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

Abstract

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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References

  1. Badgett, M. (2009). Best practices for asking questions about sexual orientation on surveys. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/SMART-FINAL-Nov-2009.pdf.

  2. Bauer, G. R., Jairam, J. A., & Baidoobonso, S. M. (2010). Sexual health, risk behaviors, and substance use in heterosexual-identified women with female sex partners: 2002 US National Survey of Family Growth. Sexually Transmitted Diseases, 37, 531–537.

    Article  Google Scholar 

  3. Bolton, S.-L., & Sareen, J. (2011). Sexual orientation and its relation to mental disorders and suicide attempts: Findings from a nationally representative sample. Canadian Journal of Psychiatry, 56, 35–43.

    Article  Google Scholar 

  4. Brewster, K. L., & Tillman, K. H. (2012). Sexual orientation and substance use among adolescents and young adults. American Journal of Public Health, 102, 1168–1176.

    Article  Google Scholar 

  5. Brewster, M., & Moradi, B. (2010). Perceived experiences of anti-bisexual prejudice: Instrument development and evaluation. Journal of Counseling Psychology, 57, 451–468.

    Article  Google Scholar 

  6. Califf, R. M., Woodcock, J., & Ostroff, S. (2016). A proactive response to prescription opioid abuse. New England Journal of Medicine, 374, 1480–1485.

    Article  Google Scholar 

  7. Centers for Disease Control and Prevention. (2014). Combining YRBS data across years and sites. Retrieved from http://www.cdc.gov/healthyyouth/data/yrbs/pdf/yrbs_combining_data.pdf.

  8. Centers for Disease Control and Prevention. (2017). National Survey of Family Growth: Questionnaires, datasets, and related documentation. Retrieved from https://www.cdc.gov/nchs/nsfg/nsfg_questionnaires.htm.

  9. Chappell, B. (2015). Supreme Court declares same-sex marriage legal in all 50 states. Retrieved from http://www.npr.org/sections/thetwo-way/2015/06/26/417717613/supreme-court-rules-all-states-must-allow-same-sex-marriages.

  10. Copen, C. E., Chandra, A., & Febo-Vazquez, I. (2016). Sexual behavior, sexual attraction, and sexual orientation among adults aged 18-44 in the United States: Data from the 2011-2013 National Survey of Family Growth. National Health Statistics Reports, 88, 1–14.

    Google Scholar 

  11. Corliss, H. L., Austin, S. B., Roberts, A. L., & Molnar, B. E. (2009). Sexual risk in “mostly heterosexual” young women: Influence of social support and caregiver mental health. Journal of Women’s Health, 18, 2005–2010.

    Article  Google Scholar 

  12. Corliss, H. L., Grella, C. E., Mays, V. M., & Cochran, S. D. (2006). Drug use, drug severity, and help-seeking behaviors of lesbian and bisexual women. Journal of Women’s Health, 15, 556–568.

    Article  Google Scholar 

  13. Diamond, L. M. (2003). Was it a phase? Young women’s relinquishment of lesbian/bisexual identities over a 5-year period. Journal of Personality and Social Psychology, 84, 352–364.

    Article  Google Scholar 

  14. Dodge, B., Herbenick, D., Friedman, M. R., Schick, V., Fu, T.-C. J., Bostwick, W., & Reece, M. (2016). Attitudes toward bisexual men and women among a nationally representative probability sample of adults in the United States. PLoS ONE, 11, e0164430. https://doi.org/10.1371/journal.pone.0164430.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dyar, C., Feinstein, B. A., & London, B. (2014). Dimensions of sexual identity and minority stress among bisexual women: The role of partner gender. Psychology of Sexual Orientation and Gender Diversity, 1, 441–451.

    Article  Google Scholar 

  16. Dyar, C., Feinstein, B. A., Schick, V., & Davila, J. (2017). Minority stress, sexual identity uncertainty, and partner gender decision making among nonmonosexual individuals. Psychology of Sexual Orientation and Gender Diversity, 4, 87–104.

    Article  Google Scholar 

  17. Eisenberg, M. (2001). Differences in sexual risk behaviors between college students with same-sex and opposite-sex experience: Results from a national survey. Archives of Sexual Behavior, 30, 575–589.

    Article  Google Scholar 

  18. England, P., Mishel, E., & Caudillo, M. L. (2016). Increases in sex with same-sex partners and bisexual identity across cohorts of women (but not men). Sociological Science, 3, 951–970.

    Article  Google Scholar 

  19. Everett, B. G. (2013). Sexual orientation disparities in sexually transmitted infections: Examining the intersection between sexual identity and sexual behavior. Archives of Sexual Behavior, 42, 225–236.

    Article  Google Scholar 

  20. Fish, J. N., Watson, R. J., Porta, C. M., Russell, S. T., & Saewyc, E. M. (2017). Are alcohol-related disparities between sexual minority and heterosexual youth decreasing? Addiction, 112, 1931–1941.

    Article  Google Scholar 

  21. Goodenow, C., Szalacha, L. A., Robin, L. E., & Westheimer, K. (2008). Dimensions of sexual orientation and HIV-related risk among adolescent females: Evidence from a statewide survey. American Journal of Public Health, 98, 1051–1058.

    Article  Google Scholar 

  22. Groves, R., Mosher, M., Lepkowski, J., & Kirgis, N. (2009). Planning and development of the continuous National Survey of Family Growth. Vital and Health Statistics, 1, 1–28.

    Google Scholar 

  23. Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707–730.

    Article  Google Scholar 

  24. Hatzenbuehler, M. L. (2011). The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics, 127, 896–903.

    Article  Google Scholar 

  25. Hatzenbuehler, M. L., McLaughlin, K. A., Keyes, K. M., & Hasin, D. S. (2010). The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: A prospective study. American Journal of Public Health, 100, 452–459.

    Article  Google Scholar 

  26. Hatzenbuehler, M. L., Wieringa, N. F., & Keyes, K. M. (2011). Community-level determinants of tobacco use disparities in lesbian, gay, and bisexual youth: Results from a population-based study. Archives of Pediatrics and Adolescent Medicine, 165, 527–532.

    Article  Google Scholar 

  27. Herrick, A. L., Matthews, A. K., & Garofalo, R. (2010). Health risk behaviors in an urban sample of young women who have sex with women. Journal of Lesbian Studies, 14, 80–92.

    Article  Google Scholar 

  28. Homma, Y., Saewyc, E., & Zumbo, B. D. (2016). Is it getting better? An analytical method to test trends in health disparities, with tobacco use among sexual minority vs. heterosexual youth as an example. International Journal for Equity in Health, 15, 79–87.

    Article  Google Scholar 

  29. Hughes, T. (2011). Alcohol use and alcohol-related problems among sexual minority women. Alcoholism Treatment Quarterly, 29, 403–435.

    Article  Google Scholar 

  30. Hughes, T., Szalacha, L. A., & McNair, R. (2010). Substance abuse and mental health disparities: Comparisons across sexual identity groups in a national sample of young Australian women. Social Science and Medicine, 71, 824–831.

    Article  Google Scholar 

  31. Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academy of Sciences.

    Google Scholar 

  32. Juster, R.-P., Smith, N. G., Ouellet, É., Sindi, S., & Lupien, S. J. (2013). Sexual orientation and disclosure in relation to psychiatric symptoms, diurnal cortisol, and allostatic load. Psychosomatic Medicine, 75, 103–116.

    Article  Google Scholar 

  33. Kann, L. (2011). Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9–12: Youth risk behavior surveillance, selected sites, United States, 2001–2009. MMWR Surveillance Summaries, 60, 1–133.

    Google Scholar 

  34. Kerr, D., Ding, K., Burke, A., & Ott-Walter, K. (2015). An alcohol, tobacco, and other drug use comparison of lesbian, bisexual, and heterosexual undergraduate women. Substance Use and Misuse, 50, 340–349.

    Article  Google Scholar 

  35. Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago, IL: University of Chicago Press.

    Google Scholar 

  36. Lehavot, K., & Simoni, J. M. (2011). The impact of minority stress on mental health and substance use among sexual minority women. Journal of Consulting and Clinical Psychology, 79, 159–170.

    Article  Google Scholar 

  37. Lepkowski, J. M., Mosher, W. D., Groves, R. M., West, B. T., Wagner, J., & Gu, H. (2013). Responsive design, weighting, and variance estimation in the 2006–2010 National Survey of Family Growth. Vital and Health Statistics, 2, 1–42.

    Google Scholar 

  38. Lindley, L. L., Walsemann, K. M., & Carter, J. W. (2013). Invisible and at risk: STDs among young adult sexual minority women in the United States. Perspectives on Sexual and Reproductive Health, 45, 66–73.

    Article  Google Scholar 

  39. MacKay, J., Robinson, M., Pinder, S., & Ross, L. E. (2017). A grounded theory of bisexual individuals’ experiences of help seeking. American Journal of Orthopsychiatry, 87, 52–61.

    Article  Google Scholar 

  40. Marrazzo, J. M., & Gorgos, L. M. (2012). Emerging sexual health issues among women who have sex with women. Current Infectious Disease Reports, 14, 204–211.

    Article  Google Scholar 

  41. Marshall, S. W. (2007). Power for tests of interaction: Effect of raising the Type I error rate. Epidemiologic Perspectives and Innovations, 4, 1–7.

    Article  Google Scholar 

  42. Matthews, D. D., Blosnich, J. R., Farmer, G. W., & Adams, B. J. (2014). Operational definitions of sexual orientation and estimates of adolescent health risk behaviors. LGBT Health, 1, 42–49.

    Article  Google Scholar 

  43. McCabe, S. E., Hughes, T. L., Bostwick, W. B., West, B. T., & Boyd, C. J. (2009). Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction, 104, 1333–1345.

    Article  Google Scholar 

  44. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.

    Article  Google Scholar 

  45. Meyer, I. H., & Wilson, P. A. (2009). Sampling lesbian, gay, and bisexual populations. Journal of Counseling Psychology, 56, 23–31.

    Article  Google Scholar 

  46. Movement Advancement Project. (2010). A decade of progress on LGBT rights. Retrieved from http://www.lgbtmap.org/policy-and-issue-analysis/a-decade-of-progress-on-lgbt-rights.

  47. Muzny, C. A., Sunesara, I. R., Martin, D. H., & Mena, L. A. (2011). Sexually transmitted infections and risk behaviors among African American women who have sex with women: Does sex with men make a difference? Sexually Transmitted Diseases, 38, 1118–1125.

    Article  Google Scholar 

  48. National Center for Health Statistics. (2016a). 20132015 National Survey of Family Growth: Public use data and documentation. Retrieved from http://www.cdc.gov/nchs/nsfg/nsfg_2013_2015_puf.htm.

  49. National Center for Health Statistics. (2016b). 20132015 NSFG user’s guide appendix 2: SAS and STATA guidelines for common file manipulations. Retrieved from https://www.cdc.gov/nchs/data/nsfg/nsfg_2013-2015_ug_app2_filemanipulations_rev.pdf.

  50. National Center on Alcohol Use and Alcoholism. (n.d.). Drinking levels defined. Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking.

  51. Pachankis, J. E. (2007). The psychological implications of concealing a stigma: A cognitive-affective-behavioral model. Psychological Bulletin, 133, 328–345.

    Article  Google Scholar 

  52. Pachankis, J. E., Hatzenbuehler, M. L., Mirandola, M., Weatherburn, P., Berg, R. C., Marcus, U., & Schmidt, A. J. (2017). The geography of sexual orientation: Structural stigma and sexual attraction, behavior, and identity among men who have sex with men across 38 European countries. Archives of Sexual Behavior, 46, 1491–1502.

    Article  Google Scholar 

  53. Parsons, J. T., Kelly, B. C., & Wells, B. E. (2006). Differences in club drug use between heterosexual and lesbian/bisexual females. Addictive Behaviors, 31, 2344–2349.

    Article  Google Scholar 

  54. Paul, R., Smith, N. G., Mohr, J. J., & Ross, L. E. (2014). Measuring dimensions of bisexual identity: Initial development of the Bisexual Identity Inventory. Psychology of Sexual Orientation and Gender Diversity, 1, 452–460.

    Article  Google Scholar 

  55. Przedworski, J. M., McAlpine, D. D., Karaca-Mandic, P., & VanKim, N. A. (2014). Health and health risks among sexual minority women: An examination of 3 subgroups. American Journal of Public Health, 104, 1045–1047.

    Article  Google Scholar 

  56. Ripley, V. (2012). An invisible issue: Women who have sex with women may be more at risk of infection than realised. Nursing Standard, 26, 22–24.

    Article  Google Scholar 

  57. Ross, L. E., Salway, T., Tarasoff, L. A., MacKay, J. M., Hawkins, B. W., & Fehr, C. P. (2018). Prevalence of depression and anxiety among bisexual people compared to gay, lesbian, and heterosexual individuals: A systematic review and meta-analysis. Journal of Sex Research, 55, 435–456.

    Article  Google Scholar 

  58. Twenge, J. M., Sherman, R. A., & Wells, B. E. (2016). Changes in American adults’ reported same-sex sexual experiences and attitudes, 1973–2014. Archives of Sexual Behavior, 45, 1713–1730.

    Article  Google Scholar 

  59. Urquia, M. L., O’Campo, P. J., & Ray, J. G. (2013). Marital status, duration of cohabitation, and psychosocial well-being among childbearing women: A Canadian nationwide survey. American Journal of Public Health, 103, e8–e15.

    Article  Google Scholar 

  60. Veldhuis, C. B., Drabble, L., Riggle, E. D., Wootton, A. R., & Hughes, T. L. (2018). “We won’t go back into the closet now without one hell of a fight”: Effects of the 2016 presidential election on sexual minority women’s and gender minorities’ stigma-related concerns. Sexuality Research and Social Policy, 15, 12–24.

    Article  Google Scholar 

  61. Wandrey, R. L., Mosack, K. E., & Moore, E. M. (2015). Coming out to family and friends as bisexually identified young adult women: A discussion of homophobia, biphobia, and heteronormativity. Journal of Bisexuality, 15, 204–229.

    Article  Google Scholar 

  62. Watson, R. J., Goodenow, C., Porta, C., Adjei, J., & Saewyc, E. (2018). Substance use among sexual minorities: Has it actually gotten better? Substance Use and Misuse, 53, 1221–1228.

    Article  Google Scholar 

  63. Wolff, M., Wells, B., Ventura-DiPersia, C., Renson, A., & Grov, C. (2017). Measuring sexual orientation: A review and critique of US data collection efforts and Implications for health policy. Journal of Sex Research, 54, 507–531.

    Article  Google Scholar 

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Funding

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.).

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Correspondence to Margaret M. Paschen-Wolff.

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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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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

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Keywords

  • Sexual minority women
  • Sexual orientation
  • Bisexuality
  • Non-monosexual
  • Substance use
  • Sexual risk behavior