This study was designed to test an exploratory path model predicting health care utilization by lesbian women. Using structural equation modeling we examined the joint influence of internalized homophobia, feminism, comfort with health care providers (HCPs), education, and disclosure of sexual identity both in one's life and to one's HCP on health care utilization. Surveys were completed by 254 Canadian lesbian women (54% participation rate) recruited through snowball sampling and specialized media. The majority (95%) of women were White, 3% (n = 7) were women of colour, and the remaining six women did not indicate ethnicity. Participants ranged in age from 18 to 67 with a mean age of 38.85 years (SD = 9.12). In the final path model, higher education predicted greater feminism, more disclosure to HCPs, and better utilization of health services. Feminism predicted both decreased levels of internalized homophobia and increased disclosure across relationships. Being more open about one's sexual identity was related to increased disclosure to HCPs, which in turn, led to better health care utilization. Finally, the more comfortable women were with their HCP the more likely they were to seek preventive care. All paths were significant at p < .01. The path model offers insight into potential target areas for intervention with the goal of improving health care utilization in lesbian women.

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Internalization of sociocultural norms about the body has been theorized to be an important factor in fostering body dissatisfaction in women. Some theorists have suggested that a lesbian identity may buffer or immunize lesbians from the damaging effects of society's pressure to be thin by reducing this internalization. This study was designed to test this claim empirically. Questionnaires were completed by 108 lesbians and 115 heterosexual women recruited through snowball sampling. Lesbians felt more fit, reported less negative attitudes toward their lower bodies, and internalized sociocultural norms less than heterosexual women. For all women, internalization of sociocultural norms significantly predicted body attitudes. Lesbians and heterosexual women appear to be similarly exposed to and aware of society's messages, and as such their body attitudes substantially overlap. However, lesbians are buffered from these views in some specific areas. These differences appear to be primarily the result of differential internalization of sociocultural norms.

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