Prevalence, predictors and negative outcomes associated with discordant sexual identity, sexual attraction and sexual behavior

This study assessed the prevalence, predictors and negative outcomes associated with discordant sexual identity in a national US sample of men and women who identified as heterosexual. Results were based on data collected from the 2004--2005 (wave 2) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The NESARC is a national sample of 34,653 adults aged 20 years and older comprised of 52% female, 71% white, 12% Hispanic, 11% African American, 4% Asian and 2% Native American. The prevalence of same sex orientation ranged from 1.41% to 6% in men and 1.35% to 8% in women.;Of those who identified as heterosexual, women were statistically more likely to be discordant than men, yet discordance was common in both men and women (4.28% and 6.21% respectively). Discordant men had increased odds of being Black, over the age of 65, widowed, less educated, unemployed, and earning a lower individual and family income. Discordant women had increased odds of being Asian, foreign born, over the age of 65, widowed, unemployed, and earning a lower family income.;Men with discordant attraction and behavior were 4 times less likely to meet criteria for alcohol use disorder but men with discordant attraction alone were 6 times more likely to have tested positive for HIV. Discordant men did not have increased risk of any other outcomes. Negative outcomes in discordant women far outweighed negative outcomes in men. Every group of discordant women demonstrated increased risk of alcohol related disorders. Risk of alcohol disorders in discordant women varied by subgroup with the greatest risk found in those with discordant sexual behavior and attraction and the least risk found in those with discordant sexual attraction alone. Some discordant women demonstrated significant risk of HIV infection and increased odds of infection ranged from 2.7 to 5.67. Overall, predictors and negative outcomes varied within each subgroup.;Results highlight gender and discordant subgroup differences indicating the need for specialized prevention and intervention efforts to each subgroup. Future research should investigate all dimensions of sexual orientation and discordance to identify subgroups in need of specialized prevention and intervention efforts.