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McClure RC, Macumber CL, Kronk C, Grasso C, Horn RJ, Queen R, Posnack S, Davison K. Gender harmony: improved standards to support affirmative care of gender-marginalized people through inclusive gender and sex representation. J Am Med Inform Assoc 2021; 29:354-363. [PMID: 34613410 PMCID: PMC8757317 DOI: 10.1093/jamia/ocab196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/04/2021] [Accepted: 09/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Accurate representation of clinical sex and gender identity in interoperable clinical
systems is a major challenge for organizations intent on improving outcomes for sex- and
gender-marginalized people. Improved data collection has been hindered by the historical
approach that presumed a single, often binary, datum was sufficient. We describe the
Health Level Seven International (HL7) Gender Harmony logical model that proposes an
improved approach. Materials and Methods The proposed solution was developed via an American National Standards Institute
(ANSI)-certified collaborative balloted process. As an HL7 Informative Document, it is
an HL7 International-balloted consensus on the subject of representing sex and
representing gender in clinical systems based on work of the gender harmony project led
by the HL7 Vocabulary Work Group. Results The Gender Harmony Model is a logical model that provides a standardized approach that
is both backwards-compatible and an improvement to the meaningful capture of gender
identity, recorded sex or recorded gender, a sex for clinical use, the name to use, and
pronouns that are affirmative and inclusive of gender-marginalized people. Conclusion Most clinical systems and current standards in health care do not meaningfully address,
nor do they consistently represent, sex and gender diversity, which has impeded
interoperability and led to suboptimal health care. The Gender Harmony Project was
formed to create more inclusive health information exchange standards to enable a safer,
higher-quality, and embracing healthcare experience. The Gender Harmony Model provides
the informative guidance for standards developers to implement a more thorough technical
design that improves the narrow binary design used in many legacy clinical systems.
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Affiliation(s)
| | | | - Clair Kronk
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | - Roz Queen
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Steven Posnack
- US Department of Health and Human Services, Office of the National Coordinator for Health IT, Washington, District of Columbia, USA
| | - Kelly Davison
- Canada Health Infoway, Toronto, ON, Canada.,School of Health Information Science, University of Victoria, Victoria, BC, Canada
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2
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Bowleg L, Landers S. The Need for COVID-19 LGBTQ-Specific Data. Am J Public Health 2021; 111:1604-1605. [PMID: 34436923 PMCID: PMC8589062 DOI: 10.2105/ajph.2021.306463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Lisa Bowleg
- Lisa Bowleg is with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC, and is an associate editor of AJPH. Stewart Landers is with US Health Services, John Snow, Inc., Boston, MA, and is an associate editor of AJPH
| | - Stewart Landers
- Lisa Bowleg is with the Department of Psychological and Brain Sciences, George Washington University, Washington, DC, and is an associate editor of AJPH. Stewart Landers is with US Health Services, John Snow, Inc., Boston, MA, and is an associate editor of AJPH
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3
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Hughes TL, Wilsnack SC, Martin K, Matthews A(P, Johnson TP. Alcohol use among sexual minority women: Methods used and lessons learned in the 20-Year Chicago Health and Life Experiences of Women Study. INTERNATIONAL JOURNAL OF ALCOHOL AND DRUG RESEARCH 2021; 9:30-42. [PMID: 37946724 PMCID: PMC10634638 DOI: 10.7895/ijadr.289] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Background Two decades ago, there was almost no research on alcohol use among sexual minority women (SMW, e.g., lesbian, bisexual). Since then, a growing body of scientific literature documents substantial sexual orientation-related disparities in alcohol use and alcohol-related problems. Research has identified multiple risk factors associated with high-risk/hazardous drinking among SMW. However, this research has almost exclusively used cross-sectional designs, limiting the ability to draw conclusions about processes through which sexual minority status affects alcohol use. Longitudinal designs, although very rare in research on alcohol use among SMW, are important for testing mediational mechanisms and necessary to understanding how changes in social determinants impact alcohol use. Aim To describe the processes and lessons learned in conducting a 20-year longitudinal study focused on alcohol use among SMW. Methods The Chicago Health and Life Experiences of Women (CHLEW) study includes five waves of data collection (2000-present) with an age and racially/ethnically diverse sample of 815 SMW (ages 18-83) originally recruited in the Chicago Metropolitan Area in Illinois, a midwestern state in the United States (U.S.). Measures and focus have evolved over the course of the study. Results The CHLEW study is the longest-running and most comprehensive study of SMW's drinking in the U.S. or elsewhere. Findings reported in more than 50 published manuscripts have contributed to understanding variations in SMW's risk for hazardous/harmful drinking based on sexual identity, age, race/ethnicity, sex/gender of partner, and many other factors. Conclusions By describing the process used in conducting this long-term study, its major findings, and the lessons learned, we hope to encourage and support other researchers in conducting longitudinal research focused on SMW's health. Such research is critically important in understanding and ultimately eliminating sexual orientation-related health disparities.
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Affiliation(s)
- Tonda L. Hughes
- School of Nursing and Department of Psychiatry, Columbia University
| | - Sharon C. Wilsnack
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine & Health Sciences
| | - Kelly Martin
- School of Nursing and Department of Psychiatry, Columbia University
| | | | - Timothy P. Johnson
- Center for Clinical and Translational Science, University of Illinois at Chicago
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4
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Akré ERL, Boekeloo BO, Dyer T, Fenelon AT, Franzini L, Sehgal NJ, Roby DH. Disparities in Health Care Access and Utilization at the Intersections of Urbanicity and Sexual Identity in California. LGBT Health 2021; 8:231-239. [PMID: 33600724 DOI: 10.1089/lgbt.2020.0259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim was to examine differences in health care access at the intersections of urbanicity and sexual identity in California. Methods: We used the 2014-2017 Adult California Health Interview Survey paired with the sexual orientation special use research file to create dummy groups representing each dimension of urbanicity and sexual identity to compare access to health care outcomes. We calculated unadjusted proportions and estimated adjusted odds ratios of each dimension relative to urban heterosexual people using logistic regressions. Results: Relative to urban heterosexual people, urban gay/lesbian people had 1.651 odds of using the emergency room (ER). Urban bisexual people had 1.429 odds of being uninsured, 1.575 odds of delaying prescriptions, and 1.907 odds of using the ER. Rural bisexual people experienced similar access barriers having 1.904 odds of uninsurance and 2.571 odds of using the ER. Conclusions: Our study findings demonstrated disparate access to health care across sexual orientation and rurality. The findings are consistent with literature that suggests urban and rural sexual minority people experience health care differently and demonstrate that bisexual people experience health care differently than gay/lesbian people. These findings warrant further study to examine how social identities, such as race/ethnicity, interact with sexual orientation to determine health care access. Furthermore, these findings demonstrate the need to emphasize the health care access needs of sexual minority people in both rural and urban areas to eliminate health care access disparities.
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Affiliation(s)
- Ellesse-Roselee L Akré
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Bradley O Boekeloo
- University of Maryland Prevention Research Center, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Typhanye Dyer
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Andrew T Fenelon
- Department of Sociology and Criminology, College of the Liberal Arts, Penn State University, University Park, Pennsylvania, USA
| | - Luisa Franzini
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Neil J Sehgal
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
| | - Dylan H Roby
- Department of Health Policy and Management, School of Public Health, University of Maryland-College Park, College Park, Maryland, USA
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5
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Paschen-Wolff MM, Reddy V, Matebeni Z, Southey-Swartz I, Sandfort T. HIV and sexually transmitted infection knowledge among women who have sex with women in four Southern African countries. CULTURE, HEALTH & SEXUALITY 2020; 22:705-721. [PMID: 31345116 PMCID: PMC6982583 DOI: 10.1080/13691058.2019.1629627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/05/2019] [Indexed: 06/10/2023]
Abstract
Women who have sex with women in Southern Africa, where HIV prevalence is high, are often presumed to have minimal risk for sexually transmitted infections (STI) and HIV despite research documenting female-to-female transmission. This study examined the demographic and social factors contributing to female-to-female STI/HIV transmission knowledge among Southern African women who have sex with women using an integrated model of health literacy. In collaboration with community-based organisations in Botswana, Namibia, South Africa and Zimbabwe, data were collected through anonymous surveys (N = 591). Multivariable stepwise forward logistic regression assessed independent associations between participant characteristics and high vs. low knowledge using five items. Overall, 64.4% (n = 362) of women had high knowledge; 35.6% (n = 200) had low knowledge. Higher education (adjusted odds ratio [aOR]: 2.24, 95% confidence interval [CI]: 1.48, 3.40), regular income (aOR: 2.14, 95% CI: 1.43, 3.21), residence in Botswana (aOR: 3.12, 95% CI: 1.15, 8.48) and having ever received tailored STI/HIV information (aOR: 2.17, 95% CI: 1.41, 3.32) predicted significantly higher odds of high knowledge in the final multivariable model. Results suggest opportunities for peer-led sexual health programming and expanded HIV prevention campaigns addressing women who have sex with women.
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Affiliation(s)
- Margaret M. Paschen-Wolff
- HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University, Department of Psychiatry, Division of Gender, Sexuality, and Health, New York, NY, USA
| | - Vasu Reddy
- Faculty of Humanities, University of Pretoria, Hatfield, South Africa
| | - Zethu Matebeni
- Department of Anthropology and Sociology, University of the Western Cape, Bellville, South Africa
| | | | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University, Department of Psychiatry, Division of Gender, Sexuality, and Health, New York, NY, USA
- Department of Psychology, University of Pretoria, Hatfield, South Africa
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6
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Mapes BM, Foster CS, Kusnoor SV, Epelbaum MI, AuYoung M, Jenkins G, Lopez-Class M, Richardson-Heron D, Elmi A, Surkan K, Cronin RM, Wilkins CH, Pérez-Stable EJ, Dishman E, Denny JC, Rutter JL. Diversity and inclusion for the All of Us research program: A scoping review. PLoS One 2020; 15:e0234962. [PMID: 32609747 PMCID: PMC7329113 DOI: 10.1371/journal.pone.0234962] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022] Open
Abstract
The All of Us Research Program (All of Us) is a national effort to accelerate health research by exploring the relationship between lifestyle, environment, and genetics. It is set to become one of the largest research efforts in U.S. history, aiming to build a national resource of data from at least one million participants. All of Us aims to address the need for more diversity in research and set the stage for that diversity to be leveraged in precision medicine research to come. This paper describes how the program assessed demographic characteristics of participants who have enrolled in other U.S. biomedical research cohorts to better understand which groups are traditionally represented or underrepresented in biomedical research. We 1) reviewed the enrollment characteristics of national cohort studies like All of Us, and 2) surveyed the literature, focusing on key diversity categories essential to the program's enrollment aims. Based on these efforts, All of Us emphasizes enrollment of racial and ethnic minorities, and has formally designated the following additional groups as historically underrepresented: individuals-with inadequate access to medical care; under the age of 18 or over 65; with an annual household income at or below 200% of the federal poverty level; who have a cognitive or physical disability; have less than a high school education or equivalent; are intersex; identify as a sexual or gender minority; or live in rural or non-metropolitan areas. Research accounting for wider demographic variability is critical. Only by ensuring diversity and by addressing the very barriers that limit it, can we position All of Us to better understand and tackle health disparities.
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Affiliation(s)
- Brandy M. Mapes
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail: (BMM); (JLR)
| | - Christopher S. Foster
- Office of the Director, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sheila V. Kusnoor
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of American
| | - Marcia I. Epelbaum
- Center for Knowledge Management, Vanderbilt University Medical Center, Nashville, TN, United States of American
| | - Mona AuYoung
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California, United States of American
| | - Gwynne Jenkins
- Office of the Director, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Maria Lopez-Class
- Office of the Director, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Dara Richardson-Heron
- Office of the Director, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ahmed Elmi
- Office of the Director, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Karl Surkan
- Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America and All of Us Research Program Participant Representative
| | - Robert M. Cronin
- Department of Biomedical Informatics, Medicine, and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Consuelo H. Wilkins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Eliseo J. Pérez-Stable
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland, United States of America
| | - Eric Dishman
- Office of the Director, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Joshua C. Denny
- Departments of Biomedical Informatics and Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Joni L. Rutter
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail: (BMM); (JLR)
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7
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The Shillam-Clipper Leadership Minimum Demographic Data Set: A Tool for Advancing Healthcare Research. J Nurs Adm 2019; 49:496-502. [PMID: 31517757 DOI: 10.1097/nna.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this research study was to develop an innovative, standardized taxonomy for leader demographic data to gather consistent and comparable data across healthcare leadership studies. BACKGROUND Minimum data sets help ensure consistent data collection strategies for standardized comparison among similar variables across settings. A standardized approach to collecting demographic data of healthcare workforce leadership will provide the structure necessary for researchers to more adequately compare the role of demographic characteristics in research outcomes. METHODS This study was conducted using systematic literature review methodology with comparative analysis across demographic data sets. Two separate literature reviews were conducted: the 1st for studies of approaches to establishing minimum data sets and another for studies of healthcare leadership. RESULTS The outcome of this study is the Shillam-Clipper Leadership Minimum Demographic Data Set tool that includes a comprehensive list of minimum demographic variables applicable to healthcare leadership research, a glossary of operational definitions for the identified demographic variables, and a clearly articulated set of instructions for consistent and accurate data collection. CONCLUSION This standardized taxonomy will result in a consistent data set that will improve the effectiveness of comparative research.
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8
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Robertson RE, Tran FW, Lewark LN, Epstein R. Estimates of Non-Heterosexual Prevalence: The Roles of Anonymity and Privacy in Survey Methodology. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1069-1084. [PMID: 28785920 DOI: 10.1007/s10508-017-1044-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 06/21/2017] [Accepted: 07/14/2017] [Indexed: 05/25/2023]
Abstract
When do people feel comfortable enough to provide honest answers to sensitive questions? Focusing specifically on sexual orientation prevalence-a measure that is sensitive to the pressures of heteronormativity-the present study was conducted to examine the variability in U.S. estimates of non-heterosexual identity prevalence and to determine how comfortable people are with answering questions about their sexual orientation when asked through commonly used survey modes. We found that estimates of non-heterosexual prevalence in the U.S. increased as the privacy and anonymity of the survey increased. Utilizing an online questionnaire, we rank-ordered 16 survey modes by asking people to rate their level of comfort with each mode in the context of being asked questions about their sexual orientation. A demographically diverse sample of 652 individuals in the U.S. rated each mode on a scale from -5 (very uncomfortable) to +5 (very comfortable). Modes included anonymous (name not required) and non-anonymous (name required) versions of questions, as well as self-administered and interviewer-administered versions. Subjects reported significantly higher mean comfort levels with anonymous modes than with non-anonymous modes and significantly higher mean comfort levels with self-administered modes than with interviewer-administered modes. Subjects reported the highest mean comfort level with anonymous online surveys and the lowest with non-anonymous personal interviews that included a video recording. Compared with the estimate produced by an online survey with a nationally representative sample, surveys utilizing more intrusive methodologies may have underestimated non-heterosexual prevalence in the U.S. by between 50 and 414%. Implications for public policy are discussed.
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Affiliation(s)
- Ronald E Robertson
- American Institute for Behavioral Research and Technology, 1035 East Vista Way, Ste. 120, Vista, CA, 92084, USA.
| | - Felix W Tran
- American Institute for Behavioral Research and Technology, 1035 East Vista Way, Ste. 120, Vista, CA, 92084, USA
| | - Lauren N Lewark
- American Institute for Behavioral Research and Technology, 1035 East Vista Way, Ste. 120, Vista, CA, 92084, USA
| | - Robert Epstein
- American Institute for Behavioral Research and Technology, 1035 East Vista Way, Ste. 120, Vista, CA, 92084, USA
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9
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McConnell EA, Janulis P, Phillips G, Truong R, Birkett M. Multiple Minority Stress and LGBT Community Resilience among Sexual Minority Men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2018; 5:1-12. [PMID: 29546228 DOI: 10.1037/sgd0000265] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minority stress theory has widespread research support in explaining health disparities experienced by sexual and gender minorities. However, less is known about how minority stress impacts multiply marginalized groups, such as lesbian, gay, bisexual, and transgender people of color (LGBT POC). Also, although research has documented resilience in the face of minority stress at the individual level, research is needed that examines macro-level processes such as community resilience (Meyer, 2015). In the current study, we integrate minority stress theory and intersectionality theory to examine multiple minority stress (i.e., racial/ethnic stigma in LGBT spaces and LGBT stigma in one's neighborhood) and community resilience (i.e., connection to LGBT community) among sexual minority men of different racial/ethnic groups who use a geosocial networking application for meeting sexual partners. Results showed that Black sexual minority men reported the highest levels of racial/ethnic stigma in LGBT spaces and White sexual minority men reported the lowest levels, with Asian and Hispanic/Latino men falling in between. Consistent with minority stress theory, racial/ethnic stigma in LGBT spaces and LGBT stigma in one's neighborhood were associated with greater stress for sexual minority men of all racial/ethnic groups. However, connection to LGBT community played more central role in mediating the relationship between stigma and stress for White than POC sexual minority men. Results suggest that minority stress and community resilience processes may differ for White and POC sexual minority men. Potential processes driving these differences and implications for minority stress theory are discussed.
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Affiliation(s)
| | - Patrick Janulis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregory Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Roky Truong
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michelle Birkett
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Abstract
OBJECTIVE To discuss lesbian, gay, bisexual, and transgender (LGBT)-specific survivorship issues including: integrating sexual and gender minority identities with cancer survivor identities; coordinating medical care and disclosing identities to health care providers; dealing with late effects of treatment; and addressing LGBT family and relationship issues. DATA SOURCES Published articles, quotes from an online survey of 311 LGBT survivors. CONCLUSION The transition from active cancer treatment to survivorship presents challenges, and LGBT cancer survivors may face additional challenges as they enter the survivorship phase. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses can improve the quality of survivorship care delivered to LGBT survivors and their caregivers by addressing the disparities and gaps in health care.
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11
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Broussard KA, Warner RH, Pope ARD. Too Many Boxes, or Not Enough? Preferences for How We Ask About Gender in Cisgender, LGB, and Gender-Diverse Samples. SEX ROLES 2017. [DOI: 10.1007/s11199-017-0823-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Wolff M, Wells B, Ventura-DiPersia C, Renson A, Grov C. Measuring Sexual Orientation: A Review and Critique of U.S. Data Collection Efforts and Implications for Health Policy. JOURNAL OF SEX RESEARCH 2017; 54:507-531. [PMID: 28010119 DOI: 10.1080/00224499.2016.1255872] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The U.S. Department of Health and Human Services' (HHS) Healthy People 2020 goals sought to improve health outcomes among sexual minorities; HHS acknowledged that a dearth of sexual orientation items in federal and state health surveys obscured a broad understanding of sexual minority-related health disparities. The HHS 2011 data progression plan aimed to advance sexual orientation data collection efforts at the national level. Sexual orientation is a complex, multidimensional construct often composed of sexual identity, sexual attraction, and sexual behavior, thus posing challenges to its quantitative and practical measurement and analysis. In this review, we (a) present existing sexual orientation constructs; (b) evaluate current HHS sexual orientation data collection efforts; (c) review post-2011 data progression plan research on sexual minority health disparities, drawing on HHS survey data; (d) highlight the importance of and (e) identify obstacles to multidimensional sexual orientation measurement and analysis; and (f) discuss methods for multidimensional sexual orientation analysis and propose a matrix for addressing discordance/branchedness within these analyses. Multidimensional sexual orientation data collection and analysis would elucidate sexual minority-related health disparities, guide related health policies, and enhance population-based estimates of sexual minority individuals to steer health care practices.
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Affiliation(s)
- Margaret Wolff
- a Department of Community Health and Social Science , CUNY Graduate School of Public Health and Health Policy
| | - Brooke Wells
- b Center for Human Sexuality Studies , Widener University
| | - Christina Ventura-DiPersia
- a Department of Community Health and Social Science , CUNY Graduate School of Public Health and Health Policy
- c Department of Physician Assistant Studies , Hofstra University
| | - Audrey Renson
- d Department of Epidemiology and Biostatistics , CUNY Graduate School of Public Health and Health Policy
| | - Christian Grov
- a Department of Community Health and Social Science , CUNY Graduate School of Public Health and Health Policy
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13
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Fergus S, Lewis MA, Darbes LA, Butterfield RM. HIV Risk and Protection Among Gay Male Couples: The Role of Gay Community Integration. HEALTH EDUCATION & BEHAVIOR 2016; 32:151-71. [PMID: 15856614 DOI: 10.1177/1090198104271964] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the association between different types of integration in the gay community and HIV risk among gay male couples. Previous research linking gay community integration and involvement among couples to HIV risk has been equivocal. Each partner in 59 gay couples completed a separate anonymous questionnaire that assessed two types of social involvement in the gay community, assimilation into the gay community, and sexual HIV risk behaviors. We used the actor-partner interdependence analysis approach, which maintains the couple as the unit of analysis while allowing for tests of within-couple, between-couple, actor, and partner effects. Analyses revealed that, controlling for symptoms of alcohol problems, going to gay bars and clubs independently predicted more HIV risk.
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Affiliation(s)
- Stevenson Fergus
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor 48109, USA.
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14
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Sell R, Goldberg S, Conron K. The Utility of an Online Convenience Panel for Reaching Rare and Dispersed Populations. PLoS One 2015; 10:e0144011. [PMID: 26641840 PMCID: PMC4671660 DOI: 10.1371/journal.pone.0144011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/12/2015] [Indexed: 11/30/2022] Open
Abstract
Gaps in data collection systems, as well as challenges associated with gathering data from rare and dispersed populations, render current health surveillance systems inadequate to identify and monitor efforts to reduce health disparities. Using sexual and gender minorities we investigated the utility of using a large nonprobability online panel to conduct rapid population assessments of such populations using brief surveys. Surveys of the Google Android Panel (four assessing sexual orientation and one assessing gender identity and sex assigned at birth) were conducted resulting in invitation of 53,739 application users (37,505 of whom viewed the invitation) to generate a total of 34,759 who completed screening questions indicating their sexual orientation, or gender identity and sex at birth. Where possible we make comparisons to similar data from two population-based surveys (NHIS and NESARC). We found that 99.4% to 100.0% of respondents across our Google Android panel samples completed the screening questions and 97.8% to 99.2% of those that consented to participate in our surveys indicated they were “OK” with the content of surveys that assessed sexual orientation and sex/gender. In our Google Android panel samples there was a higher percentage of sexual minority respondents than in either NHIS or NESARC with 7.4% of men and 12.4% of women reporting gay, lesbian or bisexual identities. The proportion sexual minority was 2.8 to 5.6 times higher in the Google Android panel samples than was found in the 2012 NHIS sample, for men and women, respectively. The percentage of “transgender” identified individuals in the Google sample was 0.7%, which is similar to 0.5% transgender identified through the Massachusetts BRFSS, and using a transgender status item we found that 2.0% of the overall sample fit could be classified as transgender. The Google samples sometimes more closely approximated national averages for ethnicity and race than NHIS.
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Affiliation(s)
- Randall Sell
- Department of Community Health and Prevention, School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Shoshana Goldberg
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Kerith Conron
- Center for Population Research in LGBT Health, Fenway Health, Boston, Massachusetts, United States of America
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15
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Kamen C, Heckler C, Janelsins MC, Peppone LJ, McMahon JM, Morrow GR, Bowen D, Mustian K. A Dyadic Exercise Intervention to Reduce Psychological Distress Among Lesbian, Gay, and Heterosexual Cancer Survivors. LGBT Health 2015; 3:57-64. [PMID: 26652029 DOI: 10.1089/lgbt.2015.0101] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Studies have found disparities in psychological distress between lesbian and gay cancer survivors and their heterosexual counterparts. Exercise and partner support are shown to reduce distress. However, exercise interventions haven't been delivered to lesbian and gay survivors with support by caregivers included. METHODS In this pilot randomized controlled trial (RCT), ten lesbian and gay and twelve heterosexual survivors and their caregivers were randomized as dyads to: Arm 1, a survivor-only, 6-week, home-based, aerobic and resistance training program (EXCAP©®); or Arm 2, a dyadic version of the same exercise program involving both the survivor and caregiver. Psychological distress, partner support, and exercise adherence, were measured at baseline and post-intervention (6 weeks later). We used t-tests to examine group differences between lesbian/gay and heterosexual survivors and between those randomized to survivor-only or dyadic exercise. RESULTS Twenty of the twenty-two recruited survivors were retained post-intervention. At baseline, lesbian and gay survivors reported significantly higher depressive symptoms (P = .03) and fewer average steps walked (P = .01) than heterosexual survivors. Post-intervention, these disparities were reduced and we detected no significant differences between lesbian/gay and heterosexual survivors. Participation in dyadic exercise resulted in a significantly greater reduction in depressive symptoms than participation in survivor-only exercise for all survivors (P = .03). No statistically significant differences emerged when looking across arm (survivor-only vs. dyadic) by subgroup (lesbian/gay vs. heterosexual). CONCLUSION Exercise may be efficacious in ameliorating disparities in psychological distress among lesbian and gay cancer survivors, and dyadic exercise may be efficacious for survivors of diverse sexual orientations. Larger trials are needed to replicate these findings.
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Affiliation(s)
- Charles Kamen
- 1 Department of Surgery, University of Rochester Medical Center , Rochester, New York
| | - Charles Heckler
- 1 Department of Surgery, University of Rochester Medical Center , Rochester, New York
| | - Michelle C Janelsins
- 1 Department of Surgery, University of Rochester Medical Center , Rochester, New York
| | - Luke J Peppone
- 1 Department of Surgery, University of Rochester Medical Center , Rochester, New York
| | - James M McMahon
- 2 School of Nursing, University of Rochester Medical Center , Rochester, New York
| | - Gary R Morrow
- 1 Department of Surgery, University of Rochester Medical Center , Rochester, New York
| | - Deborah Bowen
- 3 School of Public Health, University of Washington , Seattle, Washington
| | - Karen Mustian
- 1 Department of Surgery, University of Rochester Medical Center , Rochester, New York
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Kamen C, Mustian KM, Dozier A, Bowen DJ, Li Y. Disparities in psychological distress impacting lesbian, gay, bisexual and transgender cancer survivors. Psychooncology 2015. [PMID: 25630987 DOI: 10.1002/pon.3746:10.1002/pon.3746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Recent studies have highlighted disparities in cancer diagnosis between lesbian, gay, bisexual and transgender (LGBT) and heterosexual adults. Studies have yet to examine disparities between LGBT and heterosexual cancer survivors in prevalence of psychological distress. METHODS Data for the current study were drawn from the LIVESTRONG dataset, a US national survey that sampled 207 LGBT and 4899 heterosexual cancer survivors (all cancer types, 63.5% women, mean age 49) in 2010. Symptoms of psychological distress were assessed with dichotomous yes/no items in three symptom clusters (depression related to cancer, difficulties with social relationships post-cancer, fatigue/energy problems). We selected a sample of 621 heterosexual survivors matched by propensity score to the 207 LGBT survivors and assessed disparities in count of symptoms using Poisson regression. We also performed subgroup analyses by self-reported sex. RESULTS Relative to heterosexuals, LGBT cancer survivors reported a higher number of depression and relationship difficulty symptoms. Exploratory analyses revealed that disparities in number of symptoms were visible between gay, bisexual, and transgender versus heterosexual men but not between lesbian, bisexual, and transgender versus heterosexual women. CONCLUSIONS This study highlights several disparities in psychological distress that exist between LGBT and heterosexual survivors. A need remains for interventions tailored to LGBT survivors and for studies examining disparities within subgroups of LGBT survivors.
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Affiliation(s)
- Charles Kamen
- University of Rochester Medical Center, Cancer Control Unit, Rochester, NY, USA
| | - Karen M Mustian
- University of Rochester Medical Center, Cancer Control Unit, Rochester, NY, USA
| | - Ann Dozier
- University of Rochester Medical Center, Department of Public Health Sciences, Rochester, NY, USA
| | - Deborah J Bowen
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Yue Li
- University of Rochester Medical Center, Department of Public Health Sciences, Rochester, NY, USA
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Kamen C, Blosnich JR, Lytle M, Janelsins MC, Peppone LJ, Mustian KM. Cigarette Smoking Disparities among Sexual Minority Cancer Survivors. Prev Med Rep 2015; 2:283-286. [PMID: 25984441 PMCID: PMC4430723 DOI: 10.1016/j.pmedr.2015.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Sexual minority (i.e., lesbian, gay, and bisexual) adults smoke cigarettes at higher rates than heterosexual adults. Smoking after receiving a cancer diagnosis is a major health concern, yet risk of continued smoking among sexual minority cancer survivors is as yet unknown. The current study examines current smoking among sexual minority vs. heterosexual adult cancer survivors. METHOD Data drawn from the 2010 Behavioral Risk Factor Surveillance System survey in five states (Alaska, California, Massachusetts, New Mexico, and Wisconsin) included items about sexual orientation, cancer diagnosis, and tobacco use. The analytic sample included 124 sexual minority and 248 propensity score matched heterosexual adult cancer survivors. RESULTS Bivariate analysis showed that sexual minority cancer survivors had twice the odds of current smoking as their heterosexual counterparts (OR=2.03, 95%CI:1.09-3.80). In exploratory analyses stratified by sex, sexual minority disparities in prevalence of smoking post-cancer showed a trend toward significance among females, not males. CONCLUSION The current study offers preliminary evidence that sexual minority status is one variable among many that must be taken into account when assessing health behaviors post-cancer diagnosis. Future research should identify mechanisms leading from sexual minority status to increased rates of smoking and develop tailored smoking cessation interventions.
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Affiliation(s)
- Charles Kamen
- University of Rochester, Department of Surgery, 265 Crittenden Blvd, Rochester, NY 14642, United States
| | - John R. Blosnich
- Center for Health Equity Research and Promotion, Department of Veterans Affairs, VA Pittsburgh Healthcare System, University Drive C (151C-U), Building 30, Pittsburgh, PA 15240, United States
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto St, Pittsburgh, PA 15261, United States
| | - Megan Lytle
- University of Rochester, Department of Psychiatry, 300 Crittenden Blvd, Rochester, NY 14642, United States
| | - Michelle C. Janelsins
- University of Rochester, Department of Surgery, 265 Crittenden Blvd, Rochester, NY 14642, United States
| | - Luke J. Peppone
- University of Rochester, Department of Surgery, 265 Crittenden Blvd, Rochester, NY 14642, United States
| | - Karen M. Mustian
- University of Rochester, Department of Surgery, 265 Crittenden Blvd, Rochester, NY 14642, United States
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18
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Jans M, Viana J, Grant D, Cochran SD, Lee AC, Ponce NA. Trends in sexual orientation missing data over a decade of the California Health Interview Survey. Am J Public Health 2015; 105:e43-50. [PMID: 25790399 DOI: 10.2105/ajph.2014.302514] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored changes in sexual orientation question item completion in a large statewide health survey. METHODS We used 2003 to 2011 California Health Interview Survey data to investigate sexual orientation item nonresponse and sexual minority self-identification trends in a cross-sectional sample representing the noninstitutionalized California household population aged 18 to 70 years (n = 182 812 adults). RESULTS Asians, Hispanics, limited-English-proficient respondents, and those interviewed in non-English languages showed the greatest declines in sexual orientation item nonresponse. Asian women, regardless of English-proficiency status, had the highest odds of item nonresponse. Spanish interviews produced more nonresponse than English interviews and Asian-language interviews produced less nonresponse when we controlled for demographic factors and survey cycle. Sexual minority self-identification increased in concert with the item nonresponse decline. CONCLUSIONS Sexual orientation nonresponse declines and the increase in sexual minority identification suggest greater acceptability of sexual orientation assessment in surveys. Item nonresponse rate convergence among races/ethnicities, language proficiency groups, and interview languages shows that sexual orientation can be measured in surveys of diverse populations.
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Affiliation(s)
- Matt Jans
- Matt Jans, Joseph Viana, David Grant, and Ninez A. Ponce are with the California Health Interview Survey, UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, University of California, Los Angeles. Susan D. Cochran is with the Department of Epidemiology, UCLA Fielding School of Public Health. Annie C. Lee is with the Department of Sociology, UCLA
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Sandfort T, Frazer MS, Matebeni Z, Reddy V, Southey-Swartz I. Histories of forced sex and health outcomes among Southern African lesbian and bisexual women: a cross-sectional study. BMC WOMENS HEALTH 2015; 15:22. [PMID: 25783653 PMCID: PMC4359450 DOI: 10.1186/s12905-015-0181-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Experiences of forced sex have been shown to be prevalent in Southern Africa. Negative outcomes of forced sex have been documented in general populations of women and men and include alcohol abuse, drug use, mental health problems, mental distress, sexual health problems and poor overall health. This study is the first to examine experiences of forced sex and associated health problems among lesbian and bisexual women in Southern Africa. METHODS This study is based on data collected as part of a collaborative endeavor involving various Southern African community-based organizations. Lesbian and bisexual women in four Southern African countries participated in a cross-sectional survey, for a total study sample of 591. RESULTS Nearly one-third of participants had been forced to have sex at some time in their lives. Thirty-one percent of all women reported to have experienced forced sex at least once in their life: 14.9% reported forced sex by men only; 6.6% reported forced sex by women only; 9.6% had had forced sexual experiences with both men and women. Participants experienced forced sex by men as more serious than forced sex by women; forced sex by women was more likely to involve intimate partners compared to forced sex by men. Participants who experienced forced sex by men were more likely to report drug problems, mental distress and lower sense of belonging. Forced sex by women was associated with drinking problems and mental distress. Having experienced forced sex by both men and women was associated with lower sense of belonging to the LGBT community, drug use problem and mental distress. CONCLUSIONS The findings indicate that forced sex among Southern African women is a serious issue that needs further exploration. Clinicians should be made aware of the prevalence and possible consequences of forced sex among lesbian and bisexual women. Policies and community interventions should be designed to address this problem.
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Affiliation(s)
- Theo Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA,
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20
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Kamen C, Mustian KM, Dozier A, Bowen DJ, Li Y. Disparities in psychological distress impacting lesbian, gay, bisexual and transgender cancer survivors. Psychooncology 2015; 24:1384-91. [PMID: 25630987 DOI: 10.1002/pon.3746] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/23/2014] [Accepted: 12/10/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Recent studies have highlighted disparities in cancer diagnosis between lesbian, gay, bisexual and transgender (LGBT) and heterosexual adults. Studies have yet to examine disparities between LGBT and heterosexual cancer survivors in prevalence of psychological distress. METHODS Data for the current study were drawn from the LIVESTRONG dataset, a US national survey that sampled 207 LGBT and 4899 heterosexual cancer survivors (all cancer types, 63.5% women, mean age 49) in 2010. Symptoms of psychological distress were assessed with dichotomous yes/no items in three symptom clusters (depression related to cancer, difficulties with social relationships post-cancer, fatigue/energy problems). We selected a sample of 621 heterosexual survivors matched by propensity score to the 207 LGBT survivors and assessed disparities in count of symptoms using Poisson regression. We also performed subgroup analyses by self-reported sex. RESULTS Relative to heterosexuals, LGBT cancer survivors reported a higher number of depression and relationship difficulty symptoms. Exploratory analyses revealed that disparities in number of symptoms were visible between gay, bisexual, and transgender versus heterosexual men but not between lesbian, bisexual, and transgender versus heterosexual women. CONCLUSIONS This study highlights several disparities in psychological distress that exist between LGBT and heterosexual survivors. A need remains for interventions tailored to LGBT survivors and for studies examining disparities within subgroups of LGBT survivors.
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Affiliation(s)
- Charles Kamen
- University of Rochester Medical Center, Cancer Control Unit, Rochester, NY, USA
| | - Karen M Mustian
- University of Rochester Medical Center, Cancer Control Unit, Rochester, NY, USA
| | - Ann Dozier
- University of Rochester Medical Center, Department of Public Health Sciences, Rochester, NY, USA
| | - Deborah J Bowen
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Yue Li
- University of Rochester Medical Center, Department of Public Health Sciences, Rochester, NY, USA
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21
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Currier GW, Brown G, Walsh PG, Jager-Hyman S, Chaudhury S, Stanley B. Screening for sexual orientation in psychiatric emergency departments. West J Emerg Med 2015; 16:80-4. [PMID: 25671014 PMCID: PMC4307732 DOI: 10.5811/westjem.2014.12.22254] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 08/15/2014] [Accepted: 12/08/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction Our goal was to explore whether emergency department (ED) patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Methods Participants (n=177) presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized suicide risk assessment. We assessed participants’ willingness to answer questions regarding sexual orientation along three dimensions: a self-description of sexual orientation, a self-description of sexual attraction, and the gender of any prior sexual partners. Results No participants (0/177) refused to respond to the categorical question about sexual orientation, 168/177 (94.9%) agreed to provide information about prior sexual partners, and 100/109 (91.7%) provided information about current sexual attraction toward either gender. Of all 177 participants, 154 (87.0%) self-identified as heterosexual, 11 (6.2%) as bisexual, 10 (5.6%) as gay or lesbian, and 2 (1.1%) indicated they were not sure. As compared with heterosexual patients, lesbian, gay and bisexual (LGB) patients were significantly younger and more likely to be non-white, but did not differ significantly in terms of education, income, employment, or religious affiliation or participation. Further, LGB participants did not differ from self-identified heterosexual participants for lifetime suicide attempt rate or lifetime history of any mood, substance-related, psychotic spectrum, or other Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis I disorder. Of self-identified heterosexual participants 5.6% (5/89) reported sexual attraction as other than ‘only opposite sex,’ and 10.3% (15/142) of sexually active ‘heterosexual’ participants reported previous same-gender sexual partners. Conclusion Assessing patients’ sexual orientation in the ED by a three-question approach appeared feasible in the ED and acceptable to ED patients. However, since many patients have sexual experiences not suggested by simple labels, self-report of sexual identity alone may not inform clinicians of health risks inherent in same or opposite gender sexual contact.
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Affiliation(s)
- Glenn W Currier
- University of Rochester Medical Center, Department of Psychiatry, Rochester, New York ; University of Rochester Medical Center, Department of Emergency Medicine, Rochester, New York
| | - Gregory Brown
- University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Patrick G Walsh
- University of Rochester Medical Center, Department of Psychiatry, Rochester, New York
| | - Shari Jager-Hyman
- University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Sadia Chaudhury
- Columbia University School of Medicine, Department of Psychiatry, New York, New York
| | - Barbara Stanley
- Columbia University School of Medicine, Department of Psychiatry, New York, New York
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22
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Camperio Ciani A, Battaglia U. Implicit Measurements of Sexual Preference in Self‐Declared Heterosexual Men: A Pilot Study on the Rate of Androphilia in Italy. J Sex Med 2014; 11:2207-17. [DOI: 10.1111/jsm.12565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Matthews-Ewald MR, Zullig KJ, Ward RM. Sexual orientation and disordered eating behaviors among self-identified male and female college students. Eat Behav 2014; 15:441-4. [PMID: 25064296 DOI: 10.1016/j.eatbeh.2014.05.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/23/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
This study compared the risk of a) clinically diagnosed eating disorders, and b) disordered eating behaviors, separately among three groups of United States college students, controlling for known covariates. These groups included college students self-identifying as: 1) gay/lesbian; 2) bisexual; and, 3) unsure, with self-identified heterosexuals as the reference. Data from the American College Health Association's National College Health Assessment II (2008-2009) were utilized (N=110,412). Adjusted logistic regression analyses, stratified by self-reported gender, examined the effect of self-identified sexual identity on clinical eating disorder diagnosis and disordered eating behaviors. Covariates included self-reported binge drinking (past 2 weeks), stress (last 12 months), smoking (past 30 days), depression (past 12 months), fraternity/sorority membership, college athletics participations, and race. Additional logistic regression sub-analyses examined sexual minorities only, with gay/lesbian as the referent. Gay, unsure, or bisexual men were at significantly increased odds to report both clinical eating disorders and disordered eating behaviors when compared to heterosexual men in both the unadjusted and adjusted models (p<.002). All sexual minority men and women were significantly more likely to report dieting to lose weight compared to heterosexual men and women (p<.002). Targeted disordered eating and eating disorder prevention efforts are needed for those who are sexual minorities, particularly for sexual minority men.
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Affiliation(s)
- Molly R Matthews-Ewald
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral Medicine Laboratory, Baton Rouge, LA, United States.
| | - Keith J Zullig
- West Virginia University, School of Public Health, Department of Social and Behavioral Sciences, Morgantown, WV, United States
| | - Rose Marie Ward
- Miami University, College of Education, Health & Society, Department of Kinesiology & Health, Oxford, OH, United States
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Kamen C, Palesh O, Gerry AA, Andrykowski MA, Heckler C, Mohile S, Morrow GR, Bowen D, Mustian K. Disparities in Health Risk Behavior and Psychological Distress Among Gay Versus Heterosexual Male Cancer Survivors. LGBT Health 2014. [PMID: 26789618 DOI: 10.1089/lgbt.2013.0022:10.1089/lgbt.2013.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Gay men have been found to have higher rates of cancer diagnoses than heterosexual men and poorer outcomes postcancer diagnosis. The two aims of this study were to examine rates of cancer diagnosis in a national sample of gay and heterosexual men, and to examine disparities in health risk behavior between gay and heterosexual men and gay and heterosexual cancer survivors. The current study utilized data from a total sample of 14,354 men, including 373 gay men, collected as part of the Behavioral Risk Factor Surveillance System survey conducted in 2009 in the states of Arizona, California, Massachusetts, Ohio, and Wisconsin. This study replicated the finding that prevalence of self-reported cancer diagnoses differed significantly between gay and heterosexual men, with gay men 82% more likely to report a lifetime history of cancer diagnosis (p<0.05); however, this disparity became nonsignificant after controlling for a weakened immune system proxy variable (p=0.06). Gay men were more likely than heterosexual men to report health risk behaviors, including less time spent exercising, more psychological distress, more current alcohol use, more current smoking, and a lifetime history of smoking. Some of these disparities in health risk behavior persisted for gay cancer survivors postcancer diagnosis. This study offers a perspective on behavioral risk factors previously shown to be higher among gay men that may continue postcancer diagnosis. Future research should test the degree to which these disparities are caused by minority stress, as previous studies have indicated that increased health risk behaviors among sexual minority populations may result from exposure to chronic stress and discrimination. Developing behavior change interventions to address these risk behaviors is vital for improving cancer outcomes among gay men.
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Affiliation(s)
- Charles Kamen
- 1 James P. Wilmot Cancer Center, University of Rochester Medical Center , Rochester, New York
| | - Oxana Palesh
- 2 Department of Psychiatry & Behavioral Sciences, Stanford University , Stanford, California
| | - Arianna Aldridge Gerry
- 2 Department of Psychiatry & Behavioral Sciences, Stanford University , Stanford, California
| | - Michael A Andrykowski
- 3 Department of Behavioral Science, University of Kentucky College of Medicine , Lexington, Kentucky
| | - Charles Heckler
- 1 James P. Wilmot Cancer Center, University of Rochester Medical Center , Rochester, New York
| | - Supriya Mohile
- 1 James P. Wilmot Cancer Center, University of Rochester Medical Center , Rochester, New York
| | - Gary R Morrow
- 1 James P. Wilmot Cancer Center, University of Rochester Medical Center , Rochester, New York
| | - Deborah Bowen
- 4 School of Public Health, University of Washington , Seattle, Washington
| | - Karen Mustian
- 1 James P. Wilmot Cancer Center, University of Rochester Medical Center , Rochester, New York
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Brown MT, Grossman BR. Same-sex sexual relationships in the national social life, health and aging project: making a case for data collection. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:108-129. [PMID: 24329542 DOI: 10.1080/01634372.2013.865695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 11/11/2013] [Indexed: 06/03/2023]
Abstract
This study describes the previously unexplored subsample of respondents who reported at least 1 same-sex sexual relationship (SSSR) in the National Social Life, Health, and Aging Project (NSHAP). The NSHAP collected data from 3,005 adults (aged 57-85). Approximately 4% (n = 102) of respondents reported at least one SSSR. These sexual minority elders were younger, more educated, were more likely to be working, had fewer social supports, and better physical health. Results may indicate crisis competence in sexual minority elders. Collecting sexual orientation and gender identity data in larger, US-based probability samples would inform the development of appropriate community-based services and supports.
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Affiliation(s)
- Maria T Brown
- a Aging Studies Institute, Syracuse University , Syracuse , New York , USA
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26
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Sell RL, Holliday ML. Sexual orientation data collection policy in the United States: public health malpractice. Am J Public Health 2014; 104:967-9. [PMID: 24825192 DOI: 10.2105/ajph.2013.301814] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Randall L Sell
- Randall L. Sell is with the Department of Community Health and Prevention, Drexel School of Public Health, Philadelphia, PA. Michelle L. Holliday is with the Department of Sociology, Portland State University, Portland, OR
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Matthews DD, Lee JGL. A profile of North Carolina lesbian, gay, and bisexual health disparities, 2011. Am J Public Health 2014; 104:e98-e105. [PMID: 24825240 DOI: 10.2105/ajph.2013.301751] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the health profile of lesbian, gay, and bisexual (LGB) adults in North Carolina, the first state in the South to include a measure of sexual orientation identity in a probability-based statewide health survey. METHODS Using data from 9876 respondents in the 2011 North Carolina Behavioral Risk Factor Surveillance Survey, we compared sexual minorities to heterosexuals on a variety of health indicators. RESULTS LGB respondents were younger and more likely to be reached by cell phone. Many examined indicators were not different by sexual orientation. Significant results, however, were consistent with findings from state population surveys in other regions of the country, including disparities in mental health and, among women, smoking. CONCLUSIONS Reporting LGB identity in North Carolina is associated with poorer health. The concentration of anti-LGB policies in the South warrants ongoing monitoring of LGB health disparities in North Carolina and in other Southeastern states for potential effects on the health and well-being of LGB populations.
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Affiliation(s)
- Derrick D Matthews
- At the time of this study, Derrick D. Matthews and Joseph G. L. Lee were with the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
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28
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Frisch M, Nielsen NM, Pedersen BV. Same-sex marriage, autoimmune thyroid gland dysfunction and other autoimmune diseases in Denmark 1989-2008. Eur J Epidemiol 2013; 29:63-71. [PMID: 24306355 DOI: 10.1007/s10654-013-9869-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 11/28/2013] [Indexed: 01/05/2023]
Abstract
Autoimmune diseases have been little studied in gay men and lesbians. We followed 4.4 million Danes, including 9,615 same-sex married (SSM) persons, for 47 autoimmune diseases in the National Patient Registry between 1989 and 2008. Poisson regression analyses provided first hospitalization rate ratios (RRs) comparing rates between SSM individuals and persons in other marital status categories. SSM individuals experienced no unusual overall risk of autoimmune diseases. However, the risk of autoimmune thyroid dysfunction was increased, notably Hashimoto's thyroiditis (women(SSM), RR = 2.92; 95% confidence interval (CI) 1.74-4.55) and Graves' disease (men(SSM), RR = 1.88; 95% CI 1.08-3.01). There was also an excess of primary biliary cirrhosis (women(SSM), RR = 4.09; 95% CI 1.01-10.7), and of psoriasis (men(SSM), RR = 2.48; 95% CI 1.77-3.36), rheumatic fever (men(SSM), RR = 7.55; 95% CI 1.87-19.8), myasthenia gravis (men(SSM), RR = 5.51; 95% CI 1.36-14.4), localized scleroderma (men(SSM), RR = 7.16; 95% CI 1.18-22.6) and pemphigoid (men(SSM), RR = 6.56; 95% CI 1.08-20.6), while Dupuytren's contracture was reduced (men(SSM), RR = 0.64; 95% CI 0.39-0.99). The excess of psoriasis was restricted to same-sex married men with HIV/AIDS (men(SSM), RR = 10.5; 95% CI 6.44-15.9), whereas Graves' disease occurred in excess only among same-sex married men without HIV/AIDS (men(SSM), RR = 1.99; 95% CI 1.12-3.22). Lesbians and immunologically competent gay men in same-sex marriage face no unusual overall risk of autoimmune diseases. However, the observed increased risk of thyroid dysfunction in these lesbians and gay men deserves further study.
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Affiliation(s)
- Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, 5 Artillerivej, DK-2300, Copenhagen S, Denmark,
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29
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Kamen C, Palesh O, Gerry AA, Andrykowski MA, Heckler C, Mohile S, Morrow GR, Bowen D, Mustian K. Disparities in Health Risk Behavior and Psychological Distress Among Gay Versus Heterosexual Male Cancer Survivors. LGBT Health 2013; 1:86-92. [PMID: 26789618 DOI: 10.1089/lgbt.2013.0022] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Gay men have been found to have higher rates of cancer diagnoses than heterosexual men and poorer outcomes postcancer diagnosis. The two aims of this study were to examine rates of cancer diagnosis in a national sample of gay and heterosexual men, and to examine disparities in health risk behavior between gay and heterosexual men and gay and heterosexual cancer survivors. The current study utilized data from a total sample of 14,354 men, including 373 gay men, collected as part of the Behavioral Risk Factor Surveillance System survey conducted in 2009 in the states of Arizona, California, Massachusetts, Ohio, and Wisconsin. This study replicated the finding that prevalence of self-reported cancer diagnoses differed significantly between gay and heterosexual men, with gay men 82% more likely to report a lifetime history of cancer diagnosis (p<0.05); however, this disparity became nonsignificant after controlling for a weakened immune system proxy variable (p=0.06). Gay men were more likely than heterosexual men to report health risk behaviors, including less time spent exercising, more psychological distress, more current alcohol use, more current smoking, and a lifetime history of smoking. Some of these disparities in health risk behavior persisted for gay cancer survivors postcancer diagnosis. This study offers a perspective on behavioral risk factors previously shown to be higher among gay men that may continue postcancer diagnosis. Future research should test the degree to which these disparities are caused by minority stress, as previous studies have indicated that increased health risk behaviors among sexual minority populations may result from exposure to chronic stress and discrimination. Developing behavior change interventions to address these risk behaviors is vital for improving cancer outcomes among gay men.
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Affiliation(s)
- Charles Kamen
- 1 James P. Wilmot Cancer Center, University of Rochester Medical Center , Rochester, New York
| | - Oxana Palesh
- 2 Department of Psychiatry & Behavioral Sciences, Stanford University , Stanford, California
| | - Arianna Aldridge Gerry
- 2 Department of Psychiatry & Behavioral Sciences, Stanford University , Stanford, California
| | - Michael A Andrykowski
- 3 Department of Behavioral Science, University of Kentucky College of Medicine , Lexington, Kentucky
| | - Charles Heckler
- 1 James P. Wilmot Cancer Center, University of Rochester Medical Center , Rochester, New York
| | - Supriya Mohile
- 1 James P. Wilmot Cancer Center, University of Rochester Medical Center , Rochester, New York
| | - Gary R Morrow
- 1 James P. Wilmot Cancer Center, University of Rochester Medical Center , Rochester, New York
| | - Deborah Bowen
- 4 School of Public Health, University of Washington , Seattle, Washington
| | - Karen Mustian
- 1 James P. Wilmot Cancer Center, University of Rochester Medical Center , Rochester, New York
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Wienke C, Whaley RB. Same-gender sexual partnering: a re-analysis of trend data. JOURNAL OF SEX RESEARCH 2013; 52:162-173. [PMID: 24164090 DOI: 10.1080/00224499.2013.819066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Numerous studies have been carried out to estimate the prevalence of same-gender sexual behavior. Among studies conducted in recent years, few confirm the commonly quoted figure of 10%. Yet several studies in the early 2000s indicated that the prevalence of same-gender sex may be increasing, especially among women. This article reexamines the trends identified in previous research by using General Social Survey data from 1988 to 2010 and by focusing on multiple measures of same-gender sex over time. Results indicate that for both women and men the likelihood of having had a same-gender sexual partner since age 18 continued to increase through the 2000s, but that the likelihood of having had a same-gender sexual partner in both the past year and in the past five years leveled off for women and reversed for men. Results also indicate that the percentage of people reporting a pattern of predominantly same-gender sexual behavior has neither increased nor decreased over time. A similar result was found among persons who reported being in a same-gender sexual relationship. Overall, results paint a more complex picture than prior studies in characterizing trends in same-gender sexual behavior.
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Affiliation(s)
- Chris Wienke
- a Department of Sociology , Southern Illinois University Carbondale
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Pega F, Gray A, Veale JF, Binson D, Sell RL. Toward global comparability of sexual orientation data in official statistics: a conceptual framework of sexual orientation for health data collection in New Zealand's official statistics system. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2013; 2013:473451. [PMID: 23840231 PMCID: PMC3694548 DOI: 10.1155/2013/473451] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/14/2013] [Accepted: 05/24/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Effectively addressing health disparities experienced by sexual minority populations requires high-quality official data on sexual orientation. We developed a conceptual framework of sexual orientation to improve the quality of sexual orientation data in New Zealand's Official Statistics System. METHODS We reviewed conceptual and methodological literature, culminating in a draft framework. To improve the framework, we held focus groups and key-informant interviews with sexual minority stakeholders and producers and consumers of official statistics. An advisory board of experts provided additional guidance. RESULTS The framework proposes working definitions of the sexual orientation topic and measurement concepts, describes dimensions of the measurement concepts, discusses variables framing the measurement concepts, and outlines conceptual grey areas. CONCLUSION The framework proposes standard definitions and concepts for the collection of official sexual orientation data in New Zealand. It presents a model for producers of official statistics in other countries, who wish to improve the quality of health data on their citizens.
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Affiliation(s)
- Frank Pega
- Department of Public Health, University of Otago, P.O. Box 7343, Wellington, New Zealand.
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32
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Gattis MN. An Ecological Systems Comparison Between Homeless Sexual Minority Youths and Homeless Heterosexual Youths. JOURNAL OF SOCIAL SERVICE RESEARCH 2013; 39:38-49. [PMID: 23687399 PMCID: PMC3653327 DOI: 10.1080/01488376.2011.633814] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study examined risk and protective outcomes by comparing homeless sexual minority youths to heterosexual homeless youths regarding family, peer behaviors, school, mental health (suicide risk and depression), stigma, discrimination, substance use, and sexual risk behaviors. Structured interviews (N = 147) were conducted with individuals ages 16-24 at three drop-in programs serving homeless youths in Toronto. Bivariate analyses indicated statistically significant differences between homeless sexual minorities (n=66) and their heterosexual counterparts (n=81) regarding all variables: family, peer behaviors, stigma, discrimination, mental health, substance use and sexual risk behaviors with the exception of school belonging. Specifically, homeless sexual minority youths fared more poorly (e.g. lower satisfaction with family communication, experienced more stigma, used more drugs and alcohol) than their heterosexual counterparts. Improving family communication may be a worthwhile intervention if the youths are still in contact with their families. Future research should focus on victimization in the context of multiple systems.
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Gattis MN, Sacco P, Cunningham-Williams RM. Substance use and mental health disorders among heterosexual identified men and women who have same-sex partners or same-sex attraction: results from the national epidemiological survey on alcohol and related conditions. ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:1185-97. [PMID: 22549338 PMCID: PMC4731090 DOI: 10.1007/s10508-012-9910-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 01/04/2012] [Accepted: 01/04/2012] [Indexed: 05/26/2023]
Abstract
This study examined sexual orientation discordance, a mismatch between self-reported sexual identity and sexual behavior or sexual attraction, by describing the characteristics, substance use disorders, and mental health risks of heterosexual identified individuals who endorsed this pattern of sexual identification, behavior, and attraction. Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we created three groups based on participants' reported sexual identity and either their sexual behavior or sexual attraction: heterosexual concordant, homosexual concordant, and heterosexual discordant. Bivariate models assessed the relationship of discordant status and demographic correlates, lifetime substance use disorders, and mental health diagnoses. Logistic regression models tested associations between both behavior discordance and attraction discordance and the likelihood of having lifetime disorders of substance use, major depression, and generalized anxiety. Results of this study provided evidence of varying levels of substance use and mental health disorder risk by gender, discordance status, and discordance type. Behavioral discordance was associated with increased risk of mental health and substance use disorder among women (compared to heterosexual concordance). Findings among men were less consistent with heightened risk of alcohol and inhalant use only. Attraction discordance was notably different from behavioral discordance. The odds of substance use and mental health disorders were the same or lower compared with both the heterosexual and homosexual concordance groups. Future research should begin to test theoretical explanations for these differences.
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Affiliation(s)
- Maurice N Gattis
- School of Social Work, University of Wisconsin-Madison, 1350 University Ave., Madison, WI 53706-1510, USA.
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Drabble L, Eliason MJ. Substance Use Disorders Treatment for Sexual Minority Women. JOURNAL OF LGBTQ ISSUES IN COUNSELING 2012. [DOI: 10.1080/15538605.2012.726150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McCabe SE, Hughes TL, Bostwick W, Morales M, Boyd CJ. Measurement of sexual identity in surveys: implications for substance abuse research. ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:649-57. [PMID: 21573706 PMCID: PMC3233651 DOI: 10.1007/s10508-011-9768-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 01/09/2011] [Accepted: 02/21/2011] [Indexed: 05/13/2023]
Abstract
Researchers are increasingly recognizing the need to include measures of sexual orientation in health studies. However, relatively little attention has been paid to how sexual identity, the cognitive aspect of sexual orientation, is defined and measured. Our study examined the impact of using two separate sexual identity question formats: a three-category question (response options included heterosexual, bisexual, or lesbian/gay), and a similar question with five response options (only lesbian/gay, mostly lesbian/gay, bisexual, mostly heterosexual, only heterosexual). A large probability-based sample of undergraduate university students was surveyed and a randomly selected subsample of participants was asked both sexual identity questions. Approximately one-third of students who identified as bisexual based on the three-category sexual identity measure chose "mostly heterosexual" or "mostly lesbian/gay" on the five-category measure. In addition to comparing sample proportions of lesbian/gay, bisexual, or heterosexual participants based on the two question formats, rates of alcohol and other drug use were also examined among the participants. Substance use outcomes among the sexual minority subgroups differed based on the sexual identity question format used: bisexual participants showed greater risk of substance use in analyses using the three-category measure whereas "mostly heterosexual" participants were at greater risk when data were analyzed using the five-category measure. Study results have important implications for the study of sexual identity, as well as whether and how to recode responses to questions related to sexual identity.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, 204 S. State St., Ann Arbor, MI 48109-1290, USA.
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37
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Brewster KL, Tillman KH. Sexual orientation and substance use among adolescents and young adults. Am J Public Health 2012; 102:1168-76. [PMID: 22021322 PMCID: PMC3483938 DOI: 10.2105/ajph.2011.300261] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined interrelationships among the 3 dimensions of sexual orientation-self-identity, sexual attraction, and sexual experience-and their associations with substance use among adolescents and young adults. METHODS To estimate total and net associations of sexual identity, attraction, and experience with use of tobacco, drugs, and alcohol, we applied logistic regression to cross-sectional data from the National Survey of Family Growth Cycle 6. RESULTS We found a lack of concordance among the different dimensions of sexual orientation. More youths reported same-gender sexual attraction and same-gender sexual experiences than identified as lesbian, gay, or bisexual. Estimates of substance use prevalence differed significantly by gender and across dimensions of sexual orientation. Sexual experience was the most consistent predictor of substance use. Women and men with no sexual experience had the lowest odds of all forms of substance use; those reporting sexual experience with partners of both genders had the highest odds. CONCLUSIONS Our findings indicate that sexual identity was less strongly associated with substance use than sexual experience and attraction were, pointing to the need for more nuanced indicators of sexual orientation in public health studies.
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Affiliation(s)
- Karin L Brewster
- Center for Demography and Population Health and the Department of Sociology, Florida State University, Tallahassee, FL 32306-2240, USA.
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Hoyt D’Anna L, Nguyen HHD, Reynolds GL, Fisher DG, Janson M, Chen C, Malotte CK. The Relationship between Sexual Minority Verbal Harassment And Utilization of Health Services: Results from Countywide Risk Assessment Survey (CRAS) 2004. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2012; 24:119-139. [PMID: 23044662 PMCID: PMC3462736 DOI: 10.1080/10538720.2012.669696] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We examined the prevalence of and associations between sexual orientation-based verbal harassment and reported utilization of health services across levels of sexual orientation in a diverse sample of adult recipients of Los Angeles County-funded HIV-related health and social services. Thirty-two percent reported they had experienced verbal harassment, the majority (80.3%) of whom identified as lesbian, gay, orbisexual. Those who reported being verbally harassed received significantly more services overall than those who were not verbally harassed, and service utilization varied by sexual orientation. These findings inform future efforts to identify and assess social discrimination in health and social service settings.
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Affiliation(s)
| | | | | | | | - Michael Janson
- Los Angeles County Department of Health Services, Office of AIDS Programs and Policy
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Fernández J, Quiroga MA, Icaza VJ, Escorial S. Dimensionality and Transcultural Specificity of the Sexual Attraction Questionnaire (SAQ). SPANISH JOURNAL OF PSYCHOLOGY 2012; 15:323-33. [PMID: 22379722 DOI: 10.5209/rev_sjop.2012.v15.n1.37339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sexual attraction was considered a component of sexual orientation from the beginning of the second half of the 20th century to present times. However, some recent researchers have studied sexual attraction as an independent field measuring it by the Sexual Attraction Questionnaire (SAQ). This study analyzes sexual attraction through the SAQ in 400 university students from a Peruvian catholic university. These participants -191 women and 209 men- show a very diverse curricular background. The following hypotheses were tested: a) the structure of the SAQ, pointing out two concepts: attraction to men and attraction to women; b) the high inverse correlation between these two concepts or factors; c) the specific impact of this context in sexual attraction: higher percentage of attracted by none of the sexes and lower percentage of attracted to the opposite sex, in comparison with other contexts; and d) the Lippa prediction (2006, 2007), regarding a higher polarization of sexual attraction for men than for women. Results support the first three hypotheses. Clarifications are laid down with regard to the fourth one. Discussion focuses on theoretical and applied advantages of using the SAQ as opposed to the frequent use of a single item of sexual attraction for each sex.
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40
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Romantic attraction and adolescent smoking trajectories. Addict Behav 2011; 36:1275-81. [PMID: 21862230 DOI: 10.1016/j.addbeh.2011.07.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 06/05/2011] [Accepted: 07/29/2011] [Indexed: 11/21/2022]
Abstract
Research on sexual orientation and substance use has established that lesbian, gay, and bisexual (LGB) individuals are more likely to smoke than heterosexuals. This analysis furthers the examination of smoking behaviors across sexual orientation groups by describing how same- and opposite-sex romantic attraction, and changes in romantic attraction, are associated with distinct six-year developmental trajectories of smoking. The National Longitudinal Study of Adolescent Health dataset is used to test our hypotheses. Multinomial logistic regressions predicting smoking trajectory membership as a function of romantic attraction were separately estimated for men and women. Romantic attraction effects were found only for women. The change from self-reported heterosexual attraction to lesbian or bisexual attraction was more predictive of higher smoking trajectories than was a consistent lesbian or bisexual attraction, with potentially important differences between the smoking patterns of these two groups.
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41
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Lindley LL, Walsemann KM, Carter JW. The association of sexual orientation measures with young adults' health-related outcomes. Am J Public Health 2011; 102:1177-85. [PMID: 22021310 DOI: 10.2105/ajph.2011.300262] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined associations among 3 dimensions of sexual orientation (identity, behavior, and attraction) and key health-related indicators commonly studied among sexual minority populations: depressive symptoms, perceived stress, smoking, binge drinking, and victimization. METHODS We analyzed data from the National Longitudinal Study of Adolescent Health, Wave IV (2007-2008) when respondents were aged 24 to 32 years (n=14,412). We used multivariate linear and logistic regressions to examine consistency of associations between sexual orientation measures and health-related indicators. RESULTS Strength of associations differed by gender and sexual orientation measure. Among women, being attracted to both sexes, identifying as "mostly straight" or "bisexual," and having mostly opposite-sex sexual partners was associated with greater risk for all indicators. Among men, sexual attraction was unrelated to health indicators. Men who were "mostly straight" were at greater risk for some, but not all, indicators. Men who had sexual partners of the same-sex or both sexes were at lower risk for binge drinking. CONCLUSIONS Using all 3 dimensions of sexual orientation provides a more complete picture of the association between sexual orientation and health among young adults than does using any 1 dimension alone.
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Affiliation(s)
- Lisa L Lindley
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA.
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42
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Lee JGL, Goldstein AO, Ranney LM, Crist J, McCullough A. High tobacco use among lesbian, gay, and bisexual populations in West Virginian bars and community festivals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:2758-69. [PMID: 21845157 PMCID: PMC3155328 DOI: 10.3390/ijerph8072758] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 06/13/2011] [Accepted: 06/28/2011] [Indexed: 11/16/2022]
Abstract
With no information on tobacco use for lesbian, gay, or bisexual (LGB) populations in West Virginia (WV), it is unclear if nationally-identified LGB tobacco disparities also exist in this State. To address this data gap, we conducted a community tobacco survey in bars and events associated with the WV Pride Parade and Festival. Trained community surveyors used electronic and paper survey instruments in bars (n = 6) in three WV cities and community events associated with the WV Pride Parade and Festival. We analyzed results from 386 completed surveys from self-identified LGB individuals. Tobacco use among LGB bar patrons and LGB attendees at Pride-affiliated events was elevated (45%), as was current cigarette use (41%). Users of cigars and chewing tobacco were frequently dual users of cigarettes, with 80% and 60% reporting dual use, respectively. A substantial disparity likely exists in tobacco use among LGB West Virginians. Targeted interventions addressing tobacco use among LGB West Virginians are warranted in these venues, and the addition of a demographic question on sexual orientation would improve data collection and monitoring of this disparity.
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Affiliation(s)
- Joseph G. L. Lee
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 590 Manning Drive, CB 7595, Chapel Hill, NC 27599, USA; E-Mails: (A.O.G.); (L.M.R.); (A.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-919-966-8948; Fax: +1-919-966-9435
| | - Adam O. Goldstein
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 590 Manning Drive, CB 7595, Chapel Hill, NC 27599, USA; E-Mails: (A.O.G.); (L.M.R.); (A.M.)
| | - Leah M. Ranney
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 590 Manning Drive, CB 7595, Chapel Hill, NC 27599, USA; E-Mails: (A.O.G.); (L.M.R.); (A.M.)
| | - Jeff Crist
- West Virginia Covenant House, 600 Shrewsbury Street, Charleston, WV 25301, USA; E-Mail:
| | - Anna McCullough
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 590 Manning Drive, CB 7595, Chapel Hill, NC 27599, USA; E-Mails: (A.O.G.); (L.M.R.); (A.M.)
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The psychosocial impact of Klinefelter syndrome and factors influencing quality of life. Genet Med 2011; 13:632-42. [DOI: 10.1097/gim.0b013e3182136d19] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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McNair RP, Hegarty K. Guidelines for the primary care of lesbian, gay, and bisexual people: a systematic review. Ann Fam Med 2010; 8:533-41. [PMID: 21060124 PMCID: PMC2975689 DOI: 10.1370/afm.1173] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We assessed whether existing guidelines for the primary care of lesbian, gay, and bisexual (LGB) people meet appropriate standards of developmental rigor, and whether they provide consistent recommendations useful for primary care clinicians. METHODS We performed a systematic review of such guidelines using the Cochrane Collaboration method. The countries searched were Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. For sources, we used electronic databases, guidelines databases, primary care professional organizations, government departments of public health, LGB health care textbooks, and national LGB organizations. We assessed the quality of existing guidelines using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and compared the recommendations from all fully appraised guidelines. RESULTS Our search did not identify any previous systematic reviews on primary care of LGB people. Of 2,421 documents identified, we initially reviewed 30 and fully appraised 11, none of which completely satisfied the AGREE criteria for quality and only 2 of which were specifically designed for primary care. Developmental rigor was poor. Particular gaps were a lack of explicit inclusion criteria, independent reviewers, and updating procedures. Nonetheless, we did identify several consistent recommendations pertinent to primary care settings: guidance on inclusive clinical environments, standards for clinician-patient communication, sensitive documentation of sexual orientation, knowledge for cultural awareness, staff training, and addressing population health issues. CONCLUSIONS Currently available guidelines for LGB care are philosophically and practically consistent, and provide a degree of evidence-based clinical and systems support to primary care clinicians. There is a need, however, for evidence-based LGB guidelines that are more rigorously developed, disseminated, and evaluated specifically for the primary care setting.
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Affiliation(s)
- Ruth P McNair
- Department of General Practice, University of Melbourne, Australia.
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45
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VanKim NA, Padilla JL, Lee JGL, Goldstein AO. Adding sexual orientation questions to statewide public health surveillance: New Mexico's experience. Am J Public Health 2010; 100:2392-6. [PMID: 20966370 DOI: 10.2105/ajph.2009.186270] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We examined refusal rates for sensitive demographic questions to determine whether questions on sexual orientation are too sensitive for routine use on public health surveys. We compared the percentage of active refusals in New Mexico for a sexual orientation question and 6 other sensitive demographic questions. In 2007 and 2008, refusal rates for sexual orientation questions were similar to rates for questions on race/ethnicity and weight and significantly lower than rates for questions on household income. Perceptions that sexual orientation is too controversial a topic to be included on state surveys may be unfounded.
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Affiliation(s)
- Nicole A VanKim
- Chronic Disease Prevention and Control Bureau, New Mexico Department of Health, Albuquerque, NM, USA
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Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annu Rev Public Health 2010; 31:457-77. [PMID: 20070195 DOI: 10.1146/annurev.publhealth.012809.103636] [Citation(s) in RCA: 186] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Adolescents face a variety of challenges in their transition to adulthood; lesbian, gay, and bisexual adolescents face these typical challenges as well as additional challenges that are related to the social stigma of their sexual orientation. For some lesbian, gay, and bisexual adolescents, this stigma may induce psychosocial stress, leading to increased health risk behaviors and poorer health outcomes. In this article, we review data on the health and health care of LGB adolescents. We examine health indicators and health risks for LGB youth, including substance use, eating disorders, suicidality, risky sexual behaviors, violence exposure and victimization, and homelessness. We also examine health care provision and utilization for LGB youth. Lastly, we discuss ways in which researchers and clinicians can improve LGB adolescent health and health care.
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Affiliation(s)
- Tumaini R Coker
- Division of General Pediatrics, Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California 90024, USA.
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Hanssmann C, Morrison D, Russian E, Shiu-Thornton S, Bowen D. A community-based program evaluation of community competency trainings. J Assoc Nurses AIDS Care 2010; 21:240-55. [PMID: 20303797 DOI: 10.1016/j.jana.2009.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 12/21/2009] [Indexed: 10/19/2022]
Abstract
Transgender and gender-nonconforming individuals encounter a multitude of barriers to accessing clinically and culturally competent health care. One strategy to increase the quality and competence of care delivery is workplace trainings. This study describes a community-based program for the evaluation of this type of training. Using a mixed-methods approach, the research team assessed the effectiveness of three competency trainings administered by a local nonprofit organization in the Northwest United States. Quantitative data indicated a significant shift in self-assessed knowledge associated with completion of the training. Qualitative data confirmed this result and revealed a number of important themes about the effect of the trainings on providers and their ability to implement knowledge and skills in practice. Clinical considerations are proposed for providers who seek similar trainings and who aim to increase clinical and cultural competency in delivering care to transgender and gender-nonconforming patients and clients.
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Hatzenbuehler ML, McLaughlin KA, Keyes KM, Hasin DS. The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. Am J Public Health 2010. [PMID: 20075314 DOI: 10.2105/ajph.2009.168815)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the relation between living in states that instituted bans on same-sex marriage during the 2004 and 2005 elections and the prevalence of psychiatric morbidity among lesbian, gay, and bisexual (LGB) populations. METHODS We used data from wave 1 (2001-2002) and wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34,653), a longitudinal, nationally representative study of noninstitutionalized US adults. RESULTS Psychiatric disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, increased significantly between waves 1 and 2 among LGB respondents living in states that banned gay marriage for the following outcomes: any mood disorder (36.6% increase), generalized anxiety disorder (248.2% increase), any alcohol use disorder (41.9% increase), and psychiatric comorbidity (36.3% increase). These psychiatric disorders did not increase significantly among LGB respondents living in states without constitutional amendments. Additionally, we found no evidence for increases of the same magnitude among heterosexuals living in states with constitutional amendments. CONCLUSIONS Living in states with discriminatory policies may have pernicious consequences for the mental health of LGB populations. These findings lend scientific support to recent efforts to overturn these policies.
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Hatzenbuehler ML, McLaughlin KA, Keyes KM, Hasin DS. The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. Am J Public Health 2010; 100:452-9. [PMID: 20075314 DOI: 10.2105/ajph.2009.168815] [Citation(s) in RCA: 472] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the relation between living in states that instituted bans on same-sex marriage during the 2004 and 2005 elections and the prevalence of psychiatric morbidity among lesbian, gay, and bisexual (LGB) populations. METHODS We used data from wave 1 (2001-2002) and wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34,653), a longitudinal, nationally representative study of noninstitutionalized US adults. RESULTS Psychiatric disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, increased significantly between waves 1 and 2 among LGB respondents living in states that banned gay marriage for the following outcomes: any mood disorder (36.6% increase), generalized anxiety disorder (248.2% increase), any alcohol use disorder (41.9% increase), and psychiatric comorbidity (36.3% increase). These psychiatric disorders did not increase significantly among LGB respondents living in states without constitutional amendments. Additionally, we found no evidence for increases of the same magnitude among heterosexuals living in states with constitutional amendments. CONCLUSIONS Living in states with discriminatory policies may have pernicious consequences for the mental health of LGB populations. These findings lend scientific support to recent efforts to overturn these policies.
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