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1 Introduction
Pages 19-34

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From page 19...
... The past decade has brought remarkable changes in the social, political, and legal status of these individuals. A majority of Americans approve of same-sex relationships and support legal protections to ensure fundamental civil liberties on the basis of sexual orientation and gender identity, representing a dramatic shift from prior years (Gallup, 2018; Pew Research Center, 2017)
From page 20...
... Though an increasing number of nationwide surveys include questions about sexual orientation, gender identity, and same-sex partnerships, the extent to which empirical data accurately reflect the communities in question hinges on individuals' willingness to participate in and disclose their sexual orientation or gender identity on such surveys. In a major report that described the status of health research on LGBT populations, the Institute of Medicine (2011)
From page 21...
... They were asked to prepare a report examining the available data on and significant research needs relevant to persons of diverse sexualities and genders and persons with differences in sex development across multiple dimensions over the life course; see Box 1-1 for the complete statement of task. Considered as a whole, the findings of this report are intended to describe the current status of sexual and gender diverse populations and to offer recommendations about ways in which research can be improved to advance the health and well-being of those populations.
From page 22...
... Areas of focus will include, but are not limited to, the following: • Families and social relationships • Patterns of stigma, violence, and victimization • Role of community, cultural, educational, healthcare, and religious orga nizations and institutions • Civic engagement, political participation, and military service • Socioeconomic status/stratification, housing, and workforce issues • Justice and legal systems • Social change and geographic variations in public attitudes and public policies • Population health and well-being KEY TERMS AND DEFINITIONS This report uses numerous terms to describe sexual and gender diverse groups of people, some which might be unfamiliar to some readers or which may have varying colloquial or contextual meanings. This section describes how the committee understands these terms and how they are used in this report.
From page 23...
... Other newer terms related to sexual orientation include monosexual, which means people who are attracted to only one gender, such as straight, gay, and lesbian people; non-monosexual, which describes people attracted to more than one gender (including bisexual people) , and pansexual, which refers to people attracted to several genders.
From page 24...
... Some advocates and providers are increasingly using the term endosex to describe people whose reproductive or secondary sex characteristics align with medical binaries, just as the term cisgender is used in parallel with the term transgender. Since people who describe themselves as LGBT or intersex are numerically minority populations in the United States, researchers thus sometimes describe these populations as sexual and gender minorities.
From page 25...
... Discrimination can be interpersonal, such as denial of services based on sexual orientation or gender identity, and it can also be structural, such as laws or policies that systematically disadvantage sexual or gender diverse individuals in such areas as employment and education. Even in the absence of active discrimination or recognizable social stigma, there are occasions in which sexual and gender diverse people do not have the same access to opportunities and achievement of outcomes as others.
From page 26...
... Intersex status is almost never queried in population surveys, and the stigma associated with having intersex traits may inhibit people from self-identifying. Moreover, because medical providers until recently did not routinely educate intersex patients about their traits, many people have limited awareness of their own medical history in this area.
From page 27...
... . People with intersex traits/DSD were identified as a health disparity population by NIH, as well as by the American Association of Medical Colleges; both of these groups noted that intersex people may experience difficulties in accessing expert medical and psychosocial care similar to those encountered by SGD people.
From page 28...
... Just as research on the health of men who have sex with men validates and reinforces the difference between sexual identity and behavior, transgender health research has illuminated the spectrum of affirming medical and surgical procedures. It well may be that disparities in health and well-being among the intersex population are wholly distinct from those of other SGD populations, but given the intersections with SGD experiences and the absence of robust intersex population health research, it is difficult to justify the exclusion of intersex populations from our study.
From page 29...
... In this report the committee focuses on eight domains of well-being: the effects of various laws and the legal system on SGD populations; the effects of various public policies and structural stigma; community and civic engagement; families and social relationships; education, including school climate and level of attainment; economic experiences (e.g., employment, compensation, and housing) ; physical and mental health; and health care access and gender-affirming interventions.
From page 30...
... The committee held panels on culture, representation, and community frameworks; intersex individuals and families; non-binary and plurisexual9 identities; sexual and gender diversity law and policy; and civic engagement. See the agenda for this seminar in Appendix B
From page 31...
... That representativeness is essential for making comparisons across diverse sexual and gender populations in order to, e.g., compare rates of a particular health condition among lesbian, gay, and bisexual people to that of heterosexual people or to compare transgender people to cisgender people. However, the fact that the SGD populations studied in this report, such as lesbian, gay, bisexual, transgender, and intersex people, are relatively small means that only large samples of the whole population will include sizable numbers of people in sexual and gender diverse groups as usually defined.
From page 32...
... This general approach is appropriate for assessing whether there is a statistical association between being a member of a sexual or gender diverse group and a specific health, economic, or other social outcome. However, drawing a causal conclusion about whether and how having an SGD status or identity affects a research outcome is difficult because of the ways in which unobserved characteristics could vary by groups or by individuals and therefore affect outcomes.
From page 33...
... Lastly, when reviewing many studies, including those that demonstrate an adherence to scientific rigor, the committee was frequently reminded that the heteronormativity of common research designs (collecting data on males, females, and heterosexual relationships; not accounting for alternate identities and romantic relationships) may not enable data collection that provides detail on less prominent SGD groups or characteristics.
From page 34...
... , Best Practices for Ask ing Questions to Identify Transgender and Other Gender Minority Respondents on Population-Based Surveys. Los Angeles, CA: Williams Institute.


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