Health Inequities among Lesbian, Gay, and Bisexual Adults in North Carolina, 2011-2014

Promoting Smoking Cessation Among Lesbian and Bisexual Women: Lessons Learned From a Location-Based Media Campaign in Western North Carolina

Despite well-documented inequities in tobacco use for lesbian, gay, bisexual, and transgender populations, there is little practical guidance for local public health officials on developing and implementing media campaigns that prioritize lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. In this practice note article, we describe the development and lessons learned from a location-based media campaign to promote tobacco use cessation and raise awareness of QuitlineNC among lesbian and bisexual women in Western North Carolina. The campaign used a digital approach based on cell phone locations and marketing profiles to deliver messages across 4 years (2018-2021). Considerations for practitioners include how our project required messaging adaptation to meet Google's restrictions against using the word "yours" and the importance of addressing privacy protection concerns with state officials to enable collection of outcome evaluation measures via a conversion pixel (code for capturing metrics).

Disparities in Health Care Access and Utilization at the Intersections of Urbanicity and Sexual Identity in California

Purpose: The aim was to examine differences in health care access at the intersections of urbanicity and sexual identity in California. Methods: We used the 2014-2017 Adult California Health Interview Survey paired with the sexual orientation special use research file to create dummy groups representing each dimension of urbanicity and sexual identity to compare access to health care outcomes. We calculated unadjusted proportions and estimated adjusted odds ratios of each dimension relative to urban heterosexual people using logistic regressions. Results: Relative to urban heterosexual people, urban gay/lesbian people had 1.651 odds of using the emergency room (ER). Urban bisexual people had 1.429 odds of being uninsured, 1.575 odds of delaying prescriptions, and 1.907 odds of using the ER. Rural bisexual people experienced similar access barriers having 1.904 odds of uninsurance and 2.571 odds of using the ER. Conclusions: Our study findings demonstrated disparate access to health care across sexual orientation and rurality. The findings are consistent with literature that suggests urban and rural sexual minority people experience health care differently and demonstrate that bisexual people experience health care differently than gay/lesbian people. These findings warrant further study to examine how social identities, such as race/ethnicity, interact with sexual orientation to determine health care access. Furthermore, these findings demonstrate the need to emphasize the health care access needs of sexual minority people in both rural and urban areas to eliminate health care access disparities.

Sexual minorities and teen suicide attempts in a southeastern state with prominent exclusionary policies

This study examines differences in suicide-related behaviors between heterosexual and sexual minority youth in a southeastern state with exclusionary policies. Furthermore, it seeks to further knowledge regarding risk factors for suicide attempts among sexual minority high school students. Utilizing the 2017 Youth Risk Behavior Survey data, descriptive analysis tests, and logistic regression tests were conducted. Findings indicate that sexual minorities were three times as likely to experience suicidal thoughts and plans but four times as likely to attempt suicide. Risk factors were noted for sexual minority youth. Policy advocacy is recommended to decrease suicide-related behaviors among this population.

The historical roots and seminal research on health equity: a referenced publication year spectroscopy (RPYS) analysis

BACKGROUND

Health equity is a multidimensional concept that has been internationally considered as an essential element for health system development. However, our understanding about the root causes of health equity is limited. In this study, we investigated the historical roots and seminal works of research on health equity.

METHODS

Health equity-related publications were identified and downloaded from the Web of Science database (n = 67,739, up to 31 October 2018). Their cited references (n = 2,521,782) were analyzed through Reference Publication Year Spectroscopy (RPYS), which detected the historical roots and important works on health equity and quantified their impact in terms of referencing frequency.

RESULTS

A total of 17 pronounced peaks and 31 seminal works were identified. The first publication on health equity appeared in 1966. But the first cited reference can be traced back to 1801. Most seminal works were conducted by researchers from the US (19, 61.3%), the UK (7, 22.6%) and the Netherlands (3, 9.7%). Research on health equity experienced three important historical stages: origins (1800-1965), formative (1966-1991) and development and expansion (1991-2018). The ideology of health equity was endorsed by the international society through the World Health Organization (1946) declaration based on the foundational works of Chadwick (1842), Engels (1945), Durkheim (1897) and Du Bois (1899). The concept of health equity originated from the disciplines of public health, sociology and political economics and has been a major research area of social epidemiology since the early nineteenth century. Studies on health equity evolved from evidence gathering to the identification of cost-effective policies and governmental interventions.

CONCLUSION

The development of research on health equity is shaped by multiple disciplines, which has contributed to the emergence of a new stream of social epidemiology and political epidemiology. Past studies must be interpreted in light of their historical contexts. Further studies are needed to explore the causal pathways between the social determinants of health and health inequalities.

What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults

Background

Socio-economic and sexual orientation inequalities in cigarette smoking are well-documented; however, there is a lack of research examining the social processes driving these complex inequalities. Using an intersectional framework, the current study examines key processes contributing to inequalities in smoking between four intersectional groups by education and sexual orientation.

Methods

The sample (28,362 adults) was obtained from Wave 2 (2014–2015) of the Population Assessment of Tobacco and Health (PATH) Study. Four intersectional positions were created by education (high- and low-education) and sexual orientation (heterosexual or lesbian, gay, bisexual, or queer/questioning (LGBQ). The joint inequality, the referent socio-economic inequality, and the referent sexual orientation inequality in smoking were decomposed by demographic, material, tobacco marketing-related, and psychosocial factors using non-linear Oaxaca decomposition.

Results

Material conditions made the largest contribution to the joint inequality (9.8 percentage points (p.p.), 140.9%), referent socio-economic inequality (10.01 p.p., 128.4%), and referent sexual orientation inequality (4.91 p.p., 59.8%), driven by annual household income. Psychosocial factors made the second largest contributions to the joint inequality (2.12 p.p., 30.3%), referent socio-economic inequality (2.23 p.p., 28.9%), and referent sexual orientation inequality (1.68 p.p., 20.5%). Referent sexual orientation inequality was also explained by marital status (20.3%) and targeted tobacco marketing (11.3%).

Conclusion

The study highlights the pervasive role of material conditions in inequalities in cigarette smoking across multiple dimensions of advantage and disadvantage. This points to the importance of addressing material disadvantage to reduce combined socioeconomic and sexual orientation inequalities in cigarette smoking.

Disparities by Sexual Orientation Persist for Major Depressive Episode and Substance Abuse or Dependence: Findings from a National Probability Study of Adults in the United States

Purpose: This study updates psychiatric epidemiological research by providing recent prevalence estimates of major depression and alcohol and illicit drug abuse or dependence among sexual minority (SM) adults. Methods: Using the 2015 National Survey on Drug Use and Health, we estimated prevalence differences between SM and heterosexual adults, and within SM subgroups, with logistic regression models. Results: Bisexual adults faced an increased burden across all outcomes compared with other SM adults. Gay males had the highest prevalence of alcohol and illicit drug abuse or dependence. Conclusions: Future research must consider sex differences within SM subgroups for development of targeted interventions.

The Association between State Policy Environments and Self-Rated Health Disparities for Sexual Minorities in the United States

A large body of research has documented disparities in health and access to care for lesbian, gay, and bisexual (LGB) people in the United States. Less research has examined how the level of legal protection afforded to LGB people (the state policy environment) affects health disparities for sexual minorities. This study used data on 14,687 sexual minority adults and 490,071 heterosexual adults from the 2014⁻2016 Behavioral Risk Factor Surveillance System to document differences in health. Unadjusted state-specific prevalence estimates and multivariable logistic regression models were used to compare poor/fair self-rated health by gender, sexual minority status, and state policy environments (comprehensive versus limited protections for LGB people). We found disparities in self-rated health between sexual minority adults and heterosexual adults in most states. On average, sexual minority men in states with limited protections and sexual minority women in states with either comprehensive or limited protections were more likely to report poor/fair self-rated health compared to their heterosexual counterparts. This study adds new findings on the association between state policy environments and self-rated health for sexual minorities and suggests differences in this relationship by gender. The associations and impacts of state-specific policies affecting LGB populations may vary by gender, as well as other intersectional identities.