Reducing LGBTQ+ Physical Activity Disparities Through Improved Measurement and Inclusion of Sexual Orientation in US National Data Sets

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Keegan T. Peterson Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA

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Melissa Bopp Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA

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Adequate participation in physical activity (PA) is effective in reducing negative health outcomes, including cardiovascular disease, stroke, type 2 diabetes, as well as stress, anxiety, and depression. However, 1 in 4 adults meet the PA guidelines, with lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons reporting increased rates of inactivity and higher rates of negative health outcomes. Limited research can be conducted on best methods to promote PA among LGBTQ+ adults as there is a lack of standardized measurements for both sexual orientation status and PA used in US national data set methodologies. A call to action is warranted to highlight the lack of uniform methodologies for collecting both sexual orientation and PA data in national data sets, with an overall goal of promoting inclusion and transparency of sexual orientation as a primary, secondary, and tertiary influence on PA. The current societal disconnect of national data sets collecting sexual orientation does not allow for proper extrapolation within the LGBTQ+ classifications. LGBTQ+ identities each report differing PA and health outcomes, promoting the need for proper sexual orientation measures. Without this inclusion, we will continue to see larger health disparities among LGBTQ+ persons due to outdated measurements in current US national data sets. This commentary provides sexual orientation status on health outcomes linked to physical inactivity, the need to include uniform sexual orientation measures in national data sets, and implications of the inclusion of this measure to conduct PA research as it relates to health outcomes.

Physical activity (PA) participation has been linked to numerous physical and mental health outcomes, including reduced risk of cardiovascular disease, stroke, and type 2 diabetes, as well as reduced reports of stress, anxiety, and depression.1 However, only 1 in 4 adults meet the PA guidelines.1 Research has linked this disparity in activity to limited self-efficacy to engage in PA, a lack of social support that promotes activity, and environmental barriers that limit accessibility and engagement to activity.2 Further, those who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) report increased rates of physical inactivity due to the aforementioned factors for all adults, but also the added LGBTQ+-specific barriers of societal stereotypes3 and fear of discrimination and violence.4 Importantly, LGBTQ+ individuals experience even higher rates of cardiovascular disease,5 obesity, depression, and anxiety,6 which have all been shown to improve with adequate PA. Unfortunately, sparse research has worked to promote activity among LGBTQ+ persons based on these barriers, with limited acknowledgement about the impact sexual orientation has on PA participation.

As more individuals continue to identify as a sexual minority,7 it is imperative for research to continue in this field to understand behavioral or systematic disparities that impact health. Through US government support and funding, multiple assessments are conducted to identify and examine health and nutritional status of children and adults within the nation through surveys and questionnaires, telephone interviews, and census tracking; however, there is no uniform method of measurement for both PA and sexual orientation among all national data sets. Examples of these assessment agencies include the National Health and Nutrition Examination Survey, the Behavioral Risk Factor Surveillance System, and the National Health Interview Survey. Additionally, a gold standard for PA research is to include age, race/ethnicity, and gender as confounding factors in research given the evidence that these factors uniquely impact PA participation. The slow adaptation of measurement methods and inclusion of sexual orientation in PA research has further exacerbated the physical inactivity health disparities faced by LGBTQ+ persons. This call to action is aimed at highlighting potential discrepancies of reporting sexual orientation demographic information in publicly available US national data set summary reports, with the overall goal of promoting inclusion and transparency of sexual orientation as a primary (eg, descriptive characteristics), secondary (eg, moderator), and tertiary (eg, mediator) influence on PA.8

A Need for Improved Methodologies

The societal disconnect that exists in national data collection surveys methods continues to exist where there is often no inclusion of a sexual orientation demographic variable, or there is a crude variable that does not allow for proper extrapolation among self-identified LGBTQ+ participants. LGBTQ+ classifications exist on a spectrum, with each classification experiencing different PA behaviors and health outcomes linked to PA behaviors, requiring a need to gather large data on individuals who identify in each classification (eg, gay, lesbian, bisexual). The biocultural perspective of health research, which proposes that culture and history are inextricably related to biology, assists in describing why the need for improved inclusionary demographic questions is imperative. This understanding highlights the explicit nature of individuals recognizing the pervasiveness and dynamism of biological and cultural phenomena interactions, resulting in a distinct experience for health outcomes. As social identity can be formed based on sexual orientation, the biocultural component of PA research should also be considered when discussing transparency with demographic reporting. This is an area of concern because national findings highlight the inequalities of PA that exist based on geography, age, gender, and sexual orientation,9 but researchers are reluctant to include sexual orientations influence on PA when conducting secondary analyses due to the limited data available. Research continues to highlight the specific PA disparities linked to sexual orientation; however, with limited inclusion of this variable in large, national data sets, research will continue to be slow in discovering specific PA behaviors and health-related outcomes among LGBTQ+ individuals.

Implications and Conclusion

To evoke change at the society level, improvements to national survey methodologies must be altered to include sexual orientation as a required demographic variable. As seen in health care research, patients believe that if their sexual orientation and gender identity were assessed, their provider would gain a better understanding of their situation, leading to improved health outcomes and treatments.10 This is no different for health research, as the inclusion of these measures would be pivotal in providing clinical and social advancement and understanding of LGBTQ+-specific PA behaviors and health-related outcomes associated with reduced levels of PA. Resources are available that provide survey methods for the inclusion of LGBTQ+ individuals, detailing that there is no lack of knowledge on surveying this population, rather there is a neglect to include the proper measure. Without this inclusion, we will continue to see a larger volume of health disparities in this historically minoritized population due to the outdated variables included in the current national data methodologies.

Acknowledgments

The authors would like to thank Jaime Schultz, Ph.D. for her feedback on the manuscript idea and initial draft. Declaration of Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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    Maragh-Bass AC, Torain M, Adler R, et al. Risks, benefits, and importance of collecting sexual orientation and gender identity data in healthcare settings: a multi-method analysis of patient and provider perspectives. LGBT Health. 2017;4(2):141152. doi:10.1089/lgbt.2016.0107

    • Search Google Scholar
    • Export Citation
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  • Expand
  • 1.

    2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. U.S. Department of Health and Human Services; 2018.

    • Search Google Scholar
    • Export Citation
  • 2.

    Borodulin K, Sipilä N, Rahkonen O, et al. Socio-demographic and behavioral variation in barriers to leisure-time physical activity. Scand J Public Health. 2016;44(1):6269. doi:10.1177/1403494815604080

    • Search Google Scholar
    • Export Citation
  • 3.

    Frederick GM, Bub KL, Evans EM. Perceived benefits and barriers to physical activity among LGBTQ+ college students. Transl J Am Coll Sports Med. 2022;7(4):e000216.

    • Search Google Scholar
    • Export Citation
  • 4.

    Denison E, Bevan N, Jeanes R. Reviewing evidence of LGBTQ+ discrimination and exclusion in sport. Sport Manage Rev. 2021;24(3):389409. doi:10.1016/j.smr.2020.09.003

    • Search Google Scholar
    • Export Citation
  • 5.

    Hatzenbuehler ML, Mclaughlin KA, Slopen N. Sexual orientation disparities in cardiovascular biomarkers among young adults. Am J Prev Med. 2013;44(6):612621. doi:10.1016/j.amepre.2013.01.027

    • Search Google Scholar
    • Export Citation
  • 6.

    Williams AJ, Jones C, Arcelus J, Townsend E, Lazaridou A, Michail M. A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide. PLoS One. 2021;16(1):e0245268.

    • Search Google Scholar
    • Export Citation
  • 7.

    Conron JK, Goldberg KS. Adult LGBT Population in the United States [Report]. The Williams Institute; 2020.

  • 8.

    Gorczynski PF, Brittain DR. Call to action: the need for an LGBT-focused physical activity research strategy. Am J Prev Med. 2016;51(4):527530. doi:10.1016/j.amepre.2016.03.022

    • Search Google Scholar
    • Export Citation
  • 9.

    Marcus BH, Williams DM, Dubbert PM, et al. Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation. 2006;114(24):27392752.

    • Search Google Scholar
    • Export Citation
  • 10.

    Maragh-Bass AC, Torain M, Adler R, et al. Risks, benefits, and importance of collecting sexual orientation and gender identity data in healthcare settings: a multi-method analysis of patient and provider perspectives. LGBT Health. 2017;4(2):141152. doi:10.1089/lgbt.2016.0107

    • Search Google Scholar
    • Export Citation
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