM) are initiating anal intercourse at earlier ages. A Swiss study reveled that the mean age at first anal intercourse fell from 24.5 years among men born before 1965 to 20.0 years among men born between 1975 and 1984. The study also found that younger cohorts of MSM have been initiating anal intercourse with increasingly older partners. (more) Researchers surveyed 2,200 MSM living in Switzerland in 2004 as part of the nation's HIV behavioral surveillance. Participants were recruited from gay community venues and on-line. The study found the following relationships:

Between 20 and 30% of men engage in first anal sex with men 10 or more years older than themselves
The younger the age at first anal intercourse, the less likely the use of condoms
Use of condoms at first anal intercourse was less likely when the age gap between the partners was greater

(Source: Balthasar, H., Jeannin, A., Dubois-Arber, F., 2008, "First Anal Intercourse and Condom Use among Men Who Have Sex with Men in Switzerland," Archives of Sexual Behavior, June 17).

For Further Thought

Do these findings suggest a need for LGBT- specific content in sexual health education for adolescents?
What are some obstacles to integrating LGBT-specific content in sex education?

Older Gay and Bisexual HIV+ Men More Likely to Be Abstinent

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In one recent study of HIV+ men aged 50 and older, twice as many gay and bisexual (GB) men reported sexual abstinence compared to HIV+ heterosexual men. However, among the sexually active HIV+ men, GB men were more likely to report irregular condom use compared to their heterosexual counterparts. (more) This study surveyed a community-based sample of HIV+ men with symptoms of depression recruited from:

AIDS service organizations
in New York City, Columbus, OH and Cincinnati, OH
from November 2004 to March 2007

The findings come out of a larger intervention study aimed at reducing depressive symptomology. Study authors analyzed pre-intervention assessment data in which participants were asked to recall their sexual practices over the previous three-month period. The researchers found that:

64% of gay and bisexual men were abstinent over the span of the trial, compared to 28% of heterosexual men
Of the sexually active population, 27% of HIV-positive heterosexual males reported irregular condom use while 37% of HIV-positive gay/bisexual men reported irregular condom use

(Source: Lovejoy, Travis I. et al., 2008, "Patterns and Correlates of Sexual Activity and Condom Use Behavior in Persons 50-Plus Years of Age Living with HIV/AIDS," AIDS Behavior, Volume 12, pp. 943-956).

For Future Thought

Do our current approaches to HIV prevention meet the needs of older populations?
What factors might explain the differences in sexual practices between the heterosexual and gay/bisexual HIV+ populations?

Lesbians Have Lower Rates of Cancer Screening, Higher Risks

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Research evidence from a three city community cancer project shows that lesbian women have higher behavior risk factors for cervical cancer including early onset of sexual activity, more sexual partners, and lower rates of safe sexual practices. The study also found that lesbian women reported less frequent gynecological cancer screening than their heterosexual counterparts. (more) Researchers used data from a survey of 829 women conducted by the Chicago Lesbian Community Cancer Project from 1994 to 1996.

Lesbian participants were recruited from Chicago, IL, New York City, NY and Minneapolis/St. Paul, MN
Heterosexual participants were recruited via a matched referral method to generate a demographically similar group of heterosexual women for comparison

The study found the following relationships:

Lesbians had higher rates of behavior risks for gynecological cancer than heterosexual women, including: onset of sexual activity before age 18, higher number of sexual partners, and lower rates of safer sex practices
Lesbians had lower rates of frequent gynecological cancer screening than heterosexual women; 49% of lesbians had annual pap screens compared to 66% of heterosexual women and 81% of lesbians had pap screens at least every 3 years compared to 90% of heterosexual women (p<.001)
While not statistically significant, a higher proportion of heterosexual women (31%) reported ever having an abnormal pap result, compared to lesbian women (25%).

(Source: Matthews A.K. et al., 2004, "Correlates of Underutilization of Gynecological Cancer Screening Among Lesbian and Heterosexual Women," Preventative Medicine, Volume 38, pp. 105-113.)

For Further Thought

What might contribute to the disparity in cancer screening between lesbian and heterosexual women?
Does this study challenge your assumptions about sexual risk behaviors in lesbians?
How would you design an intervention to educate the lesbian community about cancer risks and cancer screening?

LGBs More Likely to Experience Discrimination

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Research on harassment and discrimination has found that 42% of lesbian/bisexual women and 44% of gay/bisexual men perceived being discriminated against on a day-to-day basis (either "sometimes" or "often") compared to 30% of heterosexual women and 29% of heterosexual men. Furthermore, 42% of sexual minority individuals associated their sexual orientation as the source of the discrimination. (more) Researchers used data from the MacArthur Foundation National Survey of Midlife Development in the United States (MIDUS), a large population based probability survey of English-speaking Americans conducted in 1995. Respondents reported their sexual orientation on the survey.

2,844 (93.7%) reported heterosexual orientation
41 (1.4%) reported homosexual orientation
32 (1.1%) reported bisexual orientation
115 (3.8%) did not respond to the orientation question

Among the most common experiences of discriminatory behavior reported by LGBs:

"People act as if they think you are not as good as they are" (38.1% LBs compared to 16.6% of heterosexual women; 23.3% of GBs compared to 15.9% of heterosexual men)
"Treated with less respect than other people" (29.3% LBs compared to 14.4% of heterosexual women; 21.2% of GBs compared to 13.1% of heterosexual men)
"You are called names or insulted" (20.1% LBs compared to 5.9% of heterosexual women; 16.1% of GBs compared to 5.7% of heterosexual men)

(Source: Mays, Vickie & Cochran, Susan, 2001, "Mental Health Correlates of Perceived Discrimination Among Lesbian, Gay, and Bisexual Adults in the United States," American Journal of Public Health, Volume 91, Number 11, pp. 1869-1876.)

For Further Thought

How does perceived discrimination affect psychiatric morbidity in sexual minority populations?
What are the best ways to clinically address the psychiatric health outcomes of these perceptions of discrimination?
What other outcomes might be related to higher levels of perceived discrimination for sexual minorities?