Components of sexual minority (SM) status—including lesbian or bisexual identity, having same-sex partners, or same-sex attraction—individually predict substance use and sexual risk behavior disparities among women. Few studies have measured differing associations by sexual orientation components (identity, behavior, and attraction), particularly over time. Data were drawn from the 2002–2015 National Survey of Family Growth female sample (n = 31,222). Multivariable logistic regression (adjusted for age, race/ethnicity, education, marital/cohabitation status, survey cycle, and population-weighted) compared past-year sexual risk behavior, binge drinking, drug use, and sexually transmitted infection treatment among sexual minority women (SMW) versus sexual majority women (SMJW) by each sexual orientation component separately and by all components combined, and tested for effect modification by survey cycle. In multivariable models, SM identity, behavior, and attraction individually predicted significantly greater odds of risk behaviors. SM identity became nonsignificant in final adjusted models with all three orientation components; non-monosexual attraction and behavior continued to predict significantly elevated odds of risk behaviors, remaining associated with sexual risk behavior and drug use over time (attenuated in some cases). Trends in disparities over time between SMW versus SMJW varied by sexual orientation indicator. In a shifting political and social context, research should include multidimensional sexual orientation constructs to accurately identify all SMW—especially those reporting non-monosexual behavior or attraction—and prioritize their health needs.
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This study did not receive funding as the NSFG is a free and publicly available data set. Dr. Margaret Paschen-Wolff is now supported by a training Grant (T32 MH019139; PI: Theodorus Sandfort, Ph.D.) from the National Institute of Mental Health at the HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University (P30-MH43520; Center Principal Investigator: Robert Remien, Ph.D.).
Conflict of interest
The authors declare that they have no conflicts of interest.
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.
Informed consent was obtained from all individual participants included in the study.
Disclaimer: The findings and conclusions in the article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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Paschen-Wolff, M.M., Kelvin, E., Wells, B.E. et al. Changing Trends in Substance Use and Sexual Risk Disparities among Sexual Minority Women as a Function of Sexual Identity, Behavior, and Attraction: Findings from the National Survey of Family Growth, 2002–2015. Arch Sex Behav 48, 1137–1158 (2019). https://doi.org/10.1007/s10508-018-1333-1
- Sexual minority women
- Sexual orientation
- Substance use
- Sexual risk behavior