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Arch Sex Behav. 2019 Feb 12. doi: 10.1007/s10508-018-1333-1. [Epub ahead of print]

Changing Trends in Substance Use and Sexual Risk Disparities among Sexual Minority Women as a Function of Sexual Identity, Behavior, and Attraction: Findings from the National Survey of Family Growth, 2002-2015.

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HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
CUNY Institute for Implementation Science in Population Health, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, USA.
Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
Center for Human Sexuality Studies, Widener University, Chester, PA, USA.
Department of Psychiatry and New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA.
Department of Health and Physical Education/Gerontological Studies and Services, York College of CUNY, Jamaica, NY, USA.
Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.


Components of sexual minority (SM) status-including lesbian or bisexual identity, having same-sex partners, or same-sex attraction-individually predict substance use and sexual risk behavior disparities among women. Few studies have measured differing associations by sexual orientation components (identity, behavior, and attraction), particularly over time. Data were drawn from the 2002-2015 National Survey of Family Growth female sample (nā€‰=ā€‰31,222). Multivariable logistic regression (adjusted for age, race/ethnicity, education, marital/cohabitation status, survey cycle, and population-weighted) compared past-year sexual risk behavior, binge drinking, drug use, and sexually transmitted infection treatment among sexual minority women (SMW) versus sexual majority women (SMJW) by each sexual orientation component separately and by all components combined, and tested for effect modification by survey cycle. In multivariable models, SM identity, behavior, and attraction individually predicted significantly greater odds of risk behaviors. SM identity became nonsignificant in final adjusted models with all three orientation components; non-monosexual attraction and behavior continued to predict significantly elevated odds of risk behaviors, remaining associated with sexual risk behavior and drug use over time (attenuated in some cases). Trends in disparities over time between SMW versus SMJW varied by sexual orientation indicator. In a shifting political and social context, research should include multidimensional sexual orientation constructs to accurately identify all SMW-especially those reporting non-monosexual behavior or attraction-and prioritize their health needs.


Bisexuality; Non-monosexual; Sexual minority women; Sexual orientation; Sexual risk behavior; Substance use


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