LGBT health最新文献

Purpose: Structural factors affect the health of sexual and gender minority (SGM) cancer survivors, yet how people experience minority stress within their social and health care systems remains unclear. We explored experiences of minority stress across health care and sociocultural contexts and their impact on health and cancer outcomes. Methods: We conducted a K-medoid cluster analysis (grouping technique) using data from 2519 participants (training subset = 2015, testing subset = 504) from OUT: The National Cancer Survey (2020-2021). Cluster differences in the testing subset were assessed using chi-square, analysis of variance, and nonparametric tests. Regression models examined associations between cluster membership and health (mentally unhealthy days) and cancer outcomes (perceived welcomeness after identity disclosure and treatment satisfaction), adjusting for demographic and clinical factors. Results: Five clusters emerged, differing in demographics, mental and social health outcomes, SGM identity disclosure, and perceived welcomeness after disclosure (0.017 < p < 0.001). Cluster one experienced poorer mental health than cluster five (odds ratio [OR] = 1.182, 95% confidence interval [CI] = 1.003-1.392), lower cancer care satisfaction than all other clusters (1.177 < OR <1.265; 1.091 < 95% CI <1.389), and perceived less welcoming or unchanged environments after SGM identity disclosure than all other clusters (1.278 < OR <1.314; 1.161 < 95% CI <1.431). Conclusion: The study highlights the impact of minority stress across different contexts. The findings emphasize the need for targeted interventions to address the unique vulnerabilities of SGM individuals, particularly in health care contexts, to improve their overall health and cancer care experiences.

Purpose: This study evaluated the reliability of assessing transgender status in African populations using questions about current gender identification and sex assigned at birth. Methods: Data were obtained from the HIV Prevention Trials Network 075, a study designed to assess the feasibility of recruiting and retaining 400 men who have sex with men (MSM) in a 1-year prospective cohort study in Kenya, Malawi, and South Africa and conducted from 2015 to 2017. We compared responses of 401 participants to questions about gender identity obtained at the screening and enrollment visits and, for a subset of participants, in open interviews 6-9 months after enrollment. Results: One hundred and eleven of the 401 persons reported to identify as female or transgender at either the screening visit and/or the enrollment visit. Of those 111 persons, 42 (37.8%) switched between the two assessment moments from male to female or transgender, or vice versa. Furthermore, most transgender women were sexually attracted to men and identified as gay. In the follow-up interview with a subset of participants, almost all persons categorized as transgender identified as MSM. Conclusion: Categorizing persons as transgender based on self-identified gender and sex assigned at birth has limited reliability in African populations. Possible explanations for the observed inconsistencies in the responses to gender-related questions are discussed. For future studies, an understanding is needed of what specific words and labels such as gender, female, or transgender mean to study participants.

Purpose: In 2021, New York State passed legislation that eliminated the requirement that same-sex female couples needed up to 12 months of intrauterine insemination with donor sperm to meet the medical definition of infertility and qualify for insurance coverage. This study compared the duration of time from consultation to utilization of in vitro fertilization (IVF) by same-sex female couples before and after the New York legislative change. Methods: Same-sex female couples who underwent IVF or reciprocal IVF between 2010 and 2023 in New York City were categorized into pre- and postlegislation cohorts based on when they sought initial treatment. The primary outcome was time from consultation to initiation of IVF or reciprocal IVF. Secondary outcomes included time from consultation to clinical pregnancy with discharge to obstetrical care. Results: Overall, 239 couples were included. The postlegislation cohort had a shorter median length of time from consultation to initiation of IVF (173 vs. 297 days, p < 0.001; hazard ratio 2.36, p < 0.001) and a significant increase in the proportion of couples initiating treatment less than 1 year after consultation (86% vs. 57%, p = 0.01). They also had a decreased median time to discharge with ongoing pregnancy (383 vs. 535 days, p = 0.006). Same-sex female couples had 136% increased chances of initiating IVF after consultation compared with before the legislation. Conclusion: After the expansion of fertility insurance coverage, same-sex couples at a single New York City institution initiated IVF treatment and achieved pregnancy more rapidly after consultation than prior to the expansion.

Purpose: Research suggests that sexual minority women (SMW) face elevated HIV risk compared with their heterosexual counterparts. This study examined the association between sexual minority status-defined by identity and behavior-and HIV-related vulnerabilities among heterosexually active low-income women. Methods: This analysis used National HIV Behavioral Surveillance data (n = 5542) collected in 2019 from heterosexually active low-income women in 23 U.S. urban areas. We examined sexual minority identity and behavior and a set of substance use, sexual behavior, health and health care, and social determinants of health indicators commonly associated with heightened HIV transmission risk. Log-linked Poisson regression models generated adjusted prevalence ratios and 95% confidence intervals. Results: Among women who reported sexual minority identity (22.2%; n = 1231), 34.6% (n = 426) reported past-year sex with only men. Of women who reported past-year sex with both women and men (17.8%; n = 985), 18.3% (n = 180) identified as heterosexual. In adjusted models, SMW had significantly higher prevalence of nearly every HIV risk-associated factor examined than their heterosexual counterparts. Risk profiles by identity and behavior were similar. Notably, SMW defined by behavior had similar or higher prevalence of nearly every risk factor than those defined by identity. Conclusions: This study demonstrates disproportionate HIV-related vulnerabilities among SMW compared with their heterosexual counterparts. The findings underscore the importance of measuring multiple dimensions of sexual orientation (identity and behavior), as SMW and their associated risks show important nuances. Implications include tailoring HIV prevention and health promotion interventions to meet the needs of low-income SMW.

Purpose: Several studies have found that sexual minority individuals are at greater risk for chronic pain. However, these studies did not ask about gender identity, and research on chronic pain in transgender populations remains scarce. This present study examined the relationship between transgender status and chronic joint pain disorders among U.S. adults. Methods: Data were obtained from the 2020 Behavioral Risk Factor Surveillance System. We compared odds of chronic joint pain disorders by transgender status (n transgender = 967, cisgender = 217,943, don't know/not sure = 648, refused = 2072) using logistic regression adjusting for age. Results: After adjusting for age, transgender respondents reported greater odds of chronic joint pain disorders (adjusted odds ratio [AOR] = 1.24, 95% confidence interval [CI] = 1.05-1.48), compared with cisgender respondents. Odds for chronic joint pain disorders were lower for the "refused" group (AOR = 0.84, 95% CI = 0.76-0.93) and for those who answered "don't know/not sure" (AOR = 0.73, 95% CI = 0.61-0.88). Conclusion: Consistent with preliminary evidence and with the minority stress model, transgender respondents were at increased odds of chronic joint pain disorders when adjusting for age.

Purpose: Transgender and nonbinary people (TNB) experienced a disproportionate burden of poor health and socioeconomic outcomes resulting from the coronavirus disease 2019 (COVID-19) pandemic, largely driven by increased vulnerability due to pervasive structural discrimination. To characterize the extent and nature of TNB inclusivity within COVID-19 research, we conducted a scoping review of studies published in English from 2019-2022 reporting COVID-19 pandemic impacts on TNB individuals in the United States. Methods: We searched PubMed (PubMed.gov), Embase (Elsevier), PsycInfo (EBSCO), Sociological Abstracts (ProQuest), and CINAHL (EBSCO), and TNB-focused organizational websites using search concepts 1) COVID-19, 2) TNB people. Studies were systematically reviewed for inclusion. Findings were extracted then summarized using systematic narrative synthesis. Results: Our search identified 1518 studies; 80 articles (65 peer-reviewed, 15 gray literature) met eligibility criteria. Most studies collected data early in the pandemic (69%) utilizing quantitative methods (79%), survey data (81%), and convenience sampling methods (65%); geographic foci varied. Many studies lacked transparent reporting on TNB involvement (80%), race/ethnicity of TNB subsamples (67%), and gender measurement (30%). The findings addressed COVID-19 (39%), mental health (29%), socioeconomics (26%), health care access (24%), physical health (13%), substance use (11%), violence/discrimination (8%), resiliency/coping (5%), gender identity/expression (5%), and sexual health (4%). Conclusions: A substantial amount of COVID-19 research inclusive of TNB people was conducted during the initial 2.5 years of the pandemic. However, there were key methodological (e.g., standardized measurement, enhanced community involvement) and topical gaps (e.g., social and structural resiliencies), which should be addressed in future research and practice to reduce TNB health disparities related to COVID-19 and future public health crises.

Purpose: The purpose of this study was to assess the relationship between adverse childhood experiences (ACEs) exposure, perceived discrimination, and anxiety and depressive symptoms in sexual and gender minoritized (SGM) adults in the United States. Methods: Respondents (n = 4445) from a national Qualtrics research panel completed a web-based survey. Guided by the stress proliferation (mediation model) and stress sensitization (moderation model) models, we examined the relationships between ACEs and perceived discrimination and the severity of anxiety and depressive symptoms in adulthood. Results: Cumulative ACEs exposure was positively associated with everyday discrimination scale (EDS) scores. ACEs and EDS scores had a significant direct association with anxiety and depressive symptoms. We found support for EDS as a mediator for anxiety (β = 0.12, p < 0.001) and depressive symptoms (β = 0.14, p < 0.001) and for ACEs as a moderator of the relationship between EDS and anxiety (β = -0.04, p = 0.004) and depressive (β = -0.05, p = 0.001) symptoms. Conclusions: These findings suggest that both stress proliferation and stress sensitization likely contribute to disparities in anxiety and depressive symptoms in SGM adults. This finding supports the integration of social safety and minority stress perspectives regarding health disparities in SGM populations. Exposure to early life adversity likely alters neurodevelopment, which in turn increases awareness of the lack of social safety in adulthood, reduces capacity to cope with minority stress exposure, and ultimately contributes to increased anxiety and depressive symptoms. Prevention efforts should focus on building positive and compensatory childhood experiences.

Purpose: We examined the association between family-related factors (i.e., sexual identity disclosure to family and family social support) and hypertension (HTN) among sexual minority women (SMW; i.e., lesbian/gay, bisexual, or another sexual identity). Methods: We analyzed data from Waves 3 (2010-2012) and 4 (2017-2019) of the Chicago Health and Life Experiences of Women study. Using multiple logistic regression, we examined the cross-sectional and longitudinal associations of family-related factors with self-reported HTN (diagnosis of HTN at Wave 3 and newly diagnosed HTN at Wave 4) among SMW. We also explored whether race/ethnicity and sexual identity moderated these associations. Analyses were adjusted for relevant covariates (e.g., age, tobacco use). Results: Cross-sectional analyses included 651 SMW with a mean age of 40.2 (±13.8) years, 58% of whom identified as Black/African American or Hispanic. Family social support was inversely associated with the diagnosis of HTN (adjusted odds ratio: 0.85, 95% confidence interval: 0.75-0.97). Longitudinal analyses included 377 SMW (mean age of 38.8 [±13.0] years) with 51% identifying as Black/African American or Hispanic. Family social support was not associated with newly diagnosed HTN. Neither the cross-sectional nor longitudinal associations between sexual identity disclosure to family and HTN were significant. Neither race/ethnicity nor sexual identity were significant moderators. Conclusions: Family social support was associated with lower odds of HTN diagnosis among SMW. Families and clinicians should be educated about the protective role of family social support for sexual minority adults. Further research is needed to identify factors that contribute to HTN disparities observed among these populations.

Purpose: Tobacco use is a major health disparity for lesbian, gay, bisexual, and transgender (LGBT) populations compared with heterosexual/cisgender populations. In this scoping review, we aimed to determine if LGBT tobacco use disparities are improving or worsening over time and if trends in disparities differed across subgroups. Methods: We included articles that longitudinally explored youth and adult LGB tobacco use in the United States and Canada after searching four databases and capturing records through July 2022. Two reviewers independently screened the title/abstract and full text of 2326 and 45 articles, respectively. Eleven articles from 18 larger assessments met inclusion criteria, spanning data collection from 1996 to 2020. Results: All studies consistently demonstrated tobacco disparities for LGB populations. No articles examined longitudinal transgender tobacco disparities. Most studies focused on smoking combustible cigarettes. Disparities in heavy or daily use for all LGB youth subgroups compared with heterosexual samples appear to be shrinking longitudinally. Results for early-onset, current, and lifetime smoking were less consistent. Adult evidence was relatively sparse; however, after 2010, studies show diminishing disparities over time, except for current smoking by bisexual women. Conclusions: Large tobacco use disparities persist for LGB populations, although the size of disparities may be decreasing for some groups. Initiatives for lesbian and bisexual women and girls should be prioritized, in addition to interventions addressing LGB smoking broadly. Surveillance instruments should uniformly and consistently assess LGBT identities and tobacco use behaviors.

Purpose: Sexual and gender minority (SGM) individuals often face minority stressors that negatively affect their mental health, making it important to identify protective factors against the adverse psychological effects of minority stress. We investigated the potential protective effect of trait resilience in SGM individuals assigned female at birth (SGM-AFAB), who are understudied despite being at particularly high risk for mental health problems. Methods: As part of an ongoing longitudinal cohort study, 452 SGM-AFAB young people (age 16-31 years) completed measures of resilience, minority stressors (victimization, microaggressions, internalized heterosexism, and cisgenderism), and mental health (depression, anxiety, suicidal ideation) in 2017-2018. Moderating effects of resilience on associations between the minority stressors and mental health outcomes were tested using regression analyses. Results: Resilience attenuated the positive associations of microaggressions with both depression and anxiety and of internalized cisgenderism with depression (in transgender and gender-diverse participants), suggesting protective effects. Resilience did not moderate any other associations. Conclusion: These findings suggest that resilience serves as a protective factor against depressive and anxiety symptoms following experiences of microaggressions and against depressive symptoms following internalized cisgenderism among diverse SGM-AFAB individuals. These results underscore the importance of identifying factors that bolster resilience and developing intervention strategies aimed at promoting resilience within SGM-AFAB individuals, especially following experiences of microaggressions and internalized cisgenderism.