Since many of these variables are centrally related to health status, health concerns, and access to care, this report explicitly considers a few key subgroupings of the LGBT population in each chapter:. Bisexual adolescents who are wrestling with coming out in a nonsupportive environment have different health needs than gay adult men who lack access to health insurance or older lesbians who are unable to find appropriate grief counseling services. In addition, development does not follow the same course for people of all ages.
Similarly, as discussed further below, experiences across the life course differ according to the time period in which individuals are born. For example, an adolescent coming out in would do so in a different environment than an adolescent coming out in the s. Moreover, some people experience changes in their sexual attractions and relationships over the course of their life. Some transgender people, for example, are visibly gender role nonconforming in childhood and come out at an early age, whereas others are able to conform and may not come out until much later in life.
The racial and ethnic communities to which one belongs affect self-identification, the process of coming out, available support, the extent to which one identifies with the LGBT community, affirmation of gender-variant expression, and other factors that ultimately influence health outcomes.
Members of racial and ethnic minority groups may have profoundly different experiences than non-Hispanic white LGBT individuals. As higher educational levels tend to be associated with higher income levels, members of the community who are more educated may live in better neighborhoods with.
On the other hand, members of the LGBT community who do not finish school or who live in poorer neighborhoods may experience more barriers in access to care and more negative health outcomes. Geographic location —Geographic location has significant effects on mental and physical health outcomes for LGBT individuals. Those in rural areas or areas with fewer LGBT people may feel less comfortable coming out, have less support from families and friends, and lack access to an LGBT community. LGBT individuals in rural areas may have less access to providers who are comfortable with or knowledgeable about the treatment of LGBT patients.
Although these areas represent critical dimensions of the experiences of LGBT individuals, the relationships of these variables to health care disparities and health status have not been extensively studied. The member committee included experts from the fields of mental health, biostatistics, clinical medicine, adolescent health and development, aging, parenting, behavioral sciences, HIV research, demography, racial and ethnic disparities, and health services research.
The study was supported entirely by NIH. The majority of individuals affected by disorders of sex development do not face challenges related to sexual orientation and gender identity, although homosexuality, gender role nonconformity, and gender dysphoria defined as discomfort with the gender assigned to one at birth [see Chapter 2 ] are somewhat more prevalent among this population compared with the general population Cohen-Kettenis and. An IOM committee will conduct a review and prepare a report assessing the state of the science on the health status of lesbian, gay, bisexual, and transgender LGBT populations; identify research gaps and opportunities related to LGBT health; and outline a research agenda that will assist NIH in enhancing its research efforts in this area.
Additionally, the committee will consider research training needs to foster the advancement of knowledge about LGBT health and identify impediments that hinder such advancement. Pfafflin, The committee acknowledges that while very little research exists on the subject of intersexuality, it is a separate research topic encompassing critical issues, most of which are not related to LGBT issues, and hence is beyond the scope of this report.
In a similar vein, the committee decided not to address research and theory on the origins of sexual orientation. This study was informed by four public meetings that included 35 presentations see Appendix A. In addition, the committee conducted an extensive review of the literature using Medline, PsycInfo, and the Social Science Citation Index see Appendix B for a list of search terms , as well as other resources. A brief note on the terminology used in this report is presented in Box While acknowledging that peer-reviewed journals are the gold standard for the reporting of research results and making every effort to consult works published in major research journals, the committee chose to include in this study what it judged to be the best empirical literature available: journal articles, book chapters, empirical reports, and other data sources that had been critically reviewed by the committee members.
Recognizing that academic journals differ in their publication criteria and the rigor of their peer-review process, the committee gave the greatest weight to papers published in the most authoritative journals. Given that chapters, academic books, and technical reports typically are not subjected to the same peer-review standards as journal articles, the committee gave the greatest credence to such sources that reported research employing rigorous methods, were authored by well-established researchers, and were generally consistent with scholarly consensus on the current state of knowledge.
With respect to articles describing current health issues in the LGBT community, the committee attempted to limit its review to these articles published since In the area of transgender populations, however, much of the most current research was conducted prior to and is. As discussed, the committee adopted the commonly used shorthand LGBT to stand for lesbian, gay, bisexual, and transgender.
In cases in which the literature refers only to lesbian, gay, and bisexual populations, the term LGB appears in the report without the T. Appendix C provides a glossary to assist the reader with any unfamiliar terminology. Likewise, in the case of history and theory, the committee reviewed and cites older literature. When evaluating quantitative and qualitative research, the committee considered factors affecting the generalizability of studies, including sample size, sample source, sample composition, recruitment methods, and response rate.
The committee also considered the study design, saturation the point at which new information ceases to emerge , and other relevant factors. In some cases, the committee decided that a study with sample limitations was important; in such cases, these limitations and limits on the extent to which the findings can be generalized are explicitly acknowledged.
Who's gay? It depends on how you measure it — Add Health
The inclusion of case studies was kept to a minimum given their limited generalizability. Research on U. In cases in which no U. This was frequently the case for research involving transgender people. Only English-language articles were considered. The committee considered papers whose authors employed statistical methods for analyzing data, as well as qualitative research that did not include statistical analysis.
For papers that included statistical analysis, the committee evaluated whether the analysis was appropriate and conducted properly. For papers reporting qualitative research, the committee evaluated whether the data were appropriately analyzed and interpreted. The committee does not present magnitudes of differences, which should be determined by consulting individual studies. In some cases, the committee used secondary sources such as reports. However, it always referred back to the original citations to evaluate the evidence.
In understanding the health of LGBT populations, multiple frameworks can be used to examine how multiple identities and structural arrangements intersect to influence health care access, health status, and health outcomes. This section provides an overview of each of the conceptual frameworks used for this study. First, recognizing that there are a number of ways to present the information contained in this report, the committee found it helpful to apply a life-course perspective. A life-course perspective provides a useful framework for the above-noted varying health needs and experiences of an LGBT individual over the course of his or her life.
Central to a life-course framework Cohler and Hammack, ; Elder, is the notion that the experiences of individuals at every stage of their life inform subsequent.
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This interrelationship among experiences starts before birth and in fact, before conception. A life-course framework has four key dimensions:. Life events as part of an overall trajectory— Significant experiences have a differential impact at various stages of the life course. Personal decisions— Individuals make choices influenced by the social contexts in which they live e. The committee relied on this framework and on recognized differences in age cohorts, such as those discussed earlier, in presenting information about the health status of LGBT populations. Along with a life-course framework, the committee drew on the minor ity stress model Brooks, ; Meyer, , a.
While this model was originally developed by Brooks for lesbians, Meyer expanded it to include gay men and subsequently applied it to lesbians, gay men, and bisexuals Meyer, b. This model originates in the premise that sexual minorities, like other minority groups, experience chronic stress arising from their stigmatization.
What is sexual orientation and do women have one?
In this model, actual experiences of discrimination and violence also referred to as enacted stigma are distal stress processes. There is also supporting evidence for the validity of this model for transgender individuals. Some qualitative studies strongly suggest that stigma can negatively affect the mental health of transgender people Bockting et al.
The minority stress model attributes the higher prevalence of anxiety, depression, and substance use found among LGB as compared with heterosexual populations to the additive stress resulting from nonconformity with prevailing sexual orientation and gender norms. An intersectional perspective is useful because it acknowledges simultaneous dimensions of inequality and focuses on understanding how they are interrelated and how they shape and influence one another.
These include the following:. Race is a social construct. Understanding the racial and ethnic experiences of sexual- and gender-minority individuals requires taking into account the full range of historical and social experiences both within and between sexual- and gender-minority groups with respect to class, gender, race, ethnicity, and geographical location.
The economic and social positioning of groups within society is associated with institutional practices and policies that contribute to unequal treatment. The importance of representation—the ways social groups and individuals are viewed and depicted in the society at large and the expectations associated with these depictions—must be acknowledged. These representations are integrally linked to social, structural, political, historical, and geographic factors.
Nevertheless, in a hierarchically organized society, some statuses become more important than others at any given historical moment and in specific geographic locations. Race, ethnicity, class, and community context matter; they are all powerful determinants of access to social capital—the resources that improve educational, economic, and social position in society.
Finally, the social ecology model McLeroy et al. This viewpoint is reflected in Healthy People In developing objectives to improve the health of all Americans, including LGBT individuals, Healthy People used an ecological approach that focused on both individual-and population-level determinants of health HHS, , With respect to LGBT health in particular, the social ecology model is helpful in conceptualizing that behavior both affects the social environment and, in turn, is affected by it. A social ecological model has multiple levels, each of which influences the individual; beyond the individual, these may include families, relationships, community, and society.
It is worth noting that for LGBT people, stigma can and does take place at all of these levels. Each of the above four frameworks provides conceptual tools that can help increase our understanding of health status, health needs, and health disparities in LGBT populations. Each complements the others to yield a more comprehensive approach to understanding lived experiences and their impact on LGBT health. The life-course perspective focuses on development between and within age cohorts, conceptualized within a historical context.
Who's gay? It depends on how you measure it
Sexual minority stress theory examines individuals within a social and community context and emphasizes the impact of stigma on lived ex-. Intersectionality brings attention to the importance of multiple stigmatized identities race, ethnicity, and low socioeconomic status and to the ways in which these factors adversely affect health. The chapters that follow draw on all these conceptualizations in an effort to provide a comprehensive overview of what is known, as well as to identify the knowledge gaps.
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This report is organized into seven chapters. Chapter 3 addresses the topic of conducting research on the health of LGBT people. Specifically, it reviews the major challenges associated with the conduct of research with LGBT populations, presents some commonly used research methods, provides information about available data sources, and comments on best practices for conducting research on the health of LGBT people. As noted, in preparing this report, the committee found it helpful to discuss health issues within a life-course framework. Each of these chapters addresses the following by age cohort: the development of sexual orientation and gender identity, mental and physical health status, risk and protective factors, health services, and contextual influences affecting LGBT health.
Bockting, W. Robinson, and B. Transgender HIV prevention: A qualitative needs assessment. AIDS Care 10 4 — Bronfenbrenner, U. The ecology of human development: Experiments by nature and design. Brooks, K. Bowleg, and K. Minority sexual status among minorities. In Sexualities and identities of minority women, edited by S. New York: Springer Science.
Brooks, V. The theory of minority stress. In Minority stress and lesbian women, edited by V. Lexington, MA: Lexington Books. Cohen-Kettenis, P. Transgenderism and intersexuality in childhood and adolescence: Making choices. Cohler, B. Dill, T. Emerging intersections: Race, class and gender in theory, policy and practice. Elder, G.
The life course as developmental theory. Child Development 69 1 Gamson, J. The sociology of sexualities: Queer and beyond. Annual Review of Sociology 30 1 — Herek, G. Sexual stigma and sexual prejudice in the United States: A conceptual framework. In Contemporary perspectives on lesbian, gay, and bisexual identities, edited by D. Call Number: RC G39 U Uses case studies to explore issues of lesbian and gay couples and family therapy.
Contemporary perspectives on lesbian, gay, and bisexual identities [electronic resource] by Debra A. Hope, editor. N43 eb. Includes two chapters on LGBT families. Lesbian and gay families speak out : understanding the joys and challenges of diverse family life by Jane Drucker. U5 D78 Explores definitions of family, alternative family ties, when and how to be out, and religion and spirituality in LGBT families.
M Moraga, a Chicana lesbian writer, discusses the experience of later-in-life motherhood in this e-book. Our Family Coalition - The Bay Area's LGBTQ Family Organization An organization of LGBTQ lesbian, gay, bisexual, transgender, and queer parents, caregivers and their families that provides educational programming and materials, trains service providers in cultural competency about LGBTQ families, participates in media and political forums, helps parents advocate for safe and welcoming environments for their children, and facilitates support networks for LGBTQ parents and children.
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