Date of Award
Doctor of Philosophy (PhD)
Salimah H. Meghani
Marilyn S. Sommers
Sexual minority women (SMW) face multiple barriers to sexual and reproductive health care including cervical cancer screening and sexually transmitted infection (STI) screening. Despite beliefs that they are not at risk for STIs or cervical cancer, most SMW should be screened according to standard clinical guidelines. Aspects of obstetric history, including pregnancy, birth, and elective termination, may represent opportunities for these two types of screening. Guided by intersectionality theory, we reviewed the existing literature for evidence that health care experiences may be correlates to cervical cancer screening among SMW. The review identified important healthcare experience factors, including hormonal contraceptive use, pregnancy history, provider-recommended cervical cancer screening, previous discrimination in health care settings, and disclosing one’s sexual orientation to providers. We then performed secondary analyses employing cross-sectional data from the Chicago Health and Life Experiences of Women (CHLEW) Study, a diverse sample of SMW. The primary aim was to examine associations between obstetric history and the outcomes of cervical cancer and STI screening. In our final logistic regression model of cervical cancer screening, older age was associated with decreased odds (β 0.98, p<0.01) of past year Pap testing. Having health insurance (β 1.72, p<0.01) and being Black/African American (β 1.61, p<0.05) were associated with increased odds of past year Pap testing. Variables significantly associated with increased odds of STI testing included higher numbers of lifetime sex partners (β 6.07, p <0.0001 for the highest quartile group), and being bisexual (β 3.13, p<0.0001). An annual income ≥$75,000 was associated with decreased odds of STI testing compared to an income of <$15,000 (β 0.41, p 0.004). Decision tree analysis revealed the significance of age at coming out, early sexual initiation, and early drinking on the two screening outcomes; the models also identified specific subgroups of SMW that were less likely to report Pap testing, including SMW over 60 years old. Overall, our findings suggest the need for primary, longitudinal studies of SMW’s sexual and reproductive health. They also illustrate the significance of developmental milestones on later sexual health outcomes, and support the validity of intersectionality theory in investigating cervical cancer screening among SMW.
Greene, Madelyne Zuehlke, "Obstetric History And Sexual Health Screening Among Sexual Minority Women" (2017). Publicly Accessible Penn Dissertations. 2316.