title: Sexual orientation and health: comparisons in the women's health initiative sample.
abstract: BACKGROUND
  Little is known about older lesbian and bisexual women. Existing research rarely compares characteristics of these women with comparable heterosexual women.
  
  
  OBJECTIVE
  To compare heterosexual and nonheterosexual women 50 to 79 years on specific demographic characteristics, psychosocial risk factors, screening practices, and other health-related behaviors associated with increased risk for developing particular diseases or disease outcomes.
  
  
  METHODS
  Analysis of data from 93,311 participants in the Women's Health Initiative (WHI) study of health in postmenopausal women, comparing characteristics of 5 groups: heterosexuals, bisexuals, lifetime lesbians, adult lesbians, and those who never had sex as an adult.
  
  
  METHODS
  Subjects were recruited at 40 WHI study centers nationwide representing a range of geographic and ethnic diversity.
  
  
  METHODS
  Postmenopausal women aged 50 to 79 years who met WHI eligibility criteria, signed an informed consent to participate in the WHI clinical trial(s) or observational study, and responded to the baseline questions on sexual orientation.
  
  
  METHODS
  Demographic characteristics, psychosocial risk factors, recency of screening tests, and other health-related behaviors as assessed on the WHI baseline questionnaire.
  
  
  RESULTS
  Although of higher socioeconomic status than the heterosexuals, the lesbian and bisexual women more often used alcohol and cigarettes, exhibited other risk factors for reproductive cancers and cardiovascular disease, and scored lower on measures of mental health and social support. Notable is the 35% of lesbians and 81% of bisexual women who have been pregnant. Women reporting that they never had sex as an adult had lower rates of Papanicolaou screening and hormone replacement therapy use than other groups.
  
  
  CONCLUSIONS
  This sample of older lesbian and bisexual women from WHI shows many of the same health behaviors, demographic, and psychosocial risk factors reported in the literature for their younger counterparts, despite their higher socioeconomic status and access to health care. The lower rates of recommended screening services and higher prevalence of obesity, smoking, alcohol use, and lower intake of fruit and vegetables among these women compared with heterosexual women indicate unmet needs that require effective interactions between care providers and nonheterosexual women.
authors.affiliation: Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. barbara.valanis@kp.org
authors.forename: B G
authors.initials: BG
authors.lastname: Valanis
authors.forename: D J
authors.initials: DJ
authors.lastname: Bowen
authors.forename: T
authors.initials: T
authors.lastname: Bassford
authors.forename: E
authors.initials: E
authors.lastname: Whitlock
authors.forename: P
authors.initials: P
authors.lastname: Charney
authors.forename: R A
authors.initials: RA
authors.lastname: Carter
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility; D006304:Health Status; D018452:Homosexuality, Female / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D015999:Multivariate Analysis; D011314:Preventive Health Services / Q000706:statistics & numerical data; D012725:Sexual Behavior; D014481:United States; D016387:Women's Health