Where Sexual Orientation Has No Name: Sexual Orientation Missing Data in the Canadian Community Health Survey (2005-2014)

Perceived Community Belonging as a Moderator of the Association Between Sexual Orientation and Health and Well-Being

PURPOSE

This study examines the moderating role of perceived community belonging in the association between sexual orientation and various health and well-being outcomes.

DESIGN

A national cross-sectional survey.

SETTING

Confidential microdata from the 2021 Canadian Community Health Survey.

SUBJECTS

Individuals aged 15 and older, with a sample size ranging from 43,000 to 44,100.

MEASURES

Sexual orientation, health and well-being outcomes, and sense of community belonging were all self-reported. Outcomes included self-rated general and mental health, depressive symptoms, and life satisfaction.

ANALYSIS

A series of multiple linear regression models.

RESULTS

Compared to heterosexual individuals, bisexual individuals reported poorer self-rated general health (b = .402, P < .001 for men; b = .454, P < .001 for women) and mental health (b = .520, P < .001 for men; b = .643, P < .001 for women), higher depressive symptoms (b = 2.140, P < .001 for men; b = 2.685, P < .001 for women), and lower life satisfaction (b = .383, P < .05 for men; b = .842, P < .001 for women). Few disparities were observed among gay men and lesbians. Contrary to some recent findings, no disparities were observed among individuals uncertain about their sexual orientation or those who chose not to disclose it, even without controlling for covariates. A stronger sense of community belonging mitigated the disadvantages associated with self-rated general health (b = -.276, P < .01) and depressive symptoms (b = -.983, P < .01) for gay men, and life satisfaction (b = -.621, P < .01) for lesbians.

CONCLUSION

This study is among the first to highlight the stress-buffering role of community belonging in the association between sexual orientation and health and well-being outcomes.

Contextual Influences on Nonresponse to Health Survey Questions About Sexual Orientation and Gender Identity

Purpose: We examined the relationship between state context and survey nonresponse to sexual orientation (SO) and gender identity (GI) questions. Methods: We obtained data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Item nonresponse was defined as selecting "don't know/not sure" or "refused" for each of two questions about SO and GI. Nonresponse patterns included responding to both SO and GI questions; responding only to the SO question (nonresponse to GI); responding only to the GI question (nonresponse to SO); and responding to neither question. State-level contextual measures included legal protections for lesbian, gay, bisexual, transgender, or other sexual or gender minority (LGBT+) people, LGBT+ social movement strength, and public opinion regarding LGBT+ issues. Results: The analysis included 1,459,525 respondents from 44 states (190 state-years). On weighted analysis, 96.5% of adults answered both SO/GI questions, 2.4% responded only to GI, 0.4% responded only to SO, and 0.7% responded to neither. The demographic profile of individuals with GI-only nonresponse differed markedly from the profile of adults with SO-only nonresponse. An increasingly favorable legal climate for LGBT+ people was associated with greater rates of response to SO and GI questions. However, a more LGBT+ friendly state climate measured by social movement strength or public opinion was not consistently associated with reduced SO and GI question nonresponse. Conclusion: Contextual factors have mixed association with nonresponse to SO and GI question on BRFSS surveys. Our results warrant continued development of health survey questionnaires to elicit accurate information on respondents' SO and GI.

Evaluation of Survey Nonresponse in Measuring Cardiometabolic Health Risk Factors and Outcomes among Sexual Minority Populations: A National Data Linkage Analysis

Understanding cardiometabolic health among lesbian, gay, and bisexual (LGB) people is challenged by methodological constraints, as most studies are either based on nonprobability samples or assume that missing values in population-based samples occur at random. Linking multiple years of nationally representative surveys, hospital records, and geocoded data, we analyzed selection biases and health disparities by self-identified sexual orientation in Canada. The results from 202,560 survey respondents of working age identified 2.6% as LGB, 96.4% as heterosexual, and <1.0% with nonresponse to the sexual identity question. Those who did not disclose their sexual identity were older, less highly educated, less often working for pay, and less often residing in rural and remote communities; they also had a diagnosed cardiometabolic condition or experienced a cardiometabolic-related hospitalization more often. Among those reporting their sexual identity, LGB individuals were younger, more likely to smoke tobacco or drink alcohol regularly, more likely to have heart disease, and less likely to have a regular medical provider than heterosexual persons. This investigation highlighted the potential of leveraging linked population datasets to advance measurements of sexual minority health disparities. Our findings indicated that population health survey questions on sexual identity are not generally problematic, but cautioned that those who prefer not to state their sexual identity should neither be routinely omitted from analysis nor assumed to have been randomly distributed.

Sexual Identity-Behavior Discordance in Canada

This paper uses two surveys to examine sexual identity-behavior discordance in Canada. The first is the Sex in Canada survey (SCS), which is a private survey of 2,303 Canadians. The second is the 2015-2016 Canadian Community Health Survey (CCHS), which is a large nationally representative government-administered survey with 109,659 respondents. Results from the CCHS show that identity-behavior discordance and overall rates of same-sex contact are lower in Canada than in the US, UK, or Australia. An estimated .7 percent of males and 2.7 percent of females aged 15-64 who had had lifetime sex identified as heterosexual yet have had same-sex contact, figures which equate to an estimated 65,700 males and 255,100 females. Few demographic factors were associated with discordance. Results from the SCS show that about two-thirds of heterosexuals with identity-behavior discordance were moderately supportive of LGBQ rights and one-third were moderately homophobic. Future research will need to uncover why a lower proportion of Canadians report same-sex partners and identity-behavior discordance than their counterparts in the US, UK, or Australia. Cet article utilise deux enquêtes pour examiner la discordance entre l'identité sexuelle et le comportement au Canada. La première est l'enquête Sex in Canada (SCS), qui est une enquête privée menée auprès de 2 303 Canadiens. La seconde est l'Enquête sur la santé dans les collectivités canadiennes (ESCC) de 2015-2016, qui est une grande enquête représentative à l'échelle nationale administrée par le gouvernement auprès de 109 659 répondants. Les résultats de l'ESCC montrent que la discordance identité-comportement et les taux globaux de contacts entre personnes de même sexe sont plus faibles au Canada qu'aux États-Unis, au Royaume-Uni ou en Australie. On estime que 0,7 % des hommes et 2,7 % des femmes âgés de 15 à 64 ans ayant eu des rapports sexuels au cours de leur vie se sont identifiés comme hétérosexuels, mais ont eu des contacts avec des personnes du même sexe, ce qui correspond à environ 65 700 hommes et 255 100 femmes. Peu de facteurs démographiques étaient associés à la discordance. Les résultats de l'enquête SCS montrent qu'environ deux tiers des hétérosexuels présentant une discordance entre identité et comportement étaient modérément favorables aux droits des LGBQ et qu'un tiers était modérément homophobe. Les recherches futures devront découvrir pourquoi une plus faible proportion de Canadiens déclarent avoir des partenaires de même sexe et être en désaccord avec leur identité et leur comportement que leurs homologues aux États-Unis, au Royaume-Uni ou en Australie.

Spatio-temporal trends in caries: A study on children in Berlin-Mitte

Background

Significant inequalities in caries distribution among children in Germany have been reported, but small‐scale areas remain understudied.

Aim

To examine spatio‐temporal trends in children's dental caries at the small‐area level in Berlin‐Mitte.

Design

Routinely collected data from Berlin's annual Health Examination Surveys were used, which also include information on age, sex, country of origin, and residential area. The study population consists of 14,866 children aged 5 to 7 between 2006 and 2014 in the district of Berlin‐Mitte. Outcome variables are the dmft (decayed, missing, and filled teeth), the presence of any caries experience, untreated caries, and caries risk. The outcomes are summarized descriptively and graphically presented for 10 quarters and 41 communities within Berlin‐Mitte.

Results

Relevant gaps in children's dental caries were discovered between the quarters of Mitte. Three quarters in the northeast part of Mitte have consistently indicated the lowest oral health status in all four outcomes, and children having high caries risk have been increasingly concentrating in this area over time. Despite the continuous improvements in the southern part, the averages in total of Mitte for all outcomes have risen.

Conclusion

Our findings confirm the spatiotemporally mounting disparities in children's oral health between the quarters in Berlin‐Mitte and that particular quarters need urgent attention. The small‐area approach made it easier and more effective to reveal the spatial distribution of children's dental caries at the local level. The small‐area analysis should be strongly encouraged in future caries research to narrow the inequalities in children's oral health.