A report released March 27 by the Boston-based Fenway Institute has found important health-related risks within the LGB community that are not well-documented or well-known and not addressed by prevention and treatment programs.

Many studies have shown that gay men have a higher risk of HIV infection and that LGBT youth are at higher risk of being bullied and considering suicide. But the new policy brief from Fenway found that the LGB community has a higher rate of tobacco use than the general public, that lesbians have an increased risk of being overweight, and that LGB elders have an increased risk of disability.

The Fenway report is based on data collected by the U.S. Centers for Disease Control and Prevention through an annual Behavioral Risk Factor Surveillance Surveys (BRFSS) in all 50 states, reaching 506,000 people. CDC provides the core questionnaire for each state to administer, asking questions about such health-related matters as diet, physical activity, smoking, immunization, and sleep.

CDC does not include a question about a survey participant’s sexual orientation on the core questionnaire or on a list of additional optional questions states can add if they choose.

Only 27 states have, on their own initiative, begun asking questions about sexual orientation and/or same-sex sexual behavior, according to the Fenway report.

Because sexual orientation data is not collected in all 50 states, says the Fenway report, “it is impossible to compare their health behaviors to those of other groups.”

“Without this information, states may miss the opportunity to develop programs, policies, and services to address local health disparities.”

The Fenway report urges all states “to include, at a minimum, a sexual identity measure, and, whenever possible, to also include a sexual behavior measure.” Due to the “nuances and complexity of measuring gender identity, and the unique and understudied health disparities transgender people face,” said the Fenway report, “a comprehensive assessment of these issues” requires another report.

Some of the specific findings of Fenway’s analysis of the data collected by the 27 states that do ask questions about sexual identity and/or same-sex sexual behavior include:

Lesbians and bisexual women are less likely than heterosexual women to obtain mammograms and Pap tests
Gay men have higher rates of alcohol and drug use
LGB people have higher rates of tobacco use and are more likely to lack health insurance
LGB older adults have increased risk of disability, excessive drinking, and smoking
18 percent of doctors in California are “sometimes” or “often” uncomfortable treating gay patients
9.4 percent of men who identified themselves as “straight” in New York City had sex with another man during the past year.
76 percent of self-identified lesbian sexually active adolescents reported having had sex with a male

Of the 27 states which have asked people about their sexual orientation, some have asked the question in only one year; some every year. The 27 states include: Alaska, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Maine, Massachusetts, Michigan, Montana, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Vermont, Washington, and Wisconsin.

The report urges all 50 states to begin asking about sexual orientation.

“Collecting sexual orientation data at the state level,” says the report, “can propel the federal initiative forward and enhance states’ ability to document and work toward eliminating health disparities experienced by their own populations.”