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Sexual Health Care Services Among Young Adult Sexual Minority Women

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Abstract

Young adult sexual minority women (YSMW) are at elevated risk for negative reproductive health outcomes, yet are less likely than heterosexual peers to utilize preventive health care. Medical and public health policy organizations advocate sexual orientation disclosure (“coming out”) to health care providers as a strategy for increasing service utilization among YSMW. Limited research explores relationships between disclosure and receipt of sexual health services. YSMW (N = 285) ages 21–24 participated in an online survey assessing their health behaviors and care utilization. We employed multivariable logistic regression models to examine the association between receipt of sexual health services and sexual orientation disclosure to provider, after adjusting for sociodemographic covariates. Thirty-five percent of YSMW were out to their provider. Less than half the sample had received Pap screening or STI testing in the previous year; approximately 15% had received at least one dose of the HPV vaccination. Disclosure was associated with increased likelihood of Pap screening (OR=2.66, p < .001) and HPV vaccination (OR=4.30, p < .001), but was not significantly associated with STI testing. Promoting coming out to providers may be a promising approach to increase sexual health care use among YSMW. Future research should explore causal relationships between these factors.

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References

  • Abdessamad, H. M., Yudin, M. H., Tarasoff, L. A., Radford, K. D., & Ross, L. E. (2013). Attitudes and knowledge among obstetrician-gynecologists regarding lesbian patients and their health. Journal of Women’s Health (2002), 22(1), 85–93. doi:10.1089/jwh.2012.3718.

    Article  Google Scholar 

  • Agénor, M., Krieger, N., Austin, S. B., Haneuse, S., & Gottlieb, B. R. (2014b). Sexual orientation disparities in Papanicolaou test use among US women: The role of sexual and reproductive health services. American Journal of Public Health, 104(2), e68–e73. doi:10.2105/AJPH.2013.301548.

    Article  PubMed  PubMed Central  Google Scholar 

  • Agénor, M., Bailey, Z., Krieger, N., Austin, S. B., & Gottlieb, B. R. (2015a). Exploring the cervical cancer screening experiences of black lesbian, bisexual, and queer women: The role of patient-provider communication. Women & Health, 55(6), 717–736. doi:10.1080/03630242.2015.1039182.

    Article  Google Scholar 

  • Agénor, M., Peitzmeier, S., Gordon, A. R., Haneuse, S., Potter, J. E., & Austin, S. B. (2015b). Sexual orientation identity disparities in awareness and initiation of the human papillomavirus vaccine among U.S. women and girls: A national survey. Annals of Internal Medicine, 163(2), 99–106. doi:10.7326/M14-2108.

    Article  PubMed  PubMed Central  Google Scholar 

  • American College of Obstetricians and Gynecologists. (2012). Health Care for Lesbians and Bisexual Women (No. 525). American College of Obstretricians and Gynecologists.

  • American College of Obstetricians and Gynecologists. (2013). New Guidelines for Cervical Cancer Screening: Patient Education Fact Sheet (No. PFS004). American College of Obstretricians and Gynecologists.

  • Bauermeister, J. A., Pingel, E., Zimmerman, M., Couper, M., Carballo-Diéguez, A., & Strecher, V. J. (2012a). Data quality in web-based HIV/AIDS research: Handling invalid and suspicious data. Field Methods, 24(3), 272–291. doi:10.1177/1525822X12443097.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bauermeister, J. A., Zimmerman, M. A., Johns, M. M., Glowacki, P., Stoddard, S., & Volz, E. (2012b). Innovative recruitment using online networks: Lessons learned from an online study of alcohol and other drug use utilizing a web-based, respondent-driven sampling (webRDS) strategy. Journal of Studies on Alcohol and Drugs, 73(5), 834–838.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bauermeister, J. A., Youatt, E. J., Pingel, E. S., Soler, J. H., & Johns, M. M. (in press). Psychosocial obstacles to smoking cessation attempts among young adult sexual minority women. Behavioral Medicine. doi:10.1080/08964289.2017.1282853.

  • Bergeron, S., & Senn, C. Y. (2003). Health care utilization in a sample of Canadian lesbian women: Predictors of risk and resilience. Women & Health, 37(3), 19–35. doi:10.1300/J013v37n03_02.

    Article  Google Scholar 

  • Bjorkman, M., & Malterud, K. (2007). Being lesbian—Does the doctor need to know? Scandinavian Journal of Primary Health Care, 25(1), 58–62. doi:10.1080/02813430601086178.

    Article  PubMed  PubMed Central  Google Scholar 

  • Boehmer, U., & Case, P. (2004). Physicians don’t ask, sometimes patients tell. Cancer, 101(8), 1882–1889. doi:10.1002/cncr.20563.

    Article  PubMed  Google Scholar 

  • Bradford, J., & Van Wagenen, A. (2013). Research on the Health of Sexual Minority Women. In Women and Health (Second, pp. 77–91). Academic Press.

  • Centers for Disease Control. (2013). Noninfluenza Vaccination Coverage Among Adults — United States, 2011 (Morbidity and Mortality Weekly No. 62 (4)) (pp. 66–72). Centers for Disease Control. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6204a2.htm

  • Chao, C., Velicer, C., Slezak, J. M., & Jacobsen, S. J. (2010). Correlates for human papillomavirus vaccination of adolescent girls and young women in a managed care organization. American Journal of Epidemiology, 171(3), 357–367. doi:10.1093/aje/kwp365.

    Article  PubMed  PubMed Central  Google Scholar 

  • Charlton, B. M., Corliss, H. L., Missmer, S. A., Frazier, A. L., Rosario, M., Kahn, J. A., & Austin, S. B. (2011). Reproductive health screening disparities and sexual orientation in a cohort study of U.S. adolescent and young adult females. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 49(5), 505–510. doi:10.1016/j.jadohealth.2011.03.013.

    Article  Google Scholar 

  • Charlton, B. M., Corliss, H. L., Missmer, S. A., Frazier, A. L., Rosario, M., Kahn, J. A., & Austin, S. B. (2014). Influence of hormonal contraceptive use and health beliefs on sexual orientation disparities in Papanicolaou test use. American Journal of Public Health, 104(2), 319–325. doi:10.2105/AJPH.2012.301114.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, R. A., & Bloom, B. (2010). Access to and utilization of medical care for young adults ages 20-29 years: United States, 2008. NCHS Data Brief, 29, 1–8.

    Google Scholar 

  • Cook, R. L., Zhang, J., Mullins, J., Kauf, T., Brumback, B., Steingraber, H., & Mallison, C. (2010). Factors associated with initiation and completion of human papillomavirus vaccine series among young women enrolled in Medicaid. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 47(6), 596–599. doi:10.1016/j.jadohealth.2010.09.015.

    Article  Google Scholar 

  • Coughlin, S. S., Breslau, E. S., Thompson, T., & Benard, V. B. (2005). Physician recommendation for papanicolaou testing among U.S. women, 2000. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 14(5), 1143–1148. doi:10.1158/1055-9965.EPI-04-0559.

    Article  Google Scholar 

  • Daniel-Ulloa, J., Gilbert, P. A., & Parker, E. A. (2016). Human Papillomavirus Vaccination in the United States: Uneven Uptake by Gender, Race/Ethnicity, and Sexual Orientation. American Journal of Public Health, e1–e2. doi:10.2105/AJPH.2015.303039

  • Dehart, D. D. (2008). Breast health behavior among lesbians: The role of health beliefs, heterosexism, and homophobia. Women & Health, 48(4), 409–427. doi:10.1080/03630240802575146.

    Article  Google Scholar 

  • Diamant, A., Schuster, M. A., & Lever, J. (2000). Receipt of preventive health care services by lesbians. American Journal of Preventive Medicine, 19(3), 141–148.

    Article  PubMed  Google Scholar 

  • Dreisbach, S. (2009). Fact Sheet: HIV/AIDS in Rural America: Challenges and Promising Strategies (No. 23). Rural Center for AIDS/STD Prevention: Indiana University.

  • Eliason, M. J., & Schope, R. (2001). Does “don’t ask don’t tell” apply to health care? Lesbian, gay, and bisexual people’s disclosure to health care providers. Journal of the Gay and Lesbian Medical Association, 5(4), 125–134. doi:10.1023/A:1014257910462.

    Article  Google Scholar 

  • Evans, A. L., Scally, A. J., Wellard, S. J., & Wilson, J. D. (2007). Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting. Sexually Transmitted Infections, 83(6), 470–475. doi:10.1136/sti.2006.022277.

    Article  PubMed  PubMed Central  Google Scholar 

  • HPV and Cancer. (2015). [cgvFactSheet]. Retrieved February 23, 2016, from http://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet

  • Johns, M. M., Pingel, E. S., Youatt, E. J., Soler, J. H., McClelland, S., & Bauermeister, J. A. (2013). LGBT community, social network characteristics, and smoking behaviors in young sexual minority women. American Journal of Community Psychology, 52(1), 141–154. doi:10.1007/s10464-013-9584-4.

    Article  PubMed  Google Scholar 

  • Juon, H.-S., Seung-Lee, C., & Klassen, A. C. (2003). Predictors of regular Pap smears among Korean-American women. Preventive Medicine, 37(6 Pt 1), 585–592.

    Article  PubMed  Google Scholar 

  • Kelly, A. (2011). HIV and STD Prevention Policies: Focus on Rural Areas. The Council of State Governments.

  • Kerr, D. L., Ding, K., & Thompson, A. J. (2013). A comparison of lesbian, bisexual, and heterosexual female college undergraduate students on selected reproductive health screenings and sexual behaviors. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 23(6), e347–e355. doi:10.1016/j.whi.2013.09.003.

    Article  Google Scholar 

  • Khoong, E. C., Gibbert, W. S., Garbutt, J. M., Sumner, W., & Brownson, R. C. (2014). Rural, suburban, and urban differences in factors that impact physician adherence to clinical preventive service guidelines. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 30(1), 7–16. doi:10.1111/jrh.12025.

    Article  Google Scholar 

  • Marrazzo, J. M., Stine, K., & Wald, A. (2003). Prevalence and risk factors for infection with herpes simplex virus type-1 and -2 among lesbians. Sexually Transmitted Diseases, 30(12), 890–895. doi:10.1097/01.OLQ.0000091151.52656.E5.

    Article  PubMed  Google Scholar 

  • Matthews, A. K., Brandenburg, D. L., Johnson, T. P., & Hughes, T. L. (2004). Correlates of underutilization of gynecological cancer screening among lesbian and heterosexual women. Preventive Medicine, 38(1), 105–113.

    Article  PubMed  Google Scholar 

  • McIntyre, L., Szewchuk, A., & Munro, J. (2010). Inclusion and exclusion in mid-life lesbians’ experiences of the Pap test. Culture, Health & Sexuality, 12(8), 885–898. doi:10.1080/13691058.2010.508844.

    Article  Google Scholar 

  • McNair, R. P., Hegarty, K., & Taft, A. (2012). From silence to sensitivity: A new identity disclosure model to facilitate disclosure for same-sex attracted women in general practice consultations. Social Science & Medicine (1982), 75(1), 208–216. doi:10.1016/j.socscimed.2012.02.037.

    Article  Google Scholar 

  • Mosack, K. E., Brouwer, A. M., & Petroll, A. E. (2013). Sexual identity, identity disclosure, and health care experiences: Is there evidence for differential homophobia in primary care practice? Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 23(6), e341–e346. doi:10.1016/j.whi.2013.07.004.

    Article  Google Scholar 

  • Muzny, C. A., Harbison, H. S., Pembleton, E. S., & Austin, E. L. (2013). Sexual behaviors, perception of sexually transmitted infection risk, and practice of safe sex among southern African American women who have sex with women. Sexually Transmitted Diseases, 40(5), 395–400. doi:10.1097/OLQ.0b013e31828caf34.

    Article  PubMed  Google Scholar 

  • National Center for Health Statistics. (2015). Health, United States, 2014: With Special Feature on Adults Aged 55–64. Hyattsville.

  • Neubrand, T. P. L., Breitkopf, C. R., Rupp, R., Breitkopf, D., & Rosenthal, S. L. (2009). Factors associated with completion of the human papillomavirus vaccine series. Clinical Pediatrics, 48(9), 966–969. doi:10.1177/0009922809337534.

    Article  PubMed  Google Scholar 

  • Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., et al. (2011). Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA: The Journal of the American Medical Association, 306(9), 971–977. doi:10.1001/jama.2011.1255.

    Article  PubMed  Google Scholar 

  • Peitzmeier, S. (2013). Promoting Cervical Cancer Screening Among Lesbians and Bisexual Women. The Fenway Institute.

  • Reiter, P. L., Cates, J. R., McRee, A.-L., Gottlieb, S. L., Shafer, A., Smith, J. S., & Brewer, N. T. (2010). Statewide HPV vaccine initiation among adolescent females in North Carolina. Sexually Transmitted Diseases, 37(9), 549–556. doi:10.1097/OLQ.0b013e3181d73bf8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rowen, T. S., Breyer, B. N., Lin, T.-C., Li, C.-S., Robertson, P. A., & Shindel, A. W. (2013). Use of barrier protection for sexual activity among women who have sex with women. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 120(1), 42–45. doi:10.1016/j.ijgo.2012.08.011.

    Article  Google Scholar 

  • Sanchez, N. F., Rabatin, J., Sanchez, J. P., Hubbard, S., & Kalet, A. (2006). Medical students’ ability to care for lesbian, gay, bisexual, and transgendered patients. Family Medicine, 38(1), 21–27.

    PubMed  Google Scholar 

  • Seaver, M. R., Freund, K. M., Wright, L. M., Tjia, J., & Frayne, S. M. (2008). Healthcare preferences among lesbians: A focus group analysis. Journal of Women’s Health, 17(2), 215–225. doi:10.1089/jwh.2007.0083.

    Article  PubMed  Google Scholar 

  • Staras, S. A. S., Vadaparampil, S. T., Haderxhanaj, L. T., & Shenkman, E. A. (2010). Disparities in human papillomavirus vaccine series initiation among adolescent girls enrolled in Florida Medicaid programs, 2006-2008. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 47(4), 381–388. doi:10.1016/j.jadohealth.2010.07.028.

    Article  Google Scholar 

  • STDs and HIV – CDC Fact Sheet. (2015). Retrieved February 10, 2016, from http://www.cdc.gov/std/hiv/stdfact-std-hiv-detailed.htm

  • Steele, L. S., Tinmouth, J. M., & Lu, A. (2006). Regular health care use by lesbians: A path analysis of predictive factors. Family Practice, 23(6), 631–636. doi:10.1093/fampra/cml030.

    Article  PubMed  Google Scholar 

  • Stott, D. B. (2013). The training needs of general practitioners in the exploration of sexual health matters and providing sexual healthcare to lesbian, gay and bisexual patients. Medical Teacher, 35(9), 752–759. doi:10.3109/0142159X.2013.801943.

    Article  PubMed  Google Scholar 

  • Teitcher, J., Bockting, W., Bauermeister, J. A., Hoefer, C. J., Miner, M. H., & Klitzman, R. (2015). Detecting, prevention, and responding to “fraudsters” in Internet Research: Ethics and tradeoffs. Journal of Law, Medicine & Ethics, 43(1), 116-133.

  • Tracy, J. K., Lydecker, A. D., & Ireland, L. (2010). Barriers to cervical cancer screening among lesbians. Journal of Women’s Health (2002), 19(2), 229–237. doi:10.1089/jwh.2009.1393.

    Article  Google Scholar 

  • United States Department of Health and Human Services, Office of Women’s Health. (2009). Lesbian and Bisexual Health: Frequently Asked Questions. US Dept. of Health and Human Services, Office of Women’s Health. Retrieved from http://www.womenshealth.gov/publications/our-publications/fact-sheet/lesbian-bisexual-health.html

  • Widdice, L. E., Bernstein, D. I., Leonard, A. C., Marsolo, K. A., & Kahn, J. A. (2011). Adherence to the HPV vaccine dosing intervals and factors associated with completion of 3 doses. Pediatrics, 127(1), 77–84. doi:10.1542/peds.2010-0812.

    Article  PubMed  Google Scholar 

  • Wojnar, D. M., & Katzenmeyer, A. (2014). Experiences of preconception, pregnancy, and new motherhood for lesbian nonbiological mothers. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 43(1), 50–60. doi:10.1111/1552-6909.12270.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Emily J. Youatt, Gary W. Harper & Nancy K. Janz

  2. Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI, USA

    Lisa H. Harris

  3. Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Blvd, Room 402, Philadelphia, PA, 19104, USA

    José A. Bauermeister

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  1. Emily J. Youatt
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  5. José A. Bauermeister
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Correspondence to José A. Bauermeister.

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This work was supported by a pilot grant by the University of Michigan Comprehensive Cancer Center.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Youatt, E.J., Harris, L.H., Harper, G.W. et al. Sexual Health Care Services Among Young Adult Sexual Minority Women. Sex Res Soc Policy 14, 345–357 (2017). https://doi.org/10.1007/s13178-017-0277-x

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