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.     

The Interaction of Same-Sex Marriage Access With Sexual Minority Identity on Mental Health and Subjective Wellbeing

Previous psychological and public health research has highlighted the impact of legal recognition of same-sex relationships on individual identity and mental health. Using a sample of U.S. sexual minority (N = 313) and heterosexual (N = 214) adults, participants completed a battery of mental health inventories prior to the nationwide legalization of same-sex marriage. Analyses of covariance (ANCOVAs) examining identity revealed sexual minority participants living in states where same-sex marriage was banned experienced significantly higher levels of internalized homonegativity than sexual minority participants living in states where same-sex marriage was legal, even after controlling for state-level political climate. Mental health ANCOVAs revealed sexual minority participants residing in states without same-sex marriage experienced greater anxiety and lower subjective wellbeing compared to sexual minority participants residing in states with same-sex marriage and heterosexual participants residing in states with or without same-sex marriage. Implications for public policy and future research directions are discussed.     

Methods Used and Topics Addressed in Quantitative Health Research on Gay,Bisexual and Other Men Who Have Sex With Men: A Systematic Review of the Literature

Research on sexual minority men (gay, bisexual, and other men who have sex with men) was examined with regard to the measures of sexual orientation used, the methods of research, and the main health outcomes under study. A systematic review of English-language quantitative studies was conducted focused on the health of sexual minority men published in 2010 (n = 250). The results provide a snapshot of the literature and revealed that research on sexual minority men overwhelmingly focused on HIV, STIs, and sexual health for which sexual orientation was most commonly defined behaviorally. For topics of mental health or body/fitness outcomes, sexual orientation was most commonly defined by identity. Most study samples were venue-based, and only 8.8% of published papers drew data from population-based samples. The findings suggest that there exists a need for research on sexual minority men’s health beyond STIs and HIV that will examine mental and physical health outcomes beyond sexual risk, uses probability-based samples, and addresses intersectional concerns related to race/ethnicity and age.     

Hearing “That’s So Gay” and “No Homo” on Campus and Substance Use Among Sexual Minority College Students

ABSTRACT

Sexual orientation microaggressions are common on college campuses and can contribute to negative outcomes; yet little is known about their relationship with substance use outcomes. Among a convenience sample of cisgender sexual minority college students (n= 574; 57.0% female, 24.9% people of color, 50.7% gay/lesbian; 72.4% public school) from 37 states (67.8% Midwest), this analysis investigates the association between hearing “that’s so gay” and “no homo” on campus and hazardous alcohol use and the frequency of illicit drug use. Using multivariable regression analyses, the commonly heard phrases “that’s so gay” and “no homo” were each found to significantly increase the risk for hazardous drinking and the frequency of drug use among students. Efforts should be made to create more welcoming campus climates for sexual minority students by reducing the use of these microaggressions and, in the meantime, offering supports to mitigate their harmful effects.     

Cancer Screening Utilization Among U.S. Women: How Mammogram and Pap Test Use Varies Among Heterosexual,Lesbian, and Bisexual Women

Existing research on cancer screening utilization among sexual minority women in the U.S. has mostly relied on non-random samples that combine lesbian and bisexual women into a single group. We respond to these limitations by examining the relationship between sexual orientation and cancer screening among a sample of U.S. women from the Behavioral Risk Factor Surveillance System (BRFSS). Our analytic sample includes 2273 lesbian, 1689 bisexual, and 174,839 heterosexual women interviewed in 15 U.S. states between 2000 and 2010. We examine two cancer screening measures: timely mammogram and pap tests, defined as having had a mammogram in the past 2 years for women aged 40 and older, and having had a pap test in the past 3 years for women aged 21–65. For mammogram, results showed that rates of timely use did not significantly differ by sexual orientation. However, lesbian and bisexual women report significantly lower rates of timely pap testing than heterosexual women. Logistic regression results on timely pap testing showed that lower pap test use for bisexual women is primarily driven by their poorer socioeconomic status relative to heterosexual women, while the significantly lower odds of timely pap testing for lesbian women were unaffected by control measures. Better understanding of cancer screening utilization disparities among lesbian and bisexual women is necessary to address morbidity and mortality disparities by sexual orientation.     

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.     

Patterns of Mental Health Care Utilization Among Sexual Orientation Minority Groups

Prior studies of the utilization of mental health professionals by sexual minority populations have relied on data that are now dated or not nationally representative. These studies have also provided mixed findings regarding gender differences in the utilization of mental health professionals among sexual minority individuals. Using data from the 2013–2015 National Health Interview Surveys, this study investigates (1) how sexual minority individuals compare to heterosexual participants in their utilization of mental health professionals; and (2) gender differences in that utilization. The results indicate sexual minority individuals utilize mental health care professionals at higher rates than heterosexual individuals even after controlling for measures of mental health and other demographic characteristics; this is true for both men and women. However, gender moderates the sexual minority effect on utilization rates. Sexual minority men utilize mental health professionals at a high rate, such that their utilization rates are similar to sexual minority women, contrary to the gender gap seen among heterosexuals.     

Behavioral Risk Disparities in a Random Sample of Self-Identifying Gay and Non-Gay Male University Students

This Internet-based study was designed to compare health risk behaviors of gay and non-gay university students from stratified random cross-sectional samples of undergraduate students. Mean age of the 4,167 male participants was 20.5 (±2.7) years. Of these, 206 (4.9%) self-identified as gay and 3,961 (95.1%) self-identified as heterosexual. After adjusting for selected characteristics and clustering within university, gay men had higher odds of reporting: multiple sexual partners; cigarette smoking; methamphetamine use; gamma-hydroxybutyrate (GHB) use; other illicit drug use within the past 30 days and during lifetime; and intimate partner violence (IPV). Understanding the health risk behaviors of gay and heterosexual men is crucial to identifying associated factors and intervening upon them using appropriate and tailored strategies to reduce behavioral risk disparities and improve health outcomes.     

Self-Perceived Parental Role and Mental Health Concomitants Among Israeli Gay and Heterosexual Fathers

ABSTRACT

In this study we examined the association between self-perceived parental role and adverse mental health (indicated by depressive symptoms, neuroticism, and negative affect) in a sample of 82 Israeli gay fathers (Mean age = 39.57, SD = 6.70) that were individually matched with 82 heterosexual fathers (Mean age = 39.11, SD = 7.88). Results showed that although self-perceived parental role was associated with adverse mental health, this association was moderated by sexual orientation, such that a significant negative association between self-perceived parental role and adverse mental health was evident only among gay fathers. The findings are understood by features of gay fatherhood, which is intentional and purposeful, and usually achieved after contending with particular difficulties in the journey to fatherhood. These features presumably shape the perceived parental role, and thus may link more strongly with lower levels of adverse mental health among gay fathers, compared to heterosexual fathers.     

Considering the Role of Nativity in the Health and Psychological Wellbeing of Black LGBT Adults

ABSTRACT

Recent scholars have underscored how the experiences of LGBT people of color cannot be fully understood by considering only the independent contributions of race and sexual orientation. Framed by an intersectional lens, the current study seeks to address this gap in understanding by considering the role of nativity on the health and wellbeing of Black sexual minority adults; we also examined the moderating effects of family support and racial community climate on this relationship. Using national data from the Social Justice Sexuality Project (N = 2,166), we discovered that foreign-born Black LGBT adults had similar levels of psychological wellbeing and physical health as their native counterparts; family support and racial community climate did not moderate this relationship. Our findings did, however, substantiate the importance of family and community support for all Black LGBT adults, regardless of immigration status. Implications of this finding, in addition to directions for future intersectional work on racial minority LGBT people, are discussed.     

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.     

Condom use among married and cohabiting women and its implications for HIV infection in Mahikeng,South Africa

Married and cohabiting women have been neglected in the promotion of condoms as the most effective prevention method of sexually transmitted infections (STIs) and HIV. As a result, HIV prevalence is increasing in this population group in high HIV prevalence settings. The study assesses the prevalence of and identifies the predictors of consistent use of male condoms among married and cohabiting women, and examines its implications for HIV transmission. The data used were obtained from a cross-sectional survey on sexual and reproductive health conducted among women aged 18–49 years of age in Mahikeng Local Municipality in 2012 using mixed methods. A structured questionnaire and in-depth interview guide were used to collect quantitative data from 568 and qualitative data from 33 married or cohabiting women. The data were analysed using logistic regression and thematic content analysis methods. The results show that only 16.2% of the women consistently used condoms. Women having no and 1–2 surviving children, educated women, women in relationships in which most sexual decisions were jointly made with husbands/partners, women having high risk perceptions of STIs and HIV infection and women who negotiate condom use with and know the HIV status of their husbands/partners were significantly more likely to have consistently used condoms. However, women who perceived that condoms reduce sexual pleasure, feared they would be blamed for infidelity by husbands/partners, trusted that their husbands/partners were faithful and feared condoms could lead to relationship instability used condoms inconsistently. We conclude that the prevalence of consistent use of condoms by married and cohabiting women in the study is low, indicating that promotion of condoms among married or cohabiting women is neglected, which could increase the risk of HIV transmission. Based on our findings, we recommend the review of condom programmes with a view to targeting married or cohabiting couples as an important group for condom promotion and uptake.     

A gender comparison of HIV and drug use across the rural-urban continuum

Despite the central role of women drug users in escalating AIDS statistics, there is still a limited number of studies that examine the roles of gender and drug use type in HIV seroprevalence. This lacuna in the research literature has led to significant gaps in researchers' understanding of how and to what extent women may differ in their drug-using and HIV risk behaviors compared to their better-studied male counterparts. This study, derived from a sample of 3,555 out-of-treatment drug users residing in three South Florida urban and rural communities, attempts to compare the drug usage and needle and sexual risk behaviors of male and female drug users that put them at risk for HIV infection. The overall seropositivity rate for women drug users was 26.5% compared to 19.5% for their male counterparts. Results of multivariate analyses indicate that females compared to males were 1.4 times more likely to be HIV seropositive. Risk behaviors associated with this elevated seropositivity include living arrangements, homeless status, drug use, sexual trading behaviors, and history of STDs. Furthermore, there was a strong linear relationship between drug use type and HIV seroprevalence among women drug users. Compared to those who were neither crack smokers nor injectors of illicit drugs, those who were crack smokers only were 2 times more likely to be HIV seropositive, while those who were both crack smokers and injectors were 5 times more likely to be HIV seropositive, and those who were injectors only were 6 times more likely to be HIV seropositive. These findings indicate that among women, drug abuse and its associated risk behaviors, increase the vulnerability of this population for HIV and thus render them an extremely important priority population on which to focus HIV prevention and public health efforts and programs.     

Quantifying Sexual Orientation Among Homeless and Unstably Housed Women in a Longitudinal Study: Identity,Behavior, and Fluctuations Over a Three-Year Period

ABSTRACT

Sexual orientation has been linked to certain health conditions, and yet quantifying sexual orientation in longitudinal studies is challenging. This study examined different methods of accounting for sexual orientation in a cohort study of 300 homeless and unstably housed women followed every 6 months over 3 years. Altogether, 39.7% (n = 119) could be considered sexual minority at one or more time points based on identity and/or behavior; 16.3% (n = 49) reported shifts in sexual identity. Only 24.0% (n = 72) were identified as sexual minority through a single measure of sexual identity, 27.0% (n = 81) were identified with a single measure of identity and behavior, 33.0% (n = 99) were identified through annual measures of identity and behavior, and 22.0%–22.3% (n = 66–67) were identified through latent class analysis including all identity/behavior measures. This study found that sexual fluidity is common in unstably housed women, and many sexual minority women would be missed in longitudinal studies with different methods of accounting for sexual orientation.     

Sexual minority youth victimization and social support: the intersection of sexuality, gender, race, and victimization

In comparison to heterosexual youth, sexual minority youth are more likely to experience victimization. Multiple studies have connected anti-gay prejudice and anti-gay victimization to negative outcomes. Research shows that social support may protect sexual minorities from the harmful effects of anti-gay victimization. However, rates of victimization and the negative outcomes linked to sexual identity within the sexual minority community have been relatively unexplored. Using data from three years of statewide data from heterosexual and sexual minority adolescents in grades 9-12, this study examines victimization, substance use, suicidality, and access to social support by sexuality. Results indicate that sexual minority youth are at increased risk for victimization, substance use, suicidality, and social isolation compared to their heterosexual counterparts. Results also indicate that there is very little bivariate difference within the sexual minority community. Multivariate results indicate differences among sexual minorities' experiences with victimization and substance use.     

PrEP Awareness in the Context of HIV/AIDS Conspiracy Beliefs Among Black/African American and Hispanic/Latino MSM in Three Urban US Cities

ABSTRACT

We examined HIV conspiracy beliefs and PrEP awareness in a convenience sample of minority MSM. Participants in three cities completed a behavioral self-assessment on sociodemographics, PrEP awareness, and HIV/AIDS conspiracy beliefs. HIV/AIDS conspiracy beliefs were more common among Black than Latino MSM (58% vs. 42%, p < .05), and among younger men than older men (age 18–29 (50%), 30–39 (22%), 40+ (28%); p < .05). PrEP awareness co-occurred with conspiracy belief less (37%) than with non-belief (63%, p < .05), persisting in multivariable regression (aOR = 0.52, 95% CI = 0.38–0.71). This relationship suggests that current HIV care and prevention messaging is either inaccessible or not credible to some minority subpopulations.     

Heterosexism,Depression, and Campus Engagement Among LGBTQ College Students: Intersectional Differences and Opportunities for Healing

LGBTQ people experience health disparities related to multilevel processes of sexual and gender marginalization, and intersections with racism can compound these challenges for LGBTQ people of color. Although community engagement may be protective for mental health broadly and for LGBTQ communities in buffering against heterosexism, little research has been conducted on the racialized dynamics of these processes among LGBTQ communities. This study analyzes cross-sectional survey data collected among a diverse sample of LGBTQ college students (n = 460), which was split by racial status. Linear regression models were used to test main effects of interpersonal heterosexism and engagement with campus organizations on depression, as well as moderating effects of campus engagement. For White LGBTQ students, engaging in student leadership appears to weaken the heterosexism–depression link—specifically, the experience of interpersonal microaggressions. For LGBTQ students of color, engaging in LGBTQ-specific spaces can strengthen the association between sexual orientation victimization and depression.     

Left Out? Lesbian,Gay, and Bisexual Poverty in the U.S.

This paper analyzes the risk of poverty for self-identified lesbian, gay, and bisexual (LGB) people from mid-2013 through 2016 in the National Health Interview Survey, a nationally representative survey of households that includes a sexual orientation question based on identity (n = 112,143). The study tests the role of family structure—living with a spouse or partner and having children—on the risk of poverty for LGB and heterosexual respondents. After controlling for education, demographic, and health measures in a probit model, lesbians and gay men are as likely to be poor as similar heterosexuals, but bisexual women and men are significantly more likely to be poor, regardless of relationship status. Single and childless gay men are also more likely to be poor than single heterosexual men. Being in a relationship reduces the likelihood of poverty for people of all sexual orientations, but the data show evidence of a gender composition effect: married male same-sex couples are less likely and unmarried female same-sex couples more likely to be poor than their married counterparts. Marriage reduces gay men’s poverty risk more and children increase their poverty risk less than for heterosexual men.     

When Heterosexuality is Questioned: Stifling Suspicion Through Public Displays of Heterosexual Identity

This study examined public heterosexual identity management practices of heterosexual-identified young adults in the United States. Analysis of 415 participants’ written narratives indicated that 41% (n = 169) described consciously engaging in public displays of their heterosexual status in relation to suspicion about their sexual orientation. This article describes our findings regarding five aspects of these narratives of suspicion: types of suspicion, causes of suspicion, reasons for concern about suspicion, the types of public displays of heterosexual status employed to quell suspicion, and intended audiences for these displays. Overall, the results indicated that heterosexual identity suspicion is multifaceted, this suspicion serves as a catalyst for public displays of heterosexual status, and the climate of suspicion described by our participants reflects and reinforces contemporary heterosexism.     

A National Survey on Depression,Internalized Homophobia,College Religiosity,and Climate of Acceptance on College Campuses for Sexual Minority Adults

ABSTRACT

Sexual minority persons have an increased risk for negative mental health outcomes in adulthood. This seems to largely be due to experiences of stigma in social settings. This study sought to understand the relationship between attending a religiously conservative college, internalized homophobia (a measure of sexual stigma), and depressive symptoms for sexual minority adults. Sexual minority adult participants (n = 384) from across the U.S. were recruited and completed a Web-based, anonymous survey. A mediation model predicting depression through college religious conservatism, college acceptance of sexual minority identities, and internalized homophobia was tested using path analysis. Results revealed an indirect effect of increased religious conservatism of a college predicted higher depression through lower college acceptance and higher internalized homophobia. Implications for the mental health of sexual minority adults and future research are examined.