Maternal Attitudes/Relationship Quality and Daughter’s Receipt of Reproductive Health Care Services

Abstract

BackgroundCompared to their heterosexual peers, sexual minority female youth receive fewer reproductive health care services (e.g., Pap tests, human papillomavirus [HPV] vaccination). One proposed mediator of this sexual orientation disparity is a mother’s attitudes about sexual orientation and the relationship quality she has with her daughter. Our aim was to examine if mothers’ attitudes and relationship quality were associated with daughters’ receipt of reproductive health care, and whether these associations varied by her daughter’s sexual orientation.MethodsThe Nurses’ Health Study 2 (N=116,430) began in 1989 and seven years later in 1996, a cohort of the participants’ daughters, ages 9-14, were enrolled in the Growing Up Today Study (N=8,144). Acceptance of diverse sexual orientations was reported by NHS2 participants in 2004 when their daughters were 17-22 years old. Mothers indicated on a scale of 1 to 5 (strongly agree to strongly disagree) the extent to which they “feel uneasy around people who are very open in public about being gay, lesbian, or bisexual; and whether it is important that their child(ren) be heterosexual.” Higher scores (range: 2-10) indicated greater maternal acceptance and more positive attitudes toward sexual minorities. Mother-daughter relationship quality was assessed in 2005 using a validated scale where both mother and daughter reported their degree of satisfaction, using a 5-point scale, across nine items (e.g., general communication, affection, emotional support, respect, shared time, interests). Mother and daughter responses were summed with higher scores (range: 2-10) indicating a more supportive and higher maternal-child relationship quality. Sexual orientation was measured each year starting in 1999. Log-binomial models, adjusted for age, race, and geographic region, were used to examine the association between these maternal measures and daughters’ receipt of reproductive health care services (Pap testing measured biennially starting in 1999 and HPV vaccination measured in 2014). This study was approved by the Brigham and Women’s Hospital institutional review board.ResultsMothers who were more accepting of diverse sexual orientations had daughters who were more likely to get a Pap test (risk ratio [95% confidence interval]: 1.02 [1.02, 1.03]); this association was stronger among lesbian daughters (1.10 [1.02, 1.18]) compared to heterosexuals. Mother-daughter pairs with higher scores of relationship-quality were slightly more likely to report the daughter getting a Pap test (1.01 [1.00, 1.02]) but less likely to get the HPV vaccination (0.95 [0.92, 0.98]), compared to dyads with lower relationship-quality scores.ConclusionsOverall, maternal influences do not appear to be strong mediators of the sexual orientation-based disparities in reproductive health care. Acceptance of diverse sexual orientations had the most influence among lesbian daughters but even in that group, maternal factors do little to explain the existing sexual orientation disparities and have little clinical significance.FUNDING: NIH/R01HD057368, R01HD066963, F32HD084000; MCHB/T71-MC00009, T76-MC00001. BackgroundCompared to their heterosexual peers, sexual minority female youth receive fewer reproductive health care services (e.g., Pap tests, human papillomavirus [HPV] vaccination). One proposed mediator of this sexual orientation disparity is a mother’s attitudes about sexual orientation and the relationship quality she has with her daughter. Our aim was to examine if mothers’ attitudes and relationship quality were associated with daughters’ receipt of reproductive health care, and whether these associations varied by her daughter’s sexual orientation. Compared to their heterosexual peers, sexual minority female youth receive fewer reproductive health care services (e.g., Pap tests, human papillomavirus [HPV] vaccination). One proposed mediator of this sexual orientation disparity is a mother’s attitudes about sexual orientation and the relationship quality she has with her daughter. Our aim was to examine if mothers’ attitudes and relationship quality were associated with daughters’ receipt of reproductive health care, and whether these associations varied by her daughter’s sexual orientation. MethodsThe Nurses’ Health Study 2 (N=116,430) began in 1989 and seven years later in 1996, a cohort of the participants’ daughters, ages 9-14, were enrolled in the Growing Up Today Study (N=8,144). Acceptance of diverse sexual orientations was reported by NHS2 participants in 2004 when their daughters were 17-22 years old. Mothers indicated on a scale of 1 to 5 (strongly agree to strongly disagree) the extent to which they “feel uneasy around people who are very open in public about being gay, lesbian, or bisexual; and whether it is important that their child(ren) be heterosexual.” Higher scores (range: 2-10) indicated greater maternal acceptance and more positive attitudes toward sexual minorities. Mother-daughter relationship quality was assessed in 2005 using a validated scale where both mother and daughter reported their degree of satisfaction, using a 5-point scale, across nine items (e.g., general communication, affection, emotional support, respect, shared time, interests). Mother and daughter responses were summed with higher scores (range: 2-10) indicating a more supportive and higher maternal-child relationship quality. Sexual orientation was measured each year starting in 1999. Log-binomial models, adjusted for age, race, and geographic region, were used to examine the association between these maternal measures and daughters’ receipt of reproductive health care services (Pap testing measured biennially starting in 1999 and HPV vaccination measured in 2014). This study was approved by the Brigham and Women’s Hospital institutional review board. The Nurses’ Health Study 2 (N=116,430) began in 1989 and seven years later in 1996, a cohort of the participants’ daughters, ages 9-14, were enrolled in the Growing Up Today Study (N=8,144). Acceptance of diverse sexual orientations was reported by NHS2 participants in 2004 when their daughters were 17-22 years old. Mothers indicated on a scale of 1 to 5 (strongly agree to strongly disagree) the extent to which they “feel uneasy around people who are very open in public about being gay, lesbian, or bisexual; and whether it is important that their child(ren) be heterosexual.” Higher scores (range: 2-10) indicated greater maternal acceptance and more positive attitudes toward sexual minorities. Mother-daughter relationship quality was assessed in 2005 using a validated scale where both mother and daughter reported their degree of satisfaction, using a 5-point scale, across nine items (e.g., general communication, affection, emotional support, respect, shared time, interests). Mother and daughter responses were summed with higher scores (range: 2-10) indicating a more supportive and higher maternal-child relationship quality. Sexual orientation was measured each year starting in 1999. Log-binomial models, adjusted for age, race, and geographic region, were used to examine the association between these maternal measures and daughters’ receipt of reproductive health care services (Pap testing measured biennially starting in 1999 and HPV vaccination measured in 2014). This study was approved by the Brigham and Women’s Hospital institutional review board. ResultsMothers who were more accepting of diverse sexual orientations had daughters who were more likely to get a Pap test (risk ratio [95% confidence interval]: 1.02 [1.02, 1.03]); this association was stronger among lesbian daughters (1.10 [1.02, 1.18]) compared to heterosexuals. Mother-daughter pairs with higher scores of relationship-quality were slightly more likely to report the daughter getting a Pap test (1.01 [1.00, 1.02]) but less likely to get the HPV vaccination (0.95 [0.92, 0.98]), compared to dyads with lower relationship-quality scores. Mothers who were more accepting of diverse sexual orientations had daughters who were more likely to get a Pap test (risk ratio [95% confidence interval]: 1.02 [1.02, 1.03]); this association was stronger among lesbian daughters (1.10 [1.02, 1.18]) compared to heterosexuals. Mother-daughter pairs with higher scores of relationship-quality were slightly more likely to report the daughter getting a Pap test (1.01 [1.00, 1.02]) but less likely to get the HPV vaccination (0.95 [0.92, 0.98]), compared to dyads with lower relationship-quality scores. ConclusionsOverall, maternal influences do not appear to be strong mediators of the sexual orientation-based disparities in reproductive health care. Acceptance of diverse sexual orientations had the most influence among lesbian daughters but even in that group, maternal factors do little to explain the existing sexual orientation disparities and have little clinical significance.FUNDING: NIH/R01HD057368, R01HD066963, F32HD084000; MCHB/T71-MC00009, T76-MC00001. Overall, maternal influences do not appear to be strong mediators of the sexual orientation-based disparities in reproductive health care. Acceptance of diverse sexual orientations had the most influence among lesbian daughters but even in that group, maternal factors do little to explain the existing sexual orientation disparities and have little clinical significance.