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Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
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Index

[Page numbers followed by b, f, or t refer to boxed text, figures, or tables, respectively.]

A

Academic performance, risks for LGBT youth, 158159

Adolescents. See Youth, LGBT

Adoption, 47

Adulthood, early/middle

body image, 198

cancer, 204206

cardiovascular disease, 207

childhood abuse, 115116, 219220, 271

depression in, 190, 193194

discrimination, 212213, 233

eating disorders, 198199, 232

health care access and utilization, 222225, 234

health care quality, 226227

HIV/AIDS, 208210

mental health status, 189192, 232

mood and anxiety disorders, 190, 192193

obesity, 207208

parenthood and family formation in, 228231, 234, 235

protective factors, 220222, 233

reproductive health in, 203204

research opportunities, 234235

risk factors, 211, 233

sexual functioning in, 202203

sexual orientation and gender identity, development of, 186189

sexually transmitted infections, 210211

sociodemographic factors in health outcomes, 227228, 234

stigmatization, 212213, 233

substance use in, 214219, 233

suicidal ideation and behavior, 190, 191, 195198, 232

violence risk in, 213214, 233

See also Elders, LGBT

Adulthood, late. See Elders, LGBT

Age groups

cohort differences, 15

HIV/AIDS distribution, 265

LGBT population patterns, 6061

See also Adulthood, early/middle;

Elders, LGBT;

Youth, LGBT

Agency for Healthcare Research and Quality, 120

Alcohol use

among LGBT adults, 5, 205, 216217, 218, 219

among LGBT elders, 270271, 282

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

among LGBT youth, 160, 171

See also Substance use

American Association for Public Opinion Research, 128

American College of Obstetricians and Gynecologists, 204

American Indians and Alaska Natives, 72

American Psychiatric Association, 38, 251

American Psychological Association, 38, 3940

American Public Health Association, 3940

American Society for Reproductive Medicine, 204

Anal cancer, 205206, 232, 263

Anxiety. See Mood and anxiety disorders

Asians/Pacific Islanders, 3031, 194, 226, 228

Association of American Medical Colleges, 6566

B

Barriers to care

deficiencies in provider knowledge and training as, 6566

geographical location as factor in, 16

health insurance coverage, 6667, 274

for HIV/AIDS, 69

for LGBT adults, 224, 234

for LGBT youth, 62, 274

personal-level, 62

provider bias, 6364, 274275

recommendations for research, 8, 295

reluctance to disclose sexual orientation or gender identity as, 14, 62, 63, 224225, 269270, 274

research opportunities, 75, 235

stigma-related, 6165

structural, 61, 6465

for transgender persons, 225, 274

types of, 2, 75, 224

Benjamin, Harry, 49, 50

Bigender persons, 26

Bisexual individuals

acceptance in sexual-minority community, 213

coming out and disclosure behaviors, 31, 213, 253, 254

depression, 194, 256, 257

eating disorders, 150151

economic status, 60, 74

family acceptance, 253

hate crime, 214

health service utilization, 222223

organized community of, 41

partner and family relationships research, 228

prevalence estimates, 5456

protective factors for youth, 164

racial/ethnic differences, 31

self-reported health status, 259

stigmatization and discrimination, 212213

substance use, 218

suicidal ideation and behavior, 195, 258

variability in sexual identity, 28, 212213

See also Bisexual men;

Bisexual women;

Lesbian, gay, bisexual, and transgender (LGBT) populations

Bisexual men

depression, 194

early experience of sexuality, 29

health services utilization, 5, 160, 191, 274

HIV risk and outcomes, 23, 155, 208209

mental health status, 190, 191, 192, 193, 194, 221

parenthood among, 47

prevalence estimates, 56

relationship patterns among elders, 277

sexual behavior in youth, 153, 155

substance use, 5, 160, 161, 215, 216, 217, 218

suicidal ideation and behavior, 195, 258

See also Bisexual individuals;

Lesbian, gay, bisexual, and transgender (LGBT) populations

Bisexual women

cancer risks, 5, 232, 263, 282

coming out and disclosure behaviors, 187188

contraceptive use, 261

depression, 194

early experiences of sexuality, 29

eating disorders, 150151, 198199

health services utilization, 5, 190191, 223, 234, 260, 274, 282

heart disease risk, 207, 235

history of childhood abuse among, 219

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

HIV risk and outcomes, 41, 70, 155156, 233

mental health status, 190191, 192, 193, 194, 204, 221

obesity risk, 5, 205, 207208, 233

parenthood among, 47, 187188, 204

prevalence estimates, 56

racial/ethnic differences, 227

relationship patterns among elders, 277

reproductive health in late adulthood, 261

sexual behavior and pregnancy in youth, 153154

sexually transmitted infection, 211

substance use, 5, 160161, 205, 215216, 217218, 219, 271

suicidal ideation and behavior, 190191, 195, 197, 258

victimization risk, 171

See also Bisexual individuals;

Lesbian, gay, bisexual, and transgender (LGBT) populations

Black men and women. See Race/ethnicity

Body image, 150, 198, 208

Breast cancer, 5, 205, 206, 232, 263, 282

Breast/chest surgery, 199, 206

C

California Health Interview Survey, 99101, 102b

California Quality of Life Survey, 101

Cancer risk

data sources, 204205

in early/middle adulthood, 205206, 232233

in late adulthood, 262264

research opportunities, 235

See also specific cancer types

Cardiovascular disease, 207, 211, 235, 264265, 282

Caregiving issues, 267, 275, 277280

Cauldwell, David Oliver, 49

Cervical cancer, 264, 274

Childhood abuse

associated health problems in adulthood, 115116, 219220

prevalence, 115, 163164, 171, 219220, 262, 271272

racial/ethnic patterns, 220

Children, nonheterosexual and transgender. See Youth, LGBT

Children of sexual minority parents

as caretakers for parents, 278

developmental outcomes, 5, 229230, 234

prevalence, 47, 59

See also Parents, LGBT

Chlamydia, 210

Coming out and disclosure behaviors

in adolescence, 143, 144, 167, 168, 172

age cohort differences, 15, 188, 253

demographic variation, 74

in early/middle adulthood, 186189

experiences of older LGBT cohort, 253255

family responses, 168, 169, 172, 231, 253

in health care system, 167, 172, 224, 269270, 274

individual differences, 186

in late adulthood, 255256, 269270

mental health linkage, 186

motherhood and, 187188

as protective factor for youth, 164165

racial/ethnic patterns in, 3132, 168, 253

research opportunities, 188

responses to HIV/AIDS epidemic, 4041

stage models, 189

transgender individuals, 32, 188189, 253, 254255

in workplace, 220, 254

See also Concealment of sexual orientation

Communications technology, 298

Community Intervention Trial for Youth, 105

Compton’s Cafeteria riot, 51

Concealment of sexual orientation

to avoid discrimination in health care system, 63, 64, 224225, 269, 274

by bisexual people, 213

challenges to LGBT research, 89, 9293

in minority stress model, 20

See also Coming out and disclosure behaviors

Conceptual framework for research, 2, 6, 1923, 121, 293, 294.

See also Cross-cutting perspectives

Condom use, 209

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
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Contraceptive use, 261, 282

Convenience samples, 105

Conversion therapy, 146

Crisis competence, 5, 272, 282

Cross-cutting perspectives, 6, 7, 293, 294296

D

Data collection

challenges in LGBT research, 3, 53, 74, 89, 94

cognitive interviews, 122

concealment of sexual orientation as obstacle to, 9293, 130

definitional and measurement challenges, 9091

hate crimes, 42, 43

Internet/online surveys, 114115

one-on-one interviews, 121

potential errors, 111114, 112t, 131

qualitative methods, 120122, 131

quantitative methods, 109, 131

recommendations for, 7, 9, 296297, 299302

response to AIDS epidemic, 69

on sexual orientation and gender identity, 9, 94, 118120, 122123

sources for transgender population, 1819, 27

sources of data on LGBT health, 2, 1819, 122123, 124126t, 127f

standardization of sexual orientation and gender identity measures, 910, 9192, 130, 303304

survey methods, 109114, 122, 131

See also Sampling, population

Daughters of Bilitis, 36

Defense of Marriage Act, 44, 45

Demographic research, 7, 296297

recommendations for, 6f, 294f

Demographics of LGBT population

geographic distribution, 5758, 74

household composition, 5859, 75, 94

population prevalence, 5357, 55t, 6061, 145, 235

See also Age groups;

Educational attainment;

Race/ethnicity;

Sociodemographic factors in health outcomes;

Socioeconomic status

Department of Health and Human Services, recommendations for, 9, 299303

Depression

among LGBT youth, 147, 150

in early/middle adulthood, 190, 193194, 232

in late adulthood, 256257, 282

Diagnostic and Statistical Manual of Mental Disorders, 2, 26, 3536, 37, 50, 251

Diffusion of Effective Behavioral Interventions, 116

Disability, 266267, 282

Drag kings and queens, 26

E

Eating disorders

among LGBT youth, 150151, 170

in early/middle adulthood, 198199, 232

history of childhood abuse and, 219220

Educational attainment

differences in life experience within LGBT community, 1516

early sexual experiences and, 187

income and, 60, 277

of nonheterosexual people, 277

protective factors for LGBT elders, 273, 282

Education and training of health professionals

barriers to care for LGBT population, 2, 6566, 75, 167, 224

cultural competency, 65

recommendations for research training, 10, 304305

Eisenhower administration, 35

Elders, LGBT

cancer, 262264

cardiovascular disease, 264265

caregiving issues, 5, 267, 275

childhood abuse experiences of, 271272

crisis competence, 5, 272, 282

current research base and data sources, 252

depression, 256257

disability among, 266267

discrimination, 274276

end-of-life issues, 280281

family role in lives of, 277280, 283

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

friendship networks, 279

health care access and utilization, 273274, 282283

HIV/AIDS and, 5, 265266

living arrangements, 277278

long-term care, 275, 283, 284

mental health status, 256, 282

mood and anxiety disorders among, 256

obesity, 265

physical health status, 5, 259260, 282

protective factors, 5, 257, 268, 272273, 282

quality of care expectations, 274275

reproductive health of, 260262

research opportunities, 283284

risk factors, 5, 268, 282

sexual functioning among, 260

sexual orientation and gender identity, development of, 253256

social context of health outcomes for, 277280, 283

sociodemographic factors in health outcomes, 276277, 283

stigmatization, 5, 251, 268270

substance use among, 270271, 282

suicidal ideation and behavior, 257258, 282

victimization and violence, 261262, 268, 269, 270, 271, 282

Electronic health records, recommendations for data collection in, 9, 302303

Ellis, Havelock, 48

Employment

health insurance coverage, 66

historical discrimination against LGBT people, 3536

HIV risk and, 72

workplace disclosure of sexual orientation, 31, 254

workplace environment, 220

End-of-life issues, 280281

Erectile dysfunction, 202203, 232, 260

Estrogen. See Hormone therapy to affirm gender identity

F

Families

acceptance and rejection of LGBT member by, 168, 169, 172, 231, 253

of choice, 278, 279, 283

elder care by, 277278

household composition patterns, 5859

intervention with LGBT youth in, 4

research opportunities, 173

role of, in health outcomes for LGBT adults, 231

role of, in health outcomes for LGBT elders, 277279, 280

role of, in health outcomes for LGBT youth, 168169, 172

suicide risk among LGBT youth and, 149

support for LGBT parents from, 231

violence against LGBT youth in, 159

See also Parents, LGBT

Family and Medical Leave Act, 46

Federal Bureau of Investigation, 42, 43

Focus groups, 121122

Foster-parenting, 47, 169170

Freud, Sigmund, 33, 34

Friendships, 279

G

Gay men

age at sexual identity awareness, 143

age patterns, 60

anal cancer risk, 205206, 232

body image dissatisfaction, 198

coming out and disclosure behaviors, 31, 187, 253, 254

depression risk, 193194, 256257, 282

early sexual experiences, 188

eating disorder risk, 198

economic status, 60, 74

educational attainments, 60

erectile dysfunction in, 202203, 260

fatherhood among, 47, 59, 228229, 234

geographic distribution, 58

hate crime risk, 214

history of childhood abuse among, 219

mood and anxiety disorder risk, 192, 193

population prevalence, 55, 56

prostate cancer risk, 262263

protective factors, 164165, 220221

racial/ethnic differences, 31, 187, 194

relationship status, 5859

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

self-reported health, 259

sexual behavior in youth, 153, 154

sexual identity development, 142144

social support, 220221, 272273

socioeconomic status, 227228

substance use, 215216, 217, 218, 271

suicide, 195, 258

See also HIV/AIDS;

Lesbian, gay, bisexual, and transgender (LGBT) populations

Gender, defined, 25

Gender dysphoria

definition, 26, 50

development in youth, 145

research opportunities, 202

standards of care, 50, 199202

Gender expression

definition, 26

development in youth, 145

Gender identity

age at awareness, 143

definition, 2526

definitional and measurement challenges, 9092

development in early/middle adulthood, 186189

development in late adulthood, 253256

development in LGBT youth, 142146, 170, 255

ethnic identity and, 144

origins of clinical conceptualization, 49

recommendations for research, 910, 299304

standardization of measures, 910, 303304

theoretical models of development, 143

transgender, 189

Gender identity disorder

clinical conceptualization, 26, 50

diagnostic criteria for children, 50, 151, 152b

standards of care, 199200

treatment of youth, 151153

Gender queer, 26, 202

Gender role conformity, 26

General Social Survey, 56

Geographic location

distribution of LGBT population, 5758, 74

as health outcome factor, 16, 227

See also Rural–urban differences

Gonorrhea, 210211

Grandparents, LGBT, 278

Growing Up Today Study, 118, 118b

H

Harry Benjamin International Gender Dysphoria Association, 50

Hate crimes

community resistance to, 42

criminalization of, 4243

data collection, 42, 43

HIV/AIDS epidemic and, 68

prevalence, 43, 68, 214

psychological stress effects of, 213214

Hate Crimes Sentencing Enhancement Act, 4243

Hate Crimes Statistics Act, 42

Health, defined, 13 n.1

Health care system

access and utilization patterns of LGBT adults, 62, 222223, 234, 273274, 282283

access of LGBT youth, 166, 172

attempts to change sexual orientation, 36

destigmatization of homosexuality in, 3637, 38

disclosure behaviors of LGBT adults in, 63, 224225, 269270, 274

disclosure behaviors of LGBT youth in, 166, 167, 172

evolution of sex transformation medicine, 4850, 5152

quality of care for LGBT youth, 167, 172

response to HIV/AIDS epidemic, 40, 6974

in rural areas, 276277

stigmatization and discrimination in, 32, 34, 36, 6364, 167, 224, 269270, 274276

See also Barriers to care;

Education and training of health professionals

Health insurance, 6667, 227, 234, 274

Health of LGBT population

best practices for research on, 4, 119, 123129

community health infrastructure, 14

conceptual framework for research on, 2, 4, 1923, 294296

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

contextual factors, 23, 25

current knowledge base, 1, 4, 8, 11, 234235

data sources, 2, 1819, 122123, 124126t, 127f

marriage and, 4546, 221

recommendations for research, 68, 10, 293304

research challenges, 89, 130

research opportunities, 4, 75, 235

self-reported, 259

stigmatization and victimization effects, 2, 1314, 32, 74, 268270

See also Adulthood, early/middle;

Barriers to care;

Elders, LGBT;

Mental health;

Youth, LGBT

Healthy People 2020, 22

Hirschfeld, Magnus, 4849

HIV/AIDS

age distribution, 265

among LGBT youth, 154157, 171

among transgender persons, 208, 209, 224, 233

bereavement outcomes in LGBT community, 279, 280

cardiovascular disease and, 207

education and training of health care providers, 224

erectile dysfunction and, 202

government programs and policies, 6869

human papillomavirus infection in, 206, 263

incidence, 71, 73f

mortality, 71

in older adults, 5, 265266, 282

outcomes in LGBT community, 3841

preventive interventions, 71, 210

public awareness and understanding, 4041, 6768

racial/ethnic patterns, 4, 5, 7174, 73f, 155, 171, 208, 233

Reagan administration, 69

research, 69, 7071, 72f

response of LGBT community, 6970

risk for bisexual men, 208209

risk in early/middle adulthood, 5, 208210

significance of epidemic for LGBT community, 23, 41

social risk factors, 72

stigmatization and discriminatory responses, 3940, 6769

vulnerable groups, 4

Homelessness, 4, 161163, 171

Hooker, Evelyn, 37

Hormone replacement therapy, 261, 282

Hormone therapy to affirm gender identity

age at initiation, 255

assessment and treatment planning, 199

cancer risk in, 206, 211, 233

cardiovascular disease and, 207, 211

current clinical approach, 52, 200202

health outcomes, 157, 211, 233

historical origins, 49

illicit, 200

reproductive health and, 204

research opportunities, 204, 284

risks for transgender elders, 5, 264265, 282

sexual functioning and, 203

standards of care, 199, 200

in youth, 153, 157, 171

Hospital care, 119

Human papillomavirus, 206, 263

Hysterectomy, 261, 282

I

Inequities in health care

geographical factors, 16, 227

racial/ethnic patterns of HIV infection, 4, 5, 7174, 155, 171, 208, 233

recommendations for research, 6f, 8, 294f, 297

See also Barriers to care;

Quality of care for LGBT people

Insurance. See Health insurance

Internet/online surveys, 114115

Internet use to obtain sexual partners, 208

Interpersonal violence, 214

Intersectional perspective, 7

conceptual basis, 2, 2122, 295296

rationale for LGBT research with, 21, 22, 23, 294, 295296

recommendations for research, 6f, 294f

Intersexuality, 1617

Intervention research, 6f, 8, 294f, 297298

Inversion, sexual, 33

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
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J

Johns Hopkins University, 4950

Joint Commission on Accreditation of Healthcare Organizations, 119

Jorgensen, Christine/George, 49

K

Kalman filter, 9596

Kinsey, Alfred, 3637, 53

L

Latino/latina population. See Race/ethnicity

Lawrence v. Texas, 41

Legal environment

criminalization of homosexual conduct, 3336

current state of, for sexual minorities, 42

effects of HIV/AIDS epidemic, 3940

end-of-life issues, 281

implications for health, 2, 33

LGBT civil rights movement, 3738

marriage rights, 4447

protections for LGBT populations, 4144

psychological well-being and, 220

rights of LGBT parents, 4748, 229

transgender history, 48, 5051, 52

Lesbian, gay, bisexual, and transgender (LGBT) populations

age distribution, 6061

challenges to conducting research in, 3, 5253

commonalities among, 1314

definitional and measurement issues, 9092

development and empowerment of community, 14, 35, 36, 3738, 42, 6970

diversity within, 1, 1113, 1516

in early/middle adulthood. See Adulthood, early/middle

economic status, 60, 74

geographic distribution, 5758, 74

hate crime prevalence against, 214

history of childhood abuse, 219220

household composition, 5859

in later adulthood. See Elders, LGBT

legal protections for, 4144

older adults. See Elders, LGBT

prevalence estimates, 5357, 55t

response to HIV/AIDS epidemic, 6970

sampling methodology for research on, 3, 9396

self-identification patterns, 3031

sexual orientation disclosure behaviors, 3132

strengths and resiliency, 14

subpopulations, 1

youth population. See Youth, LGBT

See also Health of LGBT population

Lesbians

age patterns, 6061

body image among, 150, 208

breast cancer, 5, 205, 232, 263, 264, 282

cardiovascular disease, 207, 235, 264, 282

coming out and disclosure behaviors, 31, 187188, 253, 254

depression, 193194, 256257, 282

eating disorders, 198

economic status, 60, 74, 269

educational attainments, 60

geographic distribution, 58, 227

hate crime, 214

health service utilization, 5, 222224, 234, 274

history of child abuse among, 219

HIV risk, 155156

mental health status, 190, 192, 193194

obesity, 5, 207208, 227, 233, 265

parenthood, 5, 47, 59, 187188, 204, 205, 228230, 231, 234, 261

population prevalence, 55, 56

protective factors for psychological well-being, 221

relationship status, 5859

reproductive health, 153154, 204, 261, 263264

school problems, 158159

self-reported health, 259

sexual behavior, 153154, 261

sexual identity development, 142144, 187

sexually transmitted infection, 211

sexual satisfaction in adulthood, 203

sociodemographic factors in health outcomes, 227

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

substance use, 160161, 205, 215218, 227, 271

suicide risk, 195, 227, 258

teen pregnancy, 153154, 170

See also Lesbian, gay, bisexual, and transgender (LGBT) populations

LGBT. See Lesbian, gay, bisexual, and transgender populations

Life-course framework

conceptual basis, 2, 1920, 22, 295

key dimensions of, 20

life stages in, 4

rationale for LGBT research with, 20, 295

recommendations for research, 6f, 7, 294f, 295, 300302t

See also Adulthood, early/middle;

Elders, LGBT;

Youth, LGBT

Longitudinal cohort studies, 7, 117118, 131, 295, 302

Long-term care, 275, 283, 284

M

Mammograms, 222, 223224

Marijuana use, 216

Marriage

custody and visitation rights of LGBT parents, 47, 48

end-of-life issues, 281

as health outcome factor, 4546, 221

rights of LGBT citizens, 4447

Massachusetts Behavioral Risk Factor Surveillance System, 99, 102b

Mattachine Society, 36, 37

Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act, 43

Mental health

among LGBT youth, 146147, 151153, 170

coming out experience and, 186

in early/middle adulthood, 5, 189192, 199202, 232

effects of discrimination and victimization, 191192, 212213, 268269

in late adulthood, 256, 282

racial/ethnic differences, 194, 227

research opportunities, 191, 235

utilization of care services, 222223

See also Depression;

Gender dysphoria;

Gender identity disorder;

Mood and anxiety disorders;

Suicidal ideation and behavior

Methamphetamine, 161

Military, U.S., 3435, 36

Minority stress model

conceptual basis, 2021, 2223, 221222, 295

definition, 2

rationale for LGBT research with, 294295

recommendations for research, 6f, 7, 294f, 295

Money, John, 49

Mood and anxiety disorders

among LGBT youth, 147

in early/middle adulthood, 190, 192193, 232

in late adulthood, 256

N

National Gay and Lesbian Task Force, 52

National Health and Nutrition Examination Survey, 123

National Health and Social Life Survey, 54, 99, 100101b

National Household Survey on Drug Abuse, 123

National Institute of Mental Health, 37

National Institutes of Health, 1, 16, 71

recommendations for, 68, 910, 293294, 303305

National Lesbian Health Care Survey, 107108

National Survey of Family Growth, 56, 100b

National Survey of Sexual Health and Behavior, 56, 99

National Transgender Discrimination Survey, 108, 110b

National Transsexual Counseling Unit, 51

Native Americans, 26, 196

Nurses’ Health Study, 117118, 118b

Nurses’ Health Study II, 118b

Nursing homes, 275

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

O

Obama memorandum on hospital visitation, 46

Obesity

among LGBT youth, 154

history of childhood abuse and, 219

research opportunities, 173, 235

risk for lesbian and bisexual women, 5, 205, 207208, 227, 233, 265

Office of the National Coordinator for Health Information Technology, 9, 302303

Ovarian cancer, 206, 211, 261

P

Panic attacks, 192, 193

Pap tests, 222, 223224

Parents, LGBT

coming out behaviors, 187188

developmental outcomes of children of, 5

health risks of childlessness, 229

legal rights, 47, 229

parenting abilities and competencies of, 229230

pathways to parenthood, 47, 229

prevalence, 47, 59, 74, 228229, 261

research opportunities, 203204, 231, 234, 235

support from families for, 231

Policy

response to HIV/AIDS epidemic, 6869, 70, 71

See also Recommendations

Pregnancy, 153154, 170

Preventive interventions

health service utilization, 5, 223, 234

HIV, 156157, 210

suicide, 150

youth-specific, 156157

Prisons system medical care, 226

Probability/nonprobability sampling, 3, 9395, 97103, 105109, 130131

Prostate cancer, 206, 262

Protective factors

crisis competence, 5, 272, 282

disclosure of sexual identity as, 164165

in early/middle adulthood, 220222, 233

in late adulthood, 268, 272273, 282

for LGBT youth, 164166, 171172

marriage, 221

resiliency, 221222, 257, 268, 272

in school environment, 165166, 171172

supportive social environment, 164, 171172, 220221, 272273

Psychoanalytic theory, 33, 34

Q

Qualitative research, 120122, 131

Quality of care for LGBT people

expectations of elders, 274276, 283

patient satisfaction, 226227, 234, 235

research opportunities, 235

for youth, 167

Quantitative research, 109, 131

Queer, 15, 26, 29, 202

R

Race/ethnicity

barriers to care based on, 64

childhood sexual abuse patterns, 220

coming out and disclosure behaviors, 3132, 168, 187, 253

cultural norms of country of origin as health factor, 228

differences in life experience within LGBT community, 15

differences in sexual expression and experience, 30

discrimination experience and, 269, 270

early sexual experience, 187

health outcomes and, 227

HIV risk, 4, 5, 7174, 73f, 155, 171, 208, 233

household composition patterns, 59

identity development, 144

intersectional perspective in LGBT research, 21

mental health status, 194, 227

perceived benefits of LGBT identity, 272

perceived racism in LGBT communities, 187

research opportunities, 4

sexual identity development in adolescence, 144, 170

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

sexual orientation self-identification, 3031

suicide risk, 196, 197, 227

Randomized controlled trials, 115117, 131

Recommendations

data collection, 7, 9, 299302

for inclusion of sexual minorities in research projects, 10, 305

for methodological research, 910, 303304

for research agenda, 68, 293299, 300302t

for research training, 10, 304305

Religious affiliation, 168

Reproductive health

in early/middle adulthood, 203204

fertility services, 204

health service utilization, 223224

insurance coverage, 66

in late adulthood, 260262, 263264

research opportunities, 204, 235, 284

risks for LGBT youth, 153154, 170

Research agenda, 6f, 294f

cross-cutting perspectives, 7, 293, 294296

recommendations for research agenda, 68, 293298

Research methodology, 1823

best practices, 4, 119, 123129

challenges in conducting LGBT research, 3, 89, 130

confidentiality practice, 93

definitional and measurement issues, 9092

importance of, 96

inclusion of sexual and gender minorities in samples, 10, 305

LGBT population estimates, 54, 5657

longitudinal cohort studies, 7, 117118, 131, 295, 302

opportunities for improving, 131132

population sampling, 3, 9396

qualitative methods, 120122

randomized controlled trials, 115117, 131

recommendations for, 910, 303304

studies of LGBT elders, 252

See also Sampling, population

Research opportunities, 300302t

barriers to care, 75, 235

communications and social networking technologies, 298

data collection, 9, 299302

health effects of coming out experience, 188

health interventions, 8, 297298

health status of LGBT population, 4, 17b, 75, 234235

HIV transmission, 156157

homelessness risks and outcomes, 163

inequities in health care, 8, 296

LGBT elders, 283284

LGBT parenting, 231

LGBT youth, 4, 172173

mental health, 146, 202, 284

reproductive health among LGBT adults, 204

sexual and reproductive health, 284

social context of LGBT health, 8, 296

sociodemographic factors, 7, 53, 75, 168, 172, 173, 234, 235, 283, 296297

standardization of definitions and measures, 9192, 131

transgender-specific, 8, 157, 173, 202, 262, 298

Resiliency, 221222, 257, 268, 272

Rural–urban differences, 16, 168, 227, 276277

S

Sampling, population

best practices, 128

challenges, 9697

challenges in LGBT research, 3, 130

combining data across studies for, 9496

community-based, 106

convenience samples, 105106

disproportionate stratification, 9899

Internet/online surveys, 114115

nonprobability-based methods, 3, 105109, 110111b, 130131

potential errors in surveys, 111112

probability-based methods, 3, 9395, 97103, 112, 130

purposive, 106

quota, 106107

for randomized controlled trials, 117

recommendations for research design, 10, 305

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

respondent-driven, 103104

snowball, 106, 107

time-location, 104105

validity issues, 96

Schools

harassment and victimization of LGBT youth in, 158, 171

intervention with LGBT youth in, 4

protective factors for LGBT youth in, 165166

Self-stigma, 6364, 190, 191

Sex, defined, 25

Sex differences

body image problems, 150

development, 2930

suicide, 257

transgender population, 57

Sex reassignment surgery

insurance coverage, 67

outcomes, 201, 232

prescribed “real life experience” before, 199, 200201

sexual functioning after, 203

standards of care, 199202

technical and conceptual evolution, 4852

Sexual behavior

among homeless, 162163

among LGBT youth, 153154, 162163

condom and contraceptive use, 209, 261, 282

criminalization of, 3335

definitional challenges in LGBT research, 90

differences between sexes, 2930

early experiences, 29, 187, 188

early scientific research, 3637

evolution of normative concepts of, 3233

HIV prevention, 71, 210

HIV risk, 208210

in late adulthood, 260, 261262

population studies, 5357

racial/ethnic differences, 30

Sexual dysfunction, 202203, 260

Sexual fluidity, 2930, 106

Sexually transmitted infections, 155156, 210211.

See also HIV/AIDS

Sexual orientation

attempts to change, 36

contextual factors in labeling, 2829

conversion therapy, 146

defining elements, 12, 2728

definitional and measurement challenges, 9092

development in early/middle adulthood, 186189

development in late adulthood, 253256

development in LGBT youth, 142146, 170

historical evolution of concepts of, 3233

main categories of, 28

origins of, 17

population studies, 5357

recommendations for research, 910, 299304

as relational construct, 27

self-identification patterns, 3031

standardization of measures, 910, 303304

See also Lesbian, gay, bisexual, and transgender (LGBT) populations

Sexual satisfaction, 203, 261

Smoking

among adult lesbians, 205, 215

among LGBT elders, 270271, 282

among LGBT youth, 4, 160, 171

risk in early/middle adulthood, 5, 215216

Social ecology perspective, 7, 172, 210, 283

conceptual basis, 2, 22, 23, 296

rationale for LGBT research with, 22, 194195, 296

recommendations for research, 6f, 294f

Social support

in health outcomes for LGBT elders, 277280

for LGBT parents, 231

organization and community memberships for, 280

protective factors for LGBT adults, 220221, 272273

recommendations for research, 6f, 8, 294f, 297

Sociocultural context

age cohort differences in life experiences, 15

country of origin attitudes as health outcome factor, 228

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

evolution of social attitudes about sexual orientation, 3336

formation of LGBT community, 35, 36, 3738

gender identity and expression, 25, 26

sexual orientation labels, 2829

Sociodemographic factors in health outcomes

for LGBT adults, 227228

for LGBT elders, 276277

for LGBT youth, 168

research opportunities, 7, 53, 75, 168, 172, 173, 234, 235, 296297

See also Educational attainment;

Race/ethnicity;

Socioeconomic status

Socioeconomic status

differences in life experience within LGBT community, 1516

educational attainment and, 60, 277

as health outcome factor, 227228

HIV transmission and, 72

intersectional perspective in LGBT research, 21

in late adulthood, 269

population patterns, 31, 60, 74

protective factors for LGBT elders, 273

recommendations for data collection, 9, 299

Sodomy laws, 34, 3940, 41

Standards of Care for Gender Identity Disorder, 199201

Stigmatization and discrimination

barriers to health care, 6165

common experiences of sexual minorities, 1314

concealment of sexual orientation to avoid, 63, 92

in diagnosis of gender identity disorder, 200

effects on LGBT health, 1314, 32, 74

enacted stigma, 62, 191

evolution of social attitudes and practices, 2, 3238

experiences of racial/ethnic minorities, 269, 270

felt stigma, 63, 191192

in health care system, 14, 34, 3637, 224, 225, 269270, 274276

historical experience of transgender persons, 48

HIV/AIDS epidemic and, 3940, 6769

internalized stigma, 6364, 190, 191

legal protections for sexual minorities from, 4244

in legal system, 3334, 35

life experiences of older LGBT cohort, 251

lifetime exposure to, 269

in military, 3435

minority stress model, 2021, 295

as obstacle to health research, 14

psychological stress caused by, 191192, 212213, 268269

resistance of LGBT community to, 14, 36, 3738

risk in early/middle adulthood, 5, 212213, 233

risk in late adulthood, 268270, 282

school-based harassment of LGBT youth, 4344

structural stigma, 6465

suicidal behavior in adulthood and, 258

Stoller, Robert, 49

Stonewall Rebellion, 3738, 48

Substance use

among LGBT elders, 270271

among LGBT youth, 4, 159161, 169, 171

in early/middle adulthood, 5, 214219, 227, 233

family factors, 169

health care provider attitudes toward LGBT patients, 224

protective factors for youth, 165166, 169

research opportunities, 235

See also Alcohol use;

Smoking

Suicidal ideation and behavior

age cohort differences, 196, 258

among LGBT youth, 4, 147150, 170

in early/middle adulthood, 5, 190, 191, 195198, 232

in general population, 257

in late adulthood, 257258, 282

preventive interventions, 150

racial/ethnic differences, 227

risk factors, 148, 170

Syphilis, 210211

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

T

Testosterone. See Hormone therapy to affirm gender identity

Text messaging, 298

Transgenderists, 26

Transgender population

acceptance in sexual-minority community, 213

aging process for, 273

barriers to care for, 225, 274

cancer, 206, 260261, 264

cardiovascular disease, 211, 264265

caregiving needs of older cohort, 267

challenges of coming out later in life, 255256

civil rights movement, 48, 5052

coming out and disclosure behaviors, 15, 32, 188189, 253, 254255

current clinical management approach, 5152, 200202

data sources for research, 27

definition, 12, 2627

definitional and measurement challenges in research with, 91

depression, 257, 259

development in youth, 145146, 170, 255

discrimination and stigmatization, 48

diversity within, 12, 50, 201202

economic status, 60, 74

educational attainments, 60

evolution of sex transformation medicine, 4850

family relationships, 168, 231, 280

gender identity development, 189

gender ratio, 57

geographic distribution, 58

health care provider attitudes toward, 224, 225

health concerns in later life, 267

HIV risk, 73, 156, 171, 208, 209, 233, 266

homelessness among, 163, 171

hormone therapy side effects, 211, 233

legal protections for, 52

marriage rights, 4647

mental health status, 151153, 190, 191, 193, 194, 257, 258259

nonprobability sample surveys, 110111b

parental rights, 48

parenthood among, 230231, 234

physical health among youth, 157

population size, 57

protective factors research, 220222, 233

psychiatric classification, 49, 50

quality of medical care, 225, 226227, 234

recommendations for research, 6f, 8, 294f, 298

relationship status, 59

research base, 1819

research opportunities, 157, 173, 202, 262

self-reported health, 259

sexual dysfunction among, 203

sexual functioning in late adulthood, 261262

sexual orientation, 12, 27

standards of care for gender dysphoria, 199202

substance use, 5, 161, 218219

suicide, 4, 5, 149150, 195, 196198, 258, 259

victimization and violence, 159, 212, 213, 262

young people’s access to care, 166

See also Hormone therapy to affirm gender identity;

Lesbian, gay, bisexual, and transgender (LGBT) populations;

Sex reassignment surgery

Transsexualism, 50

Transsexuals, 26, 27, 48, 49

Transvestites, 26, 48

Two-spirit, 26

U

Urban Men’s Health Study, 98

U.S. census data, 94, 103, 103b

V

Victimization and violence

community and legal responses to, 4243

disclosure behaviors and, 165

intimate partner, 214

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
×

research opportunities, 9, 173, 235, 284, 299

risks for LGBT adults, 211, 212, 213214, 233

risks for LGBT elders, 261262, 268, 269, 270, 271, 282

risks for LGBT youth, 4, 4344, 149, 157159, 165, 170, 171

risks for transgender persons, 213, 233

suicide risk and, 148149, 165, 170

See also Hate crimes

Virginia Transgender Health Initiative Survey, 108109, 110111b, 121

W

White, Ryan, 68

Workplace environment, 220, 254

World Professional Association for Transgender Health, 50, 52

Y

Youth, LGBT

body image, 150

childhood abuse, 163164

coming out and disclosure behaviors, 143, 144, 165, 167, 172, 253

current state of clinical knowledge about, 142

custodial care, 169170

depression, 147150

eating disorders, 150151, 170

family factors in health outcomes of, 168169, 172

gender identity disorder, diagnostic criteria for, 50, 151, 152b

gender identity disorder, treatment for, 151153

gender-variant, 145146

health care access and utilization, 62, 166, 172

historical changes in social experiences of, 141

HIV infection patterns, 154157, 171

homelessness among, 4, 161163, 171

intervention research, 4, 172

mental health status, 146147, 170

mood and anxiety disorders, 147

obesity, 154

population prevalence, 145

protective factors, 164166

quality of health care, 167

racial/ethnic differences, 144

reproductive health, 153154, 170

research opportunities, 4, 172173

school problems, 158159, 171

sex differences in sexual development, 29

sexual behavior, 153154, 155

sexual orientation and gender identity, development of, 142146, 170, 187, 254255

sociodemographic mediators of health, 168, 172

substance use, 4, 159161, 169, 171

suicidal ideation and behavior, 4, 147150, 169, 170

victimization and violence, 4, 4344, 149, 157159, 165, 170

Suggested Citation:"Index." Institute of Medicine. 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press. doi: 10.17226/13128.
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Page 348
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Get This Book
×

At a time when lesbian, gay, bisexual, and transgender individuals--often referred to under the umbrella acronym LGBT--are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs. Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs.

The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research.

The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers.

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