Printer Friendly

Men's sexual orientation and health in Canada.

Several large international population-based studies with rigorous methodologies have suggested that gay and bisexual men may be at increased risk for a variety of health problems and health risk behaviours. Gay men report higher rates of respiratory problems, arthritis, intestinal problems, and migraines (1) and overall poorer levels of physical health (2) than either bisexual or heterosexual men. Gay and bisexual men report poorer mental health and higher rates of anxiety, depression, suicidality and self-harm, (3-9) while in other studies, gay men but not bisexual men report higher rates of these mental health problems, (1,10) compared to heterosexual men. Gay and bisexual men report higher levels of smoking than heterosexual men in some studies, (11-13) although the picture is mixed for bisexual men. (1,14,15) Alcohol use is an even more mixed picture, with a number of studies showing no or few statistically significant differences by sexual orientation, (3,7,16-18) and others reporting that gay men were less likely than heterosexual men to report alcohol abuse. (5,11) However, when looking at individuals who do drink, two studies found that gay and bisexual men were more likely to drink heavily, (1,11) gay men were more likely to report drunkenness, (16) and bisexual men were more likely than heterosexual men to report alcohol-related social consequences. (18) Gay and bisexual men also reported more sexual partners, (19,20) and higher rates of STD diagnoses than heterosexual men. (21,22)

Until recently, no population-based data have been available to determine whether these types of health disparities exist for gay and bisexual men in Canada. In the current study, we have conducted a detailed analysis of the data available from the Canadian Community Health Survey (CCHS, 2003)--which for the first time included a question about sexual orientation in its 2003 data collection (Cycle 2.1)--to determine whether health status and health risk behaviours of Canadian men vary based on sexual orientation identity.

METHODS

Sampling

Our study is a cross-sectional analysis of data from the CCHS: Cycle 2.1 (2003). The CCHS is a national population-based survey designed to gather cross-sectional health data on a representative sample of Canadians. In Cycle 2.1, trained interviewers conducted extensive computer-assisted interviews with over 135,000 Canadians. The sampling frame for CCHS 2.1 included 98% of the Canadian population and the sampling methods are described by Statistics Canada. (23) The overall response rate was 80.7%. (23) For our study, we limited the sample to respondents 18 years of age and older.

Measures

Sexual Orientation

The CCHS measured respondents' sexual orientation by asking "Do you consider yourself to be: 1) heterosexual? (sexual relations with people of the opposite sex); 2) homosexual? that is lesbian or gay (sexual relations with people of your own sex); 3) bisexual? (sexual relations with people of both sexes)". Hence the CCHS 2.1 measured the proportion of Canadians who self-identified as belonging to a sexual minority.

Socio-demographic Variables

Socio-demographic variables included age (continuous), sex, recent immigration (born outside of Canada and moved to Canada within 5 years of participating in survey), education level (high school diploma or no high school diploma), low income adequacy (a dichotomous measure

based on total household income and the number of people in the household), employment status (currently employed or not) and race/ethnicity. We were obliged to aggregate ethnicity data into a binary variable ("white" or "non-white") in order to avoid small cells.

Health Status

Measures of health status included respiratory disease, hypertension, and mood or anxiety disorders. Reports of life-time suicidality, self-perceived physical health status and self-perceived mental health status were also included. The self-report global health status variables were measured using a 5-point global assessment scale (excellent, very good, good, fair, or poor). We also compared the likelihood of having an overweight or obese Body Mass Index (BMI) between sexual orientation groups.

Health Risk Behaviours

We examined health risk behaviours including tobacco use (current daily smoker or not), high-risk alcohol consumption (>8 drinks per week), and, of those who reported any sexual intercourse, any lifetime diagnosis with a sexually transmitted disease (STD).

Statistical Analysis

We described respondents' demographic characteristics by sexual orientation group. Next we conducted bivariate analyses to describe self-reported rates of outcomes and identify potential associations between gay or bisexual orientation and our outcomes relative to heterosexual men (with separate comparisons calculated for each of gay and bisexual men with heterosexual men as the referent group). Finally, we used multivariable logistic regression to assess the independent effects of sexual orientation on health status and health risk behaviours. We adjusted our analyses of health status for age, immigration, education, household income, employment level, and relevant health risk behaviours (e.g., smoking for respiratory disease, BMI for hypertension). We adjusted our health risk behaviours analyses for age (linear and quadratic terms), immigration, education level, household income, employment level and self-perceived health status.

For all logistic regression models, we calculated odds ratios, p-values, standard errors, and 95% confidence intervals (CIs) using the bootstrap re-sampling procedure recommended by Statistics Canada. All analyses were performed using Stata 10SE.

Using preliminary data provided by Statistics Canada, we assumed a sample of 536 gay men, 300 bisexual men, and 49,065 heterosexual male respondents. For each dependent variable, the range of responses varied because not all questions were asked of all participants (Range Gay men: 128-536; Bisexual men: 91-300; Heterosexual men: 18,944-49,065).

RESULTS

Table 1 shows the demographic characteristics of our sample by sexual orientation. Among the 18-59 year age group, 1.3% of Canadian men reported that they self-identified as homosexual and 0.6% of men reported that they self-identified as bisexual. (24) Heterosexual men were significantly older, on average, than gay or bisexual men and gay men were significantly less likely to be immigrants or to have lower education levels than both heterosexual and bisexual men.

Health status

Table 2 shows the unadjusted rates of self-reported health conditions by sexual orientation. Prevalence rates of hypertension before adjustment were slightly higher among heterosexual and bisexual men than among gay men. For respiratory conditions, prevalence rates were very similar across sexual orientation groups. Bisexual men were slightly more likely to report fair or poor physical health in our bivariate analyses than either gay or heterosexual men. Gay and bisexual men were less likely than heterosexual men to report overweight BMI. The results of our logistic regression analyses are presented in Table 3. After adjusting for potential confounders, there were no significant differences between the 3 sexual orientation groups for reporting respiratory conditions, hypertension, or global physical health status. Differences in overweight BMI, however, remained significant after adjustment for covariates.

In the area of mental health, both gay and bisexual men reported markedly higher rates of mood and anxiety disorder compared to heterosexual men (Table 2). Gay and bisexual men were also more likely than heterosexual men to self-report their overall mental health as fair or poor. Moreover, both bisexual and gay men were much more likely than heterosexual men to report having ever seriously considered suicide in their lifetime. After adjustment for potential confounders (Table 3), differences in self-reported mental health were not significant; however, gay men were 3.1 times more likely and bisexual men 2.4 times more likely than heterosexual men to report a mood or anxiety disorder. Also after adjustment for potential confounders, gay men were 4.1 times more likely and bisexual men 6.3 times more likely than heterosexual men to report lifetime suicidality.

Health Risk Behaviours

In our bivariate analyses, unadjusted prevalence rates of daily smoking were slightly higher for gay and bisexual men than for heterosexual men, while prevalence rates of risky drinking were highest for bisexual men and lowest for gay men (Table 2). However, after adjusting for potential confounders, there were no statistically significant differences between the 3 groups for either daily smoking or risky drinking (Table 4). Gay and bisexual men had significantly higher reported rates of ever having been diagnosed with an STD compared to heterosexual men. After adjustment for potential confounders, the difference between gay men and heterosexual men was significant with gay men being 5.8 times more likely to have been diagnosed with an STD. There was no significant difference in STD history between bisexual and heterosexual men after adjustment.

DISCUSSION

This study represents the first opportunity to examine disparities for men of differing sexual orientations related to health status and health risks using a large Canadian population-based dataset. The findings of this study show evidence of significant differences in the health status and health behaviours of Canadian men of different sexual orientations.

In terms of physical health, and in contrast to some previous research, (1) gay and bisexual men did not report more respiratory conditions than heterosexual men. There was a clear difference between heterosexual men and sexual minority men with regard to BMI, with gay and bisexual men having lower rates of obesity and overweight BMI.

Our data provide evidence of poorer mental health among gay and bisexual men when compared to heterosexual men. In particular, both gay and bisexual men reported significantly higher prevalence of mood or anxiety disorders, and were significantly more likely to report a history of lifetime suicidality. These findings corroborate other evidence that gay and bisexual men report higher rates of anxiety and depression (2-5,7,9,17,25,26) and lifetime suicidality (4,7,9) than heterosexual men. Within this data set, gay men were four times more likely to have ever seriously considered suicide, and bisexual men reported a six-fold increase in risk for having ever seriously considered suicide compared to heterosexual men. These findings highlight the significant mental health disparities affecting bisexual men in particular.

In terms of health risk behaviours, gay and bisexual men in our study did not report higher rates of daily smoking or risky drinking. Several previous studies have reported higher rates of smoking for gay men. (1,11,12,14,15) The limited research that has included bisexual men when comparing rates of smoking has shown that bisexual men's smoking rates tend to be similar to those of heterosexual men. (14,15) Our findings appear to corroborate these studies on bisexual men's smoking rates, but show a different picture for gay men. Though some previous research has shown an increased risk for alcohol use among gay and bisexual men, (1,13,16,18) our findings appear to validate the majority of research in this area that reports no increase of risky drinking for gay and bisexual men. (1,3,5,11,17,27) Finally, our findings suggest that gay men have a dramatically elevated lifetime prevalence of STDs. These findings are consistent with much previous research. (21,22)

This study represents the largest population-based sample size (n>135,000) that has looked at sexual orientation and health risks and behaviours among men. Much of the previous research also problematically combined non-heterosexually identified men into one group. The CCHS design provides the necessary sample size to examine groups of self-identified gay and bisexual men separately.

The use of a single identity variable to measure sexual orientation is an important limitation to our study. As many as 24% of men who have sex with other men do not self-identify as gay or bisexual. (28) As a result, this question may obscure health disparities between men who have sex with men and others. Recent evidence suggests that those who do not self-identify as gay or bisexual but engage in same-sex activity are likely to be at highest risk for poor health outcomes. (26) Recent advances in methodology have suggested that in addition to the use of a sexual orientation identity variable, it is useful to measure sexual behaviour and, in some populations (such as youth), desire/attraction as well, in order to fully capture the experience of sexual minorities. (29)

This study's findings suggest that current Canadian health practice and policy are not ameliorating the effects of stigma and discrimination on the marginalization of gay and bisexual men. Further research is required to understand the mechanisms that influence these health disparities in order that effective interventions and policies to address these health disparities are developed and evaluated.

Acknowledgements: This research was supported by grants from the Institute of Gender and Health (IGH), Canadian Institutes of Health Research (CIHR 2005-11HOA-1988-721), the Fonds Quebecois de Recherche sur la Societe et la Culture (FQRSC 111796) awarded to the research team SVR (www.svr.uqam.ca) and a Janus Grant from the College of Family Physicians of Canada. Dr. Steele is funded as a career scientist by the Ontario Ministry of Health and Long-Term Care. Dr. Ross is supported as a New Investigator by the Canadian Institutes of Health Research and Ontario Women's Health Council (Award NOW-84656).

Received: August 6, 2009

Accepted: February 5, 2010

REFERENCES

(1.) Sandfort TG, Bakker F, Schellevis FG, Vanwesenbeeck I. Sexual orientation and mental and physical health status: Findings from a Dutch population survey. Am J Public Health 2006;96(6):1119-25.

(2.) Sandfort TG, de Graaf R, Bijl RV. Same-sex sexuality and quality of life: Findings from the Netherlands mental health survey and incidence study. Arch Sex Behav 2003;32(1):15-22.

(3.) Cochran SD, Mays VM. Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population. Am J Epidemiol 2000;151(5):516-23.

(4.) Jorm AF, Korten AE, Rodgers B, Jacomb PA, Christensen H. Sexual orientation and mental health: Results from a community survey of young and middle-aged adults. Br J Psychiatry 2002;180:423-27.

(5.) Sandfort TGM, de Graaf R, Bijl RV, Schnabel P. Same-sex sexual behavior and psychiatric disorders: Findings from the Netherlands mental health survey and incidence study (NEMESIS). Arch Gen Psychiatry 2001;58(1):85-91.

(6.) Mays VM, Cochran SD. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health 2001;91(11):1869-76.

(7.) Gilman SE, Cochran SD, Mays VM, Hughes M. Rick of psychiatric disorders among individuals reporting same-sex sexual partners in the national comorbidity survey. Am J Public Health 2001;91(6):933.

(8.) de Graaf R, Sandfort TG, ten Have M. Suicidality and sexual orientation: Differences between men and women in a general population-based sample from the Netherlands. Arch Sex Behav 2006;35(3):253-62.

(9.) Skegg K, Nada-Raja S, Dickson N, Paul C, Williams S. Sexual orientation and self-harm in men and women. Am J Psychiatry 2003;160(3):541-46.

(10.) Bakker FC, Sandfort TGM, Vanwesenbeeck I, van Lindert H, Westert GP. Do homosexual persons use health care services more frequently than heterosexual persons: Findings from a Dutch population survey. Soc Sci Med 2006;63(8):2022-30.

(11.) McCabe SE, Hughes TL, Boyd CJ. Substance use and misuse: Are bisexual women at greater risk? J Psychoactive Drugs 2004;36(2):217-25.

(12.) Heck JE, Sell RL, Gorin SS. Health care access among individuals involved in same-sex relationships. Am J Public Health 2006;96(6):1111-18.

(13.) Gruskin EP, Gordon N. Gay/Lesbian sexual orientation increases risk for cigarette smoking and heavy drinking among members of a large northern California health plan. BMC Public Health 2006;6:241.

(14.) Gruskin EP, Greenwood GL, Matevia M, Pollack LM, Bye LL. Disparities in smoking between the lesbian, gay, and bisexual population and the general population in California. Am J Public Health 2007;97(8):1496-502.

(15.) Tang H, Greenwood GL, Cowling DW, Lloyd JC, Roeseler AG, Bal DG. Cigarette smoking among lesbians, gays, and bisexuals: How serious a problem? (United States). Cancer Causes Control 2004;15(8):797-803.

(16.) Drabble L, Midanik LT, Trocki K. Reports of alcohol consumption and alcohol-related problems among homosexual, bisexual and heterosexual respondents: Results from the 2000 National Alcohol Survey. J Stud Alcohol 2005;66(1):111-20.

(17.) Cochran SD, Keenan C, Schober C, Mays VM. Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population. J Consult Clin Psychol 2000;68(6):1062-71.

(18.) Midanik LT, Drabble L, Trocki K, Sell RL. Sexual orientation and alcohol use: Identity versus behavior measures. JLGBTHealth Res 2007;3(1):25-35.

(19.) Grulich AE, de Visser RO, Smith AM, Rissel CE, Richters J. Sex in Australia: Homosexual experience and recent homosexual encounters. Aust N Z J Public Health 2003;27(2):155-63.

(20.) Eisenberg M. Differences in sexual risk behaviors between college students with same-sex and opposite-sex experience: Results from a national survey. Arch Sex Behav 2001;30(6):575-89.

(21.) Izazola-Licea JA, Gortmaker SL, de Gruttola V, Tolbert K, Mann J. Sexual behavior patterns and HIV risks in bisexual men compared to exclusively heterosexual and homosexual men. Salud Publica Mex 2002;45(Supp 5):S662-S671.

(22.) Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: Men and women 15-44 years of age, United States, 2002. Adv Data 2005;362:1-55.

(23.) Statistics Canada. 2003 Canadian Community Health Survey, first information on sexual orientation. Ottawa, ON: Statistics Canada, 2004.

(24.) Statistics Canada. Canadian Community Health Survey 2003 user guide for the public use microdata file. Ottawa: Statistics Canada, January 2005.

(25.) Cochran SD, Mays VM. Prevalence of primary mental health morbidity and suicide symptoms among gay and bisexual men. In: Wolitski RJ, Stall RD, Valdiserri RO (Eds.), Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States. New York, NY: Oxford University Press, 2008;97-120.

(26.) Cochran SD, Mays VM. Physical health complaints among lesbians, gay men, and bisexual and homosexually experienced heterosexual individuals: Results from the California Quality of Life Survey. Am J Public Health 2007;97(11):2048-55.

(27.) Ostrow DG, Stall RD. Alcohol, tobacco and drug use among gay and bisexual men. In: Wolitski RJ, Stall RD, Valdiserri RO (Eds.), Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States. New York: Oxford University Press, 2008;121-58.

(28.) Centers for Disease Control and Prevention (CDC). HIV/AIDS among racial/ethnic minority men who have sex with men--United States, 1989-1998. MMWR 2000;49(1):4-11.

(29.) Dean L, Meyer IH, Robinson K, Sell RL, Sember R, Silenzio VMB, et al. Lesbian, gay, bisexual, and transgender health: Findings and concerns. J Gay Lesbian Med Assoc 2000;4(3):102-51.

David J. Brennan, PhD, [1] Lori E. Ross, PhD, [2] Cheryl Dobinson, MA, [2] Scott Veldhuizen, MA, [2] Leah S. Steele, MD, PhD [3]

Author Affiliations

[1.] Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON

[2.] Social Equity & Health Research Section, Centre for Addiction & Mental Health, Toronto, ON

[3.] Department of Family and Community Medicine, University of Toronto, Toronto, ON

Correspondence: Dr. David J. Brennan, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1A1, Tel: 416-978-3273, Fax: 416-978-7072, E-mail: david.brennan@utoronto.ca

Conflict of Interest: None to declare.
Table 1. Demographics by Sexual Orientation

                                      Heterosexual Men

                                   Mean/%         95% CI

Age (mean yrs)                      44.4        44.3-44.5
Immigrant (%)                       21.9        21.3-22.5
< High school Education (%)         18.1        17.6-18.5
Annual household income ($CAD)    $72,700    $71,700-$73,700
Currently working (%)               69.9        69.3-70.5

                                          Gay Men

                                   Mean/%         95% CI

Age (mean yrs)                      39.9        38.4-41.4
Immigrant (%)                       12.0         7.8-16.3
< High school Education (%)         7.7          4.9-10.6
Annual household income ($CAD)    $69,100    $61,500-$76,600
Currently working (%)               72.7        67.8-77.7

                                        Bisexual Men

                                   Mean/%         95% CI

Age (mean yrs)                      39.3        36.5-42.1
Immigrant (%)                       18.6         11.1-26
< High school Education (%)         20.7        14.7-26.7
Annual household income ($CAD)    $67,400    $26,200-$108,700
Currently working (%)               66.8        58.6-75.1

Note: 95% CI = 95% confidence interval

Table 2. Unadjusted Prevalence Rates of Self-reported Health
Status and Health Risk Behaviours by Sexual Orientation

                                  Heterosexual Men

                                   %        95% CI

Respiratory condition             8.2      7.8-8.6
Hypertension                     14.5     14.1-15.0
Physical health fair or poor     10.2      9.8-10.6
Overweight/Obese BMI             57.4     56.7-58.0
Mood or anxiety disorder          5.1      4.8-5.5
Mental health fair or poor        4.2      4.0-4.5
Life-time suicidality             7.4      6.8-7.9
Daily smoker                     21.1     20.5-21.6
Risky drinking                   13.3     12.7-13.8
Ever diagnosed with STD           5.4      5.0-5.8

                                      Gay Men

                                   %        95% CI

Respiratory condition             9.6      6.3-12.8
Hypertension                      9.6      6.7-12.6
Physical health fair or poor     11.9      8.0-15.8
Overweight/Obese BMI             39.3     33.4-45.2
Mood or anxiety disorder         15.8     12.0-19.6
Mental health fair or poor        7.3      3.9-10.7
Life-time suicidality            25.2     14.6-35.8
Daily smoker                     26.2     20.7-31.7
Risky drinking                   11.1      7.1-15.1
Ever diagnosed with STD          26.6     19.4-33.7

                                    Bisexual Men

                                   %        95% CI

Respiratory condition             8.2      3.9-12.5
Hypertension                     13.2      8.7-17.6
Physical health fair or poor     14.8      9.0-20.6
Overweight/Obese BMI             43.3     34.4-52.1
Mood or anxiety disorder         13.8      8.5-19.1
Mental health fair or poor        8.6      5.0-12.3
Life-time suicidality            34.8     13.6-56.0
Daily smoker                     27.2     20.1-34.4
Risky drinking                   16.3      9.3-23.3
Ever diagnosed with STD           9.4      3.3-15.5

Note: 95% CI = 95% confidence interval; BMI = Body Mass Index;
STD = Sexually Transmitted Disease.

Table 3. Health Status of Gay and Bisexual Men When Compared
to Heterosexual Men Using Logistic Regression *

                                                 Gay Men

                                       OR (95% CI)       p-value

Respiratory condition ([dagger])     1.19 (0.80-1.77)      0.40
Hypertension ([double dagger])       1.01 (0.72-1.43)      0.94
Physical health fair or poor         1.43 (0.96-2.14)      0.08
Overweight/Obese BMI                 0.43 (0.33-0.56)     <0.01
Mood or anxiety disorder             3.06 (2.20-4.25)     <0.01
Mental health fair or poor           1.55 (0.85-2.82)      0.15
Life-time suicidality                4.13 (2.13-8.01)     <0.01

                                              Bisexual Men

                                       OR (95% CI)       p-value

Respiratory condition ([dagger])    0.87 (0.47-1.59)       0.65
Hypertension ([double dagger])      1.17 (0.72-1.89)       0.54
Physical health fair or poor        1.50 (0.95-2.36)       0.08
Overweight/Obese BMI                0.61 (0.40-0.93)       0.02
Mood or anxiety disorder            2.38 (1.45-3.90)      <0.01
Mental health fair or poor          1.53 (0.91-2.59)       0.11
Life-time suicidality               6.32 (2.08-19.15)     <0.01

* all regressions adjusted for age, immigration, education,
household income, employment level.

([dagger]) also adjusted for smoking.

([double dagger]) also adjusted for BMI.

OR = Odds Ratio; BMI = Body Mass Index; STD = Sexually Transmitted
Disease

Table 4. Health Behaviours of Gay and Bisexual Men When Compared
to Heterosexual Men Using Logistic Regression

                                        Gay Men

                              OR (95% CI)      p-value

Daily smoker               1.15 (0.86-1.54)      0.35
Risky drinking             0.71 (0.47-1.08)      0.11
Ever diagnosed with STD    5.80 (3.92-8.57)     <0.01

                                    Bisexual Men

                              OR (95% CI)      p-value

Daily smoker               1.24 (0.86-1.80)      0.25
Risky drinking             1.27 (0.74-2.20)      0.38
Ever diagnosed with STD    2.19 (0.97-4.93)      0.06

OR = Odds Ratio
COPYRIGHT 2010 Canadian Public Health Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2010 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Brennan, David J.; Ross, Lori E.; Dobinson, Cheryl; Veldhuizen, Scott; Steele, Leah S.
Publication:Canadian Journal of Public Health
Article Type:Report
Geographic Code:1CANA
Date:May 1, 2010
Words:3864
Previous Article:The effect of cash lottery on response rates to an online health survey among members of the Canadian Association of Retired Persons: a randomized...
Next Article:Igniting an agenda for health promotion for women: critical perspectives, evidence-based practice, and innovative knowledge translation.
Topics:

Terms of use | Copyright © 2017 Farlex, Inc. | Feedback | For webmasters