Abstract
Few studies have compared cardiovascular disease (CVD) risk factors in sexual minority and heterosexual adults. It remains unclear whether changes in sexual identity over time are associated with increased CVD risk. The purposes of this longitudinal study were to: 1) compare sex differences in CVD risk factors across sexual identity subgroups, 2) examine CVD risk factors based on changes in sexual identity, and 3) to examine sex-stratified variations in CVD risk factors. Analyses of the Population Assessment of Tobacco and Health (PATH) study data assessed the longitudinal association of changes in sexual identity with self-reported CVD risk factors (alcohol misuse, cigarette smoking, sedentary behavior, high cholesterol, high blood pressure, obesity). Based on changes in sexual identity between baseline/wave 1 and wave 5, 91.7% (n = 15884) of the sample were heterosexual-stable, 1.1% (n = 265) were gay/lesbian-stable, and 0.8% (n = 265) bisexual-stable. Less than two percent (1.5%; n = 376) indicated one heterosexual (sexual majority)-to-sexual minority change, 1.4% (n =299) reported one sexual minority-to-heterosexual change, 0.7% (n= 202), one or more sexual minority-to-sexual minority changes, 1.4% (n = 345) heterosexual-to-sexual minority-to-heterosexual change, and 1.3% (n = 365) indicated two or more changes with no distinct pattern. Among women, two or more changes in sexual identity with no distinct pattern were associated with increased odds of past 30-day alcohol misuse compared to heterosexual-stable women. Associations between changes in sexual identity and alcohol misuse among women suggest the need for greater screening among healthcare providers who work with this population.