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Journal of Urban Health

, Volume 83, Issue 5, pp 970–979 | Cite as

Health Care Access and Utilization among Women Who Have Sex with Women: Sexual Behavior and Identity

  • Bonnie D. KerkerEmail author
  • Farzad Mostashari
  • Lorna Thorpe
Article

Abstract

Past research has shown that women who either have sex with women or who identify as lesbian access less preventive health care than other women. However, previous studies have generally relied on convenience samples and have not examined the multiple associations of sexual identity, behavior and health care access/utilization. Unlike other studies, we used a multi-lingual population-based survey in New York City to examine the use of Pap tests and mammograms, as well as health care coverage and the use of primary care providers, among women who have sex with women and by sexual identity status. We found that women who had sex with women (WSW) were less likely to have had a Pap test in the past 3 years (66 vs. 80%, p<0.0001) or a mammogram in the past 2 years (53 vs. 73%, p=0.0009) than other women. After adjusting for health insurance coverage and other factors, WSW were ten times [adjusted odds ratio (AOR), 9.8, 95% confidence interval (CI), 4.2, 22.9] and four times (AOR, 4.0, 95% CI 1.3, 12.0) more likely than non-WSW to not have received a timely Pap test or mammogram, respectively. Women whose behavior and identity were concordant were more likely to access Pap tests and mammograms than those whose behavior and identity were discordant. For example, WSW who identified as lesbians were more likely to have received timely Pap tests (97 vs. 48%, p<0.0001) and mammograms (86 vs. 42%, p=0.0007) than those who identified as heterosexual. Given the current screening recommendations for Pap tests and mammograms, provider counseling and public health messages should be inclusive of women who have sex with women, including those who have sex with women but identify as heterosexual.

Keywords

Health care access Health care utilization Mammogram Pap test Preventive care Random digit dial Sexual behavior Sexual identity Stratified sample Women who have sex with women. 

References

  1. 1.
    Bradford J, White J, Honnold J, Ryan C, Rothblum E. Improving the accuracy of identifying lesbians for telephone surveys about health. Women's Health Issues. 2001;11(2):126–137.PubMedCrossRefGoogle Scholar
  2. 2.
    Hughes TL, Jacobson KM. Sexual orientation and women's smoking. Current Women's Health Reports. 2003;2:254–261.Google Scholar
  3. 3.
    Valanis BG, Bowen DJ, Bassford T, Whitlock E, Charney P, Carter RA. Sexual orientation and health. Arch Fam Med. 2000;9:843–853.PubMedCrossRefGoogle Scholar
  4. 4.
    Aaron DJ, Markovic N, Danielson ME, Honnold JA, Janosky JE, Schmidt NJ. Behavioral risk factors for disease and preventive health practices among lesbians. Am J Public Health. 2001;91:972–975.PubMedCrossRefGoogle Scholar
  5. 5.
    McNair RP. Lesbian health inequalities: a cultural minority issue for health professionals. Med J Aust. 2003;178:643–645.PubMedGoogle Scholar
  6. 6.
    Cochran SD, Mays VM, Bowen D, et al. Cancer-related risk indicators among preventive screening behaviors among lesbians and bisexual women. Am J Public Health. 2001;91:591–597.PubMedGoogle Scholar
  7. 7.
    Roberts SJ, Sorensen L. Health related behaviors and cancer screening of lesbians: results from the Boston lesbian health project. Women Health. 1999;28(4):1–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Spinks VS, Andrews J, Boyle JS. Providing health care for lesbian clients. J Transcult Nurs. 2000;11(2):137–143.PubMedCrossRefGoogle Scholar
  9. 9.
    Bernhard LA. Lesbian health and health care. Annu Rev Nurs Res. 2001;19:145–177.PubMedGoogle Scholar
  10. 10.
    Mostashari FM, Kerker BD, Hajat A, Miller N, Frieden TF. Smoking practices in New York City: the use of a population-based survey to guide policy making and programming. J Urban Health. 2005;82(1):58–70.PubMedGoogle Scholar
  11. 11.
    CDC. Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2002.Google Scholar
  12. 12.
    CDC. National Health Interview Survey. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2002.Google Scholar
  13. 13.
    Case P, Austin B, Hunter DJ, et al. Sexual orientation, health risk factors, and physical functioning in the Nurses' Health Study II. J Women Health. 2004;13(9):1033–1047.CrossRefGoogle Scholar
  14. 14.
    Bowen DJ, Bradford JB, Powers D, et al. Comparing women of differing sexual orientations using population-based sampling. Women Health. 2004;40(3):19–29.PubMedGoogle Scholar
  15. 15.
    Diamant AL, Wold C, Spritzer K, Gelberg L. Health behaviors, health status, and access to and use of health care. Arch Fam Med. 2000;9:1043–1051.PubMedCrossRefGoogle Scholar
  16. 16.
    Roberts SJ, Patsdaughter CA, Grindel CG, Tarmina MS. Health related behaviors and cancer screening of lesbians: results of the Boston lesbian health project. Women Health. 2004;39(4):41–55.PubMedCrossRefGoogle Scholar
  17. 17.
    Carr SV, Scoular A, Elliott L, Ilett R, Meager M. A community based lesbian sexual health service—clinically justified or politically correct? Br J Fam Plann. 1999;25:93–95.PubMedGoogle Scholar
  18. 18.
    Roberts SJ. Lesbian health research: a review and recommendations for future research. Health Care Women Int. 2001;22:537–552.PubMedCrossRefGoogle Scholar
  19. 19.
    Brotman S, Ryan B, Cormier R. The health and social service needs of gay and lesbian elders and their families in Canada. Gerontologist. 2003;43(2):192–202.PubMedGoogle Scholar
  20. 20.
    Saulnier CF. Deciding who to see: lesbians discuss their preferences in health and mental health care providers. Soc Work. 2002;47(4):355–365.PubMedGoogle Scholar
  21. 21.
    Fish J, Anthony D. UK national lesbians and health care survey. Women Health. 2005;41(3):27–45.PubMedCrossRefGoogle Scholar
  22. 22.
    Ferris DG, Batish S, Wright TC, Cusing C, Scott EH. A neglected lesbian health concern: cervical neoplasm. J Fam Pract. 1996;43(6):581–584.PubMedGoogle Scholar
  23. 23.
    Carroll NM. Optimal gynecologic and obstetric care for lesbians. Obstet Gynecol. 1999; 93:611–613.PubMedCrossRefGoogle Scholar
  24. 24.
    Agnew C, Loving T. The role of social desirability in self-reported condom use attitudes and intentions. AIDS Behav. 1998;2(3):229–239.CrossRefGoogle Scholar
  25. 25.
    Nelson DE, Holtaman D, Bolen J, Stanwyck CA, KAM. Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Soz Praventivmed. 2001;46(Suppl 1):S3–S42.PubMedGoogle Scholar
  26. 26.
    Bowlin SJ, Morril BD, Nafziger AN, Jenkins PL, Lewis C, Pearson TA. Validity of cardiovascular disease risk factors assessed by telephone survey: the Behavioral Risk Factor Survey. J Clin Epidemiol. 1993;46(6):561–571.PubMedCrossRefGoogle Scholar
  27. 27.
    National Institutes of Health, National Cancer Institute. National Cancer Advisory Board Issues Mammography Screening Recommendations. Available at: http://www.nih.gov/news/pr/mar97/nci-27b.htm. Accessed October, 2005.
  28. 28.
    National Guideline Clearinghouse. Cervical cancer: Screening recommendations, with algorithms, for managing women with abnormal Pap test results. Available at: http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=7011. Accessed October 2005.
  29. 29.
    Foti E, Mancuso S. Early breast cancer detection. Minerva Ginecol. 2005;57(3):269–292.PubMedGoogle Scholar
  30. 30.
    Leyden WA, Manos MM, Geiger AM, et al. Cervical cancer in women with comprehensive health care access: attributable factors in the screening process. J Natl Cancer Inst. 2005;97(9):675–683.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2006

Authors and Affiliations

  • Bonnie D. Kerker
    • 1
  • Farzad Mostashari
    • 1
  • Lorna Thorpe
    • 1
  1. 1.NYC Department of Health and Mental Hygiene, Division of EpidemiologyBureau of Epidemiology ServicesNew YorkUSA

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