Introduction to the Special Section on Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Disparities: Where We Are and Where We're Going

It is our privilege to publish this Special Section of six empirical articles that address several key mechanisms for Lesbian, Gay, Bisexual, and Transgender (LGBT) health disparities. Over the past decade, we have seen attention devoted to gender disparities [1, 2], racial/ethnic disparities [3–11], and SES disparities [12–14]. Far fewer articles address the mental or physical health of LGBT individuals, the mechanisms for disparities, or the factors related to within-group differences among LGBT individuals. This relative lack of attention to LGBT individuals helped to motivate a call for such research from the Institute of Medicine [15]. There are currently about 9 million self-identified LGBT adults in the USA [16] (3.8 % of the US population), and a higher percentage report engaging in same-sex sexual behavior (about 4–6 % of men and 11–12 % of women) [17]. Physical health and mental health are often worse for LGBT individuals than for those of heterosexual sexual orientation [18]. According to the minority stress theory [18–20], which is used as a basis for the majority of papers in this Special Section, these health disparities are hypothesized to stem primarily from societal stigma that devalues minority sexual orientation. Manifestations of such societal stigma are at multiple levels, including the national and state policy level (e.g., laws prohibiting same-sex sexual behavior; anti-LGBT marriage laws; lack of laws protecting LGBT individuals from hiring and housing discrimination), the community level (e.g., anti-LGBT interpretation of religious doctrines in faith-based services), and the interpersonal level (e.g., families ostracizing gay youth and withdrawing support; hate crimes against LGBT individuals). In addition to direct experiences with discrimination (i.e., enacted stigma), societal stigma can lead LGBT individuals to experience internalized stigma, in which they personally accept the societal/cultural stigma, as well as to anticipate experiencing stigma from others in the future [21, 22]. All three types of stigma (enacted, internalized, and anticipated) have been shown to have a chilling effect on mental and physical health, and health behaviors among LGBT as well as other populations [23].