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APHA Scientific Session and Event Listing

Greta R. Bauer, PhD, MPH, Epidemiology & Biostatistics, The University of Western Ontario, Kresge Building, Room K200, London, ON N6A 5C1, Canada, (519) 661-2111 ext 86262, greta.bauer@schulich.uwo.ca

Background: The term WSW (women who have sex with women) was developed to describe a behavioral group for sexual health research. Behavior-based orientation definitions have subsequently been used for a variety of non-sexual health outcomes, and frequently assumed interchangeable with lesbian or bisexual orientation identity. Methods: Using data from the 2002 National Survey of Family Growth, orientation groups were coded for women age 20-44 using three common schemes: Heterosexual, bisexual or lesbian identity, WSW vs. only male sex partners (past year), and WSW vs. only male sex partners (lifetime). Measures were weighted to produce U.S. population estimates. Results: Most WSW (lifetime) identified as heterosexual (68%) or “something else” (6%), rather than lesbian (8%) or bisexual (18%). Comparisons on prevalence of health indicators known to vary by orientation (obesity, alcohol, tobacco, genital herpes, pregnancy, recent Pap test) rarely yielded consistent results across identity- and behavior-based classifications, in some cases even reversing direction of association. For example, while WSW were nearly twice as likely to smoke as non-WSW (40.1 vs. 20.9%; p<0.0001), lesbians were the least likely to smoke (17.9%) of any identity group (p<0.0001). Heterosexual-identified WSW had over twice the prevalence of smoking, alcohol use and binge drinking as heterosexual women with only male partners. Discussion: Heterosexually identified WSW had a unique risk profile from other heterosexual women, and lesbians from bisexual women. Behavioral and identity classifications were not comparable and produced varying or contradictory results. Results based on behavioral classification cannot be assumed to accurately inform programs targeting identity-based communities.

Learning Objectives:

• List operative definitions of sexual orientation currently in use for research.
• Articulate methodologic concerns regarding use of different definitions (e.g. identity-, recent behavior- and long-term behavior-based)and the applicability of results to intervention strategies.
• Interpret research results in a more nuanced manner.
• Design more rigorous studies involving sexual minority popoulations.

Keywords: Public Health Research, Lesbian Health

Presenting author's disclosure statement:

Any relevant financial relationships? No