Featured Findings

As demonstrated in the graph above, the study affirmed the results of previous research by finding a higher prevalence of psychiatric morbidity in LGB populations as compared with heterosexuals. The study further showed that LGBs had a higher prevalence of mental disorders if they lived in a state that did not have one or more of the following protective policies:

• Hate crime statutes that specify sexual orientation as a protected category
• Laws banning sexual orientation discrimination in employment

Compared to LGBs living in states with one or more protective policies, LGBs who lived in states with no protective policies were significantly more likely to have generalized anxiety disorder (OR=3.34 compared to 1.86; p>.05), post-traumatic stress disorder (OR=3.64 compared to 1.83; p>.05) and to be diagnosed with two or more mental health disorders (OR=4.76 compared to 2.37; p >.05). (Source: Hatzenbuehler ML, Keyes KM, and Hasin DS, 2009, "State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations." American Journal of Public Health, Volume 99, Issue 12, pp. 2275-2281.)

For Further Thought

• The study's findings seem to suggest that protective state-level policies create environments more supportive of LGB mental health. How do you think state level policies work to affect the psyches of LGBs? What are the psychological mechanisms at work?
• Even with protective state level policies, LGBs were more likely to experience many types of psychiatric disorders. Aside from state policies, what other factors might contribute to disparities in LGB mental health?

• 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?

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?

• 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?

• 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?

For Further Thought

• As a probability study, the findings of this study are arguably generalizeable to the adult population of the Commonwealth of Massachusetts. Would you expect to find similar LGB smoking disparities in your state? How might the social, political and legal context of Massachusetts impact the observed magnitude of LGB disparities?
• Bisexual respondents, and bisexual women in particular, appear to be at the greatest risk for current smoking. What factors might put bisexuals at greater risk?

For Further Thought

• What might substance abuse treatment service providers learn from the results of this study? Do you think substance abuse providers should ask youth about their sexual orientation?
• This study confirms the results of previous research showing disparities in drug use for sexual minorities. The study further showed that sexual minority females had a higher prevalence of drug use than did sexual minority males - a gender pattern that is the reverse of the findings for heterosexuals. What might account for this reversal? What might this suggest for the development of interventions to reduce drug use in sexual minority youth?

Data was compiled from PubMed searches (limited to journal articles tagged with the MeSH subject heading "humans.") LGBT search terms include variants of the following: gay, bisexual, lesbian, homosexual, queer, transgender, transsexual, transvestite, cross-dresser, sexual minority, gender minority, sexual orientation, sexual identity, same-sex partner, men who have sex with men, women who have sex with women, and women who partner with women. Readers can replicate the search for LGBT health research publications by using the LGBT Pop Center's automated PubMed search link, accessible on the Literature tab.

For Further Thought

• What contextual factors might account for the decline in the percent of LGBT health publications in the 1990s? Might improvements in HIV/AIDS therapies and perceptions of a declining significance of HIV/AIDS have played a role?
• Do you expect the percent and number of LGBT health related publications to continue to increase in future years?

• Proportion of same-sex couples living in the counties
• Proportion of Democrats living in the counties
• Proportion of schools with gay-straight alliances
• Proportion of schools with anti-bullying policies specifically protecting LGB students
• Proportion of schools with antidiscrimination policies that included sexual orientation
As demonstrated in the graph above, the risk of attempting suicide among LGB youth was 20% greater in negative environments compared with positive environments (25.47% of LGB living in negative environments attempted suicide at least once versus 20.37% in positive environments). Among heterosexual youth, the risk of suicide attempts was 9% greater in negative environments. (Source: Hatzenbuehler, M. L., 2011, "The social environment and suicide attempts in lesbian, gay, and bisexual youth," Pediatrics, Volume 127, Issue 5, pp. 896-903.)

For Further Thought

• What are the implications of this study for prevention of suicide attempts among LGB youth?
• Aside from the 5 items used to create the social environment index, what other factors would you hypothesize to be associated with a negative social environment for LGBs?
• Why might a negative climate for LGB students also impact the risk of suicide attempts for heterosexual youths?

• 9 states (California, Massachusetts, New York, North Carolina, Oregon, Pennsylvania, Vermont, Washington, and Wisconsin) included an item that assessed sexual orientation identity and an item that assessed same-sex sexual behavior.
• 5 states (Connecticut, Florida, Georgia, Illinois, and Texas) included one item that assessed same-sex sexual behavior. Georgia and Florida did not include sexual orientation items state-wide, but measures were included in some counties.
• 11 states (Alaska, Arizona, Colorado, Hawaii, Idaho, Maine, Michigan, Montana, New Mexico, North Dakota, Ohio) and the District of Columbia included one item that assessed sexual orientation identity.

In many states, inclusion of sexual orientation items changed over the period examined. Question wording varied across states and within states across years. Leigh Evans conducted the review by searching CDC's BRFSS website and State-Added Questions Database, GayData.org, and state health department websites for information and questionnaires. When information was unavailable online, she contacted BRFSS State Coordinators.

For Further Thought

• What are the advantages of included sexual orientation items on BRFSS?
• Given the variation in question wording, can findings related to sexual and gender minorities be compared across states?
• Which dimensions of sexual orientation are most important to include in population-based surveys?