A comparison of alcohol consumption between lesbians and heterosexual women in an urban population

Mental health of sexual minorities. A systematic review

Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.

Exploration of Substance Use Among Lesbian, Gay, and Bisexual Youth

The prevalence and correlates of substance use and abuse were explored among lesbian, gay male, and bisexual youth recruitedfrom gay-focused organizations in New York City. Lifetime substance use was prevalent andfrequent, as was quantity of use and substance abuse symptoms. Few significant gender or ethnic differences emerged, but the significant differences unexpectedly indicated that the female youth were at greater risk for substance abuse than the male youth. Number of substances ever used and substance abuse symptoms were associated with initiating alcohol and illicit drugs to cope with psychological issues. Howeve, number of substances ever used and substance abuse symptoms were not explained by social learning theory, social control theory, or self-derogation theory when relations were explored. Thefindings are interpretedfrom the perspective of sexual identity, specifically that gay, lesbian, and bisexual youth may use substances to cope with the societal stigma of homosexuality.

Lesbian Social Drinking: The Role of Alcohol in Growing up and Living as Lesbian

Lesbians reportedly use alcohol more frequently and in greater quantities than heterosexuals, conceivably placing them at greater risk for alcohol-related problems. Past theorists have suggested psychosocial variables such as stress or the centrality of the gay bar to account for these findings. Researchers have not examined lesbian drinking within its historical, social, and cultural contexts.

This paper reviews findings of a qualitative interview study examining sexual identity development and alcohol use patterns of 31 self-identified lesbian social drinkers. Findings reveal the importance of multiple contexts to understanding lesbian drinking. The author proposes a correspondence between identity development and alcohol use, as both are affected by the changing social conditions of different historic eras. The normalized presence of alcohol in lesbian contexts and norms related to its use present distinctive dilemmas for alcohol problem identification and treatment with this population. These findings have several implications for practice with lesbian clients.

The South Carolina LGBT needs assessment: a descriptive overview

Limited quantitative information exists about the demographics and needs of lesbian, gay, bisexual, and transgender (LGBT) persons in South Carolina, a predominately rural Southern state. Responses to a needs assessment survey (n = 715) were analyzed to understand the diversity and needs of members of the LGBT community in SC. The purpose was to inform future programming and guide the development of a more comprehensive portfolio of services to be offered by a local LGBT community center. Findings suggest that a diverse LGBT community exists in SC and needs include increased programming for community members as well as efforts to provide policy-level support and increased acceptability and understanding of LGBT persons in South Carolina.

Elevated alcohol and sexual risk behaviors among young Thai lesbian/bisexual women

BACKGROUND

Little empirical data have been published about drinking or sexual behaviors among Thai lesbians. We examine the association of sexual identity with established indicators of alcohol- and sexual-related health behaviors among female bar patrons.

METHODS

We conducted a cross-sectional study among women (N=121) aged 18-24 who frequented popular drinking establishments in Chiang Mai, Thailand. We used general linear modeling techniques to estimate associations between sexual identity and positive alcohol expectancy, harmful drinking, age at sexual debut, and number of lifetime sexual partners.

RESULTS

Nearly one-third of women aged 18-24 recruited from Chiang Mai drinking venues identified as lesbian/bisexual. As compared to their heterosexual counterparts, lesbian/bisexuals reported higher positive alcohol expectancy scores, more harmful drinking, earlier age at sexual debut, and higher number of lifetime sexual partners. In adjusted models, lesbian/bisexual identity was associated with higher positive alcohol expectancy (β=1.94 points; 95% CI: 0.75, 3.13), earlier age at sexual debut (β=-0.85 years; 95% CI: -1.46, -0.23), and higher number of lifetime sexual partners (rate ratio=1.70; 95% CI: 1.22, 2.37).

CONCLUSION

Lesbian/bisexual women in this study engaged in multiple behaviors that are potentially harmful to health, which may in turn place this group at heightened risk for alcohol abuse and sexually transmitted infections in Thailand. The clustering of alcohol- and sexual-related risk behaviors, and its consequences for health outcomes in this population, should be explored in future research and may be an important point of intervention.

International differences in alcohol use according to sexual orientation

Most research on sexual orientation and alcohol use in the United States has found higher rates of alcohol use and abuse among gay men and lesbians. Studies from other countries have found smaller or no differences between sexual minority and heterosexual women and men. The present study used general population survey data from 14 countries to examine high-volume and risky single-occasion drinking by sexual orientation. Data from 248 gay men and lesbians and 3720 heterosexuals were analyzed in a case-control design. In several countries partnered or recently partnered gay men and lesbians had no greater risk of heavy drinking or engaging in heavy drinking than heterosexual controls. Only lesbians in North America showed higher risk for both indicators. Future general population health research should include larger samples of gays and lesbians and use more comprehensive measures of sexual orientation for investigating the prevalence of health risk factors.

Sexual Minority Women and Alcohol: Intersections between drinking, relational contexts, stress and coping

Few studies explore sexual minority women's experiences and perceptions of alcohol. Qualitative interviews were conducted with six sexual minority women who reported having sought help for alcohol problems in the past and six who did not. Themes emerged in two broad areas: stressors that contributed to heavy or problem drinking and factors that enhanced coping and reduced both stress and problem use. Alcohol use across groups was framed in terms of social context (e.g., bar patronage), stress management, and addiction. The findings of the study underscore the importance of considering the role of alcohol in managing stress as well coping factors that may inform social service interventions.

Reproductive health in lesbian and bisexual women in Sweden

OBJECTIVE

Previous international studies have elucidated signs of poor physical and mental health in women who have sex with women (WSW) and an avoidance of preventive healthcare. When the first Nordic gynecological clinic for WSW was started in Stockholm in 1999, an opportunity to compile information about their physical and psychological health and social situation arose.

DESIGN

Retrospective descriptive.

SETTING AND SAMPLE

A total of 706 women: 264 patients attending a WSW clinic and 442 women attending the regular gynecological clinic.

METHODS

Questionnaires. Response rate: WSW 77%, comparison group 40%.

MAIN OUTCOME MEASURES

Possible differences in mental and reproductive health and attendance of preventive healthcare by WSW and heterosexual women.

RESULTS

Having had a male sexual partner was reported by 82.3% of the WSW, 39.5% in the last five years and 4.9% in the last year. One-fifth of WSW had been pregnant, and one in ten had given birth. Equally, many had experience of induced abortion. WSW had less experience of gynecological examination and Papanicolaou smear screening. More than one-fifth of WSW had at some time had sexually transmitted infections (STI) and 12.6% reported a history of cervical atypia. WSW remembered dissatisfaction with their sexual lives during their youth and had more frequently sought professional help for their sexuality.

CONCLUSION

WSW attend gynecological examinations to a lesser extent than heterosexual women. The fact that WSW reported having been affected by STI and cervical cell atypia underlines the opinion that they should be advised to attend the same gynecological check-ups and cervical screening programs as heterosexual women.

How does sexual minority stigma "get under the skin"? A psychological mediation framework

Sexual minorities are at increased risk for multiple mental health burdens compared with heterosexuals. The field has identified 2 distinct determinants of this risk, including group-specific minority stressors and general psychological processes that are common across sexual orientations. The goal of the present article is to develop a theoretical framework that integrates the important insights from these literatures. The framework postulates that (a) sexual minorities confront increased stress exposure resulting from stigma; (b) this stigma-related stress creates elevations in general emotion dysregulation, social/interpersonal problems, and cognitive processes conferring risk for psychopathology; and (c) these processes in turn mediate the relationship between stigma-related stress and psychopathology. It is argued that this framework can, theoretically, illuminate how stigma adversely affects mental health and, practically, inform clinical interventions. Evidence for the predictive validity of this framework is reviewed, with particular attention paid to illustrative examples from research on depression, anxiety, and alcohol-use disorders.

The association of sexual orientation with self-rated health, and cigarette and alcohol use in Mexican adolescents and youths

Evidence of health inequities associated with sexual orientation has been gathered for industrialized countries. The situation for lesbians, gay males, and bisexuals (LGB) from middle- or low-income countries may be worse than those in industrialized nations. Here, we analyze the relationship of sexual orientation with self-rated health and cigarette and alcohol use among a representative sample of Mexican adolescents and youths between the ages of 12 and 29 years, in order to explore whether this association is mediated by discrimination and violence. Three dimensions of sexual orientation (affective attraction, sexual behavior, and identity) were assessed. The outcomes were self-rated health and cigarette and alcohol use. Compared to heterosexuals, LGB youths more frequently smoked >or=6 cigarettes per day, reported having experienced family violence, having crimes perpetrated against them, and having experienced violations of their rights. Among males, gays and bisexuals exhibited a higher risk of poor health than heterosexuals. Compared to heterosexual women, lesbians and bisexual women were more likely to consume alcohol. Many differences in self-rated health and substance use according to sexual orientation were explained by having experienced discrimination and violence. We concluded that lesbian and bisexual females have a higher prevalence of cigarette and alcohol use. It is necessary to develop policies and programs aimed at the reduction of substance abuse among LGB youths (focusing on females who engage in sexual contact with persons of the same gender) and to work against discrimination and violence experienced by LGB people, particularly against non-heterosexual males.

Bar patronage and motivational predictors of drinking in the San Francisco Bay Area: gender and sexual identity differences

Prior research has found heavier drinking and alcohol-related problems to be more prevalent in sexual minority populations, particularly among women. It has been suggested that differences may be explained in part by socializing in bars and other public drinking venues. This study explores gender, sexual orientation and bar patronage in two different samples: respondents from a random digit dial (RDD) probability study of 1,043 households in Northern California and 569 individuals who were surveyed exiting from 25 different bars in the same three counties that constituted the RDD sample. Bar patrons, in most instances, were at much higher risk of excessive consumption and related problems and consequences. On several key variables, women from the bar patron sample exceeded the problem rates of men in the general population. Bisexual women and bisexual men exhibited riskier behavior on many alcohol measures relative to heterosexuals. Measures of heavier drinking and alcohol-related problems were also elevated among lesbians compared to heterosexual women. Two of the bar motive variables, sensation seeking and mood change motives, were particularly predictive of heavier drinking and alcohol-related problems. Social motives did not predict problems.

A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people

BACKGROUND

Lesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people.

METHOD

We conducted a systematic review and meta-analysis of the prevalence of mental disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people. We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of Knowledge, the Applied Social Sciences Index and Abstracts, the International Bibliography of the Social Sciences, Sociological Abstracts, the Campbell Collaboration and grey literature databases for articles published January 1966 to April 2005. We also used Google and Google Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on population based studies which contained concurrent heterosexual comparison groups and valid definition of sexual orientation and mental health outcomes.

RESULTS

Of 13706 papers identified, 476 were initially selected and 28 (25 studies) met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria. Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people. Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual people [pooled risk ratio for lifetime risk 2.47 (CI 1.87, 3.28)]. The risk for depression and anxiety disorders (over a period of 12 months or a lifetime) on meta-analyses were at least 1.5 times higher in lesbian, gay and bisexual people (RR range 1.54-2.58) and alcohol and other substance dependence over 12 months was also 1.5 times higher (RR range 1.51-4.00). Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women were particularly at risk of substance dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61; drug dependence: RR 3.50, CI 1.87, 6.53; any substance use disorder RR 3.42, CI 1.97-5.92), while lifetime prevalence of suicide attempt was especially high in gay and bisexual men (RR 4.28, CI 2.32, 7.88).

CONCLUSION

LGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people.

Nobody was out back then: a grounded theory study of midlife and older lesbians with alcohol problems

This explorative study used grounded theory methodology (GTM) to develop a substantive theory regarding the life experience of the misuse of alcohol among midlife and older lesbians. The core category in this study is represented by the overarching process of "Disconnecting from their Authentic Selves." Professional health care providers may better be able to understand and assist midlife and older lesbians who misuse alcohol by being aware of their life experience with alcohol problems and the concepts they have described. A theoretical model is presented as a visual representation of the key concepts described in this paper and their interrelationships.

Sexual orientation and alcohol use: identity versus behavior measures

BACKGROUND

Few population-based national studies include complete measures of alcohol consumption, alcohol-related problems, and sexual orientation. When measures of sexual orientation are included in alcohol surveys, typically only one measure is included. The purpose of this paper is to compare two ways of measuring sexual orientation and to explore the relationship of each measure with alcohol use and alcohol-related problems.

METHODS

Data were used from the 2000 National Alcohol Survey, a telephone national alcohol probability survey representative of U.S. adults 18 and over (N = 7,612). Sexual orientation was measured by two self-reported measures: sexual orientation identity and sexual behavior. Alcohol use and problems were assessed by number of drinks in the last year, number of days drank 5 or more drinks in the last year, social consequences, and DSM-IV alcohol dependence.

RESULTS

There is no consistent pattern of alcohol use or alcohol-related problems based on how sexual orientation is measured for men. For women, bisexual identity or bisexual behavior was consistently associated with greater alcohol use and problems as compared to heterosexual identity or heterosexual behavior. Use of behavior measures alone appears to provide lower estimates of alcohol- related consequences and dependence among lesbian respondents.

CONCLUSIONS

These results underscore the utility of using both identity and behavior items to measure sexual orientation particularly for women when assessing alcohol use and alcohol-related problems.

Trajectories and determinants of alcohol use among LGB young adults and their heterosexual peers: results from a prospective study

Lesbians, gays, and bisexuals (LGBs) are at increased risk for alcohol use during young adulthood, but the mechanisms remain inadequately understood. The aim of the present study was to examine the trajectories and determinants of alcohol use among LGB young adults who were sampled prospectively. The sample included 111 LGB individuals (47 women and 64 men) and 2,109 heterosexuals (1,279 women and 830 men), who were assessed at three time points: during the summer after their senior year of high school and during the fall and spring of their freshman year of college. Hierarchical linear modeling analyses indicated that lesbians consumed more alcohol than their heterosexual peers during high school, whereas gay men increased their alcohol use at greater rates than heterosexual men during the initial transition to college. Positive alcohol expectancies and social norms mediated this relation for both men and women. The results extend the generalizability of these processes and highlight the importance of considering normative social-cognitive influences in the development of alcohol use among LGB young adults.

A clinical comparison of lesbian and heterosexual women in a psychiatric outpatient clinic

Previous research has reported that when compared to heterosexual women, lesbians may use alcohol and illicit substances to a greater degree and may experience greater psychiatric symptomatology. This study sought to describe any differences in clinical diagnoses, familial histories, and substance usage between lesbian and heterosexual women in a psychiatric outpatient clinic. A chart review was conducted and a sample of 455 heterosexuals and 75 lesbians was obtained. Data, where available, included demographic information, clinical diagnoses, time in treatment, sexual orientation, past and present substance use, and familial substance abuse and psychiatric history. Lesbians were found to have greater past illicit substance use but less current use. No significant differences were found for alcohol use. Similarly, no significant differences in clinical diagnoses were found. Significant differences were found among families. Family members of lesbians had greater substance use and psychiatric histories. These findings both support and dispute some previous research and suggest areas for future researchers to explore.

Childhood risk factors for alcohol abuse and psychological distress among adult lesbians

OBJECTIVE

This study examined the relationships between childhood and family background variables, including sexual and physical abuse, and subsequent alcohol abuse and psychological distress in adult lesbians.

METHODOLOGY

Structural equation modeling was used to evaluate relationships between childhood sexual and physical abuse and parenting variables and latent measures of lifetime alcohol abuse and psychological distress in a large community-based sample of lesbians.

RESULTS

Childhood sexual abuse (CSA) directly predicted lifetime alcohol abuse, and childhood physical abuse (CPA) directly predicted lifetime psychological distress. In addition, CSA indirectly increased the risk of lifetime alcohol abuse through its negative effect on age at first heterosexual intercourse. Childhood physical abuse had only indirect effects on lifetime alcohol abuse through its strong relationship to lifetime psychological distress. Parental drinking problems and parental strictness directly predicted lifetime psychological distress; parental drinking problems indirectly predicted lifetime alcohol abuse through the mediators of age of drinking onset and lifetime psychological distress. White lesbians, younger lesbians, and those with lower levels of education were at greatest risk of psychological distress.

CONCLUSION

While the cross-sectional design precludes causal conclusions, study findings--especially those related to CSA--are consistent with previous research on predominantly heterosexual women in the general population. Lesbians who experienced CSA were at heightened risk of lifetime alcohol abuse and those who experienced CPA were at heightened risk of lifetime psychological distress relative to lesbians without abuse histories. Given the dearth of research on childhood abuse and sexual orientation, studies are needed that examine the similarities and differences between lesbians' and heterosexual women's experiences of, and responses to, childhood abuse.

Age differences in lesbian identity development and drinking

Women who "come out" as lesbian must learn to cope with a stigmatized identity. Stress associated with the sexual identity development process is a commonly posed explanation for the high rates of "heavy drinking" and drinking consumption-related problems within this population. However, relatively little is known about the sexual identity development process in lesbians and even less about lesbians' drinking patterns during this process. Growing societal tolerance and visibility of sexual minorities over the past 35 years has likely created substantially different environments and experiences of coming out for individuals of different age cohorts. Data from the Chicago Health and Life Experiences of Women study provided the opportunity to examine relationships between variables associated with lesbian identity development and alcohol use-related problems in three age cohorts of self-identified lesbians. The study's limitations are noted.

Do specialized services exist for LGBT individuals seeking treatment for substance misuse? A study of available treatment programs

Substance abuse research has demonstrated that client sexual orientation influences treatment outcomes. Consequently, many substance user treatment programs offer services for lesbian, gay, bisexual, and transgender (LGBT) individuals. In a recent search of SAMHSA treatment listings, 11.8% (N=911) of substance user treatment programs (including residential, outpatient, and partial hospitalization) in the United States and Puerto Rico indicated that they offer specialized services for LGBT clients. However, a telephone survey we conducted in 2003-2004 revealed that 70.8% of these "LGBT" programs were no different from services offered to the general population, and only 7.4% could identify a service specifically tailored to the needs of LGBT clients. Implications for LGBT individuals seeking services are discussed, the study's limitations are noted, and future research directions are identified.

Gay/Lesbian sexual orientation increases risk for cigarette smoking and heavy drinking among members of a large Northern California health plan

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.

Methods

Data from random sample general health surveys of adult members of a large Northern California Health Plan conducted in 1999 and 2002 were analyzed using gender-based multivariate logistic regression models to assess whether lesbians (n = 210) and gay men (n = 331) aged 20–65 were more likely than similarly aged heterosexual women (n = 12,188) and men (n = 9342) to be smokers and heavy drinkers.

Results

After adjusting for age, race/ethnicity, education, and survey year, lesbians were significantly more likely than heterosexual women to be heavy drinkers (OR 2.14, 95% CI 1.08, 4.23) and current smokers (OR 1.60, 95% CI 1.02, 2.51). Among men, gays were significantly more likely than heterosexuals to be current smokers (OR 2.40, 95% CI 1.75, 3.30), with borderline significant increased risk for heavy drinking (OR 1.54, 95% CI 0.96, 2.45).

Conclusion

Lesbians and gay men may be at increased risk for morbidity and mortality due to higher levels of cigarette and alcohol use. More population-based research is needed to understand the nature of substance use in these communities so that appropriate interventions can be developed.

Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women

BACKGROUND

Mounting evidence suggests that lesbians and bisexual women may be at especially elevated risk for the harmful health effects of alcohol and tobacco use.

METHODS

We report findings from the California Women's Health Survey (1998-2000), a large, annual statewide health surveillance survey of California women that in 1998 began to include questions assessing same-gender sexual behavior.

RESULTS

Overall, homosexually experienced women are more likely than exclusively heterosexually experienced women to currently smoke and to evidence higher levels of alcohol consumption, both in frequency and quantity. Focusing on age cohorts, the greatest sexual orientation disparity in alcohol use patterns appears clustered among women in the 26-35-year-old group. We also find that recently bisexually active women report higher and riskier alcohol use than women who are exclusively heterosexually active. By contrast, among homosexually experienced women, those who are recently exclusively homosexually active do not show consistent evidence of at-risk patterns of alcohol consumption.

DISCUSSION

Findings underscore the importance of considering within-group differences among homosexually experienced women in risk for tobacco and dysfunctional alcohol use.

Predicting, understanding and changing: three research paradigms regarding alcohol use among lesbians

The author presents a paradigmatic categorization and review of the literature that is available regarding lesbians and alcohol. She illuminates the characteristics, shortcomings, and strengths of Empirical Post Positivist, Interpretive, and Critical Social research paradigms. Results of the various studies are presented while research and funding directions are proposed.

Alcohol consumption, alcohol-related problems, and other substance use among lesbian and bisexual women

Relationships between sexual orientation and a wide range of substance use and problem variables were examined based on data from the 2000 National Alcohol Survey. Lesbians, bisexuals, and heterosexually identified women who report same-sex partners were compared to exclusively heterosexual women in relation to alcohol consumption, use of tobacco and other drugs, bar-going, alcohol-related problems, and past substance abuse treatment. Substance use patterns were complex and varied between sexual orientation groups. These differences underscore the importance of developing lesbian- and bisexual-sensitive prevention and treatment services and of including measures of sexual orientation identity and behavior in population-based surveys.

Sexual Orientation, Health Risk Factors, and Physical Functioning in the Nurses' Health Study II

OBJECTIVES

To examine associations between sexual orientation and breast cancer risk factors, cardiovascular disease (CVD) risk factors, mental health status, and health-related functioning.

METHODS

We compared participants in the Nurses' Health Study II (NHSII) reporting a lesbian or bisexual orientation with those reporting a heterosexual orientation, with heterosexuals serving as the reference group for all comparisons. Prevalence of health behaviors and conditions was adjusted for differences in the distribution of age, ancestry, and region of residence by standardizing to the distribution of the overall cohort. Multivariate prevalence ratios were calculated to compare lesbians and bisexuals with heterosexuals using binomial regression with the log link function. Means of health conditions were measured using continuous scales standardized to the distribution of the overall cohort. Differences in means comparing lesbians and bisexuals with heterosexuals were tested by multivariate linear regression. All comparisons were adjusted for age, ancestry, and region of residence.

RESULTS

Based on information from 90,823 women aged 32-51 in 1995, those reporting a sexual orientation of lesbian (n = 694) had a higher prevalence of risk factors for breast cancer, including nulliparity and high daily alcohol intake, compared with heterosexual women. Lesbians also had a higher prevalence of several risk factors for CVD, including higher body mass index (BMI) and elevated prevalence of current smoking. Lesbians were more likely to report depression and the use of antidepressants. Key results for health risk factors were similar for lesbians and bisexual women (n = 317).

CONCLUSIONS

Lesbian and bisexual women were found to have a higher prevalence of several important risk factors for breast cancer, CVD, and poor mental health and functioning outcomes. Most of these risk factors are modifiable, and appropriate interventions could play an important role in improving the health status of lesbian and bisexual women.

Treatment counselor's attitudes about lesbian, gay, bisexual, and transgendered clients: urban vs. rural settings

Treatment counselors' attitudes about lesbian, gay, bisexual, and transgendered (LGBT) clients can have important effects on these client's recovery. There is a common, but unexamined, perception that LGBT people are more accepted in urban areas (and thus urban treatment programs) and that urban counselors have greater knowledge of the needs of the LGBT community. This study examined the attitudes and knowledge of treatment counselors from two geographic regions: urban Chicago (n = 109) and rural Iowa (n = 242) in 2000. The instrument assessed demographic characteristics, knowledge, and experiences working with LGBT clients, and attitudes about LGBT clients (an adaptation of Herek's Attititudes about Lesbians and Gays rating scale). Only a few demographic differences between the urban and rural counselors were identified. Chicago counselors were more racially diverse and more likely to have grown up in an urban area than the Iowa counselors. The Iowa counselors had slightly higher levels of formal education. Although the Chicago providers reported having considerably more contact with LGBT clients and more formal and continuing education about LGBT people, they did not have more positive attitudes or report more knowledge of specific LGBT issues that might influence alcohol and drug treatment. Overall, both Chicago and Iowa counselors had very little formal education regarding the needs of LGBT clients, and nearly half reported negative or ambivalent attitudes. Many of the counselors lacked knowledge about legal issues such as domestic partnership and power of attorney, the concepts of domestic partnership and internalized homophobia, and issues related to family of origin and current family.

Lesbians' drinking patterns: beyond the data

Early studies report very high rates of "alcohol abuse" and alcoholism among lesbians. However, serious methodological problems, including nonrepresentative samples that were often recruited in lesbian or gay lesbian bars, limit the validity of findings from these studies. In this article, I briefly review the literature on lesbians' use of alcohol and present findings from a recent study conducted in Chicago (USA). This study recruited a race- and age-diverse sample of lesbians and a demographically matched group of heterosexual women. Rates of "heavy" alcohol use and alcohol-use-related problems among lesbians were much lower in this study than in early studies. However, lesbians were more likely than their heterosexual counterparts to be in recovery and to have been in treatment for alcohol-use-related problems. Further, high rates of childhood sexual abuse, depression, and suicidal ideation reported by lesbians suggest that at least some groups may be at heightened risk for "heavy" drinking and drinking-related problems. Nevertheless, results of this and other studies suggest that reports of heavy drinking and drinking-related problems among lesbians may have been inflated in earlier studies, or that heavy drinking and drinking-related problems may have declined among lesbians.

Sexual identity and substance use among undergraduate students

This study examined the association between sexual identity and use of alcohol and other drugs (AOD) among college undergraduate students. A survey regarding AOD use was administered to a random sample of 3607 undergraduate students. The sample included 65 self-identified lesbian or bisexual (LB) women and 54 self-identified gay or bisexual (GB) men. Multivariate logistic regression indicated that while alcohol use did not differ for LB and heterosexual women, LB women were significantly more likely to experience certain AOD-related consequences, smoke cigarettes, and use marijuana, ecstasy, and other drugs. GB men were significantly less likely than heterosexual men to drink heavily but were more likely to use some drugs. These findings provide evidence that sexual identity is an important predictor of AOD use among undergraduate students. These findings support the need for continued research and intervention efforts that target LGB collegians.

Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States

Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use.

Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States

Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use.

Sexual minorities seeking services

SUMMARY Understanding the mental health needs of lesbian and bisexual (sexual minority) women is an integral part of designing and providing appropriate mental health services and treatment for them. In an effort to understand the mental health needs of sexual minority women who seek community treatment, a chart review was conducted of the 223 lesbian and bisexual women who presented for services between July 1, 1997 and December 31, 2000 at Fenway Community Health in Boston, MA. Data are based on clients' self-reports and clinician assessments of clients' presenting problem, relevant developmental history, prior mental health and substance abuse treatment, current reports of emotional/psychological symptoms, and areas of impaired functioning. Although substance abuse and suicidal ideation were commonly reported problems, other concerns were more frequently reported. High percentages of lesbians and bisexual women reported relationship concerns and lack of adequate social networks; rates of depression and anxiety based on clinicians' assessments were also high. Overall, lesbians and bisexual women did not differ in the issues they brought to treatment or level or types of impairment. Compared with previous community survey samples, however, study participants appeared to be healthier than general, non-clinical samples of self-identified lesbians, possibly reflecting the special characteristics of sexual minority women who seek treatment in specialized community sites such as the Fenway. Although patients who come to these sites may not represent the more general population of sexual minority women, community health centers known to serve lesbian, gay, bisexual and transgender (LGBT) individuals may be fruitful access points for studying the mental health status and treatment needs of sexual minority women.

Psychological distress in african american lesbian and heterosexual women

SUMMARY Similarities and differences in indicators of psychological distress, risk factors for distress, and methods of coping were assessed in African American lesbians and heterosexual women. Despite similar rates of risk factors, lesbians reported more indicators of psychological distress and more frequent use of alcohol or other drugs in response to stress. In addition, findings reflect an overall trend toward higher rates of drinking, alcohol-related problems, and use of other legal and illegal drugs among lesbians.

Self-reported sexual identity, sexual behaviors and health risks

SUMMARY Data from a population-based survey of low-income young women (n = 2,438) was used to examine substance use patterns and exposure to coerced sexual activity among women who self-identify as lesbian (n = 34) or bisexual (n = 91), or who report sexual behavior exclusively with other women (n = 17) or with both women and men (n = 189). Findings for women classified by self-identity and by sexual behavior are compared. Women who identified as bisexual or lesbian reported higher rates of lifetime and recent substance use and were more likely to report experiences of coerced sex than women who identified as heterosexual. Women with both male and female sex partners reported higher rates of substance use and coerced sexual experiences than did women with male partners only. Heterosexual women with both male and female partners were more similar to self-identified bisexuals, compared to heterosexual women with male partners only. The implications of assessing multiple dimensions of sexual orientation in research focusing on lesbians' mental health are discussed.

Sexual assault and alcohol abuse: a comparison of lesbians and heterosexual women

PURPOSE

To compare and contrast lesbians' and heterosexual women's experiences of sexual assault and to investigate relationships between sexual assault and alcohol abuse.

METHODS

In-depth interviews were conducted with 63 lesbians and a demographically matched comparison group of 57 heterosexual women. Lesbians' and heterosexual women's experiences of sexual assault, drinking levels, and alcohol-abuse indicators were compared using descriptive statistics. LISREL analysis was used to test the effects of sexual assault on a latent measure of alcohol abuse.

RESULTS

Lesbians reported more childhood sexual experiences, were more likely to meet the study definition for childhood sexual abuse (CSA), and were more likely to perceive themselves as having been sexually abused as children. CSA was associated with lifetime alcohol abuse in both lesbian and heterosexual women. However, adult sexual assault (ASA) was associated with alcohol abuse only in heterosexual women.

IMPLICATIONS

Sexual assault is a common experience among both lesbians and heterosexual women. Findings emphasize the importance of asking about sexual assault in health histories, and assessing clients for substance abuse and other sequelae of sexual assault.

Substance abuse counsellor's attitudes regarding lesbian, gay, bisexual, and transgendered clients

PURPOSE

The attitudes of substance abuse counselors can have significant effects on their client's recovery. This study examined the attitudes and knowledge of substance abuse counselors regarding lesbian, gay, bisexual, and transgendered (LGBT) clients.

METHODS

242 substance abuse counselors in Iowa completed mail-in questionnaires.

RESULTS

The counselors reported very little formal education regarding the needs of these clients, and nearly half had negative or ambivalent attitudes. Respondents had the greatest negativity regarding transgendered clients and reported knowing the least about this group. Counselors frequently lacked knowledge about the legal issues of these clients, the concepts of domestic partnership and internalized homophobia, and family issues.

IMPLICATIONS

Substance abuse counselors require more education about LGBT clients.

Behavioral risk factors for disease and preventive health practices among lesbians

OBJECTIVES

This study compared the prevalence of health behaviors among lesbians and in the general population of women.

METHODS

We used a cross-sectional community-based survey of 1010 self-identified lesbians 18 years or older.

RESULTS

Compared with the general population of women, lesbians were more likely to report cigarette use, alcohol use, and heavy alcohol use. A higher percentage of lesbians were categorized as overweight, and lesbians were more likely to participate in vigorous physical activity. They were less likely to report having had a Papanicolaou test within the past 2 years but more likely to report ever having had a mammogram.

CONCLUSIONS

While there may be differences in health behaviors between lesbians and the general population of women, how these differences influence the risk of subsequent disease is unknown.

Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey

OBJECTIVES

This study examined the risk of psychiatric disorders among individuals with same-sex sexual partners.

METHODS

Data are from the National Comorbidity Survey, a nationally representative household survey. Respondents were asked the number of women and men with whom they had sexual intercourse in the past 5 years. Psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria were assessed with a modified version of the Composite International Diagnostic Interview.

RESULTS

A total of 2.1% of men and 1.5% of women reported 1 or more same-sex sexual partners in the past 5 years. These respondents had higher 12-month prevalences of anxiety, mood, and substance use disorders and of suicidal thoughts and plans than did respondents with opposite-sex partners only. Decomposition showed that the elevated same-sex 12-month prevalences were largely due to higher lifetime prevalences. Ages at onset and persistence of disorders did not differ between the same-sex and opposite-sex subsamples.

CONCLUSIONS

Homosexual orientation, defined as having same-sex sexual partners, is associated with a general elevation of risk for anxiety, mood, and substance use disorders and for suicidal thoughts and plans. Further research is needed to replicate and explore the causal mechanisms underlying this association.

Patterns of cigarette smoking and alcohol use among lesbians and bisexual women enrolled in a large health maintenance organization

OBJECTIVES

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

Lesbians and bisexual women aged 20 to 34 years are at risk for alcohol use and cigarette smoking.

Sexual identity and alcohol-related outcomes: contributions of workplace harassment

PURPOSE

While workplace sexual harassment has received a great deal of attention in both the popular media and scientific literature, less attention has been directed to the differential occurrence of sexual harassment among lesbians, gay men, and heterosexual men and women, and the relationships between these experiences and alcohol-related outcomes. Additionally, the distribution of alcohol-related outcomes of non-sexual forms of workplace harassment among these groups have not been adequately explored.

METHOD

Using data from a university-based study of workplace harassment and alcohol use (N = 2492), we focus on exposure to workplace harassment and alcohol-related outcomes for lesbians, gay men, and bisexuals compared to heterosexual men and women.

RESULTS

Lesbian/bisexual women did not differ significantly from heterosexual women in their experiences of workplace harassment. However, stronger linkages between harassment and increased alcohol consumption and problems were found for lesbian and bisexual women than for heterosexual women. Gay/bisexual men, on the other hand, experienced significantly more sexual harassment than heterosexual men, but did not report a corresponding increase in alcohol use and abuse.

IMPLICATIONS

Implications for future research on sexual identity, alcohol use, and workplace harassment are discussed.

Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population

Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.

Substance use among gay and lesbian adolescents

Surveys at a Massachusetts high school used multiple items to identify gay, lesbian, and bisexual teenagers. Students with consistent homosexual preferences had greatly elevated rates of substance use. Those who displayed a homosexual preference but answered less consistently also had somewhat higher rates of substance use but were closer to heterosexual youths than to more consistent homosexual youths. The differences in substance use were least for alcohol use and greater for "hard" drugs.

Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population

Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.

Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population

Most surveys of the prevalence of psychiatric disorders among lesbians and gay men find no increased risk in comparison with heterosexuals. However, the majority of this work has relied on convenience samples drawn from the visible lesbian and gay community. The authors examined differences in 1-year prevalence of six psychiatric syndromes among sexually active individuals in the 1996 National Household Survey of Drug Abuse who reported either exclusive heterosexuality (n = 9,714) or having any same-gender sex partners (n = 194) in the prior year. Although nearly three quarters of homosexually active individuals did not meet criteria for any of the six syndromes assessed, in multivariate logistic regression analyses, homosexually active men were more likely than other men to evidence major depression and panic attack syndromes. In contrast, homosexually active women were more likely than other women to be classified with alcohol or drug dependency syndromes. Both men and women reporting any same-gender sex partners were more likely than others to have used mental health services in the year prior to interview. These findings suggest a small increased risk among homosexually active populations in 1-year psychiatric morbidity and use of mental health care services.