Index

A

Access to health care, 6

defined, 37

financial barriers, 5, 10, 37, 41-42, 157

focus of women's health services and, 45-46

literature on, 186-189

personal/cultural barriers, 5, 10-11, 37, 42-46, 157-158

research recommendations, 10-11, 87, 157-158

structural barriers, 10, 37, 40-41, 157

test of equality in, 37, 40

Adolescents. See Children and adolescents

Adoption by same-sex parents, 37, 53

Adult lesbians, developmental issues, 52-54

Affective disorders, 68-69

African Americans

cultural values, 24

depressive distress in, 61

HIV seroprevalence, 76

Lesbian studies, 108-109

Age

and awareness of sexual identity, 50-51

and cancer risk, 56

and coming out, 48-49

and dimensions of same-sex sexuality, 28

and drinking behaviors, 80

Aging, 5, 173-174

Alcohol use, 56, 58, 64, 65, 68, 79-81, 102-103, 120

American Academy of Pediatrics, 44 n.4

American Community Survey, 160

American Medical Association, 44 n.4

American Psychiatric Association, 36, 44 n.4

American Psychological Association, 44 n.4

Division 44, 137

American Sociological Association, 138

Antigay hate crimes, 36, 38, 42

Anxiety disorders, 68, 81

Artificial insemination, 54, 76

Asian American lesbians and gay men, 24



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--> Index A Access to health care, 6 defined, 37 financial barriers, 5, 10, 37, 41-42, 157 focus of women's health services and, 45-46 literature on, 186-189 personal/cultural barriers, 5, 10-11, 37, 42-46, 157-158 research recommendations, 10-11, 87, 157-158 structural barriers, 10, 37, 40-41, 157 test of equality in, 37, 40 Adolescents. See Children and adolescents Adoption by same-sex parents, 37, 53 Adult lesbians, developmental issues, 52-54 Affective disorders, 68-69 African Americans cultural values, 24 depressive distress in, 61 HIV seroprevalence, 76 Lesbian studies, 108-109 Age and awareness of sexual identity, 50-51 and cancer risk, 56 and coming out, 48-49 and dimensions of same-sex sexuality, 28 and drinking behaviors, 80 Aging, 5, 173-174 Alcohol use, 56, 58, 64, 65, 68, 79-81, 102-103, 120 American Academy of Pediatrics, 44 n.4 American Community Survey, 160 American Medical Association, 44 n.4 American Psychiatric Association, 36, 44 n.4 American Psychological Association, 44 n.4 Division 44, 137 American Sociological Association, 138 Antigay hate crimes, 36, 38, 42 Anxiety disorders, 68, 81 Artificial insemination, 54, 76 Asian American lesbians and gay men, 24

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--> B Bacterial vaginosis, 73, 102-103 Bisexual women, 4, 22-23, 27, 31, 32 HIV seroprevalence, 76 illicit drug use, 82, 83 reproductive health studies, 106-107 Body mass index (BMI), 57, 64, 67, 68 Breast cancer, 21, 46, 64, 65, 67, 141, 142 Buddhism, 24, 25 Bureau of Labor Statistics National Longitudinal Surveys, 128 C Cancer, 46, 47, 54. See also specific forms of cancer literature on, 177 prevention studies, 112-113 research recommendations, 86 risk factors, 55, 56, 64-67, 86 Cardiovascular disease, 42, 46, 62, 68, 86, 112-113 Catholicism/Catholics, 25, 28 Centers for Disease Control and Prevention, 1, 14, 18, 140 lesbian research and programs, 142, 162-163 Office of Women's Health, 19 Cervical cancer, 66-67, 70, 73, 142 Chicago Women's Health Study, 102 Childhood sexual abuse, 58-59, 70, 77, 81 Children and adolescents coming-out process, 51-52 development of sexual identity, 50-51 heterosexual activity, 78 literature on, 170-173 raised in lesbian households, 53-54 sexuality studies, 149 suicide, 52, 110-111 Chlamydia, 70, 72-73, 78 Civil rights protection, 39 Clearinghouses on lesbian health, 163 Colon and rectal cancer, 64, 67 Coming out age and, 48-49 coping mechanisms, 51 cultural contexts of, 24, 49-50, 55 to family, 24, 49 fear of, 6, 44-45, 49 to health care providers, 6, 40, 44-45 lesbian academics, 138 process, 48-50, 51-52 Committee on Lesbian Health Research Priorities, 17, 18 Conferences on Health Survey Methods, 162 Confidentiality, 9, 13, 113, 128-129, 150 n.12, 152-153, 161, 162 Confucianism, 24, 25 Contextual barriers to research, 135-136 career ramifications, 8, 136-138 funding to study lesbian health, 8, 9, 97, 137, 139-140, 153 mentors for lesbian researchers, 8, 138-139, 164 publishing and disseminating findings, 14-15, 140-144, 153, 161 strategies for overcoming, 14-15, 144, 163-164 training and education of researchers, 14-15, 163-164, 203-204 Coronary Artery Risk Development in Young Adults, 62 n.10 Cultural competency of health care providers, 5, 41, 42-44, 157 D Death, causes of, 46, 47, 68 Definition of lesbian, 21-23 Committee, 4-5, 17, 25-33

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-->   methodological issues, 3, 6-7, 10, 23, 97-98, 99, 100-101, 102-114, 156-157 racial/ethnic minority perspectives, 3-4, 23-25 Department of Health and Human Services, 149 Secretary's Task Force on Youth Suicide, 52 Depressive illness, 60, 61, 68-69, 80 Developmental challenges of lesbians, 5, 46, 48 adults, 7-8, 42-54 children and adolescents, 7-8, 50-52 coming out, 6, 48-50, 51-52, 157 life span, 5-6, 7-8 research recommendations, 85 Disclosure of sexual orientation. See also Coming out audio computer-assisted self-interview, 8, 115-117 to researchers, 23, 31 n.9, 97, 99 n.1, 114-115, 118-119, 120, 128 -129 Discrimination. See Prejudice and discrimination Domestic partner benefits, 5, 37, 41 Duke University, 141 E East Asian cultural values, 24, 25 Eating disorders, 42 Education, and dimensions of same-sex sexuality, 28 ENCOR Eplus programs, 142 Endometrial cancer, 67 Ethical issues, 150 confidentiality, 9, 113, 152-153 risks to research participants, 9, 151 Ethnographic research, 114 F Family, 24, 49, 63, 182-184 Fear of coming out, 23, 44-45 Federal Bureau of Investigation, 36 Foster parents, same-sex, 37, 53 G Gay and Lesbian Medical Association, 19, 139, 143 n.6 Gay Urban Men Survey, 117, 122-123 Gender roles, 24, 81 General Social Survey, 26 n.4 Genital warts, 78 Geographic distribution of dimensions of same-sex sexuality, 29 of lesbians, 119 Georgetown University, 141 Gonorrhea, 70, 72-73, 78 Gynecological care, 21, 42, 66-67, 112-113 H Health, definition, 17 n.1 Health care providers coming out to, 6, 44-45 cultural competency, 5, 41, 42-44, 157-158, 163-164 dissemination of lesbian health information to, 14-15, 163 homophobic attitudes, 5, 44 recognition of partners, 41 sexual history taking, 43-44, 45 Health insurance coverage, 41-42 Health-seeking behaviors, 43, 112-113 Hepatitis, 78, 82 Herpes, 78

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--> Heterosexual activity, 52, 56, 66, 78 HIV/AIDS, 3, 21, 54, 61, 71, 74, 75-79, 82, 86, 102-107, 148, 189-192 HIV Epidemiology Research Study, 142 Homophobic attitudes, 5, 44, 151, 174-176 Homosexuality, APA classification, 36 Hormone replacement therapy, 68 Human papillomavirus infection, 56, 66, 73, 78 Hypertension, 54, 60, 62, 68 I Identity. See Sexual identity Illicit drug use, 76, 79, 81-84, 104-105, 177-180 Inter-University Consortium for Political and Social Research, 27 n.6 Institutional review boards, 12-13, 153, 161 J Jews, dimensions of same-sex sexuality, 28 L Latino cultural values, 24-25 Legal status of gay men and lesbians, 36-37, 38-39, 41, 152 Lesbian AIDS Project, New York City, 142 Lesbian Health Fund, 139 Literature on lesbian issues, 18, 140 adolescents, 170-173 aging, 173-174 attitudes and homophobia, 174-176 cancer, 177 drug abuse, 177-180 ethnic, racial, and cultural minority groups, 180-182 family, 182-184 general, 165-170 health, 185-186 health care services, 186-189 HIV/AIDS, 189-192 mental health, 192-197 methodology of studies, 198-199 relationships, 199-200 reproductive health, 200-201 sexual behavior, 201 sexually transmitted diseases, 201-202 suicide, 202-203 training and education, 203-204 violence, 204-206 work, 206 Lung cancer, 46, 67 Lyon-Martin Center, San Francisco, 142 M Maine, 37 Managed care, 5, 10, 40-41 Marital status, and dimensions of same-sex sexuality, 28 Marriage, same-sex, 37, 38 Mautner Project, 43 n.3, 142 Measures of sexual orientation, 7, 11-12, 22, 26-27 n.5, 30-32, 97 -98, 99, 101-114, 158-159 Menstrual synchrony in couples, 112-113 Mental health of lesbians, 54, 68-70 research recommendations, 10, 85-86 studies, 102-103, 108-109, 192-197 Methodological issues in research, 136. See also Sampling strategies adding sexual orientation questions to existing studies, 12-13, 119 , 126-129, 159-160 control or comparison groups, 1, 7, 98-99, 139

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-->   cross comparison of findings, 97-98, 101 defining the population, 6-7, 10, 23, 97-98, 99, 100-101, 156-157 disclosure of sexual orientation, 7, 97, 99 n.1, 114-117, 118-119, 122, 128-129 generalizability of conclusions, 7, 23, 33, 55, 70, 98, 118 literature on, 198-199 measures of sexual orientation, 7, 11, 97-98, 99, 101-114, 158-159 research recommendations, 9, 101, 114, 129-130, 156-157, 158-159 sample representativeness, 75, 80, 98, 118, 120 Miami University, 141 Michigan Lesbian Health Survey, 36, 41, 42, 43, 45, 74, 106-107 Midlife issues, 52-53, 63 Minnesota, 52 Morality issue, 150 Motherhood, 53-54, 57 Multicultural Men's Health Study, 123 N National Association of Social Workers, 44 n.4 National Black Lesbian Study, 108-109 National Cancer Institute, 65, 141 National Center for Injury Prevention and Control, 142 National Comorbidity Survey, 68, 69 National Gay and Lesbian Health Association, 43 n.3 National Health and Nutrition Examination Survey, 119, 128, 160 National Health and Social Life Survey (NHSLS), 26 n.4, 27, 30 n.7, 57, 72 n.18, 74, 83, 84, 108-109 National Health Interview Survey, 119, 128 National Household Survey on Drug Abuse, 55, 79, 82, 160 National Human Subjects Protections Education Workshop Program, 162 -163 National Institute of Allergy and Infectious Diseases, 140 National Institute of Child Health and Development, 149 National Institute of Mental Health, 140 National Institute on Drug Abuse, 140 National Institutes of Health, 12-13, 160 conference support, 14, 162-163 Office of Protection from Research Risks, 163 Office of Research on Women's Health, 1, 17-18, 19, 140, 144 Revitalization Act, 149 National Lesbian and Bisexual Women's Health Survey, 78 National Lesbian Health Care Survey (NLHCS), 36, 41-42, 45, 57, 58 , 63, 66, 69, 81-82, 108-109 National Opinion Research Center, 83 n.23, 148-149 National Research Council Committee on AIDS Research and Behavioral and Social Sciences, 99 n.1, 150 n.12 Committee on Evaluating Genetic Diversity, 150 n.12 National Survey of Adolescent Males, 116 National Survey of Family Growth, 128, 160 Nurses Health Study II Pilot Study, 110-111, 114, 127, 160

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--> O Office of Management and Budget, 149 Oral contraceptive use, 56, 57-58, 64, 67, 68 Osteoporosis, 112-113 Ovarian cancer, 64, 67 Overweight and obesity, 56, 57, 62, 64, 65, 68, 102-103 P Pap tests, 6, 21, 42, 66-67 Partners, lesbian. See also Domestic partner benefits alcohol use, 81 legal recognition of, 41 relationships, 199-200 Pregnancy history, 56, 57, 64, 65 Prejudice and discrimination and coming out, 49 laws against, 37 lesbian researchers, 136 prevalence in U.S., 5, 35-37 research used for, 151 studies of, 106-107 Prevalence of being lesbian, 23, 26, 28-29, 57 Preventive health care, 45-46, 104-105, 112-113 Professional associations, provider, 44 Prostitution, 78 Protective factors for health, 6, 10, 13-14, 63, 68, 85, 156 Protestants, 28 Providers. See Health care providers Public liaison group, 18 R Racial discrimination/racism, 61-62 Racial/ethnic minorities cancer risk, 64 coming out, 49-50, 55 and dimensions of same-sex sexuality, 3-4, 29 perspectives of sexual orientation, 23-25 research needs, 13, 117-118, 146, 156, 157, 160-161 studies of lesbians of, 13, 54-55, 70, 106-109, 129, 180-182 triple jeopardy, 61, 106-107 Religion. See also specific religions and dimensions of same-sex sexuality, 28-29 influences on attitudes, 24, 25 Reproductive health, literature on, 200-201 Research on lesbian health adolescents, 153 barriers, see Contextual barriers to research community-researcher collaboration, 8, 145-148 conferences, 14, 162-163 ethical issues, 150-153 funding, 7, 11-12, 141, 144, 148-150, 158 importance, 2-3, 20-21 informed consent, 153, 162 longitudinal, 99 methodologies, see Methodological issues in research needs and recommendations, 10-11, 50, 81, 84-87, 99, 156-164 racial and ethnic minorities, 54-55 uses, concerns about, 151, 162 Risk factors for lesbian health beliefs and misconceptions, 2, 21, 63, 65, 72-73, 76-77 communication with providers and, 43

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-->   general, 20, 55-59 literature, 185-186 research recommendations, 9, 10, 13-14, 85, 155, 156, 161-162 unique, 3, 6, 21, 59-62 S Sampling strategies, 117-118. See also Methodological issues in research combining strategies, 126, 158-159 disproportionate stratification, 122-123 location (convenience), 80, 81, 98, 120, 125-126 multiple frames, 123-124 multiplicity or network, 124 nonprobability, 7, 80, 119-120, 125-126, 139 one-stage screening, 121-122 probability, 7, 13-14, 27, 33, 68, 81, 82, 98, 116, 117, 118-119, 121-124, 158-159, 161-162 selection bias, 119, 121-122, 126 snowball, 125 two-stage screening, 122 Sensitization, 48 Sexual behavior. See also Sexual practices and cervical cancer, 66 and definition of lesbian, 22, 26, 102, 104, 106, 108, 110, 112 funding of research on, 8-9, 148-149 history taking by providers, 43-44, 45 and illicit drug use, 83-84 literature on, 201 longitudinal studies, 7-8, 110-111 measures of, 30-31 and sexual identity, 32 Sexual desire/attraction, measures of, 30 n.7, 32, 103, 113 Sexual identity adolescents, 110-111 and alcohol use, 102-103 appeal and sexual behavior by, 32 bisexual, 22 confusion, 77 definitional issues, 22, 26, 102, 104, 106, 108, 110, 112 development of, 48, 50-51, 99 and discrimination, 106-107 and gynecological care, 112-113 and HIV risk behavior, 104-107, 110-111 measures of, 27 n.7, 31 n.9, 102, 104, 106, 108, 110, 112 and mental health, 102-103, 108-111 racial, ethnic, and cultural perspectives, 3-4, 23-25, 106-109 and reproductive system problems, 106-107 and sexual practices, 102-113 and STDs, 102-103, 110-111 and weight/dieting, 102-103 Sexual orientation age of awareness of, 50-51 children raised in lesbian households, 53 determinants of, 51 dimensions of, 3-4, 5, 25-33, 101, 102-114 Kinsey scale, 112-113 measures of, 7, 11-12, 22, 26-27 n.5, 30-32, 99, 102-114, 158-159 racial/ethnic minority perspectives, 23-25 and smoking, 55-57 underreporting, 33 n.10 Sexual practices assumptions about, 70-71 and discrimination, 106-107 disease prevention studies, 112-113 and gynecological care, 112-113 heterosexual activity, 52, 56, 66, 78, 102, 106

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-->   and HIV/AIDS, 77-78, 102-107, 110-111 and menstrual synchrony in couples, 112-113 and mental health, 102-103 and reproductive health, 106-107 and STDs, 74-75, 102-103 Sexually transmitted diseases (STDs), 54, 66, 67-75, 78, 86, 102-105, 110-111, 149, 201-202 Smoking, 42, 55-57, 64, 67, 68, 81 Social networks and support systems, 63, 77, 125 Socioeconomic status, 13, 62, 70, 156, 160-161 Sodomy laws, 37, 39 Stanford University, 141 Stigmatization, 5. See also Prejudice and discrimination of conducting research, 136, 137 of lesbian academics, 137-138 research data used for, 152 and stress, 21 Stress, 3, 21, 59-62, 63, 65, 68, 81 Substance abuse, 54, 77, 79, 86-87. See also Alcohol use; Illicit drug use Suicide, 51-52, 69-70, 110-111, 202-203 Survey of Family Growth, 117 Syphilis, 70, 72-73 T Taoism, 24, 25 U University of North Carolina, 149 University of Washington, 78 University of Wisconsin, 141 U.S. Census of Population and Housing, 128 Uterine cancer, 64 V Violence against gay men and lesbians, 36, 42, 49, 59, 61, 70, 204 -206 W Whitman Walker Clinic, Washington, D.C., 142 Women's Health Initiative, 55, 57, 112-113, 114, 127, 128, 139 Work, literature on, 206 Workshop agenda, 1-2, 18, 207-213 participants, 18, 215-222 written testimony, sources, 19, 223-226 Y Yale University, 142 Young Women's Christian Association, 142 Youth Risk Behavior Study, 160