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1.  Cigarette Smoking Disparities among Sexual Minority Cancer Survivors 
Preventive medicine reports  2015;2:283-286.
Objective
Sexual minority (i.e., lesbian, gay, and bisexual) adults smoke cigarettes at higher rates than heterosexual adults. Smoking after receiving a cancer diagnosis is a major health concern, yet risk of continued smoking among sexual minority cancer survivors is as yet unknown. The current study examines current smoking among sexual minority vs. heterosexual adult cancer survivors.
Method
Data drawn from the 2010 Behavioral Risk Factor Surveillance System survey in five states (Alaska, California, Massachusetts, New Mexico, and Wisconsin) included items about sexual orientation, cancer diagnosis, and tobacco use. The analytic sample included 124 sexual minority and 248 propensity score matched heterosexual adult cancer survivors.
Results
Bivariate analysis showed that sexual minority cancer survivors had twice the odds of current smoking as their heterosexual counterparts (OR=2.03, 95%CI:1.09–3.80). In exploratory analyses stratified by sex, sexual minority disparities in prevalence of smoking post-cancer showed a trend toward significance among females, not males.
Conclusion
The current study offers preliminary evidence that sexual minority status is one variable among many that must be taken into account when assessing health behaviors post-cancer diagnosis. Future research should identify mechanisms leading from sexual minority status to increased rates of smoking and develop tailored smoking cessation interventions.
doi:10.1016/j.pmedr.2015.04.004
PMCID: PMC4430723  PMID: 25984441
Smoking; Neoplasms; Sexuality; Homosexuality; Female; Homosexuality; Male; Minority Health
2.  Sexual and Behavioral Health Disparities Among Sexual Minority Hispanics/Latinos: Findings From the National Health and Nutrition Examination Survey, 2001–2014 
Introduction
Hispanics/Latinos (henceforth, Latinos) are the largest minority group in the U.S. With growing health disparities among this group, the highest burden remains among sexual and gender minority Latinos. Differences regarding sexual orientation have not been fully explored within this group using national representative samples. This study analyzed sexual and behavioral health disparities associated with sexual minority status among Latinos in the U.S.
Methods
The study included data from 5,598 Latino adults who participated in the 2001–2014 waves of the National Health and Nutrition Examination Survey. Data analysis was conducted in 2016. Bivariate and multivariable logistic regression analyses examined the prevalence of HIV, sexually transmitted infections, mental health problems, cigarette smoking, and alcohol/illicit drug use among sexual minorities and heterosexual Latino adults. Sexual minorities were defined as “gay, lesbian, and bisexual” (GLB) and “other” non-heterosexual groups.
Results
GLB Latinos reported higher prevalence of mental health problems and cigarette smoking compared with heterosexuals. After adjusting for covariates, GLB Latinos had greater odds of testing positive for HIV, lifetime diagnosis of sexually transmitted infections, poor mental health outcomes, cigarette smoking (including lifetime and current smoking status), and illicit drug use than heterosexuals.
Conclusions
The disproportionate impact of health disparities among Latinos varies significantly by sexual orientation, with GLB individuals facing elevated prevalence. In particular, elevated odds for HIV/sexually transmitted infections, mental health problems, smoking, and illicit substance use were found. Further research, including longitudinal studies to understand the trajectories of risks, is needed to identify intervention opportunities in this population.
doi:10.1016/j.amepre.2017.01.037
PMCID: PMC5567737  PMID: 28284748
3.  Sexual-Orientation Disparities in Cigarette Smoking in a Longitudinal Cohort Study of Adolescents 
Nicotine & Tobacco Research  2012;15(1):213-222.
Introduction:
Youths with a minority sexual orientation (i.e., gay, lesbian, bisexual, and mostly heterosexual) are at high risk for cigarette smoking. We examined sexual-orientation disparities in smoking during adolescence and emerging adulthood and investigated the role of age at first smoking in contributing to smoking disparities.
Methods:
We used data from the Growing Up Today Study, a large longitudinal cohort of adolescents followed from ages 12 to 24 years (N = 13,913). Self-administered questionnaires filled out annually or biennially assessed age at first smoking, current smoking, frequency of smoking, number of cigarettes smoked daily, and nicotine dependence. Proportional hazards survival analysis and repeated measures regression estimated sexual-orientation differences in smoking.
Results:
Compared with completely heterosexuals, lesbian/gay, bisexual, and mostly heterosexual youths smoked their first cigarette at younger ages, were more likely to be current smokers, and had higher frequency of smoking. Among past-year smokers, sexual-minority females smoked more cigarettes daily and scored higher on nicotine dependence than completely heterosexual females. In some instances, gender and age modified relationships between sexual orientation and smoking, with relative risk accentuated in female sexual minorities and in sexual minorities during younger ages. Younger age of smoking onset contributed to elevated smoking in mostly heterosexuals and bisexuals, and to a lesser extent in lesbians, but not in gay males.
Conclusions:
Sexual-orientation minorities are at greater risk for smoking during adolescence and emerging adulthood than heterosexuals. Disparities are larger in females and evident in early adolescence. Prevention and cessation efforts should target this population, preferably beginning in early adolescence.
doi:10.1093/ntr/nts114
PMCID: PMC3524066  PMID: 22581940
4.  Sociodemographic Characteristics and Health Outcomes Among Lesbian, Gay, and Bisexual U.S. Adults Using Healthy People 2020 Leading Health Indicators 
LGBT Health  2017;4(4):283-294.
Abstract
Purpose: This study aimed to characterize the sociodemographic characteristics of sexual minority (i.e., gay, lesbian, bisexual) adults and compare sexual minority and heterosexual populations on nine Healthy People 2020 leading health indicators (LHIs).
Methods: Using a nationally representative, cross-sectional survey (National Health Interview Survey 2013–2015) of the civilian, noninstitutionalized population (228,893,944 adults), nine Healthy People 2020 LHIs addressing health behaviors and access to care, stratified using a composite variable of sex (female, male) and sexual orientation (gay or lesbian, bisexual, heterosexual), were analyzed individually and in aggregate.
Results: In 2013–2015, sexual minority adults represented 2.4% of the U.S. population. Compared to heterosexuals, sexual minorities were more likely to be younger and to have never married. Gays and lesbians were more likely to have earned a graduate degree. Gay males were more likely to have a usual primary care provider, but gay/lesbian females were less likely than heterosexuals to have a usual primary care provider and health insurance. Gay males received more colorectal cancer screening than heterosexual males. Gay males, gay/lesbian females, and bisexual females were more likely to be current smokers than their sex-matched, heterosexual counterparts. Binge drinking was more common in bisexuals compared to heterosexuals. Sexual minority females were more likely to be obese than heterosexual females; the converse was true for gay males. Sexual minorities underwent more HIV testing than their heterosexual peers, but bisexual males were less likely than gay males to be tested. Gay males were more likely to meet all eligible LHIs than heterosexual males. Overall, more sexual minority adults met all eligible LHIs compared to heterosexual adults. Similar results were found regardless of HIV testing LHI inclusion.
Conclusion: Differences between sexual minorities and heterosexuals suggest the need for targeted health assessments and public health interventions aimed at reducing specific negative health behaviors.
doi:10.1089/lgbt.2016.0087
PMCID: PMC5564038  PMID: 28727950
demographics; epidemiology; health outcomes; sexual minorities
5.  Smoking characteristics among lesbian, gay, and bisexual adults☆ 
Preventive medicine  2014;74:123-130.
Objective
Cigarette smoking is the leading preventable cause of death and disease in the United States. Sexual minorities (lesbians, gay men, and bisexuals), smoke at higher rates than the general population. However, little else is known about sexual minority smokers. Furthermore, the sexual minority population is diverse and little research exists to determine whether subgroups, such as lesbians, gay men, and female and male bisexuals, differ on smoker characteristics. We examine differences in smoking characteristics (advertising receptivity, age of first cigarette, non-daily smoking, cigarettes per day, nicotine dependence, desire to quit and past quit attempts) among lesbians, gay men, and female and male bisexual adults in the United States.
Methods
Secondary analysis of the CDC's 2009–2010 National Adult Tobacco Survey (N = 118,590).
Results
Controlling for age, race, socioeconomic status and geographic region, identifying as a female bisexual was associated with fewer past quit attempts, lower age at first cigarette, and higher nicotine dependence when compared to heterosexual women. There were no differences in desire to quit between male or female sexual minorities and their heterosexual counterparts.
Conclusion
Sexual minority individuals smoke at higher rates than heterosexuals and yet similarly desire to quit. Tailored efforts may be needed to address smoking among bisexual women.
doi:10.1016/j.ypmed.2014.11.026
PMCID: PMC4390536  PMID: 25485860
LGBT; Smoking; Tobacco control
6.  Tobacco Product Use Among Sexual Minority Adults 
Introduction
A growing body of evidence reveals higher rates of tobacco use among sexual minority populations relative to non-minority (“straight”) populations. This study seeks to more fully characterize this disparity by examining tobacco use by distinct sexual identities and gender to better understand patterns of: (1) cigarette smoking and smoking history; and (2) use of other tobacco products including cigars, pipes, hookah, e-cigarettes, and smokeless tobacco.
Methods
Data from the 2012–2013 National Adult Tobacco Survey, a random-digit dialed landline and cellular telephone survey of U.S. adults aged ≥18 years, were analyzed in 2014. A sexual minority category was created by combining gay, lesbian, and bisexual responses, along with those who selected an option for other non-heterosexual identities.
Results
Smoking prevalence was higher among sexual minority adults (27.4%) than straight adults (17.3%). Cigarette smoking was particularly high among bisexual women (36.0%). Sexual minority women started smoking and transitioned to daily smoking earlier than their straight peers. Use of other tobacco products was higher among sexual minority women: prevalence of e-cigarette (12.4%), hookah (10.3%), and cigar use (7.2%) was more than triple that of their straight female peers (3.4%, 2.5%, and 1.3%, respectively). Likewise, prevalence of sexual minority men’s e-cigarette (7.9%) and hookah (12.8%) use exceeded that of straight men (4.7% and 4.5%, respectively).
Conclusions
Tobacco use is significantly higher among sexual minority than straight adults, particularly among sexual minority women. These findings underscore the importance of tobacco control efforts designed to reach sexual minorities and highlight the heterogeneity of tobacco use within this population.
doi:10.1016/j.amepre.2015.07.041
PMCID: PMC4803352  PMID: 26526162
7.  Sexual orientation disparities in smoking vary by sex and household smoking among US adults: Findings from the 2003–2012 National Health and Nutrition Examination Surveys 
Preventive medicine  2015;82:1-6.
Objective
This study examined whether sexual orientation-related smoking disparities in males and females varied by household smoking behaviors in a nationally representative sample of US adults.
Methods
Data were drawn from the 2003–2012 National Health and Nutrition Examination Surveys, which assessed 14,972 individuals ages 20 to 59 years for sexual orientation, current smoking status, and household smoking. Weighted multivariable logistic models were fit to examine whether differences in current smoking status among sexual minority adults compared to heterosexuals was moderated by household smoking and sex, adjusting for covariates.
Results
The main effects of identifying as a sexual minority, being male, and living with a household smoker were all associated with a significantly higher odds of being a current smoker. However, there also was a significant three-way interaction among these variables (AOR=3.75, 95% CI: 1.33, 10.54). Follow-up analyses by sex indicated that the interaction between sexual identity and household smoking was significant for both males (AOR=6.40, 95% CI: 1.27, 32.28) and females (AOR=0.43, 95% CI: 0.23, 0.81) but was in the opposite direction. Among male, living with a smoker was associated more strongly with greater odds of smoking among gay and bisexual males, compared to heterosexual males. In contrast, among females, living with a smoker was more strongly associated with greater odds of smoking for heterosexuals compared to lesbians and bisexuals.
Conclusions
Future research is warranted to examine characteristics of households, including smoking behaviors and composition, to guide more effective and tailored smoking cessation interventions for males and females by sexual orientation.
doi:10.1016/j.ypmed.2015.10.008
PMCID: PMC4803669  PMID: 26598804
Sexual minority; sex difference; smoking; social networks
8.  Health Behaviors and Self-Reported Health Among Cancer Survivors by Sexual Orientation 
LGBT Health  2015;2(1):41-47.
Abstract
Purpose: Health behaviors and self-reported health are important for understanding cancer survivor health. However, there is a paucity of published research about how cancer survivors' health behaviors and self-rated health vary by sexual orientation. This study examined cancer survivors' health behaviors and self-reported health by sexual orientation.
Methods: This study used data from the National Health and Nutrition Examination Survey (NHANES) from 2001–2010. Self-reported health and cancer-related health behaviors were compared by sexual orientation. Propensity score adjustment was used to account for differences in age, race, education, gender and health insurance status.
Results: Of the 602 survivors eligible for the study, 4.3% identified as sexual minorities. Sexual minorities were 2.6 times more likely to report a history of illicit drug use (adjusted odds ratio [aOR]=2.4, 95% confidence interval [CI]: 1.04, 5.35), and 60% less likely to report their current health status as good (aOR=0.40, 95% CI: 0.18, 0.89), compared to heterosexual cancer survivors. These disparities persisted even after adjustment for socio-demographic characteristics.
Conclusion: Our findings suggest that sexual minority cancer survivors may be at greater risk for poorer outcomes after cancer than other survivors. A possible explanation for the observed differences involves minority stress. Future research should test stress as an explanation for these differences. However, using population-methods to achieve this goal requires larger samples of lesbian, gay, and bisexual (LGB) cancer survivors.
doi:10.1089/lgbt.2014.0038
PMCID: PMC4855727  PMID: 26790017
cancer survivors; disparities; health behaviors; sexual orientation; self-rated health
9.  Associations of Discrimination and Violence With Smoking Among Emerging Adults: Differences by Gender and Sexual Orientation 
Nicotine & Tobacco Research  2011;13(12):1284-1295.
Introduction:
Lesbian, gay, and bisexual (i.e., sexual minority) populations have higher smoking prevalence than their heterosexual peers, but there is a lack of empirical study into why such disparities exist. This secondary analysis of data sought to examine associations of discrimination and violence victimization with cigarette smoking within sexual orientation groups.
Methods:
Data from the Fall 2008 and Spring 2009 National College Health Assessments were truncated to respondents of 18–24 years of age (n = 92,470). Since heterosexuals comprised over 90% of respondents, a random 5% subsample of heterosexuals was drawn, creating a total analytic sample of 11,046. Smoking status (i.e., never-, ever-, and current smoker) was regressed on general (e.g., not sexual orientation–specific) measures of past-year victimization and discrimination. To examine within-group differences, two sets of multivariate ordered logistic regression analyses were conducted: one set of models stratified by sexual orientation and another set stratified by gender-by-sexual-orientation groups.
Results:
Sexual minorities indicated more experiences of violence victimization and discrimination when compared with their heterosexual counterparts and had nearly twice the current smoking prevalence of heterosexuals. After adjusting for age and race, lesbians/gays who were in physical fights or were physically assaulted had higher proportional odds of being current smokers when compared with their lesbian/gay counterparts who did not experience those stressors.
Conclusions:
When possible, lesbian/gay and bisexual groups should be analyzed separately, as analyses revealed that bisexuals had a higher risk profile than lesbians/gays. Further research is needed with more nuanced measures of smoking (e.g., intensity), as well as examining if victimization may interact with smoking cessation.
doi:10.1093/ntr/ntr183
PMCID: PMC3223581  PMID: 21994344
10.  Disparities in psychological distress impacting lesbian, gay, bisexual and transgender cancer survivors 
Psycho-oncology  2015;24(11):1384-1391.
Objective
Recent studies have highlighted disparities in cancer diagnosis between lesbian, gay, bisexual and transgender (LGBT) and heterosexual adults. Studies have yet to examine disparities between LGBT and heterosexual cancer survivors in prevalence of psychological distress.
Methods
Data for the current study were drawn from the LIVESTRONG dataset, a US national survey that sampled 207 LGBT and 4899 heterosexual cancer survivors (all cancer types, 63.5% women, mean age 49) in 2010. Symptoms of psychological distress were assessed with dichotomous yes/no items in three symptom clusters (depression related to cancer, difficulties with social relationships post-cancer, fatigue/energy problems). We selected a sample of 621 heterosexual survivors matched by propensity score to the 207 LGBT survivors and assessed disparities in count of symptoms using Poisson regression. We also performed subgroup analyses by self-reported sex.
Results
Relative to heterosexuals, LGBT cancer survivors reported a higher number of depression and relationship difficulty symptoms. Exploratory analyses revealed that disparities in number of symptoms were visible between gay, bisexual, and transgender versus heterosexual men but not between lesbian, bisexual, and transgender versus heterosexual women.
Conclusions
This study highlights several disparities in psychological distress that exist between LGBT and heterosexual survivors. A need remains for interventions tailored to LGBT survivors and for studies examining disparities within subgroups of LGBT survivors.
doi:10.1002/pon.3746
PMCID: PMC4517981  PMID: 25630987
11.  Sexual function and satisfaction among heterosexual and sexual minority U.S. adults: A cross-sectional survey 
PLoS ONE  2017;12(4):e0174981.
Background
Despite known health disparities for sexual minorities, few studies have described sexual function by sexual orientation using a robust approach to measurement of sexual function. We compared recent sexual function and satisfaction by sexual orientation among English-speaking US adults.
Methods and findings
Cross-sectional surveys were administered by KnowledgePanel® (GfK), an online panel that uses address-based probability sampling and is representative of the civilian, noninstitutionalized US population. Data were collected in 2013 from the general population (n = 3314, 35% response rate) and in 2014 from self-identified lesbian, gay, and bisexual adults (n = 1011, 50% response rate). Sexual function and satisfaction were measured using the Patient-Reported Outcomes Measurement Information System® Sexual Function and Satisfaction measure version 2.0 (PROMIS SexFS v2). The PROMIS SexFS v2 is a comprehensive, customizable measurement system with evidence for validity in diverse populations. A score of 50 (SD 10) on each domain corresponds to the average for US adults sexually active in the past 30 days. We adjusted all statistics for the complex sample designs and report differences within each sex where the 95% CIs do not overlap, corresponding to p<0.01. Among US men who reported any sexual activity in the past 30 days, there were no differences in erectile function or orgasm-ability. Compared to heterosexual men, sexual minority men reported higher oral dryness and lower orgasm-pleasure and satisfaction. Compared to heterosexual men, gay men reported lower interest, higher anal discomfort and higher oral discomfort. Among sexually active women, there were no differences in the domains of vulvar discomfort-clitoral, orgasm-pleasure, or satisfaction. Compared to heterosexual women, sexual minority women reported higher oral dryness. Lesbian women reported lower vaginal discomfort than other women; lesbian women reported higher lubrication and orgasm-ability than heterosexual women. Bisexual women reported higher interest, higher vulvar discomfort-labial and higher anal discomfort than other women, as well as higher oral discomfort compared to heterosexual women.
Conclusions
Recent sexual function and satisfaction differed by sexual orientation among US adults. Sexual minority men and women had decrements in domains of sexual function that have not traditionally been included in multi-dimensional self-report measures. Clinicians should make themselves aware of their patients’ sexual concerns and recognize that sexual minority patients may be more vulnerable to certain sexual difficulties than heterosexual patients.
doi:10.1371/journal.pone.0174981
PMCID: PMC5389646  PMID: 28403193
12.  Tobacco, Marijuana Use and Sensation-seeking: Comparisons Across Gay, Lesbian, Bisexual and Heterosexual Groups 
This study examined patterns of smoked substances (cigarettes and marijuana) among heterosexuals, gays, lesbians, and bisexuals based on data from the 2000 National Alcohol Survey (NAS), a population-based telephone survey of adults in the United States. We also examined the effect of bar patronage and sensation-seeking/impulsivity (SSImp) on tobacco and marijuana use. Sexual orientation was defined as: lesbian or gay self-identified, bisexual self-identified, heterosexual self-identified with same-sex partners in the last five years, and exclusively heterosexual (heterosexual self-identified, reporting no same sex partners). Findings indicate that bisexual women and heterosexual women reporting same-sex partners had higher rates of cigarette smoking than exclusively heterosexual women. Bisexual women, lesbians and heterosexual women with same-sex partners also used marijuana at significantly higher rates than exclusively heterosexual women. Marijuana use was significantly greater and tobacco use was elevated among gay men compared to heterosexual men. SSImp was associated with greater use of both of these substances across nearly all groups. Bar patronage and SSImp did not buffer the relationship between sexual identity and smoking either cigarettes or marijuana. These findings suggest that marijuana and tobacco use differ by sexual identity, particularly among women, and underscore the importance of developing prevention and treatment services that are appropriate for sexual minorities.
doi:10.1037/a0017334
PMCID: PMC2801062  PMID: 20025368
sexual orientation; tobacco use; marijuana use; sensation-seeking; bar patronage
13.  Is it getting better? An analytical method to test trends in health disparities, with tobacco use among sexual minority vs. heterosexual youth as an example 
Background
Previous studies have documented higher health risks for lesbian, gay, and bisexual youth compared to heterosexual youth. However, none has reported whether the sexual orientation-based gaps have widened, narrowed, or remained unchanged over time. The purpose of this study was to develop a way to test differences in trends between sexual minority and heterosexual youth cohorts in population-based studies, with cigarette smoking as an exemplar.
Methods
We analysed the Minnesota Student Survey of 1998–2010, a repeated, cross-sectional census of adolescent health in grades 9 and 12. Our sample was students with recent sexual experience (Ns = 17,376–19,617). Sexual orientation was measured by gender of sexual partners in the past 12 months: students with only opposite-gender partner(s) (OPPOS), students with both male and female partners (BOTH), students with only same-gender partner(s) (SAME). We used logistic regressions to examine trends in prevalence of past-month cigarette smoking from 1998 to 2010, separately for each orientation group. We then applied novel interaction analyses to test whether disparities in smoking prevalence between OPPOS and SAME/BOTH changed over time.
Results
Recent smoking rates decreased over time among all orientation groups. BOTH adolescents were more likely than OPPOS adolescents to report past 30-day smoking, but there were no significant differences between SAME adolescents and OPPOS adolescents. Year-by-orientation interactions indicated the gap between BOTH adolescents and OPPOS adolescents widened from 1998 to 2004, then persisted between 2004 and 2010. No significant interaction effects were observed between SAME adolescents and OPPOS adolescents.
Conclusions
All orientation groups had decreasing trends in recent cigarette smoking; however, disparities in smoking rates remain between heterosexual adolescents and bisexual adolescents. These results provide a new method of not just documenting trends within minority groups, but examining whether health equity is improving for them compared to dominant groups.
doi:10.1186/s12939-016-0371-3
PMCID: PMC4877985  PMID: 27215223
Sexual orientation; Adolescents; School surveys; Tobacco use; Cohort trends; Interaction analysis; Health disparities
14.  Menthol Cigarette Smoking among Lesbian, Gay, Bisexual, and Transgender Adults 
Background
Menthol can mask the harshness and taste of tobacco, making menthol cigarettes easier to use and increasing their appeal among vulnerable populations. The tobacco industry has targeted youth, women, and racial minorities with menthol cigarettes, and these groups smoke menthol cigarettes at higher rates. The tobacco industry has also targeted the lesbian, gay, bisexual, and transgender (LGBT) communities with tobacco product marketing.
Purpose
To assess current menthol cigarette smoking by sexual orientation among a nationally representative sample of U.S. adults.
Methods
Data were obtained from the 2009–2010 National Adult Tobacco Survey, a national landline and cellular telephone survey of non-institutionalized U.S. adults aged ≥18 years, to compare current menthol cigarette smoking between LGBT (n=2,431) and heterosexual/straight (n=110,841) adults. Data were analyzed during January–April 2014 using descriptive statistics and logistic regression adjusted for sex, age, race, and educational attainment.
Results
Among all current cigarette smokers, 29.6% reported usually smoking menthol cigarettes in the past 30 days. Menthol use was significantly higher among LGBT smokers, with 36.3% reporting that the cigarettes they usually smoked were menthol compared to 29.3% of heterosexual/straight smokers (p<0.05); this difference was particularly prominent among LGBT females (42.9%) compared to heterosexual/straight women (32.4%) (p<0.05). Following adjustment, LGBT smokers had greater odds of usually smoking menthol cigarettes than heterosexual/straight smokers (OR=1.31, 95% CI=1.09, 1.57).
Conclusions
These findings suggest that efforts to reduce menthol cigarette use may have the potential to reduce tobacco use and tobacco-related disease and death among LGBT adults.
doi:10.1016/j.amepre.2014.07.044
PMCID: PMC4454462  PMID: 25245795
15.  Health Disparities Among Sexual Minority Women Veterans 
Journal of Women's Health  2013;22(7):631-636.
Abstract
Background
Lesbian and bisexual (i.e., sexual minority) identity is more common among women veterans than among male veterans. Unique health issues have been identified among women veterans and among sexual minority women, but little is known about women who are both sexual minorities and veterans. This study aimed to compare demographic and health information from sexual minority women veterans with sexual minority women non-veterans and heterosexual women veterans.
Methods
Behavioral Risk Factor Surveillance Survey data were pooled from ten U.S. states that elected to ask sexual identity during 2010. The analytic sample was comprised of women who identified both their sexual identity and veteran status (n=1,908). Mental health indicators were frequent mental distress, sleep problems, low social/emotional support, and low satisfaction with life. Health risk indicators included current smoking, overweight, and obesity. Physical health status was defined by three components: disability requiring assistive equipment, >14 days of poor physical health in the past 30 days, and activity limitations.
Results
Compared with heterosexual women veterans, sexual minority women veterans had higher odds of mental distress (odds ratio [OR]=3.03, 95% confidence interval [CI]: 1.61–5.70) and smoking (OR=2.31, 95%CI: 1.19–4.48). After adjusting for demographic correlates, sexual minority women veterans had three times the odds of poor physical health (OR=3.01, 95%CI: 1.51–5.99) than their sexual minority non-veteran peers.
Conclusions
Results suggest sexual minority women veterans may experience unique health disparities relevant to provision of care in both Veterans Affairs (VA) and non-VA healthcare systems. Future research requires availability of data that include sexual minority status.
doi:10.1089/jwh.2012.4214
PMCID: PMC3761433  PMID: 23746281
16.  Demographic, Mental Health, Behavioral, and Psychosocial Factors Associated with Cigarette Smoking Status Among Young Men Who Have Sex with Men: The P18 Cohort Study 
LGBT Health  2016;3(5):379-386.
Abstract
Purpose: Young sexual minority men smoke at higher rates relative to heterosexual peers. The purpose of this study was to examine correlates of smoking in a sample of young gay, bisexual, and other men who have sex with men (MSM) who might differ from more general and age-diverse samples of sexual minority individuals and, thus, inform tailored approaches to addressing tobacco use within this population.
Methods: Data on smoking status were examined in relation to demographics, mental health, substance use behavior, and psychosocial factors. Using multinomial logistic regression, factors were identified that differentiate current and former smokers from never smokers.
Results: In bivariate analysis, smoking status was related to demographic, mental health, substance use, and psychosocial factors. Most significantly, smoking status was associated with school enrollment status, current alcohol and marijuana use, and symptoms of depression. Multivariate modeling revealed that, compared to being a never smoker, the odds of current or former smoking were highest among those currently using either alcohol or marijuana. The odds of both current and former smoking were also higher among those reporting greater levels of gay community affinity. Finally, the odds of being a former smoker were higher for those reporting internalized antihomosexual prejudice.
Conclusion: This study identifies several factors related to smoking status in a diverse sample of young sexual minority males. These findings should encourage investigations of smoking disparities among younger MSM to look beyond common smoking risk factors in an attempt to understand etiologies that may be unique to this group. Such findings may indicate multiple points of potential intervention aimed at decreasing cigarette smoking within this vulnerable population.
doi:10.1089/lgbt.2015.0128
PMCID: PMC5073225  PMID: 27158762
adolescence; health disparities; men who have sex with men (MSM); tobacco use
17.  Religiosity as a protective factor for hazardous drinking and drug use among sexual minority and heterosexual women: Findings from the National Alcohol Survey 
Drug and alcohol dependence  2016;161:127-134.
Objective
Despite research documenting disparities in risk for alcohol-related problems among sexual minority women, few studies explore potential protective factors within this population. This study examines how religiosity may function as a protective or risk factor for alcohol-problems or other substance use among sexual minorities compared to heterosexuals.
Method
Data from 11,169 women who responded to sexual identity and sexual behavior questions from three population-based National Alcohol Survey waves (2000, 2005, 2010) were utilized for analyses of religiosity in relation to lifetime drinking, past year hazardous drinking, and past year drug use.
Results
Religiosity was significantly greater among exclusively heterosexual women compared to all sexual minority groups (lesbian, bisexual and heterosexual women who report same sex partners). Lesbians reported the lowest rates of affiliation with religions/denominations discouraging alcohol use. Past year hazardous drinking and use of any illicit drugs were significantly lower among exclusively heterosexual women compared to all sexual minority groups. High religiosity was associated with lifetime alcohol abstention and was found to be protective against hazardous drinking and drug use among both sexual minority and heterosexual women. Reporting religious norms unfavorable to drinking was protective against hazardous drinking among exclusively heterosexual women but not sexual minority women
Conclusions
Findings reveal the importance of considering sexual minority status in evaluation of religion or spirituality as protective among women. Future studies should explore religiosity in the context of other individual and environmental factors, such as positive identity development and community-level acceptance, which may be salient to resiliency among sexual minorities.
doi:10.1016/j.drugalcdep.2016.01.022
PMCID: PMC4792700  PMID: 26857897
Women; sexual minorities; alcohol consumption; religiosity; risk factors; protective factors
18.  Sexual Victimization and Hazardous Drinking Among Heterosexual and Sexual Minority Women 
Addictive Behaviors  2010;35(12):1152-1156.
Aims
Although research shows that sexual minority women report high rates of lifetime sexual victimization and high rates of hazardous drinking, investigators have yet to explore the relationships between sexual victimization and hazardous drinking in this population. In addition, because rates of these problems may vary within the sexual minority population, we examined and compared relationships between sexual victimization and hazardous drinking in exclusively heterosexual and sexual minority (mostly heterosexual, bisexual, mostly lesbian and exclusively lesbian) women.
Method
Data from 548 participants in the National Study of Health and Life Experiences of Women and 405 participants in the Chicago Health and Life Experiences of Women study were pooled to address these relationships. We compared hazardous drinking, childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization (both CSA and ASA) across the five sexual identity subgroups. We then fit a multilevel general linear model to examine group differences in the relationships between hazardous drinking and sexual victimization and to test for potential interactions between victimization and identity on hazardous drinking.
Results
Sexual minority women reported higher levels of hazardous drinking and higher rates of CSA and sexual revictimization than did exclusively heterosexual women. Revictimization was the strongest predictor of hazardous drinking among women who identified as mostly heterosexual and mostly lesbian.
Conclusions
This study extends previous research by examining associations between sexual victimization and hazardous drinking in heterosexual and sexual minority women and by exploring within-group variations in these associations among sexual minority women. Higher rates of lifetime sexual victimization and revictimization may help to explain sexual minority women’s heightened risk for hazardous drinking. The findings highlight the need for additional research that examines the meanings of sexual identity labels to more fully understand differences in risk within groups of sexual minority women as well as how sexual identity may affect responses to and interpretations of sexual victimization.
doi:10.1016/j.addbeh.2010.07.004
PMCID: PMC3006188  PMID: 20692771
Adult Sexual Assault; Childhood Sexual Abuse; Hazardous Drinking; Revictimization; Sexual Orientation
19.  Sexual Minority Cancer Survivors’ Satisfaction with Care 
Journal of psychosocial oncology  2015;34(1-2):28-38.
Background
Satisfaction with care is important to cancer survivors’ health outcomes. Satisfaction with care is not equal for all cancer survivors and sexual minority (i.e., lesbian, gay, and bisexual) cancer survivors may experience poor satisfaction with care.
Methods
Data were drawn from the 2010 LIVESTRONG national survey. The final sample included 207 sexual minority and 4,899 heterosexual cancer survivors. Satisfaction with care was compared by sexual orientation and a Poisson regression model was computed to test the associations between sexual orientation and satisfaction with care, controlling for other relevant variables.
Results
Sexual minority cancer survivors had lower satisfaction with care than heterosexual cancer survivors (B=−0.12, SE=0.04, Wald χ2=9.25, p<0.002), even controlling for demographic and clinical variables associated with care.
Conclusions
Sexual minorities experience poorer satisfaction with care compared to heterosexual cancer survivors. Clinical Implications: Satisfaction with care is especially relevant to cancer survivorship in light of the cancer-related health disparities reported among sexual minority cancer survivors.
doi:10.1080/07347332.2015.1118717
PMCID: PMC4916952  PMID: 26577277
Cancer Survivorship; Sexual Orientation; Care Satisfaction
20.  Sexual Minorities in England Have Poorer Health and Worse Health Care Experiences: A National Survey 
ABSTRACT
BACKGROUND
The health and healthcare of sexual minorities have recently been identified as priorities for health research and policy.
OBJECTIVE
To compare the health and healthcare experiences of sexual minorities with heterosexual people of the same gender, adjusting for age, race/ethnicity, and socioeconomic status.
DESIGN
Multivariate analyses of observational data from the 2009/2010 English General Practice Patient Survey.
PARTICIPANTS
The survey was mailed to 5.56 million randomly sampled adults registered with a National Health Service general practice (representing 99 % of England’s adult population). In all, 2,169,718 people responded (39 % response rate), including 27,497 people who described themselves as gay, lesbian, or bisexual.
MAIN MEASURES
Two measures of health status (fair/poor overall self-rated health and self-reported presence of a longstanding psychological condition) and four measures of poor patient experiences (no trust or confidence in the doctor, poor/very poor doctor communication, poor/very poor nurse communication, fairly/very dissatisfied with care overall).
KEY RESULTS
Sexual minorities were two to three times more likely to report having a longstanding psychological or emotional problem than heterosexual counterparts (age-adjusted for 5.2 % heterosexual, 10.9 % gay, 15.0 % bisexual for men; 6.0 % heterosexual, 12.3 % lesbian and 18.8 % bisexual for women; p < 0.001 for each). Sexual minorities were also more likely to report fair/poor health (adjusted 19.6 % heterosexual, 21.8 % gay, 26.4 % bisexual for men; 20.5 % heterosexual, 24.9 % lesbian and 31.6 % bisexual for women; p < 0.001 for each).
Adjusted for sociodemographic characteristics and health status, sexual minorities were about one and one-half times more likely than heterosexual people to report unfavorable experiences with each of four aspects of primary care. Little of the overall disparity reflected concentration of sexual minorities in low-performing practices.
CONCLUSIONS
Sexual minorities suffer both poorer health and worse healthcare experiences. Efforts should be made to recognize the needs and improve the experiences of sexual minorities. Examining patient experience disparities by sexual orientation can inform such efforts.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-014-2905-y) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-014-2905-y
PMCID: PMC4284269  PMID: 25190140
sexual orientation; health care experiences; disparities
21.  Sexual Orientation Disparities in Cardiovascular Biomarkers Among Young Adults 
Background
Emerging evidence from general population studies suggests that lesbian, gay and bisexual (LGB) adults are more likely to experience adverse cardiovascular outcomes relative to heterosexuals. No studies have examined whether sexual orientation disparities exist in biomarkers of early cardiovascular disease risk.
Purpose
To determine whether sexual orientation disparities in biomarkers of early cardiovascular risk are present among young adults.
Methods
Data come from Wave IV (2008–2009) of the National Longitudinal Study for Adolescent Health (N=12,451), a prospective nationally representative study of U.S. adolescents followed into young adulthood (mean age: 28.9 years). A total of 520 respondents identified as lesbian, gay, or bisexual. Biomarkers included C-reactive protein, glycosylated hemoglobin, systolic and diastolic blood pressure, and pulse rate. Analyses were conducted in 2012.
Results
In gender-stratified models adjusted for demographics (age, race/ethnicity); SES (income, education); health behaviors (smoking, regular physical activity, alcohol consumption); and BMI, gay and bisexual men had significant elevations in C-reactive protein, diastolic blood pressure, and pulse rate, compared to heterosexual men. Despite having more risk factors for cardiovascular disease, including smoking, heavy alcohol consumption, and higher BMI, lesbians and bisexual women had lower levels of C-reactive protein than heterosexual women in fully adjusted models.
Conclusions
Evidence was found for sexual orientation disparities in biomarkers of cardiovascular risk among young adults, particularly in gay and bisexual men. These findings, if confirmed in other studies, suggest that disruptions in core physiologic processes that ultimately confer risk for cardiovascular disease may occur early in the life course for sexual minority men.
doi:10.1016/j.amepre.2013.01.027
PMCID: PMC3659331  PMID: 23683979
22.  Disparities in Adverse Childhood Experiences among Sexual Minority and Heterosexual Adults: Results from a Multi-State Probability-Based Sample 
PLoS ONE  2013;8(1):e54691.
Background
Adverse childhood experiences (e.g., physical, sexual and emotional abuse, neglect, exposure to domestic violence, parental discord, familial mental illness, incarceration and substance abuse) constitute a major public health problem in the United States. The Adverse Childhood Experiences (ACE) scale is a standardized measure that captures multiple developmental risk factors beyond sexual, physical and emotional abuse. Lesbian, gay, and bisexual (i.e., sexual minority) individuals may experience disproportionately higher prevalence of adverse childhood experiences.
Purpose
To examine, using the ACE scale, prevalence of childhood physical, emotional, and sexual abuse and childhood household dysfunction among sexual minority and heterosexual adults.
Methods
Analyses were conducted using a probability-based sample of data pooled from three U.S. states’ Behavioral Risk Factor Surveillance System (BRFSS) surveys (Maine, Washington, Wisconsin) that administered the ACE scale and collected information on sexual identity (n = 22,071).
Results
Compared with heterosexual respondents, gay/lesbian and bisexual individuals experienced increased odds of six of eight and seven of eight adverse childhood experiences, respectively. Sexual minority persons had higher rates of adverse childhood experiences (IRR = 1.66 gay/lesbian; 1.58 bisexual) compared to their heterosexual peers.
Conclusions
Sexual minority individuals have increased exposure to multiple developmental risk factors beyond physical, sexual and emotional abuse. We recommend the use of the Adverse Childhood Experiences scale in future research examining health disparities among this minority population.
doi:10.1371/journal.pone.0054691
PMCID: PMC3553068  PMID: 23372755
23.  Sexual Orientation Disparities in Weight Status in Adolescence: Findings From a Prospective Study 
Obesity (Silver Spring, Md.)  2009;17(9):1776-1782.
A growing number of studies among adult women have documented disparities in overweight adversely affecting lesbian and bisexual women, but few studies have examined sexual orientation-related patterns in weight status among men or adolescents. We examined sexual orientation group trends in body mass index (BMI; kg/m2), BMI Z-scores, and overweight using 56,990 observations from 13,785 adolescent females and males in the Growing Up Today Study, a large prospective cohort of U.S. youth. Participants provided self-reported information from six waves of questionnaire data collection from 1998 to 2005. Gender-stratified linear regression models were used to estimate BMI and BMI Z-score and modified Poisson regression models to estimate risk ratios (RR) for overweight, controlling for age and race/ethnicity, with heterosexuals as the referent group. Among females, we observed fairly consistently elevated BMI in all sexual orientation minority groups relative to heterosexual peers. In contrast, among males we documented a sexual-orientation-by-age interaction indicating steeper increases in BMI with age from early to late adolescence in heterosexuals relative to sexual orientation minorities. Additional prospective research is needed to understand the determinants of observed sexual orientation disparities and to inform appropriate preventive and treatment interventions. The long-term health consequences of overweight are well-documented and over time are likely to exact a high toll on populations with elevated rates.
doi:10.1038/oby.2009.72
PMCID: PMC2756182  PMID: 19300430
Adolescents; BMI; Epidemiology; Overweight; Sexuality
24.  Prevalence of Cigarette Smoking among Adult Cancer Survivors in Korea 
Yonsei Medical Journal  2015;56(2):556-562.
Purpose
Cigarette smoking is associated not only with increased risk of cancer incidence, but also influences prognosis, and the quality of life of the cancer survivors. Thus, smoking cessation after cancer diagnosis is necessary. However, smoking behavior among Korean cancer-survivors is yet unknown.
Materials and Methods
We investigated the smoking status of 23770 adults, aged 18 years or older, who participated in the Health Interview Survey of the Korea National Health and Nutrition Examination Survey from 2007 to 2010. Data on the cancer diagnosis and smoking history were obtained from an interview conducted by trained personals. "Cancer-survivor" was defined as anyone who has been diagnosed with cancer by a physician regardless of time duration since diagnosis. Smoking status was classified into "never-smoker", "former-smoker", and "current-smoker". Former-smoker was further divided into "cessation before diagnosis" and "cessation after diagnosis".
Results
Overall, 2.1% of Korean adults were cancer-survivors. The smoking rate of Korean cancer-survivors was lower than that of non-cancer controls (7.8±1.3% vs. 26.4±0.4%, p<0.001). However, 53.4% of the cancer-survivors continued to smoke after their cancer diagnosis. In multivariate analysis, male gender [odds ratio (OR), 6.34; 95% confidence interval (CI), 2.62-15.31], middle-aged group (OR, 2.74; 95% CI, 1.12-6.72), the lowest income (OR, 4.10; 95% CI, 1.19-14.15), living with smoking family member(s) (OR, 5.49; 95% CI, 2.42-12.48), and the poor self-perceived health status (OR, 2.78; 95% CI, 1.01-7.71) were independently associated with persistent smoking among Korean cancer-survivors.
Conclusion
The smoking rate among Korean cancer survivors is low. However, the smoking cessation rate after the cancer diagnosis is also low. This mandates comprehensive and systematic intervention for smoking cessation among cancer-survivors.
doi:10.3349/ymj.2015.56.2.556
PMCID: PMC4329372  PMID: 25684009
Cancer; survivor; smoking
25.  A systematic review of the aetiology of tobacco disparities for sexual minorities 
Tobacco control  2011;22(2):66-73.
Objective
To conduct a systematic review of the literature examining risk factors/correlates of cigarette smoking among lesbian, gay and bisexual (ie, sexual minority) populations.
Methods
Sets of terms relevant to sexual minority populations and cigarette smoking were used in a simultaneous search of 10 databases through EBSCOhost. The search was limited to the peer-reviewed literature up to January 2011, using no geographic or language limits. For inclusion, the paper was required to: (1) have been written in English, (2) have sexual minorities (defined by either attraction, behaviour, or identity) included in the study population and (3) have examined some form of magnitude of association for risk factors/correlates of any definition of cigarette smoking. A total of 386 abstracts were reviewed independently, with 26 papers meeting all inclusion criteria. Abstracts were reviewed and coded independently by authors JB and JGLL using nine codes derived from the inclusion/exclusion criteria.
Results
Studies used various measures of sexual orientation and of smoking. Risk factors that could be considered unique to sexual minorities included internalised homophobia and reactions to disclosure of sexual orientation. Some studies also indicated common smoking risk factors experienced at higher rates among sexual minorities, including stress, depression, alcohol use and victimisation.
Conclusions
This review identified risks that were associated with sexual minority status and common to the general population but experienced at potentially higher rates by sexual minorities. Government and foundation funds should be directed towards research on the origins of this disparity.
doi:10.1136/tobaccocontrol-2011-050181
PMCID: PMC3779881  PMID: 22170335

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