Arch Sex Behav DOI 10.1007/s10508-014-0457-1
ORIGINAL PAPER
A Comparative Analysis of a Community and General Sample of Lesbian, Gay, and Bisexual Individuals Lisette Kuyper • Henk Fernee • Saskia Keuzenkamp
Received: 15 January 2014 / Revised: 10 April 2014 / Accepted: 7 September 2014 Springer Science+Business Media New York 2015
Abstract Samples recruited at lesbian, gay, and bisexual (LGB) venues have certain benefits, but a major drawback is that these samples are prone to bias as they only contain LGB participants who visit such venues. Empirical data with regard to the potential differences between LGB community samples and LGB general samples may shed some light on the generalizability of research findings from convenience samples recruited through LGB venues. The current study attempted to contribute to existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and mental health between a convenience sample recruited at LGB venues (‘‘community sample,’’N = 3,403) and an LGB sample recruited from a general research panel in the Netherlands (‘‘panel sample,’’N = 1,000). Various differences were found. In general, community participants were younger, reported a more exclusive same-sex sexualorientation,weremoreopenabouttheirsexual orientation, had lower levels of internalized homonegativity, and encountered more negative social reactions on their LGB status. They also reported higher levels of psychological distress and suicidality. The Nagelkerke R2 of the analyses (which were adjusted for sociodemographic differences) ranged from .08 (suicide plans amongmen)to .27 (sexual attraction among women).However, while the estimates of sociodemographics, sexual orientation, minority stress, and mental well-being differed, the relationships between these constructs were comparable in both samples. Implications and suggestions for future studies are discussed. L. Kuyper (&) H. Fernee Department of Education, Minorities, and Methodology, The Netherlands Institute for Social Research, POB 16164, 2500 BD The Hague, The Netherlands e-mail: [email protected] S. Keuzenkamp Movisie, Utrecht, The Netherlands
Keywords Sexual orientation Gay men Lesbians Bisexuality Homosexuality Minority stress
Introduction Methods for recruiting lesbian, gay, and bisexual (LGB) research participants have come a long way (Harry, 1986; Meyer & Colten, 2008; Meyer & Wilson, 2009). In the early days of LGB research, small samples of LGB individuals were recruited from prisons, psychiatric wards, and couches of clinicians. Recruitment nowadays mainly takes place at LGB community venues such as LGB bars, prides, networks, organizations, community centers, websites, and mailings lists. In addition, a growing number of general population studies include measures on sexual orientation such as editions of the behavioral risk factor surveillance system (BRFSS), the National Survey of Family Growth (NSFG), the Growing Up Today Study (GUTS), and the Longitudinal Survey on Adolescent Health (Add Health). Although studies making use of general population samples are increasingly available, the majority of studies on LGB issues are still carried out by using convenience samples of LGB individuals recruited at LGB venues. Many studies introduce two potential biases in their research design because of this. The most important bias is that this recruitment method results in a sample of LGB individuals who visit offline and online LGB venues. This implies that they are engaged in, or at least affiliated or familiar with, the LGB community. The second bias is introduced when participants are explicitly invited to join a survey on LGB issues. This approach yields a sample of LGB people who are keen to express their opinion on and experiences with LGB issues. These biases result in samples that might not be representative of the larger sexual minority population on variables of interest. The possible problematic sampling techniques often used in LGB research have been acknowledged and discussed
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by many scholars in the field (for examples, see Corliss, Cochran, & Mays, 2009; Meyer & Wilson, 2009; Rothblum, 2007; Sandfort, 1997). Empirical dataonthepossibledifferencesmayshedsomelight on the generalizability of research findings from community samples. Even though these data are scarce, there are some studies that have examined differences between samples recruited at LGB venues and samples recruited at venues not specifically targeting an LGB crowd. Two pioneers investigating these differences were Harry (1986) and Sandfort (1997). Harry (1986) examined differences between samples of gay men recruited at various venues in the San Francisco Bay Area. Based on the venue of recruitment, two groups of gay men were compared: gay men recruited at gay venues (i.e., gay bars and private bars, gay organizations and their mailing lists, gay baths, cruising areas, and through personal contacts) and gay men recruited through advertisements in general newspapers. Harry reported multiple differences between these samples. General advertisement gay men were more likely than venue gay men to have heterosexual friends, to report sex with both men and women, and to be ‘‘loners’’ throughout adolescence. They were also less likely to be in a relationship or part of a homosexual crowd. No significant differences in self-esteem between the two groups of men were found. Some ten years later, Sandfort (1997) compared four groups of Dutch gay men recruited at different venues:‘‘General men’’ (a pooled sample of gay men taken from various studies on safe sex among the general population), ‘‘Magazine men’’ (men who completed the questionnaire in a gay magazine), ‘‘Organization men’’(who received the questionnaire from a national LGB organization),and‘‘Cohort men’’who were recruited for a cohort study on safe sex among men who have sex with men (MSM) in Amsterdam. The samples differed in various aspects. Magazine, Organization, and Cohort men were older than General men. Organization and Magazine men were of higher educational level, while General men were of lower educational level. The latter were also more religious and politically conservative. General men were more often in a relationship compared to Organization and Cohort men, but Magazine men most often reported having a steady partner. In addition, General men less frequently reported having sex with other partners outside their relationship than Magazine, Organization, and Cohort men. More recently, Meyer and Colten (2008) compared two small samples of gay and bisexual (GB) men in Manhattan recruited at an LGB community center (N = 26) or through random digit dialing (RDD) (N = 52). No significant differences in age, education, student status, or employment status were found, but the RDD sample consisted of more non-white GB men. The samples also differed in gay community involvement: participants recruited at the center were more likely to belong to gay organizations, to belong to a greater number of organizations, to read gay newspapers and/or magazines, to have a subscription to these media, and to feel more connected to the gay community.
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The center participants were also more likely to be out, reported lower levels of internalized homophobia, and were less likely to have a regular sex partner. Recent studies using larger samples were conducted among MSM in the United Kingdom by Evans, Wiggins, Mercer, Bolding, and Elford (2007) and Dodds, Mercer, Mercey, Copas, and Johnson (2006). Both studies used a similar research method comparing MSM from the general population study National Survey of Sexual Attitudes and Lifestyle (NATSAL) with an MSM community sample recruited at gay bars, clubs, saunas, and medical clinics or at MSM websites. Dodds et al. reported no significant differences in age and level of education, but NATSAL MSM were more likely to live outside inner London, to be currently unemployed, and to be non-White compared to the LGB offline community sample. Evans et al. reported no significant differences between the NATSAL sample of MSM and the sample recruited at MSM websites with regards to ethnicity, education, employment, and urbanicity. However, they did find that MSM from the online sample were younger, more likely to be students, less likely to live in London, and less likely to report good health. In addition to the studies among gay or bisexual men and MSM, Bowen, Bradford, and Powers (2006) attempted to examine differences in sample methods among women who have sex with women (WSW). However, their samples were also different in terms of location of the study (Seattle vs. Boston), so a direct and unequivocal comparison was not possible. The studies summarized above illustrate that there are differences between LGB venue and general venue participants. However, current knowledge is restricted by the small sample size of some of the studies, an almost exclusive focus on gay men or MSM, and a strong focus on social demographics and risk behaviorforSTI/HIV.Itisalsounclearwhetherthesefindingsare valid for other sexual minority groups, such as lesbian or bisexual individuals, and different issues, such as health or experiences with anti-LGB reactions. Another gap in the existing literature is that previous studies compare the prevalence of certain characteristics among different samples, but do not address possible differences in the relationships between these variables. However, many studies on LGB issues using LGB community samples not only focus on the prevalence of, for example, homonegative reactions or health problems, but also examine the relationship between encountering homonegative reactions and reporting health problems. The current study attempted to contribute to the existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and well-being between a convenience sample of LGB participants recruited at LGB venues who were invited to participate in a study on LGB issues (‘‘community sample’’) and a sample of LGB participants recruited from a general research panel in the Netherlands who were invited to participate in all kinds of research projects (‘‘panel sample’’). The specific research questions were:
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1.
2.
3.
4.
5.
Do social demographics (sex, age, education, employment, religion, ethnicity, and urbanicity) differ between a community and panel sample of LGB individuals? Does the sexual orientation of participants (sexual attraction, relationship with same-sex or opposite sex partner) differ between a community and panel sample of LGB individuals? Do minority stressors (openness, negative reactions, internalized homonegativity) differ between a community and panel sample of LGB individuals? Does mental health (psychological distress and suicidality) differ between a community and panel sample of LGB individuals? Are there differences in the relationships between minority stressors and mental health for a community sample and a panel sample of LGB individuals?
Method Participants and Procedure The current study used data collected by Keuzenkamp, Kooiman, and Van Lisdonk (2012) for a study on the experiences of LGB individuals in the Netherlands. For this study, they recruited a convenience community sample as well as a random panel sample of LGB individuals. Participants received information about the time it would take to complete the survey, an indication of the topics that would be addressed (for the LGB community sample, these were LGB issues while the topics were more generally framed for the panel sample) and a guarantee of their anonymity and confidentiality. After reading the information, they could start with the questionnaire if they wished to join the study. Under prevailing Dutch law, no formal approval of official IRB or medical ethical committee was necessary. The study was monitored by an internal review committee of The Netherlands Institute for Social Research and several external experts.
Panel Sample The panel sample was recruited from a commercial research panel (Intomart GfK) in March 2011. This panel consisted of a random sample of members willing to complete questionnaires (self-registered members were excluded from the current sample frame). For this panel, screening surveys among members 18 years or older are carried out periodically to provide an updated overview of several background characteristics. In August 2010, sexual attraction was one of the screening questions.
The invitation to join the current study was sent out to a random sample of 1,600 panel members who indicated during the screening of August 2010 that they (also) felt attracted to same-sex partners. They received an invitation by email and completed the questionnaire online. The questionnaire took about 10 min to complete. Of the 1,600 invited participants, 257 started to complete the questionnaire, but indicated they were either only attracted to opposite-sex partners, did not know which sex they felt attracted to, or were attracted to neither men nor women.1 These participants were notified that their willingness to participate was appreciated, but that they did not belong to the target population of the survey. A small number of individuals started, but did not complete the questionnaire (n = 27) and 253 individuals did not start the questionnaire at all. This yielded a sample of 1,063 participants (response rate, 79.2 %). Since the sample size was restricted to 1,000 participants (for reasons related to funding), 63 individuals (the number of participants who started the questionnaire after the limit of 1,000 participants was reached) received a notification after starting the questionnaire that their participation was appreciated, but no longer required. Hence, the final sample size of the panel sample was 1,000. LGB Community Sample The LGB community sample was recruited between October and December 2010. Participants were requested to complete a ‘‘Pink Questionnaire’’ through a website carrying the same name (www.rozevragenlijst.nl) which also contained information regarding the study, target population, funding, aim of the study, and contact details of the research team. Individuals 16 years or older with LGB feelings living in the Netherlands were invited to visit the website and complete a questionnaire on LGB issues. The invitation explained that the study was conducted on behalf of the Dutch government to assess the situation and acceptance of LGB individuals in the Netherlands and that everyone who (also) had feelings for same-sex individuals could join the survey, regardless of whether they considered themselves LGB individuals. Invitations were sent out by all major national LGB organizations and communities as well as through local and small-scale organizations serving a particular geographical area or subpopulation (e.g., LGB migrants). Accounts were made on Facebook, Hyves, and Twitter and friend-request were sent out to eminent LGB people (e.g., well-known LGB activists, writers, politicians, and so on). Editorials and ads carrying the same message were placed in LGB media and similar flyers were distributed at LGB parties/events. In addition to the LGB 1
The differences with the screening question in August might be due to the fact thatin August participantswere askedabout theirsexualattraction,while in March people were asked about their attraction in general.
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venue recruitment, recruitment took place though the general media. A press release was sent out and picked up by various general news websites and radio stations. The questionnaire took about 20 min to complete. In total, 7,146 participants started the questionnaire. Of these participants, 166 indicated that they only felt attracted to opposite sex partners or to no one at all (2.3 %). These participants received a notification that their willingness to participate was appreciated, but that they did not belong to the target population of the survey. Around a fifth (n = 1,483, 21.3 %) did not complete the questionnaire (41.0 % already stopped during the first three items, all other items had drop-out rates below 1.0 %). In total, 5,663 participants (81.1 %) completed the questionnaire. Another 243 participants were removed from the final sample due to various reasons, such as completing the questionnaire more than once (n = 76) or being younger than 16 (n = 93). This left us with 5,420 participants. As the panel sample only consisted of individuals 18 years and above, participants from the community sample aged 16 or 17 were removed from the sample (n = 336). All participants recruited at the LGB venues completed a question on how they found out about the survey [1 = social media (Facebook, Hyves or Twitter); 2 = LGB website or mail ing list; 3 = general website not aimed at LGB individuals; 4 = flyer at LGB party, bar, or cafe´; 5 = through a friend; 6 = other, namely…]. Since the aim of the current study was to compare a sample of LGB individuals recruited at LGB venues (specifically mentioning LGB issues) with a sample of LGB individuals recruited though a general venue (with a general invitation), participantswhoindicatedthattheywereonlyinformedaboutthe study through a general, non-LGB venue were removed from the sample. Hence, participants providing the answer‘‘3’’or‘‘5’’were deleted from the current sample (n = 213 and n = 1167) as were those individuals who answered‘‘6’’and of which we could not be sure that they were invited through an LGB specific venue (n = 301). This yielded a final community sample of 3,403 partic ipants. The social demographic characteristics of both samples can be found in Table 1. The mean age of the panel participants was 48.46 years (SD = 13.91). Six out of every ten participants were men. Around half of the participants (52.7 %) had a higher education, while 13.6 % had a lower education. Of the panel participants, 61.1 % currently were currently employed and 39.5 % were currently religious. Eleven percent were born outside the Netherlands. Slightly more than 60 % (61.4 %) lived in an urban area. The mean age of the community participants was 37.08 years (SD = 13.82). Slightly more women (53.9 %) than men (46.1 %) participated. Only a small percentage had a lower education (8.6 %) while many participants had a higher education (61.3 %). A third were currently religious and the majority of the community sample (74.6 %) was employed. Migrants made
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Table 1 Characteristics of the samples (valid percentages, means, and SDs) Community sample (N = 3,403)
Panel sample (N = 1,000)
Male
46.1
60.0
Female
53.9
40.0
18–24
25.2
4.8
25–24
22.2
13.1
35–44
21.9
21.4
45–54
17.8
25.8
55–64
10.3
22.2
C65
2.7
12.7
Lower
8.6
13.6
Middle
29.2
33.2
Higher Currently employed (%)
61.3 74.6
52.7 61.6
Currently religious (%)
33.3
39.5
Native Dutch
86.3
89.0
Other
13.7
11.0
Rural
34.0
38.6
Urban
66.0
61.4
Sex (%)
Age (%)
Education (%)
Ethnicity (%)
Urbanicity (%)
Sexual attraction (%) Only same-sex
69.2
52.3
Mostly same-sex
19.3
18.0
Both sexes equally
7.1
15.0
Mostly opposite sex
4.4
14.7
88.3 11.7
71.0 29.0
Open to mother (%)
93.2
77.9
Open to colleagues (%)
88.3
82.3
Negative reactions (M, SD)
1.58 (.84)
1.23 (.53)
Internalized homonegativity (M, SD)
1.87 (1.15)
1.99 (1.14)
Psychological distress (M, SD)
2.57 (.87)
2.30 (.89)
Suicidal thoughts (M, SD)
1.86 (1.01)
1.64 (.91)
Suicidal plans (%)b
34.2
32.9
Sex current partner (%)
a
Same-sex Opposite-sex
Rangesoftheintervalvariableswere: negative reactions(min = 1; max = 5), internalized homonegativity (min = 1; max = 5), psychological distress (min = 1; max = 6), and suicidal thoughts (min = 1; max = 5) a
The item was only completed by participants who were currently in a relationship
b
The item was only completed by participants who reported that they have had thoughts about ending their lives
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up 13.7 % of the community sample. Almost two-thirds (66.0 %) lived in a city. Measures Even though both questionnaires contained more items, especially the community sample questionnaire, the current study only used the items that were included in both surveys and that were phrased in the same way in both questionnaires. The descriptives of all included measures are shown in Table 1. Sociodemographics All sociodemographics were measured by simple questions. Sex was measured by asking participants whether they were male or female. Age was measured by asking the participants to provide their year of birth, from which their age in years was calculated. Education was measured by three questions: highest level of education attained, currently following education, and level of current education. The Dutch educational levels were recoded to represent lower, middle, and higher educational levels. For young people still following education, this was based on the level of education they were currently following. For the others, education was based on highest level of education attained. Current employment was assessed by a question on whether participants currently held a paid job (1 = yes; 2 = no). Ethnicity was assessed by three items: mother’s country of birth of, father’s country of birth, and participant’s country of birth. In line with the Dutch standard for coding ethnicity, participants of whom either one parent or who themselves were born in a non-Western country (mostly Morocco, Turkey, or Surinam) were categorized as having a non-Western background. Others were coded as having a Western background. Religion was assessed by one question whether participants currently hold a religion and, if so, which religion. The answers were recoded into a dichotomous variable indicating whether participants were currently religious. Urbanicity was measured by asking the participants four digits of their postal code. While this does not allow for identification, it does provide the urbanicity of their place of residence. The degree of urbanization was recoded into a dichotomous variable (0 = urban; 1 = rural). Sexual Orientation Characteristics Sexual attraction was measured by one item:‘‘Who do you feel attracted to (1 = only to women; 2 = mostly to women, but also to men; 3 = to men and women equally; 4 = mostly to men, but also to women; 5 = to women only; 6 = don’t know; 7 = neither to men nor to women).’’The answers were recoded into a variable indicating to which degree participants reported same-sex and opposite-sex attraction (1 = same-sex only; 2 = mostly same-sex; 3 = both sexes equally; 4 = mostly opposite sex)
(participants exclusively attracted to the opposite sex were not included in the survey; participants who did not know their sexual attraction or did not have any sexual attraction to men and women were omitted from the analyses). Sex of partner was assessed by two items. Participants were asked whether they were currently in a relationship (a love affair of at least 1 month) and, if so, if they were in a relationship with a man, a woman, or both. The answers of those currently involved were recoded into a variable indicating whether participants were currently in a same-sex relationship (0) or in an opposite sex relationship (1). Seven participants indicated that they were currently involved with a man and a woman. These participants were excluded from these analyses.
Minority Stressors Openness was assessed in two areas: openness to mother (‘‘Does your mother know you are attracted to same-sex partners?’’; 1 = yes; 2 = no; 3 = don’t know; 4 = not applicable) and openness to colleagues (‘‘Do your close colleagues know that you are attracted to same-sex partners?’’; 1 = yes; [almost] all; 2 = some do, some don’t; 3 = none; 4 = don’t know; 5 = not applicable). Both questions were recoded to whether one’s mother or colleagues know (0 = no, 1 = yes). Negative reactions were assessed by asking participants whether they had had any negative experiences or reactions during the past 12 months because they were (also) attracted to same-sex partners (1 = no; 2 = once; 3 = a few times during the year; 4 = at least once a month; 5 = at least once a week). Internalized homonegativity was measured by one statement to which the participants had to react:‘‘If I could change my sexual orientation and become heterosexual, I would do that’’ (1 = totally agree, 5 = totally disagree). The item was recoded with higher scores indicating higher levels of internalized homonegativity. Mental Health Psychological distress was assessed by a Dutch version of the MHI-5 (Ware & Konsinki, 2001). The MHI-5 measures the frequency of five health feelings during the preceding four weeks on a 6-point scale (1 = all the time; 6 = never). Examples of items were ‘‘very nervous,’’‘‘down and sad’’ or ‘‘calm.’’The negative items were scored in reverse and mean scores were calculated. A higher score is indicative of more distress (Cronbach’s alpha = .88). Suicidality was measures by two items: whether participants ever thought about ending their lives (1 = never; 5 = very often) and, if they did, whether they ever made a plan to end their life (1 = never; 3 = more than once). The last question was recoded and reflected whether participants ever planned to commit suicide.
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Statistical Analyses Differences between the community sample and the panel sample were assessed by conducting logistic regression analysis (LRA) with the type of sample as the dependent variable (0 = community sample, 1 = panel sample). The differences between the samples in terms of sociodemographics were assessed with one LRA including all available demographics. The analyses examining differences in sexual attraction, sex of partner, openness to mother and colleagues, negative reactions, internalized homonegativity, psychological distress, and suicidality were all conducted separately (i.e., one LRA for each measure). These analyses controlled for differences in sociodemographic characteristics and conducted separately for women and men. The relationship between minority stress and mental health (psychological distress and suicidality) was examined by multiple regression analysis (MRA) conducted in each sample (i.e., community sample and panel sample) separately. The MRA also controlled for sociodemographic characteristics, but due to the smallernumberofparticipants related to the separate analysesfor each sample, the MRA was not run separately for women and men. The level of significance was set at .01 (because of the large number of analyses and in order to minimize the chances on Type I errors). All analyses were conducted with SPSS (version 11).
Results Sociodemographics The overall models of men, v2(6, 2170) = 195.28, p\.001, Nagelkerke R2 = .13, and women, v2(6, 2233) = 281.13, p\ .001, Nagelkerke R2 = .20, were significant, indicating differences in sociodemographics between the community sample and the panel sample. As shown in Table 2, the majority of the other characteristics did not differ between the samples. Community LGBs and panel LGBs were similar in terms of education, religiousness, ethnicity or urbanity. In terms of employment, community men and panel men also did not present any differences. The only difference between the two groups of men was age: panel men were older than community men. The same difference also held true for women while, in addition, panel women were more often unemployed than community women. Sexual Orientation All models pertaining to sexual orientation characteristics were significant and showed differences between both samples in terms of sexual attraction among men, v2(9, 2145) = 278.86, p\.001, Nagelkerke R2 = .18, and women, v2(9, 2207) = 393.20, p\.001, Nagelkerke R2 = .27, and in sex of current partner among men, v2(1, 1142) = 111.27, p\.001, Nagelkerke
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Table 2 Differences in social demographic characteristics between community and panel sample Men
Age
OR
Wald
OR
Wald
1.05
135.96***
1.06
196.02***
.94
3.40
.93
1.02 1.06
.04 .28
.52 .83
.86
.87
.83
1.01
1.15
1.67
1.27
3.59
Education Employment Religious Ethnicity Urbanicity
Women
2.66 26.79*** 2.04
The dependent variable was type of sample (0 = community sample; 1 = panel sample) ***p\.001
Table 3 Differences in sexual orientation characteristics between community and panel sample Men OR
Women Wald
OR
Wald
Attraction Only same-sex
Ref
Mostly same-sex Both sexes equally
1.64 3.43
11.63** 37.99***
Ref 1.39 3.84
4.16* 54.85***
Mostly opposite-sex
4.26
51.63***
6.13
82.72***
Sex current partnera Same-sex partner
Ref
Opposite-sex partner
3.06
Ref 36.19***
3.07
35.91***
The dependent variable was type of sample (0 = community sample; 1 = panel sample). All analyses were controlled for social demographics (age, education, employment, religiousness, ethnicity, and urbanicity). Separate analyses were run for attraction (Nmen = 2,145; Nwomen = 2,207) and sex current partner (Nmen = 1,142; Nwomen = 1,197) *p\.05; **p\.01; ***p\.001 a
Item was only completed by participants currently in a relationship
R2 = .13, and women, v2(7, 1197) = 155.95, p\.001, Nagelkerke R2 = .19. Table 3 shows that both male and female panel participants were more likely than community men and women to report mostly same-sex, both-sex, and mostly opposite-sex attraction rather than exclusive same-sex attraction. The more attraction to opposite-sex partner, the higher the likelihood of belonging to the panel sample. Community men and women were three times more likely to have a same-sex partner than an opposite-sex partner. Minority Stressors Among men, the models for openness towards mother, v2(7, 1504) = 307.71, p\.001, Nagelkerke R2 = .26, openness towards colleagues, v2(6, 1479) = 100.74, p\.001, Nagelkerke
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R2 = .10, negative reactions, v2(7, 2121) = 235.38, p\.001, Nagelkerke R2 = .15, and internalized homonegativity, v2(7, 2149) = 208.08, p\.001, Nagelkerke R2 = .13, were all significant. In addition, Table 4 shows that all minority stress measures differed between the two samples of men. Among women, the models for openness towards mother, v2(6, 1769) = 120,99, p\ .001, Nagelkerke R2 = .25, openness towards colleagues, v2(7, 1481) = 123.25, p\.001, Nagelkerke R2 = .14, negative reactions, v2(7, 2159) = 338.07, p\.001, Nagelkerke R2 = .24, and internalized homonegativity, v2(7, 1504) = 281.17, p\.001, Nagelkerke R2 = .20, were also significant, but not all models showed that the female samples differed in terms of minority stressors (see Table 4). Among both men and women, the community participants’ mothers more often knew about the same-sex attractions of the participant than the mothers of the panel participants. For close colleagues, the same was true for men: colleagues from community participants more often knew about their same-sex attractions than those of panel participants. Women from both samples did not differ with regard to openness towards close colleagues. The male and female community participants reported more frequent encounters of negativereactionsorexperiencesduetotheir same-sex attractions. Among men, panel participants reported higher levels of internalized homonegativity than community participants. Among women, this difference was not found. Mental Health Three aspects of mental health were examined of which all three models were significant among men: psychological distress, v2(7, 2142) = 219.17, p\.001, Nagelkerke R2 = .14, suicidal
thoughts, v2(7, 2138) = 214.77, p\.001, Nagelkerke R2 = .14, and suicide plans, v2(7, 1041) = 57.55, p\.001, Nagelkerke R2 = .08. The same was true for the models pertaining to women: psychological distress, v2(7, 2210) = 287.67, p\.001, Nagelkerke R2 = .20, suicidal thoughts, v2(7, 2198) = 268.59, p\.001, Nagelkerke R2 = .19, and suicide plans, v2(7, 1150) = 121.29, p\.001, Nagelkerke R2 = .17. As shown in Table 5, the two samples of men differed in all aspects of mental health. Panel men, compared to community men, reported lower levels of psychological distress, lower levels of suicidal thoughts, and lower levels of actual plans for suicide. However, women from the two samples only differed in level of psychological distress: women recruited at LGB venues reported more distress than women recruited from a general sample. No significant differences in suicidality were found among women. Relationships Between Minority Stress and Mental Health The last research question addressed the issue of possible differences in the relationships between minority stress and mental health for both samples. Table 6 shows the results of the analyses. As shown in Table 6, there were no large differences in the relationships between both samples. The mod els for psychological distress were significant in the community sample, F(11, 2479) = 31.32, p\.001, adjusted R2 = .12, and the panel sample, F(11, 729) = 9.99, p\.001, adjusted R2 = .12. In both samples, more psychological distress was related to less openness towards one’s mother, encountering more negative reactions or experiences related to one’s same-sex attractions, and to higher levels of internalized homonegativity.
Table 4 Differences in minority stressors between community and panel sample Men OR
Women Wald
OR
Wald
Table 5 Differences in mental health characteristics between community and panel sample Men
Openness Openness mother No Yes
Ref .32
33.77***
Ref .26
Psychological distress 43.68***
Openness colleagues Ref
Yes
OR
Wald
OR
Wald
.73
25.13***
.81
8.39***
.74
23.26***
.92
1.84
Suicidality Suicidal thoughts
No
Women
Suicidal plansa
Ref
.38
28.00***
.57
6.30
No
Ref
Ref
Ref
Ref
Negative reactions
.60
36.38***
.38
54.06***
Yes
.06
35.36***
1.02
.01
Internalized homonegativity
1.17
12.95***
1.01
.04
The dependent variable was type of sample (0 = community sample; 1 = panel sample). All analyses were controlled for social demographics (age, education, employment, religiousness, ethnicity, and urbanicity). Separate analyses were conducted for openness mother (Nmen = 1,504; Nwomen = 1,769), openness colleagues (Nmen = 1,479; Nwomen = 1,481), negative reactions (Nmen = 2,121; Nwomen = 2,159), and internalized homonegativity (Nmen = 2,149; Nwomen = 2,212) ***p\.001
The dependent variable was type of sample (0 = community sample; 1 = panel sample). All analyses were controlled for social demographics (age, education, employment, religiousness, ethnicity, and urbanicity). Separate analyses were conducted for psychological distress (Nmen = 2,142; Nwomen = 2,210), suicidality thoughts (Nmen = 2,138; Nwomen = 2,198), and suicidality plans (nmen = 1,041; nwomen = 1,150) ***p\.001 a
Item was only completed by participants indicating they have had suicidal thoughts
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Arch Sex Behav Table 6 Differences in relationship between minority stressors and mental health in community and panel sample Psychological distress Community b Openness mother
Suicidal thoughts Panel b
t
Community t
b
2.64**
-.01
Panel b
t -.27
t
-.07
-3.37***
-.11
Negative reactions
.13
6.68***
.13
3.39***
.12
6.03***
-.01 .12
-.11 3.18***
Internalized homonegativity
.16
8.21***
.12
3.21***
.10
5.11***
.07
1.89
All analyses were controlled for social demographics (sex, sexual orientation, age, education, employment, religiousness, ethnicity, and urbanicity). Separate analyses were run for psychological distress (Ncommunity = 2,480; Npanel = 730) and suicidality thoughts (Ncommunity = 2,138; Npanel = 718) **p\.01; ***p\.001
The amount of explained variance and the standardized betas in both samples were of comparable size. The models for suicidality in the community sample, F(11, 2483) = 14.41, p\.001, adjusted R2 = .06, and the panel sample, F(11, 717) = 5.53, p\.001, adjusted R2 = .07, were both significant. In both samples, no significant relationship was found between suicidality and openness to one’s mother and, in both samples, a relationship was found between suicidality and higher levels of negative reactions. In the community sample, more frequent thoughts about suicide were related to higher levelsofinternalizedhomonegativity,whilethisrelationship was not significant in the panel sample (p = .06). It is important to note that the lack of significance in the panel sample might be due to the smaller sample size of this sample, since the size of the betas did not differ greatly and the p value approached significance.
Discussion Convenience samples of LGB individuals recruited at LGB venues have certain benefits (for overviews, see Corliss et al., 2009; Meyer & Wilson, 2009; Rothblum, 2007). Benefits include the relatively low costs, the possibility to recruit samples large enough to allow for comparisons between subgroups of LGB individuals (such as older and younger participants), and the creation of a platform for research recruitment as well as interventions due to community involvement. However, convenience samples of LGB individuals recruited at LGB venues also have a major drawback: the samples might be prone to several biases due to the selective recruitment. The current study examined in which ways a sample of LGB participants recruited at various community venues differed from a sample of LGB participants recruited from a general research panel. In general, many differences were found in the estimates of social demographics, sexual orientation, minority stressors, and health, while few differences were found in the relationships between these constructs. Most of the social demographics did not differ between community and panel LGB individuals. Among men, only age differed: community men were somewhat younger than panel
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men. Community women were also younger than their panel counterparts, while the latter were more often unemployed. Previous studies also found more similarities than differences in social demographics between gay men/MSM recruited from general or venue samples (Evans et al., 2007; Meyer & Colten, 2008), although the results were mixed. For example, while Sandfort (1997) reported that venue men were higher educated and older than general men, Meyer and Colten (2008) and Dodds et al. (2006) reported no age or educational differences, and Evans et al. (2007) reported similar educational levels in both groups, but younger men in the venue sample. The different results might be explained by differences between LGB communities from different times and places. For example, with the age of coming out in the Netherlands decreasing (De Graaf, Kruijer, Van den Akker, & Meijer, 2012), the age at which LGB individuals might become involved in the LGB community could also drop. This might explain that some 15 years ago Sandfort (1997) found that community men were older than general men, while the opposite was found in the current study. In addition to possible differences between times and places, the various studies differed in the ways in which the community samples were recruited. While the current study used online and offline LGB venues, Dodds et al. only recruited at offline MSM venues, and Evans et al. recruited only online. Since these venues might attract different LGB individuals (e.g., it seems likely that LGB individuals visiting websites are relatively young), this could also contribute to the mixed results. Large differences were found for sexual orientation: for panel men, the odds of being attracted to a certain degree to both men and women were larger than the odds of being attracted to only men. Odds for panel men were also three times larger to be in a relationship with an opposite-sex partner (vs. relationship with a same-sex partner). For women, comparable results were found. This is in line with previous studies showing that bisexual individuals are relatively underrepresented in community samples (Dodds et al., 2006; Evans et al., 2007; Harry, 1986). This might be explained by a gay and lesbian focus in the LGB community. Bars, clubs, parties, and websites of Dutch LGB venues concentrate more often on gay and/or lesbian individuals
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than on bisexual individuals. Hence, recruiting participants at LGB venues yields a sample in which individuals who are to a more or lesser degree also attracted to opposite-sex partners are underrepresented. LGB participants recruited at community venues were more open about their orientation to their mother (Nagelkerke R2men = .26; Nagelkerke R2women = .25) and to their colleagues (men only, Nagelkerke R2 = .10), received more negative reactions on their orientation (Nagelkerke R2men = .15; Nagelkerke R2women = .24), and experienced lower levels of internalized homonegativity (men only, Nagelkerke R2 = .13). Some of these findings were in line with the results of Meyer and Colten (2008) who also reported that venue GB men were more likely to be out and reported lower levels of internalized homonegativity. These findings make intuitive sense. When LGB individuals are involved in the LGB community, it is more likely that they are open about their LGB orientation. Also, being part of an LGB crowd or network might create a buffer against internalized homonegativity (Cox, DeWaele, van Houtte, & Vincke, 2011; Cox, vanden Berghe, DeWaele, & Vincke, 2010). Online and offline LGB community involvement might enhance the chances of receiving negative reactions due to the increased visibility of one’s LGB status. With regard to mental health, community men reported higher levels of psychological distress and suicidality than panel men (Nagelkerke R2distress = .14; Nagelkerke R2suicidal thoughs = .14; Nagelkerke R2suicidal plans = .08). Community women reported elevated levels of psychological distress (Nagelkerke R2distress = .20). This is in line with previous findings suggesting that venue men are less likely to report good health (Evans et al., 2007). A possible explanation is that by being involved in the LGB community, individuals are confronted with negative reactions or discrimination received by others and more likely to receive information about the negative treatment of LGB individuals in other places and times. This might enhance one’s own sense of vulnerability or stigma consciousness which, in turn, is related to mental health problems (Vanden Berghe, DeWaele, Cox, & Vincke, 2010). In the same line of reasoning, being part of the LGB community might also enhance the willingness to report problems due to political reasons. Due to an enhanced awareness of many of the problems faced by the LGB community, problems might be reported by its members more frequently in order to increase the changes of policy change and budget allocation. Another explanation might be that those with elevated levels of mental health problems might more often turn to the LGB community to seek social support of similar others. The differences in levels of minority stress and mental health problems between community and panel LGB individuals might alsobeexplainedbyfactorsthat differbetweenthesesamplesand were not included in the current study. One possible candidate is gender non-conformity. Several studies show that gender nonconformity is an important risk factor for receiving negative reactions as well as for health problems (Baams, Beek, Hille,
Zevenbergen, & Bos, 2013; Roberts, Rosario, Slopen, Calzo, & Austin, 2013; Toomey, Ryan, Diaz, Card, & Russell, 2010). In the Netherlands, gender non-conformity is also more frowned upon than an LGB orientation (Keuzenkamp & Kuyper, 2013). Because of this rejection by general society, gender non-conforming LGB individuals might be more likely to join the LGB community. If this is true, higher levels of gender non-conformity among community participants might explain higher levels of negative reactions and health problems. While the estimates of sexual orientation, levels of minority stress, and mental health problems were strongly influenced by the sampling venue, the relationship between these constructs was not. The betas in the multivariate analyses which explored the relationships between minority stressors and mental health problems did not vary greatly between the community sample and the panel sample. Openness, internalized homonegativity, and negative reactions were related in comparable ways to psychological distress and suicidality in both samples. Limitations The current study had several limitations. First of all, a general online-access panel was used as the comparison group for the LGB community sample. While online-access panels are not biased in the sense that they recruit participants at LGB venues, they are not truly random probability samples. Secondly, several constructs included in the current study were measured by only one item. While social demographics, sexual orientation, and psychological distress were measured by extensive or reliable measures, such as the MHI-5, minority stressors and suicidality were measured by a single item and several items (such as openness) would have benefitted from the use of more refined answer categories. The reliability of these findings could be increased if issues such as negative reactions and internalized homonegativity were measured by validated multi-item scales instead. It remains to be seen whether future studies using more sophisticated and validated measures for these constructs find the same results. Besides improving the sample selection and measurement of several topics, future studies are also encouraged to include other issuesthat might differbetween the samples and/orexplain the various differences in, for example, minority stress and health. As already mentioned above, gender non-conformity would be a suitable candidate. Another thing that should be kept in mind when interpreting the current results is that the study was conducted in the Netherlands, a country known for its relatively positive attitude and legislation towards homosexuality and bisexuality (Kuyper, Iedema, & Keuzenkamp, 2013). This may have influenced the current results. Differences between LGB community samples and panel or population samples could be different in other social contexts. It would be interesting to examine these issues in less tolerant countries.
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Conclusion The current study showed that prevalence estimates of sexual orientation, minority stressors, and mental health problems can be severely biased when using LGB community samples. At the same time, the current results also provide reassurance since they showed that relationships between several constructs did not differ greatly in LGB community and panel samples. An increased and reliable understanding of the living conditions of LGB individuals is probably best reached by combining both sources of data. Population studies increasingly add questions about sexual orientation to their questionnaires allowing for reliable estimates of health problems for LGB individuals. For example, items with regard to sexual orientation are included in editions of BRFSS, NSFG, GUTS, Add Health, and, outside the United States, in the Integrated Household Survey (United Kingdom) and the Dutch National Survey of General Practice (the Netherlands). However, large-scale population studies generally do not offer the possibility to include items on LGB specific issues, such as internalized homonegativity, openness about LGB orientation, or having an LGB network. Future studies carried out online (which allows for elaborate tailoring) might consider including a module with questions about specific LGB issues for LGB participants. Alternatively, with the quality of online-access panels increasing, online panels seem useful for recruiting LGB community samples for providing estimates on the prevalence of these specific LGB issues. Especially LGB studies that aim to include a significant proportion of participants who are also attracted to opposite-sex partners, a group shown in general population studies to be especially vulnerable to health problems (Corliss, Rosario, Wypij, Fisher, & Austin, 2008; Jorm, Korten, Rogers, Jacomb, & Christensen, 2002; Marshal et al., 2008; Saewyc et al., 2009), should turn to other recruitment methods than LGB community venues. However, studies with LGB community samples also remain valuable. Not only because they seem to offer a realistic picture when examining risk and resilience factors, but also because this type of recruitment offers the opportunity to connect with the LGB community which can simultaneously create a platform for interventions or community outreach. Acknowledgments We would like to acknowledge the funding for the data collection by the Dutch Ministry of Education, Culture, and Science and the role played by Jantine van Lisdonk, Niels Kooiman, and Diana van Bergen in the design and logistics of this study. While the idea of the study had been in our heads for a while, the online discussion between Dr. Cochran and Dr. Meyer on LGB sampling issues in the beginning of 2013 encouraged us to write it down.
References Baams, L., Beek, T., Hille, H. C. A., Zevenbergen, F. C., & Bos, H. M. W. (2013). Gender nonconformity, perceived stigmatization, and psy chological well-being in Dutch sexual minority youth and young
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adults: A mediation analysis. Archives of Sexual Behavior, 42, 765–773. Bowen, D. J., Bradford, J., & Powers, D. (2006). Comparing sexual minority status across sampling methods and populations. Women and Health, 44, 121–134. Corliss, H. L., Cochran, S. D., & Mays, V. M. (2009). Samplingapproaches to studying mental health in the lesbian, gay, and bisexual community. In W. Meezan & J. I. Martin (Eds.), Handbook of research with lesbian, gay, bisexual, and transgender populations (pp. 131–158). New York, NY: Routledge. Corliss, H. L., Rosario, M., Wypij, D., Fisher, L. B., & Austin, S. (2008). Sexual orientation disparities in longitudinal alcohol use patterns among adolescents: Findings from the growing up today study. Archives of Pediatrics and Adolescent Medicine, 162, 1071–1078. Cox, N., Dewaele, A., van Houtte, M., & Vincke, J. (2011). Stress-related growth, coming out, and internalized homonegativity in lesbian, gay, and bisexual youth: An examination of stress-related growth within the minority stress model. Journal of Homosexuality, 58, 117–137. Cox, N., van den Berghe, W., Dewaele, W., & Vincke, J. (2010). Acculturation strategies and mental health in gay, lesbian, and bisexual youth. Journal of Youth and Adolescence, 39, 1199–1210. de Graaf, H., Kruijer, H., van Acker, J., & Meijer, S. (2012). Seks onder je 25e. Seksuele gezondheid van jongeren in Nederland anno 2012 [Sex under 25. Sexual health of young people in the Netherlands 2012]. Delft: Eburon. Dodds, J. P., Mercer, C. H., Mercey, D. E., Copas, A. J., & Johnson, A. M. (2006). Men who have sex with men: A comparison of a probability sample survey and a community based study. Sexually Transmitted Infections, 82, 86–87. Evans, A. R., Wiggins, R. D., Mercer, C. H., Bolding, G. J., & Elford, J. (2007). Men who have sex with men in Great Britain: Comparison of a self-selected internet sample with a national probability sample. Sexually Transmitted Infections, 83, 200–205. Harry, J. (1986). Sampling gay men. Journal of Sex Research, 22, 21–34. Jorm, A. F., Korten, A. E., Rogers, B., Jacomb, P. A., & Christensen, H. (2002). Sexual orientation and mental health: Results from a community survey of young and middle-aged adults. British Journal of Psychiatry, 180, 423–427. Keuzenkamp, S., Kooiman, N., & van Lisdonk, J. (2012). Niet te ver uit de kast. Ervaringen van homo- en biseksuelen in Nederland [Just don’t stand out. Experiences of homo- and bisexual individuals in the Netherlands]. The Hague: The Netherlands Institute for Social Research. Keuzenkamp, S., & Kuyper, L. (2013). Acceptance of LGBT individuals in the Netherlands 2013. The Hague: The Netherlands Institute for Social Research. Kuyper, L., Iedema, J., & Keuzenkamp, S. (2013). Towards tolerance. Exploring changes and explaining differences in attitudes towards homosexuality in Europe. The Hague: The Netherlands Institute for Social Research. Marshal,M.P.,Friedman,M. S.,Stall,R., King,K.M.,Miles,J.,Gold,K.M., … Morse, J. Q. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103, 546– 556. Meyer, I. H., & Colten, M. E. (2008). Sampling gay men. Journal of Homosexuality, 37, 99–110. Meyer, I. H., & Wilson, P. A. (2009). Sampling lesbian, gay, and bisexual populations. Journal of Counseling Psychology, 56, 23–31. Roberts, A. L., Rosario, M., Slopen, N., Calzo, J. P., & Austin, S. B. (2013). Childhood gender nonconformity, bullying victimization, and depressive symptoms across adolescence and early adulthood: An 11-year longitudinal study. Journal of the American Academy of Child and Adolescence Psychiatry, 52, 143–152. Rothblum, E. (2007). From science fiction to computer-generated technology: Sampling lesbian, gay, and bisexual individuals. In I. H. Meyer & M. E. Northridge (Eds.), The health of sexual minorities: Public health
Arch Sex Behav perspectives on lesbian, gay, bisexual and transgender populations (pp. 441–454). New York, NY: Springer. Saewyc, E. M., Homma, Y., Skay, C. L., Bearinger, L. H., Resnick, M. D., & Reis, E. (2009). Protective factors in the lives of bisexual adolescents in North America. American Journal of Public Health, 99, 110–117. Sandfort, T. G. M. (1997). Sampling male homosexuality. In J. Bancroft (Ed.), Researching sexual behavior: Methodological issues (pp. 261–275). Bloomington: Indiana University Press. Toomey, R. B., Ryan, C., Diaz, R., Card, N. A., & Russell, S. T. (2010). Gender nonconforming lesbian, gay, bisexual, and transgender
youth: School victimization and young adult psychosocial adjustment. Developmental Psychology, 46, 1580–1589. van den Berghe, W., Dewaele, A., Cox, N., & Vincke, J. (2010). Minority specific determinants of mental well-being among lesbian, gay and bisexual youth. Journal of Applied Social Psychology, 40, 153–166. Ware, J. E., & Konsinki, M. A. (2001). SF-36: Psychical and mental health summary scales. A manual for users of version 1 (2nd ed.). Lincoln, RI: Quality Metric Inc.
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ORIGINAL PAPER
A Comparative Analysis of a Community and General Sample of Lesbian, Gay, and Bisexual Individuals Lisette Kuyper • Henk Fernee • Saskia Keuzenkamp
Received: 15 January 2014 / Revised: 10 April 2014 / Accepted: 7 September 2014 Springer Science+Business Media New York 2015
Abstract Samples recruited at lesbian, gay, and bisexual (LGB) venues have certain benefits, but a major drawback is that these samples are prone to bias as they only contain LGB participants who visit such venues. Empirical data with regard to the potential differences between LGB community samples and LGB general samples may shed some light on the generalizability of research findings from convenience samples recruited through LGB venues. The current study attempted to contribute to existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and mental health between a convenience sample recruited at LGB venues (‘‘community sample,’’N = 3,403) and an LGB sample recruited from a general research panel in the Netherlands (‘‘panel sample,’’N = 1,000). Various differences were found. In general, community participants were younger, reported a more exclusive same-sex sexualorientation,weremoreopenabouttheirsexual orientation, had lower levels of internalized homonegativity, and encountered more negative social reactions on their LGB status. They also reported higher levels of psychological distress and suicidality. The Nagelkerke R2 of the analyses (which were adjusted for sociodemographic differences) ranged from .08 (suicide plans amongmen)to .27 (sexual attraction among women).However, while the estimates of sociodemographics, sexual orientation, minority stress, and mental well-being differed, the relationships between these constructs were comparable in both samples. Implications and suggestions for future studies are discussed. L. Kuyper (&) H. Fernee Department of Education, Minorities, and Methodology, The Netherlands Institute for Social Research, POB 16164, 2500 BD The Hague, The Netherlands e-mail: [email protected] S. Keuzenkamp Movisie, Utrecht, The Netherlands
Keywords Sexual orientation Gay men Lesbians Bisexuality Homosexuality Minority stress
Introduction Methods for recruiting lesbian, gay, and bisexual (LGB) research participants have come a long way (Harry, 1986; Meyer & Colten, 2008; Meyer & Wilson, 2009). In the early days of LGB research, small samples of LGB individuals were recruited from prisons, psychiatric wards, and couches of clinicians. Recruitment nowadays mainly takes place at LGB community venues such as LGB bars, prides, networks, organizations, community centers, websites, and mailings lists. In addition, a growing number of general population studies include measures on sexual orientation such as editions of the behavioral risk factor surveillance system (BRFSS), the National Survey of Family Growth (NSFG), the Growing Up Today Study (GUTS), and the Longitudinal Survey on Adolescent Health (Add Health). Although studies making use of general population samples are increasingly available, the majority of studies on LGB issues are still carried out by using convenience samples of LGB individuals recruited at LGB venues. Many studies introduce two potential biases in their research design because of this. The most important bias is that this recruitment method results in a sample of LGB individuals who visit offline and online LGB venues. This implies that they are engaged in, or at least affiliated or familiar with, the LGB community. The second bias is introduced when participants are explicitly invited to join a survey on LGB issues. This approach yields a sample of LGB people who are keen to express their opinion on and experiences with LGB issues. These biases result in samples that might not be representative of the larger sexual minority population on variables of interest. The possible problematic sampling techniques often used in LGB research have been acknowledged and discussed
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by many scholars in the field (for examples, see Corliss, Cochran, & Mays, 2009; Meyer & Wilson, 2009; Rothblum, 2007; Sandfort, 1997). Empirical dataonthepossibledifferencesmayshedsomelight on the generalizability of research findings from community samples. Even though these data are scarce, there are some studies that have examined differences between samples recruited at LGB venues and samples recruited at venues not specifically targeting an LGB crowd. Two pioneers investigating these differences were Harry (1986) and Sandfort (1997). Harry (1986) examined differences between samples of gay men recruited at various venues in the San Francisco Bay Area. Based on the venue of recruitment, two groups of gay men were compared: gay men recruited at gay venues (i.e., gay bars and private bars, gay organizations and their mailing lists, gay baths, cruising areas, and through personal contacts) and gay men recruited through advertisements in general newspapers. Harry reported multiple differences between these samples. General advertisement gay men were more likely than venue gay men to have heterosexual friends, to report sex with both men and women, and to be ‘‘loners’’ throughout adolescence. They were also less likely to be in a relationship or part of a homosexual crowd. No significant differences in self-esteem between the two groups of men were found. Some ten years later, Sandfort (1997) compared four groups of Dutch gay men recruited at different venues:‘‘General men’’ (a pooled sample of gay men taken from various studies on safe sex among the general population), ‘‘Magazine men’’ (men who completed the questionnaire in a gay magazine), ‘‘Organization men’’(who received the questionnaire from a national LGB organization),and‘‘Cohort men’’who were recruited for a cohort study on safe sex among men who have sex with men (MSM) in Amsterdam. The samples differed in various aspects. Magazine, Organization, and Cohort men were older than General men. Organization and Magazine men were of higher educational level, while General men were of lower educational level. The latter were also more religious and politically conservative. General men were more often in a relationship compared to Organization and Cohort men, but Magazine men most often reported having a steady partner. In addition, General men less frequently reported having sex with other partners outside their relationship than Magazine, Organization, and Cohort men. More recently, Meyer and Colten (2008) compared two small samples of gay and bisexual (GB) men in Manhattan recruited at an LGB community center (N = 26) or through random digit dialing (RDD) (N = 52). No significant differences in age, education, student status, or employment status were found, but the RDD sample consisted of more non-white GB men. The samples also differed in gay community involvement: participants recruited at the center were more likely to belong to gay organizations, to belong to a greater number of organizations, to read gay newspapers and/or magazines, to have a subscription to these media, and to feel more connected to the gay community.
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The center participants were also more likely to be out, reported lower levels of internalized homophobia, and were less likely to have a regular sex partner. Recent studies using larger samples were conducted among MSM in the United Kingdom by Evans, Wiggins, Mercer, Bolding, and Elford (2007) and Dodds, Mercer, Mercey, Copas, and Johnson (2006). Both studies used a similar research method comparing MSM from the general population study National Survey of Sexual Attitudes and Lifestyle (NATSAL) with an MSM community sample recruited at gay bars, clubs, saunas, and medical clinics or at MSM websites. Dodds et al. reported no significant differences in age and level of education, but NATSAL MSM were more likely to live outside inner London, to be currently unemployed, and to be non-White compared to the LGB offline community sample. Evans et al. reported no significant differences between the NATSAL sample of MSM and the sample recruited at MSM websites with regards to ethnicity, education, employment, and urbanicity. However, they did find that MSM from the online sample were younger, more likely to be students, less likely to live in London, and less likely to report good health. In addition to the studies among gay or bisexual men and MSM, Bowen, Bradford, and Powers (2006) attempted to examine differences in sample methods among women who have sex with women (WSW). However, their samples were also different in terms of location of the study (Seattle vs. Boston), so a direct and unequivocal comparison was not possible. The studies summarized above illustrate that there are differences between LGB venue and general venue participants. However, current knowledge is restricted by the small sample size of some of the studies, an almost exclusive focus on gay men or MSM, and a strong focus on social demographics and risk behaviorforSTI/HIV.Itisalsounclearwhetherthesefindingsare valid for other sexual minority groups, such as lesbian or bisexual individuals, and different issues, such as health or experiences with anti-LGB reactions. Another gap in the existing literature is that previous studies compare the prevalence of certain characteristics among different samples, but do not address possible differences in the relationships between these variables. However, many studies on LGB issues using LGB community samples not only focus on the prevalence of, for example, homonegative reactions or health problems, but also examine the relationship between encountering homonegative reactions and reporting health problems. The current study attempted to contribute to the existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and well-being between a convenience sample of LGB participants recruited at LGB venues who were invited to participate in a study on LGB issues (‘‘community sample’’) and a sample of LGB participants recruited from a general research panel in the Netherlands who were invited to participate in all kinds of research projects (‘‘panel sample’’). The specific research questions were:
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1.
2.
3.
4.
5.
Do social demographics (sex, age, education, employment, religion, ethnicity, and urbanicity) differ between a community and panel sample of LGB individuals? Does the sexual orientation of participants (sexual attraction, relationship with same-sex or opposite sex partner) differ between a community and panel sample of LGB individuals? Do minority stressors (openness, negative reactions, internalized homonegativity) differ between a community and panel sample of LGB individuals? Does mental health (psychological distress and suicidality) differ between a community and panel sample of LGB individuals? Are there differences in the relationships between minority stressors and mental health for a community sample and a panel sample of LGB individuals?
Method Participants and Procedure The current study used data collected by Keuzenkamp, Kooiman, and Van Lisdonk (2012) for a study on the experiences of LGB individuals in the Netherlands. For this study, they recruited a convenience community sample as well as a random panel sample of LGB individuals. Participants received information about the time it would take to complete the survey, an indication of the topics that would be addressed (for the LGB community sample, these were LGB issues while the topics were more generally framed for the panel sample) and a guarantee of their anonymity and confidentiality. After reading the information, they could start with the questionnaire if they wished to join the study. Under prevailing Dutch law, no formal approval of official IRB or medical ethical committee was necessary. The study was monitored by an internal review committee of The Netherlands Institute for Social Research and several external experts.
Panel Sample The panel sample was recruited from a commercial research panel (Intomart GfK) in March 2011. This panel consisted of a random sample of members willing to complete questionnaires (self-registered members were excluded from the current sample frame). For this panel, screening surveys among members 18 years or older are carried out periodically to provide an updated overview of several background characteristics. In August 2010, sexual attraction was one of the screening questions.
The invitation to join the current study was sent out to a random sample of 1,600 panel members who indicated during the screening of August 2010 that they (also) felt attracted to same-sex partners. They received an invitation by email and completed the questionnaire online. The questionnaire took about 10 min to complete. Of the 1,600 invited participants, 257 started to complete the questionnaire, but indicated they were either only attracted to opposite-sex partners, did not know which sex they felt attracted to, or were attracted to neither men nor women.1 These participants were notified that their willingness to participate was appreciated, but that they did not belong to the target population of the survey. A small number of individuals started, but did not complete the questionnaire (n = 27) and 253 individuals did not start the questionnaire at all. This yielded a sample of 1,063 participants (response rate, 79.2 %). Since the sample size was restricted to 1,000 participants (for reasons related to funding), 63 individuals (the number of participants who started the questionnaire after the limit of 1,000 participants was reached) received a notification after starting the questionnaire that their participation was appreciated, but no longer required. Hence, the final sample size of the panel sample was 1,000. LGB Community Sample The LGB community sample was recruited between October and December 2010. Participants were requested to complete a ‘‘Pink Questionnaire’’ through a website carrying the same name (www.rozevragenlijst.nl) which also contained information regarding the study, target population, funding, aim of the study, and contact details of the research team. Individuals 16 years or older with LGB feelings living in the Netherlands were invited to visit the website and complete a questionnaire on LGB issues. The invitation explained that the study was conducted on behalf of the Dutch government to assess the situation and acceptance of LGB individuals in the Netherlands and that everyone who (also) had feelings for same-sex individuals could join the survey, regardless of whether they considered themselves LGB individuals. Invitations were sent out by all major national LGB organizations and communities as well as through local and small-scale organizations serving a particular geographical area or subpopulation (e.g., LGB migrants). Accounts were made on Facebook, Hyves, and Twitter and friend-request were sent out to eminent LGB people (e.g., well-known LGB activists, writers, politicians, and so on). Editorials and ads carrying the same message were placed in LGB media and similar flyers were distributed at LGB parties/events. In addition to the LGB 1
The differences with the screening question in August might be due to the fact thatin August participantswere askedabout theirsexualattraction,while in March people were asked about their attraction in general.
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venue recruitment, recruitment took place though the general media. A press release was sent out and picked up by various general news websites and radio stations. The questionnaire took about 20 min to complete. In total, 7,146 participants started the questionnaire. Of these participants, 166 indicated that they only felt attracted to opposite sex partners or to no one at all (2.3 %). These participants received a notification that their willingness to participate was appreciated, but that they did not belong to the target population of the survey. Around a fifth (n = 1,483, 21.3 %) did not complete the questionnaire (41.0 % already stopped during the first three items, all other items had drop-out rates below 1.0 %). In total, 5,663 participants (81.1 %) completed the questionnaire. Another 243 participants were removed from the final sample due to various reasons, such as completing the questionnaire more than once (n = 76) or being younger than 16 (n = 93). This left us with 5,420 participants. As the panel sample only consisted of individuals 18 years and above, participants from the community sample aged 16 or 17 were removed from the sample (n = 336). All participants recruited at the LGB venues completed a question on how they found out about the survey [1 = social media (Facebook, Hyves or Twitter); 2 = LGB website or mail ing list; 3 = general website not aimed at LGB individuals; 4 = flyer at LGB party, bar, or cafe´; 5 = through a friend; 6 = other, namely…]. Since the aim of the current study was to compare a sample of LGB individuals recruited at LGB venues (specifically mentioning LGB issues) with a sample of LGB individuals recruited though a general venue (with a general invitation), participantswhoindicatedthattheywereonlyinformedaboutthe study through a general, non-LGB venue were removed from the sample. Hence, participants providing the answer‘‘3’’or‘‘5’’were deleted from the current sample (n = 213 and n = 1167) as were those individuals who answered‘‘6’’and of which we could not be sure that they were invited through an LGB specific venue (n = 301). This yielded a final community sample of 3,403 partic ipants. The social demographic characteristics of both samples can be found in Table 1. The mean age of the panel participants was 48.46 years (SD = 13.91). Six out of every ten participants were men. Around half of the participants (52.7 %) had a higher education, while 13.6 % had a lower education. Of the panel participants, 61.1 % currently were currently employed and 39.5 % were currently religious. Eleven percent were born outside the Netherlands. Slightly more than 60 % (61.4 %) lived in an urban area. The mean age of the community participants was 37.08 years (SD = 13.82). Slightly more women (53.9 %) than men (46.1 %) participated. Only a small percentage had a lower education (8.6 %) while many participants had a higher education (61.3 %). A third were currently religious and the majority of the community sample (74.6 %) was employed. Migrants made
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Table 1 Characteristics of the samples (valid percentages, means, and SDs) Community sample (N = 3,403)
Panel sample (N = 1,000)
Male
46.1
60.0
Female
53.9
40.0
18–24
25.2
4.8
25–24
22.2
13.1
35–44
21.9
21.4
45–54
17.8
25.8
55–64
10.3
22.2
C65
2.7
12.7
Lower
8.6
13.6
Middle
29.2
33.2
Higher Currently employed (%)
61.3 74.6
52.7 61.6
Currently religious (%)
33.3
39.5
Native Dutch
86.3
89.0
Other
13.7
11.0
Rural
34.0
38.6
Urban
66.0
61.4
Sex (%)
Age (%)
Education (%)
Ethnicity (%)
Urbanicity (%)
Sexual attraction (%) Only same-sex
69.2
52.3
Mostly same-sex
19.3
18.0
Both sexes equally
7.1
15.0
Mostly opposite sex
4.4
14.7
88.3 11.7
71.0 29.0
Open to mother (%)
93.2
77.9
Open to colleagues (%)
88.3
82.3
Negative reactions (M, SD)
1.58 (.84)
1.23 (.53)
Internalized homonegativity (M, SD)
1.87 (1.15)
1.99 (1.14)
Psychological distress (M, SD)
2.57 (.87)
2.30 (.89)
Suicidal thoughts (M, SD)
1.86 (1.01)
1.64 (.91)
Suicidal plans (%)b
34.2
32.9
Sex current partner (%)
a
Same-sex Opposite-sex
Rangesoftheintervalvariableswere: negative reactions(min = 1; max = 5), internalized homonegativity (min = 1; max = 5), psychological distress (min = 1; max = 6), and suicidal thoughts (min = 1; max = 5) a
The item was only completed by participants who were currently in a relationship
b
The item was only completed by participants who reported that they have had thoughts about ending their lives
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up 13.7 % of the community sample. Almost two-thirds (66.0 %) lived in a city. Measures Even though both questionnaires contained more items, especially the community sample questionnaire, the current study only used the items that were included in both surveys and that were phrased in the same way in both questionnaires. The descriptives of all included measures are shown in Table 1. Sociodemographics All sociodemographics were measured by simple questions. Sex was measured by asking participants whether they were male or female. Age was measured by asking the participants to provide their year of birth, from which their age in years was calculated. Education was measured by three questions: highest level of education attained, currently following education, and level of current education. The Dutch educational levels were recoded to represent lower, middle, and higher educational levels. For young people still following education, this was based on the level of education they were currently following. For the others, education was based on highest level of education attained. Current employment was assessed by a question on whether participants currently held a paid job (1 = yes; 2 = no). Ethnicity was assessed by three items: mother’s country of birth of, father’s country of birth, and participant’s country of birth. In line with the Dutch standard for coding ethnicity, participants of whom either one parent or who themselves were born in a non-Western country (mostly Morocco, Turkey, or Surinam) were categorized as having a non-Western background. Others were coded as having a Western background. Religion was assessed by one question whether participants currently hold a religion and, if so, which religion. The answers were recoded into a dichotomous variable indicating whether participants were currently religious. Urbanicity was measured by asking the participants four digits of their postal code. While this does not allow for identification, it does provide the urbanicity of their place of residence. The degree of urbanization was recoded into a dichotomous variable (0 = urban; 1 = rural). Sexual Orientation Characteristics Sexual attraction was measured by one item:‘‘Who do you feel attracted to (1 = only to women; 2 = mostly to women, but also to men; 3 = to men and women equally; 4 = mostly to men, but also to women; 5 = to women only; 6 = don’t know; 7 = neither to men nor to women).’’The answers were recoded into a variable indicating to which degree participants reported same-sex and opposite-sex attraction (1 = same-sex only; 2 = mostly same-sex; 3 = both sexes equally; 4 = mostly opposite sex)
(participants exclusively attracted to the opposite sex were not included in the survey; participants who did not know their sexual attraction or did not have any sexual attraction to men and women were omitted from the analyses). Sex of partner was assessed by two items. Participants were asked whether they were currently in a relationship (a love affair of at least 1 month) and, if so, if they were in a relationship with a man, a woman, or both. The answers of those currently involved were recoded into a variable indicating whether participants were currently in a same-sex relationship (0) or in an opposite sex relationship (1). Seven participants indicated that they were currently involved with a man and a woman. These participants were excluded from these analyses.
Minority Stressors Openness was assessed in two areas: openness to mother (‘‘Does your mother know you are attracted to same-sex partners?’’; 1 = yes; 2 = no; 3 = don’t know; 4 = not applicable) and openness to colleagues (‘‘Do your close colleagues know that you are attracted to same-sex partners?’’; 1 = yes; [almost] all; 2 = some do, some don’t; 3 = none; 4 = don’t know; 5 = not applicable). Both questions were recoded to whether one’s mother or colleagues know (0 = no, 1 = yes). Negative reactions were assessed by asking participants whether they had had any negative experiences or reactions during the past 12 months because they were (also) attracted to same-sex partners (1 = no; 2 = once; 3 = a few times during the year; 4 = at least once a month; 5 = at least once a week). Internalized homonegativity was measured by one statement to which the participants had to react:‘‘If I could change my sexual orientation and become heterosexual, I would do that’’ (1 = totally agree, 5 = totally disagree). The item was recoded with higher scores indicating higher levels of internalized homonegativity. Mental Health Psychological distress was assessed by a Dutch version of the MHI-5 (Ware & Konsinki, 2001). The MHI-5 measures the frequency of five health feelings during the preceding four weeks on a 6-point scale (1 = all the time; 6 = never). Examples of items were ‘‘very nervous,’’‘‘down and sad’’ or ‘‘calm.’’The negative items were scored in reverse and mean scores were calculated. A higher score is indicative of more distress (Cronbach’s alpha = .88). Suicidality was measures by two items: whether participants ever thought about ending their lives (1 = never; 5 = very often) and, if they did, whether they ever made a plan to end their life (1 = never; 3 = more than once). The last question was recoded and reflected whether participants ever planned to commit suicide.
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Statistical Analyses Differences between the community sample and the panel sample were assessed by conducting logistic regression analysis (LRA) with the type of sample as the dependent variable (0 = community sample, 1 = panel sample). The differences between the samples in terms of sociodemographics were assessed with one LRA including all available demographics. The analyses examining differences in sexual attraction, sex of partner, openness to mother and colleagues, negative reactions, internalized homonegativity, psychological distress, and suicidality were all conducted separately (i.e., one LRA for each measure). These analyses controlled for differences in sociodemographic characteristics and conducted separately for women and men. The relationship between minority stress and mental health (psychological distress and suicidality) was examined by multiple regression analysis (MRA) conducted in each sample (i.e., community sample and panel sample) separately. The MRA also controlled for sociodemographic characteristics, but due to the smallernumberofparticipants related to the separate analysesfor each sample, the MRA was not run separately for women and men. The level of significance was set at .01 (because of the large number of analyses and in order to minimize the chances on Type I errors). All analyses were conducted with SPSS (version 11).
Results Sociodemographics The overall models of men, v2(6, 2170) = 195.28, p\.001, Nagelkerke R2 = .13, and women, v2(6, 2233) = 281.13, p\ .001, Nagelkerke R2 = .20, were significant, indicating differences in sociodemographics between the community sample and the panel sample. As shown in Table 2, the majority of the other characteristics did not differ between the samples. Community LGBs and panel LGBs were similar in terms of education, religiousness, ethnicity or urbanity. In terms of employment, community men and panel men also did not present any differences. The only difference between the two groups of men was age: panel men were older than community men. The same difference also held true for women while, in addition, panel women were more often unemployed than community women. Sexual Orientation All models pertaining to sexual orientation characteristics were significant and showed differences between both samples in terms of sexual attraction among men, v2(9, 2145) = 278.86, p\.001, Nagelkerke R2 = .18, and women, v2(9, 2207) = 393.20, p\.001, Nagelkerke R2 = .27, and in sex of current partner among men, v2(1, 1142) = 111.27, p\.001, Nagelkerke
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Table 2 Differences in social demographic characteristics between community and panel sample Men
Age
OR
Wald
OR
Wald
1.05
135.96***
1.06
196.02***
.94
3.40
.93
1.02 1.06
.04 .28
.52 .83
.86
.87
.83
1.01
1.15
1.67
1.27
3.59
Education Employment Religious Ethnicity Urbanicity
Women
2.66 26.79*** 2.04
The dependent variable was type of sample (0 = community sample; 1 = panel sample) ***p\.001
Table 3 Differences in sexual orientation characteristics between community and panel sample Men OR
Women Wald
OR
Wald
Attraction Only same-sex
Ref
Mostly same-sex Both sexes equally
1.64 3.43
11.63** 37.99***
Ref 1.39 3.84
4.16* 54.85***
Mostly opposite-sex
4.26
51.63***
6.13
82.72***
Sex current partnera Same-sex partner
Ref
Opposite-sex partner
3.06
Ref 36.19***
3.07
35.91***
The dependent variable was type of sample (0 = community sample; 1 = panel sample). All analyses were controlled for social demographics (age, education, employment, religiousness, ethnicity, and urbanicity). Separate analyses were run for attraction (Nmen = 2,145; Nwomen = 2,207) and sex current partner (Nmen = 1,142; Nwomen = 1,197) *p\.05; **p\.01; ***p\.001 a
Item was only completed by participants currently in a relationship
R2 = .13, and women, v2(7, 1197) = 155.95, p\.001, Nagelkerke R2 = .19. Table 3 shows that both male and female panel participants were more likely than community men and women to report mostly same-sex, both-sex, and mostly opposite-sex attraction rather than exclusive same-sex attraction. The more attraction to opposite-sex partner, the higher the likelihood of belonging to the panel sample. Community men and women were three times more likely to have a same-sex partner than an opposite-sex partner. Minority Stressors Among men, the models for openness towards mother, v2(7, 1504) = 307.71, p\.001, Nagelkerke R2 = .26, openness towards colleagues, v2(6, 1479) = 100.74, p\.001, Nagelkerke
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R2 = .10, negative reactions, v2(7, 2121) = 235.38, p\.001, Nagelkerke R2 = .15, and internalized homonegativity, v2(7, 2149) = 208.08, p\.001, Nagelkerke R2 = .13, were all significant. In addition, Table 4 shows that all minority stress measures differed between the two samples of men. Among women, the models for openness towards mother, v2(6, 1769) = 120,99, p\ .001, Nagelkerke R2 = .25, openness towards colleagues, v2(7, 1481) = 123.25, p\.001, Nagelkerke R2 = .14, negative reactions, v2(7, 2159) = 338.07, p\.001, Nagelkerke R2 = .24, and internalized homonegativity, v2(7, 1504) = 281.17, p\.001, Nagelkerke R2 = .20, were also significant, but not all models showed that the female samples differed in terms of minority stressors (see Table 4). Among both men and women, the community participants’ mothers more often knew about the same-sex attractions of the participant than the mothers of the panel participants. For close colleagues, the same was true for men: colleagues from community participants more often knew about their same-sex attractions than those of panel participants. Women from both samples did not differ with regard to openness towards close colleagues. The male and female community participants reported more frequent encounters of negativereactionsorexperiencesduetotheir same-sex attractions. Among men, panel participants reported higher levels of internalized homonegativity than community participants. Among women, this difference was not found. Mental Health Three aspects of mental health were examined of which all three models were significant among men: psychological distress, v2(7, 2142) = 219.17, p\.001, Nagelkerke R2 = .14, suicidal
thoughts, v2(7, 2138) = 214.77, p\.001, Nagelkerke R2 = .14, and suicide plans, v2(7, 1041) = 57.55, p\.001, Nagelkerke R2 = .08. The same was true for the models pertaining to women: psychological distress, v2(7, 2210) = 287.67, p\.001, Nagelkerke R2 = .20, suicidal thoughts, v2(7, 2198) = 268.59, p\.001, Nagelkerke R2 = .19, and suicide plans, v2(7, 1150) = 121.29, p\.001, Nagelkerke R2 = .17. As shown in Table 5, the two samples of men differed in all aspects of mental health. Panel men, compared to community men, reported lower levels of psychological distress, lower levels of suicidal thoughts, and lower levels of actual plans for suicide. However, women from the two samples only differed in level of psychological distress: women recruited at LGB venues reported more distress than women recruited from a general sample. No significant differences in suicidality were found among women. Relationships Between Minority Stress and Mental Health The last research question addressed the issue of possible differences in the relationships between minority stress and mental health for both samples. Table 6 shows the results of the analyses. As shown in Table 6, there were no large differences in the relationships between both samples. The mod els for psychological distress were significant in the community sample, F(11, 2479) = 31.32, p\.001, adjusted R2 = .12, and the panel sample, F(11, 729) = 9.99, p\.001, adjusted R2 = .12. In both samples, more psychological distress was related to less openness towards one’s mother, encountering more negative reactions or experiences related to one’s same-sex attractions, and to higher levels of internalized homonegativity.
Table 4 Differences in minority stressors between community and panel sample Men OR
Women Wald
OR
Wald
Table 5 Differences in mental health characteristics between community and panel sample Men
Openness Openness mother No Yes
Ref .32
33.77***
Ref .26
Psychological distress 43.68***
Openness colleagues Ref
Yes
OR
Wald
OR
Wald
.73
25.13***
.81
8.39***
.74
23.26***
.92
1.84
Suicidality Suicidal thoughts
No
Women
Suicidal plansa
Ref
.38
28.00***
.57
6.30
No
Ref
Ref
Ref
Ref
Negative reactions
.60
36.38***
.38
54.06***
Yes
.06
35.36***
1.02
.01
Internalized homonegativity
1.17
12.95***
1.01
.04
The dependent variable was type of sample (0 = community sample; 1 = panel sample). All analyses were controlled for social demographics (age, education, employment, religiousness, ethnicity, and urbanicity). Separate analyses were conducted for openness mother (Nmen = 1,504; Nwomen = 1,769), openness colleagues (Nmen = 1,479; Nwomen = 1,481), negative reactions (Nmen = 2,121; Nwomen = 2,159), and internalized homonegativity (Nmen = 2,149; Nwomen = 2,212) ***p\.001
The dependent variable was type of sample (0 = community sample; 1 = panel sample). All analyses were controlled for social demographics (age, education, employment, religiousness, ethnicity, and urbanicity). Separate analyses were conducted for psychological distress (Nmen = 2,142; Nwomen = 2,210), suicidality thoughts (Nmen = 2,138; Nwomen = 2,198), and suicidality plans (nmen = 1,041; nwomen = 1,150) ***p\.001 a
Item was only completed by participants indicating they have had suicidal thoughts
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Arch Sex Behav Table 6 Differences in relationship between minority stressors and mental health in community and panel sample Psychological distress Community b Openness mother
Suicidal thoughts Panel b
t
Community t
b
2.64**
-.01
Panel b
t -.27
t
-.07
-3.37***
-.11
Negative reactions
.13
6.68***
.13
3.39***
.12
6.03***
-.01 .12
-.11 3.18***
Internalized homonegativity
.16
8.21***
.12
3.21***
.10
5.11***
.07
1.89
All analyses were controlled for social demographics (sex, sexual orientation, age, education, employment, religiousness, ethnicity, and urbanicity). Separate analyses were run for psychological distress (Ncommunity = 2,480; Npanel = 730) and suicidality thoughts (Ncommunity = 2,138; Npanel = 718) **p\.01; ***p\.001
The amount of explained variance and the standardized betas in both samples were of comparable size. The models for suicidality in the community sample, F(11, 2483) = 14.41, p\.001, adjusted R2 = .06, and the panel sample, F(11, 717) = 5.53, p\.001, adjusted R2 = .07, were both significant. In both samples, no significant relationship was found between suicidality and openness to one’s mother and, in both samples, a relationship was found between suicidality and higher levels of negative reactions. In the community sample, more frequent thoughts about suicide were related to higher levelsofinternalizedhomonegativity,whilethisrelationship was not significant in the panel sample (p = .06). It is important to note that the lack of significance in the panel sample might be due to the smaller sample size of this sample, since the size of the betas did not differ greatly and the p value approached significance.
Discussion Convenience samples of LGB individuals recruited at LGB venues have certain benefits (for overviews, see Corliss et al., 2009; Meyer & Wilson, 2009; Rothblum, 2007). Benefits include the relatively low costs, the possibility to recruit samples large enough to allow for comparisons between subgroups of LGB individuals (such as older and younger participants), and the creation of a platform for research recruitment as well as interventions due to community involvement. However, convenience samples of LGB individuals recruited at LGB venues also have a major drawback: the samples might be prone to several biases due to the selective recruitment. The current study examined in which ways a sample of LGB participants recruited at various community venues differed from a sample of LGB participants recruited from a general research panel. In general, many differences were found in the estimates of social demographics, sexual orientation, minority stressors, and health, while few differences were found in the relationships between these constructs. Most of the social demographics did not differ between community and panel LGB individuals. Among men, only age differed: community men were somewhat younger than panel
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men. Community women were also younger than their panel counterparts, while the latter were more often unemployed. Previous studies also found more similarities than differences in social demographics between gay men/MSM recruited from general or venue samples (Evans et al., 2007; Meyer & Colten, 2008), although the results were mixed. For example, while Sandfort (1997) reported that venue men were higher educated and older than general men, Meyer and Colten (2008) and Dodds et al. (2006) reported no age or educational differences, and Evans et al. (2007) reported similar educational levels in both groups, but younger men in the venue sample. The different results might be explained by differences between LGB communities from different times and places. For example, with the age of coming out in the Netherlands decreasing (De Graaf, Kruijer, Van den Akker, & Meijer, 2012), the age at which LGB individuals might become involved in the LGB community could also drop. This might explain that some 15 years ago Sandfort (1997) found that community men were older than general men, while the opposite was found in the current study. In addition to possible differences between times and places, the various studies differed in the ways in which the community samples were recruited. While the current study used online and offline LGB venues, Dodds et al. only recruited at offline MSM venues, and Evans et al. recruited only online. Since these venues might attract different LGB individuals (e.g., it seems likely that LGB individuals visiting websites are relatively young), this could also contribute to the mixed results. Large differences were found for sexual orientation: for panel men, the odds of being attracted to a certain degree to both men and women were larger than the odds of being attracted to only men. Odds for panel men were also three times larger to be in a relationship with an opposite-sex partner (vs. relationship with a same-sex partner). For women, comparable results were found. This is in line with previous studies showing that bisexual individuals are relatively underrepresented in community samples (Dodds et al., 2006; Evans et al., 2007; Harry, 1986). This might be explained by a gay and lesbian focus in the LGB community. Bars, clubs, parties, and websites of Dutch LGB venues concentrate more often on gay and/or lesbian individuals
Arch Sex Behav
than on bisexual individuals. Hence, recruiting participants at LGB venues yields a sample in which individuals who are to a more or lesser degree also attracted to opposite-sex partners are underrepresented. LGB participants recruited at community venues were more open about their orientation to their mother (Nagelkerke R2men = .26; Nagelkerke R2women = .25) and to their colleagues (men only, Nagelkerke R2 = .10), received more negative reactions on their orientation (Nagelkerke R2men = .15; Nagelkerke R2women = .24), and experienced lower levels of internalized homonegativity (men only, Nagelkerke R2 = .13). Some of these findings were in line with the results of Meyer and Colten (2008) who also reported that venue GB men were more likely to be out and reported lower levels of internalized homonegativity. These findings make intuitive sense. When LGB individuals are involved in the LGB community, it is more likely that they are open about their LGB orientation. Also, being part of an LGB crowd or network might create a buffer against internalized homonegativity (Cox, DeWaele, van Houtte, & Vincke, 2011; Cox, vanden Berghe, DeWaele, & Vincke, 2010). Online and offline LGB community involvement might enhance the chances of receiving negative reactions due to the increased visibility of one’s LGB status. With regard to mental health, community men reported higher levels of psychological distress and suicidality than panel men (Nagelkerke R2distress = .14; Nagelkerke R2suicidal thoughs = .14; Nagelkerke R2suicidal plans = .08). Community women reported elevated levels of psychological distress (Nagelkerke R2distress = .20). This is in line with previous findings suggesting that venue men are less likely to report good health (Evans et al., 2007). A possible explanation is that by being involved in the LGB community, individuals are confronted with negative reactions or discrimination received by others and more likely to receive information about the negative treatment of LGB individuals in other places and times. This might enhance one’s own sense of vulnerability or stigma consciousness which, in turn, is related to mental health problems (Vanden Berghe, DeWaele, Cox, & Vincke, 2010). In the same line of reasoning, being part of the LGB community might also enhance the willingness to report problems due to political reasons. Due to an enhanced awareness of many of the problems faced by the LGB community, problems might be reported by its members more frequently in order to increase the changes of policy change and budget allocation. Another explanation might be that those with elevated levels of mental health problems might more often turn to the LGB community to seek social support of similar others. The differences in levels of minority stress and mental health problems between community and panel LGB individuals might alsobeexplainedbyfactorsthat differbetweenthesesamplesand were not included in the current study. One possible candidate is gender non-conformity. Several studies show that gender nonconformity is an important risk factor for receiving negative reactions as well as for health problems (Baams, Beek, Hille,
Zevenbergen, & Bos, 2013; Roberts, Rosario, Slopen, Calzo, & Austin, 2013; Toomey, Ryan, Diaz, Card, & Russell, 2010). In the Netherlands, gender non-conformity is also more frowned upon than an LGB orientation (Keuzenkamp & Kuyper, 2013). Because of this rejection by general society, gender non-conforming LGB individuals might be more likely to join the LGB community. If this is true, higher levels of gender non-conformity among community participants might explain higher levels of negative reactions and health problems. While the estimates of sexual orientation, levels of minority stress, and mental health problems were strongly influenced by the sampling venue, the relationship between these constructs was not. The betas in the multivariate analyses which explored the relationships between minority stressors and mental health problems did not vary greatly between the community sample and the panel sample. Openness, internalized homonegativity, and negative reactions were related in comparable ways to psychological distress and suicidality in both samples. Limitations The current study had several limitations. First of all, a general online-access panel was used as the comparison group for the LGB community sample. While online-access panels are not biased in the sense that they recruit participants at LGB venues, they are not truly random probability samples. Secondly, several constructs included in the current study were measured by only one item. While social demographics, sexual orientation, and psychological distress were measured by extensive or reliable measures, such as the MHI-5, minority stressors and suicidality were measured by a single item and several items (such as openness) would have benefitted from the use of more refined answer categories. The reliability of these findings could be increased if issues such as negative reactions and internalized homonegativity were measured by validated multi-item scales instead. It remains to be seen whether future studies using more sophisticated and validated measures for these constructs find the same results. Besides improving the sample selection and measurement of several topics, future studies are also encouraged to include other issuesthat might differbetween the samples and/orexplain the various differences in, for example, minority stress and health. As already mentioned above, gender non-conformity would be a suitable candidate. Another thing that should be kept in mind when interpreting the current results is that the study was conducted in the Netherlands, a country known for its relatively positive attitude and legislation towards homosexuality and bisexuality (Kuyper, Iedema, & Keuzenkamp, 2013). This may have influenced the current results. Differences between LGB community samples and panel or population samples could be different in other social contexts. It would be interesting to examine these issues in less tolerant countries.
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Conclusion The current study showed that prevalence estimates of sexual orientation, minority stressors, and mental health problems can be severely biased when using LGB community samples. At the same time, the current results also provide reassurance since they showed that relationships between several constructs did not differ greatly in LGB community and panel samples. An increased and reliable understanding of the living conditions of LGB individuals is probably best reached by combining both sources of data. Population studies increasingly add questions about sexual orientation to their questionnaires allowing for reliable estimates of health problems for LGB individuals. For example, items with regard to sexual orientation are included in editions of BRFSS, NSFG, GUTS, Add Health, and, outside the United States, in the Integrated Household Survey (United Kingdom) and the Dutch National Survey of General Practice (the Netherlands). However, large-scale population studies generally do not offer the possibility to include items on LGB specific issues, such as internalized homonegativity, openness about LGB orientation, or having an LGB network. Future studies carried out online (which allows for elaborate tailoring) might consider including a module with questions about specific LGB issues for LGB participants. Alternatively, with the quality of online-access panels increasing, online panels seem useful for recruiting LGB community samples for providing estimates on the prevalence of these specific LGB issues. Especially LGB studies that aim to include a significant proportion of participants who are also attracted to opposite-sex partners, a group shown in general population studies to be especially vulnerable to health problems (Corliss, Rosario, Wypij, Fisher, & Austin, 2008; Jorm, Korten, Rogers, Jacomb, & Christensen, 2002; Marshal et al., 2008; Saewyc et al., 2009), should turn to other recruitment methods than LGB community venues. However, studies with LGB community samples also remain valuable. Not only because they seem to offer a realistic picture when examining risk and resilience factors, but also because this type of recruitment offers the opportunity to connect with the LGB community which can simultaneously create a platform for interventions or community outreach. Acknowledgments We would like to acknowledge the funding for the data collection by the Dutch Ministry of Education, Culture, and Science and the role played by Jantine van Lisdonk, Niels Kooiman, and Diana van Bergen in the design and logistics of this study. While the idea of the study had been in our heads for a while, the online discussion between Dr. Cochran and Dr. Meyer on LGB sampling issues in the beginning of 2013 encouraged us to write it down.
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