Differences between sexual orientation behavior groups and social background, quality of life, and health behaviors.

There has been a tremendous explosion of research on sexual orientation and homosexual lifestyles in recent decades (Allgeier & Allgeier, 2000; Hawkins & Stackhouse, 1998). This has included examination of the development of a homosexual or bisexual identity, dimensions of sexual orientation, relationship dynamics, the historical emergence of a gay culture, possible etiologic factors, and a variety of related social issues, as well as basic descriptive research on the incidence or prevalence of sexual behavior. It has been difficult to form strong generalizations from this research literature for a number of reasons. There has been no widely shared agreement about how sexual orientation should be conceptualized or operationalized. Research methods and designs have varied widely, such as surveys, telephone contact, and face-to-face interviews. There has been little effort to examine the demographic characteristics of samples, and possible distinctions between clinical and nonclinical samples have not always been examined.

One area receiving increased attention by professionals in recent years has been the quality of life (QOL) associated with different sexual orientations (Gonsiorek, 1991; Ross, 1990). The concept of QOL may be seen as including direct measures that ask respondents to rate the quality of some aspect of their life, such as job satisfaction, perceived health, or general life happiness, as well as a variety of lifestyle and health patterns (i.e., smoking, drinking and/or other drug behavior, physical activity, mental health, and health background) (Horowitz, Blackburn, Edington, & Klos, 1988). Several perspectives about the association between sexual orientation and QOL have appeared in the literature. One view has been that bisexuality and homosexuality are pathological conditions, leading to reduced and disrupted QOL This may be regarded as the traditional Western position (summarized by Allgeier & Allgeier, 2000). Another view has been that homosexuals and bisexuals tend to face discrimination in a homophobic society, and, thus, face unique challenges to their QOL (Allgeier & Allgeier, 2000; Hawkins & Stackhouse, 1998). Another has been that there is no general or systematic difference between sexual orientation groups except their sexual object choice (Symons, 1979). Yet another view has been that there are differences among homosexuals or bisexuals, such as being closeted, that may make them more or less susceptible to disruptions in QOL (Harry, 1986).

The present study tested the association between sexual orientation groups and a set of demographic and QOL variables in a series of nonclinical, national probability samples. In addition, we examined the conceptualization of both sexual orientation and quality of life.

THE CONSTRUCT OF SEXUAL ORIENTATION

A major problem in sexual orientation research has been that findings from a particular study depend heavily on the conceptualization and operationalization of the orientation groups studied and on the way the sample has been assembled (Sandfort, 1997). Homosexuality and bisexuality are complex concepts, which have been defined in terms of feelings of physical or emotional attraction, fantasies (Bell, Weinberg, & Hammersmith, 1981; Storms, 1981), actual behavior, and self-definition encompassing a variety of labels (Klein, Sepekoff, & Wolf, 1985; Shiveley & DeCecco, 1977). Such dimensions do not necessarily overlap and may change throughout one's personal identity development (Coleman, 1987; Klein et al., 1985). Moreover, these dimensions may not exclude the concurrent or subsequent existence of heterosexual feelings and behaviors.

There appears to be little consistency in the literature regarding how sexual orientation is assessed. Some researchers use a 7-point Kinsey scale (Davis & Smith, 1996; Fay, Turner, Klassen, & Gagnon, 1989), whereas others use a modified 5-point scale (Michael, Laumann, Gagnon, & Smith, 1988: van Zessen & Sandfort, 1991). Bisexuals are often included within the homosexual sample, primarily due to the limited sample size. A number of studies measure sexual behavior (e.g., "Have you had any same-sex experiences in the last 12 months" or "since your 18th birthday." "How many male partners have you had sex with?"), and define this as sexual orientation (Harris Poll, 1988; Michael et al., 1988; Sandfort, 1997; Smith, 1991).

Evidently, conceptual and operational definitions of sexual orientation have varied widely. In fact, many researchers have failed to provide definitions, and sometimes the conceptual and operational definitions have hot matched (Sell, 1997). Instead, definitions of the construct have been implied by the construction of the sample or measurement tools. A common approach has been to categorize persons as heterosexual (HET), homosexual (HOM), or bisexual (BI). Sell (1997) has argued that the dominant research perspective, and one that reflects the mainstream meanings of Western culture, classifies people as either 100% heterosexual or 100% homosexual. This basic approach of defining types or categories of sexual orientation can be traced at least as far back as Ulrich's (1994) work in the 1860s. Ulrich outlined three sexual orientation groups, which can roughly be translated as HET, HOM, and BI. Here, it is worth noting that little attention has been devoted to the possibility that some persons are asexual.

Sell (1997) has further suggested that most conceptualizations since Ulrich have accepted his view that orientation is defined as having a behavioral dimension and/or a psychological dimension. Some authors have insisted that orientation is primarily a matter of one or the other of these dimensions; others have insisted that an assessment of both dimensions is necessary. For example, Paul (1983) and Herek (1986) argued that sexual orientation is defined by what a person does sexually. Others (Coleman, 1987; Klein et al., 1985) have criticized this view as too simplistic. Although the behavioral dimension seems to be rather straightforward, there has been wide disparity in defining the psychological factor. It has been conceived as a(n) urge, passion, instinct, sexual feeling, appetite, interest, desire, attraction, form of erotic arousal, fantasy, affectional preference, and sexual preference (Marmor, 1980). In recent decades, it has become popular to regard this psychological factor as a form of self-identity and to study the process of identity formation (D'Augelli & Patterson, 1995; Harry & DeVall, 1978).

Cass (1979), among others (Coleman, 1987; Schwartz & Blumstein, 1976; Shively & De Cecco, 1977), maintains that people use a variety of psychological constructions that prevent them from self-labeling as HOM. Homosexuality is uniquely perceived and given meaning by each individual (Cass, 1984). Several researchers (Bell & Weinberg, 1978; Minton & McDonald, 1984) have observed that people's sexual self-identification may differ from their erotic fantasies and behaviors. It is not uncommon for some individuals to engage in same-sex sexual activity, but not to label themselves as HOM or even BI (Doll et al., 1992; Schwartz & Blumstein, 1976; Troiden, 1984). Some may experience same-sex physical attraction, but never have sexual contact with someone of the same sex (Sandfort, 1997). In their study, Laumann et al. (1994) reported that all men who self-identified as predominantly or exclusively HOM had experienced same-sex attraction, love, and contact with another man. This was also true of men who identified as BI.

Similarly, Blumstein and Schwartz (1977) reported that they encountered women whose behavior evokes the label of BI, but who adamantly claim to be either HOM or HET. There are also women who claim to be BI, but whose behavior does not seem to support such self-definition. There has been little research on the meanings or implications of such apparently contradictory reports. According to Bell and Weinberg (1978), self-ratings of BI orientation are, for the most part, valid, and not merely indicative of homosexual denial.

At first glance, the well-known Kinsey Scale (Kinsey, Pomeroy, & Martin, 1948; Kinsey, Pomeroy, Martin, & Gebhard, 1953) appears to be a departure from the two-dimensional classification of groups. The Kinsey team assigned a single score on a unidimensional, 7-point scale ranging from exclusive HOM to exclusive HET. The underlying assumption of this bipolar model was that HOM and HET are opposites; the more a person is characterized by one, the less he/she is characterized by the other. In effect, the Kinsey scale substituted seven groups for the more typical three. It is also interesting to note that Kinsey et al. (1948) and Pomeroy et al. (1953) recommended that both the behavioral and psychological dimensions be assessed in assigning the single score, although they were vague as to how this should be done. They maintained that assessments of the two dimensions rarely differed. In contrast, Bell and Weinberg (1978) scored the two dimensions independently. They also reported little variation between the two scores.

Perhaps the most complex conceptualization of sexual orientation is a model first proposed in a popular book by Klein (1978). The model was later expanded in a professional journal article (Klein, Sepekoff, & Wolf, 1985). Klein and his associates argued that sexual orientation should be assessed on seven conceptually independent dimensions--attraction, behavior, fantasy, emotional preference, social preference, self-identification, and lifestyle. Each of these dimensions was also assessed for the past, the present, and ideal, resulting in a total of 21 separate ratings. As with the Kinsey scale, each of these ratings was scored on a scale ranging from exclusive HOM atone pole to exclusive HET at the other, and no mechanism was provided for categorizing someone as asexual. In the only empirical report exploring the possible correlations among these 21 items, Weinrich and his associates (1993) reported that all 21 items loaded together on a single factor in two separate samples of men. It should be acknowledged, however, that there were differences between the second and third factors in this analysis between the two samples, and that both samples had unusually high proportions of men who self-identified as BI or HOM. It appears that no similar studies have been conducted on women.

An additional layer of complexity is suggested by authors who maintain that sexual orientation should be viewed as a dynamic process that changes over rime, rather than as a static or permanent characteristic (Coleman, 1987; Klein et al., 1985). People's self-identification and/or behavior could, therefore, vary over time. At the very least, we can suggest that no simple conceptualization of sexual orientation has yet to emerge.

With the issues raised here about the conceptualization of sexual orientation, it seems to make sense for researchers to specify and measure particular dimensions of sexual orientation. Accordingly, we used a set of questions about behavior to assign respondents to one of four groups: HET, BI, HOM, and No Sexual Partners (NOSEX). We wanted to test the association between this measure of sexual orientation behavior (SORB) group and a series of variables concerned with QOL.

THE CONCEPT OF QUALITY OF LIFE

Historically, QOL has been used in health and social research, in such fields as medicine, public health, social work, and social policy (Farquhar, 1995). QOL shares many of the same characteristics we just reviewed regarding sexual orientation. There have been a variety of definitions and no standard conceptualization or recognized measure has emerged. There is no consensus theoretically or methodologically (Bowling, 1997). As with sexual orientation, it seems appropriate to specify and measure particular dimensions of the construct.

For example, there has been no consensus on a definition of QOL (Farquhar, 1995). One common approach has been to define the concept in terms of functionality. A number of theoretical models have been proposed (McIntyre, 1966; Parsons, 1951; Perper, 1985). Perper (1985) stressed the notion of survival and reproduction in defining biosocial functionality. However, the very idea of QOL seems to imply more than mere survival. Attempting to avoid the problems with values in the Parsonian definition (Parsons, 1951), McIntyre (1966) defined function as a consequence of activities within a system. From this perspective, QOL can be seen as deriving from functional characterictics as opposed to social values. Another approach has been to define QOL as a sense of subjective well-being (Bowling, 1997). Some authors have used the theory of Phenomenology (Benner, 1985; Bowling, 1997; Ziller, 1974), while others have used Symbolic Interactionism (Bowling, 1997).

Typically, researchers have used either a global measure of life satisfaction or happiness, or component measures (job satisfaction, marital happiness, health status) (Andrews & Withey, 1976; Beck, 1967; Bowling, 1997; Campbell, Converse, & Rodgers, 1976; DuBos, 1976; Farquhar, 1995; Parsons, 1951; Patrick & Erickson, 1993). Farquhar (1995) has noted that researchers have also included cognitions,' affect, behavior, participation in activities, self-assessments, and even socioeconomic status in measures of QOL. One novel approach has included a measure of depression (Beck 1967). In the present study, we are assessing various components of QOL, rather than trying to develop or present an aggregate measure.

SEXUAL ORIENTATION AND QUALITY OF LIFE

It is exceedingly difficult to draw generalizations from the literature examining possible differences between sexual orientation groups and QOL variables. One reason for this concerns the lack of consensus about the conceptualizations and operationalizations of both sexual orientation and QOL. Researchers have not always measured these concepts in the same way, or even in comparable ways. There has been relatively little research on how various dimensions of these two concepts correlate with each other. Another reason is that researchers have taken widely varying approaches to sampling, often with direct implications for the assignment of research participants to HOM, HET, and BI groups. Despite these limitations, there has been some suggestion that, generally, studies comparing HET, BI, and HOM have failed to find direct associations between QOL variables and sexual orientation groups per se (Peterson, Folkman, & Bakeman, 1996).

This has led to little consistency in the literature regarding sexual orientation and lifestyle. For example in some studies HOM and HET men were found to significantly differ in specific ways, but HOM and HET women did not, or vice versa. Sometimes BI were found to be similar to HOM respondents, but not always. A plethora of studies have examined the use of drugs, alcohol, and tobacco by sexual orientation. Based on a national sample of HET and HOM men and women, Skinner (1994) reported that HOM use greater amounts of marijuana or other drugs, tobacco, and alcohol (or abstain less). A number of other studies also found greater alcohol, tobacco, and drug use for HOM compared to HET (Bloomfield, 1993; Bradford, Ryan, & Rothblum, 1994; Hughes & Wilsnack, 1994; McKirnan & Peterson, 1989; Myers et al., 1992; Nardi, 1982; Saghir, Robins, Walban, & Gentry, 1970; Tori, 1989). Although their sample was relatively small (n = 50), Oberstone and Sukoneck (1976) round no differences between HOM and HET women for frequency of drinking, drug usage, or bar socializing. To the contrary, Bloomfield (1993) found that lesbians and BI women frequented bars three times more often than HET women.

Perhaps because of the stigma and discrimination associated with HOM and BI, a myriad of researchers have examined possible differences in psychological health state between HOM, BI, and HET groups. Compared to HET adults, HOM report higher stress levels (Bosanko, 1995; Bradford et al., 1994), depression (Bradford et al., 1994; Ross, 1990), fears (Granero, 1984), and suicide attempts (Bradford et al., 1994). Gonsiorek (1991) and Zinik (1985) report contradictory findings in that the subjects in their studies demonstrated no differences for anxiety, depression, hostility, or other psychological symptoms. However, Zinik did report significantly greater depression in the BI group compared to the HOM and HET groups. Gonsiorek (1982) suggested that homosexuality and bisexuality, per se, are hot indicators of psychological disturbance, but rather that the observed psychological differences are due to the greater amounts of environmental/social stresses (i.e., traumatic life events) experienced by HOM and BI groups. In one study of 1,925 lesbians, respondents cited a high prevalence of traumatic life events, such as rape and physical abuse (Bradford et al., 1994). Ross (1990) studied HOM and BI men and found that depression was significantly related to traumatic life events, particularly HIV disease. The impact of traumatic lire events could be manifested in the form of greater rates of psychological maladjustment, anxiety, fear, and depression.

The literature on depression and mental health suggests that differences between SORB groups do exist, although the evidence is equivocal. It would appear that there are higher rates of substance abuse and depression in homosexual youth, although this may vary by gender (Cyranowski, Frank, Young, & Shear, 2000). Some studies have reported greater levels of depression in homosexual men and women (Bradford et al., 1994; Dempsey, 1994). In contrast, Carlson and Baster (1984) and D'Augelli and Hershberger (1993) found no differences for depression scores as a function of sexual orientation. D'Augelli and Hershberger (1993) did find that gay men reported greater frequency of depression than lesbians. While suicide risk has been found to be associated with depression (Vincke & Bolton, 1994), Bradford et al. (1994) found no significant differences in rates of depression or suicide attempts between lesbians and heterosexual women.

With the advent of AIDS, some BI and HOM men appear to be more concerned about their health than HET men, although this is not necessarily true for women (Hiatt & Hargrave, 1994). Lesbian health is also a major concern today, hot only because of the recent findings suggesting that lesbians are at greater risk for breast cancer than HET women, but also because of the ignorance and prejudice of medical practitioners when dealing with this group.

Few studies have evaluated differences in recreation and exercise patterns between HOM, BI, and HET groups. HOM men and women appear to engage in camping, hiking, skiing, and touring more often than HET men and women (Bosanko, 1995). When comparing groups of women, however, no differences were found for exercise or social activities (Buenting, 1992). The National Opinion Research Center (Davis & Smith, 1996) obtained descriptive data on sports participation and hours of television watching, but did not report differences by sexual orientation groups.

Satisfaction with one's job has been found to be highly correlated to job stress, life satisfaction, and health, at least for university faculty and administrators (Horowitz et al., 1988). HOM may experience sizeable stress at work, which has been round to be associated with lower job satisfaction (Croteau & Lark, 1995; Ellis & Riggle, 1995). There have been no national probability studies of HET, BI, and HOM respondents that compare overall job satisfaction by sexual orientation group.

Most studies of HOM and BI are not representative of the general population, usually over-sampling higher educated, white, middle-class males and females. Convenience samples present a biased image of current BI and HOM behaviors and limit one's ability to generalize results. Samples are often obtained from clinical populations (O'Brien, 1992; Ross, 1990), gay organizations (Buenting, 1992: Skinner, 1994), gay bars (McKirnan & Peterson, 1989; Myers et al., 1992), special gay events/festivities (Brand, Rothblum, & Solomon, 1992; Trippet & Bain, 1990), public meeting places (Buenting, 1992; McKiman & Peterson, 1989), and magazine and newspaper ads (Bosanko, 1995; McKirnan & Peterson, 1989; Myers et al, 1992: Snyder, Weinrich, & Pillard, 1994). These samples predominantly result in respondents who are more or less part of an established gay culture and who will quite likely self-identify as gay. There is very little information available about HOM, particularly male, that is not linked, either superficially or strongly, to the gay community. Studies exclusively focusing on self-identification of one's sexual orientation may overlook a significant number of individuals who engage in HOM or BI behavior, but who label themselves as HET

Several studies among general populations have shown that nonresponse and self-selection do affect the outcomes of sexological studies (Catania, Gibson, Chitwood, & Coates, 1990; Wiederman, 1993; Wiederman, Weis, & Allgeier, 1994). It seems quite likely that, in studies of BI and HOM, self-selection may have a serious influence on the outcomes (Sandfort, 1997). HOM men, lesbians, and BI who are unsure of their sexual identity or who feel less positive about their sexual orientation might be less willing to participate in studies. Studies of HOM have been further complicated in that the source of the sample influenced the findings. De Wit (1994) compared responses of male subjects from three different sources (e.g., completed questionnaires from a magazine, members of a gay organization, and persons in a cohort study) and round significant differences between the groups. This suggests that different types of samples may have yielded different results to the same questions, and that combining samples from different subgroups might have further clouded interpretation of the data.

The present article reports the results of a secondary analysis of data obtained by the National Opinion Research Center (NORC) between 1988 and 1996 (Davis & Smith, 1996). We tested possible differences between sexual orientation groups (HET, BI, HOM, and NOSEX), as defined by sexual behavior, for a series of social background, QOL, and health related variables. We recognize that this approach ignores the possible influence of other dimensions of sexual orientation, but it was our intention to test whether QOL and health differences could be attributed directly to sexual orientation behavior itself.

METHOD

The data for this report were taken from the NORC General Social Surveys for 1988, 1989, 1990, 1991, 1993, 1994, and 1996 (Davis & Smith, 1996). The sample for each year contains the responses of approximately 1,500 individuals selected to represent the civilian noninstitutionalized population of the 48 contiguous United States, age 18 and older. Because the data collection methods and differences between these samples have been discussed by several researchers (Glenn & Weaver, 1979; Reiss, Anderson, & Sponaugle, 1980; Weis & Jurich, 1985; Wiederman, 1993, 1997), we omit that here to save space. A total of 11,543 individuals participated in the NORC surveys from 1988 to 1996.

Measures

Sexual orientation behavior (SORB). The NORC surveys did not directly ask respondents to identify their sexual orientation or calculate a composite score for orientation. Instead, individuals were asked to name the sex of their sexual partners in two time periods: (a) since age 18, and (b) in the last 12 months. Separate codings were performed for each time period. Persons who indicated that all of their partners in the time period were of the same sex were classified as HOM. Persons who indicated that all of their partners during the time period were of the opposite sex were classified as HET. Persons who indicated that they had had partners of both sexes during the time period were classified as BI. Finally, persons who indicated that they had no sexual partners during the time period were classified as NOSEX. Thus, each respondent was given two independent classifications, one for each time period. These classifications may not be consistent (see Table 1 for exact wordings and codings of these items).

Other measures. This study was designed to test the association between SORB and a series of variables. These included (a) demographic and social background variables, (b) quality of life (QOL) variables, (c) lifestyle and health variables, and (d) mental health or health background variables (see Table 1 for complete list of variables included in this study, exact wordings of items, and codings for each variable). The reader should be cautioned that many of these variables were assessed with a single item measure, and that no research has investigated the effects of the temporal nature of the NORC items. The scoring of the last two variables in Table 1 requires some additional explanation. Respondents were initially asked to indicate the number of days within the past week they had felt a series of particular emotions, such as feeling calm, blue, outraged, and the like. A total of 22 items were included. Responses to these items were subjected to a principal components factor analysis with oblique rotation. Factors with eigenvalues greater than 2.0 were retained. A 2 factor solution emerged. The Negative Affect factor formed a scale (n = 1,364; Alpha = .82), which included items for feeling mad, angry, anxious, tense, outraged, blue, sad, and worried. The Positive Affect factor formed a scale (n = 1,364; Alpha = .73), which included items for feeling overjoyed, excited, interested, happy, at ease, and contented.

Statistical Analysis

Each respondent was classified as HET, BI, HOM, or NOSEX by the criteria described in Table 1. Separate classifications were made for the two time periods: since age 18 and in the last 12 months. The association between these SORB groups for each time frame and the continuous variables in the study were tested with a series of ANOVAs. The alpha level for these ANOVAs was initially set at .05. With Bonferroni Adjustment for multiple tests, p < .0023 was required to reach significance. This procedure was employed to reduce the probability of Type-I errors. Post hoc Tukey tests were performed on all significant associations to identify specific differences between SORB groups. Effect sizes for these associations were calculated using [[eta].sup.2] (eta squared). Finally, [chi square] tests were conducted on race and marital status to examine possible differences among SORB groups.

RESULTS

A summary of the classification of respondents into the 4 SORB groups is presented in Table 2. This coding scheme categorizes people as exclusively HET or exclusively HOM or BI for the two time periods. Thus, it is not surprising that the rate of exclusive HOM behavior is higher for the 12-month period than since age 18. The disparity in the number of respondents classified in the two time frames is a result of differences in the number of years in which the relevant items were included in the NORC interview. There were significant gender differences. Women were more likely to be classified as NOSEX and less likely to be classified as HOM or BI than men since age 18 ([chi square] = 17.88; p = .001). In the last 12 months, women were less likely to be classified as HET, BI, or HOM and were more likely to be classified as NOSEX ([chi square] = 249.09; p < .0001). The relatively large number of persons classified as NOSEX in the last 12 months is also noteworthy. Fully 70% of these were women.

Because of the small number of persons classified as BI or HOM, and because the intent of this study was to examine the extent to which differences in QOL and lifestyle variables could be directly attributed to SORB, gender distinctions were not considered in subsequent analyses. We tested the association between SORB for persons of both genders on the remaining variables in the study. The first group of these was the demographic and social background variables. Most of these were tested with a series of ANOVAs, and summaries of the results are presented in Tables 3 and 4.

A number of significant findings emerged. For persons classified since age 18, the NOSEX group tended to be older than other groups, and both the HET and NOSEX groups were more likely to live in suburban or rural settings than the BI and HOM groups. Conversely, the BI and HOM groups were more likely to live in urban settings. However, it should be noted that the [[eta].sup.2] for both of these associations was small. Neither association explained as much as 1% of the variance. For persons classified in the last 12 months, the NOSEX group tended to be older and less educated than all other groups, and they were more religious than HET or HOM. The HET group tended to be older than the BI group and was more religious than the HOM group. The HOM group was more likely to live in urban settings than other groups and tended to have more education than the BI or NOSEX groups. Again, however, most of these associations had small effect sizes. The only variable with an [[eta].sup.2] exceeding 5% was age, where the effect size was a substantial 20%.

ANOVAs could not be calculated for two categorical demographic variables. These were race and marital status. Instead, [chi square] were performed on these variables. Blacks were less likely to be coded as NOSEX since age 18 than other racial groups ([chi square]= 4703.00; p < .0001), although there were no racial differences in the codings for the last 12 months ([chi square]= 14.83; p = .0216). Since age 18, the NOSEX group was less likely to be married or divorced and more likely to be widowed or never married. The BI and HOM groups were less likely to be married and more likely to be never married ([chi square]= 784.98; p < .0001). In the last 12 months, the NOSEX group was less likely to be married and more likely to be widowed. The HET group was more likely to be married and less likely to be widowed. The BI group was more likely to be separated, and both the BI and HOM groups were more likely to be never married ([chi square]= 3426.72; p < .0001).

All of the tests involving QOL, health, and lifestyle variables were conducted with ANOVAs. A summary of those results is presented in Tables 3 and 4. It should be noted that the number of people included in each of these independent tests varied as a function of the number of years each variable was included in the NORC interviews. For the time since age 18 period (Table 3), only 6 variables of the 24 tested reached statistical significance, and none of these explained more than 2% of the variance ([[eta].sup.2]). The NOSEX group was significantly less likely to drink alcohol or socialize in a bar than the other three groups; they were also less likely to have ever smoked, to smoke currently, or to have been punched or beaten than the HET and BI groups, and they were less likely to have received mental health counseling than the BI group. The HET group was less likely to socialize in a bar or to have received mental health counseling than the BI group, and the HOM group was less likely to report being punched or beaten than the BI group. Although it may be tempting to see potential trends (and corresponding explanations) in these findings, it should be stressed that all of these variables had weak relationships with SORB. Moreover, there were no statistically significant findings for 18 of the 24 QOL, health, and lifestyle variables.

A similar, though not quite so severe, pattern was apparent in the time period for the last 12 months (Table 4). Here, 10 of the 24 variables tested yielded significant results. The NOSEX group was significantly less likely to perceive they were healthy, to smoke currently, to socialize in a bar, to play sports, or to report being punched or beaten than the other three groups. They were also less likely to report drinking alcohol than the HET and HOM groups. Compared to the HET group, they reported lower general happiness and were more likely to deny that they drink too much. Interestingly, they were more likely to report a serious trauma in the previous 5 years than the HET group. The HET group was less likely to socialize in a bar and to watch television than the BI and HOM groups, and they were less likely to smoke currently and to report they had been punched or beaten than the BI group. Finally, the HOM group was less likely to socialize in a bar and to smoke currently than the BI group. As with the associations tested in the time since age 18 period, most of these significant relationships explained little variance. Of the 10 significant associations in the last 12-month period, only 2 variables had an [[eta].sup.2] exceeding 5%. These were the findings pertaining to socializing in a bar and playing sports. Two other associations had [[eta].sup.2] that explained 3% to 5% of the variance. These were the finding that the NOSEX group believed they have poorer health than the other groups and were less likely than the BI and HOM groups to drink alcohol.

DISCUSSION

Earlier, we suggested that the general lack of consensus about the conceptualization and measurement of sexual orientation created circumstances where researchers should specify the actual dimensions of sexual orientation they are assessing. Accordingly, we focused our analyses on a precise behavioral definition, the gender of one's sexual partners since age 18 and during the last 12 months. This led to the classification of four SORB groups: HOM, BI, HET, and NOSEX. Our analyses of data drawn from a series of national probability samples indicate that these behavioral categories have little direct association with a wide range of QOL, health, and lifestyle variables, although we caution the reader to recognize the limitations of the NORC self-report measure. In fact, there were only two variables with even a moderate effect size. Both of these occurred in the time period for the last 12 months. All four SORB groups differed from each other in the frequency with which they socialize in bars. The BI group had the highest frequency, followed by the HOM, HET, and NOSEX groups respectively. In addition, the NOSEX group was less likely to play sports than the other three groups.

These findings suggest the need for further research, particularly with the NOSEX group. In this study, NOSEX respondents tended to be older and were more likely to be widowed than the other groups. They also reported significantly lower levels of perceived health than the other groups. Moreover, there was a sizable number of respondents who were classified as HET, BI, or HOM in the since age 18 time frame, but who fit into the NOSEX category for the last 12 months. It is certainly possible that a shift from a lifetime in any of the other SORB groups into the NOSEX group during the last year would be more strongly related to QOL, health, and lifestyle. It should be emphasized that persons placed themselves into the NOSEX group by specifically stating that they had had 0 partners during the relevant time period. No one who failed to answer the questions about sex of partners was placed into the NOSEX group. As a rule, sex researchers know little about members of this group or the factors that might impact their QOL. Important questions about the NOSEX group remain.

Of course, it is also possible that associations between these SORB groups and QOL or lifestyle variables would differ for males and females. We did not examine this possibility for two reasons. First, if we had split all of the SORB groups into separate male and female groups, the number of male and female BI would have been too small for statistical analyses. Second, we wanted to test the direct association between membership in SORB groups per se and QOL measures. If, for example, the association is different for gay males and lesbians, it is not yet clear that this is attributable to SORB, to gender, or to some interaction effect involving both factors. This possibility still needs to be tested. However, our results strongly suggest that variations in QOL, health, and lifestyle variables are not strongly associated with SORB itself.

We also did not test whether shifts in SORB category from the since age 18 (lifetime) period to the last 12-month period were associated with QOL. It seems prudent for future researchers to examine whether such shifts in sexual orientation over time would be associated with disruptions in QOL. Finally, because out analyses focused on the behavioral dimension of sexual orientation, questions remain about the association between QOL, health, and lifestyle variables and other possible dimensions of sexual orientation.

Table 1. Description of Variables

Variable                Description                   Codes

Sexual orientation      (1) Male whose sex partner
  behavior                  was exclusively female
                            or female whose sex
                            partner was exclusively
                            male                      (1) Heterosexual
                        (2) Male or female whose
                            sex partners were both
                            male and female           (2) Bisexual
                        (3) Male whose sex partner
                            was exclusively male or
                            female whose sex
                            partner was exclusively
                            female                    (3) Homosexual
                        (4) Male or female who had
                            no sex partners           (4) No sex

Sex of partner in       Have your sex partners in
  last 12 months          the last 12 months
                          been ...                    (1) Exclusively
                                                          male
                                                      (2) Both male and
                                                          female
                                                      (3) Exclusively
                                                          female
                                                      (9) No answer

Sex of partners since   Since age 18 (including the
  age 18                  past 12 months) have your
                          sex partners been ...       (1) Exclusively
                                                          male
                                                      (2) Both male and
                                                          female
                                                      (3) Exclusively
                                                          female
                                                      (9) No answer

Demographic and
    social background
    variables
  Sex                   Respondent's sex              (1) Male
                                                      (2) Female

  Age                   Calculated from date of
                          birth                       (1) 18-29
                                                      (2) 30-39
                                                      (3) 40-49
                                                      (4) 50-59
                                                      (5) 60+

  Income                Respondent's income in 1991   (1) < 10,000
                                                      (2) 10,000-17,499
                                                      (3) 17,500-29,999
                                                      (4) 30,000-39,999
                                                      (5) 40,000-49,999
                                                      (6) 50,000-59,999
                                                      (7) 60,000-74,999
                                                      (8) >74,999

  Marital status        Are you currently ...         (1) Married
                                                      (2) Widowed
                                                      (3) Divorced
                                                      (4) Separated
                                                      (5) Never Married

  Race                  What race do you consider
                          yourself?                   (1) White
                                                      (2) Black
                                                      (3) Other

  State-regional-       Size of city, town, etc. in
    community size        which Respondent lives      (1) 12 largest
                                                          cities in
                                                          U.S.
                                                      (2) Next 13-100
                                                          largest
                                                          cities
                                                      (3) 100 largest
                                                          suburbs
                                                      (4) Next 13-100
                                                          largest
                                                          suburbs
                                                      (5) Other urban
                                                          (Counties
                                                          having towns
                                                          of 10,000 or
                                                          more)
                                                      (6) Other rural
                                                          (Counties of
                                                          having no
                                                          towns of
                                                          10,000 or
                                                          more)

  Religiosity           Would you describe
                          yourself as ...?            (1) Extremely
                                                          non-religious
                                                      (2) Very non-
                                                          religious
                                                      (3) Somewhat non-
                                                          religious
                                                      (4) Neither
                                                          religious nor
                                                          non-religious
                                                      (5) Somewhat
                                                          religious
                                                      (6) Very
                                                          religious
                                                      (7) Extremely
                                                          religious

  Education level       What is the highest degree
                          you have received?          (1) Less than
                                                          high school
                                                      (2) High school
                                                      (3) Associate/
                                                          Junior
                                                          college
                                                      (4) Bachelor's
                                                          Degree
                                                      (5) Graduate
                                                          degree

Quality of life
    variables
  General happiness     Taken all together, how
                          would you say things are
                          these days -- would you
                          say that you are very
                          happy, pretty happy, or
                          not too happy?              (1) Not too happy
                                                      (2) Pretty happy
                                                      (3) Very happy

  Perceived health      Would you say your own
                          health, in general, is
                          excellent, good, fair,
                          or poor?                    (1) Poor
                                                      (2) Fair
                                                      (3) Good
                                                      (4) Excellent

  Job satisfaction      On the whole, how satisfied
                          are you with the work you
                          do -- would you say you
                          are very satisfied,
                          moderately satisfied, a
                          little satisfied, or very
                          dissatisfied?               (1) Very
                                                          dissatisfied
                                                      (2) A little
                                                          dissatisfied
                                                      (3) Moderately
                                                          satisfied
                                                      (4) Very
                                                          satisfied

Lifestyle and health
    variables
  Drinking/drug
      behaviors
    Bar socializing     How often do you go to a
                          bar or tavern?              (1) Never
                                                      (2) About once a
                                                          year
                                                      (3) Several times
                                                          a year
                                                      (4) About once a
                                                          month
                                                      (5) Several times
                                                          a month
                                                      (6) Once or twice
                                                          a week
                                                      (7) Almost every
                                                          day

  Drink alcohol         Do you ever have occasion
                          to use any alcoholic
                          beverages such as liquor,
                          wine, or beer, or are you
                          a total abstainer?          (1) Total
                                                          Abstainer
                                                      (2) Use Alcohol

  Drink too much        Do you sometimes drink more
                          than you think you
                          should?                     (1) No
                                                      (2) Yes

  Drinking problem      Since February/March 1990,
                          have you had a drinking
                          problem (e.g. frequently
                          drunk, suffered from
                          alcoholism)?                (1) No
                                                      (2) Yes

  Used illegal drugs    Since February/March 1990
                          have you used illegal
                          drugs (e.g., marijuana,
                          cocaine, pills)?            (1) No
                                                      (2) Yes

  Smoking Behavior
    Smokes              Do you smoke?                 (1) No
                                                      (2) Yes

    Tried to Quit       Have you ever tried to give
                          up smoking?                 (1) No
                                                      (2) Yes

    Ever Smoked         Have you ever smoked
                          regularly?                  (1) No
                                                      (2) Yes

  Physical activities
    Played sports       Do you participate in any
                          sports activity such as
                          softball, basketball,
                          swimming, golf, bowling,
                          skiing, or tennis?          (1) No
                                                      (2) Yes

  Television viewing
    TV watched hours    On the average day, about
                          how many hours do you
                          personally watch
                          television?                  (1) 0
                                                       (2) 1
                                                       (3) 2
                                                       (4) 3
                                                       (5) 4
                                                       (6) 5
                                                       (7) 6
                                                       (8) 7
                                                       (9) 8
                                                      (10) 9
                                                      (11) 10
                                                      (12) 11
                                                      (13) 12
                                                      (14) 13

Mental health/health
    background
  Nervous breakdown     Have you ever felt that you
                          were going to have a
                          nervous breakdown?          (1) No
                                                      (2) Yes

  Mental health         Ever felt you had a mental
    problem               health problem?             (1) No
                                                      (2) Yes

  Mental health         Since February/March 1990
    counseling            have you underwent
                          counseling for mental or
                          emotional problems?         (1) No
                                                      (2) Yes

  Serious illness       Since February/March 1990
                          have you been ill enough
                          to go to a doctor?          (1) No
                                                      (2) Yes

  Punched/beaten        Have you ever been punched/
                          beaten by another person?   (1) No
                                                      (2) Yes

  Trauma past 12        Number of traumatic events
    Months                (deaths, divorces,
                          unemployments, and
                          hospitalizations/
                          disabilities that
                          happened to you last
                          year.                       (0) None
                                                      (1) 1
                                                      (2) 2
                                                      (3) 3
                                                      (4) 4

  Trauma past 5 years   Number of traumatic events
                          (deaths, divorces,
                          unemployments, and
                          hospitalizations/
                          disabilities) that
                          happened to you during
                          past five years.            (0) None
                                                      (1) 1
                                                      (2) 2
                                                      (3) 3
                                                      (4) 4

  Knew suicide          Within the past 12 months,
                          how many people have you
                          known personally that
                          have committed suicide?     (0) 0
                                                      (1) 1
                                                      (2) 2
                                                      (3) 3
                                                      (4) 4

  Death of close        Since February/March, 1990
    friend                did you experience the
                          death of a close friend?    (1) No
                                                      (2) Yes

  Positive affect       On how many days in the
                          past 7 days have you ...
                          (Specify number of days)
                          Felt overjoyed about
                          something?; Felt excited
                          about or interested in
                          something?; Felt happy?;
                          Felt at ease?; Felt
                          contented?                  (0) 0 days
                                                      (1) 1 day
                                                      (2) 2 days
                                                      (3) 3 days
                                                      (4) 4 days
                                                      (5) 5 days
                                                      (6) 6 days
                                                      (7) 7 days

  Negative affect       On how many days in the
                          past 7 days have you ...
                          (Specify number of days)
                          Felt mad at something or
                          someone?; Felt angry at
                          someone?; Felt anxious
                          and tense?; Felt rest-
                          less?; Felt outraged at
                          something somebody had
                          done?; Felt that you
                          couldn't shake the
                          blues?; Felt sad?; Felt
                          ashamed?; Felt lonely?;
                          Felt fearful; Felt
                          embarrassed?; Worried a
                          lot about little things     (0) 0 days
                                                      (1) 1 day
                                                      (2) 2 days
                                                      (3) 3 days
                                                      (4) 4 days
                                                      (5) 5 days
                                                      (6) 6 days
                                                      (7) 7 days
Table 2. Classification of Respondents Into Sexual Orientation
Behavior Groups by Gender for Each Time Period

                                                        No Sex
          Heterosexual    Bisexual     Homosexual       Partner

Sex        n     Row %    n    Row %    n    Row %     n    Row %

                            Since Age 18 (a)

Males     3638    91.2   146     3.7    61     1.5    142     3.6
Females   4723    91.3   162     3.1    44     0.9    243     4.7

                         In Last 12 Months (b)

Males     4134    83.1    23     0.5   106     2.1    712     6.2
Females   4769    72.6    22     0.2    68     0.6   1702    14.8

(a) Total number of respondents = 9,149.

(b) Total number of respondents = 11,543.
Table 3. ANOVA Since Age 18

                                      HET             BI

Variable                         (N)     Mean     (N)    Mean

Age                             (8340)   44.1    (308)   39.9
Income                          (4521)    3.84   (162)    3.81
State-regional-community size   (8351)    4.01   (308)    3.49
Education                       (8334)    1.46   (308)    1.61
Religiosity                      (987)    3.12    (29)    3.83
General happiness               (8307)    2.20   (307)    2.11
Perceived health                (5937)    3.08   (211)    3.11
Job satisfaction                (6731)    3.27   (257)    3.13
Bar socializing                 (5554)    2.43   (201)    2.98
Drink alcohol                   (3154)    1.72   (126)    1.71
Drink too much                  (8351)    2.55   (308)    2.56
Drinking problem                 (673)    1.02    (22)    1.05
Used illegal drugs               (673)    1.03    (22)    1.05
Smokes                          (3152)    1.30   (126)    1.33
Tried to quit                    (942)    1.76    (42)    1.69
Ever smoked                     (2146)    1.36    (76)    1.41
Played sports                   (1234)    1.59    (37)    1.65
TV watched (hours)              (5922)    2.88   (214)    3.02
Nervous breakdown               (1008)    1.28    (40)    1.43
Mental health problem            (731)    1.08    (23)    1.13
Mental health counseling         (674)    1.06    (22)    1.23
Serious illness                  (674)    1.57    (22)    1.59
Punched/beaten                  (3150)    1.38   (126)    1.52
Trauma past 12 months           (2982)    0.44   (116)    0.50
Trauma past 5 years             (2982)    1.02   (116)    1.06
Knew suicide                    (1912)    0.14    (66)    0.14
Death of close friend            (674)    1.22    (22)    1.14
Positive feelings               (1037)    3.97    (37)    3.77
Negative feelings               (1037)    1.83    (37)    2.19

                                     HOM             NOSEX

Variable                         (N)    Mean     (N)    Mean

Age                             (105)   43.8    (384)   47.0
Income                           (69)    3.01   (151)    2.83
State-regional-community size   (105)    3.27   (385)    4.09
Education                       (104)    1.64   (384)    1.33
Religiosity                      (11)    3.45    (49)    2.90
General happiness               (104)    2.13   (383)    2.15
Perceived health                 (64)    3.03   (282)    3.03
Job satisfaction                 (85)    3.24   (230)    3.26
Bar socializing                  (78)    2.81   (259)    1.59
Drink alcohol                    (37)    1.76   (143)    1.48
Drink too much                  (105)    2.55   (385)    2.67
Drinking problem                 (10)    1.00    (28)    1.02
Used illegal drugs               (10)    1.10    (28)    1.00
Smokes                           (37)    1.27   (143)    1.11
Tried to quit                    (10)    1.80    (16)    1.75
Ever smoked                      (27)    1.26   (118)    1.19
Played sports                    (16)    1.56    (49)    1.591
TV watched (hours)               (82)    3.00   (279)    3.05
Nervous breakdown                (20)    1.10    (35)    1.11
Mental health problem            (18)    1.00    (32)    1.09
Mental health counseling         (10)    1.20    (28)    1.00
Serious illness                  (10)    1.60    (28)    1.39
Punched/beaten                   (37)    1.38   (143)    1.24
Trauma past 12 months            (35)    0.51   (140)    0.48
Trauma past 5 years              (35)    1.06   (140)    0.91
Knew suicide                     (18)    0.00   (107)    0.18
Death of close friend            (10)    1.20    (28)    1.36
Positive feelings                (13)    4.23    (32)    4.08
Negative feelings                (13)    1.76    (32)    1.64

                                  F
Variable                        value       P value     [[eta].sup.2]

Age                             10.138   .0000 (a, b)       .0033
Income                           4.091   .0066
State-regional-community size   21.370   .0000 (c)          .0070
Education                        4.259   .0052
Religiosity                      4.417   .0043
General happiness                3.656   .0120
Perceived health                 0.587   .6236
Job satisfaction                 2.471   .0601
Bar socializing                 28.894   .0000 (d, e)       .0140
Drink alcohol                   13.380   .0000 (d)          .0115
Drink too much                   2.970   .0308
Drinking problem                 0.594   .6189
Used illegal drugs               0.828   .4788
Smokes                           8.175   .0000 (f)          .0071
Tried to quit                    0.409   .7465
Ever smoked                      5.468   .0010 (f)          .0069
Played sports                    0.176   .9130
TV watched (hours)               0.899   .4407
Nervous breakdown                4.090   .0067
Mental health problem            0.773   .5094
Mental health counseling         5.417   .0011 (e, g)       .0218
Serious illness                  1.180   .3163
Punched/beaten                   7.436   .0001 (f, h)       .0064
Trauma past 12 months            0.542   .6538
Trauma past 5 years              0.840   .4719
Knew suicide                     0.843   .4702
Death of close friend            1.285   .2783
Positive feelings                0.366   .7778
Negative feelings                0.972   .4051

Note. p [less than or equal to] 0.0023 required for significance
(based on Bonferroni Adjustment) HET = heterosexual, BI = bisexual,
HOM = homosexual, NOSEX = no sex partner.

(a) HET significantly younger than NOSEX;

(b) BI significantly younger than HET, NOSEX;

(c) HET, NOSEX more Suburban/Rural than BI, HOM;

(d) NOSEX significantly less than HET, BI, HOM;

(e) HET significantly less than BI;

(f) NOSEX significantly less than HET, BI;

(g) NOSEX significantly less than BI;

(h) HOM significantly less than BI
Table 4. ANOVA in Last 12 Months.

                          HET             BI              HOM

Variable              (N)     Mean    (N)    Mean     (N)    Mean

Age                  (8897)   41.0    (45)   33.3    (174)   38.8
Income               (4543)    3.91   (33)    3.70   (110)    3.31
State-regional-
  community size     (8903)    3.99   (45)    3.84   (174)    3.17
Education            (8887)    1.47   (45)    1.27   (173)    1.73
Religiosity           (887)    3.16    (3)    2.67    (11)    4.27
General happiness    (8856)    2.24   (45)    2.16   (173)    2.19
Perceived health     (6246)    3.14   (34)    3.26   (120)    3.13
Job satisfaction     (7638)    1.74   (43)    1.77   (149)    1.76
Bar socializing      (5912)    2.56   (31)    4.32   (128)    3.00
Drink alcohol        (3643)    1.75   (10)    1.80    (53)    1.75
Drink too much       (8903)    2.51   (45)    2.76   (174)    2.66
Drinking problem      (623)    1.02    (3)    1.00     (8)    1.00
Used illegal drugs    (623)    1.03    (3)    1.33     (8)    1.13
Smokes               (3642)    1.33   (10)    1.80    (53)    1.30
Tried to quit        (1181)    1.76    (8)    1.75    (16)    1.88
Ever smoked          (2361)    1.35    (2)    1.50    (35)    1.34
Played sports        (1068)    1.66    (6)    1.83    (23)    1.61
TV watched (hours)   (6235)    2.80   (32)    3.22   (136)    2.93
Nervous breakdown     (691)    1.08    (3)    1.00    (27)    1.04
Mental health
  problem             (961)    0.29    (8)    1.63    (35)    1.23
Mental health
  counseling          (624)    1.06    (3)    1.00     (8)    1.25
Serious illness       (624)    1.55    (3)    1.33     (8)    1.75
Punched/beaten       (3642)    1.41   (10)    1.80    (53)    1.51
Trauma past 12       (3463)    0.44   (10)    0.40    (49)    0.51
  months
Trauma past 5        (3463)    1.01   (10)    1.20    (49)    1.06
  years
Knew suicide         (1812)    0.13    (8)    0.25    (21)    0.00
Death of close        (623)    1.79    (3)    2.00     (8)    1.75
  friend
Positive feelings     (988)    3.96   (10)    4.30    (22)    4.64
Negative feelings     (988)    1.87   (10)    1.76    (22)    1.99

                         NOSEX

                                                             [[eta].
Variable              (N)     Mean    F value     P value    sup.2]

Age                  (2410)   59.7    967.521    .0000 (a,    .2012
                                                   b)
Income                (686)    4.15     1.492    .2148
State-regional-
  community size     (2421)    3.98    17.223    .0000 (c)    .0045
Education            (2414)    1.12    66.058    .0000 (d,    .0169
                                                   e)
Religiosity           (138)    2.81     7.724    .0000 (f,    .0252
                                                   i)
General happiness      (32)    2.07    45.332    .0000 (f)    .0117
Perceived health     (1715)    2.76   101.037    .0000 (g)    .0360
Job satisfaction     (9124)    1.74     0.563    .6390
Bar socializing      (1613)    1.64   149.148    .0000 (g,    .0550
                                                   h, i)
Drink alcohol         (960)    1.52    63.999    .0000 (j)    .0395
Drink too much       (2421)    2.63    17.247    .0000 (f)    .0205
Drinking problem       (91)    1.00     0.720    .5399
Used illegal drugs     (91)    1.04     3.5519   .0142
Smokes                (958)    1.23    15.366    .0000 (g,    .0097
                                                   h, i)
Tried to quit         (218)    1.71     1.419    .2355
Ever smoked           (702)    1.35     0.073    .9745
Played sports         (312)    1.30    47.088    .0000 (g)    .0914
TV watched (hours)   (1714)    3.47    39.853    .0000 (j)    .0145
Nervous breakdown     (178)    1.07     0.343    .7936
Mental health
  problem             (234)    1.25     2.716    .0892
Mental health
  counseling           (91)    1.05     1.632    .1805
Serious illness        (91)    1.58     0.697    .5542
Punched/beaten        (959)    1.23    37.626    .0000 (g,    .0237
                                                   h)
Trauma past 12
  months              (895)    0.52     3.574    .0135
Trauma past 5
  years               (895)    1.14     5.238    .0013 (f)    .0035
Knew suicide          (376)    0.16     1.259    .2868
Death of close
  friend               (91)    1.66     3.122    .0254
Positive feelings     (259)    3.92     1.558    .1978
Negative feelings     (259)    1.60     2.555    .0539

Note. p [less than or equal to] 0.0023 required for significance
(based on Bonferroni Adjustment); HET = heterosexual, BI = bisexual,
HOM = homosexual, NOSEX = no sex partner.

(a) HET significantly older than BI;

(b) NOSEX significantly older than HET, BI, HOM;

(c) HOM from larger city than HET, BI, NOSEX;

(d) HOM has significantly more education than BI, NOSEX;

(e) HET has significantly more education than NOSEX;

(f) NOSEX significantly less than HET;

(g) NOSEX significantly less than HET, BI, HOM;

(h) HET significantly less than BI, HOM;

(i) HOM significantly less than BI;

(j) NOSEX significantly less than HET, HOM;

(f) HET significantly less than NOSEX;

(g) NOSEX significantly less than HET, BI;

(h) HET significantly less than BI;

(i) HET significantly less than HOM.

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Manuscript accepted May 17, 2001

Stephen M. Horowitz, David L. Weis, and Molly T. Laflin Bowling Green State University

Address correspondence to Stephen M. Horowitz, Ph.D., 212 Eppler North, Bowling Green, OH 43403; e-mail: [e-mail].