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Health Serv Res. 2019;00:1–13.
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Health Services Research
wileyonlinelibrary.com/journal/hesr
DOI : 10.1111/1475-67 73.13 229
SPECIAL ISSUE: EXPERIE NCES OF
DISCRIMINATION IN AMERICA
Discrimination in the United States: Experiences of lesbian, gay,
bisexual, transgender, and queer Americans
Logan S. Casey PhD1 | Sari L. Reisner ScD, MA2 | Mary G. Findling PhD, SM1 |
Robert J. Blendon ScD1 | John M. Benson MA1 | Justin M. Sayde MS1 |
Carolyn Miller MS, MA3
This is an op en access article under the terms of the Creative Commons Att ribution License, which permits use, distrib ution and reproduction in any medium,
provide d the original work is properly cited.
© 2019 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust
1Depar tment of He alth Policy and
Management, Har vard T.H. Chan School of
Public Health, Boston, Massachusetts
2Department of Epidemiology, Harvard
T.H. Chan School of Public Health, Boston ,
Massachusetts
3Research, Evaluation, and Learning
Unit, Robert Wood Johnson Foundation,
Princeton, New Jersey
Correspondence
John M. Benson, MA , Department of Health
Policy and Managem ent, Har vard T.H. Chan
School of Public Health, 677 Huntington
Avenue, Kresge 4th Floor, Boston, MA
02115, USA.
Email: jmbenson@hsph.harvard.edu
Funding information
Robert Wood Johnson Foundation, Grant/
Award Number: 73713
Abstract
Objective: To examine reported experiences of discrimination against lesbian, gay,
bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly
contribute to poor health outcomes.
Data Source and Study Design: Data came from a national, probability-based tel-
ephone survey of US adults, including 489 LGBTQ adults (282 non-Hispanic whites
and 201 racial/ethnic minorities), conducted January-April 2017.
Methods: We calculated the percentages of LGBTQ adults reporting experiences of
discrimination in health care and several other domains related to their sexual orien-
tation and, for transgender adults, gender identity. We report these results overall,
by race/ethnicity, and among transgender adults only. We used multivariable models
to estimate adjusted odds of discrimination between racial/ethnic minority and white
LGBTQ respondents.
Principal Findings: Experiences of interpersonal discrimination were common for
LGBTQ adults, including slurs (57 percent), microaggressions (53 percent), sexual har-
assment (51 percent), violence (51 percent), and harassment regarding bathroom use
(34 percent). More than one in six LGBTQ adults also reported avoiding health care due
to anticipated discrimination (18 percent), including 22 percent of transgender adults,
while 16 percent of LGBTQ adults reported discrimination in health care encounters.
LGBTQ racial/ethnic minorities had statistically significantly higher odds than whites in
reporting discrimination based on their LGBTQ identity when applying for jobs, when
trying to vote or participate in politics, and interacting with the legal system.
Conclusions: Discrimination is widely experienced by LGBTQ adults across health
care and other domains, especially among racial/ethnic minorities. Policy and pro-
grammatic efforts are needed to reduce these negative experiences and their health
impact on sexual and/or gender minority adults, particularly those who experience
compounded forms of discrimination.
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1 | INTRODUCTION
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in
the United States have experienced a long histor y of discrimina-
tion, including criminalization and classifications as mentally ill, at-
tempts to forcibly change LGBTQ people's sexual orientation and/
or gender identity, hate crimes and violence, and exclusion from
employment, housing, public spaces, and social institutions.1-3 And
yet, despite this history and despite research examining beliefs
about discrimination generally and the consequences of experienc-
ing discrimination (discussed below), relatively few national efforts
have been made to systematically study LGBTQ people's repor ted
personal experiences of discrimination.3-5 While such efforts are
hindered by the inherent challenge of surveying a small, dispersed,
difficult-to-define, and internally diverse population,6-8 it is none-
theless critically important to study experiences of discrimination
because of the established impact of discrimination on health and
well-being.
Research demonstrates that experiencing discrimination or
harassment has significant and negative consequences for both
physical and mental health.9,1 0 This field of research shows that
experiences of enacted stigma, discrimination, and/or harass-
ment induce psychological, behavioral, and physiological stress
responses in the body and that the impacts of these reactions ac-
cumulate over time,11 leading to a wide range of negative health
outcomes and health-related behaviors. Even the anticipation of
or mental preparation for discrimination, whether discrimination
actually occurs (ie, felt stigma), has significantly harmful effects
on health.12-14
While much related research has focused on the effects of rac-
ism10,15,16 and sexism on health,16,17 these same effects have also
been observed in the context of discrimination, harassment, and
assault against nonrepresentative samples of LGBTQ people.18-21
In some cases, these effects persist even after basic protection
policies have been implemented.22 Experiencing discrimination
persistently leads to negative health eff ects for LGBTQ people,23 ,24
and it limit s their opportunities and access to critical resources in
areas such as health care, employment, and public safety.21,22 It
also leads to avoidance of care, further amplif ying these negative
health consequences.14 For example, transgender people who
have experienced discrimination in health care are more likely than
those who have not experienced discrimination to subsequently
avoid both preventative and urgent health care services, including
needed care due to illness or injur y.22 This leads to worse health
outcomes, including higher likelihood of depression and suicidal
ideation or attempts.14
Further, these negative consequences for health are likely to be
compounded for individuals from multiple minority backgrounds,
such as LGBTQ racial/ethnic minorities or LGBTQ women.18,25 -30
Transgender people, with their unique health concerns, may also
face special health-related vulnerabilities as a result of discrimi-
nation, including social and economic vulnerabilities that increase
health risks.31,32 These effects are particularly alarming given that
LGBTQ people are significantly less likely than non-LGBTQ people
to have health insurance31 ,33 and therefore may have less access to
medical care that could mitigate the adverse health consequences
of discrimination.
Few surveys have documented LGBTQ people's personal expe-
riences of discrimination using national data and/or across multiple
domains of life. The landmark Institute of Medicine report6 on LGBT
health in 2011 identified the need for research to overcome some of
the methodological challenges that arise in studying LGBTQ popu-
lation health, such as noninclusion of items to assess sexual orienta-
tion and/or gender identity in federal surveys, small population size,
stigma, discrimination, privacy, and dispersion in sampling, among
others.8,34,35 Although some progress has been made, large national
probability studies of discrimination across multiple domains among
LGBTQ adult s remain the exception , rather than the rule. Particularly
needed are studies that allow comparisons by race/ethnicity within
the LGBTQ population.3-6,8 This study attempts to expand on prior
telephone polling methods by examining LGBTQ adults' experiences
across many areas of life, drawn from a large national sample of US
adults.
This study, alongside complementary articles in this issue of
Health Services Research, brings a public health perspective to
the complexity and pervasiveness of discrimination in the United
States today. It was conducted as part of a larger survey fielded
in 2017 in response to a growing national debate about discrim-
ination in the United States today,36 to understand experiences
of discrimination against several different groups in America, in-
cluding blacks, Latinos, Asians, Native Americans, women, and
LGBTQ people. This particular study has four main purposes: (a)
to examine the prevalence of discrimination, harassment, and vi-
olence against LGBTQ adults specifically because of their sexual
orientation and, for transgender adults and gender nonconform-
ing adults, their gender identity; (b) to examine such experiences
across multiple domains of life raised as areas of concern among
experts,36 including health care, education, employment, housing,
political participation, police, and the criminal justice system, as
well as interpersonal areas including slurs, microaggressions, ha-
rassment, and violence; (c) to examine variation in experiences
of discrimination within LGBTQ adults by race/ethnicity, as prior
KEY WORDS
discrimination, gender identity, Lesbian, gay, bisexual, trangender, queer (LGBTQ) health,
Racial/ethnic differences in health and health care, sexual orientation, Social determinants of
health, Survey research
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research illustrates that racial/ethnic minority LGBTQ adults may
be at particular risk for experiencing discrimination; and (d) to ex-
amine experiences of discrimination and harassment among a sub-
sample of transgender adults (including those who identified as
genderqueer or gender nonconforming), who are also at particular
risk for experiencing discrimination.
2 | METHODS
2.1 | Study design and sample
Data were obtained from a nationally representative, probability-
based telephone (cell and landline) survey of US adults, conducted
from January 26 to April 9, 2017. The survey was jointly designed by
Harva rd TH Chan School of Pub lic Health, the Robert Wood Joh nson
Foundation, and National Public Radio. SSRS, an independent firm,
administered the sur vey. Because Harvard researchers were not
directly involved in data collection and de-identified datasets were
used for analysis, the study was deemed “not human subjects re-
search” by the Harvard TH Chan School of Public Health Office of
Human Research Administration.
The full sample included 3453 US adults aged 18 years and older,
including nationally representative samples of blacks, Latinos, Asian
Americans, Native Americans, whites, men, women, and LGBTQ
adults. This paper examines the subsample of 489 LGBTQ adults,
including 282 whites and 201 racial/ethnic minorities and an over-
sample of 86 transgender adults. Screening questions regarding
sexual orientation and gender identity were asked at the beginning
of the survey, so that LGBTQ respondents could be identified and
asked relevant questions (see Appendix S1). For sexual orienta-
tion, respondents were classified as LGBQ if they identified as gay
or lesbian, bisexual, or another sexual orientation specified by the
respondent that was not heterosexual or straight. For gender iden-
tity, respondents were classified as transgender if they identified as
transgender male, transgender female, genderqueer or gender non-
conforming, or another gender identity specified by the respondent
that was not male or female.
The completion rate for this survey was 74 percent among
respondents who answered initial demographic screening ques-
tions, with a 10 percent overall response rate, calculated based on
the American Association for Public Opinion Research's (AAPOR)
RR3 formula.37 Because data from this study were drawn from
a probability sample and used the best available sampling and
weighting practices in polling methods (eg, 68 percent of inter-
views were conducted by cell phone, and 32 percent were con-
ducted via landline), they are expected to provide accurate results
consistent with surveys with higher response rates.38 ,39 Surveying
LGBTQ populations faces major challenges in constructing ade-
quate sampling frames and sample sizes, as well as a stigmatized
respondent population, underreporting, and variations in ques-
tion wording on sexual orientation and/or gender identity.6-8,34,35
While federal benchmark data are limited, respondents for this
survey were similar demographically to LGB adults in other na-
tional, population-based samples obtaining higher response rates
(General Social Sur vey and National Health Interview Survey),40
though federal sur veys are also subject to the limitations noted
above. We expect these results to be generalizable to the US adult
population within a margin of error of ±6.6 percentage points at
the 95% confidence interval, while noting the potential for un-
derreporting among the US adult LGBTQ population. See Benson,
Ben-Porath, and Casey (this issue) for a further description of the
survey methodology.41
2.2 | Survey instrument
In this poll, we analyzed 25 questions about lifetime experiences of
discrimination, including adults' personal experiences of discrimina-
tion and perceptions of discrimination in the nation. The objective
of this study was to examine the extent of discrimination experi-
enced by LGBTQ adults in America, building on question modules in
this field adapted from prior sur veys on racial and LGBTQ discrimi-
nation.3-5,42,43 We conceptualized discrimination as differential or
unfair treatment of individuals based on their LGBTQ identity, and
we include discrimination that is “institutional” (based in laws, poli-
cies, institutions, and related behavior of individuals who work in
or control these laws, policies, or institutions) and “interpersonal”
(based in individuals' beliefs, words, and behavior).8,43 ,44,a
For this study, we analyzed questions about personal expe-
riences, covering six institutional and seven interpersonal areas
of discrimination (full questions and wording in Appendix S1).
Institutional areas included employment, education, health care,
housing, political participation, and police and courts. Interpersonal
areas included anti-LGBTQ slurs, microaggressions, other people's
fear of LGBTQ adults, sexual harassment, being threatened or non-
sexually harassed, being harassed or questioned regarding bath-
room use, and experiencing violence, among other experiences.
We also examined two areas where individuals might avoid seeking
help or services due to anticipation or fear of being discriminated
against: seeking medical care or the services of police or other au-
thority figures. We examined these numerous domains in order to
capture a wide range of possible discriminatory experiences across
adults' lives.
Questions were only asked among a random half-sample of
respondents to maximize the number of questions while limiting
respondent burden (half-sample A = 259, half-sample B = 230).
Questions were only asked of relevant subgroups (eg, college-re-
lated questions only asked among adults who had ever applied to
or attended college). Questions about harassment (sexual and non-
sexual), violence, and avoiding institutions for fear of discrimination
were asked about yourself or friends or family members who are also
LGBTQ, because of the sensitive nature of the questions and prior
literature demonstrating that vicariously experiencing stress (eg,
through discrimination experienced by family members) can directly
and adversely affect individuals.45
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2.3 | Statistical analyses
We first calculated the prevalence of all LGBTQ people who re-
ported they had ever experienced discrimination because of their
sexual orientation and/or gender identity in each of the afore-
mentioned domains. Second, we generated bivariate statistics to
assess whether experiencing discrimination because of LGBTQ
identity was associated with race. Because of the sample size,
particularly with split-sampled questions, responses of nonwhite
racial/ethnic minorities were pooled together, and we compared
whites to racial/ethnic minorities. Six people were included in
overall analyses but excluded from racial/ethnic comparisons be-
cause of insufficient race/ethnicity data. Using pairwise t test s of
differences in proportions, we made uncontrolled comparisons of
the weighted percentage of adults reporting discrimination be-
tween racial/ethnic minority and white adults, to examine where
race/ethnicity affects LGBTQ adults' experiences of discrimina-
tion, irrespective of cause. For all analyses, statistical significance
was determined at P < .05.
We then conducted logistic regression models to assess
whether identifying as a racial/ethnic minority remained statisti-
cally significantly associated with discrimination after controlling
for the following covariates and possible confounders: self-iden-
tified gender (male or female, excluding genderqueer or gender
nonconforming due to insufficient sample size, n = 28); age in
years (18-29 or 30+); self-reported household income (<$25 000
or $25 000+); and education (less than college degree or college
graduate). We also examined whether each of these sociodemo-
graphic variables was significantly associated with experiencing
discrimination across domains. Metropolitan status, region, and
health insurance status were omitted from these models for par-
simony, due to the sample size. Odds ratios (OR) and 95% confi-
dence intervals (95% CI) were estimated.
Finally, we conducted a subgroup descriptive analysis of
transgender adults (n = 86), to assess their experiences separately
from the larger LGBTQ population, given that we expected trans-
gender experiences to be unique.3 We did not directly compare
transgender adults to LGBQ adult s because the groups are not
mutually exclusive. Due to randomly assigned split sampling of
the survey questionnaire, there were some questions that had
too few transgender respondents to report these percentages
(half-sample A = 33, half-sample B = 55). Results are only repor ted
if n > 50.
To compensate for known biases in telephone surveys (eg,
nonresponse bias) and variations in probability of selection within
and across households, sample data were weighted by household
size and composition, cell phone/landline use, and demograph-
ics (gender, age, education, race/ethnicity, and census region) to
reflect the true population distribution of adults in the country.
Other techniques, including random-digit dialing, replicate sub-
samples, and random selection of a respondent within a house-
hold, were used to ensure that the sample is representative. All
analyses were conducted using STATA version 15.0 (StataCorp),
and all tests accounted for the variance introduced by weighted
data.
3 | RESULTS
3.1 | Characteristics of the LGBTQ study sample
Demographic and socioeconomic characteristics of US LGBTQ
adults are displayed in Table 1; percentages of LGBTQ adults who
have experienced discrimination because of their sexual orientation
and/or gender identity are shown in Table 2; adjusted odds ratios of
reporting discrimination are shown in Table 3; descriptive analysis
of transgender adults is shown in Table 4. All estimates display data
weighted using survey weights.
Table 1 shows that a majority of the LGBTQ sample were cis-
gender (77 percent), with 23 percent identifying as transgender or
genderqueer or gender nonconforming. A majority were also white
(61 percent), while 39 percent identified as racial and/or ethnic mi-
norities. LGBTQ racial/ethnic minorities were significantly less likely
than LGBTQ whites to have a college degree (23 percent vs 38 per-
cent, P < .01) and to make $25 00 0 or more per year (46 percent vs
66 percent, P < .04). LGBTQ racial/ethnic minorities were also sig-
nificantly more likely (23 percent) than LGBTQ whites (10 percent)
to be without health insurance (P < .02).
3.2 | Discrimination attributed to
sexual orientation and/or gender identity
Table 2 shows the weighted percent of LGBTQ adults, both in ag-
gregate and by race/ethnicit y, who reported personally experiencing
various forms of discrimination because of their sexual orientation
and/or gender identity.b The majority of LGBTQ adults reported
personally experiencing interpersonal discrimination: 57 percent
said they have experienced slurs and 53 percent said they had ex-
perienced microaggressions related to their sexual orientation or
gender identity. Similarly, the majority of LGBTQ adult s reported
interpersonal discrimination either personally or in their immediate
friends or family: 57 percent said they or an LGBTQ friend or fam-
ily member had been threatened or nonsexually harassed because
of their LGBTQ identity, and 51 percent said they had experienced
sexual harassment or violence because of their sexual orientation
and/or gender identity.
More than one-third (34 percent) of LGBTQ people said that they
or an LGBTQ friend or family member has personally been verbally
harassed while in a bathroom or been told or asked if they were in
the wrong bathroom. Another third (32 percent) said that they or
an LGBTQ friend/family member have been told or felt they would
be unwelcome in a neighborhood or place to live because they are
LGBTQ.
In the context of institutional discrimination, 18 percent of LGBTQ
adults reported they have avoided seeking health care for themselves
or family members due to anticipated discrimination, while 16 per-
cent reported discrimination in clinical encounters. One-fifth or more
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TABLE 1 Characteristics of LGBTQ adults in the study sample (N = 489)a
All LGBTQ adults N = 489 White LGBTQ adults N = 282
Racial/ethnic minority
LGBTQ N = 201
Weighted percentage of respondentsb
LGBQ (lesbian, gay, bisexual, and queer)c84 83 84
Cisgender 77 - -
Transgender (including genderqueer and gender
nonconforming)c
23 25 20
Self-reported gender
Male (cisgender and transgender) 38 35 43
Female (cisgender and transgender) 56 58 53
Genderqueer or gender nonconforming 6 6 5
Race
White (non-Hispanic) 61 - -
Nonwhite (racial/ethnic minority)d39 - -
Age
18-2 9 y 41 39 45
30 + y 59 61 55
Education
No college degreee68 62 77*
College degree or more 32 38 23*
Household income
<$25 000 36 31 44
$25 000+ 55 61 46*
Health insurance current statusf
Uninsured 15 10 23*
Insured, Medicaid 14 16 11
Insured, non-Medicaid 68 71 65
Area of residenceg
Urban 30 26 3
Nonurban 64 67 61
Don't know/refused 6 7 4
US region of residenceh
Northeast 23 22 26
Midwest 20 23 17
South 30 33 27
West 20 16 26
Don't know/refused 6 6 4
aPercentage of US LGBTQ population estimated with survey weights to adjust for unequal probability of sampling.
bThe sample size shown reflects the total number of respondents in each category. Percentages may not add up to 100% due to rounding and don't
know/refused responses that are included in the total n but not reported in Table 1.
cLGBQ and transgender are not mutually exclusive. A person can identify as one or both.
dThere were too few LGBTQ-identified racial/ethnic minority respondents to conduct independent analyses for each racial category (black, Latino,
Asian American, Native American), particularly when questions are split-sampled.
eIncluding those with some college experience (including business, technical, or vocational school after high school) but no college degree, as well as
those with a high school degree or GED certificate or less.
fPrimar y source of health insurance.
gNonurban includes suburban and rural.
hRegions defined by US Census Bureau 4-region definition.
*Different from whites, statistically significant at P < .05 (shown in bold).
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TABLE 2 Differences between white and racial/ethnic minority LGBTQ adults in reporting discrimination because of their LGBTQ
identitya
Subject of discriminationbN
Weighted
percent of all
LGBTQ adultsc
Weighted percent
of white LGBTQc
Weighted percent of
racial/ethnic minority
LGBTQc
Belief in overall discrimination
General belief that discrimination
against lesbian, gay, and bisexual
people exists today in the United
Statesd
All LGBTQ adults (total
sample)
489 91 92 88
General belief that discrimination
against transgender people exists
today in the United Statesd
All LGBTQ adults (total
sample)
489 91 93 88
Experiences of institutional discrimination
Employment
Being paid equally or considered for
promotionse
You (half-sample A) 245 22 19 28
Applying for jobsfYou (half-sample A) 245 20 13 32*
Education
Applying to or while attending
collegeg
You (half-sample B) 192 20 20 20
Health care
Going to a doctor or health clinic You (half-sample B) 230 16 20 9
Housing
Trying to rent a room/apartment or
buy a househ
You (half-sample B) 177 22 25 14
Political participation
Trying to vote or participate in
politics
You (half-sample A) 255 11 716
Police and courts
Interacting with police You (half-sample A) 258 16 11 24*
Unfairly stopped or treated by the
policei
You or LGBTQ friend/family
member (half-sample A)
259 26 26 26
Unfairly treated by the court siYou or LGBTQ friend/family
member (half-sample A)
259 26 23 31
Experiences of interpersonal discrimination
LGBTQ identity-based
microaggressionsj
You (half-sample B) 230 53 64 35*
Racial identity-based
microaggressions
You (half-sample B) 230 18 638*
LGBTQ identity-based slursjYou (half-sample B) 230 57 65 41*
Racial identity-based slurs You (half-sample B) 230 38 14 53*
People acted afraid because of your
LGBTQ identityj
You (half-sample B) 230 15 17 14
People acted afraid because of your
race/ethnicity
You (half-sample B) 230 12 623*
ViolenceiYou or LGBTQ friend/family
member (half-sample A)
259 51 57 42
Threatened or nonsexually harassediYou or LGBTQ friend/family
member (half-sample A)
259 57 60 52
Sexual harassmentiYou or LGBTQ friend/family
member (half-sample A)
259 51 57 43
(Continues)
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reported personally experiencing discrimination specifically because
of their LGBTQ identity across multiple domains of life: when seeking
housing (22 percent), equal pay or promotions (22 percent), applying
for jobs (20 percent), and applying to or while attending college (20
percent). About one-quarter of LGBTQ adults said they or LGBTQ
friends or family members had also been unfairly treated by the courts
(26 percent) or unfairly stopped or treated by police (26 percent) be-
cause of their LGBTQ identity.
Importantly, LGBTQ racial/ethnic minorities were more than
twice as likely as LGBTQ whites to say they had personally experi-
enced institutional discrimination because of their LGBTQ identity
when applying for jobs (32 percent vs 13 percent, P < .02) and when
interacting with police (24 percent vs 11 percent, P < .05). Compared
to LGBTQ whites, LGBTQ racial/ethnic minorities reported lower
prevalence of some forms of interpersonal discrimination, specifi-
cally LGBTQ-based microaggressions (35 percent vs 64 percent,
P < .01) and slurs (41 percent vs 65 percent, P < .02). However,
LGBTQ racial/ethnic minorities had a higher prevalence than whites
of reporting race-based microaggressions (38 percent vs 6 percent,
P < .01), slurs (53 percent vs 14 percent, P < .01), and racial fear (23
percent vs 6 percent, P < .01).
3.3 | Adjusted odds of reporting personal
experiences of discrimination in LGBTQ adults
Table 3 reports odds ratios with 95% confidence intervals examin-
ing whether race/ethnicity differences in reported experiences of
discrimination persist after controlling for pertinent demographic
variables, including age, race, gender, education, and income. For
institutional discrimination, LGBTQ racial/ethnic minority adults
had significantly higher odds than LGBTQ whites for reporting dis-
crimination on the basis of being LGBTQ when applying for jobs,
voting or par ticipating in politics, and being treated unfairly by the
courts. LGBTQ racial/ethnic minorities had lower odds for reporting
LGBTQ-based discrimination when going to a doctor or health clinic
than LGBTQ whites.
Subject of discriminationbN
Weighted
percent of all
LGBTQ adultsc
Weighted percent
of white LGBTQc
Weighted percent of
racial/ethnic minority
LGBTQc
Harassed while using bathroomiYou or LGBTQ family mem-
ber (half-sample A)
259 34 32 36
Been told or felt unwelcome because
of being LGBTQk
You or LGBTQ family mem-
ber (total sample)
489 32 34 31
Actions based on concerns about discrimination
Avoided doctor or health care be-
cause of concerns of discrimination/
poor treatment
You or LGBTQ family mem-
ber (half-sample B)
230 18 21 12
Avoided calling the police because of
concerns of discrimination
You or LGBTQ family mem-
ber (half-sample A)
259 15 11 21
Thought about moving to another
area bec ause of personally experi-
enced discriminationl
You (total sample) 489 31 31 30
aWhite and racial/ethnic minority LGBTQ adults aged 18+, excluding n = 6 adults with missing race/ethnicity that are included in the total sample.
Most questions only asked among a randomized subsample of half of respondents. Don' t know/refused responses included in the total for unad-
justed estimates.
bQuestions about you are personal experiences only; questions about you or friend/family member ask if items have happened to you or a friend/
family member because you or they are par t of the LGBTQ community.
cPercent calculated using survey weights. Bolded and starred values show a statistically significant difference between white and nonwhite LGBTQ
adults at P < .05 using a t test.
dQuestion asked as “Generally speaking, do you believe there is or is not discrimination against [lesbian, gay, and bisexual people OR transgender
people] in America today?”
eEqual pay question only asked among respondents who have ever been employed for pay.
fJobs question only asked among respondents who have ever applied for a job.
gCollege application/attendance was only asked among respondents who have ever applied for college or attended college for any amount of time.
hHousing question only asked among respondents who have ever tried to rent a room or apartment, or to apply for a mortgage or buy a home.
iQuestion wording: “Do you believe that you or a friend or family member who is also part of the LGBTQ community has [experienced/been ____ _]
because you or they are part of the LGBTQ community, or not?”
jQuestion wording: “In your day-to-day life, have any of the following things ever happened to you, or not?” and respondent indicated they had expe-
rienced this and believed this happened because your sexual orientation or gender identity. Slurs = someone referred to you or a group you belong to
using a slur or other negative word; Microaggressions = someone made negative assumptions or insensitive or offensive comments about you; People
acted afraid = people acted as if they were afraid of you.
kYou or a friend/family member who is also part of the LGBTQ community has been told or felt you would be unwelcome in a neighborhood, building,
or housing development you were interested in because you are part of the LGBTQ community.
lYou have thought about moving to another area because you have experienced discrimination or unequal treatment where you were living.
TABLE 2 (Continued)
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TABLE 3 Adjusted odds of reporting personal experiences of discrimination across institutional and interpersonal domains among US LGBTQ adults
Institutional discrimination
Na
Employment Education Health care Housing
Political
participation Police and courts Avoidance
Applying
for jobsb
Equal
pay/pro ‐
motionsc
College ap‐
plication/
attendanced
Doctor o r
health clinic
visits
Trying to
rent or buy
a housee,f
Trying to vote
or participate
in politics
Interacting
with Police
Unfairly
stopped or
treated by the
police
Unfairly
treated by
the courts
Avoided calling the
police due to dis‐
crimination concerns
Avoided
doctor due to
discrimina‐
tion concerns
214 213 167 189 151 219 222 221 223 223 193
Race/ethnicityg
White Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Racial/
ethnic
minority
3.16*
(1.35,
7.4 0 )
1.57
(0.66,
3.75)
0.83 (0.24,
2.81)
0.31* (0.10,
0.97)
0.31 (0.08,
1.24)
3.13* (1.00,
9.73)
1.75 (0.69,
4.48)
0.90 (0.41,
1.96)
2.80*
(1.26,
6.24)
1.25 (0. 50, 3.13) 0.56 (0.19,
1.64)
Self-identified gender
Male Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
Female 0.39*
(0.15 ,
0.96)
0.34*
(0.14,
0.82)
2.12 (0.77,
5.86)
1.40 (0.54,
3.66)
0.87 (0.26,
2.96)
0.28* (0.09,
0.86)
0.36 (0.13,
0.94)
1.14 (0.50,
2.64)
0.40*
(0 .17,
0.96)
0.89 (0.32, 2.53) 1.11 (0.42,
2.91)
Education
<College Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
College+ 1.12
(0.44,
2.87)
0.92
(0.38,
2.23)
0.46 (0.14,
1.48)
1.26 (0.41,
3.88)
0.24* (0.08,
0.74)
1.33 (0.35,
5.09)
1.46 (0.48,
4.45)
2.28 (0.93,
5.57)
1.72 (0.71,
4.17)
1.55 (0.53,4.51) 3.35* (1.32,
8.48)
Income
<25k Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref Ref
25k+ 0.67 (0.29,
1.56)
0.87
(0.34,
2.23)
1.28 (0.35,
4.76)
0.86 (0. 24,
3.09)
0.77 (0.21,
2.86)
0.37 (0.11,
1.22)
0.31* (0.10,
0.96)
0.79 (0.32,
1.95)
1.08 (0.46,
2.56)
0.40 (0.14, 1.15) 0.72 (0.25,
2.04)
Age
18-2 9 Ref Ref Ref Ref -Ref Ref Ref Ref Ref Ref
30+ 0.52
(0.20,
1.33)
1.17
(0.43,
3.24)
2.46 (0. 53,
11.3 9)
2.89 (0.69,
12.12)
- 0.86 (0.27,
2.72)
0.35* (0.13,
0.93)
0.84 (0.36,
1.97)
1.06 (0.45,
2.50)
0.41 (0.15, 1.13) 0.31* (0.11,
0.92)
(Continues)
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CASE Y Et Al.
Interpersonal discrimination
Na
LGBTQ iden‐
tity‐based
microaggressions
LGBTQ identity‐
based slurs Sexual harassment
Threats or non‐
sexual harassment Violence
Harassed
while using the
bathroom
Been told/felt un‐
welcome because
you are LGBTQ
Thought about
moving to another
area
421 421 222 224 225 225 412 420
OR (95% CI)
Race/ethnicityg
White Ref Ref Ref Ref Ref Ref Ref Ref
Racial/ethnic
minority
0.44* (0.21,0.88) 0.51 (0.25, 1.02) 0.72 (0.33, 1.58) 0.79 (0.35, 1.76) 0.52 (0.23, 1.15) 1.43 (0.64, 3.22) 1.07 (0.59, 1.94) 0.95 (0.51, 1.77)
Self-identified gender
Male Ref Ref Ref Ref Ref Ref Ref Ref
Female 1.11 (0.59, 2.05) 0.97 0.52, 1.82) 0.87 (0.41, 1.86) 0.68 (0.32, 1.45) 0.40 * (0.19,0.83) 1.28 (0.59, 2.75) 1.01 (0. 57, 1.79) 1.28 (0.70, 2.34)
Education
<College Ref Ref Ref Ref Ref Ref Ref Ref
College+ 1.06 (0.56, 2.00) 1.48 (0.79, 2.80) 1.94 (0.87, 4.32) 2.20 (0.96, 5.01) 1.29 (0.57, 2.88) 2.06 (0.89, 4.81) 1. 20 (0.66, 2.17) 0.85 (0.45, 1.59)
Income
<25k Ref Ref Ref Ref Ref Ref Ref Ref
25k+ 1.46 (0 .71, 2.99) 0.92 (0.44, 1 .91) 1.04 (0.44, 2.43) 1.16 (0.49, 2.70) 0.82 (0.34, 1.99) 1.43 (0.58, 3.50) 1.22 (0.65, 2.31) 0.97 (0.50, 1.89)
Age
18-2 9 Ref Ref Ref Ref Ref Ref Ref Ref
30+ 0.44* (0.21,0.89) 0.88 (0.41, 1.89) 0.50 (0.22, 1.16) 0.50 (0.21, 1.20) 0.68 (0.29, 1.57) 0.72 (0.31, 1.66) 0.67 (0.36, 1.24) 0.89 (0.46, 1.73)
Abbreviations: CI, confidence interval; OR, odds ratio.
aIndividual questions only asked among a randomized half-sample of respondents. Don't know/refused responses coded as missing.
bJobs question only asked among respondents who have ever applied for a job.
cEqual pay question only asked among respondents who have ever been employed for pay.
dCollege application/attendance only asked among respondent s who have ever applied for college or attended college for any amount of time.
eHousing question only asked among respondents who have ever tried to rent a room or apartment, or to apply for a mortgage or buy a home.
fAge variable omitted in the housing model due to too few respondents aged 18-29 who had ever attempted to rent an apartment or buy a house or mor tgage.
gWhite (non-Hispanic) or racial/ethnic minority (including African American/black, Hispanic/Latino, Asian, American Indian, Alaska Native, Native Hawaiian, Pacific Islander, and other nonwhite
identities).
*Significant at P < .05 (shown in bold). US LGBTQ adults aged 18+.
TABLE 3 (Continued)
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CASE Y Et Al.
Gender also had statistically significant associations in modeling
institutional discrimination. Here, LGBTQ females (transgender-in-
clusive) had lower odds than LGBTQ males of reporting institutional
discrimination when applying for jobs, seeking equal pay or promo-
tions, when trying to vote or participate in politics, and in unfair
treatment by the courts. Models did not meaningfully change in sen-
sitivity analyses excluding transgender adults.
Education was also influential: LGBTQ adults with a college degree
had significantly higher odds than those without a college degree of
reporting they had avoided seeking medical care out of concern they
would be discriminated against or treated poorly. LGBTQ adults with a
college degree had lower odds of reporting discrimination when seek-
ing housing, compared to those without a college degree.
For interpersonal forms of discrimination, LGBTQ racial/ethnic
minorities were less likely than LGBTQ whites to report experiencing
LGBTQ-based microaggressions. LGBTQ adults aged 30 and older also
had lower odds of reporting microaggressions, compared to those
aged 18-29. Finally, females were less likely than males to report ex-
periencing LGBTQ-related violence. No other demographic variables
were statistically significant in models of interpersonal discrimination.
3.4 | Subsample of transgender adults
Table 4 presents the unadjusted percent of transgender adults,
where sample size allowed, reporting various experiences of
discrimination because of their gender identity and/or sexual
orientation. In the context of interpersonal forms of discrimina-
tion, 38 percent of transgender adults say they have personally
experienced slurs, and 28 percent have experienced microaggres-
sions specifically related to their gender identity and/or sexual
orientation. Due to split sampling, there were too few transgen-
der respondents to analyze the question regarding bathroom
harassment.
When it comes to health care, 10 percent of transgender peo-
ple said they have personally experienced discrimination because
of their gender identit y when going to a doctor or health clinic, and
more than one in five (22 percent) said they have avoided seeking
health care due to anticipation of discrimination or poor treat-
ment. With regard to the domain of housing, nearly one-quarter
(22 percent) of transgender people reported that they have been
told or felt they would be unwelcome in a neighborhood, building,
TABLE 4 Prevalence of transgender adults reporting discriminationa
Subject of discriminationbN
Weighted percent of
transgender adultsc
Belief in overall discrimination
General belief that discrimination against transgender
people exists today in the United Statesd
All transgender adults (total sample) 86 84
Personal experiences of institutional discrimination
Health care
Going to a doctor or health clinic You (half-sample B) 55 10
Personal experiences of interpersonal discrimination
MicroaggressionseYou (half-sample B) 55 28
SlurseYou (half-sample B) 55 38
People acted afraideYou (half-sample B) 55 18
Been told or felt unwelcome because of being
transgenderf
You or LGBTQ friend/family member (total
sample)
86 22
Actions based on concerns about discrimination
Avoided doctor or health care because of concerns of
discrimination/poor treatment
You or LGBTQ family member (half-sample
B)
55 22
Thought about moving to another area because of
personally experienced discriminationg
You (total sample) 86 27
aTransgender adults include transgender, genderqueer, and gender nonconforming adults aged 18+. Most individual questions only asked among a
randomized subsample of half of respondents. Don' t know/refused responses included in the total for unadjusted estimates.
bQuestions about you are personal experiences only; questions about you or LGBTQ friend/family member ask if items have happened to you or a
friend/family member because you or they are part of the LGBTQ community.
cPercent calculated using survey weights.
dQuestion asked as “Generally speaking, do you believe there is or is not discrimination against transgender people in America today?”
eQuestion wording: “In your day-to-day life, have any of the following things ever happened to you, or not?” and respondent indicated they had ex-
perienced this and believed this happened because your sexual orientation or gender identity. Slurs = someone referred to you or a group you belong
to using a slur or other negative word; Microaggressions = someone made negative assumptions or insensitive or offensive comments about you;
People acted afraid = people acted as if they were afraid of you.
fYou or a friend/family member who is also part of the LGBTQ community has been told or felt you would be unwelcome in a neighborhood, building,
or housing development you were interested in because you are part of the LGBTQ community.
gYou have thought about moving to another area because you have experienced discrimination or unequal treatment where you were living.
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CASE Y Et Al.
or housing development because they were transgender, while
over one-quarter (27 percent) said they have thought about mov-
ing to another area to live because of the discrimination they have
already experienced.
4 | DISCUSSION
In this national US study of reported discrimination among LGBTQ
adults, four key findings emerge. First, study results extend prior
findings that LGBTQ adults in the United States experience perva-
sive discrimination across many areas of life.3-6,18-21,24,27,28 In par-
ticular, we found widespread interpersonal manifestations, including
slurs, harassment, and violence.
Second, institutional discrimination is also clearly present in
health care. Prior research has reported perceived mistreatment
in health care settings among LGB and transgender adults.6,1 8,32 In
this study, more than one in six LGBTQ adults say they have avoided
health care due to anticipated discrimination and experienced dis-
crimination in health care encounters. Among transgender adults,
these estimates are even higher. This is particularly worrisome and
merits further education and antidiscriminatory policies and train-
ing in health care, as avoiding health care can further exacerbate
health disparities between LGBTQ and non-LGBTQ adults.6 ,14, 22
Third, LGBTQ racial and ethnic minorities are significantly more
likely to report many forms of discrimination, even when controlling
for other factors. LGBTQ racial and ethnic minority adults had a
significantly lower odds of reporting LGBTQ identity-based micro-
aggressions relative to whites, though they were more likely than
LGBTQ whites to report experiencing racially based microaggres-
sions (not adjusted for demographic characteristics). These results
are largely consistent with prior research finding higher reported
racial discrimination among racial/ethnic sexual minorities relative
to white sexual minorities in public settings, accompanied by both
sexual orientation and gender discrimination.18 Our findings also
support other studies demonstrating that racial/ethnic identit y com-
pounds experiences of discrimination in addition to LGBTQ identity
in many areas of life.2 5-2 7, 29, 30
While it is beyond the scope of our results to promote specific
policies or practices to end discrimination in the United States, these
findings indicate both top-down (eg, policy) and bottom-up (eg, com-
munity organizations or local initiatives) effort s need to take steps
to address this widespread discrimination, on both institutional and
(especially) interpersonal levels. For transgender people, housing
and health care appear to be major areas of concern, while LGBTQ
racial/ethnic minorities face significant obstacles with employment
and the legal system. Multisector partnerships are urgently needed
to implement interventions, propel policy efforts, and create social
change to protect LGBTQ people across different systems, including
employment, health care, housing, and legal systems.
In addition, more research is needed that includes both new meth-
ods and novel data sources to improve the study of LGBTQ popula-
tions, given the current methodological limitations.6-8,34,35 In particular,
research using electronic health record data is a promising approach to
further study LGBTQ persons and other small populations, while mo-
bile device or computer apps and other novel methods for data capture
may also improve research on the unique experiences of discrimination
among LGBTQ persons within the health care system.8,46 At a minimum,
improving medical and administrative staff training on cultural compe-
tency for serving LGBTQ people, as well as improving data collection on
sexual orientation and gender identity in health care, is needed.
4.1 | Limitations
The findings should be viewed with several limitations in mind. First,
although we examined a broad range of domains of life, this study
covers only a subset of types of discrimination and harassment that
LGBTQ people may experience. Second, we asked whether LGBTQ
people had experienced these types of discrimination at any point
in their life, without regard to timing or severity. This limits the abil-
ity to estimate current levels of discrimination and harassment and
instead focuses on lifetime experiences.
Third, the prevalence of many sensitive topics, including sexual ha-
rassment and violence, is often un derreported—p articularly on surveys
administered by an interviewer,47 such as this study—and therefore,
the “true” prevalence of LGBTQ people's experiences of discrimina-
tion is likely higher than reported herein. Perceptions of various kinds
of discrimination (eg, race-based and sexuality-based) are also signifi-
cantly associated with each other,26, 29, 30 and it is not always possible
to disentangle these experiences from each other, so asking specifi-
cally about LGBTQ-based discrimination may lead to underreporting
of overall discrimination experienced by some respondents. Questions
about discrimination based on race/ethnicity and gender (among fe-
males only) are examined separately in other articles in this issue.
Fourth, our low response rate is a notable limitation, though ev-
idence suggests that low response rates do not bias results if the
survey sample is representative of the study population.38,39 Recent
research has shown that such surveys, when based on probability
samples and weighted using US Census parameters, yield accurate es-
timates in most cases when compared with both objective measures
and higher-response surveys.38,39,48,49 For instance, a recent study
showed that across 14 different demographic and personal charac-
teristics, the average difference between government estimates from
high-response rate sur veys and a Pew Research Center poll with a re-
sponse rate similar to this poll was 3 percentage points.38 However, it
is still possible that some selection bias may remain that is related to
the experiences being measured, particularly given the challenges of
surveying the LGBTQ population noted earlier.6-8,34-45
Fifth, transgender people are often discriminated against due
to their presumed gender or gender identity. Given that trans peo-
ple may be of any sexual orientation, they may also be discriminated
against because of their sexual orientation. Furthermore, some people
may not know the difference between sexual orientation and gender
identity, so they may discriminate against someone because of their
gender but using language about sexual orientation (or vice versa).
Therefore, it should be expected that transgender people report
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CASE Y Et Al.
experiences of discrimination related to both their gender identity
and sexual orientation, and so we report these experiences together,
and this study was unable to distinguish between these experiences.
Despite these limitations, this study was strengthened by its
probability sampling design and by the breadth of questions asked
on LGBTQ-based discrimination across institutions and interper-
sonal experiences. It allowed us to examine personal experiences of
discrimination and harassment among LGBTQ adults. Our findings
may underreport experiences of discrimination and harassment;
thus, our results can be considered a lower bound estimate of dis-
crimination and harassment in the United States today. We may also
underreport the added burden of discrimination against LGBTQ
people who are racial/ethnic minorities.
This study highlights the wide extent to which the LGBTQ adult pop-
ulation as one group experiences discrimination, providing important
data to inform national discussions and current policy debates. Yet, fu-
ture research is needed to assess the distribution and burden of discrim-
ination experiences faced by subgroups within the LGBTQ population.
5 | CONCLUSION
This study shows that lesbian, gay, bisexual, transgender, and queer
adults in America share common, yet diverse experiences of consistent
and pervasive discrimination based on their sexual orientation and/or
gender identity. Some of the most widespread reported experiences of
enacted stigma include slurs, microaggressions, violence, threats, and
both sexual and nonsexual harassment. In health care, additional efforts
are needed to reduce discrimination against LGBTQ adults. LGBTQ
racial/ethnic minorities experience particularly high rates of LGBTQ-
based discrimination in employment and workplace settings and inter-
acting with the legal system, while transgender adults report significant
discrimination in both housing and health care. Findings of this study
further illustrate the need for substantial changes in institutional poli-
cies and practices to protect the civil rights of LGBTQ people. Changes
in social norms are also needed to confront stigma and counteract the
harmful effects of discrimination in personal interactions. Addressing
both institutional and interpersonal discrimination will be vital to im-
proving and ensuring the health and well-being of LGBTQ Americans.
ACKNOWLEDGMENT
Joint Acknowledgment/Disclosure Statement: This work was sup-
porte d by Grant #73713 from the Rober t Wood Johnson Found ation.
ORCID
Mary G. Findling https://orcid.org/0000-0002-7214-5239
ENDNOTES
a Institutional and interpersonal forms of discrimination are not mutually
exclusive, but this framework is used here for organizational purposes.
b There were no statistically significant differences between LGBTQ men
and women in their unadjusted reported experiences of anti-LGBTQ
discrimination.
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SUPPORTING INFORMATION
Additional supporting information may be found online in the
Supporting Information section.
How to cite this article: Casey LS, Reisner SL, Findling MG, et
al. Discrimination in the United States: Experiences of
lesbian, gay, bisexual, transgender, and queer Americans.
Health Ser v Res. 2019;00:1–13. https ://doi.org /10.1111/1475-
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