Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women.
BACKGROUND
There is a dearth of validated information about lesbian and bisexual women's health. To better understand some of these issues, we used population-based data to assess variations in health behaviors, health status, and access to and use of health care based on sexual orientation.


METHODS
Our study population was drawn from a population-based sample of women, the 1997 Los Angeles County Health Survey. Participants reported their sexual orientation and these analyses included 4697 women: 4610 heterosexual women, 51 lesbians, and 36 bisexual women. We calculated adjusted relative risks to assess the effect of sexual orientation on important health issues.


RESULTS
Lesbians and bisexual women were more likely than heterosexual women to use tobacco products and to report any alcohol consumption, but only lesbians were significantly more likely than heterosexual women to drink heavily. Lesbians and bisexual women were less likely than heterosexual women to have health insurance, more likely to have been uninsured for health care during the preceding year, and more likely to have had difficulty obtaining needed medical care. During the preceding 2 years, lesbians, but not bisexual women, were less likely than heterosexual women to have had a Papanicolaou test and a clinical breast examination.


CONCLUSIONS
In this first population-based study of lesbian and bisexual women's health, we found that lesbians and bisexual women were more likely than heterosexual women to have poor health behaviors and worse access to health care. These findings support our hypothesis that sexual orientation has an independent effect on health behaviors and receipt of care, and indicate the need for the increased systematic study of the relationship between sexual orientation and various aspects of health and health care. Arch Fam Med. 2000;9:1043-1051
Diamant
A L
AL
Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, 911 Broxton Ave, Los Angeles, CA 90095, USA. adiamant@mednet.ucla.edu
Wold
C
C
Spritzer
K
K
Gelberg
L
L
D000328:Adult; D001727:Bisexuality / Q000706:statistics & numerical data*; D003625:Data Collection; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006304:Health Status; D020010:Heterosexuality / Q000706:statistics & numerical data; D018452:Homosexuality, Female / Q000706:statistics & numerical data*; D006801:Humans; D015141:Los Angeles