Sexual Behavior and Substance Use among Women across the Spectrum of Sexual Orientation

Abstract

Background: Compared to non-sexual minority women, sexual minority women are at greater risk for substance use and abuse, sexual risk behaviors, and unplanned teen pregnancy; few studies measure differing associations by sexual orientation (e.g., identity, behavior, attraction) or discordance (e.g., heterosexually-identified women with female partners) components. Minority stress may explain sexual minority women’s health disparities; thus, as U.S. policies evolve to reflect growing acceptance of all sexual minorities, research should examine sexual minority women’s health risk behaviors using multidimensional constructs of sexual orientation. Methods: Using the female sample of the 2002-2013 National Survey of Family Growth (Aims 1-2 n=25,523; Aim 3 n=4,471, adolescent subsample), multivariable, population-weighted logistic regression models compared sexual minority and non-sexual minority women’s substance use, sexual risk behavior, and sexually transmitted infection (STI) treatment by each sexual orientation component (Aim 1) or by each concordance/discordance component (Aim 2) separately and simultaneously. Aim 3 regression models compared odds of pregnancy among sexual minority and non-sexual minority adolescent women by sexual orientation components separately and simultaneously. Final adjusted models were stratified by survey cycle to test for effect modification (Aims 1-3). Results: Self-reported bisexual identity, behavior, and attraction significantly increased each survey cycle. After simultaneously adjusting for sexual orientation components, sexual minority identity was no longer a significant predictor of risk (Aim 1); after simultaneously adjusting for concordance/discordance components, attraction-behavior discordance was no longer significant (Aim 2). In stratified models, odds of risk attenuated for some sexual minority women but remained elevated for others. After simultaneously adjusting for sexual orientation components in Aim 3, sexual minority identity no longer predicted increased pregnancy odds; sexual minority behavior remained associated with increased odds of teen pregnancy. Discussion: Risk behaviors among sexual minority women varied by sexual orientation and concordance/discordance measures and over time. Bisexuality was associated with increased risk regardless of measurement method; greater levels of minority stress may explain such disparities. Despite attenuation in risk behavior for some sexual minority women over time, disparities persist for women with a sexual minority identity; thus, future research should examine how policies that support sexual minorities specifically impact sexual minority women. Substance abuse treatment, interventions to address sexual risk behavior, and sexual education curriculum should be tailored to meet the unique needs of all sexual minority women across a broad spectrum of sexual orientation