National Academies Press: OpenBook

Lesbian Health: Current Assessment and Directions for the Future (1999)

Chapter: 3 Methodological Challenges in Conducting Research on Lesbian Health

« Previous: 2 Lesbian Health Status and Health Risks
Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
×

3
Methodological Challenges in Conducting Research on Lesbian Health

Conducting research on lesbian health presents numerous challenges because lesbians represent a subgroup of women for which standard definitions of the population are lacking and lesbians are not readily identifiable. These challenges are further compounded because many in the lesbian community distrust research and researchers and there has been little funding support for conducting research on lesbian health topics. It is not surprising, then, that methodologically rigorous large-scale studies are lacking in this area. Furthermore, a number of methodological challenges for comparing findings across studies are consistently found in lesbian health research.

1.  

Inconsistencies in the way sexual orientation is defined make it difficult to compare findings across studies. Studies have not been consistent in how they define a lesbian sexual orientation, with some focusing on sexual behavior and others focusing on identity or desire. Studies have also used a range of time frames in which to capture reports of past or present sexual behavior, some for example looking at behavior during the past six months or a year and others looking at lifetime behavior. As discussed in Chapter 1 these can all be appropriate ways of assessing sexual orientation depending on the needs of the study. How-

Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
×
  • ever, researchers have usually failed to state how they define sexual orientation.
  • 2.  

    The lack of standard measures, including measures of sexual orientation, makes it difficult to compare findings across studies. Studies of lesbian health have lacked standard measures of sexual orientation including its three components—behavior, identity, and attraction or desire—which makes comparisons among studies difficult. In addition, like much other research on health-related behaviors, studies have often lacked standard measures of such variables as alcohol consumption and drinking behavior, depression, and childhood sexual abuse.

  • 3.  

    The use of small, nonprobability samples limits the generalizability of findings. Most lesbian health studies have relied on nonprobability samples. In particular, many studies have used convenience samples (e.g., from lesbian bars, music festivals, gay and lesbian organizations). As discussed later, these nonprobability samples are not likely to be representative of the population of lesbians. Further, most lesbian women sampled have been white, middle-class, well educated, and between 25 and 40 years old (Hughes and Wilsnack, 1997) and thus may not be representative of other socioeconomic, racial or ethnic, or age groups of lesbians.

  • 4.  

    The lack of appropriate control or comparison groups makes it difficult to assess the health of lesbians relative to other groups of women. In many research designs it may be useful to compare lesbians to another subgroup of women (e.g., heterosexual women, women in general). However, few studies have allowed direct comparisons between lesbians and other subgroups of women by using the same sampling strategies to identify subjects across sexual orientations and including measures of sexual orientation. Some studies have used as a comparison findings from earlier studies of women randomly selected from the general population. Although this method is an improvement on having no comparison group, the two groups are often quite different in terms of several key demographic variables. For example, most studies of lesbian health have included women who are more highly educated, of higher socioeconomic status, younger, and more predominately white compared to probability samples of women in general. In addition, it is important to note that samples from the general population of women include some

  • Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
  • unknown percentage of lesbians whose results affect the general population findings in undetermined ways.

    In selecting a sample comparison group, it could be useful to consider some of the matching strategies commonly used in epidemiological case-control studies where the intent is to sample a control group that is similar to the case group on one or more specified characteristics. In applying these general principles from epidemiology, the comparison group of women could be matched to the lesbians on a pairwise or groupwise basis. Some lesbian health studies are using this approach by defining the comparison group of women as a sister, work colleague, or neighbor of the lesbian research participant.

  • 5.  

    The lack of longitudinal data limits understanding of lesbian development and its implications for how to define and measure lesbian sexual orientation. Most existing studies portray cross sections of experience at one point in time, rather than development over time. Although discontinuity and change characterize the lives of many lesbians, the available cross-sectional data cannot address compelling questions of behavior and identity across time. Prospective, longitudinal studies are essential for understanding vulnerability, resilience, and well-being of lesbians across their life span.

    In the following sections, several key methodological issues in conducting research on lesbian health are discussed briefly: defining and sampling the study population, developing instruments to assess being lesbian, and eliciting disclosure of information.1

    1  

    The research design and data collection issues involved in conducting research on sexual behavior were addressed more comprehensively by the National Research Council Committee on AIDS Research and the Behavioral, Social, and Statistical Sciences (NRC, 1989, 1990). The reader is also referred to Bradburn et al. (1979) for a more detailed discussion of response effects to threatening questions in survey research and strategies for improving interview methods and questionnaire design.

    An in-depth discussion of the methodological issues in conducting research on lesbian health is beyond the scope and resources of this workshop study. The intent of the committee is to highlight the range of issues involved in doing research with lesbians and to suggest some approaches for addressing them. Numerous books on research design and methodology are available that provide more detailed and technical analyses of these issues.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    Defining the Population

    A critical initial step in conducting research is to clearly specify the target population you wish to study. To sample and identify the lesbian study population, researchers must thus clarify how they have defined sexual orientation in terms of identity, behavior, attraction or desire, or some combination of these. The type of question (e.g., identity versus behavior versus attraction) should be driven by the hypotheses being assessed. Thus, if one wishes to do a study of women who describe themselves as lesbian, perhaps to explore the process of coming out to family members, it may be sufficient to ask a single question such as, Do you consider yourself to be a lesbian? Women who answer yes can then be considered eligible respondents or subjects. In another instance where one wishes to study, for example, woman-to-woman transmission of a sexually transmitted disease, this question would not be a very appropriate strategy for identifying eligible participants. Some women who self-identify as lesbians and would thus qualify for the first study would not fit parameters of the transmission study because they have never had sex with a woman, they may be in an active sexual relationship with a man, or they are not sexually active.

    Definitions of the lesbian population and assumptions about its composition and behavior have varied in this body of research, a characteristic also of research on gay men and homosexuality in general. A review by Sell and Petrulio (1996) of 152 public health articles published between 1990 and 1992 that included gay men or lesbians revealed that only four of the studies reported the conceptual definition of sexual orientation employed to identify the population sampled (e.g., indicating that they defined homosexuality in terms of sexual behavior or attraction). The remaining studies typically relied on self-identification to define subjects or defined their sample based on the setting from which it was obtained (e.g., gay and lesbian organizations, bars, clinical settings). Table 3.1 presents information about the way in which lesbian sexual orientation has been defined in a wide range of studies. As illustrated in the table, specific questions have varied across studies, and studies have focused on different components of sexual orientation.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    We found that there were just so many different varieties of combinations of self-identification, of attraction to women and men, and sexual behavior, either current sexual behavior or past sexual behavior, that well over 30 different groups were defined by the combination of those variables

    Alice Dan, Public Workshop, October 6-7, 1997

    Washington, D.C.

    Instrumentation

    There are no agreed-upon standard questions with which to assess whether or not a woman is a lesbian (see Chapter 1). Once researchers wishing to assess sexual orientation determine which dimensions or aspects of sexual orientation are most relevant to the study, they must then decide how to measure the chosen dimensions.

    Researchers have used an array of questions to identity lesbians, focusing on the different components of lesbian sexual orientation: self-identification, sexual behavior, or sexual attraction or desire. Further, there is variation in the time periods during which the different components were assessed (e.g., lifetime or recently). However, there are no standard questions for measuring these dimensions. Thus, in one study, women might be identified as lesbian if they had had only female sex partners during their lifetime; in another study, women might be identified as lesbian if they had had any female sex partners during the past five years. This lack of standardization has made it very difficult to compare results across studies. Sell and Petrulio (1996) found that self-reported lesbian, homosexual, or bisexual identity was by far the most common method used to categorize lesbians in public health research in the studies they surveyed (see Table 3.2).

    The committee does not believe that enough information is available at this time to determine what, if any, particular wording is best in questions designed to elicit information about various aspects of sexual orientation. Methodological research is needed to improve measurement

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    TABLE 3.1 Summary of Measures of Sexual Orientation Used in Studies of Lesbian Health

     

    Measures Used to Assess Sexual Orientation

    Study

    Identity

    Behavior

    Desire

    Focus of Study (sample size)

    Berger et al., 1995

     

    Sexually active during lifetime with one or more female partners; no sexual intercourse with men during past 12 months

     

    Whether bacterial vaginosis occurs in lesbians and, if it does, whether it is sexually transmitted (n = 103)

    Bevier et al., 1995

     

    Sex of sexual partners since 1978; engagement in vaginal intercourse, oral-penile sex, and/or anal intercourse in more than 50% of sexual encounters

     

    Characteristics, behaviors, and HIV infection of women attending an STDa clinic who reported same-sex contact (n = 135) compared to women who had sex only with men (n = 1,383)

    Bloomfield, 1993

    Whether women report being primarily heterosexual, primarily or exclusively lesbian, or bisexual

     

     

    Drinking patterns of self-identified heterosexual women and self-identified lesbian or bisexual women in San Francisco (n = 844)

    Brand et al., 1992

    Scale from 1 = exclusively heterosexual to 5 = exclusively gay or lesbian

     

     

    Comparison of lesbians, gay men, and heterosexuals on weight, dieting, preoccupation with weight, and exercise activity (n = 124)

    Buenting, 1992

     

     

    Sex of preferred sexual partner

    Survey of health lifestyles of lesbian and heterosexual women (n = 79)

    Carroll et al., 1997

    Self-identification as lesbian, bisexual, heterosexual, or other

    Sex of partner asked with respect to participation in nine specific sexual practices; years since last male sexual encounter; lifetime number of male and female partners

     

    STD testing, diagnosis, and sexual practices among self-identified lesbian and bisexual women (n = 421)

    Chicago Women's Health Study (Hughes et al., 1997)

    Self-identification: "only heterosexual, mostly heterosexual, bisexual, mostly homosexual, or only homosexual"

    Sexual behavior in the past year: "only men, mostly men, equally men and women, mostly women, only women"

    Current sexual interest or attraction: "only men, mostly men, equally men and women, mostly women, only women"

    Indicators of mental health in lesbians (n = 284) and a comparison group of heterosexual women (n = 134)

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

     

    Measures Used to Assess Sexual Orientation

    Study

    Identity

    Behavior

    Desire

    Focus of Study (sample size)

    Chu et al., 1990

     

    ''After 1977 and preceding the diagnosis of AIDS, did this patient have sexual relations with a male partner?"

     

    Assess demographic characteristics and behavioral risk factors in lesbians in national surveillance data for reported cases of AIDS (n = 79)

     

     

    "After 1977 and preceding the diagnosis of AIDS, did this patient have sexual relations with a female partner?" If only female partners, then classified as lesbian; if both male and female partners, then bisexual

     

     

    Deren et al., 1996

    "Do you consider yourself to be heterosexual [straight], lesbian, bisexual, other?"

    Sex of sexual partner(s) during past 30 days (men only, women only, women and men)

     

    Relationship of sexual orientation to HIV risk behavior and serostatus in a multisite sample of drug-injecting and crack-using women (n = 830 lesbians; n = 5,791 heterosexual women)

    Einhorn and Polgar, 1994

    Self-defined as lesbians, bisexual, or undefined

    Sex of sexual partners since 1978

     

    HIV risk behavior among lesbians and bisexual women (n = 1,086)

    Turner et al., 1998b

     

    Whether engaged in woman-to-woman sex during period between consecutive interviews or blood samples (approximately 6 months)

     

    Assess HIV status in male and female out-of-treatment drug injectors to determine risk factors for HIV seroconversion in high- and low-seroprevalence cities (n = 6,882)

    Gómez et al., 1996

    "What do you consider your sexual orientation to be?"

    "How many women, in total, have you had sex with in the past 3 years?"

     

    Risk for HIV and other STDs in order to develop relevant prevention strategies (n= 461)

     

     

    "In the past 3 years, how many men have you had sex with?"

     

     

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

     

    Measures Used to Assess Sexual Orientation

    Study

    Identity

    Behavior

    Desire

    Focus of Study (sample size)

    Johnson et al., 1987

    Categorize self as lesbian, bisexual, or heterosexual

    Lifetime history of heterosexual intercourse (0, 1-9, 10-100, or>100 episodes)

     

    Reproductive system problems of lesbian and bisexual women in a nonclinical setting (n = 1,921 lesbians; n = 424 bisexual women)

    Krieger and Sidney, 1997

    "Have you experienced discrimination, been prevented from doing something, or been hassled or made to feel inferior in any of the following situations because of your sexual preference (heterosexual, bisexual, homosexual)? (yes or no) a. In your family; b. at school; c. getting a job; d. at work; e. at home"

    Lifetime number of same-and other-sex sexual partners

     

    Prevalence of self-reported experiences of discrimination based on sexual orientation among black and white adults with same-sex sexual partners, and health-related consequences of discrimination (n =1,724; n = 1,031 women; n = 114 lesbian or bisexual women)

    Lemp et al., 1995

    Self-reported lesbian or bisexual identity

    Sex of sexual partners since 1978 (men only, men and women, women only); engagement in specific sexual behaviors (e.g., oral sex with women)

     

    HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley (n = 550)

    Michigan Lesbian Health Survey (Bybee and Roeder, 1990)

    7-point scale: "Circle the number below that best describes how you think of yourself" Lesbian = 1; 4 = bisexual; heterosexual only = 7

    Whether ever had sexual contact with a woman; number of female sexual partners in the past year; whether ever had sex with a man; time since most recent sexual contact with a man; age at first sexual experience with a woman.

     

    General health and HIV risk of lesbians across the state of Michigan (n = 1,681)

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

     

    Measures Used to Assess Sexual Orientation

    Study

    Identity

    Behavior

    Desire

    Focus of Study (sample size)

    National Black Lesbian Study (Cochran and Mays, 1988, 1994; Cochran et al., 1996)

    Whether consider self gay or lesbian, bisexual, or neither, but homosexually active

    Number of female sexual partners; whether have ever had heterosexual sexual intercourse, time since last previous heterosexual experience; whether currently heterosexually active "never," "rarely," "sometimes," or "regularly"

     

    Health of African-American women in the United States who have sex with women (n = 605)

    National Health and Social Life Survey (Laumann et al., 1994)

    "Do you think of yourself as heterosexual, homosexual, bisexual, or something else?"

    During the past 12 months, past 5 years, and since turning age 18, what was sex of sexual partner(s); how many male and female partners; whether engaged in specific sexual acts: "Now I would like to ask you some questions about sexual experience with females after you were 12 or 13, that is, after puberty. How old were you the first time you had sex with a female?"

    "On a scale of 1 to 4, where 1 is very appealing and 4 is not at all appealing, how would you rate each of these activities: having sex with someone of the same sex?" "In general, are you sexually attracted to only men, mostly men, both men and women, mostly women, only women?"

    Sexual behaviors and practices of Americans (n = 3,432 total men and women; n =1,749 women; n = 150 women reporting any same-gender sexuality)

    National Lesbian Health Care Survey (Bradford and Ryan, 1988)

    7-point scale: "Please circle the number on the line below that best describes how you think of yourself."1 = lesbian only; 4 = bisexual; 7 = heterosexual only

    "Describe your past and present situations: in a tight committed primary relationship with a woman; single, but somewhat involved with a woman; single, not involved with anyone; living with a male lover; legally married to a man"; "How old were you when you first had sex with a woman?"

     

    Health and mental health status and needs of U.S. lesbians (n = 1,925)

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

     

    Measures Used to Assess Sexual Orientation

     

     

    Study

    Identity

    Behavior

    Desire

    Focus of Study (sample size)

    Norman et al., 1996

    5-point scale: exclusively heterosexual, primarily heterosexual, bisexual, primarily homosexual, exclusively homosexual

    Number of male and female partners during past 2 months with whom engaged in particular sexual practices; number of times engaged in such practices

     

    Risk for HIV infection of lesbian and bisexual women residing in small cities (n = 1,057)

    Nurses' Study II Pilot Study (Case, 1996; Case et al., 1996)

    "Whether you are sexually active or not, what is your sexual identity or orientation? Heterosexual; bisexual; lesbian, gay, or homosexual; none of the above; prefer not to answer"

     

     

    Longitudinal study of health status and behaviors of a national cohort of registered nurses (n = 1,050 in pilot study)

    Robertson and Schachter, 1981

     

    Whether sexually active with only women during the past 6 months

     

    Screening of sexually active lesbians for STDs (n = 148)

    Russell et al., 1995

    Indicate whether heterosexual, homosexual, lesbian, or bisexual

    “Have you had any of the following forms of sexual contact in the past 2 weeks? 1. Between your mouth and a partner's penis? 2. Between your mouth and a partner's vulva/ vagina? 3. Between your mouth and a partner's anus?"

     

    Presence of sexually transmitted pharyngeal bacteria and carriage rate in sexually active adults attending a genitourinary clinic ( n = 492 heterosexual women; n = 41 lesbians; n = 9 bisexual women; n = 586 men)

    Shaffer et al., 1995

    “Did she describe herself as gay/bisexual?"

    "Did she ever have a homosexual experience?"

     

    Use of psychological autopsies of adolescents who had committed suicide to examine relationship between sexual orientation and suicide (n = 120)

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

     

    Measures Used to Assess Sexual Orientation

     

     

    Study

    Identity

    Behavior

    Desire

    Focus of Study (sample size)

    Smith et al., 1985

    "When did you first consider yourself to be a lesbian?" "Do you consider yourself to be bisexual?"

    7-point Kinsey scaleb

    7-point Kinsey scaleb

    Experiences during gynecologic care, sources of care, and utilization patterns of lesbian and bisexual women (n = 424 bisexual women; n = 1,921 lesbians)

    Trevathan et al., 1993

     

    Evidence of intimate contact between the members of the dyad (sleeping in the same bed or sexual interaction reported on the daily checklists); no sleeping or sex with men reported on the daily checklists

     

    Menstrual synchrony in lesbian couples (n = 29 couples)

    Women's Health Initiative (The Women's Health Initiative Study Group, 1998)

     

    "Regardless of whether you are currently sexually active, which response best describes who you have had sex with over your adult lifetime: 1) have never had sex; 2) sex with a woman or with women; 3) sex with a man or with men; 4) sex with both men and women; 5) prefer not to answer" If option 4 selected, then "Which response best describes who you have had sex with after 45 years of age? 0) never had sex 1) sex with a woman or with women; 2) sex with a man or with men; 3) sex with both men and women"

     

    Strategies for the prevention and control of common causes of morbidity and mortality among postmenopausal women, including cancer, cardiovascular disease, and osteoporosis-related fractures (n = 64,500 women in the clinical trial; n = 100,000 women in the observational study only)

    NOTE: Reports of studies rarely include the exact wording of the questions used to determine sexual orientation. Where this information is available, it is included in the table. Otherwise, the questions are described as in the report of research results.

    a STD = sexually transmitted disease.

    b The Kinsey scale (NRC, 1997) of sexual orientation rates sexual orientation on a 7-point scale with 0 = exclusively heterosexual behavior and attraction and 6 = exclusively homosexual behavior and attraction. The scale does not separate behavior and attraction.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    TABLE 3.2 Operational Methods of Identifying Subjects in Public Health Research, 1990-1992

    Operational Method

    Percent*

    Self-reported identity

    64.6

    Setting (e.g., lesbian bar)

    29.2

    Sexual history

    4.2

    Kinsey scale

    6.2

    Other scale

    16.7

    * Categories total more than 100% because some studies used more than one method. Data are included from 48 studies that categorized women as homosexual, lesbian, or bisexual.

    SOURCE: Adapted from Sell and Petrulio, 1996.

    of various dimensions of lesbian sexual orientation. It is particularly important to discover how best to measure these dimensions among women of different racial and ethnic backgrounds, birth cohorts, religious backgrounds, and social classes. This should include qualitative studies—among them, ethnographic research—to better understand how a lesbian sexual orientation is defined in different subgroups of lesbians. In light of the current lack of information for better defining a lesbian sexual orientation, the committee believes that researchers of lesbian health should take care to clearly state the reasons they selected particular questions for their study and, where possible, should use questions whose wording has already been tested in comparable studies, particularly such large-scale studies as the Nurses' Health Study II (NHS-II) and the Women's Health Initiative (WHI).

    Disclosure of Sexual Orientation2

    In order to identify lesbians in a sample, respondents to study questions must be willing to disclose information about their sexual orientation and sexual behaviors. An important challenge for researchers on les

    2  

    This section incorporates portions of the workshop presentation of Dr. Charles Turner.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    bian health is to design instruments and strategies that increase the chances that women will reveal this kind of sensitive information about themselves. It is, of course, important to ensure confidentiality in surveys of lesbian health whether or not the surveys are anonymous (see Chapter 4). However, even when precautions have been taken to ensure that confidentiality will be maintained, respondents may remain distrustful. If respondents do not believe and trust the researcher, they are unlikely to respond honestly to sensitive questions.

    Methods to Increase Disclosure

    People's willingness to disclose sensitive information about themselves can be influenced by the methods used to elicit the information. For example, in a large-scale field experiment that included measures of self-reported drug use, respondents revealed more information about their drug use on a self-administered paper-and-pencil form than when they were questioned by an interviewer (Turner et al., 1992). These differences in reporting became more pronounced as the sensitivity of the information increased (e.g., cocaine use compared to alcohol use, a more socially accepted behavior). However, although this information might suggest that self-administered questionnaires should always be used, since all respondents do not have the appropriate level of literacy to understand and answer the questions, this method can also lead to substantial amounts of total or item nonresponse. 3

    New techniques have been developed to increase the likelihood that respondents will report sensitive behaviors. One promising technology is the audio computer-assisted self-interview (audio-CASI) in which questions are asked of the respondent by using digitized audio files of a human voice, rather than a human interviewer, and the subject responds using a computer keyboard. A major advantage of using audio-CASI is that it provides fully private administration in a completely standardized interview situation. Additionally, respondents do not have to be literate. Al

    3  

    Total nonresponse occurs when the subject answers no items on a questionnaire: item nonresponse occurs when a respondent who answers most of the questions does not respond to a particular item.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    though they must be able to use a computer keyboard, this has not been a big problem, even in studies of special populations such as elderly monolingual Koreans surveyed by monolingual English-speaking interviewers (Hendershot et al., 1996).

    The audio-CASI method can also be employed over the telephone (telephone audio-CASI, or T-ACASI). This approach, in which respondents actually respond to a computer, can be set up as a call-in program, so that in a prospective study, respondents can be scheduled to call every week to report on the behaviors of interest (e.g., sensitive health behaviors). Follow-ups can then be done with those who fail to keep these appointments. To maximize the representativeness of the sample the research project should be prepared to supply the required touch-tone phones to the few participants who do not have them.

    Studies using the audio-CASI method have found that people are much more likely to reveal sensitive information about themselves (e.g., sexual difficulties) than they would if responding to a human interviewer. For example, in the National Survey of Adolescent Males, which is a national probability sample of 15- to 19-year-old males, respondents were almost four times as likely to report some type of male-to-male sexual contact when the audio-CASI method was used rather than a self-administered paper questionnaire (Turner et al., 1998b). This pattern of higher rates of reported behaviors when using the CASI mode was true for specific sexual acts as well.4

    In a pilot study described at the workshop (Turner, 1997), male participants were randomly assigned to one of two conditions for gathering their responses to questions on high-risk sexual behavior: punching buttons on their touch-tone phones or reporting in to an interviewer. Those using the telephone punch button method were much more likely to reveal higher levels of more sensitive behaviors (e.g., more anal sex, less condom use) and to report having had sex fewer than ten times in the last six months.

    4  

    Respondents were asked whether they had ever engaged in such male-to-male sexual contacts as mutual masturbation; receptive or insertive oral sex; or, receptive or insertive anal sex. For the individual behaviors assessed, crude odds ratios ranged from 1.9 to 7.9, and adjusted odds ratios from 2.3 to 7.9, for the alternate estimates of prevalence using different methods of questioning, with higher estimates obtained using CASI methods (Turner et al., 1998b). Odds were adjusted for race, age, whether ever had sexual intercourse with a female, and health insurance status.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    These technologies have been field-tested in other groups. In the 1995 Survey of Family Growth (Mosher and Duffer, 1995), 10,000 females were asked questions about their history of abortions and other sensitive topics using both audio-CASI and interviewer questioning. Women in this survey reported significantly more abortions when questioned by using audio-CASI (Miller et al., in press). Similarly, in the Gay Urban Men Survey (Turner et al., 1998a) a randomly selected subset of respondents answered questions using T-ACASI.

    There has been some suggestion that computer-assisted techniques will not be well accepted among lesbians. Interestingly, although the same concerns were voiced about using this technology with gay men, it has now been employed quite successfully in studies of this population (Turner, 1997). Additional testing will be needed to determine whether this is, in fact, a useful technology in studies of lesbians.

    Sampling5

    Sampling is the method by which subjects are selected from a target population. Subpopulation subgroups that represent only a small proportion of the general population present significant challenges for probability sampling (Kalton, 1993). The challenge of sampling rare population subgroups such as lesbians is to find economical methods for obtaining the sample (Kalton, 1993). This is even more difficult in the case of lesbians because they are a stigmatized group and are not readily identifiable.

    When developing sampling strategies it is important to keep in mind that lesbians are not a homogeneous population. The samples in most lesbian health research to date can be characterized as primarily white, relatively well-educated, middle-class, young adults who identify themselves as lesbians (Greene, 1994; Rankow, 1995; Trippet, 1994). Few studies have captured the diversity of the experiences of lesbians across race, culture, socioeconomic spheres, age, and time. In particular, few studies have attempted to explicitly sample racial or ethnic minority groups

    5  

    This section incorporates significant portions of the testimony presented by Drs. Susan Cochran and Graham Kalton.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    such as African Americans, Latinos, or Asians, or to sample across the socioeconomic spectrum. To obtain representative samples, however, research sampling plans must take care to include all appropriate segments of these communities.

    In the following sections, several different approaches to sampling rare populations are considered for their applicability to research with lesbians. The section begins with a discussion of probability sampling and nonprobability sampling, and follows with descriptions of probability sampling techniques that can be used to identify a sample. Certain of these sampling strategies hold potential for improving research on lesbian issues; others are not yet practical. Some studies use only one of these methods to select a sample; others incorporate several methods into the research sampling plan.

    Probability Sampling

    In a probability-based design, individuals in the population (in this case, the population of lesbians) are enumerated in some fashion and a sample is then selected. Ideally, to conduct population-based sampling the population of interest (the target population) is clearly defined and identifiable. Researchers have a means of reaching out to each and every member of the population, and the probability of selecting each potential respondent is known. If all of these sampling conditions are met and there is a high response rate, then the prevalence of a risk factor or an outcome in a sample can be generalized confidently to the population as a whole. In practice, however, such ideal conditions are rarely met. Probability sampling has rarely been used in studies of lesbian health.

    The population-based sampling frame most likely to be useful for lesbians would be to sample women in general and collect information to identify a lesbian subsample. However, most probability sampling designs are extremely difficult to use with the lesbian population for three important reasons:

    1.  

    Lesbians represent a hidden population. Lesbians do not represent a readily visible population. Many lesbians are reluctant to disclose their sexual orientation for fear of stigmatization, discrimination, or

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    • other negative impact. Thus, it can be very difficult to identify lesbians in the population.
    • 2.  

      Lesbians tend to be a geographically dispersed population. Lesbians live in all parts of the country, in both urban and rural areas, and in all types of communities. Although communities can be identified in most large cities where high concentrations of gay men reside, lesbians have been less likely to live in these or similar areas. Thus, it can be extremely difficult to locate the population from which to draw a sample.

    • 3.  

      Lesbians represent only a small minority of women. Because lesbians represent only a small percentage of the population, the overall sample of women must be very large to identify a large enough subsample of lesbians for meaningful analyses. For example, if lesbians represent 2 to 3% of women, then drawing an overall sample of 1,000 women would be expected to yield a subsample of only 20 to 30 lesbians, too few for most analytic purposes. As noted before, adding sexual orientation questions to large population-based surveys (e.g., the National Health and Nutrition Examination Survey [NHANES] or the National Health Interview Survey [NHIS]), is one possible option for identifying larger probability-based samples of lesbians.

    Nonprobability Sampling

    Sample surveys on lesbian health have most commonly used non-probability sampling. Unlike probability sampling, in nonprobability designs the probability of selecting any one individual is unknown. Because the effects of potential bias cannot be determined with nonprobability samples, observed prevalences and relationships may or may not reflect those existing in the lesbian population as a whole.

    Nonprobability samples are always vulnerable to selection bias, but the nature of this bias can change over time. For example, several decades ago, because social scientists and psychiatrists presumed that homosexuality represented psychopathology, it was believed reasonable to look for lesbians in psychiatric settings. Not surprisingly, these researchers found a high prevalence of psychiatric problems in their lesbian subjects. In a wave of social science research beginning in the 1970s, researchers looked for

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    their samples in sites where lesbians obviously congregated, such as bars or feminist and lesbian activist meetings. Not surprisingly, scientists found in those samples that lesbians consumed alcohol and, parenthetically, were predominantly feminists and lesbian activists. This confounding of outcome variables with convenience sampling strategies undermines confidence in the prevalences of particular behaviors, health risks, and health and mental health conditions reported in these studies.

    Much of the existing research on lesbians has obtained research subjects from lesbian community groups (e.g., mailing or membership lists from lesbian or gay organizations). Other researchers have obtained subjects at regional or national gay or lesbian events that draw people from a large geographic area. These nonprobability methods of obtaining lesbian research subjects yield samples that are not representative of the general population of lesbians since they are limited to lesbians who are open enough about their sexual orientation to attend community events or who subscribe to lesbian and gay newspapers and magazines.

    These sampling biases may not be fatal flaws, however, if the researcher's interest is in a particular subset of the lesbian population. For example, a sample drawn at a widely attended lesbian event may be relatively representative of lesbians who have come out, a potentially important group for researchers to study because they are the most visible to the public and so may affect how heterosexuals view lesbians. Therefore, nonprobability samples can generate population estimates that may be generalizable to restricted subpopulations of lesbians. It is critical, however, that the limits of generalization be acknowledged and that the findings observed in these restricted groups are not assumed to apply to all lesbians. For many purposes of health research, however, such as measuring the prevalence of disease conditions or risk factors in lesbians, more representative sampling designs will be preferable to nonprobability samples.

    Sampling Techniques

    A variety of sampling techniques have been designed to identify members of "rare" population subgroups for research studies (i.e., sub-

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    groups which comprise a small percentage of the general population). 6 Probability sampling techniques include one-stage screening and two-phase screening, disproportionate stratification, multiple frames, and multiplicity sampling. Nonprobability sampling techniques include location (or convenience) sampling and snowball sampling. The possible uses of these methods to select samples of lesbians are described in the following sections.

    One-Stage Screening and Two-Phase Screening

    The most straightforward method of sampling a rare population subgroup is to take a sample of the total population and screen out everybody who is not a member of this population subgroup. The amount of screening necessary depends on the prevalence of the population subgroup of interest. For example, to obtain a sample of 1,000 members of a population subgroup with a prevalence rate of 10%, 10,000 people will have to be screened. If the prevalence is 5%, 20,000 people will have to be screened, and so forth. Clearly, this strategy can become very expensive if face-to-face interviews are used; less expensive alternatives include telephone interviews and mail questionnaires.

    A possible application of one-stage screening would be to sample from communities in which lesbians are known to live, such as North Hampton, Massachusetts, or some neighborhoods in San Francisco. In these areas, the density of lesbian residents might be high enough to make initial household screening economically feasible, particularly by telephone. Unfortunately, the focus on these geographical areas, although it solves the problem of economically feasible enumeration, also introduces significant selection bias because lesbians who reside in high-density lesbian

    6  

    Researchers have developed a number of innovative strategies to sample rare and/or difficult-to-identify populations. For example, people who are homeless represent an example of another difficult-to-identify subpopulation for which there is a lack of agreed-upon definition. Rossi et al. (1987) attempted to enumerate literally homeless individuals in Chicago by both taking a probability sample of individuals spending the night in homeless shelters and conducting a complete enumeration of people encountered in a thorough search of non-dwelling unit places in a probability sample of census blocks.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    neighborhoods are not likely to be representative of the lesbian population as a whole.

    A two-phase screening procedure can be used when it is expensive or difficult to screen for a member of a rare population subgroup. In this case, a few questions are asked in the first phase of screening to quickly identify either households likely to contain lesbians or individuals likely to be lesbian. Then, only these households or persons are asked more detailed screening questions in the second stage to determine which individuals actually are lesbian. However, this two-phase strategy is useful only if two conditions apply: (1) the first phase of screening must be much cheaper than the second; (2) the first-phase screening process must not screen out many women who actually are lesbian.

    These strategies obviously depend on the willingness of lesbians to disclose their sexual orientation in the screening interview. Depending on the sampling strategies used, there is also a risk that some desired subgroups of the lesbian population will be excluded. In the case of telephone survey sampling of lesbians (e.g., using random digit dialing), there is a risk that individuals will be missed who live in nontelephone households, which is disproportionally true of poor households, as well as those in institutions, those who are homeless, and so on. Methodological research needs to be conducted to determine the feasibility of using screening methods to identify samples of lesbians and to assess the effects of possible bias.

    Disproportionate Stratification

    In disproportionate stratification, some part of the general population in which the population of interest is concentrated is identified and oversampled (i.e., sampled with a higher probability than the rest of the population). The geographic areas in which a population subgroup tends to be concentrated are placed in one stratum and all other geographic areas in another stratum. In other words, areas where high concentrations of lesbians reside are identified and the ''lesbian-rich" stratum is then oversampled.

    There are a variety of methods for identifying a sampling stratum in which population subgroups are concentrated. For example, the Gay Ur-

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    ban Men Study (also known as the Multicultural Men's Health Survey), which is selecting a probability sample of gay and bisexual men in 10 large cities, employed such sources as census information on households with two adult male unmarried partners, local informants, membership lists, and commercial marketing lists to identify geographic areas with high concentrations of gay men (Binson et al., 1996). The researchers note that these methods have some inherent biases: they are more likely to identify those who self-identify as gay or bisexual, and they will be less likely to sample those who have same-sex partners but do not identify as gay or bisexual.

    For a disproportionate stratification strategy to work effectively, two conditions—which rarely occur together—must be met. First, there must be a much higher prevalence of the population subgroup of interest (e.g., lesbians) in the geographic area where it is believed to be concentrated. Secondly, this geographic area also has to contain a high proportion of the population subgroup. Although there are potential gains from using this form of oversampling, they are limited because lesbians may not be concentrated in particular geographic areas, and even if they are, the areas may not contain a large percentage of the total lesbian population. Further, lesbians who do choose to live in areas where lesbians are concentrated are likely not representative of the lesbian population in general, although the analyses can in part be corrected for this by weighting the sample to get the proper representation. Also, in some cases, this strategy can be more costly than alternatively taking a large enough random sample to reach the desired sample size.

    Multiple Frames

    If no one sampling frame gives adequate coverage of the population subgroup of interest, a combination of frames may be used. For example, household sampling may be combined with membership lists of one or more lesbian organizations to increase the number of lesbians in the sample. A risk with this approach, however, is that individuals will appear on more than one of the sampling lists or frames, thus increasing their chances of being selected into the sample. This issue can be addressed by collating the multiple lists or frames and then eliminating duplicates before

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    drawing the sample or by weighting responses in the analyses to adjust for the chances that names on one list are duplicated on another.

    Multiplicity or Network Sampling

    The goal of multiplicity or network sampling is to reduce the amount of screening necessary to identify members of the population subgroup by capitalizing on linkages to relatives or neighbors. Its most likely use is to estimate the size of a hard-to-identify population subgroup. 7 With this strategy, an interviewed subject is asked to identify others (e.g., relatives or neighbors) who are members of the population subgroup and, in some cases, to provide data on them. This method requires that respondents be able and willing to report whether people linked to them are members of the population subgroup. Further, if the characteristics of the population subgroup are being studied, the respondents must be able to report on these characteristics accurately, or the individuals they identify must be contacted in person and interviewed. If multiple routes of sample selection are used, responses must be weighted in the analyses to compensate for differential probabilities of selection. There are clearly both ethical and logistical problems in using this technique to estimate the number of lesbians or to obtain samples of lesbians. First, lesbians' sexual orientation may not be known to all others in their networks and so they would not be identified. Second, even if a lesbian's sexual orientation is known to the respondent, she may not want the respondent to disclose this information to others.

    7  

    Killworth et al. (1998) describe the use of a social network approach to estimate the size of hard-to-count populations. In their study, a representative sample of the U.S. population was asked how many people they knew in 29 populations of known size, and how many people they knew in 3 populations of unknown size whose size the researchers wanted to estimate (people who are homeless, women who were raped in the past 12 months, and people who are HIV-positive). Responses were then used to calculate a maximum likelihood estimate of the number of people in the respondent's social network, and the patterns of all respondents' responses about the populations of unknown size were used to estimate the size of the unknown subpopulations. The method accurately estimated the size of 20 of the 29 known populations, and the calculated estimates of the unknown populations were consistent with other published estimates. To the committee's knowledge, this approach has not yet been used to estimate the size of the lesbian population, but it is a strategy that might yield useful information.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Snowball Sampling

    In snowball sampling, members of a population subgroup are identified and asked to identify or report on other members of the population subgroup. The chances of being identified thus depend to some extent on the level of involvement in various social and community networks. Once a list or frame is obtained that contains all or a large proportion of the population subgroup, it is possible to draw a probability sample from the list. It is important that the snowball technique not simply be stopped when a desired sample size is reached. Rather, snowball sampling should be continued until a full roster of names believed to contain a large percentage of the population of interest is developed; then individuals from this list can be randomly sampled into the study.

    Although snowballing can be useful for constructing a sampling frame of all members of some population subgroups, given the hidden nature of the lesbian population and the potential risks of disclosure, it is not likely to be a feasible strategy for use with this population.

    Location (Convenience) Sampling

    In location sampling, sometimes referred to as convenience sampling, members of a rare population are sampled in places where they congregate, for example, gay bars or bookstores, where there is a high expectation of sufficient lesbian density to make the sampling efficient. Unfortunately, this strategy, too, results in significant sampling bias because bars are more likely to be frequented by young women who are old enough to drink and by women who drink more frequently, just as lesbian bookstores might be visited more frequently by feminists, and so forth.

    One suggested strategy for improving location sampling is first to map all of the possible sites and then to draw samples from within these sites in ways that cover multiple time periods and geographic areas. There are, nevertheless, significant problems with this methodology. First, only people who go to these particular sites (e.g., bars or bookstores) will be sampled. Second, people who go to these sites more frequently have a greater probability of being selected into the sample. Thus, the location

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    sampling method produces a probability sample of visits rather than visitors.

    Combining Strategies for Sampling Lesbians

    Many lesbian health research studies have used nonprobability sampling that goes far beyond convenience sampling, employing multiple methods in an attempt to obtain more broadly representative samples in a geographic area (e.g., sampling from newsletter rosters, women in gay and lesbian bookstores, lesbian community organizations, attendees at women's music festivals). Each of these methods casts the net wider and wider, attempting to sample participants from outside the social networks of the researcher or from outside institutional settings such as clinics and hospitals. Nonetheless, no matter how wide the net becomes, these methods are all still non-probability-based sample designs and are subject to criticism for selection bias even if they represent the most sophisticated methods now used in lesbian research.

    Given the difficulties in conducting population-based probability sampling of lesbians and the cost-efficiency of non-probability-based designs, an important research question is whether techniques can be employed to improve the usefulness of non-probability-based samples. One strategy might be to examine the consistency of findings across studies that use different sampling methods across different settings, with the expectation that results might center around the true population parameter. Confidence in reported estimates can increase as replicated well-designed studies are published on lesbian health using similar variables.

    Adding Sexual Orientation Questions to Existing Studies

    One suggestion for increasing the amount of information on lesbian health is to add sexual orientation items to large sample surveys or other large studies. This would add a significant amount of analytical capability at little additional cost. Adding appropriate questions about sexual orientation to large cross-sectional or cohort studies strengthens the ability to understand variation in health status by sexual orientation. However, in-

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    vestigators have been reluctant to add such questions to their studies for fear that women would not answer them and, in addition, might be so alienated by the questions that they would not participate in the study. There is evidence, however, that sexual orientation items can be used successfully in studies and in surveys (NRC, 1989).

    Two examples of ongoing studies that have included sexual orientation items in their data collection efforts are the Nurses' Health Study II8,9 and the Women's Health Initiative. In September 1994, NHS-II investigators began to receive requests for information on sexual orientation and health from other researchers and, more importantly, from both lesbian and heterosexual participants in the study itself. In response to these requests, investigators decided to add a question to gather information about sexual identity, hypothesizing that the social experience of women with a lesbian or bisexual sexual orientation might put them at higher risk for a number of conditions, particularly chronic disease and cancer.

    Questions were first pilot-tested on a sample of 1,050 nurses for inclusion in the June 1995 questionnaire. A variety of questions were asked in order to compare the willingness of respondents to answer different types, including questions about sexual identity 10 and about the sex of sexual partners over the past five years and during one's lifetime. The researchers found that women were willing to return the form (response rate = 78.4%) and answer the questions on sexual orientation, that they considered these questions acceptable, and that there was little negative feedback.11 As a result, investigators added a question on sexual identity to the 1995 Nurses' Health Study cohort questionnaire, which was mailed to 116,000 women.

    These results must be interpreted with some caution because nurses

    8  

    NHS-II is a prospective cohort of 116,680 female registered nurses established in 1989 as a companion study to the long-running Nurses' Health Study I. Participants are mailed questionnaires every two years that include comprehensive health questions.

    9  

    The description of the NHS-II is based on the workshop presentation of Dr. Patricia Case.

    10  

    The item categories included heterosexual; bisexual; lesbian, gay, or homosexual; none of the above; or prefer not to answer.

    11  

    In the NHS-II pilot study, 98.0% of the respondents reported that they were heterosexual; 0.9% that they were lesbian, gay, or homosexual; and 0.1% that they were bisexual (Case et al., 1996).

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    may be more willing to respond to questions about sexuality than general population samples. Nonetheless, these results are promising and demonstrate that careful pilot testing of questions in advance can help to reveal patterns of response and ease investigators' fears, often legitimate, of negative effects on the study.

    The WHI,12 a longitudinal study of about 100,000 postmenopausal women, has included one question on its baseline data collection forms about gender of adult lifetime sexual partners (i.e., men, women, both men and women, or never had sex). Questions on sexual orientation could also potentially be added to large national sample surveys such as the Bureau of Labor Statistics National Longitudinal Surveys, NHIS, the NHANES, and the National Survey of Family Growth. Only very large population-based surveys such as these can be expected to yield sufficient sample sizes of lesbians without substantial changes in the existing research design. Consequently, these surveys represent an important opportunity to attempt population-based sampling of lesbians if they were to include questions of sexual orientation. The committee does not believe, however, that it is feasible at this time to add questions regarding sexual orientation to the U.S. Census of Population and Housing for a variety of reasons, including the facts that questions are often asked of one individual in a household who serves as a proxy for the others; that efforts are made to minimize the number of questions, making it difficult to have any kind of item added to the questionnaire; and that the census questions require the approval of the U.S. Congress.

    It should be noted that there are also potential drawbacks to the strategy of adding questions to existing surveys. For example, including questions on sexual orientation does not guarantee that they will be considered in the analyses. Alternatively, the data may be analyzed and interpreted by persons who are unfamiliar with the nuances of conducting research with and defining the lesbian population. Another potentially very significant problem is the issue of confidentiality (see Chapter 4). Because these large-scale surveys are confidential but not anonymous, the extent to which lesbians will disclose their sexual orientation in this setting is unclear. Indeed, the degree to which sexual orientation will be

    12  

    See information on WHI in footnote 8 in Chapter 2.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    disclosed even when anonymity is ensured is unclear for all studies that inquire about sexual orientation.

    Areas for Further Methodological Research in Studying Lesbian Health

    The committee identified several strategies for increasing the statistical power of research on lesbians. These include pooling data across studies using similar measures and methods; meta-analysis of methodologically sound studies, including those with smaller sample sizes; multisite studies; and fostering national and international collaborations. Nonetheless, the field would benefit greatly from additional research focused on improving research methodologies. This type of research also has significant potential to benefit the conduct of health-related research with other populations, especially other hard-to-identify and/or rare population subgroups.

    The committee suggests the following areas for additional research:

    1. Research is needed on how techniques for sampling other hard-to-identify and/or rare population subgroups might be applied to obtaining probability samples of lesbians.
    2. Research is recommended on the validity and reliability of questions measuring the different dimensions of sexual orientation: identity, behavior, and attraction or desire.
    3. Research is needed on technologies to elicit disclosure in order to determine their usefulness in studies with lesbians. It is particularly important to consider how factors such as race and ethnicity, socioeconomic status, age, and region of residence affect the use of such technologies.
    4. Qualitative research is needed to increase the depth of understanding of lesbians' lives and to better inform other research. Consideration should be given in larger studies to including experts in qualitative methods in the design team for an integrated approach to seeking information.
    5. Existing databases from federal and other large surveys should be reviewed to identify those with potential for analysis by sexual orientation.
    6. In the absence of the ability to conduct targeted population-based
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    • studies of lesbians, efforts to create more effective non-probability-based designs should be undertaken.
    • Methodological research is needed on the feasibility of using matched control designs for research directed toward assessing the health status of lesbians compared to other women.
    • There may be innovative ways of sampling that have not been widely used. One suggestion made at the workshop (Gruskin, 1997) is to work with managed care organizations, many of which have research divisions, to obtain samples of lesbians and nonlesbian matched controls. The membership of a managed care organization usually is quite large and captured in a medical care delivery system, and access to information-rich medical records may be possible. Methodological research should be done to investigate the utility of this approach and to examine the ethical issues that it raises, with careful attention to how to maintain confidentiality.

    References

    Berger BJ, Kolton S, Zenilman JM, Cummings MC, Feldman J, McCormack WM. 1995. Bacterial vaginosis in lesbians: A sexually transmitted disease. Clinical Infectious Diseases 21(6):1402-1405.

    Bevier PJ, Chaisson MA, Hefferman RT, Castro KG. 1995. Women at a sexually transmitted disease clinic who reported same-sex contact: Their HIV seroprevalence and risk behaviors. American Journal of Public Health 85(10):1366-1371.

    Binson D, Moskowitz TM, Anderson K, Paul J, Stall R, Catania J. 1996. Sampling men who have sex with men: Strategies for a telephone survey in urban areas in the United States. Proceedings of the Section on Survey Research Methods, American Statistical Association. Alexandria, VA: American Statistical Association, pp. 68-72.

    Bloomfield K. 1993. A comparison of alcohol consumption between lesbians and heterosexual women in an urban population. Drug and Alcohol Dependence 33:257-269.

    Bradburn NM, Sudman S, Blair E, Locander W, Miles C, Singer E, Stocking C. 1979. Improving Interview Method and Questionnaire Design. San Francisco: Jossey-Bass.

    Bradford J, Ryan C. 1988. The National Lesbian Health Care Survey: Final Report. Washington, DC: National Lesbian and Gay Health Foundation.

    Brand PA, Rothblum ED, Solomon LJ. 1992. A comparison of lesbians, gay men, and heterosexuals on weight and restrained eating. International Journal of Eating Disorders 11(3):253-259.

    Buenting JA. 1992. Health life-styles of lesbian and heterosexual women. Special Issue: Lesbian health: What are the issues? Health Care for Women International 13(2):165-171.

    Bybee D, Roeder V. 1990. Michigan Lesbian Health Survey: Results Relevant to AIDS. A Report to the Michigan Organization for Human Rights and the Michigan Department of Public Health. Lansing: Michigan Department of Health and Human Services.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    Carroll N, Goldstein RS, Lo W, Mayer KH. 1997. Gynecological infections and sexual practices of Massachusetts lesbian and bisexual women. Journal of the Gay and Lesbian Medical Association 1 (1):15-23.

    Case P, Spiegelman D, Hunter DJ, Manson JE, Willet WC. 1996. Sexual Orientation in Relation to Behaviors in the Nurses' Health Study II: Selected Results from a Pilot Study. Presentation to the American Public Health Association. New York: National Development and Research Institutes.

    Chu SY, Buehler JW, Fleming PL, Berkelman RL. 1990. Epidemiology of reported cases of AIDS in lesbians, United States 1980-89. American Journal of Public Health 80(11):1380-1381.

    Cochran SD, Mays VM. 1988. Disclosure of sexual preference to physicians by black lesbian and bisexual women. Western Journal of Medicine 149(5):616-619.

    Cochran SD, Bybee D, Gage S, Mays VM. 1996. Prevalence of HIV-related self-reported sexual behaviors, sexually transmitted diseases, and problems with drugs and alcohol in 3 large surveys of lesbian and bisexual women: A look into a segment of the community. Women's Health Research on Gender, Behavior, and Policy 2(1-2):11-33.


    Deren S, Goldstein M, Williams M, Stark M, Estrada A, Friedman SR, Young RM. 1996. Sexual orientation, HIV risk behavior, and serostatus in a multisite sample of drug-injecting and crack-using women. Women's Health: Research on Gender, Behavior, and Policy 2(1-2):35-47.


    Einhorn L, Polgar M. 1994. HIV-risk behavior among lesbians and bisexual women. AIDS Education and Prevention 6(6):514-523.


    Gómez CA, Garcia DR, Kegebein VJ, Shade SB, Hernandez SR. 1996. Sexual identity versus sexual behavior: Implications for HIV prevention strategies for women who have sex with women. Women's Health: Research on Gender, Behavior, and Policy 2(1-2):91-109.

    Greene B. 1994. Ethnic-minority lesbians and gay men: Mental health and treatment issues. Journal of Consulting and Clinical Psychology 62(2):243-251.

    Gruskin E. 1997. Presentation before the Institute of Medicine Committee on Lesbian Health Research Priorities. Washington, DC, October 6-7, 1997.


    Hendershot TP, Rogers SM, Thornberry JP, Miller HG, Turner CF. 1996. Multilingual audio-CASI: Using English-speaking field interviewers to survey elderly Korean households. In: Warnecke R, ed. Health Survey Research Methods. Hyattsville, MD: National Center for Health Statistics.

    Hughes TL, Haas AP, Avery L. 1997. Mental health concerns of lesbians: Preliminary results from the Chicago Women's Health Survey. Journal of the Gay and Lesbian Medical Association 1(3): 137-148.

    Hughes TL, Wilsnack SC. 1997. Use of alcohol among lesbians: Research and clinical implications. American Journal of Orthopsychiatry 67(1):20-36.


    Johnson SR, Smith EM, Guenther SM. 1987. Comparison of gynecologic health care problems between lesbians and bisexual women. A survey of 2,345 women. Journal of Reproductive Medicine 32(11):805-811.


    Kalton G. 1993. Sampling considerations in research on HIV risk and illness. In: Ostrow DG, Kessler RC, eds. Methodological Issues in AIDS Behavioral Research. New York: Plenum Press. Pp. 53-74.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    Killworth PD, McCarty C, Bernard HR, Shelley GA, Johnsen EC. 1998. Estimation of seroprevalence, rape, and homelessness in the United States using a social network approach. Evaluation Review 22(2):189-308.

    Krieger N, Sidney S. 1997. Prevalence and health implications of anti-gay discrimination: A study of black and white women and men in the CARDIA Cohort. International Journal of Health Services 27(1):157-176.

    Laumann EO, Gagnon JH, Michael RT, Michaels S. 1994. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago: University of Chicago Press.

    Lemp GF, Jones M, Kellogg TA, Nieri GN, et al. 1995. HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley, California. American Journal of Public Health 85(11):1549-1552.


    Miller HG, Gribble JN, Rogers SM, Turner CF. In press. Abortion and breast cancer risk: Fact or artifact? In: Stone A, ed. Science of Self Report (provisional title). Mahwah, NJ: Lawrence Erlbaum Associates.

    Mosher W, Duffer A. 1995. Innovations in the 1995 National Survey of Family Growth. Paper presented at the annual meeting of the Population Survey of America, San Francisco, CA.


    Norman AD, Perry MJ, Stevenson LY, Kelly JA, Roffman RA. 1996. Lesbian and bisexual women in small cities—At risk for HIV? HIV Prevention Community Collaborative. Public Health Reports 111(4):347-352.

    NRC (National Research Council). 1989. AIDS: Sexual Behavior and Intravenous Drug Use. Washington, DC: National Academy Press.

    NRC. 1990. AIDS: The Second Decade. Washington, DC: National Academy Press.

    NRC. 1997. Evaluating Genetic Diversity. Washington, DC: National Academy Press.


    Rankow EJ. 1995. Lesbian health issues for the primary care provider. Journal of Family Practice 40(5):486-496.

    Robertson P, Schachter J. 1981. Failure to identify venereal disease in a lesbian population. Sexually Transmitted Diseases 8(2):75-76.

    Rossi PH, Wright JD, Fisher GA, Willis G. 1987. The urban homeless: Estimating composition and size. Science 235:1336-1341.

    Russell JM, Azadian BS, Roberts AP, Talboys CA. 1995. Pharyngeal flora in a sexually active population. International Journal of STD and AIDS 6(3):211-215.


    Sell RL, Petrulio C. 1996. Sampling homosexuals, bisexuals, gays, and lesbians for public health research: A review of the literature from 1990 to 1992. Journal of Homosexuality 30(4):31-47.

    Shaffer D, Fisher P, Hicks RH, Parides M, Gould M. 1995. Sexual orientation in adolescents who commit suicide. Suicide and Life-Threatening Behavior 25(Suppl):64-71.

    Smith EM, Johnson SR, Guenther SM. 1985. Health care attitudes and experiences during gynecologic care among lesbians and bisexuals. American Journal of Public Health 75(9):1085-1087.


    Trevathan WR, Burleson MH, Gregory WL. 1993. No evidence for menstrual synchrony in lesbian couples. Psychoneuroendocrinology 18(5-6):425-435.

    Trippet SE. 1994. Lesbians' mental health concerns. Health Care for Women International 15(4):317-323.

    Turner CF. 1997. Presentation before the Institute of Medicine Committee on Lesbian Health Research Priorities. Washington, DC, October 6-7, 1997 .

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×

    Turner CF, Forsyth BH, O'Reilly J, Cooley PC, Smith TK, Rogers SM, Miller HG. 1998a. Automated self-interviewing and the survey measurement of sensitive behaviors. In: Couper M, et al., eds. Computer-Assisted Survey Information Collection. New York: Wiley and Sons.

    Turner CF, Ku L, Rogers SM, Lindberg LD, Pleck JH, Sonenstein FL. 1998b. Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology. Science 280:867-873.

    Turner CF, Lessler JT, Devore J. 1992. Effects of mode administration and wording on reporting of drug use. In: Turner CF, Lessler JT, Gfroerer JD, eds. Survey Measurement of Drug Use: Methodological Issues. DHHS Pub. No. 92-1929. Washington, DC: U.S. Government Printing Office.

    Women's Health Initiative Study Group. 1998. Design of the Women's Health Initiative Clinical Thai and Observational Study. Controlled Clinical Trials 19:61-109.

    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    This page in the original is blank.
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 97
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 98
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 99
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 100
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 101
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 102
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 103
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 104
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 105
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 106
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 107
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 108
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 109
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 110
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 111
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 112
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 113
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 114
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 115
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 116
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 117
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 118
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 119
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 120
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 121
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 122
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 123
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 124
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 125
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 126
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 127
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 128
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 129
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 130
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 131
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 132
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 133
    Suggested Citation:"3 Methodological Challenges in Conducting Research on Lesbian Health." Institute of Medicine. 1999. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: The National Academies Press. doi: 10.17226/6109.
    ×
    Page 134
    Next: 4 Contextual Barriers to Conducting Research on Lesbian Health »
    Lesbian Health: Current Assessment and Directions for the Future Get This Book
    ×

    Women's health, as a field of study, is a developing discipline. Health theories in general have been based on studies of men. However, in recent years, more attention has shifted to women's health, realizing the disparities between men and women in relation to their health. During the last two decades, a similar shift has occurred for a group of women—lesbian women—to further identify and specify their health needs.

    Over the past decade, lesbians have organized to call for attention to the health issues of this community, resulting in several federally funded research initiatives. This book offers a comprehensive view of what is known about lesbian health needs and what questions need further investigation, including:

    • How do we define who is lesbian?
    • Are there unique health issues for lesbians?
    • Are lesbians at higher or lower risk for such health problems as AIDS, sexually transmitted diseases, breast cancer, mental disorders, and substance abuse?
    • How does homophobia affect lesbian health and the funding of research on lesbian health?
    • How do lesbian health needs fit into the health care system and the larger society?
    • What risk and protective factors shape the physical and mental health of lesbians?

    The book discusses how to determine which questions to ask about sexual orientation, the need to obtain information without violating privacy, the importance of considering racial and ethnic diversity in the study of lesbians, strategies for exchanging information among researchers and disseminating findings to the public, and mechanisms for supporting greater numbers of researchers.

    Lesbian Health takes a frank look at the political pressures, community attitudes, and professional concerns uniquely affecting the study of lesbian health issues. The book explores many other issues including the potential for transferring findings in this field to other population groups, including other rare populations and women in general.

    1. ×

      Welcome to OpenBook!

      You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

      Do you want to take a quick tour of the OpenBook's features?

      No Thanks Take a Tour »
    2. ×

      Show this book's table of contents, where you can jump to any chapter by name.

      « Back Next »
    3. ×

      ...or use these buttons to go back to the previous chapter or skip to the next one.

      « Back Next »
    4. ×

      Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

      « Back Next »
    5. ×

      Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

      « Back Next »
    6. ×

      To search the entire text of this book, type in your search term here and press Enter.

      « Back Next »
    7. ×

      Share a link to this book page on your preferred social network or via email.

      « Back Next »
    8. ×

      View our suggested citation for this chapter.

      « Back Next »
    9. ×

      Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

      « Back Next »
    Stay Connected!