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1.  Suicidality and sexual orientation: Characteristics of symptom severity, disclosure, and timing across the life course 
This investigation explored suicide-related characteristics and help-seeking behavior by sexual orientation. Population-based data are from the California Quality of Life Surveys, which included 1,478 sexual minority (lesbian, gay, bisexual, and homosexually experienced individuals) and 3,465 heterosexual individuals. Bisexual women had nearly 6-fold increased risk of lifetime suicide attempts than heterosexual women (RR=5.88, 95%CI: 3.89–8.90), and homosexually experienced men had almost 7 times higher risk of lifetime suicide attempts than heterosexual men (RR=6.93, 95%CI: 3.65–13.15). Sexual minority men and women were more likely than heterosexual men and women to have disclosed suicide attempts to a medical professional (RR=1.48 and RR=1.44, respectively). Among persons who ever attempted suicide, sexual minority women had a younger age of index attempt than heterosexual women (15.9 versus 19.6 years of age, respectively). Health care professionals should be aware of suicidal risk heterogeneity among sexual minority individuals, including vulnerable points of risk and evidenced-based treatments.
PMCID: PMC4720972  PMID: 26752446
mental disorders; gay; lesbian; bisexual; sexual minority; suicide
2.  Women and AIDS-Related Concerns 
The American psychologist  1989;44(3):529-535.
Acquired Immunodeficiency Syndrome (AIDS) has important implications for the practice of psychology. As the epidemic continues, the role of behavior change and psychosocial factors in the spread and transmission of Human Immunodeficiency Virus (HIV) infections assumes increasing significance. Psychologists, as behavior change experts, have a special and challenging role to play in educating the public, particularly women, about AIDS. This article examines AIDS- and HIV-related concerns in women with a focus on the personal dilemmas for the practicing psychologist, problems in health behavior advocacy, and methods and pitfalls in modifying sexual behaviors.
PMCID: PMC4197969  PMID: 2930055
3.  Prevalence of Mental Disorders, Psychological Distress, and Mental Health Services Use Among Lesbian, Gay, and Bisexual Adults in the United States 
Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay–bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian–bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use.
PMCID: PMC4197971  PMID: 12602425
4.  Estimates of Alcohol Use and Clinical Treatment Needs Among Homosexually Active Men and Women in the U.S. Population 
Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.
PMCID: PMC4197972  PMID: 11142540
5.  Optimal Scaling of HIV-Related Sexual Risk Behaviors in Ethnically Diverse Homosexually Active Men 
As HIV-related behavioral research moves increasingly in the direction of seeking to determine predictors of high-risk sexual behavior, more efficient methods of specifying patterns are needed. Two statistical techniques, homogeneity analysis and latent class analysis, useful in scaling binary multivariate data profiles are presented. Both were used to analyze reported sexual behavior patterns in two samples of homosexually active men, one sample of 343 primarily White gay men attending an HIV workshop and one sample of 837 African American gay men recruited nationally. Results support the existence of a single, nonlinear, latent dimension underlying male homosexual behaviors consistent with HIV-related risk taking. Both statistical methods provide an efficient means to optimally scale sexual behavior patterns, a critical outcome variable in HIV-related research.
PMCID: PMC4196998  PMID: 7751488
6.  Proposed declassification of disease categories related to sexual orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11) 
The World Health Organization is developing the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), planned for publication in 2017. The Working Group on the Classification of Sexual Disorders and Sexual Health was charged with reviewing and making recommendations on disease categories related to sexuality in the chapter on mental and behavioural disorders in the 10th revision (ICD-10), published in 1990. This chapter includes categories for diagnoses based primarily on sexual orientation even though ICD-10 states that sexual orientation alone is not a disorder. This article reviews the scientific evidence and clinical rationale for continuing to include these categories in the ICD. A review of the evidence published since 1990 found little scientific interest in these categories. In addition, the Working Group found no evidence that they are clinically useful: they neither contribute to health service delivery or treatment selection nor provide essential information for public health surveillance. Moreover, use of these categories may create unnecessary harm by delaying accurate diagnosis and treatment. The Working Group recommends that these categories be deleted entirely from ICD-11. Health concerns related to sexual orientation can be better addressed using other ICD categories.
PMCID: PMC4208576  PMID: 25378758
PMCID: PMC4265924  PMID: 25393195
8.  Influence of American acculturation on cigarette smoking behaviors among Asian American subpopulations in California 
Using combined data from the population-based 2001 and 2003 California Health Interview Surveys, we examined ethnic and gender-specific smoking behaviors and the effect of three acculturation indicators on cigarette smoking behavior and quitting status among 8,192 Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese American men and women. After adjustment for potential confounders, current smoking prevalence was higher and the quit rate was lower for Korean, Filipino, and Vietnamese American men compared with Chinese American men. Women’s current smoking prevalence was lower than men’s in all six Asian American subgroups. South Asian and Korean American women reported lower quit rates than women from other ethnic subgroups. Asian American men who reported using only English at home had lower current smoking prevalence and higher quit rates, except for Filipino and South Asian American men. Asian American women who reported using only English at home had higher current smoking prevalence except for Japanese women. Being a second or later generation immigrant was associated with lower smoking prevalence among all Asian American subgroups of men. Less educated men and women had higher smoking prevalence and lower quit rates. In conclusion, both current smoking prevalence and quit rates vary distinctively across gender and ethnic subgroups among Asian Americans in California. Acculturation appears to increase the risk of cigarette smoking for Asian American women. Future tobacco-control programs should target at high-risk Asian American subgroups, defined by ethnicity, acculturation status, and gender.
PMCID: PMC3652889  PMID: 18418780
9.  Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use 
Journal of General Internal Medicine  2015;30(12):1828-1836.
The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders.
To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS).
Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics.
A total of 2,358 adults, aged 18–64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics.
We defined “usual provider” as a primary care provider/practice, and “PCMH provider” as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year.
Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2–13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4–21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7–14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5–15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI = 1.0–19.0).
Access to a usual provider is associated with increased receipt of needed MHS. Patients who have a usual provider with PCMH qualities are more likely to receive mental health counseling.
PMCID: PMC4636587  PMID: 26037232
patient-centered medical home; primary care; mental health services; Affordable Care Act; race
10.  The Mental Health of Sexual Minority Adults In and Out of the Closet: A Population-Based Study 
Previous studies find that sexual orientation concealment affords escape from stigma and discrimination but also creates a psychological toll. While disclosure alleviates the mental burden of concealment, it invites the stress of navigating a new public identity. Population-based samples that include both “in” and “out” sexual minorities provide an ideal opportunity to resolve limitations and inconsistencies of previous non-probability investigations into the mental health correlates of concealment and disclosure.
Sexual minority participants in the California Quality of Life Survey (n=2,083) indicated whether and when they had first disclosed their sexual orientation to others. Prevalence of one-year major depressive disorder and generalized anxiety disorder was derived from the Composite International Diagnostic Interview Short Form.
Closeted men (n=84) were less likely to be depressed than out men (n=1,047; OR=0.41 95% CI: 0.17-0.996). Men who were recently out (n=201) experienced higher odds of major depressive disorder (OR=6.21 95% CI: 1.53-24.47) and generalized anxiety disorder (OR=5.51 95% CI: 1.51-20.13) as compared to closeted men. Men who were distantly out (n = 846) also experienced higher odds of major depressive disorder than men who were closeted (OR=2.91; 95% CI: 1.10-7.69). Recently out women (n=243) experienced lower odds of depression than closeted women (n=63) (OR=0.21; 95% CI: 0.05-0.96).
Whether being in or out of the closet is associated with depression and anxiety largely depends on gender. Clinical and policy implications are discussed in terms of the unique stressors facing men and women both in and out of the closet.
PMCID: PMC4573266  PMID: 26280492
stigma; concealment; disclosure; gay, lesbian, and bisexual; mental health
11.  Mortality Risks Among Persons Reporting Same-Sex Sexual Partners: Evidence From the 2008 General Social Survey—National Death Index Data Set 
American journal of public health  2015;105(2):358-364.
We investigated the possibility that men who have sex with men (MSM) and women who have sex with women (WSW) may be at higher risk for early mortality associated with suicide and other sexual orientation–associated health risks.
We used data from the 1988–2002 General Social Surveys, with respondents followed up for mortality status as of December 31, 2008. The surveys included 17 886 persons aged 18 years or older, who reported at least 1 lifetime sexual partner. Of these, 853 reported any same-sex partners; 17 033 reported only different-sex partners. Using gender-stratified analyses, we compared these 2 groups for all-cause mortality and HIV-, suicide-, and breast cancer–related mortality.
The WSW evidenced greater risk for suicide mortality than presumptively heterosexual women, but there was no evidence of similar sexual orientation–associated risk among men. All-cause mortality did not appear to differ by sexual orientation among either women or men. HIV-related deaths were not elevated among MSM or breast cancer deaths among WSW.
The elevated suicide mortality risk observed among WSW partially confirms public health concerns that sexual minorities experience greater burden from suicide-related mortality.
PMCID: PMC4289448  PMID: 25033136
12.  Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population 
Addiction (Abingdon, England)  2004;99(8):989-998.
The aim of this study was to compare patterns of drug use and dependence between homosexually experienced and exclusively heterosexually experienced individuals.
We used a cross-sectional national household interview survey conducted in the United States.
Secondary data analysis of the 1996 National Household Survey on Drug Abuse was employed.
Participants were sexually active individuals, aged 18 years and older, who reported the genders of their sexual partners in the past 12 months; included 174 homosexually experienced (98 men, 96 women) and 9714 exclusively heterosexually experienced (3922 men, 5792 women) respondents.
Life-time, past 30 days and daily use of nine classes of drugs. Symptoms of dysfunctional use and dependence.
There were consistent patterns of elevated drug use in homosexually experienced individuals for life-time drug use, but these were greatly attenuated for recent use. Homosexually experienced men were more likely to report use of marijuana, cocaine and heroin, and homosexually experienced women more likely to report use of marijuana and analgesics than individuals reporting only opposite-sex partners. Both homosexually active men and women were more likely than exclusively heterosexually active respondents to report at least one symptom indicating dysfunctional drug use across all drug classes, and to meet criteria for marijuana dependence syndrome. The only difference between homosexually experienced men and women was that men were more likely to report any daily drug use.
These data are consistent with surveys suggesting that there is a moderate elevation of drug, particularly marijuana, use and dependence in gay and bisexual men and women when compared to heterosexual men and women.
PMCID: PMC4190042  PMID: 15265096
Drug use; drug dependence; epidemiology; homosexuality
13.  Drug Use, Drug Severity, and Help-Seeking Behaviors of Lesbian and Bisexual Women 
Journal of women's health (2002)  2006;15(5):556-568.
Illicit substance use and abuse may be an important contributor to behavioral health problems of lesbian and bisexual women. This paper describes the nature and extent of self-reported illicit and licit drug use, associated severity, and substance use-related help-seeking behaviors in an urban/metropolitan community sample of sexual minority women in California.
Self-administered questionnaire data from 2011 lesbian and bisexual women recruited through multiple strategies were used. Multiple logistic regression was employed to describe patterns of reported drug use and to compare lifetime severity of drug use with demographic characteristics, recent drug use, indicators of current social and emotional problems, and help-seeking behaviors.
Drug use, especially marijuana (33% used in the past year), was fairly common. Overall, 16.2% of the women in the study reported lifetime drug use that was associated with self-reported severity of substance use, and another 10.8% indicated moderate-risk use. Extent of lifetime drug use was positively correlated with self-reported recent drug use as well as current life problems. Of the respondents who evidenced more problematic drug use, 41.5% indicated that they had received professional help for a substance use problem, and 16.3% wanted but had not received such help.
The women in this study reported elevated rates of illicit drug use that was frequently associated with impairment and specific life problems. A significant proportion wanted and had not received professional treatment for their drug use problems. Future studies that examine pathways by which lesbians and bisexual women can obtain referrals and treatment for substance use problems are needed.
PMCID: PMC4174333  PMID: 16796483
14.  Relation between Psychiatric Syndromes and Behaviorally Defined Sexual Orientation in a Sample of the US Population 
American journal of epidemiology  2000;151(5):516-523.
Most surveys of the prevalence of psychiatric disorders among lesbians and gay men find no increased risk in comparison with heterosexuals. However, the majority of this work has relied on convenience samples drawn from the visible lesbian and gay community. The authors examined differences in 1-year prevalence of six psychiatric syndromes among sexually active individuals in the 1996 National Household Survey of Drug Abuse who reported either exclusive heterosexuality (n = 9,714) or having any same-gender sex partners (n = 194) in the prior year. Although nearly three quarters of homosexually active individuals did not meet criteria for any of the six syndromes assessed, in multivariate logistic regression analyses, homosexually active men were more likely than other men to evidence major depression and panic attack syndromes. In contrast, homosexually active women were more likely than other women to be classified with alcohol or drug dependency syndromes. Both men and women reporting any same-gender sex partners were more likely than others to have used mental health services in the year prior to interview. These findings suggest a small increased risk among homosexually active populations in 1-year psychiatric morbidity and use of mental health care services.
PMCID: PMC3698226  PMID: 10707921
health surveys; homosexuality; mental disorders; psychiatry; substance-related disorders
15.  Risk of Breast Cancer Mortality Among Women Cohabiting with Same Sex Partners: Findings from the National Health Interview Survey, 1997–2003 
Journal of Women's Health  2012;21(5):528-533.
Lesbians and bisexual women are more likely than other women to evidence a unique mix of common breast cancer risk factors. It is not known if this results in greater breast cancer mortality risk. We investigate possible sexual orientation-related differences in risk for fatal breast cancer in a large representative U.S. sample of married and cohabiting women.
Between 1997 and 2003, the National Health Interview Survey (NHIS) interviewed married or cohabiting female participants, aged 18–80 years inclusively, who reported either a male (n=136,174) or female (n=693) coresidential relationship partner. These records are linked to the National Death Index to provide information on mortality status as of December 31, 2006. Employing these data, we estimated the age-adjusted relative risk (RR) and its 95% confidence interval (CI) for mortality attributed to breast cancer using a Cox proportional hazard model.
Women in same-sex couples, compared to women in different-sex relationships, had greater age-adjusted risk for fatal breast cancer (RR=3.2, CI 1.01-10.21) but did not differ in their overall risk for mortality.
Our findings provide tentative support that sexual orientation is differentially linked to risk of fatal breast cancer. These findings underscore the need to investigate further breast cancer morbidity and mortality risk among women with minority sexual orientation.
PMCID: PMC3353824  PMID: 22360695
16.  Age of Minority Sexual Orientation Development and Risk of Childhood Maltreatment and Suicide Attempts in Women 
Women with minority sexual orientations (e.g., lesbian, bisexual) are more likely than heterosexual women to report histories of childhood maltreatment and attempted suicide; however, the importance of the timing of minority sexual orientation development in contributing to this increased risk is uncertain. This study investigated relationships between self-reported ages of achieving minority sexual orientation development milestones (first awareness of same-gender attractions, disclosure of a minority sexual orientation to another person, and same-gender sexual contact), and childhood maltreatment and suicide attempt experiences in a sample of 2,001 women recruited from multiple-community sources. Younger age of minority sexual orientation development milestones was positively linked to self-reported recall of childhood maltreatment experiences, and to a childhood suicide attempt. After adjusting for differences in maltreatment, the odds of suicide attempt attributable to younger age of sexual orientation development milestones was reduced by 50 to 65%, suggesting that maltreatment may account for about half of the elevated risk for childhood suicide attempts among women with early minority sexual orientation development. Implications for services, interventions, and further research to address maltreatment disparities for sexual minorities are discussed.
PMCID: PMC3375131  PMID: 20099942
sexual orientation; suicide attempt; childhood maltreatment; victimization; racial/ethnic minority
Journal of sex research  1992;29(3):425-434.
The development of appropriate AIDS risk reduction interventions targeted at African-American gay men could be aided by an awareness of their terminology for specific sexual behaviors and types of sexual encounters. This paper explores similarities and differences between the HIV-related sexual language of Black and White gay men. While much of the vernacular is shared, differences in some terms and greater or lesser emphasis on others are apparent.
PMCID: PMC4222679  PMID: 25382870
Black gay men; AIDS; sexual language
18.  Issues in the Perception of AIDS Risk and Risk Reduction Activities by Black and Hispanic/Latina Women 
The American psychologist  1988;43(11):949-957.
Although to date most cases of Acquired Immunodeficiency Syndrome (AIDS) have occurred among men, AIDS poses a serious threat for Black and Latina women, particularly for those who are poor and live in geographic areas of higher AIDS incidence. Yet many may not perceive themselves to be at risk from what has generally been portrayed as a “White gay disease.” This article examines patterns of AIDS infection in women and factors associated with risk perception and behavior change. In doing so, the influence of ethnic minority culture on the behavior of individual women is explored.
PMCID: PMC4196373  PMID: 3214007
19.  Sex, lies, and HIV. 
The New England journal of medicine  1990;322(11):774-775.
PMCID: PMC4194074  PMID: 2308606
20.  Reports of parental maltreatment during childhood in a United States population-based survey of homosexual, bisexual, and heterosexual adults☆ 
Child abuse & neglect  2002;26(11):1165-1178.
The study objective was to determine the nature and prevalence of childhood maltreatment experiences among lesbian, gay, and bisexual adults and to compare findings to those obtained from similar heterosexual adults.
Data from the National Survey of Midlife Development in the United States (MIDUS), which measured both childhood experiences with parental emotional and physical maltreatment and adult sexual orientation, were used to compare childhood maltreatment experiences of 2917 heterosexual, homosexual, and bisexual individuals, age 25–74 years, separately by gender.
Homosexual/bisexual men reported higher rates than heterosexual men of childhood emotional and any physical maltreatment (including major physical maltreatment) by their mother/maternal guardian and major physical maltreatment by their father/paternal guardian. In contrast, homosexual/bisexual women, as compared to heterosexual women, reported higher rates of major physical maltreatment by both their mother/maternal guardian and their father/paternal guardian. Differences among individuals with differing sexual orientations were most pronounced for the more extreme forms of physical maltreatment.
Adult minority sexual orientation is a risk indicator for positive histories of experiencing parental maltreatment during childhood. While the reasons for this are beyond the scope of the current study, previous research suggests that childhood individual differences, including possibly gender atypicality, may be a causal factor.
PMCID: PMC4194076  PMID: 12398854
Child maltreatment; Child abuse; Homosexuality
21.  Sexual Orientation–Related Differences in Tobacco Use and Secondhand Smoke Exposure Among US Adults Aged 20 to 59 Years: 2003–2010 National Health and Nutrition Examination Surveys 
American journal of public health  2013;103(10):1837-1844.
We investigated sexual orientation–related differences in tobacco use and secondhand smoke (SHS) exposure in a nationally representative sample of US adults.
The 2003–2010 National Health and Nutrition Examination Surveys assessed 11 744 individuals aged 20 to 59 years for sexual orientation, tobacco use, and SHS exposure (cotinine levels ≥ 0.05 ng/mL in a nonsmoker). We used multivariate methods to compare tobacco use prevalence and SHS exposure among gay or lesbian (n = 180), bisexual (n = 273), homosexually experienced (n = 388), and exclusively heterosexual (n = 10 903) individuals, with adjustment for demographic confounding.
Lesbian and bisexual women evidenced higher rates of tobacco use than heterosexual women. Among nonsmokers, SHS exposure was more prevalent among lesbian and homosexually experienced women than among heterosexual women. Nonsmoking lesbians reported greater workplace exposure and bisexual women greater household exposure than heterosexual women did. Identical comparisons among men were not significant except for lower workplace exposure among nonsmoking gay men than among heterosexual men.
Nonsmoking sexual-minority women are more likely to be exposed to SHS than nonsmoking heterosexual women. Public health efforts to reduce SHS exposure in this vulnerable population are needed.
PMCID: PMC3780743  PMID: 23948019
22.  Race, Race-Based Discrimination, and Health Outcomes Among African Americans 
Annual review of psychology  2007;58:201-225.
Persistent and vexing health disadvantages accrue to African Americans despite decades of work to erase the effects of race discrimination in this country. Participating in these efforts, psychologists and other social scientists have hypothesized that African Americans’ continuing experiences with racism and discrimination may lie at the root of the many well-documented race-based physical health disparities that affect this population. With newly emerging methodologies in both measurement of contextual factors and functional neuroscience, an opportunity now exists to cleave together a comprehensive understanding of the ways in which discrimination has harmful effects on health. In this article, we review emerging work that locates the cause of race-based health disparities in the external effects of the contextual social space on the internal world of brain functioning and physiologic response. These approaches reflect the growing interdisciplinary nature of psychology in general, and the field of race relations in particular.
PMCID: PMC4181672  PMID: 16953796
racism; Blacks; allostatic load; social exclusion; brain; residential segregation; social cognition; cognitive appraisal; self-regulation
23.  Correlates of overweight and obesity among lesbian and bisexual women 
Preventive medicine  2003;36(6):676-683.
Recent studies find lesbians at greater risk for overweight and obesity than heterosexual women. While this may reflect differences in attitudes concerning weight and body shape, little is actually known about risk factors within this group. This study examines correlates of obesity and exercise frequency among lesbians and bisexual women.
Data from a snowball sample (n = 1209) of lesbians/bisexual women living in Los Angeles Country were utilized. Overweight was defined as BMI ≥ 25 kg/m2; obesity as BMI ≥ 30. Associations between sociodemographic characteristics, exercise frequency, health indicators, and weight-related measures were evaluated to identify independent predictors of BMI and exercise frequency.
Prevalence of overweight and obesity among lesbians varied by racial/ethnic background. Higher BMI was associated with older age, poorer health status, lower educational attainment, relationship cohabitation, and lower exercise frequency. Higher BMI, perceptions of being overweight, and reporting a limiting health condition were identified as independent predictors of infrequent exercise. Women were generally quite accurate in self-perceptions of weight status.
Correlates of overweight and obesity among lesbians and bisexual women are generally comparable to those observed in studies of heterosexual women. Evidence that lesbians’ higher BMI is associated with higher levels of fitness is not supported.
PMCID: PMC4174334  PMID: 12744910
Obesity; Lesbian; Bisexual; Women of color
24.  Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women 
Drug and alcohol dependence  2005;77(1):61-70.
Mounting evidence suggests that lesbians and bisexual women may be at especially elevated risk for the harmful health effects of alcohol and tobacco use.
We report findings from the California Women’s Health Survey (1998–2000), a large, annual statewide health surveillance survey of California women that in 1998 began to include questions assessing same-gender sexual behavior.
Overall, homosexually experienced women are more likely than exclusively heterosexually experienced women to currently smoke and to evidence higher levels of alcohol consumption, both in frequency and quantity. Focusing on age cohorts, the greatest sexual orientation disparity in alcohol use patterns appears clustered among women in the 26–35-year-old group. We also find that recently bisexually active women report higher and riskier alcohol use than women who are exclusively heterosexually active. By contrast, among homosexually experienced women, those who are recently exclusively homosexually active do not show consistent evidence of at-risk patterns of alcohol consumption.
Findings underscore the importance of considering within-group differences among homosexually experienced women in risk for tobacco and dysfunctional alcohol use.
PMCID: PMC4174335  PMID: 15607842
Alcohol; Tobacco; Sexual minority; Gay; Lesbian; Epidemiology
25.  Does Neighborhood Social Capital Buffer the Effects of Maternal Depression on Adolescent Behavior Problems? 
Neighborhood characteristics have been shown to impact child well-being. However, it remains unclear how these factors combine with family characteristics to influence child development. The current study helps develop that understanding by investigating how neighborhoods directly impact child and adolescent behavior problems as well as moderate the influence of family characteristics on behavior. Using multilevel linear models, we examined the relationship among neighborhood conditions (poverty and social capital) and maternal depression on child and adolescent behavior problems. The sample included 741 children, age 5–11, and 564 adolescents, age 12–17. Outcomes were internalizing (e.g. anxious/depressed) and externalizing (e.g. aggressive/hyperactive) behavior problems. Neighborhood poverty and maternal depression were both positively associated with behavior problems for children and adolescents. However, while neighborhood social capital was not directly associated with behavior problems, the interaction of social capital and maternal depression was significantly related to behavior problems for adolescents. This interaction showed that living in neighborhoods with higher levels of social capital attenuated the relationship between maternal depression and adolescent behavior problems and confirmed the expectation that raising healthy well-adjusted children depends not only on the family, but also the context in which the family lives.
PMCID: PMC4172356  PMID: 24659390
Neighborhood; Social capital; Child; Adolescent; Behavior problems

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