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The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding
Index
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A
Academic performance, risks for LGBT youth, 158–159
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Index
[Page numbers followed by b, f, or t refer to boxed text, figures, or tables, respectively.]
A
Academic performance, risks for LGBT youth, 158–159
Adolescents. See Youth, LGBT
Adoption, 47
Adulthood, early/middle
body image, 198
cancer, 204–206
cardiovascular disease, 207
childhood abuse, 115–116, 219–220, 271
depression in, 190, 193–194
discrimination, 212–213, 233
eating disorders, 198–199, 232
health care access and utilization, 222–225, 234
health care quality, 226–227
HIV/AIDS, 208–210
mental health status, 189–192, 232
mood and anxiety disorders, 190, 192–193
obesity, 207–208
parenthood and family formation in, 228–231, 234, 235
protective factors, 220–222, 233
reproductive health in, 203–204
research opportunities, 234–235
risk factors, 211, 233
sexual functioning in, 202–203
sexual orientation and gender identity, development of, 186–189
sexually transmitted infections, 210–211
sociodemographic factors in health outcomes, 227–228, 234
stigmatization, 212–213, 233
substance use in, 214–219, 233
suicidal ideation and behavior, 190, 191, 195–198, 232
violence risk in, 213–214, 233
See also Elders, LGBT
Adulthood, late. See Elders, LGBT
Age groups
cohort differences, 15
HIV/AIDS distribution, 265
LGBT population patterns, 60–61
See also Adulthood, early/middle;
Elders, LGBT;
Youth, LGBT
Agency for Healthcare Research and Quality, 120
Alcohol use
among LGBT adults, 5, 205, 216–217, 218, 219
among LGBT elders, 270–271, 282
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among LGBT youth, 160, 171
See also Substance use
American Association for Public Opinion Research, 128
American College of Obstetricians and Gynecologists, 204
American Indians and Alaska Natives, 72
American Psychiatric Association, 38, 251
American Psychological Association, 38, 39–40
American Public Health Association, 39–40
American Society for Reproductive Medicine, 204
Anal cancer, 205–206, 232, 263
Anxiety. See Mood and anxiety disorders
Asians/Pacific Islanders, 30–31, 194, 226, 228
Association of American Medical Colleges, 65–66
B
Barriers to care
deficiencies in provider knowledge and training as, 65–66
geographical location as factor in, 16
health insurance coverage, 66–67, 274
for HIV/AIDS, 69
for LGBT adults, 224, 234
for LGBT youth, 62, 274
personal-level, 62
provider bias, 63–64, 274–275
recommendations for research, 8, 295
reluctance to disclose sexual orientation or gender identity as, 14, 62, 63, 224–225, 269–270, 274
research opportunities, 75, 235
stigma-related, 61–65
structural, 61, 64–65
for transgender persons, 225, 274
types of, 2, 75, 224
Benjamin, Harry, 49, 50
Bigender persons, 26
Bisexual individuals
acceptance in sexual-minority community, 213
coming out and disclosure behaviors, 31, 213, 253, 254
depression, 194, 256, 257
eating disorders, 150–151
economic status, 60, 74
family acceptance, 253
hate crime, 214
health service utilization, 222–223
organized community of, 41
partner and family relationships research, 228
prevalence estimates, 54–56
protective factors for youth, 164
racial/ethnic differences, 31
self-reported health status, 259
stigmatization and discrimination, 212–213
substance use, 218
suicidal ideation and behavior, 195, 258
variability in sexual identity, 28, 212–213
See also Bisexual men;
Bisexual women;
Lesbian, gay, bisexual, and transgender (LGBT) populations
Bisexual men
depression, 194
early experience of sexuality, 29
health services utilization, 5, 160, 191, 274
HIV risk and outcomes, 2–3, 155, 208–209
mental health status, 190, 191, 192, 193, 194, 221
parenthood among, 47
prevalence estimates, 56
relationship patterns among elders, 277
sexual behavior in youth, 153, 155
substance use, 5, 160, 161, 215, 216, 217, 218
suicidal ideation and behavior, 195, 258
See also Bisexual individuals;
Lesbian, gay, bisexual, and transgender (LGBT) populations
Bisexual women
cancer risks, 5, 232, 263, 282
coming out and disclosure behaviors, 187–188
contraceptive use, 261
depression, 194
early experiences of sexuality, 29
eating disorders, 150–151, 198–199
health services utilization, 5, 190–191, 223, 234, 260, 274, 282
heart disease risk, 207, 235
history of childhood abuse among, 219
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HIV risk and outcomes, 41, 70, 155–156, 233
mental health status, 190–191, 192, 193, 194, 204, 221
obesity risk, 5, 205, 207–208, 233
parenthood among, 47, 187–188, 204
prevalence estimates, 56
racial/ethnic differences, 227
relationship patterns among elders, 277
reproductive health in late adulthood, 261
sexual behavior and pregnancy in youth, 153–154
sexually transmitted infection, 211
substance use, 5, 160–161, 205, 215–216, 217–218, 219, 271
suicidal ideation and behavior, 190–191, 195, 197, 258
victimization risk, 171
See also Bisexual individuals;
Lesbian, gay, bisexual, and transgender (LGBT) populations
Black men and women. See Race/ethnicity
Body image, 150, 198, 208
Breast cancer, 5, 205, 206, 232, 263, 282
Breast/chest surgery, 199, 206
C
California Health Interview Survey, 99–101, 102b
California Quality of Life Survey, 101
Cancer risk
data sources, 204–205
in early/middle adulthood, 205–206, 232–233
in late adulthood, 262–264
research opportunities, 235
See also specific cancer types
Cardiovascular disease, 207, 211, 235, 264–265, 282
Caregiving issues, 267, 275, 277–280
Cauldwell, David Oliver, 49
Cervical cancer, 264, 274
Childhood abuse
associated health problems in adulthood, 115–116, 219–220
prevalence, 115, 163–164, 171, 219–220, 262, 271–272
racial/ethnic patterns, 220
Children, nonheterosexual and transgender. See Youth, LGBT
Children of sexual minority parents
as caretakers for parents, 278
developmental outcomes, 5, 229–230, 234
prevalence, 47, 59
See also Parents, LGBT
Chlamydia, 210
Coming out and disclosure behaviors
in adolescence, 143, 144, 167, 168, 172
age cohort differences, 15, 188, 253
demographic variation, 74
in early/middle adulthood, 186–189
experiences of older LGBT cohort, 253–255
family responses, 168, 169, 172, 231, 253
in health care system, 167, 172, 224, 269–270, 274
individual differences, 186
in late adulthood, 255–256, 269–270
mental health linkage, 186
motherhood and, 187–188
as protective factor for youth, 164–165
racial/ethnic patterns in, 31–32, 168, 253
research opportunities, 188
responses to HIV/AIDS epidemic, 40–41
stage models, 189
transgender individuals, 32, 188–189, 253, 254–255
in workplace, 220, 254
See also Concealment of sexual orientation
Communications technology, 298
Community Intervention Trial for Youth, 105
Compton’s Cafeteria riot, 51
Concealment of sexual orientation
to avoid discrimination in health care system, 63, 64, 224–225, 269, 274
by bisexual people, 213
challenges to LGBT research, 89, 92–93
in minority stress model, 20
See also Coming out and disclosure behaviors
Conceptual framework for research, 2, 6, 19–23, 121, 293, 294.
See also Cross-cutting perspectives
Condom use, 209
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Contraceptive use, 261, 282
Convenience samples, 105
Conversion therapy, 146
Crisis competence, 5, 272, 282
Cross-cutting perspectives, 6, 7, 293, 294–296
D
Data collection
challenges in LGBT research, 3, 53, 74, 89, 94
cognitive interviews, 122
concealment of sexual orientation as obstacle to, 92–93, 130
definitional and measurement challenges, 90–91
hate crimes, 42, 43
Internet/online surveys, 114–115
one-on-one interviews, 121
potential errors, 111–114, 112t, 131
qualitative methods, 120–122, 131
quantitative methods, 109, 131
recommendations for, 7, 9, 296–297, 299–302
response to AIDS epidemic, 69
on sexual orientation and gender identity, 9, 94, 118–120, 122–123
sources for transgender population, 18–19, 27
sources of data on LGBT health, 2, 18–19, 122–123, 124–126t, 127f
standardization of sexual orientation and gender identity measures, 9–10, 91–92, 130, 303–304
survey methods, 109–114, 122, 131
See also Sampling, population
Daughters of Bilitis, 36
Defense of Marriage Act, 44, 45
Demographic research, 7, 296–297
recommendations for, 6f, 294f
Demographics of LGBT population
geographic distribution, 57–58, 74
household composition, 58–59, 75, 94
population prevalence, 53–57, 55t, 60–61, 145, 235
See also Age groups;
Educational attainment;
Race/ethnicity;
Sociodemographic factors in health outcomes;
Socioeconomic status
Department of Health and Human Services, recommendations for, 9, 299–303
Depression
among LGBT youth, 147, 150
in early/middle adulthood, 190, 193–194, 232
in late adulthood, 256–257, 282
Diagnostic and Statistical Manual of Mental Disorders, 2, 26, 35–36, 37, 50, 251
Diffusion of Effective Behavioral Interventions, 116
Disability, 266–267, 282
Drag kings and queens, 26
E
Eating disorders
among LGBT youth, 150–151, 170
in early/middle adulthood, 198–199, 232
history of childhood abuse and, 219–220
Educational attainment
differences in life experience within LGBT community, 15–16
early sexual experiences and, 187
income and, 60, 277
of nonheterosexual people, 277
protective factors for LGBT elders, 273, 282
Education and training of health professionals
barriers to care for LGBT population, 2, 65–66, 75, 167, 224
cultural competency, 65
recommendations for research training, 10, 304–305
Eisenhower administration, 35
Elders, LGBT
cancer, 262–264
cardiovascular disease, 264–265
caregiving issues, 5, 267, 275
childhood abuse experiences of, 271–272
crisis competence, 5, 272, 282
current research base and data sources, 252
depression, 256–257
disability among, 266–267
discrimination, 274–276
end-of-life issues, 280–281
family role in lives of, 277–280, 283
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friendship networks, 279
health care access and utilization, 273–274, 282–283
HIV/AIDS and, 5, 265–266
living arrangements, 277–278
long-term care, 275, 283, 284
mental health status, 256, 282
mood and anxiety disorders among, 256
obesity, 265
physical health status, 5, 259–260, 282
protective factors, 5, 257, 268, 272–273, 282
quality of care expectations, 274–275
reproductive health of, 260–262
research opportunities, 283–284
risk factors, 5, 268, 282
sexual functioning among, 260
sexual orientation and gender identity, development of, 253–256
social context of health outcomes for, 277–280, 283
sociodemographic factors in health outcomes, 276–277, 283
stigmatization, 5, 251, 268–270
substance use among, 270–271, 282
suicidal ideation and behavior, 257–258, 282
victimization and violence, 261–262, 268, 269, 270, 271, 282
Electronic health records, recommendations for data collection in, 9, 302–303
Ellis, Havelock, 48
Employment
health insurance coverage, 66
historical discrimination against LGBT people, 35–36
HIV risk and, 72
workplace disclosure of sexual orientation, 31, 254
workplace environment, 220
End-of-life issues, 280–281
Erectile dysfunction, 202–203, 232, 260
Estrogen. See Hormone therapy to affirm gender identity
F
Families
acceptance and rejection of LGBT member by, 168, 169, 172, 231, 253
of choice, 278, 279, 283
elder care by, 277–278
household composition patterns, 58–59
intervention with LGBT youth in, 4
research opportunities, 173
role of, in health outcomes for LGBT adults, 231
role of, in health outcomes for LGBT elders, 277–279, 280
role of, in health outcomes for LGBT youth, 168–169, 172
suicide risk among LGBT youth and, 149
support for LGBT parents from, 231
violence against LGBT youth in, 159
See also Parents, LGBT
Family and Medical Leave Act, 46
Federal Bureau of Investigation, 42, 43
Focus groups, 121–122
Foster-parenting, 47, 169–170
Freud, Sigmund, 33, 34
Friendships, 279
G
Gay men
age at sexual identity awareness, 143
age patterns, 60
anal cancer risk, 205–206, 232
body image dissatisfaction, 198
coming out and disclosure behaviors, 31, 187, 253, 254
depression risk, 193–194, 256–257, 282
early sexual experiences, 188
eating disorder risk, 198
economic status, 60, 74
educational attainments, 60
erectile dysfunction in, 202–203, 260
fatherhood among, 47, 59, 228–229, 234
geographic distribution, 58
hate crime risk, 214
history of childhood abuse among, 219
mood and anxiety disorder risk, 192, 193
population prevalence, 55, 56
prostate cancer risk, 262–263
protective factors, 164–165, 220–221
racial/ethnic differences, 31, 187, 194
relationship status, 58–59
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self-reported health, 259
sexual behavior in youth, 153, 154
sexual identity development, 142–144
social support, 220–221, 272–273
socioeconomic status, 227–228
substance use, 215–216, 217, 218, 271
suicide, 195, 258
See also HIV/AIDS;
Lesbian, gay, bisexual, and transgender (LGBT) populations
Gender, defined, 25
Gender dysphoria
definition, 26, 50
development in youth, 145
research opportunities, 202
standards of care, 50, 199–202
Gender expression
definition, 26
development in youth, 145
Gender identity
age at awareness, 143
definition, 25–26
definitional and measurement challenges, 90–92
development in early/middle adulthood, 186–189
development in late adulthood, 253–256
development in LGBT youth, 142–146, 170, 255
ethnic identity and, 144
origins of clinical conceptualization, 49
recommendations for research, 9–10, 299–304
standardization of measures, 9–10, 303–304
theoretical models of development, 143
transgender, 189
Gender identity disorder
clinical conceptualization, 26, 50
diagnostic criteria for children, 50, 151, 152b
standards of care, 199–200
treatment of youth, 151–153
Gender queer, 26, 202
Gender role conformity, 26
General Social Survey, 56
Geographic location
distribution of LGBT population, 57–58, 74
as health outcome factor, 16, 227
See also Rural–urban differences
Gonorrhea, 210–211
Grandparents, LGBT, 278
Growing Up Today Study, 118, 118b
H
Harry Benjamin International Gender Dysphoria Association, 50
Hate crimes
community resistance to, 42
criminalization of, 42–43
data collection, 42, 43
HIV/AIDS epidemic and, 68
prevalence, 43, 68, 214
psychological stress effects of, 213–214
Hate Crimes Sentencing Enhancement Act, 42–43
Hate Crimes Statistics Act, 42
Health, defined, 13 n.1
Health care system
access and utilization patterns of LGBT adults, 62, 222–223, 234, 273–274, 282–283
access of LGBT youth, 166, 172
attempts to change sexual orientation, 36
destigmatization of homosexuality in, 36–37, 38
disclosure behaviors of LGBT adults in, 63, 224–225, 269–270, 274
disclosure behaviors of LGBT youth in, 166, 167, 172
evolution of sex transformation medicine, 48–50, 51–52
quality of care for LGBT youth, 167, 172
response to HIV/AIDS epidemic, 40, 69–74
in rural areas, 276–277
stigmatization and discrimination in, 32, 34, 36, 63–64, 167, 224, 269–270, 274–276
See also Barriers to care;
Education and training of health professionals
Health insurance, 66–67, 227, 234, 274
Health of LGBT population
best practices for research on, 4, 119, 123–129
community health infrastructure, 14
conceptual framework for research on, 2, 4, 19–23, 294–296
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contextual factors, 2–3, 25
current knowledge base, 1, 4, 8, 11, 234–235
data sources, 2, 18–19, 122–123, 124–126t, 127f
marriage and, 45–46, 221
recommendations for research, 6–8, 10, 293–304
research challenges, 89, 130
research opportunities, 4, 75, 235
self-reported, 259
stigmatization and victimization effects, 2, 13–14, 32, 74, 268–270
See also Adulthood, early/middle;
Barriers to care;
Elders, LGBT;
Mental health;
Youth, LGBT
Healthy People 2020, 22
Hirschfeld, Magnus, 48–49
HIV/AIDS
age distribution, 265
among LGBT youth, 154–157, 171
among transgender persons, 208, 209, 224, 233
bereavement outcomes in LGBT community, 279, 280
cardiovascular disease and, 207
education and training of health care providers, 224
erectile dysfunction and, 202
government programs and policies, 68–69
human papillomavirus infection in, 206, 263
incidence, 71, 73f
mortality, 71
in older adults, 5, 265–266, 282
outcomes in LGBT community, 38–41
preventive interventions, 71, 210
public awareness and understanding, 40–41, 67–68
racial/ethnic patterns, 4, 5, 71–74, 73f, 155, 171, 208, 233
Reagan administration, 69
research, 69, 70–71, 72f
response of LGBT community, 69–70
risk for bisexual men, 208–209
risk in early/middle adulthood, 5, 208–210
significance of epidemic for LGBT community, 2–3, 41
social risk factors, 72
stigmatization and discriminatory responses, 39–40, 67–69
vulnerable groups, 4
Homelessness, 4, 161–163, 171
Hooker, Evelyn, 37
Hormone replacement therapy, 261, 282
Hormone therapy to affirm gender identity
age at initiation, 255
assessment and treatment planning, 199
cancer risk in, 206, 211, 233
cardiovascular disease and, 207, 211
current clinical approach, 52, 200–202
health outcomes, 157, 211, 233
historical origins, 49
illicit, 200
reproductive health and, 204
research opportunities, 204, 284
risks for transgender elders, 5, 264–265, 282
sexual functioning and, 203
standards of care, 199, 200
in youth, 153, 157, 171
Hospital care, 119
Human papillomavirus, 206, 263
Hysterectomy, 261, 282
I
Inequities in health care
geographical factors, 16, 227
racial/ethnic patterns of HIV infection, 4, 5, 71–74, 155, 171, 208, 233
recommendations for research, 6f, 8, 294f, 297
See also Barriers to care;
Quality of care for LGBT people
Insurance. See Health insurance
Internet/online surveys, 114–115
Internet use to obtain sexual partners, 208
Interpersonal violence, 214
Intersectional perspective, 7
conceptual basis, 2, 21–22, 295–296
rationale for LGBT research with, 21, 22, 23, 294, 295–296
recommendations for research, 6f, 294f
Intersexuality, 16–17
Intervention research, 6f, 8, 294f, 297–298
Inversion, sexual, 33
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J
Johns Hopkins University, 49–50
Joint Commission on Accreditation of Healthcare Organizations, 119
Jorgensen, Christine/George, 49
K
Kalman filter, 95–96
Kinsey, Alfred, 36–37, 53
L
Latino/latina population. See Race/ethnicity
Lawrence v. Texas, 41
Legal environment
criminalization of homosexual conduct, 33–36
current state of, for sexual minorities, 42
effects of HIV/AIDS epidemic, 39–40
end-of-life issues, 281
implications for health, 2, 33
LGBT civil rights movement, 37–38
marriage rights, 44–47
protections for LGBT populations, 41–44
psychological well-being and, 220
rights of LGBT parents, 47–48, 229
transgender history, 48, 50–51, 52
Lesbian, gay, bisexual, and transgender (LGBT) populations
age distribution, 60–61
challenges to conducting research in, 3, 52–53
commonalities among, 13–14
definitional and measurement issues, 90–92
development and empowerment of community, 14, 35, 36, 37–38, 42, 69–70
diversity within, 1, 11–13, 15–16
in early/middle adulthood. See Adulthood, early/middle
economic status, 60, 74
geographic distribution, 57–58, 74
hate crime prevalence against, 214
history of childhood abuse, 219–220
household composition, 58–59
in later adulthood. See Elders, LGBT
legal protections for, 41–44
older adults. See Elders, LGBT
prevalence estimates, 53–57, 55t
response to HIV/AIDS epidemic, 69–70
sampling methodology for research on, 3, 93–96
self-identification patterns, 30–31
sexual orientation disclosure behaviors, 31–32
strengths and resiliency, 14
subpopulations, 1
youth population. See Youth, LGBT
See also Health of LGBT population
Lesbians
age patterns, 60–61
body image among, 150, 208
breast cancer, 5, 205, 232, 263, 264, 282
cardiovascular disease, 207, 235, 264, 282
coming out and disclosure behaviors, 31, 187–188, 253, 254
depression, 193–194, 256–257, 282
eating disorders, 198
economic status, 60, 74, 269
educational attainments, 60
geographic distribution, 58, 227
hate crime, 214
health service utilization, 5, 222–224, 234, 274
history of child abuse among, 219
HIV risk, 155–156
mental health status, 190, 192, 193–194
obesity, 5, 207–208, 227, 233, 265
parenthood, 5, 47, 59, 187–188, 204, 205, 228–230, 231, 234, 261
population prevalence, 55, 56
protective factors for psychological well-being, 221
relationship status, 58–59
reproductive health, 153–154, 204, 261, 263–264
school problems, 158–159
self-reported health, 259
sexual behavior, 153–154, 261
sexual identity development, 142–144, 187
sexually transmitted infection, 211
sexual satisfaction in adulthood, 203
sociodemographic factors in health outcomes, 227
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substance use, 160–161, 205, 215–218, 227, 271
suicide risk, 195, 227, 258
teen pregnancy, 153–154, 170
See also Lesbian, gay, bisexual, and transgender (LGBT) populations
LGBT. See Lesbian, gay, bisexual, and transgender populations
Life-course framework
conceptual basis, 2, 19–20, 22, 295
key dimensions of, 20
life stages in, 4
rationale for LGBT research with, 20, 295
recommendations for research, 6f, 7, 294f, 295, 300–302t
See also Adulthood, early/middle;
Elders, LGBT;
Youth, LGBT
Longitudinal cohort studies, 7, 117–118, 131, 295, 302
Long-term care, 275, 283, 284
M
Mammograms, 222, 223–224
Marijuana use, 216
Marriage
custody and visitation rights of LGBT parents, 47, 48
end-of-life issues, 281
as health outcome factor, 45–46, 221
rights of LGBT citizens, 44–47
Massachusetts Behavioral Risk Factor Surveillance System, 99, 102b
Mattachine Society, 36, 37
Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act, 43
Mental health
among LGBT youth, 146–147, 151–153, 170
coming out experience and, 186
in early/middle adulthood, 5, 189–192, 199–202, 232
effects of discrimination and victimization, 191–192, 212–213, 268–269
in late adulthood, 256, 282
racial/ethnic differences, 194, 227
research opportunities, 191, 235
utilization of care services, 222–223
See also Depression;
Gender dysphoria;
Gender identity disorder;
Mood and anxiety disorders;
Suicidal ideation and behavior
Methamphetamine, 161
Military, U.S., 34–35, 36
Minority stress model
conceptual basis, 20–21, 22–23, 221–222, 295
definition, 2
rationale for LGBT research with, 294–295
recommendations for research, 6f, 7, 294f, 295
Money, John, 49
Mood and anxiety disorders
among LGBT youth, 147
in early/middle adulthood, 190, 192–193, 232
in late adulthood, 256
N
National Gay and Lesbian Task Force, 52
National Health and Nutrition Examination Survey, 123
National Health and Social Life Survey, 54, 99, 100–101b
National Household Survey on Drug Abuse, 123
National Institute of Mental Health, 37
National Institutes of Health, 1, 16, 71
recommendations for, 6–8, 9–10, 293–294, 303–305
National Lesbian Health Care Survey, 107–108
National Survey of Family Growth, 56, 100b
National Survey of Sexual Health and Behavior, 56, 99
National Transgender Discrimination Survey, 108, 110b
National Transsexual Counseling Unit, 51
Native Americans, 26, 196
Nurses’ Health Study, 117–118, 118b
Nurses’ Health Study II, 118b
Nursing homes, 275
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O
Obama memorandum on hospital visitation, 46
Obesity
among LGBT youth, 154
history of childhood abuse and, 219
research opportunities, 173, 235
risk for lesbian and bisexual women, 5, 205, 207–208, 227, 233, 265
Office of the National Coordinator for Health Information Technology, 9, 302–303
Ovarian cancer, 206, 211, 261
P
Panic attacks, 192, 193
Pap tests, 222, 223–224
Parents, LGBT
coming out behaviors, 187–188
developmental outcomes of children of, 5
health risks of childlessness, 229
legal rights, 47, 229
parenting abilities and competencies of, 229–230
pathways to parenthood, 47, 229
prevalence, 47, 59, 74, 228–229, 261
research opportunities, 203–204, 231, 234, 235
support from families for, 231
Policy
response to HIV/AIDS epidemic, 68–69, 70, 71
See also Recommendations
Pregnancy, 153–154, 170
Preventive interventions
health service utilization, 5, 223, 234
HIV, 156–157, 210
suicide, 150
youth-specific, 156–157
Prisons system medical care, 226
Probability/nonprobability sampling, 3, 93–95, 97–103, 105–109, 130–131
Prostate cancer, 206, 262
Protective factors
crisis competence, 5, 272, 282
disclosure of sexual identity as, 164–165
in early/middle adulthood, 220–222, 233
in late adulthood, 268, 272–273, 282
for LGBT youth, 164–166, 171–172
marriage, 221
resiliency, 221–222, 257, 268, 272
in school environment, 165–166, 171–172
supportive social environment, 164, 171–172, 220–221, 272–273
Psychoanalytic theory, 33, 34
Q
Qualitative research, 120–122, 131
Quality of care for LGBT people
expectations of elders, 274–276, 283
patient satisfaction, 226–227, 234, 235
research opportunities, 235
for youth, 167
Quantitative research, 109, 131
Queer, 15, 26, 29, 202
R
Race/ethnicity
barriers to care based on, 64
childhood sexual abuse patterns, 220
coming out and disclosure behaviors, 31–32, 168, 187, 253
cultural norms of country of origin as health factor, 228
differences in life experience within LGBT community, 15
differences in sexual expression and experience, 30
discrimination experience and, 269, 270
early sexual experience, 187
health outcomes and, 227
HIV risk, 4, 5, 71–74, 73f, 155, 171, 208, 233
household composition patterns, 59
identity development, 144
intersectional perspective in LGBT research, 21
mental health status, 194, 227
perceived benefits of LGBT identity, 272
perceived racism in LGBT communities, 187
research opportunities, 4
sexual identity development in adolescence, 144, 170
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sexual orientation self-identification, 30–31
suicide risk, 196, 197, 227
Randomized controlled trials, 115–117, 131
Recommendations
data collection, 7, 9, 299–302
for inclusion of sexual minorities in research projects, 10, 305
for methodological research, 9–10, 303–304
for research agenda, 6–8, 293–299, 300–302t
for research training, 10, 304–305
Religious affiliation, 168
Reproductive health
in early/middle adulthood, 203–204
fertility services, 204
health service utilization, 223–224
insurance coverage, 66
in late adulthood, 260–262, 263–264
research opportunities, 204, 235, 284
risks for LGBT youth, 153–154, 170
Research agenda, 6f, 294f
cross-cutting perspectives, 7, 293, 294–296
recommendations for research agenda, 6–8, 293–298
Research methodology, 18–23
best practices, 4, 119, 123–129
challenges in conducting LGBT research, 3, 89, 130
confidentiality practice, 93
definitional and measurement issues, 90–92
importance of, 96
inclusion of sexual and gender minorities in samples, 10, 305
LGBT population estimates, 54, 56–57
longitudinal cohort studies, 7, 117–118, 131, 295, 302
opportunities for improving, 131–132
population sampling, 3, 93–96
qualitative methods, 120–122
randomized controlled trials, 115–117, 131
recommendations for, 9–10, 303–304
studies of LGBT elders, 252
See also Sampling, population
Research opportunities, 300–302t
barriers to care, 75, 235
communications and social networking technologies, 298
data collection, 9, 299–302
health effects of coming out experience, 188
health interventions, 8, 297–298
health status of LGBT population, 4, 17b, 75, 234–235
HIV transmission, 156–157
homelessness risks and outcomes, 163
inequities in health care, 8, 296
LGBT elders, 283–284
LGBT parenting, 231
LGBT youth, 4, 172–173
mental health, 146, 202, 284
reproductive health among LGBT adults, 204
sexual and reproductive health, 284
social context of LGBT health, 8, 296
sociodemographic factors, 7, 53, 75, 168, 172, 173, 234, 235, 283, 296–297
standardization of definitions and measures, 91–92, 131
transgender-specific, 8, 157, 173, 202, 262, 298
Resiliency, 221–222, 257, 268, 272
Rural–urban differences, 16, 168, 227, 276–277
S
Sampling, population
best practices, 128
challenges, 96–97
challenges in LGBT research, 3, 130
combining data across studies for, 94–96
community-based, 106
convenience samples, 105–106
disproportionate stratification, 98–99
Internet/online surveys, 114–115
nonprobability-based methods, 3, 105–109, 110–111b, 130–131
potential errors in surveys, 111–112
probability-based methods, 3, 93–95, 97–103, 112, 130
purposive, 106
quota, 106–107
for randomized controlled trials, 117
recommendations for research design, 10, 305
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respondent-driven, 103–104
snowball, 106, 107
time-location, 104–105
validity issues, 96
Schools
harassment and victimization of LGBT youth in, 158, 171
intervention with LGBT youth in, 4
protective factors for LGBT youth in, 165–166
Self-stigma, 63–64, 190, 191
Sex, defined, 25
Sex differences
body image problems, 150
development, 29–30
suicide, 257
transgender population, 57
Sex reassignment surgery
insurance coverage, 67
outcomes, 201, 232
prescribed “real life experience” before, 199, 200–201
sexual functioning after, 203
standards of care, 199–202
technical and conceptual evolution, 48–52
Sexual behavior
among homeless, 162–163
among LGBT youth, 153–154, 162–163
condom and contraceptive use, 209, 261, 282
criminalization of, 33–35
definitional challenges in LGBT research, 90
differences between sexes, 29–30
early experiences, 29, 187, 188
early scientific research, 36–37
evolution of normative concepts of, 32–33
HIV prevention, 71, 210
HIV risk, 208–210
in late adulthood, 260, 261–262
population studies, 53–57
racial/ethnic differences, 30
Sexual dysfunction, 202–203, 260
Sexual fluidity, 29–30, 106
Sexually transmitted infections, 155–156, 210–211.
See also HIV/AIDS
Sexual orientation
attempts to change, 36
contextual factors in labeling, 28–29
conversion therapy, 146
defining elements, 12, 27–28
definitional and measurement challenges, 90–92
development in early/middle adulthood, 186–189
development in late adulthood, 253–256
development in LGBT youth, 142–146, 170
historical evolution of concepts of, 32–33
main categories of, 28
origins of, 17
population studies, 53–57
recommendations for research, 9–10, 299–304
as relational construct, 27
self-identification patterns, 30–31
standardization of measures, 9–10, 303–304
See also Lesbian, gay, bisexual, and transgender (LGBT) populations
Sexual satisfaction, 203, 261
Smoking
among adult lesbians, 205, 215
among LGBT elders, 270–271, 282
among LGBT youth, 4, 160, 171
risk in early/middle adulthood, 5, 215–216
Social ecology perspective, 7, 172, 210, 283
conceptual basis, 2, 22, 23, 296
rationale for LGBT research with, 22, 194–195, 296
recommendations for research, 6f, 294f
Social support
in health outcomes for LGBT elders, 277–280
for LGBT parents, 231
organization and community memberships for, 280
protective factors for LGBT adults, 220–221, 272–273
recommendations for research, 6f, 8, 294f, 297
Sociocultural context
age cohort differences in life experiences, 15
country of origin attitudes as health outcome factor, 228
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evolution of social attitudes about sexual orientation, 33–36
formation of LGBT community, 35, 36, 37–38
gender identity and expression, 25, 26
sexual orientation labels, 28–29
Sociodemographic factors in health outcomes
for LGBT adults, 227–228
for LGBT elders, 276–277
for LGBT youth, 168
research opportunities, 7, 53, 75, 168, 172, 173, 234, 235, 296–297
See also Educational attainment;
Race/ethnicity;
Socioeconomic status
Socioeconomic status
differences in life experience within LGBT community, 15–16
educational attainment and, 60, 277
as health outcome factor, 227–228
HIV transmission and, 72
intersectional perspective in LGBT research, 21
in late adulthood, 269
population patterns, 31, 60, 74
protective factors for LGBT elders, 273
recommendations for data collection, 9, 299
Sodomy laws, 34, 39–40, 41
Standards of Care for Gender Identity Disorder, 199–201
Stigmatization and discrimination
barriers to health care, 61–65
common experiences of sexual minorities, 13–14
concealment of sexual orientation to avoid, 63, 92
in diagnosis of gender identity disorder, 200
effects on LGBT health, 13–14, 32, 74
enacted stigma, 62, 191
evolution of social attitudes and practices, 2, 32–38
experiences of racial/ethnic minorities, 269, 270
felt stigma, 63, 191–192
in health care system, 14, 34, 36–37, 224, 225, 269–270, 274–276
historical experience of transgender persons, 48
HIV/AIDS epidemic and, 39–40, 67–69
internalized stigma, 63–64, 190, 191
legal protections for sexual minorities from, 42–44
in legal system, 33–34, 35
life experiences of older LGBT cohort, 251
lifetime exposure to, 269
in military, 34–35
minority stress model, 20–21, 295
as obstacle to health research, 14
psychological stress caused by, 191–192, 212–213, 268–269
resistance of LGBT community to, 14, 36, 37–38
risk in early/middle adulthood, 5, 212–213, 233
risk in late adulthood, 268–270, 282
school-based harassment of LGBT youth, 43–44
structural stigma, 64–65
suicidal behavior in adulthood and, 258
Stoller, Robert, 49
Stonewall Rebellion, 37–38, 48
Substance use
among LGBT elders, 270–271
among LGBT youth, 4, 159–161, 169, 171
in early/middle adulthood, 5, 214–219, 227, 233
family factors, 169
health care provider attitudes toward LGBT patients, 224
protective factors for youth, 165–166, 169
research opportunities, 235
See also Alcohol use;
Smoking
Suicidal ideation and behavior
age cohort differences, 196, 258
among LGBT youth, 4, 147–150, 170
in early/middle adulthood, 5, 190, 191, 195–198, 232
in general population, 257
in late adulthood, 257–258, 282
preventive interventions, 150
racial/ethnic differences, 227
risk factors, 148, 170
Syphilis, 210–211
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T
Testosterone. See Hormone therapy to affirm gender identity
Text messaging, 298
Transgenderists, 26
Transgender population
acceptance in sexual-minority community, 213
aging process for, 273
barriers to care for, 225, 274
cancer, 206, 260–261, 264
cardiovascular disease, 211, 264–265
caregiving needs of older cohort, 267
challenges of coming out later in life, 255–256
civil rights movement, 48, 50–52
coming out and disclosure behaviors, 15, 32, 188–189, 253, 254–255
current clinical management approach, 51–52, 200–202
data sources for research, 27
definition, 12, 26–27
definitional and measurement challenges in research with, 91
depression, 257, 259
development in youth, 145–146, 170, 255
discrimination and stigmatization, 48
diversity within, 12, 50, 201–202
economic status, 60, 74
educational attainments, 60
evolution of sex transformation medicine, 48–50
family relationships, 168, 231, 280
gender identity development, 189
gender ratio, 57
geographic distribution, 58
health care provider attitudes toward, 224, 225
health concerns in later life, 267
HIV risk, 73, 156, 171, 208, 209, 233, 266
homelessness among, 163, 171
hormone therapy side effects, 211, 233
legal protections for, 52
marriage rights, 46–47
mental health status, 151–153, 190, 191, 193, 194, 257, 258–259
nonprobability sample surveys, 110–111b
parental rights, 48
parenthood among, 230–231, 234
physical health among youth, 157
population size, 57
protective factors research, 220–222, 233
psychiatric classification, 49, 50
quality of medical care, 225, 226–227, 234
recommendations for research, 6f, 8, 294f, 298
relationship status, 59
research base, 18–19
research opportunities, 157, 173, 202, 262
self-reported health, 259
sexual dysfunction among, 203
sexual functioning in late adulthood, 261–262
sexual orientation, 12, 27
standards of care for gender dysphoria, 199–202
substance use, 5, 161, 218–219
suicide, 4, 5, 149–150, 195, 196–198, 258, 259
victimization and violence, 159, 212, 213, 262
young people’s access to care, 166
See also Hormone therapy to affirm gender identity;
Lesbian, gay, bisexual, and transgender (LGBT) populations;
Sex reassignment surgery
Transsexualism, 50
Transsexuals, 26, 27, 48, 49
Transvestites, 26, 48
Two-spirit, 26
U
Urban Men’s Health Study, 98
U.S. census data, 94, 103, 103b
V
Victimization and violence
community and legal responses to, 42–43
disclosure behaviors and, 165
intimate partner, 214
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research opportunities, 9, 173, 235, 284, 299
risks for LGBT adults, 211, 212, 213–214, 233
risks for LGBT elders, 261–262, 268, 269, 270, 271, 282
risks for LGBT youth, 4, 43–44, 149, 157–159, 165, 170, 171
risks for transgender persons, 213, 233
suicide risk and, 148–149, 165, 170
See also Hate crimes
Virginia Transgender Health Initiative Survey, 108–109, 110–111b, 121
W
White, Ryan, 68
Workplace environment, 220, 254
World Professional Association for Transgender Health, 50, 52
Y
Youth, LGBT
body image, 150
childhood abuse, 163–164
coming out and disclosure behaviors, 143, 144, 165, 167, 172, 253
current state of clinical knowledge about, 142
custodial care, 169–170
depression, 147–150
eating disorders, 150–151, 170
family factors in health outcomes of, 168–169, 172
gender identity disorder, diagnostic criteria for, 50, 151, 152b
gender identity disorder, treatment for, 151–153
gender-variant, 145–146
health care access and utilization, 62, 166, 172
historical changes in social experiences of, 141
HIV infection patterns, 154–157, 171
homelessness among, 4, 161–163, 171
intervention research, 4, 172
mental health status, 146–147, 170
mood and anxiety disorders, 147
obesity, 154
population prevalence, 145
protective factors, 164–166
quality of health care, 167
racial/ethnic differences, 144
reproductive health, 153–154, 170
research opportunities, 4, 172–173
school problems, 158–159, 171
sex differences in sexual development, 29
sexual behavior, 153–154, 155
sexual orientation and gender identity, development of, 142–146, 170, 187, 254–255
sociodemographic mediators of health, 168, 172
substance use, 4, 159–161, 169, 171
suicidal ideation and behavior, 4, 147–150, 169, 170
victimization and violence, 4, 43–44, 149, 157–159, 165, 170
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