摘要：Objectives. We investigated the health profile of lesbian, gay, and bisexual (LGB) adults in North Carolina, the first state in the South to include a measure of sexual orientation identity in a probability-based statewide health survey. Methods. Using data from 9876 respondents in the 2011 North Carolina Behavioral Risk Factor Surveillance Survey, we compared sexual minorities to heterosexuals on a variety of health indicators. Results. LGB respondents were younger and more likely to be reached by cell phone. Many examined indicators were not different by sexual orientation. Significant results, however, were consistent with findings from state population surveys in other regions of the country, including disparities in mental health and, among women, smoking. Conclusions. Reporting LGB identity in North Carolina is associated with poorer health. The concentration of anti-LGB policies in the South warrants ongoing monitoring of LGB health disparities in North Carolina and in other Southeastern states for potential effects on the health and well-being of LGB populations. The unavailability of data from probability-based samples has been among the greatest impediments to identifying and addressing health disparities for lesbian, gay, and bisexual (LGB; or sexual minority) populations. 1–3 The earliest studies restricted sampling of gay men and lesbians to psychiatric institutions and served to pathologize sexual minorities. 4 Later efforts purposively sampled communities, providing more nuanced profiles of LGB health that proved instrumental in early identification of health disparities. 5,6 Additionally, LGB and transgender communities themselves organized health data collection efforts even before the HIV/AIDS epidemic to document determinants of their health disparities, including barriers to health care, patterns of health behavior, and experiences of discrimination. 7,8 Yet, notwithstanding the richness of these data, all nonprobability samples suffer from limitations of external validity. 9 Concerns about the representativeness of data render studies using nonprobability sampling less influential in informing state and federal policy. Convenience samples have helped provide a burgeoning understanding of health disparities affecting LGB populations in the United States, alongside reports from the few states that have included sexual orientation in routine state surveillance. 2 However, probability-based data about sexual minorities come primarily from surveys in a few states, including California, 10 Massachusetts, 11 New Mexico, 12 Oregon, 13 Vermont, 14 and Washington, 15 limiting the generalizability of results from these states to other parts of the country. Data on the health of sexual minorities may be particularly critical in the Southeastern United States, as this region generally bears a disproportionate burden of poorer health than do other parts of the country. 16 Of additional concern is that many Southeastern states have failed to incorporate sexual minorities into existing laws (e.g., employment nondiscrimination) or have adopted new anti-LGB policies (e.g., prohibiting legal recognition of same-sex relationships), both of which may create and exacerbate unhealthful social environments for LGB populations, even as evidence of the health impact of local and state policies on LGB health grows. 17–20 Differences in policy context by region and state relevant to LGB and transgender people are shown in Figure 1 . This context may yield health profiles different from New England and the Pacific Northwest, areas that currently have a greater number of policies in place that support LGB and transgender rights. Nevertheless, a substantial number of LGB people live across the South. 21,22 The Southeastern state of North Carolina is estimated to be home to more than 212 000 LGB people, 23 and the 2010 US Census shows same-sex couples living in all of North Carolina’s 100 counties. 24 Open in a separate window FIGURE 1— Lesbian, gay, bisexual, and transgender (LGBT)-specific policies across the United States by region: May 2013. In 2011, North Carolina became the first state in the South to include a sexual orientation identity question on its statewide Behavioral Risk Factor Surveillance Survey (BRFSS). We examined the profile of health disparities of the LGB population living in North Carolina across domains derived from Healthy People 2020 objectives. Specifically, we a priori selected available BRFSS indicators from which previous research had identified LGB disparities responsible for substantial morbidity and mortality, related risk factors for poor health, and factors that have public health policy relevance. We categorized these indicators across 6 domains: health status, chronic disease risk behavior, injury prevention, screening behavior, health care access, and social context (i.e., variables that reflect the social environment that can influence health or health behavior) to present a health profile of LGB North Carolinians.
