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Rabbitte M, Enriquez M. Factors that impact assigned female sexual minority individuals health care experiences: A qualitative descriptive study. AMERICAN JOURNAL OF SEXUALITY EDUCATION 2023; 19:97-120. [PMID: 38576876 PMCID: PMC10989845 DOI: 10.1080/15546128.2023.2187502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This qualitative descriptive study identified factors that impact assigned female at birth (AFAB) cisgender and non-binary sexual minority individuals' decision to engage, or not engage, in health-seeking behaviors and receive preventative health care services. AFAB sexual minority individuals were asked to describe their health care experiences to determine modifiable factors that could improve their intention to seek care and improve their health care experiences. Purposive sampling was used to recruit AFAB sexual minority individuals between 18-30 years of age in the Chicago metropolitan area. Three main themes emerged from data acquired through individual interviews: (1) "ask the right questions"; main themes (2 lack of trust in health professionals; (3 the need for better sexual health education. An important finding was participants wanted to be asked about their sexual orientation, sexual behavior, and gender identity. Participants wanted to be able to share their sexual orientation and gender identity with health care professionals so they could receive appropriate care, accurate information, and feel comfortable sharing aspects about their life. Additionally, the results suggested that general and health sciences curricula should include content about diverse sexual and gender minority populations. Findings have important implications for health education and clinical practice.
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Arnold EM, Bridges SK, Goldbeck C, Norwood P, Swendeman D, Rotheram-Borus MJ. HPV Vaccination among Sexual and Gender Minority Youth Living with or at High-Risk for HIV. Vaccines (Basel) 2022; 10:vaccines10050815. [PMID: 35632571 PMCID: PMC9144140 DOI: 10.3390/vaccines10050815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is epidemic among young people, especially those at highest risk of acquiring HPV-related cancers. METHODS Youth aged 14-24 years old (N = 1628) were recruited from 13 clinics, community agencies, and social media sites in Los Angeles, California, and New Orleans, Louisiana, that specialized in serving sexual and gender minority youths (SGMY), especially males at risk for HIV. A cross-sectional comparison of sociodemographic and risk histories of HPV vaccinated/unvaccinated youths was conducted using both univariate and multivariate regressions. RESULTS About half (51.9%) of youth were vaccinated, with similar percentages across states and across genders. Sexual and gender minority youths (SGMY, i.e., gay, bisexual, transgender, and non-heterosexual; 68.8%) and their heterosexual peers (15%) were equally likely to be vaccinated (54%), even though their risk for HPV-related cancers is very different. Vaccinations were higher among younger youth, those not using condoms, youth with greater education, that possessed a primary health care provider, and youth diagnosed with HIV. Vaccinations were lower among youth that were out-of-home due to mental health inpatient hospitalization, drug treatment, homelessness, or incarceration. CONCLUSIONS Special programs are required to target youth experiencing multiple life stressors, especially out-of-home experiences, those with less education, and without the safety net of health insurance or a provider.
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Affiliation(s)
- Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
- Correspondence: ; Tel.: +1-214-648-8140
| | - S. Kate Bridges
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Cameron Goldbeck
- Center for HIV Identification, Prevention, and Treatment Services, University of California Los Angeles, Los Angeles, CA 90024, USA; (C.G.); (P.N.); (D.S.); (M.J.R.-B.)
| | - Peter Norwood
- Center for HIV Identification, Prevention, and Treatment Services, University of California Los Angeles, Los Angeles, CA 90024, USA; (C.G.); (P.N.); (D.S.); (M.J.R.-B.)
| | - Dallas Swendeman
- Center for HIV Identification, Prevention, and Treatment Services, University of California Los Angeles, Los Angeles, CA 90024, USA; (C.G.); (P.N.); (D.S.); (M.J.R.-B.)
| | - Mary Jane Rotheram-Borus
- Center for HIV Identification, Prevention, and Treatment Services, University of California Los Angeles, Los Angeles, CA 90024, USA; (C.G.); (P.N.); (D.S.); (M.J.R.-B.)
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Stenzel AE, Bustamante G, Sarkin CA, Harripersaud K, Jewett P, Teoh D, Vogel RI. The intersection of sexual orientation with race and ethnicity in cervical cancer screening. Cancer 2022; 128:2753-2759. [PMID: 35570647 DOI: 10.1002/cncr.34213] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cervical cancer screening is recommended for those with a cervix who are 21 to 65 years old, with specific timelines being dependent on individual risk. This study compared rates of ever undergoing Papanicolaou (Pap) testing at the intersection of self-reported sexual minority (SM) status and race/ethnicity. METHODS Data from the National Health Interview Survey (2015 and 2018) were used to examine cervical cancer screening disparities. Natal females without a history of hysterectomy who were 21 to 65 years old and had reported their sexual orientation and Pap testing history were included. Demographic and health characteristics were summarized with descriptive statistics. To adjust for differences in confounding variables between groups, propensity score-based inverse probability of treatment weighting (IPTW) was performed. IPTW-adjusted multivariable logistic regression models estimated odds of ever undergoing a Pap test by sexual orientation alone and with race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic). RESULTS SM persons (n = 877) had significantly reduced odds of ever undergoing Pap testing (odds ratio, 0.54; 95% confidence interval, 0.42-0.70) in comparison with heterosexual persons (n = 17,760). When the intersection of sexual orientation and race/ethnicity was considered, non-Hispanic White SM participants and Hispanic SM participants had reduced odds of ever undergoing Pap testing in comparison with non-Hispanic White heterosexual participants. No significant differences were observed between non-Hispanic White heterosexual participants and participants of non-Hispanic Black SM or Hispanic heterosexual identities. CONCLUSIONS SM participants were significantly less likely to have ever undergone a Pap test in comparison with heterosexual participants, with Hispanic SM participants having the lowest uptake. Future studies should further examine the roles of systemic discrimination and other key drivers of these disparities.
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Affiliation(s)
- Ashley E Stenzel
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota.,Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Gabriela Bustamante
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.,School of Public Health, Universidad San Francisco de Quito, Quito, Ecuador
| | - Courtney A Sarkin
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.,Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Katherine Harripersaud
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Patricia Jewett
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota.,Division of Hematology and Oncology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Deanna Teoh
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
| | - Rachel I Vogel
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
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Kaniuka AR, Job SA, Brooks BD, Guo Y, Bowling J. Human Papillomavirus Vaccination Initiation and Completion Among Heterosexual and Sexual Minority U.S. Adults. LGBT Health 2022; 9:177-185. [PMID: 35180364 DOI: 10.1089/lgbt.2021.0369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The current study examined the relationship between sexual orientation and human papillomavirus (HPV) vaccination status (no vaccination vs. vaccination initiation [one to two doses] or completion [three or more doses]) among a nationally representative sample of U.S. adults. Methods: Pooled Integrated Public Use Microdata Series-National Health Interview Survey data from 2013 to 2017 were used. The analysis sample (N = 35,266) reported on HPV vaccination status, sexual orientation, and demographic covariates. Multinomial logistic regression, stratified by sex, was conducted to assess the relationship between sexual orientation and HPV vaccination status. Results: Most of the sample (80.37%) had not received any HPV vaccination dose, and only ∼10% reported vaccine completion (three or more doses). After adjusting for demographic covariates, gay and bisexual males were more likely than heterosexual males to initiate (gay: adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI] = 1.67-3.62; bisexual: AOR = 2.30, 95% CI = 1.28-4.12) and complete (gay: AOR = 2.59, 95% CI = 1.45-4.65; bisexual: AOR = 3.20, 95% CI = 1.56-6.55) HPV vaccination. Bisexual females were more likely than heterosexual females to initiate (AOR = 1.99, 95% CI = 1.55-2.54) and complete (AOR = 1.45, 95% CI = 1.23-1.86) HPV vaccination. Females of another sexual orientation were less likely than heterosexual females to complete HPV vaccination (AOR = 0.49, 95% CI = 0.26-0.92). Conclusions: HPV vaccination remains low across sexual orientation groups. Sexual minority status may be a promotive factor in HPV vaccination for specific subgroups.
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Affiliation(s)
- Andrea R Kaniuka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Sarah A Job
- Department of Population Health Sciences, University of Central Florida, Orlando, Florida, USA
| | - Byron D Brooks
- Department of Psychology, Loyola University Chicago, Chicago, Illinois, USA
| | - Yuqi Guo
- School of Social Work, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, USA.,School of Data Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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Hao Z, Guo Y, Bowling J, Ledenyi M. Facilitators and Barriers of HPV Vaccine Acceptance, Initiation, and Completion among LGBTQ Community in the U.S.: A Systematic Review. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 34:291-307. [PMID: 38596525 PMCID: PMC10903696 DOI: 10.1080/19317611.2021.1989535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/22/2021] [Accepted: 09/25/2021] [Indexed: 04/11/2024]
Abstract
Objective: This study aims to identify facilitators and barriers of Human Papillomavirus (HPV) vaccine acceptance, initiation, and completion among LGBTQ (lesbian, gay, bisexual, trans, and queer) individuals. Method: A systematic review of qualitative and quantitative studies on HPV vaccine acceptance, initiation, and completion from 2006 to June 15, 2020 was performed in each database. Results: Twenty-six studies focusing on HPV vaccination among LGBTQ individuals were reviewed. Conclusions: Knowledge of HPV vaccine and healthcare providers' recommendations were identified as facilitators to receive HPV vaccinate, while high co-pay cost and concerns of the effectiveness and safety were identified as barriers.
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Affiliation(s)
- Zhichao Hao
- College of State Governance, Southwest University, Chongqing, China
| | - Yuqi Guo
- School of Social Work, University of North Carolina at Charlotte, Charlotte, NC, USA
- School of Data Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Madeleine Ledenyi
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
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Griffin M, Jaiswal J, Stults CB. Human Papillomavirus Vaccination Rates by Gender Identity and Sexual Orientation Among 18-44-Year-Olds in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3079-3092. [PMID: 33942195 DOI: 10.1007/s10508-020-01900-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 11/22/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
In the U.S., human papillomavirus (HPV) vaccination has been recommended for individuals up to age 26, although the vaccination is currently approved for all people up to the age of 45. This research sought to explore HPV vaccination disparities by age with subgroup analysis by gender identity and sexual orientation groups, as well as sociodemographic factors that may serve as barriers to or facilitators of vaccination. This study used data from the 2018 Behavioral Risk Factor Surveillance System. Only data for individuals who reported their gender identity, sexual orientation, and HPV vaccination status were included in the analytic sample (n = 7330). HPV vaccination rates for this sample were low, as only 18.2% (n = 1332) of the sample had received the HPV vaccination. These low rates of vaccination were similar across all subsamples: cisgender men (9.8%, n = 343), cisgender women (25.8%, n = 985), heterosexuals (17.5%, n = 1197), lesbian women or gay men (20.8%, n = 40), and bisexuals (30.8%, n = 95). In multivariable logistic regression models, younger participants (18-34) were more likely to report receiving the HPV vaccination across all subsamples. Further modeling indicated several common factors associated with higher odds of vaccination: living in a metropolitan area, having insurance coverage, and having at least one provider. Understanding vaccination disparities, as well as vaccination facilitators and barriers, is important to inform policy and program efforts. This is especially significant for adults between the ages of 35 and 44 who were excluded from the initial vaccination recommendations but are vulnerable due to changing cultural norms, including delayed marriage, nonmonogamous long-term relationships, and the ending of long-term partnerships.
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Affiliation(s)
- Marybec Griffin
- Rutgers University School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.
| | - Jessica Jaiswal
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA
- Department of Health Science, University of Alabama, Tuscaloosa, AL, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Christopher B Stults
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA
- Department of Psychology, Baruch College, City University of New York, New York, NY, USA
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Cervical cancer screening among sexual minority women: findings from a national survey. Cancer Causes Control 2021; 32:911-917. [PMID: 33987774 DOI: 10.1007/s10552-021-01442-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Sexual minority women (SMW; lesbian, bisexual, and other women who have sex with women) are at risk for cervical cancer but less likely than non-SMW to receive regular cervical cancer screening (Pap- and/or HPV-testing). We examined factors contributing to receipt of guideline-based cervical cancer screening among SMW. METHODS During October 2019, we conducted an online survey of self-identified SMW aged 21-45 years living in the United States (n = 435). We estimated risk differences (RD) in women's likelihood of being within current cervical cancer screening guidelines by sociodemographic and health-related characteristics. RESULTS Overall, 75% of respondents were within current screening guidelines. Adjusting for other factors, SMW were more likely to be within guidelines if they were insured (aRD 0.26, 95% CI 0.13, 0.39), had a partner (aRD 0.18, 95% CI 0.09, 0.28), and were older (aRD 0.12, 95% CI 0.04, 0.20). Overall, the most common reasons for not being screened recently were lack of insurance/cost (42%) and perceiving it was unnecessary (28%). CONCLUSION Many SMW are not being screened for cervical cancer according to guidelines. Findings can inform efforts to improve screening among this population.
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Gilbert PA, Lee AA, Pass L, Lappin L, Thompson L, Sittig KW, Baker E, Hoffman-Zinnel D. Queer in the Heartland: Cancer Risks, Screenings, and Diagnoses among Sexual and Gender Minorities in Iowa. JOURNAL OF HOMOSEXUALITY 2020:1-17. [PMID: 33074787 DOI: 10.1080/00918369.2020.1826832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Little is known about the cancer experiences of sexual and gender minority (SGM) persons in Midwestern areas. In response, a statewide survey of 567 SGM adults in Iowa, a largely rural Midwestern state, assessed cancer prevalence, screening tests, and related risk factors. Skin cancer accounted for nearly half of reported cancers. Individuals assigned female sex at birth reported high levels of lifetime mammograms and Papanicolaou (Pap) tests. In contrast, there were almost no colorectal cancer screenings reported among older (age 50+) respondents, regardless of gender identity or sexual orientation. Current tobacco use was modest overall, and cisgender women were more likely to report heavy drinking than cisgender men. Cisgender men age 40 and younger were less likely to have any human papillomavirus vaccination than cisgender women. The survey identified both strengths to leverage and deficits to address, which may inform future cancer prevention efforts in Iowa and other Midwestern states.
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Affiliation(s)
- Paul A Gilbert
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Abigail A Lee
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Lauren Pass
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | - Levi Lappin
- Iowa Cancer Consortium, Coralville, Iowa, USA
| | - Lena Thompson
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa, USA
| | | | - Elizabeth Baker
- Department of Public Health, Des Moines University, Des Moines, Iowa, USA
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Luoto S, Krams I, Rantala MJ. A Life History Approach to the Female Sexual Orientation Spectrum: Evolution, Development, Causal Mechanisms, and Health. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1273-1308. [PMID: 30229521 DOI: 10.1007/s10508-018-1261-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 05/29/2018] [Accepted: 06/14/2018] [Indexed: 05/12/2023]
Abstract
Women's capacity for sexual fluidity is at least as interesting a phenomenon from the point of view of evolutionary biology and behavioral endocrinology as exclusively homosexual orientation. Evolutionary hypotheses for female nonheterosexuality have failed to fully account for the existence of these different categories of nonheterosexual women, while also overlooking broader data on the causal mechanisms, physiology, ontogeny, and phylogeny of female nonheterosexuality. We review the evolutionary-developmental origins of various phenotypes in the female sexual orientation spectrum using the synergistic approach of Tinbergen's four questions. We also present femme-specific and butch-specific hypotheses at proximate and ultimate levels of analysis. This review article indicates that various nonheterosexual female phenotypes emerge from and contribute to hormonally mediated fast life history strategies. Life history theory provides a biobehavioral explanatory framework for nonheterosexual women's masculinized body morphology, psychological dispositions, and their elevated likelihood of experiencing violence, substance use, obesity, teenage pregnancy, and lower general health. This pattern of life outcomes can create a feedback loop of environmental unpredictability and harshness which destabilizes intrauterine hormonal conditions in mothers, leading to a greater likelihood of fast life history strategies, global health problems, and nonheterosexual preferences in female offspring. We further explore the potential of female nonheterosexuality to function as an alloparental buffer that enables masculinizing alleles to execute their characteristic fast life history strategies as they appear in the female and the male phenotype. Synthesizing life history theory with the female sexual orientation spectrum enriches existing scientific knowledge on the evolutionary-developmental mechanisms of human sex differences.
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Affiliation(s)
- Severi Luoto
- English, Drama and Writing Studies, University of Auckland, Arts 1, Building 206, Room 616, 14A Symonds St., Auckland, 1010, New Zealand.
- School of Psychology, University of Auckland, Auckland, New Zealand.
| | - Indrikis Krams
- Department of Zoology and Animal Ecology, University of Latvia, Riga, Latvia
- Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia
| | - Markus J Rantala
- Department of Biology & Turku Brain and Mind Center, University of Turku, Turku, Finland
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Abstract
Sexual minority women are more likely to delay care, less likely to have a usual place of care, and more likely to exhibit higher risk behaviors such as smoking, obesity, heavy drinking resulting in a disproportionate number of chronic conditions. It is imperative for obstetrician-gynecologists to be at the forefront of providing comprehensive health care to all women, no matter their sexual orientation. This article seeks to discuss health care disparities as well as health behaviors and outcomes in this population. In addition, it will review the appropriate recommendations for clinical care of sexual minority women for the obstetrician/gynecologist.
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Vaccination differences among U.S. adults by their self-identified sexual orientation, National Health Interview Survey, 2013-2015. PLoS One 2019; 14:e0213431. [PMID: 30845220 PMCID: PMC6405200 DOI: 10.1371/journal.pone.0213431] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 02/21/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Very few studies have explored the associations between self-identified sexual orientation and comprehensive vaccination coverage. Most of the previous studies that reported health disparities among lesbian, gay and bisexual populations were not based on a nationally representative sample of U.S. adults, limiting the generalizability of the findings. Starting in 2013, the National Health Interview Survey (NHIS) included questions to ascertain the adult’s self-identified sexual orientation that allowed national level vaccination estimation by sexual orientation. This study examined associations of self-reported vaccination coverage for selected vaccines among U.S. adults by their sexual orientation. Methods We analyzed combined data from 2013–2015 NHIS, a nationally representative probability-based health survey of the noninstitutionalized U.S. population ≥18 years. For vaccines other than influenza, weighted proportions were calculated. Influenza coverage was calculated using the Kaplan-Meier procedure. Multivariable logistic regression models were used to calculate adjusted prevalence differences for each vaccine overall and stratified by sexual orientation and to identify factors independently associated with vaccination. Results Significant differences were observed by sexual orientation for self-reported receipt of human papillomavirus (HPV), hepatitis A (HepA), hepatitis B (HepB), and influenza vaccination. Bisexual females (51.6%) had higher HPV coverage than heterosexual females (40.2%). Gay males (40.3% and 53.6%, respectively) had higher HepA and HepB coverage than heterosexual males (25.4% and 32.6%, respectively). Bisexual females (33.9% and 58.5%, respectively) had higher HepA and HepB coverage than heterosexual females (23.5% and 38.4%, respectively) and higher HepB coverage than lesbian females (45.4%). Bisexual adults (34.1%) had lower influenza coverage than gay/lesbian (48.5%) and heterosexual adults (43.8%). Except for the association of having self-identified as gay/lesbian orientation with greater likelihood of HepA, HepB, and influenza vaccination, sexual orientation was not associated with higher or lower likelihood of vaccination. Health status or other behavioral characteristics studied had no consistent relationship with vaccination among all populations. Conclusion Differences were identified in vaccination coverage among the U.S. adult population by self-reported sexual orientation. This study is the first to assess associations of sexual orientation with a comprehensive list of vaccinations. Findings from this study can serve as a baseline for monitoring changes over time. All populations could benefit from improved vaccination.
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