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1.  Gay Acres: Sexual Orientation Differences in Health Indicators Among Rural and Non-rural Individuals 
Purpose
Geographic location is a significant factor that influences health status and health disparities. Yet, little is known about the relationship between geographic location and health and health disparities among lesbian, gay, and bisexual (LGB) persons. This study used a US population-based sample to evaluate the associations of sexual orientation with health indicators by rural/non-rural residence.
Methods
Data were pooled from the 10 states that collected sexual orientation in the 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Rural status was defined using metropolitan statistical area (MSA), and group differences by sexual orientation were stratified by gender and rural/non-rural status. Chi-square tests for categorical variables were used to assess bivariate relationships. Multivariable logistic regression models stratified by gender and rural/non-rural status were used to assess the association of sexual orientation to health indicators, while adjusting for age, race/ethnicity, education, and partnership status. All analyses were weighted to adjust for the complex sampling design.
Findings
Significant differences between LGB and heterosexual participants emerged for several health indicators, with bisexuals having a greater number of differences than gay men/lesbians. There were fewer differences in health indicators for rural LGB participants compared to heterosexuals than non-rural participants.
Conclusions
Rural residence appears to influence the pattern of LGB health disparities. Future work is needed to confirm and identify the exact etiology or rural/non-rural differences in LGB health.
doi:10.1111/jrh.12161
PMCID: PMC4887433  PMID: 26625172
bisexuality; health disparities; homosexuality; rural health; sexual orientation
2.  Health Inequalities Among Sexual Minority Adults 
Background
Improving the health of lesbian, gay, and bisexual (LGB) individuals is a Healthy People 2020 goal; however, the IOM highlighted the paucity of information currently available about LGB populations.
Purpose
To compare health indicators by gender and sexual orientation statuses.
Methods
Data are from Behavioral Risk Factor Surveillance System surveys conducted January–December of 2010 with population-based samples of non-institutionalized U.S. adults aged over 18 years (N=93,414) in ten states that asked about respondents’ sexual orientation (response rates=41.1%–65.6%). Analyses were stratified by gender and sexual orientation to compare indicators of mental health, physical health, risk behaviors, preventive health behaviors, screening tests, health care utilization, and medical diagnoses. Analyses were conducted in March 2013.
Results
Overall, 2.4% (95% CI=2.2, 2.7) of the sample identified as LGB. All sexual minority groups were more likely to be current smokers than their heterosexual peers. Compared with heterosexual women, lesbian women had over 30% decreased odds of having an annual routine physical exam, and bisexual women had over 2.5 times the odds of not seeking medical care owing to cost. Compared with heterosexual men, gay men were less likely to be overweight or obese, and bisexual men were twice as likely to report a lifetime asthma diagnosis.
Conclusions
This study represents one of the largest samples of LGB adults and finds important health inequalities, including that bisexual women bear particularly high burdens of health disparities. Further work is needed to identify causes of and intervention for these disparities.
doi:10.1016/j.amepre.2013.11.010
PMCID: PMC4102129  PMID: 24650836
3.  Operational Definitions of Sexual Orientation and Estimates of Adolescent Health Risk Behaviors 
LGBT health  2013;1(1):42-49.
Purpose
Increasing attention to the health of lesbian, gay, and bisexual (LGB) populations comes with requisite circumspection about measuring sexual orientation in surveys. However, operationalizing these variables also requires considerable thought. This research sought to document the consequences of different operational definitions of sexual orientation by examining variation in health risk behaviors.
Methods
Using Massachusetts Youth Risk Behavior Survey data, we examined how operational definitions of sexual behavior and sexual identity influenced differences among three health behaviors known to disparately affect LGB populations: smoking, suicide risk, and methamphetamine use. Sexual behavior and sexual identity were also examined together to explore if they captured unique sources of variability in behavior.
Results
Estimates of health disparities changed as a result of using either sexual behavior or sexual identity. Youth who reported their sexual identity as “not sure” also had increased odds of health risk behavior. Disaggregating bisexual identity and behavior from same-sex identity and behavior frequently resulted in the attenuation or elimination of health disparities that would have otherwise been attributable to exclusively same-sex sexual minorities. Finally, sexual behavior and sexual identity explained unique and significant sources of variability in all three health behaviors.
Conclusion
Researchers using different operational definitions of sexual orientation could draw different conclusions, even when analyzing the same data, depending upon how they chose to represent sexual orientation in analyses. We discuss implications that these manipulations have on data interpretation and provide specific recommendations for best-practices when analyzing sexual orientation data collected from adolescent populations.
PMCID: PMC4123795  PMID: 25110718
adolescents; data analysis; health behavior; measurement; sexual orientation

Results 1-3 (3)