Research shows that sexual minorities e. However, the majority of studies have examined sexual orientation disparities in a narrow range of health outcomes and behaviors using convenience samples comprised of either men or women living in restricted geographic areas. To investigate the relationship between sexual orientation identity and health among U.
Three percent of the sample identified as sexual minorities. Sexual minorities had a higher prevalence of some poor health behaviors and outcomes. Department of Health and Human Services has identified understanding and improving the health of lesbian, gay, bisexual, and transgender LGBT populations as a national priority.
Moreover, the Institute of Medicine released a report underscoring the need to conduct additional research on the health of all LGBT populations across the life course, including using national probability samples [ 2 ]. Studies show that many sexual minorities — namely, individuals who self-identify as gay, lesbian, or bisexual and who engage in same-gender sexual behavior or report Harvard sexual orientation test for women sexual attractions but do not self-identify as such — have a higher prevalence of health risk behaviors [ 34 ] and poor health outcomes [ 4 — 8 ] and a lower prevalence of access to health insurance as well as healthcare [ 4579 ] compared to their heterosexual counterparts, even after controlling for socioeconomic position SEP.
Few studies, however, have generated nationally representative estimates for a range of health and healthcare measures by sexual orientation identity while using a sample size large enough to provide estimates for both U. Therefore, we examined sexual orientation identity disparities in health behaviors, health outcomes, and healthcare access and utilization indicators using data from the and National Health Interview Survey NHISwhich is based on a national probability sample of adult U.
We also investigated the relationship between sexual orientation identity and health and healthcare indicators stratified by two age Harvard sexual orientation test for women. This study also extends previous findings by adjusting for potential confounders and using a larger sample size among both men and women.
These data will help future studies identify potential drivers of disparities among sexual minorities and test mechanisms posited by the Minority Stress Model. We analyzed data from the National Health Interview Survey NHISwhich is a series of cross-sectional, nationally representative surveys that use a three-stage stratified cluster probability sampling design to conduct in-person interviews in the households of non-institutionalized U.
A detailed description of NHIS procedures has been published elsewhere [ 16 ].
Briefly, a probability sample of households was interviewed by trained interviewers from the U. Census Bureau to obtain information about health and sociodemographic characteristics of the sampled household on a continuous basis each week. Data were collected using computer-assisted personal interviewing.
A randomly selected adult and child not included in this analysis provided more specific health-related information. The final response rate for sample adults was The NHIS received written informed consent from each study participant.
Our final analytic sample consisted of 69, adults. Leisure-time physical activity was categorized as none, low, or high. Participants engaging in at least some level of activity and providing a specific number of activity bouts were dichotomized at the midpoint and classified as low or high.
Participants reported how many hours of sleep they, on average, obtained in a hour period. Seven hours of sleep was used as the reference because it has been associated with the lowest levels of morbidity and mortality [ 1819 ]. Self-reported height and weight were used to calculate body mass index BMI by dividing measured weight in kilograms by height in meters squared. Participants were considered to have a functional limitation if they reported Harvard sexual orientation test for women limited in engaging in specific activities because of a physical, mental, or emotional health problem that did not include pregnancy.
Participants reported if they currently had health insurance coverage and whether they had at least one place they usually went when sick or needed health advice. Participants were asked if they ever had an HIV test not including any tests during blood donations. We placed self-reported general health status into three categories excellent or very good, good, and fair or poor. Participants self-identified with 1 or more of the following categories: Marital status was categorized as married or living with partner, divorced, separated, or widowed, and never married.
Standard errors or variance
Harvard sexual orientation test for women were calculated using Taylor series linearization.
We used the direct-adjustment method to calculate age-standardized prevalence estimates of sociodemographic characteristics, health behaviors, health outcomes, and healthcare access and utilization indicators among U.
The age distribution from the U. Census was used as the standard population. Poisson regression with robust error variance was used to estimate gender-specific prevalence ratios for health behaviors, health outcomes, and services use comparing sexual minority and heterosexual individuals [ 20 ]. Prevalence ratios were also estimated separately for younger and older age groups. The final analytic sample consisted of 69, participants.
Gay and bisexual men and lesbians
Harvard sexual orientation test for women generally more likely than heterosexual individuals to have at least a college education. In contrast, there were no differences in sleep duration by sexual orientation identity among men and women. Boldface indicates statistically significant results at the 0. Similarly, Harvard sexual orientation test for women minority men were more likely than heterosexual men to have a functional limitation.
PR prevalence ratio, CI confidence interval. Compared to their heterosexual counterparts, younger and older gay men and lesbians were more likely to report being current drinkers. Older lesbian and bisexual women were more likely than older heterosexual women to be former drinkers and former cigarette smokers.
Younger lesbian and bisexual women and older bisexual women were more likely than their heterosexual counterparts to report heavy drinking. While there were no statistically significant sexual orientation differences in health insurance status across age groups, all sexual minorities with the exception of younger gay men were more likely than their heterosexual counterparts to delay healthcare due to cost concerns. There were also no sexual orientation differences in emergency room visits across age groups.
We identified important disparities in health behaviors, health outcomes, and healthcare access and utilization indicators between sexual minorities and heterosexual individuals in a nationally representative sample of U.
Lesbians were more likely to be obese than heterosexual women, to have suffered a stroke, and to have a functional limitation. Sexual minority men were more likely to have a functional limitation.
Our study appears fairly consistent with prior studies. For instance, prior research has found that alcohol, tobacco, and other drug use as well as the morbidities associated with these exposures were higher among sexual minorities than heterosexuals [ 21 — 26 ].
These studies show that lesbians are more likely to be in recovery and to have been in treatment for alcohol use related problems compared to heterosexual women [ 25 ]. High rates of risk factors for heavy drinking and drinking problems — namely, childhood sexual abuse, depression, and suicidal ideation — among lesbians in other studies may explain the sexual orientation disparities in alcohol use that we observed in our analysis [ 25 ].
Harvard sexual orientation test for women, a meta-analysis found that sexual minorities across North America and Europe were much more likely than heterosexual individuals to experience anxiety, depression, and suicidal ideation [ 27 ] as well as panic attacks and psychological distress [ 28 ], which may explain higher rates of alcohol use and cigarette smoking among sexual minority women, possibly to cope with stigma, discrimination, and stress.
Lastly, it is possible that higher rates of obesity among sexual minority women may be due to a higher prevalence of binge eating in this population relative to heterosexual women, which has been linked to minority stress [ 29 ]. In this study, older gay men, younger bisexual men, and bisexual women were more likely than their heterosexual counterparts to report initiating HPV vaccination.
The difference in these study findings may be due to differences in study population age.
Although all sexual minorities except younger gay men were more likely than heterosexual persons to delay healthcare because of cost, we observed no sexual orientation identity disparities in health insurance status. In contrast, prior studies have found that sexual minorities were less likely to have health insurance, have received a checkup within in the past year, and have unmet medical needs compared to their heterosexual counterparts [ 931 ].
A different study found results similar to ours for women but showed that healthcare access among men in same-sex relationships was the same as or greater than among men in opposite-sex relationships [ 32 ]. However, this study used a different dimension of sexual orientation i. The demographics of the participants in each study could also contribute to disparate findings. For instance, both affluent Harvard sexual orientation test for women impoverished sexual minorities are included in our nationally representative sample and other studies may have had disproportionate representation from either group.
Furthermore, although our study did not identify any difference in sleep duration between sexual minority and heterosexual individuals, prior research has found evidence of shorter sleep duration among sexual minorities compared to their heterosexual counterparts [ 33 ]. According to the minority stress model [ 34 ], experiences of stigma, discrimination, and victimization related to being a sexual minority may lead to a stress response that increases the risk of poor mental and Harvard sexual orientation test for women health outcomes among sexual minorities.
Specific parts of the stress process linked to being a sexual minority are believed to include expectations Harvard sexual orientation test for women rejection, sexual orientation identity masking, internalized homophobia, and coping by, for instance, attempting to decrease minority stress through problem solving, expressing emotions, and using substances to cope [ 35 ].
Discrimination may be a particularly important mechanism by which inequities related to being a sexual minority in U. Experiencing discrimination was positively associated with poor quality of life and psychiatric morbidity in this study [ 36 ].
Further, interpersonal and institutional discrimination based on sexual orientation identity also contributes to a lack of supportive social and services for sexual minorities [ 37 ] and may help explain sexual orientation identity disparities in healthcare access and utilization among U. This study has several limitations. First, we used data from a cross-sectional survey that included only one dimension of sexual orientation i. Sexuality is fluid and sexual orientation categories are historically contingent.
Therefore, we need longitudinal studies to examine sexual orientation disparities over the lifecourse and historical time [ 3839 ]. Second, all data are based on self-report, and some estimates e.
BMItherefore, may be conservative. Third, data on social stressors e. Pap smear testing among women was also unavailable. Fourth, there could also be differences in reporting of health and healthcare experiences by sexual orientation identity, which could bias our results; however, such differences have not been documented.
This study also has important strengths. Specifically, our analyses used data from a large national probability sample of the U. In conclusion, sexual minorities had a higher prevalence of some poor health behaviors and outcomes. In order to help inform evidence-based programs and policies that promote the health and healthcare of sexual minorities, future research identifying the factors that may mediate the relationship between sexual orientation identity and health behaviors, outcomes, and services use is needed — including among "Harvard sexual orientation test for women." Additionally, the interaction between other social factors e.
Austin is supported by U. The funding sources were not involved in the data collection, data analysis, manuscript writing and publication. The datasets generated during and analysed during this study are available at the National Center for Health Statistics National Health Interview Survey website http: CLJ conceived the study, acquired the data, participated in its design, performed the statistical analyses, and drafted the manuscript. IK additionally provided adminstrative, technical, and material support.
National Center for Biotechnology InformationU. Published online Aug Johnson4 S. Bryn Austin2, 5 and Ichiro Kawachi 2. Author information Article notes Copyright and License information Disclaimer.
Received Apr 1; Accepted Aug 5. This article has been cited by other articles in PMC. The Sexuality Implicit Association Test (Sexuality IAT)  has been the most Looking at participants with different sexual orientation, site (https://implicit.
xspazio.com) self-selected to participate in Their mean age was (SD = ; range from 13 to 70), and (%) were female. If asked whether men and women are equal, most people would say the TAKE THE UNCONSCIOUS GENDER BIAS TEST This is both a normal preference for most people but has also been seen in.