Understanding the Well-Being of
Committee on Understanding the Well-Being of Sexual and
Gender Diverse Populations
Charlotte J. Patterson, Martín-José Sepúlveda, and Jordyn White,
Committee on Population
Division of Behavioral and Social Sciences and Education
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
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This activity was supported by contracts between the National Academy of Sciences and Gilead Sciences (award no. 05352), the Sexual and Gender Minority Research Office of the National Institutes of Health (award no. 75N98019F00850), the Robert Wood Johnson Foundation (award no. 75874), the TAWANI Foundation (unnumbered), and the Tegan and Sara Foundation (unnumbered). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-68081-3
International Standard Book Number-10: 0-309-68081-6
Digital Object Identifier: https://doi.org/10.17226/25877
Library of Congress Control Number: 2020949996
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. (2020). Understanding the Well-Being of LGBTQI+ Populations. Washington, DC: The National Academies Press. https://doi.org/10.17226/25877.
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COMMITTEE ON UNDERSTANDING THE STATUS AND WELL-BEING OF SEXUAL AND GENDER DIVERSE POPULATIONS
CHARLOTTE J. PATTERSON (Cochair), Department of Psychology, University of Virginia
MARTÍN-JOSÉ SEPÚLVEDA (Cochair), Health Systems and Policy Research, IBM Corporation (retired); CLARALUZ Consulting LLC
M.V. LEE BADGETT, Department of Economics, University of Massachusetts Amherst
MARLON M. BAILEY, Department of Women and Gender Studies, School of Social Transformation, Arizona State University
KATHARINE B. DALKE, Department of Psychiatry and Behavioral Health and Humanities, Pennsylvania State University College of Medicine
ANDREW R. FLORES, Department of Government, School of Public Affairs, American University
GARY J. GATES, retired
ANGELIQUE C. HARRIS, Department of Medicine, Boston University Medical Campus, Boston University
MARK L. HATZENBUEHLER, Department of Psychology, Harvard University
NAN D. HUNTER, Georgetown University Law Center
TONIA C. POTEAT, Department of Social Medicine, University of North Carolina Chapel Hill
SARI L. REISNER, Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Fenway Health
STEPHEN T. RUSSELL, Department of Human Development and Family Sciences, University of Texas at Austin
DEBRA J. UMBERSON, Population Research Center, University of Texas at Austin
JORDYN WHITE, Study Director
KELLAN BAKER, Consultant, Bloomberg School of Public Health, Johns Hopkins University
KENNE DIBNER, Senior Program Officer
TARA BECKER, Program Officer
MARY GHITELMAN, Senior Program Assistant
MALAY K. MAJMUNDAR, Director, Committee on Population
COMMITTEE ON POPULATION
KATHLEEN MULLAN HARRIS (Chair), Department of Sociology, Carolina Population Center, and National Longitudinal Study of Adolescent to Adult Health, University of North Carolina at Chapel Hill
DEBORAH BALK, Marxe School of Public and International Affairs, and CUNY Institute for Demographic Research, Baruch College of the City University of New York
NANCY BIRDSALL, Center for Global Development, Washington, DC
ANN K. BLANC, Population Council, New York, NY
COURTNEY C. COILE, Department of Economics, Wellesley College
VICKI A. FREEDMAN, Institute for Social Research, University of Michigan
DANA A. GLEI, Georgetown University
ROBERT A. HUMMER, Department of Sociology, and Carolina Population Center, University of North Carolina at Chapel Hill
HEDWIG (HEDY) LEE, Department of Sociology, Washington University in St. Louis
JENNIFER J. MANLY, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Columbia University
EMILIO A. PARRADO, Department of Sociology and Population Studies Center, University of Pennsylvania
ANNE R. PEBLEY, Department of Community Health Sciences, Department of Sociology, California Center for Population Research, Bixby Center on Population and Reproductive Health, University of California, Los Angeles
ISABEL V. SAWHILL, The Brookings Institution, Washington, DC
REBECA WONG, University of Texas Medical Branch at Galveston
MALAY K. MAJMUNDAR, Director
In 2011 the Institute of Medicine of the U.S. National Academies of Sciences, Engineering, and Medicine (National Academies) published The Health of Lesbian, Gay, Bisexual, and Transgender People, a landmark report about the health of this population. The report discussed the existing body of research about the health of lesbian, gay, bisexual, and transgender (LGBT) people, identified opportunities for further research, and made recommendations for actions to improve the health of LGBT people. By mid-2020 the report had been downloaded more than 15,000 times, and it had been used by researchers, educators, attorneys, health care professionals, government workers, journalists, community groups, and many others. It has influenced the work of the National Institutes of Health, the Centers for Disease Control and Prevention, and other governmental and nongovernmental organizations.
Since 2011 much has changed. Some of the challenges identified in the 2011 volume have been met, but others certainly remain. Research on LGBT health has burgeoned, but there is still much to learn. In 2019, the National Academies convened a committee to assess the current state of knowledge about the status and well-being of sexual and gender diverse people to identify important gaps in knowledge and to recommend research and research infrastructure actions to help fill these gaps. The committee’s work was supported by the Robert Wood Johnson Foundation, the Gilead Foundation, the Sexual and Gender Minority Research Office at the National Institutes of Health, the TAWANI Foundation, and the Tegan and Sara Foundation.
The task set for the committee was broader than the one addressed by the 2011 report. The committee was charged with reviewing data on people with differences of sex development (sometimes called “intersex”), as well as those who could, by virtue of their identities, behaviors, or attractions, either identify or be seen as LGBT. In undertaking its work, the committee was asked to address not only the mental and physical health of these populations, but also additional aspects of well-being in their lives as lived in families, communities, and in the context of cultural, legal, educational, economic, and religious institutions. The committee undertook to provide an overview of both existing evidence and of future research needs in these areas.
Thus, this report presents a considerable body of information across a wide array of topics and disciplines. The report was made possible by a year of discussion, information gathering, review, and deliberation among committee members, aided by a dedicated staff. We thank all of the committee members for their dedication and spirit as well as for their invaluable expertise.
In addition to the invited guests, reviewers, and members of the public who contributed to this report, and on behalf of the entire committee, we want to thank the National Academies staff members who made this report possible. In particular, we extend our sincere thanks to Jordyn White, study director; Kenne Dibner, senior program officer; Tara Becker, program officer; Kellan Baker, project consultant; Mary Ghitelman, senior program assistant; and Malay K. Majmundar, director of the Committee on Population. We would also like to thank Daniel Desautels for his contribution during his time at the National Academies as a Christine Mirzayan Science and Technology Policy Graduate Fellow. Without the constant support and guidance from these individuals, the report could not have been completed.
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report: Walter O. Bockting, Program for the Study of LGBT Health, Columbia University Irving Medical Center; Christopher (Kitt) S. Carpenter, Vanderbilt LGBT Policy Lab, Vanderbilt University; Laura E. Durso, executive director and chief learning officer, Whitman-Walker Institute; Heath Fogg Davis, Gender, Sexuality and Women’s Studies, Political Science, Temple University; Donald Haider-Markel, Kentucky University; Jennifer S. Hirsch,
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University; Trevon D. Logan, Department of Economics, Ohio State University; Christy Mallory, School of Law, University of California, Los Angeles; Wendy D. Manning, Department of Sociology, Bowling Green State University; Jae M. Sevelius, Department of Medicine, Division of Prevention Science, University of California, San Francisco; and Russell Toomey, Family Studies and Human Development, University of Arizona.
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by Marshall H. Chin, Department of Medicine, University of Chicago, and Sara Rosenbaum, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Charlotte J. Patterson and Martín-José Sepúlveda, Cochairs
Committee on Understanding the Status and Well-Being of
Sexual and Gender Diverse Populations
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Committee’s Approach to the Study
Methods and Approach to the Evaluation of Evidence
2 Health and Well-Being in Diverse Populations: Frameworks and Concepts
PART II UNDERSTANDING SEXUAL AND GENDER DIVERSE POPULATIONS
3 Demography and Public Attitudes of Sexual and Gender Diverse Populations
4 Current State of Data Collection
PART III DOMAINS OF WELL-BEING
Continuing Gaps in Legal Protection
Areas of Law That Lack Protections Against Discrimination
Religious Liberty Exceptions to Anti-Discrimination Laws
6 Public Policy and Structural Stigma
Public Policy, Social Movements, and Public Opinion
7 Community and Civic Engagement
The Nature of Sexual and Gender Diverse Communities
The Importance of Space to Sexual and Gender Diverse Communities
Civic and Political Involvement
8 Families and Social Relationships
Social and Family Relationships in Childhood and Adolescence
Parenting and Other Family Relationships
Close Relationships in Adulthood
Discriminatory Experiences at School
Education Laws and School Policies
Sexual and Gender Diverse Parents and Their Children
Sexual and Reproductive Health
12 Coverage, Access, and Utilization of Evidence-Based Health Care
Coverage, Access, and Utilization
Gender-Affirming Care for Transgender People
Evidence-Based Programming and Interventions
A Summary of Prior Related National Academies Reports and Activities
B Agenda: Public Seminar on Amplifying Visibility and Increasing Capacity for Sexual and Gender Diverse Populations