Sampling homosexuals, bisexuals, gays, and lesbians for public health research: a review of the literature from 1990 to 1992

'The Wild Women of the West (Midlands)': how LesBeWell imagined queer women's health and its obstacles in the 1990s through the pages of Dykenosis

In 1994, the Birmingham based lesbian health activism group LesBeWell began to produce a newsletter titled Dykenosis. Variously describing itself as 'for women who have sex with women', 'health information for dykes' and 'the national bi-monthly newsletter about lesbian health', the newsletter offers a window into how one activist group imagined the health and ill health of women who had sex with women in the 1990s. By analysing Dykenosis, this article illuminates how LesBeWell identified and attempted to eliminate social and institutional obstacles to 'dyke' health. The article focuses on Dykenosis' collation of experiences of invisibility and hypervisibility within Britain's National Health Service, and the mobilisation of research, complaint, and community self-help within its pages and beyond as remedy to NHS shortcomings.

Face Validity Ratings of Sexual Orientation Scales by Sexual Minority Adults: Effects of Sexual Orientation and Gender Identity

The present research explored sexual minority individuals' ratings of two traditional (Kinsey and Klein Sexual Orientation Grid [KSOG]) and two novel (Sexual-Romantic and Gender Inclusive) sexual orientation scales with regard to how well they capture their sexuality. Participants included 363 sexual minority individuals who identified as lesbian, gay, bisexual, pansexual, or queer, and included individuals who identified as transgender (n = 85) and cisgender (n = 278). The findings indicated clear patterns of responses across both sexual orientation and gender identity, where participants differed in the degree to which they felt the scales captured their sexuality. A main effect of sexual orientation was found for all four scales, where participants endorsing monosexual (lesbian/gay) identities rated the scales more positively than did participants endorsing plurisexual (bisexual and pansexual/queer) identities. Bisexual individuals had a unique pattern of ratings, which sometimes aligned with those of lesbian/gay participants and sometimes aligned with pansexual/queer participants. A main effect of gender identity was found for the Kinsey, KSOG, and Sexual-Romantic (but not Gender Inclusive) scales, where cisgender individuals rated the scales more positively than did transgender individuals. There were no significant interaction effects between sexual orientation and gender identity for any of the four scales. The present findings can be used to understand sexual minority individuals' assessment of the face validity of four sexual orientation measures. Discussion focused on the implications for using traditional measures of sexual orientation in research as well as for the development of new measures that better capture the range of sexual minority experience.

Sensorimotor gating in healthy adults tested over a 15 year period

BACKGROUND

Prepulse inhibition (PPI) of startle, an operational measure of sensorimotor gating, is used to study normal and pathological brain function. From 2001 to 2016, we screened healthy subjects (HS) to establish their suitability for tests of drug effects on PPI. Because of the size and systematic characterization of this sample across variables of relevance to PPI, we now report these screening results.

METHODS

Acoustic startle and PPI were assessed in HS to identify those eligible for studies of drug effects on PPI from 2001 to 2016, yielding 457 "eligible" subjects.

RESULTS

Data confirmed the consistency of PPI across this 15-year period, and supported the role of several variables previously reported to moderate either startle or PPI.

CONCLUSIONS

Startle and PPI are robust physiological measures that are predictably moderated by specific physiological variables in healthy adults. As such, these measures serve as robust markers of neurobiological processes in healthy and patient populations.

Similarities and Differences in Relational Boundaries among Heterosexuals, Gay Men, and Lesbians

This study investigated the relative contributions of gender and sexual orientation as factors associated with the formation of boundaries in dyadic intimate relating in both same- and opposite-sex couples. The study examined a relational pattern previously not empirically investigated but widely accepted as an actuality unique to lesbians; specifically, that lesbians tend to remain connected to ex-serious-relationship partners after breakup. The study utilized a research design approach emphasizing the methodological utility and heuristic value of including sexual orientation as an independent variable in studies of gender dynamics. Two general classes of theoretical frameworks, those emphasizing gender role socialization influences and those emphasizing systems influences, were discussed in terms of their relative goodness of fit as conceptual bases for the data. Questionnaires were completed by 60 lesbians, 37 gay men, 45 heterosexual women, and 39 heterosexual men. Lesbians and gay men reported higher levels of connection to ex-serious-relationship partners than heterosexuals. The data reflect how inclusion of sexual orientation can broaden understandings of gender differentiated phenomena beyond more traditional gender-only based accounts.

A New View of Lesbian Subtypes: Stable Versus Fluid Identity Trajectories over an 8-Year Period

Research has increasingly documented that the distinction between lesbian and bisexual women is one of degree rather than kind, and some researchers have therefore argued for an end to sexual categorization altogether. To the contrary, I maintain that researchers should explore alternative criteria for sexual categorization that might allow us to discern novel and meaningful subtypes of same-sex sexuality Toward this end, I explore the usefulness of a typology that focuses on change in lesbian identification over time, using a sample of young sexual-minority women that has been observed longitudinally for a period of 8 years. Specifically, I contrast women who have maintained consistent lesbian identifications over this time period (stable lesbians) to women who have alternated between lesbian and nonlesbian labels (fluid lesbians) and women who never adopted lesbian labels (stable nonlesbians). The pattern of similarities and differences among the groups changes as a function of the specific phenomenon being assessed (e.g., sexual and emotional attractions, sexual contact, developmental histories), suggesting the value of using multiple, alternative sexual typologies as heuristics to guide future research into life span development of sexual orientation and identity.

Comparing health survey data from Internet- and paper-based convenience samples of lesbian women in Germany

Background Members of populations that are measured online should be compared with paper-based samples in order to determine whether data from these different sources can be merged or must be analysed separately due to substantial differences. Methods: A sample of lesbian women recruited via the Internet were compared with a paper-based sample. Both groups used a questionnaire consisting of demographic variables, questions regarding dealing with homosexuality, psychological burden, access to care, and discrimination experience within the German healthcare system. Results: Only small differences emerged in dealing with homosexuality between both groups. Moderately more women in the Internet-based sample suffered from nervous tension and the impression of being out of balance. Moderately more women in the paper-based sample stated that their main contact person regarding health matters was informed about their sexual orientation. Most differences had small effect sizes. No substantial differences occurred between the two groups in the area of discrimination experience. No large differences in socioeconomic data, psychological burden, healthcare utilisation, or dealing with or experiences with homosexuality were found. Conclusions: Health survey data derived from Internet- and paper-based samples of lesbian women in Germany are not too dissimilar. Further research in additional contexts is needed to decide whether they can be merged for further analyses.

A profile of North Carolina lesbian, gay, and bisexual health disparities, 2011

OBJECTIVES

We investigated the health profile of lesbian, gay, and bisexual (LGB) adults in North Carolina, the first state in the South to include a measure of sexual orientation identity in a probability-based statewide health survey.

METHODS

Using data from 9876 respondents in the 2011 North Carolina Behavioral Risk Factor Surveillance Survey, we compared sexual minorities to heterosexuals on a variety of health indicators.

RESULTS

LGB respondents were younger and more likely to be reached by cell phone. Many examined indicators were not different by sexual orientation. Significant results, however, were consistent with findings from state population surveys in other regions of the country, including disparities in mental health and, among women, smoking.

CONCLUSIONS

Reporting LGB identity in North Carolina is associated with poorer health. The concentration of anti-LGB policies in the South warrants ongoing monitoring of LGB health disparities in North Carolina and in other Southeastern states for potential effects on the health and well-being of LGB populations.

"Aren't labels for pickle jars, not people?" Negotiating identity and community in talk about 'being gay'

Understanding how people in any given population think about and experience their sexuality is fundamental to developing and implementing good health policy, research, and practice. Yet despite several decades of focus on sexual identity and HIV risk within health research, gay men as a category are often treated in an uncomplicated way. This article reports on focus group discussions held with 45 gay and other men who have sex with men in New Zealand to identify how they talked about issues of gay identity and gay community/ies. The men negotiated and renegotiated their gay identity and being gay was reported as just one part of most men's lives. Many men did not like to be labeled as gay and downplayed aspects of their gay identity. Only a few men proclaimed being gay. Men reported very mixed experiences with the gay community/ies. Understanding how men experience being gay, provides information vital to enhancing policy, research and practice responses to gay men's health issues. A major challenge for health service provision to appropriately engage with men who have sex with other men but resist being labeled as gay was identified.

LGB cultural phenomena and the social work research enterprise: toward a strengths-based, culturally anchored methodology

Although the lesbian, gay, and bisexual (LGB) community has seen new protections and benefits in the last quarter century, LGB people continue to experience stigmatization throughout American society. Social work research that frames the LBG community and its members as disenfranchised, marginalized, and oppressed tends to support a stigmatizing attitude toward LGB people. Social work research with the LGB community and its members must shift from a focus on pathology to strengths and resources. This article examines the potential application of a strengths perspective and its usefulness in reshaping the discourse on stigmatization of the LGB community and its members.

Substance use disorder in the context of LGBT health: a social work perspective

The impacts of public and private funding of lesbian, gay, bisexual, and transgender (LGBT) health research, the state of integration of LGBT health issues into the academic and professional training programs of health care practitioners, and the larger social reality experienced by LGBT people profoundly affect substance use and substance use disorders in those populations. This analysis uses a social work perspective and considers the current state of research, professional training, and social oppression as they affect the health of LGBT people. Suggestions for action are offered that may improve the health of LGBT peoples and the practice of social work.

Substance use and mental health disorders among heterosexual identified men and women who have same-sex partners or same-sex attraction: results from the national epidemiological survey on alcohol and related conditions

This study examined sexual orientation discordance, a mismatch between self-reported sexual identity and sexual behavior or sexual attraction, by describing the characteristics, substance use disorders, and mental health risks of heterosexual identified individuals who endorsed this pattern of sexual identification, behavior, and attraction. Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we created three groups based on participants' reported sexual identity and either their sexual behavior or sexual attraction: heterosexual concordant, homosexual concordant, and heterosexual discordant. Bivariate models assessed the relationship of discordant status and demographic correlates, lifetime substance use disorders, and mental health diagnoses. Logistic regression models tested associations between both behavior discordance and attraction discordance and the likelihood of having lifetime disorders of substance use, major depression, and generalized anxiety. Results of this study provided evidence of varying levels of substance use and mental health disorder risk by gender, discordance status, and discordance type. Behavioral discordance was associated with increased risk of mental health and substance use disorder among women (compared to heterosexual concordance). Findings among men were less consistent with heightened risk of alcohol and inhalant use only. Attraction discordance was notably different from behavioral discordance. The odds of substance use and mental health disorders were the same or lower compared with both the heterosexual and homosexual concordance groups. Future research should begin to test theoretical explanations for these differences.

Gender role conflict scale: validation for a sample of gay men and lesbian women

This study tested the oblique four-factor model of the Gender Role Conflict Scale for a sample of gay men and lesbian women residing in the United States. 400 gay men and 292 lesbian women recruited from university and college gay, lesbian, bisexual, and transgender LISTSERVs participated. The internal consistency reliability of the Gender Role Conflict Scale scores was high, but low means on the expressive dimension of gender role conflict were noted. The results of two separate sets of confirmatory factor analyses indicated that the four-factor model's fit to the data could be enhanced for both groups by applying item parceling to lower the number of indicators per factor, suggesting that the actual structural validity of the Gender Role Conflict Scale may be better than suggested by the reported fit indices.

Relationship contingency and sexual motivation in women: implications for sexual satisfaction

Deriving self-worth from romantic relationships (relationship contingency) may have implications for women's sexual motives in relationships. Because relationship contingency enhances motivation to sustain relationships to maintain positive self-worth, relationship contingent women may engage in sex to maintain and enhance their relationships (relational sex motives). Using structural equation modeling on Internet survey data from a convenience sample of 462 women in heterosexual and lesbian relationships, we found that greater relationship contingency predicted greater relational sex motives, which simultaneously predicted both sexual satisfaction and dissatisfaction via two distinct motivational states. Having sex to improve intimacy with one's partner was associated with greater sexual satisfaction and autonomy, while having sex to earn partner's approval was associated with sexual dissatisfaction and inhibition. While some differences exist between lesbian and heterosexual relationships, relationship contingency had sexual costs and benefits, regardless of relationship type.

Demographic, Psychological, and Social Characteristics of Self-Identified Lesbian, Gay, and Bisexual Adults in a US Probability Sample

Using data from a US national probability sample of self-identified lesbian, gay, and bisexual adults (N = 662), this article reports population parameter estimates for a variety of demographic, psychological, and social variables. Special emphasis is given to information with relevance to public policy and law. Compared with the US adult population, respondents were younger, more highly educated, and less likely to be non-Hispanic White, but differences were observed between gender and sexual orientation groups on all of these variables. Overall, respondents tended to be politically liberal, not highly religious, and supportive of marriage equality for same-sex couples. Women were more likely than men to be in a committed relationship. Virtually all coupled gay men and lesbians had a same-sex partner, whereas the vast majority of coupled bisexuals were in a heterosexual relationship. Compared with bisexuals, gay men and lesbians reported stronger commitment to a sexual-minority identity, greater community identification and involvement, and more extensive disclosure of their sexual orientation to others. Most respondents reported experiencing little or no choice about their sexual orientation. The importance of distinguishing among lesbians, gay men, bisexual women, and bisexual men in behavioral and social research is discussed.

The health and health care of lesbian, gay, and bisexual adolescents

Adolescents face a variety of challenges in their transition to adulthood; lesbian, gay, and bisexual adolescents face these typical challenges as well as additional challenges that are related to the social stigma of their sexual orientation. For some lesbian, gay, and bisexual adolescents, this stigma may induce psychosocial stress, leading to increased health risk behaviors and poorer health outcomes. In this article, we review data on the health and health care of LGB adolescents. We examine health indicators and health risks for LGB youth, including substance use, eating disorders, suicidality, risky sexual behaviors, violence exposure and victimization, and homelessness. We also examine health care provision and utilization for LGB youth. Lastly, we discuss ways in which researchers and clinicians can improve LGB adolescent health and health care.

Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder

OBJECTIVES

We assessed sexual orientation disparities in exposure to violence and other potentially traumatic events and onset of posttraumatic stress disorder (PTSD) in a representative US sample.

METHODS

We used data from 34 653 noninstitutionalized adult US residents from the 2004 to 2005 wave of the National Epidemiologic Survey on Alcohol and Related Conditions.

RESULTS

Lesbians and gay men, bisexuals, and heterosexuals who reported any same-sex sexual partners over their lifetime had greater risk of childhood maltreatment, interpersonal violence, trauma to a close friend or relative, and unexpected death of someone close than did heterosexuals with no same-sex attractions or partners. Risk of onset of PTSD was higher among lesbians and gays (adjusted odds ratio [AOR] = 2.03; 95% confidence interval [CI] = 1.34, 3.06), bisexuals (AOR = 2.13; 95% CI = 1.38, 3.29), and heterosexuals with any same-sex partners (AOR = 2.06; 95% CI = 1.54, 2.74) than it was among the heterosexual reference group. This higher risk was largely accounted for by sexual orientation minorities' greater exposure to violence, exposure to more potentially traumatic events, and earlier age of trauma exposure.

CONCLUSIONS

Profound sexual orientation disparities exist in risk of PTSD and in violence exposure, beginning in childhood. Our findings suggest there is an urgent need for public health interventions aimed at preventing violence against individuals with minority sexual orientations and providing follow-up care to cope with the sequelae of violent victimization.

Asthma Diagnosis Among Individuals in Same-Sex Relationships

This study examined ever and current asthma diagnosis among persons in same-sex relationships (SSRs) using data from the pooled 1997-2004 National Health Interview Surveys. Among SSRs, 13.5% of men and 14.3% of women reported ever diagnosis of asthma, compared to 7.6% and 10.2% opposite-sex relationship (OSR) men and women. SSRs had higher rates of smoking, stress, and among women, obesity. In regression analyses, male SSRs had a significantly elevated risk of ever asthma diagnosis (adjusted OR = 1.51), while 12-month asthma was elevated among SSR women (adjusted OR = 2.48). SSRs may be at higher risk for asthma due to a spectrum of risk factors.

Sexual orientation and sexual behavior: results from the Massachusetts Behavioral Risk Factor Surveillance System, 2002-2006

Few population-based surveys in the United States include sexual orientation as a demographic variable. As a result, estimating the proportion of the U.S. population that is gay, lesbian, or bisexual (GLB) is a substantial challenge. Prior estimates vary widely, from 1-21%. In 2001, questions on sexual orientation and sexual behavior were added to the Massachusetts Behavioral Risk Factor Surveillance System (MA BRFSS) and have been asked continually since that time. The purpose of this study was to determine the prevalence of adults in Massachusetts identifying as GLB and providing a demographic description of this group. The study also examined the correlation of reported sexual behavior and sexual identity within this group. Overall, 1.9% of Massachusetts adults identified as gay or lesbian and 1.0% of Massachusetts adults identified as bisexual. Of those identifying as gay or lesbian, 95.4% reported sexual behavior concordant with this identification, and 99.4% of respondents identifying as heterosexual reported behavior concordant with heterosexual sexual orientation. Among those reporting a GLB sexual orientation, men were more likely than women to identify as gay, and women were more likely than men to identify as bisexual. Younger adults (18-25 years old) were more likely than people in other age groups to identify as bisexual. Respondents with 4 or more years of education were more likely to identify as gay or lesbian than those in all other education categories. The addition of sexual orientation to population-based surveys will allow for research on the health of GLB adults and provide critical information for those charged with the creation of public policy regarding sexual orientation.

Sexual identity development and self-esteem as predictors of body image in a racially diverse sample of gay men

The current study examined the relationship between sexual identity development and body image, as well as the potential mediating effect of self-esteem, in a community sample of gay men. A diverse group of participants (N = 172), recruited through listservs and flyers, completed an online survey. Regression analyses were conducted to assess the relationships between identity development and self-esteem, identity development and body image, self-esteem and body image, and the mediating role of self-esteem. As predicted, significant relationships were identified between each pair of variables, and self-esteem was found to be a mediator when the sample was considered as a whole. When participants of color were compared to those who were White, however, between-group differences emerged; identity stage did not predict self-esteem or body image for participants of color, nor did the mediated relationship exist. Self-esteem did predict body image in both groups. The sociocultural context of these findings is considered.

Sexual orientation and alcohol use: identity versus behavior measures

BACKGROUND

Few population-based national studies include complete measures of alcohol consumption, alcohol-related problems, and sexual orientation. When measures of sexual orientation are included in alcohol surveys, typically only one measure is included. The purpose of this paper is to compare two ways of measuring sexual orientation and to explore the relationship of each measure with alcohol use and alcohol-related problems.

METHODS

Data were used from the 2000 National Alcohol Survey, a telephone national alcohol probability survey representative of U.S. adults 18 and over (N = 7,612). Sexual orientation was measured by two self-reported measures: sexual orientation identity and sexual behavior. Alcohol use and problems were assessed by number of drinks in the last year, number of days drank 5 or more drinks in the last year, social consequences, and DSM-IV alcohol dependence.

RESULTS

There is no consistent pattern of alcohol use or alcohol-related problems based on how sexual orientation is measured for men. For women, bisexual identity or bisexual behavior was consistently associated with greater alcohol use and problems as compared to heterosexual identity or heterosexual behavior. Use of behavior measures alone appears to provide lower estimates of alcohol- related consequences and dependence among lesbian respondents.

CONCLUSIONS

These results underscore the utility of using both identity and behavior items to measure sexual orientation particularly for women when assessing alcohol use and alcohol-related problems.

Making sense of sexual orientation measures: findings from a cognitive processing study with adolescents on health survey questions

OBJECTIVE

To carry out a study using cognitive processing interview methods to explore ways in which adolescents understand sexual orientation questions currently used on epidemiologic surveys.

METHODS

In-depth, individual interviews were conducted to probe cognitive processes involved in answering four self-report survey questions assessing sexual identity, sexual attraction, and sex of sexual partners.A semi-structured interview guide was used to explore variation in question interpretation, information retrieval patterns and problems, item clarity, valence of reactions to items (positive, negative, neutral), respondent burden, and perceived threat associated with the measures. Thirty adolescents aged 15 to 21 of diverse sexual orientations and race/ethnicities participated in the study, including female, male, and transgender youth.

RESULTS

A question on sexual attraction was the most consistently understood and thus was easy for nearly all youth to answer. In contrast, a measure of sexual identity with options heterosexual, bisexual, gay/lesbian, and unsure was the most difficult to answer. Most preferred a sexual identity item that also provided the intermediate options mostly heterosexual and mostly homosexual, which many said reflected their experience of feeling between categories. Participants had varying and inconsistent interpretations of sexual behavior terms, such as sex and sexual intercourse, used in assessing the sex of sexual partners.

CONCLUSION

Differences in understanding could affect interpretation of survey data in important ways. Development of valid measures of sexual orientation will be essential to better monitor health disparities.

Queer in Southern MSW Programs: Lesbian and Bisexual Women Discuss Stigma Management

The author described the processes by which a sample of lesbian and bisexual women assessed and managed prejudice and discrimination while pursuing degrees of masters of social work. The author presented as being pivotal to the participants' assessments of social work settings the social cues that participants identified as indicative of potential attitudes and beliefs regarding lesbian and bisexual women. In addition, the author discussed strategies that the women used to manage others' expression of prejudicial attitudes. Through these interactional processes, the participants demonstrated that they were active in shaping and reducing their experience of oppression.

Mulheres que fazem sexo com mulheres: algumas estimativas para o Brasil

O objetivo deste trabalho é descrever a proporção de mulheres que fazem sexo com mulheres, com base em três recortes temporais a partir de dados produzidos por um inquérito populacional de abrangência nacional realizado em 1998. A proporção de mulheres que relatam relações sexuais com mulheres na vida diminui de 3% para 1,7% nos cinco anos anteriores à pesquisa, mantendo-se praticamente no mesmo patamar, 1,7%, no último ano. Ao comparar esses dados com os disponíveis para os homens, os resultados sugerem que homens e mulheres transitam entre experiências homo e heterossexuais de maneiras distintas ao longo da vida.

Health care access among individuals involved in same-sex relationships

OBJECTIVES

We used data from the National Health Interview Survey to compare health care access among individuals involved in same-sex versus opposite-sex relationships.

METHODS

We conducted descriptive and logistic regression analyses from pooled data on 614 individuals in same-sex relationships and 93418 individuals in opposite-sex relationships.

RESULTS

Women in same-sex relationships (adjusted odds ratio [OR]=0.60; 95% confidence interval [CI]=0.39, 0.92) were significantly less likely than women in opposite-sex relationships to have health insurance coverage, to have seen a medical provider in the previous 12 months (OR=0.66; 95% CI=0.46, 0.95), and to have a usual source of health care (OR=0.50; 95% CI=0.35, 0.71); they were more likely to have unmet medical needs as a result of cost issues (OR=1.85; 95% CI=1.16, 2.96). In contrast, health care access among men in same-sex relationships was equivalent to or greater than that among men in opposite-sex relationships.

CONCLUSIONS

In this study involving a nationwide probability sample, we found some important differences in access to health care between individuals in same-sex and opposite-sex relationships, particularly women.

Recruiting minority men who have sex with men for HIV research: results from a 4-city campaign

We describe the efforts of a 4-city campaign to recruit Black and Hispanic men who have sex with men into an established HIV epidemiological study. The campaign used community organizing principles and a social marketing model that focused on personnel, location, product, costs and benefits, and promotion. The campaign was developed at the community, group, and individual levels to both increase trust and reduce barriers.The proportion of Hispanic men recruited during the 2002-2003 campaign doubled compared with the 1987 campaign, and the proportion and number of White men decreased by 20%. The proportion of Black men decreased because of the large increase in Hispanic men, although the number of Black men increased by 56%. Successful recruitment included training recruitment specialists, involving knowledgeable minority community members during planning, and having an accessible site with convenient hours.

Disclosure of sexual orientation and behavior in the Nurses' Health Study II: results from a pilot study

OBJECTIVE

To examine disclosure of sexual orientation and response rates in a pilot study of questions on sexual orientation and gender of sexual partners in the Nurses' Health Study II.

METHODS

A pilot questionnaire was mailed to random samples of 350 women from each of three marital status strata: never married, previously married, and currently married. We estimated prevalence of each category of sexual orientation in the pilot study. Response rates to the sexual orientation question for the pilot questionnaire and the 1995 cohort questionnaire were compared.

RESULTS

The overall response rate to the pilot study was 78%. In the pilot study, 98% of women reported a sexual orientation of heterosexual, 0.1% bisexual, and 0.9% lesbian, with 0.7% either declining to answer, leaving the question blank, or categorizing themselves as none of the above, weighted for stratified sampling by marital status. The distribution of sexual orientation in the cohort study (N = 91,654) was similar. Asking women to participate in the pilot study of sexual orientation questions did not appear to cause participants to drop out of the cohort. Concordance between reported sexual orientation on the pilot study and the cohort study was high.

CONCLUSIONS

Based on our experience, researchers may be encouraged to add questions on sexual orientation to large studies of women.

Comparing women of differing sexual orientations using population-based sampling

OBJECTIVES

Area probability sampling was used to conduct a women's health survey in Boston, MA. Sexual minority women (SMW) and heterosexual adult women were compared on a variety of health-related measures.

METHODS

SMW-rich census tracts were identified and mapped onto zip code boundaries. Eligible respondents were women 18 and older who lived within the defined area, who were able to complete a personal interview or self-administered questionnaire in English. Differences in significant health-related outcomes by sexual orientation were examined.

RESULTS

SMW and heterosexual women differed on access to health care and utilization of screening tests. There were no significant differences in smoking rates, eating less calories or fat, and intentions to follow mammography recommendations.

CONCLUSIONS

In certain respects, study results are congruent with previous non-probability surveys, while in others the results are different. It is likely that real differences exist in some health-related variables by sexual orientation category.

Alcohol consumption, alcohol-related problems, and other substance use among lesbian and bisexual women

Relationships between sexual orientation and a wide range of substance use and problem variables were examined based on data from the 2000 National Alcohol Survey. Lesbians, bisexuals, and heterosexually identified women who report same-sex partners were compared to exclusively heterosexual women in relation to alcohol consumption, use of tobacco and other drugs, bar-going, alcohol-related problems, and past substance abuse treatment. Substance use patterns were complex and varied between sexual orientation groups. These differences underscore the importance of developing lesbian- and bisexual-sensitive prevention and treatment services and of including measures of sexual orientation identity and behavior in population-based surveys.

Health Related Behaviors and Cancer Screening of Lesbians: Results of the Boston Lesbian Health Project II

This paper reports data on health related behaviors and cancer screening from the Boston Lesbian Health Project II (BLHP II), a replication of a national survey of lesbians on a variety of health-related variables completed in 1987. The findings suggest that lesbians have increased their use of primary care, including routine physical examinations, pap smear screening for cervical cancer, and mammography for breast cancer, but that rates continue to be lower than would be expected for women in general. Younger lesbians in this sample smoked at high rates. Smoking rates continue to be of concern in other age groups, although they are lower than national data from women in general. BLHP II data confirm other findings that lesbians are more likely to drink alcohol and to drink more heavily than other women. Implications for health care of lesbians and future research with this population are discussed.

Changes in psychosocial well-being during stages of gay identity development

The current study evaluated the stage theory of Homosexual Identity Formation (HIF) developed by Cass (1979), in terms of the relationship between stage of gay identity development and psychosocial well-being. Four hundred twenty-five males (12 to 64 years, M = 29.2) reporting sexual attraction to other men provided demographic information and completed psychosocial measures: the Happiness-Sadness Scale (McGreal & Joseph, 1993), the Satisfaction with Life Scale (Diener, Emmons, Larsen & Griffin, 1985), the UCLA Loneliness Scale (Russell, Peplau & Ferguson, 1978), the Index of Self-Esteem (Hudson, 1982), and the Gay Identity Questionnaire (Brady & Busse, 1994). Correlation analysis and ANCOVAs controlling for age and nationality demonstrated that the 6 sequential stages of HIF were associated with a U-shaped function for the psychosocial variables. Well-being was high during the initial Confusion and Comparison stages of HIF, was reduced during the middle Tolerance and Acceptance stages, and was again high in the later Pride and Synthesis stages. Each of the psychosocial variables was significantly different according to stage of development (p <.001). Qualitative analysis of subjects' comments also revealed support for the U-shaped pattern.

Health care utilization in a sample of Canadian lesbian women: predictors of risk and resilience

This study was designed to test an exploratory path model predicting health care utilization by lesbian women. Using structural equation modeling we examined the joint influence of internalized homophobia, feminism, comfort with health care providers (HCPs), education, and disclosure of sexual identity both in one's life and to one's HCP on health care utilization. Surveys were completed by 254 Canadian lesbian women (54% participation rate) recruited through snowball sampling and specialized media. The majority (95%) of women were White, 3% (n = 7) were women of colour, and the remaining six women did not indicate ethnicity. Participants ranged in age from 18 to 67 with a mean age of 38.85 years (SD = 9.12). In the final path model, higher education predicted greater feminism, more disclosure to HCPs, and better utilization of health services. Feminism predicted both decreased levels of internalized homophobia and increased disclosure across relationships. Being more open about one's sexual identity was related to increased disclosure to HCPs, which in turn, led to better health care utilization. Finally, the more comfortable women were with their HCP the more likely they were to seek preventive care. All paths were significant at p < .01. The path model offers insight into potential target areas for intervention with the goal of improving health care utilization in lesbian women.

A discussion of chain referral as a method of sampling hard-to-reach populations

Nursing research often requires inquiry into sensitive topics that involve hidden or hard- to reach populations. However, identifying and sampling these populations for research purposes is often fraught with difficulties. Barriers include society's lack of tolerance of diverse groups, social stigma, concern for issues of confidentiality, and fear of exposure because of possible threats to security. Chain referral sampling techniques are proposed to minimize bias while maintaining privacy and confidentiality. Techniques of chain referral sampling are detailed for use in researching sensitive topics and hidden populations. When carefully planned and executed, this sampling design offers transcultural nurse researchers a reasonable method for accessing and studying special populations that are particularly hard-to-reach.

Twenty years of public health research: inclusion of lesbian, gay, bisexual, and transgender populations

OBJECTIVES

This study determined to what extent lesbian, gay, bisexual, and transgender (LGBT) populations have been studied over the past 20 years of public health research.

METHODS

From MEDLINE English-language articles on human subjects published between 1980 and 1999, I identified articles that included LGBT individuals. The abstracts were analyzed with a coding procedure that categorized the content by topic, sexual orientation, and race/ethnicity.

RESULTS

LGBT issues were addressed by 3777 articles, or 0.1% of all Medline articles; 61% of the articles were disease-specific, and 85% omitted reference to race/ethnicity. Research unrelated to sexually transmitted diseases addressed lesbians and gay men with similar frequency, whereas bisexual persons were less frequently considered, and the least amount of research focused on transgender individuals.

CONCLUSIONS

Findings supported that LGBT issues have been neglected by public health research and that research unrelated to sexually transmitted diseases is lacking.

A brief telephone interview to identify lesbian and bisexual women in random digit dialing sampling

Lesbian health research has most often relied on nonprobability samples that are biased and restrict generalizability. Random sampling could reduce bias, but requires development of a method for fast and reliable screening of a large number of women. We tested the feasibility of using a brief telephone interview to assess sexual attraction, behavior, and identity. Using Random Digit Dialing in a neighborhood of Boston with a high density of lesbian residents, we interviewed 202 women aged 18 to 59. Of the respondents, 33% reported some sexual attraction to other women, 20% reported sex with women since age 18, and 14% identified as a lesbian. The high level of cooperation with the study among eligible women (94%) and the high proportion of women who disclosed homosexual attraction, behavior, or identity show that it is feasible to use a brief screening questionnaire about sexuality of women over the telephone even without building special rapport with the respondents.

Against all odds

Abstract Research with gay, lesbian and bisexual adolescents has tended to focus on their psychosocial risk factors, with little attention paid to their dating experiences. Unique in its focus on younger, high school-age women, the present study examined dating relationships among 112 lesbian and bisexual women, ages 13 to 18. Characteristics of the young women's dating relationships were explored, as well as dating stress, the presence of verbal and physical abuse in their dating relationships, and psychosocial factors associated with dating. Findings indicate that, despite potential barriers, adolescent lesbian and bisexual women actively date. Relationship concerns requiring supportive interventions by youth-serving professionals are identified and study limitations are discussed.

Selected characteristics of research on lesbian women: 1995-1997

This study examined characteristics of social science research that specifically included lesbians in their sample and was published from 1995-1997. A search of the PsycINFO data base identified 59 articles for analysis. Characteristics of the research that were examined included sampling issues, topics studied, and funding sources. Findings revealed: (1) snowball sampling and friendship networks were the most frequently used method of obtaining respondents; (2) lesbians were the only group studied in 22 (37.3%) of the studies; (3) family and relationships were the most frequently studied topics; and (4) 18 (30.5%) of the studies indicated receipt of at least one external funding source. Findings suggest that while lesbians are a population increasingly worthy of study. challenges remain in identifying respondents for participation in research.

Lesbian health research: a review and recommendations for future research

Prior to 1990 lesbians were "invisible" in health care research. Researchers who asked questions specifically about lesbian health concerns were rare, and the burgeoning research on women's health seldom included variables that measured sexual orientation or behavior. In the last decade, however, lesbian health has emerged as a major area of study. A 1999 Institute of Medicine (IOM) report on Lesbian Health has outlined the challenges and gaps in this area of research and has called for focus and funding on specific areas of need. In this article I review research on lesbian health, discuss methodological issues specific to this area of research, and summarize the recommendations of the IOM report.

Beyond assumptions of negligible risk: sexually transmitted diseases and women who have sex with women

OBJECTIVES

This study evaluated the association of female-female sexual behavior with sexually transmitted diseases (STDs).

METHODS

Female participants (n = 286) were recruited from the Twin Cities Gay/Lesbian/Bisexual/Transgender Pride Festival. Logistic regression was used to examine the association between female-female sexual behavior and STDs.

RESULTS

Women in all partner history groups, including 13% of women with only female partners, reported a history of STD. Increased sexual exposures with women predicted an increase in the likelihood of STDs after known risk factors had been controlled. Neither number of female partners nor number of exposures was associated with obtaining regular STD testing.

CONCLUSIONS

The risk of STDs through female-female sexual exposure is not negligible. Nevertheless, patterns of STD testing do not reflect this risk.

Time-space sampling in minority communities: results with young Latino men who have sex with men

OBJECTIVES

This study addressed methodological issues influencing the feasibility of time-space sampling in HIV prevention studies targeting hard-to-reach populations of minority young men who have sex with men (MSM).

METHODS

We conducted interviews with 400 men in 32 venues where young Latino MSM congregate in New York City. Response rates and demographic and sexual risk profiles are compared by venue type.

RESULTS

More than 90% of the men approached were screened. Among eligible men, participation rates exceeded 82%. Participation was higher at special events and gay venues compared with nongay venues (P < .05). Young MSM in nongay venues were less likely to self-identify as gay (P < .01) or to report recent anal sex with a male (P < .10). Condom use did not vary by venue type but was lower with women than with men. If surveys had been limited to gay venues, about half of the young MSM surveyed in nongay venues would have been missed.

CONCLUSIONS

Time-space sampling of a relatively "hidden" minority young MSM population can be successful across a range of venues. However, the benefits of greater outreach must be weighed against the costs incurred recruiting participants in nongay venues.

Behavioral risk factors for disease and preventive health practices among lesbians

OBJECTIVES

This study compared the prevalence of health behaviors among lesbians and in the general population of women.

METHODS

We used a cross-sectional community-based survey of 1010 self-identified lesbians 18 years or older.

RESULTS

Compared with the general population of women, lesbians were more likely to report cigarette use, alcohol use, and heavy alcohol use. A higher percentage of lesbians were categorized as overweight, and lesbians were more likely to participate in vigorous physical activity. They were less likely to report having had a Papanicolaou test within the past 2 years but more likely to report ever having had a mammogram.

CONCLUSIONS

While there may be differences in health behaviors between lesbians and the general population of women, how these differences influence the risk of subsequent disease is unknown.

Sexual orientation data collection and progress toward Healthy People 2010

Without scientifically obtained data and published reports, it is difficult to raise awareness and acquire adequate resources to address the health concerns of lesbian, gay, and bisexual Americans. The Department of Health and Human Services must recognize gaps in its information systems regarding sexual orientation data and take immediate steps to monitor and eliminate health disparities as delineated in Healthy People 2010. A paper supported by funding from the Office of the Assistant Secretary for Planning and Evaluation explores these concerns and suggests that the department (1) create work groups to examine the collection of sexual orientation data; (2) create a set of guiding principles to govern the process of selecting standard definitions and measures; (3) recognize that racial/ethnic, immigrant-status, age, socioeconomic, and geographic differences must be taken into account when standard measures of sexual orientation are selected; (4) select a minimum set of standard sexual orientation measures; and (5) develop a long-range strategic plan for the collection of sexual orientation data.

Substance use among gay and lesbian adolescents

Surveys at a Massachusetts high school used multiple items to identify gay, lesbian, and bisexual teenagers. Students with consistent homosexual preferences had greatly elevated rates of substance use. Those who displayed a homosexual preference but answered less consistently also had somewhat higher rates of substance use but were closer to heterosexual youths than to more consistent homosexual youths. The differences in substance use were least for alcohol use and greater for "hard" drugs.

Event-related potentials in homosexual and heterosexual men and women: sex-dimorphic patterns in verbal asymmetries and mental rotation

To elucidate neurobiological factors related to gender and sexual orientation, event-related brain potentials of 20 heterosexual (HT) men, 20 HT women, 20 homosexual (HM) men, and 20 HM women were examined for neurophysiological differences. Cognitive tasks which typically elicit sex differences were administered. A mental rotation (MR) task assessed spatial ability, and a divided-visual-field lexical-decision/semantic monitoring task (LD/SM) assessed verbal ability and relative degrees of language lateralization. Slow wave activity recorded during MR was greater for HT men than for HT women and gay men. N400 asymmetries recorded during the LD/SM task revealed differences between men and women, but no intrasex differences.