Understanding the Well-Being of LGBTQI+ Populations

There are more lesbian, gay, bisexual, transgender, queer, intersex, and other sexual and diverse (LGBTQI+) people in the U.S. than ever before. A wide range of factors influence LGBTQI+ individuals’ well-being, including social relationships, access to health care, structural stigma, laws and policies, employment, housing, the criminal justice system, and more. A landmark 2020 study from the Committee on Population at the National Academies of Sciences, Engineering, and Medicine found widespread and significant gaps in data collection on the lives and experiences of sexual and gender diverse populations. These gaps have led to a dearth of research, policies, and programs that address the specific needs of LGBTQI+ people, families, and communities.

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What Do We Mean by “Sexual and Gender Diverse”?

Understandings of sexual orientation, gender identity, and intersex status—and the terms used to describe them—continue to evolve. This report uses the term sexual and gender diverse to acknowledge the broad spectrum of natural human variation in sexual orientation, gender identity, and sex development.

 

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Sexual and Gender Diverse Populations are Rapidly Growing

There are over 11 million lesbian, gay, bisexual, and transgender (LGBT) people in the U.S. Available data show substantial increases in LGBT identification over the last decade—a 2021 Gallup report found that 5.6% of U.S. adults identify as LGBT, up from 4.5% in 2017. An estimated 1.4 million people (0.6% of the U.S. population) identified as transgender in a 2016 analysis, and approximately 1.7% of people are born with an intersex trait. The demographics of sexual and gender diverse populations are dynamic and rapidly evolving: these communities are becoming younger and more racially and ethnically diverse, and they include growing proportions of women, non-binary people, and people who identify as bisexual. Increasing numbers of people, particularly women, also report same-sex sexual attraction or behavior. Data remain scarce on many characteristics of LGBTQI+ populations, however, particularly about transgender and intersex people and LGBTQI+ people of color.


Data Gaps

Sexual and gender diverse people are often made invisible in data collection

Most data collection efforts—population surveys, medical records, administrative forms, and clinical trials and other research studies—do not routinely collect data on sexual orientation, gender identity, and intersex status.

Nearly all sexual and gender diverse population research has focused on sexual orientation or same-sex sexual behavior or relationships, with limited data on transgender populations and almost no demographic data on people with differences of sex development (DSD) or people who identify as intersex.

We don’t see the whole picture

Evolving societal and political contexts have created new possibilities for growing numbers of people to understand and claim diverse sexual and gender identities. However, the climate around social acceptance and legal protections across the U.S. is still fluctuating.

In the absence of affirming and protective environments, policies, and practices, some who consider themselves to be LGBTQI+ may decide not to disclose details of their sexual orientation, gender identity, or intersex status. This has a direct effect on how much we are able to learn about their lives and experiences.


To close these data gaps, the report calls for government agencies, private entities, and others to change their data collection systems and practices to better capture the needs of sexual and gender diverse populations. This starts with routinely collecting, analyzing, and reporting data on sexual orientation, gender identity, and intersex status in contexts such as population surveys, clinical trials, public health, electronic medical records, and administrative records.


Recommendations for Closing Data Gaps

Recomendation 1: Entities throughout the federal statistical system; other federal agencies; state, local, and tribal departments and agencies; private entities; and other relevant stakeholders should consider adding measures of sexual orientation, gender identity, and intersex status to all data collection efforts and instruments, such as population-based surveys, administrative records, clinical records, and forms used to collect demographic data.

Recomendation 2: Federal statistical agencies, state, local, and tribal departments and agencies; private entities; and other relevant stakeholders should fund and conduct methodological research to develop, improve, and expand measures that capture the full range of sexual and gender diversity in the population—including but not limited to intersex status and emerging sexual and gender identities, sexual behaviors, and intersecting identities—as well as determinants of well-being for sexual and gender diverse populations.

Recomendation 3: Public and private funders should support and researchers should conduct studies using a variety of methods and sampling techniques—driven by the questions under study—in order to examine family and other social relationships, community, health, education, economic, and legal issues that will enhance understanding of sexual and gender diverse populations.

Recomendation 4: The U.S. Office of Management and Budget should convene federal, state, and private funders, as well as other relevant stakeholders, to address significant problems in linking data from different datasets to facilitate research on the health status and well-being of sexual and gender diverse people. These stakeholders will differ by content area but could include researchers, legal advocacy groups, research institutions and centers, think tanks, policy-tracking groups, health, and surveillance organizations.

Recomendation 5: Public and private research funders, together with federal statistical agencies, should prioritize research into the development, implementation, and evaluation of evidence-based services, programs, and interventions that promote the well-being of sexual and gender diverse populations.

Understanding Well-Being

Understanding Well-Being as a Complex System

A person’s well-being is a combination of experiences, opportunities, and decisions that are influenced by individual aspects of identity, by interactions with families and other social relationships, and by encounters with institutions and systems such as education, health care, government, public safety, housing, immigration, criminal justice, the military, and employment. The experiences of sexual and gender diverse people in these complex systems vary by sexual orientation, gender identity, and intersex status. They are also influenced by factors such as age, family composition, geography, race, ethnicity, language, ability, socioeconomic status, and religion.

The committee used the following frameworks to organize its thinking around these systems and their complex interactions:


social ecology how individuals are embedded in families, communities, and societies

social constructionism how individuals give meaning to their own and others’ lives, identities, and experiences

identity affirmation how people become aware of and express their identity, including their sexual orientation, gender identity, and intersex status

stigma how dominant cultural beliefs and imbalances in power can lead to negative experiences for those who do not align with societal expectations

life course how experiences from early to late in life accumulate and affect health and well-being at different ages and stages of development

intersectionality how multiple forms of structural inequality and discrimination, such as racism, sexism, and classism, combine to produce complex, cumulative systems of disadvantage for people who live at the intersections of multiple marginalized groups

Domains of Well-Being

To better understand the existing evidence on how sexual and gender diverse people's experiences differ over the course of their lives, the committee used a variety of frameworks and perspectives to explore well-being:

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Resources