Jun 21, 2018
The Health Related Behaviors Survey (HRBS) is the U.S. Department of Defense (DoD)'s flagship survey for understanding the health, health-related behaviors, and well-being of service members. Fielded periodically for more than 30 years, the HRBS includes content areas — such as substance use, mental and physical health, sexual behavior, and postdeployment problems — that may affect force readiness or the ability to meet the demands of military life. The Defense Health Agency asked the RAND Corporation to revise and field the 2015 HRBS.
In this brief, we review results describing sexual orientation, transgender identity, and how they are related to health. The 2015 HRBS provides the first direct estimate of the percentage of service personnel who identify as lesbian, gay, bisexual, or transgender (LGBT). It is also, to our knowledge, the first to examine the health-related behavior or health status of LGBT service members, a fact made even more important by the 2010 DoD policy changes allowing for open LGBT service in the military.
Research on the general U.S. population suggests that the health issues and needs of LGBT individuals may differ somewhat from the needs of others. Smoking, alcohol, and other drug use are greater in this group than in the rest of the population, as are some mental health problems and sexual and reproductive health issues. LGBT individuals may experience overweight and obesity more often than others and may access routine health care less often. Such disparities could affect readiness among LGBT service members.
Sexual orientation can be measured as (1) relative attraction to same-sex individuals, (2) sexual activity with same-sex individuals, and (3) sexual identity (i.e., lesbian, gay, or bisexual [LGB]). The 2015 HRBS assessed sexual orientation in all of these ways. The survey also assessed transgender identity, or when a person experiences a different gender identity from their sex at birth. Table 1 summarizes overall estimates of sexual orientation and transgender identity for men and women in the HRBS.
Overall, as Table 1 shows, 5.8 percent (CI: 5.0–6.6) of HRBS respondents identified as LGB. This estimate falls between estimates for U.S. adults aged 18–64 years and for U.S. high school students, which is not surprising given the age profile of the military.
|Only attracted to men||1.7% (1.1–2.3)||68.2% (66.2–70.2)|
|Mostly attracted to men||0.5% (0.2–0.8)||16.1% (14.6–17.7)|
|Equally attracted to men and women||1.2% (0.7–1.8)||5.2% (4.2–6.3)|
|Mostly attracted to women||4.3% (3.4–5.1)||3.2% (2.4–4.0)|
|Only attracted to women||90.1% (88.8–91.4)||4.4% (3.5–5.3)|
|Not attracted to either men or women||0.7% (0.3–1.0)||1.3% (0.7–1.9)|
|Not sure||1.5% (0.9–2.1)||1.7% (1.1–2.3)|
|Sex with one or more same-sex partners in the past 12 months||3.3% (2.6–4.1)||9.4% (8.1–10.6)|
|Gay or lesbian||1.9% (1.3–2.5)||7.0% (5.8–8.1)|
|Bisexual||2.0% (1.4–2.6)||9.1% (7.8–10.4)|
|Total LGBb||5.8% (5.0–6.6)|
|Transgender||0.5% (0.2–0.8)||1.2% (0.6–1.7)|
|Total transgenderc||0.6% (0.3–0.9)|
|Total LGBT identityd||6.1% (5.3–6.9)|
NOTE: All data are weighted. 95-percent CIs are presented in parentheses. Percentages are reported for the sample overall, not among only LGBT respondents.
a As with all 2015 HRBS data, service members are categorized by gender as self-reported in the survey.
b If all respondents who declined to answer this item (0.3 percent) were LGB, the overall percentage would be 6.0 percent.
c If all respondents who declined to answer this item (0.4 percent) were transgender, the overall percentage would be 1.0 percent. If weights were calculated based on reported gender instead of the gender in Defense Manpower Data Center records, the overall percentage would be 1.1 percent.
d The total LGBT percentage does not equal a simple sum of the LGB and the transgender percentages because of overlap in the two groups (n = 40) and some differences in item-level nonresponse across the two items.
Figure 1 summarizes the percentages of gay and bisexual men and lesbian and bisexual women, by service branch. A significantly larger percentage of Navy men identified as gay than did men in any other service branch, and there were no statistically significant differences by service in the percentage of men identifying as bisexual. The percentage of women who identified as lesbian was significantly lower in the Air Force than in all other services except the Navy, and the percentage of women who were bisexual was significantly higher in the Marine Corps than in all other services.
|Percentage Reporting Use|
|Air Force||5.3% (4.3–6.3)|
|Marine Corps||4.4% (3.0–5.8)|
|Coast Guard||5.2% (4.4–6.0)|
NOTE: All data are weighted. 95-percent CIs are presented in parentheses.
Among HRBS respondents, 0.6 percent (CI: 0.3–0.9) identified as transgender. The most-recent estimate in the U.S. adult population also found that 0.6 percent (credible interval: 0.4–1.0) identified as transgender.
Altogether, 6.1 percent (CI: 5.3–6.9) of service members identified as LGBT. As Table 2 shows, LGBT identity was higher among personnel in the Navy than in other services and among junior enlisted personnel than other pay grades. Almost four times as many service members who reported being female identified as LGBT than those who reported being male.
LGBT respondents were more likely to report several adverse health behaviors and some worse health outcomes than non-LGBT service members. We compared the two groups on a wide variety of measures where prior studies of the general population have previously shown adverse behaviors or outcomes for LGBT individuals overall or the subgroups this category encompasses (Table 3). Compared with other personnel, LGBT service members were
|Routine medical checkup in the past year||81.7%||81.4%|
|Overweight or obese||54.2%||67.0%|
|Binge drinking in the past month||37.6%||29.3%|
|Heavy drinking in the past month||5.6%||5.2%|
|Current cigarette smoker||24.8%||16.0%|
|Minimal or mild depression||73.1%||82.8%|
|Lifetime non-suicidal self-injury||26.5%||10.3%|
|Lifetime suicide ideation||32.7%||17.1%|
|Suicide ideation in the past year||15.3%||5.8%|
|Lifetime suicide attempt||13.0%||4.6%|
|Suicide attempt in the past year||4.8%||1.2%|
|Lifetime unwanted sexual contact||39.9%||15.4%|
|Lifetime physical abuse||21.4%||12.4%|
|Sex with a new partner without a condom in past 12 months||42.4%||35.6%|
|More than one sex partner in the past year||40.2%||17.7%|
|Sexually transmitted infection in the past year||7.4%||1.4%|
|HIV test in the past year||75.7%||73.2%|
|No birth control during the most-recent vaginal sex (within the past year)||31.5%||21.6%|
|Unintended pregnancy in the past year||1.6%||2.5%|
NOTE: All data are weighted.
While LGBT personnel obtained routine medical care in percentages similar to non-LGBT personnel, they reported more smoking, binge drinking, risky sexual behavior, and adverse sexual health outcomes. The percentages of LGBT personnel experiencing mental health issues and those with a history of physical abuse and sexual assault were particularly high. These observed differences were similar to those observed for LGBT people in the general U.S. population.
Although these individuals are a small portion of the force, these disparities warrant close attention and tracking by DoD and the Coast Guard so that the specific needs of this subgroup can be addressed. This is particularly important for the Navy, which has the highest percentage of gay men serving and of LGBT service members overall, and in the Marine Corps, which has the highest percentage of bisexual women serving. Policies that enhance, for example, efforts to prevent substance use and sexual risk behaviors may address LGBT health disparities. Although one option is to target the LGBT population with clinical and population efforts, such an approach may stigmatize LGBT service members. Therefore, it may be best to apply these efforts equally across the military, which could lead to broader population benefits.