Differences in Adjustment in HIV+ African American Heterosexual and Homosexual Women

This preliminary study explores differences in adjustment in lesbians and heterosexual women by examining three dimensions: psychological distress, major depression, and social support. Surveys were administered to 48 participants. HIV-positive African American lesbians experienced higher levels of psychological distress, anxiety, and current major depression than did their heterosexual counterparts. Lesbians reported less social support from their immediate family, but not from other sources such as friends, compared to the heterosexual women. Lesbians also reported less satisfaction with their social support network. The results presented here highlight the merit of future research to examine factors associated with the lack of family-based social support in HIV-infected lesbians and the potential of developing interventions that assess relationships with members of the immediate family, explore the possibility of repairing these relationships, and capitalize on social support from friends.     

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     

The Emergence of Lesbian Sexuality and Identity Cross-Culturally: Brazil, Peru, the Philippines, and the United States

Questionnaire data were collected from 205 lesbians and 224 heterosexual women in Brazil, Peru, the Philippines, and the United States between 1981 and 1988. Items include direction of childhood sexual interests, age of first awareness of sexual attraction, cross-attractions, age of first sexual contact, sex of partner in first sexual contact, age of awareness that sexual attractions were serious, and age of realization of adult sexual orientation. In general, similarities in the development of lesbian sexuality and differences between lesbians and heterosexual women were found, regardless of culture. Findings include: Lesbians were more sexually active as children and displayed more sexual interest in girls than heterosexuals did in boys; lesbians tended to become aware of their attractions to women later than heterosexuals realized attractions to men; lesbians reported considerably more early attraction to men than heterosexuals did to women; lesbians reported earlier sexual contact than did heterosexual women; the sex of the partner of first sexual contact for lesbians was split roughly equally between males and females whereas heterosexuals reported contact with males almost exclusively; childhood awareness that sexual attractions were serious were similar in lesbians and heterosexuals; lesbians defined themselves as homosexual later than heterosexuals defined themselves as heterosexual. We conclude that norms for heterosexual behavior impact the development of lesbian sexuality and identity, impeding, but not obliterating,their development. Lesbian sexualityand identityeventuallyemerge regardless of culture.     

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.     

A comparison of lesbians,gay men,and heterosexuals on weight and restrained eating

It is possible that lesbians are as concerned with weight and dieting as are heterosexual women in order to be socially accepted in our society, while men (both gay and heterosexual) have more flexibility in this regard. On the other hand, lesbians, like heterosexual men, may be less concerned with weight than are heterosexual woman and gay men, since the latter groups may strive to be desirable to men. To test these hypotheses, lesbians, gay men, and heterosexual women and men were compared on weight, dieting, preoccupation with weight, and exercise activity. Heterosexual women and gay men reported lower ideal weights and tended to be more preoccupied with their weights than were lesbians or heterosexual men. However, gender was a more salient factor than sexual orientation on most variables, with both lesbians and heterosexual women reporting greater concern with weight, more body dissatisfaction, and greater frequency of dieting than did gay or heterosexual men. The results indicate that both lesbians and heterosexual women are influenced by cultural pressures to be thin, but that these pressures may be greater for heterosexual women.     

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.     

Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women

OBJECTIVES: This study examined whether lesbians are at increased risk for certain cancers as a result of an accumulation of behavioral risk factors and difficulties in accessing health care. METHODS: Prevalence estimates of behavioral risk factors (nulliparity, obesity, smoking, and alcohol use), cancer screening behaviors, and self-reported breast cancer histories derived from 7 independently conducted surveys of lesbians/bisexual women (n = 11,876) were compared with national estimates for women. RESULTS: In comparison with adjusted estimates for the US female population, lesbians/bisexual women exhibited greater prevalence rates of obesity, alcohol use, and tobacco use and lower rates of parity and birth control pill use. These women were also less likely to have health insurance coverage or to have had a recent pelvic examination or mammogram. Self-reported histories of breast cancer, however, did not differ from adjusted US female population estimates. CONCLUSIONS: Lesbians and bisexual women differ from heterosexual women in patterns of health risk. These women would be expected to be at especially greater risk for chronic diseases linked to smoking and obesity.     

Women's Sexual Orientation and Health: Results from a Canadian Population-Based Survey

The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents. Sexual orientation was associated with disparities in health status and health risk behaviors for lesbian and bisexual women in Canada. Bisexual women were more likely than lesbians or heterosexual women to report poor or fair mental and physical health, mood or anxiety disorders, lifetime STD diagnosis, and, most markedly, life-time suicidality. Lesbians and bisexual women were also more likely to report daily smoking and risky drinking than heterosexual women. In sum, sexual orientation was associated with health status in Canada. Bisexual women, in particular, reported poorer health outcomes than lesbian or heterosexual women, indicating this group may be an appropriate target for specific health promotion interventions.     

UK national Lesbians and Health Care Survey

Lesbians are less prevention oriented in their health care behavior than heterosexual women and avoid routine screening tests such as Pap smears and mammograms. The reasons for these differences have been partly attributed to beliefs about risk, (for example, lesbians are said to be at lower risk of cervical cancer) and partly attributed to lesbians' poor experiences of health care because of heterosexism. The Lesbians and Health Care Survey was conducted during the 12 month period of 1997-8. The sample consisted of 1066 lesbians living throughout the UK. The study examined whether risk perceptions, experiences of health care and health-seeking behavior were correlated. Data were analyzed using SPSS to determine which variables were associated with participation in screening. While lesbians were less likely than lesbians in a similar US study to report that their risk of cervical cancer was the same as that of heterosexual women, perceptions of risk were not correlated with participation in screening. We assumed that bad experiences of screening would act as a barrier to attendance; instead, good experiences were associated with the increased likelihood of attendance. These findings under-score the need for a pro-active agenda for lesbian health which addresses the need for culturally competent health care, the sharing of best practice amongst health care providers and the creation of systemic institutional change to improve the care lesbians receive.     

Understanding lesbians' healthcare behaviour: the case of breast self-examination

Lesbians' risk of breast cancer is a much-debated issue in health research because lesbians are believed to be at higher risk of the disease than are heterosexual women. This belief is based upon particular risk factors for breast cancer, which are said to be more prevalent in lesbians; and upon differences in preventive health behaviours: in particular, lesbians are said to be less likely to practise breast self-examination (BSE). This paper presents data collected as part of the UK Lesbians and Healthcare Survey (n = 1066) focusing on lesbians who report never practising BSE (n = 218, 20%) and the explanations they offer for their healthcare behaviours. It identifies six types of explanation for not practising BSE: (i) "I don't know what I'm looking for"; (ii) "I've never got into the habit"; (iii) "I'm frightened in case I find something"; (iv) "I don't think I'm at much risk"; (v) "I'm uncomfortable with my body"; and (vi) "My partner does it for me". These findings are important for increasing understanding of lesbians' healthcare behaviour and for developing health promotion materials relevant to their needs.     

A Neuropsychologic Profile of Homosexual and Heterosexual Men and Women

To examine the applicability of psychosexual differentiation theory to the development of sexual orientation, heterosexual (HT) women, HT men, lesbians, and gay men (20 per group) completed a lexical-decision/semantic monitoring task (LD/SM) to assess verbal ability, as well as a Water Level Task (WLT) and two Mental Rotation (MR) Tasks designed to assess spatial ability. All tests have been shown to differentiate HT men and women. Results replicated previously reported sexdifferences between the HT men and women. Further, gay men performed akin to HT women on the verbal task and the MR tasks, but not in the WLT. Lesbians, however, primarily performed in a sex-typical manner. The dissociation in sex-atypicality between lesbians and gay men is discussed in relation to neurobiological factors related to the development of both sex-dimorphic cognitive ability and sexual orientation.     

Correlates of underutilization of gynecological cancer screening among lesbian and heterosexual women

BACKGROUND: Study aims were to examine cervical cancer risk factors, screening patterns, and predictors of screening adherence in demographically similar samples of lesbian (N=550) and heterosexual women (N=279). METHODS: Data are from a multisite survey study of women's health conducted from 1994 to 1996. RESULTS: Differences in sexual behavior risk factors for cervical cancer were observed with lesbians reporting earlier onset of sexual activity (P<0.05), more sexual partners (P<0.001), and lower use of safer sex activities (P<0.01). Lesbian and heterosexual women were equally likely to have ever had a Pap test; however, lesbians were less likely to report annual (P<0.001) or routine (P<0.001) testing. Multivariate analyses were used to determine the associations between demographics, health care factors, health behaviors, and worry about health and screening behaviors. Individual predictors of never screening included younger age, lower income, and lack of annual medical visits. Independent predictors of both recent and annual screenings included history of an abnormal Pap test, being heterosexual, and annual medical visits. CONCLUSION: Data indicate that lesbians are at risk for cervical cancer, yet underutilize recommended screening tests. Findings have implications for research, education, and cancer control among lesbians.     

Comparing breast cancer risk between lesbians and their heterosexual sisters.

PURPOSE: The purpose of this study was to explore the similarities and differences between lesbians and their heterosexual sisters in the established risks for developing breast cancer. METHODS: The design for this study was a matched (lesbian with heterosexual sister) cross-sectional, mail-back, anonymous survey. We distributed the surveys throughout the state of California to English-speaking women who identified themselves as lesbians, age 40 and older, and their sisters. Using the modified Gail Breast Cancer Risk model as well as other well-established factors associated with the development of breast cancer, we compared the breast cancer risk potential for 324 sister pairs (N = 648). Data were analyzed using paired t-tests, analysis of covariance (ANCOVA), McNemar's chi(2), or the Bowker statistic, as appropriate for the level of data. MAIN FINDINGS: The lesbians had significantly higher 5-year (p <.0001) and lifetime (p =.001) risk for developing breast cancer. The reasons for lesbians' predicted rate of breast cancer were most likely their higher scores on all pregnancy-related variables and the relatively high number of breast biopsies they reported. The lesbians had used birth control pills less (p <. 0001), had significantly fewer pregnancies (p <.0001), children (p <.0001), abortions (p <.0001), and miscarriages (p <.0001) as well as significantly more breast biopsies (p =.02) than did their heterosexual sisters. CONCLUSIONS: A lesbian who comes out to her clinician is relying on the clinician to be informed and be open to discuss her life. When a lesbian has a lump or a suspicious mammogram, she needs her clinician to advocate for her within the health care system because she is at higher risk for having cancer than a heterosexual woman.     

Comparison of stress and stress management strategies between lesbian and heterosexual women

Stress is said to be part of life, but stress may be uniquely experienced by different groups of women. We conducted this study to compare the experiences of stress and the methods of stress management used by lesbian and heterosexual women. A convenience sample of 215 (136 lesbian and 79 heterosexual) urban women was used. All women reported generally good mental health; however, more than 80% of the women reported moderate or severe stress. There were more similarities than differences between the groups, but lesbians reported more stress due to sexual identity, being female, and mental problems, and heterosexual women reported more stress due to parents and children. Both groups used a wide range of stress management strategies, although lesbians more frequently used meditation and therapy.     

Comparing Subjective Ratings of Sexual Arousal and Desire in Partnered Sexual Activities from Women of Different Sexual Orientations

Little is known about non-monosexual women’s sexual arousal and desire. Typically, bisexual women have been excluded from research on sexual arousal and desire, whereas mostly heterosexual and mostly lesbian women have been placed into monosexual categories. This research (1) compared the subjective sexual arousal and desire of self-identified heterosexual, mostly heterosexual, bisexual, mostly lesbian, and lesbian women in partnered sexual activities with men and with women, and (2) compared within-group differences for subjective sexual arousal and desire with men versus women for the five groups. Participants included 388 women (M age = 24.40, SD = 6.40, 188 heterosexual, 53 mostly heterosexual, 64 bisexual, 32 mostly lesbian, 51 lesbian) who filled out the Sexual Arousal and Desire Inventory (SADI). Sexual orientation was associated with sexual arousal and desire in sexual activities with both men and with women. Bisexuals reported higher sexual arousal and desire for women than heterosexuals and lesbians, while lesbians reported lower sexual arousal and desire with men than the other groups. Heterosexuals and mostly heterosexuals scored higher on the male than on the female motivational dimension of the SADI, while the reverse was found for lesbians and mostly lesbians. Findings indicate that non-monosexuals have higher sexual arousal and desire in sexual activities with women than monosexuals. Further, bisexual women did not differentiate their sexual arousal with men versus women, while the other sexual orientation groups differentiated in terms of their motivation to engage in sexual activity. These findings may have implications for how female sexual orientation is conceptualized.     

Sexual minority status and long-term breast cancer survivorship

Sexual minority women, such as lesbians, bisexuals, and women who have a woman partner face unique challenges, such as deciding on disclosing their sexual minority status to health providers. The purpose of this qualitative study was to explore the perceptions of sexual minority women who were long-term breast cancer survivors. Twenty-two sexual minority women, diagnosed with non-metastatic breast cancer between 2000 and 2005, participated in semi-structured, open-ended interviews. Interviews were audio-recorded, transcribed, and analyzed to identify emergent themes to summarize sexual minority women's perceptions of breast cancer survivorship. Participants' perceptions about the impact of their sexual minority identity on breast cancer survivorship consisted of: (1) breast cancer is a women's issue, not a lesbian issue; (2) I can manage my identity in the context of breast cancer; and (3) I am better off than heterosexual women. The authors' findings suggest a possible disconnect between sexual minority women with breast cancer who de-emphasized the importance of sexual minority status and the research community that emphasizes the importance of this status. Prior to counting on sexual minority women's interest in studies, researchers may need to educate sexual minority women about the need of breast cancer studies.     

Understanding lesbians' mammography utilization.

Lesbians face unique barriers to health care, and may be at higher risk for breast cancer than are other women. Yet, no research on lesbians and mammography utilization exists. We conducted telephone interviews of 107 lesbians aged 51-80, of whom 68 had had mammograms in the last year and 39 had not. Responses to open-ended questions identified the barriers lesbians face in obtaining mammography, lesbians, reasons for obtaining mammograms, and factors that would help lesbians obtain mammograms. Some issues identified were particular to lesbians; many issues were common to those identified by general samples of women (which include lesbians).     

Coping Styles as Mediator of Sexual Orientation-Related Health Differences

The higher prevalence of health problems in homosexual compared to heterosexual populations is usually understood as a consequence of minority stress. We hypothesized that differential rates of health problems also could result from sexual orientation-related differences in coping styles. We explored this using data collected in a general population-based study (N = 9684) via face-to-face interviews. A higher prevalence of both mental and physical health problems, as assessed with individual questions, the GHQ-12, and checklists, was observed in homosexual compared to heterosexual men and women. Coping style was related to sexual orientation in men, but not in women. Compared to heterosexual men, homosexual men more strongly applied emotion-oriented and avoidance coping strategies. Emotion-oriented coping mediated the differences in mental and physical health between heterosexual and homosexual men. Findings suggest the importance of further exploration of the development and use of emotion-oriented and avoidance coping by homosexual men.     

A Comparison of Lesbian,Bisexual, and Heterosexual Female College Undergraduate Students on Selected Reproductive Health Screenings and Sexual Behaviors

BackgroundThe purpose of this study was to compare lesbian, bisexual, and heterosexual college undergraduate women on selected reproductive health screenings. Associations between sexual orientation and preventive health screenings and sexual behaviors were made to determine if differences existed between the groups.MethodsThe study was a secondary analysis of three semesters of the American College Health Association's National College Health Assessment-II.FindingsBisexuals were 1.1 times as likely as heterosexuals to have a gynecological examination and perform a breast self-examination (BSE), and 1.5 times as likely to have an HIV test. Bisexuals also were 1.5 times as likely as lesbians to have a gynecological examination, 1.2 times as likely to perform BSE, and 1.4 times as likely to have an HIV test. Lesbians were 0.70 times as likely as heterosexuals to have a gynecological examination, but no different in BSE or HIV testing. Bisexuals were more likely to have anal intercourse than heterosexuals or lesbians (p < .001). Bisexuals were less likely to use condoms than heterosexuals for vaginal intercourse but more likely to use them for anal intercourse (p < .001). Most of the women (90%) used no barrier protection for oral sex. Bivariate tests found associations between sexual orientation and each of the preventive screenings and that those with more partners screened more frequently.ConclusionsHealth educators should attend to the unique needs of each sexual orientation group when presenting sexual health information to college women. Health care providers should undergo diversity and sensitivity training to work more effectively with these groups.