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Fan CA, Upham M, Beaver K, Dashtestani K, Skiby MM, Pentel KZ, Rhew IC, Kauth MR, Shipherd JC, Kaysen D, Simpson T, Lehavot K. Recruiting Sexual and Gender Minority Veterans for Health Disparities Research: Recruitment Protocol of a Web-Based Prospective Cohort Study. JMIR Res Protoc 2023; 12:e43824. [PMID: 37782536 PMCID: PMC10580138 DOI: 10.2196/43824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/12/2023] [Accepted: 08/15/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The Health for Every Veteran Study is the first Veterans Health Administration-funded, nationwide study on lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) veterans' health that relies exclusively on primary recruitment methods. This study aimed to recruit 1600 veterans with diverse sexual and gender identities to study the mental health and health risk behaviors of this population. A growing body of literature highlights the health inequities faced by LGBTQ+ veterans when compared with their heterosexual or cisgender peer groups. However, there is little to no guidance in the health disparities literature describing the recruitment of LGBTQ+ veterans. OBJECTIVE This paper provides an overview of the recruitment methodology of Health for Every Veteran Study. We describe the demographics of the enrolled cohort, challenges faced during recruitment, and considerations for recruiting LGBTQ+ veterans for health research. METHODS Recruitment for this study was conducted for 15 months, from September 2019 to December 2020, with the goal of enrolling 1600 veterans evenly split among 8 sexual orientation and gender identity subgroups: cisgender heterosexual women, cisgender lesbian women, cisgender bisexual women, cisgender heterosexual men, cisgender gay men, cisgender bisexual men, transgender women, and transgender men. Three primary recruitment methods were used: social media advertising predominantly through Facebook ads, outreach to community organizations serving veterans and LGBTQ+ individuals across the United States, and contracting with a research recruitment company, Trialfacts. RESULTS Of the 3535 participants screened, 1819 participants met the eligibility criteria, and 1062 completed the baseline survey to enroll. At baseline, 25.24% (268/1062) were recruited from Facebook ads, 40.49% (430/1062) from community outreach, and 34.27% (364/1062) from Trialfacts. Most subgroups neared the target enrollment goals, except for cisgender bisexual men, women, and transgender men. An exploratory group of nonbinary and genderqueer veterans and veterans with diverse gender identities was included in the study. CONCLUSIONS All recruitment methods contributed to significant portions of the enrolled cohort, suggesting that a multipronged approach was a critical and successful strategy in our study of LGBTQ+ veterans. We discuss the strengths and challenges of all recruitment methods, including factors impacting recruitment such as the COVID-19 pandemic, negative comments on Facebook ads, congressional budget delays, and high-volume surges of heterosexual participants from community outreach. In addition, our subgroup stratification offers important disaggregated insights into the recruitment of specific LGBTQ+ subgroups. Finally, the web-based methodology offers important perspectives not only for reaching veterans outside of the Veterans Health Administration but also for research studies taking place in the COVID-19-impacted world. Overall, this study outlines useful recruitment methodologies and lessons learned to inform future research that seeks to recruit marginalized communities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43824.
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Affiliation(s)
- Carolyn A Fan
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Michelle Upham
- Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Kristine Beaver
- Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Krista Dashtestani
- Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Malachi M Skiby
- Downtown Emergency Service Center (DESC), Seattle, WA, United States
| | - Kimberly Z Pentel
- Pacific Northwest Individual and Couple Therapy, Seattle, WA, United States
| | - Isaac C Rhew
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Michael R Kauth
- LGBTQ+ Health Program, Office of Patient Care Services, Veterans Health Administration, Washington, DC, United States
- South Central Mental Illness Research, Education and Clinical Center, Michael E DeBakey VA Medical Center, Houston, TX, United States
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Jillian C Shipherd
- LGBTQ+ Health Program, Office of Patient Care Services, Veterans Health Administration, Washington, DC, United States
- National Center for Posttraumatic Stress Disorder (PTSD), VA Boston Healthcare System, Boston, MA, United States
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
- National Center for Posttraumatic Stress Disorder (PTSD), VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Tracy Simpson
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Keren Lehavot
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
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Carey FR, Jacobson IG, Lehavot K, LeardMann CA, Kolaja CA, Stander VA, Rull RP. Military service experiences and reasons for service separation among lesbian, gay, and bisexual individuals in a large military cohort. BMC Public Health 2022; 22:39. [PMID: 34991524 PMCID: PMC8739987 DOI: 10.1186/s12889-021-12420-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The well-being of lesbian, gay, and bisexual (LGB) individuals is a topic of increasing concern within the military where significant institutional barriers, targeted aggression, and differential organizational policies such as "Don't Ask Don't Tell" have historically contributed to experiences of exclusion and discrimination. However, limited research has examined specific military and post-separation experiences among LGB service members and veterans. The goal of this study was to examine differences in military and service separation experiences by sexual orientation among a large representative sample of United States service members and veterans. METHODS Survey data from the 2016 Millennium Cohort Study follow-up questionnaire were used to assess sexual orientation and multiple outcomes of interest: military experiences (morale, feelings about the military, missed workdays) and service separation experiences (reasons for separation, post-separation employment). The associations between sexual orientation (LGB versus heterosexual) and each of these outcomes were evaluated in a series of adjusted logistic regression models, stratified by sex when interactions were observed. RESULTS Of the 99,599 participants, 3.4% identified as LGB. In adjusted models, LGB service members had significantly higher odds than heterosexual service members of feeling: unimpressed by the quality of unit leadership, unsupported by the military, and negative about the military overall. Bisexual women were more likely than heterosexual women to feel less unit camaraderie; both gay and bisexual men felt less camaraderie than heterosexual men. LGB veterans were more likely than heterosexual peers of the same sex to separate from service due to unplanned administrative reasons. Compared to heterosexual women, lesbian and bisexual women were more likely to separate from service due to dissatisfaction with promotions/pay and disability/medical reasons, while bisexual women specifically separated due to dissatisfaction with leadership and incompatibility with the military. Gay and bisexual men also reported separating due to incompatibility with the military, but only bisexual men were more likely to report separating due to disability/medical reasons compared to heterosexual men. CONCLUSIONS Less positive military- and separation-specific experiences disproportionately affected LGB service members in this study. Promoting inclusion and increasing support for LGB service members may improve satisfaction with military service and retention.
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Affiliation(s)
- Felicia R Carey
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA. .,Leidos, San Diego, CA, USA.
| | - Isabel G Jacobson
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, San Diego, CA, USA
| | - Keren Lehavot
- Health Services Research & Development (HSR&D) Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Cynthia A LeardMann
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, San Diego, CA, USA
| | - Claire A Kolaja
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.,Leidos, San Diego, CA, USA
| | - Valerie A Stander
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Rudolph P Rull
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
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Thomas KH, Shields M. Writing of Moral Injury and Mental Wellness: A Book Review of Fidelis, by Teresa Fazio. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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4
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Mankowski M, Brennan-Ing M, Seidel L, Larson B, Karpiak S. Aging gay male veterans: a community-based study on their health and psychosocial needs. SOCIAL WORK IN HEALTH CARE 2019; 58:870-884. [PMID: 31634076 DOI: 10.1080/00981389.2019.1659906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/22/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
Lesbian, gay, and bisexual persons have served in the military throughout history despite military policies that necessitated concealment of their sexual orientation. This secondary data analysis of research from a community-based study of sexual and gender minority (SGM) older adults sought to explore the unique needs of this growing "out" population and identify the future program, policy, and research goals. The sampling population for this study was drawn from a community-based study conducted initially by researchers from the ACRIA center. The SGM veterans in this pilot study were recruited from the Center on Halstead, the largest SGM community-based center in the Midwest. Twenty-six veterans' self-identified as gay men. Considering the minority stress model, data from this study identified a group of men with less social support - either formal or informal, less housing and economic security, and low service utilization. Interestingly, this group also self-reported as having a more positive mental and physical health outlook than previous research with this population. This study also identified a clear need for education, more extensive population-based mixed methods studies to help understand fully the needs of this previously "invisible" population of older military veterans.
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Affiliation(s)
- Mariann Mankowski
- Department of Social Work and Equitable Community Practice, The University of Saint Joseph , West Hartford , CT , USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, City University of New York , New York , NY , USA
| | - Liz Seidel
- Geriatrics Workforce Enhancement Program (GWEP), The Hartford Institute for Geriatric Nursing | NYU Rory Meyers College of Nursing , New York , NY , USA
| | | | - Stephen Karpiak
- ACRIA Center on HIV & Aging at GMHC,Gay Men's Health Crisis (GMHC),New York University College of Nursing , New York , NY , USA
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5
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Shipherd JC, Darling JE, Klap RS, Rose D, Yano EM. Experiences in the Veterans Health Administration and Impact on Healthcare Utilization: Comparisons Between LGBT and Non-LGBT Women Veterans. LGBT Health 2019; 5:303-311. [PMID: 29979640 DOI: 10.1089/lgbt.2017.0179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aimed to compare experiences related to healthcare of LGBT women and non-LGBT women in a sample of routine users of Veterans Health Administration (VHA) primary care services and examine the impact of those experiences on delaying or missing appointments for VHA care. METHODS Women veterans (N = 1391) who had at least three primary care visits in the previous year at 12 VHA facilities were surveyed by phone in January-March 2015 in a baseline wave of a cluster-randomized quality improvement trial. The majority identified as non-LGBT (1201; 85.6%) with 190 (14.4%) women identified as LGBT, based on items measuring sexual orientation and gender identity. RESULTS In models controlling for demographics, health status, and positive trauma screens, LGBT identity was predictive of women veterans experiencing harassment from male veterans at VHA in the past 12 months, as well as feeling unwelcome or unsafe at their VHA. Compared with non-LGBT women veterans, LGBT women veterans attributed missing needed care more often in the previous 12 months to concerns about interacting with other veterans. Participant descriptions of harassment indicated that male veterans' comments and actions were distressing and influenced LGBT women's healthcare accessing behavior. CONCLUSIONS Compared with non-LGBT women, LGBT women were more likely to report harassment and feeling unwelcome at VHA. Some LGBT women reported delaying or missing needed care, primarily due to concerns about interacting with other veterans. Additional work is necessary to help LGBT women veterans feel safe and welcome at VHA facilities and, thereby, reduce barriers to LGBT women veterans accessing needed care.
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Affiliation(s)
- Jillian C Shipherd
- 1 Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Program, Office of Patient Care Services, Veterans Health Administration , Washington, District of Columbia.,2 Women's Health Sciences Division, National Center for PTSD , VA Boston Healthcare System, Boston, Massachusetts.,3 Department of Psychiatry, Boston University School of Medicine , Boston, Massachusetts
| | - Jill E Darling
- 4 VA Health Services Research and Development Center for the Study of Healthcare Innovation , Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.,5 Dornsife Center for Economic and Social Research, University of Southern California , Los Angeles, California
| | - Ruth S Klap
- 4 VA Health Services Research and Development Center for the Study of Healthcare Innovation , Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Danielle Rose
- 4 VA Health Services Research and Development Center for the Study of Healthcare Innovation , Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M Yano
- 4 VA Health Services Research and Development Center for the Study of Healthcare Innovation , Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.,6 Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles , Los Angeles, California
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6
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Mark KM, McNamara KA, Gribble R, Rhead R, Sharp ML, Stevelink SAM, Schwartz A, Castro C, Fear NT. The health and well-being of LGBTQ serving and ex-serving personnel: a narrative review. Int Rev Psychiatry 2019; 31:75-94. [PMID: 30997848 DOI: 10.1080/09540261.2019.1575190] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The relaxation of discriminatory policies against lesbian, gay, bisexual, transgender, and queer (LGBTQ) service personnel has led to increased diversity among military populations. Given this increase, it is important to assess sexual and gender minority groups' health and well-being in the context of military service. This narrative review assessed these outcomes in LGBTQ military personnel. The electronic databases OVID Medline, PsycInfo, and Embase were searched for papers published between January 2000 and July 2018. Thirty papers were included. In line with life course model, studies aligned with four themes: (1) mental health and well-being; (2) stigma and healthcare utilization; (3) sexual trauma; and (4) physical health. These themes highlighted that LGBTQ military personnel and veterans have poorer mental health and well-being; report more stigma and barriers to mental healthcare, which reduces uptake of accessed healthcare services; experience more sexual trauma; and have poorer physical health than heterosexual military personnel and veterans. However, there are substantial gaps in the current evidence for this population. Future research should aim to address limitations of the literature, and to ensure that data on LGBTQ personnel and veterans is collected as standard.
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Affiliation(s)
- Katharine M Mark
- a King's Centre for Military Health Research , King's College London , London , UK
| | - Kathleen A McNamara
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Rachael Gribble
- a King's Centre for Military Health Research , King's College London , London , UK
| | - Rebecca Rhead
- a King's Centre for Military Health Research , King's College London , London , UK
| | - Marie-Louise Sharp
- a King's Centre for Military Health Research , King's College London , London , UK
| | - Sharon A M Stevelink
- a King's Centre for Military Health Research , King's College London , London , UK.,c Department of Psychological Medicine , King's College London , London , UK
| | - Alix Schwartz
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Carl Castro
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Nicola T Fear
- a King's Centre for Military Health Research , King's College London , London , UK.,d Academic Department of Military Mental Health , King's College London , London , UK
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7
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Lucas CL, Goldbach JT, Mamey MR, Kintzle S, Castro CA. Military Sexual Assault as a Mediator of the Association Between Posttraumatic Stress Disorder and Depression Among Lesbian, Gay, and Bisexual Veterans. J Trauma Stress 2018; 31:613-619. [PMID: 30088291 DOI: 10.1002/jts.22308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 11/07/2022]
Abstract
Lesbian, gay, and bisexual (LGB) civilians report higher rates of sexual assault, posttraumatic stress disorder (PTSD), and depression compared to their heterosexual counterparts. In this study, we compared military sexual assault (MSA), PTSD, and depression in LGB individuals and their non-LGB peers in two community samples of veterans (N = 2,583). Participants were selected for inclusion if they identified as LGB (n = 110) and were matched 1 to 3 on gender and age with non-LGB veterans (n = 330). Chi-square analyses showed significant differences for LGB veterans compared to non-LGB veterans for experiencing MSA (32.7% vs. 16.4%, respectively), p < .001; probable PTSD (41.2% vs. 29.8%, respectively), p = .039; and probable depression (47.9% vs. 36.0%, respectively), p = .039. Multivariable logistic regression analyses showed LGB veterans were 1.93 times more likely to have experienced MSA compared to non-LGB veterans, 95% CI [1.30, 2.88], p = .001. The experience of MSA significantly mediated associations with probable PTSD, odds ratio (OR) = 1.43, 95% CI [1.13, 1.80], p = .003, and probable depression, OR = 1.32, 95% CI [1.07, 1.64], p = .009. As the experience of MSA fully mediates the presence of PTSD and depression among LGB veterans, we highly recommend health providers assess for MSA among LGB veterans, especially those who meet clinical thresholds for PTSD and depression.
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Affiliation(s)
- Carrie L Lucas
- United States Air Force, Travis Air Force Base, Fairfield, California, USA
| | - Jeremy T Goldbach
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Mary Rose Mamey
- Children's Hospital Los Angeles, Division of Hospital Medicine, Los Angeles, California, USA
| | - Sara Kintzle
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA.,Center for Innovation and Research on Military Veterans & Families, Los Angeles, California, USA
| | - Carl Andrew Castro
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA.,Center for Innovation and Research on Military Veterans & Families, Los Angeles, California, USA
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8
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9
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Muirhead L, Hall P, Jones-Taylor C, Clifford GD, Felton-Williams T, Williams K. Critical questions: Advancing the health of female Veterans. J Am Assoc Nurse Pract 2017; 29:571-580. [PMID: 28731291 DOI: 10.1002/2327-6924.12490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 06/04/2017] [Indexed: 11/09/2022]
Abstract
PURPOSE Women are the fastest growing Veteran population in the United States and many receive all or part of their health care outside of the Department of Veterans Affairs (VA). The purpose of this article is to review the healthcare issues of women Veterans and discuss implications for care. DATA SOURCES Review of selected literature, VA resources and guidelines, and expert opinion. CONCLUSIONS Few providers are aware of the impact military service has on the health of women and fail to ask the all-important question, "Have you served in the military?" Recognizing women's military service can reveal important information that can answer perplexing clinical questions, aid in designing comprehensive plans of care, and enable women to receive the assistance needed to address complex physical and psychosocial issues to improve the quality of their lives. IMPLICATIONS FOR PRACTICE There are gender disparities related to physical health conditions, mental health issues, environmental exposures, and socioeconomic factors that contribute to female Veterans' vulnerabilities. Many of the health conditions, if recognized in a timely manner, can be ameliorated and shift the health trajectory of this population. Clinicians play a critical role in identifying health risk and helping female Veterans start the sometimes arduous journey toward wellness. Discovering and acknowledging women's military history is critical in ensuring quality care and appropriate decision making.
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Affiliation(s)
- Lisa Muirhead
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Priscilla Hall
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Cedrella Jones-Taylor
- Primary Care, Atlanta VA Medical Center, Emory University School of Medicine, Decatur, Georgia
| | - Gari D Clifford
- Department of Biomedical Informatics, Georgia Institute of Technology, Emory University, Atlanta, Georgia.,Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia
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Ruben MA, Shipherd JC, Topor D, AhnAllen CG, Sloan CA, Walton HM, Matza AR, Trezza GR. Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study. JOURNAL OF HOMOSEXUALITY 2017; 64:1411-1431. [PMID: 28459380 DOI: 10.1080/00918369.2017.1321386] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.
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Affiliation(s)
- Mollie A Ruben
- a Department of Humanities, Behavioral, and Social Sciences, School of Arts and Sciences , Massachusetts College of Pharmacy and Health Sciences (MCPHS) University , Boston , Massachusetts , USA
- b Section of General Internal Medicine, Boston University School of Medicine , Boston , Massachusetts , USA
- c Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System , Boston , Massachusetts , USA
| | - Jillian C Shipherd
- d Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA
- e VA Boston Healthcare System , Boston , Massachusetts , USA
- f Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Program, Veterans Health Administration , Washington , DC , USA
- g National Center for PTSD, Women's Health Sciences Division , Boston , Massachusetts , USA
| | - David Topor
- h Mental Health Service, VA Boston Healthcare System , Boston , Massachusetts , USA
- i Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - Christopher G AhnAllen
- h Mental Health Service, VA Boston Healthcare System , Boston , Massachusetts , USA
- i Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
- j Department of Psychiatry , Brigham and Women's Hospital , Boston , Massachusetts , USA
| | - Colleen A Sloan
- d Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA
- h Mental Health Service, VA Boston Healthcare System , Boston , Massachusetts , USA
| | - Heather M Walton
- h Mental Health Service, VA Boston Healthcare System , Boston , Massachusetts , USA
- i Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - Alexis R Matza
- f Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Program, Veterans Health Administration , Washington , DC , USA
- k Boston VA Research Institute, Inc. , Boston , Massachusetts , USA
| | - Glenn R Trezza
- d Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA
- h Mental Health Service, VA Boston Healthcare System , Boston , Massachusetts , USA
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11
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Soto-Salgado M, Colón-López V, Perez C, Muñoz-Masso C, Marrero E, Suárez E, Ortiz AP. Same-Sex Behavior and its Relationship with Sexual and Health-Related Practices Among a Population-Based Sample of Women in Puerto Rico: Implications for Cancer Prevention and Control. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2016; 28:296-305. [PMID: 28286595 PMCID: PMC5341788 DOI: 10.1080/19317611.2016.1223250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This secondary data analysis aimed to estimate the prevalence of same-sex behavior and sexual and health-related practices of a population-based sample (n=560) of women aged 16-64 years in Puerto Rico (PR). Data collection included interviews and biologic samples. Seven percent of the sample had had sex with other women (WSW). Age-adjusted logistic regression models indicated that WSW had higher odds of history of cancer, having ≥ 7 lifetime sexual partners, using sex toys and sharing them, and use of tobacco and illicit drugs. Future research is needed to address the health needs of WSW, including cancer-related risk factors and sexual practices.
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Affiliation(s)
- Marievelisse Soto-Salgado
- Department of Social Sciences, Graduate School of Public
Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto
Rico
- UPR/MDACC Partnership for Excellence in Cancer Research,
University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Vivian Colón-López
- Cancer Control and Population Sciences Program, University
of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Evaluation
Program, Graduate School of Public Health, University of Puerto Rico Medical
Sciences Campus, San Juan, Puerto Rico
| | - Cynthia Perez
- Department of Biostatistics and Epidemiology, Graduate
School of Public Health, University of Puerto Rico Medical Sciences Campus, San
Juan, Puerto Rico
| | - Cristina Muñoz-Masso
- Cancer Control and Population Sciences Program, University
of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Edmir Marrero
- Cancer Control and Population Sciences Program, University
of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Erick Suárez
- Department of Biostatistics and Epidemiology, Graduate
School of Public Health, University of Puerto Rico Medical Sciences Campus, San
Juan, Puerto Rico
| | - Ana P. Ortiz
- Cancer Control and Population Sciences Program, University
of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Biostatistics and Epidemiology, Graduate
School of Public Health, University of Puerto Rico Medical Sciences Campus, San
Juan, Puerto Rico
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12
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Dardis CM, Shipherd JC, Iverson KM. Intimate partner violence among women veterans by sexual orientation. Women Health 2016; 57:775-791. [PMID: 27322372 DOI: 10.1080/03630242.2016.1202884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
National estimates suggest intimate partner violence (IPV) rates are equal or higher among lesbian, bisexual, or questioning (LBQ)-identified women than heterosexual-identified women. Women veterans are a population at high risk for IPV, yet the occurrence of lifetime and past-year IPV experiences by sexual orientation have not been examined in this population. Lifetime and past-year IPV experiences and current IPV-related posttraumatic stress disorder (PTSD) symptoms were assessed with validated screening measures as part of a 2014 web-based national survey of women veterans. Among 403 respondents, 9.7% (n = 39) identified as LBQ, and 90.3% (n = 364) identified as heterosexual. When controlling for age, LBQ-identified women veterans were significantly more likely to report lifetime sexual and physical IPV and lifetime intimate partner stalking. In the past year, LBQ-identified veterans were twice as likely to endorse emotional mistreatment and physical IPV, and three times more likely to endorse sexual IPV, than were heterosexual-identified women veterans. However, sexual orientation was unrelated to IPV-related PTSD symptoms, when controlling for age, race, and number IPV forms experienced. IPV is prevalent among LBQ-identified women veterans, suggesting the need to understand the potentially unique contextual factors and health-care needs of this group.
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Affiliation(s)
- Christina M Dardis
- a National Center for PTSD , VA Boston Healthcare System , Boston , Massachusetts , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Jillian C Shipherd
- a National Center for PTSD , VA Boston Healthcare System , Boston , Massachusetts , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA.,c Lesbian, Gay, Bisexual and Transgender Program, Office of Patient Care Services , Veterans Health Administration , Washington , DC , USA
| | - Katherine M Iverson
- a National Center for PTSD , VA Boston Healthcare System , Boston , Massachusetts , USA.,b Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA
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Caska-Wallace CM, Katon JG, Lehavot K, McGinn MM, Simpson TL. Posttraumatic Stress Disorder Symptom Severity and Relationship Functioning Among Partnered Heterosexual and Lesbian Women Veterans. LGBT Health 2016; 3:186-92. [PMID: 26895547 DOI: 10.1089/lgbt.2015.0097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Few studies have examined associations of posttraumatic stress disorder (PTSD) and relationship satisfaction among women Veterans, and no research has explored these factors in lesbian women Veterans, a large subgroup that may have unique concerns. This study examined the link between PTSD and relationship satisfaction in partnered heterosexual and lesbian women Veterans and evaluated potential moderation by sexual orientation, partner support, and conflict. METHODS Women Veterans (heterosexual n = 260; lesbian n = 128) were recruited nationally to complete a cross-sectional online survey. Multiple linear regression models were used to evaluate moderation, using two- and three-way interactions. RESULTS Partner support moderated the association between PTSD symptoms and relationship satisfaction to a different degree for heterosexual and lesbian women Veterans, playing a more prominent role in this association for lesbian women. Specifically, for lesbians with low partner support, as PTSD symptoms worsened, relationship satisfaction decreased at a steeper rate than for heterosexual women with low partner support. On the other hand, for lesbians with high partner support, as PTSD symptoms worsened, relationship satisfaction decreased less sharply than for heterosexual women with high partner support. Degree of conflict was highly correlated with relationship satisfaction and also appeared to moderate these relations differently by sexual orientation. CONCLUSION These findings suggest that women Veterans with PTSD experience impairments in their romantic relationships, which vary by sexual orientation, partner support, and conflict. Partner support and conflict may be important targets in assessment and therapy for women Veterans with PTSD, and especially so for sexual minorities.
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Affiliation(s)
- Catherine M Caska-Wallace
- 1 Mental Health Service, VA Puget Sound Health Care System , Seattle, Washington
- 2 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington
| | - Jodie G Katon
- 3 Health Services Research and Development (HSR&D), VA Puget Sound Health Care System , Seattle, Washington
- 4 Department of Health Services, University of Washington , Seattle, Washington
- 5 US Department of Veterans Affairs (VA), Office of Patient Care Services , Women's Health Services, Washington, DC
| | - Keren Lehavot
- 2 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington
- 3 Health Services Research and Development (HSR&D), VA Puget Sound Health Care System , Seattle, Washington
- 4 Department of Health Services, University of Washington , Seattle, Washington
- 6 Mental Illness Research, Education, and Clinical Center (MIRECC) , VA Puget Sound Health Care System, Seattle, Washington
| | - Meghan M McGinn
- 1 Mental Health Service, VA Puget Sound Health Care System , Seattle, Washington
- 2 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington
| | - Tracy L Simpson
- 2 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington
- 6 Mental Illness Research, Education, and Clinical Center (MIRECC) , VA Puget Sound Health Care System, Seattle, Washington
- 7 Center of Excellence in Substance Abuse Treatment and Education (CESATE) , VA Puget Sound Health Care System, Seattle, Washington
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Lehavot K, Rillamas-Sun E, Weitlauf J, Kimerling R, Wallace RB, Sadler AG, Woods NF, Shipherd JC, Mattocks K, Cirillo DJ, Stefanick ML, Simpson TL. Mortality in Postmenopausal Women by Sexual Orientation and Veteran Status. THE GERONTOLOGIST 2016; 56 Suppl 1:S150-62. [PMID: 26768389 PMCID: PMC5881613 DOI: 10.1093/geront/gnv125] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/27/2015] [Indexed: 01/11/2023] Open
Abstract
PURPOSE OF THE STUDY To examine differences in all-cause and cause-specific mortality by sexual orientation and Veteran status among older women. DESIGN AND METHODS Data were from the Women's Health Initiative, with demographic characteristics, psychosocial factors, and health behaviors assessed at baseline (1993-1998) and mortality status from all available data sources through 2014. Women with baseline information on lifetime sexual behavior and Veteran status were included in the analyses (N = 137,639; 1.4% sexual minority, 2.5% Veteran). The four comparison groups included sexual minority Veterans, sexual minority non-Veterans, heterosexual Veterans, and heterosexual non-Veterans. Cox proportional hazard models were used to estimate mortality risk adjusted for demographic, psychosocial, and health variables. RESULTS Sexual minority women had greater all-cause mortality risk than heterosexual women regardless of Veteran status (hazard ratio [HR] = 1.20, 95% confidence interval [CI]: 1.07-1.36) and women Veterans had greater all-cause mortality risk than non-Veterans regardless of sexual orientation (HR = 1.14, 95% CI: 1.06-1.22), but the interaction between sexual orientation and Veteran status was not significant. Sexual minority women were also at greater risk than heterosexual women for cancer-specific mortality, with effects stronger among Veterans compared to non-Veterans (sexual minority × Veteran HR = 1.70, 95% CI: 1.01-2.85). IMPLICATIONS Postmenopausal sexual minority women in the United States, regardless of Veteran status, may be at higher risk for earlier death compared to heterosexuals. Sexual minority women Veterans may have higher risk of cancer-specific mortality compared to their heterosexual counterparts. Examining social determinants of longevity may be an important step to understanding and reducing these disparities.
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Affiliation(s)
- Keren Lehavot
- Health Services Research & Development, VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
| | - Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Washington
| | - Julie Weitlauf
- Sierra Pacific Mental Illness, Research, Education and Clinical Center and Center for Innovation to Implementation, VA Palo Alto Health Care System, California. Department of Psychiatry & Behavioral Sciences and Stanford Cancer Institute, California
| | | | | | | | | | - Jillian C Shipherd
- VA Boston Healthcare System, National Center for PTSD Women's Health Sciences, Boston University School of Medicine, Massachusetts. LGBT Program Patient Care Services, Washington DC
| | - Kristin Mattocks
- VA Central Western Massachusetts, Leeds. University of Massachusetts Medical School, Worcester
| | - Dominic J Cirillo
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, the University of Iowa Department of Epidemiology, New York
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Stanford University School of Medicine, California
| | - Tracy L Simpson
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
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Blosnich JR, Marsiglio MC, Gao S, Gordon AJ, Shipherd JC, Kauth M, Brown GR, Fine MJ. Mental Health of Transgender Veterans in US States With and Without Discrimination and Hate Crime Legal Protection. Am J Public Health 2016; 106:534-40. [PMID: 26794162 DOI: 10.2105/ajph.2015.302981] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine whether indicators of community- and state-level lesbian, gay, bisexual, and transgender equality are associated with transgender veterans' mental health. METHODS We extracted Veterans Administration data for patients who were diagnosed with gender identity disorder, had at least 1 visit in 2013, and lived in a zip code with a Municipality Equality Index score (n = 1640). We examined the associations of whether a state included transgender status in employment nondiscrimination laws and in hate crimes laws with mood disorders; alcohol, illicit drug, and tobacco use disorders; posttraumatic stress disorder; and suicidal ideation or attempt. RESULTS Nearly half (47.3%) of the sample lived in states with employment discrimination protection, and 44.8% lived in states with hate crimes protection. Employment nondiscrimination protection was associated with 26% decreased odds of mood disorders (adjusted odds ratio [AOR] = 0.74; 95% confidence interval [CI] = 0.59, 0.93) and 43% decreased odds of self-directed violence (AOR = 0.57; 95% CI = 0.34, 0.95). CONCLUSIONS Understanding lesbian, gay, bisexual, and transgender social stressors can inform treatment and care coordination for transgender populations.
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Affiliation(s)
- John R Blosnich
- At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN
| | - Mary C Marsiglio
- At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN
| | - Shasha Gao
- At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN
| | - Adam J Gordon
- At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN
| | - Jillian C Shipherd
- At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN
| | - Michael Kauth
- At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN
| | - George R Brown
- At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN
| | - Michael J Fine
- At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN
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Langer A, Meleis A, Knaul FM, Atun R, Aran M, Arreola-Ornelas H, Bhutta ZA, Binagwaho A, Bonita R, Caglia JM, Claeson M, Davies J, Donnay FA, Gausman JM, Glickman C, Kearns AD, Kendall T, Lozano R, Seboni N, Sen G, Sindhu S, Temin M, Frenk J. Women and Health: the key for sustainable development. Lancet 2015; 386:1165-210. [PMID: 26051370 DOI: 10.1016/s0140-6736(15)60497-4] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ana Langer
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Afaf Meleis
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Ruth Bonita
- University of Auckland, Auckland, New Zealand
| | - Jacquelyn M Caglia
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Jewel M Gausman
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Annie D Kearns
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Tamil Kendall
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rafael Lozano
- National Institute of Public Health, Cuernavaca, Mexico
| | - Naomi Seboni
- International Planned Parenthood Federation Governing Council, London, UK
| | - Gita Sen
- Indian Institute of Management, Bangalore, India
| | | | - Miriam Temin
- Center for Global Development, Washington, DC, USA
| | - Julio Frenk
- Harvard T H Chan School of Public Health, Boston, MA, USA
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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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18
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Mattocks KM, Sullivan JC, Bertrand C, Kinney RL, Sherman MD, Gustason C. Perceived Stigma, Discrimination, and Disclosure of Sexual Orientation Among a Sample of Lesbian Veterans Receiving Care in the Department of Veterans Affairs. LGBT Health 2015; 2:147-53. [PMID: 26790121 DOI: 10.1089/lgbt.2014.0131] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Many lesbian women experience stigma and discrimination from their healthcare providers as a result of their sexual orientation. Additionally, others avoid disclosure of their sexual orientation to their providers for fear of mistreatment. With the increasing number of lesbian, gay, bisexual, and transgender (LGBT) veterans seeking care from the Veterans Health Administration (VHA), it is important to understand lesbian veterans' experiences with stigma, discrimination, and disclosure of sexual orientation. This article examines lesbian veterans' experiences with perceived stigma and discrimination in VHA healthcare, their perspectives on disclosure of sexual orientation to VHA providers, and their recommendations for improvements in VHA healthcare to create a welcoming environment for lesbian veterans. METHODS This is a mixed methods study of twenty lesbian veterans at four VHA facilities. The women veterans participated in a one-hour interview and then completed an anonymous survey. RESULTS Ten percent of lesbian veterans had experienced mistreatment from VHA staff or providers, but nearly 50% feared that their Veterans Affairs (VA) providers would mistreat them if they knew about their sexual orientation. A majority of lesbian veterans (70%) believed that VHA providers should never ask about sexual orientation or should only ask if the veteran wanted to discuss it. A majority (80%) believed the VHA had taken steps to create a welcoming environment for LBGT veterans. CONCLUSION Though many lesbian veterans have fears of stigma and discrimination in the context of VHA care, few have experienced this. Most lesbian veterans believed the VHA was trying to create a welcoming environment for its LGBT veterans. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.
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Affiliation(s)
- Kristin M Mattocks
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
- 2 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - J Cherry Sullivan
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Christina Bertrand
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Rebecca L Kinney
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Michelle D Sherman
- 3 Department of Psychology, University of Minnesota , St. Paul, Minnesota
| | - Carolyn Gustason
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
- 4 Department of Nursing, University of Massachusetts , Amherst, Massachusetts
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20
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Affiliation(s)
- Dario M. Torre
- />Drexel University College of Medicine, Philadelphia, PA USA
| | - Darcy A. Reed
- />College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
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Bastian LA, Bosworth HB, Washington DL, Yano EM. Setting the stage: Research to inform interventions, practice and policy to improve women veterans' health and health care. J Gen Intern Med 2013; 28 Suppl 2:S491-4. [PMID: 23807053 PMCID: PMC3695276 DOI: 10.1007/s11606-013-2470-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Lori A. Bastian
- />VA Connecticut Healthcare System, University of Connecticut Health Center, 555 Willard Avenue, Newington, CT 06011 USA
| | | | - Donna L. Washington
- />VA Greater Los Angeles Healthcare System, UCLA School of Medicine, Los Angeles, CA USA
| | - Elizabeth M. Yano
- />VA Greater Los Angeles Healthcare System, UCLA School of Public Health, Los Angeles, CA USA
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