The Impact of Community Involvement, Religion, and Spirituality on Happiness and Health among a National Sample of Black Lesbians
The health and health-care research community is slowly turning its attention to LGBT (lesbian, gay, bisexual, transgender) people of color. This study advances such efforts by exploring the relative impact of engagement in the LGBT community, religiosity, and spirituality on self-reported happiness and overall health among a national sample of black lesbians. Employing OLS (ordinary least squares) regression analysis, we find that having a higher household income, being in a romantic relationship, and having higher levels of spirituality are robust predictors of happiness, while being younger, having a higher household income, a regular health-care provider, no religious affiliation, and higher levels of spirituality all predict increased levels of self-reported overall health. We conclude that access and spirituality are key factors shaping happiness and health among black lesbian women. Future research should build upon this finding and the limited number of works exploring the unique capacities of spirituality as practiced among this population to promote positive health behaviors and shape health-related policy.
Introduction
Over the last two decades, federal legislation and initiatives have evolved in recognition of a greater need to reduce health disparities across marginalized populations (Allen and Meadows-Oliver 2012; Baker and Krehely 2011; Boehmer 2002; Mayer et al. 2008). While health-care researchers and practitioners have begun to give more attention to disparities across racial-ethnic lines and sexual-minority communities, it is less frequent that we focus on the experiences of LGBT people of color (Wilson and Yoshikawa 2007). Research on LGBT people is often homogenizing, obscuring the unique health needs and behaviors within the LGBT population (Bostwick et al. 2010; [End Page 1] Cochran et al. 2007). What has been referred to as “triple jeopardy” (Greene 1994)—the unique challenges faced by women who identify as black1 and lesbian necessitate further inquiry into health-care accessibility and outcomes for this population (Battle and Crum 2007; Dibble et al. 2012).
That LGBT people fare worse than the general population on many health-related outcomes is well documented. But recent work has shown that black lesbian women face unique health-related challenges. For example, though, compared to heterosexual women, lesbians and bisexual women overall are at greater risk for certain cancers, black lesbian women face barriers to health-care access that impede the likelihood of early detection and treatment of many chronic illnesses (Bowen et al. 2007; Cochran 2001; Council of Scientific Affairs 1996; Fingerhut et al. 2010; McAleavey et al. 2011; McCabe et al. 2010; Wilson and Yoshikawa 2007). And while research shows that LGBT people have higher likelihoods of suffering major depression and anxiety disorders (Cochran et al. 2003; Gilman et al. 2001), analysts have hypothesized that the experience of stigma puts lesbians of color at even greater risk for mental health challenges (Greene 1997; Phillip 1993). A rare study utilizing a national sample of sexual-minority women found evidence of psychological distress among black sexual-minority women to be significantly higher than that of black women in the general population (Mays et al. 2003).
Even as health researchers begin to take more seriously the health-related implications of simultaneously occupying a multitude of oppressed social locations, very little is known regarding how black lesbian women think about and assess their own happiness and health. Research provides evidence that women are (moderately) happier than men (Easterlin 2001); that the happiness gap, which once favored women, is closing and expected to shift (Stevenson and Wolfer 2009); that married men and women report higher levels of well-being compared to cohabitors of same or different sexes (Denney et al. 2013); that whites are far happier than blacks, even after controlling for factors like SES (socioeconomic status) and perceived discrimination (Davis 1984; Hughes and Thomas 1998); and that the negative effect of low SES is exponentially greater than the positive effect of high SES when it comes to self-reports of health (Yang 2008). Given these findings, it stands to reason that the cumulative disadvantages that accrue to black lesbian women would negatively impact their sense of happiness and health. A recent study (Liu et al. 2013) concerned with the health implications of legalizing same-sex marriages compared self-reported health across different-sex married and nonmarried women and same-sex cohabitating [End Page 2] women. In the presence of SES, same-sex cohabitating women had higher odds of reporting fair or poor health than did their different-sex married counterparts, suggesting a health benefit linked to the economic rights afforded legally married couples. Additionally, the health benefit of same-sex cohabitation relative to different-sex nonmarried women only held for white women, suggesting that black lesbian women not only lacked a health benefit derived from the inability to enter into unions with full marriage rights, but they also looked more like nonmarried black women who were more likely to report fair or poor health compared to white lesbian women who did experience health benefits compared to their different-sex non-married counterparts. That we are just beginning to explore self-reports of happiness and overall health among this population speaks volumes, given the general belief that one measure of the success of our democracy is the attention we give to each individual’s assessment of her well-being (Diener 2000).
The Social Justice Sexuality (SJS) Project explores the impact of occupying positions of intersecting marginal identities and describes the dynamic experience of LGBT people of color. Employing data from the SJS Project, this article addresses the specific experience of black lesbians as they relate to self-reports of happiness and health. Of particular interest are the relationships between engagement in the LGBT and person of color (POC) communities, religiosity and spirituality, and self-reports of happiness and overall health.
Literature Review
By occupying uniquely intersecting categories of race, gender, and sexual orientation, black LGBT people inhabit a peculiar location of identity (Battle and Lemelle 2002; Collins 2004; Crenshaw 1991; Ward 2005). Therefore, some argue that black LGBT people may have primary allegiance to either the black community or the LGBT community. Concomitantly, as it specifically applies to individuals who are both members of racial and sexual minorities, researchers have raised major concerns when a disconnect exists between how people are identified/labeled and how they behave or might label themselves (Young and Meyer 2005). By definition, the power to name a group or an experience is informed (and therefore biased) based on one’s attitude or cultural experience (Gergen 2001). Further, self-identity labels vary across time, geography, age, cohort, period, race, gender, and other demographic variables (Adam et al. 1999; Altman 2001; Battle et al. 2002; Ponse 1998). Therefore, assuming how, when, or even if racial- or sexual-minority status is [End Page 3] more salient than the other can be (inadvertently) racist, sexist, homophobic, and/or some combination of all three (Collins 2004; Crenshaw 1991; Glenn 2000; Stewart and McDermott 2004).
Solarz (1999) has identified lack of access to health care as an obstacle that disproportionately impacts LGBT people. Many lack insurance and are unable to receive benefits from their partners’ employment packages, as heterosexual spouses are entitled (O’Hanlan et al. 1994). A recent study utilizing a sample of over 400,000 women to analyze differences in health insurance ownership, access to health services, and health outcomes between women in lesbian-versus-heterosexual relationships found that women in lesbian relationships were less likely to have insurance coverage, to have had a regular physical in the past year, or to have had a recent mammogram or Pap test (Buchmueller and Carpenter 2010). They were also more likely to report unmet medical needs. Diamant and colleagues (2000) have suggested that a diminished capacity to seek health services decreases the likelihood that lesbians will be screened for risk factors tied to substance use. Black lesbian women—who are already predisposed to negative mental and health outcomes, as well as facing the burden of triple oppression in seeking and obtaining adequate healthcare services—have a greater likelihood of lacking health insurance and not receiving preventative care (Dean et al. 2000; Mays et al. 2003).
The unique social location of black lesbian women requires that we consider how membership in multiple and overlapping minority groups shapes their self-reports of happiness and health (Institute of Medicine 2011; Miller 2001; Scout and Fields 2001). To that end, we consider literature that speaks to the ways in which black lesbian women interact within LGBT and POC communities as such interactions influence health-related outcomes. Additionally, given the paradox of the black church’s historical role as both an indispensible source of comfort for those pursuing social justice and the simultaneous bulwark of conservative views on human sexuality (Ward 2005), we also consider how black lesbian women engage religion and spirituality in relation to self-reported happiness and health. We begin with a brief overview of black people’s experiences with the black church, black people’s continued embrace of religiosity and spirituality, and the innovative ways in which black lesbians have responded to the church and their own spiritual identities. We then consider the role of other forms of LGBT/POC community engagement and the influence of such engagements for self-reports of happiness and health. [End Page 4]
Religion and Spirituality
The relationship between the LGBT community and mainstream American religious organizations is complex—fraught with moments of great tension and life-affirming transformation. Though there has been a growth of “gay-accepting/-positive” churches, as well as increases in the numbers of “out” members of more traditional religious institutions (Comstock 1996; Rodriguez and Oullette 2000; Shaw and McDaniel 2007), many members of the LGBT community have had to rework their relationships with organized religion and retool their spiritual identities, rejecting religion altogether (Truluck 2000), distancing themselves from mainstream religious institutions but maintaining belief in the sacred and/or attempting to reconcile their identities with church dogma (Barton 2010; Johnson 1998). Such efforts often have direct and indirect implications for health behaviors and perceptions of health, which differ across race and socioeconomic status (Franzini et al. 2005; Scandrett 1994). Because of the well-noted historical significance of the black church in American freedom struggles (Pinn 2002, 2006) and blacks’ persistently high levels of religiosity and spirituality, the extent to which homophobia in black churches undermines its role as a source of social support is a key area for explorations of black LGBT health.
The Baylor Religion Survey in 2005 (; Shaw and McDaniel 2007) found that 64 percent of people who identified as black prayed or meditated once a day or several times a day in comparison to 48 percent of people who identified as white. The General Social Survey in 2008 (; Shaw and McDaniel 2007) found similar results, with 78 percent of blacks reporting praying once a day or several times a day in comparison to 56 percent of whites. Similarly, a Pew Research Center’s Forum on Religion and Public Life survey (2007) found that blacks are significantly more religious than other racial groups: 76 percent of blacks pray on a daily basis, compared to less than 60 percent of the total U.S. population. Black women were found to exhibit more religious commitment than any other racial group as well, with 84 percent claiming that religion is very important to them, and 59 percent stating that they attend religious services at least once a week. With regard to the church’s influence on the daily life of black lesbians specifically, Battle and his colleagues (2002) found that 27 percent of lesbians reported that their church “somewhat” influenced their daily lives, while 24 percent reported a “constant” influence.
In part because of their experiences with a stigmatizing and discriminatory health-care apparatus, blacks are likely to turn to the church and to [End Page 5] their spiritual beliefs when faced with health-related challenges (Chatters et al. 1992). Qualitative studies with black churchgoers have suggested that the influence of reliance on church, faith, and belief in God may shape decisions to refrain from unhealthy behaviors and maintain a “healthy—spirit” to feel at peace and live the church’s teachings that the body “is a temple of God” (Holt and McClure 2006; Marks et al. 2005). Older women active in the church have been referred to in the literature as “Church mothers” because participants view their religious community as a family that provides them with social support to cope during times of ill health or other challenges (Holt and McClure 2006; Marks et al. 2005).
Despite the role of the black church as a positive support for general and mental health, stigmatization and fear of discrimination have been seen to lead to negative adaptations for many members of the LGBT community in navigating their relationships with the church and its members. Research has found that LGBT churchgoers employ passing strategies that range from harboring feelings of deserving the antipathy directed at LGBT people by members of their churches to denouncing their own sexual identities outright (Griffin 2006), distancing themselves from the religious community (Mahaffy 1996) or unsuccessfully trying to integrate sexual and religious identities in ways that exacerbate psychological distress (Schuck and Liddle 2001; Szymanski et al. 2001). Still others engage a process whereby they distinguish religion from spirituality, attempting to balance one against the other in a way that affirms their sexual identities (Love et al. 2005; Mattis and Watson 2009; Morrow and Tyson 2006; Tan 2005).
Halkitis et al. (2009) used a mixed-methods approach with a sample of 498 LGBT identified individuals attending a “Pride”2 event to examine spiritual and religious practices, but also to ascertain if and how LGBT people distinguish spirituality and religion. The study found that spirituality was defined in terms of one’s relation with God and self, while religion was defined with regard to communal practice and negatively viewed as denoting an oppressive legacy. Moreover, spiritual identities were more pronounced. This is attributed to the premium placed upon prosocial engagement and universal interdependence among the LGBT individuals in the sample. Though these findings held across racial groups and sexual orientations, the religiosity/spirituality distinction is apparent in how black lesbians reconcile religion, sexuality, and health (Davis 2011; Hagen et al. 2011; Loue 2007; Townes 1995). Highlighting the complex relationship between spirituality and religion, Dominique who is transgender (male-to-female), shares this sentiment: [End Page 6]
I struggle to let go of the anger and resentment and reside in a space where I know God will take care of me; if it is not addressed in this lifetime, it will be addressed in the next. I guess I do not understand His plan, the greater plan for human rights, I just believe
(Loue 2007, 165).
Deeply connected to her religious roots, Dominique is seen here to take liberties with how the precepts of that religion are to be interpreted. Her resentment, as likely held against worldly institutions as against God, leads her not only to question but also to forge a self-relevant appreciation of her situation. Angela Denise Davis (2011), on the centrality of therapy in her journey “coming out and coming through,” links sexuality and spirituality as a sense of personal integrity to her mental health and well-being:
The work I had done in therapy made me ready for the new friendships and, eventually, a relationship with a lesbian partner. The journey was not easy, but I knew that my time in therapy was extremely meaningful. As the poet Langston Hughes said, I was “free within myself,” and vowed to do the work to maintain that freedom
(Davis 2011, 82).
As indicated above, religious and spiritual experiences play a major part in the lived experiences of black lesbian women, as they represent sites of contestation and transformation, isolation and cohesion, acceptance and rejection—dynamics with deep implications for perceptions of happiness and health. While the SJS Project aims to document many facets of the lives of LGBT people of color, in this study, we are uniquely positioned to consider the impacts of religiosity and spirituality on the ways in which black lesbian women perceive their happiness and health. Though religion and spirituality reflect key areas of social interaction, we are also concerned with broader forms of engagement, to which we turn below.
Engagement in the LGBT/POC Community
The ways in which LGBT people of color navigate social structures that are hostile to both their racial and sexual beings through building community among themselves and attempting to create bridges with racist and hetero-sexist institutions are important to understand to celebrate this population fully and create social policy. The challenge of integrating identities—that have been discriminated against separately throughout history—is integral to LGBT research. As in the case of religion and spirituality, LGBT people of color have responded creatively to the challenge of reconciling community relationships and their often-ostracized sexual identities. These processes [End Page 7] have expanded and altered institutions and individual identities, shifting between strategies of hiding, denial, and self-renunciation to becoming out-spoken advocates and change agents.
The lived experience of discrimination, and the threat of potential discrimination, has been shown to affect intimate relationships with family and partners, as well as workplace relationships (Griffith and Hebl 2002; Mays et al. 1993). In a recent, small, qualitative study exploring the family and community factors in identity development and management for black lesbian women, Shannon Miller (2011) illustrates the challenges of the intersection of race, gender, and sexual orientation. The narratives in this study reveal the possibility of acceptance within the community as long as sexual orientation is neither visible nor openly discussed. The silence that Miller documents within the community is a method of avoiding the shame, stigma, and stress of homophobia. One of the interviews she reports relates that the stress of managing race and gender prejudice influences silence in regard to sexual orientation: “I don’t want to be the black gay girl; it’s hard enough that anytime anything minority comes up everybody looks at me . . . without having that extra” (Miller 2011, 556). While one of the participants in Miller’s study affirms that integration of multiple identities is possible within the community, the others indicate that support was only possible by separating these identities.
At the same time, isolation has led to the galvanizing of LGBT people of color to establish community spaces. One such space is the ballroom community3; it serves not just as a social safe space, but a place that can be supportive of positive health behaviors. Arnold and Bailey (2009) find that the unique gender-sex system in these communities is key to novel “intraventions” that can support traditional HIV-related services and support. Though much of the health information provided at the balls is HIV-oriented, that information is not exclusively for men. Further, there is often health information provided regarding chronic diseases disproportionately affecting communities of color (for example, obesity, high cholesterol, and so forth), many of which are prevalent among lesbians of color (Battle and Crum 2007). As research supports the link between community support and positive health outcomes, the balls serve as key sites for finding, establishing, and strengthening preexiting social support networks and increasing social capital.
Another study examined the factors predicting the coming-out process among black lesbians and bisexual women (Bowleg et al. 2008). Several of their findings underscore the importance of community for black sexual-minority women. Women who were out and actively disclosing and discussing their sexual identities were more likely to have greater social support and identify [End Page 8] strongly as lesbian as compared to placing an emphasis on their racial identity. That study also supported previous findings that, despite the difficulties in coming out to family members and close friends, because black lesbians so value those social ties, they develop strategies to maintain familial and racial bonds. The black women in this study understand their situation to be unique in comparison to their white counterparts, whom they do not see as facing the same challenges nor having the same needs to maintain those relationships.
The challenges of maintaining familial and racial bonds spill over into the mainstream political realm for black lesbian women, as that landscape is characterized by secondary marginalization whereby black leaders who conform to patriarchal, heterosexist, raced, and classed normativities further marginalize blacks who do not meet those standards (Cohen 1999). Worse still, black LGBT people face secondary marginalization within the LGBT community where mainstream notions of gender performance, as well as ideas about the appropriate issues and strategies to be taken up by sexual minorities, serve to suppress exponentially the voices of the most vulnerable (Battle and Bennett 2006).
In the face of continual neglect of LGBT politics, there is an increasing awareness that the study of LGBT communities’ struggles has served to sharpen scholarly understandings of power and politics, social movements, public opinion, and policy preferences (Mucciaroni 2011). Moreover, an increasing number of studies are beginning to address the integration of sexual and political identities—a process with implications for LGBT inclusion and, by extension, well-being. For example, some authors have suggested that involvement with other LGBT individuals creates a buffer from the constant negative self-comparisons LGBT people might make due to their exposure to heterosexist discrimination (Crocker and Major 1989; Herek and Glunt 1995). As such, community involvement is thought to ease the psychological distress associated with minority status (Major and O’Brien 2005) and facilitate the coming-out process (Corrigan and Matthews 2003).
Again, there is evidence that researchers need to be sensitive to the heterogeneity that exists within the LGBT community, even among women with varying sexual-minority identities. One recent study found that, among lesbian women involved in struggles for LGBT rights, black lesbian women were more likely than white lesbian women to engage in civic behaviors such as voting and protesting (Swank and Fahs 2012). Among a sample of college-aged sexual-minority women, lesbian- and queer-identified women were more likely than bisexual women to express commitment to LGBT activism (Friedman and Leaper 2010). And in one study explicitly aimed at [End Page 9] assessing the mental health effects of registering multiple socially disadvantaged statuses, not only were gender and race not related to adverse mental health burdens, but community connectedness was only significant for men and women who identified as bisexual (Kertzner et al. 2009).
With regard to both the significance of religiosity and spirituality for self-reports of happiness and overall health, the evidence is mixed. Religious institutions have handled the needs of their LGBT members in varying ways; likewise, LGBT people of color have adapted to these institutional forces. Sometimes they have succumbed to the pressures to remain hidden or to internalize the heterosexist views of those around them. At other times, they have confronted such heterosexist forces directly, challenging the institution to change. And at yet other times, LGBT people of color have distanced themselves from the church, instead embracing their own personal forms of faith and spirituality. Similarly, community engagement does not come in one size; neither do the LGBT people of color who constitute those communities. The SJS Project seeks to further explore the community and civic engagement of LGBT persons of color, as well as the religious and spiritual domains of their experiences. This exploration begins with the cultivation of a high-quality national data set with which to perform a more systematic assessment than has been previously undertaken of the relative impacts of religiosity, spirituality, and LGBT/POC community engagement on black lesbian women’s self-reports of happiness and overall health.
Sample and Data
The SJS Survey: Development and Sampling Strategies
The SJS survey was developed through an iterative process that included several focus groups conducted to identify issues for LGBT people of color and to obtain feedback on initial versions of the survey. Researchers also piloted drafts of the instrument four times before fielding the survey.
To ensure reliability of the items, many were taken word for word from other surveys. However, numerous questions were modified or created anew to tailor them specifically to LGBT people of color. To develop the survey, some of the sources used included, but were not limited to, the National Black Lesbian Survey; the Black Pride Survey 2000; the Santa Clara Strength of Religious Faith Survey; Dos Comunidades; Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders (SAGE); the General Social Survey; the National Health and Nutrition Examination Survey (NHANES); the [End Page 10] Lavender Islands Study on Family; LGBT Asian Pacific Islander Community Survey; Nuestras Voces; People of Color in Crisis; and the Black Youth Project.
The 10-page, 105-item self-administered SJS survey centered on five themes: family formations and dynamics; civic engagement; spirituality and religion; sexual, racial, and ethnic identity; and mental and overall health. The data were collected from January to December 2010, in all 50 states, including Washington, DC, and Puerto Rico. There were two versions of the survey, one in English and one in Spanish.
The purposive sample yielded over 5,500 self-administered surveys that were collected using a variety of strategies, including venue-based sampling, snowball sampling, the Internet, and partnerships with community-based organizations, activists, and opinion leaders. The venues at which the SJS team gathered data included LGBT-of-color Pride marches, parades, picnics, religious gatherings, festivals, rodeos, senior events, and small house parties across the nation. The total sample consisted of 4,953 valid surveys, with 33.8 percent of the respondents identifying as black (N=2086). Of the black participants, 52 percent were male, 42 percent were female, and 7 percent did not identify as either male or female. Most were adults between the ages of 25 and 49 (61 percent), with 21 percent aged 18 to 24 and 18 percent adults over the age of 50. With regard to sexual orientation, 36.4 percent of black participants identified as gay, 22.6 percent identified as lesbian, 10.7 percent identified as bisexual, and 4 percent identified as queer.
Variables
The text above reflects information for the full sample of respondents who completed the survey. Table 1 provides the descriptive information for a list-wise deletion of missing values for the black lesbian women from the larger sample. The analyses are based on the number of respondents providing valid answers to all the questions used to analyze self-reports of happiness and general health.
Dependent Variables
This article is interested in investigating variables that impact the self-reported happiness and overall health of black women in the SJS sample. The happiness measure is a composite variable of the following four questions: “Over the past week, how often have you felt (a) that you were just as good as other people, (b) hopeful about the future, (c) happy, and (d) that you enjoyed life.” Conversely, for perceived overall health, respondentd were asked, “In general, [End Page 11] would you say that your health is . . .” and were able to respond “poor” to “excellent” on a five-point scale.
Independent Variables
In addition to the community engagement and religiosity/spirituality measures, we also consider the impact of age and household income. Other demographic variables include health insurance, a dummy variable where those with insurance are coded “1”; regular health-care provider, a dummy variable where those with a regular provider are coded “1”; and single, a dummy variable where respondents who selected “not partnered” as their current relationship status were coded “1.”
The “single” dummy variable may also be significant for self-reports of happiness. As stated above, the narrowing of the gender gap in happiness has recently challenged the depiction of women as happier than men. Moreover, while marriage and similar relationships that provide positive social support have been touted in the past as good for individual’s objective and subjective health and happiness (Waite and Gallagher 2000), marital happiness is also on the decline, and increasing numbers of single women pin their lack of happiness not on their bachelorette status but on a sense of being looked down on for choosing singlehood (Stavrova et al. 2011). Conversely, among lesbian women, relationship quality is among the most common stressors associated with psychological distress (Balsam and Szymanski 2005; Otis et al. 2006; Peplau 1993). We include “single” here to assess its impact on this specific population.
Methodology
Employing multiple regression for each dependent variable—happiness and overall health—eight models were built. Model I included the demographic variables; Model II added variables measuring civic and community engagement to the first model; Model III added variables measuring religion/spirituality experience; and Model IV—or the full model—included all three sets of variables—demographic variables (Model I), civic and community engagement variables (Model II), and variables measuring religious/spirituality experience (Model III). Below a brief description of each set is further described.
For Model I, the set of demographic variables, five variables were used: (a) age, (b) income, if the respondent (c) is single, (d) has health insurance, and (e) has a regular doctor or health-care provider. For Model II, measuring civic and community engagement, four variables were used. Respondents were [End Page 12] asked to report, on a scale of 1–6, where 6 indicates the greatest amount of agreement (a) how connected the respondents felt to their local LGBT community, (b) how much they felt problems faced by the larger LGBT community were also their problems, and (c) how much of a bond the respondents felt with other LGBT people. Model II also includes a composite variable where respondents indicated the frequency with which they engaged in specified political or civic activities. For example, two of the six questions in that composite were “Thinking about groups, organization, and activities for people of color, during the past 12 months, how often have you (a) participated in political events, and (b) donated money to an organization.” Finally, for the set of variables measuring religiosity/spirituality (Model III), three variables were utilized. First, those who currently practice no religious expression (for example, atheists and those who responded “none”) were compared to those who practiced any (for example, Christians and Muslims). Second, a composite variable of five questions measuring religious faith was included. For those questions, respondents were asked to respond to such statements as “I pray daily” and “My faith impacts many of my decisions.” The third variable asked respondents “How often do you attend religious services?” The eight-point response scale ranged from “never” to “every week.”
For Models V through VIII, we ran the analysis using the same sets of independent variables and changed the dependent variable to self-reported overall health.
Findings
While the larger dataset was developed to examine the experiences of people of color (for example, black, Latino, and Asian Pacific Islanders) of all gender expressions (for example, women, men, transgender, and more), this article focuses on the subsample of black women. Our sample had an average age of 36, just lower than the median age of 37 for the American population, but above the median age for blacks—32 years (Howden and Meyer 2011). Thirty-five percent of our sample was single, while nationally 43.2 percent of black women ages 35–39 report having never been married (Howden and Meyer 2011); when we include women who are divorced, separated, or widowed, it appears that the women in our sample fare well relative to their nonlesbian counterparts in terms of being in partnered relationships. Our sample reported an average household income of roughly $30,000, compared to $32,068 for black families and $54,620 for non-Hispanic whites. Some 80 percent of the sample had health insurance, and 81 percent had a regular [End Page 13] doctor or health-care provider, mirroring numbers for the black population as a whole (DeNavas-Walt et al. 2011).
Below, we present findings from the analyses regressing demographic, civic and community engagement, and religiosity/spirituality measures on our two outcomes of interest—happiness and self-reported overall health—respectively. These analyses suggest that self-reports of happiness and overall health are analytically distinct. More interestingly, among black lesbian women, different factors shape these dimensions of health.
Means, standard deviants, ranges, and description of variables for black women
[End Page 14]
In Model I, which only includes the demographic variables, we found that increases in household income led to increased self-reports of happiness. Being single decreased self-reported happiness. Age, having a regular health-care provider, and having health insurance were all nonsignificant.
Unstandardized regression coefficients for black women (betas in parenthesis)
In Model II, we added the set of civic and community engagement variables. None of those reached significance; therefore, not surprisingly, all the relationships in Model I held. More specifically, civic and community engagement did not predict happiness among this sample of black lesbians. The impact of household income and being single maintained. We then considered the impact of religiosity and spirituality (Model III). While having no religious affiliation and frequency of church attendance were nonsignificant, those who were higher on the measure of spirituality [End Page 15] also had higher self-reported happiness. Again, the demographic variables’ relationships maintained.
Finally, in the full model (Model IV), we include the demographic variables, variables measuring civic and community engagement, and measures of religiosity and spirituality. In this model, being single decreases from significance to near nonsignificance, while black lesbian women in households with higher reported incomes continue to report higher levels of happiness. And while involvement with POC groups moves from nonsignificance (see Model II) to approach significance, other measures of civic and community engagement, religious affiliation, and religious attendance continue to be nonsignificant. Further, in that full model, black lesbian women with higher levels of spirituality continue to report increased happiness.
Analyses of the predictors of overall health reveal different dynamics at work among black lesbians. Again, we progress through four models (Models V through VIII) regressing demographic variables age, household income, having health insurance, having a regular healthcare provider, and being single (Model V); civic and community engagement measures (Model VI); demographic and religiosity/spirituality measures (Model VII); and, finally, all measures on self-reported overall health.
In Model V, we see a strong negative relationship between age and reports of general health, such that older black lesbian women are more likely to report lower levels of general health. Both household income and having a regular health-care provider increase levels of self-reported general well-being. Adding the measures of civic and community engagement does not change the impact of the demographic variables, and the engagement measures themselves are not significant predictors of self-reported general health (Model VI). Model VII, reveals an interesting relationship between religiosity/spirituality measures and self-reports of overall health. First, the impacts of the demographic variables remain. Additionally, while the religious attendance variable is not significant, having higher levels of spirituality and claiming no religious affiliation both lead to increases in self-reported general health. The full model (Model VIII) reveals the same relationships.
Discussion
This study used an innovative combination of strategies to develop a large purposive sample in response to mandates for higher quality data on the health-related experiences of black lesbian women. Given the mixed bag [End Page 16] that currently characterizes our understandings of how black lesbian women assess their happiness and overall health, the factors that we find to be significant predictors of self-reported happiness and general health, as well as those factors that are nonsignificant in our models, all offer some insight into the unique experience of black lesbian women.
Getting Black Lesbian Women to Their Happy Place
With regard to self-reported overall health, we see that household income, being single, and spirituality are all highly robust predictors.
The positive relationship between income and self-reported happiness is not atypical, even if it is atypically powerful among this sample. That is, higher incomes are generally associated with higher levels of self-reported happiness and overall health and well-being (Clark et al. 2008; Kahneman and Krueger 2006; McBride 2001), though, in recent years, the relative gains in self-reported well-being contingent upon income have declined (Diener and Shigehiro 2003). Still, household income is one of the main drivers of self-reported happiness. We revisit the impact of income in our discussion of self-reported overall health.
As discussed above, the verdict is still out regarding the association between relationship status and happiness. This analysis gives us an opportunity to locate black lesbian women within that discussion. Though being single decreases in significance slightly in the full model, in Models I through III, it is a moderately strong predictor of self-reported happiness. That is, being single was associated with significant decreases in self-reports of happiness. This finding is supported by researchers who have found that increases in the level of commitment in a relationship (marriage being the most committed, casually or not dating being the least) lead to self-reports of greater happiness (Dush and Amato 2005). Another recent study that used a large probability sample to compare same-sex partnered couples to heterosexual couples (Wienke and Hill 2012) found that, while heterosexual couples saw greater happiness gains than partnered lesbian couples, partnered lesbians were still happier than single individuals, regardless of sexual orientation. It appears that this trend also applies to black lesbian women: that is, some portion of their self-reported happiness depends on having a partner. This finding is particularly interesting in light of studies that have documented the unique difficulties that LGBT people face in terms of dealing with psychosocial stressors related to maintaining intimate relationships (Balsam and Szymanski 2005; Otis et al. 2006). Perhaps in this sample, the power [End Page 17] of household income combined with the personal resources engendered by high levels of spirituality helps to mitigate the stressors typically associated with forming intimate relationships.
That spirituality so powerfully predicts happiness corroborates research that highlights the cultural agency and adaptability of black lesbian women (Davis 2011; Hagen et al. 2011). In his extensive work on subjective well-being, Diener (2000) established adaptability as a key factor in shaping individual’s experiences of happiness. That is, in conjunction with goal setting, individuals have the ability to assess and make the most out of their particular circumstances. One interpretation of the relative significance of spirituality is that black lesbian women have maintained the high level of religiosity traditionally associated with the black church but have creatively channeled those devotional energies into faith-based practices and principles of a more personal nature. Whether this heightened spirituality reflects an attempt to extricate oneself from the confines of a historically male-centered and molded experience of the divine or it has its genesis in a less conflict-ridden space, there is no question as to its significance for self-reported happiness.
When it comes to self-reports of happiness among black lesbian women, those with higher incomes, partners, and high levels of spirituality fare best. These findings are instructive for health-care research, policy, and practice. We consider those implications following our discussion of the factors related to self-reports of overall health.
Black Lesbian Women: Healthy, Wealthy, and Wise
Age, income, having a regular health-care provider, having no religious affiliation, and spirituality all predict self-reports of overall health. We focus first on the set of demographic variables before moving on to the religiosity/spirituality findings.
Looking at the demographic variables, we see an unsurprising link between age and lower self-reported health (Perlmutter and Nyquist 1990). As age increases, self-reports of overall health decline are typically thought to reflect actual declines in biological function and comparisons to more youthful periods of life. However, this finding may say something more about black lesbian women. That is, research has found some benefits associated with aging among lesbians with direct relevance for health behaviors, including seeking and obtaining satisfying health-care experiences, increasing their comfort of sharing their sexual orientation with their health-care providers, increases in health knowledge, and enhancing ability to self-advocate. Aging thus represents a “catching-up” period in terms of health-related issues and [End Page 18] in comparison to earlier periods in life (Daley 2012; McIntyer et al. 2010). This process of “catching up” might make members of this sample acutely aware of the changes in their health as it relates to aging.
Whether or not the women in this sample have any unique insight into their declining health, the predictive power of having a regular health-care provider supports research on the importance of overcoming barriers to access for better learning and meeting the health needs of lesbian women in general (Van Dame, Koh, and Dibble 2001). A population-based study of lesbian and bisexual women’s health conducted in 2000 in Los Angeles County sought to determine disparities in health among sexual minorities across race (Mays et al. 2003). These authors found that significantly more black lesbian and bisexual women lack insurance and a regular source of care when compared to black heterosexual women. Similarly, Razzano et al. (2006) found that racial-minority lesbians were more likely to report depressive symptoms but less likely to utilize mental health services than were their white counterparts. For the black lesbian women in our sample, it seems that high levels of access to health care as indicated by the robust effect of having a regular health-care provider bolster their overall sense of health.
To return briefly to income—as mentioned in the discussion on the relationship between income and high levels of self-reported happiness—the positive link between self-reported overall health and income is typical. However, the nonsignificance of having health insurance in relation to self-reports of overall health is unexpected. The impact of income, again, very robust in each model predicting self-reported overall health, may be diminishing the variance explained by having health insurance; moreover, the combined impact of income and having regular health care likely reflects an increased sense of access, which, again, tends to increase self-reports of overall health.
Our interpretation of the relationship of the religiosity and spirituality measures to self-reports of overall health closely follows the one offered with regard to happiness. In the main, this finding supports research that has begun to explore the cultural ingenuity developed by segments of the LGBT community in response to its marginalization. However, the fact that increased spirituality combines with a positive effect of having no religious affiliation underscores the potential benefit of distancing oneself from the more dogmatic approaches associated with organized religion.
The predictive power of spirituality is supported by research suggesting that a common coping strategy to homophobia in the church is to value one’s spiritual identity more highly, that is, a personal relationship with God, over and above one’s ties to the broader traditional religious community. Further, [End Page 19] research also shows that heightened spirituality need not be an isolating experience; rather, LGBT people and subgroups of the LGBT community often form associations around shared holistic spiritual beliefs and practices. For example, Magrini and Maloy (2007) document the effectiveness of Spirit Health Education (SHE) circles, a health promotion intervention aimed at black lesbian women to encourage early cancer detection and education. The program incorporates elements of African spirituality with health and wellness practices. These self-formed, spiritually oriented communities may afford a level of therapeutic experience for black lesbians not created in more traditionally religious spaces.
The positive impact of having no religious affiliation and having higher self-reported spirituality, similar to the discussion of spirituality in relation to happiness, confirms literature that suggests that LGBT people have innovative responses to homophobic institutions; in the case of the church, while many find ways to maintain their affiliations, this may come at the expense of a sense of well-being (Griffin 2006). In short, black lesbian women who focus on their spirituality and find like-minded persons may enjoy an enhanced sense of well-being.
In contradistinction to the above interpretation of the impact of spirituality and what that could mean for forming faith communities around a shared sense of spirituality with other black lesbians women, the LGBT community engagement measures were surprisingly unrelated to either self-reported happiness or perceived overall health. Given the paucity of research linking engagement to self-reported health, the assertions made here are purely speculative. However, it seems plausible that, because of the nature of LGBT exclusion, issues of faith and self-affirmation may take precedence over more public forms of redressing the scars of heteronormativity, patriarchy, and racism. This is not to suggest that social movements and direct challenges to hegemonic patriarchy, racism, and heterosexism are not important factors in the health and well-being of LGBT people, but, as has been the case with other oppressed minorities, a protracted and sprawling period of consciousness raising often precedes the long-term struggles to integrate and transform existing institutions while also building alternative modes of social interaction. Such consciousness-raising moments may turn more immediately upon issues perceived to be in the personal sphere, where control is more readily apparent and agency more directly realized.
Among black lesbian women, higher levels of self-reported health are associated with those who are younger, have higher incomes, have a regular health-care provider, are high in spirituality, and have no religious affiliation. [End Page 20] We suggest that income and having a regular health-care provider may reflect greater access, which, in turn, supports self-reports of good overall health. Having no religious affiliation, combined with high levels of spirituality, may reflect a health benefit of critically questioning or at least decreasing associations with institutions that tend to denigrate one’s identities. Such an interpretation is supported by the social support and community connectedness literature that suggests community members allow each other to arrive at more positive self-assessments compared to when members of marginalized groups take dominant group members as their reference group (Cross 1981). We consider the implications of these findings and those related to self-reports of happiness following a brief description of some of the study’s limitations.
Limitations
While this study makes its major contribution through providing high-quality data drawn from an innovatively developed sample to facilitate an exploration of some basic factors related to self-reported happiness and overall health among black lesbian women, it has several instructive limitations.
First, implied causal effect is impossible to unpack here. In other words, (1) does spirituality impact happiness and perceived overall health, (2) does being happy make black lesbian women more likely to be open to spirituality, or (3) some iterative combination of the two? Interrogating these questions merits longitudinal and/or qualitative information, both of which go beyond the scope of this dataset.
Additionally, though from a national sample, the data are quantitative and cross-sectional. Qualitative data would allow researchers to nuance not just the what (disparities) but also the why (how they develop). Further, longitudinal quantitative data would allow for a parsing out of age, period, and cohort effects. Second, this paper focuses on one racial group. Providing analyses that compares this group to other racial groups (say, Latinas/os or Native Americans) would highlight what findings are specific to black LGBT populations versus those that may be prevalent across racial-minority groups. Finally, more elaborate analyses such as path analysis or structural equation modeling would allow researchers a more nuanced description of the intervening effects of some of the relationships found here. It is worth mentioning, however, that, though the findings from such analyses may be more elaborate, they may not be more “correct” than the ones presented here. [End Page 21]
Concomitant with these concerns is the innovative sampling design used in this study. The (possible) overrepresentation of black lesbians who are comfortable being out, would lead to a sample of women who are more likely to exercise agency in relation to their sexual identities and more likely to be knowledgeable self-advocates when it comes to health-related issues. Hence, the high levels of subjective well-being and self-reports of general health may not reflect those found among black lesbians in general. Similarly, our respondents held health insurance and reported having a regular health-care provider at relatively high rates, which may also be a function of our sampling strategy. Additionally, our sample may be predisposed to the protective benefits accorded to a critical awareness of patriarchal, homophobic, sexist, and racist institutions.
Another limitation involves our use of subjective versus diagnostic measures. Most studies that have managed to isolate black lesbian women’s mental health outcomes have focused on diagnostic measures. It is possible that there is enough of a disjuncture between such diagnostic and subjective measures that we have produced an overly optimistic view of happiness and health among this population. Similarly, we lacked direct measures of help-seeking behavior, challenges associated with disclosure of sexual orientation to health-care providers, and quality of care. Fitting with our exploratory aims, some of our assertions regarding links between access and quality of services, on the one hand, and self-reports of health and happiness, on the other, remain largely speculative.
Finally, while clearly establishing the importance of spirituality for self-reports of health and happiness among black lesbian women, we were not able to supplement these associations with more in-depth assessments of the distinctions between religiosity and spirituality; further, we were not able to probe into qualitative distinctions in understandings of “health.” As suggested by other researchers (Fogel et al. 2012), the meanings associated with “health,” “religiosity,” and/or “spirituality” are not uniform and are based on standards reflecting the views of more privileged social groups. Similarly, while lesbians appear to be prone to create and utilize alternative institutions, as evidenced in their greater utilization of alternative medical services (Matthews et al. 2005), we were unable to explore this phenomenon, nor to link it to our findings regarding self-reports of happiness and health.
These limitations notwithstanding, our research underscores the plethora of literature highlighting the unique challenges lesbians face with(in) the health-care system (for excellent reviews, see Roberts 2001 and Stevens 1992). Unfortunately, our research further highlights that problems clearly persist (Stevens 1996). [End Page 22]
Conclusion
We focus on two broad areas whereby these findings can be used to suggest recommendations for health-care policy and practice: access (establishing a relationship with the health-care community) and quality (making the most of the institutions after gaining access).
Our findings support the work of myriad researchers who have noted that structural barriers to health-care access—whether due to cost or legal restriction against using partner benefits—lie at the heart of a cycle of poor health behaviors and outcomes. In the case of self-reports of overall health, being able to access a regular health-care provider is key. While it would be best to lower barriers to health care access through lowering costs, increasing incomes, or offsetting costs, as well as through legislation that would recognize nontraditional families and their rights to shared health care, the significance of household income notwithstanding, establishing regular contact with a health-care professional is tantamount to positive self-assessments of health.
Access alone will not always produce positive health outcomes. Lesbian women have articulated very specific ways in which the present health-care system fails them, along with prescriptions on what would enhance their experiences with health-care institutions. The increases in self-reports of both happiness and overall health are related to clear indicators of black lesbian women’s abilities, willingness, and needs to establish parallel institutions supportive of their multiple identities. Health researchers, policy makers, and practitioners should continue to take cues from those members of the LGBT community they hope to understand, protect, and serve. Research has already established the benefits of capitalizing on existing LGBT networks to promote positive health behaviors, and there are growing numbers of participatory action research projects involving the leadership of LGBT youth, elders, and people of color. Policymakers should make attempts to provide structural supports for such research and practice-based endeavors. Greater inclusion of LGBT people as stakeholders and decision makers in health policy, research, and practice matters can only augment their apparent capabilities to create and sustain affirming institutions.
Additionally, this paper contains very important findings that merit attention from medical professionals, academics, and activists alike. Medical professionals need to be better and more extensively trained to avoid heteronormative assumptions about their patients. Doing so would create a safe(r) space for patients to disclose their sexual orientation and thus receive [End Page 23] medical treatment specific to the unique experiences and circumstances of LGBT people . . . and this is especially true for female patients. Academics should continue researching physical and sociocultural conduits and barriers to positive health outcomes for racial minorities, sexual minorities, and the intersection of the two. Finally, using successes garnered by social movements such as ACT UP and others (Shepard and Hayduk 2002), activists should continue to find appropriate mechanisms to push the medical establishment to move from a “wealth care” system for some to a health-care system for all.
Juan Battle is a professor of sociology, public health, and urban education at the Graduate Center of the City University of New York (CUNY). He is also the coordinator of the Africana Studies Certificate Program. With over 60 grants and publications—including books, book chapters, academic articles, and encyclopedia entries—his research focuses on race, sexuality, and social justice. Among his current projects, he is heading the Social Justice Sexuality initiative—a project exploring the lived experiences of black, Latina/o, and Asian lesbian, gay, bisexual, and transgender people in the United States and Puerto Rico.
Alfred W. DeFreece Jr. is an assistant professor of sociology at Roosevelt University in Chicago, where he serves on the advisory board for the Mansfield Institute for Social Justice and teaches African American Studies courses as a faculty affiliate of the St. Clair Drake Center for African and African American Studies. His research is conducted under the broad umbrella of cultural sociology and focuses on multiple substantive areas, including racial attitudes, youth development and activism, urban education, and perceptions of health among diverse vulnerable populations. Continuing his primary research on black youths’ constructions of racial inequality, a chapter based on a preliminary analysis of his dissertation data recently appeared in Reading African American Experiences in the Obama Era, edited by Ebony Thomas and Shanesha Brooks-Tatum (2011) and School Sucks: Arguments for Alternative Education, edited by Rochelle Brock and Greg S. Goodman (2013). He currently is developing projects around black male retention in higher education and place-based education as a means of promoting critical political engagement among urban youth. He holds a B.A. from Hunter College-CUNY and received his M.A. and Ph.D. from the University of Michigan (2011).
Notes
1. Throughout this text, we will use the term black to refer to people of the African Diaspora and to such populations that reside within the United States. To some, African Americans are a subgroup within the larger black community. Since our discussion purposely includes first-generation immigrants and others who, for whatever reason, do not identify as African American, we will employ the term black.
2. Pride events are large public events put on by members of the LGBT community and their allies, intended to make visible and celebrate inherent sexual diversity, instill pride in one’s sexual and gender identities and orientations, and advocate for LGBT civil and human rights.
3. The ballroom community, also known as “ball culture,” has emerged from the “house system”—an LGBT subculture composed of “houses” that compete in various fashion and dance-inspired competitions. These houses are often headed by an older LGBT individual who serves as a mentor, protector, and guide for LGBT youth who may otherwise lack social networks where they feel unconditional acceptance of their sexual identities and orientations.
