title: Health status, behavior, and care of lesbian and bisexual women in Israel.
abstract: BACKGROUND
  Lesbian and bisexual women (LBs) have unique health needs compared with heterosexual women (HW).
  
  
  OBJECTIVE
  This study aimed to associate the health status of LB, their health behavior, disclosure of sexual orientation (SO), and avoidance of health care with that of HW.
  
  
  METHODS
  Participants in this cross-sectional study completed anonymous questionnaires, which were distributed in Internet sites and public venues in Israel, comparing health behaviors and outcomes between LB and HW.
  
  
  METHODS
  Health outcomes included subjective health status, general practitioner or gynecologist visit in the last 6 months, and satisfaction from the Israeli healthcare system.
  
  
  RESULTS
  In 2012, 681 (34.4%) lesbians, 242 (13.5%) bisexual women, and 937 (52.1%) HW completed the questionnaire. In comparison with HW, LBs were more commonly single, used drugs/alcohol, smoked, experienced eating disorders, and reported an earlier sexual debut. In comparison with all women, lesbians performed less physical activities and were more satisfied with their body weight, whereas bisexuals had riskier sexual behavior and reported more verbal/physical abuse. LB reported more emergency room visits, more visits to psychiatrists, yet underwent Pap smears less frequently compared with HW. In a multivariate analysis, lesbians had fewer gynecologists' visits and were less satisfied with the healthcare system than HW, whereas bisexuals visited their general practitioner or gynecologist less frequently and were less satisfied with the primary healthcare system. Lesbians were more likely to disclose their SO with their doctors than bisexuals and were satisfied with the disclosure. Nondisclosure of SO was correlated with poor subjective health status. The interaction between being bisexual and nondisclosure of SO was strong.
  
  
  CONCLUSIONS
  LB utilized health care less frequently than HW, resulting in unmet medical needs. SO disclosure was associated with better healthcare utilization and health outcomes, especially among bisexuals. Providers should be trained about LB's unique health needs and improve their communication skills to encourage SO disclosure.
authors.affiliation: Ramla Department of Health, Ministry of Health, Ramla, Israel.
authors.forename: Zohar
authors.initials: Z
authors.lastname: Mor
authors.affiliation: Hoshen-Education and Information Center of the LGBT (Lesbian, Gay, Bisexual, and Transgender) Community, Tel Aviv, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Eick
authors.affiliation: Department of Family Medicine, Gan Meir Clinic, Clalit Health Services, Tel Aviv, Israel.
authors.forename: Gal
authors.initials: G
authors.lastname: Wagner Kolasko
authors.affiliation: Hoshen-Education and Information Center of the LGBT (Lesbian, Gay, Bisexual, and Transgender) Community, Tel Aviv, Israel.
authors.forename: Irit
authors.initials: I
authors.lastname: Zviely-Efrat
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Harvey
authors.initials: H
authors.lastname: Makadon
authors.affiliation: Department of Health Policy, Ben Gurion University in the Negev, Beer Sheva, Israel.
authors.forename: Nadav
authors.initials: N
authors.lastname: Davidovitch
mesh_terms: D000328:Adult; D000368:Aged; D001727:Bisexuality / Q000523:psychology* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D001068:Feeding and Eating Disorders; D005260:Female; D015438:Health Behavior; D006304:Health Status; D018452:Homosexuality, Female / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012309:Risk-Taking; D057545:Social Stigma; D011795:Surveys and Questionnaires; D014342:Truth Disclosure
keywords: Bisexual; Health Behavior; Health Utilization; Lesbian; Women