May I Ask Who Is Calling? Findings on Health Disparities and Sexual Orientation from the Washington State BRFSS, a Population-based Telephone Survey

Background: Sexual orientation has been proposed as a key social influence on health outcomes. Although empirical evidence exists documenting health disparities among gay males, lesbians and bisexuals (LGB), sexual orientation as a potential risk factor has been largely neglected in the public and scientific discourse. To date most studies of LGB health have relied on small convenience samples. This paper will present findings based on data from the Washington State Behavioral Risk Factor Surveillance System (BRFSS) survey to assess health disparities by sexual orientation including health access, health behaviors and conditions, health status and socio-demographic and background characteristics.

Methods: In order to examine sexual orientation as a factor impacting health disparities and obtain generalizable findings, data was obtained from that Behavioral Risk Factor Surveillance System (BRFSS) survey, which has been developed by The Center for Disease Control. The BRFSS is an annual nation-wide telephone interview survey of randomly selected non-institutionalized adults age 18 and older. The measurement of sexual orientation was added in 2003 in Washington State; data for this paper was collected between 2003 and 2007. The total sample size was 15,728, and approximately 5% reported their sexual orientation as lesbian, gay or bisexual. The data was weighted and analyses were conducted separately by gender.

Results: In terms of background characteristics, lesbian/gay/bisexual respondents compared to heterosexuals tended to be younger and less likely to be married and have children. The income level of bisexuals was lower than the other groups. When examining differences in health related quality of life, LGB respondents reported, on average, more frequent days of activity limitations and poor physical and mental health. The significant associations between sexual orientation and poor mental health among sexual minorities remained significant even after controlling for age, education, and income. Bisexual women were found to be at particularly high risk of negative health outcomes.

Conclusions: This paper highlights important findings regarding health disparities impacting LGB communities and suggests that information on sexual orientation can effectively be obtained in population-based health surveys. The benefits and limitations of using a population-based telephone survey to examine health disparities in these populations must be considered. The methodology allows for generalizing results and can provide sufficient data needed to test complex models of health in sexual minority communities. However, there may be underreporting, and the survey is only available in English and Spanish. Hence, such methodologies will need to be supplemented with other sampling strategies to reach sexual minorities that are hidden and hard-to-reach. Implications of this research for social work research and policy will be discussed.