Annals of LGBTQ public and population health最新文献

Enhancing communicative competence of healthcare providers (HCPs) is a critical initiative for improving the healthcare experience of sexual and gender minority (SGM) cancer patients. This study presents the development, implementation, and preliminary efficacy of a new training curriculum for improving oncology HCPs' skills in providing a safe and welcoming environment for SGM cancer patients (SGM Comskil training). Thirty-three (N = 33) oncology HCPs including nurses, nurse leaders, and nurse practitioners participated in a 4.25-hour SGM Comskil Training between July and August 2019. Overall, participants reported highly favorable evaluations of the training, with more than 80% of the participants reacting positively to 12 of the 15 evaluation items assessing engagement and reflectiveness for experiential role-plays with lesbian, gay, bisexual (LGB) and transgender standardized patients (SPs), respectively. Participants also demonstrated significant improvements in SGM healthcare knowledge, self-efficacy, beliefs toward LGB and transgender persons, and SGM-sensitive language use skills following the training. Encouraged by the feasibility of conducting this experiential training with busy cancer care HCPs and the initial favorable participant evaluation of the SGM Comskil training, results clearly indicate that this training can be rolled out into clinical settings to ensure its translational potential. The next steps should assess observable changes in communication skills and SGM-sensitive language skills with SGM patients and improvements in SGM patients' healthcare experience.

Introduction: This study explored whether structural stigma, defined by U.S. state policies related to sexual minority rights, moderated the relationship between sexual identity identity and heavy drinking, alcohol problems, and marijuana use among men and women.

Methods: Using combined data from the National Alcohol Survey (NAS) series (2000, 2005, 2010, and 2015), the sample included 11,115 men (421 sexual minority and 10,694 heterosexual) and 14,395 women (413 sexual minority and 13,982 heterosexual). State policy environment was assessed using a time-varying dichotomous indicator of comprehensive protections for sexual minorities (4-6 protections vs. limited or no protections). Gender-stratified logistic regression analyses examined the differential effect of the policy environment by sexual identity on three past-year substance use outcomes: high-intensity drinking (8+ drinks/day), any DSM-5 alcohol use disorder, and marijuana use.

Results: Among women, sexual minority status was associated with increased odds of all alcohol and marijuana use outcomes. Among men, sexual minority status was associated with decreased odds of high-intensity drinking but increased use of marijuana. Comprehensive policy protections were associated significantly decreased odds of high-intensity drinking among sexual minority men and marginally significant decreases among women.

Conclusions: Comprehensive policy protections appear to be protective for high-intensity drinking among sexual minority men and women. Findings underscore the importance of supportive policies in reducing risk of alcohol-related problems among sexual minorities.

The present study was designed to identify social support classes across time among midlife (40-64 years) and older (65+ years) gay, bisexual, and other men who have sex with men (MSM), and whether social support protects against depressive symptoms in this population. This study applied longitudinal latent class analysis across five visits on 1,329 individuals age 40 or older at baseline using data from the Multicenter AIDS Cohort Study (MACS) Healthy Aging substudy collected from April 2016 to October 2018. We identified four classes of social support across time: Partner-centered, that is, high levels of support from one's primary partner(s) and moderate support from friends and family; Friend-centered, that is, high levels of support from friends and chosen family; Low, that is, low levels of support from all sources; and Robust, that is, high levels of support from all sources. We found differences in class membership by age, race/ethnicity, employment status, sexual identity, education, relationship status, and HIV status. Finally, compared to MSM in the low support class, men in the other classes had lower odds of depressive symptoms at the final visit. The most common type of social support was partner-centered, while the least common type was robust. These findings suggest that the presence of any social support, regardless of the source, protects against depressive symptoms.

Discrimination negatively impacts the health of HIV-positive Latino sexual minority men (LSMM+). A growing literature on LSMM+ chronicles associations based on multiple devalued identities and mental health symptoms, HIV medication nonadherence, and sexual behaviors with the potential to transmit HIV. To gain additional insights on identity-based discrimination-as well as the associated coping responses-we conducted 30 qualitative interviews with LSMM+.Participantswereprobedregardingrecentdiscriminationevents(context,details,perpetrator, type) based on their intersecting identities (Latinx ethnicity, residency status, sexual minority orientation, HIV-positive serostatus) and their coping responses. We transcribed and translated the interviews and conducted a content analysis. Participants reported inter-group (i.e., between majority and minority group members) and intraminority-group (i.e., within minority group members) experiences as common. Participants described their intraminority-group experiences with discrimination based on being a Latinx sexual minority person in their families and home communities. Participants reported a range of coping responses to discrimination experiences. However, participants reported only functional (and no dysfunctional) coping strategies, and they endorsed using similar strategies in response to inter-group and intraminority-group discrimination. Coping strategies included strategic avoidance, social support, self-advocacy, and external attribution. Additional coping strategies (spirituality and positive reframing) emerged more strongly in response to inter-group experiences with discrimination. Our results underscore the need to address both inter-group and intraminority-group discrimination experiences. Future interventions can focus on strengthening the effective coping skills that LSMM+ currently employ as potential levers to address LSMM+ health disparities.

Sexual and gender minorities assigned female at birth (SGM-AFAB) are at heightened risk for problematic cannabis use compared to heterosexual cisgender women. Despite evidence that social context influences patterns of substance use, no known studies have examined context of cannabis use among SGM-AFAB. The current study examined two aspects of social contexts of cannabis use (locations and companions) and their associations with problematic use, motives for use, and protective behavioral strategies among SGM-AFAB. We utilized three waves of data from 358 SGM-AFAB from a larger study. We aimed to: (1) identify subgroups of SGM-AFAB based on contexts in which they used cannabis; (2) examine changes in contexts over time; and (3) examine associations between contexts, problematic use, motives for use, and protective behavioral strategies. Using latent class analysis, we identified four classes: those who used cannabis at home; those who used with friends; those who used alone and with friends; and those who used in all contexts. Those who used in all contexts reported more problematic use, higher coping motives, and used fewer protective behavioral strategies compared to other classes. Transitioning to using cannabis in fewer contexts was associated with a subsequent decrease in problematic use. Classes that were most stable over time (using in all contexts or alone and with friends) were also those that were associated with more problematic use. Social context has important implications for problematic cannabis use among SGM-AFAB. As such, interventions may benefit from attending to social context to reduce problematic use in this population.

Latinx sexual minority men (LSMM) are at the intersection of two communities disproportionately impacted by COVID-19. To develop and deploy appropriate resources to support LSMM, it is important to understand the behavioral, psychosocial, and medical experiences of this population during COVID-19, as well as for LSMM of different immigration statuses. The current study uses the Pandemic Stress Index (PSI) to describe LSMM's self-reported behavioral, psychosocial, and medical experiences during COVID-19. Logistic and linear regressions compared experiences during COVID-19 among LSMM across different immigration statuses (recent, established, and US-born as the reference group). LSMM's responses to the PSI indicated they experienced anxiety (64.4%), depression (59.0%), alcohol/substance use (27.6%), as well as loneliness (50.1%) and sleep problems (60.4%). Overall, over half reported personal financial loss, the odds of which were 2.75 times greater among LSMM who were recent immigrants compared to US-born LSMM (OR = 2.75, 95% CI: 1.30, 5.82). Nearly 8% reported being diagnosed with COVID-19, with the odds four and a half times greater among established immigrants compared to US-born LSMM (OR = 4.52, 95% CI: 1.60, 12.81). The findings have implications for tailored support resources and public health interventions to reach LSMM in general and LSMM with immigration histories.

Our objective was to characterize the proportion of U.S. mental health clinics that offered LGBT-tailored mental health services between 2014 and 2018. We used data from the National Mental Health Services Survey (NMHSS) to construct a mixed logistic model of availability of LGBT-tailored mental health services over time, by region (Northeast, South, Midwest and West), and by facility type (Veterans Administration, inpatient/residential, outpatient, community mental health centers and mixed). Our results show that the overall proportion of mental health clinics that offered LGBT-tailored services decreased from 2014 to 2018. Our results also indicate that Veteran Affairs clinics and facilities in the West and Northeast were most likely to offer LGBT-tailored mental health services. Given the temporal, regional, and facility gaps in LGBT-tailored mental health services availability, more effort should be dedicated to addressing this disparity.