14 Data from the National Study of Midlife Development in the United States revealed a greater proportion of LGB individuals than heterosexuals to report physical and emotional maltreatment by their parents. 13 However, data from the National Epidemiologic Survey on Alcohol and Related Conditions found lesbian and bisexual women to be 3 times as likely as heterosexual women to report childhood sexual abuse, and gay men to be twice as likely as heterosexual men to report such abuse. In that review, a direct comparison with experiences of childhood sexual abuse among heterosexual adults was not possible, given the relatively limited number of studies that have collected such comparison data.
13–18 A comprehensive review of the literature found that approximately 22.7% of gay and bisexual men and 34.5% of lesbian and bisexual women reported childhood sexual abuse. Both population- and community-based studies have found that a greater proportion of LGB adults report childhood sexual, physical, and emotional abuse than do heterosexual adults. Research has also identified disparities by sexual orientation for certain forms of childhood abuse and trauma. 1 Research regarding physical health outcomes, although more limited, has found LGB individuals to have a higher prevalence of asthma and activity limitation than heterosexuals, and lesbian and bisexual women to have a higher prevalence of asthma, poor physical health, cardiovascular disease risk, and obesity than heterosexual women. 8–10 Results from the 2013 NHIS parallel these findings, with a higher prevalence of current smoking, binge drinking, and psychological distress among LGB individuals than among heterosexuals. 7 Results from population-based studies have demonstrated an increased prevalence of smoking among LGB individuals compared with heterosexuals. A recent meta-analysis found the risk of lifetime or past-year depression, anxiety, and alcohol and other substance dependence to be higher among LGB individuals than among heterosexuals. Several studies have documented mental health and substance abuse disparities among LGB individuals. 5 The Institute of Medicine and Healthy People 2020 have identified health disparities and risk and protective factors among the LGB population as one of the main gaps in current health research. 4 Even so, the existing research remains limited, with a heavy reliance on convenience samples, lack of comparison of LGB individuals with heterosexuals, and little data regarding disparities in physical health outcomes. 1–3 Inclusion of questions regarding sexual orientation on population-based surveys such as the Behavioral Risk Factor Surveillance System (BRFSS) survey, the National Health Interview Survey (NHIS), and others has helped public health and clinical practitioners identify health disparities and unique risk factors among this population. Individuals identifying as lesbian, gay, or bisexual (LGB) make up between 2% and 6% of the US population, but they have been largely neglected by public health research. The higher prevalence of ACEs among LGB individuals may account for some of their excess risk for poor adult health outcomes. Associations with poor mental health, activity limitation, HIV risk behaviors, current asthma, depression, and disability remained, but were attenuated.Ĭonclusions.
After adjustment for cumulative exposure to ACEs, sexual orientation was no longer associated with poor physical health, current smoking, and binge drinking.
LGB individuals had a higher prevalence of all ACEs than heterosexuals, with odds ratios ranging from 1.4 to 3.1. There were 711 lesbian, gay, and bisexual (LGB) respondents and 29 690 heterosexual respondents. Data were from the 2012 North Carolina, 2011 Washington, and 20 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding health risks, perceived poor health, and chronic conditions by sexual orientation and 8 categories of ACEs. We explored the association of sexual orientation with poor adult health outcomes before and after adjustment for exposure to adverse childhood experiences (ACEs).