LGBT health最新文献

Purpose: The purpose was to investigate differences in polycystic ovary syndrome (PCOS) prevalence by sexual orientation among young adults in the United States. Methods: We used data from the Growing Up Today Study, a longitudinal cohort of young adults (age 23-35 in 2019). Participants assigned female at birth (N = 11,148) reported PCOS diagnoses on questionnaires between 2010 and 2019. We used modified-Poisson regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for PCOS diagnoses, comparing completely heterosexual participants (referent) to sexual minority participants (i.e., heterosexual with same-sex partnership, mostly heterosexual, bisexual, and lesbian). We also assessed whether health care utilization modified the association between sexual orientation and PCOS diagnosis. Models were adjusted for age and race/ethnicity. Results: The overall prevalence of PCOS in the sample was 8.1%. Compared to completely heterosexual participants, sexual minority participants had a higher adjusted prevalence of PCOS diagnosis (PR: 1.28, 95% CI: 1.12-1.46). Within sexual minority subgroups, mostly heterosexual (PR: 1.24, 95% CI: 1.06-1.45), bisexual (PR: 1.69, 95% CI: 1.29-2.22), and lesbian (PR: 1.50, 95% CI: 1.04-2.16) participants had an elevated prevalence of PCOS compared to completely heterosexual participants. Differences in PCOS diagnosis persisted within strata of time since the last routine physical exam. Conclusion: These findings provide some of the first estimates of PCOS among sexual minority people, emphasizing the need to address differences in reproductive health among sexual minority young adults. They also reveal that health care utilization increases the likelihood of receiving a diagnosis and highlight the importance of health care access.

Purpose: Sexual and gender minority (SGM) populations face substance use disparities attributed to minority stress. We examined the relationship between discrimination and alcohol and cannabis use among SGM and cisgender heterosexual people. Method: We conducted a cross-sectional analysis of the All of Us Research Program data (2017-2022) to examine the relationship between discrimination (Everyday Discrimination Scale [EDS]) and alcohol use (Alcohol Use Disorders Identification Test-consumption items [AUDIT-C]) and past 3-month cannabis use. Adjusted linear and logistic regression models were used for AUDIT-C scores and past 3-month cannabis use, respectively. We used interaction terms to assess how associations differed across sexual orientation and gender modality groups. Results: Among 98,820 participants, mean EDS scores were highest among gender minority (GM) people assigned female at birth (M = 14.78) and lowest among cisgender heterosexual men (M = 6.14). There was a nonlinear association between EDS and AUDIT-C scores. EDS scores were positively associated with AUDIT-C scores at low levels of discrimination; there was an inverse association at higher levels of EDS. EDS was associated with greater odds of past 3-month cannabis use, but associations were not significant at 2 standard deviations above mean EDS and higher. Interaction by sexual orientation and gender modality group was significant (p < 0.05), indicating that associations between discrimination and alcohol and cannabis use varied by group. Although estimates were largely imprecise, associations particularly varied among GM groups and cisgender sexual minority men. Conclusion: Discrimination had a nonlinear relationship with alcohol and cannabis use, and these relationships were pronounced among SGM subgroups.

Purpose: We aimed to investigate the association between sexual orientation and multiple types of adverse childhood experiences (ACEs) and to what extent ACEs mediate the association between sexual orientation and symptoms of depression and anxiety among sexual minority women (SMW). Methods: This was a cross-sectional analysis nested within the nationally representative Icelandic Stress-And-Gene-Analysis cohort. Data were collected from March 2018 to June 2019. Participants included 11,007 women, aged 18-69, with data on sexual orientation and ACEs. Self-reported data were obtained on 13 different ACEs, and current symptoms of depression and anxiety. Results: Overall, 724 (6.6%) identified as sexual minority. The mean age of SMW was 34.0 years (standard deviation [SD] 14.0) and 44.7 years (SD 14.0) for heterosexual women. SMW were more likely to report six or more ACEs than heterosexual women (21.7% vs. 11.3%, respectively), yielding an adjusted odds ratio (aOR) of 2.26 (95% confidence interval [CI] 1.76-2.91). SMW were more likely than heterosexual women to report four types of ACEs: specifically bullying, emotional abuse, sexual abuse, and mental illness in the household (aOR ranging from 1.36 to 1.71). SMW reported higher odds of current symptoms of depression (aOR = 2.10, 95% CI 1.77-2.49) and anxiety (aOR = 1.69, 95% CI 1.41-2.02). The total number of ACEs mediated 32.6% of the association between sexual orientation and depression, and 43.2% of the association between sexual orientation and anxiety. Conclusion: These findings suggest that ACEs are a major contributor to the mental health disparities observed among SMW.

Purpose: Our aim was to expand existing evidence on structural determinants of cardiovascular health disparities among lesbian, gay, and bisexual (LGB) adults by examining sexual orientation differences in the impact of sexual orientation-related nondiscrimination laws on 30-year cardiovascular disease (CVD) risk. Methods: We analyzed data from Waves III (2001-2002), IV (2008-2009), and V (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health. Sexual orientation was categorized as exclusively heterosexual, mostly heterosexual, bisexual, or gay/lesbian. We categorized changes in sexual orientation-related nondiscrimination laws between Waves III-IV as no change (reference group), increased, or decreased. We assessed 30-year CVD risk at Wave V using the Framingham Risk Score. We ran sex-stratified regression models to examine whether the association between changes in sexual orientation-related nondiscrimination laws and 30-year CVD risk was moderated by sexual orientation. Results: The sample included 3768 participants (mean age [standard deviation] = 28.7 [±1.72] years) of whom approximately 77% were White, 11% Hispanic, and 51% female. Compared with exclusively heterosexual participants, an increase in nondiscrimination laws was associated with lower CVD risk among mostly heterosexual women (B = -5.05, 95% confidence interval [CI] = -8.50 to -1.59) and gay men (B = -10.22, 95% CI = -19.05 to -1.39). There were no significant differences for other LGB subgroups when compared with exclusively heterosexual adults. Conclusions: Increasing laws that prohibit sexual orientation-related discrimination may play an important role in reducing CVD risk among some LGB subgroups. These findings can inform structural-level interventions to reduce CVD risk among LGB adults.

Amid increasing political threats to sexual and gender minority (SGM) research, this perspective reflects on the evolution of SGM research from the margins of public health to a robust field and assesses the unique vulnerabilities facing SGM researchers across career stages. We discuss how the field can protect its infrastructure, sustain its workforce, and preserve its impact, drawing inspiration from the harm reduction movement and our individual and collective experiences. This is both a reflection and a call to action grounded in care, intergenerational knowledge and solidarity, and the refusal to be erased.

Purpose: This study examined receipt of a well-woman visit (WWV) and cervical cancer screening (CCS) at the intersection of sexual orientation and race/ethnicity among Illinois women aged 21-65. Methods: This study used 2016, 2018, and 2020 Illinois Behavioral Risk Factor Surveillance System (BRFSS) data for women aged 21-65 to examine rates of CCS (n = 2848) and 2016-2018, 2020, and 2021 Illinois BRFSS data to examine WWV receipt (n = 5863) by sexual orientation (heterosexual vs. lesbian, gay, and bisexual [LGB]). Self-reported race/ethnicity was tested as an effect modifier to assess intersectionality. Using binomial regression, adjusted prevalence differences (aPD) and 95% confidence intervals (CIs) were estimated. Covariates included age, education, marital status, employment, and health insurance coverage. Results: Overall, 4.6% of Illinois women aged 21-65 self-identified as LGB. Heterosexual and LGB women had a similar prevalence of receipt of both a WWV (77.1% and 71.7%, respectively; aPD = 3.22, 95% CI: -3.62 to 10.06) and CCS (85.3% and 83.4%, respectively; aPD = 2.13, 95% CI: -4.77 to 9.04). Among non-Hispanic (NH) Black women, heterosexual compared with LGB women had a higher prevalence of receiving both types of care; however, adjusted associations included the null. Hispanic women had similar prevalence estimates by sexual orientation for both outcomes, and NH White heterosexual compared with LGB women had a higher prevalence of CCS, but not WWV. Conclusion: In Illinois overall, heterosexual and LGB women received preventive care at similar rates. However, when stratified by race/ethnicity, WWV and CCS receipt rates may be higher for heterosexual compared with LGB women, indicating potential missed opportunities for preventive care.

Purpose: This study aimed to characterize benefits of asynchronous online focus groups (AOFGs) for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexuality- and gender-expansive (LGBTQIA+) young adults with a cervix and to identify strategies for maximizing those benefits and optimizing data collection in order to increase equitable representation of this population in health research. Methods: From March to September 2022, we conducted six gender-stratified AOFGs with cisgender women, nonbinary people, and transgender men with a cervix ages 21-29 living in Massachusetts and Rhode Island. Participants completed a questionnaire to evaluate AOFG procedures and experiences. Based on these data and our observations of AOFG engagement, we developed and evaluated strategies to optimize both data collection and participant benefit. Results: AOFGs provided participants with informational and instrumental support, connection through shared experiences, and opportunity for introspection. Participants expressed a strong desire for social interaction within AOFG discussions, and we identified several strategies that were effective in promoting engagement and interaction in AOFGs. Conclusion: AOFGs can facilitate inclusion in research of LGBTQIA+ individuals for whom other data collection methods are inaccessible, and may offer direct social and emotional benefits to participants. Promoting social interaction among participants is essential for optimizing these benefits. These findings offer important insight for AOFG methodology as a means of increasing equitable representation of LGBTQIA+ people in health research while offering direct and immediate benefits to participants.

Purpose: This cross-sectional study investigated self-reassurance as a protective factor in mitigating depression related to internalized gender stigma and enhancing overall well-being among transgender and nonbinary (TNB) individuals during the first step of the gender-affirmation process. Methods: The study included 101 TNB individuals (mean age = 26.42, standard deviation = 8.83) accessing the "Be as You Are" Clinical and Research Center at Sapienza University of Rome, Italy, which offers psychological support for individuals undergoing gender-affirmation processes, from 2021 to 2024. Participants completed the Gender Minority Stress and Resilience Scale to assess internalized gender stigma; the Self-Criticizing/Attacking and Self-Reassuring Scale to evaluate self-criticism (i.e., hated-self and inadequate-self), and self-reassurance; and the Symptom Checklist-90 to measure depressive symptoms. Mediation and moderated mediation models were tested. Results: Mediation models indicated that inadequate-self significantly mediated the relationship between internalized gender stigma and depressive symptoms. The moderated mediation analysis revealed a complex pattern: higher levels of self-reassurance were associated with a more pronounced mediating effect of inadequate-self, suggesting that self-reassurance may facilitate awareness and processing of self-critical thoughts rather than simply buffer their impact. These findings suggest that self-reassurance is a complex psychological resource that may facilitate recognizing self-critical processes and contribute to emotional regulation during the gender-affirming process. Conclusion: These results underscore the dynamic role of self-reassurance in the initial stages of the gender-affirming process. Clinical approaches such as compassion-focused therapy may help foster self-reassurance and alleviate the psychological burden of minority stress, particularly during the vulnerable period of accessing gender-affirming care.

Purpose: This study examined the association between sexual orientation and the impact, diagnosis, and treatment of endometriosis. Methods: An online survey was conducted in 2023 with 150 adults in the United States diagnosed with endometriosis, 119 of whom identified as heterosexual and 31 with a minority sexual orientation. The impact of endometriosis was measured using the Endometriosis Impact Questionnaire (EIQ), consisting of eight subscales. We also assessed factors related to diagnosis and treatment satisfaction. Data were analyzed using independent samples t-tests and multiple linear regression. Results: Participants with a minority sexual orientation had a higher average impact of endometriosis on the EIQ physical, psychological, and social subscales than heterosexual participants but a lower impact on the fertility subscale, all with medium effect sizes. They took an average of 5 years longer to be diagnosed, with 83.9% of sexual minority versus 45.4% of heterosexual participants receiving at least one misdiagnosis. More sexual minority versus heterosexual participants also reported feeling dismissed or disbelieved (96.8% vs. 64.4%), not feeling listened to by providers (96.8% vs. 62.2%), and having difficulty communicating with providers (90.3% vs. 55.5%). The association between sexual orientation and the EIQ physical, psychological, and social subscales could be explained, in particular, by having been misdiagnosed. Conclusions: These results highlight the need for better medical education and inclusive gynecological care to promote timely diagnosis and treatment of endometriosis. They also suggest that provider biases and discrimination may contribute to a greater impact of endometriosis on sexual minority patients.