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Sexual Orientation and Health
Comparisons in the Women's Health Initiative Sample
Barbara G. Valanis, DrPH;
Deborah J. Bowen, PhD;
Tamsen Bassford, MD;
Evelyn Whitlock, MD, MPH;
Pamela Charney, MD;
Rachel A. Carter, MStat
Arch Fam Med. 2000;9:843-853.
Context Little is known about older lesbian and bisexual women. Existing research rarely compares characteristics of these women with comparable heterosexual women.
Objective To compare heterosexual and nonheterosexual women 50 to 79 years on specific demographic characteristics, psychosocial risk factors, screening practices, and other health-related behaviors associated with increased risk for developing particular diseases or disease outcomes.
Design Analysis of data from 93,311 participants in the Women's Health Initiative (WHI) study of health in postmenopausal women, comparing characteristics of 5 groups: heterosexuals, bisexuals, lifetime lesbians, adult lesbians, and those who never had sex as an adult.
Setting Subjects were recruited at 40 WHI study centers nationwide representing a range of geographic and ethnic diversity.
Participants Postmenopausal women aged 50 to 79 years who met WHI eligibility criteria, signed an informed consent to participate in the WHI clinical trial(s) or observational study, and responded to the baseline questions on sexual orientation.
Main Outcome Measures Demographic characteristics, psychosocial risk factors, recency of screening tests, and other health-related behaviors as assessed on the WHI baseline questionnaire.
Results Although of higher socioeconomic status than the heterosexuals, the lesbian and bisexual women more often used alcohol and cigarettes, exhibited other risk factors for reproductive cancers and cardiovascular disease, and scored lower on measures of mental health and social support. Notable is the 35% of lesbians and 81% of bisexual women who have been pregnant. Women reporting that they never had sex as an adult had lower rates of Papanicolaou screening and hormone replacement therapy use than other groups.
Conclusions This sample of older lesbian and bisexual women from WHI shows many of the same health behaviors, demographic, and psychosocial risk factors reported in the literature for their younger counterparts, despite their higher socioeconomic status and access to health care. The lower rates of recommended screening services and higher prevalence of obesity, smoking, alcohol use, and lower intake of fruit and vegetables among these women compared with heterosexual women indicate unmet needs that require effective interactions between care providers and nonheterosexual women.
From the Kaiser Permanente Center for Health Research, Women's Health Initiative Clinical Center, Portland, Ore (Drs Valanis and Whitlock); Coordinating Center, Women's Health Initiative, Fred Hutchinson Cancer Research Center, Seattle, Wash (Dr Bowen and Ms Carter); University of Arizona School of Medicine, Women's Health Initiative Clinical Center, Tucson (Dr Bassford); Albert Einstein College of Medicine, Women's Health Initiative Clinical Center, New York, NY (Dr Charney).
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