Index

[Page numbers followed by b, f, or t refer to boxed text, figures, or tables, respectively.]

A

Academic performance, risks for LGBT youth, 158159

Adolescents. See Youth, LGBT

Adoption, 47

Adulthood, early/middle

body image, 198

cancer, 204206

cardiovascular disease, 207

childhood abuse, 115116, 219220, 271

depression in, 190, 193194

discrimination, 212213, 233

eating disorders, 198199, 232

health care access and utilization, 222225, 234

health care quality, 226227

HIV/AIDS, 208210

mental health status, 189192, 232

mood and anxiety disorders, 190, 192193

obesity, 207208

parenthood and family formation in, 228231, 234, 235

protective factors, 220222, 233

reproductive health in, 203204

research opportunities, 234235

risk factors, 211, 233

sexual functioning in, 202203

sexual orientation and gender identity, development of, 186189

sexually transmitted infections, 210211

sociodemographic factors in health outcomes, 227228, 234

stigmatization, 212213, 233

substance use in, 214219, 233

suicidal ideation and behavior, 190, 191, 195198, 232

violence risk in, 213214, 233

See also Elders, LGBT

Adulthood, late. See Elders, LGBT

Age groups

cohort differences, 15

HIV/AIDS distribution, 265

LGBT population patterns, 6061

See also Adulthood, early/middle;

Elders, LGBT;

Youth, LGBT

Agency for Healthcare Research and Quality, 120

Alcohol use

among LGBT adults, 5, 205, 216217, 218, 219

among LGBT elders, 270271, 282



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Index [Page numbers followed by b, f, or t refer to protective factors, 220–222, 233 boxed text, figures, or tables, respectively.] reproductive health in, 203–204 research opportunities, 234–235 risk factors, 211, 233 A sexual functioning in, 202–203 sexual orientation and gender identity, Academic performance, risks for LGBT development of, 186–189 youth, 158–159 sexually transmitted infections, 210–211 Adolescents. See Youth, LGBT sociodemographic factors in health Adoption, 47 outcomes, 227–228, 234 Adulthood, early/middle stigmatization, 212–213, 233 body image, 198 substance use in, 214–219, 233 cancer, 204–206 suicidal ideation and behavior, 190, 191, cardiovascular disease, 207 195–198, 232 childhood abuse, 115–116, 219–220, violence risk in, 213–214, 233 271 See also Elders, LGBT depression in, 190, 193–194 Adulthood, late. See Elders, LGBT discrimination, 212–213, 233 Age groups eating disorders, 198–199, 232 cohort differences, 15 health care access and utilization, HIV/AIDS distribution, 265 222–225, 234 LGBT population patterns, 60–61 health care quality, 226–227 See also Adulthood, early/middle; Elders, HIV/AIDS, 208–210 LGBT; Youth, LGBT mental health status, 189–192, 232 Agency for Healthcare Research and mood and anxiety disorders, 190, Quality, 120 192–193 Alcohol use obesity, 207–208 among LGBT adults, 5, 205, 216–217, parenthood and family formation in, 218, 219 228–231, 234, 235 among LGBT elders, 270–271, 282 333

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334 INDEX among LGBT youth, 160, 171 economic status, 60, 74 See also Substance use family acceptance, 253 American Association for Public Opinion hate crime, 214 Research, 128 health service utilization, 222–223 American College of Obstetricians and organized community of, 41 Gynecologists, 204 partner and family relationships American Indians and Alaska Natives, 72 research, 228 American Psychiatric Association, 38, 251 prevalence estimates, 54–56 American Psychological Association, 38, protective factors for youth, 164 39–40 racial/ethnic differences, 31 American Public Health Association, 39–40 self-reported health status, 259 American Society for Reproductive stigmatization and discrimination, Medicine, 204 212–213 Anal cancer, 205–206, 232, 263 substance use, 218 Anxiety. See Mood and anxiety disorders suicidal ideation and behavior, 195, 258 Asians/Pacific Islanders, 30–31, 194, 226, variability in sexual identity, 28, 228 212–213 Association of American Medical Colleges, See also Bisexual men; Bisexual 65–66 women; Lesbian, gay, bisexual, and transgender (LGBT) populations Bisexual men B depression, 194 early experience of sexuality, 29 Barriers to care health services utilization, 5, 160, 191, deficiencies in provider knowledge and 274 training as, 65–66 HIV risk and outcomes, 2–3, 155, geographical location as factor in, 16 208–209 health insurance coverage, 66–67, 274 mental health status, 190, 191, 192, for HIV/AIDS, 69 193, 194, 221 for LGBT adults, 224, 234 parenthood among, 47 for LGBT youth, 62, 274 prevalence estimates, 56 personal-level, 62 relationship patterns among elders, 277 provider bias, 63–64, 274–275 sexual behavior in youth, 153, 155 recommendations for research, 8, 295 substance use, 5, 160, 161, 215, 216, reluctance to disclose sexual orientation 217, 218 or gender identity as, 14, 62, 63, suicidal ideation and behavior, 195, 258 224–225, 269–270, 274 See also Bisexual individuals; Lesbian, research opportunities, 75, 235 gay, bisexual, and transgender stigma-related, 61–65 (LGBT) populations structural, 61, 64–65 Bisexual women for transgender persons, 225, 274 cancer risks, 5, 232, 263, 282 types of, 2, 75, 224 coming out and disclosure behaviors, Benjamin, Harry, 49, 50 187–188 Bigender persons, 26 contraceptive use, 261 Bisexual individuals depression, 194 acceptance in sexual-minority early experiences of sexuality, 29 community, 213 eating disorders, 150–151, 198–199 coming out and disclosure behaviors, 31, health services utilization, 5, 190–191, 213, 253, 254 223, 234, 260, 274, 282 depression, 194, 256, 257 heart disease risk, 207, 235 eating disorders, 150–151 history of childhood abuse among, 219

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335 INDEX HIV risk and outcomes, 41, 70, Children, nonheterosexual and transgender. 155–156, 233 See Youth, LGBT mental health status, 190–191, 192, Children of sexual minority parents 193, 194, 204, 221 as caretakers for parents, 278 obesity risk, 5, 205, 207–208, 233 developmental outcomes, 5, 229–230, parenthood among, 47, 187–188, 204 234 prevalence estimates, 56 prevalence, 47, 59 racial/ethnic differences, 227 See also Parents, LGBT relationship patterns among elders, 277 Chlamydia, 210 reproductive health in late adulthood, Coming out and disclosure behaviors 261 in adolescence, 143, 144, 167, 168, 172 sexual behavior and pregnancy in youth, age cohort differences, 15, 188, 253 153–154 demographic variation, 74 sexually transmitted infection, 211 in early/middle adulthood, 186–189 substance use, 5, 160–161, 205, experiences of older LGBT cohort, 215–216, 217–218, 219, 271 253–255 suicidal ideation and behavior, 190–191, family responses, 168, 169, 172, 231, 195, 197, 258 253 victimization risk, 171 in health care system, 167, 172, 224, See also Bisexual individuals; Lesbian, 269–270, 274 gay, bisexual, and transgender individual differences, 186 (LGBT) populations in late adulthood, 255–256, 269–270 Black men and women. See Race/ethnicity mental health linkage, 186 Body image, 150, 198, 208 motherhood and, 187–188 Breast cancer, 5, 205, 206, 232, 263, 282 as protective factor for youth, 164–165 Breast/chest surgery, 199, 206 racial/ethnic patterns in, 31–32, 168, 253 research opportunities, 188 C responses to HIV/AIDS epidemic, 40–41 stage models, 189 California Health Interview Survey, 99–101, transgender individuals, 32, 188–189, 102b 253, 254–255 California Quality of Life Survey, 101 in workplace, 220, 254 Cancer risk See also Concealment of sexual data sources, 204–205 orientation in early/middle adulthood, 205–206, Communications technology, 298 232–233 Community Intervention Trial for Youth, in late adulthood, 262–264 105 research opportunities, 235 Compton’s Cafeteria riot, 51 See also specific cancer types Concealment of sexual orientation Cardiovascular disease, 207, 211, 235, to avoid discrimination in health care 264–265, 282 system, 63, 64, 224–225, 269, 274 Caregiving issues, 267, 275, 277–280 by bisexual people, 213 Cauldwell, David Oliver, 49 challenges to LGBT research, 89, 92–93 Cervical cancer, 264, 274 in minority stress model, 20 Childhood abuse See also Coming out and disclosure associated health problems in adulthood, behaviors 115–116, 219–220 Conceptual framework for research, 2, prevalence, 115, 163–164, 171, 6, 19–23, 121, 293, 294. See also 219–220, 262, 271–272 Cross-cutting perspectives racial/ethnic patterns, 220 Condom use, 209

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336 INDEX Contraceptive use, 261, 282 Department of Health and Human Services, Convenience samples, 105 recommendations for, 9, 299–303 Conversion therapy, 146 Depression Crisis competence, 5, 272, 282 among LGBT youth, 147, 150 Cross-cutting perspectives, 6, 7, 293, in early/middle adulthood, 190, 294–296 193–194, 232 in late adulthood, 256–257, 282 Diagnostic and Statistical Manual of Mental D Disorders, 2, 26, 35–36, 37, 50, 251 Diffusion of Effective Behavioral Data collection Interventions, 116 challenges in LGBT research, 3, 53, 74, Disability, 266–267, 282 89, 94 Drag kings and queens, 26 cognitive interviews, 122 concealment of sexual orientation as obstacle to, 92–93, 130 E definitional and measurement challenges, 90–91 Eating disorders hate crimes, 42, 43 among LGBT youth, 150–151, 170 Internet/online surveys, 114–115 in early/middle adulthood, 198–199, 232 one-on-one interviews, 121 history of childhood abuse and, 219–220 potential errors, 111–114, 112t, 131 Educational attainment qualitative methods, 120–122, 131 differences in life experience within quantitative methods, 109, 131 LGBT community, 15–16 recommendations for, 7, 9, 296–297, early sexual experiences and, 187 299–302 income and, 60, 277 response to AIDS epidemic, 69 of nonheterosexual people, 277 on sexual orientation and gender protective factors for LGBT elders, 273, identity, 9, 94, 118–120, 122–123 282 sources for transgender population, Education and training of health 18–19, 27 professionals sources of data on LGBT health, 2, barriers to care for LGBT population, 2, 18–19, 122–123, 124–126t, 127f 65–66, 75, 167, 224 standardization of sexual orientation cultural competency, 65 and gender identity measures, 9–10, recommendations for research training, 91–92, 130, 303–304 10, 304–305 survey methods, 109–114, 122, 131 Eisenhower administration, 35 See also Sampling, population Elders, LGBT Daughters of Bilitis, 36 cancer, 262–264 Defense of Marriage Act, 44, 45 cardiovascular disease, 264–265 Demographic research, 7, 296–297 caregiving issues, 5, 267, 275 recommendations for, 6f, 294f childhood abuse experiences of, Demographics of LGBT population 271–272 geographic distribution, 57–58, 74 crisis competence, 5, 272, 282 household composition, 58–59, 75, 94 current research base and data sources, population prevalence, 53–57, 55t, 252 60–61, 145, 235 depression, 256–257 See also Age groups; Educational disability among, 266–267 attainment; Race/ethnicity; discrimination, 274–276 Sociodemographic factors in health end-of-life issues, 280–281 outcomes; Socioeconomic status family role in lives of, 277–280, 283

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337 INDEX friendship networks, 279 of choice, 278, 279, 283 health care access and utilization, elder care by, 277–278 273–274, 282–283 household composition patterns, 58–59 HIV/AIDS and, 5, 265–266 intervention with LGBT youth in, 4 living arrangements, 277–278 research opportunities, 173 long-term care, 275, 283, 284 role of, in health outcomes for LGBT mental health status, 256, 282 adults, 231 mood and anxiety disorders among, 256 role of, in health outcomes for LGBT obesity, 265 elders, 277–279, 280 physical health status, 5, 259–260, 282 role of, in health outcomes for LGBT protective factors, 5, 257, 268, 272–273, youth, 168–169, 172 282 suicide risk among LGBT youth and, quality of care expectations, 274–275 149 reproductive health of, 260–262 support for LGBT parents from, 231 research opportunities, 283–284 violence against LGBT youth in, 159 risk factors, 5, 268, 282 See also Parents, LGBT sexual functioning among, 260 Family and Medical Leave Act, 46 sexual orientation and gender identity, Federal Bureau of Investigation, 42, 43 development of, 253–256 Focus groups, 121–122 social context of health outcomes for, Foster-parenting, 47, 169–170 277–280, 283 Freud, Sigmund, 33, 34 sociodemographic factors in health Friendships, 279 outcomes, 276–277, 283 stigmatization, 5, 251, 268–270 G substance use among, 270–271, 282 suicidal ideation and behavior, 257–258, Gay men 282 age at sexual identity awareness, 143 victimization and violence, 261–262, age patterns, 60 268, 269, 270, 271, 282 anal cancer risk, 205–206, 232 Electronic health records, recommendations body image dissatisfaction, 198 for data collection in, 9, 302–303 coming out and disclosure behaviors, 31, Ellis, Havelock, 48 187, 253, 254 Employment depression risk, 193–194, 256–257, 282 health insurance coverage, 66 early sexual experiences, 188 historical discrimination against LGBT eating disorder risk, 198 people, 35–36 economic status, 60, 74 HIV risk and, 72 educational attainments, 60 workplace disclosure of sexual erectile dysfunction in, 202–203, 260 orientation, 31, 254 fatherhood among, 47, 59, 228–229, workplace environment, 220 234 End-of-life issues, 280–281 geographic distribution, 58 Erectile dysfunction, 202–203, 232, 260 hate crime risk, 214 Estrogen. See Hormone therapy to affirm history of childhood abuse among, 219 gender identity mood and anxiety disorder risk, 192, 193 population prevalence, 55, 56 F prostate cancer risk, 262–263 Families protective factors, 164–165, 220–221 acceptance and rejection of LGBT racial/ethnic differences, 31, 187, 194 member by, 168, 169, 172, 231, 253 relationship status, 58–59

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338 INDEX self-reported health, 259 Gonorrhea, 210–211 sexual behavior in youth, 153, 154 Grandparents, LGBT, 278 sexual identity development, 142–144 Growing Up Today Study, 118, 118b social support, 220–221, 272–273 socioeconomic status, 227–228 H substance use, 215–216, 217, 218, 271 suicide, 195, 258 Harry Benjamin International Gender See also HIV/AIDS; Lesbian, gay, Dysphoria Association, 50 bisexual, and transgender (LGBT) Hate crimes populations community resistance to, 42 Gender, defined, 25 criminalization of, 42–43 Gender dysphoria data collection, 42, 43 definition, 26, 50 HIV/AIDS epidemic and, 68 development in youth, 145 prevalence, 43, 68, 214 research opportunities, 202 psychological stress effects of, 213–214 standards of care, 50, 199–202 Hate Crimes Sentencing Enhancement Act, Gender expression 42–43 definition, 26 Hate Crimes Statistics Act, 42 development in youth, 145 Health, defined, 13 n.1 Gender identity Health care system age at awareness, 143 access and utilization patterns of LGBT definition, 25–26 adults, 62, 222–223, 234, 273–274, definitional and measurement challenges, 282–283 90–92 access of LGBT youth, 166, 172 development in early/middle adulthood, attempts to change sexual orientation, 186–189 36 development in late adulthood, 253–256 destigmatization of homosexuality in, development in LGBT youth, 142–146, 36–37, 38 170, 255 disclosure behaviors of LGBT adults in, ethnic identity and, 144 63, 224–225, 269–270, 274 origins of clinical conceptualization, 49 disclosure behaviors of LGBT youth in, recommendations for research, 9–10, 166, 167, 172 299–304 evolution of sex transformation standardization of measures, 9–10, medicine, 48–50, 51–52 303–304 quality of care for LGBT youth, 167, theoretical models of development, 143 172 transgender, 189 response to HIV/AIDS epidemic, 40, Gender identity disorder 69–74 clinical conceptualization, 26, 50 in rural areas, 276–277 diagnostic criteria for children, 50, 151, stigmatization and discrimination in, 32, 152b 34, 36, 63–64, 167, 224, 269–270, standards of care, 199–200 274–276 treatment of youth, 151–153 See also Barriers to care; Education and Gender queer, 26, 202 training of health professionals Gender role conformity, 26 Health insurance, 66–67, 227, 234, 274 General Social Survey, 56 Health of LGBT population Geographic location best practices for research on, 4, 119, distribution of LGBT population, 57–58, 123–129 74 community health infrastructure, 14 as health outcome factor, 16, 227 conceptual framework for research on, See also Rural–urban differences 2, 4, 19–23, 294–296

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339 INDEX contextual factors, 2–3, 25 social risk factors, 72 current knowledge base, 1, 4, 8, 11, stigmatization and discriminatory 234–235 responses, 39–40, 67–69 data sources, 2, 18–19, 122–123, vulnerable groups, 4 124–126t, 127f Homelessness, 4, 161–163, 171 marriage and, 45–46, 221 Hooker, Evelyn, 37 recommendations for research, 6–8, 10, Hormone replacement therapy, 261, 282 293–304 Hormone therapy to affirm gender identity research challenges, 89, 130 age at initiation, 255 research opportunities, 4, 75, 235 assessment and treatment planning, 199 self-reported, 259 cancer risk in, 206, 211, 233 stigmatization and victimization effects, cardiovascular disease and, 207, 211 2, 13–14, 32, 74, 268–270 current clinical approach, 52, 200–202 See also Adulthood, early/middle; health outcomes, 157, 211, 233 Barriers to care; Elders, LGBT; historical origins, 49 Mental health; Youth, LGBT illicit, 200 Healthy People 2020, 22 reproductive health and, 204 Hirschfeld, Magnus, 48–49 research opportunities, 204, 284 HIV/AIDS risks for transgender elders, 5, 264–265, age distribution, 265 282 among LGBT youth, 154–157, 171 sexual functioning and, 203 among transgender persons, 208, 209, standards of care, 199, 200 224, 233 in youth, 153, 157, 171 bereavement outcomes in LGBT Hospital care, 119 community, 279, 280 Human papillomavirus, 206, 263 cardiovascular disease and, 207 Hysterectomy, 261, 282 education and training of health care providers, 224 I erectile dysfunction and, 202 government programs and policies, Inequities in health care 68–69 geographical factors, 16, 227 human papillomavirus infection in, 206, racial/ethnic patterns of HIV infection, 263 4, 5, 71–74, 155, 171, 208, 233 incidence, 71, 73f recommendations for research, 6f, 8, mortality, 71 294f, 297 in older adults, 5, 265–266, 282 See also Barriers to care; Quality of care outcomes in LGBT community, 38–41 for LGBT people preventive interventions, 71, 210 Insurance. See Health insurance public awareness and understanding, Internet/online surveys, 114–115 40–41, 67–68 Internet use to obtain sexual partners, 208 racial/ethnic patterns, 4, 5, 71–74, 73f, Interpersonal violence, 214 155, 171, 208, 233 Intersectional perspective, 7 Reagan administration, 69 conceptual basis, 2, 21–22, 295–296 research, 69, 70–71, 72f rationale for LGBT research with, 21, response of LGBT community, 69–70 22, 23, 294, 295–296 risk for bisexual men, 208–209 recommendations for research, 6f, 294f risk in early/middle adulthood, 5, Intersexuality, 16–17 208–210 Intervention research, 6f, 8, 294f, 297–298 significance of epidemic for LGBT Inversion, sexual, 33 community, 2–3, 41

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340 INDEX J legal protections for, 41–44 older adults. See Elders, LGBT Johns Hopkins University, 49–50 prevalence estimates, 53–57, 55t Joint Commission on Accreditation of response to HIV/AIDS epidemic, 69–70 Healthcare Organizations, 119 sampling methodology for research on, Jorgensen, Christine/George, 49 3, 93–96 self-identification patterns, 30–31 sexual orientation disclosure behaviors, K 31–32 strengths and resiliency, 14 Kalman filter, 95–96 subpopulations, 1 Kinsey, Alfred, 36–37, 53 youth population. See Youth, LGBT See also Health of LGBT population Lesbians L age patterns, 60–61 Latino/latina population. See Race/ethnicity body image among, 150, 208 Lawrence v. Texas, 41 breast cancer, 5, 205, 232, 263, 264, Legal environment 282 criminalization of homosexual conduct, cardiovascular disease, 207, 235, 264, 33–36 282 current state of, for sexual minorities, 42 coming out and disclosure behaviors, 31, effects of HIV/AIDS epidemic, 39–40 187–188, 253, 254 end-of-life issues, 281 depression, 193–194, 256–257, 282 implications for health, 2, 33 eating disorders, 198 LGBT civil rights movement, 37–38 economic status, 60, 74, 269 marriage rights, 44–47 educational attainments, 60 protections for LGBT populations, geographic distribution, 58, 227 41–44 hate crime, 214 psychological well-being and, 220 health service utilization, 5, 222–224, rights of LGBT parents, 47–48, 229 234, 274 transgender history, 48, 50–51, 52 history of child abuse among, 219 Lesbian, gay, bisexual, and transgender HIV risk, 155–156 (LGBT) populations mental health status, 190, 192, 193–194 age distribution, 60–61 obesity, 5, 207–208, 227, 233, 265 challenges to conducting research in, 3, parenthood, 5, 47, 59, 187–188, 204, 52–53 205, 228–230, 231, 234, 261 commonalities among, 13–14 population prevalence, 55, 56 definitional and measurement issues, protective factors for psychological well- 90–92 being, 221 development and empowerment of relationship status, 58–59 community, 14, 35, 36, 37–38, 42, reproductive health, 153–154, 204, 261, 69–70 263–264 diversity within, 1, 11–13, 15–16 school problems, 158–159 in early/middle adulthood. See self-reported health, 259 Adulthood, early/middle sexual behavior, 153–154, 261 economic status, 60, 74 sexual identity development, 142–144, geographic distribution, 57–58, 74 187 hate crime prevalence against, 214 sexually transmitted infection, 211 history of childhood abuse, 219–220 sexual satisfaction in adulthood, 203 household composition, 58–59 sociodemographic factors in health in later adulthood. See Elders, LGBT outcomes, 227

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341 INDEX substance use, 160–161, 205, 215–218, utilization of care services, 222–223 227, 271 See also Depression; Gender dysphoria; suicide risk, 195, 227, 258 Gender identity disorder; Mood and teen pregnancy, 153–154, 170 anxiety disorders; Suicidal ideation See also Lesbian, gay, bisexual, and and behavior transgender (LGBT) populations Methamphetamine, 161 LGBT. See Lesbian, gay, bisexual, and Military, U.S., 34–35, 36 transgender populations Minority stress model Life-course framework conceptual basis, 20–21, 22–23, conceptual basis, 2, 19–20, 22, 295 221–222, 295 key dimensions of, 20 definition, 2 life stages in, 4 rationale for LGBT research with, rationale for LGBT research with, 20, 294–295 295 recommendations for research, 6f, 7, recommendations for research, 6f, 7, 294f, 295 294f, 295, 300–302t Money, John, 49 See also Adulthood, early/middle; Elders, Mood and anxiety disorders LGBT; Youth, LGBT among LGBT youth, 147 Longitudinal cohort studies, 7, 117–118, in early/middle adulthood, 190, 131, 295, 302 192–193, 232 Long-term care, 275, 283, 284 in late adulthood, 256 M N Mammograms, 222, 223–224 National Gay and Lesbian Task Force, Marijuana use, 216 52 Marriage National Health and Nutrition Examination custody and visitation rights of LGBT Survey, 123 parents, 47, 48 National Health and Social Life Survey, 54, end-of-life issues, 281 99, 100–101b as health outcome factor, 45–46, National Household Survey on Drug Abuse, 221 123 rights of LGBT citizens, 44–47 National Institute of Mental Health, 37 Massachusetts Behavioral Risk Factor National Institutes of Health, 1, 16, 71 Surveillance System, 99, 102b recommendations for, 6–8, 9–10, Mattachine Society, 36, 37 293–294, 303–305 Matthew Shepard and James Byrd, Jr. Hate National Lesbian Health Care Survey, Crimes Prevention Act, 43 107–108 Mental health National Survey of Family Growth, 56, among LGBT youth, 146–147, 151–153, 100b 170 National Survey of Sexual Health and coming out experience and, 186 Behavior, 56, 99 in early/middle adulthood, 5, 189–192, National Transgender Discrimination 199–202, 232 Survey, 108, 110b effects of discrimination and National Transsexual Counseling Unit, 51 victimization, 191–192, 212–213, Native Americans, 26, 196 268–269 Nurses’ Health Study, 117–118, 118b in late adulthood, 256, 282 Nurses’ Health Study II, 118b racial/ethnic differences, 194, 227 Nursing homes, 275 research opportunities, 191, 235

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342 INDEX O for LGBT youth, 164–166, 171–172 marriage, 221 Obama memorandum on hospital visitation, resiliency, 221–222, 257, 268, 272 46 in school environment, 165–166, Obesity 171–172 among LGBT youth, 154 supportive social environment, 164, history of childhood abuse and, 219 171–172, 220–221, 272–273 research opportunities, 173, 235 Psychoanalytic theory, 33, 34 risk for lesbian and bisexual women, 5, 205, 207–208, 227, 233, 265 Office of the National Coordinator for Q Health Information Technology, 9, Qualitative research, 120–122, 131 302–303 Quality of care for LGBT people Ovarian cancer, 206, 211, 261 expectations of elders, 274–276, 283 patient satisfaction, 226–227, 234, P 235 research opportunities, 235 Panic attacks, 192, 193 for youth, 167 Pap tests, 222, 223–224 Quantitative research, 109, 131 Parents, LGBT Queer, 15, 26, 29, 202 coming out behaviors, 187–188 developmental outcomes of children of, 5 R health risks of childlessness, 229 Race/ethnicity legal rights, 47, 229 barriers to care based on, 64 parenting abilities and competencies of, childhood sexual abuse patterns, 220 229–230 coming out and disclosure behaviors, pathways to parenthood, 47, 229 31–32, 168, 187, 253 prevalence, 47, 59, 74, 228–229, 261 cultural norms of country of origin as research opportunities, 203–204, 231, health factor, 228 234, 235 differences in life experience within support from families for, 231 LGBT community, 15 Policy differences in sexual expression and response to HIV/AIDS epidemic, 68–69, experience, 30 70, 71 discrimination experience and, 269, 270 See also Recommendations early sexual experience, 187 Pregnancy, 153–154, 170 health outcomes and, 227 Preventive interventions HIV risk, 4, 5, 71–74, 73f, 155, 171, health service utilization, 5, 223, 234 208, 233 HIV, 156–157, 210 household composition patterns, 59 suicide, 150 identity development, 144 youth-specific, 156–157 intersectional perspective in LGBT Prisons system medical care, 226 research, 21 Probability/nonprobability sampling, 3, mental health status, 194, 227 93–95, 97–103, 105–109, 130–131 perceived benefits of LGBT identity, 272 Prostate cancer, 206, 262 perceived racism in LGBT communities, Protective factors 187 crisis competence, 5, 272, 282 research opportunities, 4 disclosure of sexual identity as, 164–165 sexual identity development in in early/middle adulthood, 220–222, 233 adolescence, 144, 170 in late adulthood, 268, 272–273, 282

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343 INDEX sexual orientation self-identification, communications and social networking 30–31 technologies, 298 suicide risk, 196, 197, 227 data collection, 9, 299–302 Randomized controlled trials, 115–117, health effects of coming out experience, 131 188 Recommendations health interventions, 8, 297–298 data collection, 7, 9, 299–302 health status of LGBT population, 4, for inclusion of sexual minorities in 17b, 75, 234–235 research projects, 10, 305 HIV transmission, 156–157 for methodological research, 9–10, homelessness risks and outcomes, 163 303–304 inequities in health care, 8, 296 for research agenda, 6–8, 293–299, LGBT elders, 283–284 300–302t LGBT parenting, 231 for research training, 10, 304–305 LGBT youth, 4, 172–173 Religious affiliation, 168 mental health, 146, 202, 284 Reproductive health reproductive health among LGBT adults, in early/middle adulthood, 203–204 204 fertility services, 204 sexual and reproductive health, 284 health service utilization, 223–224 social context of LGBT health, 8, 296 insurance coverage, 66 sociodemographic factors, 7, 53, 75, in late adulthood, 260–262, 263–264 168, 172, 173, 234, 235, 283, research opportunities, 204, 235, 284 296–297 risks for LGBT youth, 153–154, 170 standardization of definitions and Research agenda, 6f, 294f measures, 91–92, 131 cross-cutting perspectives, 7, 293, transgender-specific, 8, 157, 173, 202, 294–296 262, 298 recommendations for research agenda, Resiliency, 221–222, 257, 268, 272 6–8, 293–298 Rural–urban differences, 16, 168, 227, Research methodology, 18–23 276–277 best practices, 4, 119, 123–129 challenges in conducting LGBT research, S 3, 89, 130 confidentiality practice, 93 Sampling, population definitional and measurement issues, best practices, 128 90–92 challenges, 96–97 importance of, 96 challenges in LGBT research, 3, 130 inclusion of sexual and gender minorities combining data across studies for, 94–96 in samples, 10, 305 community-based, 106 LGBT population estimates, 54, 56–57 convenience samples, 105–106 longitudinal cohort studies, 7, 117–118, disproportionate stratification, 98–99 131, 295, 302 Internet/online surveys, 114–115 opportunities for improving, 131–132 nonprobability-based methods, 3, population sampling, 3, 93–96 105–109, 110–111b, 130–131 qualitative methods, 120–122 potential errors in surveys, 111–112 randomized controlled trials, 115–117, probability-based methods, 3, 93–95, 131 97–103, 112, 130 recommendations for, 9–10, 303–304 purposive, 106 studies of LGBT elders, 252 quota, 106–107 See also Sampling, population for randomized controlled trials, 117 Research opportunities, 300–302t recommendations for research design, barriers to care, 75, 235 10, 305

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344 INDEX respondent-driven, 103–104 contextual factors in labeling, 28–29 snowball, 106, 107 conversion therapy, 146 time-location, 104–105 defining elements, 12, 27–28 validity issues, 96 definitional and measurement challenges, Schools 90–92 harassment and victimization of LGBT development in early/middle adulthood, youth in, 158, 171 186–189 intervention with LGBT youth in, 4 development in late adulthood, 253–256 protective factors for LGBT youth in, development in LGBT youth, 142–146, 165–166 170 Self-stigma, 63–64, 190, 191 historical evolution of concepts of, Sex, defined, 25 32–33 Sex differences main categories of, 28 body image problems, 150 origins of, 17 development, 29–30 population studies, 53–57 suicide, 257 recommendations for research, 9–10, transgender population, 57 299–304 Sex reassignment surgery as relational construct, 27 insurance coverage, 67 self-identification patterns, 30–31 outcomes, 201, 232 standardization of measures, 9–10, prescribed “real life experience” before, 303–304 199, 200–201 See also Lesbian, gay, bisexual, and sexual functioning after, 203 transgender (LGBT) populations standards of care, 199–202 Sexual satisfaction, 203, 261 technical and conceptual evolution, Smoking 48–52 among adult lesbians, 205, 215 Sexual behavior among LGBT elders, 270–271, 282 among homeless, 162–163 among LGBT youth, 4, 160, 171 among LGBT youth, 153–154, 162–163 risk in early/middle adulthood, 5, condom and contraceptive use, 209, 215–216 261, 282 Social ecology perspective, 7, 172, 210, 283 criminalization of, 33–35 conceptual basis, 2, 22, 23, 296 definitional challenges in LGBT research, rationale for LGBT research with, 22, 90 194–195, 296 differences between sexes, 29–30 recommendations for research, 6f, 294f early experiences, 29, 187, 188 Social support early scientific research, 36–37 in health outcomes for LGBT elders, evolution of normative concepts of, 277–280 32–33 for LGBT parents, 231 HIV prevention, 71, 210 organization and community HIV risk, 208–210 memberships for, 280 in late adulthood, 260, 261–262 protective factors for LGBT adults, population studies, 53–57 220–221, 272–273 racial/ethnic differences, 30 recommendations for research, 6f, 8, Sexual dysfunction, 202–203, 260 294f, 297 Sexual fluidity, 29–30, 106 Sociocultural context Sexually transmitted infections, 155–156, age cohort differences in life experiences, 210–211. See also HIV/AIDS 15 Sexual orientation country of origin attitudes as health attempts to change, 36 outcome factor, 228

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345 INDEX evolution of social attitudes about sexual HIV/AIDS epidemic and, 39–40, 67–69 orientation, 33–36 internalized stigma, 63–64, 190, 191 formation of LGBT community, 35, 36, legal protections for sexual minorities 37–38 from, 42–44 gender identity and expression, 25, 26 in legal system, 33–34, 35 sexual orientation labels, 28–29 life experiences of older LGBT cohort, Sociodemographic factors in health 251 outcomes lifetime exposure to, 269 for LGBT adults, 227–228 in military, 34–35 for LGBT elders, 276–277 minority stress model, 20–21, 295 for LGBT youth, 168 as obstacle to health research, 14 research opportunities, 7, 53, 75, 168, psychological stress caused by, 191–192, 172, 173, 234, 235, 296–297 212–213, 268–269 See also Educational attainment; Race/ resistance of LGBT community to, 14, ethnicity; Socioeconomic status 36, 37–38 Socioeconomic status risk in early/middle adulthood, 5, differences in life experience within 212–213, 233 LGBT community, 15–16 risk in late adulthood, 268–270, 282 educational attainment and, 60, 277 school-based harassment of LGBT as health outcome factor, 227–228 youth, 43–44 HIV transmission and, 72 structural stigma, 64–65 intersectional perspective in LGBT suicidal behavior in adulthood and, research, 21 258 in late adulthood, 269 Stoller, Robert, 49 population patterns, 31, 60, 74 Stonewall Rebellion, 37–38, 48 protective factors for LGBT elders, 273 Substance use recommendations for data collection, 9, among LGBT elders, 270–271 299 among LGBT youth, 4, 159–161, 169, Sodomy laws, 34, 39–40, 41 171 in early/middle adulthood, 5, 214–219, Standards of Care for Gender Identity Disorder, 199–201 227, 233 Stigmatization and discrimination family factors, 169 barriers to health care, 61–65 health care provider attitudes toward common experiences of sexual LGBT patients, 224 minorities, 13–14 protective factors for youth, 165–166, concealment of sexual orientation to 169 avoid, 63, 92 research opportunities, 235 in diagnosis of gender identity disorder, See also Alcohol use; Smoking 200 Suicidal ideation and behavior effects on LGBT health, 13–14, 32, 74 age cohort differences, 196, 258 enacted stigma, 62, 191 among LGBT youth, 4, 147–150, 170 evolution of social attitudes and in early/middle adulthood, 5, 190, 191, practices, 2, 32–38 195–198, 232 experiences of racial/ethnic minorities, in general population, 257 269, 270 in late adulthood, 257–258, 282 felt stigma, 63, 191–192 preventive interventions, 150 in health care system, 14, 34, 36–37, racial/ethnic differences, 227 224, 225, 269–270, 274–276 risk factors, 148, 170 historical experience of transgender Syphilis, 210–211 persons, 48

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346 INDEX T parental rights, 48 parenthood among, 230–231, 234 Testosterone. See Hormone therapy to physical health among youth, 157 affirm gender identity population size, 57 Text messaging, 298 protective factors research, 220–222, Transgenderists, 26 233 Transgender population psychiatric classification, 49, 50 acceptance in sexual-minority quality of medical care, 225, 226–227, community, 213 234 aging process for, 273 recommendations for research, 6f, 8, barriers to care for, 225, 274 294f, 298 cancer, 206, 260–261, 264 relationship status, 59 cardiovascular disease, 211, 264–265 research base, 18–19 caregiving needs of older cohort, 267 research opportunities, 157, 173, 202, challenges of coming out later in life, 262 255–256 self-reported health, 259 civil rights movement, 48, 50–52 sexual dysfunction among, 203 coming out and disclosure behaviors, 15, sexual functioning in late adulthood, 32, 188–189, 253, 254–255 261–262 current clinical management approach, sexual orientation, 12, 27 51–52, 200–202 standards of care for gender dysphoria, data sources for research, 27 199–202 definition, 12, 26–27 substance use, 5, 161, 218–219 definitional and measurement challenges suicide, 4, 5, 149–150, 195, 196–198, in research with, 91 258, 259 depression, 257, 259 victimization and violence, 159, 212, development in youth, 145–146, 170, 213, 262 255 young people’s access to care, 166 discrimination and stigmatization, 48 See also Hormone therapy to affirm diversity within, 12, 50, 201–202 gender identity; Lesbian, gay, economic status, 60, 74 bisexual, and transgender (LGBT) educational attainments, 60 populations; Sex reassignment evolution of sex transformation surgery medicine, 48–50 Transsexualism, 50 family relationships, 168, 231, 280 Transsexuals, 26, 27, 48, 49 gender identity development, 189 Transvestites, 26, 48 gender ratio, 57 Two-spirit, 26 geographic distribution, 58 health care provider attitudes toward, 224, 225 U health concerns in later life, 267 Urban Men’s Health Study, 98 HIV risk, 73, 156, 171, 208, 209, 233, U.S. census data, 94, 103, 103b 266 homelessness among, 163, 171 hormone therapy side effects, 211, 233 V legal protections for, 52 marriage rights, 46–47 Victimization and violence mental health status, 151–153, 190, community and legal responses to, 191, 193, 194, 257, 258–259 42–43 nonprobability sample surveys, disclosure behaviors and, 165 110–111b intimate partner, 214

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347 INDEX research opportunities, 9, 173, 235, 284, gender identity disorder, diagnostic 299 criteria for, 50, 151, 152b risks for LGBT adults, 211, 212, gender identity disorder, treatment for, 213–214, 233 151–153 risks for LGBT elders, 261–262, 268, gender-variant, 145–146 269, 270, 271, 282 health care access and utilization, 62, risks for LGBT youth, 4, 43–44, 149, 166, 172 157–159, 165, 170, 171 historical changes in social experiences risks for transgender persons, 213, 233 of, 141 suicide risk and, 148–149, 165, 170 HIV infection patterns, 154–157, 171 See also Hate crimes homelessness among, 4, 161–163, 171 Virginia Transgender Health Initiative intervention research, 4, 172 Survey, 108–109, 110–111b, 121 mental health status, 146–147, 170 mood and anxiety disorders, 147 obesity, 154 W population prevalence, 145 protective factors, 164–166 White, Ryan, 68 quality of health care, 167 Workplace environment, 220, 254 racial/ethnic differences, 144 World Professional Association for reproductive health, 153–154, 170 Transgender Health, 50, 52 research opportunities, 4, 172–173 school problems, 158–159, 171 sex differences in sexual development, Y 29 sexual behavior, 153–154, 155 Youth, LGBT sexual orientation and gender identity, body image, 150 development of, 142–146, 170, 187, childhood abuse, 163–164 254–255 coming out and disclosure behaviors, sociodemographic mediators of health, 143, 144, 165, 167, 172, 253 168, 172 current state of clinical knowledge substance use, 4, 159–161, 169, 171 about, 142 suicidal ideation and behavior, 4, custodial care, 169–170 147–150, 169, 170 depression, 147–150 victimization and violence, 4, 43–44, eating disorders, 150–151, 170 149, 157–159, 165, 170 family factors in health outcomes of, 168–169, 172

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