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.     

Parents' supportive reactions to sexual orientation disclosure associated with better health: results from a population-based survey of LGB adults in Massachusetts

This study investigated associations between coming out to parents, experiences of parental support, and self-reported health behaviors and conditions among a population-based sample of LGB individuals using data collected via the 2002 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS; N = 177). We explored the following two hypotheses: 1) Lesbian, gay, and bisexual (LGB) individuals who had never disclosed their sexual orientation to a parent would report higher levels of risk behaviors and poorer health conditions than those who had come out; and 2) among LGB respondents who had come out to their parents, the individuals whose parents had reacted unsupportively would report higher levels of risk behaviors and poorer health conditions than those who had come out to parents who were supportive. Approximately two thirds of gay and bisexual (GB) males and lesbian and bisexual (LB) females reported receiving adequate social and emotional support from the parent to whom they first disclosed their sexual orientation. Among LB females, no disclosure of sexual orientation to a parent was associated with significantly elevated levels of past-month illicit drug use (AOR 12.16, 95% CI 2.87-51.54), fair or poor self-reported health status (AOR 5.71, 95% CI 1.45-22.51), and >15 days of depression in the past month (AOR 5.95, 95% CI 1.78-19.90), controlling for potential confounders. However, nondisclosure to a parent by GB males was not associated with greater odds of any of the health indicators assessed. Among GB males, those with unsupportive parents were significantly more likely to report current binge drinking (AOR 6.94, 95% CI 1.70-28.35) and >15 days depression in the past month (AOR 6.08, 95% CI 1.15-32.15), and among LB females, those with unsupportive parents were significantly more likely to report lifetime illicit drug use (AOR 11.43, 95% CI 2.50-52.30), and >15 days depression in the past month (AOR 5.51, 95% CI 1.36-22.36). We conclude that coming out may be associated with better health for LB women, and that parents who react nonsupportively when their children disclose LGB sexual orientation may contribute to children's increased odds of depression and hazardous substance use.     

Sense of belonging in secondary schools: a survey of LGB and heterosexual students in Flanders

This study focuses on differences in sense of belonging between lesbian, gay, and bisexual (LGB) and heterosexual students. Data from 1,745 secondary school students were collected with an online survey. Step-wise multiple regression analyses was used to investigate the relationship between sexual orientation and sense of school belonging. The results show that sexual orientation has an impact on sense of belonging for girls, but not for boys. Perceived discrimination and LGB friendliness of the school appeared to be important indicators of sense of belonging for all the respondents, irrespective of their sexual orientation.     

Minority Stress,Parenting Styles,and Mental Health in Brazilian Homosexual Men

ABSTRACT

Homosexual men are constantly exposed to prejudice and violence in Brazil. The aim of this study was to investigate the relationship between minority stress, parenting styles, and indicators of mental health problems in a sample of homosexual men. Method: quantitative, cross-sectional, correlational, and retrospective design. Participants were 101 Brazilian men who selfidentified as homosexuals, aged between 18 and 55 years. Results: concealing sexual identity was a predictor of depression and stress. Parental responsiveness was associated with a lower incidence of enacted stigma and depression. Conclusions: the mental health of homosexual men can be negatively affected by the need to conceal their sexual orientation. Parental responsiveness is a protective factor in terms of experiencing enacted stigma and depression. The results found in the study may be useful for counselors and social workers who are working with LGBT people and their families.     

Mental Health Concerns of Gay and Bisexual Men Seeking Mental Health Services

ABSTRACT

Little data exist about the mental health needs of gay and bisexual men. This is due to limitations of existing studies such as small and nonrepresentative samples, failure to assess sexual orientation, and concerns about stigmatization, possibly causing sexual minority individuals to be reluctant to disclose their sexual orientation to researchers. Fenway Community Health is a large urban health center that serves the LGBT community. The large number of gay and bisexual men who present for mental health treatment allows for a unique opportunity to gain insight into mental health, prevention, and intervention needs for this group. The current study is a review of the mental health information from all of the gay and bisexual men who reported that they were HIV-negative during their mental health intake over a six-month period at Fenway Community Health (January to June 2000; N = 92). The most frequent presenting problems were depression, anxiety, and relationship issues. Additionally, presenting problems included current or past abuse, substance abuse, finance and employment, recent loss, and family issues. The most frequent diagnoses were depression, anxiety disorders, and adjustment disorders. These findings support the notion that presenting problems and mental health concerns among gay and bisexual men are similar to those frequently reported by individuals in other mental health facilities, however, specific psychosocial stressors are unique to this population.     

Chasing Sexual Orientation: A Comparison of Commonly Used Single-Indicator Measures of Sexual Orientation

This research investigated the utility of single-indicator measures of sexual orientation in examining group differences. Adolescents and young adults reported their sexual orientations, preferences, and partners. Results indicate that, (a) depending on the measure of sexual orientation, 10% to 22% cannot be categorized into a sexual orientation group using a single-indicator measure; (b) self-identified sexual orientation is often incongruent with preference and behavior; (c) incongruity differs by gender and self-identified sexual orientation; and (d) detected differences in gay/lesbian, bisexual, and straight individuals vary by measure of sexual orientation. These results indicate that classification of sexual orientation by single-indicator measures can lead to inconsistent conclusions across studies.     

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.     

Seeking safer sexual spaces: queer and trans young people labeled with intellectual disabilities and the paradoxical risks of restriction

Young lesbian, gay, bisexual, and transgender (LGBT) people labeled with intellectual disabilities have unique sexual health needs that are not being met. Denial by others of their right to pleasure and the exercise of heightened external control over their sexuality are commonplace. Current research indicates that these youth are at heightened risk for compromised sexual health. This study aimed to explore the ways in which social and environmental conditions influence vulnerability to adverse sexual health outcomes for this population. We used a community-based research approach to conduct qualitative interviews and focus groups with 10 young LGBT people (aged 17-26) labeled with intellectual disabilities. Participants reported multiple limitations on their autonomy that resulted in having sex in places where they did not feel comfortable and were unlikely to practice safer sex. Attempts by authority figures to protect youth through limits on their autonomy may be unintentionally leading to negative sexual health outcomes.     

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.     

The Influence of Health Promoting Practices on the Quality of Life of Community Adults in Hong Kong

The importance of a healthy lifestyle is receiving increasing attention due to its impact on health and well-being. However, very few studies have been done on health promoting practices of the general public in Hong Kong. The present study aimed to identify the patterns of health promoting practices of the general public in Hong Kong, to compare health promoting practices across gender and education levels, and to examine the relationship between health promoting practices and quality of life. A total of 941 community adults were recruited using a randomized household survey design. Results revealed that a large proportion of participants reported practicing various types of health promoting behavior related to healthy food choice, engaging in stress management strategies, and refraining from health compromising behavior such as smoking and drinking excessively. Female participants were more likely to choose healthy food, refrain from smoking and drinking alcohol excessively, and take vitamin supplements, whereas male participants were more likely to exercise regularly. Both men and women with higher levels of education were more likely to report not smoking, not drinking alcohol excessively, and participating in social activities. Women with higher levels of education were also more likely to engage in relaxing activities but less likely to report exercising regularly and sleeping sufficiently. Hierarchical regression analyses revealed that stress management and social relations significantly predicted better quality of life for both male and female participants, and types of preventive health behavior were significant predictors of quality of life for female participants only. Results highlighted the importance of advocating health promoting practices among the general public in Hong Kong. Implications for future practice were discussed.     

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.     

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.     

Support for a Fluid-Continuum Model of Sexual Orientation: A Large-Scale Internet Study

In a study with 17,785 subjects obtained over the Internet from the United States and 47 other countries, Kinsey's hypothesis that sexual orientation lies on a continuum was supported. Self-identifications of subjects as gay, straight, bisexual, and other corresponded to broad, skewed distributions, suggesting that such terms are misleading for many people. Sexual orientation range—roughly, how much flexibility someone has in expressing sexual orientation—was also measured. The results support a fluid-continuum model of sexual orientation, according to which genetic and environmental factors determine both the size of the sexual orientation range and the point at which an individual's sexual orientation is centered on the continuum.     

The Politics of Sexual Citizenship: Negotiating Acts of Citizenship Among Non-Heterosexuals in Hong Kong

ABSTRACT

The notion of sexual citizenship has been developed over the past two decades, and its discussion has been expanded to other regions. This article investigates the claiming of rights by non-heterosexuals in Hong Kong to achieve two objectives: to articulate the importance of the rights claiming process, particularly regarding how non-heterosexuals are being transformed to become claimants through rights claims, and to extend the notion of sexual citizenship in East Asia, particularly in the Hong Kong context. The findings show four distinctive characteristics of sexual citizenship in Hong Kong. Non-heterosexuals are found to have faced different struggles and barriers before or during the process of claiming rights, including restricted welfare rights access in various social institutions. Furthermore, the development of sexual citizenship in the Hong Kong local context is found to be limited.     

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.     

Measuring Adult Children’s Perceptions of Their Parents’ Acceptance and Rejection of Their Sexual Orientation: Initial Development of the Parental Acceptance and Rejection of Sexual Orientation Scale (PARSOS)

ABSTRACT

The Parental Acceptance and Rejection of Sexual Orientation Scale was administered to 256 self-identified lesbian, gay, bisexual, or queer adults who had been out of the closet to their parents for at least 1 year. Principal component analysis revealed a clear two-component solution: parental acceptance and parental rejection. Findings showed that perceived maternal sexual orientation-specific acceptance was higher, and perceived maternal sexual orientation-specific rejection was lower, for gay/bisexual sons compared to their lesbian/bisexual daughters. Results of regression analyses suggest that both perceived sexual orientation specific acceptance and rejection predicted adult children’s psychological symptoms after accounting for perceived global parental acceptance and rejection and the child’s gender. The scale’s utility for research and practice are noted.     

Mental health concerns of gay and bisexual men seeking mental health services

Little data exist about the mental health needs of gay and bisexual men. This is due to limitations of existing studies such as small and nonrepresentative samples, failure to assess sexual orientation, and concerns about stigmatization, possibly causing sexual minority individuals to be reluctant to disclose their sexual orientation to researchers. Fenway Community Health is a large urban health center that serves the LGBT community. The large number of gay and bisexual men who present for mental health treatment allows for a unique opportunity to gain insight into mental health, prevention, and intervention needs for this group. The current study is a review of the mental health information from all of the gay and bisexual men who reported that they were HIV-negative during their mental health intake over a six-month period at Fenway Community Health (January to June 2000; N = 92). The most frequent presenting problems were depression, anxiety, and relationship issues. Additionally, presenting problems included current or past abuse, substance abuse, finance and employment, recent loss, and family issues. The most frequent diagnoses were depression, anxiety disorders, and adjustment disorders. These findings support the notion that presenting problems and mental health concerns among gay and bisexual men are similar to those frequently reported by individuals in other mental health facilities, however, specific psychosocial stressors are unique to this population.     

Reported excellent health among men in same-sex and mixed-sex couples: Behavioral Risk Factor Surveillance System, 1993-2010

Self-reported excellent health was examined across sexual orientation among male adult couples using 18 years of data from the Behavioral Risk Factor Surveillance System. Men in same-sex couples were more likely to report being in excellent health (28.7%) than men in unmarried and married mixed-sex couples (20.4% and 23.2%). After adjusting for other demographic and health factors, men in same-sex couples remained more likely to report excellent health than men in unmarried mixed-sex couples, but not than men in married mixed-sex couples. Reporting only adverse health disparities provides a partial picture of sexual minority health, and discounts the role of resilience and other health promoting factors in these populations.     

“All of My Lovers Fit Into This Scale”: Sexual Minority Individuals’ Responses to Two Novel Measures of Sexual Orientation

Previous qualitative research on traditional measures of sexual orientation raise concerns regarding how well these scales capture sexual minority individuals’ experience of sexuality. The present research focused on the critique of two novel scales developed to better capture the way sexual and gender minority individuals conceptualize sexuality. Participants were 179 sexual minority (i.e., gay, lesbian, bisexual, pansexual, queer, asexual) individuals who identified as cisgender (n = 122) and transgender (n = 57). Participants first completed the new scales, then provided qualitative responses regarding how well each scale captured their sexuality. The Sexual-Romantic Scale enabled the measurement of sexual and romantic attraction to each sex independently (same-sex and other-sex). Participants resonated with the way the Sexual-Romantic scale disaggregated sexual and romantic attraction. Although cisgender monosexual (lesbian/gay) individuals positively responded to the separation of same- and other-sex attraction, individuals with either plurisexual (bisexual, pansexual, or fluid) or transgender identities found the binary conceptualization of sex/gender problematic. The Gender-Inclusive Scale incorporated same- and other-sex attraction as well as dimensions of attraction beyond those based on sex (attraction to masculine, feminine, androgynous, and gender non-conforming individuals). The incorporation of dimensions of sexual attraction outside of sex in the Gender-Inclusive Scale was positively regarded by participants of all identities. Findings indicate that the Sexual-Romantic and Gender-Inclusive scales appear to address some of the concerns raised in previous research regarding the measurement of sexual orientation among sexual minority individuals.     

Perceptions of Campus Climate by Sexual Minorities

Previous research has indicated that students who identify as lesbian, gay, bisexual, or transgender (LGBT) often have negative experiences on university campuses due to their sexual orientation or gender identity. Direct and indirect experiences contribute to an overall perception of the campus climate. This study used an online survey to assess students' perceptions of campus climate, their experiences confronting bias, support of family members and friends, and whether they had considered leaving campus. Multiple regression analysis indicated that perceptions of poorer campus climate were predicted by greater unfair treatment by instructors, more impact from anti-lesbian, gay, bisexual, transgender, or queer (LGBTQ) bias on friends’ and families’ emotional support, and having hidden one's LGBT identity from other students. Cluster analyses revealed four groups of participants distinguished by openness about their sexual orientation and negative experiences, with one group appearing to be at risk for poor retention. Results are discussed in terms of the needs of LGBTQ students on campus.