professional to access hormone therapy and surgery), high satisfaction can be achieved.

Several salient contextual influences, including sociodemographic and familial factors, influence the health of sexual- and gender-minority adults.

One prominent contextual influence on LGBT individuals is race/ ethnicity and its intersection with low socioeconomic status. While few studies have examined racial/ethnic differences in health outcomes across sexual- and gender-minority populations, some studies suggest that racial/ ethnic variability in mental disorders may exist. Using a sample of 388 New York City residents who identified as lesbian, gay, or bisexual, Meyer and colleagues (2008) found that black LGB individuals experienced a lower prevalence of all psychiatric disorders than Latino and white LGB individuals (Meyer et al., 2008). The same study also found that Latino sexual minorities attempted suicide more often than white sexual minorities. Using survey data to examine health indicators among racial and ethnic minorities, Mays and colleagues (2002) compared a sample of self-identified black and Latino lesbians obtained from a non-population-based survey (n = 365) with a sample of self-identified heterosexual black and Latino women drawn from a population-based survey. She found that black and Latino lesbians and bisexual women had some negative health outcomes compared with heterosexual women, including higher rates of obesity and increased rates of tobacco and alcohol use; they also had lower rates of health insurance coverage.

While few studies have looked at racial/ethnic differences in health outcomes in LGBT populations, even fewer have explored the effect of geography. Some small qualitative studies suggest that social isolation exists among rural LGB populations (McCarthy, 2000; Williams et al., 2005). To evaluate the health status of lesbians living in southern states, Austin and Irwin (2010) compared findings from a convenience sample of self-identified lesbians living in the south (n = 1,141) with results from CDC’s Behavioral Risk Factor Surveillance System. They found that the lesbians residing in southern states were more likely to have experienced recent depression and more likely to have engaged in risky health behaviors than women in the general U.S. population (in both southern and nonsouthern states).

Socioeconomic status is another relevant contextual factor that may affect sexual minorities. One study, examining a sample of men who have