Drawing on information from four recent national and two state-level population-based surveys, the analyses suggest that there are more than 8 million adults in the US who are lesbian, gay, or bisexual, comprising 3.5% of the adult population. There are also nearly 700,000 transgender individuals in the US. In total, the study suggests that approximately 9 million Americans – roughly the population of New Jersey – identify as LGBT. Key findings from the study include among adults who identify as lesbian, gay, or bisexual, bisexuals comprise a slight majority (1.8% compared to 1.7% who identify as lesbian or gay); women are substantially more likely than men to identify as bisexual; estimates of those who report any lifetime same-sex sexual behavior and any same-sex sexual attraction are substantially higher than estimates of those who identify as lesbian, gay, or bisexual. An estimated 19 million Americans (8.2%) report that they have engaged in same-sex sexual behavior and nearly 25.6 million Americans (11%) acknowledge at least some same-sex sexual attraction.

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How Many People are Lesbian, Gay, Bisexual and Transgender? - eScholarship

Background 
Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers.


Methodology 
LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas.


Results 
Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men.


Conclusions 
The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.

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Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations.

Sexual orientation and gender identity are not commonly addressed in health and human service delivery, or in educational degree programs. Based on findings from Caring and Aging with Pride: The National Health, Aging and Sexuality Study (CAP), the first national federally-funded research project on LGBT health and aging, this article outlines 10 core competencies and aligns them with specific strategies to improve professional practice and service development to promote the well-being of LGBT older adults and their families. The articulation of key competencies is needed to provide a blueprint for action for addressing the growing needs of LGBT older adults, their families, and their communities.

Creating a Vision for the Future: Key Competencies and Strategies for Culturally Competent Practice With Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the Health and Human Services

Objectives. To assess the extent to which lesbian, gay, and bisexual (LGB) adults aged 18 to 64 years experience barriers to health care.Methods. We used 2013 National Health Interview Survey data on 521 gay or lesbian (291 men, 230 women), 215 bisexual (66 men, 149 women), and 25 149 straight (11 525 men, 13 624 women) adults. Five barrier-to-care outcomes were assessed (delayed or did not receive care because of cost, did not receive specific services because of cost, delayed care for noncost reasons, trouble finding a provider, and no usual source of care).Results. Relative to straight adults, gay or lesbian and bisexual adults had higher odds of delaying or not receiving care because of cost. Bisexual adults had higher odds of delaying care for noncost reasons, and gay men had higher odds than straight men of reporting trouble finding a provider. By contrast, gay or lesbian women had lower odds of delaying care for noncost reasons than straight women. Bisexual women had higher odds than gay or lesbian...

Barriers to Health Care Among Adults Identifying as Sexual Minorities: A US National Study.

Very little research exists examining the interactions between community-based aging service providers and lesbian, gay, bisexual, and transgender (LGBT) older adults. It is unclear whether mainstream aging services acknowledge the needs of this community. We asked direct care providers and administrators in the Michigan aging services network to describe their work with LGBT older adults. We found there are very few services specific to the needs of older LGBT adults and very little outreach to this community. At the agency level, resistance to providing services was found.

Awareness of LGBT aging issues among aging services network providers.

The study examines the frequency and nature of the informal caregiving experience for midlife and older lesbian, gay, bisexual, or transgender (LGBT) adults. Responses from a Twin Cities Metropolitan Area LGBT aging needs assessment survey were analyzed for social supports, current caregiving activity and availability of a caregiver. The majority of respondents identified a primary caregiver who was not a legal relation; and compared to the general population were (a) less likely to have traditional sources of caregiver support and (b) more likely to be serving as a caregiver and caring for someone to whom they were not legally related. Implications of the findings for enhancing resources to more fully support the 10% of caregivers that are caring for non-kin are discussed.

Friends, family, and caregiving among midlife and older lesbian, gay, bisexual, and transgender adults.

This research study surveyed leaders of Area Agencies on Aging (agencies) to understand their services, training, and beliefs about serving lesbian, gay, bisexual, and transgender (LGBT) older adults. Half of the existing agencies in the United States (320) participated. Few agencies provided LGBT services or outreach. One-third had trained staff around LGBT aging and four-fifths were willing to offer training; these numbers were significantly higher for urban-based agencies. Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests. Training, policy, organizing, and research implications are considered.

Training, geography, and provision of aging services to lesbian, gay, bisexual, and transgender older adults.

The lesbian and gay population is largely invisible in the gerontological literature and in planning and provision of aging services. A recent survey of providers of aging services in a large midwestern metropolitan area provides insight into providers’ beliefs, preparation, and experience with serving old lesbian and gay people. Few agencies that participated in the study provided services targeted to this population, and some agencies were unwilling to consider their unique needs. Participating agencies generally recognized a need for greater knowledge and specific training in working with aging lesbian and gay people. Providers diverged over whether separate services should be established for the old lesbian and gay population. Providers consistently expressed values of care, inclusiveness, sensitivity, respect, and provision of service to everyone. The study results provide direction for future training and research with providers of aging services.

Are Old Lesbian and Gay People Well Served? Understanding the Perceptions, Preparation, and Experiences of Aging Services Providers

Many providers recognize the importance of creating culturally competent services for lesbian, gay, bisexual, and transgender (LGBT) older adults. Although multiple resources list steps to make professional practices more LGBT-welcoming, these resources provide no empirical data to support their recommendations. LGBT older adults (N = 327) were asked to describe what signals that a provider is LGBT-welcoming. Six of the top 10 signals related to provider behavior and suggest the importance of staff training; the balance included display of signage and rainbow flags, use of inclusive language on forms and the presence of LGBT-identified staff. Results provide evidence-based recommendations for working with LGBT older adults.

Working With LGBT Baby Boomers and Older Adults: Factors That Signal a Welcoming Service Environment

As the population ages and LGBT older adults become more visible among senior service providers, the need for cultural competency training will grow. Although this training is a relatively new phenomenon, curricula exist. These are generally in person for 2- to 8-hr durations. Training to Serve embarked on a study to investigate preferences in cultural competency format and duration. One-hundred and eighty-four Minnesota service providers participated in the online survey. The majority (90%) were interested in participating in LGBT cultural competency training. Results suggest a preference for shorter duration and online formats. Implications for curricula development and future research are included.

Catherine F. Croghan

Papers

Friends, family, and caregiving among midlife and older lesbian, gay, bisexual, and transgender adults.

Training, geography, and provision of aging services to lesbian, gay, bisexual, and transgender older adults.

Are Old Lesbian and Gay People Well Served? Understanding the Perceptions, Preparation, and Experiences of Aging Services Providers

Working With LGBT Baby Boomers and Older Adults: Factors That Signal a Welcoming Service Environment

Working With LGBT Older Adults: An Assessment of Employee Training Practices, Needs, and Preferences of Senior Service Organizations in Minnesota