Graduate Thesis Or Dissertation


The Relationship Between Sexual Orientation Identity and Specific Health Behaviors Public Deposited

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  • The American Counseling Association's Code of Ethics states that counselors and counselor trainees must be competent providers of multicultural counseling, able to practice effectively with clients whose identities differ from their own. Counseling students and trainees receive very little training around sexual orientation and how to work with clients who identify as members of a sexual minority group (i.e., LGB; lesbian, gay or bisexual). Counselors, counselor educators and pre-service counselors are also asked to seek out current, relevant research to provide a basis for the interventions and treatment offered to clients. Recent literature in public health has identified health disparities among individuals who identify as, or are identified as, sexual minorities. Higher rates of psychiatric disorders, substance use, heart disease, tobacco use, and obesity have been found in LGB samples as compared to heterosexual samples. However, existing articles are limited by: (a) sampling issues, including small sample sizes, (b) an overall lack of racial and ethnic diversity, and (c) the conflation of sexual behavior with identity. Additionally, counselors and counselor educators have not researched these differences in health behaviors and conditions. In the current study, the prevalence of harmful or potentially hazardous alcohol use and drug use among patients who self-identified as gay, lesbian, bisexual and heterosexual was compared in a diverse sample of patients visiting New York City STD clinics. Levels of alcohol and drug use were compared by sexual orientation identity using nonparametric analyses. Results showed that patients who identified as LGB reported higher rates of potentially harmful drug and alcohol use than patients who identified as heterosexual. Next, data collected from patients visiting New York City STD clinics for a physician visit were examined using binary logistic regression analyses. The aim of this study was to determine whether a relationship exists between sexual orientation identity and likelihood of diagnosis with a sexually transmitted infection (STI). In addition, known demographic and behavioral predictor variables were included in this regression analysis as covariates (i.e., race, ethnicity, age, gender identity, alcohol use, drug use, same-sex sexual behavior). Results showed that a relationship does exist between sexual orientation identity and likelihood of STI diagnosis, such that identifying as LGB increases an individual's odds of receiving a STI diagnosis. This predictor variable was found to increase the likelihood of diagnosis along with covariates including Black/African American racial identity, Hispanic ethnicity, same-sex sexual behavior, and drug use. Covariates that decreased the odds of STI diagnosis included female gender identity, transgender identity, and older age. The primary implication that emerged from the aforementioned research was that individuals who identify as sexual minorities (i.e., as LGB) have different relationships to health behaviors than individuals who identify as heterosexual. Therefore, LGB individuals should be given an opportunity to self-identify their sexual orientation upon intake and screened for quantity and frequency of substance use so that counselors can be aware of the individual’s risk of developing a substance use disorder. Individuals should also be asked discrete questions about sexual orientation identity as well as attraction and behavior, so that individuals who identify as LGB can be engaged in open discussion about sexual behaviors and safer sex practices as necessary, and not assumed to be engaging in behavior that places them at risk for STIs. More qualitative research is needed to determine why some LGB individuals engage in hazardous levels of alcohol and drug use while others do not, and to explore the relationship between LGB identity and engagement in sexual risk behaviors.
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