2015 Health Related Behaviors Survey

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).^[1] 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.^[2]

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 and Transgender Identity

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.

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.

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^[5]) 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 Health

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

• equally likely to have a routine medical checkup in the past year
• less likely to be overweight or obese
• more likely to report binge drinking but equally likely to report heavy drinking in the past month
• more likely to be current cigarette smokers
• more likely to report symptoms of moderate or severe depression but less likely to report symptoms of mild depression
• more likely to report non-suicidal self-injury, suicide ideation, and a suicide attempt
• more likely to have ever experienced physical abuse or unwanted sexual contact
• more likely to have had unprotected sex with a new partner in the past year, as well as to have had more than one sex partner in the past year
• more likely to have had a sexually transmitted infection in the past year
• more likely to have not used contraception during the most-recent vaginal sex (in the past year).

Conclusions and Policy Implications

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.

Notes

• [1] As this brief was in the final stages of production, findings from the 2016 Workplace and Gender Relations Survey of Active Duty Members were released, indicating that 12 percent of female service members and 3 percent of male service members identify as LGBT.
• [2] On July 26, 2017, as this brief was in the final stages of production, President Donald Trump announced intentions to prohibit transgender individuals from serving in the military.
• [3] When calculating response rates, we excluded service members whom we were unable to contact because of incorrect email or mailing addresses. The number we were unable to contact was 6,770, or 3.4 percent of the sample.
• [4] CIs provide a range in which we expect the true population value to fall. They account for sampling variability when calculating point estimates but do not account for problems with question wording, response bias, or other methodological issues that, if present in the HRBS, might bias point estimates.
• [5] The interpretation of a credible interval differs from that of a CI. In this context, the credible interval indicates that there is a 95-percent probability that the true percentage of service members who are transgender lies between 0.4 and 1.0.

Available for Download

Download PDF

Topics

• Health Risk Behaviors
• Health-Related Quality of Life
• LGBTQ+ Populations
• Military Personnel
• United States Air Force
• United States Army
• United States Coast Guard
• United States Marine Corps
• United States Navy