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Bleasdale J, Wilson K, Aidoo-Frimpong G, Gabriel SJ, Przybyla SM. Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Education in Healthcare Professional Graduate Programs: A Comparison of Medical, Nursing, and Pharmacy Students. JOURNAL OF HOMOSEXUALITY 2024; 71:193-206. [PMID: 35984396 PMCID: PMC10804216 DOI: 10.1080/00918369.2022.2111535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Relative to cisgender heterosexual persons, lesbian, gay, bisexual, and transgender (LGBT) people experience greater health inequities, thereby affecting their engagement in care. One strategy to address these disparities is to educate future healthcare professionals to provide nondiscriminatory care to LGBT people. The goal of this study was to explore the perceived coverage of LGBT health education topics in graduate-level medical (MD), pharmacy (PharmD) and nursing (DNP) curricula. Cross-sectional data were collected from web-based surveys (N = 733) completed by healthcare professional students enrolled at two universities in New York State. Of those who responded, 50.5% were MD, 38.9% were PharmD, and 10.6% were DNP students. Overall, mean scores indicated a dearth of perceived LGBT health coverage. Results demonstrated variations in coverage by degree program. Findings highlight the need to develop educational curricula inclusive of topics concerning LGBT patient health. Adequately educating the next generation of healthcare professionals can further promote healthcare engagement among LGBT persons and improve pedagogical practices in healthcare professional education programs.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Kennethea Wilson
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Steven J Gabriel
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Sarahmona M Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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Sullivan K, Simmang MK, Aguiar EJ, Winchester LJ, Wind SA, Esco MR, Fedewa MV. Disparities in physical activity between sexual minority and heterosexual women: A systematic review and meta-analysis. Prev Med 2023; 175:107708. [PMID: 37726039 DOI: 10.1016/j.ypmed.2023.107708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Abstract
Research examining potential differences in physical activity (PA) between sexual minority women (SMW) and heterosexual women have yielded inconsistent results. OBJECTIVE Therefore, the purpose of this systematic review and meta-analysis is to examine potential differences in PA between SMW and heterosexual women and to identify potential moderators that may partially explain observed differences in PA. METHODS All studies were peer reviewed, published in English, and included a continuous measure of PA for SMW and heterosexual women. A standardized mean difference effect size (ES) was used to compare groups, with random effects models used to estimate a mean ES and 95% CI using a 3-level meta-analysis model to adjust for the correlation between effects nested within studies. RESULTS The cumulative results of 24 effects gathered from 7 studies indicated there was no difference in PA between SMW (n = 1619) and heterosexual women (n = 103,295) (ES = -0.038, 95%CI -0.179 to 0.102, p = 0.576). Despite no mean differences, moderate-high heterogeneity was observed, indicating that the results were not consistent across effects (I2 = 64.8%, Q23 = 36.7, p = 0.035). The difference in PA was associated with age (β = -0.018, 95%CI -0.034 to -0.003, p = 0.022) and BMI (β = -0.145, 95%CI -0.228 to -0.061, p = 0.002), with a quadratic relationship observed for both variables. CONCLUSIONS Although the results of the current analysis did not indicate significant differences in PA behaviors between SMW and heterosexual women, age and BMI modify the association and are curvilinear in nature; such that smaller differences in PA were observed between SMW and heterosexual women when samples were middle-aged and overweight.
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Affiliation(s)
- Katherine Sullivan
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America; Division of Kinesiology, Health and Sport Studies, Wayne State University, Detroit, MI 48202, United States of America.
| | - Madelyn K Simmang
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| | - Elroy J Aguiar
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| | - Lee J Winchester
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| | - Stefanie A Wind
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| | - Michael R Esco
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| | - Michael V Fedewa
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America
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Oswald F, Champion A, Khera D, Young M, Pedersen CL. Stereotype Application at the Intersection of Body Shape, Gender/Sex, and Sexual Orientation. JOURNAL OF SEX RESEARCH 2022:1-18. [PMID: 35060416 DOI: 10.1080/00224499.2022.2026286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Though much work has examined how sexual orientation and body shape are jointly constituted, less has examined the joint perception of body shape, gender/sex, and sexuality. We draw upon multifarious person perception approaches to examine how personality and sexuality-related traits are attributed to bodies of varying shape (skinny, average, fat) when presented with differing social identities along the axes of gender/sex (male, female) and sexual orientation (heterosexual, lesbian/gay). In a sample of 991 participants, we found robust evidence that trait application varied by both body shape and sexual orientation. Further, supporting our hypotheses, we found that gay male bodies were perceived as more feminine than heterosexual male bodies, and skinny male bodies were perceived as more feminine than other body shapes. Supporting additional hypothesizing, lesbian female bodies were perceived as more masculine than heterosexual female bodies, and fat female bodies were perceived as the most masculine across sexual orientations. Partially supporting our hypotheses, we found that average bodies were perceived as the most typical for all identities; further, bodies perceived as less typical of their social identity category were perceived as experiencing heightened prejudice on the basis of body shape.
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Affiliation(s)
- Flora Oswald
- Department of Psychology, Pennsylvania State University
- Department of Women's, Gender, & Sexuality Studies, Pennsylvania State University
| | | | | | - Madeline Young
- Department of Psychology, Kwantlen Polytechnic University
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Waugh E, Myhre D, Beauvais C, Thériault G, Bell NR, Dickinson JA, Grad R, Singh H, Szafran O. Preventive screening in women who have sex with women. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:830-836. [PMID: 34772710 PMCID: PMC8589139 DOI: 10.46747/cfp.6711830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Earle Waugh
- Professor Emeritus and Emeritus Director of the Centre for Health and Culture in the Department of Family Medicine at the University of Alberta in Edmonton.
| | - Douglas Myhre
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary in Alberta
| | - Cassandre Beauvais
- Clinical Instructor in the Department of Family Medicine and Emergency Medicine at the University of Montreal in Laval, Que
| | - Guylène Thériault
- Academic Lead for the Physicianship Component and Director of Pedagogy at Outaouais Medical Campus in the Faculty of Medicine at McGill University in Montreal, Que
| | - Neil R Bell
- Professor of Research in the Department of Family Medicine at the University of Alberta
| | - James A Dickinson
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary
| | - Roland Grad
- Associate Professor in the Department of Family Medicine at McGill University
| | - Harminder Singh
- Associate Professor in the Department of Internal Medicine and the Department of Community Health Sciences at the University of Manitoba in Winnipeg and in the Department of Hematology and Oncology at CancerCare Manitoba
| | - Olga Szafran
- Associate Director of Research in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary
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5
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McDonald KM, Delgado A, Roeckner JT. Papanicolaou Test Rates Among Sexual Minority Women: A Systematic Review and Meta-Analysis. LGBT Health 2021; 9:1-7. [PMID: 34665668 DOI: 10.1089/lgbt.2020.0423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: The purpose of this review was to compare differences in Papanicolaou (pap) test rates between sexual minority women (SMW) and heterosexual women. Methods: PubMed, Embase, and Scopus were searched from inception until June 2020 for articles reporting pap test rates among SMW. Studies were selected if they included pap test rates for SMW with a comparison rate for heterosexual women; studies were excluded if they did not report pap test rates. A quality assessment scale was used to assess study quality. A random-effects model was employed to calculate pooled odds ratios (ORs) for each outcome along with 95% confidence intervals (CI). Heterogeneity was assessed by implementation of the I2 statistic, and L'Abbe plots were inspected visually to assess for homogeneity. Sensitivity analyses were performed by omitting each study sequentially and analyzing the overall impact of that study on the pooled results. Meta-regression was conducted to identify potential causes of heterogeneity among any statistically significant outcomes by an examination of the covariable of insurance coverage. Results: We identified 21 cross-sectional studies comprising 24,207 SMW and 546,259 heterosexual women that met inclusion criteria. Overall, studies were of a fair quality. When compared with heterosexual women, SMW received less frequent pap tests (OR 0.58, 95% CI 0.48-0.71, 21 studies, 24,207 SMW, 546,259 heterosexual women). Compared with heterosexual women, lesbian women had routine pap tests less frequently (OR 0.46, 95% CI 0.37-0.56, 17 studies, 9595 lesbian women and 516,760 heterosexual women). Meta-regression for insurance status did not alter these results. Conclusion: SMW, in general, and lesbian women, in particular, receive pap tests less frequently than heterosexual women. The reasons for this disparity should be investigated to better serve the needs of this population. PROSPERO Registration: CRD#42020191887.
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Affiliation(s)
- Katherine M McDonald
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Arlin Delgado
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jared T Roeckner
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Panza E, Olson K, Selby EA, Wing RR. State versus trait weight, shape, and eating concerns: Disentangling influence on eating behaviors among sexual minority women. Body Image 2021; 36:107-116. [PMID: 33279785 PMCID: PMC7987775 DOI: 10.1016/j.bodyim.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 01/20/2023]
Abstract
This study examined the relative influence of trait and state weight, shape, and eating concerns on dysregulated eating in the daily lives of sexual minority women with overweight and obesity. This study is a secondary analysis of data from an Ecological Momentary Assessment (EMA) study of 55 sexual minority women with overweight/obesity. Trait shape, weight, and eating concerns were assessed at baseline. For the following five days, participants used a smartphone to report state weight/shape concerns, overeating, and binge eating five times daily. Women who endorsed higher levels of trait weight, shape, and eating concerns at baseline reported more frequent state weight/shape concerns in daily life. Trait eating concerns were associated with higher odds of binge eating during EMA, but trait weight/shape concerns were unrelated to future dysregulated eating. In daily life, state weight/shape concerns was associated with greater risk for over/binge eating at the concurrent EMA prompt, the subsequent EMA prompt, and over the course of a full day, independent of trait concerns. State weight and shape concerns may play an important role in predicting dysregulated eating in daily life among sexual minority women of higher body weight.
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Affiliation(s)
- Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - KayLoni Olson
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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Rodrigues JL, Falcão MTC. Vivências de atendimentos ginecológicos por mulheres lésbicas e bissexuais: (in)visibilidades e barreiras para o exercício do direito à saúde. SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021181062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Embora lésbicas e mulheres bissexuais tenham sido incluídas nas políticas de saúde, na busca por uma atenção integral e que inclua o reconhecimento da diversidade sexual, a discriminação persiste nos espaços de atenção à saúde, especialmente nas consultas clínicas. Este trabalho, de vertente qualitativa, teve por objetivo discutir, a partir das percepções e vivências dessas mulheres, as relações estabelecidas nas consultas ginecológicas, abordando especificamente a (não) revelação da condição de lésbica/bissexual, as experiências com exames e orientações pertinentes à sexualidade e as dificuldades de negociação de condutas. A produção dos dados empíricos deu-se por meio de entrevistas semiestruturadas com doze lésbicas e cinco mulheres bissexuais. Os resultados apontam para a invisibilidade bissexual no contexto clínico, para as dificuldades na consulta ginecológica tanto para lésbicas quanto bissexuais e para o temor das mulheres quanto à exposição da orientação sexual, bem como o não reconhecimento de sua sexualidade. Nesse sentido, as consultas em ginecologia continuam centradas em pressupostos heteronormativos, preponderando aspectos reprodutivos em detrimento dos aspectos sexuais da vida.
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Szél Z, Kiss D, Török Z, Gyarmathy VA. Hungarian Medical Students' Knowledge About and Attitude Toward Homosexual, Bisexual, and Transsexual Individuals. JOURNAL OF HOMOSEXUALITY 2020; 67:1429-1446. [PMID: 31034340 DOI: 10.1080/00918369.2019.1600898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Discrimination that LGBTQ individuals experience in health care settings might affect their health and intention of using health care services. However, health needs of LGBTQ patients are still inappropriately addressed in the medical curriculum. First-, third-, and fourth-year medical students (N = 569) from the four Hungarian medical universities participated in a study in 2017 to assess knowledge about homosexuality, homonegativity, and their attitude as health care professionals toward sexual minorities. We found that higher levels of knowledge about homosexuality were associated with lower levels of homonegativity, upper-grade level in university, not being religious, and having close LGBTQ acquaintances. Our results suggest that it may be necessary to introduce LGBTQ themes in the medical curricula (not only in Hungary, but also in other countries) in order to improve the knowledge and attitude of medical students and thereby improve the health care of LGBTQ individuals.
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Affiliation(s)
- Zsuzsanna Szél
- Institute of Behavioural Sciences, Semmelweis University , Budapest, Hungary
| | - Dániel Kiss
- Doctoral School of Psychology, ELTE Eötvös Loránd University , Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University , Budapest, Hungary
| | - Zsófia Török
- Department of Public Health, Semmelweis University , Budapest, Hungary
| | - V Anna Gyarmathy
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA
- Károly Rácz School of PhD Studies, Semmelweis University , Budapest, Hungary
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9
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Mereish EH, Goldstein CM. Minority Stress and Cardiovascular Disease Risk Among Sexual Minorities: Mediating Effects of Sense of Mastery. Int J Behav Med 2020; 27:726-736. [PMID: 32734472 DOI: 10.1007/s12529-020-09919-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Sexual minority adults are at greater risk for cardiovascular disease (CVD) risk factors than heterosexual adults. There is a dearth of research identifying factors that are associated with CVD risk among sexual minorities. This study examined the associations between distal and proximal minority stressors and CVD risk. We also tested a sense of mastery as one mechanism that might explain the link between minority stressors and CVD risk. METHODS Participants were 670 sexual minority adults (53.6% male; 76% White), ages 18 to 76 years (M = 41.19, SD = 14.73), obtained from a non-probability sample. Using an online survey, participants self-reported family history of CVD risk, physiological conditions (diabetes mellitus, high cholesterol, hypertension), and health behaviors (e.g., tobacco use, diet, exercise) that confer or protect against CVD risk. A weighted CVD risk index was computed. Linear and logistic regressions were conducted to test the effects of minority stressors on the CVD risk index and its specific indicators and to examine mediation. RESULTS Minority stressors were associated with a sense of mastery, and mastery was associated with lower CVD risk index scores. Proximal and distal minority stressors were not directly associated with the overall CVD risk index but were associated with some specific risk indicators. Mediation analyses revealed that both distal and proximal minority stressors were indirectly associated with the CVD risk index through mastery. CONCLUSIONS Research and interventions should aim to reduce CVD risk factors and target minority stressors and mastery to improve the cardiovascular health of sexual minorities.
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Affiliation(s)
- Ethan H Mereish
- Department of Health Studies, American University, Washington, DC, USA.
| | - Carly M Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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Agénor M, Pérez AE, Tabaac AR, Bond KT, Charlton BM, Bowen DJ, Austin SB. Sexual Orientation Identity Disparities in Mammography Among White, Black, and Latina U.S. Women. LGBT Health 2020; 7:312-320. [PMID: 32668184 PMCID: PMC7475089 DOI: 10.1089/lgbt.2020.0039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: Our goal was to examine sexual orientation identity disparities in mammography in relationship to race/ethnicity among U.S. women. Methods: Using nationally representative 2013-2017 National Health Interview Survey data, we used multivariable logistic regression to estimate the odds of receiving a mammogram in the past year in relationship to sexual orientation identity among White, Black, and Latina U.S. women 40-75 years of age (N = 45,031) separately, adjusting for demographic factors. We also assessed whether socioeconomic and health care factors attenuated sexual orientation identity disparities in mammography across racial/ethnic groups. Results: Among White women, bisexual women had significantly lower adjusted odds of mammography compared to heterosexual women (odds ratio = 0.70, 95% confidence interval: 0.50-0.99). Among Black women, the adjusted odds of mammography were significantly higher among bisexual women relative to heterosexual women (2.53, 1.08-5.92). Black lesbian women appeared to have lower adjusted odds of mammography compared to their heterosexual counterparts; however, this difference was not statistically significant (0.80, 0.46-1.38). Similarly, among Latina women, lesbian women also seemed to have lower adjusted odds of mammography relative to heterosexual women, but this disparity was also not statistically significant (0.64, 0.37-1.13). Adding socioeconomic factors completely attenuated the disparity between White bisexual and heterosexual women (0.76, 0.52-1.10). Conclusions: Sexual orientation identity disparities in receiving a mammogram in the past year differed in relationship to race/ethnicity among White, Black, and Latina U.S. women. Additional research with larger samples of Black and Latina lesbian and bisexual women is needed to more accurately estimate and explain observed differences.
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Affiliation(s)
- Madina Agénor
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ashley E. Pérez
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Ariella R. Tabaac
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Keosha T. Bond
- Department of Public Health, New York Medical College, Valhalla, New York, USA
| | - Brittany M. Charlton
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | - S. Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Taşkın L, Şentürk Erenel A, Yaman Sözbir Ş, Gönenç İM, Yücel Ç, Alan Dikmen H, Çetinkaya ŞŞ. Sexual Health/Reproductive Health-Related Problems of Lesbian, Gay, Bisexual and Transgender People in Turkey and Their Health-Care Needs. Florence Nightingale Hemsire Derg 2020; 28:97-109. [PMID: 34263189 PMCID: PMC7968460 DOI: 10.5152/fnjn.2020.19032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/02/2019] [Indexed: 11/22/2022] Open
Abstract
Aim To determine sexual and reproductive health problems and needs of lesbian, gay, bisexual and transgender people based on their experiences and to develop solutions. Method A mixed method, which includes quantitative (descriptive) and qualitative (phenomenological) methods, was used (n=106). An online questionnaire was used to collect the data. Results Of the participants, 42.5% stated that they had experienced problems receiving sexual and reproductive health-care services, and 77.8% of those who stated they had problems indicated that the attitude of the health-care professionals was discriminatory or unfavorable. In the qualitative analysis, two themes were created: “Experiences during Health-care Services” and “Recommendations for Health Services.” Conclusion It was determined that lesbian, gay, bisexual and transgender individuals have sexual problems, sexually transmitted diseases, and suffer from sexual harassment. However, it was found that they do not receive sufficient health-care due to health-care professionals’ attitudes, homophobia, and disregard of privacy or confidentiality. In line with the results of the present research and the suggestions of the participants, it is suggested that training programs should be organized for health-care professionals providing services for lesbian, gay, bisexual and transgender people to raise awareness and ultimately promote more effective services.
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Affiliation(s)
- Lale Taşkın
- Department of Nursing, Başkent University Faculty of Health Sciences, Ankara, Turkey
| | - Ayten Şentürk Erenel
- Department of Nursing, Gazi University Faculty of Health Sciences, Ankara, Turkey
| | - Şengül Yaman Sözbir
- Department of Nursing, Gazi University Faculty of Health Sciences, Ankara, Turkey
| | | | - Çiğdem Yücel
- Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Hacer Alan Dikmen
- Department of Midwifery, Selçuk University Faculty of Health Sciences, Konya, Turkey
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12
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Yertutanol FDK, Candansayar S, Seydaoğlu G. Homophobia in Health Professionals in Ankara, Turkey: Developing a Scale. Transcult Psychiatry 2019; 56:1191-1217. [PMID: 30484756 DOI: 10.1177/1363461518808166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aims of this study were to develop a sexual orientation attitude scale and use it to investigate the attitudes of psychiatrists, other physicians and first year medical students toward homosexuals and homosexuality in Ankara, Turkey. A cross-sectional study was performed with three groups including psychiatrists (n = 147), non-psychiatric physicians (n = 224) and first year medical students (n = 280). A scale with 43 items consisting of four subscales (heterosexism, homophobia, homonegativity, neutrality) was developed which showed high internal consistency, validity and reliability in this sample of Turkish individuals. The internal consistency coefficients (Cronbach's alpha) for the subscales were 0.85-0.86, 0.95-0.95, 0.95-0.95, and 0.85-0.86, respectively. Being male, single, a graduate of a religious (Imam Hatip) or vocational high school, of rural origin, a student, more religious, heterosexual and studying at university hospitals were found to be related to higher scores (indicating more negative attitudes) on all subscales and the total scale and these differences were significant. Students had the highest scores and psychiatrists had the lowest scores in all subscales and the total scale. The results of this study indicate that physicians and medical students have negative attitudes toward homosexuals and that medical training on sexual health issues should be improved in Turkey.
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Azagba S, Shan L, Latham K. Overweight and Obesity among Sexual Minority Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101828. [PMID: 31126042 PMCID: PMC6572698 DOI: 10.3390/ijerph16101828] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/16/2019] [Accepted: 05/18/2019] [Indexed: 12/18/2022]
Abstract
There is evidence that sexual minority populations have a potentially heightened risk of poor health outcomes due in part to the discrimination they may face. In the present study, we examined whether overweightness and obesity vary by sexual minority subgroup using a large, nationally representative sample. Data were drawn from 2014–2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys (n = 716,609). We grouped participants according to sexual identity (straight, lesbian or gay, bisexual, and other/don’t know/not sure). The propensity score matching technique was used to address covariate imbalance among sexual identity groups. In addition, subgroup analyses were performed for both males and females. Compared to straight adults, lesbian females had significantly higher odds of being overweight (OR (odds ratio) 1.33; 95% CI (confidence interval) 1.17–1.53), whereas gay males had significantly lower odds (OR 0.66; 95% CI 0.59–0.73). Similarly, lesbians were more likely to be obese (OR 1.49; 95% CI 1.31–1.70), whereas gay men had significantly lower odds of obesity (OR 0.77; 95% CI 0.69–0.86) when compared to straight adults. Bisexual females had significantly higher odds of being overweight (OR 1.21; 95% CI 1.10–1.34) and obese (OR 1.43; 95% CI 1.29–1.59), whereas bisexual males showed no significant difference. Our results strengthen previous findings and further highlight the need for research by sexual minority subgroup.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
| | - Keely Latham
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
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Abstract
Sexual minority women may be invisible in health care settings unless practitioners ask every patient about sexual attractions/behaviors and identity. Sexual minority women need to feel comfortable and able to share information about their sexual identity, partners, and lives. No medical diagnoses are found more commonly in sexual minority women, but problems such as overweight/obesity, increased tobacco and alcohol use, increased mental health problems, and a past history of childhood sexual abuse are common. These factors intertwine when treating sexual minority women.
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Bazzi AR, Clark MA, Winter M, Tripodis Y, Boehmer U. Recruitment of breast cancer survivors and their caregivers: implications for dyad research and practice. Transl Behav Med 2018; 7:300-308. [PMID: 27154790 DOI: 10.1007/s13142-016-0400-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Breast cancer survivors' informal caregivers experience adverse health outcomes and could benefit from interventions. Studies of caregivers' participation in research, to date, have assumed heterosexuality. The aim of this study is to identify factors associated with caregiver participation among survivors with diversity in sexual orientation. We recruited breast cancer survivors into a telephone survey and asked them to invite a caregiver. Logistic regression identified factors associated with caregivers' participation. Among 297 survivors, 12 (4 %) had no caregivers, 82 (28 %) refused to provide caregiver information, 203 (68 %) provided caregiver contact, and 167 (56 %) had caregivers participate. Caregiver participation was more likely among sexual minority than heterosexual survivors (aOR: 1.89; 95 % CI: 1.08, 3.32), dyads with higher cohesion, and among caregivers who were partners. Caregiver participation was less likely among survivors with lower education and higher comorbidity. Findings provide insight into recruitment of diverse dyads into cancer survivorship research that will ultimately inform intervention design.
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Affiliation(s)
- Angela Robertson Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA
| | - Melissa A Clark
- Warren Alpert School of Medicine and School of Public Health, Brown University, Providence, RI, USA
| | - Michael Winter
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA.
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Silberman P, Buedo PE, Burgos LM. [Barriers to sexual health care in Argentina: perception of women who have sex with women]. Rev Salud Publica (Bogota) 2018; 18:1-12. [PMID: 28453149 DOI: 10.15446/rsap.v18n1.48047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 12/07/2015] [Indexed: 11/09/2022] Open
Abstract
Objective The objective is to describe the barriers to sexual health care of Women Who Have Sex with Women (WSW) in Argentina during 2013. Methods A cross-sectional, descriptive and quantitative study. An online survey was conducted using the Internet, in the period of April-July 2013, with homosexual and bisexual women over 18 living in Argentina, making use of the snowball methodology. Results A total of 161 women were surveyed. The results showed that 97.5 % had previously visited a doctor. The doctor did not ask about their sexual orientation in 82.8 % of cases. 93.6 % of the surveyed did not receive information about STDs; 83.8 % perceive little/no risk regarding STDs. 48.4 % are unaware of the methods of protection of STDs among women and 51.6 % obtained this information from websites and friends. 77.5 % reported not using protection methods. The main reasons were: stable partner, discomfort and the inability to acquire them. Discussion The results of this research allow for identifying the low perception among WSW regarding STDs, and the difficulty of approaching health professionals about this subject.
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Affiliation(s)
- Pedro Silberman
- Departamento Ciencias de la Salud, Universidad Nacional del Sur, Bahía Blanca, Argentina,
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17
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Hasson RE, Brown DR, Dorn J, Barkley L, Torgan C, Whitt-Glover M, Ainsworth B, Keith N. Achieving Equity in Physical Activity Participation: ACSM Experience and Next Steps. Med Sci Sports Exerc 2017; 49:848-858. [PMID: 27870795 DOI: 10.1249/mss.0000000000001161] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
There is clear and consistent evidence that regular physical activity is an important component of healthy lifestyles and fundamental to promoting health and preventing disease. Despite the known benefits of physical activity participation, many people in the United States remain inactive. More specifically, physical activity behavior is socially patterned with lower participation rates among women; racial/ethnic minorities; sexual minority youth; individuals with less education; persons with physical, mental, and cognitive disabilities; individuals >65 yr of age; and those living in the southeast region of the United States. Many health-related outcomes follow a pattern that is similar to physical activity participation. In response to the problem of inequities in physical activity and overall health in the United States, the American College of Sports Medicine (ACSM) has developed a national roadmap that supports achieving health equity through a physically active lifestyle. The actionable, integrated pathways that provide the foundation of ACSM's roadmap include the following: 1) communication-raising awareness of the issue and magnitude of health inequities and conveying the power of physical activity in promoting health equity; 2) education-developing educational resources to improve cultural competency for health care providers and fitness professionals as well as developing new community-based programs for lay health workers; 3) collaboration-building partnerships and programs that integrate existing infrastructures and leverage institutional knowledge, reach, and voices of public, private, and community organizations; and 4) evaluation-ensuring that ACSM attains measurable progress in reducing physical activity disparities to promote health equity. This article provides a conceptual overview of these four pathways of ACSM's roadmap, an understanding of the challenges and advantages of implementing these components, and the organizational and economic benefits of achieving health equity.
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Affiliation(s)
- Rebecca E Hasson
- 1Schools of Kinesiology and Public Health, University of Michigan, Ann Arbor, MI; 2Physical Activity and Health Branch, Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA; 3City College of New York, New York, NY; 4Department of Clinical Medicine, College of Medicine, University of Central Florida, Orlando, FL; 5Kinetics Consulting, Bethesda, MD; 6Gramercy Research Group, Winston-Salem, NC; 7Department of Exercise and Wellness, School of Nutrition and Health Promotion, Arizona State University, Tempe, AZ; and 8Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN
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18
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VanKim NA, Austin SB, Jun HJ, Corliss HL. Physical Activity and Sedentary Behaviors Among Lesbian, Bisexual, and Heterosexual Women: Findings from the Nurses' Health Study II. J Womens Health (Larchmt) 2017; 26:1077-1085. [PMID: 28816590 DOI: 10.1089/jwh.2017.6389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Lesbian and bisexual (LB) women are at greater risk of obesity than heterosexuals. However, few studies have examined sexual orientation differences in physical activity (PA) and even fewer have examined differences in sedentary behaviors. This study assessed PA more comprehensively than previous research by including aerobic PA, strengthening PA, and sitting time, to explore sexual orientation differences among adult women. METHODS Nearly 100,000 women from Nurses' Health Study II were included in multivariable-adjusted repeated measures analyses. PA and sedentary behaviors were assessed in 1989, 1991, 1997, 2001, 2005, and 2009 (age range: 24-64 years). Aerobic PA was converted to metabolic equivalent task (MET)-hours/week, whereas strengthening PA and sedentary behaviors were measured in hours/week. About 1.3% of the sample identified as lesbian (n = 926) or bisexual (n = 415). RESULTS On average over repeated measures, LB women reported engaging in 2-3 MET-hours/week more of total aerobic PA (β [95% confidence interval, CI]: lesbian: 2.0 MET-hours/week [0.6-3.4]; bisexual: 2.8 MET-hours/week [0.7-4.7]) than heterosexual women. Bisexual women reported engaging in 0.2 hours/week more of strengthening PA (95% CI: 0.06-0.42) than heterosexuals; there were no differences between lesbians and heterosexuals in strengthening PA. LB women reported sitting an average of 4-5 hours/week more than heterosexuals (lesbian: 4.1 hours/week [3.1-5.2]; bisexual: 5.1 hours/week [3.6-6.7]). CONCLUSIONS Interventions promoting less sitting time among LB women may be warranted. Additionally, findings highlight need for more research into other modifiable factors besides PA, such as minority stress or disordered eating behaviors that may contribute to greater obesity among LB women.
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Affiliation(s)
- Nicole A VanKim
- 1 Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts , Amherst, Massachusetts
| | - S Bryn Austin
- 2 Division of Adolescent and Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts.,3 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,4 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
| | - Hee-Jin Jun
- 5 Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University , San Diego, California
| | - Heather L Corliss
- 3 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,5 Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University , San Diego, California
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19
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Branstetter AJ, McRee AL, Reiter PL. Correlates of Human Papillomavirus Infection Among a National Sample of Sexual Minority Women. J Womens Health (Larchmt) 2017; 26:1004-1011. [PMID: 28486052 DOI: 10.1089/jwh.2016.6177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many sexual minority women are infected with human papillomavirus (HPV), yet little is known about correlates of HPV infection among this population. MATERIALS AND METHODS We analyzed data from a national sample of sexual minority women (i.e., women who either reported a history of female sexual partners or identified as nonheterosexual) aged 20-59 from the 2003 to 2012 National Health and Nutrition Examination Survey (n = 830). Weighted logistic regression identified correlates of infection with any HPV type and infection with a high-risk HPV type. RESULTS About 53% of women were infected with any HPV type, and about 37% were infected with a high-risk HPV type. Women who reported five or more sexual partners during their lifetime (adjusted odds ratio [aOR] = 5.07, 95% confidence interval [CI]: 2.26-11.42) were more likely to be infected with a high-risk HPV type. Compared to women aged 20-29, women aged 40-49 (aOR = 0.51, 95% CI: 0.32-0.81) or 50-59 (aOR = 0.27, 95% CI: 0.14-0.53) were less likely to be infected with a high-risk HPV type, as were women who were married or living with a partner (aOR = 0.62, 95% CI: 0.44-0.89). Mostly similar correlates were identified for infection with any HPV type, although infection with any HPV type was also less common among women who identified as lesbian compared to those who identified as heterosexual (aOR = 0.38, 95% CI: 0.21-0.68). CONCLUSIONS Demographic and health-related characteristics were associated with HPV infection outcomes. Findings can inform HPV prevention efforts for sexual minority women by providing information about risk factors and subgroups at particular risk for infection.
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20
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Qualitative Study of Cervical Cancer Screening Among Lesbian and Bisexual Women and Transgender Men. Cancer Nurs 2016; 39:455-463. [DOI: 10.1097/ncc.0000000000000338] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Tomisek A, Flinn B, Balsky T, Gruman C, Rizer AM. Strong, healthy, energized: Striving for a healthy weight in an older lesbian population. J Women Aging 2016; 29:230-242. [DOI: 10.1080/08952841.2015.1137436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ashley Tomisek
- Center for Aging and Disability Policy, The Lewin Group, Falls Church, Virginia, USA
| | - Brendan Flinn
- Center for Aging and Disability Policy, The Lewin Group, Falls Church, Virginia, USA
| | - Tanya Balsky
- Federal Health and Human Services, The Lewin Group, Falls Church, Virginia, USA
| | - Cindy Gruman
- Center for Aging and Disability Policy, The Lewin Group, Falls Church, Virginia, USA
| | - Allison M. Rizer
- Federal Health and Human Services, The Lewin Group, Falls Church, Virginia, USA
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22
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Farmer GW, Blosnich JR, Jabson JM, Matthews DD. Gay Acres: Sexual Orientation Differences in Health Indicators Among Rural and Nonrural Individuals. J Rural Health 2016; 32:321-31. [PMID: 26625172 PMCID: PMC4887433 DOI: 10.1111/jrh.12161] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Geographic location is a significant factor that influences health status and health disparities. Yet, little is known about the relationship between geographic location and health and health disparities among lesbian, gay, and bisexual (LGB) persons. This study used a US population-based sample to evaluate the associations of sexual orientation with health indicators by rural/nonrural residence. METHODS Data were pooled from the 10 states that collected sexual orientation in the 2010 Behavioral Risk Factor Surveillance System surveys. Rural status was defined using metropolitan statistical area, and group differences by sexual orientation were stratified by gender and rural/nonrural status. Chi-square tests for categorical variables were used to assess bivariate relationships. Multivariable logistic regression models stratified by gender and rural/nonrural status were used to assess the association of sexual orientation to health indicators, while adjusting for age, race/ethnicity, education, and partnership status. All analyses were weighted to adjust for the complex sampling design. FINDINGS Significant differences between LGB and heterosexual participants emerged for several health indicators, with bisexuals having a greater number of differences than gay men/lesbians. There were fewer differences in health indicators for rural LGB participants compared to heterosexuals than nonrural participants. CONCLUSIONS Rural residence appears to influence the pattern of LGB health disparities. Future work is needed to confirm and identify the exact etiology or rural/nonrural differences in LGB health.
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Affiliation(s)
- Grant W. Farmer
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, Missouri
| | - John R. Blosnich
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer M. Jabson
- Department of Public Health, College of Education Health and Human Sciences, University of Tennessee, Knoxville, Tennessee
| | - Derrick D. Matthews
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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23
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Warren JC, Smalley KB, Barefoot KN. Differences in Psychosocial Predictors of Obesity Among LGBT Subgroups. LGBT Health 2016; 3:283-91. [PMID: 27228031 DOI: 10.1089/lgbt.2015.0076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of the current study was to examine the overall presence of and differences in rates of overweight/obesity among a large, nationally diverse sample of lesbian, gay, bisexual, transgender (LGBT)-identified individuals (i.e., cisgender lesbians, cisgender gay men, cisgender bisexual women, cisgender bisexual men, transgender women, and transgender men) and to identify specific psychosocial predictors of obesity within each of the six LGBT subgroups. METHODS A total of 2702 LGBT-identified participants participated in the online study. Participants completed a series of demographic questions (including weight and height) and the Depression Anxiety Stress Scale 21. RESULTS The percentage of participants who were overweight/obese did not differ significantly across LGBT subgroups, with 61.1% of the total sample being overweight/obese. However, the percentage of participants who self-reported body mass indexes in the obese range differed significantly across the six LGBT subgroups, with the highest prevalence in transgender men (46.0%). In addition, the predictors of obesity varied by subgroup, with age a significant predictor for cisgender lesbians, cisgender gay men, and cisgender bisexual women, relationship status for cisgender bisexual women, employment status for both cisgender gay men and cisgender bisexual women, education level for cisgender lesbians, and depression, anxiety, and stress for cisgender gay men. None of the examined psychosocial factors emerged as predictors of obesity for cisgender bisexual men, transgender women, or transgender men. CONCLUSION These findings suggest that there are substantial variations in the presence and predictors of obesity across LGBT subgroups that support the need for culturally tailored healthy weight promotion efforts within the LGBT community.
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Affiliation(s)
- Jacob C Warren
- 1 Center for Rural Health and Health Disparities, Mercer University School of Medicine , Macon, Georgia .,2 Department of Community Medicine, Mercer University School of Medicine , Macon, Georgia
| | - K Bryant Smalley
- 3 Rural Health Research Institute, Georgia Southern University , Statesboro, Georgia .,4 Department of Psychology, Georgia Southern University , Statesboro, Georgia
| | - K Nikki Barefoot
- 3 Rural Health Research Institute, Georgia Southern University , Statesboro, Georgia
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Primary care of women who have sex with women. Recommendations from the research. Nurse Pract 2016; 40:24-32. [PMID: 25757088 DOI: 10.1097/01.npr.0000431883.32986.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research on women who have sex with women has increased in the last decade. Attention has been brought to this group of women through the IOM report, which noted a lack of research related to their care. Most of the research has not been published in nursing literature. This article reviews this literature with recommendations for primary care practice.
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Fear of cancer recurrence in survivor and caregiver dyads: differences by sexual orientation and how dyad members influence each other. J Cancer Surviv 2016; 10:802-13. [PMID: 26899851 DOI: 10.1007/s11764-016-0526-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 02/13/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to identify explanatory factors of fear of recurrence (FOR) in breast cancer survivors of different sexual orientations and their caregivers and to assess the directionality in the survivor and caregiver dyads' FOR. METHODS We recruited survivors of non-metastatic breast cancer of different sexual orientations and invited their caregivers into this study. Using a telephone survey, we collected data from 167 survivor and caregiver dyads. Using simultaneous equation models and a stepwise selection process, we identified the significant determinants of survivors' and caregivers' FOR and determined the directionality of survivors' and caregivers' FOR. Weighting the model by the inverse propensity score ensured that differences by sexual orientation in age and proportion of life in the caregiver-survivor relationship were accounted for. RESULTS Caregivers' FOR predicted survivors' FOR, and sexual orientation had a significant effect on survivors' FOR, in that sexual minority women reported less FOR than heterosexual women. Other determinants of survivors' FOR included their medical characteristics, coresidence with caregivers, and caregivers' social support and use of counseling. Caregivers' FOR was related to their social support and survivors' medical characteristics. CONCLUSIONS This study suggests a need for caregiver interventions. Because survivors' FOR is affected by caregivers' FOR, caregiver interventions will likely benefit survivors' FOR. IMPLICATIONS FOR CANCER SURVIVORS Both sexual minority and heterosexual breast cancer survivors' FOR are affected by their caregivers' FOR, which suggests that the caregivers of breast cancer survivors are central for the survivors' well-being and shall therefore be integrated into the care process.
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The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women. J Urban Health 2015; 92:1092-104. [PMID: 26438415 PMCID: PMC4675741 DOI: 10.1007/s11524-015-9989-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.
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Eliason MJ, Ingraham N, Fogel SC, McElroy JA, Lorvick J, Mauery DR, Haynes S. A systematic review of the literature on weight in sexual minority women. Womens Health Issues 2015; 25:162-75. [PMID: 25747521 DOI: 10.1016/j.whi.2014.12.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Over the past 20 years, a growing literature has demonstrated that sexual minority women have greater weight than heterosexual women, prompting concern that they may be at high risk for disparities in physical disorders. In 2008, Bowen et al. published a review of the existing research on sexual minority women and obesity, finding no methodologically strong studies with representative sampling procedures. METHOD We conducted a systematic review of the literature covering the period of July 2006 to February 2014 on the relationship between sexual orientation and weight. The review includes 20 population-based and 17 nonprobability sample studies. CONCLUSIONS The majority of these studies found that lesbian and bisexual women had significantly greater body mass index (BMI) or a higher percentage with a BMI over 30 than heterosexual women. The difference in BMI was fairly consistent across the lifespan, with the weight differences beginning in adolescence. The studies, however, did not show a higher prevalence of physical disorders thought to be associated with weight. This potentially paradoxical finding warrants further research to compare prevalence of chronic disease by BMI category and sexual orientation.
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Affiliation(s)
- Michele J Eliason
- Department of Health Education, San Francisco State University, San Francisco, California.
| | | | - Sarah C Fogel
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Jane A McElroy
- Family and Community Medicine Department, University of Missouri, School of Medicine, Columbia, Missouri
| | - Jennifer Lorvick
- Urban Health Program, RTI International, San Francisco, California
| | - D Richard Mauery
- Department of Health Policy, George Washington School of Public Health and Health Services, Washington, DC
| | - Suzanne Haynes
- U.S. Department of Health and Human Services, Office on Women's Health, Washington, DC
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28
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Cancer Risk Factors, Diagnosis and Sexual Identity in the Australian Longitudinal Study of Women's Health. Womens Health Issues 2015; 25:509-16. [DOI: 10.1016/j.whi.2015.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 03/29/2015] [Accepted: 04/06/2015] [Indexed: 11/20/2022]
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29
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Agénor M, Peitzmeier S, Gordon AR, Haneuse S, Potter JE, Austin SB. Sexual Orientation Identity Disparities in Awareness and Initiation of the Human Papillomavirus Vaccine Among U.S. Women and Girls: A National Survey. Ann Intern Med 2015; 163:99-106. [PMID: 25961737 PMCID: PMC4509853 DOI: 10.7326/m14-2108] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lesbians and bisexual women are at risk for human papillomavirus (HPV) infection from female and male sexual partners. OBJECTIVE To examine the association between sexual orientation identity and HPV vaccination among U.S. women and girls. DESIGN Cross-sectional, using 2006-2010 National Survey of Family Growth data. SETTING U.S. civilian noninstitutionalized population. PARTICIPANTS The 2006-2010 National Survey of Family Growth used stratified cluster sampling to establish a national probability sample of 12,279 U.S. women and girls aged 15 to 44 years. Analyses were restricted to 3253 women and girls aged 15 to 25 years who were asked about HPV vaccination. MEASUREMENTS Multivariable logistic regression was used to obtain prevalence estimates of HPV vaccine awareness and initiation adjusted for sociodemographic and health care factors for each sexual orientation identity group. RESULTS Among U.S. women and girls aged 15 to 25 years, 84.4% reported having heard of the HPV vaccine; of these, 28.5% had initiated HPV vaccination. The adjusted prevalence of vaccine awareness was similar among heterosexual, bisexual, and lesbian respondents. After adjustment for covariates, 8.5% (P = 0.007) of lesbians and 33.2% (P = 0.33) of bisexual women and girls who had heard of the vaccine had initiated vaccination compared with 28.4% of their heterosexual counterparts. LIMITATION Self-reported, cross-sectional data, and findings may not be generalizable to periods after 2006 to 2010 or all U.S. lesbians aged 15 to 25 years (because of the small sample size for this group). CONCLUSION Adolescent and young adult lesbians may be less likely to initiate HPV vaccination than their heterosexual counterparts. Programs should facilitate access to HPV vaccination services among young lesbians. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Madina Agénor
- From Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Fenway Health, Beth Israel Deaconess Medical Center, and Boston Children's Hospital, Boston, Massachusetts, and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Peitzmeier
- From Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Fenway Health, Beth Israel Deaconess Medical Center, and Boston Children's Hospital, Boston, Massachusetts, and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allegra R. Gordon
- From Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Fenway Health, Beth Israel Deaconess Medical Center, and Boston Children's Hospital, Boston, Massachusetts, and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sebastien Haneuse
- From Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Fenway Health, Beth Israel Deaconess Medical Center, and Boston Children's Hospital, Boston, Massachusetts, and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer E. Potter
- From Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Fenway Health, Beth Israel Deaconess Medical Center, and Boston Children's Hospital, Boston, Massachusetts, and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - S. Bryn Austin
- From Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Fenway Health, Beth Israel Deaconess Medical Center, and Boston Children's Hospital, Boston, Massachusetts, and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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VanKim NA, Erickson DJ, Eisenberg ME, Lust K, Rosser BRS, Laska MN. College Women's Weight-related Behavior Profiles Differ by Sexual Identity. Am J Health Behav 2015; 39:461-70. [PMID: 26018094 DOI: 10.5993/ajhb.39.4.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To identify and describe homogenous profiles of female college students based on weight-related behaviors and examine differences across 5 sexual orientation groups. METHODS Data from the 2009-2013 College Student Health Survey (Minnesota-based survey of 2- and 4-year college students) were used to fit latent class models. RESULTS Four profiles were identified across all sexual orientation groups: "healthier eating habits," "moderate eating habits," "unhealthy weight control," and "healthier eating habits, more physically active." Differences in patterns and prevalence of profiles across sexual orientation suggest need for interventions addressing insufficient physical activity and unhealthy weight control behaviors. CONCLUSIONS Future interventions should consider the diversity of behavioral patterns across sexual orientation to more effectively address weight-related behavioral disparities.
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Affiliation(s)
- Nicole A VanKim
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, USA.
| | - Darin J Erickson
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Marla E Eisenberg
- University of Minnesota, Division of General Pediatrics and Adolescent Health, Minneapolis, MN, USA
| | - Katherine Lust
- University of Minnesota, Boynton Health Service, Minneapolis, MN, USA
| | - B R Simon Rosser
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Melissa N Laska
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
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Rizer AM, Mauery DR, Haynes SG, Couser B, Gruman C. Challenges in Intervention Research for Lesbian and Bisexual Women. LGBT Health 2015; 2:105-12. [PMID: 26790115 DOI: 10.1089/lgbt.2014.0122] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE More than one-third of U.S. adults are obese, the highest prevalence occurring among women age 60 and older (42.3%), and women ages 40 to 59 (36.0%). This issue is even more pronounced among lesbian and bisexual (LB) women. Studies suggest this population may be twice as likely to be overweight or obese as heterosexual women. Despite this public health issue, little has been done to reduce overweight and obesity in LB women. METHODS During the design of healthy-weight interventions aimed at reducing overweight and obesity in older LB women through increased physical activity and improved nutrition, we conducted a systematic review of health interventions targeting older LB women to identify and describe core characteristics present in such interventions. We identified 878 articles and studies as potentially relevant to our review and evaluated them for inclusion in our analysis. We analyzed five interventions, including two on smoking cessation and one each on physical activity, breast cancer screening, and alcohol abuse. RESULTS Results indicate that, regardless of desired health outcome, typical intervention characteristics included: social support, education, goal setting, peer-based facilitation, and lesbian, gay, bisexual, and transgender (LGBT)-friendly intervention environments. CONCLUSION The lack of health interventions in this population is disconcerting. Coupled with the high and disparate prevalence of overweight and obesity in LB women, the lack of published evidence of efforts targeting this population presents a critical opportunity for policymakers and researchers to respond to this public health concern.
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Affiliation(s)
| | - D Richard Mauery
- 2 Jacobs Institute of Women's Health, The George Washington University School of Public Health and Health Services , Washington, D.C
| | - Suzanne G Haynes
- 3 Office on Women's Health , U.S. Department of Health and Human Services, Washington, D.C
| | - Babette Couser
- 3 Office on Women's Health , U.S. Department of Health and Human Services, Washington, D.C
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Abstract
The purpose of this article is to identify Pap testing rates among lesbians and identify reasons for lack of recognition of cervical cancer risks in lesbians. Articles that reported cervical cancer screening rates among lesbians were searched. Between 48% and 81% of lesbians reported recent Pap smears. The lesbian community requires better education, and healthcare providers should promote regular Pap smears for all women.
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Eliason MJ, Fogel SC. An ecological framework for sexual minority women's health: factors associated with greater body mass. JOURNAL OF HOMOSEXUALITY 2015; 62:845-882. [PMID: 25569747 DOI: 10.1080/00918369.2014.1003007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In recent years, many studies have focused on the body of sexual minority women, particularly emphasizing their larger size. These studies rarely offer theoretically based explanations for the increased weight, nor study the potential consequences (or lack thereof) of being heavier. This article provides a brief overview of the multitude of factors that might cause or contribute to larger size of sexual minority women, using an ecological framework that elucidates upstream social determinants of health as well as individual risk factors. This model is infused with a minority stress model, which hypothesizes excess strain resulting from the stigma associated with oppressed minority identities such as woman, lesbian, bisexual, woman of color, and others. We argue that lack of attention to the upstream social determinants of health may result in individual-level victim blaming and interventions that do not address the root causes of minority stress or increased weight.
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Affiliation(s)
- Michele J Eliason
- a Department of Health Education , San Francisco State University , San Francisco , California , USA
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Jordan JN, Everett KD, Ge B, McElroy JA. Smoking and intention to quit among a large sample of black sexual and gender minorities. JOURNAL OF HOMOSEXUALITY 2015; 62:604-620. [PMID: 25470333 DOI: 10.1080/00918369.2014.987569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this study is to more completely quantify smoking and intention to quit from a sample of sexual and gender minority (SGM) Black individuals (N = 639) through analysis of data collected at Pride festivals and online. Frequencies described demographic characteristics; chi-square analyses were used to compare tobacco-related variables. Black SGM smokers were more likely to be trying to quit smoking than White SGM smokers. However, Black SGM individuals were less likely than White SGM individuals to become former smokers. The results of this study indicate that smoking behaviors may be heavily influenced by race after accounting for SGM status.
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Affiliation(s)
- Jenna N Jordan
- a Department of Family & Community Medicine , University of Missouri , Columbia , Missouri , USA
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35
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McPhail D, Bombak AE. Fat, queer and sick? A critical analysis of ‘lesbian obesity’ in public health discourse. CRITICAL PUBLIC HEALTH 2014. [DOI: 10.1080/09581596.2014.992391] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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36
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Fredriksen-Goldsen KI, Simoni JM, Kim HJ, Lehavot K, Walters KL, Yang J, Hoy-Ellis CP, Muraco A. The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2014; 84:653-63. [PMID: 25545433 DOI: 10.1037/ort0000030] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbian, gay, bisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the Health Equity Promotion Model-a framework oriented toward LGBT people reaching their full mental and physical health potential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered.
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Affiliation(s)
| | | | | | - Keren Lehavot
- MIRECC Postdoctoral Fellow, VA Puget Sound Health Care System
| | | | - Joyce Yang
- Department of Psychology, University of Washington
| | | | - Anna Muraco
- Department of Sociology, Loyola Marymount University
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Drummond JD, Brotman S. Intersecting and Embodied Identities: A Queer Woman’s Experience of Disability and Sexuality. SEXUALITY AND DISABILITY 2014. [DOI: 10.1007/s11195-014-9382-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Amir H, Gophen R, Amir Levy Y, Hasson J, Gordon D, Amit A, Azem F. Obstetricians and gynecologists: which characteristics do Israeli lesbians prefer? J Obstet Gynaecol Res 2014; 41:283-93. [PMID: 25227636 DOI: 10.1111/jog.12512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/29/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to explore lesbians' preferences when choosing obstetricians/gynecologists. MATERIAL AND METHODS This cross-sectional study included 100 lesbian and 100 heterosexual women. A 40-item questionnaire assessed the correlation between a patient's sexual identity and her specific preferences for obstetricians/gynecologists. RESULTS The top five most important parameters for both groups in choosing obstetricians/gynecologists overlapped greatly. Four of those were experience, ability, knowledge and personality. Only one parameter differed: lesbians ranked 'sexually tolerant' as the third most important characteristic while heterosexuals ranked 'availability' as the fifth most important characteristic. Lesbians rated 'sexual tolerance' significantly higher than heterosexuals (P < 0.001). More lesbians (56%) preferred female obstetricians/gynecologists compared to heterosexuals (21%) (P < 0.001). When compared to heterosexuals, more lesbians preferred female obstetricians/gynecologists for intimate and non-intimate procedures (P < 0.001). But within the lesbian population, a higher percentage of subjects showed a preference for female obstetricians/gynecologists only for intimate procedures. Lesbians used the following to describe their preference for female obstetricians/gynecologists: feeling more comfortable; gentle; sympathetic; patient; more understanding of women's health; better physicians in general; and more sexually tolerant (P < 0.001 vs heterosexual). However, when we looked only at the lesbian population, the majority did not exhibit a preference for a female obstetrician/gynecologist for any of these reasons. The main reason given by the 56% of the lesbians who said they prefer female obstetricians/gynecologists was feeling more comfortable. CONCLUSION Overwhelmingly lesbians prefer sexually tolerant obstetricians/gynecologists regardless of their gender; however, only a small number of lesbian subjects in this study considered their obstetricians/gynecologists as displaying this characteristic.
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Affiliation(s)
- Hadar Amir
- Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv, Israel
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Matthews AK, McConnell EA, Li CC, Vargas MC, King A. Design of a comparative effectiveness evaluation of a culturally tailored versus standard community-based smoking cessation treatment program for LGBT smokers. BMC Psychol 2014; 2:12. [PMID: 25566383 PMCID: PMC4269994 DOI: 10.1186/2050-7283-2-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/15/2014] [Indexed: 11/30/2022] Open
Abstract
Background Smoking prevalence rates among the lesbian, gay, bisexual, and transgender (LGBT) population are significantly higher than the general population. However, there is limited research on smoking cessation treatments in this group, particularly on culturally targeted interventions. Moreover, there are few interventions that address culturally specific psychosocial variables (e.g., minority stress) that may influence outcomes. This paper describes the protocol for a comparative effectiveness trial testing an evidence-based smoking cessation program, Courage to Quit, against a culturally tailored version for LGBT smokers, and examines the role of culturally specific psychosocial variables on cessation outcomes. Methods/Design To examine the effectiveness of a culturally targeted versus standard smoking cessation intervention, the study utilizes a 2-arm block, randomized, control trial (RCT) design. Adult LGBT participants (n = 400) are randomized to one of the two programs each consisting of a six-session group program delivered in a community center and an eight week supply of the transdermal nicotine patch. Four individualized telephone counseling sessions occur at weeks 2, 5, 7, and 9, at times of greatest risk for relapse. Study outcome measures are collected at baseline, and 1, 3, 6, and 12 months post quit date. Primary outcomes are expired air carbon monoxide verified 7-day point-prevalence quit rates at each measurement period. Secondary outcomes assess changes in cravings, withdrawal symptoms, smoking cessation self-efficacy, and treatment adherence. Additionally, study staff examines the role of culturally specific psychosocial variables on cessation outcomes using path analysis. Discussion Determining the efficacy of culturally specific versus standard evidence based approaches to smoking cessation is a critical issue facing the field today. This study provides a model for the development and implementation of a culturally tailored smoking cessation intervention for LGBT participants and addresses a gap in the field by examining the role of culturally psychosocial variables associated with cessation outcomes. Trial registration U.S. National Institutes of Health Clinical Trials NCT01633567 Registered 30 May 2012.
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Affiliation(s)
- Alicia K Matthews
- University of Illinois at Chicago (UIC), Chicago, IL USA ; College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, Chicago, IL 60612 USA
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Boehmer U, Miao X, Linkletter C, Clark MA. Health Conditions in Younger, Middle, and Older Ages: Are There Differences by Sexual Orientation? LGBT Health 2014; 1:168-76. [PMID: 26789710 DOI: 10.1089/lgbt.2013.0033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Sexual minorities engage in more risk behaviors at a younger age than heterosexuals and many are subject to minority stress from a young age, which raises questions about the age at which sexual minorities' experience morbidities. Our objective was to estimate the prevalence of health conditions among young, middle age, and older age groups to examine sexual orientation differences while stratifying by gender. METHODS We pooled 4 years of data from the California Health Interview Survey to obtain a representative sample of the male and female population in California, allowing us to examine health conditions by sexual orientation in three age strata, age 20-39, age 40-59, and age 60 and older. RESULTS Compared with same-gender heterosexuals, sexual minority women had a higher likelihood of physical morbidities (disability: adjusted odds ratio [AOR] 2.66 for lesbians and AOR 2.21 for bisexuals; arthritis: AOR 2.12 for lesbians) at a young age, whereas gay men had a higher likelihood of heart disease (AOR 2.78) and cancer (AOR 4.75) at a young age. Across the life span, sexual minorities had higher likelihoods of poor mental health than heterosexuals. CONCLUSION These findings suggest that at a young age, sexual minorities experience more morbidities than heterosexual individuals. Consideration should be given to early detection, identification, and treatment of these conditions among sexual minorities particularly at younger ages.
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Affiliation(s)
- Ulrike Boehmer
- 1 Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts
| | - Xiaopeng Miao
- 2 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | | | - Melissa A Clark
- 4 Warren Alpert School of Medicine and School of Public Health, Brown University , Providence, Rhode Island
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41
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Marques AM, Nogueira C, de Oliveira JM. Lesbians on Medical Encounters: Tales of Heteronormativity, Deception, and Expectations. Health Care Women Int 2014; 36:988-1006. [PMID: 24498920 DOI: 10.1080/07399332.2014.888066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The experiences of lesbian women in medical encounters prove particularly relevant for understanding their difficulties in their relationship with professionals and health services. We carried out semistructured interviews with 30 women aged 21 to 63 years, who define themselves as lesbian. The analysis highlights the difficulties experienced in disclosure of sexuality in medical encounters, the tendency for doctors to come across as heteronormative, and also medical practices experienced as appropriate by interviewees. Analysis of participant experiences demonstrates the need for reflection and decision making to promote the recognition of the sexual citizenship of lesbian women and their empowerment.
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Affiliation(s)
- António Manuel Marques
- a Departamento de Ciências Sociais e Humanas, Escola Superior de Saúde do Instituto Politécnico de Setúbal , Setúbal , Portugal
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Molina Y, Lehavot K, Beadnell B, Simoni J. Racial Disparities in Health Behaviors and Conditions Among Lesbian and Bisexual Women: The Role of Internalized Stigma. LGBT Health 2014; 1:131-139. [PMID: 25364769 PMCID: PMC4212827 DOI: 10.1089/lgbt.2013.0007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There are documented disparities in physical health behaviors and conditions, such as physical activity and obesity, with regard to both race/ethnicity and sexual orientation. However, physical health disparities for lesbian and bisexual (LB) women who are also racial minorities are relatively unexplored. Minority stressors, such as internalized stigma, may account for disparities in such multiply marginalized populations. We sought to (1) characterize inequalities among non-Hispanic white and African American LB women and (2) examine the roles of internalized sexism and homophobia in disparities. Data on health behaviors (diet, physical activity); physical health (hypertension, diabetes, overweight/obesity); internalized sexism; and internalized homophobia were collected via a web-based survey. Recruitment ads were sent electronically to over 200 listservs, online groups, and organizations serving the lesbian, gay, and bisexual community in all 50 U.S. states. The analytic sample consisted of 954 white and 75 African American LB women. African American participants were more likely than white participants to report low fruit/vegetable intake and physical activity, a higher body mass index, and a history of diabetes and hypertension. There were no racial differences in internalized homophobia, but African American women reported higher levels of internalized sexism. Internalized sexism partially mediated racial disparities in physical activity and diabetes, but not in the other outcomes. Findings suggest that African American LB women may be at greater risk than their white counterparts for poor health and that internalized sexism may be a mediator of racial differences for certain behaviors and conditions.
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Affiliation(s)
- Yamile Molina
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Epidemiology and Biostatistics Division, University of Illinois–Chicago, Chicago, Illinois
- Department of Health Services, University of Washington, Seattle, Washington
| | - Keren Lehavot
- VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington
| | - Blair Beadnell
- School of Social Work, University of Washington, Seattle, Washington
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, Washington
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Agénor M, Krieger N, Austin SB, Haneuse S, Gottlieb BR. Sexual orientation disparities in Papanicolaou test use among US women: the role of sexual and reproductive health services. Am J Public Health 2013; 104:e68-73. [PMID: 24328650 DOI: 10.2105/ajph.2013.301548] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We investigated sexual orientation disparities in Papanicolaou screening among US women aged 21 to 44 years (n = 9581) in the 2006 to 2010 National Survey of Family Growth. The odds ratios for lesbian versus heterosexual women and women with no versus only male sexual partners were 0.40 and 0.32, respectively, and were attenuated after adjustment for sexual and reproductive health (SRH) care indicators. Administering Papanicolaou tests through mechanisms other than SRH services would promote cervical cancer screening among all women.
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Affiliation(s)
- Madina Agénor
- Madina Agénor, Nancy Krieger, S. Bryn Austin, and Barbara R. Gottlieb are with the Department of Social and Behavioral Sciences, and Sebastien Haneuse is with the Department of Biostatistics, Harvard School of Public Health, Boston, MA. S. Bryn Austin is also with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital. Barbara R. Gottlieb is also with the Department of Medicine, Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston
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Deputy NP, Boehmer U. Weight status and sexual orientation: differences by age and within racial and ethnic subgroups. Am J Public Health 2013; 104:103-9. [PMID: 24228650 DOI: 10.2105/ajph.2013.301391] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We determined differences in weight at age 18 years and at current age and weight change by sexual orientation within different racial/ethnic populations, stratifying by gender. METHODS We used 2001-2007 data from the California Health Interview Survey, resulting in an unweighted sample of 120,274 individuals aged 18 to 74 years. Using regression models, we examined overweight status and change in weight by sexual orientation, stratifying by race/ethnicity and gender. RESULTS Compared with heterosexual women of the same race/ethnicity, White and African American lesbians and bisexuals had increased likelihood of being overweight at age 18 years and maintaining overweight status during adulthood. Sexual minority status was unrelated to weight among Latinas and inconsistently linked to weight among Asian women compared with heterosexual women of the same race/ethnicity. Sexual minority status was protective against unhealthy weight among White, African American, Asian, and Latino men compared with heterosexual counterparts of the same race/ethnicity. This protective effect was seen after age 18 years except among African American bisexual men. CONCLUSIONS Our findings indicate a need for age- and culture-sensitive interventions that reduce weight or prevent weight gain in sexual minority women and men.
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Affiliation(s)
- Nicholas P Deputy
- Nicholas P. Deputy and Ulrike Boehmer are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
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Boehmer U, Glickman M, Winter M, Clark MA. Lesbian and bisexual women's adjustment after a breast cancer diagnosis. J Am Psychiatr Nurses Assoc 2013; 19:280-92. [PMID: 24055955 DOI: 10.1177/1078390313504587] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little research has been devoted to lesbian and bisexual survivors' adjustment after breast cancer. OBJECTIVES To determine differences between lesbian and bisexual survivors and to examine whether sexual minority-specific issues contribute to these survivors' adjustment. DESIGN We recruited 180 lesbian and bisexual survivors with primary diagnoses of DCIS (ductal carcinoma in situ) or I-III nonrecurrent breast cancer from a cancer registry and the community. RESULTS The characteristics of lesbian and bisexual survivors of breast cancer were similar, with few exceptions, such as partner status and gender of partner. Sexual minority-specific factors contributed toward explaining lesbian and bisexual survivors' anxiety and depression but did not contribute toward explaining survivors' physical and mental health. CONCLUSIONS Awareness about vulnerabilities due to partner status and about the sexual minority-specific issues that contribute to adjustment is important for medical and mental health professionals who have lesbian and bisexual breast cancer survivors as patients.
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Farmer GW, Jabson JM, Bucholz KK, Bowen DJ. A population-based study of cardiovascular disease risk in sexual-minority women. Am J Public Health 2013; 103:1845-50. [PMID: 23948018 DOI: 10.2105/ajph.2013.301258] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine if sexual-minority women were at greater risk for cardiovascular disease (CVD) than their heterosexual counterparts. METHODS We aggregated data from the 2001-2008 National Health and Nutrition Examination Surveys to examine differences in CVD risk between heterosexual and sexual-minority women by using the Framingham General CVD Risk Score to calculate a ratio of vascular and chronological age. We also examined differences in the prevalence of various CVD risk factors. RESULTS Sexual-minority women were more likely to be current or former smokers, to report a history of drug use, to report risky drinking, and to report a family history of CVD. On average, sexual-minority women were 13.9% (95% confidence interval [CI] = 8.5%, 19.3%) older in vascular terms than their chronological age, which was 5.7% (95% CI = 1.5%, 9.8%) greater than that of their heterosexual counterparts. Family history of CVD and history of drug use were unrelated to increased CVD risk, and this risk was not fully explained by either risky drinking or smoking. CONCLUSIONS Sexual-minority women are at increased risk for CVD compared with heterosexual women.
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Affiliation(s)
- Grant W Farmer
- Grant W. Farmer is with the Department of Epidemiology, Saint Louis University School of Public Health, St. Louis, MO. Jennifer M. Jabson and Deborah J. Bowen are with the Department of Community Health Sciences, Boston University School of Public Health, Boston, MA. Kathleen K. Bucholz is with the Department of Psychiatry, Washington University School of Medicine, St. Louis
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Boehmer U, Glickman M, Winter M, Clark MA. Breast cancer survivors of different sexual orientations: which factors explain survivors' quality of life and adjustment? Ann Oncol 2013; 24:1622-30. [PMID: 23448806 DOI: 10.1093/annonc/mdt035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Little is known about differences by sexual orientation in explanatory factors of breast cancer survivors' quality of life, anxiety, and depression. PATIENTS AND METHODS Survivors were recruited from a cancer registry and additional survivors recruited through convenience methods. Data were collected via telephone survey from all 438 survivors, who were disease free and diagnosed with non-metastatic breast cancer an average of 5 years earlier. To explain quality of life, anxiety, and depression, we focused on sexual orientation as the primary independent factors, in addition, considering demographic, psychosocial, clinical, and functional factors as correlates. RESULTS Sexual orientation had indirect associations with each of the outcomes, through disease-related and demographic factors as well as psychosocial and coping resources. The various explanatory models explain between 36% and 50% of the variance in outcomes and identified areas of strengths and vulnerabilities in sexual minority compared with heterosexual survivors. CONCLUSIONS This study's findings of strengths among specific subgroups of sexual minority compared with heterosexual survivors require further explorations to identify the reasons for this finding. Most of the identified vulnerabilities among sexual minority compared with heterosexual survivors of breast cancer are amenable to change by interventions.
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Affiliation(s)
- U Boehmer
- Department of Community Health Sciences, Boston University, School of Public Health, Boston, MA 02118, USA.
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Brittain DR, Dinger MK, Hutchinson SR. Sociodemographic and lesbian-specific factors associated with physical activity among adult lesbians. Womens Health Issues 2013; 23:e103-8. [PMID: 23403070 DOI: 10.1016/j.whi.2012.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 11/30/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although participation in moderate and vigorous physical activity (MVPA) results in health benefits, the majority of adult lesbians are not sufficiently active. The purpose of this study was to examine the relationships between sociodemographic factors (age, education level, body mass index [BMI], race, partner status, employment status, annual household income, general health status, diagnosis of chronic conditions, children under 18 years living at home) and lesbian-specific factors (connection with the lesbian community, public identification as a lesbian) to participation in MVPA. METHODS Participants included 847 self-identified lesbians 18 to 74 years old (M(age) = 40.5; SD = 11.6) who completed a 20-minute, web-based survey. FINDINGS The binary logistic regression model that included the 10 demographic factors was significantly associated with MVPA, χ(2) (15, N = 847) = 105.62, p < .001. However, when the two lesbian-specific factors were added, the model did not improve significantly, χ(2) (2, N = 847) = 5.20, p = .07. BMI and general health status were significantly associated with MVPA (Wald χ(2) (2) = 19.5, p < .001) and (Wald χ(2) (4) = 41.2, p < .001). Obese participants had 54.5% lower odds than healthy weight participants to engage in sufficient amounts of MVPA. Participants who reported general health status as excellent compared with those who reported poor had 12.7 times greater odds of engaging in sufficient amounts of MVPA. CONCLUSIONS Future research should extend on this study by utilizing sampling methods that target the recruitment of lesbian women not actively involved in lesbian-related activities.
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Affiliation(s)
- Danielle R Brittain
- School of Human Sciences, Community Health Program, University of Northern Colorado, Greeley, Colorado 80639, USA.
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Everett BG. Sexual orientation disparities in sexually transmitted infections: examining the intersection between sexual identity and sexual behavior. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:225-36. [PMID: 22350122 PMCID: PMC3575167 DOI: 10.1007/s10508-012-9902-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 08/27/2011] [Accepted: 12/01/2011] [Indexed: 05/18/2023]
Abstract
The terms MSM (men who have sex with men) and WSW (women who have sex with women) have been used with increasing frequency in the public health literature to examine sexual orientation disparities in sexual health. These categories, however, do not allow researchers to examine potential differences in sexually transmitted infection (STI) risk by sexual orientation identity. Using data from the National Longitudinal Survey of Adolescent Health, this study investigated the relationship between self-reported STIs and both sexual orientation identity and sexual behaviors. Additionally, this study examined the mediating role of victimization and STI risk behaviors on the relationship between sexual orientation and self-reported STIs. STI risk was found to be elevated among heterosexual-WSW and bisexual women, whether they reported same-sex partners or not, whereas gay-identified WSW were less likely to report an STI compared to heterosexual women with opposite sex relationships only. Among males, heterosexual-identified MSM did not have a greater likelihood of reporting an STI diagnosis; rather, STI risk was concentrated among gay and bisexual identified men who reported both male and female sexual partners. STI risk behaviors mediated the STI disparities among both males and females, and victimization partially mediated STI disparities among female participants. These results suggest that relying solely on behavior-based categories, such as MSM and WSW, may mischaracterize STI disparities by sexual orientation.
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Affiliation(s)
- Bethany G Everett
- Institute of Behavioral Science, Population Program, University of Colorado, Campus Box 484, Boulder, CO, 80309-0484, USA.
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Abdessamad HM, Yudin MH, Tarasoff LA, Radford KD, Ross LE. Attitudes and Knowledge Among Obstetrician-Gynecologists Regarding Lesbian Patients and Their Health. J Womens Health (Larchmt) 2013; 22:85-93. [DOI: 10.1089/jwh.2012.3718] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hasan M. Abdessamad
- Hôpital Régional Chaleur, Vitalité Health Networks, Bathurst, New Brunswick, Canada
| | - Mark H. Yudin
- Obstetrics, Gynecology, & Reproductive Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lesley A. Tarasoff
- Health Systems and Health Equity Research Group, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Kimberly D. Radford
- Health Systems and Health Equity Research Group, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Lori E. Ross
- Health Systems and Health Equity Research Group, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
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