Elsevier

Annals of Epidemiology

Volume 25, Issue 9, September 2015, Pages 661-667
Annals of Epidemiology

Original article
Associations of sexual and gender minority status with health indicators, health risk factors, and social stressors in a national sample of young adults with military experience

https://doi.org/10.1016/j.annepidem.2015.06.001Get rights and content

Abstract

Purpose

To assess the associations of self-identified lesbian, gay, bisexual, and questioning sexual orientation or transgender status (LGBTQ) and military experience with health indicators.

Methods

We used data from the Fall 2012 National College Health Assessment. The survey included self-identified sociodemographic characteristics, mental (e.g., depression) and physical (e.g., human immunodeficiency virus) conditions, health risk behaviors (e.g., smoking), and social stressors (e.g., victimization). We used modified Poisson regression models, stratified by self-reported military service, to examine LGBTQ-related differences in health indicators, whereas adjusting for sociodemographic characteristics.

Results

Of 27,176 in the sample, among the military-experienced group, LGBTQ individuals had increased adjusted risks of reporting a past-year suicide attempt (adjusted risk ratio [aRR] = 4.37; 95% confidence interval [CI] = 1.39–13.67), human immunodeficiency virus (aRR = 9.90; 95% CI = 1.04–79.67), and discrimination (aRR = 4.67; 95% CI = 2.05–10.66) than their non-LGBTQ peers. Among LGBTQ individuals, military experience was associated with a nearly four-fold increased risk of reporting a past-year suicide attempt (aRR = 3.61; 95% CI = 1.46–8.91) adjusting for age, sex, race and ethnicity, marital status, depression, and other psychiatric diagnoses.

Conclusions

Military experience may moderate health indicators among LGBTQ populations, and likewise, LGBTQ status likely modifies health conditions among military-experienced populations. Results suggest that agencies serving military populations should assess how and if the health needs of LGBTQ individuals are met.

Introduction

In the United States, an estimated 9 million adults identify as lesbian, gay, bisexual, or transgender (LGBT or sexual and gender minority) [1]. These groups are vulnerable to disparities in several health risk behaviors, such as cigarette smoking [2], substance use [3], violence [4], and discrimination [5], and in adverse health outcomes, such as depression [6], respiratory illnesses [7], and sexually transmitted diseases [8]. In 2011, the Institute of Medicine recommended further research to explore how specific sociodemographic factors may further influence health among LGBT populations [9].

Current and former military experience is one example of a characteristic that may influence health because of the unique stressors (e.g., combat exposure, military sexual trauma, transitions between deployments [10], [11], [12]) and culture (e.g., norms and beliefs [13], [14]) of military service. Several studies document elevated burdens of mental health problems among individuals with military service history, including suicide risk [15] and post-traumatic stress disorder (PTSD) [16]. LGBT persons who served in the U.S. military may have experienced more stressors, such as discrimination and harassment, than their non-LGBT peers because of the recently rescinded “Don't Ask, Don't Tell” policy that banned openly lesbian, gay, and bisexual people from military service [17], [18]. Individuals can still be discharged from the U.S. military if they are transgender [19]. Despite these potential unique experiences and health needs, there is a paucity of health information about LGBT persons who have served in the U.S. military.

Data from the U.S. Census and general population surveys suggest that nearly 1 million U.S. military veterans identify as lesbian, gay, bisexual individuals, and recent findings suggest that more than 70,000 lesbian, gay, bisexual individuals and 15,500 transgender individuals serve in active duty, the guard, or the reserves [20], [21]. To some extent, the sexual orientation–related and transgender-related health differences observed in general samples have also been documented in studies with veteran populations. For instance, studies comparing sexual minority with heterosexual veterans have documented higher prevalence of smoking [22], [23], suicidal ideation [24], [25], [26], [27], PTSD [28], and victimization [29], [30]. There are, however, studies that suggest veteran status may moderate differences among sexual minority individuals. Blosnich et al. [31] noted that sexual minority veterans had twice the odds of keeping firearms in the home compared with their sexual minority nonveteran peers. In another study, lesbian and bisexual women veterans had significantly greater prevalence of mental distress, sleep disturbances, current smoking, and poor physical health than lesbian and bisexual nonveterans [22]. The few empirical studies about transgender veterans note a substantially higher burden of poor mental health compared with nontransgender veterans [32], [33], [34].

Relatively, very little is known about health risk behaviors and social stressors (e.g., violence and discrimination) among sexual and gender minority individuals with military experience. Research efforts have been hampered by the relative rarity of LGBT status in data collection systems.[35], [36]. When LGBT status is collected, large sample sizes are necessary to find analyzable groups of persons who report both LGBT status and military experience. Moreover, many extant studies of LGBT veterans lack direct comparison groups of non-LGBT veterans or LGBT nonveterans groups. To address these gaps, we examine differences in a variety of health indicators (i.e., physical and mental health, health risk behaviors, and social stressors) by sexual and gender minority status among persons reporting a military experience in a large national sample of young adults.

Section snippets

Data

Data are from the National College Health Assessment Fall 2012 survey sponsored by the American College Health Association (ACHA). Postsecondary educational institutions purchase the National College Health Assessment, and ACHA aggregates data collected from institutions that use probability-based sampling methods. The Fall 2012 data set had a total of 28,237 respondents from 51 institutions in the United States. Most institutions (n = 48) used Web-based surveys and three used paper

Sociodemographics

Our analytic sample included individuals who indicated their sexual orientation, gender identity, and military experience (n = 27,176). Of the survey respondents, 2316 (8.5%) self-identified as LGBTQ, and 587 (2.2%) indicated military experience. Because sexual orientation and gender identity were assessed separately, we examined a cross-tabulation to assure that LGBTQ persons were only counted once when coding LGBTQ individuals with military service. Among LGBTQ persons with military

Discussion

These findings contribute to the growing attention of LGBTQ individual with military experience by corroborating results from previous studies, highlighting new areas of focus, and exploring heterogeneity among LGBTQ populations based on military experience. First, similar to earlier studies, we observed higher prevalence of poor mental health [22], [26], [28], [32] and sexual assault [29], [30] among sexual and gender minority veterans in this sample. Second, we noted several differences

Conclusion

Military experience may be a salient modifier of health indicators among LGBTQ populations, and likewise, LGBTQ status is likely a modifier of health conditions among military-experienced populations. With the recent repeal of “Don't Ask, Don't Tell” [5] and ongoing efforts to allow transgender individuals also to serve openly in the U.S. military [59], [60] both the Department of Defense and VA are likely to see increases in their current LGBTQ populations. Agencies that serve military and

Acknowledgments

The authors thank the American College Health Association for use of the Fall 2012 survey data set. This work was partially supported by a postdoctoral fellowship to J.R. Blosnich through the Department of Veterans Affairs Office of Academic Affiliations and the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System. The opinions expressed in this work are those of the authors and do not represent the funders, institutions, the Department of Veterans Affairs, or

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