Health studies rarely ask about sexual or gender orientation. Unfortunately, the few that have been interested in sexual orientation have often had serious methodological flaws.

For example, most of the early studies comparing the alcohol and tobacco use of heterosexuals and sexual minorities recruited gay and lesbian participants in bars. Not surprisingly, they found high levels of smoking and drinking among these particular people.

Based on these studies, researchers concluded that gay and lesbian people smoke and drink more than the population as a whole. This may or may not be true, but certainly it cannot be proven by studies that recruit subjects in such biased ways. Truly representative studies on the health of the GLBT community are rare and needed.

Problems with studying the GLBT community include the following:

There is no universally accepted meaning of the terms "lesbian," "gay," "bisexual," "sexual minority," or "homosexual." For example, various researchers may define a lesbian as someone who:

• is attracted to women,
• has sex with women and never with men,
• has sex with women more often than with men,
• forms romantic attachments to women,
• wants to have sex with women,
• has had sex with women in the past,
• calls herself a lesbian, whether she has had sex with women or not, and so on.

Depending on how the term is defined, a researcher may get quite different results, both in terms of how many women are considered "lesbians" and what their behaviors, health status, and health risks are.

Definitions of the term "transgender" are even less examined, and may encompass such varying individuals as transsexuals, cross-dressers, and the intersexed (people born with male and female organs). In fact, each of these groups will have very different health needs.

Without firm definitions of who is a "sexual minority," it is impossible to gauge how large the community is. Even if definitions could be agreed upon, a population which is feared and discriminated against and which is defined by very private behaviors is difficult to count. Without clear measures of the size of the lesbian or gay or sexual minority community, it is not possible to make reliable statements comparing health risks between communities. For example, a seemingly simple statement such as "Smoking is more common in the gay community" implies a comparison between the rate of smoking in the gay community and the heterosexual community. But such a comparison is crude guesswork if we do not know the size of the community as a whole.

Researchers commonly struggle with studying populations that are rare, geographically dispersed, and hidden. For this reason, many researchers have recruited gay and lesbian people at bars, although this is hardly a representative sample of the community, and is likely a less-healthy segment of the whole. Other methods that have been used to recruit sexual minority populations include mailing lists from gay community organizations, networking from known people in the community to others known by those people and so on, and placing advertisements about studies in gay/lesbian newspapers. It is very difficult, and takes a great deal of work, to achieve a sample of the sexual minority community that is truly random and representative. Most studies have relied on less random samples that are easier to find.

Only in recent years have there been random, representative studies of the general papulation in which participants were asked about sexual orientation and/or gender(s) of partners. Only a few of these studies are large enough to contain subsets of sexual minorities from which conclusions can be drawn about their health.

Sexual minorities experience many forms of discrimination. Furthermore, homosexual behaviors are criminal in many states in the United States. This makes it difficult and time-consuming to construct a study in which participants feel safe talking about personal feelings and behaviors. The sensitive nature of studying this population affects all levels of the research, including what questions will be asked, who will ask them, where the research will take place, and how and where the study will be published.

This concern has been present in the minds of the writers of the materials on this website. Although in 1974, psychiatrists removed homosexuality from the list of mental health illnesses, sexual minority people have long been considered to be mentally and physically unhealthy by some. Public Health - Seattle & King County does not support this view. Instead, we hope to encourage greater preventive care on the part of gay, lesbian, bisexual, and transgender people and their health care providers, in order to achieve and sustain a more healthy population overall.

PubMed is the National Library of Medicine's database of references to more than 11 million articles published in 4300 biomedical journals. Click here for more information about getting access.

Further information on methodological problems inherent in studying the sexual minority community can be found in the following documents:

• Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concerns by the Gay and Lesbian Medical Association and the Center for Lesbian, Gay, Bisexual and Transgender Health at Columbia University.
  
  
• Gay and Lesbian Health Report, New York City Department of Health.