Health Risk Behavior Variations between Rural and Urban Gender and Sexual Minorities

objectives: There is a critical shortage of both public health research and health-related programming and services that specifically consider the distinct health risks of rural gender and sexual minorities. Therefore, the goal of the current study was to examine rural-urban differences across 28 health risk behaviors among gender and sexual minorities (GSM; i.e., lesbian, gay, bisexual, queer, pansexual/omnisexual, transgender, genderqueer, nonbinary, and/or gender non-conforming) in a large, geographically-diverse sample.

methods: As part of a parent study, a sample of 3,279 self-identified gender and sexual minorities was recruited online via listservs and Craigslist advertisements, with participation from all 50 US states. Participants completed a demographics assessment that assessed rurality and an inventory of 28 separate health risk behavior frequencies. To compare level of engagement in each of the risk behaviors between rural and urban participants, a series of Mann-Whitney U-tests were conducted.

results: Rural-urban differences emerged in 10 of the 28 investigated health behaviors, within 9 of these 10 differences impacting rural GSM. Namely, rural GSM were found to have less healthy diets, engage in more motor vehicle risk and aggressive behaviors, to smoke more frequently, and to have riskier medical care engagement behaviors.

conclusions: It appears that rural GSM engage in even higher levels of behavioral risk-taking than their urban counterparts, suggesting that rural GSM are doubly impacted by health risk behavior disparities rooted in gender identity/sexual orientation and location of residence. These differences underscore the dire need for health promotion interventions designed specifically to reach the rural GSM community.