in the WHI sample were least likely to report having used oral contraceptives between the ages of 25 and 35 (only 16.7%). Approximately one-third of heterosexual women (32.0%) had used oral contraceptives during this age period as had 42.4% of mature lesbians.

Alcohol Use Among Lesbians. Reviews of lesbian health research have consistently identified alcohol abuse as a problem for which lesbians appear to be at greater risk than are heterosexual women (Cassidy and Hughes, 1997; Eliason, 1996; Haas, 1994; O'Hanlan, 1995; Rosser, 1993). Most studies, however, have had significant methodological limitations, so caution must be used in interpreting the results. Alcohol use among lesbians is described in more detail in a later section of this chapter dealing with substance abuse.

Childhood Sexual Abuse. Childhood sexual abuse has been associated with a variety of negative outcomes, including alcohol use and mental disorders such as depression (IOM, 1994). Most studies of lesbians indicate that their experiences of childhood sexual abuse are about the same as those of heterosexual women. For example, in a study of 50 lesbians admitted for substance abuse treatment in 1986-1987, Neisen and Sandall (1990) found that nearly 70% of the women reported a history of childhood sexual abuse, a rate comparable to that reported in studies of the general population of women in treatment for substance abuse (Rohsenow et al., 1988).

Like women in general, studies of lesbians who are not in treatment reveal significantly lower rates of childhood sexual abuse. Of the women surveyed in the NLHCS (Bradford et al., 1994b), 21% reported that they had been raped or attacked during childhood. Somewhat different results were obtained in a recent survey of lesbian health conducted in Chicago (Kalton, 1993). In this study, lesbians (n = 284) reported significantly higher overall rates of childhood sexual abuse (29%) than a comparison group of 134 heterosexual work colleagues (14%). However, childhood sexual abuse was not related to level of alcohol consumption or alcohol problems in either group. Finally, in a study of 523 female clients seen at a primary care health center, women who had experienced childhood sexual abuse were more likely than women who had not experienced abuse to

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