Abstract
Background
Sexual minority women (i.e., women minoritized for their sexualities) are identified
as high risk for mental health and substance use problems; however, there is no consensus
on the criteria by which women are categorized as sexual minority. Though there is
some evidence suggesting that certain subgroups of women are at higher risk than others
based on sexual orientation, different categorization schemes for sexual orientation
have yet to be compared within the same sample.
Method
Using data from the National Epidemiologic Survey of Alcohol and Related Conditions–III
(N = 19,528), we examined how multiple categorization schemes (i.e., identity, behavior,
recency of sexual behavior) for categorizing women who have sex with women (WSW) yield
different estimates of prevalence of mental health and substance use issues. We used
chi-square and logistic regression to analyze the link between sexual orientation
categorization schemes and health, categorizing by 1) self-identification only, 2)
behavior only, and 3) the combination of self-identification and behavior (recent
vs. past).
Results
We discovered high prevalence rates of health problems among heterosexual-identified
WSW who reported no recent sexual activity with women (i.e., previously had sex with
women but not within the past 12 months); this category of women comprised 35% of
all WSW.
Discussion
Step by step, we found more detailed information about these women's experiences by
moving to the complex categorization scheme (the combination of self-identification
and behavior). Heterosexual-identified women who have had sex with women in their
past (though not recently) presented as a large group with high prevalence rates of
substance use and mental disorders. These women remain invisible to researchers who
categorize sexual orientation only by sexual identity or by behavior and ignore the
role of behavior change over time—imprecisely categorizing such women as heterosexual
or as women who have sex with men. They thus are underserved by health research and
represent a significant population for further study and intervention.
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Biography
Anna C. Salomaa, PhD, is a Clinical Fellow in Psychiatry at VA Boston Healthcare System. Her research interests include 1) addressing issues in measuring sexual orientation in clinical and research settings and 2) enhancing health outcomes among sexual minority populations.
Biography
Jes L. Matsick, PhD, is Assistant Professor of Psychology and Women's, Gender, and Sexuality Studies at Penn State. Her research incorporates feminist perspectives into the psychological study of stigma and prejudice, with an emphasis on outcomes for stigmatized groups (e.g., LGBTQ+ people).
Biography
Cara E. Exten, PhD, MPH, is Assistant Professor in Penn State's College of Nursing. As an infectious disease epidemiologist, her research is focused on health disparities in the context of sexual health (e.g., HIV, STIs) and substance use, particularly among LGBTQ+ populations.
Biography
Mary Kruk, MS, is a PhD candidate in Psychology and Women's, Gender, and Sexuality Studies at Penn State. Her research focuses on 1) experiences of stigma (e.g., identity threat and safety) and health and 2) women's resistance of conventional gendered expectations.
Article info
Publication history
Published online: August 18, 2022
Accepted:
July 18,
2022
Received in revised form:
May 24,
2022
Received:
August 18,
2021
Footnotes
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding Statement: The authors received no funding, private or public, for this research.
Anna C. Salomaa had full access to the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
