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 increased...in 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...


  1. The other thought I have that perhaps different from your thesis, this was dealing with adults whose feelings of self are perhaps more "set" already than with your "subjects."

  2. Yeah, I think that probably plays a big role. Another thought that occurred to me is that attitudes towards homosexuality in Sweden may not really have changed that much - whereas similar gender marriage here has been a very contentious issue, perhaps in Sweden it was more like "Oh, sure, we can do that." when the subject came up, rather than a huge struggle. I don't know much about attitudes towards homosexuality in Sweden, so that's pure speculation...