Childhood Sexual Abuse, Adult Sexual Orientation, and Their Combined Influences on Mental Health and Health-Risk Behaviors
Ray M Merrill*, Jacob C Palmer, Kenyon C Chipman and Steven B Ko
ABSTRACT
This study evaluated (1) adult sexual orientation by selected demographic variables; (2) the association between sexual adverse childhood experiences (ACEs) and adult sexual orientation; and (3) the estimated associations of both sexual ACEs and adult sexual orientation with stress, poor mental health, smoking, and alcohol drinking. Multiple logistic regression models adjusted for selected demographic variables and assessed whether the associations differed between men and women. Analyses involved 84,266 men and 99,963 women from 18 U.S. states and the Virgin Islands who completed 2020-2024 BRFSS surveys. A higher percentage of women were a sexual minority than men (9% vs. 6%), primarily due to higher bisexual orientation. Higher sexual minority orientation in women (vs. men) tended to occur across the levels of the demographic variables. Sexual ACEs were significantly positively associated with sexual minority orientation in adulthood. Each type of sexual minority orientation was significantly greater for those with sexual ACEs. The associations were greater for men than for women. Stress and poor mental health were significantly greater in those with sexual minority orientation and in those with sexual ACEs (vs. none), with associations involving sexual ACEs greater. Women with sexual minority orientation and men and women with sexual ACEs were significantly more likely to be current smokers, binge drinkers, and heavy drinkers. Current smoking was more strongly associated with sexual ACEs than adult sexual orientation among men and women, and binge and heavy drinking were more strongly associated with sexual ACEs than adult sexual orientation among men but less for women.
