title: Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations.
abstract: BACKGROUND
  Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers.
  
  
  METHODS
  LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and "outness," and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals' demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas.
  
  
  RESULTS
  Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men.
  
  
  CONCLUSIONS
  The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients' disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.
authors.affiliation: Department of Pediatrics, School of Medicine, Northwestern University, Chicago, IL, United States of America.
authors.forename: J
authors.initials: J
authors.lastname: Whitehead
authors.affiliation: Department of Health and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: John
authors.initials: J
authors.lastname: Shaver
authors.affiliation: Department of Health and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001727:Bisexuality; D005260:Female; D006297:Health Services Accessibility; D006716:Homosexuality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012424:Rural Population; D057545:Social Stigma; D063106:Transgender Persons; D055815:Young Adult