LGBT health最新文献

Purpose: Toward the goal of developing standardized sex, sexual orientation, and gender identity (SSOGI) measures that can be used across demographics and regions, this review aimed to synthesize and summarize how SSOGI have been assessed within health research, including the quality and validity of these measures. Methods: We conducted a systematic review of peer-reviewed research developing or evaluating SSOGI measures in PubMed, PsycInfo, CINAHL, and Health and Psychosocial Instruments bibliographic databases. Eligible studies reported original peer-reviewed research focused on SSOGI measurement in adult populations in the United States from 2012 through June 7, 2022. In consultation with librarians, search results were screened for inclusion using an innovative multiple-phase method of stratification, supervised clustering, and supervised machine learning. We conducted manual screening and data extraction in Covidence. Results: In total, 17,814 citations were returned from all databases, with 30 studies eligible for final inclusion in the review. Gender identity measurement was the focus of half of the included studies (51%), followed by sexual orientation (40%), with little asexuality-specific measurement research (n = 1 study), and beyond sexual orientation, research on sex or variations in sexual characteristics (n = 1 study, each). Conclusions: Although the field of sexual and gender minority health research has grown exponentially over the past decade, there remains a dearth of literature focused on the development and evaluation of SSOGI measures. We found heterogeneity across the SSOGI measurement literature including by study design, sampling strategy, and study population. Important identified gaps include the need for attention to the measurement of sex, variations in sex characteristics, and asexuality-inclusive sexual orientation measures.

Purpose: We evaluated the performance of computational phenotypes (CPs) in commercial insurance claims for identifying transgender (TG) individuals and assessed trends in population size and depression and anxiety prevalence of the TG population. Methods: We compared two previously defined CPs by measuring their concordance. We combined CPs to establish a cohort of TG individuals from Merative^TM MarketScan® commercial insurance claims (2007-2021) to measure population and mental health trends using joinpoint regression. Results: Due to high levels of overlap between CPs, we combined CPs to reach our sample size of 67,809 unique individuals. TG-related International Classification of Diseases (ICD) diagnoses codes increased from 59% of TG claims in 2007 to 97% in 2021. We observed a sharp increase in the prevalence of TG-related claims in 2012 by 42.3% (95% confidence interval [CI] = 35.8-56.8) per year then by 17.0% per year (95% CI = 6.1-23.7) from 2017 to 2021. Among TG individuals there was a gradual increase in mental health-related claims from 2007 to 2015, which remained stable until there was a 10% decrease in 2021. Conclusion: The combined CP identified the largest TG population in commercial insurance claims to date. Most TG individuals were identified through TG-related ICD codes for both CPs. Increases over calendar time may represent an increased access to insurance-covered gender-affirming services. Persistently high depression and anxiety-related claims suggest an ongoing need to reduce the burden of psychiatric-related claims in this population.

Purpose: The current study examined relations among racial discrimination (RD), depression/suicidality, substance use, and school connectedness among Black youth who identified as lesbian, gay, bisexual, some other way, or not sure (LGBQ) and heterosexual youth. Methods: Data were obtained from the Adolescent Behaviors and Experiences Survey (ABES) conducted by the Centers for Disease Control and Prevention during January-June 2021. ABES was a one-time, online survey given to a nationally representative sample of U.S. high school students. Data for the current study included 1189 Black 9th-12th graders (50.0% female and 18.8% LGBQ). Measures included self-reports of depression/suicidality during the past year, substance use in the past 30 days, current feelings of school connectedness, RD in school across the lifespan, and sexual identity. Structural equation modeling was utilized to examine study aims. Results: Black LGBQ youth reported higher levels of RD, depression/suicidality, and substance use but lower school connectedness compared with heterosexual Black youth. RD was positively associated with depression/suicidality (b = 0.876, standard error = 0.197, p < 0.001) but not with substance use (p = 0.366). Sexual identity and school connectedness did not moderate the relationships between RD and depression/suicidality or RD and substance use. Conclusion: RD's positive association with depression/suicidality and lack of association with substance use was similar for Black heterosexual and LGBQ youth. Future research should expand on the role of intersectionality with other identity groups and protective factors for school-based RD experiences. Educators should explore interventions beyond only school connectedness for reducing school-based RD for Black youth.

Purpose: Sexual minority (SM) women have more dementia risk factors than heterosexual women, but it remains unknown whether they experience increased symptoms of subjective cognitive decline (SCD)-a key predictor of dementia. Methods: We investigated sexual orientation-related disparities in SCD in Nurses' Health Study II (N = 70,772). Sexual orientation subgroups included completely heterosexual (n = 62,884); participants identifying as heterosexual with same-sex experience ("heterosexual-SM", n = 5017); and participants identifying as mostly heterosexual (n = 1825), bisexual (n = 287), or lesbian/gay (n = 759). SCD was measured using seven symptoms from the Structured Telephone Interview for Dementia Assessment, controlling for demographics with Poisson regression models. Results: Relative to completely heterosexual participants, SM participants had 29% more SCD symptoms (95% confidence interval [CI] = 1.26-1.32). Symptoms were elevated in every SM subgroup; the largest disparities were among bisexual and mostly heterosexual subgroups (adjusted risk ratios for 1-unit increment in symptoms [aRR]: 1.60, 95% CI = 1.45-1.77; 1.48, 95% CI = 1.42-1.54, respectively) followed by lesbian/gay (aRR: 1.22, 95% CI = 1.14-1.31) and heterosexual-SM participants (aRR: 1.21, 95% CI = 1.18-1.25). Conclusion: SM women-particularly bisexual and mostly heterosexual women-had more symptoms of SCD than completely heterosexual women. These findings align with known sexual orientation-related disparities in dementia risk factors (e.g., mental health, substance use), and indicate that better understanding and closer monitoring of cognitive health in SM groups remains important for prevention efforts as an increasing proportion of aging Americans identifies as SM.

Purpose: The purpose of this study was to examine associations across gender identity subgroups and cardiovascular disease (CVD) subsets including myocardial infarction (MI), stroke, and coronary heart disease/angina. Methods: Nationally representative cross-sectional data from the Behavioral Risk Factor Surveillance System years 2019 and 2021 were analyzed. Multivariable logistic regression was conducted to assess the odds ratios of CVD and disease subsets for transgender women, transgender men, and gender nonconforming individuals compared to cisgender men and cisgender women. Results: In total, 2108 survey participants identified as transgender of which 35.0% were transgender women, 34.1% were transgender men, and 30.9% were gender nonconforming individuals. Compared to cisgender women, transgender men (adjusted odds ratio [aOR]: 1.62; 95% confidence interval [CI]: 1.02-2.58) and cisgender men (aOR: 1.85; 95% CI: 1.76-1.94) had increased odds of CVD. Transgender women (aOR: 2.25; 95% CI: 1.07-4.73), transgender men (aOR: 1.97; 95% CI: 1.06-3.65), gender nonconforming individuals (aOR: 2.47; 95% CI: 1.08-5.61), and cisgender men (aOR: 2.55; 95% CI: 2.37-2.73) all had higher odds of MI when compared to cisgender women. Transgender men (aOR: 2.05; 95% CI: 1.01-4.16) and cisgender men (aOR: 2.07; 95% CI: 1.94-2.21) had higher odds of heart disease/angina than cisgender women. Conclusion: This study revealed variability in self-reported CVD among transgender men, transgender women, and gender nonconforming individuals compared with cisgender men and cisgender women. This emphasizes the need for targeted research and interventions to improve health outcomes in these populations.

Purpose: This study examined associations between social determinants of health (SDOH) and overall health and quality of life (QOL) among sexual and gender minority (SGM) people in New York State. Methods: SGM individuals (N = 2342) completed a community needs assessment survey in 2021. Among an analytic sample (N = 2279), hierarchical regression models examined the relative strength of the association between primary SDOH barriers (i.e., food insecurity, unstable housing, economic insecurity) and overall health and QOL relative to secondary SDOH barriers (i.e., medical mistrust, social isolation, SGM health-related structural barriers) and psychosocial barriers to engaging in care (i.e., depressive symptoms, lack of SGM community connectedness). Path models explored significant secondary barriers to care as potential explanatory mechanisms between primary SDOH barriers and outcomes. Results: In hierarchical regression models, depressive symptoms were most strongly associated with overall health, whereas primary SDOH barriers were associated with poor QOL over other factors considered. In path models, a statistically significant path for depressive symptoms was found for both overall health and QOL. Social isolation and SGM health related structural barriers were also significant paths between primary SDOH barriers and both outcomes. Conclusion: This study demonstrates the complex relationships that exist between SDOH-related barriers and critical health outcomes for SGM people. Entities seeking to improve these outcomes should focus attention on advancing structural competency to assess and address a broader than traditionally considered range of barriers that are likely present at elevated levels for SGM populations.

Purpose: This longitudinal study compared the presence of information about gender-affirming care (GAC) on U.S. pediatric hospital websites in March 2022, when bans on the provision of pediatric GAC had been passed in two states, versus in October 2023, when bans had been passed in 22 states and implemented in 15 states without court blockage. Methods: All U.S. pediatric hospitals, sourced from online databases, excluding specialty hospitals (e.g., rehabilitation) were included (n = 149). In March 2022 and October 2023, two independent reviewers systematically reviewed each hospital website for GAC information. The presence of GAC information on websites was analyzed based on: 1) GAC legal status (legal, banned, or proposed ban blocked by court) in the hospital's state, (2) geographic location using the U.S. Census regions (Northeast, Midwest, South, and West), (3) the presence of hospital affiliation with a U.S. medical school, and (4) presence of hospital religious affiliation. Results: A total of 149 pediatric hospital websites were surveyed. In 2022, 105 (70%) hospital websites published content about GAC offerings versus 87 (58%) in 2023 (p = 0.001). This decrease in available information was significant in states where GAC bans had been passed without court blockage (60% vs. 29%, p = 0.001) and in the Southern region (63% vs. 39%, p = 0.004). Academic and secular hospitals were also more likely to include GAC information on websites. Conclusion: Legislation may hinder the ability of transgender youth and/or their parents to access previously available information about GAC and to identify local transgender care providers.

Purpose: The Social Media and Sexual Health (SMASH) campaign, a multi-component study, aimed to address disparities in pre-exposure prophylaxis (PrEP) use among young Black and Latino men, ages 18-29, who have sex with men (YBLMSM) by using social media influencers and short videos to promote awareness and uptake. To inform the campaign's content and strategy, we conducted focus groups to explore YBLMSM's social media behaviors and perceptions of social influencers as PrEP messengers, including preferences for content, messaging, length, selection of appropriate influencers, and delivery methods that resonated with the target audience, and aligned with the SMASH campaign's goals. Methods: Between January and March 2021, we conducted five virtual focus groups with 22 YBLMSM to identify their preferred social media platforms, how they engage with social media, and their views on the potential of influencers to be effective PrEP messengers. Focus groups were audio-recorded, transcribed, and analyzed using template analysis. Results: Instagram was the most frequently used platform, considered a "jack-of-all-trades," while Facebook was viewed as outdated, and TikTok as catering to a younger audience. Participants emphasized several key factors for effective messaging: (1) authenticity, (2) lived experience, (3) targeted marketing versus broad reach, (4) sex positivity, and (5) balance of humor with seriousness. Conclusions: These findings shaped the casting and content creation for the SMASH campaign, providing valuable guidance for health promotion initiatives aimed at engaging YBLMSM with PrEP through social media.

Purpose: Black sexually and gender minoritized (SGM) people who were assigned female at birth (AFAB) experience compounding health care inequities, barriers to equitable care, and disproportionately adverse health outcomes. Given prior literature indicating that both experienced and/or anticipated reported health care discrimination and medical mistrust may shape these health care experiences of Black SGM AFAB people, we sought to investigate the specific interplay between these two factors to bolster understanding of their relationship. Methods: In January and February 2023, we conducted a cross-sectional online survey of 156 Black SGM AFAB adults in the United States (U.S.) assessing their reported lifetime experiences of all-cause and gender-, race/ethnicity-, and weight-based discrimination in health care settings, in addition to their ratings of medical mistrust on the Medical Mistrust Index (MMI). Univariate statistics, analysis of variance, post hoc pairwise tests, and multivariable linear regression were conducted to assess measures of health care discrimination, medical mistrust, and covariates and their associations among the analytic sample (n = 130). Results: Most participants reported prior experiences of health care discrimination. Adjusting for demographic, socioeconomic, and health care factors, we identified an association between experiencing any-cause-, race/ethnicity-, or weight-based discrimination and significantly higher MMI scores. The association for gender-based discrimination was not statistically significant. Conclusion: Black SGM AFAB people who experience any-cause-, race/ethnicity-, or weight-based discrimination may be more likely to experience higher levels of medical mistrust. Identifying interventions and pathways to tackle health care discrimination and the systemic and structural drivers of medical mistrust will be critical to augmenting health care outcomes and experiences of Black SGM communities.

Purpose: Many transgender and gender-diverse (TGD) people experience significant barriers to health care access, facing disparities in care, limited payments for gender-affirming services, or insufficient training and knowledge among providers. Given validation studies reporting increasing rates of TGD-related status, we documented health care types used by TGD veterans to signal whether engagement in Veterans Health Administration (VHA) care increased or decreased following documentation of a TGD-related diagnosis code. Methods: The cohort was defined by receipt of a TGD-related diagnosis code in the VHA Corporate Data Warehouse from October 1, 1999, through September 30, 2021 (fiscal years 2000 through 2021). Data were summarized in two 1-year periods before and after TGD-related diagnosis. Logistic regression estimated predictors of VHA care post-TGD-related diagnosis as well as filling gender-affirming prescriptions in the VHA. Results: Over the 23-year study period, 9894 transgender veterans were identified. Among the 91% using VHA both before and after TGD diagnosis, visits for primary, specialty, and mental and behavioral health care increased whereas emergency care did not change. Factors associated with discontinuing VHA care were Black/African American and another race, married status, older age, and service in recent versus earlier eras. Younger, highly disabled from military service veterans and those in the West (vs. South) were more likely to fill gender-affirming prescriptions in the VHA. Conclusion: This study established high levels of disability and apparent willingness to continue with care in the VHA following establishment of TGD status. The role of interpersonal, provider, and policy in VHA retention remains to be examined.