Monday, January 26, 2009

Excellent health in the Current Population Survey (March Supplement)

Another data source that has data on general health is the "Current Population Survey", which is the dataset the US Gov't uses to estimate the unemployment rate, among other things. They interview about 47,000 to 57,000 households every month from all over the country.
Mostly they ask about who in the household is employed, unemployed, looking for work, etc. But every March, they ask a lot more questions, mostly about income & benefits, including health insurance.
Near the very end of the survey, they ask about the general health of everyone in the household, and that's what I'm interested in. The datasets are pretty huge relative to the capacity of my computer, so I've only been able to look at one year, 1998, so far.
In 1998, out of 64,659 households, I could identify 25,821 couple-headed households with non-imputed data on health. 23,124 of these were mixed-sex married, 1,366 were mixed-sex unmarried, and 24 were same-sex unmarried.
Admittedly, 24 couples out of 64,659 households is a pretty disappointing yield, but I'm told that as the years go on, more and more same-sex couples get accurately recorded, so I'm looking forward to more data from the other 10 years. But, on the plus side, 24 couples have 48 men in them, so that makes the sample size a bit more robust.
As you can see from the chart, there's really not much difference between the proportion of men in male couples who report excellent health (33%, 20%-46%), and the proportion of men in mixed-sex unmarried couples (33.6%, 31.1%-36.1%), or the proportion of men in mixed-sex marriages who do (31.0%, 30.4%-31.6%).
So, the fact that these results don't support the findings I'm seeing from California is mildly disappointing, but it's also clear that gay men (at least the ones in live-in relationships) aren't in dramatically worse health, which is what you'd expect to find given how we have been portrayed in the medical literature thus far.

I'm especially excited about the prospects for this dataset for a few reasons. First, it uses the same methodology (with minor twists) over an 11 year time span, so there is a lot of data to work with, even if the gay men in relationships are probably not representative of all gay men (but neither are married men representative of all straight men, for that matter), and since it spans an 11-year period, it might be possible to look at trends in 'excellent' health over time.
Second, they try to interview about half the same households the following year, so it would be possible to look at changes in health status over time (though this would only be true for one year's change for any individual), and also health in relationships that last vs. those that dissolve.
Finally, and best of all, is that the survey covers the whole geography of the United States, so I can look at health in relation to homophobia levels much more in-depth than is possible within the state of California. Perhaps the health of gay men is better in California and New York City than straight men, and worse than straight men in Wyoming and Nebraska, that might help explain why many of the national studies don't show much difference...
What do y'all think?

Thursday, January 22, 2009

401 in the House

What an exciting week! Filled with visitors from Rhode Island...

Martin has been visiting for a few days, we walked all over town with his friends Sam and Byron, and did a bunch of touristy things on a gorgeous Sunday after dim sum. Then on Tuesday we played badminton at the Y, and last night had a gym date & dinner in the Castro.

Sam from the public health Dep't at Brown came out for a postdoc interview at UCB/UCSF yesterday and we had a grand time catching up. She's doing really interesting work looking at the effect of court-mandated desegregation orders on teen pregnancy rates. I can't wait to read it.

And tonight, I'm going to see Beach Blanket Bablyon with woolverine and ellison. We've got one extra ticket, so if you know me & want to go, don't be bashful. It will only go to waste otherwise...

Monday, January 19, 2009

More Results on Gay Men in Excellent Health

So, I've looked at two more datasets in examining this phenomenon which started with noting that gay men were more likely to be in excellent health than straight men in the California Health Interview Study (CHIS).
Many thanks to Randy Sell at Drexel who has collated information on a large number of national and state-level studies that ask people about their sexual orientation and/or sexual partners at

In the General Social Survey (GSS), a large telephone survey that has been on-going since 1972, they asked about the sex of respondent's sexual partners in the last year, the last 5 years, and since age 18, in various combinations since 1988. (I used this same dataset to look at the phenomenon of gay men giving blood, which can also be considered as an indicator of well-being).

In the GSS, 33% of men who had sex exclusively with other men over the prior five years (26%-40%) were in excellent health, virtually identical to the 33% (31%-34%) of men who had sex exclusively with women over the prior five years.
Looking at sexual partners just in the last year, 35% of men who had sex only with men in the previous year (29%-42%) were in excellent health, about the same as 34% (33%-35%) as men who had sex only with women in the previous year.

In the National Household Survey on Drug Abuse (NHSDU), on on-going telephone survey used to understand drug use in the US, they asked about sexual partners in one year, 1996. For reasons I don't understand, they never asked before or since. If they had, this survey could have been one of the best sources of information on LGB population health.

52% of the 58 men who reported sex only with males were in excellent health (39%-65%), which is much higher than the 36% of the 3,196 men who reported sex only with women (35%-38%).

The proportion of men who had sex with men who reported excellent health in this survey was a lot higher than in other surveys, too, so I'd be a little cautious in putting much faith in these particular results.

Saturday, January 17, 2009

Tuna, the turd burglar

There's just no polite way to say this.
My dog is an aficionado of human waste. Especially when it is redolent with the flavors of a hard night out drinking.

Oh, it's not just Tuna. All dogs are turd burglars. Keep that in mind when you're thinking about that cute puppy in the window. It'll be a cute puppy for another 2-3 months, and then you've got a full lifetime of turd burgling ahead of you. It's worth it, but just walk into it with your eyes open.

We take our morning walk in Buena Vista Park at about 8:30-9, and given how many other dogs have been running around sniffing it out, I'm amazed that any of it is left for us on the late end of the morning shift.

But every once in a while she'll come strutting out of the bushes, a little swagger in her step, and of course the shit-eating grin, smacking her lips. So, when we get home, I hose out her mouth and feed her a breath-freshener.

One of Harvey Milk's great accomplishments was a pooper-scooper law, memorialized in the recent movie Milk. I'm wondering what we can do about the human waste problem in the city now... Of course, the vast majority of our un-housed citizens figure out a way to take care of these needs hygienically (if you can call the bathroom at Carl's Jr. on UN Plaza hygienic), but I'm thinking maybe we should be handing out sturdy large-size plastic bags alongside the blankets and food.

Friday, January 16, 2009

New York City MSM more likely to be in excellent health

More evidence that gay men are more likely to be in excellent health than straight men...
The New York City Department of Health and Mental Hygiene kindly makes data from its BRFSS available online.
Since 2002, they have been asking men their sexual orientation and also whether they have sex with men. Although the sexual orientation data is in there, it is not accessible on the website broken down by gender. But the sex with men variable is, so I used that as the closest approximation until I can get my hands dirty with the SAS programming.

The upshot is that in 5 out of 6 years, men who have sex with men were more likely to be in excellent health, after age-adjusting, than their (mostly) heterosexual counterparts.

When averaging the six years together, 27.5% (24.4%-30.6%) of New York City's MSM population were in excellent health, compared to 21.5% (20.7%-22.3%) of mostly heterosexual men in New York City.

That's very similar to the results from CHIS. After combining data from 2003,2005 & 2007, the proportion of California gay men in excellent health is 26.6% (23.1%-30.2%), compared to 22.1% (21.5%-22.6%) of straight men in California. These results are not age-adjusted like the NYC results, but I don't think that would make much difference.

Anyone want to speculate as to why gay men (at least in California and New York City, if not Canada) are more likely to be in excellent health than straight men? What lessons can straight men learn from us to be healthier?

Canadian Gay Men Only Slightly Healthier than Straight Men

Came across a neat study done by Statistics Canada. They interviewed about 260,000 Canadians for the study in 2003 & 2005 (Canadian Community Health Survey, CCHS). They found that gay men were slightly more likely to be in "very good or excellent" physical health (65.4%) than heterosexual men (63.9%, difference not statistically significant) but slightly less likely to be in "very good or excellent" mental health (73.8% vs. 75.4%, also not statistically significant).

I used the population from the California Health Interview Survey (CHIS) that most closely matches the Canadian study for comparison, adults aged 18-59 interviewed in 2003 & 2005, and lumped "excellent" and "very good" the same way they did. In California, 61.2% of gay-identified men reported "very good or excellent" general health, versus 54.3% of heterosexual men, a much larger difference.

The first thing that jumps out at me is that Canadian men seem to be a much healthier lot no matter what their sexual orientation is.

But it does leave me scratching my head - why are gay men more likely to be in excellent health than straight men in California - but not necessarily so in Canada, which has had a much friendlier political climate? Hmmmm...

Tuesday, January 13, 2009

Research Worth Reading (2)

Well, the first installment of Research Worth Reading was such a hit I'll try my hand at another.

This article is interesting to me because it attempts to measure the impact of a changing society on gay men's health, which is similar to what my dissertation thesis work was about, too. My interest is mainly in their approach and rationale. Unfortunately, their results didn't pan out the way I would have hoped, but it's important to take negative results humbly into consideration as well.

I came across this article while doing some background reading on excellent health, in my quest to understand why gay men (at least in California) are more likely than str8 men to be in excellent health.

Health-related quality of life in homo- and bisexual men attending a sexually transmitted disease clinic in Sweden.
Lars E. Eriksson & T. Berglund (2007)
International Journal of STD & AIDS 18:207-211.

In 1996, these guys asked 164 men who came to the Karolinska University Gay Men's Health Clinic (basically an STD clinic, from what I can tell) a ton of questions about their well-being and quality of life, and then they did the same thing again in 2004 with 201 different gay/bi men.
They reasoned that since major shifts in Swedish law had occurred between these dates (gay rights protections and recognition of similar gender marriage), the quality of life of gay men would have improved as a result.
So, they compared the average health/well-being/quality of life of the gay/bi men they interviewed in 1996 with the gay/bi men interviewed in 2004. All-in-all, there was not any big improvement, counter to their expectation.
For example, they measured 'general health perception' on a scale from 0-100, and half the men in 1996 gave responses between 72 and 94, while in 2004, half the men gave responses between 67 and 94, so there's really not much difference in these distributions.

Why not?
The authors puzzled over why they didn't see improvements in gay men's health in Sweden: "Firstly, it might require a longer time frame for the positive changes in legislation and attitudes to have positive influences on the individual experience of health-related quality of life. Secondly, other factors could counteract the legal and attitudinal changes... {such as} hate crimes related to homophobia, a phenomenon that has increased in Sweden during the last few years. Another reason could be the increased vulnerability due to health aspects. For example, since the 1990s, the STD incidence among MSM has Sweden."

Of these, I find the first the most compelling. Although in my own study, there doesn't seem to be much, if any, lag time between the societal attitudinal changes resulting in passing a gay rights law and reductions in white male teen suicide rates. On the other hand, the men they studied were mostly adults, whose general well-being may be more influenced by conditions during their own adolesence than the rapid changes that occurred in Sweden in the late 1990's. If that's the case, they might well see effects if they compared young gay men who "came of age" since 2000 to young gay men who came of age in years past.
The second argument (that some countervailing force undid whatever benefits came about from changes in societal attitudes around homosexuality) rings hollow to me. I base this on the fact that, in the US anyway, one finds the highest hate crime rates in areas that are most tolerant of homosexuality. At first, this doesn't make sense, but when you stop to think about it, crimes are only counted if they are reported, and once reported if they are taken seriously and recorded. So, it is not surprising that hate crime reporting is higher in more tolerant areas, even if hate crime rates may not be.
The third argument (that rising STD rates are responsible for gay/bi men in Sweden not feeling their best) also rings hollow to me. It might affect the gay men who do get STDs, but that's a minority, and the overall distributions of health are pretty much the same in both years, it's not like some men are feeling less healthy and others are feeling healthier, resulting in the same average.
One explanation that they seem not to have considered is that the gay/bi men that they interviewed in both years were generally very healthy on all subscales, so that there just wasn't a lot of (statistical) room for improvement. For example, over half the gay/bi men in 1996 reported no pain at all, and thus scored 100/100 on that scale. So, it would be virtually impossible to show any improvement in that measure. And that was the case for 6 of the 13 subscales they assessed.

At any rate, the thing that excited me about this paper was that it is another example of trying to understand the impact of shifts in public discourse on health, and it was also looking at health as a positive attribute, not the absence of illness. It's too bad that their results didn't pan out...

Friday, January 9, 2009

Gay Men in Excellent Health - More from CHIS

So, I decided to look at this phenomenon of gay men being more likely to report being in excellent health than straight men from a slightly different angle - namely does it make a difference where one lives.
In particular, does the social environment of heteronormativity play a role in gay men being more likely to report being in excellent health?

The recent vote in California on whether to restrict the legal definition of marriage to "one man and one woman" (OMOW) seems like a pretty good way to define an area's heteronormativity, the more people who endorsed proposition 8, the higher the level of heteronormativity. Got this data from the California Secretary of State's Statement of the Vote.

So, using AskCHIS, I got estimates for the proportion of gay men and straight men reporting themselves to be in excellent health for 11 regions of the state: the counties of Los Angeles, San Francisco, and Riverside, and then 8 groups of counties (East Bay, South Bay, North Bay, Sacramento area, North & Sierras, Central Coast, Orange & San Bernardino, San Diego & Imperial, and the San Joaquin (Central) Valley). I had to use groups of counties in order to get enough sample size to estimate the proportion of men reporting excellent health within each region.

The proportion of gay men reporting excellent health was highest in San Francisco county, 34%, but this needs to be taken with a pretty big grain of salt, because the CHIS survey data would be compatible with a range from 25% to 42%. The lowest proportion of gay men in excellent health was in Riverside county, 13%, with a range compatible with the survey from 5% to 21%.
These two seem to line up with my hypothesis pretty well, in that only 25% of San Francisco voters endorsed a OMOW definition of marriage, while 65% of Riverside county voters did.
But, voters in the San Joaquin Valley (San Joaquin county down to Kern) endorsed OMOW by 70%, and yet had the 2nd highest proportion of gay men reporting excellent health: 32%, range 12% to 51%. So, it's not like there's a one-to-one correspondence.

Among straight men, the highest proportion reporting excellent health was also in San Francisco, 26% (23%-30%), and the lowest was in the San Joaquin Valley, 19% (17%-21%). In general, there was a much tighter correlation between the proporotion of str8 men reporting excellent health and how voters endorsed the OMOW restriction of Prop8. The tight correlation has mostly to do with the fact that there are more str8 men, and therefore better estimates of how healthy they are.

Of course there are many other potential explanations for why gay men (and str8 men) seem to be healthier in areas that are less homophobic (as measured by endorsing Prop8) in the CHIS data. For instance, it could be that older people are more likely to live in the more homophobic areas, and since old people are less likely to report being in excellent health, that's why you see fewer gay and str8 men reporting excellent health in the more homophobic areas.
Also, the mode of analysis I used is very preliminary - not only no control for potential confounders, but also the estimates of how likely men are to report being in excellent health is based on some pretty small numbers. But, it's enough to get the brain juices flowing, and perhaps to help me convince CHIS to give me access to individual-level data files...

Thursday, January 8, 2009

Disarm BART Police

The murder of Oscar Grant on January 1st by BART police officers Johannes Mehserle and an as yet unidentified accomplice who held him face down with a knee to the neck has got me (and a lot of people) hopping mad.
There is no need for transit police officers to have lethal force at their disposal.
I love BART. It's a great asset to my lifestyle, being able to commute conveniently with a minimum of pollution. But it makes me fear for my safety knowing that these officers are armed. This morning, I saw a BART officer at the top of the stairs at the Downtown Berkeley station and I waited until he left before leaving the station. I didn't want to be anywhere near him.

Friday, January 2, 2009

Research Worth Reading

About a month ago, I was engaged in an on-line discussion about what constitutes 'lousy' research. In my opinion, the majority of health research related to gay men qualifies as 'lousy'. But, I thought it would be a good idea to focus on research worth reading, holding up examples of research that is well conceived and thought-provoking.

So, I went on to and rooted through the most recent stuff pertaining to 'gay' and 'health'. I went through literally hundreds of titles and dozens of abstracts before finding the first article that I actually wanted to read.

So, here's the first installment of 'research worth reading'.

A Phenomenological Investigation of the Experience of Taking Part in 'Extreme Sports'
Carla Willig, City University, London, UK
Journal of Health Psychology 13(5):690-702
DOI: 10.1177/1359105307082459
Abstract: "This article is concerned with what it may mean to individuals to engage in practices that are physically challenging and risky. The article questions the assumptions that psychological health is commensurate with maintaining physical safety, and that risking one's health and physical safety is necessarily a sign of psychopathology. The research was based upon semi-structured interviews with eight extreme sport practitioners. The interviews were analysed using Colaizzi's version of the phenomenological method. The article explicates the themes identified in the analysis, and discusses their implications for health psychology theory and practice."

The thing that grabbed my attention about this article is that it is trying to understand 'risk' from an inherently non-pathological perspective. Basically, the author interviewed eight people who frequently engage in extreme sports (sky diving, mountaineering, etc.) about why they do it and what they get out of it.
I thought that was a brilliant strategy to get past some of the problems presented by risk-oriented thinking in various health fields, and she definitely puts it in that same context.

She encourages the reader to imagine a parallel non-pathologizing approach to understanding health-related risk taking, from smoking and diet, to speeding and unprotected sex. And so I was reading along thinking about what parallels there were to what she reported hearing in those interviews with gay men and sex. Some of it seems to fit perfectly, and some seems incongruous. The point, for me anyway, is not to portray gay sex as entirely analogous to extreme sports, but rather to begin to re-conceptualize the reasons gay men have sex they way they do that isn't about 'making bad choices' on one hand, or being completely overwhelmed by structural forces (the internalization of homophobia, racism, etc.) on the other. Of course, this re-conceptualization happens all the time, but it seems to have a hard time sinking in to public health types.

A choice quote framing her motivation for conducting the study:
"... behavioural choices that do not prioritize health and safety constitute a challenge to psychologists, and one way of meeting this challenge has been to re-conceptualize such choices as the product of psychopathology or false beliefs, and thus not really choices at all. ... An alternative viewpoint would be that there is more than one rationality and that ... it is possible, and worthwhile, to attempt to bring to light their meaning and value to those who engage in them."

Parallels with the experiences of, and motivation to participate in, extreme sports
Just imagine the parallels while reading these quotes about extreme sports participation.

"...among those who practise a particular extreme sport there may exist a strong bond and strong feelings of comraderie generated by being together during moments of great vulnerability."

"The experience offers its participants access to combinations of feelings and sensations which are not available in everyday life."

"In some cases, a sense of loss of control and letting other people take responsibility for one's safety forms an important part of the experience as a whole."

"...taking part in these activities constitutes an extremely important part of one's life and that one's sense of self, identity and well-being is clearly bound up with them. ... life without it was inconceivable."

"Gaining experience and getting better at performing the sport generated a sense of mastery, and this was experienced as rewarding."

"... one's world is reduced to the immediate present. Participants described life becoming very 'simple' and 'straightforward' ... Participants experienced this sense of being in the present as calming and relaxing, comparable to a 'meditative state'. It allowed them to lose themselves in the present and to be momentarily freed from the concerns and responsibilities associated with everyday life."

"...taking part in extreme sports on a regular basis was experienced as therapeutic, reducing stress levels and preventing the build up of tension by minimizing the significance of past and future concerns."

"the experience of extreme sport provided something vital for participants which they could not access in other ways."

"There was a sense of pleasure through feeling alive, energized and vital ... sometimes lasting for days afterwards. They were felt throughout the body and they seemed to lie outside the normal range of emotions experienced by participants in their everyday life."

"...what may appear, from an outsider point-of-view, as reckless ... participants' own accounts suggest that what is required is a carefully staged scenario which produces just the right balance between challenge and comfort in order to allow a certain kind of {transcendent} experience to become possible."

"...the acquisition of the necessary skills and experience takes place over time, ... and may involve status and identity formation within the context of a community of likeminded and supportive peers."

"...taking part in extreme sports activities means more to participants than searching for thrills and excitement, ... they are making informed choices rather than simply acting out unresolved conflicts or implementing distorted cognitions."

"These observations raise questions about the extent to which taking part in extreme sports may itself constitute a therapeutic experience."

"From this perspective, the adoption of what may appear to be extreme, excessive or maladaptive practices or preferences may, in fact, be ways of (re-)establishing psychological balance by adding missing meaning elements and by allowing neglected or marginalized dimensions of existence to be lived."