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Sexual Orientation Discrimination and Exclusive, Dual, and Polytobacco Use among Sexual Minority Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106305. [PMID: 35627843 PMCID: PMC9142070 DOI: 10.3390/ijerph19106305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/16/2022]
Abstract
Research on whether sexual orientation discrimination is associated with multiple tobacco product use among sexual minority (SM) adults is limited. Thus, we explored the associations between sexual orientation discrimination and exclusive, dual, and polyuse among a subset of SM adults (18+) (n = 3453) using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. We evaluated six indicators of prior-to-past-year sexual orientation discrimination separately and as a summary scale and defined past-year exclusive, dual, and polyuse based on cigarette, electronic nicotine delivery systems, other combustible (cigars and traditional pipe), and smokeless tobacco products. Using multinomial logistic regression, we estimated adjusted associations between sexual orientation discrimination and exclusive, dual, and polyuse. Experiencing discrimination in public places, being called names, and being bullied, assaulted, or threatened were associated with dual use, while experiencing discrimination when obtaining health care or insurance and when receiving health care were associated with polyuse. Each one-unit increase in the sexual orientation discrimination summary scale was associated with 5% and 10% higher odds of dual (95% CI: 1.01–1.10) and polyuse (95% CI: 1.02–1.18), respectively. To conclude, we advise health professionals to consider the salience of discrimination against SM adults and how these experiences lead to dual/polyuse.
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Lynch KE, Shipherd JC, Gatsby E, Viernes B, DuVall SL, Blosnich JR. Sexual orientation-related disparities in health conditions that elevate COVID-19 severity. Ann Epidemiol 2021; 66:5-12. [PMID: 34785397 PMCID: PMC8601164 DOI: 10.1016/j.annepidem.2021.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/18/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023]
Abstract
Purpose The Veterans Health Administration (VA) is the largest single integrated healthcare system in the US and is likely the largest healthcare provider for people with minoritized sexual orientations (e.g., gay, lesbian, bisexual). The purpose of this study was to use electronic health record (EHR) data to replicate self-reported survey findings from the general US population and assess whether sexual orientation is associated with diagnosed physical health conditions that may elevate risk of COVID-19 severity among veterans who utilize the VA. Methods A retrospective analysis of VA EHR data from January 10, 1999–January 07, 2019 analyzed in 2021. Veterans with minoritized sexual orientations were included if they had documentation of a minoritized sexual orientation within clinical notes identified via natural language processing. Veterans without minoritized sexual orientation documentation comprised the comparison group. Adjusted prevalence and prevalence ratios (aPR) were calculated overall and by race/ethnicity while accounting for differences in distributions of sex assigned at birth, age, calendar year of first VA visit, volumes of healthcare utilization, and VA priority group. Results Data from 108,401 veterans with minoritized sexual orientation and 6,511,698 controls were analyzed. After adjustment, veterans with minoritized sexual orientations had a statistically significant elevated prevalence of 10 of the 11 conditions. Amongst the highest disparities observed were COPD (aPR:1.24 [95% confidence interval:1.23–1.26]), asthma (1.22 [1.20–1.24]), and stroke (1.26 [1.24–1.28]). Conclusions Findings largely corroborated patterns among the general US population. Further research is needed to determine if these disparities translate to poorer COVID-19 outcomes for individuals with minoritized sexual orientation.
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Affiliation(s)
- Kristine E Lynch
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA.
| | - Jillian C Shipherd
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington, DC, USA; National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Elise Gatsby
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Benjamin Viernes
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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The Association of Asthma, Sexual Identity, and Inhaled Substance Use among U.S. Adolescents. Ann Am Thorac Soc 2021; 18:273-280. [PMID: 33027599 DOI: 10.1513/annalsats.202001-062oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Minority sexual identity appears to confer asthma risks. Although associations between inhaled substances and asthma are established, these have not been examined among sexual minority youths. Given sexual minority adolescents' disproportionately high rates of substance use, research is needed to fill this important gap.Objectives: Using a representative sample of adolescents from the United States, we 1) examined associations among asthma, sexual identity, and inhaled substance use and tested 2a) whether sexual identity moderates relationships between asthma and inhaled substance use and 2b) whether inhaled substance use mediates associations between sexual identity and asthma.Methods: Data are from the 2015 and 2017 Youth Risk Behavior Surveillance Survey. Adolescents (n = 30,113) reported if they were ever diagnosed with asthma, current use of cigarettes, cigars and/or cigarillos, marijuana, and electronic vapor products and if they ever used inhalants or synthetic marijuana. We used logistic regression to examine associations between asthma, sexual identity, and inhaled substance use controlling for age, race or ethnicity, and body mass index percentile, stratified by sex.Results: Lesbian, gay, and bisexual respondents had higher relative risks for asthma than heterosexual youth. Sexual minority female youths had significantly higher relative risks than heterosexual female youths for use of every inhaled substance. There were few sexual identity differences in inhaled substance use among male youths. Inhaled substance use was significantly associated with higher risks for asthma. In general, associations between each individual inhaled substance and asthma did not differ between sexual minority and heterosexual youths. However, when all inhaled substances were added into the models concurrently, inhaled substance use appeared to mediate associations with asthma among lesbian and bisexual female youths, and partially mediated these associations among sexual minority male youths.Conclusions: Sexual identity and inhaled substance use appear to play important roles in asthma risk. However, these variables do not fully explain the risk, suggesting that other unmeasured variables (e.g., stress and victimization) may be implicated in risks for both inhaled substance use and asthma. It is important that clinicians providing care to adolescents ask about sexual identity and inhaled substance use. Effective approaches to reducing inhaled substance use among adolescents, especially sexual minorities, are needed.
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Tan ASL, Hanby EP, Sanders-Jackson A, Lee S, Viswanath K, Potter J. Inequities in tobacco advertising exposure among young adult sexual, racial and ethnic minorities: examining intersectionality of sexual orientation with race and ethnicity. Tob Control 2021; 30:84-93. [PMID: 31857490 DOI: 10.1136/tobaccocontrol-2019-055313] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examined sexual orientation differences in encoded exposure to tobacco product ads and intersections with race and ethnicity. METHODS We analysed data from young adults (18-24) from the US Population Assessment of Tobacco and Health Study in 2013 and 2014 (N=9110). First, we compared encoded exposure to cigarette, electronic cigarette (e-cigarette), cigar and smokeless tobacco ads between sexual minorities (lesbian/gay, bisexual and something else) versus heterosexual young adults. We then analysed encoded ad exposure across sexual orientation, racial and ethnic subgroups. Analyses controlled for demographic and tobacco use variables. RESULTS Bisexual women had significantly higher prevalence of encoded exposure to cigarette and cigar ads compared with heterosexual women, and significantly higher prevalence of encoded e-cigarette ad exposure compared with both heterosexual and lesbian/gay women. There were no significant differences in encoded ad exposure between lesbian versus heterosexual women and between gay or bisexual men versus heterosexual men. Compared with heterosexual white counterparts, increased encoded ad exposures were reported by heterosexual black women (cigarette and cigar ads), black heterosexual men (cigar ads) and bisexual black women (cigarette and cigar ads). Compared with heterosexual non- Hispanic counterparts, increased encoded ad exposures were reported by bisexual Hispanic women (cigarette, e-cigarette and cigar ads) and heterosexual Hispanic men (cigarettes and cigar ads). CONCLUSION Sexual minority women of colour and black heterosexual women and men have increased encoded exposure to certain forms of tobacco ads. Further research is needed to address the impact of tobacco ads among multiple minority individuals based on sex, sexual orientation, race and ethnicity.
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Affiliation(s)
- Andy S L Tan
- Department of Medical Oncology, Division of Population Sciences, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elaine P Hanby
- Department of Medical Oncology, Division of Population Sciences, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ashley Sanders-Jackson
- Department of Advertising and Public Relations, College of Communication Arts and Science, Michigan State University, Lansing, Michigan, USA
| | - Stella Lee
- Department of Medical Oncology, Division of Population Sciences, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kasisomayajula Viswanath
- Department of Medical Oncology, Division of Population Sciences, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Potter
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Lahey Health, Boston, Massachusetts, USA
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Curry CW, Felt D, Beach LB, Ruprecht MM, Wang X, Phillips GL. Lifetime Asthma Prevalence and Correlates Among US Youths by Sexual Identity and Race/Ethnicity, 2009-2017. Am J Public Health 2020; 110:e1-e8. [PMID: 32437280 PMCID: PMC7287544 DOI: 10.2105/ajph.2020.305664] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2020] [Indexed: 12/28/2022]
Abstract
Objectives. To comprehensively assess asthma disparities and identify correlates in youths at the intersections of sex, sexual identity, and race/ethnicity in the United States.Methods. We obtained a diverse sample of youths (n = 307 073) from the Centers for Disease Control and Prevention's Youth Risk Behavior Survey. We pooled data across 107 jurisdiction-years (2009-2017). We calculated lifetime asthma prevalence by sexual identity, race/ethnicity, and their intersections-stratified by sex. We developed multivariable weighted logistic regression models to examine the impact of selected correlates on lifetime asthma prevalence.Results. Lesbian, gay, and bisexual youths have significant disparities in asthma prevalence compared with heterosexual peers. Moreover, across sex, higher prevalence of lifetime asthma was seen for most sexual identity and race/ethnicity subpopulations (27 of 30) when compared with White heterosexual sex-matched participants. Selected traditional risk factors (overweight, obese, and smoking) and bullying tended to attenuate odds among groups, especially those with a minority sexual identity.Conclusions. Asthma inequities at the intersection of sexual identity and race/ethnicity are substantive. Future studies should investigate the mechanisms contributing to these disparities to promote health equity among vulnerable youth populations. (Am J Public Health. Published online ahead of print May 21, 2020: e1-e8. doi:10.2105/AJPH.2020.305664).
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Affiliation(s)
- Caleb W Curry
- Caleb W. Curry, Dylan Felt, Lauren B. Beach, Megan M. Ruprecht, Xinzi Wang, and Gregory L. Phillips II are with the Department of Medical Social Sciences and the Evaluation, Data Integration, and Technical Assistance Program at Northwestern University, Chicago, IL. Caleb W. Curry is also affiliated with Case Western Reserve University, Cleveland, OH
| | - Dylan Felt
- Caleb W. Curry, Dylan Felt, Lauren B. Beach, Megan M. Ruprecht, Xinzi Wang, and Gregory L. Phillips II are with the Department of Medical Social Sciences and the Evaluation, Data Integration, and Technical Assistance Program at Northwestern University, Chicago, IL. Caleb W. Curry is also affiliated with Case Western Reserve University, Cleveland, OH
| | - Lauren B Beach
- Caleb W. Curry, Dylan Felt, Lauren B. Beach, Megan M. Ruprecht, Xinzi Wang, and Gregory L. Phillips II are with the Department of Medical Social Sciences and the Evaluation, Data Integration, and Technical Assistance Program at Northwestern University, Chicago, IL. Caleb W. Curry is also affiliated with Case Western Reserve University, Cleveland, OH
| | - Megan M Ruprecht
- Caleb W. Curry, Dylan Felt, Lauren B. Beach, Megan M. Ruprecht, Xinzi Wang, and Gregory L. Phillips II are with the Department of Medical Social Sciences and the Evaluation, Data Integration, and Technical Assistance Program at Northwestern University, Chicago, IL. Caleb W. Curry is also affiliated with Case Western Reserve University, Cleveland, OH
| | - Xinzi Wang
- Caleb W. Curry, Dylan Felt, Lauren B. Beach, Megan M. Ruprecht, Xinzi Wang, and Gregory L. Phillips II are with the Department of Medical Social Sciences and the Evaluation, Data Integration, and Technical Assistance Program at Northwestern University, Chicago, IL. Caleb W. Curry is also affiliated with Case Western Reserve University, Cleveland, OH
| | - Gregory L Phillips
- Caleb W. Curry, Dylan Felt, Lauren B. Beach, Megan M. Ruprecht, Xinzi Wang, and Gregory L. Phillips II are with the Department of Medical Social Sciences and the Evaluation, Data Integration, and Technical Assistance Program at Northwestern University, Chicago, IL. Caleb W. Curry is also affiliated with Case Western Reserve University, Cleveland, OH
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Tuthill Z, Denney JT, Gorman B. Racial disparities in health and health behaviors among gay, lesbian, bisexual and heterosexual men and women in the BRFSS-SOP. ETHNICITY & HEALTH 2020; 25:177-188. [PMID: 29226695 DOI: 10.1080/13557858.2017.1414157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Research on sexual minority health lack examinations of how sexual orientation intersects with other identities, including racial/ethnic identity, to shape health outcomes among U.S. adults. This study examines how health status and health behavior varies for gay, lesbian, and bisexual men and women who identify as non-Hispanic white, non-Hispanic black, Latino, Asian/Pacific Islander, and American Indian/Alaskan Native. By examining health and health behaviors within and across sexual minority subgroups, our study reports on race/ethnic, gender, and sexual orientation specific health risks.Methods: We respond to shortcomings in current data by utilizing aggregated data from fourteen states from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2005 and 2010 (n = 557,773). We investigated the odds of reporting poorer health, current cigarette smoking, and obesity by sexual orientation within race/ethnic and gender subgroups; all statistical analyses were performed in 2016.Results: Results suggest persistent health and behavior disadvantages for lesbian and bisexual women of all racial and ethnic identities, relative to heterosexuals. Some of the heightened odds are extreme. Asian/Pacific Islander lesbian (OR = 3.92) and bisexual (OR = 4.61) women, for example, have 4.0 times higher odds of smoking than heterosexual A/PI women. Results for men are more variable. To illustrate, the odds of obesity for White and A/PI men are indistinguishable between bisexuals and heterosexuals, and Black and American Indian/Alaskan Native bisexuals have lower odds of obesity than their heterosexual counterparts.Conclusion: These findings highlight the need for policy efforts aimed at improving health and health behaviors among lesbian and bisexual women across groups, and more targeted efforts among sexual minority men.
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Affiliation(s)
- Zelma Tuthill
- Department of Sociology, Rice University, Houston, USA
| | - Justin T Denney
- Department of Sociology, Washington State University, Pullman, USA
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McCabe SE, Hughes TL, Matthews AK, Lee JGL, West BT, Boyd CJ, Arslanian-Engoren C. Sexual Orientation Discrimination and Tobacco Use Disparities in the United States. Nicotine Tob Res 2020; 21:523-531. [PMID: 29300994 DOI: 10.1093/ntr/ntx283] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/28/2017] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Differences in tobacco/nicotine use by sexual orientation are well documented. Development of interventions requires attention to the etiology of these differences. This study examined associations among sexual orientation discrimination, cigarette smoking, any tobacco/nicotine use, and DSM-5 tobacco use disorder (TUD) in the United States. METHODS We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions based on in-person interviews with a nationally representative sample of noninstitutionalized US adults. Approximately 8.3% of the target population was estimated to have same-sex sexual attraction, 3.1% had at least one same-sex sexual partner in the past-year, and 2.8% self-identified as lesbian, gay, or bisexual. RESULTS Sexual attraction, sexual behavior, and sexual identity were significantly associated with cigarette smoking, any tobacco/nicotine use, and DSM-5 TUD. Risk of all tobacco/nicotine outcomes was most pronounced for bisexual adults across all three sexual orientation dimensions. Approximately half of sexual minorities who identified as lesbian or gay and one-fourth of those who identified as bisexual reported past-year sexual orientation discrimination. Sexual minorities who experienced high levels of past-year sexual orientation discrimination had significantly greater probability of past-year cigarette smoking, any tobacco/nicotine use, and TUD relative to sexual minorities who experienced lower levels of sexual orientation discrimination or no discrimination. CONCLUSIONS Sexual minorities, especially bisexual adults, are at heightened risk of cigarette smoking, any tobacco/nicotine use, and DSM-5 TUD across all three major sexual orientation dimensions. Tobacco prevention and cessation efforts should target bisexual adults and consider the role that sexual orientation discrimination plays in cigarette smoking and treatment of TUD. IMPLICATIONS Differences in tobacco/nicotine use by sexual orientation are well documented, but little is known about differences across all three sexual orientation dimensions (attraction, behavior, and identity) or the origins of these differences. This study is the first to show that differences in tobacco/nicotine use across the three sexual orientation dimensions for respondents who were exclusively heterosexually-oriented were minimal, but varied more substantially among sexual minority women and men across the three sexual orientation dimensions. Sexual minorities who experienced high levels of past-year sexual orientation discrimination had significantly greater probability of cigarette smoking, any tobacco/nicotine use and DSM-5 tobacco use disorder.
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Affiliation(s)
- Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY
| | | | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC
| | - Brady T West
- Institute for Social Research, Survey Research Center, University of Michigan, Ann Arbor, MI
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Cynthia Arslanian-Engoren
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, MI
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Pelts MD, Albright DL, McDaniel J, Godfrey K. Physical health characteristics of student service members and veterans by sexual orientation. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:727-732. [PMID: 30365361 DOI: 10.1080/07448481.2018.1502774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/05/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Abstract
Objective: Little is known about the health status of the diverse population of student service members and veterans (SSM/V) enrolling in higher education in great numbers. The objective of this study was to explore the differences in physical health characteristics by sexual orientation among a national sample of SSM/V. Methods: Using secondary data, a series of maximum likelihood (ML) logistic regression models were estimated to explore physical health characteristics by sexual orientation in a sample of SSM/V. Results: SSM/V that identify as lesbian or gay reported higher rates of treatment and diagnosis for some physical health matters (respiratory illness and HIV) when compared with their heterosexual counterparts. Conclusions: Our findings support the need for campus health officials and policymakers to develop services to address the physical health needs of this population that differ from their peers.
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Affiliation(s)
- Michael D Pelts
- School of Social Work, University of Arkansas at Little Rock, Little Rock, Arkansas, USA
| | - David L Albright
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Justin McDaniel
- Department of Public Health and Recreation Professions, Southern Illinois University, Carbondale, Illinois, USA
| | - Kelli Godfrey
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
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Sheffer CE, Webb Hooper M, Ostroff JS. Commentary: Educational and Clinical Training for Addressing Tobacco-Related Cancer Health Disparities. Ethn Dis 2019; 28:187-192. [PMID: 30038480 PMCID: PMC6051502 DOI: 10.18865/ed.28.3.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In the United States, tobacco use is a leading contributor to inequities in cancer health among individuals for many ethnic, racial, sexual minority, and other minority groups as well as individuals in lower socioeconomic groups and other underserved populations. Despite remarkable decreases in tobacco use prevalence rates in the United States over the past 50 years, the benefits of tobacco control efforts are not equitably distributed. Tobacco-related disparities include higher prevalence rates of smoking, lower rates of quitting, less robust responses to standard evidence-based treatments, substandard tobacco treatment delivery by health care providers, and an increased burden of tobacco-related cancers and other diseases. Among the multiple critical barriers to achieving progress in reducing tobacco treatment-related disparities, there are several educational barriers including a unidimensional or essentialist conceptualizations of the disparities; a tobacco treatment workforce unprepared to address the needs of tobacco users from underserved groups; and known research-to-practice gaps in understanding, assessing, and treating tobacco use among underserved groups. We propose the development of competency-based curricula that: 1) use intersectionality as an organizing framework for relevant knowledge; 2) teach interpersonal skills, such as expressing sociocultural respect, a lack of cultural superiority, and empathy as well as skills for developing other-oriented therapeutic relations; and 3) are grounded in the science of the evidence-based treatments for tobacco dependence. These curricula could be disseminated nationally in multiple venues and would represent significant progress toward addressing tobacco-related disparities.
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Affiliation(s)
- Christine E. Sheffer
- Department of Health Behavior; Roswell Park Cancer Institute; Buffalo, NY, Address correspondence to Christine E. Sheffer, PhD; Associate Member and Associate Professor of Oncology, Department of Health Behavior; Carlton House, Room 402; Roswell Park Cancer Institute; Buffalo, NY 14263; 716.845.1186;
| | - Monica Webb Hooper
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland, OH
| | - Jamie S. Ostroff
- Department of Psychiatry & Behavioral Sciences; Memorial Sloan Kettering Cancer Center; New York, NY
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Ramo DE, Meacham M, Thrul J, Belohlavek A, Sarkar U, Humfleet G. Exploring Identities and Preferences for Intervention Among LGBTQ+ Young Adult Smokers Through Online Focus Groups. J Adolesc Health 2019; 64:390-397. [PMID: 30509769 DOI: 10.1016/j.jadohealth.2018.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE LGBTQ+ young adults are disproportionately affected by tobacco use and associated health conditions. A culturally tailored intervention may improve smoking cessation with this priority population. We conducted focus groups to inform development of a social media intervention to help LGBTQ+ young adults quit smoking. METHODS We conducted two focus groups with LGBTQ+ young adults (N = 27) throughout the United States in a Facebook secret group online setting. An online survey characterized tobacco and other substance use. Questions posed to focus group participants addressed patterns and contexts of smoking, LGBTQ+ identity, and barriers and facilitators to participating in a culturally tailored smoking cessation intervention on social media. Focus group transcripts were coded and analyzed using directed content analysis. RESULTS Overall, young adults had mixed feelings about linking the identities of LGBTQ+ and smoking, and reflected differences in online and "real life" identities. Participants were generally receptive to a social media smoking cessation intervention with concerns about privacy in sharing their smoking status and LGBTQ+ identities with their online social networks. Gender nonconforming individuals had some unique concerns about Facebook policies. CONCLUSIONS This study highlights important considerations in tailoring a social media intervention for LGBTQ+ young adults. We identified experiences of LGBTQ+ young adults that would support tailoring to a diverse community, and suggestions for how to make smoking cessation programs more appealing to this priority population.
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Affiliation(s)
- Danielle E Ramo
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, California.
| | - Meredith Meacham
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, California
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Alina Belohlavek
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, California
| | - Urmimala Sarkar
- Department of General Internal Medicine, Center for Vulnerable Populations, University of California, San Francisco, California
| | - Gary Humfleet
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, California
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Vogel EA, Thrul J, Humfleet GL, Delucchi KL, Ramo DE. Smoking cessation intervention trial outcomes for sexual and gender minority young adults. Health Psychol 2018; 38:12-20. [PMID: 30489104 DOI: 10.1037/hea0000698] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Sexual and gender minority (SGM) individuals are more likely to smoke than are non-SGM individuals. It is unclear whether smoking cessation interventions for young adults are effective in the SGM population. The purpose of this study was to compare smoking cessation, other health risk behaviors, and intervention usability between SGM and non-SGM young adult smokers participating in a digital smoking cessation intervention trial. METHODS Young adult smokers (N = 500; 135 SGM) were assigned to a 90-day Facebook smoking cessation intervention (treatment) or referred to Smokefree.gov (control). Intervention participants were assigned to private Facebook groups tailored to their readiness to quit smoking. Participants reported their smoking status and other health risk behaviors at baseline, 3, 6, and 12 months. Usability of the intervention (i.e., perceptions of the intervention and treatment engagement) was assessed in the intervention group at 3 months. RESULTS Smoking cessation and intervention usability did not significantly differ between SGM participants and non-SGM participants. A greater proportion of SGM participants were at high risk for physical inactivity over the 12-month follow-up period (odds ratio [OR] = 1.55, p = .005). CONCLUSION SGM and non-SGM young adult smokers did not differ in their smoking cessation rates, perceptions of, or engagement in a digital intervention. Health risk behavior patterns were mostly similar; however, the disparity in physical activity between SGM and non-SGM smokers widened over time. Tailored interventions for SGM young adult smokers could increase focus on SGM experiences that can underlie multiple health risk behaviors, such as discrimination and the normativity of smoking. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Treatment Outcomes Associated with Quitting Cigarettes Among Sexual Minority Men Living with HIV: Antiretroviral Adherence, Engagement in Care, and Sustained HIV RNA Suppression. AIDS Behav 2018; 22:2868-2876. [PMID: 29680935 DOI: 10.1007/s10461-018-2116-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Cigarette smoking is particularly harmful for sexual minority men living with HIV. This study aimed to find benefits of quitting by examining relationships between smoking and sustained HIV RNA suppression, recent CD4 count, ART medication adherence, and engagement in HIV medical care. Sexual minority men (n = 346), former or current smokers, received HIV care at a community health center. Survey responses were combined with electronic health record data in adjusted regression models. Most patients were Caucasian (87%) and 148 (46%) had incomes below the poverty level and 80% had sustained HIV RNA suppression. Compared to current smokers, former smokers had increased odds of sustaining HIV RNA suppression (OR 1.89; 95% CI 1.02-3.48) of reporting > 90% adherence (OR 2.25; 95% CI 1.21-4.17), and were less likely to miss appointments (OR 0.37; 95% CI 0.17-0.82). Heavier smokers (OR 0.36; 95% CI 0.17-0.77) and patients who smoked the longest (OR 0.31; 95% CI 0.14-0.68) had reduced odds of sustaining HIV RNA suppression. Smoking assessment, treatment, and referral could augment HIV outcomes for sexual minority men with HIV.
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O'Cleirigh C, Elsesser SA, King D, Ehlinger PP, Bradford JB, Grasso C, Mayer KH. Characteristics and Correlates of Tobacco Use in a Community Sample of Sexual Minority Men and Women: Implications for Smoking Cessation Program Development. LGBT Health 2018; 5:197-202. [PMID: 29641316 DOI: 10.1089/lgbt.2016.0157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Tobacco use is the single most preventable cause of disease, death, and disability in the United States. Research suggests that sexual minorities have an increased risk for smoking and tobacco use. This study aimed to identify characteristics of patients affected by tobacco use disparities and examined demographic and substance use differences between tobacco users and nonusers in a sample of sexual minorities. METHODS Patients at an urban community health center (specializing in the needs of sexual and gender minorities) were invited to complete a cross-sectional 25-item questionnaire. RESULTS Of the 3068 questionnaire respondents, 1543 identified as gay, lesbian, or bisexual. Of these sexual minority respondents, most identified as White (84.4%), 67.3% identified as male and 32.7% as female, with a mean age of 37.7 (SD = 9.44). More than a quarter of sexual minority men (26.7%) and women (28.3%) reported current tobacco use. Among men, younger age (OR = 0.97, CI: 0.95-0.98, P < 0.001), less education (OR = 0.58, CI: 0.35-0.96, P < 0.01), heroin use (OR = 3.3, CI: 1.18-9.39, P < 0.05), and alcohol use (OR = 3.0, CI: 1.86-4.80, P < 0.001) were associated with increased odds of current tobacco use. Among women, younger age (OR = 0.97, CI: 0.95-0.99, P = 0.004), less education (OR = 0.45, CI: 0.22-0.91, P < 0.001), and alcohol use (OR = 3.78, CI: 1.87-7.65, P < 0.001) were associated with current tobacco use. CONCLUSION Cessation programs placed within the context of co-occurring substance and alcohol use for young sexual minority tobacco users from lower socioeconomic backgrounds may be particularly effective.
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Affiliation(s)
- Conall O'Cleirigh
- 1 Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School , Boston, Massachusetts.,2 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Steven A Elsesser
- 3 Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia, Pennsylvania
| | - Dana King
- 2 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | | | | | - Chris Grasso
- 2 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Kenneth H Mayer
- 2 The Fenway Institute , Fenway Health, Boston, Massachusetts
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Christensen DN, Franks ZG, McCrary HC, Saleh AA, Chang EH. A Systematic Review of the Association between Cigarette Smoke Exposure and Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2018; 158:801-816. [PMID: 29460678 DOI: 10.1177/0194599818757697] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives Cigarette smoking and passive smoke exposure have been associated with chronic rhinosinusitis (CRS). Our goal in this systematic review was to (1) determine if there was a strong correlative effect in large population studies between cigarette smoke exposure and the prevalence of CRS, (2) investigate pathogenic mechanisms of cigarette smoke in the upper airway, and (3) determine if a history of cigarette smoking affects the medical and surgical outcomes of CRS. Data Sources MEDLINE, Embase, Cochrane CENTRAL, Web of Science SCI and CPCI-S, and websites. Methods A comprehensive literature review and quantitative meta-analysis of studies based on the PRISMA protocol and examining the relationship between cigarette smoke exposure and CRS was performed. A search strategy was developed using various terms such as sinusitis, rhinitis, rhinosinusitis, and smoking. The articles were categorized by (1) epidemiology, (2) pathophysiology, and (3) outcomes. Data regarding study design, population/setting, methods, and bias were collected. Results The initial search generated 2621 titles/abstracts with 309 articles undergoing secondary review and 112 articles for final review. We determined that there is a strong correlation between active and passive cigarette smoke with the prevalence of CRS. Cigarette smoke challenge to sinonasal epithelia results in the release of inflammatory mediators and altered ciliary beat frequency. Pediatric patients exposed to secondhand smoke appear to have particularly poor outcomes. Conclusion There is clear evidence that cigarette smoke is related to CRS, but longitudinal and mechanistic studies are required to determine a causative effect. This information is critical for greater understanding of CRS health outcomes.
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Affiliation(s)
- Dallin N Christensen
- 1 Department of Otolaryngology-Head and Neck Surgery, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Zechariah G Franks
- 1 Department of Otolaryngology-Head and Neck Surgery, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Hilary C McCrary
- 1 Department of Otolaryngology-Head and Neck Surgery, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Ahlam A Saleh
- 2 The University of Arizona College of Medicine, Tucson, Arizona, USA.,3 The University of Arizona Health Sciences Library, Tucson, Arizona, USA
| | - Eugene H Chang
- 1 Department of Otolaryngology-Head and Neck Surgery, The University of Arizona College of Medicine, Tucson, Arizona, USA
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Arayasirikul S, Pomart WA, Raymond HF, Wilson EC. Unevenness in Health at the Intersection of Gender and Sexuality: Sexual Minority Disparities in Alcohol and Drug Use Among Transwomen in the San Francisco Bay Area. JOURNAL OF HOMOSEXUALITY 2018; 65:66-79. [PMID: 28332945 PMCID: PMC5683394 DOI: 10.1080/00918369.2017.1310552] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Research on the health of transwomen is largely focused on heterosexual HIV risk. Little is known about the health of sexual minority transwomen. We conducted a secondary cross-sectional analysis of data from a HIV risk and resilience study of transwomen aged 16 to 24 years in the San Francisco Bay Area (N = 259). Prevalence and demographic characteristics of sexual minority transwomen was assessed and logistic regression models were used to examine the relationship between sexual minority status and alcohol and drug use. In logistic regression models, sexual minority transwomen had greater fold odds of heavy episodic drinking and illicit prescription drug use compared to their heterosexual counterparts, controlling for race/ethnicity, age, income, nativity, hormone status, and history of feminization procedures. These results suggest that sexual minority status may be an important social determinant of health among gender minorities. Populations of transwomen are heterogeneous; effective interventions must consider sexual minority status.
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Affiliation(s)
- Sean Arayasirikul
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA 94102, United States
- Medical Sociology, Department of Social and Behavioral Sciences, University of California San Francisco, 3333 California Street Suite #455, San Francisco, CA 94118, United States
| | | | - H. Fisher Raymond
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA 94102, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street 2 Floor, San Francisco, CA 94158, United States
| | - Erin C. Wilson
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA 94102, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street 2 Floor, San Francisco, CA 94158, United States
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16
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Gibson AW, Radix AE, Maingi S, Patel S. Cancer care in lesbian, gay, bisexual, transgender and queer populations. Future Oncol 2017; 13:1333-1344. [DOI: 10.2217/fon-2017-0482] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Lesbian, gay, bisexual, transgender and queer (LGBTQ) populations experience health and healthcare disparities that may place them at higher risk for developing cancer. In addition, LGBTQ communities have psychosocial factors, such as fear of discrimination, that have substantial impacts on their medical care. As a result, these populations have specific needs with regard to cancer screening, treatment and support that must be addressed by cancer care providers. Although much has been done to address cancer care in the general population, more improvement is needed in the care of LGBTQ patients. We aim to present an overview of the current state of LGBTQ cancer care, opportunities for improvement and how cancer centers and providers can create a better future for the care of LGBTQ cancer patients.
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Affiliation(s)
- Alec W Gibson
- Medical Scientist Training Program & Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, NY, USA
| | - Shail Maingi
- Department of Medical Oncology, St Peter's Health Partners Cancer Care, Troy, NY, USA
| | - Shilpen Patel
- Department of Radiation Oncology & Department of Global Health, University of Washington, Seattle, WA, USA
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17
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Health Care Use, Health Behaviors, and Medical Conditions Among Individuals in Same-Sex and Opposite-Sex Partnerships: A Cross-Sectional Observational Analysis of the Medical Expenditures Panel Survey (MEPS), 2003-2011. Med Care 2017; 54:547-54. [PMID: 26974678 DOI: 10.1097/mlr.0000000000000529] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior research documents disparities between sexual minority and nonsexual minority individuals regarding health behaviors and health services utilization. However, little is known regarding differences in the prevalence of medical conditions. OBJECTIVES To examine associations between sexual minority status and medical conditions. RESEARCH DESIGN We conducted multiple logistic regression analyses of the Medical Expenditure Panel Survey (2003-2011). We identified individuals who reported being partnered with an individual of the same sex, and constructed a matched cohort of individuals in opposite-sex partnerships. SUBJECTS A total of 494 individuals in same-sex partnerships and 494 individuals in opposite-sex partnerships. MEASURES Measures of health risk (eg, smoking status), health services utilization (eg, physician office visits), and presence of 15 medical conditions (eg, cancer, diabetes, arthritis, HIV, alcohol disorders). RESULTS Same-sex partnered men had nearly 4 times the odds of reporting a mood disorder than did opposite-sex partnered men [adjusted odds ratio (aOR)=3.96; 95% confidence interval (CI), 1.85-8.48]. Compared with opposite-sex partnered women, same-sex partnered women had greater odds of heart disease (aOR=2.59; 95% CI, 1.19-5.62), diabetes (aOR=2.75; 95% CI, 1.10-6.90), obesity (aOR=1.92; 95% CI, 1.26-2.94), high cholesterol (aOR=1.89; 95% CI, 1.03-3.50), and asthma (aOR=1.90; 95% CI, 1.02-1.19). Even after adjusting for sociodemographics, health risk behaviors, and health conditions, individuals in same-sex partnerships had 67% increased odds of past-year emergency department utilization and 51% greater odds of ≥3 physician visits in the last year compared with opposite-sex partnered individuals. CONCLUSIONS A combination of individual-level, provider-level, and system-level approaches are needed to reduce disparities in medical conditions and health care utilization among sexual minority individuals.
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Martin DN, Lam TK, Brignole K, Ashing KT, Blot WJ, Burhansstipanov L, Chen JT, Dignan M, Gomez SL, Martinez ME, Matthews A, Palmer JR, Perez-Stable EJ, Schootman M, Vilchis H, Vu A, Srinivasan S. Recommendations for Cancer Epidemiologic Research in Understudied Populations and Implications for Future Needs. Cancer Epidemiol Biomarkers Prev 2017; 25:573-80. [PMID: 27196089 DOI: 10.1158/1055-9965.epi-15-1297] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022] Open
Abstract
Medically underserved populations in the United States continue to experience higher cancer burdens of incidence, mortality, and other cancer-related outcomes. It is imperative to understand how health inequities experienced by diverse population groups may contribute to our increasing unequal cancer burdens and disparate outcomes. The National Cancer Institute convened a diverse group of scientists to discuss research challenges and opportunities for cancer epidemiology in medically underserved and understudied populations. This report summarizes salient issues and discusses five recommendations from the group, including the next steps required to better examine and address cancer burden in the United States among our rapidly increasing diverse and understudied populations. Cancer Epidemiol Biomarkers Prev; 25(4); 573-80. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".
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Affiliation(s)
- Damali N Martin
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland.
| | - Tram Kim Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Katy Brignole
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Kimlin T Ashing
- Center for Community Alliance for Research and Education, City of Hope Cancer Center, Duarte, California
| | - William J Blot
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee. International Epidemiology Institute, Rockville, Maryland
| | - Linda Burhansstipanov
- Native American Cancer Research Corporation, Denver, Colorado. Native American Cancer Initiatives, Incorporated, Colorado
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark Dignan
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Alicia Matthews
- School of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Eliseo J Perez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Mario Schootman
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Hugo Vilchis
- Burrell College of Osteopathic Medicine/Burrell Institute for Health Policy & Research, Las Cruces, New Mexico
| | - Alexander Vu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
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The Lesbian, Gay, Bisexual, and Transgender Community and Respiratory Health. Respir Med 2017. [DOI: 10.1007/978-3-319-43447-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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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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Burkhalter JE, Margolies L, Sigurdsson HO, Walland J, Radix A, Rice D, Buchting FO, Sanchez NF, Bare MG, Boehmer U, Cahill S, Griebling TL, Bruessow D, Maingi S. The National LGBT Cancer Action Plan: A White Paper of the 2014 National Summit on Cancer in the LGBT Communities. LGBT Health 2016. [PMCID: PMC4770841 DOI: 10.1089/lgbt.2015.0118] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Despite growing social acceptance of lesbians, gay men, bisexuals, and transgender (LGBT) persons and the extension of marriage rights for same-sex couples, LGBT persons experience stigma and discrimination, including within the healthcare system. Each population within the LGBT umbrella term is likely at elevated risk for cancer due to prevalent, significant cancer risk factors, such as tobacco use and human immunodeficiency virus infection; however, cancer incidence and mortality data among LGBT persons are lacking. This absence of cancer incidence data impedes research and policy development, LGBT communities' awareness and activation, and interventions to address cancer disparities. In this context, in 2014, a 2-day National Summit on Cancer in the LGBT Communities was convened by a planning committee for the purpose of accelerating progress in identifying and addressing the LGBT communities' concerns and needs in the spheres of cancer research, clinical cancer care, healthcare policy, and advocacy for cancer survivorship and LGBT health equity. Summit participants were 56 invited persons from the United States, United Kingdom, and Canada, representatives of diverse identities, experiences, and knowledge about LGBT communities and cancer. Participants shared lessons learned and identified gaps and remedies regarding LGBT cancer concerns across the cancer care continuum from prevention to survivorship. This white paper presents background on each of the Summit themes and 16 recommendations covering the following: sexual orientation and gender identity data collection in national and state health surveys and research on LGBT communities and cancer, the clinical care of LGBT persons, and the education and training of healthcare providers.
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Affiliation(s)
- Jack E. Burkhalter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Hrafn Oli Sigurdsson
- Nursing Professional Development, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Walland
- The Office of General Counsel, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York
| | | | - Francisco O. Buchting
- Buchting Consulting, Oakland, California; Horizons Foundation, San Francisco, California
| | - Nelson F. Sanchez
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | | | - Tomas L. Griebling
- Department of Urology, School of Medicine, University of Kansas, Kansas City, Kansas
| | | | - Shail Maingi
- St. Peter's Health Partners Cancer Care, Troy, New York
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Electronic Cigarettes Among Priority Populations: Role of Smoking Cessation and Tobacco Control Policies. Am J Prev Med 2016; 50:199-209. [PMID: 26410185 PMCID: PMC4718827 DOI: 10.1016/j.amepre.2015.06.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The electronic cigarette (e-cigarette) market has evolved rapidly in recent years, with exploding growth in brands and product types; however, e-cigarette use among priority (sexual minority and low-income) populations and its relationship with smoking-cessation and tobacco control policies have yet to be fully characterized. METHODS The authors conducted a nationally representative online survey of 17,522 U.S. adults in 2013. Participants were drawn from GfK's KnowledgePanel. Logistic regression models were used to analyze relationships between e-cigarettes (awareness, ever use, current use) and cigarette smoking and cessation behaviors, tobacco control policies, and demographics. Analyses were conducted in 2014. RESULTS Approximately 15% of participants reported ever use of e-cigarettes, 5.1% reported current use, and 34.5% of ever users reported current use. E-cigarette awareness was lower among women, minorities, and those with low education. Ever and current use of e-cigarettes was higher among current cigarette smokers, young adults, and those with low SES; both ever use and current use were correlated with current cigarette smoking status, particularly when combined with quit intentions or attempts. Lesbian/gay/bisexual/transgender respondents had higher rates of ever use and current use. Ever use was lower in states with comprehensive smoking bans. No significant relationship between cigarette price and e-cigarette use was detected. CONCLUSIONS Ongoing surveillance of e-cigarette use among subpopulation groups and monitoring their use for combustible cigarette cessation are needed. Important variations in the patterns and correlates of e-cigarette awareness and use exist among priority populations. These findings have implications for future e-cigarette policy decisions.
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Pelster ADK, Fisher CM, Irwin JA, Coleman JD, McCarthy MA. Tobacco Use and Its Relationship to Social Determinants of Health in LGBT Populations of a Midwestern State. LGBT Health 2016; 2:71-6. [PMID: 26790020 DOI: 10.1089/lgbt.2014.0012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Researchers have documented that lesbian, gay, bisexual, and transgender (LGBT) people have a higher proportion of tobacco use as compared to general population smoking rates. This study examined the relationships between tobacco use and social determinants of health in a sample of self-identifying LGBT people who spend time in Nebraska. METHODS A community-based participatory research approach was used to develop an online survey to assess the physical, mental, social, and sexual health of LGBT populations who live, work, or play in Nebraska. Chi-squared and logistic regression analyses explored the use of tobacco among respondents. RESULTS Of the 770 people who completed the survey, 763 respondents completed questions about smoking status. The prevalence of current smoking among these 763 respondents was 26.47%. Some LGBT-specific social determinants of health had significant relationships to smoking status. However, after controlling for known risk factors of smoking in logistic regression models, these variables were not related to smoking status. CONCLUSIONS This study shows that there is a significant relationship between smoking and several general social determinants of health, including employment status, education, and income as well as binge drinking. Limitations include lack of adequate survey respondents to divide subgroups of LGBT individuals and inherent limitations of convenience sampling, which may not allow for an accurate representation of the situation faced by LGBT in Nebraska. In addition to this, the list of LGBT-specific determinants of health used in the survey may not be exhaustive, and there may be additional factors facing LGBT individuals. Public health professionals can use this information in designing smoking reduction campaigns for LGBT populations in Nebraska and culturally similar regions of the United States. These programs and interventions may want to consider a more holistic approach to smoking cessation grounded in the social-ecological model.
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Affiliation(s)
- Aja D Kneip Pelster
- 1 College of Public Health, University of Nebraska Medical Center , Omaha, Nebraska
| | - Christopher M Fisher
- 1 College of Public Health, University of Nebraska Medical Center , Omaha, Nebraska
| | - Jay A Irwin
- 2 College of Arts and Sciences, University of Nebraska Omaha , Omaha, Nebraska
| | - Jason D Coleman
- 3 College of Education, University of Nebraska Omaha , Omaha, Nebraska
| | - Molly A McCarthy
- 1 College of Public Health, University of Nebraska Medical Center , Omaha, Nebraska
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Rahn RN, Pruitt B, Goodson P. Utilization and limitations of the American College Health Association's National College Health Assessment instrument: A systematic review. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:214-237. [PMID: 26730993 DOI: 10.1080/07448481.2015.1117463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To analyze the literature in which researchers have utilized the National College Health Assessment (NCHA) I or the NCHA II. PARTICIPANTS AND METHODS The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument use, limitations, and data analyses. RESULTS The search resulted in 72 articles for inclusion. Researchers used the instrument to either conduct a primary investigation or utilize reference group data for secondary analysis. Researchers used many data analyses, statistical tests, techniques, and methods. Limitations of the instrument were consistently mentioned by researchers. CONCLUSIONS Results indicate limitations in the NCHA. To ensure college health professionals are gaining the best information possible regarding students on their campuses, specific improvements to the NCHA are recommended.
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Affiliation(s)
- Rhonda N Rahn
- a Department of Health and Kinesiology , Texas A&M University , College Station , Texas , USA
| | - Buster Pruitt
- a Department of Health and Kinesiology , Texas A&M University , College Station , Texas , USA
| | - Patricia Goodson
- a Department of Health and Kinesiology , Texas A&M University , College Station , Texas , USA
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Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE. Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. J Adolesc Health 2015; 57:144-9. [PMID: 25937471 PMCID: PMC4545276 DOI: 10.1016/j.jadohealth.2015.03.003] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/28/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study examined associations of gender identity and sexual orientation with self-reported eating disorder (SR-ED) diagnosis and compensatory behaviors in transgender and cisgender college students. METHODS Data came from 289,024 students from 223 U.S. universities participating in the American College Health Association-National College Health Assessment II (median age, 20 years). Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were compared among transgender students (n = 479) and cisgender sexual minority (SM) male (n = 5,977) and female (n = 9,445), unsure male (n = 1,662) and female (n = 3,395), and heterosexual male (n = 91,599) and female (n = 176,467) students using chi-square tests. Logistic regression models were used to estimate the odds of eating-related pathology outcomes after adjusting for covariates. RESULTS Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were highest among transgender students and lowest among cisgender heterosexual men. Compared to cisgender heterosexual women, transgender students had greater odds of past-year SR-ED diagnosis (odds ratio [OR], 4.62; 95% confidence interval [CI], 3.41-6.26) and past-month use of diet pills (OR, 2.05; 95% CI, 1.48-2.83) and vomiting or laxatives (OR, 2.46; 95% CI, 1.83-3.30). Although cisgender SM men and unsure men and women also had elevated rates of SR-ED diagnosis than heterosexual women, the magnitudes of these associations were lower than those for transgender individuals (ORs; 1.40-1.54). CONCLUSIONS Transgender and cisgender SM young adults have elevated rates of compensatory behavior and SR-ED diagnosis. Appropriate interventions for these populations are urgently needed.
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Affiliation(s)
| | - Julia D. Grant
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130,Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, MO 63110
| | - Melissa A. Munn-Chernoff
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130,Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, MO 63110
| | - David A. Patterson
- George Warren Brown School of Social Work, Washington University, St. Louis, MO 63130
| | - Alexis E. Duncan
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63130,Midwest Alcoholism Research Center, Washington University School of Medicine, St. Louis, MO 63110,George Warren Brown School of Social Work, Washington University, St. Louis, MO 63130
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Associations of sexual and gender minority status with health indicators, health risk factors, and social stressors in a national sample of young adults with military experience. Ann Epidemiol 2015; 25:661-7. [PMID: 26184439 DOI: 10.1016/j.annepidem.2015.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/29/2015] [Accepted: 06/03/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess the associations of self-identified lesbian, gay, bisexual, and questioning sexual orientation or transgender status (LGBTQ) and military experience with health indicators. METHODS We used data from the Fall 2012 National College Health Assessment. The survey included self-identified sociodemographic characteristics, mental (e.g., depression) and physical (e.g., human immunodeficiency virus) conditions, health risk behaviors (e.g., smoking), and social stressors (e.g., victimization). We used modified Poisson regression models, stratified by self-reported military service, to examine LGBTQ-related differences in health indicators, whereas adjusting for sociodemographic characteristics. RESULTS Of 27,176 in the sample, among the military-experienced group, LGBTQ individuals had increased adjusted risks of reporting a past-year suicide attempt (adjusted risk ratio [aRR] = 4.37; 95% confidence interval [CI] = 1.39-13.67), human immunodeficiency virus (aRR = 9.90; 95% CI = 1.04-79.67), and discrimination (aRR = 4.67; 95% CI = 2.05-10.66) than their non-LGBTQ peers. Among LGBTQ individuals, military experience was associated with a nearly four-fold increased risk of reporting a past-year suicide attempt (aRR = 3.61; 95% CI = 1.46-8.91) adjusting for age, sex, race and ethnicity, marital status, depression, and other psychiatric diagnoses. CONCLUSIONS Military experience may moderate health indicators among LGBTQ populations, and likewise, LGBTQ status likely modifies health conditions among military-experienced populations. Results suggest that agencies serving military populations should assess how and if the health needs of LGBTQ individuals are met.
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Coulter RWS, Kinsky SM, Herrick AL, Stall RD, Bauermeister JA. Evidence of Syndemics and Sexuality-Related Discrimination Among Young Sexual-Minority Women. LGBT Health 2015; 2:250-7. [PMID: 26788674 DOI: 10.1089/lgbt.2014.0063] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Syndemics, or the co-occurrence and interaction of health problems, have been examined extensively among young men who have sex with men, but their existence remain unexamined, to our knowledge, among sexual-minority (i.e., lesbian, gay, and bisexual) women. Thus, we investigated if syndemics were present among young sexual-minority women, and if sexual-orientation discrimination was an independent variable of syndemic production. METHODS A total of 467 sexual-minority women between the ages of 18 and 24 completed a cross-sectional online survey regarding their substance use, mental health, sexual behaviors, height, weight, and experiences of discrimination. We used structural equation modeling to investigate the presence of syndemics and their relationship to sexual-orientation discrimination. RESULTS Heavy episodic drinking, marijuana use, ecstasy use, hallucinogen use, depressive symptoms, multiple sexual partners, and history of sexually transmitted infections (STIs) comprised syndemics in this population (chi-square=24.989, P=.201; comparative fit index [CFI]=0.946; root mean square error of approximation [RMSEA]=0.023). Sexual-orientation discrimination is significantly and positively associated with the latent syndemic variable (unstandardized coefficient=0.095, P<.05), and this model fit the data well (chi-square=33.558, P=.059; CFI=0.914; RMSEA=0.029). The reverse causal model showed syndemics is not an independent variable of sexual-orientation discrimination (unstandardized coefficient=0.602, P>.05). CONCLUSIONS Syndemics appear to be present and associated with sexual-orientation discrimination among young sexual-minority women. Interventions aimed at reducing discrimination or increasing healthy coping may help reduce substance use, depressive symptoms, and sexual risk behaviors in this population.
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Affiliation(s)
- Robert W S Coulter
- 1 Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Suzanne M Kinsky
- 1 Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Amy L Herrick
- 1 Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Ron D Stall
- 1 Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - José A Bauermeister
- 2 Center for Sexuality & Health Disparities, School of Public Health, University of Michigan , Ann Arbor, Michigan
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Lian Q, Zuo X, Lou C, Gao E, Cheng Y. Sexual orientation and smoking history: results from a community-based sample of youth in Shanghai, China. Environ Health Prev Med 2015; 20:179-84. [PMID: 25648257 DOI: 10.1007/s12199-015-0444-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/20/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Cigarette smoking has been found to be more prevalent among adults and youths with a minority sexual orientation (lesbian, gay, bisexual, LGB) than among the general population, while less is known about smoking among LGB youth in low- and middle-income countries. The goal of the study was to examine cigarette smoking in relation to sexual orientation in a community-based sample of youth in Shanghai, China. METHODS A multi-center cross-sectional survey of 17,016 youth aged 15-24 years was conducted in rural and urban areas of Hanoi, Vietnam; Taipei, Taiwan; and Shanghai, China in 2006. In this article, analysis was restricted to the 6,299 respondents in Shanghai. Assessments included ever smoking, age at first smoking, frequency of smoking, and number of cigarettes smoked daily. Logistic regression was used to estimate the association between sexual orientation and cigarette smoking. RESULTS Nine percent (594/6,299) of eligible participants considered themselves as LGB youths; 34.2% ever smoked, 14.81% initiated smoking before age 13, 15.9% smoked in the past 30 days, and 14.1% were moderate or heavy smokers. LGB identity predicted moderate or heavy smoking (OR 2.2, 95% CI 1.3, 3.9). Male LGB youth smoked more cigarettes daily (OR 2.2, 95% CI 1.3, 3.9) whilst female LGB youth reported less any prior cigarette use (OR 0.7, 95% CI 0.5, 1.0). CONCLUSIONS Few meaningful disparities in cigarette smoking were related to sexual orientation, except male LGB youth consumed more cigarettes daily. Prevention and cessation should target this population, especially male LGB youth.
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Affiliation(s)
- Qiguo Lian
- Department of Epidemiology, School of Public Health, Fudan University, 200032, Shanghai, China
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Matthews-Ewald MR, Zullig KJ, Ward RM. Sexual orientation and disordered eating behaviors among self-identified male and female college students. Eat Behav 2014; 15:441-4. [PMID: 25064296 DOI: 10.1016/j.eatbeh.2014.05.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/23/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
This study compared the risk of a) clinically diagnosed eating disorders, and b) disordered eating behaviors, separately among three groups of United States college students, controlling for known covariates. These groups included college students self-identifying as: 1) gay/lesbian; 2) bisexual; and, 3) unsure, with self-identified heterosexuals as the reference. Data from the American College Health Association's National College Health Assessment II (2008-2009) were utilized (N=110,412). Adjusted logistic regression analyses, stratified by self-reported gender, examined the effect of self-identified sexual identity on clinical eating disorder diagnosis and disordered eating behaviors. Covariates included self-reported binge drinking (past 2 weeks), stress (last 12 months), smoking (past 30 days), depression (past 12 months), fraternity/sorority membership, college athletics participations, and race. Additional logistic regression sub-analyses examined sexual minorities only, with gay/lesbian as the referent. Gay, unsure, or bisexual men were at significantly increased odds to report both clinical eating disorders and disordered eating behaviors when compared to heterosexual men in both the unadjusted and adjusted models (p<.002). All sexual minority men and women were significantly more likely to report dieting to lose weight compared to heterosexual men and women (p<.002). Targeted disordered eating and eating disorder prevention efforts are needed for those who are sexual minorities, particularly for sexual minority men.
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Affiliation(s)
- Molly R Matthews-Ewald
- Pennington Biomedical Research Center, Louisiana State University System, Behavioral Medicine Laboratory, Baton Rouge, LA, United States.
| | - Keith J Zullig
- West Virginia University, School of Public Health, Department of Social and Behavioral Sciences, Morgantown, WV, United States
| | - Rose Marie Ward
- Miami University, College of Education, Health & Society, Department of Kinesiology & Health, Oxford, OH, United States
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Johns MM, Pingel ES, Youatt EJ, Soler JH, McClelland SI, Bauermeister JA. LGBT community, social network characteristics, and smoking behaviors in young sexual minority women. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 52:141-54. [PMID: 23783884 DOI: 10.1007/s10464-013-9584-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Smoking rates among young sexual minority women (YSMW) are disproportionately high as compared to heterosexual populations. While this disparity has commonly been attributed to the sexual minority stress process, little empirical work has explored what may protect YSMW from high rates of smoking. Using data (N = 471) from a cross-sectional study designed to investigate YSMW's (age 18-24) smoking behaviors and correlates; we explore the relationship of LGBT community connections, YSMW's social network characteristics, and stress to smoking behaviors (i.e., status, frequency, amount). Through this analysis, we find support for LGBT community connection as well as friendships with other sexual minorities as protective in relation to YSMW's smoking behaviors. We discuss the implications of our results, highlighting the need for future longitudinal research and interventions designed to bolster YSMW's connections to the LGBT community and their social networks.
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Affiliation(s)
- Michelle Marie Johns
- Center for Sexuality and Health Disparities, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Cochran SD, Bandiera FC, Mays VM. Sexual orientation-related differences in tobacco use and secondhand smoke exposure among US adults aged 20 to 59 years: 2003-2010 National Health and Nutrition Examination Surveys. Am J Public Health 2013; 103:1837-44. [PMID: 23948019 DOI: 10.2105/ajph.2013.301423] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated sexual orientation-related differences in tobacco use and secondhand smoke (SHS) exposure in a nationally representative sample of US adults. METHODS The 2003-2010 National Health and Nutrition Examination Surveys assessed 11 744 individuals aged 20 to 59 years for sexual orientation, tobacco use, and SHS exposure (cotinine levels ≥ 0.05 ng/mL in a nonsmoker). We used multivariate methods to compare tobacco use prevalence and SHS exposure among gay or lesbian (n = 180), bisexual (n = 273), homosexually experienced (n = 388), and exclusively heterosexual (n = 10 903) individuals, with adjustment for demographic confounding. RESULTS Lesbian and bisexual women evidenced higher rates of tobacco use than heterosexual women. Among nonsmokers, SHS exposure was more prevalent among lesbian and homosexually experienced women than among heterosexual women. Nonsmoking lesbians reported greater workplace exposure and bisexual women greater household exposure than heterosexual women did. Identical comparisons among men were not significant except for lower workplace exposure among nonsmoking gay men than among heterosexual men. CONCLUSIONS Nonsmoking sexual-minority women are more likely to be exposed to SHS than nonsmoking heterosexual women. Public health efforts to reduce SHS exposure in this vulnerable population are needed.
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Affiliation(s)
- Susan D Cochran
- Susan D. Cochran is with the Department of Epidemiology, the Fielding School of Public Health, the Department of Statistics, and the BRITE Center, University of California, Los Angeles. Frank C. Bandiera is with the Center for Tobacco Control Research and Education, University of California, San Francisco. Vickie M. Mays is with the Department of Health Services, the Fielding School of Public Health, the Department of Psychology, and the BRITE Center, University of California, Los Angeles
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Results from a community-based smoking cessation treatment program for LGBT smokers. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2013; 2013:984508. [PMID: 23840237 PMCID: PMC3694499 DOI: 10.1155/2013/984508] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 04/29/2013] [Accepted: 05/04/2013] [Indexed: 11/29/2022]
Abstract
Introduction. Little is known about lesbian, gay, bisexual, and transgender (LGBT) people's response to smoking cessation interventions. This descriptive study examined the benefits of a community-based, culturally tailored smoking cessation treatment program for LGBT smokers. Methods. A total of N = 198 LGBT individuals recruited from clinical practice and community outreach participated in group-based treatment. Sessions were based on the American Lung Association's “Freedom from Smoking Program” (ALA-FFS) and were tailored to LGBT smokers' needs. Seven-day smoking point prevalence abstinence served as the primary outcome. Results. Participants (M age = 40.5) were mostly White (70.4%) and male (60.5%) and had at least a college degree (58.4%). Forty-four percent scored in the moderate range on the Fagerström Test for Nicotine Dependence pretreatment, and 42.4% completed treatment (≥75% sessions). Higher educational attainment and use of nicotine replacement therapy (NRT) were associated with treatment completion. Self-reported quit rates were 32.3% at posttreatment assessment. Treatment attendance (OR = 2.45), use of NRT (OR = 4.24), and lower nicotine dependency (OR = 0.73) were positively associated with quitting smoking. Conclusions. Results suggest the benefits of offering LGBT smokers culturally tailored smoking cessation treatments. Future research could improve outcomes by encouraging treatment attendance and promoting NRT uptake.
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Abstract
Disparities in cancer burden between specific populations are widely acknowledged, including differences associated with sexual orientation. We searched PubMed for articles about cancer in men who have sex with men. Of the 410 publications that we identified, 47 reports were eligible for inclusion and review. Most addressed issues of cancer prevention, followed by diagnosis, survivorship, detection, and cancer treatment. Disparities exist mainly in the prevalence of viruses linked to cancers. Knowledge about sexual orientation and cancer is skewed towards infection-related cancers, so information about the association between sexual orientation and other cancers, and social and cultural causes for disparities in cancer, is less available. Men who have sex with men are still a largely overlooked minority group in this respect. Future research should examine the effects of sexual orientation on cancer, from prevention to survivorship.
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA.
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Lee JGL, Blosnich JR, Melvin CL. Up in smoke: vanishing evidence of tobacco disparities in the Institute of Medicine's report on sexual and gender minority health. Am J Public Health 2012; 102:2041-3. [PMID: 22994185 DOI: 10.2105/ajph.2012.300746] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Institute of Medicine (IOM) released a groundbreaking report on lesbian, gay, bisexual, and transgender (LGBT) health in 2011, finding limited evidence of tobacco disparities. We examined IOM search terms and used 2 systematic reviews to identify 71 articles on LGBT tobacco use. The IOM omitted standard tobacco-related search terms. The report also omitted references to studies on LGBT tobacco use (n = 56), some with rigorous designs. The IOM report may underestimate LGBT tobacco use compared with general population use.
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Affiliation(s)
- Joseph G L Lee
- Department of Health Behavior, The University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, NC 27599, USA.
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Corliss HL, Wadler BM, Jun HJ, Rosario M, Wypij D, Frazier AL, Austin SB. Sexual-orientation disparities in cigarette smoking in a longitudinal cohort study of adolescents. Nicotine Tob Res 2012; 15:213-22. [PMID: 22581940 DOI: 10.1093/ntr/nts114] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Youths with a minority sexual orientation (i.e., gay, lesbian, bisexual, and mostly heterosexual) are at high risk for cigarette smoking. We examined sexual-orientation disparities in smoking during adolescence and emerging adulthood and investigated the role of age at first smoking in contributing to smoking disparities. METHODS We used data from the Growing Up Today Study, a large longitudinal cohort of adolescents followed from ages 12 to 24 years (N = 13,913). Self-administered questionnaires filled out annually or biennially assessed age at first smoking, current smoking, frequency of smoking, number of cigarettes smoked daily, and nicotine dependence. Proportional hazards survival analysis and repeated measures regression estimated sexual-orientation differences in smoking. RESULTS Compared with completely heterosexuals, lesbian/gay, bisexual, and mostly heterosexual youths smoked their first cigarette at younger ages, were more likely to be current smokers, and had higher frequency of smoking. Among past-year smokers, sexual-minority females smoked more cigarettes daily and scored higher on nicotine dependence than completely heterosexual females. In some instances, gender and age modified relationships between sexual orientation and smoking, with relative risk accentuated in female sexual minorities and in sexual minorities during younger ages. Younger age of smoking onset contributed to elevated smoking in mostly heterosexuals and bisexuals, and to a lesser extent in lesbians, but not in gay males. CONCLUSIONS Sexual-orientation minorities are at greater risk for smoking during adolescence and emerging adulthood than heterosexuals. Disparities are larger in females and evident in early adolescence. Prevention and cessation efforts should target this population, preferably beginning in early adolescence.
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Affiliation(s)
- Heather L Corliss
- Division of Adolescent and Young Adult Medicine, Children's Hospital, Boston, MA 02115, USA.
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Blosnich J, Lee JGL, Horn K. A systematic review of the aetiology of tobacco disparities for sexual minorities. Tob Control 2011; 22:66-73. [PMID: 22170335 DOI: 10.1136/tobaccocontrol-2011-050181] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a systematic review of the literature examining risk factors/correlates of cigarette smoking among lesbian, gay and bisexual (ie, sexual minority) populations. METHODS Sets of terms relevant to sexual minority populations and cigarette smoking were used in a simultaneous search of 10 databases through EBSCOhost. The search was limited to the peer-reviewed literature up to January 2011, using no geographic or language limits. For inclusion, the paper was required to: (1) have been written in English, (2) have sexual minorities (defined by either attraction, behaviour, or identity) included in the study population and (3) have examined some form of magnitude of association for risk factors/correlates of any definition of cigarette smoking. A total of 386 abstracts were reviewed independently, with 26 papers meeting all inclusion criteria. Abstracts were reviewed and coded independently by authors JB and JGLL using nine codes derived from the inclusion/exclusion criteria. RESULTS Studies used various measures of sexual orientation and of smoking. Risk factors that could be considered unique to sexual minorities included internalised homophobia and reactions to disclosure of sexual orientation. Some studies also indicated common smoking risk factors experienced at higher rates among sexual minorities, including stress, depression, alcohol use and victimisation. CONCLUSIONS This review identified risks that were associated with sexual minority status and common to the general population but experienced at potentially higher rates by sexual minorities. Government and foundation funds should be directed towards research on the origins of this disparity.
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Affiliation(s)
- John Blosnich
- Department of Psychiatry, University of Rochester, 300 Crittenden Blvd. Rochester, NY 14642, USA.
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Blosnich JR, Horn K. Associations of discrimination and violence with smoking among emerging adults: differences by gender and sexual orientation. Nicotine Tob Res 2011; 13:1284-95. [PMID: 21994344 PMCID: PMC3223581 DOI: 10.1093/ntr/ntr183] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 07/18/2011] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Lesbian, gay, and bisexual (i.e., sexual minority) populations have higher smoking prevalence than their heterosexual peers, but there is a lack of empirical study into why such disparities exist. This secondary analysis of data sought to examine associations of discrimination and violence victimization with cigarette smoking within sexual orientation groups. METHODS Data from the Fall 2008 and Spring 2009 National College Health Assessments were truncated to respondents of 18-24 years of age (n = 92,470). Since heterosexuals comprised over 90% of respondents, a random 5% subsample of heterosexuals was drawn, creating a total analytic sample of 11,046. Smoking status (i.e., never-, ever-, and current smoker) was regressed on general (e.g., not sexual orientation-specific) measures of past-year victimization and discrimination. To examine within-group differences, two sets of multivariate ordered logistic regression analyses were conducted: one set of models stratified by sexual orientation and another set stratified by gender-by-sexual-orientation groups. RESULTS Sexual minorities indicated more experiences of violence victimization and discrimination when compared with their heterosexual counterparts and had nearly twice the current smoking prevalence of heterosexuals. After adjusting for age and race, lesbians/gays who were in physical fights or were physically assaulted had higher proportional odds of being current smokers when compared with their lesbian/gay counterparts who did not experience those stressors. CONCLUSIONS When possible, lesbian/gay and bisexual groups should be analyzed separately, as analyses revealed that bisexuals had a higher risk profile than lesbians/gays. Further research is needed with more nuanced measures of smoking (e.g., intensity), as well as examining if victimization may interact with smoking cessation.
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Affiliation(s)
- John R Blosnich
- Translational Tobacco Reduction Research Program, Mary Babb Randolph Cancer Center and Prevention Research Center, Department of Community Medicine, West Virginia University, PO Box 9190, Morgantown, WV 26506, USA.
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Lee JGL, Goldstein AO, Ranney LM, Crist J, McCullough A. High tobacco use among lesbian, gay, and bisexual populations in West Virginian bars and community festivals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:2758-69. [PMID: 21845157 PMCID: PMC3155328 DOI: 10.3390/ijerph8072758] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 06/13/2011] [Accepted: 06/28/2011] [Indexed: 11/16/2022]
Abstract
With no information on tobacco use for lesbian, gay, or bisexual (LGB) populations in West Virginia (WV), it is unclear if nationally-identified LGB tobacco disparities also exist in this State. To address this data gap, we conducted a community tobacco survey in bars and events associated with the WV Pride Parade and Festival. Trained community surveyors used electronic and paper survey instruments in bars (n = 6) in three WV cities and community events associated with the WV Pride Parade and Festival. We analyzed results from 386 completed surveys from self-identified LGB individuals. Tobacco use among LGB bar patrons and LGB attendees at Pride-affiliated events was elevated (45%), as was current cigarette use (41%). Users of cigars and chewing tobacco were frequently dual users of cigarettes, with 80% and 60% reporting dual use, respectively. A substantial disparity likely exists in tobacco use among LGB West Virginians. Targeted interventions addressing tobacco use among LGB West Virginians are warranted in these venues, and the addition of a demographic question on sexual orientation would improve data collection and monitoring of this disparity.
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Affiliation(s)
- Joseph G. L. Lee
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 590 Manning Drive, CB 7595, Chapel Hill, NC 27599, USA; E-Mails: (A.O.G.); (L.M.R.); (A.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-919-966-8948; Fax: +1-919-966-9435
| | - Adam O. Goldstein
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 590 Manning Drive, CB 7595, Chapel Hill, NC 27599, USA; E-Mails: (A.O.G.); (L.M.R.); (A.M.)
| | - Leah M. Ranney
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 590 Manning Drive, CB 7595, Chapel Hill, NC 27599, USA; E-Mails: (A.O.G.); (L.M.R.); (A.M.)
| | - Jeff Crist
- West Virginia Covenant House, 600 Shrewsbury Street, Charleston, WV 25301, USA; E-Mail:
| | - Anna McCullough
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill, 590 Manning Drive, CB 7595, Chapel Hill, NC 27599, USA; E-Mails: (A.O.G.); (L.M.R.); (A.M.)
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