BMC Public Health 2006, 6:127 http://www.biomedcentral.com/1471-2458/6/127 Table 5: Health comparisons in heterosexual, bisexual and gay classified men (Continued) Gay Bisexual Gay White Civil status 1.50 (0.63, 3.60) 1.00 (0.27, 3.71) 1.53 (0.63, 3.73) 0.75 (0.39, 1.45) 0.83 (0.48, 1.45) 1.09 0.58 Odd Ratio below the line in each row are adjusted for civil and ethnic status LR = Likelihood ratio * Heterosexual used as reference category OR 1.0 # married/cohabiting reported in a population-based study in North American, where bisexual (and lesbian) women had higher lifetime rates of substance misuse and coerced sex than heterosex- ual women [44]. Physical and sexual health There were no differences between people classified as gay and heterosexual in terms of physical functioning based on a quality of life measure. People classified as bisexual on the other hand were more likely to be smokers raising concern about smoking related diseases such as cancers, cardiovascular diseases and chronic obstructive airway diseases. There is now good data on smoking among gay, lesbian and bisexual people. Data from population based health surveys and random student population samples in North America have suggested high rates of smoking in LGB people [38]. Men and women classified as bisexual were also more likely than heterosexuals to report contact with two or more sexual partners in the preceding month, potentially increasing their likelihood of acquiring sexu- ally transmitted infections. For women classified as bisex- ual this combination with alcohol misuse could also place them at a greater risk of sexually transmitted infections. There is good evidence that risky sexual behaviour is increasing among men and women but comparative data on sexual behaviour of different sexual orientations has to our knowledge not been previously reported [14]. Family practice There is varying evidence on the use of family practice by lesbian, gay and bisexual people. We have previously reported that LGB people consult general practitioners for emotional reasons more often than heterosexuals [12]. However, other research in the UK suggests that LGB peo- ple may avoid primary medical care [49] and those that do attend may not reveal their sexual orientation [50]. Awareness of a patient's sexual orientation may alert the family practitioner to potential difficulties, particularly with regard to alcohol misuse and smoking and to some extent sexual behaviour. There is a clear need for aware- ness on the part of family practitioners and openness on the part of patients about sexual orientation. This would allow practice staff adequate opportunities to monitor the smoking status, alcohol use, mental health, current num- bers of sexual contacts and childhood sexual experiences in people of range of sexual orientation attending family practice. People at risk could then be offered early inter- ventions to minimise their chances of developing more advanced illnesses. Conclusion Bisexual and lesbian classified people attending London general practices were more likely to be smokers and gay classified men were at increased risk of psychological dis- tress when compared to people classified as heterosexual. Sexual experiences in childhood were associated with cur- rent psychological distress in heterosexual classified women and in gay and bisexual classified men but this was not the case for non-heterosexual women or hetero- sexual classified men. Increased awareness of the sexuality of people seen in primary care can provide opportunities for health promotion. Competing interests The author(s) declare that they have no competing inter- ests. Authors' contributions MK and IN conceived the idea, obtained funding for the study, analysed the data and wrote the paper. MK and IN are guarantors for the study. Page 9 of 12 (page number not for citation purposes)