title: Association of Alcohol Misuse With Sexual Identity and Sexual Behavior in Women Veterans.
abstract: BACKGROUND
  Sexual minority women report greater alcohol misuse than heterosexual women in the general population, with more pronounced differences found among younger age groups. It is unknown whether these differences exist among women veterans.
  
  
  OBJECTIVE
  We evaluated differences in alcohol misuse across two dimensions of sexual orientation (identity and behavior) among women veterans, and examined whether these differences were modified by age.
  
  
  METHODS
  Women veterans were recruited via the internet to participate in an online survey. Participants provided information on their self-reported sexual identity and behavior and responded to the validated 3-item Alcohol Use Disorders Identification Test-Consumption questionnaire (AUDIT-C). Regression models were used to compare the prevalence of alcohol misuse (AUDIT-C ≥ 3) and severity (AUDIT-C scores) across sexual identity and behavior and to test effect modification by age.
  
  
  RESULTS
  Among the 702 participants (36% lesbian/bisexual), prevalence and severity of alcohol misuse varied by both sexual identity and behavior, but there were significant interactions with age. Prevalence and severity of alcohol misuse were higher among relatively younger self-identified lesbians compared to heterosexual women. Similarly, both prevalence and severity of alcohol misuse were generally higher among younger women who had any sex with women compared to those who had sex only with men.
  
  
  CONCLUSIONS
  In this online study of women veterans, younger sexual minority women were more likely to screen positive for alcohol misuse, and they had more severe alcohol misuse, than their heterosexual counterparts. Prevention and treatment efforts focused specifically on sexual minority women veterans may be needed.
authors.affiliation: a VA Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound , Seattle , Washington , USA.|b Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System , Seattle , Washington , USA.|c Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , Washington , USA.|d Department of Health Services, University of Washington , Seattle , Washington , USA.
authors.forename: Keren
authors.initials: K
authors.lastname: Lehavot
authors.affiliation: a VA Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound , Seattle , Washington , USA.|d Department of Health Services, University of Washington , Seattle , Washington , USA.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.affiliation: b Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System , Seattle , Washington , USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Millard
authors.affiliation: a VA Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound , Seattle , Washington , USA.|d Department of Health Services, University of Washington , Seattle , Washington , USA.|e Group Health Research Institute , Seattle , Washington , USA.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
authors.affiliation: b Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System , Seattle , Washington , USA.|c Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , Washington , USA.|f Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System , Seattle , Washington , USA.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Simpson
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology*; D063425:Binge Drinking / Q000453:epidemiology*; D001727:Bisexuality / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D020010:Heterosexuality / Q000706:statistics & numerical data*; D018452:Homosexuality, Female / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D012725:Sexual Behavior / Q000706:statistics & numerical data; D000072339:Sexual and Gender Minorities / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D014930:Women
keywords: AUDIT-C; Women veterans; alcohol disparities; lesbian and bisexual women; sexual orientation