In this review, the authors provide an approach to the study of health disparities in the US Latino population and evaluate the evidence, using mortality rates for discrete medical conditions and the total US population as a standard for comparison. They examine the demographic structure of the Latino population and how nativity, age, income, and education are related to observed patterns of health and mortality. A key issue discussed is how to interpret the superior mortality indices of Latino immigrants and the subsequent declining health status of later generations. Explanations for differences in mortality include selection, reverse selection, death record inconsistencies, inequalities in health status, transnational migration, social marginality, and adaptation to environmental conditions in the United States. The utility of the public health social inequality framework and the status syndrome for explaining Latino disparities is discussed. The authors examine excess mortality from 8 causes: diabetes, stomach cancer, liver cancer, cervical cancer, human immunodeficiency virus/acquired immunodeficiency syndrome, liver disease, homicide, and work-related injuries. The impact of intergenerational changes in health behavior within the Latino population and the contributory role of suboptimal health care are interpreted in the context of implications for future research, public health programs, and policies.

Tobacco control efforts targeting the LGB population are needed to reduce this group's high rate of cigarette smoking.

This study explored the reported processes, conditions, and consequences of lesbian and heterosexual female smoking and relapse to understand the reasons for elevated lesbian smoking rates. Using grounded theory techniques, we conducted semistructured, face-to-face interviews with an ethnically diverse sample of 35 lesbian and 35 heterosexual female participants in Northern California. We found minority stress/sexual stigma to be an additional, unique cause of negative emotions and stress reported by 75% of lesbian participants, leading to smoking and relapse. Implications for smoking cessation programs tailored to lesbians are discussed.

Background and significance: Tobacco and alcohol use and related morbidity and mortality are critical public health problems. Results of several, but not all, studies suggest that lesbians and gay men are at elevated risk for smoking tobacco and alcohol misuse.

Participation in cancer clinical trials at a large HMO did not result in substantial increases in the direct costs of medical care.

Research indicates that lesbians who frequent bars are more likely to drink and that lesbians drink more than their heterosexual counterparts. We explored in detail the consequences of lesbians' bar attendance. We conducted 35 in-person, semi-structured interviews and analyzed the data using qualitative methods. The findings are organized into the following categories: safety and support over the life course; lesbian identity development; reduction of stress; and social networks and intimate relationships. In each category, participants' stories are presented to highlight the health tradeoffs associated with bar patronage, the psychosocial importance of the bar, and the relationship between minority stress and alcohol use. Public health implications are discussed.

A B S T R A C TObjectives. This study compared the prevalence of cigarette smoking and alcohol use among lesbians and bisexual women with that among heterosexual women.Methods. Logistic regression models were created with data from an extensive member health survey at a large health maintenance organization. Sexual orientation was the primary predictor, and alcohol consumption and cigarette smoking were outcomes.Results. Lesbians and bisexual women younger than 50 years were more likely than heterosexual women to smoke cigarettes and drink heavily. Lesbians and bisexual women aged 20 to 34 reported higher weekly alcohol consumption and less abstinence compared with heterosexual women and older lesbians and bisexual women.Conclusions. Some research has suggested that lesbians and bisexual women are more likely to drink alcohol heavily and to smoke cigarettes than are heterosexual women, 1-6 whereas other research has showed no significant differences. 7-13Research published before 2000 on the prevalence of alcohol consumption and cigarette smoking among lesbians and bisexual women was based primarily on small, homogeneous convenience samples recruited from the lesbian and bisexual communities, and the findings therefore have had limited generalizability. In 2000, 4 published population-based studies investigating alcohol use and smoking indicated that lesbians and bisexual women were more likely to drink heavily and smoke cigarettes than were heterosexual women. The results on levels of abstinence from drinking were mixed. 2-5

We recommend the use of patient reminder letters as a first step in a mammography or Pap smear screening outreach program. Further research is needed to evaluate a cost-effective provider reminder system and additional outreach strategies directed to women who do not use health care services.