- Health Resources and Services Administration (HRSA)
- Centers for Disease Control and Prevention (CDC)
- National Institutes of Health (NIH)
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- Office of Disease Prevention and Health Promotion (ODPHP)
- National Center for Health Statistics (NCHS)
Lesbian, Gay, Bisexual, and Transgender Health Workgroup Objectives (10)
About the Workgroup
Approach and Rationale
People who identify as LGBT — sometimes collectively referred to as sexual and gender minorities — come from all races/ethnicities, religions, and economic backgrounds.1 A growing number of federal surveys and other population data collection tools include questions about a person’s sexual orientation and gender identity to better understand their health and ability to access health care and improve health outcomes.2,3 Since sexual orientation and gender identity are different parts of one’s identity, objectives selected by the LGBT Workgroup cover sexual orientation and gender identity separately.
In 2017, 8 national federal surveys collected sexual orientation data and 2 collected data about gender identity. Therefore, core objectives for LGBT Health focus on increasing the availability of data to better understand the health and well-being of LGBT people throughout the life course. Additional core objectives focus on sexual minority youth (lesbian, gay, or bisexual) — as data indicate that they’re at increased risk of being bullied, having suicidal thoughts, and using illicit drugs.4
Developmental objectives highlight high-priority public health issues that lack data. The LGBT Workgroup selected 3 developmental objectives for transgender youth that mirror the core objectives for sexual minority youth on bullying, suicidal ideation, and illicit drug use.
Understanding Lesbian, Gay, Bisexual, and Transgender Health
LGBT people experience multiple barriers to health care,5,6,7 including stigma related to their identities.8,9 Other risk factors disproportionately affect intersectional populations including gay men of color, bisexual people,10 and transgender and gender non-conforming people.11
Emerging Issues in Lesbian, Gay, Bisexual, and Transgender Health
The need to provide culturally appropriate preventive care will increase over the decade. As the demographics of the population continue to shift, public health and health care systems will need to expand their ability to meet the growing needs of a diverse and aging population, particularly LGBT people.
Emerging data and evidence show high rates of family rejection12 and significant barriers for transgender youth.9,11,13 There are also gaps in research about aging, bisexual,14 and transgender populations.15 Transgender Medicare beneficiaries, including older adults, experience disproportionately worse health, evidenced by having more multiple chronic conditions than their cisgender peers.16
Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. (2011). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64806/
Federal Interagency Working Group on Improving Measurement of Sexual Orientation and Gender Identity in Federal Surveys. (2016). Current Measures of Sexual Orientation and Gender Identity in Federal Surveys. Retrieved from https://nces.ed.gov/FCSM/pdf/buda5.pdf
Federal Interagency Working Group on Improving Measurement of Sexual Orientation and Gender Identity in Federal Surveys. (2016). Evaluations of Sexual Orientation and Gender Identity Survey Measures: What Have We Learned. Retrieved from https://nces.ed.gov/FCSM/pdf/Evaluations_of_SOGI_Questions_20160923.pdf
Kann, L., et al. (2016). Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015. Morbidity and Mortality Weekly Report, 65(9), 1-202. http://dx.doi.org/10.15585/mmwr.ss6509a1
Dahlhamer, J.M., Galinsky, A.M., Joestl, S.S., & Ward, B.W. (2016). Barriers to Health Care Among Adults Identifying as Sexual Minorities: A US National Study. American Journal of Public Health 106(6), 1116-1122. https://doi.org/10.2105/AJPH.2016.303049
Gonzales, G., Przedworski, J., & Henning-Smith C. (2016). Comparison of Health and Health Risk Factors Between Lesbian, Gay, and Bisexual Adults and Heterosexual Adults in the United States: Results From the National Health Interview Survey. JAMA Internal Medicine, 176(9), 1344-1351. https://doi.org/10.1001/jamainternmed.2016.3432
Kauth, M.R., Shipherd, J.C., Lindsay, J., Blosnich, J.R., Brown, G.R., & Jones, K.T. (2014). Access to Care for Transgender Veterans in the Veterans Health Administration: 2006-2013. American Journal of Public Health, 104, S532-S534. DOI: 10.2105/AJPH.2014.302086
Macapagal, K., Bhatia, R., & Greene, G.J. (2016). Differences in Healthcare Access, Use, and Experiences Within a Community Sample of Racially Diverse Lesbian, Gay, Bisexual, Transgender, and Questioning Emerging Adults. LGBT Health, 3(6), 434-442. DOI: 10.1089/lgbt.2015.0124
Hatzenbuehler, M. L. (2009). How Does Sexual Minority Stigma “Get Under the Skin”? A Psychological Mediation Framework. Psychological Bulletin, 135(5), 707-730. DOI: 10.1037/a0016441
Taggart, T., et al. (2018). Sexual Orientation and Sex-Related Substance Use: The Unexplored Role of Bisexuality. Behaviour Research and Therapy, 115, 55-63. DOI: 10.1016/j.brat.2018.12.012.
James, S.E., Herman, J.L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality
Pariseau, E.M., et al. (2019). The Relationship Between Family Acceptance-Rejection and Transgender Youth Psychosocial Functioning. Clinical Practice in Pediatric Psychology, 7(3), 267-277. https://doi.org/10.1037/cpp0000291
Keuroghlian, A.S., Shtasel, D., & Bassuk, E.L. (2014). Out On the Street: A Public Health and Policy Agenda for Lesbian, Gay, Bisexual, and Transgender Youth Who Are Homeless. The American Journal of Orthopsychiatry, 84(1), 66-72. DOI: 10.1037/h0098852
Fredriksen-Goldsen, K.I., Shiu, C., Bryan, A.E., Goldsen, J., & Kim, H.J. (2017). Health Equity and Aging of Bisexual Older Adults: Pathways of Risk and Resilience. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 72(3), 468-478. DOI: 10.1093/geronb/gbw120
Fredriksen-Goldsen, K.I., Cook-Daniels, L., Kim, H.J., Erosheva, E.A., Emlet, C.A., Hoy-Ellis, C.P., … Muraco, A. (2014). Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population. Gerontologist, 54(3), 488-500. DOI: 10.1093/geront/gnt021
Dragon, C.N., Guerino, P., Ewald, E., & Laffan, A.M. (2017). Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data. LGBT Health, 4(6), 404-411. doi: 10.1089/lgbt.2016.0208