Health Behaviors, Health Status, and Access to and Use of Health Care

A Population-Based Study of Lesbian, Bisexual, and Heterosexual Women

Published in: Archives of Family Medicine, vol. 9, Nov./Dec. 2000, p.1043-1051

Posted on RAND.org on December 31, 1999

by Allison Diamant, Cheryl Wold, Karen Spritzer, Lillian Gelberg

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BACKGROUND: There is a dearth of validated information about lesbian and bisexual women's health. To better understand some of these issues, the authors used population-based data to assess variations in health behaviors, health status, and access to and use of health care based on sexual orientation. METHODS: The study population was drawn from a population-based sample of women, the 1997 Los Angeles County Health Survey. Participants reported their sexual orientation and these analyses included 4697 women: 4610 heterosexual women, 51 lesbians, and 36 bisexual women. The authors calculated adjusted relative risks to assess the effect of sexual orientation on important health issues. RESULTS: Lesbians and bisexual women were more likely than heterosexual women to use tobacco products and to report any alcohol consumption, but only lesbians were significantly more likely than heterosexual women to drink heavily. Lesbians and bisexual women were less likely than heterosexual women to have health insurance, more likely to have been uninsured for health care during the preceding year, and more likely to have had difficulty obtaining needed medical care. During the preceding 2 years, lesbians, but not bisexual women, were less likely than heterosexual women to have had a Papanicolaou test and clinical breast examination. CONCLUSIONS: In this first population-based study of lesbian and bisexual women's health, the authors found that lesbians and bisexual women were more likely than heterosexual women to have poor health behaviors and worse access to health care. These findings support the hypothesis that sexual orientation has an independent effect on health behaviors and receipt of care, and indicate the need for the increased systematic study of the relationship between sexual orientation and various aspects of health and health care.

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