Self-reported sexual identity, sexual behaviors and health risks

Disparities in alcohol use and heavy episodic drinking among bisexual people: A systematic review, meta-analysis, and meta-regression

BACKGROUND

Alcohol consumption is more prevalent among sexual minorities than among heterosexuals; however, differences between minority sexual orientation groups are understudied. This systematic review and meta-analysis aimed to summarize existing evidence on the prevalence of alcohol use among bisexual people compared to their lesbian/gay and heterosexual counterparts.

METHODS

A systematic review of literature from 1995 to May 2020 was performed using Medline, PsycInfo, and Embase (OVID), Scopus, CINHAL and LGBT Life (EBSCO), combining keywords for bisexuality and alcohol use. Peer-reviewed publications that reported quantitative data on alcohol use among bisexual people were included. A random-effects model was used to pool the prevalence of two outcomes: any alcohol use and heavy episodic drinking (HED). Subgroup analysis and random-effects meta-regression were used to explore heterogeneity.

RESULTS

Of 105 studies eligible for data extraction, the overall prevalence of alcohol use was higher among bisexuals compared to lesbian/gay and heterosexual people. For example, the prevalence of past-month HED was 30.0% (28.2, 31.8) among bisexual people versus 25.5% (23.8, 27.2) among lesbian/gay and 21.3% (19.6, 23.0) among heterosexual individuals. Pooled odds ratio estimates showed that bisexual people were more likely to report alcohol use and HED compared to their counterparts. Gender was a significant effect modifier in meta-regression analysis, with greater disparities among women than among men.

CONCLUSIONS

These results highlight the need for additional research to understand factors underlying bisexual people's greater risk, and particularly bisexual women, as well as alcohol use interventions that are targeted towards the specific needs of bisexual people.

Perceptions of Marijuana Decriminalization Among Young Sexual and Gender Minorities in Chicago: An Initial Measure Validation and Test of Longitudinal Associations with Use

Background: There is a high rate of marijuana use among young sexual and gender minorities (SGM) and, as a result of recent state-level, fragmented marijuana laws, there is also likely high variability in their perceptions of marijuana decriminalization (PMD). Methods: Data came from two cohorts of young SGM (aged 16-29) in Chicago, RADAR and FAB400, recruited from 2015 to 2017 (N=1,114). We developed a measure to assess PMD among this population, performed initial validation, and assessed its relationship to longitudinal changes in patterns of marijuana use and geographic distribution. Results: In multivariable models, mean PMD score was prospectively associated with general (adjusted odds ratio [aOR]=2.00; 95% confidence interval [CI]: 1.46-2.77), but not problematic marijuana use. An increase in perceived decriminalization also predicted a significant increase in odds of general (aOR=1.67; 95% CI: 1.18-2.39) marijuana use. Significant concentrations of high PMD scores existed in across the city. Conclusion: These results suggest further study of longitudinal changes in marijuana use as decriminalization or legalization increases in the U.S. to better understand shifting trends in use.

Sexual orientation measurement, bisexuality, and mental health in a sample of men who have sex with men in Vancouver, Canada

This cross-sectional study used a validated index (i.e., Hospital Anxiety and Depression Scale) to measure anxiety and depression (caseness score: ≥8) among men who have sex with men recruited via respondent-driven sampling in Vancouver, Canada (n=774), and investigated whether differences in mental health outcomes varied by sexual orientation measure (i.e., identity, attraction, behavior). Of the sample, 15.5% identified as bisexual, 33.4% reported any bisexual attraction, and 22.7% reported any bisexual sexual activity. More bisexual than gay men met the case definition for anxiety and depression, across all sexual orientation measures. In adjusted multivariable models, bisexual men had higher odds of anxiety by attraction and identity and higher odds of depression by identity. Findings highlight the value of measuring multiple sexual orientation dimensions in surveys and routine surveillance, and the need to ensure sexual minority groups and sexual orientation dimensions are not considered commensurate for mental health prevention and treatment.

Substance Use Patterns of Gay and Bisexual Men in the Momentum Health Study

Research with male sexual minorities frequently combines gay and bisexual men as Men Who Have Sex with Men or Gay and Bisexual Men. When analyzed separately, bisexual men consistently feature negative health differentials, exemplified by higher substance use levels. This interpretation is not clear-cut because studies may combine bisexual men and women, use different dimensions of sexual orientation to define bisexuality, and/or not consider number of sexual partners as a possible confounding factor. This study conducted separate bivariate and multivariate analyses comparing gay to bisexual Momentum Study participants based on self-identity, sexual attraction, and sexual behavior, while controlling for number of sexual partners and sociodemographic, psychosocial, and sexual behavior measures. The study hypothesized that, regardless of definition, bisexual men feature higher substance use levels compared to gay men. Bivariate analyses revealed significantly higher ( p < .05) use among bisexual men for multiple substances in all samples. Nonprescription stimulants and heroin were significant in all multivariate logistic regression models. In contrast, all bisexual samples reported lower use of erectile dysfunction drugs and poppers, substances associated with anal sex among gay men. Subsequent analysis linked these results to lower levels of anal sex in all bisexual samples. Bivariate analyses also revealed that bisexual men featured significantly lower educational levels, annual incomes, and Social Support Scales scores and higher Anxiety and Depression Sub-Scale Scores. In summary, findings revealed bisexual men's distinctive substance use, sexual behavior, psychosocial, and sociodemographic profiles, and are important for tailoring specific health programs for bisexual men.

Health Risk Behaviors in a Representative Sample of Bisexual and Heterosexual Female High School Students in Massachusetts

BACKGROUND

Differences in sexual health-related outcomes by sexual behavior and identity remain underinvestigated among bisexual female adolescents.

METHODS

Data from girls (N = 875) who participated in the Massachusetts Youth Risk Behavior Surveillance survey were analyzed. Weighted logistic regression models were fit to examine sexual and psychosocial health by lifetime sexual behavior (behaviorally bisexual vs behaviorally heterosexual) and sexual identity (bisexual vs heterosexual) adjusting for grade and race/ethnicity.

RESULTS

Overall, 10.5% of girls reported lifetime bisexual behavior and 8.1% reported a bisexual identity. Behavior and identity were discordant for bisexual young women as 53.2% of behaviorally bisexual students had a bisexual identity and 46.8% had a heterosexual identity. Bisexual identity and behavior were associated with unprotected intercourse at last sexual encounter, early sexual debut, 4 or more lifetime partners, history of forced/unwanted sex, sexually transmitted infection testing history, past-year depression, and past-month drug use (all ps < .05).

CONCLUSION

Bisexuality, whether defined by identity or behavior, is associated with adverse sexual and psychosocial health outcomes in adolescent girls. Studies that explore wellness across the life span, and are designed to recognize developmental differences burgeoning in adolescence, may provide insights into the differential sexual risk outcomes observed among bisexual girls.

Reciprocal relationships over time between descriptive norms and alcohol use in young adult sexual minority women

Young adulthood, roughly ages 18-25, is a period of great risk for excessive consumption of alcohol, especially among sexual minority women (SMW). Despite the substantial literature examining the relationships between social norms and behavior in general, little attention has been given to the role of descriptive norms on the drinking behaviors of sexual minorities. The present study had 3 aims: to compare both typical woman descriptive norms and sexual minority-specific descriptive normative perceptions among a sample of SMW, to examine reciprocal associations between sexual minority-specific descriptive norms and alcohol consumption over time, and to examine whether these reciprocal associations were moderated by sexual orientation (i.e., whether 1 identifies as lesbian or bisexual). A national sample of 1,057 lesbian and bisexual women between the ages of 18 and 25 was enrolled in this study. Participants completed an online survey at 4 time points that assessed the constructs of interest. Results indicated that SMW consistently perceived that SMW drank more than their nonsexual minority peers; that SMW-specific descriptive drinking norms and alcohol consumption influenced 1 another over time in a reciprocal, feed-forward fashion; and that these associations were not moderated by sexual orientation. These findings highlight the importance of considering SMW-specific norms as an important factor in predicting alcohol consumption in SMW. Results further support the development and testing of normative interventions for high-risk drinking among SMW.

Everyday places, heterosexist spaces and risk in contemporary Sweden

Subjective feelings of risk are a central feature of everyday life, and evidence shows that people who do not conform to contemporary normative notions are often more exposed to everyday risks than others. Despite this, normative notions are rarely acknowledged as risk objects. By drawing on the theory of 'doing' and 'undoing' risk, which combines intersectional and risk theory, this study contributes new perspectives on the everyday risks in contemporary society that face people who many would label as being 'at risk' - lesbian, gay, bisexual and transgender people. The study consists of five focus group interviews with lesbian, gay, bisexual and transgender people of different ages in Sweden. Findings pinpoint risks and how these are done and un-done in different spheres of interviewees' lives: the emotional risks prevailing in their private lives; the risk of discrimination at work and in relations with other institutions; and the risk of violence and harassment in public places. These risks are all related to the heteronormative order in which the mere fact of being lesbian, gay, bisexual and transgender is perceived as a risk.

Longitudinal Associations among Discordant Sexual Orientation Dimensions and Hazardous Drinking in a Cohort of Sexual Minority Women

We examined differences between sexual minority women's (SMW's) sexual identity and sexual behavior or sexual attraction as potential contributors to hazardous drinking across a 10-year period. Data are from a longitudinal study examining drinking and drinking-related problems in a diverse, community-based sample of self-identified SMW (Wave 1: n = 447; Wave 2: n = 384; Wave 3: n = 354). Longitudinal cross-lagged models showed that SMW who report higher levels of identity-behavior or identity-attraction discordance may be at greater risk of concurrent and subsequent hazardous drinking. Results of multigroup models suggest that sexual orientation discordance is a more potent risk factor for risky drinking outcomes among SMW in older adulthood than in younger adulthood. Findings support that discordance between sexual orientation dimensions may contribute to hazardous drinking among SMW and provide evidence that cognitive-behavioral consistency is important for individuals expressing diverse and fluid sexual identities, attraction, and behavior.

Sexual orientation disparities in adolescent cigarette smoking: intersections with race/ethnicity, gender, and age

OBJECTIVES

We examined sexual orientation differences in adolescent smoking and intersections with race/ethnicity, gender, and age.

METHODS

We pooled Youth Risk Behavior Survey data collected in 2005 and 2007 from 14 jurisdictions; the analytic sample comprised observations from 13 of those jurisdictions (n = 64,397). We compared smoking behaviors of sexual minorities and heterosexuals on 2 dimensions of sexual orientation: identity (heterosexual, gay-lesbian, bisexual, unsure) and gender of lifetime sexual partners (only opposite sex, only same sex, or both sexes). Multivariable regressions examined whether race/ethnicity, gender, and age modified sexual orientation differences in smoking.

RESULTS

Sexual minorities smoked more than heterosexuals. Disparities varied by sexual orientation dimension: they were larger when we compared adolescents by identity rather than gender of sexual partners. In some instances race/ethnicity, gender, and age modified smoking disparities: Black lesbians-gays, Asian American and Pacific Islander lesbians-gays and bisexuals, younger bisexuals, and bisexual girls had greater risk.

CONCLUSIONS

Sexual orientation, race/ethnicity, gender, and age should be considered in research and practice to better understand and reduce disparities in adolescent smoking.

Adolescent gender-related abuse, androphilia, and HIV risk among transfeminine people of color in New York City

Public health research has indicated extremely high HIV seroprevalence (13%-63%) among low-income transfeminine people of color of African, Latina, and Asian descent living in the U.S. This article combines two data sets. One set is based on an ethnographic study (N = 50, 120 hours of participant observation). The other set is based on a longitudinal quantitative study (baseline N = 600, N = 275 followed for 3 years). Transfeminine people of color are much more likely to be androphilic and at high HIV risk. A greater understanding of adolescent gender-related abuse and trauma-impacted androphilia contributes toward a holistic conceptual model of HIV risk. A theoretical model is proposed that incorporates findings from both studies and integrates sociostructural, interpersonal, and intrapsychic levels of HIV risk.

Sexual victimization and associated risks among lesbian and bisexual women

This study examines relationships among childhood sexual abuse (CSA), risky alcohol use, and adult sexual victimization among bisexual and lesbian women. Half (51.2%) of women reported CSA and 71.2% reported adult sexual victimization. Perpetrators were generally male, and 56.4% of women's most recent adult sexual victimization incidents occurred after coming out. Regression results indicated that adult sexual victimization severity was associated with a bisexual identity, more severe CSA history, more lifetime sexual partners, and higher alcohol severity scores. Compared to lesbians, bisexual women reported more severe adult sexual victimization experiences, greater revictimization, riskier drinking patterns, and more lifetime male sexual partners.

Born Both Ways: The Alloparenting Hypothesis for Sexual Fluidity in Women

Given the primacy of reproduction, same-sex sexual behavior poses an evolutionary puzzle. Why would selection fashion motivational mechanisms to engage in sexual behaviors with members of the same sex? We propose the alloparenting hypothesis, which posits that sexual fluidity in women is a contingent adaptation that increased ancestral women's ability to form pair bonds with female alloparents who helped them rear children to reproductive age. Ancestral women recurrently faced the adaptive problems of securing resources and care for their offspring, but were frequently confronted with either a dearth of paternal resources due to their mates' death, an absence of paternal investment due to rape, or a divestment of paternal resources due to their mates' extra-pair mating efforts. A fluid sexuality would have helped ancestral women secure resources and care for their offspring by promoting the acquisition of allomothering investment from unrelated women. Under this view, most heterosexual women are born with the capacity to form romantic bonds with both sexes. Sexual fluidity is a conditional reproductive strategy with pursuit of men as the default strategy and same-sex sexual responsiveness triggered when inadequate paternal investment occurs or when women with alloparenting capabilities are encountered. Discussion focuses on (a) evidence for alloparenting and sexual fluidity in humans and other primates; (b) alternative explanations for sexual fluidity in women; and (c) fourteen circumstances predicted to promote same-sex sexual behavior in women.

Childhood Trauma, Adult Sexual Assault, and Adult Gender Expression among Lesbian and Bisexual Women

Several studies have demonstrated that lesbian and bisexual women are more likely than heterosexual women to report childhood abuse and adult sexual assault. It is unknown, however, which sexual minority women are most likely to experience such abuse. We recruited adult sexual minority women living in the US through electronic fliers sent to listservs and website groups inviting them to complete an online survey (N=1,243). We examined differences in both childhood abuse and adult sexual assault by women's current gender identity (i.e., butch, femme, androgynous, or other) and a continuous measure of gender expression (from butch/masculine to femme/feminine), adjusting for sexual orientation identity, age, education, and income. Results indicated that a more butch/masculine current self-assessment of gender expression, but not gender identity, was associated with more overall reported childhood trauma. Although one aspect of gender expression, a more butch/masculine gender role, was associated with adult sexual assault, feminine appearance and a femme gender identity also significantly predicted adult sexual assault. These findings highlight the significance of gender identity and expression in identifying women at greater risk for various abuse experiences.

Measurement of sexual identity in surveys: implications for substance abuse research

Researchers are increasingly recognizing the need to include measures of sexual orientation in health studies. However, relatively little attention has been paid to how sexual identity, the cognitive aspect of sexual orientation, is defined and measured. Our study examined the impact of using two separate sexual identity question formats: a three-category question (response options included heterosexual, bisexual, or lesbian/gay), and a similar question with five response options (only lesbian/gay, mostly lesbian/gay, bisexual, mostly heterosexual, only heterosexual). A large probability-based sample of undergraduate university students was surveyed and a randomly selected subsample of participants was asked both sexual identity questions. Approximately one-third of students who identified as bisexual based on the three-category sexual identity measure chose "mostly heterosexual" or "mostly lesbian/gay" on the five-category measure. In addition to comparing sample proportions of lesbian/gay, bisexual, or heterosexual participants based on the two question formats, rates of alcohol and other drug use were also examined among the participants. Substance use outcomes among the sexual minority subgroups differed based on the sexual identity question format used: bisexual participants showed greater risk of substance use in analyses using the three-category measure whereas "mostly heterosexual" participants were at greater risk when data were analyzed using the five-category measure. Study results have important implications for the study of sexual identity, as well as whether and how to recode responses to questions related to sexual identity.

The prevalence of sexual assault against people who identify as gay, lesbian, or bisexual in the United States: a systematic review

This article systematically reviews 75 studies that examine the prevalence of sexual assault victimization among gay or bisexual (GB) men, and lesbian or bisexual (LB) women, in the United States. All studies were published between 1989 and 2009 and report the results of quantitative research. The authors reviewed the reported prevalence of lifetime sexual assault victimization (LSA), and where available, childhood sexual assault (CSA), adult sexual assault (ASA), intimate partner sexual assault (IPSA), and hate crime-related sexual assault (HC). The studies were grouped into those that used a probability or census sampling technique (n=25) and those that used a non-probability or ''community-based'' sampling technique (n=50). A total of 139,635 gay, lesbian, and bisexual (GLB) respondents participated in the underlying studies reviewed. Prevalence estimates of LSA ranged from 15.6-85.0% for LB women and 11.8-54.0% for GB men. Considering the median estimates derived from the collective set of studies reviewed, LB women were more likely to report CSA, ASA, LSA, and IPSA than GB men, whereas GB men were more likely to report HC than LB women. Across all studies, the highest estimates reported were for LSA of LB women (85.0%), CSA of LB women (76.0%), and CSA of GB men (59.2%). With some exceptions, studies using non-probability samples reported higher sexual assault prevalence rates than did population-based or census sample studies. The challenges of assessing sexual assault victimization with GLB populations are discussed, as well as the implications for practice, policy, and future research.

Voices from the margin: a case study of a rural lesbian's experience with woman-to-woman sexual violence

The purpose of this case study is to understand how a lesbian survivor coped with traumatic stress resulting from woman-to-woman sexual violence in a rural context. This research was grounded on the feminist paradigm, and the case study approach was used for data collection and analysis. The results indicate that the lesbian survivor encountered numerous obstacles to admitting the rape and seeking help. A number of these perceived challenges were associated with the rural sociocultural context (e.g., conservative culture, religious fundamentalism, low levels of anonymity, small gay/lesbian communities, and geographical isolation), myths of lesbian utopia, a heterosexist legal system, and a lack of lesbian-friendly helping resources. Despite being confronted with numerous challenges, the survivor demonstrated her resilience through the use of a variety of strategies to cope with the rape aftermath and detrimental social reactions. Positive social support from her gay and lesbian friends also facilitated her recovery. The findings highlight the importance of considering the intersection of trauma and cultural oppression in understanding lesbian survivors' experiences with same-sex sexual assault.

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.

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 x 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.

Tobacco, marijuana, and sensation seeking: comparisons across gay, lesbian, bisexual, and heterosexual groups

This study examined patterns of smoked substances (cigarettes and marijuana) among heterosexuals, gays, lesbians, and bisexuals based on data from the 2000 National Alcohol Survey, a population-based telephone survey of adults in the United States. We also examined the effect of bar patronage and sensation seeking/impulsivity (SSImp) on tobacco and marijuana use. Sexual orientation was defined as lesbian or gay self-identified, bisexual self-identified, heterosexual self-identified with same-sex partners in the past 5 years, and exclusively heterosexual (heterosexual self-identified, reporting no same-sex partners). Findings indicate that bisexual women and heterosexual women reporting same-sex partners had higher rates of cigarette smoking than exclusively heterosexual women. Bisexual women, lesbians, and heterosexual women with same-sex partners also used marijuana at significantly higher rates than exclusively heterosexual women. Marijuana use was significantly greater and tobacco use was elevated among gay men compared with heterosexual men. SSImp was associated with greater use of both of these substances across nearly all groups. Bar patronage and SSImp did not buffer the relationship between sexual identity and smoking either cigarettes or marijuana. These findings suggest that marijuana and tobacco use differ by sexual identity, particularly among women, and underscore the importance of developing prevention and treatment services that are appropriate for sexual minorities.

Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States

OBJECTIVES

We used data from a nationally representative sample to examine the associations among 3 dimensions of sexual orientation (identity, attraction, and behavior), lifetime and past-year mood and anxiety disorders, and sex.

METHODS

We analyzed data from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

RESULTS

Mental health outcomes differed by sex, dimension of sexual orientation, and sexual minority group. Whereas a lesbian, gay, or bisexual identity was associated with higher odds of any mood or anxiety disorder for both men and women, women reporting only same-sex sexual partners in their lifetime had the lowest rates of most disorders. Higher odds of any lifetime mood or anxiety disorder were more consistent and pronounced among sexual minority men than among sexual minority women. Finally, bisexual behavior conferred the highest odds of any mood or anxiety disorder for both males and females.

CONCLUSIONS

Findings point to mental health disparities among some, but not all, sexual minority groups and emphasize the importance of including multiple measures of sexual orientation in population-based health studies.

Sexual orientation, substance use behaviors and substance dependence in the United States

AIMS

To assess past-year prevalence rates of substance use behaviors and substance dependence across three major dimensions of sexual orientation (identity, attraction and behavior) in a large national sample of adult women and men in the United States.

DESIGN

Data were collected from structured diagnostic face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version IV (AUDADIS-IV).

SETTING

Prevalence estimates were based on data collected from the 2004-2005 (wave 2) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

PARTICIPANTS

A large national sample of 34 653 adults aged 20 years and older: 52% female, 71% white, 12% Hispanic, 11% African American, 4% Asian and 2% Native American.

FINDINGS

Approximately 2% of the population self-identified as lesbian, gay or bisexual; 4% reported at least one life-time same-sex sexual partner and 6% reported same-sex sexual attraction. Although non-heterosexual orientation was generally associated with a higher risk of substance use and substance dependence, the majority of sexual minority respondents did not report substance use or meet criteria for DSM-IV substance dependence. There was considerable variation in substance use outcomes across sexual orientation dimensions; these variations were more pronounced among women than among men.

CONCLUSIONS

Results support previous research findings of heightened risk of substance use and substance dependence among some sexual minority groups and point to the need for research that examines the reasons for such differences. Results also highlight important gender differences and question previous findings indicating uniformly higher risk for substance dependence among sexual minorities. Risks appear to vary based on gender and how sexual orientation is defined. Findings have implications for more effective prevention and intervention efforts that target subgroups at greatest risk.

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.

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.

Understanding differences in substance use among bisexual and heterosexual young women

BACKGROUND

Numerous studies have documented higher substance use rates among bisexual than heterosexual young women, although little is known about the developmental factors contributing to these differences. Based on self-reported sexual orientation collected at age 23, this study identified similarities and differences between bisexual and heterosexual women in their substance use at ages 14 and 18, compared these groups at ages 14 and 18 on key psychosocial factors known to predict young adult substance use, and determined whether these psychosocial factors at age 18 could account for sexual orientation differences in substance use at age 23.

METHODS

Longitudinal survey data from a West Coast cohort were used to compare heterosexual (n = 1,479) and bisexual (n = 141) women on their substance use and psychosocial characteristics.

RESULTS

During adolescence, bisexual women were more likely to have been current and solitary substance users; reported stronger pro-drug beliefs and lower resistance self-efficacy; perceived greater parental approval of their substance use; had more exposure to substance-using peers; and reported poorer mental health. By age 23, bisexual women had higher rates of current substance use, greater quantity and frequency of use, and more problematic alcohol and drug use. Differences in problematic use at age 23 could be partially explained by risk factors assessed five years earlier at age 18, particularly pro-drug social influences and beliefs.

CONCLUSIONS

Notwithstanding the lack of longitudinal data on sexual orientation, these results provide important insights regarding the drug prevention needs of bisexual women.

The Impact of Prior Heterosexual Experiences on Homosexuality in Women

An abundance of unwanted sexual opportunities perpetrated by insensitive, physically and sexually abusive men may be a factor in the expression of homosexuality in some women. In the present study, we examined self-reports of dating histories, sexual experiences, and physical and sexual abuse among lesbians and heterosexual women. Lesbians with prior heterosexual experience reported more severe and more frequent physical abuse by men. Lesbians also reported more instances of forced, unwanted sexual contact perpetrated by men, and this sexual abuse occurred at a significantly earlier age. These data show that adverse experiences with the opposite sex are more common in lesbians than heterosexual women, and therefore negative heterosexual experiences may be a factor in the expression of a same-sex sexual orientation in women. We propose an evolutionary psychological interpretation of this phenomenon based on the cardinally different mating strategies of women and men that have evolved for maximizing the likelihood of reproduction.

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.

Research, curricula, and resources related to lesbian, gay, bisexual, and transgender health in US schools of public health

To assess the extent to which public health schools conduct research, offer planned curricula, and provide resources related to lesbian, gay, bisexual, and transgender health, we mailed a self-administered questionnaire to individual department chairpersons at each school. Survey results suggested that departmental lesbian, gay, bisexual, and transgender research and curricular activities extending beyond HIV and AIDS were uncommon in most public health school programs. Expanding lesbian, gay, bisexual, and transgender health research and curricula may help health professionals improve their response to lesbian, gay, bisexual, and transgender health disparities.

Sexual Orientation and Mental Health

This article provides an overview of current psychological research on mental health and sexual orientation, as well as clinical practice with sexual minorities. The historical context for current research questions and controversies is described, and the findings of recent empirical research on psychological well-being and distress among nonheterosexuals are summarized. The minority stress model is used to frame a discussion of stressors unique to sexual minorities and to consider their possible effects on psychological well-being. The possible ameliorative effects of adopting a sexual orientation identity are examined, followed by a discussion of how these ideas translate into contemporary clinical work with sexual minority clients. The review concludes with a brief discussion of priority areas for empirical research and clinical practice.

Health concerns of sexual minority adolescent girls

PURPOSE OF REVIEW

The goal of this article is to provide an overview of up-to-date health information about sexual minority female youth so that healthcare practitioners can better serve their healthcare needs.

RECENT FINDINGS

Sexual minority adolescent girls may follow diverse sexual developmental trajectories. Many in this population are quite healthy, but some may be disproportionately vulnerable to health risks, perhaps because of the stigma associated with minority sexuality in society. If sexually active, girls in this population often have sex with boys as well as girls and confront risks attendant with sex with both genders. They may demonstrate fluidity in their sexual identity as they move through adolescence. Data suggest that sexual minority adolescent girls are more likely to smoke cigarettes, drink alcohol, or use illicit drugs compared with girls who are heterosexual. They may be more likely to be victims of violence or victimization or to be depressed or suicidal.

SUMMARY

Sexual minority adolescent girls may be quite resilient, but they face a range of possible adverse health risks. Healthcare practitioners should keep their health issues in mind so they can offer healthcare and counseling that is sensitive, comprehensive, and appropriate.

The health of people classified as lesbian, gay and bisexual attending family practitioners in London: a controlled study

BACKGROUND

The morbidity of gay, lesbian or bisexual people attending family practice has not been previously assessed. We compared health measures of family practice attendees classified as lesbian, gay and bisexual.

METHODS

We conducted a cross-sectional, controlled study conducted in 13 London family practices and compared the responses of 26 lesbian and 85 bisexual classified women, with that of 934 heterosexual classified women and 38 gay and 23 bisexual classified men with that of 373 heterosexual classified men. Our outcomes of interest were: General health questionnaire; CAGE questionnaire; short form12; smoking status; sexual experiences during childhood; number of sexual partners and sexual function and satisfaction.

RESULTS

In comparison to people classified as heterosexuals: men classified as gay reported higher levels of psychological symptoms (OR 2.48, CI 1.05-5.90); women classified as bisexual were more likely to misuse alcohol (OR 2.73, 1.70-4.40); women classified as bisexual (OR 2.53, 1.60-4.00) and lesbian (OR 3.13, 1.41-6.97) and men classified as bisexual (OR 2.48, 1,04, 5.86) were more likely to be smokers and women classified as bisexual (OR 3.27, 1.97-5.43) and men classified as gay (OR 4.86, 2.28-10.34) were much more likely to report childhood sexual experiences in childhood. Psychological distress was associated with reporting sexual experiences in childhood in men classified as gay and bisexual and women classified as heterosexual. Men classified as bisexual (OR 5.00, 1.73-14.51) and women classified as bisexual (OR 2.88, 1.24- 6.56) were more likely than heterosexuals to report more than one sexual partner in the preceding four weeks. Lesbian, gay and bisexual classified people encountered no more sexual function problems than heterosexuals but men classified as bisexual (OR 2.74, 1.12-6.70) were more dissatisfied with their sex lives.

CONCLUSION

Bisexual and lesbian classified people attending London general practices were more likely to be smokers and gay classified men were at increased risk of psychological distress in comparison to heterosexual classified people. Increased awareness of the sexuality of people seen in primary care can provide opportunities for health promotion.

Risks and prevention of sexually transmissible infections among women who have sex with women

Health care providers working with women who have sex with women (WSW) have been ill-informed about a range of sexual health issues for these women. Pertinent issues include sexual behaviours that carry risks of sexually transmissible infection (STI), prevention strategies for safer sex and understanding experiences of abuse. A relative silence continues in all of these areas within the mainstream medical literature, textbooks, research and policy documents, which perpetuates medical ignorance. There is evidence that the prevalence of STIs among WSW is at least as high as among heterosexual women, if not higher among some sub-groups. Risk factors include the sex and number of sexual partners, minimal use of protected sexual behaviours and low levels of knowledge of STI prevention among WSW. Importantly, marginalisation leading to poorer mental health and experiences of abuse can combine to influence risk taking including substance abuse and risky sexual behaviours. Safe-sex guidelines and the need to recognise the impact of sexual abuse are presented.

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.

Substance use and misuse: are bisexual women at greater risk?

The objective of this study was to compare the prevalence of substance use and alcohol-related consequences among bisexual and heterosexual women. A cross-sectional survey was self-administered to a random sample of undergraduate women. The final sample consisted of 49 self-identified bisexual women and 2,042 self-identified heterosexual women. Bivariate and multivariate results indicated that bisexual women were more likely than heterosexual women to report cigarette smoking, illicit drug use and medically prescribed use of antidepressant prescription medication. Although their drinking behaviors were similar, bisexual women were more likely than heterosexual women to experience adverse alcohol-related consequences. These findings suggest that traditional-age undergraduate women who self-identify as bisexual may be at heightened risk for substance use. However, additional research is needed to replicate these findings with larger samples of bisexual women.