This article was downloaded by: [McMaster University] On: 04 December 2014, At: 11:34 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
Impediments to Academic Performance of Bisexual College Students a
b
Nicole Aydt Klein PhD & Michael G. Dudley PhD a
Department of Kinesiology and Health Education, Southern Illinois University Edwardsville Edwardsville, Illinois b
Department of Psychology, Southern Illinois University Edwardsville, Edwardsville, Illinois Accepted author version posted online: 02 May 2014.Published online: 15 Aug 2014.
To cite this article: Nicole Aydt Klein PhD & Michael G. Dudley PhD (2014) Impediments to Academic Performance of Bisexual College Students, Journal of American College Health, 62:6, 399-406, DOI: 10.1080/07448481.2014.917653 To link to this article: http://dx.doi.org/10.1080/07448481.2014.917653
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JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 62, NO. 6
Major Article
Impediments to Academic Performance of Bisexual College Students
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Nicole Aydt Klein, PhD; Michael G. Dudley, PhD
Abstract. Objective: To investigate health-related impediments to academic success for bisexual college students. Participants: Respondents to the Fall 2011 American College Health Association–National College Health Assessment II (ACHA-NCHA II) survey who self-identified as bisexual, heterosexual, gay, or lesbian. Methods: Secondary analyses of the ACHA-NCHA II data were conducted to compare the experiences of bisexual students with both each other (bisexual men and bisexual women) and those of their nonbisexual counterparts (heterosexual and gay/lesbian students). Results: Bisexual college students are a large and distinct sexual minority group. On all measures with the exception of discrimination, bisexual college students reported the strongest threats to academic success of all sexual orientations. Conclusions: Given the unique impediments for bisexual students, college health professionals should consider specifically addressing needs for bisexual students, bisexual women in particular.
LGB students who navigate multiple challenges, such as discrimination based on sexual orientation as well as disabilities, race, gender, or sex, are at a higher risk. Bernert et al11 found that college students who reported a disability (eg, attention-deficit/hyperactivity disorder [ADHD], chronic illness, psychiatric condition, physical disability), which included a high percentage of LGB students, were more likely to engage in both substance abuse and sexual risk–taking than those without disabilities. Other studies have found that LGB adults who report having experienced more than 1 type of discrimination (eg, sexual orientation and gender discrimination or sexual orientation and race) were more likely to have abused illicit drugs in the previous year than LGB adults who reported no discrimination.12,13 Of particular interest to those working in student health are experiences that affect LGB individuals’ academic success. The Gay, Lesbian and Straight Education Network’s (GLSEN’s) most recent study on the experiences of LGBT (lesbian, gay, bisexual, transgender) students in middle and high schools found that students who reported higher levels of victimization at school had grade point averages (GPAs) that were lower (2.9 vs 3.2) and were less likely to plan to attend college or university than other students.14 For those who do continue to postsecondary education, college students who identify as LGBQ (lesbian, gay, bisexual, queer) often consider leaving the institution, especially in their first years.15 A study of how mental health and stress affected academic performance for sexual minority college students by Oswalt and Wyatt16 found that LGB students reported experiencing more anxiety, depression, and discrimination that had an effect on their academic performance than heterosexual students. Within the LGB and unsure students, the researchers found that bisexual students reported the highest frequency of mental health challenges and had more relationship difficulties, physical assaults, and sexual assaults that affected their academic performance.
Keywords: academic performance, bisexual, college health, health education
A
s public discussion of issues related to sexual orientation increases, researchers and health professionals have identified specific health disparities that exist for lesbian, gay, and bisexual (LGB) populations.1 Consistently, the bulk of the research finds that LGB (ie, sexual minority) individuals have increased risks for sexual victimization,2 self-injury and suicide ideations and attempts,3 overweight and obesity for lesbian and bisexual women,4 mood and anxiety disorders,5,6 tobacco use,7–9 and alcohol and illicit drug use,10,11 particularly when compared with their heterosexual counterparts.
Dr Klein is with the Department of Kinesiology and Health Education at Southern Illinois University Edwardsville in Edwardsville, Illinois. Dr Dudley is with the Department of Psychology at Southern Illinois University Edwardsville in Edwardsville, Illinois. Copyright Ó 2014 Taylor & Francis Group, LLC 399
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Traditionally, research on health-related outcomes among sexual orientation minority members has combined lesbian, gay, and bisexual respondents into 1 homogenous category. The Institute of Medicine’s report on LGBT health recommends studying these groups separately.17 Studies that have focused specifically on differences between these sexual orientation minority groups yield some interesting results. Those specifically examining the health of bisexual populations, for example, have found greater incidence of suicide,3 more negative alcohol outcomes such as self- or otherinjury,18 poorer mental health19 and greater stress,5,20 higher incidence of substance abuse,7,21 and greater rates of sexually transmitted infections22 than in heterosexual and lesbian/gay populations. Bostwick et al13 found that although bisexual women drank less alcohol than heterosexual women, they were more likely to contemplate suicide while intoxicated. With few exceptions, such as Struble et al,4 who found no difference in rates of overweight and obesity in lesbian and bisexual college women, research finds that bisexual individuals often report more health risks than both heterosexual and gay and lesbian populations, which strongly suggests that additional investigation into the potentially unique characteristics of individuals who identify as bisexual is certainly warranted.23 Although most studies of sexual minority groups combine lesbian, gay, and bisexual respondents into 1 group, studies that do examine the groups separately still are unlikely to look at differences between men and women. This study examines how health-related impediments to academic success affect sexual minority students, specifically bisexual college students, by asking several questions. First, to what extent do bisexual college students report different factors affecting their academic performance than heterosexual students and gay/lesbian students? To what extent to bisexual women report different factors affecting their academic performance than bisexual men? Are there significant differences in impediments to academic performance between bisexual women and lesbian women and bisexual men and gay men? Finally, are there impediments that affect the GPA of bisexual students that do not affect the GPA of nonbisexual students? METHODS To examine these research questions, data from the American College Health Association–National College Health Assessment II (ACHA-NCHA II)24 obtained during the survey period Fall 2011 were analyzed. This annual survey is designed to collect information from both public and private 2- and 4-year institutions about college students’ health behaviors. Although only schools that randomly select classrooms to survey are included in the database and the data have compared favorably with other national college student surveys, the survey cannot be considered generalizable because colleges and universities must self-select to participate. The full data set used in the current analyses included 44 schools, with 27,774 students taking the full 66-item survey. The majority of the participants were 400
female (66.1%), white (75.6%), not in a relationship (50.5%), heterosexual (92.2%), with a mean age of 22.25 years (median 20 years). As this project used secondary analysis of data with no identifiers, it was determined by the authors’ Institutional Review Board to not meet the human subjects research definition. Exploratory analyses were conducted using SPSS Statistics 20 for Windows (IBM SPSS, Armonk, New York) to investigate the experiences of bisexual college students, compared with their nonbisexual counterparts. The participants were asked, “Within the last 12 months, have any of the following affected your academic performance?” Response options were “This did not happen to me,” “I have experienced this issue but my academics have not been affected,” “Received a lower grade on an exam or important project,” “Received a lower grade in the course,” “Received an incomplete or dropped the course,” and “Significant disruption in thesis, dissertation, research, or practicum work.” For use as dependent variables, these 6 responses were averaged together, with higher scores reflecting greater interruptions to academic performance (range from 1 D did not happen to 6 D significant disruption). Similar composites were created for each variable as shown in the tables (eg, alcohol use, drug use). As shown in Table 1, a series of 1-way multivariate analyses of variance was conducted to investigate differences in potential impediments to academic performance based on sexual orientation. Specifically, bisexual students were compared first with heterosexual students, then with gay/lesbian students. Table 2 was similarly computed, comparing bisexual women and bisexual men, bisexual women and lesbian women, and, finally, bisexual women and heterosexual women. Table 3 specifically examined the same academic impediments for bisexual men versus gay men and bisexual men versus heterosexual men. Finally, a set of exploratory analyses was conducted to test for possible interaction effects between sexual orientation and academic impediments. For ease of interpretation, categorical variables were created using a median split, with GPA as the dependent variable. This was conducted for bisexual men and bisexual women separately as well as for both genders combined. RESULTS Bisexual college students were found to be a large and distinct group. Although often combined with gay, lesbian, and sometimes transgendered students, more respondents identified as bisexual (n D 792) than gay or lesbian (n D 572). In addition, bisexual respondents had distinctly different threats to their academic success than either heterosexual or gay/lesbian respondents. When compared with heterosexual students (n D 21,835), bisexual students had significantly stronger impediments to academic success than heterosexual students for virtually all the variables studied. When compared with gay/lesbian respondents, the bisexual respondents reported that certain experiences had a similar or greater negative effect on their academic JOURNAL OF AMERICAN COLLEGE HEALTH
Impediments to Academic Performance and Bisexuality
TABLE 1. Impediments to Academic Performance for Bisexual College Students, Compared With Heterosexual and Gay/Lesbian Students
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Impediments Alcohol use Drug use Eating disorder/problem Gambling Internet use/Computer games Allergies Cold/Flu/Sore throat Chronic health problem Chronic pain Injury Pregnancy STD/STI Sinus/Ear/Streptococcal infection Anxiety Depression Discrimination Homesickness Sleep difficulties Stress Assault (physical) Assault (sexual) ADHD Learning disability Concern for family or friend Death of family member or friend Relationship difficulties Roommate difficulties Finances Extracurricular activities Work Other
Bisexual (n D 792)
Heterosexual (n D 21,835)
Bisexual vs Heterosexual p
Gay/Lesbian (n D 572)
Bisexual vs Gay/Lesbian p
1.58 1.24 1.14 1.04 1.72 1.45 1.86 1.34 1.29 1.19 1.06 1.04 1.37 2.15 2.04 1.23 1.35 2.12 2.52 1.09 1.13 1.37 1.18 1.83 1.37 1.71 1.44 1.71 1.60 1.81 1.12
1.46 1.10 1.06 1.03 1.54 1.34 1.66 1.15 1.13 1.15 1.04 1.02 1.26 1.70 1.41 1.04 1.31 1.77 2.11 1.03 1.04 1.16 1.10 1.50 1.25 1.45 1.33 1.41 1.54 1.62 1.06
.000 .000 .000 .511 .000 .000 .000 .000 .000 .043 .082 .001 .000 .000 .000 .000 .033 .000 .000 .000 .000 .000 .003 .000 .000 .000 .000 .000 .012 .000 .002
1.52 1.16 1.10 1.05 1.61 1.40 1.67 1.26 1.20 1.18 1.03 1.07 1.31 1.90 1.69 1.46 1.28 1.95 2.22 1.07 1.07 1.25 1.14 1.55 1.29 1.60 1.39 1.55 1.62 1.75 1.07
.519 .005 .233 .889 .095 .474 .000 .151 .007 .971 .585 .087 .467 .000 .000 .000 .227 .014 .000 .641 .001 .016 .678 .000 .257 .100 .636 .003 .986 .663 .246
Note. STD/STI D sexually transmitted disease/sexually transmitted infection; ADHD D attention-deficit/hyperactivity disorder. Response options were 1 D This did not happen to me; 2 D I have experienced this issue, but my academics have not been affected; 3 D Received a lower grade on an exam or important project; 4 D Received a lower grade in a class; 5 D Received an incomplete or dropped the course; 6 D Significant disruption in thesis, dissertation, research, or practicum work.
performance than did gay/lesbian respondents. Specifically, these included drug use, cold/flu/sore throat, chronic pain, anxiety, depression, sleep difficulties, stress, sexual assault, ADHD, concern for family members or friends, and finances (see Table 1). The only measured variable where bisexual students reported less negative effect on their academics than gay/lesbian students was in the area of discrimination—bisexual respondents reported less of an effect due to discrimination. Bisexual women emerged as a distinct group. Bisexual women (n D 609) reported significantly greater educational impediments than bisexual men (n D 170) for cold/flu/sore throat, sinus/ear/strep, anxiety, depression, homesickness, sleep difficulties, stress, concern for family or friend, relationship difficulties, and finances (see Table 2). Bisexual women had fewer impediments due to gambling than bisexual men, which was low in general. Bisexual women reported greater health-related impediments to academic success than heterosexual women in all areas except for VOL 62, AUGUST/SEPTEMBER 2014
gambling, injury, pregnancy, homesickness, learning disabilities, and extracurricular commitments. Bisexual women differed from lesbian respondents in that they reported that depression, stress, sexual assault, and concern for family or friends were more likely to have affected their academic success. Conversely, bisexual women in the study reported discrimination affecting their academics less often than lesbian students. Bisexual men reported greater health-related impediments to academic success than heterosexual men for drug use, chronic health problems, chronic pain, anxiety, depression, discrimination, sleep difficulties, stress, ADHD, learning disabilities, and concern for family and friends (see Table 3). Bisexual men reported similar impediments as gay men, but bisexual men reported greater challenges from ADHD and learning disabilities and less effects from discrimination. Finally, results of the exploratory analyses involving the interaction effects between sexual orientation and academic 401
Klein & Dudley
TABLE 2. Impediments to Academic Performance for Bisexual Women, Compared With Bisexual Men, Lesbian Women, and Heterosexual Women
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Impediments Alcohol use Drug use Eating disorder/problem Gambling Internet use/Computer games Allergies Cold/Flu/Sore throat Chronic health problem Chronic pain Injury Pregnancy STD/STI Sinus/Ear/Streptococcal infection Anxiety Depression Discrimination Homesickness Sleep difficulties Stress Assault (physical) Assault (sexual) ADHD Learning disability Concern for family or friend Death of family member/friend Relationship difficulties Roommate difficulties Finances Extracurricular activities Work Other
Lesbian Bisexual women Heterosexual Bisexual women Bisexual Bisexual Bisexual vs Heterosexual women vs Lesbian women women vs men women women p (n D 14,580) women p (n D 609) (n D 170) Bisexual men p (n D 222) 1.57 1.22 1.16 1.02 1.70 1.48 1.92 1.36 1.31 1.20 1.06 1.04 1.42 2.23 2.12 1.23 1.38 2.18 2.58 1.09 1.15 1.35 1.15 1.89 1.38 1.77 1.47 1.76 1.59 1.84 1.12
1.59 1.26 1.08 1.09 1.79 1.38 1.66 1.25 1.22 1.17 1.03 1.04 1.21 1.82 1.78 1.19 1.24 1.92 2.30 1.08 1.05 1.41 1.27 1.58 1.32 1.51 1.32 1.50 1.61 1.68 1.08
.927 .689 .148 .003 .554 .292 .005 .368 .440 .883 .703 .906 .005 .000 .009 .788 .036 .024 .022 .962 .129 .753 .101 .004 .705 .009 .062 .001 .971 .214 .660
1.46 1.16 1.09 1.05 1.54 1.41 1.77 1.32 1.26 1.25 1.03 1.05 1.41 2.03 1.70 1.46 1.29 2.02 2.31 1.08 1.07 1.34 1.19 1.65 1.37 1.72 1.37 1.60 1.61 1.78 1.11
.123 .136 .190 .094 .069 .629 .192 .874 .673 .501 .761 .989 .997 .095 .000 .000 .291 .187 .006 .972 .012 .997 .751 .007 .996 .919 .321 .080 .997 .872 .989
1.44 1.07 1.07 1.01 1.51 1.36 1.74 1.18 1.14 1.14 1.04 1.02 1.31 1.79 1.44 1.04 1.36 1.81 2.21 1.03 1.04 1.14 1.10 1.57 1.27 1.48 1.35 1.44 1.55 1.65 1.06
.000 .000 .000 .979 .000 .000 .000 .000 .000 .061 .448 .044 .001 .000 .000 .000 .824 .000 .000 .000 .000 .000 .082 .000 .003 .000 .000 .000 .620 .000 .012
Note. STD/STI D sexually transmitted disease/sexually transmitted infection; ADHD D attention-deficit/hyperactivity disorder. Response options were 1 D This did not happen to me; 2 D I have experienced this issue, but my academics have not been affected; 3 D Received a lower grade on an exam or important project; 4 D Received a lower grade in a class; 5 D Received an incomplete or dropped the course; 6 D Significant disruption in thesis, dissertation, research, or practicum work.
impediments yielded several intriguing findings. Specifically, the following academic impediments were found to have a significant effect (p < .05) on GPA for bisexual college students, as compared with nonbisexual college students (heterosexual, gay/lesbian, and unsure). For collegiate bisexual males, physical assault (p D .003), injury (p D .029), pregnancy of a partner (p D .011), sexual assault (p D .002), and finances (p D .000) were more likely to affect their GPA. For collegiate bisexual women, only discrimination had a significant effect (p D .042), as compared with nonbisexual collegiate women. When both bisexual men and bisexual women were combined, only gambling (p D .012) and injury (p D .010) were significant. COMMENT Given that previous studies reveal that sexual minority students experience more health-related threats, is it not surprising that bisexual college students experience more 402
impediments to academic performance than heterosexual students. However, more interesting is that bisexual students are quite distinct from gay and lesbian students. This is important to consider because researchers and college health personnel often combine all sexual minority orientations into 1 LGB group, occasionally adding transgendered students who may or may not self-identify as gay, lesbian, or bisexual. When examining groups closely, it becomes clear that bisexual college students, particularly bisexual women, have more challenges to optimal performance in college and may need special consideration. The link between sexual orientation and health challenges is not new, yet it is important to be clear that being a sexual minority is not what increases negative outcomes for LGB individuals.23 Instead, it is likely the effect of social stressors such as discriminatory practices of individuals, groups, and institutions.25 The Meyer Minority Stress Model outlines the stigma, prejudice, and discrimination JOURNAL OF AMERICAN COLLEGE HEALTH
Impediments to Academic Performance and Bisexuality
TABLE 3. Impediments to Academic Performance for Bisexual Men, Compared With Gay Men and Heterosexual Men
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Impediments Alcohol use Drug use Eating disorder/problem Gambling Internet use/Computer games Allergies Cold/Flu/Sore throat Chronic health problem Chronic pain Injury Pregnancy STD/STI Sinus/Ear/Streptococcal infection Anxiety Depression Discrimination Homesickness Sleep difficulties Stress Assault (physical) Assault (sexual) ADHD Learning disability Concern for family or friend Death of family member or friend Relationship difficulties Roommate difficulties Finances Extracurricular activities Work Other
Bisexual men (n D 203)
Gay men (n D 383)
Bissexual men vs Gay men p
Heterosexual men (n D 8,187)
Bisexual men vs Heterosexual men p
1.59 1.26 1.08 1.09 1.79 1.38 1.66 1.25 1.22 1.17 1.03 1.04 1.21 1.82 1.78 1.19 1.24 1.92 2.30 1.08 1.05 1.41 1.27 1.58 1.32 1.51 1.32 1.50 1.61 1.68 1.08
1.56 1.14 1.08 1.03 1.64 1.38 1.58 1.20 1.12 1.11 1.01 1.06 1.23 1.79 1.66 1.43 1.25 1.88 2.14 1.04 1.05 1.18 1.08 1.44 1.23 1.49 1.38 1.50 1.60 1.71 1.02
.965 .065 1.000 .162 .345 1.000 .776 .679 .130 .656 .887 .574 .977 .990 .596 .000 .998 .983 .419 .507 .999 .006 .002 .261 .405 .988 .825 1.000 .999 .987 .490
1.50 1.15 1.03 1.06 1.62 1.30 1.51 1.10 1.11 1.17 1.04 1.02 1.17 1.53 1.34 1.05 1.21 1.70 1.91 1.03 1.02 1.19 1.11 1.38 1.19 1.39 1.27 1.37 1.53 1.56 1.06
.311 .038 .280 .738 .108 .294 .111 .001 .012 1.000 .990 .603 .171 .001 .000 .000 .901 .031 .000 .133 .305 .000 .001 .002 .052 .254 .753 .188 .598 .411 .934
Note. STD/STI D sexually transmitted disease/sexually transmitted infection; ADHD D attention-deficit/hyperactivity disorder. Response options were 1 D This did not happen to me; 2 D I have experienced this issue, but my academics have not been affected; 3 D Received a lower grade on an exam or important project; 4 D Received a lower grade in a class; 5 D Received an incomplete or dropped the course; 6 D Significant disruption in thesis, dissertation, research, or practicum work.
that shape an environment for sexual minorities that can influence their mental health.26 Multiple minority stressors such being victimized, pressure to hide sexual orientation, and internalized homophobia have been found to decrease the quality and quantity of social support for sexual minority women, in turn increasing their mental health and substance abuse issues.27 With the exception of discrimination, on every impediment studied, bisexual college students either had similar or more negative effects on their academic performance than gay or lesbian students. The additional challenges that bisexual students report may be due to myriad factors. It is possible that bisexual respondents are experiencing the stress of a “double closet” where they may be hiding samesex relationships from some friends and family and hiding other sex relationships from lesbian and gay peers.3 Not surprisingly, behaviorally bisexual men who conceal their sexual orientation have been found to have poorer mental VOL 62, AUGUST/SEPTEMBER 2014
health than gay men.28 In addition, bisexual college students may be experiencing internal and/or external biphobia—a less commonly recognized phobia in which bisexual people experience discrimination and negativity. Damaging assumptions (eg, individuals are actually gay/lesbian but afraid to fully come out, bisexuals are promiscuous, bisexuality is “trendy”) about bisexual people can exist within lesbian and gay communities as well as in the general population.29 Despite evidence that bisexuality is a true, physiological orientation,30,31 the rejection of bisexuality as legitimate persists and can contribute to bisexual college students’ health concerns becoming invisible. Perceptions such as these can contribute to a lack of a community identity and resources. Bisexual college women, the largest sexual minority group, experience numerous threats to health and academics. The current study compared bisexual women with 403
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bisexual men and found that the women had stronger impediments to academic performance than the men. An earlier study of the ACHA-NCHA II data found that bisexual women reported more mental health issues, and they had more of an effect of academic performance than lesbian women.16 Among other health-related issues, bisexual women have also been found to be at high risk of alcohol abuse8 and poor general health and distress.32 A recent study comparing bisexual and lesbian college students found bisexual women reported more anxiety, hopelessness, loneliness, sadness, and depression than lesbian women, in addition to being 1.26 times more likely to seriously consider suicide.21 We found that bisexual women reported depression and stress having more of an effect on their academics than any other group of women studied. An earlier study found higher rates of drug use in LGB adults who had experienced multiple discriminations; it is possible that bisexual women must navigate more marginalized identities than either lesbian women or bisexual men (sexism, heterosexism, biphobia), and this has a cumulative effect on their health- and academic-related outcomes. The results revealed that bisexual men had more impediments to their academic success than heterosexual men, but that bisexual men were very similar to gay men. Thus, interventions aimed at heterosexual men might not address issues with the sexual minority population, but those aimed at the general LGB college population are likely to be helpful for sexual minority men. Conversely, bisexual female students are quite different than lesbian students in what they report affects their academic performance. Programs intended for the general LGB college population are unlikely to address the unique needs of bisexual female college students. Having staff and faculty support for bisexual students might be as important to academic success for college students as it is to high school students. The GLSEN study referenced earlier found that middle and high school LGBT students who reported having 6 or more supportive staff members had GPAs that were significantly higher (3.2) than those who reported no support (2.9).14 Improving support and services to bisexual college students can include educating faculty and staff about bisexuality and challenges to academic success reported by bisexual college students, tailoring programs and support groups to bisexual students, and encouraging future research to study bisexuality separately from other sexual minority groups. Of particular interest in the ACHA-NCHA II data are those individuals who chose “unsure” regarding their sexual orientation status. Whereas bisexuality has often been theorized as a potential precursor towards a gay or lesbian identity, it is further possible that “unsure” could be a potential precursor towards a bisexual identity. A study by Lindley et al22 found that whereas lesbian women were least likely to report having had a sexually transmitted infection (STI), bisexual women and those who reported being unsure about their sexual orientation (particularly if they reported both male and female partners) had the 404
highest reports of STIs. Although outside the scope of the current study, it would be interesting to investigate to what extent the same personal and interpersonal variables affecting one’s academic progress for bisexual individuals may also be relevant indicators for the general well-being of those individuals who are unsure of their sexual orientation status.
Limitations One obvious limitation concerning this overall data set is the reliance on self-report data when categorizing individuals into their respective sexual orientation categories. As previously discussed, given the relative lack of empirical research regarding the identity formation processes of bisexuals, it is possible that some individuals who are more accurately gay or lesbian felt more comfortable identifying as bisexual for the purposes of this study, perhaps feeling this categorization was less stigmatizing than the other nonheterosexual options. As such, interpretation of the data indicating differences among gay, lesbian, and bisexual individuals should be understood to be only as accurate as the self-report data regarding sexual orientation status are accurate. An additional limitation concerning the interpretation of the significant differences between bisexual and nonbisexual individuals in this study is the relatively low detrimental impact that these variables had on academic outcomes. As indicated in Table 1, most responses were reported towards the lower end of the scale items, suggesting that the occurrence of these variables did not affect their academic performance to a great extent. However, because bisexual students do report distinctly greater academic difficulties compared with their nonbisexual counterparts, it merits particular attention to determine what specific strategies or interventions educators and health practitioners could engage in to either reduce or eliminate these additional obstacles for bisexuals as it relates to their academic success. Finally, as noted in Methods, ACHA-NCHA II data are not representative of US colleges and universities and therefore caution must be taken when generalizing the results. However, comparisons of the ACHA-NCHA II with samples intended to represent all US college students have yielded similar results.
Conclusions A particular strength to the current study is its specific focus on the academic-related outcomes of self-reported bisexual individuals as a distinct and separate category from nonbisexual individuals, even distinct from those who identify as gay or lesbian. As previously discussed, often all non–heterosexual-identified individuals are grouped together into one large category, suggesting that their life experiences and outcomes are homogenous. As the results JOURNAL OF AMERICAN COLLEGE HEALTH
Impediments to Academic Performance and Bisexuality
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of this study indicate, however, such an amorphous categorization is greatly misleading and, more importantly, fails to account for the myriad ways in which bisexual individuals specifically are at greater risk for academic failure as a function of their unique sexual orientation minority status. Many campuses have services and student organizations that target LGBT populations, but given the specific needs for bisexual students, college health professionals should consider addressing the needs unique to this group, particularly bisexual women. Initiatives could start by promoting simple awareness with faculty, staff, and students that bisexual students outnumber those who identify as gay and lesbian. Other programming could address various topics, including the stress of constantly coming out that bisexual students may experience with each new relationship and inservice training with medical staff about specific health concerns. FUNDING No funding was used to support this research and/or the preparation of the manuscript. CONFLICT OF INTEREST DISCLOSURE The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board of Southern Illinois University Edwardsville. NOTE For comments and further information, address correspondence to Nicole Aydt Klein Department of Kinesiology and Health Education, Southern Illinois University Edwardsville, Edwardsville, IL 62026-1126, USA (e-mail: [email protected]). REFERENCES 1. Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S. Sexual and gender minority health: what we know and what needs to be done. Am J Public Health. 2008;98:989–995. 2. Rothman E, Silverman J. The effect of a college sexual assault prevention program on first-year students’ victimization rates. J Am Coll Health. 2007;55:283–290. 3. Blosnich J, Bossarte R. Drivers of disparity: differences in socially based risk factors of self-injurious and suicidal behaviors among sexual minority college students. J Am Coll Health. 2012;60:141–149. 4. Struble CB, Lindley LL, Montgomery K, Hardin J, Burcin M. Overweight and obesity in lesbian and bisexual college women. J Am Coll Health. 2010;59:51–56. 5. Bostwick WB, Boyd CJ, Hughes TL, McCabe SE. Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. Am J Public Health. 2010;100: 468–475. 6. Grant JE, Odlaug BL, Derbyshire K, Schreiber LRN, Lust K, Christenson G. Mental health and clinical correlates in lesbian, gay, bisexual, and queer young adults. J Am Coll Health. 2014;62:75–78. VOL 62, AUGUST/SEPTEMBER 2014
7. Lee JG, Griffin GK, Melvin CL. Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review. Tob Control. 2009;18:275–282. 8. Boehmer U, Miao X, Linkletter C, Clark MA. Adult health behaviors over the life course by sexual orientation. Am J Public Health. 2012;102:292–300. 9. Blosnich JR, Jarrett T, Horn K. Racial and ethnic differences in current use of cigarettes, cigars, and hookahs among lesbian, gay, and bisexual young adults. Nicotine Tob Res. 2011;13:487–491. 10. Reed E, Prado G, Matsumoto A, Amaro H. Alcohol and drug use and related consequences among gay, lesbian and bisexual college students: role of experiencing violence, feeling safe on campus, and perceived stress. Addict Behav. 2010;35:168–171. 11. Bernert DJ, Ding K, Hoban MT. Sexual and substance use behaviors of college students with disabilities. Am J Health Behav. 2012;36:459–471. 12. McCabe SE, Hughes TL, Bostwick WB, West BT, Boyd CJ. Sexual orientation, substance use behaviors and substance dependence in the united states. Addiction. 2009;104:1333–1345. 13. Bostwick WB, McCabe SE, Horn S, Hughes T, Johnson T, Valles JR. Drinking patterns, problems and motivations among collegiate bisexual women. J Am Coll Health. 2007;56:285–292. 14. Kosciw JG, Greytak EA, Bartkiewicz MJ, Boesen MJ, Palmer NA, Gay, Lesbian and Straight Education Network (G.L.S.E.N.). The 2011 National School Climate Survey: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth in Our Nation’s Schools. New York, NY: Gay, Lesbian and Straight Education Network (GLSEN); 2012. 15. Rankin S, Weber GN, Blumenfeld WJ, Frazer S, Pride C. State of Higher Education For Lesbian, Gay, Bisexual & Transgender People: Campus Pride 2010 National College Climate Survey. Charlotte, NC: Campus Pride; 2010. 16. Oswalt SB, Wyatt TJ. Sexual orientation and differences in mental health, stress, and academic performance in a national sample of U.S. college students. J Homosex. 2011;58:1255–1280. 17. Institute of Medicine. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press; 2011. 18. Duryea DG, Frantz TT. An examination of drinkers’ consequences by sexual orientation. J Am Coll Health. 2011;59:649–654. 19. Fredriksen-Goldsen KI, Kim HJ, Barkan SE, Balsam KF, Mincer SL. Disparities in health-related quality of life: a comparison of lesbians and bisexual women. Am J Public Health. 2010;100:2255–2261. 20. Kerr DL, Santurri L, Peters P. A comparison of lesbian, bisexual, and heterosexual college undergraduate women on selected mental health issues. J Am Coll Health. 2013;61:185–194. 21. Green KE, Feinstein BA. Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment. Psychol Addict Behav. 2012;26:265–278. 22. Lindley LL, Barnett CL, Brandt HM, Hardin JW, Burcin M. STDs among sexually active female college students: does sexual orientation make a difference? Perspect Sex Reprod Health. 2008;40:212–217. 23. Oswalt SB. Don’t forget the “B”: considering bisexual students and their specific health needs. J Am Coll Health. 2009;57:557–560. 24. American College Health Association. American College Health Association-National College Health Assessment, Fall 2011. Baltimore, MD: American College Health Association; 2012. 25. Schick V, Dodge B. Introduction to the special issue: Bisexual health: unpacking the paradox. J Bisex. 2012;12:161–167. 26. Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36:38–56. 27. Lehavot K, Simoni JM. The impact of minority stress on mental health and substance use among sexual minority women. J Consult Clin Psychol. 2011;79:159–170. 405
Klein & Dudley 31. Rieger G, Savin-Williams R. The eyes have it: sex and sexual orientation differences in pupil dilation patterns. PLoS ONE. 2012;7(8):e40256. 32. Kim H, Fredriksen-Goldsen K. Hispanic lesbians and bisexual women at heightened risk or health disparities. Am J Public Health. 2012;102:e9–e15. Received: 31 October 2013 Revised: 18 March 2014 Accepted: 19 April 2014
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28. Schrimshaw EW, Siegel K, Downing MJ, Parsons JT. Disclosure and concealment of sexual orientation and the mental health of non-gay-identified, behaviorally-bisexual men. J Consult Clin Psychol. 2010;81:141–153. 29. Ross LE, Dobinson C, Eady A. Perceived determinants of mental health for bisexual people: a qualitative examination. Am J Public Health. 2010;100:496–502. 30. Cerny JA, Janssen E. Patterns of sexual arousal in homosexual, bisexual, and heterosexual men. Arch Sex Behav. 2011;40:687–697.
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JOURNAL OF AMERICAN COLLEGE HEALTH
Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
Impediments to Academic Performance of Bisexual College Students a
b
Nicole Aydt Klein PhD & Michael G. Dudley PhD a
Department of Kinesiology and Health Education, Southern Illinois University Edwardsville Edwardsville, Illinois b
Department of Psychology, Southern Illinois University Edwardsville, Edwardsville, Illinois Accepted author version posted online: 02 May 2014.Published online: 15 Aug 2014.
To cite this article: Nicole Aydt Klein PhD & Michael G. Dudley PhD (2014) Impediments to Academic Performance of Bisexual College Students, Journal of American College Health, 62:6, 399-406, DOI: 10.1080/07448481.2014.917653 To link to this article: http://dx.doi.org/10.1080/07448481.2014.917653
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JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 62, NO. 6
Major Article
Impediments to Academic Performance of Bisexual College Students
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Nicole Aydt Klein, PhD; Michael G. Dudley, PhD
Abstract. Objective: To investigate health-related impediments to academic success for bisexual college students. Participants: Respondents to the Fall 2011 American College Health Association–National College Health Assessment II (ACHA-NCHA II) survey who self-identified as bisexual, heterosexual, gay, or lesbian. Methods: Secondary analyses of the ACHA-NCHA II data were conducted to compare the experiences of bisexual students with both each other (bisexual men and bisexual women) and those of their nonbisexual counterparts (heterosexual and gay/lesbian students). Results: Bisexual college students are a large and distinct sexual minority group. On all measures with the exception of discrimination, bisexual college students reported the strongest threats to academic success of all sexual orientations. Conclusions: Given the unique impediments for bisexual students, college health professionals should consider specifically addressing needs for bisexual students, bisexual women in particular.
LGB students who navigate multiple challenges, such as discrimination based on sexual orientation as well as disabilities, race, gender, or sex, are at a higher risk. Bernert et al11 found that college students who reported a disability (eg, attention-deficit/hyperactivity disorder [ADHD], chronic illness, psychiatric condition, physical disability), which included a high percentage of LGB students, were more likely to engage in both substance abuse and sexual risk–taking than those without disabilities. Other studies have found that LGB adults who report having experienced more than 1 type of discrimination (eg, sexual orientation and gender discrimination or sexual orientation and race) were more likely to have abused illicit drugs in the previous year than LGB adults who reported no discrimination.12,13 Of particular interest to those working in student health are experiences that affect LGB individuals’ academic success. The Gay, Lesbian and Straight Education Network’s (GLSEN’s) most recent study on the experiences of LGBT (lesbian, gay, bisexual, transgender) students in middle and high schools found that students who reported higher levels of victimization at school had grade point averages (GPAs) that were lower (2.9 vs 3.2) and were less likely to plan to attend college or university than other students.14 For those who do continue to postsecondary education, college students who identify as LGBQ (lesbian, gay, bisexual, queer) often consider leaving the institution, especially in their first years.15 A study of how mental health and stress affected academic performance for sexual minority college students by Oswalt and Wyatt16 found that LGB students reported experiencing more anxiety, depression, and discrimination that had an effect on their academic performance than heterosexual students. Within the LGB and unsure students, the researchers found that bisexual students reported the highest frequency of mental health challenges and had more relationship difficulties, physical assaults, and sexual assaults that affected their academic performance.
Keywords: academic performance, bisexual, college health, health education
A
s public discussion of issues related to sexual orientation increases, researchers and health professionals have identified specific health disparities that exist for lesbian, gay, and bisexual (LGB) populations.1 Consistently, the bulk of the research finds that LGB (ie, sexual minority) individuals have increased risks for sexual victimization,2 self-injury and suicide ideations and attempts,3 overweight and obesity for lesbian and bisexual women,4 mood and anxiety disorders,5,6 tobacco use,7–9 and alcohol and illicit drug use,10,11 particularly when compared with their heterosexual counterparts.
Dr Klein is with the Department of Kinesiology and Health Education at Southern Illinois University Edwardsville in Edwardsville, Illinois. Dr Dudley is with the Department of Psychology at Southern Illinois University Edwardsville in Edwardsville, Illinois. Copyright Ó 2014 Taylor & Francis Group, LLC 399
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Traditionally, research on health-related outcomes among sexual orientation minority members has combined lesbian, gay, and bisexual respondents into 1 homogenous category. The Institute of Medicine’s report on LGBT health recommends studying these groups separately.17 Studies that have focused specifically on differences between these sexual orientation minority groups yield some interesting results. Those specifically examining the health of bisexual populations, for example, have found greater incidence of suicide,3 more negative alcohol outcomes such as self- or otherinjury,18 poorer mental health19 and greater stress,5,20 higher incidence of substance abuse,7,21 and greater rates of sexually transmitted infections22 than in heterosexual and lesbian/gay populations. Bostwick et al13 found that although bisexual women drank less alcohol than heterosexual women, they were more likely to contemplate suicide while intoxicated. With few exceptions, such as Struble et al,4 who found no difference in rates of overweight and obesity in lesbian and bisexual college women, research finds that bisexual individuals often report more health risks than both heterosexual and gay and lesbian populations, which strongly suggests that additional investigation into the potentially unique characteristics of individuals who identify as bisexual is certainly warranted.23 Although most studies of sexual minority groups combine lesbian, gay, and bisexual respondents into 1 group, studies that do examine the groups separately still are unlikely to look at differences between men and women. This study examines how health-related impediments to academic success affect sexual minority students, specifically bisexual college students, by asking several questions. First, to what extent do bisexual college students report different factors affecting their academic performance than heterosexual students and gay/lesbian students? To what extent to bisexual women report different factors affecting their academic performance than bisexual men? Are there significant differences in impediments to academic performance between bisexual women and lesbian women and bisexual men and gay men? Finally, are there impediments that affect the GPA of bisexual students that do not affect the GPA of nonbisexual students? METHODS To examine these research questions, data from the American College Health Association–National College Health Assessment II (ACHA-NCHA II)24 obtained during the survey period Fall 2011 were analyzed. This annual survey is designed to collect information from both public and private 2- and 4-year institutions about college students’ health behaviors. Although only schools that randomly select classrooms to survey are included in the database and the data have compared favorably with other national college student surveys, the survey cannot be considered generalizable because colleges and universities must self-select to participate. The full data set used in the current analyses included 44 schools, with 27,774 students taking the full 66-item survey. The majority of the participants were 400
female (66.1%), white (75.6%), not in a relationship (50.5%), heterosexual (92.2%), with a mean age of 22.25 years (median 20 years). As this project used secondary analysis of data with no identifiers, it was determined by the authors’ Institutional Review Board to not meet the human subjects research definition. Exploratory analyses were conducted using SPSS Statistics 20 for Windows (IBM SPSS, Armonk, New York) to investigate the experiences of bisexual college students, compared with their nonbisexual counterparts. The participants were asked, “Within the last 12 months, have any of the following affected your academic performance?” Response options were “This did not happen to me,” “I have experienced this issue but my academics have not been affected,” “Received a lower grade on an exam or important project,” “Received a lower grade in the course,” “Received an incomplete or dropped the course,” and “Significant disruption in thesis, dissertation, research, or practicum work.” For use as dependent variables, these 6 responses were averaged together, with higher scores reflecting greater interruptions to academic performance (range from 1 D did not happen to 6 D significant disruption). Similar composites were created for each variable as shown in the tables (eg, alcohol use, drug use). As shown in Table 1, a series of 1-way multivariate analyses of variance was conducted to investigate differences in potential impediments to academic performance based on sexual orientation. Specifically, bisexual students were compared first with heterosexual students, then with gay/lesbian students. Table 2 was similarly computed, comparing bisexual women and bisexual men, bisexual women and lesbian women, and, finally, bisexual women and heterosexual women. Table 3 specifically examined the same academic impediments for bisexual men versus gay men and bisexual men versus heterosexual men. Finally, a set of exploratory analyses was conducted to test for possible interaction effects between sexual orientation and academic impediments. For ease of interpretation, categorical variables were created using a median split, with GPA as the dependent variable. This was conducted for bisexual men and bisexual women separately as well as for both genders combined. RESULTS Bisexual college students were found to be a large and distinct group. Although often combined with gay, lesbian, and sometimes transgendered students, more respondents identified as bisexual (n D 792) than gay or lesbian (n D 572). In addition, bisexual respondents had distinctly different threats to their academic success than either heterosexual or gay/lesbian respondents. When compared with heterosexual students (n D 21,835), bisexual students had significantly stronger impediments to academic success than heterosexual students for virtually all the variables studied. When compared with gay/lesbian respondents, the bisexual respondents reported that certain experiences had a similar or greater negative effect on their academic JOURNAL OF AMERICAN COLLEGE HEALTH
Impediments to Academic Performance and Bisexuality
TABLE 1. Impediments to Academic Performance for Bisexual College Students, Compared With Heterosexual and Gay/Lesbian Students
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Impediments Alcohol use Drug use Eating disorder/problem Gambling Internet use/Computer games Allergies Cold/Flu/Sore throat Chronic health problem Chronic pain Injury Pregnancy STD/STI Sinus/Ear/Streptococcal infection Anxiety Depression Discrimination Homesickness Sleep difficulties Stress Assault (physical) Assault (sexual) ADHD Learning disability Concern for family or friend Death of family member or friend Relationship difficulties Roommate difficulties Finances Extracurricular activities Work Other
Bisexual (n D 792)
Heterosexual (n D 21,835)
Bisexual vs Heterosexual p
Gay/Lesbian (n D 572)
Bisexual vs Gay/Lesbian p
1.58 1.24 1.14 1.04 1.72 1.45 1.86 1.34 1.29 1.19 1.06 1.04 1.37 2.15 2.04 1.23 1.35 2.12 2.52 1.09 1.13 1.37 1.18 1.83 1.37 1.71 1.44 1.71 1.60 1.81 1.12
1.46 1.10 1.06 1.03 1.54 1.34 1.66 1.15 1.13 1.15 1.04 1.02 1.26 1.70 1.41 1.04 1.31 1.77 2.11 1.03 1.04 1.16 1.10 1.50 1.25 1.45 1.33 1.41 1.54 1.62 1.06
.000 .000 .000 .511 .000 .000 .000 .000 .000 .043 .082 .001 .000 .000 .000 .000 .033 .000 .000 .000 .000 .000 .003 .000 .000 .000 .000 .000 .012 .000 .002
1.52 1.16 1.10 1.05 1.61 1.40 1.67 1.26 1.20 1.18 1.03 1.07 1.31 1.90 1.69 1.46 1.28 1.95 2.22 1.07 1.07 1.25 1.14 1.55 1.29 1.60 1.39 1.55 1.62 1.75 1.07
.519 .005 .233 .889 .095 .474 .000 .151 .007 .971 .585 .087 .467 .000 .000 .000 .227 .014 .000 .641 .001 .016 .678 .000 .257 .100 .636 .003 .986 .663 .246
Note. STD/STI D sexually transmitted disease/sexually transmitted infection; ADHD D attention-deficit/hyperactivity disorder. Response options were 1 D This did not happen to me; 2 D I have experienced this issue, but my academics have not been affected; 3 D Received a lower grade on an exam or important project; 4 D Received a lower grade in a class; 5 D Received an incomplete or dropped the course; 6 D Significant disruption in thesis, dissertation, research, or practicum work.
performance than did gay/lesbian respondents. Specifically, these included drug use, cold/flu/sore throat, chronic pain, anxiety, depression, sleep difficulties, stress, sexual assault, ADHD, concern for family members or friends, and finances (see Table 1). The only measured variable where bisexual students reported less negative effect on their academics than gay/lesbian students was in the area of discrimination—bisexual respondents reported less of an effect due to discrimination. Bisexual women emerged as a distinct group. Bisexual women (n D 609) reported significantly greater educational impediments than bisexual men (n D 170) for cold/flu/sore throat, sinus/ear/strep, anxiety, depression, homesickness, sleep difficulties, stress, concern for family or friend, relationship difficulties, and finances (see Table 2). Bisexual women had fewer impediments due to gambling than bisexual men, which was low in general. Bisexual women reported greater health-related impediments to academic success than heterosexual women in all areas except for VOL 62, AUGUST/SEPTEMBER 2014
gambling, injury, pregnancy, homesickness, learning disabilities, and extracurricular commitments. Bisexual women differed from lesbian respondents in that they reported that depression, stress, sexual assault, and concern for family or friends were more likely to have affected their academic success. Conversely, bisexual women in the study reported discrimination affecting their academics less often than lesbian students. Bisexual men reported greater health-related impediments to academic success than heterosexual men for drug use, chronic health problems, chronic pain, anxiety, depression, discrimination, sleep difficulties, stress, ADHD, learning disabilities, and concern for family and friends (see Table 3). Bisexual men reported similar impediments as gay men, but bisexual men reported greater challenges from ADHD and learning disabilities and less effects from discrimination. Finally, results of the exploratory analyses involving the interaction effects between sexual orientation and academic 401
Klein & Dudley
TABLE 2. Impediments to Academic Performance for Bisexual Women, Compared With Bisexual Men, Lesbian Women, and Heterosexual Women
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Impediments Alcohol use Drug use Eating disorder/problem Gambling Internet use/Computer games Allergies Cold/Flu/Sore throat Chronic health problem Chronic pain Injury Pregnancy STD/STI Sinus/Ear/Streptococcal infection Anxiety Depression Discrimination Homesickness Sleep difficulties Stress Assault (physical) Assault (sexual) ADHD Learning disability Concern for family or friend Death of family member/friend Relationship difficulties Roommate difficulties Finances Extracurricular activities Work Other
Lesbian Bisexual women Heterosexual Bisexual women Bisexual Bisexual Bisexual vs Heterosexual women vs Lesbian women women vs men women women p (n D 14,580) women p (n D 609) (n D 170) Bisexual men p (n D 222) 1.57 1.22 1.16 1.02 1.70 1.48 1.92 1.36 1.31 1.20 1.06 1.04 1.42 2.23 2.12 1.23 1.38 2.18 2.58 1.09 1.15 1.35 1.15 1.89 1.38 1.77 1.47 1.76 1.59 1.84 1.12
1.59 1.26 1.08 1.09 1.79 1.38 1.66 1.25 1.22 1.17 1.03 1.04 1.21 1.82 1.78 1.19 1.24 1.92 2.30 1.08 1.05 1.41 1.27 1.58 1.32 1.51 1.32 1.50 1.61 1.68 1.08
.927 .689 .148 .003 .554 .292 .005 .368 .440 .883 .703 .906 .005 .000 .009 .788 .036 .024 .022 .962 .129 .753 .101 .004 .705 .009 .062 .001 .971 .214 .660
1.46 1.16 1.09 1.05 1.54 1.41 1.77 1.32 1.26 1.25 1.03 1.05 1.41 2.03 1.70 1.46 1.29 2.02 2.31 1.08 1.07 1.34 1.19 1.65 1.37 1.72 1.37 1.60 1.61 1.78 1.11
.123 .136 .190 .094 .069 .629 .192 .874 .673 .501 .761 .989 .997 .095 .000 .000 .291 .187 .006 .972 .012 .997 .751 .007 .996 .919 .321 .080 .997 .872 .989
1.44 1.07 1.07 1.01 1.51 1.36 1.74 1.18 1.14 1.14 1.04 1.02 1.31 1.79 1.44 1.04 1.36 1.81 2.21 1.03 1.04 1.14 1.10 1.57 1.27 1.48 1.35 1.44 1.55 1.65 1.06
.000 .000 .000 .979 .000 .000 .000 .000 .000 .061 .448 .044 .001 .000 .000 .000 .824 .000 .000 .000 .000 .000 .082 .000 .003 .000 .000 .000 .620 .000 .012
Note. STD/STI D sexually transmitted disease/sexually transmitted infection; ADHD D attention-deficit/hyperactivity disorder. Response options were 1 D This did not happen to me; 2 D I have experienced this issue, but my academics have not been affected; 3 D Received a lower grade on an exam or important project; 4 D Received a lower grade in a class; 5 D Received an incomplete or dropped the course; 6 D Significant disruption in thesis, dissertation, research, or practicum work.
impediments yielded several intriguing findings. Specifically, the following academic impediments were found to have a significant effect (p < .05) on GPA for bisexual college students, as compared with nonbisexual college students (heterosexual, gay/lesbian, and unsure). For collegiate bisexual males, physical assault (p D .003), injury (p D .029), pregnancy of a partner (p D .011), sexual assault (p D .002), and finances (p D .000) were more likely to affect their GPA. For collegiate bisexual women, only discrimination had a significant effect (p D .042), as compared with nonbisexual collegiate women. When both bisexual men and bisexual women were combined, only gambling (p D .012) and injury (p D .010) were significant. COMMENT Given that previous studies reveal that sexual minority students experience more health-related threats, is it not surprising that bisexual college students experience more 402
impediments to academic performance than heterosexual students. However, more interesting is that bisexual students are quite distinct from gay and lesbian students. This is important to consider because researchers and college health personnel often combine all sexual minority orientations into 1 LGB group, occasionally adding transgendered students who may or may not self-identify as gay, lesbian, or bisexual. When examining groups closely, it becomes clear that bisexual college students, particularly bisexual women, have more challenges to optimal performance in college and may need special consideration. The link between sexual orientation and health challenges is not new, yet it is important to be clear that being a sexual minority is not what increases negative outcomes for LGB individuals.23 Instead, it is likely the effect of social stressors such as discriminatory practices of individuals, groups, and institutions.25 The Meyer Minority Stress Model outlines the stigma, prejudice, and discrimination JOURNAL OF AMERICAN COLLEGE HEALTH
Impediments to Academic Performance and Bisexuality
TABLE 3. Impediments to Academic Performance for Bisexual Men, Compared With Gay Men and Heterosexual Men
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Impediments Alcohol use Drug use Eating disorder/problem Gambling Internet use/Computer games Allergies Cold/Flu/Sore throat Chronic health problem Chronic pain Injury Pregnancy STD/STI Sinus/Ear/Streptococcal infection Anxiety Depression Discrimination Homesickness Sleep difficulties Stress Assault (physical) Assault (sexual) ADHD Learning disability Concern for family or friend Death of family member or friend Relationship difficulties Roommate difficulties Finances Extracurricular activities Work Other
Bisexual men (n D 203)
Gay men (n D 383)
Bissexual men vs Gay men p
Heterosexual men (n D 8,187)
Bisexual men vs Heterosexual men p
1.59 1.26 1.08 1.09 1.79 1.38 1.66 1.25 1.22 1.17 1.03 1.04 1.21 1.82 1.78 1.19 1.24 1.92 2.30 1.08 1.05 1.41 1.27 1.58 1.32 1.51 1.32 1.50 1.61 1.68 1.08
1.56 1.14 1.08 1.03 1.64 1.38 1.58 1.20 1.12 1.11 1.01 1.06 1.23 1.79 1.66 1.43 1.25 1.88 2.14 1.04 1.05 1.18 1.08 1.44 1.23 1.49 1.38 1.50 1.60 1.71 1.02
.965 .065 1.000 .162 .345 1.000 .776 .679 .130 .656 .887 .574 .977 .990 .596 .000 .998 .983 .419 .507 .999 .006 .002 .261 .405 .988 .825 1.000 .999 .987 .490
1.50 1.15 1.03 1.06 1.62 1.30 1.51 1.10 1.11 1.17 1.04 1.02 1.17 1.53 1.34 1.05 1.21 1.70 1.91 1.03 1.02 1.19 1.11 1.38 1.19 1.39 1.27 1.37 1.53 1.56 1.06
.311 .038 .280 .738 .108 .294 .111 .001 .012 1.000 .990 .603 .171 .001 .000 .000 .901 .031 .000 .133 .305 .000 .001 .002 .052 .254 .753 .188 .598 .411 .934
Note. STD/STI D sexually transmitted disease/sexually transmitted infection; ADHD D attention-deficit/hyperactivity disorder. Response options were 1 D This did not happen to me; 2 D I have experienced this issue, but my academics have not been affected; 3 D Received a lower grade on an exam or important project; 4 D Received a lower grade in a class; 5 D Received an incomplete or dropped the course; 6 D Significant disruption in thesis, dissertation, research, or practicum work.
that shape an environment for sexual minorities that can influence their mental health.26 Multiple minority stressors such being victimized, pressure to hide sexual orientation, and internalized homophobia have been found to decrease the quality and quantity of social support for sexual minority women, in turn increasing their mental health and substance abuse issues.27 With the exception of discrimination, on every impediment studied, bisexual college students either had similar or more negative effects on their academic performance than gay or lesbian students. The additional challenges that bisexual students report may be due to myriad factors. It is possible that bisexual respondents are experiencing the stress of a “double closet” where they may be hiding samesex relationships from some friends and family and hiding other sex relationships from lesbian and gay peers.3 Not surprisingly, behaviorally bisexual men who conceal their sexual orientation have been found to have poorer mental VOL 62, AUGUST/SEPTEMBER 2014
health than gay men.28 In addition, bisexual college students may be experiencing internal and/or external biphobia—a less commonly recognized phobia in which bisexual people experience discrimination and negativity. Damaging assumptions (eg, individuals are actually gay/lesbian but afraid to fully come out, bisexuals are promiscuous, bisexuality is “trendy”) about bisexual people can exist within lesbian and gay communities as well as in the general population.29 Despite evidence that bisexuality is a true, physiological orientation,30,31 the rejection of bisexuality as legitimate persists and can contribute to bisexual college students’ health concerns becoming invisible. Perceptions such as these can contribute to a lack of a community identity and resources. Bisexual college women, the largest sexual minority group, experience numerous threats to health and academics. The current study compared bisexual women with 403
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bisexual men and found that the women had stronger impediments to academic performance than the men. An earlier study of the ACHA-NCHA II data found that bisexual women reported more mental health issues, and they had more of an effect of academic performance than lesbian women.16 Among other health-related issues, bisexual women have also been found to be at high risk of alcohol abuse8 and poor general health and distress.32 A recent study comparing bisexual and lesbian college students found bisexual women reported more anxiety, hopelessness, loneliness, sadness, and depression than lesbian women, in addition to being 1.26 times more likely to seriously consider suicide.21 We found that bisexual women reported depression and stress having more of an effect on their academics than any other group of women studied. An earlier study found higher rates of drug use in LGB adults who had experienced multiple discriminations; it is possible that bisexual women must navigate more marginalized identities than either lesbian women or bisexual men (sexism, heterosexism, biphobia), and this has a cumulative effect on their health- and academic-related outcomes. The results revealed that bisexual men had more impediments to their academic success than heterosexual men, but that bisexual men were very similar to gay men. Thus, interventions aimed at heterosexual men might not address issues with the sexual minority population, but those aimed at the general LGB college population are likely to be helpful for sexual minority men. Conversely, bisexual female students are quite different than lesbian students in what they report affects their academic performance. Programs intended for the general LGB college population are unlikely to address the unique needs of bisexual female college students. Having staff and faculty support for bisexual students might be as important to academic success for college students as it is to high school students. The GLSEN study referenced earlier found that middle and high school LGBT students who reported having 6 or more supportive staff members had GPAs that were significantly higher (3.2) than those who reported no support (2.9).14 Improving support and services to bisexual college students can include educating faculty and staff about bisexuality and challenges to academic success reported by bisexual college students, tailoring programs and support groups to bisexual students, and encouraging future research to study bisexuality separately from other sexual minority groups. Of particular interest in the ACHA-NCHA II data are those individuals who chose “unsure” regarding their sexual orientation status. Whereas bisexuality has often been theorized as a potential precursor towards a gay or lesbian identity, it is further possible that “unsure” could be a potential precursor towards a bisexual identity. A study by Lindley et al22 found that whereas lesbian women were least likely to report having had a sexually transmitted infection (STI), bisexual women and those who reported being unsure about their sexual orientation (particularly if they reported both male and female partners) had the 404
highest reports of STIs. Although outside the scope of the current study, it would be interesting to investigate to what extent the same personal and interpersonal variables affecting one’s academic progress for bisexual individuals may also be relevant indicators for the general well-being of those individuals who are unsure of their sexual orientation status.
Limitations One obvious limitation concerning this overall data set is the reliance on self-report data when categorizing individuals into their respective sexual orientation categories. As previously discussed, given the relative lack of empirical research regarding the identity formation processes of bisexuals, it is possible that some individuals who are more accurately gay or lesbian felt more comfortable identifying as bisexual for the purposes of this study, perhaps feeling this categorization was less stigmatizing than the other nonheterosexual options. As such, interpretation of the data indicating differences among gay, lesbian, and bisexual individuals should be understood to be only as accurate as the self-report data regarding sexual orientation status are accurate. An additional limitation concerning the interpretation of the significant differences between bisexual and nonbisexual individuals in this study is the relatively low detrimental impact that these variables had on academic outcomes. As indicated in Table 1, most responses were reported towards the lower end of the scale items, suggesting that the occurrence of these variables did not affect their academic performance to a great extent. However, because bisexual students do report distinctly greater academic difficulties compared with their nonbisexual counterparts, it merits particular attention to determine what specific strategies or interventions educators and health practitioners could engage in to either reduce or eliminate these additional obstacles for bisexuals as it relates to their academic success. Finally, as noted in Methods, ACHA-NCHA II data are not representative of US colleges and universities and therefore caution must be taken when generalizing the results. However, comparisons of the ACHA-NCHA II with samples intended to represent all US college students have yielded similar results.
Conclusions A particular strength to the current study is its specific focus on the academic-related outcomes of self-reported bisexual individuals as a distinct and separate category from nonbisexual individuals, even distinct from those who identify as gay or lesbian. As previously discussed, often all non–heterosexual-identified individuals are grouped together into one large category, suggesting that their life experiences and outcomes are homogenous. As the results JOURNAL OF AMERICAN COLLEGE HEALTH
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of this study indicate, however, such an amorphous categorization is greatly misleading and, more importantly, fails to account for the myriad ways in which bisexual individuals specifically are at greater risk for academic failure as a function of their unique sexual orientation minority status. Many campuses have services and student organizations that target LGBT populations, but given the specific needs for bisexual students, college health professionals should consider addressing the needs unique to this group, particularly bisexual women. Initiatives could start by promoting simple awareness with faculty, staff, and students that bisexual students outnumber those who identify as gay and lesbian. Other programming could address various topics, including the stress of constantly coming out that bisexual students may experience with each new relationship and inservice training with medical staff about specific health concerns. FUNDING No funding was used to support this research and/or the preparation of the manuscript. CONFLICT OF INTEREST DISCLOSURE The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board of Southern Illinois University Edwardsville. NOTE For comments and further information, address correspondence to Nicole Aydt Klein Department of Kinesiology and Health Education, Southern Illinois University Edwardsville, Edwardsville, IL 62026-1126, USA (e-mail: [email protected]). REFERENCES 1. Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S. Sexual and gender minority health: what we know and what needs to be done. Am J Public Health. 2008;98:989–995. 2. Rothman E, Silverman J. The effect of a college sexual assault prevention program on first-year students’ victimization rates. J Am Coll Health. 2007;55:283–290. 3. Blosnich J, Bossarte R. Drivers of disparity: differences in socially based risk factors of self-injurious and suicidal behaviors among sexual minority college students. J Am Coll Health. 2012;60:141–149. 4. Struble CB, Lindley LL, Montgomery K, Hardin J, Burcin M. Overweight and obesity in lesbian and bisexual college women. J Am Coll Health. 2010;59:51–56. 5. Bostwick WB, Boyd CJ, Hughes TL, McCabe SE. Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. Am J Public Health. 2010;100: 468–475. 6. Grant JE, Odlaug BL, Derbyshire K, Schreiber LRN, Lust K, Christenson G. Mental health and clinical correlates in lesbian, gay, bisexual, and queer young adults. J Am Coll Health. 2014;62:75–78. VOL 62, AUGUST/SEPTEMBER 2014
7. Lee JG, Griffin GK, Melvin CL. Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review. Tob Control. 2009;18:275–282. 8. Boehmer U, Miao X, Linkletter C, Clark MA. Adult health behaviors over the life course by sexual orientation. Am J Public Health. 2012;102:292–300. 9. Blosnich JR, Jarrett T, Horn K. Racial and ethnic differences in current use of cigarettes, cigars, and hookahs among lesbian, gay, and bisexual young adults. Nicotine Tob Res. 2011;13:487–491. 10. Reed E, Prado G, Matsumoto A, Amaro H. Alcohol and drug use and related consequences among gay, lesbian and bisexual college students: role of experiencing violence, feeling safe on campus, and perceived stress. Addict Behav. 2010;35:168–171. 11. Bernert DJ, Ding K, Hoban MT. Sexual and substance use behaviors of college students with disabilities. Am J Health Behav. 2012;36:459–471. 12. McCabe SE, Hughes TL, Bostwick WB, West BT, Boyd CJ. Sexual orientation, substance use behaviors and substance dependence in the united states. Addiction. 2009;104:1333–1345. 13. Bostwick WB, McCabe SE, Horn S, Hughes T, Johnson T, Valles JR. Drinking patterns, problems and motivations among collegiate bisexual women. J Am Coll Health. 2007;56:285–292. 14. Kosciw JG, Greytak EA, Bartkiewicz MJ, Boesen MJ, Palmer NA, Gay, Lesbian and Straight Education Network (G.L.S.E.N.). The 2011 National School Climate Survey: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth in Our Nation’s Schools. New York, NY: Gay, Lesbian and Straight Education Network (GLSEN); 2012. 15. Rankin S, Weber GN, Blumenfeld WJ, Frazer S, Pride C. State of Higher Education For Lesbian, Gay, Bisexual & Transgender People: Campus Pride 2010 National College Climate Survey. Charlotte, NC: Campus Pride; 2010. 16. Oswalt SB, Wyatt TJ. Sexual orientation and differences in mental health, stress, and academic performance in a national sample of U.S. college students. J Homosex. 2011;58:1255–1280. 17. Institute of Medicine. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press; 2011. 18. Duryea DG, Frantz TT. An examination of drinkers’ consequences by sexual orientation. J Am Coll Health. 2011;59:649–654. 19. Fredriksen-Goldsen KI, Kim HJ, Barkan SE, Balsam KF, Mincer SL. Disparities in health-related quality of life: a comparison of lesbians and bisexual women. Am J Public Health. 2010;100:2255–2261. 20. Kerr DL, Santurri L, Peters P. A comparison of lesbian, bisexual, and heterosexual college undergraduate women on selected mental health issues. J Am Coll Health. 2013;61:185–194. 21. Green KE, Feinstein BA. Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment. Psychol Addict Behav. 2012;26:265–278. 22. Lindley LL, Barnett CL, Brandt HM, Hardin JW, Burcin M. STDs among sexually active female college students: does sexual orientation make a difference? Perspect Sex Reprod Health. 2008;40:212–217. 23. Oswalt SB. Don’t forget the “B”: considering bisexual students and their specific health needs. J Am Coll Health. 2009;57:557–560. 24. American College Health Association. American College Health Association-National College Health Assessment, Fall 2011. Baltimore, MD: American College Health Association; 2012. 25. Schick V, Dodge B. Introduction to the special issue: Bisexual health: unpacking the paradox. J Bisex. 2012;12:161–167. 26. Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36:38–56. 27. Lehavot K, Simoni JM. The impact of minority stress on mental health and substance use among sexual minority women. J Consult Clin Psychol. 2011;79:159–170. 405
Klein & Dudley 31. Rieger G, Savin-Williams R. The eyes have it: sex and sexual orientation differences in pupil dilation patterns. PLoS ONE. 2012;7(8):e40256. 32. Kim H, Fredriksen-Goldsen K. Hispanic lesbians and bisexual women at heightened risk or health disparities. Am J Public Health. 2012;102:e9–e15. Received: 31 October 2013 Revised: 18 March 2014 Accepted: 19 April 2014
Downloaded by [McMaster University] at 11:34 04 December 2014
28. Schrimshaw EW, Siegel K, Downing MJ, Parsons JT. Disclosure and concealment of sexual orientation and the mental health of non-gay-identified, behaviorally-bisexual men. J Consult Clin Psychol. 2010;81:141–153. 29. Ross LE, Dobinson C, Eady A. Perceived determinants of mental health for bisexual people: a qualitative examination. Am J Public Health. 2010;100:496–502. 30. Cerny JA, Janssen E. Patterns of sexual arousal in homosexual, bisexual, and heterosexual men. Arch Sex Behav. 2011;40:687–697.
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