Disparities in Physical Health Conditions Among Lesbian and Bisexual Women: A Systematic Review of Population-Based Studies

We conducted a systematic review to assess evidence for disparities for lesbian and bisexual women (i.e., sexual minority women [SMW]) in comparison with heterosexual women across a range of nine physical health conditions. Among the k = 11 studies meeting eligibility criteria, almost every comparison (i.e., heterosexual vs. (a) lesbian, (b) bisexual, or (c) both lesbian and bisexual women) was in a direction indicating SMW disparities. Despite limited power due to small samples of SMW, we found evidence of disparities as indicated by a statistically significant adjusted odds ratios for asthma (5 of 7 comparisons), obesity (8 of 12), arthritis (2 of 3), global ratings of physical health (4 of 7), and cardiovascular disease (1 of 1). Evidence was lacking for cancer (1 of 4), diabetes and hypertension (both 1 of 5), and high cholesterol (0 of 3). Future work should confirm findings in more diverse, larger samples and should examine potential explanatory factors.     

Examining Sexual Orientation Disparities in Unmet Medical Needs Among Men and Women

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen’s model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.     

Women's Sexual Identity Patterns: Differences Among Lesbians,Bisexuals, and Unlabeled Women

To better understand women with same-sex attractions who do not identify as lesbian or bisexual (i.e., unlabeled women), we examined differences and similarities among self-designated lesbian, bisexual, and unlabeled women. Two hundred eight non-heterosexual women ranging in age from 18 to 69 years (85% identified as White) completed an online survey examining indicators of sexual orientation and beliefs and self-perceptions associated with sexual identity. Compared to lesbians, unlabeled women reported the weakest collective sexual identities and, along with bisexuals, they were less likely to view sexual orientation as fixed, being more focused on the “person, not the gender.” Unlabeled women reported the greatest likelihood that their sexual identity would change in the future. These findings highlight the complexity of women's sexual identities and question the adequacy of categorical approaches.     

Mental health issues: a comparison of lesbian, bisexual and heterosexual women

This study examines mental health issues among women of different sexual orientations. An anonymous survey was administered at 33 health care sites across the United States; the sample (N = 1304) included lesbians (n = 524), bisexual (n = 143) and heterosexual women (n = 637). Not only did sexual orientation influence the probability of experiencing emotional stress, but also whether a bisexual woman or lesbian had disclosed her sexual orientation (was "out") impacted the likelihood of having or having had mental health problems. Bisexual women and lesbians experienced more emotional stress as teenagers than did heterosexual women. Bisexual women were more than twice as likely to have had an eating disorder compared to lesbians. If a bisexual woman reported being out she was twice as likely to have had an eating disorder compared to a heterosexual woman. Lesbians who were not out and bisexual women who were out were 2-2.5 times more likely to experience suicidal ideation in the past 12 months. Lesbians and bisexual women who were not out were more likely to have had a suicide attempt compared to heterosexual women. Lesbians used psychotherapy for depression more commonly than did heterosexual or bisexual women. This is one of the few studies that compares lesbians, bisexual and heterosexual women. The implications of these findings are discussed.     

Health Status and Risk Behaviors of Sexual Minorities Among Chinese Adolescents: A School-Based Survey

This study aimed to examine the association between sexual orientation and health disparities among a stratified random sample of 3776 secondary students in Hong Kong. The prevalence of homosexuality and bisexuality were 1.5% and 2.6% in boys and 1.8% and 3.7% in girls, respectively. A total of 10.7% of boys and 8.8% of girls were unsure of their sexual orientation. Homosexual and bisexual boys reported poorer physical and mental health than their heterosexual peers. Homosexual and bisexual boys were more likely to engage in smoking, frequent drinking, and vaginal sex and be subjected to sexually transmitted disease and sexual victimization. However, lesbian and bisexual girls were less likely to engage in risky health behaviors except for smoking and being subjected to sexual victimization. There is a gender-specific problem that may warrant prevention and intervention programs to address the unique health issues facing homosexual and bisexual adolescents in Hong Kong.     

Concealing Concealment: The Mediating Role of Internalized Heterosexism in Psychological Distress Among Lesbian,Gay, and Bisexual Older Adults

ABSTRACT

Recent population-based studies indicate that sexual minorities aged 50 and older experience significantly higher rates of psychological distress than their heterosexual age-peers. The minority stress model has been useful in explaining disparately high rates of psychological distress among younger sexual minorities. The purpose of this study is to test a hypothesized structural relationship between two minority stressors—internalized heterosexism and concealment of sexual orientation—and consequent psychological distress among a sample of 2,349 lesbian, gay, and bisexual adults aged 50 to 95 years old. Structural equation modeling indicates that concealment has a nonsignificant direct effect on psychological distress but a significant indirect effect that is mediated through internalized heterosexism; the effect of concealment is itself concealed. This may explain divergent results regarding the role of concealment in psychological distress in other studies, and the implications will be discussed.     

Minority Stress and Binge Eating Among Lesbian and Bisexual Women

Previous research demonstrates that lesbian and bisexual (LB) women report more binge eating behaviors compared to heterosexual women although the explanations for this disparity are not well understood. LB women also experience distal (e.g., discrimination) and proximal (e.g., expectations of rejection) minority stressors that are related to negative mental and physical health outcomes. The present study investigated the association between minority stressors and binge eating behaviors in LB women. A sample of 164 LB women completed an online survey that included measures of distal and proximal sexual minority stressors, emotional-focused coping, social isolation, negative affect, and binge eating. The resultant model partially supported both the psychological mediation framework and the affect regulation model. The principal finding was that among LB women, proximal stressors were associated with social isolation and emotion-focused coping, which in turn were associated with negative affect and ultimately binge eating. Overall, the study provides evidence that minority stress is associated with binge eating and may partially explain the disparity in binge eating between LB and heterosexual women.     

Exploring Shame,Guilt, and Risky Substance Use Among Sexual Minority Men and Women

This study examined the interrelations among shame-proneness, guilt-proneness, internalized heterosexism (IH), and problematic substance use among 389 gay, lesbian, and bisexual men and women. Problematic alcohol and drug use were positively related to shame-proneness and negatively related to guilt-proneness. Bisexuals reported riskier substance use behaviors, lower levels of guilt-proneness, and higher levels of IH than gay men and lesbians. Furthermore, study findings indicated that shame and IH are related. Additional investigations of these associations would supplement current understandings of sexual minority stress and advance the development of substance-related intervention and prevention efforts targeting sexual minorities.     

Sexual orientation and differences in mental health, stress, and academic performance in a national sample of U.S. college students

This study examined the relationships of mental health issues and sexual orientation in a national sample of college students. Using the Fall 2009 American College Health Association-National College Health Assessment, responses from heterosexual, gay, lesbian, bisexual, and unsure students (N = 27,454) relating to mental health issues and impact of these issues on academics were examined. The findings indicate that gay, lesbian, bisexual, and unsure students consistently reported higher levels of mental health issues and a more frequent impact on academics because of these issues than heterosexual students. Bisexuals frequently reported higher levels than students identifying as gay, lesbian, and unsure.     

Performativity Double Standards and the Sexual Orientation Climate at a Southern Liberal Arts University

This study employs quantitative and qualitative methods to examine how heterosexual, bisexual, and gay students rate and describe a Southern, religiously affiliated university’s sexual orientation climate. Using qualitative data, queer theory, and the concept tyranny of sexualized spaces, we explain why non-heterosexual students have more negative perceptions of the university climate than heterosexual male students, in both bivariate and multivariate analyses. Although heterosexual students see few problems with the campus sexual orientation climate, bisexual men and women describe being challenged on the authenticity of their orientation, and lesbian and, to a greater extent, gay male students report harassment and exclusion in a number of settings. These distinct processes are influenced by broader heteronormative standards. We also shed much-needed light on how gendered sexual performativity double standards within an important campus microclimate (fraternity parties) contribute to creating a tyrannical sexualized space and negatively affect overall campus climate perceptions.     

Children of the closet: a measurement of the anxiety and self-esteem of children raised by a non-disclosed homosexual or bisexual parent

This research examined whether a parent's non-disclosure of his or her homosexual or bisexual orientation within the family unit negatively affects self-esteem and anxiety in children, as measured in adulthood. Thirty-six subjects indicated that they had not known of their parent's sexual orientation until an average age of sixteen for the children of lesbian or bisexual mothers, and twenty-two for the children of gay or bisexual fathers. This group's scores on the Rosenberg Self-Esteem Scale, the Marlowe Crowne Social Desirabilty Scale and the State-Trait Anxiety Scale were compared to scores obtained by sixty-three participants who did not have a homosexual/bisexual parent. The number of years a secretive environment surrounded the child was measured, as were participants' attitudes about the secret sexual identity. Although the study did not find that adults previously raised with a closeted parent had significantly higher levels of anxiety or lower levels of self-esteem, results indicated that those who had been raised as children with non-disclosed lesbian mothers showed a significantly higher level of self-esteem than participants with heterosexual parents. Implications of the findings for the targeted population are discussed.     

Mothers’ Sexual Identity and Children’s Health

Sexual minority women face a plethora of structural, socioeconomic, and interpersonal disadvantages and stressors. Research has established negative associations between women’s sexual minority identities and both their own health and their infants’ birth outcomes. Yet a separate body of scholarship has documented similarities in the development and well-being of children living with same-sex couples relative to those living with similarly situated different-sex couples. This study sought to reconcile these literatures by examining the association between maternal sexual identity and child health at ages 5–18 using a US sample from the full population of children of sexual minority women, including those who identify as mostly heterosexual, bisexual, or lesbian, regardless of partner sex or gender. Analyses using data from the National Longitudinal Study of Adolescent to Adult Health (N?=?8978) followed women longitudinally and examined several measures of their children’s health, including general health and specific developmental and physical health conditions. Analyses found that children of mostly heterosexual and bisexual women experienced health disadvantages relative to children of heterosexual women, whereas the few children of lesbian women in our sample evidenced a mixture of advantages and disadvantages. These findings underscore that to understand sexual orientation disparities and the intergenerational transmission of health, it is important to incorporate broad measurement of sexual orientation that can capture variation in family forms and in sexual minority identities.

     

Self-Identified Heterosexual Clients in Substance Abuse Treatment With a History of Same-Gender Sexual Contact

There is virtually no literature concerning the experiences of self-identified heterosexual clients in substance abuse treatment who have a history of same-gender sexual contact (HSGS). In a U.S. urban inpatient program in 2009–2010, 99 HSGS clients were compared to 681 other heterosexual and 86 lesbian, gay, and bisexual clients regarding background factors, program completion rates, and feelings about treatment. Male HSGS participants had lower completion rates than other male heterosexual participants. Qualitative data indicated that most male HSGS participants experienced difficult emotions regarding same-gender sexual encounters, particularly those involving trading sex for money or drugs. Implications for treatment are discussed.     

Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma

ABSTRACT

LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.     

Gender Role Violations and the Sexual Double Standard

ABSTRACT

The sexual double standard (SDS) suggests that women are evaluated negatively and men positively for engaging in similar sexual behaviors. According to social role theory, the SDS exists due to gender role structures. Consequently, perceived violations of women’s sexual behavior are associated with the SDS. In addition to gender role violations of sexual behavior, two additional violations of gender roles exist: heterosexual sexual orientation norms and gender role characteristics. The current study aims to investigate whether the SDS persists for sexual orientation–violating and gender role characteristic–violating targets, and to examine which of the three gender role violations influence evaluations of others’ sexual behavior. A U.S. sample of 483 participants evaluated target individuals who were either female or male, heterosexual/gay man or lesbian, feminine or masculine, and had 1 or 12 sexual partners. Results indicate that SDS persists for gender role–violating targets but is exhibited differently for targets violating heterosexual sexual orientation norms and gender role characteristics.     

Factors influencing the career and academic choices of lesbian, gay, bisexual, and transgender people

This is an empirical study of academic and career choices for 119 lesbian, gay, bisexual, and transgender (LGBT) students using a questionnaire. Respondents who reported that their sexual orientation influenced their choices a great deal indicated that the influences were both positive and negative. This group was most likely to have experienced anti-LGBT discrimination in the past. In comparing lesbian, bisexual people, and gay males, gay males and respondents from visible minorities were the most likely to feel a negative impact, while bisexual respondents were the least likely. There were too few transgender respondents to include in these statistical comparisons; however, frequencies suggest that transgender people may be the most vulnerable of all. Results suggest that counselors need to take sexual orientation issues, particularly past experiences of discrimination, when working with LGBT clients.     

Factors Influencing the Career and Academic Choices of Lesbian,Gay, Bisexual,and Transgender People

This is an empirical study of academic and career choices for 119 lesbian, gay, bisexual, and transgender (LGBT) students using a questionnaire. Respondents who reported that their sexual orientation influenced their choices a great deal indicated that the influences were both positive and negative. This group was most likely to have experienced anti-LGBT discrimination in the past. In comparing lesbian, bisexual people, and gay males, gay males and respondents from visible minorities were the most likely to feel a negative impact, while bisexual respondents were the least likely. There were too few transgender respondents to include in these statistical comparisons; however, frequencies suggest that transgender people may be the most vulnerable of all. Results suggest that counselors need to take sexual orientation issues, particularly past experiences of discrimination, when working with LGBT clients.     

A Clinical Comparison of Lesbian and Heterosexual Women in a Psychiatric Outpatient Clinic

ABSTRACT

Previous research has reported that when compared to heterosexual women, lesbians may use alcohol and illicit substances to a greater degree and may experience greater psychiatric symptomatology. This study sought to describe any differences in clinical diagnoses, familial histories, and substance usage between lesbian and heterosexual women in a psychiatric outpatient clinic. A chart review was conducted and a sample of 455 heterosexuals and 75 lesbians was obtained. Data, where available, included demographic information, clinical diagnoses, time in treatment, sexual orientation, past and present substance use, and familial substance abuse and psychiatric history. Lesbians were found to have greater past illicit substance use but less current use. No significant differences were found for alcohol use. Similarly, no significant differences in clinical diagnoses were found. Significant differences were found among families. Family members of lesbians had greater substance use and psychiatric histories. These findings both support and dispute some previous research and suggest areas for future researchers to explore.     

Characteristics of gay, lesbian, and bisexual Asians, Asian Americans, and immigrants from Asia to the USA

An exploratory study of self-identified lesbian, gay, and bisexual Asians and Asian Americans surveyed respondents (60 women and 254 men) using a questionnaire in four languages from nineteen different sources in Korea, Japan, China, and the US. Respondents were compared in terms of country of residence, whether they immigrated to the US, having a same-sex lover, living with the lover, being open about their sexual orientation to the family, and age. Respondents in the US were generally more open about their sexual orientation. Openness to the family was related to other variables suggesting an affirmative lesbian, gay, or bisexual identity.     

Religiosity as a Protective Factor against Heavy Episodic Drinking (HED) in Heterosexual,Bisexual, Gay,and Lesbian Young Adults

Although religiosity has been shown to be associated with positive outcomes in studies of general population samples, few studies have considered the potential differential effect of religiosity on those who are consolidating gay, lesbian, or bisexual (GLB) identities. Logistic regression analyses using a sample of 13,038 emerging adults from the National Longitudinal Survey of Adolescent Health (Add Health) revealed main effects for religiosity and a significant religiosity × sexual identity interaction in women. Specifically, religiosity was protective against alcohol use and heavy episodic drinking (HED) in heterosexual women, but not lesbian women. In bisexual women, higher religiosity increased the odds of alcohol use and HED. Among men, religiosity was protective, with no differential effects based on sexual identity. Prevention efforts should consider that individual religiosity may be a risk, rather than protective factor for some young adults.