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.     

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.     

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.     

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.     

Health Needs and Experiences of a LGBT Population in Georgia and South Carolina

ABSTRACT

The 2016 Municipal Equality Index rated Augusta, the largest city in the Central Savannah River Area (CSRA), as one of the least lesbian, gay, bisexual, and transgender (LGBT) friendly cities in America. To understand the context of our region in relation to LGBT wellness, we conducted the first LGBT health needs assessment of the CSRA, assessing physical and mental health status and health care needs and experiences in the community. Participants (N = 436) were recruited using venue and snowball sampling and completed an anonymous online survey. Overall, the health problems experienced (i.e., obesity, depression) were not uniformly experienced across sexual orientation and gender identity; some groups experienced significantly higher rates of these conditions than others. Similarly, transgender individuals in particular reported higher rates of negative experiences with health care providers. Regional and national dissemination of these findings is critical to reducing health disparities and improving wellness of our local LGBT community.     

Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma

ABSTRACT

LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.     

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.

     

Health Status and Risk Behaviors of Sexual Minorities Among Chinese Adolescents: A School-Based Survey

This study aimed to examine the association between sexual orientation and health disparities among a stratified random sample of 3776 secondary students in Hong Kong. The prevalence of homosexuality and bisexuality were 1.5% and 2.6% in boys and 1.8% and 3.7% in girls, respectively. A total of 10.7% of boys and 8.8% of girls were unsure of their sexual orientation. Homosexual and bisexual boys reported poorer physical and mental health than their heterosexual peers. Homosexual and bisexual boys were more likely to engage in smoking, frequent drinking, and vaginal sex and be subjected to sexually transmitted disease and sexual victimization. However, lesbian and bisexual girls were less likely to engage in risky health behaviors except for smoking and being subjected to sexual victimization. There is a gender-specific problem that may warrant prevention and intervention programs to address the unique health issues facing homosexual and bisexual adolescents in Hong Kong.     

Left Out? Lesbian,Gay, and Bisexual Poverty in the U.S.

This paper analyzes the risk of poverty for self-identified lesbian, gay, and bisexual (LGB) people from mid-2013 through 2016 in the National Health Interview Survey, a nationally representative survey of households that includes a sexual orientation question based on identity (n = 112,143). The study tests the role of family structure—living with a spouse or partner and having children—on the risk of poverty for LGB and heterosexual respondents. After controlling for education, demographic, and health measures in a probit model, lesbians and gay men are as likely to be poor as similar heterosexuals, but bisexual women and men are significantly more likely to be poor, regardless of relationship status. Single and childless gay men are also more likely to be poor than single heterosexual men. Being in a relationship reduces the likelihood of poverty for people of all sexual orientations, but the data show evidence of a gender composition effect: married male same-sex couples are less likely and unmarried female same-sex couples more likely to be poor than their married counterparts. Marriage reduces gay men’s poverty risk more and children increase their poverty risk less than for heterosexual men.     

Invisible Scars: Comparing the Mental Health of LGB and Heterosexual Intimate Partner Violence Survivors

Intimate partner violence (IPV) affects countless women and men in lesbian, gay, and bisexual (LGB) as well as heterosexual relationships, but few studies have examined how such abuse is associated with the mental health of LGB victims. The present study addresses this issue using data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey to examine differences in depression and anxiety among IPV victims in LGB and heterosexual partnerships. The findings indicate LGB IPV victims are much more likely to have a history of depression (OR 1.70, p < .05) and anxiety (OR 1.70, p < .05) than heterosexual victims. These differences are slightly mediated by the victim’s perceived emotional support but not the type of abuse experienced. Our findings accentuate the need for greater inclusion of LGB persons in the IPV and mental health discourse, as well as the importance of social support for IPV victims. Policy implications for members of the LGB community are discussed.     

Sexual orientation and differences in mental health, stress, and academic performance in a national sample of U.S. college students

This study examined the relationships of mental health issues and sexual orientation in a national sample of college students. Using the Fall 2009 American College Health Association-National College Health Assessment, responses from heterosexual, gay, lesbian, bisexual, and unsure students (N = 27,454) relating to mental health issues and impact of these issues on academics were examined. The findings indicate that gay, lesbian, bisexual, and unsure students consistently reported higher levels of mental health issues and a more frequent impact on academics because of these issues than heterosexual students. Bisexuals frequently reported higher levels than students identifying as gay, lesbian, and unsure.     

Religiosity as a Protective Factor against Heavy Episodic Drinking (HED) in Heterosexual,Bisexual, Gay,and Lesbian Young Adults

Although religiosity has been shown to be associated with positive outcomes in studies of general population samples, few studies have considered the potential differential effect of religiosity on those who are consolidating gay, lesbian, or bisexual (GLB) identities. Logistic regression analyses using a sample of 13,038 emerging adults from the National Longitudinal Survey of Adolescent Health (Add Health) revealed main effects for religiosity and a significant religiosity × sexual identity interaction in women. Specifically, religiosity was protective against alcohol use and heavy episodic drinking (HED) in heterosexual women, but not lesbian women. In bisexual women, higher religiosity increased the odds of alcohol use and HED. Among men, religiosity was protective, with no differential effects based on sexual identity. Prevention efforts should consider that individual religiosity may be a risk, rather than protective factor for some young adults.     

Women's Sexual Identity Patterns: Differences Among Lesbians,Bisexuals, and Unlabeled Women

To better understand women with same-sex attractions who do not identify as lesbian or bisexual (i.e., unlabeled women), we examined differences and similarities among self-designated lesbian, bisexual, and unlabeled women. Two hundred eight non-heterosexual women ranging in age from 18 to 69 years (85% identified as White) completed an online survey examining indicators of sexual orientation and beliefs and self-perceptions associated with sexual identity. Compared to lesbians, unlabeled women reported the weakest collective sexual identities and, along with bisexuals, they were less likely to view sexual orientation as fixed, being more focused on the “person, not the gender.” Unlabeled women reported the greatest likelihood that their sexual identity would change in the future. These findings highlight the complexity of women's sexual identities and question the adequacy of categorical approaches.     

Assessing the Gender Invariance of the Modern Homonegativity Scale

The measurement invariance of the Modern Homonegativity Scale (MHS) was examined among heterosexual female (n = 449) and male (n = 329) university students who were predominantly Mexican American. The MHS demonstrated full invariance of factor loadings and partial invariance of latent intercepts. At the latent mean level, heterosexual men compared to heterosexual women held more negative attitudes toward both gay men and lesbian women. There were no latent mean differences in attitudes toward gay men and lesbian women when rated by either heterosexual men or heterosexual women. The MHS can be used by heterosexual men and heterosexual women to assess their homonegativity.     

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.     

More Than a Feeling? An Empirical Analysis of the Dual-Continua Model on a National Sample of Lesbian,Gay, and Bisexual Identified Canadians

The goal of the study is to investigate whether positive mental health complements mental illness within a theoretically informed (the dual-continua model) and psychometrically tested (the Mental Health Continuum-Short Form) framework. National-level, population-based data from the 2012 Canadian Community Health Survey on Mental Health (CCHS-MH) was used, with comparisons between sexual minority and heterosexual adults. Results show that gay, lesbian, and bisexual Canadians have substantially lower rates of positive mental health and are more likely to have been diagnosed with a mental illness, with the disparities between health and illness being the most pronounced among lesbians and bisexual females. Results show considerable support for the dual-continua model, which posits that the absence of health does not automatically translate into the presence of illness, and vice versa. Suggestions are made for practitioners and researchers toward the use of the dual-continua model as a surveillance tool, especially among sexual minority individuals.     

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.     

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.     

Emotional Reactions of Heterosexual Men to Gay Imagery

Studies of homonegativity in the general population typically use scales to examine the attitudes of a heterosexual sample toward gay men and lesbian women. However, these scales fail to address that accepting gay and lesbian people in theory is not tantamount to accepting the sexual practices engaged in by gay and lesbian people. As a result, relying on homonegativity scales and hypothetical scenarios (i.e., asking a participant to imagine a gay man or lesbian woman from personality characteristics provided) may not offer a complete view of the complexities of homonegativity. To explore this possibility, 83 men self-identifying as either largely or exclusively heterosexual rated one of three groups of images (romantic gay, erotic gay, and control) on the basis of five questions related to their emotional responses. A psychometrically sound homonegativity scale was also completed. Results indicated that homonegativity was a significant predictor of decreased happiness, anger, disgust, task enjoyment, and reported liking of the imagery. Furthermore, homonegativity was found to moderate the association between exposure to the romantic images and four of the five emotional responses (happiness, anger, disgust, and liking). Exposure to the set of erotic gay images, however, was associated with negative emotional responses, regardless of participants’ self-reported level of homonegativity (i.e., overt homonegativity possessed less moderational power for this type of imagery). These findings suggest that standard scales of homonegative attitudes may be unable to capture the affective negativity that heterosexual men experience when viewing gay male intimacy.