Page 30 - Cultural Competence in Health Education

8 Cultural Competence in Health Education and Health Promotion

Sexual Orientation
Although the U.S. Census Bureau asks respondents to identify their race and ethnicity, it
does not contain a question about sexual orientation; hence it is difficult to estimate the

prevalence of lesbian, gay, bisexual, and transgender (LGBT) individuals in the popula-
tion. However, the Census does ask several questions about respondents ’ household com-
position by marital status and gender of partner (see Table 1.5 ). Twelve and 11 percent,
respectively, of family households with an unmarried male or female householder and 8
and 6 percent, respectively, of nonfamily households with an unmarried male or female
householder reported same - gender partners. Still, even in combination, these numbers
represent less than 1 percent of the total households (U.S. Census Bureau, 2006).
Several studies have estimated that 5 to 10 percent of the U.S. population is les-
bian, gay, bisexual, or transgender (National Coalition for LGBT Health & Boston
Public Health Commission, 2002). Nonetheless, it is important to understand that the
estimate that 10 percent of men are gay and 5 percent of women are lesbian is based on
Kinsey Institute data, which may not accurately represent the percentage of LGBT
individuals in the population (Gay and Lesbian Medical Association [GLMA] et al.,
2001). Other studies have estimated the percentage of the gay and lesbian population
to be from 1 to 10 percent. Thus the actual number of people who identify themselves
as lesbian, gay, bisexual, or transgender is not known (GLMA et al., 2001).
The relative lack of research focusing on the size of this population and the fear
that many LGBT people, especially youths, have concerning revealing their sexual

identity make reliable data difficult to obtain (GLMA et al., 2001). Numbers may be
underestimated, as many participants are fearful or reluctant to classify themselves as
lesbian, gay, bisexual, or transgender when completing survey studies. A number of
other factors that make estimates diffi cult are explored in Chapter Twelve . For exam-
ple, many gay men and lesbians have participated in or continue to participate in sex-
ual activities with member of the opposite sex and also choose not to identify as gay or
bisexual. Others who have never participated in sexual activities at all may still iden-
tify as gay, lesbian, or bisexual.

People with Disabilities
In 2000, 49.7 million people aged 5 years old and older in the United States had some
type of long - lasting, disabling condition. This number represented approximately 19

percent of the population, or one in every five persons (Waldrop & Stern, 2003). More-
over, the disability rate varied by race and ethnic group. Two groups, African Americans
and American Indians/Alaska Natives, had the highest overall disability rate, 24 percent,
whereas the rate for non - Hispanic whites was 18 percent. Approximately 21 and 19 per-
cent, respectively, of Hispanics and of Native Hawaiians and Pacifi c Islanders reported
having at least one disability in 2000. Asians had the lowest overall disability rate,
17 percent, of any racial and ethnic group (Waldrop & Stern, 2003).
By 2005, the overall estimated disability rate among people aged 5 and older had
decreased to 15 percent of the population. Notwithstanding, disability continues to
affect approximately 40 million people in the United States. In addition, the disability

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