Pub Date : 2024-05-01Epub Date: 2024-01-11DOI: 10.1089/lgbt.2023.0055
Annesa Flentje, Gowri Sunder, Alexis Ceja, Nadra E Lisha, Torsten B Neilands, Bradley E Aouizerat, Micah E Lubensky, Matthew R Capriotti, Zubin Dastur, Mitchell R Lunn, Juno Obedin-Maliver
Purpose: Sexual and gender minority (SGM) people are at greater risk for substance use than heterosexual and cisgender people, but most prior work is limited by cross-sectional analyses or the examination of single substance use. This study examined substance use over time among SGM people to identify patterns of polysubstance use at the intersection of sex and gender. Methods: Data were collected annually over 4 years from SGM respondents (n = 11,822) in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Differences in substance use patterns (any prior 30-day use of 15 substances) by gender subgroup were examined with latent class analysis, and multinomial regression models tested relationships between gender subgroup and substance use. Results: Eight classes of substance use were observed. The three most common patterns were low substance use (49%), heavy episodic alcohol use (≥5 alcoholic drinks on one occasion) with some cannabis and tobacco use (14%), and cannabis use with some tobacco and declining heavy episodic alcohol use (13%). Differences observed included lower odds of patterns defined by heavy episodic alcohol use with some cannabis and tobacco use in all gender subgroups relative to cisgender men and persons with low substance use (odds ratios [ORs] 0.26-0.60). Gender expansive people assigned female at birth, gender expansive people assigned male at birth, and transgender men had greater odds of reporting cannabis use with small percentages of heavy episodic alcohol and tobacco use (ORs: 1.41-1.60). Conclusion: This study suggests that there are unique patterns of polysubstance use over time among gender subgroups of SGM people.
{"title":"Substance Use Over Time Among Sexual and Gender Minority People: Differences at the Intersection of Sex and Gender.","authors":"Annesa Flentje, Gowri Sunder, Alexis Ceja, Nadra E Lisha, Torsten B Neilands, Bradley E Aouizerat, Micah E Lubensky, Matthew R Capriotti, Zubin Dastur, Mitchell R Lunn, Juno Obedin-Maliver","doi":"10.1089/lgbt.2023.0055","DOIUrl":"10.1089/lgbt.2023.0055","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Sexual and gender minority (SGM) people are at greater risk for substance use than heterosexual and cisgender people, but most prior work is limited by cross-sectional analyses or the examination of single substance use. This study examined substance use over time among SGM people to identify patterns of polysubstance use at the intersection of sex and gender. <b><i>Methods:</i></b> Data were collected annually over 4 years from SGM respondents <i>(n</i> = 11,822) in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Differences in substance use patterns (any prior 30-day use of 15 substances) by gender subgroup were examined with latent class analysis, and multinomial regression models tested relationships between gender subgroup and substance use. <b><i>Results:</i></b> Eight classes of substance use were observed. The three most common patterns were low substance use (49%), heavy episodic alcohol use (≥5 alcoholic drinks on one occasion) with some cannabis and tobacco use (14%), and cannabis use with some tobacco and declining heavy episodic alcohol use (13%). Differences observed included lower odds of patterns defined by heavy episodic alcohol use with some cannabis and tobacco use in all gender subgroups relative to cisgender men and persons with low substance use (odds ratios [ORs] 0.26-0.60). Gender expansive people assigned female at birth, gender expansive people assigned male at birth, and transgender men had greater odds of reporting cannabis use with small percentages of heavy episodic alcohol and tobacco use (ORs: 1.41-1.60). <b><i>Conclusion:</i></b> This study suggests that there are unique patterns of polysubstance use over time among gender subgroups of SGM people.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Frank DeVone, Eric Jutkowitz, Christopher Halladay, M. Kauth, Alicia J Cohen, Jack Tsai
Purpose: The Veterans Health Administration (VHA) systematically asks Veterans to self-report gender identity for documentation in their electronic health record. Veterans with transgender and gender diverse (TGD) identities experience higher rates of several health conditions compared to Veterans without minoritized gender identities. Historically, cohorts of TGD Veterans were built with International Classification of Diseases Version 10 (ICD-10) codes assigned during clinical encounters. We examined concordance between self-reported gender identity and relevant ICD-10 codes in VHA health records to inform use of these indicators for examining the health needs of TGD Veterans. Methods: TGD-related ICD-10 codes were compared to self-reported gender identity from more than 1.5 million Veterans (2019-2022). Results: Only 34% of TGD Veterans included through self-report had an ICD-10 code associated with transgender care. ICD-10 codes had low sensitivity and high specificity compared to self-reported gender. Conclusion: These findings suggest ICD-10 codes alone undercount the larger population of TGD Veterans in the VHA.
{"title":"Moving Beyond International Classification of Diseases Codes for the Retrospective Identification of Gender Diverse Veterans.","authors":"Frank DeVone, Eric Jutkowitz, Christopher Halladay, M. Kauth, Alicia J Cohen, Jack Tsai","doi":"10.1089/lgbt.2023.0327","DOIUrl":"https://doi.org/10.1089/lgbt.2023.0327","url":null,"abstract":"Purpose: The Veterans Health Administration (VHA) systematically asks Veterans to self-report gender identity for documentation in their electronic health record. Veterans with transgender and gender diverse (TGD) identities experience higher rates of several health conditions compared to Veterans without minoritized gender identities. Historically, cohorts of TGD Veterans were built with International Classification of Diseases Version 10 (ICD-10) codes assigned during clinical encounters. We examined concordance between self-reported gender identity and relevant ICD-10 codes in VHA health records to inform use of these indicators for examining the health needs of TGD Veterans. Methods: TGD-related ICD-10 codes were compared to self-reported gender identity from more than 1.5 million Veterans (2019-2022). Results: Only 34% of TGD Veterans included through self-report had an ICD-10 code associated with transgender care. ICD-10 codes had low sensitivity and high specificity compared to self-reported gender. Conclusion: These findings suggest ICD-10 codes alone undercount the larger population of TGD Veterans in the VHA.","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140665344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhigang Xie, K. Terrell, Juhan Lee, Ryan Suk, Young-Rock Hong
Purpose: We aimed to identify the self-reported reasons for being uninsured and sociodemographic factors associated with uninsurance among lesbian, gay, or bisexual (LGB) adults before and after the Affordable Care Act (ACA). Methods: We analyzed the 2013-2018 National Health Interview Survey data using multivariable logistic regression models to estimate the odds of being uninsured and the prevalence of self-reported reasons for not having insurance among LGB adults aged 18-64 years. Results: The study included 2124 LGB adults. The weighted uninsured rate decreased significantly from 19.6% in 2013 to 13.2% in 2017-2018 (odds ratio 0.61; 95% confidence interval 0.47-0.78). The primary reason cited for not having insurance post-ACA was similar to pre-ACA, with cost-related factors being the most commonly reported (31.5%). Conclusion: The overall uninsured rate decreased among LGB adults from 2013 to 2018, whereas disparities across subpopulations remained. Cost-related factors remained significant barriers to obtaining insurance coverage.
{"title":"Patterns and Reasons for Being Uninsured Among Sexual Minority Adults Before and After the Affordable Care Act Implementation.","authors":"Zhigang Xie, K. Terrell, Juhan Lee, Ryan Suk, Young-Rock Hong","doi":"10.1089/lgbt.2023.0166","DOIUrl":"https://doi.org/10.1089/lgbt.2023.0166","url":null,"abstract":"Purpose: We aimed to identify the self-reported reasons for being uninsured and sociodemographic factors associated with uninsurance among lesbian, gay, or bisexual (LGB) adults before and after the Affordable Care Act (ACA). Methods: We analyzed the 2013-2018 National Health Interview Survey data using multivariable logistic regression models to estimate the odds of being uninsured and the prevalence of self-reported reasons for not having insurance among LGB adults aged 18-64 years. Results: The study included 2124 LGB adults. The weighted uninsured rate decreased significantly from 19.6% in 2013 to 13.2% in 2017-2018 (odds ratio 0.61; 95% confidence interval 0.47-0.78). The primary reason cited for not having insurance post-ACA was similar to pre-ACA, with cost-related factors being the most commonly reported (31.5%). Conclusion: The overall uninsured rate decreased among LGB adults from 2013 to 2018, whereas disparities across subpopulations remained. Cost-related factors remained significant barriers to obtaining insurance coverage.","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140661865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher Hansen, Melissa Heim Viox, Erin M Fordyce, Michelle M. Johns, Sabrina Avripas, Stuart Michaels
Purpose: Research and lived experience demonstrate that sexual orientation and gender identity (SOGI) can change over the life course; however, little empirical work exists to understand the prevalence of such changes. To address this gap, we used data from a large nationally representative panel of adults and adolescents to assess changes in self-reported SOGI over time and identify trends by sex assigned at birth, age, race and ethnicity, and survey mode. Methods: We reviewed SOGI data collected between 2014 and 2022 for a sample of 19,469 adults and 970 adolescents. Up to eight SOGI measurements per panelist were available over the nine-year period, collected through a combination of panel recruitment and demographic refresh surveys and topic-specific surveys. Results: Among adults older than 18 years, 4.1% reported a change in sexual orientation and 3.6% reported a change in gender identity. Among teens, who are developmentally more apt to change identity, 13.5% reported a change in sexual orientation and 9.3% reported a change in gender identity. Conclusions: Findings demonstrate that SOGI can change over time, particularly for adolescents, so it is important to re-ask SOGI questions to ensure current information. We recommend re-asking SOGI questions at least every three years of adults and every two years of adolescents. Potential undercounting of sexual and gender minority (SGM) respondents decreases visibility and our ability to understand health and economic disparities affecting these populations. Improvements in SOGI measurement can help advance data quality and, ultimately, evidence-based interventions in support of SGM communities that these data help to inform.
{"title":"The Longitudinal Measurement of Sexual Orientation and Gender Identity: A Study of Identity Change in a Nationally Representative Sample of U.S. Adults and Adolescents.","authors":"Christopher Hansen, Melissa Heim Viox, Erin M Fordyce, Michelle M. Johns, Sabrina Avripas, Stuart Michaels","doi":"10.1089/lgbt.2023.0260","DOIUrl":"https://doi.org/10.1089/lgbt.2023.0260","url":null,"abstract":"Purpose: Research and lived experience demonstrate that sexual orientation and gender identity (SOGI) can change over the life course; however, little empirical work exists to understand the prevalence of such changes. To address this gap, we used data from a large nationally representative panel of adults and adolescents to assess changes in self-reported SOGI over time and identify trends by sex assigned at birth, age, race and ethnicity, and survey mode. Methods: We reviewed SOGI data collected between 2014 and 2022 for a sample of 19,469 adults and 970 adolescents. Up to eight SOGI measurements per panelist were available over the nine-year period, collected through a combination of panel recruitment and demographic refresh surveys and topic-specific surveys. Results: Among adults older than 18 years, 4.1% reported a change in sexual orientation and 3.6% reported a change in gender identity. Among teens, who are developmentally more apt to change identity, 13.5% reported a change in sexual orientation and 9.3% reported a change in gender identity. Conclusions: Findings demonstrate that SOGI can change over time, particularly for adolescents, so it is important to re-ask SOGI questions to ensure current information. We recommend re-asking SOGI questions at least every three years of adults and every two years of adolescents. Potential undercounting of sexual and gender minority (SGM) respondents decreases visibility and our ability to understand health and economic disparities affecting these populations. Improvements in SOGI measurement can help advance data quality and, ultimately, evidence-based interventions in support of SGM communities that these data help to inform.","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alex McDowell, Meghan L Rieu-Werden, Steven J. Atlas, Colin D. Fields, Robert H. Goldstein, Gabrielle D. Gundersen, Jennifer S Haas, Robin T. Higashi, Sandi L. Pruitt, Michelle I Silver, Jasmin A Tiro, A. Kamineni
Purpose: We examined characteristics of clinicians caring for transgender men and nonbinary (TMNB) individuals and guideline concordance of clinicians' cervical cancer screening recommendations. Methods: Using a survey of clinicians who performed ≥10 cervical cancer screenings in 2019, we studied characteristics of clinicians who do versus do not report caring for TMNB individuals and guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women. Results: In our sample (N = 492), 49.2% reported caring for TMNB individuals, and 25.4% reported performing cervical cancer screening for TMNB individuals with a cervix. Differences in guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women (45.8% vs. 50% concordant) were not statistically significant. Conclusion: Sizable proportions of clinicians cared for and performed cervical cancer screening for TMNB individuals. Research is needed to better understand clinicians' identified knowledge deficits to develop interventions (e.g., clinician trainings) to improve gender-affirming cervical cancer prevention.
{"title":"Characteristics of Clinicians Caring for Transgender Men and Nonbinary Individuals and Guideline Concordance of Clinicians' Cervical Cancer Screening Counseling for Cisgender Individuals Versus Transgender Men and Nonbinary Individuals with a Cervix.","authors":"Alex McDowell, Meghan L Rieu-Werden, Steven J. Atlas, Colin D. Fields, Robert H. Goldstein, Gabrielle D. Gundersen, Jennifer S Haas, Robin T. Higashi, Sandi L. Pruitt, Michelle I Silver, Jasmin A Tiro, A. Kamineni","doi":"10.1089/lgbt.2023.0067","DOIUrl":"https://doi.org/10.1089/lgbt.2023.0067","url":null,"abstract":"Purpose: We examined characteristics of clinicians caring for transgender men and nonbinary (TMNB) individuals and guideline concordance of clinicians' cervical cancer screening recommendations. Methods: Using a survey of clinicians who performed ≥10 cervical cancer screenings in 2019, we studied characteristics of clinicians who do versus do not report caring for TMNB individuals and guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women. Results: In our sample (N = 492), 49.2% reported caring for TMNB individuals, and 25.4% reported performing cervical cancer screening for TMNB individuals with a cervix. Differences in guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women (45.8% vs. 50% concordant) were not statistically significant. Conclusion: Sizable proportions of clinicians cared for and performed cervical cancer screening for TMNB individuals. Research is needed to better understand clinicians' identified knowledge deficits to develop interventions (e.g., clinician trainings) to improve gender-affirming cervical cancer prevention.","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Owen Jessup, Carrie L Nacht, Marianna Amato, Hannah E Reynolds, Jennifer K. Felner, Chenglin Hong, Sandhya Muthuramalingam, Daniel E Siconolfi, Glenn J. Wagner, Rob Stephenson, Erik D. Storholm
Purpose: Sexual minority men (SMM) experience intimate partner violence (IPV) at disproportionately high rates. The objective of this article was to identify the experiences of SMM and health care providers on how social identity impacts IPV. Methods: SMM participants (N = 23) were recruited from online community settings and a lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) organization in Los Angeles; providers (N = 10) were recruited from LGBTQ+ organizations. Semistructured interviews were audio recorded and transcribed verbatim. An applied thematic analysis approach was implemented to create memos, inductively generate a codebook, apply codes to the transcripts, and identify key themes in data. Results: Three main themes were identified. The first theme was weaponizing social identity to control a partner, which had three subthemes: (1) immigration status, race/ethnicity, and skin color, (2) threatening to "out" the partner's sexual orientation, and (3) abusing power inequity. Men who perpetrated IPV often used minority identities or undisclosed sexuality to leverage power over their partner. The second theme was use of IPV to establish masculinity, by exerting power over the more "feminine" partner. The third theme was internalized homophobia as a root cause of IPV, which details how internalized homophobia was often expressed in violent outbursts toward partners. Conclusion: These findings highlight how IPV among SMM can be influenced by social and sexual identity. Future research must consider socially constructed power structures and the multiple identities of SMM when developing interventions to address IPV in this population.
{"title":"How Intimate Partner Violence Is Influenced by Social Identity Among Sexual Minority Men.","authors":"Owen Jessup, Carrie L Nacht, Marianna Amato, Hannah E Reynolds, Jennifer K. Felner, Chenglin Hong, Sandhya Muthuramalingam, Daniel E Siconolfi, Glenn J. Wagner, Rob Stephenson, Erik D. Storholm","doi":"10.1089/lgbt.2023.0129","DOIUrl":"https://doi.org/10.1089/lgbt.2023.0129","url":null,"abstract":"Purpose: Sexual minority men (SMM) experience intimate partner violence (IPV) at disproportionately high rates. The objective of this article was to identify the experiences of SMM and health care providers on how social identity impacts IPV. Methods: SMM participants (N = 23) were recruited from online community settings and a lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) organization in Los Angeles; providers (N = 10) were recruited from LGBTQ+ organizations. Semistructured interviews were audio recorded and transcribed verbatim. An applied thematic analysis approach was implemented to create memos, inductively generate a codebook, apply codes to the transcripts, and identify key themes in data. Results: Three main themes were identified. The first theme was weaponizing social identity to control a partner, which had three subthemes: (1) immigration status, race/ethnicity, and skin color, (2) threatening to \"out\" the partner's sexual orientation, and (3) abusing power inequity. Men who perpetrated IPV often used minority identities or undisclosed sexuality to leverage power over their partner. The second theme was use of IPV to establish masculinity, by exerting power over the more \"feminine\" partner. The third theme was internalized homophobia as a root cause of IPV, which details how internalized homophobia was often expressed in violent outbursts toward partners. Conclusion: These findings highlight how IPV among SMM can be influenced by social and sexual identity. Future research must consider socially constructed power structures and the multiple identities of SMM when developing interventions to address IPV in this population.","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140730523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maya I Ragavan, Robert W. S. Coulter, Lynz Sickler, Daniel S Shaw, Natacha M. De Genna
Purpose: The goal of this study was to examine plurisexual identity, intimate partner violence (IPV), reproductive coercion, and parental monitoring among pregnant 13-21-year-olds. Methods: We conducted a cross-sectional analysis of data collected from a cohort of pregnant adolescents and young adults between October 2019 and May 2023 (n = 398). Logistic regression was completed to assess IPV and reproductive coercion as a function of plurisexual identity. Next, we assessed potential interactions between parental monitoring and plurisexual identity and examined IPV and reproductive coercion as a function of parental monitoring for the full sample and stratified by plurisexuality. Results: Plurisexual identity was associated with IPV (adjusted odds ratio [aOR] = 2.3; confidence interval [CI]: 1.4-4.0). IPV was inversely related to parental monitoring among plurisexual participants (aOR: 0.51; CI: 0.32-0.82), but this association was not significant for heterosexual participants (aOR: 1.1; CI: 0.75-1.6). Conclusions: This work demonstrates the importance of parental monitoring in supporting young plurisexual pregnant people.
{"title":"Associations Among Plurisexual Identity, Intimate Partner Violence, Reproductive Coercion, and Parental Monitoring in a Sample of Adolescent and Young Adult Pregnant People.","authors":"Maya I Ragavan, Robert W. S. Coulter, Lynz Sickler, Daniel S Shaw, Natacha M. De Genna","doi":"10.1089/lgbt.2023.0288","DOIUrl":"https://doi.org/10.1089/lgbt.2023.0288","url":null,"abstract":"Purpose: The goal of this study was to examine plurisexual identity, intimate partner violence (IPV), reproductive coercion, and parental monitoring among pregnant 13-21-year-olds. Methods: We conducted a cross-sectional analysis of data collected from a cohort of pregnant adolescents and young adults between October 2019 and May 2023 (n = 398). Logistic regression was completed to assess IPV and reproductive coercion as a function of plurisexual identity. Next, we assessed potential interactions between parental monitoring and plurisexual identity and examined IPV and reproductive coercion as a function of parental monitoring for the full sample and stratified by plurisexuality. Results: Plurisexual identity was associated with IPV (adjusted odds ratio [aOR] = 2.3; confidence interval [CI]: 1.4-4.0). IPV was inversely related to parental monitoring among plurisexual participants (aOR: 0.51; CI: 0.32-0.82), but this association was not significant for heterosexual participants (aOR: 1.1; CI: 0.75-1.6). Conclusions: This work demonstrates the importance of parental monitoring in supporting young plurisexual pregnant people.","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140744200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erin F Welsh, E. Andrus, Claire B. Sandler, Molly B Moravek, D. Stroumsa, S. Kattari, H. Walline, C. Goudsmit, A. Brouwer
Purpose: Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for cervical cancer screening. At-home human papillomavirus (HPV) testing may expand access to cervical cancer screening for TGD people AFAB. This study assessed the perceptions of TGD individuals AFAB who self-collected cervicovaginal and anal samples. Methods: We recruited TGD individuals AFAB to collect cervicovaginal and anal specimens at home using self-sampling for HPV testing, and individuals reported their perceptions of self-sampling. Associations between demographic and health characteristics and each of comfort of use, ease of use, and willingness to use self-sampling were estimated using robust Poisson regression. Results: Of 137 consenting participants, 101 completed the sample collection and the surveys. The majority of participants reported that the cervicovaginal self-swab was not uncomfortable (68.3%) and not difficult to use (86.1%), and nearly all (96.0%) were willing to use the swab in the future. Fewer participants found the anal swab to not be uncomfortable (47.5%), but most participants still found the anal swab to not be difficult to use (70.2%) and were willing to use the swab in the future (89.1%). Participants were more willing to use either swab if they had not seen a medical professional in the past year. Conclusions: TGD individuals AFAB were willing to use and preferred self-sampling methods for cervicovaginal and anal HPV testing. Developing clinically approved self-sampling options for HPV testing could expand access to cancer screening for TGD populations.
{"title":"Cervicovaginal and Anal Self-Sampling for Human Papillomavirus Testing in a Transgender and Gender Diverse Population Assigned Female at Birth: Comfort, Difficulty, and Willingness to Use.","authors":"Erin F Welsh, E. Andrus, Claire B. Sandler, Molly B Moravek, D. Stroumsa, S. Kattari, H. Walline, C. Goudsmit, A. Brouwer","doi":"10.1089/lgbt.2023.0336","DOIUrl":"https://doi.org/10.1089/lgbt.2023.0336","url":null,"abstract":"Purpose: Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for cervical cancer screening. At-home human papillomavirus (HPV) testing may expand access to cervical cancer screening for TGD people AFAB. This study assessed the perceptions of TGD individuals AFAB who self-collected cervicovaginal and anal samples. Methods: We recruited TGD individuals AFAB to collect cervicovaginal and anal specimens at home using self-sampling for HPV testing, and individuals reported their perceptions of self-sampling. Associations between demographic and health characteristics and each of comfort of use, ease of use, and willingness to use self-sampling were estimated using robust Poisson regression. Results: Of 137 consenting participants, 101 completed the sample collection and the surveys. The majority of participants reported that the cervicovaginal self-swab was not uncomfortable (68.3%) and not difficult to use (86.1%), and nearly all (96.0%) were willing to use the swab in the future. Fewer participants found the anal swab to not be uncomfortable (47.5%), but most participants still found the anal swab to not be difficult to use (70.2%) and were willing to use the swab in the future (89.1%). Participants were more willing to use either swab if they had not seen a medical professional in the past year. Conclusions: TGD individuals AFAB were willing to use and preferred self-sampling methods for cervicovaginal and anal HPV testing. Developing clinically approved self-sampling options for HPV testing could expand access to cancer screening for TGD populations.","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140741384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-01-30DOI: 10.1089/lgbt.2022.0349
Jennifer R Pharr, Lung-Chang Chien, Maxim Gakh, Jason D Flatt, Krystal Kittle, Emylia Terry
Purpose: This study aimed to conduct a moderated mediation analysis to understand further the complex pathways through which structural stigma in the form of transgender sports bans was associated with suicidal ideation and behaviors among sexual and gender minority (SGM) adults. Methods: A cross-sectional survey of 1033 adults who identified as SGM from across the 50 U.S. states and Washington, DC was conducted between January 28 and February 7, 2022. Distal discrimination distress was the mediation variable; individual resilience and social resources were the moderation variables. Familiarity with transgender sports bans represented structural stigma. The conditional process analysis was applied to build a moderated mediation model. Both conditional direct and indirect effects were computed by estimated coefficients. All models were based on linear regression. Results: Our final model explained nearly half (46%) of the variation in suicidal ideation and behaviors between those SGM adults familiar and those not familiar with transgender sports bans. Social resources significantly moderated the conditional indirect effect of distal discrimination distress (adjusted estimate = -0.23; 95% confidence interval = -0.37 to -0.08). Conclusion: Both discrimination distress and social resources influenced the association between structural stigma as measured by familiarity with transgender sports bans and suicidal ideation and behaviors among SGM adults. Findings support the need for future research examining the pathway between structural stigma and suicidal ideation and behaviors among SGM adults and how minority stress, social safety, and other constructs shape this pathway.
{"title":"Moderated Mediation Analysis of Structural Stigma and Suicidal Ideation and Behaviors Among Sexual and Gender Minority Adults.","authors":"Jennifer R Pharr, Lung-Chang Chien, Maxim Gakh, Jason D Flatt, Krystal Kittle, Emylia Terry","doi":"10.1089/lgbt.2022.0349","DOIUrl":"10.1089/lgbt.2022.0349","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This study aimed to conduct a moderated mediation analysis to understand further the complex pathways through which structural stigma in the form of transgender sports bans was associated with suicidal ideation and behaviors among sexual and gender minority (SGM) adults. <b><i>Methods:</i></b> A cross-sectional survey of 1033 adults who identified as SGM from across the 50 U.S. states and Washington, DC was conducted between January 28 and February 7, 2022. Distal discrimination distress was the mediation variable; individual resilience and social resources were the moderation variables. Familiarity with transgender sports bans represented structural stigma. The conditional process analysis was applied to build a moderated mediation model. Both conditional direct and indirect effects were computed by estimated coefficients. All models were based on linear regression. <b><i>Results:</i></b> Our final model explained nearly half (46%) of the variation in suicidal ideation and behaviors between those SGM adults familiar and those not familiar with transgender sports bans. Social resources significantly moderated the conditional indirect effect of distal discrimination distress (adjusted estimate = -0.23; 95% confidence interval = -0.37 to -0.08). <b><i>Conclusion:</i></b> Both discrimination distress and social resources influenced the association between structural stigma as measured by familiarity with transgender sports bans and suicidal ideation and behaviors among SGM adults. Findings support the need for future research examining the pathway between structural stigma and suicidal ideation and behaviors among SGM adults and how minority stress, social safety, and other constructs shape this pathway.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Callie Kluitenberg Harris, Horng-Shiuann Wu, Rebecca Lehto, Gwen Wyatt, Barbara Given
Purpose: To address cancer screening disparities and reduce cancer risk among sexual minority (SM) groups, this review identifies individual, interpersonal, and community/societal determinants of cancer screening (non)participation among differing SM identities. Methods: Seven scientific databases were searched. Inclusion criteria were as follows: (1) used quantitative methods; (2) English language; (3) cancer screening focus; and (4) at least one SM group identified. Articles were excluded if: (1) analysis was not disaggregated by SM identity (n = 29) and (2) quantitative analysis excluded determinants of cancer screening (n = 19). The Sexual and Gender Minority Health Disparities Research Framework guided literature synthesis. Results: Twelve studies addressed cervical (n = 4), breast (n = 3), breast/cervical (n = 3), or multiple cancers (n = 2). Other cancers were excluded due to inclusion/exclusion criteria. The total sample was 20,622 (mean 1525), including lesbian (n = 13,409), bisexual (n = 4442), gay (n = 1386), mostly heterosexual (n = 1302), and queer (n = 83) identities. Studies analyzing individual-level determinants (n = 8) found that socioeconomic status affected cervical, but not breast, cancer screening among lesbian and bisexual participants (n = 2). At the interpersonal level (n = 7), provider-patient relationship was a determinant of cervical cancer screening among lesbian participants (n = 4); a relationship not studied for other groups. Studies analyzing community/societal determinants (n = 5) found that rurality potentially affected cervical cancer screening among lesbian, but not bisexual people (n = 3). Conclusions: This review identified socioeconomic status, provider-patient relationship, and rurality as determinants affecting cancer screening among SM people. While literature addresses diverse SM groups, inclusion/exclusion criteria identified studies addressing cisgender women. Addressing disparities in the identified determinants of cervical cancer screening may improve participation among SM women. Further research is needed to understand determinants of cancer screening unique to other SM groups.
目的：为了解决性少数群体（SM）中癌症筛查的差异并降低癌症风险，本综述确定了不同性少数群体身份中（不）参与癌症筛查的个人、人际和社区/社会决定因素。方法：检索了七个科学数据库。纳入标准如下：(1) 使用定量方法；(2) 英语；(3) 癌症筛查重点；(4) 至少确定一个 SM 群体。在以下情况下，文章将被排除在外：(1) 分析未按 SM 身份分类（n = 29）；(2) 定量分析不包括癌症筛查的决定因素（n = 19）。性与性别少数群体健康差异研究框架指导文献综述。结果：12 项研究涉及宫颈癌（4 项）、乳腺癌（3 项）、乳腺癌/宫颈癌（3 项）或多种癌症（2 项）。其他癌症因纳入/排除标准而被排除在外。样本总数为 20622（平均 1525），包括女同性恋（n = 13409）、双性恋（n = 4442）、男同性恋（n = 1386）、大部分为异性恋（n = 1302）和同性恋（n = 83）。分析个人层面决定因素的研究（n = 8）发现，社会经济地位影响了女同性恋和双性恋参与者的宫颈癌筛查，但不影响乳腺癌筛查（n = 2）。在人际关系层面（n = 7），提供者与患者的关系是女同参与者（n = 4）进行宫颈癌筛查的一个决定因素；其他群体未对这种关系进行研究。分析社区/社会决定因素的研究（n = 5）发现，乡村地区可能会影响女同性恋的宫颈癌筛查，但不会影响双性恋（n = 3）。结论：本综述将社会经济地位、医疗服务提供者与患者的关系以及乡村地区确定为影响 SM 群体癌症筛查的决定因素。虽然文献涉及不同的 SM 群体，但纳入/排除标准确定了针对顺性别女性的研究。解决已确定的宫颈癌筛查决定因素中的差异可能会提高 SM 妇女的参与率。要了解其他 SM 群体癌症筛查的独特决定因素，还需要进一步的研究。
{"title":"Relationships Among Determinants of Health, Cancer Screening Participation, and Sexual Minority Identity: A Systematic Review.","authors":"Callie Kluitenberg Harris, Horng-Shiuann Wu, Rebecca Lehto, Gwen Wyatt, Barbara Given","doi":"10.1089/lgbt.2023.0097","DOIUrl":"https://doi.org/10.1089/lgbt.2023.0097","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> To address cancer screening disparities and reduce cancer risk among sexual minority (SM) groups, this review identifies individual, interpersonal, and community/societal determinants of cancer screening (non)participation among differing SM identities. <b><i>Methods:</i></b> Seven scientific databases were searched. Inclusion criteria were as follows: (1) used quantitative methods; (2) English language; (3) cancer screening focus; and (4) at least one SM group identified. Articles were excluded if: (1) analysis was not disaggregated by SM identity (<i>n</i> = 29) and (2) quantitative analysis excluded determinants of cancer screening (<i>n</i> = 19). The Sexual and Gender Minority Health Disparities Research Framework guided literature synthesis. <b><i>Results:</i></b> Twelve studies addressed cervical (<i>n</i> = 4), breast (<i>n</i> = 3), breast/cervical (<i>n</i> = 3), or multiple cancers (<i>n</i> = 2). Other cancers were excluded due to inclusion/exclusion criteria. The total sample was 20,622 (mean 1525), including lesbian (<i>n</i> = 13,409), bisexual (<i>n</i> = 4442), gay (<i>n</i> = 1386), mostly heterosexual (<i>n</i> = 1302), and queer (<i>n</i> = 83) identities. Studies analyzing individual-level determinants (<i>n</i> = 8) found that socioeconomic status affected cervical, but not breast, cancer screening among lesbian and bisexual participants (<i>n</i> = 2). At the interpersonal level (<i>n</i> = 7), provider-patient relationship was a determinant of cervical cancer screening among lesbian participants (<i>n</i> = 4); a relationship not studied for other groups. Studies analyzing community/societal determinants (<i>n</i> = 5) found that rurality potentially affected cervical cancer screening among lesbian, but not bisexual people (<i>n</i> = 3). <b><i>Conclusions:</i></b> This review identified socioeconomic status, provider-patient relationship, and rurality as determinants affecting cancer screening among SM people. While literature addresses diverse SM groups, inclusion/exclusion criteria identified studies addressing cisgender women. Addressing disparities in the identified determinants of cervical cancer screening may improve participation among SM women. Further research is needed to understand determinants of cancer screening unique to other SM groups.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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