affected by larger cultural and legal forces. Personal relationships, social support, and community involvement may also assume different forms, similarly affected by cultural influences.

The last two decades have seen a growing recognition of the unique health needs of LGBT individuals. Research, however, is still sparse on the developmental life stage of adulthood with regard to the specific health issues confronted by the LGBT community broken down by race/ethnicity and socioeconomic status, with the largest body of work focusing on HIV/ AIDS.

The following sections describe research on LGBT adults in the areas of the development of sexual orientation and gender identity; mental health status; physical health status; risk and protective factors; health services; and contextual influences, including demographic characteristics and the role of the family. The final section presents a summary of key findings and research opportunities. It is important to note that some of the literature presented in this chapter may also appear in the following chapter on later adulthood because studies do not always delineate their findings according to the age ranges used in this report, and certain studies may present findings that are relevant to both early/middle and later adulthood.

DEVELOPMENT OF SEXUAL ORIENTATION AND GENDER IDENTITY

The process of sexual orientation development and of “coming out” is different for each LGBT individual. As individuals come out, they reach various milestones in the process: they experience their first awareness of same-sex attraction, they have their first same-sex sexual experience, they self-identify as LGB, and they choose to disclose their sexual orientation identity to others. Depending on contextual factors in their lives, LGB individuals may choose to come out at many different times throughout the life course, and the stage at which they come out will influence their experiences. Moreover, the association between sexual orientation identity, or coming out, and mental health is not invariant across LGBT populations in the United States. Multiple social, cultural, and psychological influences affect the extent to which members of homosexually active populations experience favorable consequences from self-identity as lesbian or gay. Thus, the assumption of a universal positive link between coming out and mental health appears unwarranted.

Gates (2010) examined the relationship between demographic factors and coming out among different age cohorts using data from the 2008 General Social Survey, a nationally representative sample of 2,023 adults aged 18 and older. Of the 1,773 respondents providing information about sexual orientation and behavior, 58 self-identified as LGB, and 104 reported



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