Sexual orientation and sexual health care needs: a comparison of women beneficiaries in outpatient military health care settings

The objectives of this study are to compare the sexual concerns, interest and experiences in discussing these concerns with their doctor for women of "Only Men" and "Some to Only Women" sexual orientation. A survey was mailed to women patients from two military outpatient settings, with 1,196 women responding. Of eligible respondents (N = 1,170), 90% reported "Only Men" and 10% reported "Some to Only Women" sexual orientation. Sexual concerns varied by sexual orientation, while interest and experience in discussing sexual concerns and desire for physicians to initiate the topic differed minimally. Women with "Some to Only Women" sexual orientation have both similar and differing sexual concerns compared to "male-only" oriented women. Larger primary care patient-based studies of sexual health care needs of sexual minorities are needed.     

Sexual Orientation and Sexual Health Care Needs: A Comparison of Women Beneficiaries in Outpatient Military Health Care Settings

ABSTRACT

The objectives of this study are to compare the sexual concerns, interest and experiences in discussing these concerns with their doctor for women of “Only Men” and “Some to Only Women” sexual orientation. A survey was mailed to women patients from two military outpatient settings, with 1,196 women responding. Of eligible respondents (N = 1,170), 90% reported “Only Men” and 10% reported “Some to Only Women” sexual orientation. Sexual concerns varied by sexual orientation, while interest and experience in discussing sexual concerns and desire for physicians to initiate the topic differed minimally. Women with “Some to Only Women” sexual orientation have both similar and differing sexual concerns compared to “male-only” oriented women. Larger primary care patient-based studies of sexual health care needs of sexual minorities are needed.     

Is Patients' Sexual Orientation a Blind Spot of Family Physicians?

ABSTRACT

Even though certain health needs of gay, lesbian, and bisexual (GLB) patients are unique and different from those of the heterosexual patient, physicians do not usually ask patients about their sexual orientation. This study investigates family physicians' common practice regarding their patients' sexual orientation. Most of the physicians surveyed knew of less than 0.5% GLB patients in their practice; 44.4% did not know of any GLB patients. Only one physician commonly asked his patients about their sexual orientation; other physicians rarely or never asked. Asking patients about their sexual orientation significantly (P < 0.01) predicted the number of GLB patients known to the physician. Asking about patients' sexual orientation is not a common practice for family physicians, and, thus, they are usually unaware of the GLB patients in their practice.     

Barriers to Optimal Care between Physicians and Lesbian,Gay, Bisexual,Transgender, and Questioning Adolescent Patients

The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.     

Gay, lesbian, and bisexual youth and young adults: social support in their own words

Perceived social support was explored in a qualitative study of 17 gay, lesbian, and bisexual youth and young adults from a Seattle-based sexual minority youth drop-in center. The participants were interviewed in person with an open-ended question format to describe, in their own words, perceived social support they received as sexual minorities. Support was organized into four types, those fulfilling concrete, emotional, financial, or informational needs. Content analysis revealed several themes of support tailored to the specialized needs participants had as sexual minorities: locating parental figures among other gays and lesbians, parental reactions to learning of the youths' sexual orientation, the ability to reciprocate support, and finding supporters who introduced the youth to the gay, lesbian, and bisexual community. Non-family members were found to be more supportive than family members, particularly regarding informational support. Sexual minorities were perceived as more supportive than non-sexual minorities. Understanding the process and significance of acquiring a sense of community from which youth may garner continued support may present an avenue for intervention among social service providers. Additional implications for practice and research are also discussed.     

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.     

Reaching Egyptian Gays Using Social Media: A Comprehensive Health Study and a Framework for Future Research

The Internet has revolutionized research on sexual minorities by providing direct and safe access to hidden, stigmatized, and high-risk populations. This study investigated the possibility of using Facebook to reach Egyptian gays. The questionnaire was manually distributed to an extensive list of Facebook pages and groups related to the topic that has been collected using a snowball-like technique. The recruitment lasted from August 2015 to May 2016. Among the 461 eligible participants, the mean age was 26.6 (SD = 7.6), and the majority (74%) were highly educated. Only 17% use condoms consistently, and 34% have ever tested for HIV. Guilt feelings and trying to change sexual orientation were very high and were associated with higher religiosity and low condom use and HIV testing (p < .05). Also, 10% have ever tried to end their life. Most of the participants did not disclose their sexual orientation to anybody other than their partners, and 60% will not disclose it to health care providers even if needed. The low health awareness among Egyptian gays requires Internet-based health campaigns.     

Same-Sex Sexuality and Educational Attainment: The Pathway to College

Research finds lower levels of academic performance among sexual minority high school students, but some studies suggest sexual minorities have higher levels of educational attainment in adulthood. To further our understanding of how and why sexual orientation is associated with educational success, this study turns attention to the pathways to college completion, examining points along educational trajectories in which sexual minorities fall behind or surpass their heterosexual peers. Using data from the National Longitudinal Study of Adolescent to Adult Health, we find that sexual minority women are less likely than women with no same-sex sexuality to complete college, in part due to their high school performance and transition into college. Men who experience same-sex sexuality only in adolescence struggle in high school, but men who experience same-sex sexuality for the first time in adulthood are more likely to earn a college degree than men who do not experience same-sex sexuality.     

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.     

Sexual Orientation and Fear at Night: Gender Differences Among Sexual Minorities and Heterosexuals

Using data from the 2000–2010 General Social Survey, a nationally representative sample of 5,086 adults in the United States, the authors examine sexual orientation and gender differences in reports of being afraid to walk alone at night. Results indicate that sexual minorities are significantly more likely to report fear at night than heterosexuals, and women are significantly more likely to report such fear than men. Further, our findings suggest that these sexual orientation and gender differences are due to sexual minority men being more likely than heterosexual men to report fear at night. Thus, the results of this study reveal that three groups—heterosexual women, sexual minority women, and sexual minority men—do not differ from one another in reporting fear, yet these groups are all more likely than heterosexual men to report fear at night. These findings give weight to the importance of investigating the intersection of sexual orientation and gender in individuals’ reports of fear.     

Building a Dignified Identity: An Ethnographic Case Study of LGBT Catholics

ABSTRACT

This ethnographic case study offers insight into religiously devout sexual minorities and the reasons behind their continued participation in an anti-gay religious institution, the Roman Catholic Church. I demonstrate how members of Dignity, an organization for gay, lesbian, bisexual, and transgender (LGBT) Catholics, strategically use their identity as gay Catholics to initiate action, to build community, and to destigmatize other religious sexual minorities. Members leverage this unique identity to push for change and equality within the Church. At the same time, this identity also allows members to see their continued participation in the anti-gay Roman Catholic Church as activism, a positive and affirming identity, thereby alleviating potential conflict and contradiction between their sexuality and their spirituality as Roman Catholics.     

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.     

A probability sample of gay males

Data are presented from a national probability sample of males interviewed by telephone and asked their sexual orientation. Of these males 3.7 percent reported that they were homosexual or bisexual. Homosexual/bisexual men were compared with heterosexual ones on the demographic variables. This sample produced larger numbers in those groups which appear to be underrepresented in the usual samples drawn from the gay world. These groups include those with little education, married men, older men, minorities, and those living in small towns. It is suggested that probability samples which do not draw directly or heavily from the gay world for homosexual respondents obtain a broader sampling of those having homosexual feelings or behaviors.     

Minding the Noise: Conducting Health Research Among Bisexual Populations and Beyond

In this article, we draw upon our experiences conducting health-related studies with sexual minorities to suggest guidelines and best-practices for carrying out research among bisexual populations specifically. Too often bisexuality has been treated as “noise in the data,” because it does not conform to monosexual notions of sexual orientation. We discuss methodological, theoretical and conceptual concerns as they pertain to conducting research among bisexual persons. We hope that the insights we offer will prompt greater attention to bisexual groups and their specific concerns, not only among health researchers, but among those from other fields and disciplines as well.     

Introduction: Population Perspectives on Sexual Minorities

Population scientists investigate a multitude of important issues surrounding demographic trends and change. Yet, sexual minorities—including gay, lesbian, bisexual, and transgender persons—continue to represent an understudied group in population-based research. This has both social and political implications, as it hampers our ability to identify and locate where sexual minorities fall along the spectrum of issues typically investigated by demographers. This special issue includes important population-level studies aimed at understanding the demographic landscape for sexual minorities. Though not an exhaustive list, these include family organization, health disparities, educational attainment, and important implications for measurement and estimation. Perhaps more important, these studies also provide a roadmap that population scientists can use to help develop areas ripe for inquiry.     

Sexual minority identity formation in an adult population

This study reflects an initial empirical attempt to assess the validity of a widely accepted model of sexual identity formation proposed by Cass (1979). Using a cross-sectional sample of 143 sexual minority participants, factor analytic and multidimensional scaling results suggest that sexual minorities view the identity formation process as occurring in two phases, rather than multiple discrete linear stages. These two phases can be best characterized by individuals having either an "unintegrated" or "fully integrated" sense of sexual orientation into one's self-identity. Future research is suggested utilizing a longitudinal design in order to conduct a more rigorous test of this model.     

A feminist model of family care: practice and policy directions

Using a feminist perspective, this article examines women's experiences in caring for older family members with chronic illnesses or disabilities. Central to this analysis are the concepts of the social construction of gender-based inequities in caring, the interconnections between generations of women as givers and receivers of care, and variations in family care by gender, race, ethnicity, social class and sexual orientation. The authors critique current practice interventions and policies and purpose models for the elimination of gender-based inequities in caregiving and the provision of caregiver choice and empowerment for women and men, including feminist models of practice with women caregivers and economic and long-term care supports.     

Staff Reactions Toward Lesbian,Gay, or Bisexual (LGB) People Living in Residential Aged Care Facilities (RACFs) Who Actively Disclose Their Sexual Orientation

Fifty-three staff members currently working in residential aged care facilities located in Barcelona, Spain, were asked about the way they would react if a resident told them that he or she felt sexually attracted and had maintained sexual relationships with another resident of the same gender. Acceptance of non-heterosexual sexual orientation was a frequent answer, and around one in four professionals stated that they would try helping the resident in question, by offering a private space or giving some emotional support. However, some reactions were not consistent with a respectful approach toward sexual diversity, as, for instance, informing the resident’s family or advising the resident to keep his or her sexual orientation hidden. We highlight the importance of developing formal policies and offering formal training to staff in order to address the specific needs of older LGB people living in RACFs.     

Disclosing a LGB Sexual Identity When Living in an Elderly Long-Term Care Facility: Common and Best Practices

ABSTRACT

This study aims at exploring staff perceptions of common and best practices toward a situation in which an older resident discloses their non-heterosexual sexual identity, differentiating between gay men, lesbians, and bisexuals. A total of 2,254 staff members from 96 Spanish long-term care facilities took part in the study. They were asked about what they think most of their workmates would do and what they think should be done in a situation in which an older resident discloses his/her non-heterosexual sexual orientation. The results indicate that, in general, staff’s attitudes to non-heterosexual older residents’ disclosure of their sexual identity are quite tolerant and open. However, differences in staff perceptions of common and best practices indicate that there is still potential for improvement. Results underline that factors such as residents’ sexual identity (and particularly, bisexuality), generation, professional position, and the prevailing model of care influence staff responses.