The Association between State Policy Environments and Self-Rated Health Disparities for Sexual Minorities in the United States

Int J Environ Res Public Health. 2018 Jun 1;15(6):1136. doi: 10.3390/ijerph15061136.


A large body of research has documented disparities in health and access to care for lesbian, gay, and bisexual (LGB) people in the United States. Less research has examined how the level of legal protection afforded to LGB people (the state policy environment) affects health disparities for sexual minorities. This study used data on 14,687 sexual minority adults and 490,071 heterosexual adults from the 2014⁻2016 Behavioral Risk Factor Surveillance System to document differences in health. Unadjusted state-specific prevalence estimates and multivariable logistic regression models were used to compare poor/fair self-rated health by gender, sexual minority status, and state policy environments (comprehensive versus limited protections for LGB people). We found disparities in self-rated health between sexual minority adults and heterosexual adults in most states. On average, sexual minority men in states with limited protections and sexual minority women in states with either comprehensive or limited protections were more likely to report poor/fair self-rated health compared to their heterosexual counterparts. This study adds new findings on the association between state policy environments and self-rated health for sexual minorities and suggests differences in this relationship by gender. The associations and impacts of state-specific policies affecting LGB populations may vary by gender, as well as other intersectional identities.

Keywords: LGBT health; health disparities; health policy; state policy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Behavioral Risk Factor Surveillance System
  • Bisexuality
  • Female
  • Health Status Disparities*
  • Health Surveys
  • Heterosexuality
  • Homosexuality, Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Policy Making*
  • Prevalence
  • Sexual Behavior
  • Sexual and Gender Minorities*
  • State Government*
  • United States
  • Young Adult