Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)


Community Health and Social Sciences


Christian Grov

Committee Members

Christian Grov

Hongbin Zhang

Nicholas Grosskopf

Margaret Paschen-Wolff

Subject Categories

Public Health


lesbian, bisexual, sexual minority women, sexual health, reproductive health


Background: Sexual minority women experience disparities in sexual and reproductive health outcomes including higher rates of certain STIs, lower engagement in preventive sexual health behaviors, and higher rates of unintended pregnancy compared to their non sexual minority counterparts. Much prior research on sexual minority women’s health has been limited by incomplete or inconsistent definitions of sexual minority status, and has failed to consider sexual orientation branchedness as a risk factor.

Method: Using pooled National Survey of Family Growth data, survey cycles 2011-2013, 2013-2015, and 2015-2017, we performed bivariate and multivariable logistic and multinomial regression analyses to estimate the independent associations between multiple components of sexual orientation (sexual identity, behavior, and attraction), sexual orientation branchedness (disagreement between societally expected pairings of sexual orientation components), and pregnancy intendedness, any contraception use at last intercourse with a male partner, type of contraceptive use at last intercourse, past-year STI-treatment, receipt of the Human Papillomavirus (HPV) vaccine, and age at first HPV vaccination. Multivariable analyses were adjusted for race/ethnicity, age, highest level of education, and total household income, and age-stratified analyses were conducted when effect modification by age was found to be present. All analyses were population-weighted.

Results: Lesbian or bisexual identity predicted increased odds of unwanted pregnancy in the 15-25 age group. In addition, bisexual identity and sex with both men and women predicted increased odds of unwanted pregnancy in the 26-35 age group [Aim 1]. Examining contraceptive use at last intercourse, attraction to women predicted higher odds of having used a contraceptive method. However, bisexual identity and attraction to women both predicted higher odds of having used a low efficacy contraceptive method at last intercourse among women in the 15-25 age group [Aim 2]. In terms of STI-related outcomes, bisexual identity and sex with both women and men predicted higher odds of past-year STI treatment. Further, both identity-behavior branchedness and identity-attraction branchedness predicted elevated odds of having received past-year STI treatment. Lesbian identity and sex with women only predicted decreased odds of having initiated the HPV vaccine. Additionally, sex with both male and female partners predicted higher odds of having received the vaccine during the later age range (from ages 18-25) [Aim 3].

Conclusions: Our findings indicate that specific subgroups of sexual minority women continue to be at risk for poor sexual and reproductive health outcomes. Public health practitioners, policy-makers, and clinicians should consider all components of sexual orientation in order to develop culturally appropriate health promotion programs, policies, and clinical counseling approaches.

Included in

Public Health Commons



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