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.     

Breast cancer risk and screening: a comparison of lesbian and heterosexual women

OBJECTIVES: Using data collected as part of the Multisite Women's Health Study, we examined the differences between lesbians and heterosexual women on objective breast cancer risk calculations using the Gail Model. Health risk behaviors and screening behaviors for breast cancer were also examined. It was hypothesized that lesbians would have higher objective cancer risk estimates and report more behavioral and screening risk factors for breast cancer than heterosexual women. METHODS: Secondary data analyses were conducted using data from a study of women's health conducted from 1994 to 1996. Using a cross sectional design, a convenience sample of lesbian (n = 550) and heterosexual (n = 279) women was recruited from Chicago, New York City and Minneapolis-St. Paul. Data were collected using a self-administered questionnaire. RESULTS: Estimates of 5-year and lifetime breast cancer risk were higher for lesbians compared to heterosexual women. Groups did not differ in self-perceptions of being overweight, but more lesbians reported heavier drinking and more reported abstinence from alcohol. Group differences in adherence to breast cancer screening were not significant. CONCLUSIONS: Findings suggest a small but statistically significant difference in the calculated breast cancer risk estimates of lesbian and heterosexual women, which seem to be largely accounted for by differences in reproductive risk factors.     

Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women

BACKGROUND: There is a dearth of validated information about lesbian and bisexual women's health. To better understand some of these issues, we used population-based data to assess variations in health behaviors, health status, and access to and use of health care based on sexual orientation. METHODS: Our study population was drawn from a population-based sample of women, the 1997 Los Angeles County Health Survey. Participants reported their sexual orientation and these analyses included 4697 women: 4610 heterosexual women, 51 lesbians, and 36 bisexual women. We calculated adjusted relative risks to assess the effect of sexual orientation on important health issues. RESULTS: Lesbians and bisexual women were more likely than heterosexual women to use tobacco products and to report any alcohol consumption, but only lesbians were significantly more likely than heterosexual women to drink heavily. Lesbians and bisexual women were less likely than heterosexual women to have health insurance, more likely to have been uninsured for health care during the preceding year, and more likely to have had difficulty obtaining needed medical care. During the preceding 2 years, lesbians, but not bisexual women, were less likely than heterosexual women to have had a Papanicolaou test and a clinical breast examination. CONCLUSIONS: In this first population-based study of lesbian and bisexual women's health, we found that lesbians and bisexual women were more likely than heterosexual women to have poor health behaviors and worse access to health care. These findings support our hypothesis that sexual orientation has an independent effect on health behaviors and receipt of care, and indicate the need for the increased systematic study of the relationship between sexual orientation and various aspects of health and health care. Arch Fam Med. 2000;9:1043-1051     

Sexual orientation and health: comparisons in the women's health initiative sample

CONTEXT: Little is known about older lesbian and bisexual women. Existing research rarely compares characteristics of these women with comparable heterosexual women. OBJECTIVE: To compare heterosexual and nonheterosexual women 50 to 79 years on specific demographic characteristics, psychosocial risk factors, screening practices, and other health-related behaviors associated with increased risk for developing particular diseases or disease outcomes. DESIGN: Analysis of data from 93,311 participants in the Women's Health Initiative (WHI) study of health in postmenopausal women, comparing characteristics of 5 groups: heterosexuals, bisexuals, lifetime lesbians, adult lesbians, and those who never had sex as an adult. SETTING: Subjects were recruited at 40 WHI study centers nationwide representing a range of geographic and ethnic diversity. PARTICIPANTS: Postmenopausal women aged 50 to 79 years who met WHI eligibility criteria, signed an informed consent to participate in the WHI clinical trial(s) or observational study, and responded to the baseline questions on sexual orientation. MAIN OUTCOME MEASURES: Demographic characteristics, psychosocial risk factors, recency of screening tests, and other health-related behaviors as assessed on the WHI baseline questionnaire. RESULTS: Although of higher socioeconomic status than the heterosexuals, the lesbian and bisexual women more often used alcohol and cigarettes, exhibited other risk factors for reproductive cancers and cardiovascular disease, and scored lower on measures of mental health and social support. Notable is the 35% of lesbians and 81% of bisexual women who have been pregnant. Women reporting that they never had sex as an adult had lower rates of Papanicolaou screening and hormone replacement therapy use than other groups. CONCLUSIONS: This sample of older lesbian and bisexual women from WHI shows many of the same health behaviors, demographic, and psychosocial risk factors reported in the literature for their younger counterparts, despite their higher socioeconomic status and access to health care. The lower rates of recommended screening services and higher prevalence of obesity, smoking, alcohol use, and lower intake of fruit and vegetables among these women compared with heterosexual women indicate unmet needs that require effective interactions between care providers and nonheterosexual women.     

Correlates of overweight and obesity among lesbian and bisexual women

BACKGROUND: Recent studies find lesbians at greater risk for overweight and obesity than heterosexual women. While this may reflect differences in attitudes concerning weight and body shape, little is actually known about risk factors within this group. This study examines correlates of obesity and exercise frequency among lesbians and bisexual women. METHODS: Data from a snowball sample (n = 1209) of lesbians/bisexual women living in Los Angeles Country were utilized. Overweight was defined as BMI >/= 25 kg/m(2); obesity as BMI >/= 30. Associations between sociodemographic characteristics, exercise frequency, health indicators, and weight-related measures were evaluated to identify independent predictors of BMI and exercise frequency. RESULTS: Prevalence of overweight and obesity among lesbians varied by racial/ethnic background. Higher BMI was associated with older age, poorer health status, lower educational attainment, relationship cohabitation, and lower exercise frequency. Higher BMI, perceptions of being overweight, and reporting a limiting health condition were identified as independent predictors of infrequent exercise. Women were generally quite accurate in self-perceptions of weight status. CONCLUSIONS: Correlates of overweight and obesity among lesbians and bisexual women are generally comparable to those observed in studies of heterosexual women. Evidence that lesbians' higher BMI is associated with higher levels of fitness is not supported.     

Health related behaviors and cancer screening of lesbians: results of the Boston Lesbian Health Project II

This paper reports data on health related behaviors and cancer screening from the Boston Lesbian Health Project II (BLHP II), a replication of a national survey of lesbians on a variety of health-related variables completed in 1987. The findings suggest that lesbians have increased their use of primary care, including routine physical examinations, pap smear screening for cervical cancer, and mammography for breast cancer, but that rates continue to be lower than would be expected for women in general. Younger lesbians in this sample smoked at high rates. Smoking rates continue to be of concern in other age groups, although they are lower than national data from women in general. BLHP II data confirm other findings that lesbians are more likely to drink alcohol and to drink more heavily than other women. Implications for health care of lesbians and future research with this population are discussed.     

Caregiving associated with selected cancer risk behaviors and screening utilization among women: cross-sectional results of the 2009 BRFSS

ABSTRACT: BACKGROUND: Informal caregiving is increasingly common as the U.S. population ages, and there is concern that caregivers are less likely than non-caregivers to practice health-promoting behaviors, including cancer screening. We examined caregiving effects on cancer risk behaviors and breast and cervical cancer screening in the 2009 Behavioral Risk Factor Surveillance System. METHODS: Women age [GREATER-THAN OR EQUAL TO]41 with data on breast and cervical cancer screening were included (weighted frequency 3,478,000 women). Cancer screening was classified according to American Cancer Society guidelines. We evaluated the association of caregiving with cancer risk behaviors (obesity, physical activity, alcohol intake, smoking status, and fruit/vegetable consumption) and cancer screening (mammography, clinical breast exam [CBE], and Pap test) using logistic regression overall and with stratification on age (<65, [GREATER-THAN OR EQUAL TO]65) or race (white, non-white). RESULTS: Caregivers had greater odds of being obese, physically active, and current smokers. Subgroup analyses revealed that caregiving was associated with obesity in younger women and whites, and with less obesity in older women. Also, caregiving was associated with smoking only among younger women and non-whites. Caregivers had greater odds of ever having had a mammogram or CBE, yet there was no association with mammogram, CBE, or Pap test within guidelines. CONCLUSIONS: Caregiving was associated with some health behaviors that increase cancer risk, yet not with cancer screening within guidelines. Effects of caregiving by age and race require confirmation by additional studies.     

Heterogeneity of health disparities among African American, Hispanic, and Asian American women: unrecognized influences of sexual orientation

OBJECTIVES: This study compared health indicators among self-identified lesbians/bisexual women and heterosexual women residing in Los Angeles County. METHODS: Respondents were English-speaking Hispanic, African American, and Asian American women. Health status, behavioral risks, access barriers, and indicators of health care were assessed. RESULTS: Prevalence rates of chronic health conditions were similar among women in the 3 racial/ethnic groups. However, lesbians and bisexual women evidenced higher behavioral risks and lower rates of preventive care than heterosexual women. CONCLUSIONS: Among racial/ethnic minority women, minority sexual orientation is associated with increased health risks. The effects of sexual minority status need to be considered in addressing health disparities affecting this population.     

Sexual orientation and women's smoking

An extensive review of the literature on sexual orientation and health, lesbian health, and women and smoking revealed no studies that focus on smoking among lesbians or bisexual women. However, several health surveys conducted in the past 15 to 20 years report rates of current smoking. Findings from these studies as a whole suggest that lesbians are more likely than heterosexual women to smoke. Research on women and smoking is reviewed to identify potential risk factors for lesbians' smoking. Implications for future research and for prevention and intervention are discussed.     

Smoking characteristics among lesbian,gay, and bisexual adults

ObjectiveCigarette smoking is the leading preventable cause of death and disease in the United States. Sexual minorities (lesbians, gay men, and bisexuals), smoke at higher rates than the general population. However, little else is known about sexual minority smokers. Furthermore, the sexual minority population is diverse and little research exists to determine whether subgroups, such as lesbians, gay men, and female and male bisexuals, differ on smoker characteristics. We examine differences in smoking characteristics (advertising receptivity, age of first cigarette, non-daily smoking, cigarettes per day, nicotine dependence, desire to quit and past quit attempts) among lesbians, gay men, and female and male bisexual adults in the United States.MethodsSecondary analysis of the CDC's (Centers for Disease Control and Prevention) 2009–2010 National Adult Tobacco Survey (N = 118,590).ResultsControlling for age, race, socioeconomic status and geographic region, identifying as a female bisexual was associated with fewer past quit attempts, lower age at first cigarette, and higher nicotine dependence when compared to heterosexual women. There were no differences in desire to quit between male or female sexual minorities and their heterosexual counterparts.ConclusionSexual minority individuals smoke at higher rates than heterosexuals and yet similarly desire to quit. Tailored efforts may be needed to address smoking among bisexual women.     

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.     

Hispanic lesbians and bisexual women at heightened risk for [corrected] health disparities

Objectives. We investigated whether elevated risks of health disparities exist in Hispanic lesbians and bisexual women aged 18 years and older compared with non-Hispanic White lesbians and bisexual women and Hispanic heterosexual women.Methods. We analyzed population-based data from the Washington State Behavioral Risk Factor Surveillance System (2003–2009) using adjusted logistic regressions.Results. Hispanic lesbians and bisexual women, compared with Hispanic heterosexual women, were at elevated risk for disparities in smoking, asthma, and disability. Hispanic bisexual women also showed higher odds of arthritis, acute drinking, poor general health, and frequent mental distress compared with Hispanic heterosexual women. In addition, Hispanic bisexual women were more likely to report frequent mental distress than were non-Hispanic White bisexual women. Hispanic lesbians were more likely to report asthma than were non-Hispanic White lesbians.Conclusions. The elevated risk of health disparities in Hispanic lesbians and bisexual women are primarily associated with sexual orientation. Yet, the elevated prevalence of mental distress for Hispanic bisexual women and asthma for Hispanic lesbians appears to result from the cumulative risk of doubly disadvantaged statuses. Efforts are needed to address unique health concerns of diverse lesbians and bisexual women.Equity in health and health care is of critical societal importance given its ethical and social justice implications. Despite tremendous advancements in medicine and improved health for many Americans, historically disadvantaged and underserved communities continue to bear higher levels of illness, disability, and premature death. The National Institutes of Health affirms a commitment to reducing and eliminating health disparities affecting disadvantaged populations across the country.1 In addition, Healthy People 2020 has specifically recognized racial/ethnic minorities and sexual minorities as primary targets of health disparity reduction.2A growing body of literature endorses such federal initiatives’ recognition of health disparities by race/ethnicity and sexual orientation. Health disparities among the Hispanic population, for example, have been well documented. Higher death rates from stroke, chronic liver disease, diabetes, and HIV/AIDS have been observed among Hispanics compared with non-Hispanic Whites, and Hispanics are more likely to be obese and less likely to participate in regular physical activities.3,4 Furthermore, the Hispanic population is at increased risk for limited health care access.5–7 The likelihood of Hispanics not having health insurance is almost twice as high as that of the general population.8The evidence of health disparities affecting sexual minority women is also growing. According to previous studies based on probability samples, sexual minority women, compared with heterosexual women, report experiencing higher levels of poor physical and general health,9–11 mental distress,9,11–13 and higher prevalence rates of asthma10,11,13 and disability.10,11 In terms of health risk behaviors, lesbians and bisexual women are more likely to smoke9–11,13,14 and to consume higher quantities of alcohol.9,11,13,14 Sexual minority women are also at increased risk for poor health care access.10,14,15 Emerging research has also found within-group differences among sexual minority women; for example, lesbians, but not bisexual women, are more likely to be obese10,16 and have arthritis12 than are heterosexual women, whereas bisexual women are more likely to report poor general health and mental distress than are lesbians.17Yet, the evidence of health disparities by race/ethnicity and sexual orientation might not be generalized to sexual minorities of color,18 and knowledge regarding health among Hispanic sexual minorities is still limited. Without better understanding the potential interplay between these marginalized statuses, it remains difficult, if not impossible, to develop culturally sensitive health services that are responsive to the needs of the Hispanic sexual minority population.19The possibility of cumulative risks resulting from multiple disadvantaged statuses affecting health among Hispanic sexual minorities has been raised in the literature. It has been suggested that Hispanic sexual minorities experience heightened risks of poor physical and mental health compared with non-Hispanic White sexual minorities and Hispanic heterosexuals. According to a comprehensive review on racial/ethnic disparities in health, racial discrimination and related stressors have an inverse relationship to physical and mental health and health care access.20 Previous studies also have emphasized that health disparities among sexual minorities likely result from exposure to life stressors, including stigmatization, victimization, and discrimination.21–23 The consequences of multiple stressors, such as racial/ethnic discrimination within sexual minority communities and antigay values within Hispanic communities, may lead to an increased risk of poor physical and mental health.18,24,25 Furthermore, Hispanic sexual minority women may experience additional stressors if they are perceived to violate conventional feminine norms in Hispanic communities.26A few studies have assessed health-related concerns among Hispanic sexual minority women. One study found that Hispanic sexual minority women had increased psychiatric morbidity risk compared with Hispanic heterosexual women.27 Another study found that among sexual minority women, Hispanic women were more likely than were non-Hispanic White women to report depressive symptoms.28 In terms of physical health status and behaviors, Hispanic lesbians and bisexual women have shown elevated risks and higher prevalences of obesity, smoking, and drinking than have Hispanic heterosexual women.29Yet, to identify the potentially cumulative impact of multiple disadvantaged statuses on health disparities, the prevalence of health indicators for Hispanic sexual minority women must be compared with Hispanic heterosexual women as well as non-Hispanic White lesbians and bisexual women within the same sample. Furthermore, because the patterns and extents of health disparities may be dissimilar between lesbians and bisexual women, the cumulative effects should be tested separately among lesbians and bisexual women. Disaggregating groups of sexual minorities is an important stage in developing tailored interventions to respond to the unique health-related needs of these subgroups.17The Washington State Behavioral Risk Factor Surveillance System (BRFSS) provides population-based data that allow us to examine indicators of health disparities. In this study, we compared the unadjusted and adjusted prevalence of health disparities including health status, health risk behaviors, health care access, and health outcomes by Hispanic lesbians (the reference group), non-Hispanic White lesbians, and Hispanic heterosexual women as well as by Hispanic bisexual women (the reference group), non-Hispanic White bisexual women, and Hispanic heterosexual women. We hypothesized that Hispanic lesbians and bisexual women would experience higher risks of health disparities than would non-Hispanic White lesbians and bisexual women as well as Hispanic heterosexual women.     

Interaction between smoking and obesity and the risk of developing breast cancer among postmenopausal women: the Women's Health Initiative Observational Study

Obesity is a well-established risk factor for postmenopausal breast cancer. Recent studies suggest that smoking increases the risk of breast cancer. However, the effect of co-occurrence of smoking and obesity on breast cancer risk remains unclear. A total of 76,628 women aged 50-79 years enrolled in the Women's Health Initiative Observational Study were followed through August 14, 2009. Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals. Over an average 10.3 years of follow-up, 3,378 incident cases of invasive breast cancer were identified. The effect of smoking on the risk of developing invasive breast cancer was modified significantly by obesity status among postmenopausal women, regardless of whether the obesity status was defined by body mass index (P(interaction) = 0.01) or waist circumference (P(interaction) = 0.02). A significant association between smoking and breast cancer risk was noted in nonobese women (hazard ratio = 1.25, 95% confidence interval: 1.05, 1.47) but not in obese women (hazard ratio = 0.96, 95% confidence interval: 0.69, 1.34). In conclusion, this study suggests that the effect of smoking exposure on breast cancer risk was modified by obesity among postmenopausal women. The modification effect did not differ by general versus abdominal obesity.     

Health behavior change among women with recent familial diagnosis of breast cancer

BACKGROUND: Although first-degree female relatives (FDFR) of women with breast cancer are at increased risk for the disease, little is understood about how familial diagnosis impacts health behaviors and what personal factors predict such changes. METHODS: Six hundred women, ages 18 and over with a FDFR recently diagnosed with breast cancer, were interviewed after the diagnosis and again in 6 months. Participants self-reported changes in physical activity, fruit and vegetable consumption, fat consumption, alcohol and tobacco use. The effect of baseline demographics, health status, perceptions of relative's disease severity, personal risk, control over the disease and the effect of lifestyle behaviors on risk was assessed in relation to behavior changes. RESULTS: Forty-two percent reported improving one or more behaviors. Perception that the behavior was a risk factor for breast cancer was positively associated with change for all behaviors except smoking. Poor health status, obesity and perception of control over breast cancer were associated with improvements in physical activity, fruit and vegetable consumption and fat consumption. CONCLUSIONS: Diagnosis of breast cancer in a first-degree relative can provide motivation to improve health behavior. Educational interventions highlighting the importance of these behaviors in reducing breast cancer risk and promoting health in general may be effective in this population.     

Disparities in Health-Related Quality of Life: A Comparison of Lesbians and Bisexual Women

Objectives. We investigated the association of health-related quality of life (HRQOL) with sexual orientation among lesbians and bisexual women and compared the predictors of HRQOL between the 2 groups.Methods. We used multivariate logistic regression to analyze Washington State Behavioral Risk Factor Surveillance System population-based data (2003 to 2007) in a sample of 1496 lesbians and bisexual women and examined determinants of HRQOL among lesbians and bisexual women.Results. For lesbians and bisexual women, frequent mental distress and poor general health were associated with poverty and lack of exercise; poor general health was associated with obesity and mental distress. Bisexual women showed a higher likelihood of frequent mental distress and poor general health than did lesbians. The odds of mental distress were higher for bisexual women living in urban areas as compared with nonurban areas. Lesbians had an elevated risk of poor general health and mental distress during midlife.Conclusions. Despite the standard practice of collapsing sexual minority women into a single group, lesbian and bisexual women in this study emerge as distinct groups that merit specific attention. Bisexual women are at elevated risk for poor HRQOL.Sexual minority women (SMW) were acknowledged as a health disparate population in Healthy People 2010.¹ Despite many recent advances in sociopolitical and cultural acceptance for sexual minorities in the United States, these women continue to live in a society in which their lives run counter to the dominant culture. Meyer''s² model of minority stress attributes health disparities to the greater exposure to life stressors that accompanies minority status among this population. Such stressors include victimization, discrimination, stigmatization, expectations of rejection, and vigilance and are well documented in some empirical studies.^2–4According to the minority stress model, disparities in health outcomes are expected between lesbians and bisexual women and heterosexual women. The inclusion of questions about sexual orientation on some epidemiological health surveys such as the National Comorbidity Survey, the National Health and Nutrition Examination Survey, the National Household Survey on Drug Abuse, and the Midlife in the United States Survey has allowed researchers interested in this population to conduct such between-group research.^5–9 Overall, these data suggest that SMW are at higher risk for mental health disorders, particularly depression and anxiety (see Cochran¹⁰ and Meyer² for reviews). Relative to mental health outcomes, less research has been published focusing on physical health outcomes among SMW. There is evidence, however, that SMW are more likely to be obese, which puts them at greater risk for major health problems such as cancer and heart disease.¹¹ Other studies have demonstrated higher rates of health risk behaviors such as alcohol and drug abuse¹⁰ and smoking¹² among SMW compared with their heterosexual counterparts. Differences in physical health outcomes may be confounded by mental health problems; for example, Cochran and Mays¹³ found that differences in physical health between SMW and heterosexual women were no longer significant when psychological distress was taken into account.Although some studies document differences between SMW and heterosexual women,^14–18 relatively few studies look within SMW subpopulations to examine determinants of health for these populations. Because of small numbers of participants, most studies combine lesbians and bisexual women into a single group for analysis, thereby obscuring potentially important differences. Yet, bisexual women may face additional stressors associated with lack of support from both lesbian and heterosexual communities. Indeed, studies that examine bisexuals as a separate group suggest that this group may have even greater health disparities relative to heterosexual women than do lesbians. For example, in Cochran and Mays''s study,¹³ bisexual women, but not lesbians, were significantly more likely to report a functional health limitation, poor overall physical health, and a greater number of physical health conditions than were heterosexual women. In a recent study, Dilley et al.¹⁹ suggested that bisexual women may have more health risks relative to both heterosexual women and lesbians, although heterosexual women again served as the referent group. Because these prior studies do not report statistically based comparisons of lesbians and bisexual women, we know little about how these 2 groups of women may differ in terms of health.Another limitation of the existing literature on SMW is the inconsistent use of measures across studies, making comparisons difficult. For example, although health-related quality of life (HRQOL) has received much attention in recent health research and has been used extensively to track population trends and assess health disparities,^20,21 HRQOL has not been used in studies of sexual minority health. Moreover, there is little research specifically examining determinants of health and HRQOL among lesbians and bisexual women. Such within-group analyses are the next step in advancing our understanding of minority stress² by highlighting the factors within a minority population that make individuals relatively more vulnerable to poor health outcomes. To date, little is known about whether and how such determinants of health and HRQOL are similar or different for lesbians versus for bisexual women. Hence, we have little information on how best to focus preventive intervention efforts for these groups.In this population-based study, we used Behavioral Risk Factor Surveillance System data from Washington State (WA-BRFSS) to examine the relationship between HRQOL and sociodemographic characteristics, access to health care, and health risk behaviors among lesbians and bisexual women. We hypothesized that compared with lesbians, bisexual women would have lower levels of HRQOL, after controlling for the other health-related factors. We also examined similarities and differences in the predictors of HRQOL between these 2 groups.     

Adult Health Behaviors Over the Life Course by Sexual Orientation

Objectives. We estimated differences in health behaviors among adults by sexual orientation.Methods. We pooled 4 years of data (2001, 2003, 2005, and 2007) from the California Health Interview Survey. We estimated the frequency of smoking, alcohol use, healthy dietary behaviors, physical activity, and health care utilization, and we used logistic regression modeling to determine the odds of each behavior with increasing age and for 2 age groups: younger than 50 years and 50 years old or older.Results. At any adult age, lesbians had greater odds of smoking and binge drinking than did heterosexual women, and gay and bisexual men had greater health care utilization than did heterosexual men. Other risk behaviors differed with age.Conclusions. Some behavioral change interventions should target lesbians, gays, and bisexuals at all ages, whereas other interventions should specifically target individuals at younger ages.Researchers have identified differences in negative health behaviors by sexual orientation. For example, population-based data show that gay men, lesbians, and bisexual women are more likely than are heterosexual men and women to be smokers.¹ Lesbians and bisexual women have lower alcohol abstention rates and are more likely to report alcohol-related social consequences, alcohol dependence, and past help-seeking for an alcohol problem.² Among men, sexual orientation is linked to fewer differences in alcohol use.² In addition, several studies indicate that sexual minorities (e.g., lesbians, gays, bisexuals) are not receiving regular medical care and are more frequently utilizing the emergency room (ER).^3–5 Parallel to the literature showing sexual minority individuals exhibiting riskier behaviors is a body of literature linking risky behaviors to minority stress and more experiences of discrimination.^6,7Despite the emergence of an increasing number of studies indicating differences in risk behaviors by sexual orientation and describing the societal conditions that contribute to these risk behaviors, there is still no certainty about the extent to which risky behaviors are consistent across age cohorts. To date, alcohol use among women is highest among sexual minority women aged 26 to 35 years.⁸ Similarly, Hughes concluded that rates of drinking, heavy drinking, and problem drinking among lesbians and gay men decline less with age compared with declines among heterosexual women and men.⁹ However, other studies have suggested that although lesbians smoke more than do heterosexual women at younger ages, the difference is not significant at older ages.^10,11Research that assesses risk behaviors across age cohorts is lacking because of a number of barriers, including data sets with small subsamples of lesbian, gay, and bisexual individuals, which do not allow for further detailed analyses by age. We suggest that understanding risk behaviors by age is important to determine the extent to which there are age and sexual orientation disparities in risk behaviors and to inform interventions to reduce these risk behavior disparities. Therefore, we sought to determine the extent to which risk behaviors of lesbian, gay, and bisexual individuals differed from those of heterosexual populations across age cohorts. We tested 2 hypotheses for each gender: (1) risk behaviors are more prevalent among younger sexual minorities compared with same-aged heterosexuals, and (2) risk behavior disparities by sexual orientation are reduced at older ages.     

Studies of breast cancer and alcohol consumption

Alcohol consumption as a potential risk factor for breast cancer was examined in a case-control study of 1,467 female breast cancer patients and 10,178 hospital controls. Lean females (Quetelet index less than 22) had elevated unadjusted odds ratios for breast cancer of 2.1, 1.7, and 1.4, associated with consuming less than 5, 5-15, and greater than 15 g of alcohol per day, respectively. However, this pattern is not consistent with a dose-response, and adjustment for a risk profile of confounding factors, including education and occupation (which are strong correlates of age at first pregnancy and parity), reduced these estimates to 1.4, 1.2, and 0.9; none of which differs significantly from 1.0. Among all subgroups, the odds ratios adjusted for pertinent confounders and interactions fluctuated randomly by about 0.9 and showed no consistent trend with increased alcohol consumption. In a second investigation, proportional breast cancer rates were estimated for female veterans diagnosed in Veterans Administration Hospitals during 1970-1982 using 1973-1977 rates for the general population as the standard of comparison. In the VA cohort of females, which had an approximate twofold higher prevalence of alcohol abuse and chronic cigarette smoking, the proportional rates of known alcohol and tobacco-related malignancies were significantly elevated but the rates of breast cancer were not. The standardized proportional morbidity rates of breast cancer for white, black, and all VA females were 0.92, 0.85, and 0.91, respectively. Although these results do not rule out weak associations between breast cancer and alcohol in certain subgroups, neither do they provide any compelling evidence that alcohol has a role in the genesis of this malignancy.     

Total and cause specific mortality among participants and non-participants of population based health surveys: a comprehensive follow up of 54 372 Finnish men and women

STUDY OBJECTIVE: To assess total and cause specific mortality among participants and non-participants of large population based health surveys. DESIGN: A prospective follow up study. Baseline surveys were conducted in 1972, 1977, 1982, 1987, and 1992. Study end points were overall, cardiovascular, cancer and violent mortality, and deaths related to smoking and alcohol. Study cohorts were followed up until the end of 2000 through computerised record linkage. All analyses were adjusted for age. SETTING: Finland. PARTICIPANTS: Participants and non-participants of five population based risk factor surveys. The samples included 54 372 men and women aged 25 to 64 years at baseline. MAIN RESULTS: The average participation rate was 81.7% among men and 87% among women. At eight year follow up, the non-participating men had twice and non-participating women 2.5-fold higher overall mortality than the participating men and women. Non-participants had also significantly higher cause specific mortality, except cancer and smoking related mortality among women. Relative differences in mortality were largest in violent and alcohol related deaths. Non-participants had considerably higher overall mortality than smoking participants, and their mortality was threefold compared with non-smoking participants. CONCLUSIONS: Observed differences in mortality show that health behaviour and health status substantially differ between non-participants and participants. Low participation rate may considerably bias the results of population based health surveys.     

Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women

CONTEXT: Sexually transmitted diseases (STDs) can be spread between female sex partners, probably through the exchange of cervicovaginal fluid and direct mucosal contact. Additionally, lesbians have a high prevalence of bacterial vaginosis, which may represent an STD in this population. However, few data on sexual practices or perceived STD risk among lesbians are available to guide development of interventions aimed at reducing the risk. METHODS: To inform the development of a safer-sex intervention for women who have sex with women, focus group discussions were conducted with 23 lesbian and bisexual women aged 18-29. Topics included sexual practices, STD transmission and prevention, and knowledge about bacterial vaginosis. RESULTS: Although six participants had had bacterial vaginosis and three an STD, women reported little use of preventive measures with female partners (washing hands, using rubber gloves and cleaning sex toys). Participants said that vaginal penetrative practices using sex toys and fingers or hands are common, and that partners frequently share sex toys during a sexual encounter, generally without condoms. Knowledge of potential for STD transmission between women, and of bacterial vaginosis, was limited. Participants viewed use of barrier methods (gloves or condoms) as acceptable, provided that there is a reason (usually STD-focused) to use them and that they are promoted in the context of sexual health and pleasure. CONCLUSIONS: Safer-sex messages aimed at lesbian and bisexual women should emphasize the plausibility of STD transmission between women, personal responsibility and care for partners' well-being; should target common sexual practices; and should promote healthy sexuality.     

Hormonal factors and risk of lung cancer among women?

BACKGROUND: Gender differences in the histological distribution of lung carcinoma and a possibly greater susceptibility of women than men to tobacco carcinogens, suggest a possible influence of sex-specific hormones. This study examines endocrine factors and risk of lung cancer among women by smoking status and histology. METHODS: We used data of a case-control study on lung cancer conducted from 1990 to 1996 in Germany, including 811 histologically confirmed female cases and 912 female population controls. Information on various menstrual and reproductive factors, use of oral contraceptives (OC), hormone replacement therapy (HRT), and smoking was gathered through personal interviews using a structured questionnaire. Odds ratios (OR) and 95% CI adjusted for age, region, smoking, and education were calculated via logistic regression. RESULTS: A reduction in lung cancer risk was observed with the use of OC (OR = 0.69; 95% CI: 0.51-0.92), but no trend in risk with increasing duration of use, age at first use, or calendar year of first use was present. A history of HRT was associated with a reduced risk (OR = 0.83; 95% CI: 0.64-1.09), particularly after long duration (>/=7 years) (OR = 0.59; 95% CI: 0.37-0.93). No clear association was found with regard to age at menarche, length of menstrual cycle, number of live-births, and age at menopause. Overall results did not differ much by histological cell subtype. The reduction in lung cancer risk associated with the use of exogenous hormones was primarily seen among smoking women. CONCLUSIONS: Our data provide evidence for a possible role of hormonal factors in the aetiology of lung cancer in women.