Abstract
Sexual orientation differences in pregnancy and abortion across the lifecourse
Brittany Charlton, ScD1, Bethany Everett, PhD2, Alexis Light, MD, Rachel Jones, PhD4, Elizabeth Janiak, ScD5, Audrey Gaskins, ScD, Vishnudas Sarda, MPH and Bryn Austin, ScD6
(1)Harvard Medical School and Boston Children's Hospital, Boston, MA, (2)The University of Utah, Salt Lake City, UT, (3)Guttmacher Institute, New York, NY, (4)Planned Parenthood League of Massachusetts, (5)Harvard T.H. Chan School of Public Health, Boston, MA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Compared to heterosexual women, sexual minority women (e.g., bisexual, lesbian) are more likely to have teen and unintended pregnancies. There is now a growing literature on sexual orientation-related abortion disparities but these studies have a number of methodological limitations. Data were from three U.S. longitudinal cohort studies of 129,516 females enrolled in the Nurses’ Health Study (NHS) 2 and 3 and the Growing Up Today Study (GUTS) followed from 1989 to 2017. Multivariate regression was used to calculate the risk ratios or beta estimates of each outcome—ever pregnancy, ever teen pregnancy, age at first birth, and ever abortion—by sexual orientation groups, adjusting for potential confounders. Compared to their heterosexual peers, women who identified as a sexual minority (e.g., mostly heterosexual, bisexual)—except lesbians—were as likely, or more likely, to have had a pregnancy, a teen pregnancy, and an abortion. Lesbian women were as likely, or less likely, than their heterosexual peers to have had a pregnancy, a teen pregnancy, or an abortion. Among parous participants, few differences were detected in age at first birth except among NHS2 lesbians who reported a younger age than their heterosexual peers. All patterns were similar when restricted to participants who had male sexual partners in their lifetime and adjusted further for sexual behavior. Healthcare providers must not assume that pregnant patients are heterosexual and researchers must continue to document sexual orientation-related reproductive health differences, including their association with other health outcomes, to improve the lives of all women.
Chronic disease management and prevention Diversity and culture Epidemiology Public health biology Public health or related research Social and behavioral sciences
Abstract
Health Disparities Among Reproductive Age Women by Sexual Minority and Pregnancy Status
Gilbert Gonzales, PhD, MHA
Vanderbilt University, Nashville, TN
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background. A large body of research has documented disparities in health and access to care among sexual minority populations, but very little research has focused on health care needs and health risk factors among pregnant sexual minority women.
Methods. Data for this study came from 4,020 reproductive age (18-44 years) women who identified as lesbian or bisexual and 64,188 reproductive age women who identified as heterosexual in the 2014-2016 Behavioral Risk Factor Surveillance System. Logistic regression models were used to compare health care access, physical and mental health, and behavioral risk factors by sexual minority and pregnancy status, while controlling for sociodemographic characteristics.
Results. Approximately 3% of reproductive age women were pregnant. After adjusting for sociodemographic characteristics, pregnant sexual minority women were significantly (p<0.05) more likely to have unmet medical care needs due to cost, frequent mental distress, depression, poor physical health days, activity limitations, chronic conditions, and behavioral health risk factors, such as smoking and alcohol consumption compared to pregnant heterosexual women. Non-pregnant sexual minority women were also more likely to report barriers to care and adverse health outcomes compared to non-pregnant heterosexual women.
Conclusions. This study adds new population-based research to the limited body of evidence on health and access to care for pregnant sexual minority women, who may face stressors associated with discrimination and stigma that lead to worse health outcomes and health behaviors during pregnancy. More research and programs should focus on pre- and perinatal care that is inclusive of diverse families and sexual orientations.
Advocacy for health and health education Diversity and culture Provision of health care to the public Public health or related nursing Public health or related public policy Public health or related research
Abstract
Polyvicimization and Substance Abuse among Sexual Minority Cisgender Women
Athena Ford, PhD(c), BSN, RN1, Andrea Cimino, PhD, MSW1, Natasha Mendoza, PhD, MSW2 and Tara Noorani, BSN, RN3
(1)Johns Hopkins University, Baltimore, MD, (2)Arizona State University, Phoenix, AZ, (3)Emory, Atlanta, GA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Substance use is high among sexual minority cisgender women (SMCW) compared to heterosexually oriented cisgender women (HOCW). Furthermore, SMCW are disproportionately affected by violence, often experiencing multiple forms of violence through their lifespan (polyvictimization), when compared with HOCW. This study aims to examine the association between polyvictimization and substance abuse among a convenience sample of 116 self-identified SMCW. We examined the prevalence of polyvictimization ( i.e., experiencing both sexual and physical violence in their lifetime) via the Trauma History Questionnaire and past-year substance abuse via the Drug Abuse Screening Test (DAST-10). Differences in substance abuse (DAST-10 scores) by (a) abused/non-abused SMCW, and (b) type of violence (physical, sexual, both physical and sexual, no violence reported) were examined using independent t-tests and ANOVA, respectively. Participants reported a lifetime prevalence of experienced physical violence (10.3%), sexual violence (26%), and polyvictimization (20.7%). Average DAST-10 scores for SMCW were 1.59 (SD = 2.167). SMCW who had experienced violence reported significantly higher scores on the DAST scale when compared to SMCW who did not report any violence (mean difference=0.646; p=0.037). Participants who experienced both physical and sexual violence (polyvictimization) had significantly higher scores on DAST-10 than participants who reported no violence (mean difference = 1.593; p=0.015). Our results indicate a need for service providers working with SMCW to consider and assess for polyvictimization in the treatment of substance use disorders. Practitioners must use a trauma-informed healthcare plan, such as holistic case management, to address the potential physical, mental, and social effects of violence among SMCW.
Public health or related nursing Social and behavioral sciences
Abstract
Sexual orientation disparities in eating disorder diagnosis among female college students
Vivienne Hazzard, MPH, RD1, Kelley Borton, MPH1, Sarah Lipson, PhD2 and Kendrin Sonneville, ScD, RD1
(1)University of Michigan School of Public Health, Ann Arbor, MI, (2)University of Michigan, Ann Arbor, MI
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Sexual minority males have consistently been found to exhibit higher rates of disordered eating than their heterosexual counterparts, but the relationship between sexual orientation and disordered eating is less clear among females. The purpose of this study was to examine the association between sexual orientation and lifetime eating disorder (ED) diagnosis among female college students, an important population for ED prevention and early intervention as traditional undergraduate age coincides with ED age of onset. This study used data from 29,401 female college students from 54 schools in the United States participating in the 2016-2017 Healthy Minds Study. Participants described their sexual orientation as heterosexual, questioning, bisexual, gay, or lesbian and reported whether or not they had ever been diagnosed with an ED by a health professional. Logistic regression models were adjusted for age and race/ethnicity. In this sample, 85.8% identified as heterosexual, 2.9% identified as questioning, 9.1% identified as bisexual, and 2.2% identified as gay/lesbian, and 4.2% reported having ever been diagnosed with an ED. Compared with participants who identified as heterosexual, those who identified as questioning (odds ratio [OR]=1.82; 95% confidence interval [CI]: 1.34-2.47), bisexual (OR=2.50; 95% CI: 2.12-2.94), or gay/lesbian (OR=1.98; 95% CI: 1.41-2.78) were more likely to report having ever been diagnosed with an ED. The findings from this study suggest that sexual minority women on college campuses, particularly those identifying as bisexual, may be at elevated risk for EDs and therefore should be considered when developing interventions aimed at reducing sexual orientation disparities in EDs.
Epidemiology