Weight Misperception and Unhealthy Weight Control Behaviors Among Sexual Minorities in the General Adolescent Population

PurposeGay, lesbian, and bisexual youth may experience significant body dissatisfaction. We examined sexual orientation differences in self-perceived weight status and the prevalence of potentially dangerous weight control behaviors in a representative sample of adolescents.MethodsData were obtained from 12,984 youth between 2003 and 2009 over four cycles of the Massachusetts Youth Risk Behavior Survey, a statewide survey of ninth- through 12th-grade students. Self-perceived weight status and past-month unhealthy weight control behaviors (fasting >24 hours, using diet pills, and vomiting or using laxatives) were compared among gay/lesbian, bisexual, or self-identified heterosexual youth with same-sex partners, unsure youth, and exclusively heterosexual youth using logistic regression, adjusting for age and race/ethnicity.ResultsCompared with exclusively heterosexual males, heterosexual males with prior same-sex partners and bisexual males were more likely to self-perceive as overweight despite being of healthy weight or underweight (respectively, adjusted odds ratio [AOR], 2.61; 95% confidence interval [CI], 1.68–4.05; and AOR, 2.56; 95% CI, 1.64–4.00). Compared with exclusively heterosexual females, lesbians and bisexual females were more likely to self-perceive as being of healthy weight or underweight despite being overweight or obese (respectively, AOR, 3.17; 95% CI, 1.15–8.71; and AOR, 2.00; 95% CI, 1.20–3.33). Unhealthy weight control behaviors were significantly more prevalent among sexual minority males (32.5%; AOR, 4.38; 95% CI, 3.38–5.67) and females (34.7%; AOR, 2.27; 95% CI, 1.85–2.78) when considered together relative to exclusively heterosexual males (9.7%) and females (18.8%).ConclusionsOne third of sexual minority youth engage in hazardous weight control behaviors. Future research should investigate underlying mechanisms and determine whether clinicians should routinely screen for these behaviors.     

Gender Expression and Sexual Orientation Differences in Diet Quality and Eating Habits from Adolescence to Young Adulthood

BackgroundDiet and eating habits during youth have implications on diet and eating habits during adulthood, however, little longitudinal research has examined sexual orientation and gender expression differences in diet.ObjectiveOur aim was to examine sexual orientation and gender expression differences in diet quality and eating habits from adolescence to young adulthood.DesignData across multiple time points from the longitudinal Growing Up Today Study cohorts (1997 to 2011) were used.Participants/settingParticipants (n=12,880; aged 10 to 23 years) were the children of women from the Nurses’ Health Study II cohort.Main outcome measuresDiet quality scores were assessed using the Alternative Healthy Eating Index-2010. In addition, breakfast consumption (≥5 days/wk) and family dinners (≥5 days/wk) were assessed.Statistical analyses performedMultivariable generalized estimating equation regression models were fit to estimate sexual orientation and gender expression differences in diet quality scores, breakfast consumption, and family dinners, stratified by sex assigned at birth over available repeated measures.Results“Gender-nonconforming” males had significantly higher diet quality scores than “very gender-conforming” males (P<0.05). Diet quality scores did not differ by gender expression among females. “Mostly heterosexual” females and gay males had higher diet quality scores than their same-sex completely heterosexual counterparts (P<0.05). Adjustment for mother’s diet quality scores attenuated effects, except for gay males (P<0.05). “Gender-nonconforming” females were less likely to consume breakfast than “very gender-conforming” females (P<0.05). Similar results were found for “mostly heterosexual” and bisexual compared to completely heterosexual females. There were no gender expression or sexual orientation differences in family dinners among males and females.ConclusionsSexual orientation and gender expression have independent effects on diet quality scores and eating habits for both males and females. Very gender-conforming and completely heterosexual males had the lowest diet quality scores compared to other gender expression and sexual orientation groups. Additional research to explore the effects of sexual orientation and gender expression on diet-related health is needed to build upon these findings.     

Sexual Orientation and Bullying Among Adolescents in the Growing Up Today Study

PurposeTo examine the relationship between sexual orientation and past-year reports of bullying victimization and perpetration in a large sample of American youth.MethodsSurvey data from 7,559 adolescents aged 14–22 who responded to the 2001 wave questionnaire of the Growing Up Today Study were examined cross-sectionally. Multivariable generalized estimating equations regression was performed using the modified Poisson method. We examined associations between sexual orientation and past-year bully victimization and perpetration with heterosexuals as the referent group, stratifying by gender and controlling for age, race/ethnicity, and weight status.ResultsCompared to heterosexual males, mostly heterosexual males (risk ratio [RR]: 1.45; 95% confidence interval [CI]: 1.13, 1.86) and gay males (RR 1.98; CI: 1.39, 2.82) were more likely to report being bullied. Similarly, mostly heterosexual females (RR: 1.72, 95% CI: 1.45, 2.03), bisexual females (RR: 1.63, 95% CI: 1.14, 2.31), and lesbians (RR: 3.36, 95% CI: 1.76, 6.41) were more likely to report being bullied than were heterosexual females. Gay males (RR: 0.34, 95% CI: 0.14, 0.84) were much less likely to report bullying others than were heterosexual males. Mostly heterosexual females (RR: 1.70, 95% CI: 1.42, 2.04) and bisexual females (RR: 2.41, 95% CI: 1.80, 3.24) were more likely to report bullying others than heterosexual females. No lesbian participants reported bullying others.ConclusionsThere are significant differences in reports of bullying victimization and perpetration between heterosexual and sexual minority youth. Clinicians should inquire about sexual orientation and bullying, and coordinate care for youth who may need additional support.     

Mostly Heterosexual and Mostly Gay/Lesbian: Evidence for New Sexual Orientation Identities

A sample of 1,784 individuals responded to an online survey advertised on the Facebook social networking website. We explored the sexual orientation continuum by focusing on three components: self-reported sexual orientation identity, sexual attraction, and sexual partners. Results supported a 5-category classification of identity (heterosexual, mostly heterosexual, bisexual, mostly gay/lesbian, gay/lesbian) in that two added identity labels (mostly heterosexual and mostly gay/lesbian) were frequently chosen by participants and/or showed unique patterns of attraction and partners, distinct from their adjacent identities (heterosexual and bisexual, and bisexual and gay/lesbian, respectively). Those who reported an exclusive label (heterosexual, gay/lesbian) were not necessarily exclusive in other components; a significant minority of heterosexuals and the majority of gays/lesbians reported some attraction and/or partners toward their nonpreferred sex. The five identity groups differed in attraction and partners in a manner consistent with a continuous, rather than a categorical, distribution of sexual orientation. Findings also supported a sexual orientation continuum as consisting of two, rather than one, distinct dimensions (same- and other-sex sexuality). Having more same-sex sexuality did not necessarily imply having less other-sex sexuality, and vice versa. More men than women were at the exclusive ends of the continuum; however, men were not bimodally distributed in that a significant minority reported nonexclusivity in their sexuality.     

Physical Development and Sexual Orientation in Men and Women: An Analysis of NATSAL-2000

In the present study, three physical development characteristics—weight, height, and age of menarche—were examined for their relation to sexual orientation. Participants were men and women comprising the National Survey of Sexual Attitudes and Lifestyles-2000 (N > 11,000). Participants completed self-report measures of sexual orientation, height, weight, and, for women, age of menarche. Results indicated that gay/bisexual men were significantly shorter and lighter than heterosexual men. There were no significant differences between lesbians and heterosexual women in height, weight, and age of puberty. The results add to literature suggesting that, relative to heterosexual men, gay/bisexual men may have different patterns of growth and development because of early biological influences (e.g., exposure to atypical levels of androgens prenatally). However, the present results do not support a number of studies suggesting that lesbian/bisexual women are taller and heavier than heterosexual women.     

Health Disparities Among Women by Sexual Orientation Identity and Same-Sex or Different-Sex Cohabiting Partnership Status

BackgroundThe objective of this study was to compare health outcomes by sexual orientation identity and cohabiting partnership status (defined as whether heterosexual, lesbian, and bisexual women were non-partnered, partnered in a cohabiting same-sex relationship, or partnered in a cohabiting different-sex relationship).MethodsWe used data on heterosexual (n = 95,289) and sexual minority (n = 2,600) women aged 18 years and older from the 2013–2018 National Health Interview Survey. We estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) from multivariable logistic regression models comparing health outcomes by sexual orientation identity and cohabiting partnership status while controlling for sociodemographic characteristics.ResultsCompared with heterosexual women in a different-sex relationship, nonpartnered women generally reported worse health outcomes regardless of sexual orientation. Lesbian women with a same-sex partner were more likely to report poor/fair health (AOR, 1.61; 95% CI, 1.09–2.37), current cigarette smoking (AOR, 1.48; 95% CI, 1.14–1.94), and binge drinking (AOR, 1.63; 95% CI, 1.19–2.23) compared with heterosexual women with a different-sex partner. Bisexual women with a different-sex partner were more likely to report poor/fair health (AOR, 1.91; 95% CI, 1.23–2.97), severe psychological distress (AOR, 2.86; 95% CI, 1.78–4.59), current cigarette smoking (AOR, 1.38; 95% CI, 1.01–1.88), and binge drinking (AOR, 1.66; 95% CI, 1.18–2.32) compared with heterosexual women with a different-sex partner.ConclusionMore research is needed to identify the processes in which heterosexual and sexual minority women partner and cohabitate with members of the same or different sex—and whether or how this influences their health. Meanwhile, health care providers should be mindful that families are diverse, and acknowledging this diversity could be a first step toward achieving health equity for all women regardless of sexual orientation.     

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.     

Dating violence among gay, lesbian, and bisexual adolescents: results from a community survey

PURPOSE: To characterize the prevalence of dating violence experienced by gay, lesbian, bisexual (GLB), and heterosexual adolescents. METHODS: Self-report surveys were collected and analyzed from 521 adolescents at a GLB youth rally. Respondents were asked about dating violence, including types of abuse, threats of "outing," and gender of abuser. Multivariate logistic regression analyses were used to test group differences. RESULTS: Reports of dating violence were prevalent in all sexual orientation groups, and there were few statistically significant differences. Compared with heterosexuals and controlling for age, bisexual males had greater odds of reporting any type of abuse, and bisexual females had greater odds of experiencing sexual abuse. Controlling for age, lesbians had greater odds of being scared about their safety, compared with heterosexual females, and bisexuals were more likely to be threatened with outing, compared with gay males/lesbians. CONCLUSIONS: Overall, the prevalence of dating violence among GLB adolescents is similar to that of heterosexuals. Dating violence outreach and prevention efforts should be targeted to reach GLB adolescents.     

Sexual Health Behaviors and Sexual Orientation in a U.S. National Sample of College Students

Many studies have examined differences in sexual behavior based on sexual orientation with results often indicating that those with same-sex partners engage in higher risk sexual behavior than people with opposite sex partners. However, few of these studies were large, national sample studies that also include those identifying as unsure. To address that gap, this study examined the relationship of sexual orientation and sexual health outcomes in a national sample of U.S. college students. The Fall 2009 American College Health Association–National College Health Assessment was used to examine sexual health related responses from heterosexual, gay, lesbian, bisexual, and unsure students (N = 25,553). Responses related to sexual behavior, safer sex behaviors, prevention and screening behaviors, and diagnosis of sexual health related conditions were examined. The findings indicated that sexual orientation was significantly associated with engaging in sexual behavior in the last 30 days. Sexual orientation was also significantly associated with the number of sexual partners in the previous 12 months, with unsure men having significantly more partners than gay, bisexual and heterosexual men and heterosexual men having significantly less partners than gay, bisexual and unsure men. Bisexual women had significantly more partners than females reporting other sexual orientations. Results examining the associations between sexual orientation and safer sex, prevention behaviors, and screening behaviors were mixed. Implications for practice, including specific programmatic ideas, were discussed.     

Health Disparities by Sexual Orientation: Results and Implications from the Behavioral Risk Factor Surveillance System

Until recently, population-based data for monitoring sexual minority health have been limited, making it difficult to document and address disparities by sexual orientation. The primary objective of this study was to examine differences by sexual orientation in an array of health outcomes and health risk factors using one of the nation’s largest health surveys. Data for this study came from 8290 adults who identified as lesbian, gay, or bisexual (LGB) and 300,256 adults who identified as heterosexual in the 2014–2015 Behavioral Risk Factor Surveillance System (BRFSS). Logistic regression models were used to compare physical and mental health outcomes, health condition diagnoses, and health risk factors by sexual orientation, controlling for demographic and socioeconomic status. Controlling for sociodemographic characteristics, gay and bisexual men reported higher odds of frequent mental distress [odds ratio (OR) 1.71, P?=?0.001; OR 2.33, P?<?0.001] and depression (OR 2.91, P?<?0.001; OR 2.41, P?<?0.001), compared with heterosexual men. Lesbian and bisexual women had higher odds of frequent mental distress (OR 1.53, P?<?0.001; OR 2.08, P?<?0.001) and depression (OR 1.93, P?<?0.01; OR 3.15, P?<?0.001), compared to heterosexual women. Sexual minorities also faced higher odds of poor physical health, activity limitations, chronic conditions, obesity, smoking, and binge drinking, although these risks differed by sexual orientation and gender. This study adds to the mounting evidence of health disparities by sexual orientation. Community health practitioners and policymakers should continue to collect data on sexual orientation in order to identify and address root causes of sexual orientation-based disparities, particularly at the community-level.     

Racial/Ethnic and Sexual Orientation Identity Differences in the Receipt of a Sexual History Assessment from a Health Care Provider among Women in the United States

BackgroundDifferential sexual history assessment, whereby certain groups are more or less likely to be asked questions about their sexual behavior by a health care provider, may lead to differential sexual health care and counseling.MethodsUsing nationally representative data from the 2013 through 2019 waves of the National Survey of Family Growth, we examined racial/ethnic and sexual orientation identity differences in receiving a sexual history assessment from a health care provider in the last 12 months among U.S. women aged 15–44 years (N = 14,019).ResultsAdjusting for survey wave, Black and Latina heterosexual women; White, Black, and Latina bisexual women; and Black or Latina lesbian women had higher odds (odds ratio range, 1.47 [Latina heterosexual] to 2.71 [Black bisexual]) of having received a sexual history assessment in the last 12 months compared with White heterosexual women. All differences except for those among Black or Latina lesbian women persisted after controlling for demographic, socioeconomic, and health care factors (odds ratio range, 1.43 [Latina heterosexual] to 2.14 [Black bisexual]). Of note, Black bisexual women, about whom providers may hold biased assumptions of promiscuity rooted in both racism and biphobia, had the highest predicted probability of being asked about their sexual behavior by a provider.ConclusionsPerson-centered, structurally competent, and anti-oppressive practices and programs aimed at combating bias, stigma, and discrimination in the health care system and facilitating an inclusive clinic environment for all patients are needed to address differences in the provision of sexual health services and promote sexual health equity.     

Racial disparities in health and health behaviors among gay,lesbian, bisexual and heterosexual men and women in the BRFSS-SOP

ABSTRACT

Objectives: Research on sexual minority health lack examinations of how sexual orientation intersects with other identities, including racial/ethnic identity, to shape health outcomes among U.S. adults. This study examines how health status and health behavior varies for gay, lesbian, and bisexual men and women who identify as non-Hispanic white, non-Hispanic black, Latino, Asian/Pacific Islander, and American Indian/Alaskan Native. By examining health and health behaviors within and across sexual minority subgroups, our study reports on race/ethnic, gender, and sexual orientation specific health risks.

Methods: We respond to shortcomings in current data by utilizing aggregated data from fourteen states from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2005 and 2010 (n?=?557,773). We investigated the odds of reporting poorer health, current cigarette smoking, and obesity by sexual orientation within race/ethnic and gender subgroups; all statistical analyses were performed in 2016.

Results: Results suggest persistent health and behavior disadvantages for lesbian and bisexual women of all racial and ethnic identities, relative to heterosexuals. Some of the heightened odds are extreme. Asian/Pacific Islander lesbian (OR?=?3.92) and bisexual (OR?=?4.61) women, for example, have 4.0 times higher odds of smoking than heterosexual A/PI women. Results for men are more variable. To illustrate, the odds of obesity for White and A/PI men are indistinguishable between bisexuals and heterosexuals, and Black and American Indian/Alaskan Native bisexuals have lower odds of obesity than their heterosexual counterparts.

Conclusion: These findings highlight the need for policy efforts aimed at improving health and health behaviors among lesbian and bisexual women across groups, and more targeted efforts among sexual minority men.     

Sexual Orientation and Sexual and Reproductive Health Among Adolescent Young Women in the United States

PurposeWe studied sexual and reproductive health among self-identified bisexual, lesbian, and heterosexual adolescent young women. Prior research has suggested that bisexual and lesbian young women may be at greater risk for many negative health outcomes, including risky sexual and reproductive health behavior.MethodsUsing data from the U.S. nationally representative 2006–2010 National Survey of Family Growth (NSFG), we examined sexual and reproductive health among young women 15–20 years of age as a function of sexual orientation. We used logistic regression and ANCOVA to examine differences in sexual and reproductive health across groups while controlling for demographic group differences.ResultsBisexual and lesbian young women reported elevated sexual and reproductive health risks. Bisexual and lesbian participants reported being younger at heterosexual sexual debut, and having more male and female sexual partners, than did heterosexual participants. Further, they were more likely than heterosexual young women to report having been forced to have sex by a male partner. Bisexual young women reported the earliest sexual debut, highest numbers of male partners, greatest use of emergency contraception, and highest frequency of pregnancy termination.ConclusionsOverall, sexual minority young women—especially those who identified as bisexual—were at higher sexual and reproductive risk than their heterosexual peers.     

Sexual Orientation Differences in Pregnancy and Abortion Across the Lifecourse

ObjectivesWe examined sexual orientation-related differences in various pregnancy outcomes (e.g., teen pregnancy, abortion) across the lifespan.MethodsWe collected data from 124,710 participants in three U.S. longitudinal cohort studies, the Nurses’ Health Study 2 and 3 and Growing Up Today Study 1, followed from 1989 to 2017. Multivariate regression was used to calculate differences of each outcome—ever had pregnancy, teen pregnancy, ever had abortion, and age at first birth—by sexual orientation groups (e.g., heterosexual, mostly heterosexual, bisexual, lesbian), adjusting for potential confounders of age and race/ethnicity.ResultsAll sexual minority groups—except lesbians—were generally more likely than heterosexual peers to have a pregnancy, a teen pregnancy, and an abortion. For example, Growing Up Today Study 1 bisexual participants were three times as likely as heterosexuals to have had an abortion (risk ratio, 3.21; 95% confident interval, 1.94–5.34). Lesbian women in all of the cohorts were approximately half as likely to have a pregnancy compared with heterosexual women. Few sexual orientation group differences were detected in age at first birth.ConclusionsThe increased risk of unintended pregnancy among sexual minority women likely reflects structural barriers to sexual and reproductive health services. It is critical that sex education programs become inclusive of sexual minority individuals and medical education train health care providers to care for this population. Health care providers should not make harmful heteronormative assumptions about pregnant patients and providers must learn to take sexual histories as well as offer contraceptive counseling to all patients who want to prevent a pregnancy regardless of sexual orientation.     

Healthy Eating Index-2015 Scores Among Adults Based on Observed vs Recalled Dietary Intake

BackgroundThe construct and predictive validity of the Healthy Eating Index (HEI) have been demonstrated, but how error in reported dietary intake may affect scores is unclear.ObjectiveThese analyses examined concordance between HEI-2015 scores based on observed vs reported intake among adults.DesignData were from two feeding studies (Food and Eating Assessment STudy, or FEAST, I and II) in which true intake was observed for three meals on 1 day. The following day, participants completed an unannounced 24-hour dietary recall.Participants/settingFEAST I (2012) included 81 men and women, aged 20 to 70 years, living in the Washington, DC, area. FEAST II (2016) included 302 women, aged 18 years or older, with low household incomes and living in the Washington, DC, area. In FEAST I, recalls were completed independently using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24-2011) or interviewer-administered using the Automated Multiple-Pass Method. In FEAST II, recalls were completed using ASA24-2016, independently or in a small group setting with assistance.Main outcome measuresHEI-2015 scores were calculated using the population ratio method.Statistical analyses performedT-tests determined whether differences between scores based on observed and reported intake were different from zero. FEAST I data were stratified by sex, and in FEAST II, analyses were repeated by education and body mass index (BMI).ResultsDifferences in total HEI-2015 scores between observed and reported intake ranged from −1.3 to 5.8 points among those completing ASA24 independently in both studies, compared with −2.5 points in the small group setting. For interviewer-administered recalls, the differences were −1.1 for men and 2.3 for women. In FEAST II, total HEI-2015 scores derived from observed intake were lower than scores derived from reported intake among those who had completed high school or less (−3.2, SE 1.1, P<0.01) and those with BMI ≥ 30 (−2.8, SE 1.1, P = 0.01).ConclusionsHEI-2015 scores based on 24-hour dietary recall data are generally well estimated.     

Sexual Minority Youth Report High-Intensity Binge Drinking: The Critical Role of School Victimization

Purpose

To examine standard binge drinking (≥4 drinks for females, ≥5 drinks for males) and high-intensity binge drinking (≥8 drinks for females, ≥10 drinks for males) among heterosexual and sexual minority youth in the US and whether reports of school-based victimization mediate this association.

Child Abuse as a Predictor of Gendered Sexual Orientation Disparities in Body Mass Index Trajectories Among U.S. Youth From the Growing Up Today Study

PurposeThis research aimed to explain sexual orientation disparities in body mass index (BMI) by examining child abuse history, weight-related behaviors, and sociodemographics.MethodsWe used data from 7,960 females and 5,992 males from the prospective Growing Up Today Study over nine waves between 1996 (ages 12–14 years) and 2007 (ages 20–25 years). Using repeated measures of BMI (kg/m²) as a continuous outcome, gender-stratified latent quadratic growth models adjusted for child abuse history, weight-related behaviors, and sociodemographics. BMI at age 17 years (intercept) and 1-year change in BMI (slope) are reported.ResultsBisexual females had higher BMI at age 17 years (β = 1.59, 95% CI = 1.00–2.18) and displayed greater one-year increases in BMI (β = .09, 95% CI = .03–.14), compared with completely heterosexual females. Gay males displayed smaller 1-year increases in BMI (β = −.19, 95% CI = −.25 to −.12), compared with completely heterosexual males. No sexual orientation differences in BMI at age 17 years were observed for males, but gay males' BMI at age 25 was less than completely heterosexual males' BMI by 2 units. Among females, sexual orientation differences remained but were slightly attenuated after controlling for child abuse history, weight-related behaviors, and sociodemographics. Among males, the addition of child abuse and weight-related behaviors did not change the estimated difference in 1-year BMI increases.ConclusionsSexual orientation differences in BMI were partly explained by child abuse and weight-related behaviors in females. More research is needed to explore additional drivers of these disparities among both females and males.     

Sexual Orientation Differences in Cervical Cancer Prevention among a Cohort of U.S. Women

BackgroundAlthough much has been published in recent years on differences in Papanicolaou (Pap) tests across sexual orientation, other aspects of cervical cancer prevention remain underexplored, such as human papillomavirus (HPV) vaccination, HPV co-tests, or abnormal Pap tests.MethodsData came from participants (aged 24–54 years) enrolled in an ongoing, longitudinal, U.S.-based cohort study, the Nurses’ Health Study 3 (N = 12,175). Analyses were restricted to participants who met the current guidelines for care (e.g., ≥21 years of age for Pap tests).ResultsMostly heterosexual women were more likely to initiate HPV vaccination than completely heterosexual women with no same-sex partners. All other comparisons across sexual orientation for HPV vaccination initiation and completion and the age of initiation were not statistically significant. Compared with completely heterosexual women with no same-sex partners, mostly heterosexual and lesbian women had lower odds of having a Pap test within the past 2 years. Completely heterosexual women with same-sex partners, mostly heterosexual women, and bisexual women had their first Pap test at an earlier age, had higher odds of having an HPV co-test, and had higher odds of having a positive HPV or abnormal Pap test compared with completely heterosexual women with no same-sex partners. In contrast, lesbian women had lower odds of having positive HPV or abnormal Pap results (odds ratio, 0.65; 95% confidence interval, 0.49–0.86) than completely heterosexual women with no same-sex partners.ConclusionsThere are significant differences across sexual orientation groups in cervical cancer prevention for Pap test timing and positive HPV and abnormal Pap tests, but few differences in HPV vaccination initiation, completion, and age at initiation. Interventions should focus on increasing routine Pap testing among mostly heterosexual and lesbian women.     

Disparities in Depressive Distress by Sexual Orientation in Emerging Adults: The Roles of Attachment and Stress Paradigms

Lesbian, gay, and bisexual (BI) youth have elevated rates of depression compared to heterosexuals. We proposed and examined a theoretical model to understand whether attachment and stress paradigms explain disparities in depressive distress by sexual orientation, using the longitudinal Growing Up Today Study (GUTS) and Nurses’ Health Study II (NHSII). GUTS participants eligible for this analysis reported sexual orientation, childhood gender nonconforming behaviors (GNBs), attachment to mother (all in 2005), and depressive symptoms (in 2007). Mothers of the GUTS participants who are the NHSII participants reported attitudes toward homosexuality (in 2004) and maternal affection (in 2006). The sample had 6,122 participants. Of GUTS youth (M = 20.6 years old in 2005; 64.4 % female), 1.7 % were lesbian/gay (LG), 1.7 % bisexual (BI), 10.0 % mostly heterosexual (MH), and 86.7 % completely heterosexual (CH). After adjusting for demographic characteristics and sibling clustering, LGs, BIs, and MHs reported more depressive distress than CHs. This relation was partially mediated (i.e., explained) for LGs, BIs, and MHs relative to CHs by less secure attachment. A conditional relation (i.e., interaction) indicated that BIs reported more distress than CHs as GNBs increased for BIs; no comparable relation was found for LGs versus CHs. Sibling comparisons found that sexual minorities (LGs, BIs, and MHs) reported more depressive distress, less secure attachment, and more childhood GNBs than CH siblings; the mothers reported less affection for their sexual-minority than CH offspring. The findings suggest that attachment and childhood gender nonconformity differentially pattern depressive distress by sexual orientation. Attachment and related experiences are more problematic for sexual minorities than for their CH siblings.