Disparities in Physical Health Conditions Among Lesbian and Bisexual Women: A Systematic Review of Population-Based Studies

We conducted a systematic review to assess evidence for disparities for lesbian and bisexual women (i.e., sexual minority women [SMW]) in comparison with heterosexual women across a range of nine physical health conditions. Among the k = 11 studies meeting eligibility criteria, almost every comparison (i.e., heterosexual vs. (a) lesbian, (b) bisexual, or (c) both lesbian and bisexual women) was in a direction indicating SMW disparities. Despite limited power due to small samples of SMW, we found evidence of disparities as indicated by a statistically significant adjusted odds ratios for asthma (5 of 7 comparisons), obesity (8 of 12), arthritis (2 of 3), global ratings of physical health (4 of 7), and cardiovascular disease (1 of 1). Evidence was lacking for cancer (1 of 4), diabetes and hypertension (both 1 of 5), and high cholesterol (0 of 3). Future work should confirm findings in more diverse, larger samples and should examine potential explanatory factors.     

A Grounded Theory of Sexual Minority Women and Transgender Individuals’ Social Justice Activism

Psychosocial benefits of activism include increased empowerment, social connectedness, and resilience. Yet sexual minority women (SMW) and transgender individuals with multiple oppressed statuses and identities are especially prone to oppression-based experiences, even within minority activist communities. This study sought to develop an empirical model to explain the diverse meanings of social justice activism situated in SMW and transgender individuals’ social identities, values, and experiences of oppression and privilege. Using a grounded theory design, 20 SMW and transgender individuals participated in initial, follow-up, and feedback interviews. The most frequent demographic identities were queer or bisexual, White, middle-class women with advanced degrees. The results indicated that social justice activism was intensely relational, replete with multiple benefits, yet rife with experiences of oppression from within and outside of activist communities. The empirically derived model shows the complexity of SMW and transgender individuals’ experiences, meanings, and benefits of social justice activism.     

Examining Sexual Orientation Disparities in Unmet Medical Needs Among Men and Women

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen’s model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.     

An Exploration of Sexual Minority Stress Across the Lines of Gender and Sexual Identity

Despite growing evidence to suggest that gays, lesbians, and bisexuals experience a range of stressors and consequences related to their sexual minority status, no known studies to date have employed focus group discussion to explore and document their perceptions of sexual minority stress. In this exploratory study, we present focus group data on a range of sexual minority stressors as described by 43 gay men, lesbians, and bisexual men and women. We explore gender and sexual identity differences in the respondents' perceptions of heteronormativity, disclosure issues in different social settings, sources of support, and strategies for coping with stress. Respondents reported that women's same-sex relationships were eroticized and distorted to accommodate heterosexual male desire, while men were negatively depicted as sexually promiscuous and deviant. These differing stereotypes held important consequences for disclosure decisions and affected men's and women's social interactions with heterosexual men. Bisexual respondents reported unique strategies to cope with exclusion and isolation associated with misunderstandings about their sexual identities. Directions for future research on sexual minority stress are discussed.     

Sexual minority youth victimization and social support: the intersection of sexuality, gender, race, and victimization

In comparison to heterosexual youth, sexual minority youth are more likely to experience victimization. Multiple studies have connected anti-gay prejudice and anti-gay victimization to negative outcomes. Research shows that social support may protect sexual minorities from the harmful effects of anti-gay victimization. However, rates of victimization and the negative outcomes linked to sexual identity within the sexual minority community have been relatively unexplored. Using data from three years of statewide data from heterosexual and sexual minority adolescents in grades 9-12, this study examines victimization, substance use, suicidality, and access to social support by sexuality. Results indicate that sexual minority youth are at increased risk for victimization, substance use, suicidality, and social isolation compared to their heterosexual counterparts. Results also indicate that there is very little bivariate difference within the sexual minority community. Multivariate results indicate differences among sexual minorities' experiences with victimization and substance use.     

Cancer Screening Utilization Among U.S. Women: How Mammogram and Pap Test Use Varies Among Heterosexual,Lesbian, and Bisexual Women

Existing research on cancer screening utilization among sexual minority women in the U.S. has mostly relied on non-random samples that combine lesbian and bisexual women into a single group. We respond to these limitations by examining the relationship between sexual orientation and cancer screening among a sample of U.S. women from the Behavioral Risk Factor Surveillance System (BRFSS). Our analytic sample includes 2273 lesbian, 1689 bisexual, and 174,839 heterosexual women interviewed in 15 U.S. states between 2000 and 2010. We examine two cancer screening measures: timely mammogram and pap tests, defined as having had a mammogram in the past 2 years for women aged 40 and older, and having had a pap test in the past 3 years for women aged 21–65. For mammogram, results showed that rates of timely use did not significantly differ by sexual orientation. However, lesbian and bisexual women report significantly lower rates of timely pap testing than heterosexual women. Logistic regression results on timely pap testing showed that lower pap test use for bisexual women is primarily driven by their poorer socioeconomic status relative to heterosexual women, while the significantly lower odds of timely pap testing for lesbian women were unaffected by control measures. Better understanding of cancer screening utilization disparities among lesbian and bisexual women is necessary to address morbidity and mortality disparities by sexual orientation.     

Mental health issues: a comparison of lesbian, bisexual and heterosexual women

This study examines mental health issues among women of different sexual orientations. An anonymous survey was administered at 33 health care sites across the United States; the sample (N = 1304) included lesbians (n = 524), bisexual (n = 143) and heterosexual women (n = 637). Not only did sexual orientation influence the probability of experiencing emotional stress, but also whether a bisexual woman or lesbian had disclosed her sexual orientation (was "out") impacted the likelihood of having or having had mental health problems. Bisexual women and lesbians experienced more emotional stress as teenagers than did heterosexual women. Bisexual women were more than twice as likely to have had an eating disorder compared to lesbians. If a bisexual woman reported being out she was twice as likely to have had an eating disorder compared to a heterosexual woman. Lesbians who were not out and bisexual women who were out were 2-2.5 times more likely to experience suicidal ideation in the past 12 months. Lesbians and bisexual women who were not out were more likely to have had a suicide attempt compared to heterosexual women. Lesbians used psychotherapy for depression more commonly than did heterosexual or bisexual women. This is one of the few studies that compares lesbians, bisexual and heterosexual women. The implications of these findings are discussed.     

Patterns of Mental Health Care Utilization Among Sexual Orientation Minority Groups

Prior studies of the utilization of mental health professionals by sexual minority populations have relied on data that are now dated or not nationally representative. These studies have also provided mixed findings regarding gender differences in the utilization of mental health professionals among sexual minority individuals. Using data from the 2013–2015 National Health Interview Surveys, this study investigates (1) how sexual minority individuals compare to heterosexual participants in their utilization of mental health professionals; and (2) gender differences in that utilization. The results indicate sexual minority individuals utilize mental health care professionals at higher rates than heterosexual individuals even after controlling for measures of mental health and other demographic characteristics; this is true for both men and women. However, gender moderates the sexual minority effect on utilization rates. Sexual minority men utilize mental health professionals at a high rate, such that their utilization rates are similar to sexual minority women, contrary to the gender gap seen among heterosexuals.     

Intimate Partner Violence Among Sexual Minorities in Japan: Exploring Perceptions and Experiences

Using qualitative interviews (n = 39) and participant observation (n = 54), this study documents perceptions and experiences of violence between lesbian, gay, bisexual, transgender, and intersex intimate partners in Japan, thereby providing exploratory, formative data on a previously unexamined issue. Results indicate that intimate partner violence (IPV) is experienced physically, sexually, and psychologically in all sexual minority groups. Participants perceived the violence to be: a) very similar to heterosexual IPV against women; b) more likely perpetrated and experienced by lesbians, bisexual women, and transgender persons compared to gay and bisexual men and intersex persons; c) the cause of several negative physical and mental health outcomes; and d) largely unrecognized in both sexual minority communities and broader Japanese society.     

Sexual Orientation and Fear at Night: Gender Differences Among Sexual Minorities and Heterosexuals

Using data from the 2000–2010 General Social Survey, a nationally representative sample of 5,086 adults in the United States, the authors examine sexual orientation and gender differences in reports of being afraid to walk alone at night. Results indicate that sexual minorities are significantly more likely to report fear at night than heterosexuals, and women are significantly more likely to report such fear than men. Further, our findings suggest that these sexual orientation and gender differences are due to sexual minority men being more likely than heterosexual men to report fear at night. Thus, the results of this study reveal that three groups—heterosexual women, sexual minority women, and sexual minority men—do not differ from one another in reporting fear, yet these groups are all more likely than heterosexual men to report fear at night. These findings give weight to the importance of investigating the intersection of sexual orientation and gender in individuals’ reports of fear.     

Comparing Heterosexuals’ and Gay Men/Lesbians’ Responses to Relationship Problems and the Effects of Internalized Homophobia on Gay Men/Lesbians’ Responses to Relationship Problems in Turkey

The purpose of the present study was twofold: (1) to investigate the effects of sexual orientation (heterosexuals and gay men/lesbians) and gender difference on responses to romantic relationship problems (Exit, Voice, Loyalty, and Neglect [EVLN] responses) and of perceived partner’s EVLN responses in Turkey, and (2) to examine whether internalized homophobia was associated with EVLN responses and perceived partner’s EVLN responses for gay men and lesbians. Responses to Dissatisfaction Scale-Accommodation Instrument, Internalized Homophobia, and Demographics Information were administered to 187 participants (44 lesbians, 44 gay men, 53 heterosexual women, 46 heterosexual men).The MANCOVA results showed that men reported higher loyalty than women, whereas women presented more exit responses than men. Further, the interactions between gender and sexual orientation on the participants’ EVLN responses and on the perceived partner’s EVLN responses were significant. With respect to heterosexual women, heterosexual men displayed more loyalty responses. Lesbians had higher scores on loyalty than did heterosexual women. Lesbians also had higher scores on perceived partner’s exit response than did heterosexual women and gay men. On the contrary, heterosexual women reported more perceived partner’s voice response than lesbians. In addition, lesbians reported higher perceived partner’s neglect responses than heterosexual women. Compared to heterosexual women, heterosexual men reported higher perceived partner’s exit response. Finally, internalized homophobia was associated with destructive responses for both lesbians and gay men.     

Negative sexual experiences with men among heterosexual women and lesbians

Survey responses on traumatic experiences with men were compared from 50 matched pairs of heterosexual women and lesbians. Prior research has implied that lesbians have had more traumatic experiences with men than heterosexual women. The purpose of this study was to test the hypothesis that lesbians would report more negative sexual experiences with men than heterosexual women. The findings of the present study did not support this hypothesis. The only significant difference found between the two groups was that heterosexual women were more likely to report multiple categories of traumatic experiences and lesbians were more likely to report experiences in only one category of trauma. Contrary to prior studies, these results indicate that previous traumatic experiences with men may not be a significant factor in the development of sexual orientation.     

Minority Stress and Binge Eating Among Lesbian and Bisexual Women

Previous research demonstrates that lesbian and bisexual (LB) women report more binge eating behaviors compared to heterosexual women although the explanations for this disparity are not well understood. LB women also experience distal (e.g., discrimination) and proximal (e.g., expectations of rejection) minority stressors that are related to negative mental and physical health outcomes. The present study investigated the association between minority stressors and binge eating behaviors in LB women. A sample of 164 LB women completed an online survey that included measures of distal and proximal sexual minority stressors, emotional-focused coping, social isolation, negative affect, and binge eating. The resultant model partially supported both the psychological mediation framework and the affect regulation model. The principal finding was that among LB women, proximal stressors were associated with social isolation and emotion-focused coping, which in turn were associated with negative affect and ultimately binge eating. Overall, the study provides evidence that minority stress is associated with binge eating and may partially explain the disparity in binge eating between LB and heterosexual women.     

Mothers’ Sexual Identity and Children’s Health

Sexual minority women face a plethora of structural, socioeconomic, and interpersonal disadvantages and stressors. Research has established negative associations between women’s sexual minority identities and both their own health and their infants’ birth outcomes. Yet a separate body of scholarship has documented similarities in the development and well-being of children living with same-sex couples relative to those living with similarly situated different-sex couples. This study sought to reconcile these literatures by examining the association between maternal sexual identity and child health at ages 5–18 using a US sample from the full population of children of sexual minority women, including those who identify as mostly heterosexual, bisexual, or lesbian, regardless of partner sex or gender. Analyses using data from the National Longitudinal Study of Adolescent to Adult Health (N?=?8978) followed women longitudinally and examined several measures of their children’s health, including general health and specific developmental and physical health conditions. Analyses found that children of mostly heterosexual and bisexual women experienced health disadvantages relative to children of heterosexual women, whereas the few children of lesbian women in our sample evidenced a mixture of advantages and disadvantages. These findings underscore that to understand sexual orientation disparities and the intergenerational transmission of health, it is important to incorporate broad measurement of sexual orientation that can capture variation in family forms and in sexual minority identities.

     

Non-Heterosexuality,Relationships, and Young Women’s Contraceptive Behavior

Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women’s higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.     

Relationship of Religiosity and Spirituality to Hazardous Drinking,Drug Use,and Depression Among Sexual Minority Women

Using data from Wave 3 of the Chicago Health and Life Experiences of Women (CHLEW) study (N = 699), we explored whether religiosity and spirituality were associated with risk of hazardous drinking, drug use, and depression among sexual minority women (SMW; i.e., lesbian, bisexual) and possible differences by race/ethnicity. Participants were more likely to endorse spirituality than religiosity, and endorsement of each was highest among African American SMW. We found no protective effect of religiosity or spirituality for hazardous drinking or drug use. An association initially found between identifying as very spiritual and past-year depression disappeared when controlling for help-seeking. Among SMW with high religiosity, African American SMW were more likely than White SMW to report hazardous drinking. Latina SMW with higher spirituality were more likely than White SMW to report drug use. Results suggest that religiosity and spirituality affect subgroups differently, which should be considered in future research on resiliency among SMW.     

Sexual and Physical Abuse: A Comparison Between Lesbians and Their Heterosexual Sisters

The purpose of this study was to investigate similarities and differences in the incidence and patterns of abuse experienced by lesbians and their heterosexual sisters. In a matched sample of 324 lesbian/heterosexual sister pairs, the lesbians reported a greater incidence than their sisters of childhood physical and sexual abuse, as well as adult sexual abuse. Both groups identified male relatives as the most common perpetrator of both childhood physical and sexual abuse. Male relatives were most commonly identified as perpetrators of adult physical abuse and male strangers were most commonly identified as adult sexual abusers. Our results demonstrate that both sexual and physical abuse are common experiences for lesbian and heterosexual women; however, since the context of these experiences is different, each group will have special needs for services and treatment.     

Treatment decision-making among older women with breast cancer

This study examined breast cancer treatment decision-making among older adults, including professional and lay involvement. Thirty respondents were interviewed for this study; cancer survivors (70%) and newly diagnosed (30%) women with breast cancer. Respondents reported making treatment decisions in consultation with their oncologists. However, women differed on the extent to which they perceived their participation in the treatment process. Respondents' oncologists appear to be the primary factor associated with older women's breast cancer surveillance decision-making and adherence. The influence of women's support systems on their treatment decisions and surveillance activities appears to be minimal. Informal support systems, however, likely enhance women's ability to be active participants in their care. The growing need for interventions which target older women has been indicated. Interventions, however, cannot be adequately developed without first identifying the physical and psychosocial phenomena which affect decision-making.     

Battered gay men: an exploration of abuse, help seeking, and why they stay

In comparison to a large body of literature about battered heterosexual women and a growing body about battered lesbians, this is one of the first published studies that investigates the experiences of battered gay and bisexual men. Results indicated that these men suffered patterns, forms, and frequencies of physical, emotional, and sexual abuse similar to what has been documented by research on battered heterosexual and lesbian women. Likewise, the most commonly reported reasons for staying--namely, hope for change and love for partner--appear to be universal to the experience of being battered. Unlike battered heterosexual women, respondents in this study were not likely to report that being financially trapped was a major reason why they had remained. HIV-status, however, appears to significantly influence their decision to remain. Moreover, lack of knowledge about domestic violence and the lack of availability of appropriate resources play a significant role in same-gender domestic violence victims' decisions to remain. Like battered lesbians, battered gay men infrequently sought assistance from battered women's services and perceived these services as not helpful. By contrast, individual counselors and agencies who provided individual counselors were rated as quite helpful.     

Relationship Characteristics of Women in Interracial Same-Sex Relationships

The purpose of this study was to examine the relationship characteristics of women in interracial same-sex relationships with respect to their current level of stress, internalized homophobia, perceived relationship equality, relationship satisfaction, and social support. Four groups were compared according to their current type of race relationship (ethnic minority women with White partners, White partners only, both ethnic minority partners, and White women with ethnic minority partners). No significant differences were found in terms of children and income; however, ethnic minority women with ethnic minority partners reported lower education attainment than the other groups. Relationally, there were no significant differences by race relationship for social support, relationship equality, relationship satisfaction, or stress. Internalized homophobia was lowest for interracial partnerships (ethnic minority paired with White partner). These findings are discussed in relationship to minority stress.