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Parker VL, Liechty JM, Cantoni NP. Associations Between Trauma and Health Behaviors and Outcomes Among Sexual Minoritized Adults: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241233270. [PMID: 38415318 DOI: 10.1177/15248380241233270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Sexual minoritized (SM) adults experience health disparities and report higher rates of trauma history compared to heterosexual adults. This scoping review synthesizes the extant literature that investigates associations between trauma and physical health among SM adults. It also describes research instruments utilized to assess trauma in relation to health outcomes among SM adults. We searched CINAHL, LGBT+ Life, PsycINFO, and PubMed to identify studies meeting inclusion criteria: peer-reviewed, English, assessed trauma as an independent variable, and assessed health behaviors or outcomes among SM adults. From 587 nonduplicate articles, 69 full texts were reviewed; 18 met criteria and were included in this review. To enhance rigor, we utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Scoping Reviews checklist. Most (n = 12) of the included studies were cross-sectional. Trauma was assessed 16 different ways, including 9 validated measures, in relation to 5 health behaviors and 17 health conditions. Trauma was operationalized by history of childhood sexual abuse, adverse childhood experiences, lifetime rape, current symptoms of post-traumatic stress disorder, and lifetime victimization among SM adults. All but one study found associations between trauma and one or more unfavorable health behaviors or outcomes. Studies used widely heterogeneous instruments to assess trauma, health, and SM identity. Greater specification and standardization of measurement is needed, along with contextualized assessments of trauma and its impact on health such as sexual minority stress-related victimization and resilience, and post-traumatic growth and recovery processes.
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Affiliation(s)
| | - Janet M Liechty
- University of Illinois, Urbana-Champaign, USA
- Carle-Illinois College of Medicine, University of Illinois, Urbana-Champaign, USA
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2
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Bochicchio L, Porsch L, Zollweg S, Matthews AK, Hughes TL. Health Outcomes of Sexual Minority Women Who Have Experienced Adverse Childhood Experiences: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:764-794. [PMID: 37070743 PMCID: PMC10582204 DOI: 10.1177/15248380231162973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Sexual minority women (SMW; e.g., lesbian, bisexual) report higher rates of almost every negative physical health (e.g., asthma, arthritis, cardiovascular disease), mental health (e.g., depression, anxiety), and substance use outcome compared to heterosexual women. Adverse Childhood Experiences (ACEs) have been identified as risk factors for negative health outcomes. Despite this, no study to date has synthesized existing literature examining ACEs and health outcomes among SMW. This gap is important because SMW are significantly more likely than heterosexual women to report every type of ACE and a higher total number of ACEs. Therefore, using a scoping review methodology, we sought to expand understanding of the relationship between ACEs and health outcomes among SMW. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for. Scoping Reviews protocol, we searched five databases: Web of Science, PsycInfo, CINAHL, PubMed, and Embase for studies published between January 2000 and June 2021 that examined mental health, physical health, and/or substance use risk factors and outcomes among adult cisgender SMW who report ACEs. Our search yielded 840 unique results. Studies were screened independently by two authors to determine eligibility, and 42 met full inclusion criteria. Our findings provide strong evidence that ACEs are an important risk factor for multiple negative mental health and substance use outcomes among SMW. However, findings were mixed with respect to some health risk behaviors and physical health outcomes among SMW, highlighting the need for future research to clarify these relationships.
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Affiliation(s)
| | - Lauren Porsch
- Columbia University School of Nursing, New York, NY, USA
| | - Sarah Zollweg
- Columbia University School of Nursing, New York, NY, USA
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Caceres BA, Sharma Y, Levine A, Wall MM, Hughes TL. Investigating the Associations of Sexual Minority Stressors and Incident Hypertension in a Community Sample of Sexual Minority Adults. Ann Behav Med 2023; 57:1004-1013. [PMID: 37306778 PMCID: PMC10653588 DOI: 10.1093/abm/kaac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Sexual minority adults are at higher risk of hypertension than their heterosexual counterparts. Sexual minority stressors (i.e., unique stressors attributed to sexual minority identity) are associated with a variety of poor mental and physical health outcomes. Previous research has not tested associations between sexual minority stressors and incident hypertension among sexual minority adults. PURPOSE To examine the associations between sexual minority stressors and incident hypertension among sexual minority adults assigned female sex at birth. METHODS Using data from a longitudinal study, we examined associations between three sexual minority stressors and self-reported hypertension. We ran multiple logistic regression models to estimate the associations between sexual minority stressors and hypertension. We conducted exploratory analyses to determine whether these associations differed by race/ethnicity and sexual identity (e.g., lesbian/gay vs. bisexual). RESULTS The sample included 380 adults, mean age 38.4 (± 12.81) years. Approximately 54.5% were people of color and 93.9% were female-identified. Mean follow-up was 7.0 (± 0.6) years; during which 12.4% were diagnosed with hypertension. We found that a 1-standard deviation increase in internalized homophobia was associated with higher odds of developing hypertension (AOR 1.48, 95% Cl: 1.06-2.07). Stigma consciousness (AOR 0.85, 95% CI: 0.56-1.26) and experiences of discrimination (AOR 1.07, 95% CI: 0.72-1.52) were not associated with hypertension. The associations of sexual minority stressors with hypertension did not differ by race/ethnicity or sexual identity. CONCLUSIONS This is the first study to examine the associations between sexual minority stressors and incident hypertension in sexual minority adults. Implications for future studies are highlighted.
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Affiliation(s)
- Billy A Caceres
- Columbia University School of Nursing, 560 West 168th Street, Room 603, New York, NY 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA
| | - Yashika Sharma
- Columbia University School of Nursing, 560 West 168th Street, Room 603, New York, NY 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA
| | - Alina Levine
- Department of Biostatistics, Columbia Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Melanie M Wall
- Department of Biostatistics, Columbia Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 West 168th Street, Room 603, New York, NY 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA
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Scheer JR, Wall MM, Veldhuis CB, Ford JV, Cascalheira CJ, Helminen EC, Shaw TJ, Jaipuriyar V, Zaso MJ, Hughes TL. Associations Between Latent Classes of Trauma Exposure and Minority Stressors and Substance Use Among Cisgender Sexual Minority Women. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:8286-8315. [PMID: 36843440 DOI: 10.1177/08862605231153886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Psychosocial stressors (e.g., minority stressors, trauma exposure) profoundly impact sexual minority women's (SMW's) risk of alcohol and other drug (AOD) use. However, research has not examined whether there are distinct typologies (i.e., patterns) of psychosocial stressors and whether these vary based on sociodemographic characteristics or are differentially associated with AOD outcomes (e.g., alcohol dependence) among SMW. This study aimed to identify latent classes of SMW reporting distinct typologies of psychosocial stressors and examine predictors and outcomes of latent classes of psychosocial stressors among SMW. Participants included a community sample of 602 SMW (Mage = 39.9, SD = 14.0; 74.0% lesbian; 37.4% White, 36.6% Black, 22.3% Latinx; 26.6% annual income ≤$14,999). Latent class analysis was used to identify typologies of psychosocial stressors. Regression analyses were employed to examine sociodemographic predictors and AOD outcomes of class membership. Three classes of psychosocial stressors emerged. Participants in Class 1 were likely to report relatively low adversity. SMW in Class 2, who reported childhood physical abuse (CPA), severe childhood sexual abuse, and adult physical assault, were vulnerable to discrimination and stigma consciousness. A distinct subgroup of SMW (Class 3) was at heightened risk of CPA, adult sexual assault (ASA), and stigma consciousness. Older SMW, Black SMW, and SMW with lower social support were more likely to be in classes characterized by higher adversity. Older SMW were at disproportionate risk of CPA and ASA. Different combinations of psychosocial stressors were uniquely associated with AOD outcomes. Findings underscore the importance of considering within-group heterogeneity in SMW's differential risk of psychosocial stressors and AOD outcomes. Routine screening of psychosocial stressors across several dimensions, brief interventions targeting AOD outcomes, and policies mitigating structural drivers of SMW's increased risk of trauma and minority stressors may be especially important for older SMW, Black SMW, and SMW who lack social support.
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Affiliation(s)
| | - Melanie M Wall
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University School of Nursing, Center for Sexual and Gender Minority Health Research, New York, NY, USA
| | - Cindy B Veldhuis
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Cory J Cascalheira
- Syracuse University, Syracuse, NY, USA
- New Mexico State University, Las Cruces, NM, USA
| | - Emily C Helminen
- Syracuse University, Syracuse, NY, USA
- Rochester Institute of Technology, Rochester, NY, USA
| | - Thomas J Shaw
- Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | | | | | - Tonda L Hughes
- Columbia University, New York, NY, USA
- Columbia University School of Nursing, Center for Sexual and Gender Minority Health Research, New York, NY, USA
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5
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Caceres BA, Sharma Y, Ravindranath R, Ensari I, Rosendale N, Doan D, Streed CG. Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults. JAMA Cardiol 2023; 8:335-346. [PMID: 36811854 PMCID: PMC9947804 DOI: 10.1001/jamacardio.2022.5660] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/23/2022] [Indexed: 02/24/2023]
Abstract
Importance Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures, which has limited development of behavioral interventions. Objective To investigate sexual identity differences in CVH, measured using the American Heart Association's revised measure of ideal CVH, among adults in the US. Design, Setting, and Participants This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2007-2016) in June 2022. Participants included noninstitutional adults aged 18 to 59 years. We excluded individuals who were pregnant at the time of their interview and those with a history of atherosclerotic cardiovascular disease or heart failure. Exposures Self-identified sexual identity categorized as heterosexual, gay/lesbian, bisexual, or something else. Main Outcomes and Measures The main outcome was ideal CVH (assessed using questionnaire, dietary, and physical examination data). Participants received a score from 0 to 100 for each CVH metric, with higher scores indicating a more favorable CVH profile. An unweighted average was calculated to determine cumulative CVH (range, 0-100), which was recoded as low, moderate, or high. Sex-stratified regression models were performed to examine sexual identity differences in CVH metrics, disease awareness, and medication use. Results The sample included 12 180 participants (mean [SD] age, 39.6 [11.7] years; 6147 male individuals [50.5%]). Lesbian (B = -17.21; 95% CI, -31.98 to -2.44) and bisexual (B = -13.76; 95% CI, -20.54 to -6.99) female individuals had less favorable nicotine scores than heterosexual female individuals. Bisexual female individuals had less favorable body mass index scores (B = -7.47; 95% CI, -12.89 to -1.97) and lower cumulative ideal CVH scores (B = -2.59; 95% CI, -4.84 to -0.33) than heterosexual female individuals. Compared with heterosexual male individuals, gay male individuals had less favorable nicotine scores (B = -11.43; 95% CI, -21.87 to -0.99) but more favorable diet (B = 9.65; 95% CI, 2.38-16.92), body mass index (B = 9.75; 95% CI, 1.25-18.25), and glycemic status scores (B = 5.28; 95% CI, 0.59-9.97). Bisexual male individuals were twice as likely as heterosexual male individuals to report a diagnosis of hypertension (adjusted odds ratio [aOR], 1.98; 95% CI, 1.10-3.56) and use of antihypertensive medication (aOR, 2.20; 95% CI, 1.12-4.32). No differences in CVH were found between participants who reported their sexual identity as something else and heterosexual participants. Conclusion and Relevance Results of this cross-sectional study suggest that bisexual female individuals had worse cumulative CVH scores than heterosexual female individuals, whereas gay male individuals generally had better CVH than heterosexual male individuals. There is a need for tailored interventions to improve the CVH of sexual minority adults, particularly bisexual female individuals. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual female individuals.
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Affiliation(s)
- Billy A. Caceres
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York
| | - Yashika Sharma
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York
| | - Rohith Ravindranath
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York
| | - Ipek Ensari
- Hasso Plattner Institute for Digital Health at Mount Sinai, Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicole Rosendale
- Department of Neurology, University of California, San Francisco, San Francisco
| | - Danny Doan
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, New York
| | - Carl G. Streed
- Boston University School of Medicine, Boston, Massachusetts
- Center for Transgender Medicine and Surgery, Mount Sinai, New York, New York
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Vuong E, Peer N, Chirwa E, Mhlongo S, Lombard C, Hemmings S, Kengne AP, Abrahams N, Seedat S. Prospective Association of Circulating Adipokines with Cardiometabolic Risk Profile Among Women: The Rape Impact Cohort Evaluation Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:820-833. [PMID: 36340478 PMCID: PMC9629977 DOI: 10.1089/whr.2022.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Sexual violence is associated with poor cardiometabolic outcomes, yet the etiopathogenic pathways remain unclear. Adipokines may contribute to pathways in the development of cardiometabolic disease (CMD), including in vulnerable populations. Further investigation of adipokines among sexually traumatized individuals may inform cardiometabolic screening. This study aimed to investigate the association between circulating adipokines, metabolic syndrome (MetS), and longitudinal change in MetS components (namely abdominal obesity, blood pressure, lipid profile, and glycemic status) over a 1-year period in a cohort of rape exposed (RE) and rape unexposed (RUE) females. MATERIALS AND METHODS Seven hundred seventy-eight RE and 617 RUE black South African women aged 18-40 years were recruited for the Rape Impact Cohort Evaluation study. Nonfasting blood samples were analyzed for cardiometabolic variables and adipokine levels using enzyme-linked immunosorbent assay. Serum adiponectin was measured in both RE and RUE and resistin, leptin, and leptin/adiponectin (L/A) ratio in RE only. Associations between baseline serum adipokines, MetS, and its components were assessed at baseline and follow-up using adjusted linear and logistic regressions. RESULTS In the RE group, adiponectin, leptin, and L/A ratio were significantly associated with MetS prevalence cross-sectionally (all p ≤ 0.001). No adipokine marker was related to incident MetS at 12-month follow-up. In the RE group, significant longitudinal associations with high-density lipoprotein cholesterol were shown for adiponectin (β = 0.146 [0.064], p = 0.022) and leptin (β = 0.001 [0.002], p = 0.012). CONCLUSIONS Findings suggest that adipokines may have a potential role as biomarkers to identify RE individuals at high risk for CMD.
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Affiliation(s)
- Eileen Vuong
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.,Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.,Address correspondence to: Eileen Vuong, MBchB, MMed(Psych), Department of Psychiatry, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa,
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa.,School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Sian Hemmings
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.,SAMRC/SU Genomics of Brain Disorders Unit, Stellenbosch University, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Soraya Seedat
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.,Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.,SAMRC/SU Genomics of Brain Disorders Unit, Stellenbosch University, South Africa
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7
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Beckie TM, Lengacher C, Rodriguez C, Pares-Avila J, Turner D, Sanchez M, Nair US. A framework for addressing health inequities in sexual and gender diverse populations by nurses. Nurs Outlook 2022; 70:651-663. [DOI: 10.1016/j.outlook.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
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Caceres BA, Sharma Y, Doan D. Hypertension risk in sexual and gender minority individuals. Expert Rev Cardiovasc Ther 2022; 20:339-341. [PMID: 35532894 PMCID: PMC9233064 DOI: 10.1080/14779072.2022.2075345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Billy A Caceres
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, NY, USA
| | - Yashika Sharma
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, NY, USA
| | - Danny Doan
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, NY, USA
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9
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Foley JD, Stanton AM, Shepard C, Morris J, O'Cleirigh C, Potter J, Batchelder AW. Discrimination experiences, resilience, and cardiovascular disease risk factors among sexual minority women. J Behav Med 2022; 45:461-471. [PMID: 35503193 DOI: 10.1007/s10865-022-00320-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
Resilience, or the process of adapting to adversity, may protect against the harmful effects of minority-related stressors on the cardiovascular health of sexual minority women (SMW). An online survey was conducted in a sample of cisgender, non-heterosexual women to evaluate resilience as a moderator of the association between discrimination experiences and key cardiovascular disease (CVD) risk factors: stress, tobacco-smoking, hazardous alcohol consumption, poor diet quality, physical inactivity, and sedentary behaviors. Overall, 191 women (mean age = 29.34, SD = 6.92; 84.5% White) completed the survey and met eligibility to be included in the data analysis. White race (b = - 6.71, SE = 2.49) and education (b = - 3.36, SE = 0.56) were each independently associated with fewer discrimination experiences. Latinx ethnicity was associated with more discrimination experiences (b = 9.34, SE = 2.61). Education was associated with greater resilience (b = 4.57, SE = 0.83). Multivariable regression models were adjusted for race, ethnicity, and education. Discrimination was associated with a higher likelihood of smoking in the past month (b = 0.04, SE = 0.02) and drinking at hazardous levels (b = 0.09, SE = 0.02). Resilience was associated with less stress (b = - 0.15, SE = 0.02), a lower likelihood of hazardous alcohol consumption (b = - 0.02, SE = 0.01) and less time spent engaging in sedentary behaviors (b = - 0.02, SE = 0.01). One moderation emerged, such that discrimination was negatively associated with stress for those low in resilience (b = - 1.75, SE = 0.58), and not associated with stress for those high in resilience. These findings may inform the development of CVD-risk reduction interventions for SMW, which could include both strategies to mitigate the effects of discrimination on substance use and coping skills to promote resilience.
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Affiliation(s)
- Jacklyn D Foley
- Massachusetts General Hospital/Harvard Medical School, Boston, USA. .,Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA, 02114, USA.
| | - Amelia M Stanton
- Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | | | | | - Conall O'Cleirigh
- Massachusetts General Hospital/Harvard Medical School, Boston, USA.,The Fenway Institute, Fenway Health, Boston, USA
| | | | - Abigail W Batchelder
- Massachusetts General Hospital/Harvard Medical School, Boston, USA.,The Fenway Institute, Fenway Health, Boston, USA
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10
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Ancheta AJ, Caceres BA, Zollweg SS, Heron KE, Veldhuis CB, VanKim NA, Hughes TL. Examining the associations of sexual minority stressors and past-year depression with overeating and binge eating in a diverse community sample of sexual minority women. Eat Behav 2021; 43:101547. [PMID: 34412003 PMCID: PMC8629849 DOI: 10.1016/j.eatbeh.2021.101547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 02/01/2023]
Abstract
Sexual minority stressors (e.g., stigma consciousness, internalized homophobia, discrimination) are posited to contribute to higher prevalence of overeating and binge eating among sexual minority women (SMW) relative to heterosexual women. Few studies have examined psychosocial mediators of the associations of minority stressors with overeating and binge eating in SMW. Using data from a diverse, community-based sample of SMW, we examined these associations, including the potential mediating effects of past-year depression. We also conducted exploratory analyses to determine if the associations of sexual minority stressors with overeating and binge eating differed by sexual identity or by race and ethnicity. The sample included 607 SMW (38.2% White, 37.1% African American, 24.7% Latina) with a mean age of 39.7 years. Approximately 17% and 9% of SMW reported overeating and binge eating, respectively, in the past 3 months. Greater stigma consciousness was associated with higher odds of overeating (AOR 1.31, 95% CI = 1.03-1.66). We found no significant associations between minority stressors and binge eating. Past-year depression did not mediate associations between minority stressors and overeating or binge eating. Although we found no sexual identity differences, stigma consciousness among Latina SMW was associated with higher odds of overeating relative to White SMW (AOR 1.95, 95% CI = 1.21-3.12) and African American SMW (AOR 1.99, 95% CI = 1.19-3.31). Findings highlight the importance of screening SMW for stigma consciousness as a correlate of overeating and considering racial and ethnic differences in overeating and binge eating in this population.
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Affiliation(s)
- April J Ancheta
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Billy A Caceres
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Sarah S Zollweg
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Kristin E Heron
- Department of Psychology, Old Dominion University, Virginia Consortium Program in Clinical Psychology, 250 Mills Godwin Building, Norfolk, VA 23529, United States of America.
| | - Cindy B Veldhuis
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Nicole A VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences University of Massachusetts Amherst, 406 Arnold House, Amherst, MA 01003, United States of America.
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
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Diamond LM, Dehlin AJ, Alley J. Systemic inflammation as a driver of health disparities among sexually-diverse and gender-diverse individuals. Psychoneuroendocrinology 2021; 129:105215. [PMID: 34090051 DOI: 10.1016/j.psyneuen.2021.105215] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 01/28/2023]
Abstract
Sexually-diverse individuals (those who seek sexual or romantic relationships with the same and/or multiple genders) and gender-diverse individuals (those whose gender identity and/or expression differs from their birth-assigned sex/gender) have disproportionately high physical health problems, but the underlying biological causes for these health disparities remain unclear. Building on the minority stress model linking social stigmatization to health outcomes, we argue that systemic inflammation (the body's primary response to both physical and psychological threats, indicated by inflammatory markers such as C-reactive protein and proinflammatory cytokines) is a primary biobehavioral pathway linking sexual and gender stigma to physical health outcomes. Expectations and experiences of social threat (i.e., rejection, shame, and isolation) are widespread and chronic among sexually-diverse and gender-diverse individuals, and social threats are particularly potent drivers of inflammation. We review research suggesting that framing "minority stress" in terms of social safety versus threat, and attending specifically to the inflammatory consequences of these experiences, can advance our understanding of the biobehavioral consequences of sexual and gender stigma and can promote the development of health promoting interventions for this population.
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12
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Caceres BA, Wardecker BM, Anderson J, Hughes TL. Revictimization Is Associated With Higher Cardiometabolic Risk in Sexual Minority Women. Womens Health Issues 2021; 31:341-352. [PMID: 33766475 PMCID: PMC8260453 DOI: 10.1016/j.whi.2021.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Although there is evidence that interpersonal trauma is associated with cardiometabolic risk in women, previous studies have not assessed the potential role of revictimization (victimization in both childhood and adulthood) among sexual minority women. METHODS We used data from the Chicago Health and Life Experiences of Women study to examine the associations of revictimization (including physical, sexual, and any revictimization) with self-reported psychosocial factors, health behaviors, and cardiometabolic risk factors (e.g., obesity, hypertension, and diabetes). We tested multiple logistic regression models, adjusted for covariates, to estimate odds ratios of the associations between revictimization and cardiometabolic risk. RESULTS The sample included 615 sexual minority women with a mean age of 40.0 years; 38.7% White. Eighty-three (13.5%) and 101 (16.4%) participants reported experiencing sexual revictimization and physical revictimization, respectively. Each form of revictimization was associated with higher odds of reporting lifetime depression and recent binge eating, but lower odds of having high social support. Physical revictimization was associated with higher odds of obesity (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 1.38-4.10) and hypertension (AOR, 3.31; 95% CI, 1.70-6.46). Similarly, participants who reported any revictimization were more likely to have obesity (AOR, 2.36; 95% CI, 1.42-3.92) and hypertension (AOR, 2.60; 95% CI, 1.31-5.26). No form of revictimization was associated with a higher odds of diabetes. CONCLUSIONS The higher odds of obesity and hypertension observed among sexual minority women who reported revictimization reinforce the need for early interventions to reduce cardiometabolic risk in this vulnerable population.
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Affiliation(s)
- Billy A Caceres
- Program for the Study of LGBT Health, Columbia University School of Nursing, New York, New York.
| | | | - Jocelyn Anderson
- Pennsylvania State College of Nursing, University Park, Pennsylvania
| | - Tonda L Hughes
- Program for the Study of LGBT Health, Columbia University School of Nursing, New York, New York
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Caceres BA, Streed CG, Corliss HL, Lloyd-Jones DM, Matthews PA, Mukherjee M, Poteat T, Rosendale N, Ross LM. Assessing and Addressing Cardiovascular Health in LGBTQ Adults: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e321-e332. [PMID: 33028085 DOI: 10.1161/cir.0000000000000914] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is mounting evidence that lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adults experience disparities across several cardiovascular risk factors compared with their cisgender heterosexual peers. These disparities are posited to be driven primarily by exposure to psychosocial stressors across the life span. This American Heart Association scientific statement reviews the extant literature on the cardiovascular health of LGBTQ adults. Informed by the minority stress and social ecological models, the objectives of this statement were (1) to present a conceptual model to elucidate potential mechanisms underlying cardiovascular health disparities in LGBTQ adults, (2) to identify research gaps, and (3) to provide suggestions for improving cardiovascular research and care of LGBTQ people. Despite the identified methodological limitations, there is evidence that LGBTQ adults (particularly lesbian, bisexual, and transgender women) experience disparities across several cardiovascular health metrics. These disparities vary by race, sex, sexual orientation, and gender identity. Future research in this area should incorporate longitudinal designs, elucidate physiological mechanisms, assess social and clinical determinants of cardiovascular health, and identify potential targets for behavioral interventions. There is a need to develop and test interventions that address multilevel stressors that affect the cardiovascular health of LGBTQ adults. Content on LGBTQ health should be integrated into health professions curricula and continuing education for practicing clinicians. Advancing the cardiovascular health of LGBTQ adults requires a multifaceted approach that includes stakeholders from multiple sectors to integrate best practices into health promotion and cardiovascular care of this population.
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Flatt JD. Addressing Life Course Trauma and Cardiometabolic Risk in Sexual Minority Women. J Womens Health (Larchmt) 2019; 28:1177-1178. [DOI: 10.1089/jwh.2019.7941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jason D. Flatt
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California
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