Despite gains in recent years in marriage equality and access to health insurance for lesbian, gay, bisexual, and transgender (LGBT) adults, long-standing health disparities by sexual orientation and gender identity persist. These were exacerbated by transphobic policies at the state and federal levels in recent years (e.g., "bathroom bills" and policies targeting transgender youth in sports and adults in the military). In addition to discriminatory policy, health disparities for LGBT adults are made worse by stigma, bigotry, and hate crimes leading to higher exposure to chronic stress and increased allostatic load. These disparities matter for current health equity, as well as for longer-term planning for future health care needs. Yet, there is limited information on rural/urban differences in health and health care access by sexual orientation and gender identity, despite heightened risk factors for poor health and reduced access to care in rural settings. This project addressed that gap by identifying differences in health and health care access (e.g., usual provider, delayed/forgone care, health insurance status) by sexual orientation and gender identity for rural and urban adults, and by identifying examples of best practices in supporting LGBT health and wellbeing in rural areas.

Publications

• Access to Health Care for Transgender and Gender-Diverse Adults in Urban and Rural Areas in the United States
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 08/2023
  This study examines access to care based on gender identity in urban and rural areas, focusing on transgender and gender diverse (TGD) populations. Data came from the 2019 to 2020 Behavioral Risk Factor Surveillance System. Researchers found greater barriers to care for TGD adults, with the most frequent barriers found among rural TGD adults.
• Anxiety, Depression, and Access to Mental Health Care by Sexual Orientation and Rurality
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 06/2022
  This policy brief addresses the research gap among rural sexual minorities by illuminating differences in mental health for two of the most common mental health disorders (depression and anxiety), as well as differences in access to health care.
• Improving Access to LGBTQIA+-Friendly Care in Rural Areas
  University of Minnesota Rural Health Research Center
  Date: 06/2022
  The purpose of this case series is to highlight organizations doing exemplary work to improve access to and experiences of health care among lesbian, gay, bisexual, transgender, queer/questioning, and asexual/agender (LGBTQIA+) individuals in rural communities across the U.S.
• Indicators of Familial Social Support by Rurality and Gender Identity
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 03/2023
  Social and emotional support from family significantly contributes to positive health outcomes. Understanding how familial social support differs for those with overlapping marginalized identities is critical to advance population health and health equity. This brief examines differences in familial social support by rurality and gender identity.
• Key Informant Perspectives on Supporting Health and Well-Being for LGBTQ+ Rural Residents
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 09/2022
  This policy brief presents findings from interviews with national lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) support and advocacy organizations regarding challenges to physical and mental health and well-being for rural LGBTQ+ individuals, as well as recommendations to meet the needs of LGBTQ+ individuals in rural areas.
• Prevalence of Chronic Conditions by Sexual Orientation and Rural-Urban Location
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 06/2022
  This policy brief examines rates of individual chronic conditions, as well as differences in the number of chronic conditions by sexual orientation and rural-urban location.
• Rural Community Organizations Building Inclusive Environments for LGBTQ+ Residents
  University of Minnesota Rural Health Research Center
  Date: 06/2022
  The purpose of this case series is to highlight rural organizations doing exemplary work to build community among lesbian, gay, bisexual, transgender, and queer/ questioning residents, and create a more inclusive environment in their communities.
• Rural School- and Community-Based Programs Supporting LGBTQ+ Youth
  University of Minnesota Rural Health Research Center
  Date: 02/2023
  The purpose of this case series is to highlight youth-focused and school- and community-based organizations that affirm and support LGBTQ+ individuals in their rural communities. These may serve as examples to others considering this work.
• Self-Rated Health Among Gay, Lesbian, and Bisexual Adults: Rural/Urban Differences
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 07/2022
  Research has documented worse health outcomes and constrained access to care for lesbian, gay, and bisexual adults. Rural residents also experience persistent disparities in health and access to care. This policy brief examines differences in self-rated health by sexual orientation and rural/urban location.
• Small-Town Pride Celebrations Supporting Social Connectedness & Well-Being for LGBTQ+ Rural Residents
  University of Minnesota Rural Health Research Center
  Date: 06/2022
  The purpose of this case series is to highlight organizations in two states doing exemplary work to celebrate and affirm lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals in their rural communities through Pride events. These may serve as examples to others considering this work.
• Social and Emotional Support During the COVID-19 Pandemic by Sexual Orientation and Rurality
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 06/2022
  This brief identifies differences in social and emotional support and changes to that support during the COVID-19 pandemic by rurality and sexual orientation.