Randall L. Sell

Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concerns

Laura Dean, MEd,1 Ilan H. Meyer, PhD,1 Kevin Robinson, MHA, MSW,1 Randall L. Sell, ScD,1 Robert Sember, PhD,1 Vincent M.B. Silenzio, MPH, MD,1 Deborah J. Bowen, PhD,2 Judith Bradford, PhD,2 Esther Rothblum, PhD,2 Scout, MA,2 Jocelyn White, MD,2 Patricia Dunn, MSW, JD,3 Anne Lawrence, M.D., Ph.D.(c),4 Daniel Wolfe,1 Jessica Xavier,5 and With acknowledgment to Darren Carter, MD, Jennifer Pittman, and Ronald Tierney

Health care access among individuals involved in same-sex relationships.

OBJECTIVES We used data from the National Health Interview Survey to compare health care access among individuals involved in same-sex versus opposite-sex relationships. METHODS We conducted descriptive and logistic regression analyses from pooled data on 614 individuals in same-sex relationships and 93418 individuals in opposite-sex relationships. RESULTS Women in same-sex relationships (adjusted odds ratio [OR]=0.60; 95% confidence interval [CI]=0.39, 0.92) were significantly less likely than women in opposite-sex relationships to have health insurance coverage, to have seen a medical provider in the previous 12 months (OR=0.66; 95% CI=0.46, 0.95), and to have a usual source of health care (OR=0.50; 95% CI=0.35, 0.71); they were more likely to have unmet medical needs as a result of cost issues (OR=1.85; 95% CI=1.16, 2.96). In contrast, health care access among men in same-sex relationships was equivalent to or greater than that among men in opposite-sex relationships. CONCLUSIONS In this study involving a nationwide probability sample, we found some important differences in access to health care between individuals in same-sex and opposite-sex relationships, particularly women.

Sexual orientation data collection and progress toward Healthy People 2010

Without scientifically obtained data and published reports, it is difficult to raise awareness and acquire adequate resources to address the health concerns of lesbian, gay, and bisexual Americans. The Department of Health and Human Services must recognize gaps in its information systems regarding sexual orientation data and take immediate steps to monitor and eliminate health disparities as delineated in Healthy People 2010. A paper supported by funding from the Office of the Assistant Secretary for Planning and Evaluation explores these concerns and suggests that the department (1) create work groups to examine the collection of sexual orientation data; (2) create a set of guiding principles to govern the process of selecting standard definitions and measures; (3) recognize that racial/ethnic, immigrant-status, age, socioeconomic, and geographic differences must be taken into account when standard measures of sexual orientation are selected; (4) select a minimum set of standard sexual orientation measures; and (5) develop a long-range strategic plan for the collection of sexual orientation data.

Adolescent Same-Sex and Both-Sex Romantic Attractions and Relationships: Implications for Smoking

OBJECTIVES We examined cross-sectional and longitudinal associations between smoking and romantic attractions and relationships. METHODS We used data from the National Longitudinal Study of Adolescent Health to assess associations of smoking at Waves I and II with same-sex, both-sex, and opposite-sex romantic attractions or relationships as determined at Wave I. We used logistic regression to predict smoking at Wave II by sexual orientation. RESULTS Both adolescent boys and adolescent girls with both-sex attractions or relationships were significantly more likely than those with opposite-sex attractions or relationships to be current smokers. Adolescent boys and girls with both-sex attractions or relationships who were nonsmokers at Wave I were more likely to be current smokers at Wave II than those with opposite-sex attractions or relationships. CONCLUSIONS Our findings support previous research on smoking among youths who report same-sex or both-sex romantic attractions or relationships and demonstrate the increased risk bisexual youths have for smoking initiation and smoking prevalence. Tobacco use prevention programs targeting gay and bisexual youths are warranted, particularly among adolescent girls and boys who have had both-sex romantic attractions or relationships.

Defining and Measuring Sexual Orientation for Research

Conceptually defining populations, such as those defined by race and ethnicity, and developing methods to identify members of those populations operationally have continually challenged researchers (LaVeist, 2002). Today, as scientists begin to treat sexual orientation as a demographic variable like race and ethnicity, it is important to examine critically and clarify our conceptualizations of sexual orientation as well as critically examine measures used for operationally identifying the sexual orientation of research subjects.

Sex and Gender in the US Health Surveillance System: A Call to Action

Youth Risk Behavior Survey (YRBS) data have exposed significant sexual orientation disparities in health. Interest in examining the health of transgender youths, whose gender identities or expressions are not fully congruent with their assigned sex at birth, highlights limitations of the YRBS and the broader US health surveillance system. In 2009, we conducted the mixed-methods Massachusetts Gender Measures Project to develop and cognitively test measures for adolescent health surveillance surveys. A promising measure of transgender status emerged through this work. Further research is needed to produce accurate measures of assigned sex at birth and several dimensions of gender to further our understanding of determinants of gender disparities in health and enable strategic responses to address them.

The importance of both sexual behavior and identity.

In the July 2005 issue, Young and Meyer suggest that the terms “men who have sex with men (MSM)” and “women who have sex with women (WSW)” are used inappropriately to displace information regarding sexual identity.1 While information regarding sexual identity is important, measures of both sexual identity and sexual behavior should routinely be included on population-based surveys and surveys of health risk behaviors to illuminate interactions between identity, behavior, and adverse health outcomes, including sexually transmitted infections. The Bureau of Sexually Transmitted Disease Control at the New York City Department of Health and Mental Hygiene attempts to interview all persons diagnosed and reported with early syphilis to ensure adequate treatment and appropriate notification and treatment of partners. Since January 2004, interviews have included a sexual identity question phrased as it is in the Massachusetts Youth Risk Behavior Survey.2 Respondents are asked, “Which of the following best describes you? Heterosexual (straight), gay or lesbian, bisexual, not sure, none of the above.” In interviews conducted from January 2004 through June 2005, 84% of men with primary or secondary syphilis infection who reported having sex with other men identified themselves as gay; 11% identified as bisexual and only 4% identified as heterosexual. A high degree of concordance between identity and behavior was seen in all racial/ethnic groups. In contrast, large venue-specific3–5 and population-based studies have revealed a very different picture. Among 3000 men sampled for a general population–based survey of health and risk behaviors conducted by the the New York City Department of Health and Mental Hygiene in 2003,6 there was notable discordance between sexual behavior and sexual identity among MSM, 73% of whom self-identified as heterosexual. Heterosexual-identified MSM and gay-identified MSM had different demographic and behavioral characteristics. Sexual identity and behavior information derived from special studies can be useful for targeting case-based interventions; however, when such data are available on a population level, they give case-based data critical context and can be used to guide broader outreach efforts to groups with differing demographic characteristics. Young and Meyer’s suggestion that investigators should capture the full range of identity terms may not be practical for public health practice and research. Instead, we suggest that public health practitioners and researchers strive to adopt a standard means of measurement and nomenclature for sexual behavior and identity. Furthermore, we caution persons collecting such data, including health care providers, not to rely solely on the terms individuals use to describe themselves, as a man who has sex with another man may well report a heterosexual identity. Providers should specifically inquire about the gender of sexual partners when assessing patients’ risk for sexually transmitted infections.

Sexual Orientation Data Collection Policy in the United States: Public Health Malpractice

The authors reflect on sexual orientation data collection policy in the U.S. They suggest that the greatest threat to LGBT Americans is a lack of data about their health and that the lack of data can be attributed to a lack of leadership at the U.S. Department of Health and Human Services. They argue that publicly funded health data sets which exclude sexual minorities can not be allowed and that the U.S. Centers for Disease Control and Prevention needs to collect data on sexual minorities.

Inclusion of Lesbian, Gay, Bisexual and Transgender People in Tobacco Use-Related Surveillance and Epidemiological Research

Researchers and public health advocates have long recognized the importance of demographic characteristics such as sex, race, ethnicity, age, and socioeconomic status in their efforts to understand and control the use of tobacco among population groups. Targeting prevention and cessation efforts based upon such characteristics has consistently been demonstrated to be both efficient and effective. In recent years, attention has modestly turned to how two additional demographic variables, sexual orientation and gender identity, can add to our understanding of how to reduce tobacco use. Research of tobacco industry papers has clearly documented targeted media campaigns to encourage smoking among lesbians and gays in the marketplace. The tobacco industry has long understood the role that sexual orientation can play in the uptake of smoking and the targeted marketing of brands. Those concerned with tobacco use prevention and cessation research have consequently responded to address tobacco use by lesbians and gays, and bisexuals and transgender people as well, but even more can be done. This article reviews what is known about smoking in lesbian, gay, bisexual, and transgender populations and then reviews recommendations from four panels created to examine this topic. In conclusion, we recommend that sexual orientation and gender identity be considered for inclusion as variables in all major research and epidemiological studies of tobacco use. Just as such studies, without hesitation, measure sex, race, ethnicity, age, and socioeconomic status, they need to also include questions assessing sexual orientation and gender identity. Although these new variables need not be the primary focus of these studies, at a minimum, considering their use as controlling variables should be explored. Lesbian, gay, bisexual, and transgender people can benefit from being openly included in the work researchers conduct to inform the design of tobacco control programs and policies.