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1.  Gay Acres: Sexual Orientation Differences in Health Indicators Among Rural and Non-rural Individuals 
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.
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.
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.
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.
PMCID: PMC4887433  PMID: 26625172
bisexuality; health disparities; homosexuality; rural health; sexual orientation
2.  Health Care Use, Health Behaviors, and Medical Conditions Among Individuals in Same-Sex and Opposite-Sex Partnerships 
Medical care  2016;54(6):547-554.
Prior research documents disparities between sexual minority and nonsexual minority individuals regarding health behaviors and health services utilization. However, little is known regarding differences in the prevalence of medical conditions.
To examine associations between sexual minority status and medical conditions.
Research Design
We conducted multiple logistic regression analyses of the Medical Expenditure Panel Survey (2003–2011). We identified individuals who reported being partnered with an individual of the same sex, and constructed a matched cohort of individuals in opposite-sex partnerships.
A total of 494 individuals in same-sex partnerships and 494 individuals in opposite-sex partnerships.
Measures of health risk (eg, smoking status), health services utilization (eg, physician office visits), and presence of 15 medical conditions (eg, cancer, diabetes, arthritis, HIV, alcohol disorders).
Same-sex partnered men had nearly 4 times the odds of reporting a mood disorder than did opposite-sex partnered men [adjusted odds ratio (aOR) = 3.96; 95% confidence interval (CI), 1.85–8.48]. Compared with opposite-sex partnered women, same-sex partnered women had greater odds of heart disease (aOR =2.59; 95% CI, 1.19–5.62), diabetes (aOR= 2.75; 95% CI, 1.10–6.90), obesity (aOR =1.92; 95% CI, 1.26–2.94), high cholesterol (aOR = 1.89; 95% CI, 1.03–3.50), and asthma (aOR=1.90; 95% CI, 1.02–1.19). Even after adjusting for sociodemographics, health risk behaviors, and health conditions, individuals in same-sex partnerships had 67% increased odds of past-year emergency department utilization and 51% greater odds of ≥3 physician visits in the last year compared with opposite-sex partnered individuals.
A combination of individual-level, provider-level, and system-level approaches are needed to reduce disparities in medical conditions and health care utilization among sexual minority individuals.
PMCID: PMC5137194  PMID: 26974678
sexual orientation; health disparities; health care utilization; minority health
3.  Operational Definitions of Sexual Orientation and Estimates of Adolescent Health Risk Behaviors 
LGBT health  2013;1(1):42-49.
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.
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.
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.
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)