Exploring the relationship between sexual orientation components and health risk behaviors

In recent studies, women who identify as lesbian, gay, or bisexual (LGB), or who report attraction to or sex with women indicated greater levels of substance use and risky sexual behavior. Few studies have measured associations between different components of sexual orientation (i.e., sexual identity, attraction, or behavior) and health risk behaviors, particularly over time.

To address this, CUNY SPH doctoral graduate Margaret Paschen-Wolff led a study for her dissertation with committee members Christian Grov, Elizabeth Kelvin and Nicholas Grosskopf. Using data from the National Survey of Family Growth (NSFG), the researchers 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 NSFG survey cycle. The study was published in the Archives of Sexual Behavior.

The researchers found that, in multivariable models, SM identity, behavior, and attraction individually predicted significantly greater odds of risk behaviors. After adjusting for all three orientation components simultaneously, only non-monosexual attraction and behavior (i.e., attraction to and sex with both males and females) continued to predict elevated odds of risk behaviors. Non-monosexual attraction and behavior remained associated with sexual risk behavior and drug use over time. Trends in disparities over time between SMW versus SMJW varied depending on how sexual orientation was measured.

Paschen-Wolff says that, in a shifting political and social context, research should include multidimensional sexual orientation constructs to accurately identify all SMW and prioritize their health needs.

"Our findings indicate that measurement methods matter when assessing associations between sexual orientation and health risk behaviors," says Paschen-Wolff. "To identify the specific mechanisms that contribute to elevated risks for non-monosexual women observed in multiple NSFG survey cycles, future research should investigate health outcomes separately among women who express non-monosexuality in terms of identity, behavior, and/or attraction rather than considering all sexual minority women as a composite group. Multilevel interventions should be implemented to achieve health equity for all SMW."