Asking Sexual Orientation Questions On State Risk Factor Surveys Allows 27 States To Document Health Disparities Affecting Sexual Minorities

BRFSS Policy Brief Cover

The Fenway Institute today issued “a call to action” to state health departments, urging them to ask questions about sexual orientation on their Behavioral Risk Factor Surveillance System surveys (BRFSS). In a policy brief focused on why states should ask about sexual orientation and how they should do this, The Fenway Institute noted that BRFSS surveys 500,000 Americans in all 50 states annually. Asking about sexual orientation—ideally both identity and behavior—dramatically increases knowledge about health disparities affecting lesbian, gay, and bisexual people (LGB).

The brief, written by Fenway researchers Leigh Evans, Kelsey Lawler, and Sammy Sass, examines efforts by 27 states to gather sexual orientation data in at least one year of BRFSS data collection from 1995 through 2012. These included southern states like North Carolina, Georgia, and Florida, as well as Texas and several Great Plains and Rocky Mountain states. However, in any given year only a small number of states ask the sexual orientation questions. For example, in 2009, only 13 states and the District of Columbia included a sexual orientation question on their BRFSS. The Fenway Institute encourages all 50 states to ask sexual orientation and gender identity questions on their BRFSS surveys every year.

States that have asked about sexual orientation have documented disparities and used the data to inform public health programming to address them. For example:

  • Arizona’s public health department found through its BRFSS that 31% of Arizona lesbians smoked, about twice the rate of the state’s general female population. As a result, Tobacco Free Arizona targets lesbians and other members of the lesbian, gay, bisexual and transgender (LGBT) community with prevention and cessation interventions.
  • New Mexico, Washington state, and Massachusetts also documented tobacco use disparities affecting lesbian, gay and bisexual people through, and also target the LGBT community with tobacco prevention and cessation efforts.
  • BRFSS data from several states have shown that lesbians are less likely to get mammograms than other women, and have found higher rates of suicidality among LGB veterans, findings that have important public health implications.

“States in all regions of the country have tested sexual orientation questions on their Behavioral Risk surveys and gathered invaluable public health data,” said Sean Cahill, PhD, Director of Health Policy Research at The Fenway Institute. “But right now most states are not asking these questions. We strongly urge state health departments to add sexual orientation and gender identity questions to their BRFSS surveys to help identify health disparities affecting LGBT people.”

The policy brief recommends language for sexual identity and sexual behavior questions and recommends that data on lesbians, gay men and bisexual women and men be analyzed separately, as lumping the data together can mask important differences among these groups. For example, BRFSS data show that gay men are less overweight and obese, on average, than heterosexual men, while lesbians are more likely to be overweight or obese. The Massachusetts BRFSS found poorer health among bisexual respondents compared with gay, lesbian, and heterosexual respondents, as well as higher rates of mental health issues and smoking. The Youth Risk Behavior Survey in seven states and six large cities—a survey of high school students—also found higher rates of health risk behaviors among bisexual youth compared with gay and lesbian youth. Lesbian, gay and bisexual youth report much higher rates of health risk behaviors than heterosexual youth.

The Fenway Institute recommends inclusion of sexual orientation measures in the BRFSS core questionnaire. This would recognize the health disparities facing sexual minority populations and allow for a larger data set that can be analyzed.

“If all 50 states asked these questions every year, we would have a much larger data set and could look at the intersection of racial/ethnic health disparities with sexual minority disparities, and at issues affecting older adults who are lesbian, gay and bisexual,” said Leigh Evans, Evaluation Manager at The Fenway Institute.

Some state BRFSS surveys only ask sexual orientation questions of people under 65, leaving out LGB elders. The Fenway Institute brief recommends that all adult age cohorts be asked about sexual orientation, to increase our understanding of issues affecting LGB elders. These include living alone and social isolation.

The Fenway Institute also encourages states to ask about gender identity on their BRFSS surveys. A separate group of researchers, called GENIUSS, is promoting the inclusion of gender identity questions on health surveys. The Fenway Institute Research Scientist Kerith Conron, ScD is an active member of that group.

For more than forty years, Fenway Health has been working to make life healthier for the people in our neighborhood, the LGBT community, people living with HIV/AIDS and the broader population.  The Fenway Institute at Fenway Health is an interdisciplinary center for research, training, education and policy development focusing on national and international health issues. Fenway’s Sidney Borum Jr. Health Center cares for youth and young adults ages 12 to 29 who may not feel comfortable going anywhere else, including those who are LGBT or just figuring things out; homeless; struggling with substance use; or living with HIV/AIDS.  In 2013, AIDS Action Committee of Massachusetts joined the Fenway Health family, allowing both organizations to improve delivery of care and services across the state and beyond.

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