A

Access to health care, 6

defined, 37

financial barriers, 5, 10, 37, 41-42, 157

focus of women's health services and, 45-46

literature on, 186-189

personal/cultural barriers, 5, 10-11, 37, 42-46, 157-158

research recommendations, 10-11, 87, 157-158

structural barriers, 10, 37, 40-41, 157

test of equality in, 37, 40

Adolescents. See Children and adolescents

Adoption by same-sex parents, 37, 53

Adult lesbians, developmental issues, 52-54

Affective disorders, 68-69

African Americans

cultural values, 24

depressive distress in, 61

HIV seroprevalence, 76

Lesbian studies, 108-109

Age

and awareness of sexual identity, 50-51

and cancer risk, 56

and coming out, 48-49

and dimensions of same-sex sexuality, 28

and drinking behaviors, 80

Aging, 5, 173-174

Alcohol use, 56, 58, 64, 65, 68, 79-81, 102-103, 120

American Academy of Pediatrics, 44 n.4

American Community Survey, 160

American Medical Association, 44 n.4

American Psychiatric Association, 36, 44 n.4

American Psychological Association, 44 n.4

Division 44, 137

American Sociological Association, 138

Antigay hate crimes, 36, 38, 42

Anxiety disorders, 68, 81

Artificial insemination, 54, 76

Asian American lesbians and gay men, 24

B

Bacterial vaginosis, 73, 102-103

Bisexual women, 4, 22-23, 27, 31, 32

HIV seroprevalence, 76

illicit drug use, 82, 83

reproductive health studies, 106-107

Body mass index (BMI), 57, 64, 67, 68

Breast cancer, 21, 46, 64, 65, 67, 141, 142

Buddhism, 24, 25

Bureau of Labor Statistics National Longitudinal Surveys, 128

C

Cancer, 46, 47, 54.

See also specific forms of cancer

literature on, 177

prevention studies, 112-113

research recommendations, 86

risk factors, 55, 56, 64-67, 86

Cardiovascular disease, 42, 46, 62, 68, 86, 112-113

Catholicism/Catholics, 25, 28

Centers for Disease Control and Prevention, 1, 14, 18, 140

lesbian research and programs, 142, 162-163

Office of Women's Health, 19

Cervical cancer, 66-67, 70, 73, 142

Chicago Women's Health Study, 102

Childhood sexual abuse, 58-59, 70, 77, 81

Children and adolescents

coming-out process, 51-52

development of sexual identity, 50-51

heterosexual activity, 78

literature on, 170-173

raised in lesbian households, 53-54

sexuality studies, 149

suicide, 52, 110-111

Chlamydia, 70, 72-73, 78

Civil rights protection, 39

Clearinghouses on lesbian health, 163

Colon and rectal cancer, 64, 67

Coming out

age and, 48-49

coping mechanisms, 51

cultural contexts of, 24, 49-50, 55

to family, 24, 49

fear of, 6, 44-45, 49

to health care providers, 6, 40, 44-45

lesbian academics, 138

process, 48-50, 51-52

Committee on Lesbian Health Research Priorities, 17, 18

Conferences on Health Survey Methods, 162

Confidentiality, 9, 13, 113, 128-129, 150 n.12, 152-153, 161, 162

Confucianism, 24, 25

Contextual barriers to research, 135-136

career ramifications, 8, 136-138

funding to study lesbian health, 8, 9, 97, 137, 139-140, 153

mentors for lesbian researchers, 8, 138-139, 164

publishing and disseminating findings, 14-15, 140-144, 153, 161

strategies for overcoming, 14-15, 144, 163-164

training and education of researchers, 14-15, 163-164, 203-204

Coronary Artery Risk Development in Young Adults, 62 n.10

Cultural competency of health care providers, 5, 41, 42-44, 157

D

Death, causes of, 46, 47, 68

Definition of lesbian, 21-23

Committee, 4-5, 17, 25-33

methodological issues, 3, 6-7, 10, 23, 97-98, 99, 100-101, 102-114, 156-157

racial/ethnic minority perspectives, 3-4, 23-25

Department of Health and Human Services, 149

Secretary's Task Force on Youth Suicide, 52

Depressive illness, 60, 61, 68-69, 80

Developmental challenges of lesbians, 5, 46, 48

adults, 7-8, 42-54

children and adolescents, 7-8, 50-52

coming out, 6, 48-50, 51-52, 157

life span, 5-6, 7-8

research recommendations, 85

Disclosure of sexual orientation.

See also Coming out

audio computer-assisted self-interview, 8, 115-117

to researchers, 23, 31 n.9, 97, 99 n.1, 114-115, 118-119, 120, 128 -129

Discrimination. See Prejudice and discrimination

Domestic partner benefits, 5, 37, 41

Duke University, 141

E

East Asian cultural values, 24, 25

Eating disorders, 42

Education, and dimensions of same-sex sexuality, 28

ENCOR Eplus programs, 142

Endometrial cancer, 67

Ethical issues, 150

confidentiality, 9, 113, 152-153

risks to research participants, 9, 151

Ethnographic research, 114

F

Family, 24, 49, 63, 182-184

Fear of coming out, 23, 44-45

Federal Bureau of Investigation, 36

Foster parents, same-sex, 37, 53

G

Gay and Lesbian Medical Association, 19, 139, 143 n.6

Gay Urban Men Survey, 117, 122-123

Gender roles, 24, 81

General Social Survey, 26 n.4

Genital warts, 78

Geographic distribution

of dimensions of same-sex sexuality, 29

of lesbians, 119

Georgetown University, 141

Gonorrhea, 70, 72-73, 78

Gynecological care, 21, 42, 66-67, 112-113

H

Health, definition, 17 n.1

Health care providers

coming out to, 6, 44-45

cultural competency, 5, 41, 42-44, 157-158, 163-164

dissemination of lesbian health information to, 14-15, 163

homophobic attitudes, 5, 44

recognition of partners, 41

sexual history taking, 43-44, 45

Health insurance coverage, 41-42

Health-seeking behaviors, 43, 112-113

Hepatitis, 78, 82

Herpes, 78

Heterosexual activity, 52, 56, 66, 78

HIV/AIDS, 3, 21, 54, 61, 71, 74, 75-79, 82, 86, 102-107, 148, 189-192

HIV Epidemiology Research Study, 142

Homophobic attitudes, 5, 44, 151, 174-176

Homosexuality, APA classification, 36

Hormone replacement therapy, 68

Human papillomavirus infection, 56, 66, 73, 78

Hypertension, 54, 60, 62, 68

I

Identity. See Sexual identity

Illicit drug use, 76, 79, 81-84, 104-105, 177-180

Inter-University Consortium for Political and Social Research, 27 n.6

Institutional review boards, 12-13, 153, 161

J

Jews, dimensions of same-sex sexuality, 28

L

Latino cultural values, 24-25

Legal status of gay men and lesbians, 36-37, 38-39, 41, 152

Lesbian AIDS Project, New York City, 142

Lesbian Health Fund, 139

Literature on lesbian issues, 18, 140

adolescents, 170-173

aging, 173-174

attitudes and homophobia, 174-176

cancer, 177

drug abuse, 177-180

ethnic, racial, and cultural minority groups, 180-182

family, 182-184

general, 165-170

health, 185-186

health care services, 186-189

HIV/AIDS, 189-192

mental health, 192-197

methodology of studies, 198-199

relationships, 199-200

reproductive health, 200-201

sexual behavior, 201

sexually transmitted diseases, 201-202

suicide, 202-203

training and education, 203-204

violence, 204-206

work, 206

Lung cancer, 46, 67

Lyon-Martin Center, San Francisco, 142

M

Maine, 37

Managed care, 5, 10, 40-41

Marital status, and dimensions of same-sex sexuality, 28

Marriage, same-sex, 37, 38

Mautner Project, 43 n.3, 142

Measures of sexual orientation, 7, 11-12, 22, 26-27 n.5, 30-32, 97 -98, 99, 101-114, 158-159

Menstrual synchrony in couples, 112-113

Mental health of lesbians, 54, 68-70

research recommendations, 10, 85-86

studies, 102-103, 108-109, 192-197

Methodological issues in research, 136.

See also Sampling strategies

adding sexual orientation questions to existing studies, 12-13, 119 , 126-129, 159-160

control or comparison groups, 1, 7, 98-99, 139

cross comparison of findings, 97-98, 101

defining the population, 6-7, 10, 23, 97-98, 99, 100-101, 156-157

disclosure of sexual orientation, 7, 97, 99 n.1, 114-117, 118-119, 122, 128-129

generalizability of conclusions, 7, 23, 33, 55, 70, 98, 118

literature on, 198-199

measures of sexual orientation, 7, 11, 97-98, 99, 101-114, 158-159

research recommendations, 9, 101, 114, 129-130, 156-157, 158-159

sample representativeness, 75, 80, 98, 118, 120

Miami University, 141

Michigan Lesbian Health Survey, 36, 41, 42, 43, 45, 74, 106-107

Midlife issues, 52-53, 63

Minnesota, 52

Morality issue, 150

Motherhood, 53-54, 57

Multicultural Men's Health Study, 123

N

National Association of Social Workers, 44 n.4

National Black Lesbian Study, 108-109

National Cancer Institute, 65, 141

National Center for Injury Prevention and Control, 142

National Comorbidity Survey, 68, 69

National Gay and Lesbian Health Association, 43 n.3

National Health and Nutrition Examination Survey, 119, 128, 160

National Health and Social Life Survey (NHSLS), 26 n.4, 27, 30 n.7, 57, 72 n.18, 74, 83, 84, 108-109

National Health Interview Survey, 119, 128

National Household Survey on Drug Abuse, 55, 79, 82, 160

National Human Subjects Protections Education Workshop Program, 162 -163

National Institute of Allergy and Infectious Diseases, 140

National Institute of Child Health and Development, 149

National Institute of Mental Health, 140

National Institute on Drug Abuse, 140

National Institutes of Health, 12-13, 160

conference support, 14, 162-163

Office of Protection from Research Risks, 163

Office of Research on Women's Health, 1, 17-18, 19, 140, 144

Revitalization Act, 149

National Lesbian and Bisexual Women's Health Survey, 78

National Lesbian Health Care Survey (NLHCS), 36, 41-42, 45, 57, 58 , 63, 66, 69, 81-82, 108-109

National Opinion Research Center, 83 n.23, 148-149

National Research Council

Committee on AIDS Research and Behavioral and Social Sciences, 99 n.1, 150 n.12

Committee on Evaluating Genetic Diversity, 150 n.12

National Survey of Adolescent Males, 116

National Survey of Family Growth, 128, 160

Nurses Health Study II Pilot Study, 110-111, 114, 127, 160

O

Office of Management and Budget, 149

Oral contraceptive use, 56, 57-58, 64, 67, 68

Osteoporosis, 112-113

Ovarian cancer, 64, 67

Overweight and obesity, 56, 57, 62, 64, 65, 68, 102-103

P

Pap tests, 6, 21, 42, 66-67

Partners, lesbian.

See also Domestic partner benefits

alcohol use, 81

legal recognition of, 41

relationships, 199-200

Pregnancy history, 56, 57, 64, 65

Prejudice and discrimination

and coming out, 49

laws against, 37

lesbian researchers, 136

prevalence in U.S., 5, 35-37

research used for, 151

studies of, 106-107

Prevalence of being lesbian, 23, 26, 28-29, 57

Preventive health care, 45-46, 104-105, 112-113

Professional associations, provider, 44

Prostitution, 78

Protective factors for health, 6, 10, 13-14, 63, 68, 85, 156

Protestants, 28

Providers. See Health care providers

Public liaison group, 18

R

Racial discrimination/racism, 61-62

Racial/ethnic minorities

cancer risk, 64

coming out, 49-50, 55

and dimensions of same-sex sexuality, 3-4, 29

perspectives of sexual orientation, 23-25

research needs, 13, 117-118, 146, 156, 157, 160-161

studies of lesbians of, 13, 54-55, 70, 106-109, 129, 180-182

triple jeopardy, 61, 106-107

Religion.

See also specific religions

and dimensions of same-sex sexuality, 28-29

influences on attitudes, 24, 25

Reproductive health, literature on, 200-201

Research on lesbian health

adolescents, 153

barriers, see Contextual barriers to research

community-researcher collaboration, 8, 145-148

conferences, 14, 162-163

ethical issues, 150-153

funding, 7, 11-12, 141, 144, 148-150, 158

importance, 2-3, 20-21

informed consent, 153, 162

longitudinal, 99

methodologies, see Methodological issues in research

needs and recommendations, 10-11, 50, 81, 84-87, 99, 156-164

racial and ethnic minorities, 54-55

uses, concerns about, 151, 162

Risk factors for lesbian health

beliefs and misconceptions, 2, 21, 63, 65, 72-73, 76-77

communication with providers and, 43

general, 20, 55-59

literature, 185-186

research recommendations, 9, 10, 13-14, 85, 155, 156, 161-162

unique, 3, 6, 21, 59-62

S

Sampling strategies, 117-118.

See also Methodological issues in research

combining strategies, 126, 158-159

disproportionate stratification, 122-123

location (convenience), 80, 81, 98, 120, 125-126

multiple frames, 123-124

multiplicity or network, 124

nonprobability, 7, 80, 119-120, 125-126, 139

one-stage screening, 121-122

probability, 7, 13-14, 27, 33, 68, 81, 82, 98, 116, 117, 118-119, 121-124, 158-159, 161-162

selection bias, 119, 121-122, 126

snowball, 125

two-stage screening, 122

Sensitization, 48

Sexual behavior.

See also Sexual practices

and cervical cancer, 66

and definition of lesbian, 22, 26, 102, 104, 106, 108, 110, 112

funding of research on, 8-9, 148-149

history taking by providers, 43-44, 45

and illicit drug use, 83-84

literature on, 201

longitudinal studies, 7-8, 110-111

measures of, 30-31

and sexual identity, 32

Sexual desire/attraction, measures of, 30 n.7, 32, 103, 113

Sexual identity

adolescents, 110-111

and alcohol use, 102-103

appeal and sexual behavior by, 32

bisexual, 22

confusion, 77

definitional issues, 22, 26, 102, 104, 106, 108, 110, 112

development of, 48, 50-51, 99

and discrimination, 106-107

and gynecological care, 112-113

and HIV risk behavior, 104-107, 110-111

measures of, 27 n.7, 31 n.9, 102, 104, 106, 108, 110, 112

and mental health, 102-103, 108-111

racial, ethnic, and cultural perspectives, 3-4, 23-25, 106-109

and reproductive system problems, 106-107

and sexual practices, 102-113

and STDs, 102-103, 110-111

and weight/dieting, 102-103

Sexual orientation

age of awareness of, 50-51

children raised in lesbian households, 53

determinants of, 51

dimensions of, 3-4, 5, 25-33, 101, 102-114

Kinsey scale, 112-113

measures of, 7, 11-12, 22, 26-27 n.5, 30-32, 99, 102-114, 158-159

racial/ethnic minority perspectives, 23-25

and smoking, 55-57

underreporting, 33 n.10

Sexual practices

assumptions about, 70-71

and discrimination, 106-107

disease prevention studies, 112-113

and gynecological care, 112-113

heterosexual activity, 52, 56, 66, 78, 102, 106

and HIV/AIDS, 77-78, 102-107, 110-111

and menstrual synchrony in couples, 112-113

and mental health, 102-103

and reproductive health, 106-107

and STDs, 74-75, 102-103

Sexually transmitted diseases (STDs), 54, 66, 67-75, 78, 86, 102-105, 110-111, 149, 201-202

Smoking, 42, 55-57, 64, 67, 68, 81

Social networks and support systems, 63, 77, 125

Socioeconomic status, 13, 62, 70, 156, 160-161

Sodomy laws, 37, 39

Stanford University, 141

Stigmatization, 5.

See also Prejudice and discrimination

of conducting research, 136, 137

of lesbian academics, 137-138

research data used for, 152

and stress, 21

Stress, 3, 21, 59-62, 63, 65, 68, 81

Substance abuse, 54, 77, 79, 86-87.

See also Alcohol use;

Illicit drug use

Suicide, 51-52, 69-70, 110-111, 202-203

Survey of Family Growth, 117

Syphilis, 70, 72-73

T

Taoism, 24, 25

U

University of North Carolina, 149

University of Washington, 78

University of Wisconsin, 141

U.S. Census of Population and Housing, 128

Uterine cancer, 64

V

Violence against gay men and lesbians, 36, 42, 49, 59, 61, 70, 204 -206

W

Whitman Walker Clinic, Washington, D.C., 142

Women's Health Initiative, 55, 57, 112-113, 114, 127, 128, 139

Work, literature on, 206

Workshop

agenda, 1-2, 18, 207-213

participants, 18, 215-222

written testimony, sources, 19, 223-226

Y

Yale University, 142

Young Women's Christian Association, 142

Youth Risk Behavior Study, 160