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While much related research has focused on the effects of racism 10, 15, 16 and sexism on health, 16, 17 these same effects have also been observed in the context of discrimination, harassment, and assault against nonrepresentative samples of LGBTQ people. Even the anticipation of or mental preparation for discrimination, whether discrimination actually occurs (ie, felt stigma), has significantly harmful effects on health. 9, 10 This field of research shows that experiences of enacted stigma, discrimination, and/or harassment induce psychological, behavioral, and physiological stress responses in the body and that the impacts of these reactions accumulate over time, 11 leading to a wide range of negative health outcomes and health-related behaviors. Research demonstrates that experiencing discrimination or harassment has significant and negative consequences for both physical and mental health. 3- 5 While such efforts are hindered by the inherent challenge of surveying a small, dispersed, difficult-to-define, and internally diverse population, 6- 8 it is nonetheless critically important to study experiences of discrimination because of the established impact of discrimination on health and well-being. 1- 3 And yet, despite this history and despite research examining beliefs about discrimination generally and the consequences of experiencing discrimination (discussed below), relatively few national efforts have been made to systematically study LGBTQ people's reported personal experiences of discrimination.
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Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in the United States have experienced a long history of discrimination, including criminalization and classifications as mentally ill, attempts to forcibly change LGBTQ people's sexual orientation and/or gender identity, hate crimes and violence, and exclusion from employment, housing, public spaces, and social institutions. Policy and programmatic efforts are needed to reduce these negative experiences and their health impact on sexual and/or gender minority adults, particularly those who experience compounded forms of discrimination. LGBTQ racial/ethnic minorities had statistically significantly higher odds than whites in reporting discrimination based on their LGBTQ identity when applying for jobs, when trying to vote or participate in politics, and interacting with the legal system ConclusionsÄiscrimination is widely experienced by LGBTQ adults across health care and other domains, especially among racial/ethnic minorities. More than one in six LGBTQ adults also reported avoiding health care due to anticipated discrimination (18 percent), including 22 percent of transgender adults, while 16 percent of LGBTQ adults reported discrimination in health care encounters. Principal FindingsÄ®xperiences of interpersonal discrimination were common for LGBTQ adults, including slurs (57 percent), microaggressions (53 percent), sexual harassment (51 percent), violence (51 percent), and harassment regarding bathroom use (34 percent). We used multivariable models to estimate adjusted odds of discrimination between racial/ethnic minority and white LGBTQ respondents. We report these results overall, by race/ethnicity, and among transgender adults only. We calculated the percentages of LGBTQ adults reporting experiences of discrimination in health care and several other domains related to their sexual orientation and, for transgender adults, gender identity. Data Source and Study DesignÄata came from a national, probability-based telephone survey of US adults, including 489 LGBTQ adults (282 non-Hispanic whites and 201 racial/ethnic minorities), conducted January-April 2017. To examine reported experiences of discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly contribute to poor health outcomes.