Are You in, or Are You Out? Implications of Inclusion Criteria in Sexual Minority Health Disparities Research

Those who identify as lesbian, gay, or bisexual are found to be at a heightened risk for problematic health outcomes, including substance use. Sexual minority identities are concealable, multidimensional, exist on a continuum, and develop fluidly. Together, these factors are important predictors of health outcomes, yet they have been neglected in the process of sample identification in health disparity research. Inclusion criteria employed when identifying samples affects research findings and potentially biases results when crucial factors are neglected. Using the National Longitudinal Study of Adolescent to Adult (Add Health), the authors identified four samples of sexual minorities (i.e., broad self-identified, broad multidimensional, narrow self-identified, and narrow multidimensional) based on the continuum of self-identification and multidimensional factors and examined a trajectory of binge drinking predicted by various relevant factors. When the authors defined the samples using different inclusion criteria and examined the results across these samples, differences in the results emerged and fell into four main patterns: (1) sex differences, (2) differences in the average frequency and rate of change in binge drinking, (3) differences in statistical significance, and (4) Implications. Inclusion criteria alone had a significant impact on the health implications for lesbian, gay, and bisexual individuals in this study and thus should encourage cautious interpretation and application of research on sexual minority health by care professionals. The authors discuss research implications for these findings.