AcademyHealth
2009 Annual Research Meeting
June 29, 2009
Judith Bradford, PhD
Co-Chair, The Fenway Institute
Director, Center for Population Research in LGBT Health

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Populations are groups of people who have certain characteristics in common. Traditionally, a
“population” is made up of people who live within a defined geographic area; and population research refers to data sets that adequately represent the population of interest, using randomized samples.
Increasingly, we think of populations (or population groups) as people who have certain cultural or behavioral characteristics in common. (Such as sexual and gender minorities). Range of qualitative and quantitative methods are used to develop representative samples.

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 Larger portions of lesbians, gay men, and bisexuals may be choosing to couple with partners of the same sex.
 Larger numbers of same-sex couples may be willing to report the nature of their relationship to the Census Bureau.

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“Do you think of yourself as heterosexual, homosexual, bisexual or something else?”
Men:
Heterosexual:
* Homosexual:
* Bisexual:
90%
2.3
1.8
Something else: 3.9
No answer: 1.8
* Total 4.1%
Women:
Heterosexual:
*Homosexual:
* Bisexual:
92%
1.3
2.8
Something else: 3.8
No answer: 1.8
* Total 4.1%

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How our health suffers:
Leading Health Indicators in the General US Population
Healthy People 2010 (US Surgeon General’s Office)
Physical Activity
Overweight and Obesity
Tobacco Use
Substance Abuse
Responsible Sexual Behavior
Mental Health
Injury and Violence
Environmental Quality
Immunization
Access to Care
Sexual and
Gender
Minorities
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In order to receive funding for LGBT research and services, we had to demonstrate need.
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In order to demonstrate need, we had to make our case with sound data.
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In order to get the data, we had to solve both political and scientific challenges.
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To gain recognition, we had to strengthen ties across organizations, maximize our institutional and intellectual resources.
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A full-court press was needed.

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 Institute of Medicine report on lesbian health and research priorities (1997-1999) funded by CDC and
ORWH (NIH)
 Short paper
 White paper
 Persons defined by sexual orientation included as a disparities group in HP2010
 LGBT Community Health Centers broadened focus from
AIDS to LGBT health
 Incorporation of health concerns in LGBT community centers and other community-based programs
 National Coalition on LGBT Health (lgbthealth.net)

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 HP2010 companion document
 Inclusion of sexual orientation measures in
Federal surveys
 Expanding coalition membership and diversity
 Communication within LGBT communities and with government agencies
 Representation on federal committees and advisory groups
 Consensus-building for advocacy efforts

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 Population data with adequate samples of sexual and gender minorities is lacking.
 Measurement issues, samples too small to represent diversity.
 Measures utterly lacking, as for transgender.
 Reliance on national surveys as prevalence benchmarks for sexual and gender minorities is insufficient.
 Progress is being made, much left to do.
A review and description of data sets with measures of sexual orientation (LGB) or attitudes toward sexual minorities can be found at: www.gaydata.org
(regularly updated)

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1. Massachusetts BRFSS
2. Virginia Transgender Health Study
3. California Tobacco Survey
4. American Community Survey

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 Substantial disparities for LGBs v. HETS, many bisexual rates higher than LGs
 Access to care, self-reported health status, anxiety, depression, suicide ideation, smoking, binge drinking, illicit drug use, sexual assault victimization, intimate partner violence, disability, obesity, heart disease
 E.g., gays and lesbians 2.5 times more likely than hets to report current smoking.
 Lesbians 2.2 times more likely than het women to be obese.
 Many disparities greater for bisexuals than LGs
 Bisexuals 3.1 times more likely than hets to report feeling tense or worried
 Bisexuals 4.4 times more likely than hets to report “poor” or “fair” health (LGs 1.5 times more likely).

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 Gay men smoke at rates 50% higher than other men.
 Lesbians smoke at rates almost 70% higher than other women.
 LGBT women smoke at rates almost 200 percent higher than other women.
 9% of heterosexual female adolescents were smokers v. 42% of lesbian/bi female adolescents.
 8% of heterosexual adolescent males v. 17% of
“mostly heterosexual” males.

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Social Determinants of Health
 Social organization, stress and health
 Early life
 The life course, the social gradient, and health
 Understanding the health consequences of unemployment
 Health and the psychosocial environment at work
 Social support and social cohesion
 Poverty, social exclusion and minorities
 Social patterning of individual health behaviors: the case of cigarette smoking
Marmot M, Wilkinson RG, Social Determinants of Health. NYC: Oxford University Press, 2003.

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Summary of Census 2000 Data
Related to People of Color in Same-Sex Relationships
Gary J. Gates, Ph.D., the Williams Institute at UCLA School of Law
 “The number of same-sex couples is generally even across races.
 LG couples of color have equivalent education and income disparities as in their referent racial/ethnic groups.
 Disability rates are higher among LG couples of color, as they are for referent racial/ethnic groups.
 LG couples of color are more likely to be raising children than are White LG groups.
 Almost 30 percent of same-sex Black/African American male couples have a child in their household, versus 8 percent of same-sex White male couples.”

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 Black/African American and Latino/Hispanic same-sex couples cluster in distinct geographical areas, in different areas than White same-sex couples.
 Highest density same-sex couple neighborhoods are most like those where White same-sex couples live.
 Thus, same-sex couples of color will likely be underrepresented in research conducted in high-density
LGBT neighborhoods.
 Need attention to neighborhoods with higher clusters of same-sex couples of color.

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 Population-based methods not feasible.
 Strong desire for representative sample – geographic regions and both gender vectors.
 Careful formative research, statewide, regional focus groups.
 Web-based survey, posted on comprehensive mix of websites and list servs.
 Regional network to distribute hard copy questionnaires.
 $15 incentive, blank money orders sent to name and address given by respondent.
 N=350 in analysis sample.

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140
(40%)
210
(60%)
Web
Paper

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30
20
10
0
60
50
40
90
80
70
90
10
Northern
32
68
Eastern
66
Central
34
85
15
61
39
Western Statewide
Web
Paper

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Paper
 58% African American; 28% white; 10% Hispanic
 56% urban, 28% suburban,
16% rural
 38% no health insurance
 23% not out to regular doc
 19% own their homes
 34% live alone
 6% live with spouse
Web
 3% African American; 85% white; 9% multiracial
 34% urban, 48% suburban,
19% rural
 21% no health insurance
 33% not out to regular doc
 40% own homes
 25% live alone
 22% live with spouse

LGBT Health is Not Just an Individual Matter
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McElroy KR, Bibeau D, Steckler A, Glanz . An ecological perspective on health promotion programs. Health Education Quarterly 15:351-377, 1988.

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Greater awareness of and attention to demographic and cultural diversity within LGBT communities
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More awareness of common concerns, such as measurement and methodological issues
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More expansive, inclusive way of thinking, demonstrating increasing confidence
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More balanced emphasis on all sexual and gender minorities - national policy frameworks apply to all
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Focus on more rapid translation of research to practice
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Increased understanding and focus on population-based data

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 www.gaydata.org
 http://www.law.ucla.edu/williamsinstitute/home.html
 Gates GJ. 2006. Same-sex Couples and the Gay, Lesbian, Bisexual
Population: New Estimates from the American Community Survey . The
Williams Institute on Sexual Orientation Law and Public Policy, UCLA School of Law. (presented at national mtg, in next reference)
 Lesbians, Gays, Bisexuals, and Transgenders of Color Sampling Methodology:
Strategies for Collecting Data in Small, Hidden, or Hard-to-Reach Groups to
Reduce Tobacco-Related Health Disparities. Fall 2006 Meeting. (contact
Bradford if needed)
 Virginia Transgender Health Initiative Survey. Virginia Department of Health,
Department of Disease Prevention. http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/documents/pdf/T
HISFINALREPORTVol1.pdf
 Healthy People 2010: Companion Document for Lesbian, Gay, Bisexual and
Transgender (LGBT) Health. http://www.lgbthealth.net/downloads/hp2010doc.pdf

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Contact:
Judy Bradford, jbradford@fenwayhealth.org
(c) 804-304-2667
(o) 617-927-6015