{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T09:52:56Z","timestamp":1764841976244,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T00:00:00Z","timestamp":1500940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Inequalities in health have been identified for lesbian, gay, and bisexual (LGB) populations nationally. Policies in the U.S. South offer fewer protections for LGB people than in other regions, yet, limited data exist for this region. North Carolina (NC) BRFSS data from 2011 to 2014 were combined (LGB n = 604; heterosexual n = 33,170) and analyzed using SAS survey procedures to estimate health characteristics by sexual orientation within gender. Many examined indicators were not different by sexual orientation, however, other results were significant and consistent with findings from state population surveys in other regions of the country. Both genders showed inequities in mental health, having over twice the odds of five or more poor mental health days in the past month and of having ever been diagnosed with a depressive disorder. Sexual minority women had higher odds compared with heterosexual women for ever having smoked cigarettes, current smoking, exposure to secondhand smoke both in the workplace and at home, and both alcohol risk factors, binge and heavy drinking. Being part of the LGB population in NC is associated with worse health. The implementation of anti-LGB policies in the NC warrants ongoing monitoring of LGB health inequities in NC and in other southeastern states for potential effects on the health and well-being of sexual minorities.<\/jats:p>","DOI":"10.3390\/ijerph14080835","type":"journal-article","created":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T10:04:36Z","timestamp":1500977076000},"page":"835","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Health Inequities among Lesbian, Gay, and Bisexual Adults in North Carolina, 2011\u20132014"],"prefix":"10.3390","volume":"14","author":[{"given":"Melissa","family":"Barnhill","sequence":"first","affiliation":[{"name":"Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9698-649X","authenticated-orcid":false,"given":"Joseph","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann","family":"Rafferty","sequence":"additional","affiliation":[{"name":"Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2017,7,25]]},"reference":[{"key":"ref_1","unstructured":"Institute of Medicine (2011). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, National Academies Press."},{"key":"ref_2","unstructured":"(2017, February 09). North Carolina\u2019s Equality Profile. Available online: http:\/\/www.lgbtmap.org\/equality_maps\/profile_state\/NC."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1037\/0033-2909.129.5.674","article-title":"Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence","volume":"129","author":"Meyer","year":"2003","journal-title":"Psychol. Bull."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.2105\/AJPH.2008.153510","article-title":"State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations","volume":"99","author":"Hatzenbuehler","year":"2009","journal-title":"Am. J. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"808","DOI":"10.2105\/AJPH.2015.303031","article-title":"Reconciling epidemiology and social justice in the public health discourse around the sexual networks of black men who have sex with men","volume":"106","author":"Matthews","year":"2016","journal-title":"Am. J. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.healthplace.2009.05.003","article-title":"Mental health in sexual minorities: Recent indicators, trends, and their relationships to place in North America and Europe","volume":"15","author":"Lewis","year":"2009","journal-title":"Health Place"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1300\/J041v11n01_01","article-title":"Alcohol, tobacco, and pharmaceutical industry funding: Considerations for organizations serving lesbian, gay, bisexual, and transgender communities","volume":"11","author":"Drabble","year":"2000","journal-title":"J. Gay Lesbian Soc. Serv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e156","DOI":"10.1136\/tobaccocontrol-2013-051288","article-title":"Out smoking on the big screen: Tobacco use in LGBT movies, 2000\u20132011","volume":"23","author":"Lee","year":"2013","journal-title":"Tob. Control"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1136\/jech.2005.038760","article-title":"What makes an ad a cigarette ad? Commercial tobacco imagery in the lesbian, gay, and bisexual press","volume":"59","author":"Smith","year":"2005","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_10","unstructured":"(2016, October 16). Equality Maps. Available online: http:\/\/lgbtmap.org\/equality-maps."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.2105\/AJPH.2009.174169","article-title":"A population-based study of sexual orientation identity and gender differences in adult health","volume":"100","author":"Conron","year":"2010","journal-title":"Am. J. Public Health"},{"key":"ref_12","first-page":"E136","article-title":"Sexual orientation and sex differences in adult chronic conditions, health risk factors, and protective health practices, Oregon, 2005\u20132008","volume":"11","author":"Fiala","year":"2014","journal-title":"Prev. Chronic Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"460","DOI":"10.2105\/AJPH.2007.130336","article-title":"Demonstrating the importance and feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest","volume":"100","author":"Dilley","year":"2010","journal-title":"Am. J. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.amepre.2013.11.010","article-title":"Health inequalities among sexual minority adults: Evidence from ten U.S. states, 2010","volume":"46","author":"Blosnich","year":"2014","journal-title":"Am. J. Prev. Med."},{"key":"ref_15","unstructured":"Howard, J. (1999). Men Like That: A Southern Queer History, University of Chicago Press."},{"key":"ref_16","unstructured":"Black, A.M., and Philadelphia, P.A. (2001). Health care, the AIDS crisis, and the politics of community: The North Carolina lesbian and gay health project, 1982\u20131996. Modern American Queer History, Temple University Press."},{"key":"ref_17","unstructured":"Jolly, D.H. (1985). The North Carolina Lesbian and Gay Health Survey: Summary Report, North Carolina Lesbian and Gay Health Project."},{"key":"ref_18","unstructured":"(2016, October 16). Lesbian, Gay, Bisexual, and Transgender Health, Available online: https:\/\/www.healthypeople.gov\/2020\/topics-objectives\/topic\/lesbian-gay-bisexual-and-transgender-health."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.2105\/AJPH.2013.301751","article-title":"A profile of North Carolina lesbian, gay, and bisexual health disparities, 2011","volume":"104","author":"Matthews","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_20","unstructured":"(2017, January 23). Survey Data and Documentation, Available online: https:\/\/www.cdc.gov\/brfss\/data_documentation\/index.htm."},{"key":"ref_21","unstructured":"(2017, January 23). Behavioral Risk Factor Surveillance System Overview, Available online: http:\/\/www.schs.state.nc.us\/units\/stat\/brfss\/."},{"key":"ref_22","unstructured":"(2016, October 16). BRFSS 2012 Annual Results Technical Notes, Available online: http:\/\/www.schs.state.nc.us\/schs\/brfss\/2012\/technical.html."},{"key":"ref_23","unstructured":"(2016, October 16). Technical Notes 2014. Available online: http:\/\/www.schs.state.nc.us\/data\/brfss\/2014\/technical.htm."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Barros, A.J., and Hirakata, V.N. (2003). Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio. BMC Med. Res. Methodol., 3.","DOI":"10.1186\/1471-2288-3-21"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1197\/aemj.9.12.1430","article-title":"Advanced statistics: Up with odds ratios! A case for odds ratios when outcomes are common","volume":"9","author":"Cook","year":"2002","journal-title":"Acad. Emerg. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2582","DOI":"10.1001\/archinte.159.21.2582","article-title":"Prospective study of body mass index, weight change, and risk of adult-onset asthma in women","volume":"159","author":"Camargo","year":"1999","journal-title":"Arch. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1007\/s11524-008-9340-5","article-title":"The associations between area of residence, sexual violence victimization, and asthma episodes among US adult women in 14 states and territories, 2005\u20132007","volume":"86","author":"Bossarte","year":"2009","journal-title":"J. Urban Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.paid.2012.02.008","article-title":"Gender, sexual orientation, and occupational interests: Evidence of their interrelatedness","volume":"53","author":"Ellis","year":"2012","journal-title":"Personal. Individ. Differ."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ypmed.2015.10.008","article-title":"Sexual orientation disparities in smoking vary by sex and household smoking among US adults: Findings from the 2003\u20132012 National Health and Nutrition Examination Surveys","volume":"82","author":"Gamarel","year":"2016","journal-title":"Prev. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1002\/(SICI)1098-108X(199901)25:1<89::AID-EAT11>3.0.CO;2-T","article-title":"Lesbians, bisexual women, and body image: An investigation of gender roles and social group affiliation","volume":"25","author":"Ludwig","year":"1999","journal-title":"Int. J. Eat. Disord."},{"key":"ref_31","first-page":"195","article-title":"Hazards of stigma: The sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada","volume":"85","author":"Saewyc","year":"2006","journal-title":"Child Welf."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/02791072.2004.10399732","article-title":"Substance use and misuse: Are bisexual women at greater risk?","volume":"36","author":"McCabe","year":"2004","journal-title":"J. Psychoact. Drugs"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1093\/ntr\/ntv208","article-title":"Intragroup variance in lesbian, gay, and bisexual tobacco use behaviors: Evidence that subgroups matter, notably bisexual women","volume":"18","author":"Emory","year":"2016","journal-title":"Nicotine Tob. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1136\/tobaccocontrol-2011-050181","article-title":"A systematic review of the aetiology of tobacco disparities for sexual minorities","volume":"22","author":"Blosnich","year":"2013","journal-title":"Tob. Control"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"452","DOI":"10.2105\/AJPH.2009.168815","article-title":"The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: A prospective study","volume":"100","author":"Hatzenbuehler","year":"2010","journal-title":"Am. J. Public Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/8\/835\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:43:54Z","timestamp":1760208234000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/8\/835"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,25]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2017,8]]}},"alternative-id":["ijerph14080835"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14080835","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2017,7,25]]}}}