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: We aimed to classify youth using a longitudinal, multidimensional construct of gender, and examine associations of gender subgroups with substance cognitions and substance use.

Methods: We used data from the Adolescent Brain Cognitive Development study (N = 11,868 youth ages 9-10 years at baseline [2016-2018] through the year 4 follow-up [ages 13-14 years, 2020-2022]) to conduct latent class models using measures of gender identity, felt gender, gender expression, and gender non-contentedness. We used multivariable logistic regression to assess associations of gender classes with curiosity to use, intention to use, and use of alcohol, nicotine/tobacco, and cannabis, respectively, adjusting for sociodemographic factors.

Results: A four-class model was selected based on model fit: transgender (2.5%), questioning (9.0%), naïve (36.3%), and cisgender (52.1%). Youth in the questioning and transgender classes were more likely to report curiosity to use alcohol, nicotine/tobacco, and cannabis (adjusted odds ratio [aOR] range 1.68-2.45, p < 0.001) and intention to use alcohol and nicotine/tobacco (questioning youth; aOR range 1.69-1.88, p < 0.01) or nicotine/tobacco and cannabis (transgender youth; aOR range 2.66-3.14, p < 0.001) but not actual use of alcohol, nicotine/tobacco, and cannabis, whereas members of the naïve class were less likely to report curiosity to use alcohol, nicotine/tobacco, and cannabis, intention to use cannabis, and use of alcohol, nicotine/tobacco, and cannabis (aOR range 0.48-0.81, p < 0.001), relative to cisgender youth.

Conclusion: These findings suggest that a more nuanced understanding of gender among preadolescent youth and their heterogeneous risk for substance use is critical for the development of early prevention services. The timing of prevention efforts may be ideal during this developmental period.

Purpose: This study investigated how age at the time of surgery influences patient-reported outcomes using the Transgender Quality of Life Questionnaire (TRANS-Q).

Methods: We conducted a retrospective survey from 2021 to 2023 among trans masculine individuals who underwent bilateral mastectomy at a single academic institution. The TRANS-Q was distributed postoperatively (n = 131; response rate: 49.2%). In addition, three items assessing the perceived ideal age for surgery were added. Participants were stratified into three age groups based on age at the time of surgery (16-20, 21-30, ≥31 years). Primary outcomes were group comparisons across TRANS-Q items. Secondary outcomes included predictors of (1) overall satisfaction, (2) ideal age for surgery, (3) self-confidence during sex, and (4) scar appearance. Predictors, selected based on clinical rationale, were incision technique, body mass index (BMI), mental disorder, resection weight, satisfaction scores, and age group. Analyses included nonparametric group comparisons and proportional odds logistic regression.

Results: Across all age cohorts satisfaction scores were high. The only significant intergroup variation concerned the ideal age for surgery: younger patients expressed a preference for earlier intervention compared to older cohorts (p < 0.001). Regression models identified BMI and incision technique as relevant predictors of satisfaction and scar appearance, respectively. Mental health diagnoses were weakly associated with earlier preferred timing.

Conclusions: Our findings affirm the benefit of chest masculinization across age groups, while highlighting that younger patients favor earlier surgical timing. This underscores the need for age-sensitive counseling. Personalized timing strategies-rooted in autonomy-may optimize long-term outcomes in gender-affirming care.

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: Experiences with the criminal legal system can increase the risk of HIV transmission and disrupt linkage to HIV care and prevention. This study quantified the association between criminal legal system involvement and HIV outcomes among transgender women of color (TWOC).

Methods: We conducted a cross-sectional analysis using first-wave data from the Trying to Understand Relationships, Networks, and Neighborhoods Among Transgender Women of Color Cohort Study (n = 314). We investigated the association between measures of criminal legal system involvement (history of arrest and history of incarceration) and HIV care and prevention outcomes (serostatus, testing, condom use, pre-exposure prophylaxis use, and viral load suppression) among TWOC living in New York City from August 2020 to November 2022. We used modified Poisson regression models to calculate the adjusted prevalence ratios.

Results: Among our cohort of TWOC, 50% had previously been arrested and 28% had previously been incarcerated. Half of the participants were living with HIV. History of incarceration was positively associated with living with HIV. Among those living with HIV, a history of incarceration was associated with an increased risk of having a detectable HIV viral load.

Conclusions: Among TWOC in our study, criminal legal system involvement was significantly associated with HIV seropositivity and having a detectable viral load among those living with HIV. These findings highlight the negative health implications of the criminal legal system for a socially oppressed population and can potentially inform future directions to challenge policing practices that disproportionately target TWOC.

Purpose: This study compared the prevalence of hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD) between transgender and gender-diverse (TGD) individuals and cisgender individuals.

Methods: We conducted a retrospective analysis using a large electronic health record database spanning 2004-2024. TGD individuals were identified using International Classification of Diseases, Tenth Revision codes related to gender identity and stratified by hormone therapy status. Cisgender comparison groups were defined by the absence of gender identity diagnoses and hormone therapy exposure. Prevalence odds ratios (ORs) with 95% confidence intervals were calculated to compare hEDS and HSD diagnoses between groups.

Results: TGD individuals demonstrated a significantly higher prevalence of hEDS and HSD than cisgender individuals (OR: 18.45). The prevalence among TGD individuals assigned female at birth was 2.62%, and among those assigned male at birth, 1.00%, compared with 0.16% and 0.04% in cisgender females and males, respectively. Hormone therapy status was not associated with significant differences in prevalence.

Conclusions: These findings indicate a substantially increased burden of hypermobility-related disorders among TGD individuals. Enhanced clinical recognition and multidisciplinary management strategies are needed to address the unique health care challenges faced by this population.

Purpose: The purpose of this study was to reexamine the association between marriage and health among partnered gay and lesbian adults, comparing married individuals with those in unmarried couples.

Methods: Using a decade of large-scale, representative data from the Behavioral Risk Factor Surveillance System 2014-2023, we analyzed partnered, cisgender gay and lesbian adults aged 18-65 (N = 10,973). Negative binomial regression models estimated the number of poor mental and physical health days, whereas logistic regression models predicted the probability of frequent mental and physical distress. Analyses adjusted for sociodemographic factors and explored the role of socioeconomic factors. To enhance comparability between married and partnered, unmarried individuals, a propensity score-based inverse probability weighting approach was adopted.

Results: Married gay and lesbian individuals exhibited mental and physical health comparable to their partnered, unmarried counterparts. However, an exception was that married gay men experienced a mental health advantage, even after adjusting for socioeconomic resources.

Conclusion: The mental health advantage among married gay men highlights the importance of symbolic resources such as social recognition. Overall, however, the findings did not support the marital advantage theory among partnered lesbian and gay individuals, potentially due to the weaker institutionalization of same-sex marriage and elevated couple-level minority stress. Future research should further investigate sexual minority health within family contexts, incorporating diverse gender and sexual identities.

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.