Association for Public Policy Analysis & Management

A large body of research has documented disparities in health and access to care for lesbian, gay, bisexual, and transgender (LGBT) people in the United States, but less research has examined how state policy environments affect health disparities for LGBT people. This study used data on 14,687 sexual minority and 490,071 heterosexual adults from the 2014-2016 Behavioral Risk Factor Surveillance System (BRFSS) to document differences in poor/fair health by state policy environment. Unadjusted state-specific prevalence estimates and multivariable logistic regression models were used to compare poor/fair self-rated health by gender, sexual minority status, and state policy environments. We found wide differences in self-rated health between sexual minorities and heterosexuals in most states. On average, sexual minority men in states with limited protections were more likely to report poor/fair self-rated health compared to their heterosexual counterparts (odds ratio [OR]=1.23; 95% confidence interval [CI]=1.03-1.47). There were no significant differences in poor/fair self-rated health for sexual minority men in states with comprehensive protections for sexual minorities (OR=0.96; 95% CI=0.82-1.13). Meanwhile, sexual minority women living in states with either limited (OR=1.19; 95% CI=1.01-1.40) or comprehensive (OR=1.26; 95% CI=1.08-1.46) legal protections for sexual minorities were more likely to report poor/fair self-rated health. This study adds new evidence on the association between state policy environments and self-rated health for sexual minorities and suggests differences in this relationship by gender. The associations and impacts of state-specific policies affecting LGBT populations may vary by gender, as well as other intersectional identities.