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Health Services Research & Development

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2015 HSR&D/QUERI National Conference Abstract

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3017 — Are there Sexual Orientation Disparities in Alcohol Misuse among Women Veterans?

Lehavot K, VA Puget Sound Health Care System; Williams EC, VA Puget Sound Health Care System; Millard SP, VA Puget Sound Health Care System; Bradley KA, Group Health Research Institute; Simpson TL, VA Puget Sound Health Care System;

Objectives:
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. Thus, 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 anonymous online survey. Participants provided information on their sexual identity and behavior and responded to the validated 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 704 participants (36% lesbian/bisexual and 43% with some sexual history with women), 38% screened positive for alcohol misuse in the past year. Sexual minority women, whether categorized by self-identity or sexual behavior, were more likely to screen positive for alcohol misuse than heterosexual women and those who have had sex only with men (37-56% vs. 29-30%), all p-values < .05. However, findings were dependent on age. Lesbians, bisexual women, and women who reported a history of having had sex with women reported greater prevalence of alcohol misuse and higher alcohol severity scores than their heterosexual counterparts at younger ages but differences decreased with age.

Implications:
Sexual minority status was associated with greater prevalence and severity of alcohol misuse for younger and middle-aged women. The study extends the literature by investigating sexual orientation disparities in a growing but understudied population--women Veterans, showing differences in alcohol misuse using two measures of sexual orientation and highlighting modifications by age.

Impacts:
Efforts to target sexual minority women Veterans for education, assessment, and/or treatment of alcohol misuse may be called for, particularly those in young adulthood. VA and community providers should consider assessment of sexual history in addition to administration of an alcohol misuse screening tool. Finally, future research that examines mechanisms underlying sexual orientation differences may be necessary in order to eliminate disparities.