LGBT health最新文献

Purpose: This article investigates rates of violent victimization, subsequent help-seeking, and health-related consequences within sexual and gender minority (SGM) communities. Methods: Aggregate data from the 2017-2021 National Crime Victimization Survey were examined to determine nationally representative estimates of rates and distributions of violent victimization, help-seeking, and socioemotional consequences within those 16 years of age and older. Due to sample size, most analyses aggregated sexual orientation and gender identity to allow comparison of SGM persons to non-SGM persons and examine differences within the SGM population. Results: Persons who identified as lesbian, gay, or bisexual experienced violent victimization at rates two to six times higher than straight persons. Transgender persons were victimized more than three times as often than cisgender persons. SGM persons experienced higher rates of all types of violent victimization than non-SGM persons regardless of victim-offender relationship. There were differences by victim demographic characteristics, including sex, race and Hispanic origin, age, marital status, and household income. A higher proportion of SGM victims reported only problems with work/school or problems both at work/school and with family/friends. Finally, higher proportions of SGM victims reported socioemotional consequences when they were female, older, or experienced serious violent crime. Conclusion: The findings in this study continue to highlight high levels of violence experienced by SGM persons and disproportionate socioemotional consequences. There is an evident need to develop targeted interventions and provide services to address the consequences of victimization among this population. The analyses demonstrate the necessity of continued research to better understand the impact of violence on SGM communities.

Purpose: Clinical monitoring for patients receiving gender-affirming hormone therapy (GAHT) has the potential to facilitate their receipt of preventive health services. We aimed to determine whether GAHT is associated with increased utilization of cervical cancer screening among transgender men (TM) and nonbinary persons assigned female at birth (NB-AFAB). Methods: We conducted a cross-sectional observational study of a single community health center in Boston. Persons of all gender identities eligible for cervical cancer screening during 2008-2019 were assessed. The outcome of interest was receipt of cervical cancer screening based on U.S. Preventive Services Task Force recommendations. We compared the proportion of persons who received cervical cancer screening by prescription of GAHT. Results: We identified 13,267 eligible persons. This cohort included 10,547 (79.5%) cisgender women, 1547 (11.7%) TM, and 1173 (8.8%) NB-AFAB persons. Among all persons eligible for cervical cancer screening, TM and NB-AFAB persons were less likely to receive screening than cisgender women (56.2% and 56.1% vs. 60.5% respectively; odds ratio [OR] = 0.84; 95% confidence interval [CI] = 0.75-0.93; OR = 0.84; 95% CI = 0.74-0.94, respectively). Among TM, those prescribed testosterone were more likely to receive cervical cancer screening than those not prescribed testosterone (57.9% vs. 48.2%, OR = 1.47; 95% CI = 1.14-1.92). Among NB-AFAB adults, those prescribed testosterone were more likely to receive cervical cancer screening than those not prescribed testosterone (61.9% vs. 51.5%, OR = 1.53; 95% CI = 1.21-1.93). Conclusions: The benefits of engagement in care to access GAHT may extend beyond the hormonal intervention to preventive health services.

Purpose: Our aim was to examine associations between transgender identity and sleep disturbance in a demographically diverse, national sample of U.S. early adolescents. Methods: We conducted a cross-sectional analysis of the Adolescent Brain Cognitive Development Study from Year 3 (2019-2021, n = 10,277, 12-13 years) to investigate the association between transgender identity and caregiver-reported measures of their adolescent's sleep, assessed by the Sleep Disturbance Scale for Children. Results: Transgender adolescents had a higher risk of overall sleep disturbance and symptoms of insomnia and excessive sleepiness. Furthermore, per caregiver report, transgender adolescents were more likely to have shorter sleep duration categories; particularly concerning is the significant risk of <5 hours of sleep for transgender adolescents compared with their cisgender peers. Conclusion: These findings indicate that transgender adolescents had worse caregiver-reported sleep outcomes compared to cisgender peers. This study highlights the need for screenings and interventions targeted at improving sleep among transgender adolescents.

Purpose: Previous research has found that stigma, discrimination, and depression are associated with the sexual minority population's medical experiences. However, there is still a lack of relevant research results in Taiwan. This study investigated the health-seeking experiences and influencing factors of gay men and lesbian women in Taiwan. Methods: We recruited gay men and lesbian women through lesbian, gay, bisexual, and transgender (LGBT)-friendly websites and associations between November 2019 and June 2020. Surveys included the demographics, medical visiting experiences, Measure of Internalized Stigma, Patient Health Questionnaire-9, and Daily Heterosexist Experiences Questionnaire. Results: There were 270 participants, including 188 gay men and 82 lesbian women. Most respondents refused to disclose their sexual orientation to health care providers; some feared seeking medical care and preferred seeking LGBT-friendly health care services. Compared with lesbian women, gay men had higher levels of internalized sexual stigma, victimization, concealing sexual orientation, and experiences of medical staff denying services. Discrimination, depressive severity, and internalized sexual stigma affected the medical visit experience. Conclusion: In Taiwan, the health care experiences of gay men and lesbian women are affected by discrimination, internalized sexual stigma, and severe depression, while facing challenges of fear of seeking medical care or reluctance to disclose their sexual orientation.

Purpose: Sexual and gender minoritized (SGM) populations face health disparities along the cancer care continuum, although attempts to define these disparities are limited by a lack of comprehensive sexual orientation and gender identity (SOGI) data collection. The objective of this study was to interview a diverse group of stakeholders to understand attitudes, barriers, and facilitators to inform data collection approaches in a cancer care setting. Methods: This was a qualitative study conducted from March to July 2023 with paired surveys of stakeholders including patients, caregivers, providers, and cancer registry staff. Twenty participants across these categories, including half who identified as SGM, completed surveys and interviews. Qualitative data were reduced to themes with exemplar quotations using rapid qualitative analysis methods and compared to survey data. Results: Themes revealed general support for SOGI data collection as part of holistic cancer care, and all participants acknowledged that specific SOGI-related information, particularly correct pronoun usage, was essential to inform patient-centered care. Themes revealed tensions around optimal SOGI data collection methods, mixed opinions on the relevance of sexual orientation, experiences of discrimination and discomfort related to SOGI, and limited acknowledgment of population benefits of SOGI data collection. Conclusion: Themes demonstrated overall support for SOGI data collection but also revealed several barriers, such as a lack of recognition of population benefits and experiences of discrimination and discomfort, that will need to be addressed to comprehensively collect these data. Based on diverse preferences and limitations of all methods of collection, a multimodal approach may be needed to optimize completion.

Purpose: The present study investigated associations of sexual orientation and/or gender identity-based medical mistrust and racial/ethnic-based medical mistrust, respectively, with unmet medical care need among lesbian, gay, bisexual, transgender, queer, and/or sexually or gender diverse (LGBTQ+) people of color (POC) assigned female at birth (AFAB). We also tested the interaction of the two types of medical mistrust on unmet medical care need. Methods: Participants were 266 LGBTQ+ POC AFAB. Participants completed measures of medical mistrust based on race/ethnicity and LGBTQ+ identity. Unmet medical care need was assessed using the item: "During the past 12 months, was there ever a time where you felt that you needed health care but you didn't receive it?" Multivariate logistic regression models were run with either type of medical mistrust, as well as their interaction, as the predictor and unmet medical care need as the outcome variable. Results: There were no significant main effects of either type of medical mistrust on unmet medical care need. However, there was an interaction between the two types of medical mistrust, such that associations between each type of medical mistrust and unmet medical care needs were stronger at higher levels of the other type of medical mistrust. Racial/ethnic medical mistrust was associated with a greater likelihood of unmet medical needs at high, but not low, levels of LGBTQ+ medical mistrust. Conclusions: Racial/ethnic medical mistrust and LGBTQ+ medical mistrust exacerbate each other's influence on unmet medical care need. These results underscore the need for inclusive clinical practices for LGBTQ+ POC.

Purpose: Our purpose was to understand the completeness of sex and gender fields in electronic health record (EHR) data and patient-level factors associated with completeness of those fields. In doing so, we aimed to inform approaches to EHR sex and gender data collection. Methods: This was a retrospective observational study using 2016-2021 deidentified EHR data from a large health care system. Our sample included adults who had an encounter at any of three hospitals within the health care system or were enrolled in the health care system's Accountable Care Organization. The sex and gender fields of interest were gender identity, sex assigned at birth (SAB), and legal sex. Patient characteristics included demographics, clinical features, and health care utilization. Results: In the final study sample (N = 3,473,123), gender identity, SAB, and legal sex (required for system registration) were missing for 75.4%, 75.8%, and 0.1% of individuals, respectively. Several demographic and clinical factors were associated with having complete gender identity and SAB. Notably, the odds of having complete gender identity and SAB were greater among individuals with an activated patient portal (odds ratio [OR] = 2.68; 95% confidence interval [CI] = 2.66-2.70) and with more outpatient visits (OR = 4.34; 95% CI = 4.29-4.38 for 5+ visits); odds of completeness were lower among those with any urgent care visits (OR = 0.80; 95% CI = 0.78-0.82). Conclusions: Missingness of sex and gender data in the EHR was high and associated with a range of patient factors. Key features associated with completeness highlight multiple opportunities for intervention with a focus on patient portal use, primary care provider reporting, and urgent care settings.

Purpose: This study aimed to uncover sexual identity development and investigate the psychiatric risks for bisexual people across mainland China, Hong Kong, and Taiwan by examining ecologically informed factors at the individual, family, and community levels. Methods: An internet-based survey was administered to 685 respondents, from June to August 2021, reached primarily through lesbian, gay, bisexual, transgender, and queer community organizations and professional networks. Participants reported their demographics, identity milestones, and psychiatric symptoms. Results: Significant birth cohort and regional differences were observed regarding bisexual identity milestones. Individuals who were older, transgender and/or nonbinary, and based in Taiwan disclosed their sexual identity more. All respondents reported clinically elevated depression and anxiety symptoms, with a majority experiencing moderately severe depression (60%) and moderate or severe anxiety (80%). Approximately half of respondents contemplated suicide in the past year. Compared with cisgender women, identifying as transgender and nonbinary assigned female at birth was significantly associated with increased depression and higher odds of suicidal ideation in the past year. Enhanced self-esteem was associated with greater well-being and decreased psychiatric symptoms. Experiencing family shame was associated with increased anxiety and depression. At the community level, living in Hong Kong was linked to lower depression and suicidal ideation compared to mainland China. The presence of an LGBT group correlated with improved psychological well-being. Conclusions: Chinese bisexual people face substantial risks for depression, anxiety, and suicidal ideation, influenced by factors including self-esteem, transgender and nonbinary gender identity, family dynamics, and community context. Significant birth cohort and regional differences in bisexual identity development exist.

Purpose: This study was conducted to understand whether health education materials made specifically for members of sexual and gender minority (SGM) groups play a pivotal role in SGM cancer survivors' care satisfaction and experiences. Methods: We identified 2250 SGM cancer survivors who completed the "OUT: National Cancer Survey," conducted by the National LGBT Cancer Network in 2020-2021, and classified participants by their self-reported satisfaction with overall cancer care. We examined care satisfaction in relation to use of SGM-tailored health education resources and factors surrounding their SGM identities, which may influence their satisfaction, including feelings of safety with care teams. Results: Regardless of satisfaction with overall care, substantial proportions of survivors reported lacking vital health education resources specific to their SGM identities in areas of mental health (69%), physical activity (91%), tobacco use cessation (89%), and alcohol consumption (86%), despite attributing value to these materials. Contextualizing SGM survivor satisfaction with care, it was notable that among SGM survivors who felt safe with members of their care team knowing their SGM identity, only 3% were less than satisfied with their overall cancer care, compared to 38% who felt unsafe. Conclusion: SGM survivors value tailored information and health education resources that incorporate their intersectional identities. More research must be done to elucidate why SGM survivors do not receive these materials, while creating spaces where they feel safe receiving care. Increased delivery of SGM-tailored materials and prioritization of SGM safety in health care may have implications for overall cancer care satisfaction among SGM survivors.