1
|
Danielewicz M. Medical Issues Affecting Older Gay and Bisexual Men. Clin Geriatr Med 2024; 40:239-250. [PMID: 38521595 DOI: 10.1016/j.cger.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Older gay and bisexual men constitute diverse, sizable, and potentially vulnerable populations. They have and continue to face discrimination and stigma in multiple settings, including health care. Older gay and bisexual men report worse health, higher rates of alcohol and tobacco use, and higher HIV rates compared with their heterosexual counterparts. They have unique needs and experiences in multiple realms of health care including mental health, sexual health, and cancer screenings. Geriatric medicine physicians and providers can educate themselves on these unique needs and risks and take steps to provide inclusive, affirming care.
Collapse
Affiliation(s)
- Michael Danielewicz
- Pride at the Jefferson Center for Healthy Aging, Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA 19147, USA.
| |
Collapse
|
2
|
Matthews AK, Murray M, Ben Levi J, Odell D, Jeremiah R, Moore L, Oyaluade D, Chappel A, Burke L, Watson K. Preliminary Evaluation of a Citizen Scientist Educational Curriculum Aimed at Engaging Black Men in Lung Cancer Early Detection Screening. Am J Mens Health 2022; 16:15579883221099417. [PMID: 35694882 PMCID: PMC9201322 DOI: 10.1177/15579883221099417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/03/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Abstract
This article describes an educational program to engage African American men as citizen scientists (CSs) and future research partners in a lung cancer screening project. We provide an overview of the curriculum used, the structure and format of the educational sessions, and associated educational outcomes. Furthermore, we describe lessons learned in the engagement of African American men as CS in community-based lung-health equity research. The CS educational program included five group-based sessions delivered through zoom. The educational curriculum was adapted from the University of Florida Citizen Scientist program and tailored to address lung health and the contextual experiences of African American men. Each session lasted 90 minutes. Pre- and post-test measures were collected to examine changes in knowledge, comfort, health literacy, research interests, and medical mistrust. Eight African American men completed the CS educational program. Attendance rates were high for each session (100%). Seven participants completed additional human subject research certification. Improvements were observed from pre- to post-test in participants' level of knowledge, comfort, and health literacy but not medical mistrust. CS reported the most interest in participating in research aimed to identify important community strengths and problems. Study findings suggest that it was feasible to deliver an online citizen scientist educational program designed to prepare participants to serve as partners in a lung cancer screening intervention for African American men. Results suggest the educational program has the potential to improve key outcomes including completion of regulatory training and increased research-related knowledge, comfort, and health literacy.
Collapse
Affiliation(s)
- Alicia K. Matthews
- College of Nursing, The University of
Illinois at Chicago, Chicago, IL, USA
| | | | - Josef Ben Levi
- College of Education, Northeastern
Illinois University, Chicago, IL, USA
| | - David Odell
- Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA
| | - Rohan Jeremiah
- College of Nursing, The University of
Illinois at Chicago, Chicago, IL, USA
| | | | - Damilola Oyaluade
- Cancer Center, The University of
Illinois at Chicago, Chicago, IL, USA
| | - Alexis Chappel
- College of Education, Northeastern
Illinois University, Chicago, IL, USA
| | - Larisa Burke
- College of Nursing, The University of
Illinois at Chicago, Chicago, IL, USA
| | - Karriem Watson
- School of Public Health, The University
of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
3
|
Tan ASL, Potter J. How the Expansion of the U.S. Preventive Services Task Force Lung Cancer Screening Eligibility May Improve Health Equity Among Diverse Sexual and Gender Minority Populations. LGBT Health 2021; 8:503-506. [PMID: 34619037 DOI: 10.1089/lgbt.2021.0188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article discusses the potential implications of addressing lung cancer disparities among diverse sexual and gender minority (SGM) populations based on the recently expanded U.S. Preventive Services Task Force 2021 guidelines on lung cancer screening using low-dose computed tomography to include adults aged 50-80 years who have a 20 pack-year smoking history (one pack-year equals smoking one pack or 20 cigarettes per day for 1 year) and currently smoke or have quit within the past 15 years. Research on lung cancer screening barriers and facilitators and efforts to increase awareness and screening uptake among SGM populations are proposed.
Collapse
Affiliation(s)
- Andy S L Tan
- Annenberg School for Communication and University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer Potter
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,The Fenway Institute, Boston, Massachusetts, USA.,Division of General Internal Medicine, Beth Israel Lahey Health, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Hasson RM, Phillips JD, Fay KA, Millington TM, Finley DJ. Lung Cancer Screening in a Surgical Lung Cancer Population: Analysis of a Rural, Quaternary, Academic Experience. J Surg Res 2021; 262:14-20. [PMID: 33530004 PMCID: PMC10750227 DOI: 10.1016/j.jss.2020.11.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/21/2020] [Accepted: 11/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Rural populations face many health disadvantages including higher rates of tobacco use and lung cancer than more populated areas. Given this, we specifically sought to understand the current screening landscape in a cohort of patients with resected lung cancer to help direct improvements in the screening process. MATERIALS AND METHODS We retrospectively reviewed our prospective database at a rural, quaternary, academic institution from January 2015 to June 2018. All patients who underwent resection for primary lung cancer were studied to assess the frequency of preoperative low-dose chest computed tomography per accepted guidelines. The intent was to evaluate participant demographics, clinical stage, frequency, and distribution of Lung-RADS reporting. RESULTS About 446 patients underwent primary resection, of which 252 were deemed screening-eligible. About 57 (22.6%) underwent low-dose chest computed tomography screening and 195 (77.4%) did not. No significant demographic differences were identified between groups. However, 82.5% (47/57) of the screened patients presented with clinical stage IA disease, compared with 67.1% (131/195) of the nonscreened patients (P = 0.03). Among those screened, 36.8% (21/57) did not have a Lung-RADS score documented despite 52.3% (11/21) of those coming from accredited programs. CONCLUSIONS Our screening completion rate was only 22.6% of eligible patients and 36.8% of those patients did not have a documented Lung-RADS score. These findings, in combination with the increased rate of diagnosis of stage IA disease, provide compelling reasons to further investigate factors designed to improve access and screening practices at rural institutions.
Collapse
Affiliation(s)
- Rian M Hasson
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire; The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, New Hampshire.
| | - Joseph D Phillips
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | - Kayla A Fay
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, Lebanon, New Hampshire; The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Timothy M Millington
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | - David J Finley
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| |
Collapse
|
5
|
McCabe SE, West BT, Matthews AK, Evans-Polce R, Lee JG, Hughes TL, Veliz P, McCabe V, Boyd CJ. Sexual Orientation, Tobacco Use, and Tobacco Cessation Treatment-Seeking: Results From a National U.S. Survey. Behav Med 2021; 47:120-130. [PMID: 32703084 PMCID: PMC7854762 DOI: 10.1080/08964289.2019.1676191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite higher rates of tobacco use and smoking-related diseases among sexual minorities, tobacco cessation treatment-seeking behaviors (e.g., medication, nicotine replacement products) remain poorly understood across sexual orientation subgroups. This study examines tobacco cessation treatment-seeking behaviors associated with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition tobacco use disorder (TUD) across the three major sexual orientation dimensions (identity, attraction, behavior) in U.S. adults. Prevalence estimates reflect data collected from a 2012-2013 national sample of adults 18 years and older. More than three-fourths of U.S. adults with TUD had never engaged in tobacco cessation treatment-seeking behaviors, regardless of sexual orientation. Despite having the highest rates of TUD, bisexual men and women had some of the lowest rates of tobacco cessation treatment-seeking. Men who identified as gay, reported same-sex attraction, or reported same-sex behaviors had the highest rates of tobacco cessation treatment-seeking. In contrast, women with same-sex attraction or same-sex behavior had higher rates of TUD but were less likely to engage in tobacco cessation treatment-seeking behaviors than women with only other-sex attraction or other-sex behavior, respectively. Heterosexual women were more likely to engage in tobacco cessation treatment-seeking than heterosexual men; this sex difference was not present for sexual minorities. Medications and nicotine replacement therapy products were the most prevalent forms of treatment-seeking. There were notable differences in tobacco cessation treatment-seeking behaviors based on sex and sexual orientation. Findings highlight the underutilization of tobacco cessation treatment-seeking among all U.S. adults and point to important factors to consider when working with sexual minorities who are trying to reduce or stop using tobacco.
Collapse
Affiliation(s)
- Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Brady T. West
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Alicia K. Matthews
- College of Nursing, Department of Health Systems Science, University of Illinois at Chicago, Chicago, Illinois
| | - Rebecca Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Joseph G.L. Lee
- Department of Health Education and Promotion, College of Health and Human Performance, and Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Tonda L. Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, New York
| | - Phil Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Vita McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,St. Joseph Mercy Ann Arbor, St. Joseph Mercy Health System, Ypsilanti, Michigan
| | - Carol J. Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
6
|
Stowell JT, Parikh Y, Tilson K, Narayan AK. Lung Cancer Screening Eligibility and Utilization Among Transgender Patients: An Analysis of the 2017–2018 United States Behavioral Risk Factor Surveillance System Survey. Nicotine Tob Res 2020; 22:2164-2169. [DOI: 10.1093/ntr/ntaa127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022]
Abstract
Abstract
Introduction
Transgender and gender diverse (TGD) persons disproportionately face many health disparities including a higher risk of lung cancer. Lung cancer screening (LCS) using low-dose chest computed tomography has reduced lung cancer mortality in eligible high-risk smokers across several large trials, yet utilization of LCS remains low. TGD persons may be less likely to receive recommended cancer screening compared with cisgender populations. We sought to compare eligibility for and utilization of LCS between TGD and cisgender persons in the United States. We also examined if the utilization of LCS varied by smoking status within each gender identity group.
Methods
We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional survey to determine eligibility and utilization of LCS among TGD participants compared with cisgender persons. Logistical regression analysis of potentially confounding variables included age category, race/ethnicity, income, employment status, health insurance, and having a personal doctor.
Results
Of 37 023 weighted respondents, 0.5% were TGD. Although eligibility for LCS was statistically similar (8.8% TGD vs. 12.2% cisgender) (adjusted odds ratio = 0.81, 95% confidence interval = 0.27–2.39, p = .703), only 2.3% of TGD participants reported obtaining a LCS chest computed tomography versus 17.2% of cisgender participants (adjusted odds ratio = 0.04, 95% confidence interval = 0.01–0.59, p = .019). Smoking status showed no association with LCS utilization among gender identity groups.
Conclusions
TGD persons may be less likely to receive LCS despite having similar smoking status and eligibility of cisgender persons, suggesting a disparity in utilization of this preventative health service.
Implications
Targeted efforts to increase LCS utilization and promote smoking cessation for at-risk TGD patients may be warranted.
Collapse
Affiliation(s)
| | - Yasha Parikh
- Department of Radiology, Mount Auburn Hospital, Cambridge, MA
| | - Kimberly Tilson
- Behavioral Health Community Access Program, Truman Medical Centers, Kansas City, MO
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
7
|
Veliz P, Matthews AK, Arslanian-Engoren C, Evans-Polce RJ, Lee JGL, Boyd CJ, Hughes T, McCabe VV, McCabe SE. LDCT lung cancer screening eligibility and use of CT scans for lung cancer among sexual minorities. Cancer Epidemiol 2019; 60:51-54. [PMID: 30909153 DOI: 10.1016/j.canep.2019.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/09/2019] [Accepted: 03/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare eligibility for lung cancer screening and receipt of a CT scan for lung cancer among sexual minorities. METHODS Secondary data analysis of cross-sectional data from older U.S. adults in the Behavioral Risk Factor Surveillance System survey during the 2017 cycle (n = 20,685). RESULTS Rates of eligibility for low-dose helical computed tomography (LDCT) were roughly twice as high among sexual minorities than among heterosexuals (21.1% vs. 11.7%). The odds of gay men and lesbian women indicating eligibility for LDCT screening were four to five times higher when compared to their heterosexual peers. No statistically significant differences were found between sexual minorities and heterosexuals with respect to having a CT scan for lung cancer in the past year. CONCLUSIONS There are potential sexual-identity-related disparities in the utilization of lung cancer screening among eligible smokers. Interventions are needed to increase awareness and uptake of lung cancer screening in order to detect and manage this common form of cancer in the U.S.
Collapse
Affiliation(s)
- Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 N. Ingalls, Ann Arbor, MI 48109, USA; Institute for Research on Women and Gender, University of Michigan, 204 S. State St., Ann Arbor, MI 48109, USA.
| | - Alicia K Matthews
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, Chicago, IL, 60612, USA
| | - Cynthia Arslanian-Engoren
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 N. Ingalls, Ann Arbor, MI 48109, USA
| | - Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 N. Ingalls, Ann Arbor, MI 48109, USA
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 1000 East 5th Street, Greenville, NC, 27858, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 N. Ingalls, Ann Arbor, MI 48109, USA; Institute for Research on Women and Gender, University of Michigan, 204 S. State St., Ann Arbor, MI 48109, USA; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Tonda Hughes
- School of Nursing, Columbia University, 560 W. 168th Street, New York, NY, 10032, USA
| | - Vita V McCabe
- Lung Care and Center for Tobacco-Free Living, St. Joseph Mercy Health System, 5333 McAuley Drive, RHB-4005, Ann Abor, MI 48197, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 N. Ingalls, Ann Arbor, MI 48109, USA; Institute for Research on Women and Gender, University of Michigan, 204 S. State St., Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex (NCRC), Building 16, Ann Arbor, MI 48109, USA
| |
Collapse
|