along the multiple dimensions of sexual orientation: sexual identity, sexual behavior, and attraction or desire. Only in some cases are definitions conceptualized based on the goals of a particular study. Population-based data are needed to better understand these dimensions of sexual orientation and the interrelationships among them.

Lesbians are a very diverse group, varying along dimensions of sexual orientation and in terms of demographic characteristics such as socioeconomic status, race and ethnicity, culture, religious background, and age. Population-based "baseline" studies are needed to better understand the characteristics of the population and how these characteristics interrelate with health status. Studies are especially needed to better understand the developmental course of lesbians across the life span. In particular, research is needed on the impact of stigma on lesbians across the life span, especially among different racial and ethnic groups and a range of socioeconomic classes. International and cross-cultural studies may also be helpful for increasing understanding of the interrelationships among these factors and their impact on lesbian health. Because the field of lesbian health research is still relatively undeveloped, studies are needed that use qualitative research methods, such as ethnographies and focus groups, to increase understanding of the diversity and distinct subgroupings and behaviors of the population.

Research Priority 3: Research is needed to identify possible barriers to access to mental and physical health care services for lesbians and ways to increase their access to these services.

It is commonly believed in the lesbian community that lesbians fail to access traditional health services at the same levels as other women, although population-based data are not available to determine the degree to which this problem exists. Nonetheless, the committee did identify a number of barriers to access to mental and physical health care services for lesbians. These include structural barriers, such as the potential impact of managed care and the lack of legal recognition of relationship partners; financial barriers, which have an impact on access to health insurance coverage; and personal and cultural barriers, including attitudes of health care providers and the lack of cultural competency among providers for



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