Sexual Health Care Services among Young Adult Sexual Minority Women

Past experiences and preferences for LGBTQ + sex education among LGBTQ + college students

Background: Lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) students experience more negative sexual health outcomes than their cisgender, heterosexual peers and do not have access to relevant sex education. This denial necessitates comprehensive sex education in college for LGBTQ + students. Objective: Given the rise of online learning and that LGBTQ + students are already drawn to online spaces, this research seeks to determine preferences in virtual LGBTQ + sexuality education content and delivery LGBTQ + college students. Methods: We conducted a survey with US college students who identified as LGBTQ+ (N = 91) to identify past experiences with sex education, desires for future sex education, and preferences for online learning. Results: Past sex education, resources used, consequences, preferences for LGBTQ + sexuality and online education are discussed. Conclusions: Overall, we find high comfort with online learning, heteronormative and cisnormative past sex education courses created negative physical and mental health outcomes, and desires for tailored sex education.

Factors that impact assigned female sexual minority individuals health care experiences: A qualitative descriptive study

This qualitative descriptive study identified factors that impact assigned female at birth (AFAB) cisgender and non-binary sexual minority individuals' decision to engage, or not engage, in health-seeking behaviors and receive preventative health care services. AFAB sexual minority individuals were asked to describe their health care experiences to determine modifiable factors that could improve their intention to seek care and improve their health care experiences. Purposive sampling was used to recruit AFAB sexual minority individuals between 18-30 years of age in the Chicago metropolitan area. Three main themes emerged from data acquired through individual interviews: (1) "ask the right questions"; main themes (2 lack of trust in health professionals; (3 the need for better sexual health education. An important finding was participants wanted to be asked about their sexual orientation, sexual behavior, and gender identity. Participants wanted to be able to share their sexual orientation and gender identity with health care professionals so they could receive appropriate care, accurate information, and feel comfortable sharing aspects about their life. Additionally, the results suggested that general and health sciences curricula should include content about diverse sexual and gender minority populations. Findings have important implications for health education and clinical practice.

Participation, barriers, and facilitators of cancer screening among LGBTQ+ populations: A review of the literature

The LGBTQ+ community is at higher risk of certain cancers but is less likely to participate in screening programs or engage with preventive healthcare. Despite this, the barriers and facilitators to cancer screening are not well understood in this population. We conducted a literature review of research related to LGBTQ+ participation in cancer screening, as well as barriers and facilitators to participation. Following abstract and full-text screening, 50 studies were included in the final synthesis. Compared to their heterosexual counterparts, lesbian and bisexual women were less likely to participate in cervical cancer screening and mammography, but gay and bisexual men were more likely to participate in anal and colorectal cancer screening. Transgender individuals had lower rates of screening than cisgender individuals for all cancer types. Barriers to participation were found at the individual-, provider-, and administrator-level, and good communication with a healthcare provider was the strongest facilitator. These results provide reasonable first steps toward improving participation rates for LGBTQ+ populations in cancer screening. Patient-centered approaches should draw on core guiding principles to inform the provision of care, including anticipating LGBTQ+ patients, improving knowledge about care for these patients, and confronting individually-held biases that may affect care, in order to improve care experiences and participation rates in preventive services.

HPV Testing Behaviors and Willingness to Use HPV Self-sampling at Home Among African American (AA) and Sub-Saharan African Immigrant (SAI) Women

BACKGROUND

HPV self-sampling is an emerging HPV testing method that offers reliable identification of cervical precancer and cancer. To determine the feasibility of HPV self-sampling in the USA, information is needed regarding women's use of HPV test and willingness to use self-sampling, especially among disparate groups such as African American (AA) and sub-Saharan African immigrant (SAI) women. The purpose of this study was to examine factors associated with having had at least one HPV test and willingness to use HPV self-sampling among AA and SAI women.

METHODS

AA and SAI women (n = 91) recruited from community settings completed a survey in a cross-sectional study. Data included sociodemographics, HPV and HPV testing knowledge, and willingness to use a HPV self-sampling test at home. Logistic regressions were performed to evaluate associations with having had a HPV test and willingness to use self-sampling.

RESULTS

Respondents mean age was 38.2 years (SD = 12.6) and 65% were SAIs. The majority (84%) reported having had at least one Pap test and (36%) had at least one HPV test. Sixty-seven percent were willing to self-sample at home. Age, education, and HPV testing knowledge were associated with having had a HPV test. Being uninsured and likelihood to accept a Pap test if recommended were associated with willingness to use self-sampling at home for an HPV test.

CONCLUSIONS

Health care providers have an important role in recommending cervical cancer screening according to current guidelines. HPV self-sampling may be a promising strategy to reach older, less educated, uninsured, and underinsured Black women.

Human Papillomavirus Infection: Knowledge, Risk Perceptions and Behaviors among SMW and AFAB

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) in the United States, and persistent HPV infection has been established as playing a major role in the development of cervical cancer. Providing HPV vaccination and regular screening tests have reduced the risk of developing cervical cancer or helped to detect the cancer at an early stage. Despite the above measures, cervical cancer still remains a major public health problem worldwide. Infection with HPV, and consequently cervical cancer, affects all people with an intact cervix, so not only heterosexual women, but also women from sexual minorities (SMW) together with people assigned female at birth (AFAB). These populations may be even more likely to develop cervical cancer, mainly because they are less likely to be aware of HPV transmission and prevention of cervical cancer. In our review, we summarized the current state of HPV knowledge, collected data assessing the orientation of this issue among SMW and AFAB, and indicated the causes of possible negligence in the prevention of cervical cancer.

Building Families Through Healthcare: Experiences of Lesbians Using Reproductive Services

The use of assisted human reproduction (AHR) represents a meaningful and important life event for lesbians wishing to create biologically related families. Despite increasing numbers of lesbians utilizing AHR services, barriers to access persist. This qualitative study investigated the experiences of lesbians and their interactions with reproductive services in Ontario, Canada, where limited public funding is available for all AHR patients and where the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community makes up to 30% of clientele. Eleven semi-structured interviews were conducted, and findings revealed a wide range of experiences. Lesbian patients expressed a desire for more support from their care providers in navigating a complex and costly medical journey through a system largely designed for the needs of heterosexual patients. Additionally, private fertility clinics, as the environment for accessing publicly funded services, were felt to contribute pressure to pay out-of-pocket for add-on medical procedures. To improve the quality of care, participants recommended providing more high-level information on the medical journey and taking an individual approach with lesbian patients, in particular, assuming a patient has sufficient fertility until proven otherwise.

Disclosure of male attraction to primary care clinicians by adolescent sexual minority males

INTRODUCTION

Adolescent sexual minority males (ASMM) experience higher rates of HIV and other sexually transmitted infections (STIs) relative to their heterosexual peers. Primary care clinicians (PCCs) are well positioned to discuss sexual health and STI prevention with adolescent males; however, ASMM report they are rarely asked about their sexual health, especially with respect to attraction and identity. This study sought to determine variables associated with disclosure of male attraction ("being out") to a PCC.

METHODS

ASMM (N=206; 14 to 17 years in the United States) completed an online sexual health survey in 2017. We assessed socio-demographics, sexuality, being out to a guardian, and being out to a PCC, and calculated proportions and associations among the variables using univariable (Fisher exact) and multivariable (Firth logistic regression) analyses.

RESULTS

Only 20% (n=41) of ASMM were out to their PCC even though 53% (n=109) were out to a parent or guardian. ASMM who were out to a parent or guardian were seven times more likely to be out to their PCC (adjusted odds ratio = 6.69, 95% confidential interval 2.69 to 16.60). No other variables were associated with being out to a PCC.

CONCLUSIONS

Among ASMM, the only predictor of outness to a PCC in this study was outness to a parent or guardian, yet only half were out to a parent or guardian.

POLICY IMPLICATIONS

PCCs should proactively and routinely inquire about sexual health and screen adolescent males for same sex attraction and sexual minority identity in order to provide optimal health care.

Correlates of sexual minority women's sexual behavior

Sexual minority women (SMW) experience sociocultural barriers to healthcare access and utilization. A common misconception is that SMW are at lower risk for sexually transmitted infections (STIs). Such stereotypes, coupled with prioritization of reproductive health care for heterosexual women and STI prevention for men, contribute to fewer STI testing and appropriate reproductive examinations for SMW. Thus, this study examined SMW's current sexual behaviors, protective mechanisms, and STI history. Data was collected 2018 and 2019 during a weekend festival. Utilizing the cross-sectional design, 90 surveys were completed. The findings indicated that 70% of respondents were not utilizing protective mechanisms for same-sex behaviors; 13% had never been tested for an STI; and of those tested, 1 in 4 were diagnosed with an STI in their lifetime. Participants that engaged in bisexual behaviors were more likely to engage in genital-to-genital repetitive contact (p < .05). SMW with higher education were more likely to be screened for STIs (p < .01). This study highlights the variation of sexual and testing behaviors that SMW exhibit. Safer sex information and STI testing aimed at SMW should be led by healthcare providers. Thus, a national training curriculum geared toward healthcare providers to promote culturally appropriate care is suggested.

Human Papillomavirus Vaccination Among Transgender and Gender Diverse People in the United States: An Integrative Review

Objective

This integrative review explores the barriers to and facilitators for human papillomavirus (HPV) vaccination among adult transgender and gender diverse (TGD) people in the United States.

Data Source

A systematic search of electronic databases included PubMed/MEDLINE, CINAHL, and EMBASE from 1985 to 2020.

Inclusion and Exclusion Criteria

Inclusion criteria included studies from the United States that described HPV vaccination barriers or facilitators and included adult TGD participants, both quantitative and qualitative studies. Exclusion criteria were studies that reported only HPV vaccine prevalence, non-English/non-U.S. studies, and studies limited to pediatric populations.

Data Extraction

Two investigators used Covidence software to screen studies and manage data extraction. Quality of the quantitative studies was appraised using a checklist proposed by the Joanna Briggs Institute (JBI); qualitative studies were appraised using quality criteria informed by the literature.

Data Synthesis

The Social Ecological Model guided the review to organize barriers to and facilitators for HPV vaccination at the patient-, provider-, and system-levels.

Results

Database searches and hand-searching yielded 843 citations. After screening, eight articles were retained in the review. Seven were cross-sectional studies and one was a qualitative focus-group. All retained quantitative studies met six of the eight JBI quality checklist items.

Conclusion

The low proportion of TGD participants in the retained studies highlights a gap in knowledge about HPV vaccination among this population. Future studies of HPV vaccination should recruit TGD people to better represent their perspectives.

Dyadic Intervention for Sexually Transmitted Infection Prevention in Urban Adolescents and Young Adults (The SEXPERIENCE Study): Protocol for a Randomized Controlled Trial (Preprint)

Background

Adolescents and young adults (AYA) aged younger than 25 years have the highest rates of sexually transmitted infections (STIs) in the United States. Current STI prevention strategies for AYA rely primarily on individual approaches, leaving sexual partners with significant unmet sexual and reproductive health care and health education needs. Dyadic interventions may hold promise for harnessing the power of communal coping within relationship dynamics to enhance sexual decision making, communication, and behavior changes that reduce the future risk of STIs.

Objective

This paper describes the protocol and research methods of a dyad-based behavioral intervention that augments individual evidence-based interventions with joint health education counseling for heterosexual AYA dyads within a primary care setting. The trial aims to improve partner communication and collaborative sexual decision making and promote the adoption of sexual behaviors such as consistent condom use. The primary objective of this study is to assess the feasibility, acceptability, and effectiveness of a dyadic intervention targeted at preventing STIs in heterosexual couples in an urban setting.

Methods

A total of 100 AYA (50 dyads) aged 16 to 25 years, engaged in heterosexual intercourse, who reside in the city and are willing to recruit their main sexual partner for the study will be recruited and randomized into 2 groups, an intervention arm and a control arm. Participants will be recruited from an AYA medicine clinic and by using social media (Facebook and Instagram). The index participant and partner will complete a single individual session separately (Sister to Sister or Focus on the Future) with a gender-matched health educator. Dyads will then be randomized to receive an additional joint debriefing session together to discuss relationship dynamics, condom negotiation, etc. Participants will separately complete a telephone interview 6 weeks postintervention to determine the feasibility, acceptability, and impact of the intervention on mutual sexual negotiation, consistency of condom use, and communal coping skills, etc.

Results

So far, 25.4% (44/173) of eligible participants have been enrolled and randomized. Participants are mostly female (20/22, 91%), with at least a high school diploma (19/22, 86%), and 9 average lifetime sexual partners. Acceptability is high, with 98% (43/44) of participants expressing satisfaction with their study experience; 100% of dyads recruited were still together at 6-week follow-up.

Conclusions

Findings from this study will add to the current literature on the approaches to STI prevention, and its success will inform its application in risk reduction counseling for youth who are most at risk.

Trial Registration

Clinical Trials.gov NCT03275168; https://www.clinicaltrials.gov/ct2/history/NCT03275168

International Registered Report Identifier (IRRID)

DERR1-10.2196/29389

Improving Research, Policy, and Practice to Address Women's Sexual and Reproductive Health Care Needs During Emerging Adulthood

Women in the period of emerging adulthood (18-25 years of age) have the greatest rates of unintended pregnancy and sexually transmitted infections. Despite this disproportionate risk, women's sexual and reproductive health needs during emerging adulthood are poorly understood. As a result, few age-specific policies or person-centered practice guidelines are available to reduce sexual risk. In this commentary we explore the unique characteristics of emerging adulthood that contribute to greater sexual and reproductive health risks for women. Current evidence on sexual and reproductive health outcomes of women during emerging adulthood and limited practice guidelines are discussed. Recommendations for health care providers, especially nurses, for guiding personalized care for women in emerging adulthood are discussed.

Cervical Cancer Screening and Human Papillomavirus Vaccination among Korean Sexual Minority Women by Sex of Their Sexual Partners

Cervical cancer-preventive behaviors in Korean sexual minority women (SMW) are underexplored. We aimed to assess the differences in cervical cancer screening uptake and completion of human papillomavirus (HPV) vaccination among Korean SMW by sex of their sexual partners. This cross-sectional study used data from the 2017 Korean Sexual Minority Women's Health Study; we included Korean lesbian and bisexual women aged ≥20 years. They were divided into three groups: SMW with more than one male sexual partner (male only/both), SMW with only female sexual partners (female-only), or no sexual partner (no partner). Among the 671 participants, 266 (39.6%), 294 (43.8%), and 111 (16.5%) belonged to the male-only/both, female-only, and no partner groups, respectively. Compared to the male-only/both group, the female-only group was significantly less likely to have undergone cervical cancer screening (Adjusted odds ratio (AOR) = 0.24, 95% confidence interval (CI) = 0.15-0.37) and to have completed HPV vaccinations (AOR = 0.58, 95% CI = 0.37-0.91). In conclusion, Korean SMW with only female sexual partners had lower cervical cancer screening and HPV vaccination completion rates than SMW who had male sexual partners. More extensive efforts are needed to improve cervical cancer-preventive behaviors among Korean SMW.

Sexual Identity and Racial/Ethnic Differences in Awareness of Heart Attack and Stroke Symptoms: Findings From the National Health Interview Survey

PURPOSE

Investigate sexual identity and racial/ethnic differences in awareness of heart attack and stroke symptoms.

DESIGN

Cross-sectional.

SETTING

2014 and 2017 National Health Interview Survey.

SAMPLE

54 326 participants.

MEASURES

Exposure measures were sexual identity (heterosexual, gay/lesbian, bisexual, "something else") and race/ethnicity. Awareness of heart attack and stroke symptoms was assessed.

ANALYSIS

Sex-stratified logistic regression analyses to examine sexual identity and racial/ethnic differences in awareness of heart attack and stroke symptoms.

RESULTS

Gay men were more likely than heterosexual men to identify calling 911 as the correct action if someone is having a heart attack (adjusted odds ratio [AOR] = 2.16, 95% CI: 1.18-3.96). The majority of racial/ethnic minority heterosexuals reported lower rates of awareness of heart attack and stroke symptoms than White heterosexuals. Hispanic sexual minority women had lower awareness of heart attack symptoms than White heterosexual women (AOR = 0.43, 95% CI: 0.25-0.74), whereas Asian sexual minority women reported lower awareness of stroke symptoms (AOR = 0.25, 95% CI: 0.08-0.80). Hispanic (AOR = 0.52, 95% CI: 0.33-0.84) and Asian (AOR = 0.35, 95% CI: 0.14-0.84) sexual minority men reported lower awareness of stroke symptoms than White heterosexual men.

CONCLUSION

Hispanic and Asian sexual minorities had lower rates of awareness of heart attack and stroke symptoms. Health information technology may be a platform for delivering health education and targeted health promotion for sexual minorities of color.

Sexual Minority Women's Experiences With Sexual Identity Disclosure in Contraceptive Care

OBJECTIVE

To describe a group of young sexual minority women's experiences with and preferences for sexual identity disclosure in the context of contraceptive care.

METHODS

In Chicago, Illinois, Salt Lake City, Utah, and Madison, Wisconsin, investigators conducted five focus groups (n=22) and 11 interviews with women aged 20-30 years who identified as something other than heterosexual. Focus groups explored social norms regarding contraceptive care; interviews documented individual experiences with contraceptive care. Using a qualitative descriptive approach and combined deductive and inductive content analysis, investigators coded transcripts for themes related to disclosing sexual orientation to contraceptive providers.

RESULTS

Participants described the process of sexual identity disclosure in contraceptive care in three stages: 1) listening for whether, when, and how health care providers asked about sexual orientation, 2) deciding whether or not to disclose sexual identity to providers, and 3) evaluating responses from providers after disclosure. Participants wanted providers to: avoid assumptions and ask about both sexual identity and sexual behaviors, signal their openness and competence around the health of sexual minority women during contraceptive encounters, and focus discussions on the individual patient's priorities and needs for contraceptive care.

CONCLUSION

Decisions made by sexual minority women about sexual identity disclosure in contraceptive contexts are influenced by previous and current interactions with health care providers. Contraceptive providers should ask all patients about sexual identity and sexual behavior, avoid assumptions about use of and need for contraception, and acknowledge the prevalence of marginalization, discrimination, and stigma experienced by sexual minority women and their communities in health care contexts.

Health Care-Related Correlates of Cervical Cancer Screening among Sexual Minority Women: An Integrative Review

INTRODUCTION

Sexual minority women (SMW; lesbian, bisexual, nonheterosexual women) may have lower rates of cervical cancer screening than heterosexual women. Health care-related factors may explain some of the variation in cervical cancer screening rates among SMW. We aimed to synthesize published evidence of health care-related correlates of cervical cancer screening among SMW.

METHODS

We searched PubMed, CINAHL, and PsycINFO databases for English-language studies published between January 2000 and March 2017 that 1) assessed sexual identity or the sexual partners of female participants, 2) included cervical cancer screening as a main outcome of interest, and 3) measured at least one health care-related variable in addition to cervical cancer screening. We excluded articles that 1) reported on non-US samples or 2) did not report original research. We reviewed the sample, methods, and findings of 17 studies. We then summarized current knowledge about health care-related factors across 3 categories and generated recommendations for clinical practice and future research.

RESULTS

Several health care-related factors such as previous contraception use, having a primary care provider, knowledge of screening recommendations, and disclosing sexual orientation to providers were consistently positively associated with cervical cancer screening. Three groups of factors-previous health care use, health care provider-related factors, and belief-related factors-account for a substantial part of the variation in cervical cancer screening among SMW.

DISCUSSION

Several gaps in knowledge remain that could be addressed by recruiting more diverse samples of SMW with improved generalizability. Clinicians and clinical institutions can address factors associated with low rates of screening among SMW by preventing sexual orientation-based discrimination, inviting sexual orientation disclosure, and offering cervical cancer screening to SMW at a variety of health care encounters. Future research should examine how the location of care and health care provider type affect SMW's cervical cancer screening behaviors and should test the effectiveness of health care interventions designed to address sexual orientation-related disparities.

Association of Pregnancy History and Cervical Cancer Screening in a Community Sample of Sexual Minority Women

BACKGROUND

Sexual minority women (SMW) face barriers to healthcare that may result in lower utilization of cervical cancer screening. Previous experiences with the healthcare system-specifically reproductive health-related encounters-have the potential to affect future use of screening services. This study aimed to examine the association between pregnancy history and cervical cancer screening in a diverse sample of SMW. Anderson's Behavioral Model of Health Services Use guided the selection of variables included in the study.

METHODS

We performed a secondary analysis of cross-sectional data from the third wave of the Chicago Health and Life Experiences of Women (CHLEW) Study, a longitudinal study of SMW in the Midwestern United States. We performed multivariable logistic regression to address the study aims, restricting the sample to women ages 21-45 (n = 430).

RESULTS

Reporting a previous pregnancy was consistently positively associated with past-year Pap testing. In the multivariable model, bisexual identity and disclosing one's sexual orientation to healthcare providers were also positively associated with past-year Pap test.

CONCLUSIONS

This analysis provides preliminary evidence that SMW who have been pregnant are more likely to receive Pap testing and that multiple sociodemographic factors are likely to impact screening in this population. Clinicians should screen all patients with a cervix for cervical cancer and should encourage screening for all SMW. Future studies should prioritize longitudinal analyses to examine the temporality of reproductive history and healthcare seeking, focus on where SMW seek care, and understand how intersecting components of identity may shape the healthcare utilization of this population.