Lesbian Health Current Assessment and Directions for the Future (1999) / Chapter Skim
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3 Methodological Challenges in Conducting Research on Lesbian Health
3 Methodological Challenges in Conducting Research on Lesbian Health
Pages 97-134
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From page 97... ...
It is not surprising, then, that methodologically rigorous large-scale studies are lacking in this area. Furthermore, a number of methodological challenges for comparing findings across studies are consistently found in lesbian health research.
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From page 98... ...
Most lesbian health studies have relied on nonprobability samples. In particular, many studies have used convenience samples (e.g., from lesbian bars, music festivals, gay and lesbian organizations)
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From page 99... ...
In applying these general principles from epidemiology, the comparison group of women could be matched to the lesbians on a pair~vise or groupwise basis. Some lesbian health studies are using this approach by defining the comparison group of women as a sister, work colleague, or neighbor of the lesbian research participant.
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From page 100... ...
of 152 public health articles published between 1990 and 1992 that included gay men or lesbians revealed that only four of the studies reported the conceptual definition of sexual orientation employed to identify the population sampled (e.g., indicating that they defined homosexuality in terms of sexual behavior or attraction)
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From page 101... ...
Researchers have used an array of questions to identity lesbians, focusing on the different components of lesbian sexual orientation: selfidentification, sexual behavior, or sexual attraction or desire. Further, there is variation in the time periods during which the different components were assessed (e.g., lifetime or recently)
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From page 102... ...
LESBIAN HEALTH TABLE 3.1 Summary of Measures of Sexual Orientation Used in Studies of Lesbian Health Measures Used to Assess Sexual Orientation Study Identity Behavior Desire Berger et al., 1995 Bevier et al., 1995 Bloomfield, 1993 Brand et al., 1992 Whether women report being primarily heterosexual, primarily or exclusively lesbian, or bisexual Scale from 1 = exclusively heterosexual to 5 = exclusively gay or lesbian with weight, and exercise activity (n = 124) Buenting, 1992 Carroll et al., 1997 Sexually active during lifetime with one or more female partners; no sexual intercourse with men during past 12 months Sex of sexual partners since 1978; engagement in vaginal intercourse, oral-penile sex, and/or anal intercourse in more than 50% of sexual encounters Self-identification as Sex of partner asked with lesbian, bisexual, hetero- respect to participation in sexual, or other nine specific sexual practices; years since last male sexual encounter; lifetime number of male and female partners Sex of p Chicago Women's Health Self-identification: "only Sexual behavior in the past Current Study (Hughes et al., heterosexual, mostly year: "only men, mostly attract 1997)
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From page 103... ...
Sex of preferred sexual partner Current sexual interest or Survey of health lifestyles of lesbian and heterosexual women (n = 79) STD testing, diagnosis, and sexual practices among self-identified lesbian and bisexual women (n = 421)
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From page 104... ...
" If only female partners, then classified as lesbian; if both male and female partners, then bisexual Deren et al., 1996 "Do you consider Sex of sexual partners during yourself to be hetero- past 30 days (men only, sexual "straight] , women only, women and lesbian, bisexual, men)
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From page 105... ...
Relationship of sexual orientation to HIV risk behavior and serostatus in a multisite sample of drug-injecting and crack-using women (n = 830 lesbians; n = 5,791 heterosexual women) HIV risk behavior among lesbians and bisexual women (n = 1,086)
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From page 106... ...
; · ~ engagement In specific sexual behaviors (e.g., oral sex with women) Whether ever had sexual contact with a woman; number of female sexual partners in the past year; whether ever had sex with .
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From page 107... ...
HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley (n = 550) General health and HIV risk of lesbians across the state of Michigan (n = 1 ,681 )
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From page 108... ...
National Lesbian Health Care Survey (Bradford and Ryan, 1988) Whether consider self gay Number of female sexual or lesbian, bisexual, or partners; whether have ever neither, but homosexually active "Do you think of yourself as heterosexual, homosexual, bisexual, or something else?
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From page 109... ...
"On a scale of 1 to 4, where 1 Sexual behaviors and practices of Americans is very appealing and 4 is not (n = 3,432 total men and women; n = 1,749 at all appealing, how would women; n = 150 women reporting any you rate each of these same-gender sexuality)
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From page 110... ...
Heterosexual; bisexual; lesbian, gay, or homosexual; none of the above; prefer not to ,, answer Number of male and female partners during past 2 months with whom engaged in particular sexual practices; number of times engaged in such practices Whether sexually active with only women during the past 6 months Russell et al., 1995 Indicate whether hetero- "Have you had any of the sexual, homosexual, following forms of sexual lesbian, or bisexual contact in the past 2 weeks?
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From page 111... ...
~/~f~/ CA~ f~ Co~ Rc;~6 Dcsirc Focus of Study (sample si~c) ~d ~malc ast 2 m ular ~umbor in sucb [CtlVC duNng ofthc ~f soxu~ 2 ~?
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From page 112... ...
; no sleeping or sex with men reported on the daily checklists "Regardless of whether you are currently sexually active, which response best describes who you have had sex with over your adult lifetime: 1) have never had sex; 2)
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From page 113... ...
sex ad women; answer" If , then best have had years of I sex 1) sex with ith a man sex with ~men" 7-point Kinsey scaled Experiences during gynecologic care, sources of care, and utilization patterns of lesbian and bisexual women (n = 424 bisexual women; n = 1,921 lesbians)
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From page 114... ...
This should include qualitative studies among them, ethnographic research to better understand how a lesbian sexual orientation is defined in different subgroups of lesbians. In light of the current lack of information for better defining a lesbian sexual orientation, the committee believes that researchers of lesbian health should take care to clearly state the reasons they selected particular questions for their study and, where possible, should use questions whose wording has already been tested in comparable studies, particularly such large-scale studies as the Nurses' Health Study II (NHS-II)
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From page 115... ...
One promising technology is the audio computer-assisted self-interview (audio-CASI) in which questions are asked of the respondent by using digitized audio files of a human voice, rather than a human interviewer, and the subject responds using a computer keyboard.
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From page 116... ...
than they would if responding to a human interviewer. For example, in the National Survey of Adolescent Males, which is a national probability sample of 15- to 19-year-old males, respondents were almost four times as likely to report some type of male-to-male sexual contact when the audio-CASI method was used rather than a self-administered paper questionnaire (Turner et al., 1998b)
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From page 117... ...
When developing sampling strategies it is important to keep in mind that lesbians are not a homogeneous population. The samples in most lesbian health research to date can be characterized as primarily white, relatively well-educated, middle-class, young adults who identify themselves as lesbians (Greene, 1994; Rankow, 1995; Trippet, 1994~.
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From page 118... ...
In practice, however, such ideal conditions are rarely met. Probability sampling has rarely been used in studies of lesbian health.
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From page 119... ...
Nonp~robability Sampling Sample surveys on lesbian health have most commonly used nonprobability sampling. Unlike probability sampling, in nonprobability designs the probability of selecting any one individual is unknown.
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From page 120... ...
This confounding of outcome variables with convenience sampling strategies undermines confidence in the prevalences of particular behaviors, health risks, and health and mental health conditions reported in these studies. Much of the existing research on lesbians has obtained research subjects from lesbian community groups (e.g., mailing or membership lists from lesbian or gay organizations)
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From page 121... ...
Nonprobability sampling techniques include location (or convenience) sampling and snowball sampling.
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From page 122... ...
In other words, areas where high concentrations of lesbians reside are identified and the "lesbian-rich" stratum is then oversampled. There are a variety of methods for identifying a sampling stratum in which population subgroups are concentrated.
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From page 123... ...
Secondly, this geographic area also has to contain a high proportion of the population subgroup. Although there are potential gains from using this form of oversampling, they are limited because lesbians may not be con centrated in particular geographic areas, and even if they are, the areas may not contain a large percentage of the total lesbian population.
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From page 124... ...
This method requires that respondents be able and willing to report whether people linked to them are members of the population subgroup. Further, if the characteristics of the population subgroup are being studied, the respondents must be able to report on these characteristics accurately, or the individuals they identify must be contacted in person and interviewed.
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From page 125... ...
Rather, snowball sampling should be continued until a full roster of names believed to contain a large percentage of the population of interest is developed; then individuals from this list can be randomly sampled into the study. Although snowballing can be useful for constructing a sampling frame of all members of some population subgroups, given the hidden nature of the lesbian population and the potential risks of disclosure, it is not likely to be a feasible strategy for use with this population.
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From page 126... ...
ADDING SEXUAL ORIENTATION QUESTIONS no EXISTING STUDIES One suggestion for increasing the amount of information on lesbian health is to add sexual orientation items to large sample surveys or other large studies. This would add a significant amount of analytical capability at little additional cost.
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From page 127... ...
Two examples of ongoing studies that have included sexual orientation items in their data collection efforts are the Nurses' Health Study II89 and the Women's Health Initiative. In September 1994, NHS-II investi gators began to receive requests for information on sexual orientation and health from other researchers and, more importantly, from both lesbian and heterosexual participants in the study itself.
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From page 128... ...
The WHIT, a longitudinal study of about 100,000 postmenopausal women, has included one question on its baseline data collection forms about gender of adult lifetime sexual partners (i.e., men, women, both men and women, or never had sex)
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From page 129... ...
AREAS FOR FURTHER METHODOLOGICAL RESEARCH IN STUDYING LESBIAN HEALTH The committee identified several strategies for increasing the statistical power of research on lesbians. These include pooling data across studies using similar measures and methods; meta-analysis of methodologically sound studies, including those with smaller sample sizes; multisite studies; and fostering national and international collaborations.
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From page 130... ...
1990. Michigan Lesbian Health Survey: Results Relevant to AIDS.
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From page 131... ...
1996. Prevalence of HIV-related self-reported sexual behaviors, sexually transmitted diseases, and problems with drugs and alcohol in 3 large surveys of lesbian and bisexual women: A look into a segment of the community.
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From page 132... ...
1997. Presentation before the Institute of Medicine Committee on Lesbian Health Research Priorities.
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From page 133... ...
1998. Design of the Women's Health Initiative Clinical Trial and Observational Study.
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From page 134... ...
1996. Prevalence of HIV-related self-reported sexual behaviors, sexually transmitted diseases, and problems with drugs and alcohol in 3 large surveys of lesbian and bisexual women: A look into a segment of the community.
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