Abstract
Inequalities in health have been identified for lesbian, gay, and bisexual (LGB) populations nationally. Policies in the U.S. South offer fewer protections for LGB people than in other regions, yet, limited data exist for this region. North Carolina (NC) BRFSS data from 2011 to 2014 were combined (LGB n = 604; heterosexual n = 33,170) and analyzed using SAS survey procedures to estimate health characteristics by sexual orientation within gender. Many examined indicators were not different by sexual orientation, however, other results were significant and consistent with findings from state population surveys in other regions of the country. Both genders showed inequities in mental health, having over twice the odds of five or more poor mental health days in the past month and of having ever been diagnosed with a depressive disorder. Sexual minority women had higher odds compared with heterosexual women for ever having smoked cigarettes, current smoking, exposure to secondhand smoke both in the workplace and at home, and both alcohol risk factors, binge and heavy drinking. Being part of the LGB population in NC is associated with worse health. The implementation of anti-LGB policies in the NC warrants ongoing monitoring of LGB health inequities in NC and in other southeastern states for potential effects on the health and well-being of sexual minorities.
Highlights
Significant health inequities exist for lesbian, gay, and bisexual (LGB) adults compared to heterosexual adults, including in mental health, sexually transmitted infections, substance abuse, and violent victimization [1]
While one study reported on health inequities among the North Carolina (NC) LGB population using 2011 Behavioral Risk Factor Surveillance System (BRFSS) data [19], that study was limited by a small sample size of 161 LGB participants
North Carolina has participated in the BRFSS since 1987 [21]; four years of data from the NC BRFSS were used for this study
Summary
Significant health inequities exist for lesbian, gay, and bisexual (LGB) adults compared to heterosexual adults, including in mental health, sexually transmitted infections, substance abuse, and violent victimization [1]. Inequities in health for LGB people are most commonly posited to exist because of psychosocial stress, discrimination, and stigma unique to this population [3]. Internalized homophobia, effort required to conceal sexual orientation or gender identity, and family rejection are common proximal sources of psychosocial stress [3]. These sources of stress are supplemented by more distal violence, personally-mediated discrimination, and institutional discrimination or structural stigma [4,5]. Others use a social-ecological approach to note the role of place [6], healthcare, community organizations [7], and the media environment [8,9] in the production of these health inequities
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