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Sexual Orientation and Variation in Physical and Mental Health Status among Women
Abstract
To assess and compare the physical and mental health status of women of differing sexual orientation within a population-based sample.
We used a population-based telephone survey performed using random digit dialing techniques. Our study population was drawn from the 1999 Los Angeles County Health Survey and included women age 18-64 years who reported their sexual orientation (98%, n = 4135). These analyses include 4023 heterosexuals, 69 bisexuals, and 43 lesbians.
We assessed the unique association of sexual orientation with physical and mental health status using bivariate and multivariate analyses. Both lesbians and bisexuals were more likely than heterosexual women to report a diagnosis of heart disease. Among women with a depressive disorder, lesbians were more likely than heterosexuals to be using an antidepressant medication. Compared with heterosexuals within the preceding 30 days, lesbians reported significantly more days of poor mental health, and bisexuals reported significantly more days of poor physical health. However, there were no significant differences by sexual orientation in impaired ability to perform daily activities due to physical or mental health.
In this rare opportunity to use population-based data to study lesbian and bisexual health, we found that sexual orientation as a nonheterosexual woman was associated with increased rates of poor physical and mental health. We believe these findings support the need for the increased systematic study of the relationship between sexual orientation and health.
... [37][38][39][40][41] Finally, 44 studies were included. 9,13,26,28,31,[36][37][38][39] The vast majority (39/44) derived from large national (or regional) representative health surveys 9,13,28,31,[36][37][38][39][41][42][43][44][45][46][47]49,50, and the remaining (5/44) were single cross-sectional or cohort studies. 26,48,51,52,74 The included studies comprise data from four different countries (the United States (n = 39), Australia (n = 2), the United Kingdom (n = 2), Belgium (n = 1)). ...
... 47 However, a considerable number of the included studies discussed not having information on gender identity as a limitation. 28,36,39,41,49,53,[58][59][60][61]66,73 In most cases, this was because publicly available data from the statewide or regional health surveys did not include information on gender identity (assessment). The 44 included studies contained a total of 369 relevant comparisons (236 ORs + 133 AORs) on 21 different health outcomes assigned to these 12 different main categories (GBD): cardiovascular diseases, chronic respiratory diseases, diabetes and chronic kidney diseases, digestive diseases, maternal and neonatal diseases, musculoskeletal disorders, neoplasms, neurological disorders, nutritional deficiencies, other infectious diseases, other non-communicable diseases, and skin diseases (see Supplementary Table S2 for counts of ORs and AORs per category). ...
... The predetermined threshold to perform meta-analysis (⩾2 non-overlapping weighted studies on the same health condition) was met for eleven health conditions (in order of appearance): heart attacks, 47 9,72 and hepatitis. 36,38,60 We did not run meta-analyses, but report results narratively on the combined categories other or one out of multiple cardiovascular 13,31,37,43,58,69 and chronic respiratory diseases 49,58,60,67,72 since these categories summarize conditions with different pathologies that were not considered similar enough to be combined in a meta-analysis. ...
Background
Sexual minority individuals experience discrimination, leading to mental health disparities. Physical health disparities have not been examined to the same extent in systematic reviews so far.
Objectives
To provide a systematic review and, where possible, meta-analyses on the prevalence of physical health conditions in sexual minority women (i.e. lesbian- and bisexual-identified women) compared to heterosexual-identified women.
Design
The study design is a systematic review with meta-analyses.
Data Sources and Methods
A systematic literature search in MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science databases was conducted on epidemiologic studies on physical health conditions, classified in the Global Burden of Disease project, published between 2000 and 2021. Meta-analyses pooling odds ratios were calculated.
Results
In total, 23,649 abstracts were screened and 44 studies were included in the systematic review. Meta-analyses were run for arthritis, asthma, back pain, cancer, chronic kidney diseases, diabetes, headache disorders, heart attacks, hepatitis, hypertension, and stroke. Most significant differences in prevalence by sexual identity were found for chronic respiratory conditions, especially asthma. Overall, sexual minority women were significantly 1.5–2 times more likely to have asthma than heterosexual women. Furthermore, evidence of higher prevalence in sexual minority compared to heterosexual women was found for back pain, headaches/migraines, hepatitis B/C, periodontitis, urinary tract infections, and acne. In contrast, bisexual women had lower cancer rates. Overall, sexual minority women had lower odds of heart attacks, diabetes, and hypertension than heterosexual women (in terms of diabetes and hypertension possibly due to non-consideration of pregnancy-related conditions).
Conclusion
We found evidence for physical health disparities by sexual identity. Since some of these findings rely on few comparisons only, this review emphasizes the need for routinely including sexual identity assessment in health research and clinical practice. Providing a more detailed picture of the prevalence of physical health conditions in sexual minority women may ultimately contribute to reducing health disparities.
... Previous literatures have well-documented the health disparities experienced by the sexual minorities. These studies have re-ported that compared to the general population, lesbian, gay, and bisexual (LGB) individuals are having more adverse health conditions [1][2][3][4][5][6][7][8][9][10][11]. ...
... For women, the prevalence of reporting poor self-rated health and smoking was higher in the LGB population, and the prevalence of hazardous drinking was higher in the LGB population, with the exception of bisexual men, than in the general population. These findings are consistent with previous studies on health disparities of the LGB population [1][2][3][4][5][6][7][8][9][10][11]. ...
... To address the limitations of this study and to gain a more systematic understanding of the health disparities of the Korean LGB population, nationally representative surveys should include sexual orientation in their questionnaires. A growing number of health surveys in North America and Europe include sexual orientation as a demographic variable, based on which many studies are conducted to investigate health disparities of sexual minorities [1][2][3]6,7,9,10,36,37]. The Korea Youth Risk Behavior Web-based Survey is the only national-level health survey in Korea measuring sexual orientation by asking respondents to indicate the gender of the person with whom they had a sexual intercourse. ...
... Across these studies, consistent evidence suggests that sexual minority individuals report poorer physical health, more disability, and more activity limitations compared to heterosexuals (Cochran & Mays, 2007;Fredriksen-Goldsen, Kim, & Barkan, 2012). In terms of specific health conditions, sexual minority women are more likely to receive a breast cancer diagnosis, be obese, and be at risk of cardiovascular disease compared to heterosexual women (Kavanaugh-Lynch, White, Daling, & Bowen, 2002;Diamant & Wold, 2003). Sexual minority men are at higher risk of HIV infection (Cochran & Mays, 2007). ...
... Sexual minority men are at higher risk of HIV infection (Cochran & Mays, 2007). Sexual minority men and women, but particularly women, are more likely to indicate an asthma diagnosis (Diamant & Wold, 2003;Heck & Jacobson, 2006). Limited findings also suggest that compared to heterosexuals, sexual minorities might experience higher rates of diabetes (Fredriksen-Goldsen, Kim, Barkan, Muraco, & Hoy-Ellis, 2013;Wallace, Cochran, Durazo, & Ford, 2011), and sexual minority men might experience higher rates of lymphoma and anal cancer (Koblin et al., 1996) as well as headaches (Cochran & Mays, 2007). ...
Throughout the world, groups that are socially disadvantaged have poorer health compared to groups that are more advantaged. This book examines the role that stigma and discrimination play in creating and sustaining these group health disparities. Stigma is a social construction in which people who are distinguished by a “mark” are viewed as deviant, socially excluded, and devalued. Stigma and the discrimination it engenders negatively affect health through multiple mechanisms operating at several different levels of influence. Collectively, these shape both the orientations of people toward members of stigmatized groups and the experiences, and often the self-concepts, of members of groups targeted by stigma. Stigma affects individual-level affective, cognitive, behavioral, and physiological responses that increase stress in the lives of stigmatized groups. Stigma also restricts access to social and community-level resources relevant to good health and exposes individuals to more toxic environments. All act to erode the health of people who are stigmatized. This volume provides a cutting edge, multidisciplinary, multilevel analysis of health and health disparities through the integrative lens of stigma. It brings together the research of leading social and health psychologists, sociologists, public health scholars, and medical ethicists who study stigma and health. It integrates independent literatures on the health-related outcomes of stigma and discrimination and the diverse pathways and processes by which stigma and discrimination affect multiple health outcomes. The book is also forward-looking: It discusses the implications of these themes for policy, interventions, and health care, as well as identifies the most important directions for future research.
... For example, in one nationally representative survey in the USA, sexual minority women (e.g., women who identify as lesbian, bisexual, queer) were found to have 50% increased risks of adverse mental health compared to heterosexual women (Operario et al., 2015). In another survey, lesbian women were found to take antidepressants at 13 times the rate of heterosexual women (Diamant & Wold, 2003). Similarly, findings from a recent nationally representative survey found that, compared to heterosexual women, sexual minority women had between two to three times the risk of suicidal thoughts and feelings and a four-fold increase in the risk of past-year suicide attempts (Ramchand et al., 2022). ...
... Minority stressors act as key moderators that may either buffer or exacerbate the impact of neighborhood-level deprivation. Sexual minority women are at elevated risks of adverse mental health outcomes relative to the general population (Bolton & Sareen, 2011;Cochran et al., 2003;Diamant & Wold, 2003;Operario et al., 2015;Plöderl & Tremblay, 2015;Ramchand et al., 2022), and understanding how these individual-level processes interact with sources of structural disadvantage is essential to tailoring interventions, screening, and policy for this vulnerable population. ...
Introduction
Little is known about how neighborhood socioeconomic disadvantage influences sexual minority women’s (e.g., lesbian, bisexual) mental health and whether minority stress moderates these associations. We examined the association between neighborhood deprivation and mental health and the potential moderating effects of minority stressors in a community-based sample of sexual minority women.
Methods
Using data from Wave 4 of the Chicago Health and Life Experiences of Women study (N = 359, surveyed 2017–2019), we examined associations between census-tract deprivation—measured using the area deprivation index—and days of poor mental health, with moderation by minority stressors (LGBT community connectedness, internalized homophobia, concealment, stigma consciousness, gender presentation). We controlled for individual and neighborhood demographics and other stressors.
Results
Higher area deprivation was unrelated to days of poor self-rated mental health in adjusted models, but effects were heterogeneous by gender presentation and LGBT community connectedness. As deprivation increased, more masculine and androgynous women evidenced no increased risks of poor mental health. However, among women presenting as neither masculine nor androgynous, risks were positively associated with deprivation (IRRs: 1.44 and 1.34, respectively). Unexpectedly, women with higher levels of LGBT community connectedness (IRR: 1.48) reported worse mental health as deprivation increased. No other minority stressor moderated associations.
Conclusions
Gender presentation appears to be a key factor in the impact of neighborhood deprivation on poor mental health among sexual minority women; the relationship may be more complicated for community connectedness. Our findings suggest that to improve sexual minority women’s mental health, interventions targeting deprivation ought to complement interventions targeting sexual minority stigma.
Policy Implications
To improve mental health among sexual minority women, advocates must promote both broad economic policies and specific protective, anti-stigma policies.
... [2] LGB women also report poorer physical health and greater disability, [3] including early diagnosis of heart disease. [4] This is in contrast to sexual minority men, who are less likely to be obese and tend not to differ from heterosexual males in terms of cardiometabolic disease. [5] Against this backdrop of emerging data indicating health disparities among sexual minorities, the National Institutes of Health requested the Institute of Medicine (IOM) to assess the current state of knowledge of the health of lesbian, gay, bisexual, and transgender people. ...
... Average slopes for BMI from ages 10 to 14 years for LGB participants and heterosexual participants at low and high levels of self-reported loneliness at age 8 years. Controlling for race, BMI and peer victimization at age 10, the slope for heterosexual participants did not differ as a function of high loneliness (F [4,1660] sexual identity, including the emergence of same-sex attraction in childhood. Thus, the temporal occurrence of the mediator was not tied to a specific age or date, but instead to the developmental period during which the emergence of identity began. ...
Objective
To determine whether childhood body mass index (BMI), assessed in childhood, differs between lesbian/gay and bisexual (LGB) and heterosexual late adolescents, and whether childhood social stressors impact the association between sexual orientation and childhood BMI.
Methods
Participants included 2,070 late adolescents from the Pittsburgh Girls Study, of whom 233 (11.2%) identified as lesbian or bisexual and 1,837 (88.8%) as heterosexual at ages 17–20 years. Weight and height were used to calculate body mass index (BMI) at ages 10 through 14 years. Data were collected on child reported loneliness at ages 8 to 10 and peer victimization from 10 to 14 years.
Results
LGB females had higher BMIs and greater increases in BMI from ages 10–14 years compared to heterosexual females and reported higher levels of loneliness and peer victimization in childhood. Loneliness moderated the association between sexual identity and changes in BMI; for participants with loneliness scores in the upper quartile, the increase in BMI over time was approximately 30% higher for LGB females compared to heterosexual females. Child report of peer victimization mediated the association between sexual identity and changes in BMI, with nearly 18% of the total effect of sexual identity on BMI over time accounted for by peer victimization.
Conclusions
Lesbian and bisexual adolescents report greater loneliness and peer victimization as children than heterosexual adolescents; these stressors confer risk for higher BMI among LGB females. These data underscore the importance of research on the social determinants of health. The hypothesis that the social stressors may partially account for differences in BMI and other cardiometabolic risk factors between LGB and heterosexual females should be addressed in future research.
... In agreement with the aforementioned theory, previous research has found that sexual and gender minorities experience mental health problems at a higher rate than members of the majority society (Cochran et al., 2003;Diamant & Wold, 2003;Fredriksen-Goldsen et al., 2013;Gubán et al., 2021;Hickson et al., 2017;King et al., 2003;Lick et al., 2013;Mustanski et al., 2010;Plöderl & Tremblay, 2015). Similar tendencies are uncovered concerning several chronic diseases such as asthma, certain malignant tumors, diabetes, eating disorders or obesity (Bränström et al., 2016;Brooks et al., 2018;Cochran et al., 2013;Frost et al., 2015;Gubán et al., 2021;Mustanski et al., 2010). ...
... Future research should focus on developing a better Introduction A growing body of research has demonstrated extensive health disparities affecting sexual minority populations, relative to their heterosexual counterparts [1][2][3]. For example, sexual minorities are at increased risk for both physical health disparities (e.g., stroke, cardiovascular disease, cancer, and diabetes [4][5][6][7]) and mental health disparities (e.g., depression and anxiety [8][9][10]). A key driver of these disparities can be found in stigma-related stressors (i.e., chronic stress arising from the stigmatization of non-heterosexuality) [11,12]. ...
Introduction
A growing body of research has demonstrated extensive mental health disparities affecting sexual minority populations, yet little research has assessed how these disparities may affect cognitive functioning among subgroups of sexual minorities.
Methods
Data come from the 2021 National Health Information Survey (NHIS). Survey-weighted linear regression analyses were used to assess self-reported measures of cognition, stratified by subgroups sexual identity. In particular, we focused on the association between symptoms of depression or anxiety and each of the measures of cognition, adjusting for demographic covariates.
Results
Among 31,994 NHIS participants in the 2021 survey, 5,658 (17.7%) reported at least some difficulty in remembering or concentrating. Basic demographic differences existed when assessing any cognitive difficulty, particularly for bisexual participants (aOR = 2.73; 95% CI: 2.07, 3.60) and participants identifying as a different identity (aOR = 4.22; 95% CI: 2.72, 6.56). Depression was significantly associated with cognitive difficulty with the largest relationship observed among gay/lesbian participants (aOR = 1.39; 95% CI: 1.29, 1.49). The association between anxiety and cognitive difficulty was smallest among bisexuals (aOR = 1.13; 95% CI: 1.08, 1.18) and relatively consistent across other subgroups: heterosexuals (aOR = 1.23; 95% CI: 1.22, 1.24), gay/lesbians (aOR = 1.27; 95% CI: 1.19, 1.36), and those with a different identity (aOR = 1.22; 95% CI: 1.10, 1.35).
Conclusion
There is a clear set of health disparities between sexual minority subgroups and heterosexuals across all cognitive difficulties. Future research should focus on developing a better understanding of differences in cognition based on sexual minority status while also working to ascertain how disparities vary among sexual minorities.
... However, students with nonheterosexual sexual orientation bear a relatively heavy psychological burden of hostility and isolation from the surrounding groups. The mental health status of non-heterosexual students is worse than that of heterosexual students, and they tend to experience multiple levels and multiple aspects of sexual and gender-related mental health problems [7][8]. ...
In recent years, with the increasing yearning of the Chinese people for a better life, people gradually began to have a diversified understanding and awakening of their sexual orientation. The world no longer sees only heterosexuality, to which most people belong, but also gays, bisexuals, and even pansexuals, who are collectively referred to as sexual minorities. However, at the same time, because the existence of sexual minorities subverts the mission of procreation, which has been given to men and women for thousands of years in China, sexual minorities are stigmatized, stereotyped, and discriminated against by society. Among them, for underage sexual minorities, school bullying is one of the most serious minority pressure they are facing at present. Therefore, based on the research of scholars in the fields of mental health and public health on the relationship between school abuse in high school and sexual orientation, this paper finds that school bullying has a serious negative impact on the physical and mental health of underage sexual minorities, such as depression and suicidal tendencies. In addition, underage sexual minorities can pass first the school perpetration of school violence punishment measures into the school rules; Second, talk about stress to the family, friends, or other sexual minorities; Thirdly, conduct sex education for the whole society in a way to reduce the negative impact of school bullying on them.
... It looks like GM more often abuse marijuana, heroin, and cocaine, while LW abuse more marijuana and analgesics. One study suggests that LW have more problems with mental health, while BW have more problems with physical health when compared to heterosexual ones (Diamant & Wold, 2003). On the other hand, some other international studies failed to find any significant difference regarding psychiatric disorders between LGB subgroups (Bolton & Sareen, 2011;Jager & Davis-Kean, 2011;Kuyper, & Fokkema, 2011). ...
Since there is scarcity of psychological research on lesbian, gay, and bisexual persons (LGB) in Croatia, we aimed to collect first information about the prevalence of psychiatric disorders, psychosocial characteristics and factors related to those issues in LGB adults living there. We focused on bulimia nervosa, binge eating, alcohol abuse, major depressive disorder, other depressive syndromes, panic syndrome, and other anxiety syndromes and somatoform syndrome. Psychosocial information was also gathered and included details about abuse, being out, sexually risky behavior, employment, education, socio-economic status, relationships status and sociodemographic characteristics. According to research, 39% of LGB persons were unemployed and 52.2% were abused. Alcohol abuse is high among all subgroups. Women are prone to somatoform symptoms and alcohol abuse. Since there is insufficient research on the problems of Croatian LGB persons, our results show that there is a real need for regular screening for psychopathology in Croatian homosexual and bisexual persons and for preventive interventions. Keywords: LGBT, mental health, prevalence, psychopathology, assessment, psychiatric disorders, psychosocial problems
... According to the National Alliance on Mental Illness (NAMI; 2019), lesbian, gay, bisexual, transgender, and queer (LGBTQ+) college students are five times more likely to attempt suicide than their heterosexual counterparts, and LGBTQ+ individuals, in general, are at a higher risk than the general population for experiencing suicidal thoughts and distress. LGBTQ+ individuals have also been shown to have greater rates of depressive symptoms and are more likely than heterosexual individuals to be on antidepressant medications (Diamant & Wold, 2003;NAMI, 2019). Relatedly, LGBTQ+ individuals engage in higher rates of substance and alcohol misuse than heterosexual individuals (Hughes & Eliason, 2002;Marshal et al., 2008;Office of Disease Prevention and Health Promotion, 2016) such as binge drinking and illicit drug use (National Institute on Drug Abuse; 2017). ...
LGBTQ+ individuals are at increased risk of experiencing mental health concerns including depression and substance use. Understanding these mental health disparities has been an increasing focus for researchers, but there is still limited research on the relationship between religion and depression and substance use among LGBTQ+ individuals. In the current study, it was theorized that higher perceived parental religiosity influences current experiences of depression and alcohol and substance use/abuse through the mediator of the perceived familial stigma of sexuality (stigmatizing behaviors experienced in the home). Individuals (N = 427) who identified as gay/lesbian, queer, bisexual, pansexual, asexual, and/or demisexual were recruited for the study. Results showed that perceived parental religiosity was positively linked to both current reports of depression, alcohol use, and cannabis use. In line with predictions, perceived familial stigma of sexuality was found to fully mediate the relationships between perceived parental religiosity and depression and cannabis use and to partially mediate the relationship between perceived parental religiosity and alcohol use. Furthermore, there was a moderating effect of gender, showing that gay men experienced the strongest links between perceived parental religiosity and perceived familial stigma and between perceived familial stigma and depression, alcohol use, and cannabis use. The findings of this study implicate perceived familial stigma of sexuality as an important factor that could explain how perceived parental religiosity increases LGBTQ+ individuals’ experiences of mental health concerns.
... The theoretical framework of the minority stress model (Meyer, 1995(Meyer, , 2003, which holds that prejudice, vigilance, isolation, and discrimination are unique and chronic stressors among minority populations, may be applied to understand the impact of COVID-19 (and related factors) on LGB couples' psychophysical health. Previous studies have shown that minority stress is associated with adverse effects on both physical (Diamant and Wold, 2003) and psychological health (D'Augelli et al., 1998;Cochran and Mays, 2006). Thus, the COVID-19 pandemic may represent an indirect mechanism through which same-sex couples experience distal (e.g., discrimination, violence, interpersonal homophobia) and proximal (e.g., ISS, fear of rejection) minority stress (Meyer, 1995(Meyer, , 2003, thereby exacerbating their existing relationships by reducing satisfaction and increasing conflict. ...
Research on the effects of the COVID-19 pandemic on same-sex relationships is limited. The present study aimed at analyzing the association between the psychophysical impact of the COVID-19 pandemic and same-sex couples’ conflict, also considering the potential mediating effect of internalized sexual stigma (ISS). For this purpose, psychophysical challenges and couples’ conflict during the COVID-19 pandemic, ISS, age, biological sex, sexual orientation, relationship duration, religiosity, involvement in lesbian, gay, and bisexual (LGB) associations, sexual satisfaction, and interpersonal partner violence were assessed in an Italian sample of 232 LGB people engaged in a same-sex relationship (aged 18–45 years; Mage = 28.68, SD = 6.91). The results indicated that the psychophysical impact of the COVID-19 pandemic was significantly associated with couples’ conflict, and ISS mediated this relationship. Among the covariates considered, only sexual satisfaction was associated with couples’ conflict. The findings suggest that ISS, over and above the adverse effects of the COVID-19 pandemic on psychophysical health, triggered conflict within same-sex relationships. Studying the role of ISS in various relational and social contexts is important, as ISS may have an adverse effect on the mental health of sexual minority people. We recommend that more efforts be made to improve research on the LGB population during the public health response to the COVID-19 emergency, because the paucity of studies underlines the invisibility of this population in many domains, including the domain of romantic relationships. Implications and directions for future research are discussed.
... This qualitative exploration of how elder SOM individuals' were impacted by historical events provides insights into the complex interaction of social influences and resiliency during times of societal reformation. These insights contribute to the growing body of literature that highlights the strengths and resilience of the SOM community, while acknowledging unique challenges and experiences of SOM elders (e.g., Boggs et al., 2017;Cochran & Mays, 2007;Correro & Nielson, 2020;Diamant & Wold, 2003;McCabe et al., 2010;Gilman et al., 2001;Roberts et al., 2010). We hope that the exploration of these SOM elders' experiences can continue to inspire more research to study hope and resilience in relation to identity, historical events, and social changes. ...
Despite the challenges faced by sexual orientation minority (SOM) individuals, many SOM individuals are able to persist and develop resiliency over the course of their lives. The present study explored how prominent SOM elders perceived the LGBTQ+ community as developing hope and resiliency in relation to major events of lesbian, gay, bisexual, transgender, queer (LGBTQ+) rights development. Using a basic qualitative approach, we analyzed interview data and three categories emerged. More specifically, these categories were: (1) internalization of societal views; (2) fostering safety and acceptance by creating a sense of community; and (3) sources of inspiration for initiating change. The resulting categories show the complex interaction of social influences and resiliency during times of societal reformation. We discuss the implications of how group-based emotions and identity processes during times of societal reformation foster a life-long resilience.
... บทสรุ ปการศึ กษาประสบการณ์ และความต้ องการการสนั บสนุ นในด้ านต่ าง ๆ ของพ่ อแม่ /สมาชิ กครอบครั ว เพื ่ อน และคู ่ ชี วิ ตของประชากรกลุ ่ มความหลากหลายทางเพศ และผู ้ ให้ บริ การสุ ขภาพ และการศึ กษาจากการ สนทนากลุ ่ มกั บกลุ ่ มประชากรความหลากหลายทางเพศในประเด็ นที ่ เกี ่ ยวข้ องกั บความสั มพั นธ์ กั บพ่ อแม่ / สมาชิ กครอบครั ว เพื ่ อน คู ่ ชี วิ ต และผู ้ ให้ บริ การสุ ขภาพ (Clements-Nolle, Marx, & Katz, 2006;Diamant & Wold, 2003;DiStefano, 2008;Fergusson, Horwood, Ridder, & Beautrais, 2005;Fitzpatrick, Euton, Jones, & Schmidt, 2005;King et al., 2003;Warner et al., 2004) นอกจากนี ้ ยั งพบว่ าปั ญหาสุ ขภาพจิ ตเหล่ านี ้ มี ความเชื ่ อมโยงกั บการเลื อกปฏิ บั ติ และ ความบี บคั ้ นทางสั งคมที ่ มี ต่ อกลุ ่ มประชากรความหลากหลายทางเพศ (Díaz, Bein, & Ayala, 2006;Warner et al., 2004) จาก การศึ กษาแบบอภิ มาน (meta-analysis) โดย Marshal และคณะพบว่ าเยาวชนกลุ ่ มความหลากหลายทางเพศมี ความเสี ่ ยงสู งกว่ า ต่ อการฆ่ าตั วตายและการเป็ นโรคซึ มเศร้ า (Marshal et al., 2011) (Almeida, Johnson, Corliss, Molnar, & Azrael, 2009;Birkett, Espelage, & Koenig, 2009;Marshal, Burton, Chisolm, Sucato, & Friedman, 2013;Sopitarchasak et al., 2017;Williams, Connolly, Pepler, & Craig, 2005) Fredriksen-Goldsen และคณะได้ เสนอโมเดลการสร้ างเสริ มความเท่ าเที ยมทางสุ ขภาพ หรื อ Health Equity Promotion Model (Fredriksen-Goldsen et al., 2014) (Midgley, 2013;Shilo & Savaya, 2011;Snapp, Watson, Russell, Diaz, & Ryan, 2015) จากการศึ กษาวิ จั ยในผู ้ ป่ วยโรคมะเร็ งที ่ เป็ นกลุ ่ มความหลากหลายทางเพศพบว่ าคนใกล้ ชิ ดที ่ มี ส่ วนในการสนั บสนุ นผู ้ ป่ วย มากที ่ สุ ดอั นดั บหนึ ่ งคื อเพื ่ อน อั นดั บสองคื อคู ่ ชี วิ ตในขณะนั ้ น และอั นดั บสามคื อสมาชิ กในครอบครั ว (Kamen, Smith-Stoner, Heckler, Flannery, & Margolies, 2015) และพบว่ ารู ปแบบการสนั บสนุ นในลั กษณะของ peer support ในบริ บททางสุ ขภาพมี อยู ่ ด้ วยกั นสามรู ปแบบใหญ่ ๆ คื อ การสนั บสนุ นด้ านอารมณ์ ความรู ้ สึ ก (emotional support) ด้ านข้ อมู ล (informational support) และด้ านการยื นยั น (appraisal support) (Dennis, 2003) นอกจากสมาชิ ...
... Lesbian and bisexual cisgender women are at increased risk of cardiovascular disease and are more likely to be overweight or have obesity compared with heterosexual women. 79,80 This risk is likely secondary to minority stress and rejection of societal standards of beauty. 81 Cisgender gay men tend to have a lower body mass index than heterosexual men but have higher body dissatisfaction and risk for eating disorders. ...
The annual examination is a comprehensive evaluation of patients in which all aspects of health and well-being are considered, including proper screening, appropriate preventive care, and recommendations and resources for healthy living. Clinicians commonly avoid certain topics with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients because they may be unprepared to address their health needs. Therefore, clinicians should learn how to conduct an LGBTQ-friendly annual examination in order to provide high-quality care. This article focuses on both the general and unique health needs of lesbian, gay, bisexual, and queer patients; care for transgender and gender-diverse patients is considered elsewhere.
... Research consistently documents disparities in psychological well-being and mental health outcomes among lesbian, gay, bisexual, and transgender (LGBT 1 ) individuals. For example, compared to their heterosexual counterparts, LGB individuals have increased prevalence of mental health disorders (Cochran, Sullivan, & Mays, 2003;King et al., 2008;Meyer, 2003), greater likelihood of reporting poor mental health (Diamant & Wold, 2003;Dilley, Simmons, Boysun, Pizacani, & Stark, 2010;McNair, Kavanagh, Agius, & Tong, 2005), greater likelihood of O R I G I N A L A R T I C L E reporting psychological distress Conron, Mimiaga, & Landers, 2010), and greater likelihood of experiencing suicidal ideation and attempting suicide (Conron et al., 2010;King et al., 2008). Additionally, transgender and gender non-binary individuals have a higher prevalence than their cisgender counterparts of clinical depression and anxiety (Bockting, Miner, Swinburne Romine, Hamilton, & Coleman, 2013) and suicidality (Herman, Brown, & Hass, 2019). ...
People who identify as lesbian, gay, bisexual, and/or transgender (LGBT) experience disparate levels of psychological distress due to marginalization, yet there are also opportunities for community connectedness and sociopolitical involvement in identify-specific issues and organizations, which may improve psychological well-being. This study contributes to intersectional research on LGBT psychological well-being by locating LGBT community connectedness as a mediator of the associations between well-being and (a) LGBT sociopolitical involvement and (b) being out as LGBT among a sample of predominately LGBT-identified adults in the United States and Puerto Rico (n = 4940) across four racial/ethnic identity groups: non-Hispanic Black, Latinx/Hispanic, non-Hispanic White, and other races/ ethnicities. Analyses revealed that separate models were operating across racial/ethnic identity groups. Path analysis further showed that LGBT community connectedness mediated (either partially or fully) the effects of both LGBT sociopolitical involvement and outness on well-being. Direct effects on well-being were also found for family support across all groups and for outness only among the non-Hispanic White and other races/ethnicities groups. Community leaders and practitioners should seek to create opportunities for LGBT sociopolitical involvement and other activities that may facilitate feeling connected to LGBT community as part of efforts to promote LGBT well-being.
... These high rates of discriminatory stress and violence contribute to increased drug, alcohol, and tobacco use among sexual minority (SM) people and may also negatively impact bone health. To date very little research has examined bone health among persons of minority sexual orientations, independent of HIV infection (Diamant & Wold, 2003;Grijsen et al., 2013). As the global incidence of osteoporosis increases, it is critical to investigate the socioeconomic, psychosocial, and ecological risk factors for osteoporosis among individuals from marginalized and minority subpopulations in order to develop comprehensive policies that meet the needs of diverse communities. ...
Introduction: Sexual minority (SM) people experience significant stress associated with stigma, contributing to a higher rate of adverse health outcomes. Several known factors (eg, smoking) elevate risk of poor bone health, but to date little research has examined disparities in bone health among SM people. To address this, we analyzed sexual orientation differences in an available bone mineral density (BMD) cross-sectional dataset assessed via dual X-ray absorptiometry.
Methods: We combined the to 2014 cycles of US National Health and Nutrition Examination Survey to examine sexual orientation-based differences in z-scored BMD in the proximal femur (greater trochanter and intertrochanter locations), bone mineral content (BMC) in the femur and spine, and osteoporosis risk among Lesbian/Gay (n = 53), Bisexual (n = 97), Same-Sex Experienced (n = 103), and Heterosexual (n = 2990) adults.
Results: Sexual orientation-based disparities in bone mass were observed across all anatomical sites. This effect was due to differences between heterosexual and gay men and persisted in linear regressions after adjusting for risk factors. We found differences in femoral and femoral neck BMC in heterosexual and gay men (P = .02) and in femoral, femoral neck and spinal BMC between heterosexual and bisexual women (P = .05). Sexual orientation remained significant in BMC regressions.
Conclusion: Our findings suggest that SM men but not women are at greater risk for poor bone health relative to heterosexuals and this disparity is independent of the lifestyle and psychosocial risks included in our models.
... These high rates of discriminatory stress and violence contribute to increased drug, alcohol, and tobacco use among sexual minority (SM) people and may also negatively impact bone health. To date very little research has examined bone health among persons of minority sexual orientations, independent of HIV infection (Diamant & Wold, 2003;Grijsen et al., 2013). As the global incidence of osteoporosis increases, it is critical to investigate the socioeconomic, psychosocial, and ecological risk factors for osteoporosis among individuals from marginalized and minority subpopulations in order to develop comprehensive policies that meet the needs of diverse communities. ...
... Similarly, Diamant and Wold (2003) found that lesbian and bisexual women reported more instances of CVD diagnoses than heterosexual women. Unfortunately, seemingly no research has examined the prevalence of CVD in transgender individuals. ...
Much of the existing research in the area of LGBTQ health demonstrates that LGBTQ individuals have worse health than non-LGBTQ individuals. The proposed reason for these disparities is minority stress. Some existing research does not support the idea that LGBTQ individuals have worse health that non-LGBTQ individuals, resulting in mixed findings in the literature. Previous works in the social identity literature suggest that identifying as a member of a social group predicts better health and greater well-being. Identifying with the LGBTQ community may act as a buffer against the negative health outcomes of experiencing minority stress for LGBTQ individuals. The current study utilized multilevel meta-analytic techniques to explore the relationship between LGBTQ community identification and four main indicators of physical health identified in the literature: substance use, sexual behavior, health status, and utilization of health services. Ninety-nine effect sizes from 32 articles were analyzed using multilevel random effects models. Stronger identification with the LGBTQ community was found to be associated with greater substance use (r = -.058, p = .037, 95% CI = -.113, -.003). No other indicators of physical health were statistically significantly associated with LGBTQ community identification. Additionally, moderators of the association between LGBTQ community identification and each of the four indicators of physical health were explored. Findings indicate that stronger identification with the LGBTQ community may not foster community resilience, especially for LGBTQ individuals with multiple marginalized identities.
... It is well established that lesbian, gay, bisexual, transgender, queer plus (LGBTQ+) individuals face substantial health disparities compared to the general population. 6,7,8 To address these disparities and improve patient care, the medical community has started to integrate more training on LGBTQ+ health into medical education. 9 Resources specifically targeting pronoun use among clinicians are also available. ...
In September 2019, a prominent dictionary recognized they as a proper pronoun for nonbinary individuals. This change can be seen as a source of newfound legitimacy for students and trainees self-advocating for nonbinary pronoun recognition in health care practice and training. This article considers one student's experience after coming out as nonbinary and voicing that their pronouns are they/them.
... Approximately 4.5% of Americans identify as LGBT, and out of this percentage, 7% of LGBT individuals are older adults (LGBT Data and Demographics, 2019). It has been well documented that individuals identifying as LGBT are an underserved population and they experience a number of health problems relative to their cisgender and straight peers (Fredriksen-Goldsen et al., 2013). 1 Compared with those identifying as cisgender and straight, those identifying as LGBT endorse higher rates of depression, anxiety, and psychological distress (Chae & Ayala, 2010;Cochran et al., 2003;Conron et al., 2010;Diamant & Wold, 2003;Dilley et al., 2010;Riggle et al., 2010;Wallace et al., 2011). ...
Objectives: Previous research has examined the link between discrimination and health in lesbian, gay, bisexual, and/or transgender (LGBT) individuals. The purpose of this study was to examine if health-promoting variables, like social networks, might disrupt this association. Method: Participants were 2,560 LGBT older adults who reported on the composition of their social network, level of discrimination, stress, and health/well-being. Results: Moderated mediation results indicated that social network size disrupted the associations between discrimination, stress, and health outcomes when social networks were (a) larger and (b) comprised of LGBT individuals (but not straight individuals), regardless of age. Discussion: Larger social networks that include fellow LGBT individuals helped buffer experiences of stress and discrimination on health outcomes among LGBT older adults. Implications for how protective factors can reduce the negative effects of discrimination and stress are discussed.
... [13][14][15] Lesbian and bisexual women may have increased rates of obesity, heart disease, and postpartum depression compared with heterosexual women. 16,17 Transgender patients undergoing hormone therapy may be at elevated risk of venous thromboembolism and may have undergone airway surgery. 10 With successful deliveries following uterine transplant, the question of uterine transplant and delivery for transgender women is a real possibility. ...
Purpose:
Improved patient-provider relationships can positively influence patient outcomes. Sexual and gender minorities (SGM) represent a wide variety of marginalized populations. There is an absence of studies examining the inclusion of SGM-related health education within postgraduate training in anesthesia. This study's objective was to perform an environmental scan of the educational content of North American obstetric anesthesia fellowship programs.
Methods:
An online survey was developed based on a review of the existing literature assessing the presence of SGM content within other healthcare-provider curricula. The survey instrument was distributed electronically to 50 program directors of North American obstetric anesthesia fellowship programs. Survey responses were summarized using descriptive statistics.
Results:
Survey responses were received from 30 of the 50 program directors (60%). Of these, 54% (14/26) felt their curriculum adequately prepares fellows to care for SGM patients, yet only 19% (5/26) of participants stated that SGM content was part of their curriculum and 31% (8/26) would like to see more incorporated in the future. Perceived lack of need was chosen as the biggest barrier to curricular inclusion of SGM education (46%; 12/26), followed by lack of available/interested faculty (19%; 5/26) and time (19%; 5/26).
Conclusions:
Our results suggest that, although curriculum leaders appreciate that SGM patients are encountered within the practice of obstetric anesthesia, most fellowship programs do not explicitly include SGM curricular content. Nevertheless, there appears to be interest in developing SGM curricular content for obstetric anesthesia fellowship training. Future steps should include perspectives of trainees and patients to inform curricular content.
... Compared with gay men, lesbian women have greater social invisibility and fewer role models. Studies using population-based samples and reports of self-identified sexual orientation (rather than sexual practices) found that, in comparison with heterosexual women, lesbian women reported higher daily alcohol intake, higher rates of depression and antidepressant medication usage, greater emotional stress as teenagers, higher rates of eating disorders, greater frequency of suicidal ideation in the past 12 months, greater frequency of suicide attempts, and more days of poor mental health within the past month (Diamant and Wold 2003;Institute of Medicine 2011;Koh and Ross 2006). ...
... Compared with gay men, lesbian women have greater social invisibility and fewer role models. Studies using population-based samples and reports of self-identified sexual orientation (rather than sexual practices) found that, in comparison with heterosexual women, lesbian women reported higher daily alcohol intake, higher rates of depression and antidepressant medication usage, greater emotional stress as teenagers, higher rates of eating disorders, greater frequency of suicidal ideation in the past 12 months, greater frequency of suicide attempts, and more days of poor mental health within the past month (Diamant and Wold 2003;Institute of Medicine 2011;Koh and Ross 2006). ...
This chapter addresses the psychiatric care of lesbian, gay, bisexual, transgender (LGBT), and gender non-conforming individuals. Today, psychiatric focus is on treating depression, anxiety, trauma, or other diagnoses in LGBT patients, as well as addressing problems encountered in living as a lesbian, gay, bisexual, transgender, or gender non-conforming person. As a minority population facing a high degree of stress and discrimination, LGBT and gender non-conforming individuals are at greater risk for poor mental health outcomes and may use mental health services at higher rates than heterosexual cisgender patients. Mental health professionals must be sensitive to the needs of lesbian, gay, bisexual, transgender, and gender non-conforming persons.
... Compared with gay men, lesbian women have greater social invisibility and fewer role models. Studies using population-based samples and reports of self-identified sexual orientation (rather than sexual practices) found that, in comparison with heterosexual women, lesbian women reported higher daily alcohol intake, higher rates of depression and antidepressant medication usage, greater emotional stress as teenagers, higher rates of eating disorders, greater frequency of suicidal ideation in the past 12 months, greater frequency of suicide attempts, and more days of poor mental health within the past month (Diamant and Wold 2003;Institute of Medicine 2011;Koh and Ross 2006). ...
This chapter addresses the psychiatric care of lesbian, gay, bisexual, transgender (LGBT), and gender non-conforming individuals. Today, psychiatric focus is on treating depression, anxiety, trauma, or other diagnoses in LGBT patients, as well as addressing problems encountered in living as a lesbian, gay, bisexual, transgender, or gender non-conforming person. As a minority population facing a high degree of stress and discrimination, LGBT and gender non-conforming individuals are at greater risk for poor mental health outcomes and may use mental health services at higher rates than heterosexual cisgender patients. Mental health professionals must be sensitive to the needs of lesbian, gay, bisexual, transgender, and gender non-conforming persons.
... Both fear of and prior experience with discrimination from health care professionals might prevent LGBTQ individuals from seeking medical care and participating in medical screenings (Council of Europe, 2011;Elliott et al., 2015;van der Star & Branstrom, 2015). The experienced discrimination and this lower level of health-seeking behavior and use of health care services might lead to higher levels of mental (Bränström, 2017;Cochran, Mays, & Sullivan, 2003;King et al., 2003;Mays & Cochran, 2001;Ploderl & Tremblay, 2015;Russell & Fish, 2016) and physical health problems (Bränström et al., 2016;Cochran & Mays, 2007;Conron, Mimiaga, & Landers, 2010;Diamant & Wold, 2003;Elliott et al., 2015;Fredriksen-Goldsen et al., 2013;Huebner & Davis, 2007;Sandfort, Bakker, Schellevis, & Vanwesenbeeck, 2006). Furthermore, a maladaptive coping mechanism for dealing with discrimination is the use and abuse of alcohol, tobacco, and illegal drugs (Aaron et al., 2001;Burgard, Cochran, & Mays, 2005;McLaughlin, Hatzenbuehler, & Keyes, 2010;Valanis et al., 2000), which are not only more frequent among LGBTQ populations than among the general population, but may also further deteriorate the health of LGBTQ persons (Elliott et al., 2015;Faix-Prukner & Rózsa, 2015;Fredriksen-Goldsen, Hoy-Ellis, Goldsen, Emlet, & Hooyman, 2014;Mayer et al., 2008;Mereish, O'Cleirigh, & Bradford, 2014;Mustanski, Garofalo, & Emerson, 2010). ...
Discrimination that LGBTQ individuals experience in health care settings might affect their health and intention of using health care services. However, health needs of LGBTQ patients are still inappropriately addressed in the medical curriculum. First-, third-, and fourth-year medical students (N = 569) from the four Hungarian medical universities participated in a study in 2017 to assess knowledge about homosexuality, homonegativity, and their attitude as health care professionals toward sexual minorities. We found that higher levels of knowledge about homosexuality were associated with lower levels of homonegativity, upper-grade level in university, not being religious, and having close LGBTQ acquaintances. Our results suggest that it may be necessary to introduce LGBTQ themes in the medical curricula (not only in Hungary, but also in other countries) in order to improve the knowledge and attitude of medical students and thereby improve the health care of LGBTQ individuals.
... Researchers have examined the lives of LGBTQ people and frequently conclude that this population encounters a disproportionate amount of violence and harassment (Kann et al., 2016;Kosciw et al., 2014Kosciw et al., , 2016Waters, Jindasurat, & Wolfe, 2016) and issues of mental health (Cochran & Mays, 2000, 2005Cochran et al., 2003;Diamant & Wold, 2003;Gilman et al., 2001;Meyer, 2003;Oswalt & Wyatt, 2011;Przedworski et al., 2015). Specifically, LGBTQ people report higher rates of depression (Cohen, Blasey, Barr Taylor, Weiss, & Newman, 2016;Kerr, Santurri, & Peters, 2013;Shearer et al., 2016), anxiety (Cohen et al., 2016;Kerr et al., 2013;Oswalt & Wyatt, 2011;Shearer et al., 2016), traumatic distress (Cohen et al., 2016;Shearer et al., 2016), social phobia (Cohen et al., 2016), bullying (Kann et al., 2016), substance use and abuse (Kann et al., 2016), and suicide-related behaviors (Kann et al., 2016;Kerr et al., 2013;Oswalt & Wyatt, 2011;Shearer et al., 2016) than their heterosexual counterparts. ...
The purpose of this study was to explore features of university environments that support well-being as perceived by undergraduate lesbian, gay, bisexual, and questioning (LGBQ) music and art students. Data were drawn from the 2013–2015 administrations of the College Student Report (CSR) by the National Survey of Student Engagement. Responses of students who identified as music majors, music or art education majors, or as LGBQ (n = 30,014) were extracted. CSR items regarding the students’ collegiate experiences corresponding with dimensions of Seligman’s well-being theory (i.e., positive emotions, engagement, relationships, meaning, achievement) were used to create composite variables for analysis. The data indicated similar ratings between heterosexual and LGBQ music/art students for positive emotion, engagement, and relationships. In contrast, non–music/art LGBQ students rated items pertaining to positive emotions and relationships lower than heterosexual music/art students and lower than both heterosexual students and LGBQ music/art students in engagement. Both LGBQ groups rated meaning items significantly higher than heterosexual music/art students. The data also indicated that heterosexual music/art students rated achievement items significantly higher than both LGBQ groups. These findings suggest that heterosexual and LGBQ music/art students may perceive better support for their well-being by their institutions’ environments than their non–music/art LGBQ peers.
... Utilizing recent data from the National Health Interview Survey, it has been revealed that sexual minority adults report poorer health status in a number of health categories [4]. Compared to their heterosexual peers, lesbian and bisexual women have higher rates of heart disease [5] as well as asthma and chronic obstructive pulmonary disease [6]. Similarly, gay and bisexual men have an increased risk of cardiovascular disease when compared to their heterosexual peers [7]. ...
Purpose of Review
Sexual and gender minority (SGM) populations, including lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, continue to experience significant health and healthcare disparities. One mechanism proposed to address these disparities is improving the education of healthcare professionals. This narrative review summarizes recent trends specifically in medical education related to LGBTQ/SGM populations and highlights examples of curricular innovations.
Recent Findings
Efforts are described in all levels of medical education. The predominant contributions to literature include documenting the current state of education and patient care, including further defining gaps. There are many reports of educational efforts in various institutions, with reports of outcomes mostly in the domain of activity acceptability and learner self-efficacy. Interventions have been developed by both faculty and learners with broad acceptability and perceived value.
Summary
Existing publications continue to point out needed research in LGBTQ/SGM medical education. We also identify areas for additional innovation efforts.
... [4][5][6][7][8][9][10][11][12][13][14]. 정신건강의 측면에서 동성애자와 양성애자는 전반적인 정신건강의 수준이 낮으며 [6][7][8]13,14], 자살생각을 더 많 이 하는 것 [9]으로 나타났다. 신체적 건강의 측면에서도 동성애자 · 양성애자는 일반인구에 비해 불면증이나 피부염 [4]을 포함한 여 러 만성질환 [6]의 유병률이 높은 것으로 나타났다. ...
... LGBTQI2S people report poorer mental health overall than heterosexual, cis-gender, non-intersex-identifying populations, and face higher rates of depression, anxiety, self-harm, substance use, and suicidality. [61][62][63] Within women, there are higher rates of unmet mental health care needs, particularly among bisexual women and trans women. Trans people are 2.4 times more likely to report an unmet need for mental health supports, and bisexual women are 1.8 times more likely, relative to cisgender, heterosexual women. ...
British Columbia's Women's Health Research Agenda reviews the landscape of women’s health research in BC and charts the priorities, challenges, and opportunities for women’s health research, knowledge translation (KT), and implementation across the province.
... [4][5][6][7][8][9][10][11][12][13][14]. 정신건강의 측면에서 동성애자와 양성애자는 전반적인 정신건강의 수준이 낮으며 [6][7][8]13,14], 자살생각을 더 많 이 하는 것 [9]으로 나타났다. 신체적 건강의 측면에서도 동성애자 · 양성애자는 일반인구에 비해 불면증이나 피부염 [4]을 포함한 여 러 만성질환 [6]의 유병률이 높은 것으로 나타났다. ...
This chapter will describe five noncommunicable diseases (NCDs) and their implications for the sexual and gender minority (SGM) population: cardiovascular diseases (CVD), cancer, diabetes mellitus (DM), asthma, and chronic obstructive pulmonary disease (COPD). These were selected due to their high relative prevalence among NCDs (World Health Organization, Fact sheet: noncommunicable diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases . Accessed 25 Nov 2022, 2018). An extensive literature review was undertaken to uncover studies that reported on NCD prevalence among the SGM population, globally. For SM studies, nine countries that are considered mature from an economic perspective represented almost all of the findings. For transgender studies, almost all studies about cancer were case and case series reports, and these represented numerous countries around the world. The limited data representing a global perspective among sexual minorities hints at the possibility of a similar burden for CVD, cancer (excluding HIV/AIDS-related cancers), DM, COPD, and asthma (among SM men) compared to heterosexual and/or cisgender populations. The same seems to be true for transgender populations, with some evidence of elevated CVD risk among transfeminine populations.
Gender identity and sexual orientation are determinants of health that can contribute to health inequities. In the 2SLGBTQIA+ community, belonging to a sexual and/or gender minority group leads to a higher risk of negative health outcomes such as depression, anxiety, and cancer, as well as maladaptive behaviors leading to poorer health outcomes such as substance abuse and risky sexual behavior. Empirical evidence suggests that inequities in terms of accessibility to health care, quality of care, inclusivity, and satisfaction of care, are pervasive and entrenched in the health care system. A better understanding of the current Canadian health care context for individuals of the 2SLGBTQIA+ community is imperative to inform public policy and develop sensitive public health interventions to make meaningful headway in reducing inequity. Our search strategy was Canadian-centric and aimed at highlighting the current state of 2SLGBTQIA+ health inequities in Canada. Discrimination, patient care and access to care, education and training of health care professionals, and crucial changes at the systemic and infrastructure levels have been identified as main themes in the literature. Furthermore, we describe health care-related disparities in the 2SLGBTQIA+ community, and present available resources and guidelines that can guide healthcare providers in narrowing the gap in inequities. Herein, the lack of training for both clinical and non-clinical staff has been identified as the most critical issue influencing health care systems. Researchers, educators, and practitioners should invest in health care professional training and future research should evaluate the effectiveness of interventions on staff attitudinal changes toward the 2SLGBTQIA+ community and the impact on patient outcomes.
Purpose:
This continuing professional development module aims to elucidate the current demographics of anesthesiology in Canada and the experience of anesthesiologists from equity-seeking groups. This module will also identify and describe factors impacting the health care experience of patients from equity-seeking groups who receive perioperative, pain, and obstetric care.
Principal findings:
In recent years, discrimination based on sex, gender, race, ethnicity, sexual orientation, ability, other demographic factors, and the intersection of these identities have gained greater attention not only in our society at large but also within medicine and anesthesiology. The stark consequences of this discrimination for both anesthesiologists and patients from equity-seeking groups have become clearer in recent years, although the full scope of the problem is not fully understood. Data regarding the demographics of the national anesthesia workforce are lacking. Literature describing patient perspectives of various equity-seeking groups is also sparse, although increasing. Health disparities impacting people who are racialized, women, LGBTQIA+, and/or living with disability are also present in the perioperative context.
Conclusion:
Discrimination and inequity persist in the Canadian health care system. It is incumbent upon us to actively work against these inequities every day to create a kinder and more just health care system in Canada.
Systemic, institutional, and individual-level responses to difference have been found to be associated with the development of health and healthcare disparities across various groups in the USA. This chapter provides an overview of existing disparities across a selection of diseases and disorders and access to healthcare. This chapter then examines the research relating to the relationship between such disparities and structural racism, as well as the hypothesized mechanisms through which structural racism may affect health outcomes. This chapter discusses, as well, other models that may explain health disparities affecting various minoritized groups.KeywordsAcculturative stressBuilt environmentCancerHealth disparitiesMental illnessMinority stressStructural racism
Compared to heterosexual individuals, gay men and lesbian women experience multiple health inequities, including higher prevalence of substance use and cardiovascular disease (CVD). Gay men and lesbian women also face structural stigma, including laws that fail to protect or actively discriminate against them. These phenomena can be understood by considering two theories previously tested among gay men and lesbian women: minority stress and cognitive escape. Minority stress theory suggests being stigmatized for one's minority identity relates to negative health sequelae, while cognitive escape theory suggests escape-related behaviors may mediate links between chronic stress exposure and health. Using 2017 Behavioral Risk Factor Surveillance System data, we ran binary logistic regressions to test models in which binge drinking and cigarette smoking independently mediated links between structural stigma and health among gay men and lesbian women. Structural stigma was operationalized at the U.S. state level as number of sexual orientation anti-discrimination laws. Health was operationalized as presence of any CVD. Models were tested in an aggregated sample, and also in subsamples by sex. In bivariate and component-path analyses, structural stigma predicted smoking across samples. Structural stigma-binge drinking associations were more salient among lesbian women compared to gay men. Per Sobel test results, smoking mediated associations between structural stigma and CVD in the gay men sample, suggesting gay men may smoke to escape from structural stigma, with negative implications for cardiovascular health.
Sexual minority women, or women who identify as lesbian, gay, or bisexual (LGB), are a diverse and individually unique group of women; however, at a population level, they face unique health challenges and are affected by health disparities. Compared to heterosexual adults, LGB adults appear to experience mood disorders at a higher rate and may be at increased risk for cardiovascular disease. Individuals who identify as LGB are also at increased risk for discrimination, stigmatization, and violent crimes compared to their heterosexual counterparts. In this chapter, we discuss ways to improve the experience of women who identify as LGB have with healthcare providers, as well as ways to improve preventative care and counseling on population-specific topics.
The purpose of this study was to explore potential differences in health behaviors and outcomes of sexual minority women (SMW) of color compared to White SMW, heterosexual women of color, and White heterosexual women. Data from 4878 women were extracted from the 2011 to 2016 National Health and Nutritional Examination Survey. The four-category independent variable (SMW of color, White SMW, heterosexual women of color, and White heterosexual women) was included in binary and multinomial logistic regression models predicting fair/poor self-reported health status, depression, cigarette smoking, alcohol, cannabis, and illicit drug use. Compared to White heterosexual women, SMW of color and heterosexual women of color had significantly higher odds of fair/poor self-reported health and lower odds of being a current or former smoker, binge drinking or using alcohol in the past year, being a former cannabis user, and ever using illicit drugs. In contrast, White SMW had significantly greater odds of depression, current smoking and cannabis and illicit drug use. Results of post-hoc tests indicated that the adjusted ORs for SMW of color differed significantly from those of White SMW for all outcomes, and did not differ significantly from those for heterosexual women of color for any outcome other than no binge drinking (OR = 0.34 vs. 0.67, p < 0.01) and current cannabis use (OR = 0.93 vs. 0.44, p < 0.01). SMW of color are more similar to heterosexual women of color than to White SMW in terms of depression, substance use, and self-reported health.
Shared historical and social contexts influence a generational group’s needs, risk factors, and resiliency mechanisms. Sexual and gender minority (SGM) older adults have experienced structural exclusion and systematic discrimination throughout their lifetime. The minority stress model posits that SGM individuals experience stressors, like discrimination, unique to their social status which affect physical and mental health. SGM older adults experience worse physical and mental health outcomes than their heterosexual peers suggesting unique needs for SGM older adults. Research also points to resiliency mechanisms that offset the impact of stressors on SGM older adults. The examination of these needs and resiliency mechanisms help to better understand how to improve quality of life and health outcomes among SGM older adults. To identify needs and resiliency mechanisms, a concurrent mixed method study was conducted with SGM older adults (50 years and older). First, a secondary data analysis of a statewide cross-sectional online survey examined the community needs of SGM older adults in Texas. A total of 104 SGM older adults completed the survey (7.63% of survey participants). Comparisons across gender and sexual identity were conducted using chi square and Fisher’s exact tests to probe for significant findings. Three categories of needs were identified: culturally sensitive healthcare, mental health and suicide, and social determinants of health. Second, primary data collection through focus groups and semi-structured interviews further explored community needs. Three one-hour focus groups were conducted with SGM older adults. Emerging needs for SGM women included the role of social support, pets, and religion/spirituality in health. Thirty- seven semi-structured interviews were then conducted to better understand these needs as well as the emerging resiliency mechanisms of SGM women and gender non-binary adults. Two resiliency mechanisms were identified from the interviews, social networks and religiosity or spirituality. Common themes were identified surrounding experiences influencing support networks types and their influence on health. Another important source of resiliency was an individual’s religiosity or spirituality. There were differences among those who reported conflict between their SGM and religious identity during their lifetime. These findings suggest implications for interventions tailored to specific SGM older adult populations to increase healthcare and social support resources especially for those experiencing isolation and/or conflict between SGM or religious identity.
Stereotype threats have been documented in an academic and work setting and have been found to have a significant impact on an individual's behavior as it could be a barrier in receiving healthcare services. This paper explores the impact of health-related stereotype threats and its influence within a LGBT sample with the use of an online survey to explore underlying and unconscious barriers within mental health services. A series of regressions were used to analyze and explore the potential predictability the health-related stereotype threats may have on the fear of communicating with a physician, delay in mental health services, and poor mental health outcomes. High reports of health-related stereotype threats significantly predicted high reports of fear of the physician which could indicate that many LGBT patients are afraid to communicate with their providers about their mental health due to stereotype threats (F (1,91) = 9.844, p < .005). In addition, high reports of health-related stereotype threats slightly but significantly predicted reported delays in seeking mental health services (χ2(1) = 4.220, p < .05). In addition, although there was no significance related to positive affect scores, health related stereotype threats significantly predicted self-reported poor mental health outcomes (F (1,90) = 4.545, p < .05) and high rates of negative affect scores (i.e., anxiety, depression; F (1,89) = 4.933, p < .05). Recommendations and future study will also be discussed.
Background
Recognizing the unique health needs of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer/questioning individuals) is critical to providing competent and comprehensive healthcare.
Objective
To assess resident knowledge of healthcare issues uniquely affecting sexual and gender minorities as well as the role of online case-based didactics to measure and improve knowledge in the diagnosis and treatment of these patients.
Design
A multicenter online education intervention from December 2016 to April 2018.
Participants
The study population consisted of 833 PGY1-3 residents at 120 internal medicine residency programs in the USA who completed 1018 tests.
Interventions
A 1-h online module addressing sexual and gender minority (SGM) health. The test evaluated each resident in four categories: (1) terminology relevant to SGM patients; (2) health disparities and preventive care issues affecting SGM patients; (3) substance use and mental health issues unique to SGM patients; and (4) common sexually transmitted illnesses affecting SGM populations.
Main Measures
Participants completed a pre-test assessing SGM health knowledge. A didactic module reviewing diagnosis and management of these diseases was then completed, followed by a post-test.
Key Results
Among 1018 resident respondents, there was no difference between post-graduate year pre-test performance (PGY-1 52%, PGY-2 50%, PGY-3 51%; p = 0.532) or post-test performance (PGY-1 80%, PGY-2 82%, PGY-3 82%; p = 0.285). Pre-test and post-test performance of an online didactic module was the same across test categories and patient populations for PGY-1 vs. PGY-2 vs. PGY-3. Residents demonstrated an improvement between pre- and post-test knowledge.
Conclusions
Baseline knowledge of health issues of sexual and gender minorities, as assessed by pre-test performance, did not change during residency training. An online didactic module introduced trainees to critical issues regarding the care of these vulnerable populations until such curricula are required in training. Health disparities in LGBTQ communities may improve with improved physician training on clinical care of LGBTQ patients and families.
Limited research has examined lesbian and bisexual women’s sexual health practices in the Caribbean, where lesbian and bisexual women experience sexual stigma that may reduce sexual healthcare utilisation. We conducted a sequential multi-method research study, including semi-structured individual interviews (n = 20) and a focus group (n = 5) followed by a cross-sectional survey (n = 205) with lesbian and bisexual women in Kingston, Montego Bay, and Ocho Rios, Jamaica. Binary logistic analyses and ordinal logistic regression were conducted to estimate the odds ratios for social-ecological factors associated with lifetime STI testing, sex work involvement, and the last time of STI testing. Over half of participants reported a lifetime STI test and of these, 6.1% reported an STI diagnosis. One-fifth of the sample reported ever selling sex. Directed content analysis of women’s narratives highlighted that stigma and discrimination from healthcare providers, in combination with low perceived STI risk, limited STI testing access and safer sex practices. Participants described how safer sex self-efficacy increased their safer sex practices. Quantitative results revealed that a longer time since last STI test was positively associated with depression, sexual stigma, and forced sex, and negatively associated with residential location, perceived STI risk, safer sex self-efficacy, and LGBT connectedness. Selling sex was associated with perceived STI risk, relationship status, sexual stigma, food insecurity, and forced sex. Sexual health practices among lesbian and bisexual women in Jamaica are associated with intrapersonal, interpersonal, and structural factors, underscoring the urgent need for multi-level interventions to improve sexual health and advance sexual rights among lesbian and bisexual women in Jamaica.
The purpose of this review article is to connect sociological perspectives on global health to Lesbian, Gay, and Bisexual health disparities. This article uses the ecosocial theory of health to analyze the ratification of LGB human rights as a cross‐national contributor to health outcomes for the LGB population. I outline the findings of previous research on this intersection as well as call for more research on this relationship by addressing the gaps within the literature and available data, which have stalled more robust analysis. Finally, I address potential future directions for research including further data collection and attentiveness to national contexts.
A number of studies have described lesbians in the United States as an underserved patient population. Among women in the United States, having a sexual orientation other than heterosexual is associated with increased rates of poor physical and mental health. This chapter will provide background to the ways that lesbians in the United States have been shown to be underserved in terms of health care and describe what clinicians can do to improve the quality of care provided to lesbian women, including detailed recommendations for gynecologic care in the outpatient setting.
Background:
HIV prevalence among men who have sex with men (MSM) in Jamaica, where same sex practices are criminalized, is among the Caribbean's highest. Sexual stigma, the devaluation, mistreatment and reduced power afforded to sexual minorities, is a distal driver of HIV vulnerabilities. The mechanisms accounting for associations between sexual stigma and condom use outcomes are underexplored. We examined pathways from sexual stigma to condom use and condom breakage and/or slippage among MSM in Jamaica.
Methods:
We conducted a cross-sectional survey with a chain referral sample of MSM (n=556) in Kingston, Montego Bay, and Ocho Rios. Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of sexual stigma on inconsistent condom use and condom breakage/slippage, and the indirect effects via depression, sexual abuse history, and condom use self-efficacy, adjusting for socio-demographic factors.
Results:
One-fifth of participants (21%; 90/422) who had engaged in anal sex reported inconsistent condom use and 38% (155/410) reported condom breakage/slippage during the prior four weeks. The relationship between sexual stigma and inconsistent condom use was mediated by the combination effect of sexual abuse history, condom use self-efficacy, and depression. The relationship between sexual stigma and condom breakage and slippage was mediated by the combination effect of condom use self-efficacy and sexual abuse history.
Conclusions:
Sexual stigma is associated with negative condom use outcomes in Jamaican MSM, mediated by psychosocial factors. Multilevel social ecological approaches to the HIV prevention cascade can inform interventions at individual, interpersonal, community, and systemic levels.
Sexual minority women may be invisible in health care settings unless practitioners ask every patient about sexual attractions/behaviors and identity. Sexual minority women need to feel comfortable and able to share information about their sexual identity, partners, and lives. No medical diagnoses are found more commonly in sexual minority women, but problems such as overweight/obesity, increased tobacco and alcohol use, increased mental health problems, and a past history of childhood sexual abuse are common. These factors intertwine when treating sexual minority women.
Abstract This article presents demographic, lifestyle, and mental health information about 1,925 lesbians from all 50 states who participated as respondents in the National Lesbian Health Care Survey (1984-1985), the most comprehensive study on U.S. lesbians to date. Over half the sample had had thoughts about suicide at some time, and 18% had attempted suicide. Thirty-seven percent had been physically abused as a child or adult, 32% had been raped or sexually attacked, and 19% had been involved in incestuous relationships while growing up. Almost one third used tobacco on a daily basis, and about 30% drank alcohol more than once a week, 6% daily. About three fourths had received counseling at some time, and half had done so for reasons of sadness and depression. Lesbians in the survey also were socially connected and had a variety of social supports, mostly within the lesbian community. However, few had come out to all family members and coworkers. Level of openness about lesbianism was associated with less fear of exposure and with more choices about mental health counseling.
As mandated by the Affordable Care Act, Community Health Needs Assessments must be conducted on all Critical Access Hospitals in the U.S. This report not only satisfies the legal requirement but offers strong community feedback and guidance for hospitals administrators to follow for their strategic implementation planning. A mixed methods research design is employed, utilizing both primary and secondary data, Findings are synthesized and presented to a community group which determines the most significant needs by voting for the top community health needs they perceive as most pressing to their community.
Lesbian, gay, and bisexual youths (aged 15–21 yrs) were studied to determine the impact of verbal abuse, threat of attacks, and assault on their mental health, including suicide. Family support and self-acceptance were hypothesized to act as mediators of the victimization and mental health-suicide relation. Structural equation modeling revealed that in addition to a direct effect of victimization on mental health, family support and self-acceptance in concert mediated the victimization and mental health relation. Victimization was not directly related to suicide. Victimization interacted with family support to influence mental health, but only for low levels of victimization. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Bisexuals (N = 424) and lesbians (N = 1,921) were surveyed regarding their sources of gynecologic care, utilization patterns, openness with physicians, and assessment of quality of care. About 40 per cent of each group believed that physician knowledge about their sexual preference would hinder the quality of medical care and about as many believed that it would have no effect. About one-third in each group had not disclosed their sexual behavior although they desired to do so. Physicians rarely requested this information. A lesbian physician was overwhelmingly preferred for gynecologic care (96 per cent), particularly for problems with sexual functioning. Previous satisfaction with gynecologic care was most often described as "adequate," but almost as often as "variable" and "poor." Data suggest that quality, utilization, and medical outcomes of gynecologic care to this group would be improved if physicians would communicate greater awareness of sexual orientation in a nonprejudicial manner and ensure confidentiality.
This article presents demographic, lifestyle, and mental health information about 1,925 lesbians from all 50 states who participated as respondents in the National Lesbian Health Care Survey (1984-1985), the most comprehensive study on U.S. lesbians to date. Over half the sample had had thoughts about suicide at some time, and 18% had attempted suicide. Thirty-seven percent had been physically abused as a child or adult, 32% had been raped or sexually attacked, and 19% had been involved in incestuous relationships while growing up. Almost one third used tobacco on a daily basis, and about 30% drank alcohol more than once a week, 6% daily. About three fourths had received counseling at some time, and half had done so for reasons of sadness and depression. Lesbians in the survey also were socially connected and had a variety of social supports, mostly within the lesbian community. However, few had come out to all family members and coworkers. Level of openness about lesbianism was associated with less fear of exposure and with more choices about mental health counseling.
Health care providers may not solicit a comprehensive sexual history from lesbian patients because of provider assumptions that lesbians have not been sexually active with men. We performed this study to assess whether women who identify themselves as lesbians have a history of sexual activities with men that have implications for receipt of preventive health screening.
To convey the importance for health care providers to know their patients' sexual history when making appropriate recommendations for preventive health care.
A survey was printed in a national news magazine aimed at homosexual men, lesbians, and bisexual men and women. The sample included 6935 self-identified lesbians from all 50 US states. The outcomes we measured were respondents' number of lifetime male sexual partners and partners during the past year, their lifetime history of specific sexual activities (e.g., vaginal intercourse, anal intercourse), their lifetime condom use, and their lifetime history of sexually transmitted diseases.
Of respondents, 77.3% had 1 or more lifetime male sexual partners, 70.5% had a lifetime history of vaginal intercourse, 17.2% had a lifetime history of anal intercourse, and 17.2% had a lifetime history of a sexually transmitted disease. Exactly 5.7% reported having had a male sexual partner during the past year.
These findings reinforce the need for providers to know their patients' sexual history regardless of their reported sexual orientation, especially with regard to recommendations for Papanicolaou smears and screening for sexually transmitted diseases.
This work provides an overview of standard social science data sources that now allow some systematic study of the gay and lesbian population in the United States. For each data source, we consider how sexual orientation can be defined, and we note the potential sample sizes. We give special attention to the important problem of measurement error, especially the extent to which individuals recorded as gay and lesbian are indeed recorded correctly. Our concern is that because gays and lesbians constitute a relatively small fraction of the population, modest measurement problems could lead to serious errors in inference. In examining gays and lesbians in multiple data sets we also achieve a second objective: We provide a set of statistics about this population that is relevant to several current policy debates.
While workplace sexual harassment has received a great deal of attention in both the popular media and scientific literature, less attention has been directed to the differential occurrence of sexual harassment among lesbians, gay men, and heterosexual men and women, and the relationships between these experiences and alcohol-related outcomes. Additionally, the distribution of alcohol-related outcomes of non-sexual forms of workplace harassment among these groups have not been adequately explored.
Using data from a university-based study of workplace harassment and alcohol use (N = 2492), we focus on exposure to workplace harassment and alcohol-related outcomes for lesbians, gay men, and bisexuals compared to heterosexual men and women.
Lesbian/bisexual women did not differ significantly from heterosexual women in their experiences of workplace harassment. However, stronger linkages between harassment and increased alcohol consumption and problems were found for lesbian and bisexual women than for heterosexual women. Gay/bisexual men, on the other hand, experienced significantly more sexual harassment than heterosexual men, but did not report a corresponding increase in alcohol use and abuse.
Implications for future research on sexual identity, alcohol use, and workplace harassment are discussed.
This study examined whether lesbians are at increased risk for certain cancers as a result of an accumulation of behavioral risk factors and difficulties in accessing health care.
Prevalence estimates of behavioral risk factors (nulliparity, obesity, smoking, and alcohol use), cancer screening behaviors, and self-reported breast cancer histories derived from 7 independently conducted surveys of lesbians/bisexual women (n = 11,876) were compared with national estimates for women.
In comparison with adjusted estimates for the US female population, lesbians/bisexual women exhibited greater prevalence rates of obesity, alcohol use, and tobacco use and lower rates of parity and birth control pill use. These women were also less likely to have health insurance coverage or to have had a recent pelvic examination or mammogram. Self-reported histories of breast cancer, however, did not differ from adjusted US female population estimates.
Lesbians and bisexual women differ from heterosexual women in patterns of health risk. These women would be expected to be at especially greater risk for chronic diseases linked to smoking and obesity.
Using data from the 1996 and 1998 General Social Surveys, we explore the relationships among age, age-linked personal and social qualities, and two measures of psychological distress: depression (1996) and generalized distress (1998). Our study has three aims: (1) to replicate the u-shaped age-distress relationship in two recent U.S. data sets, (2) to confirm and elaborate on the mediators of the parabolic association, and (3) to explore the possible suppressor effects. In 1996, depression decreases from young adulthood into midlife and increases among the oldest-old. Less education, lower control, and widowhood contribute to old-age upturn; however, fewer time demands and greater financial satisfaction suppress the upward curve. Conversely, greater control, less shame, and greater religious attendance contribute to the decline through midlife; however, poorer health in midlife suppress that decline. Age patterns in distress are similar in the 1998 sample. Greater satisfaction with finances and fewer religious doubts contribute to the downward slope; however, declining levels of health suppress that downturn. Less education and retired status contribute to the old-age upturn. In sum, personal and social conditions have opposing influences on the parabolic relationship between age and distress.
Psychosocial stressors have been shown to predict hypertension in several cohort studies; patterns of importance, sex differences, and interactions with standard risk factors have not been fully characterized.
Among 2357 adults in a population sample of Alameda County, California, free of hypertension in 1974, 637 reported in 1994 having ever used antihypertensive medication (27.9% of the men and 26.3% of the women). The effects of baseline psychosocial, behavioral, and sociodemographic factors on the incidence of treated hypertension were examined using multiple logistic regression.
Low education, African American race, low occupational prestige, worry about job stability, feeling less than very good at one's job, social alienation, and depressive symptoms each had significant (P<.05) age-adjusted associations with incident hypertension. Associations were weakened by adjustment for body mass index, alcohol consumption, smoking status, and leisure time physical activity, especially the associations of anomy and depression, which persisted in women but not in men. In multivariate models, job insecurity (odds ratio, 1.6), unemployment (odds ratio, 2.7), and low self-reported job performance (odds ratio, 2.1) remained independent predictors of hypertension in men, whereas low-status work (odds ratio, 1.3) was an independent predictor of hypertension in women.
In the general population, low occupational status and performance and the threat or reality of unemployment increase the likelihood of developing hypertension, especially among men, independent of demographic and behavioral risk factors. Psychological distress and social alienation may also increase hypertension incidence, especially in women, chiefly through an association with health risk behaviors.
This study examined the risk of psychiatric disorders among individuals with same-sex sexual partners.
Data are from the National Comorbidity Survey, a nationally representative household survey. Respondents were asked the number of women and men with whom they had sexual intercourse in the past 5 years. Psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria were assessed with a modified version of the Composite International Diagnostic Interview.
A total of 2.1% of men and 1.5% of women reported 1 or more same-sex sexual partners in the past 5 years. These respondents had higher 12-month prevalences of anxiety, mood, and substance use disorders and of suicidal thoughts and plans than did respondents with opposite-sex partners only. Decomposition showed that the elevated same-sex 12-month prevalences were largely due to higher lifetime prevalences. Ages at onset and persistence of disorders did not differ between the same-sex and opposite-sex subsamples.
Homosexual orientation, defined as having same-sex sexual partners, is associated with a general elevation of risk for anxiety, mood, and substance use disorders and for suicidal thoughts and plans. Further research is needed to replicate and explore the causal mechanisms underlying this association.
Homosexuality has been variously defined throughout modern history. The shifts in perception from sinful abomination to criminal act to psychiatric disease set the stage for the debate that led the American Psychiatric Association (APA) to remove homosexuality from its official diagnostic nomenclature. This decision by the APA hierarchy and membership in 1973 was accompanied by a daring statement of unequivocal support for the protection of homosexuals' civil rights. Given the dominant role that the psychiatric establishment had played in creating the view of homosexuality as psychopathology, these pronouncements may be construed as among the most important events to influence how homosexuals are perceived in American culture. It is not surprising, then, that virtually every author in this noteworthy text refers to the 1973 decision and its implications throughout the mental health field.One crucial aftermath of the decision has been the astounding growth in the last two decades of a
The Social Organization of Sexuality reports the complete results of the nation's most comprehensive representative survey of sexual practices in the general adult population of the United States. This highly detailed portrait of sex in America and its social context and implications has established a new and original scientific orientation to the study of sexual behavior. "The most comprehensive U.S. sex survey ever." âUSA Today "The findings from this survey, the first in decades to provide detailed insights about the sexual behavior of a representative sample of Americans, will have a profound impact on how policy makers tackle a number of pressing health problems." âAlison Bass, The Boston Globe "A fat, sophisticated, and sperm-freezingly serious volume. . . . This book is not in the business of giving us a good time. It is in the business of asking three thousand four hundred and thirty-two other people whether they had a good time, and exactly what they did to make it so good." âAnthony Lane, The New Yorker New York Times Book Review Notable Book of the Year
Lesbians are often "invisible" in primary care settings and literature. They frequently feel anxious, mistreated, and misunderstood by providers if they reveal their sexuality. Increasingly these women are "coming out" to providers and asking for knowledgeable and sensitive care. This article reviews the literature on lesbian health care and makes suggestions about history taking and health promotion that is sensitive to the needs of lesbian clients. (C) Williams & Wilkins 1995. All Rights Reserved.
The literature on lesbians' mental health issues offers mostly research on selected issues and few comprehensive studies. Using a pretested qualitative and quantitative instrument, I elicited 503 lesbian women's responses to questions on issues known to affect lesbians' mental health. The participants were more likely to seek professional assistance for depression when depression and relationship issues were identified as occurring simultaneously. Content analysis of the women's responses revealed four categories of changes desired in the mental health care system.
To examine the attitudes of physicians practicing in New Mexico toward gay and lesbian medical students, house officers, and physician colleagues.
In May 1996, the authors mailed a questionnaire with demographic and attitude questions to 1,949 non-federally employed physicians practicing in New Mexico. The questionnaire consisted of questions dealing with medical school admission, residency training, and referrals to colleagues. The response rate was 53.6%.
Of all the responding physicians, 4.3% would refuse medical school admission to applicants known to be gay or lesbian. Respondents were most opposed to gay and lesbian physicians' seeking residency training in obstetrics and gynecology (10.1%), and least opposed to their seeking residency training in radiology (4.3%). Disclosure of homosexual orientation would also threaten referrals to gay and lesbian obstetrician-gynecologists (11.4%) more than to gay or lesbian physicians in other specialties.
Physicians' attitudes toward gay and lesbian medical students, house officers, and physician colleagues seem to have improved considerably from those reported previously in the literature. However, gay men and lesbians in medicine continue to face opposition in their medical training and in their pursuit of specialty practice.
Health problems of gay, lesbian, and bisexual (GLB) youth are reported as differing from those of heterosexual youth. Increased depression, suicide, substance use, homelessness, and school dropout have been reported. Most studies of GLB youth use clinical or convenience samples. The authors conducted a community school-based health survey that included an opportunity to self-identify as GLB.
An anonymous self-report health care questionnaire was used during a community-based survey in 2 high schools in an upper middle class district.
Significantly increased health risks for self-identified GLB youth were found in mental health, sexual risk-taking, and general health risks compared with self-identified heterosexuals, but not in health domains associated with substance abuse, homelessness, or truancy.
Self-identified GLB youth in community settings are at greater risk for mental health, sexual risk-taking, and poorer general health maintenance than their heterosexual peers.
There is a dearth of validated information about lesbian and bisexual women's health. To better understand some of these issues, we used population-based data to assess variations in health behaviors, health status, and access to and use of health care based on sexual orientation.
Our study population was drawn from a population-based sample of women, the 1997 Los Angeles County Health Survey. Participants reported their sexual orientation and these analyses included 4697 women: 4610 heterosexual women, 51 lesbians, and 36 bisexual women. We calculated adjusted relative risks to assess the effect of sexual orientation on important health issues.
Lesbians and bisexual women were more likely than heterosexual women to use tobacco products and to report any alcohol consumption, but only lesbians were significantly more likely than heterosexual women to drink heavily. Lesbians and bisexual women were less likely than heterosexual women to have health insurance, more likely to have been uninsured for health care during the preceding year, and more likely to have had difficulty obtaining needed medical care. During the preceding 2 years, lesbians, but not bisexual women, were less likely than heterosexual women to have had a Papanicolaou test and a clinical breast examination.
In this first population-based study of lesbian and bisexual women's health, we found that lesbians and bisexual women were more likely than heterosexual women to have poor health behaviors and worse access to health care. These findings support our hypothesis that sexual orientation has an independent effect on health behaviors and receipt of care, and indicate the need for the increased systematic study of the relationship between sexual orientation and various aspects of health and health care. Arch Fam Med. 2000;9:1043-1051
Recent research on gender and health challenges the prevailing notion of women's generalized health disadvantage by revealing a more variable pattern of gender differences in health. As such differences come to be comprehended as more complex than previously thought, there is a need to reassess the pathways linking gender and health. Using data from a Canadian national probability sample, we examine: (1) gender differences in distress, self-rated health, chronic conditions, restricted activity and heavy drinking; and (2) the role of gender-based differential exposure and vulnerability to chronic stress and life events in explaining observed differences. We find that women report more distress and chronic conditions than men, but gender differences are reversed for heavy drinking, and negligible for self-rated health and restricted activity. Although women reported more chronic stress and life events, their greater exposure accounted for only some of the gender disparity in health, and only for distress. Differential vulnerability to stressors played no role in explaining gender differences in health. These findings raise questions about a gendered, generalized health response to the vicissitudes of life and suggest the need for further theoretical and empirical exploration of "gendered" experiences and their pathways to health.
Although the concept of stress is hard to define or measure, it is a phenomenon associated with a number of health conditions, including hypertension, heart disease, and decreased immunocompetency. Events such as migration are known to create stress; researchers refer to this as acculturative stress. Given that cultural background might influence a patient's recognition, interpretation, and coping mechanisms for stress, we wondered how self-reports of stress by Asian immigrants compare with those of non-Hispanic Whites, and how these self-reports vary with years since immigration, a proxy for acculturation.
Data from the National Health Information Survey for 1993 and 1995 were analyzed for six groups of Asian national origin, and were compared with non-Hispanic Whites. Using ordered logistic regression, we examined self-reports of stress over two weeks and twelve months, as well as the changes in these self-reports with years since immigration.
Adjusted for age, income, educational level, marital status, and gender, Asian immigrants were uniformly less likely to report stress over a two-week period than were non-Hispanic Whites (OR ranges: 0.34[Asian Indian]-0.59[Korean], P values<.05). There were no significant differences in reported stress among Asian ethnic groups. Compared with immigrants who have lived in the United States for at least 15 years, recent immigrants (<1 year) were likely to report less stress over two weeks and twelve months, OR = 0.13 and 0.23, respectively, P values<.005.
Despite their status as immigrants, Asians report less stress than non-Hispanic Whites. These reports of stress increase as years since immigration increase. One potential explanation for these discrepancies is under-reporting, which might reflect underlying cultural differences in the perception or definition of stress, differences that may diminish with "acculturation."
Monitoring the health status of populations is a core function of all public health agencies but is particularly important at the municipal and community levels, where population health data increasingly are used to drive public health decision making and community health improvement efforts. 1– ³ Unfortunately, most local health jurisdictions lack important data for developing population health profiles, such as data on chronic disease prevalence, quality-of-life measures, functional status, and self-perceptions of health status. In addition, data on important determinants of health, including health behaviors and access to health care services, are rarely available locally.
These data frequently are collected in national and state surveys (e.g., the National Health Interview Survey and the Behavioral Risk Factor Surveillance System) and provide critical information to assess progress toward achieving state and national health objectives. ⁴ The surveys rarely serve local data needs, however, because of insufficient sample size and lack of flexibility to address local health issues. To address gaps in local health data, in 1997 the Los Angeles County Department of Health Services inaugurated the Los Angeles County Health Survey.
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