A social ecological approach to understanding correlates of breast health among a sample of gender non-conforming sexual minority women in Toronto, Canada

Background: Sexual minority women (SMW) experience significant and pervasive mental and physical health disparities. Given the increasing attention to biological risk factors for breast cancer among SMW, understanding multi-level (individual, social, structural) factors correlated with clinical breast exams (CBE), may inform a deeper understanding of factors associated with breast health for SMW. 

Methods: A cross-sectional internet-based survey was conducted with 160 gender non-conforming SMW in December 2011.  The 105-item survey assessed socio-demographic variables, health outcomes, and individual, social and structural factors.  We conducted descriptive analyses followed by logistic regression analyses based on the social ecological framework to assess correlates of having a CBE in the past 2 years.   

Results:  Women were a mean age of 31.1 years (SD:8.0); most were white (64.4%), had at least some post-secondary education (87.5%) and identified as queer (53.1%).  In multivariate logistic regression, significant predictors of having a CBE within the past two years included higher age, higher mean scores of depression and self-esteem, and their healthcare provider (HCP) knowing their sexual orientation.  Higher mean gender non-conformity stigma and overall sexual risk practices scores were associated with reduced likelihood of having a CBE within the past two years.   

Conclusions:  These findings enhance understanding of intrapersonal (self-esteem, depression), interpersonal (sexual risk practices), social (gender non-conformity stigma) and structural (HCP assessment of sexual orientation) factors correlated with breast health among SMW.  More research is needed to understand the complex interplay of these factors to inform multi-level interventions to address health disparities, enhance HCP competence and challenge stigma.