HIV prevention
Gay and bisexual men make up the group most affected by HIV, according to the CDC’s report on new HIV diagnoses in 2019. The following studies based on data distributed by ICPSR aimed to identify the barriers to HIV prevention in this population. Based on data from Generations: A Study of the Life and Health of LGB People in a Changing Society, United States, 2016-2019, Krueger et al. 2020 found that felt stigma related to sexual identity served as a moderating factor between psychological distress and lower rates of HIV testing and prevention among sexual minority men. Looking at the transgender population, Olakunde et al. 2021 found that 45 percent of the respondents of the 2015 U.S. Transgender Survey never took an HIV test, which is mostly due to low risk perception, but, as in the general population, many of the respondents could not name a specific reason for not testing.
Using the more recent TransPop data, Sevelius et al. 2020 also found low adherence to the CDC’s recommendations of annual testing among the sexually active transgender population, however, they also found that “people of color and those who reported looking online for LGBT and/or transgender health information were more likely to meet CDC guidelines” (Sevelius et. al, 440.) Those who reported gender affirmation were more aware of pre-exposure prophylaxis (PrEP) as a tool for prevention, which highlights the importance of gender affirmation for HIV prevention in this population.
The Multilevel Influences on HIV and Substance Use in a YMSM Cohort (RADAR) study sampled a racially diverse population of young men, aged 16-29, who have sex with men and transgender women (MSM). Mustanski et al. 2020 reported a high incidence of HIV positivity in this sample, especially among Black men, which was high even compared to MSM’s incidence rates in the 2015 national annual estimates. The researchers found that racially segregated social networks were drivers of HIV positivity among minority MSM, which necessitates structural interventions for young minority populations.
This intervention could come in the form of more social involvement for minority MSM. According to Ramirez-Valles et al. 2010, participation in HIV/AIDS and LGBT organizations proved protective against certain high-risk behaviors in the case of Latino gay, bisexual, and transgender (GBT) individuals. The authors used data from the study, Latino MSM Community Involvement: HIV Protective Effects, which sampled Latino MSM in Chicago and San Francisco. They found that social involvement helped decrease substance abuse and sex under the influence, both used by this population to cope with internalized racial and sexual stigma, therefore, it could serve as an alternative intervention.
Tobacco use in sexual minorities
Based on public health research, the harms of tobacco use disproportionately impact LGBTQ people. The Population Assessment of Tobacco and Health (PATH) Study provides nationally representative data on youth and adult populations’ smoking-related and other health behaviors. The following publications relied on sexual orientation and tobacco use data from the PATH Study.
Wheldon et al. 2018 provided a detailed picture of LGBT smoking: they assessed the regular, experimental, and never use of different tobacco products among both young and old “lesbian/gay and bisexual identified women” and those identifying as gay men, but also considered the information on sexual attraction in the sample. The respondents identifying as sexual minority, and those with same-sex or both-sex sexual attraction all had higher odds ratios than heterosexual women and men for regular or ever-use of different tobacco products, but there are differences by age groups and gender. Sexual minority women were more likely than any other groups, including gay men, to use tobacco products of all types (Wheldon et al. 2018). Marijuana initiation in the past 12 months was also significant for the female sexual minority population, while not for their male counterparts as compared to the general population (Mantey, Yockey, and Lee, 2021).
Wheldon and Wiseman 2021 identified the barriers to smoking cessation that LGBT populations face. These included psychological, environmental, and normative barriers, which stem from psychological distress, socializing with other tobacco users, and, for gay men, living in urban neighborhoods that are targeted by tobacco marketing. The policy recommendations of these articles highlight the need for gender- and sexual identity-specific interventions.
Using data from the PATH Study on sexual minority status, subjective well-being, and education Assari and Bazargan 2019a found that high educational attainment among LGB people had a smaller positive effect on subjective health and well-being than it did for the non-LGB population. The authors looked at the subjective well-being of LGB people through the lens of the Minorities Diminished Returns theory, which suggests that some determinants of health, such as educational attainment, don’t have a protective effect of the same magnitude for minorities as for the general population. The authors applied the same theory to PATH Study data to assess tobacco use among sexual minority adults in Assari and Bazargan 2019b. They came to a similar conclusion: even though higher educated respondents were less likely to be smokers, the protective effect of education was weaker in the case of LGB adults.
Intersectionality between sex, race, and sexual orientation
A contributing factor to increased prevalence of smoking and its adverse health outcomes is the intersectionality between sexual orientation and race. Targeted tobacco marketing impacts LGBT people, racial and ethnic minorities, as well as young people more than other demographics. Tan et al. 2021 analyzed PATH Study data to assess the “encoded exposure to tobacco ads” of various tobacco products– that is exposure with minimal memory of the advertisements. The researchers found that “sexual minority women of colour and black heterosexual women and men have increased encoded exposure to certain forms of tobacco ads,” while bisexual women and heterosexual Hispanic men also had increased exposure to several tobacco products.
This finding is echoed in other publications that concern the health status of people with intersectional identities. Wilson et al. 2020 relied on data from, among others, the Generations Study and the TransPop Survey to estimate the percentages of sexual and gender minority adults experiencing homelessness. The lifetime prevalence of experiencing homelessness was 17 percent for sexual minority people, as opposed to 6 percent recorded in the general population. The authors also found significant differences between racial and ethnic groups, with Black sexual minority people disproportionately high rates of recent experiences being homeless. This finding is important from a health perspective, as being without stable housing brings many health risks.
LGBTQ health over the life course
Longitudinal studies involving questions on sexual orientation provide an outlook for longer-term health trajectories among LGBTQ people. An example of this is Midlife in the United States (MIDUS), three waves of which were used in Nelson and Andel 2020 to assess the association between sexual orientation and health outcomes for LGB and heterosexual adults. The authors based their hypothesis on the minority stress theory, which posits that sexual minorities, among other groups, suffer negative impacts on their health through increased stress resulting from social stigmatization (Nelson and Andel, 2020). At baseline, sexual minority participants reported more chronic conditions than their heterosexual counterparts, but this difference was lessened over time, as the change in functional limitation scores did not differ significantly between the two groups. Based on these findings, the authors concluded that LGB people grow resilient to minority stress over time, and preventive interventions could improve the health of younger LGB individuals.
The National Social Life, Health, and Aging Project (NSHAP) is “the only probability-based nationally representative study of older Americans that captures data on the sexual behavior of older adults” (Brown and Grossman, 2014). Since sexual identity data was not collected in NSHAP, sexual behavior is the only indicator of orientation in the sample. According to Brown and Grossman 2014’s analysis of the sample, participants with more than two same-sex sexual relationships were younger and had higher education levels, and were more likely to be childless, working, and physically active. They also tended to be former or current drinkers, ever been tested for HIV, and reported good or excellent physical health, as compared to the rest of the sample.
Based on cross-sectional data analysis from NSHAP, Ritter and Ueno 2019 found that older people who reported lifetime same-sex contact had a higher prevalence of sexually transmitted diseases (STDs). This is in part due to lower risk perception among certain sexual minority groups, mainly women and older adults, and financial or institutional barriers to health care. The authors drew attention to the need for public health intervention for older adults, who grew up in a culture that was not outspoken about sexuality and therefore tended to engage in riskier sexual practices than their younger counterparts, leading to adverse health outcomes.
The adoption of legal same-sex marriage in Massachuetts in 2004 also allows for the comparative study of long-term different- and same-sex marriages. The Health and Relationship Project collected survey and daily diary data from legally married couples aged 35 to 65 in 2015. As it is known that married couples influence one another’s health behaviors, Pollitt et al. 2020 looked at influences on alcohol consumption in different- and same-sex marriages. Men in same-sex marriages drank more overall than men in different-sex marriages, even though the latter reported more drinking days, while women in same-sex marriages did not differ from women in different-sex marriages in their alcohol consumption. Certain factors, such as higher income and education levels, and no children in the household predisposed same-sex couples to higher alcohol consumption. However, only women in same-sex marriages didn’t adjust their drinking to their spouses’ previous day drinking, which highlights the gendered nature of alcohol use and the greater risk of excessive alcohol use for men (Pollitt et al., 2020).
Men’s greater risk for alcohol consumption was highlighted by Umberson, Donnelly, and Pollitt’s 2018 research brief, where they found that spouses wanted to change men’s alcohol consumption behavior, regardless of same- or different-sex partnerships. Women married to women were more receptive to their spouses’ attempts to influence their health behaviors, while men reacted negatively to such attempts regardless of the gender of their spouse. This research highlighted the remarkable similarities that married couples have in influencing each others’ health behaviors in both same- and different-sex relationships.
Conclusion
This Research Spotlight does not reflect all of the existing research regarding the physical health of the LGBTQ population. To see how each of the ICPSR studies mentioned in this Spotlight has been examined in other scholarly literature, to gain ideas for extending prior research, or to conduct a larger literature review, you can search the ICPSR Bibliography of Data-related Literature. The term, “LGBT,” typically encompasses identities of “gay,” “lesbian,” “bisexual,” and “transgender,” but may also include other communities identifying under terminology such as “pansexual,” “nonbinary,” or “genderqueer.” Using search terms like transgender AND health or “sexual minority” AND health will lead you to search results containing publications linked to the study data analyzed in them. Discovering data via the literature in this way can begin your investigation of the existing and potential uses of the data distributed by ICPSR.
When authoring publications that include your secondary analysis of study data downloaded from ICPSR, be sure to cite the study in the publication’s references section, using the provided data citation and unique identifier (in the form of a URL containing a DOI). Once your paper is published, submit its citation to the ICPSR Bibliography via this form, so it can be added to ICPSR’s collection of linked data-related literature, enabling others to find, learn from, and cite your work.
*LGBTQ people are represented in some or all of the study samples and publications used in this Research Spotlight; other members of the LGBTQ2+ community are not.
