title: Regular health care use by lesbians: a path analysis of predictive factors.
abstract: BACKGROUND
  Lesbians have more health risks than other women but access preventive medical care less frequently.
  
  
  OBJECTIVE
  To test the influence of (i) provider inquiry about sexual orientation, (ii) perceived provider gay-positivity and (iii) patient disclosure of sexual orientation on regular health care use in a sample of Canadian lesbians.
  
  
  METHODS
  A path analysis using community survey data from 489 lesbian respondents.
  
  
  RESULTS
  78.5% [95% confidence interval (CI): 74.7-82.0] of women reported regular health service use; 75.8% (95% CI: 72.2-79.8) of women had disclosed their sexual orientation to their provider; and 24.4% (95% CI: 20.6-28.2) of women had been asked about their sexual orientation by their provider. Of those women whose physicians had inquired about their sexual orientation, 100% (95% CI: 97.5-100.0) had disclosed. In the final path analysis, perceived provider gay-positivity and level of patient outness predicted disclosure, which, along with health status predicted regular health care use. All paths were significant at P < 0.05.
  
  
  CONCLUSIONS
  Provider-related factors including perceived gay-positivity and inquiry about sexual orientation are strongly associated with disclosure of sexual orientation. Disclosure is associated with regular health care use. Minor changes to practice could improve access to health services for lesbians.
authors.affiliation: Department of Family and Community Medicine, St Michael's Hospital University of Toronto and the Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, Canada. leah_steele@camh.net
authors.forename: Leah S
authors.initials: LS
authors.lastname: Steele
authors.forename: Jill M
authors.initials: JM
authors.lastname: Tinmouth
authors.forename: Annie
authors.initials: A
authors.lastname: Lu
mesh_terms: D000328:Adult; D003625:Data Collection; D005163:Factor Analysis, Statistical; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D018452:Homosexuality, Female / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012650:Self Disclosure; D012725:Sexual Behavior