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Dickson MF, Annett J, Walker M, Leukefeld C, Webster JM, Levi MM, Tillson M, Staton M. Overdose Experiences Among a Sample of Women in Jail with Opioid Use Disorder. Subst Use Misuse 2024; 59:1911-1920. [PMID: 39069728 PMCID: PMC11444883 DOI: 10.1080/10826084.2024.2383982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background: Previous non-fatal overdose may increase risk of overdose fatality for women reentering the community following incarceration, but pre-incarceration overdose experiences are understudied. This study describes the prevalence and correlates of non-fatal overdose prior to jail among women with opioid use disorder (OUD). Methods: Women (N = 700) were randomly selected from eight Kentucky jails, screened for OUD, and interviewed as part of the NIDA-funded Kentucky Justice Community Opioid Innovation Network (JCOIN) trial. Descriptive statistics were used to examine women's prior overdose experiences, while bivariate analyses and logistic regression were used to identify correlates of overdose in the 90 days prior to jail. Results: Analyses found that 55.4% of women had overdosed in their lifetime, and 21.4% overdosed in the 90 days prior to jail. Of those who overdosed in the 90 days prior to jail, heroin (80.7%) was the most-commonly used drug prior to overdose, 35.2% received emergency, medically-attended services post-overdose, and 92.4% were administered naloxone - primarily by acquaintances. Overdosing in the 90 days prior to jail was positively correlated with identifying as a sexual minority, being from an urban community, childhood victimization, as well as recent heroin, fentanyl, and injection drug use. Conclusions: Findings indicate that prior overdose is common among jailed women with OUD, and although naloxone was often administered, few women received medically-attended services post-overdose. Results highlight the importance of distributing naloxone to community members and women reentering the community from jail, and suggest additional research is needed to understand factors inhibiting medical care following an overdose.
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Affiliation(s)
- Megan F. Dickson
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
- University of Kentucky College of Medicine, Department of Behavioral Science,109 Medical Behavioral Science Building, Lexington, KY 40536, USA
| | - Jaxin Annett
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
| | - Meghan Walker
- University of Kentucky College of Medicine, 800 Park St, Bowling Green, KY 42101, USA
| | - Carl Leukefeld
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
- University of Kentucky College of Medicine, Department of Behavioral Science,109 Medical Behavioral Science Building, Lexington, KY 40536, USA
| | - J. Matthew Webster
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
- University of Kentucky College of Medicine, Department of Behavioral Science,109 Medical Behavioral Science Building, Lexington, KY 40536, USA
| | - Mary M. Levi
- Department of Psychology, University of Kentucky College of Arts and Sciences, Lexington, KY, USA
| | - Martha Tillson
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
| | - Michele Staton
- University of Kentucky Center on Drug and Alcohol Research, 643 Maxwelton Ct, Lexington, KY 40508, USA
- University of Kentucky College of Medicine, Department of Behavioral Science,109 Medical Behavioral Science Building, Lexington, KY 40536, USA
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Kluitenberg Harris C, Wu HS, Lehto R, Wyatt G, Given B. Relationships Among Determinants of Health, Cancer Screening Participation, and Sexual Minority Identity: A Systematic Review. LGBT Health 2024. [PMID: 38557207 DOI: 10.1089/lgbt.2023.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Purpose: To address cancer screening disparities and reduce cancer risk among sexual minority (SM) groups, this review identifies individual, interpersonal, and community/societal determinants of cancer screening (non)participation among differing SM identities. Methods: Seven scientific databases were searched. Inclusion criteria were as follows: (1) used quantitative methods; (2) English language; (3) cancer screening focus; and (4) at least one SM group identified. Articles were excluded if: (1) analysis was not disaggregated by SM identity (n = 29) and (2) quantitative analysis excluded determinants of cancer screening (n = 19). The Sexual and Gender Minority Health Disparities Research Framework guided literature synthesis. Results: Twelve studies addressed cervical (n = 4), breast (n = 3), breast/cervical (n = 3), or multiple cancers (n = 2). Other cancers were excluded due to inclusion/exclusion criteria. The total sample was 20,622 (mean 1525), including lesbian (n = 13,409), bisexual (n = 4442), gay (n = 1386), mostly heterosexual (n = 1302), and queer (n = 83) identities. Studies analyzing individual-level determinants (n = 8) found that socioeconomic status affected cervical, but not breast, cancer screening among lesbian and bisexual participants (n = 2). At the interpersonal level (n = 7), provider-patient relationship was a determinant of cervical cancer screening among lesbian participants (n = 4); a relationship not studied for other groups. Studies analyzing community/societal determinants (n = 5) found that rurality potentially affected cervical cancer screening among lesbian, but not bisexual people (n = 3). Conclusions: This review identified socioeconomic status, provider-patient relationship, and rurality as determinants affecting cancer screening among SM people. While literature addresses diverse SM groups, inclusion/exclusion criteria identified studies addressing cisgender women. Addressing disparities in the identified determinants of cervical cancer screening may improve participation among SM women. Further research is needed to understand determinants of cancer screening unique to other SM groups.
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Affiliation(s)
| | - Horng-Shiuann Wu
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Rebecca Lehto
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Gwen Wyatt
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Barbara Given
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
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Wirtz MR, Ahmad ZN, Ford JS. "What if I die and no one had ever romantically loved me?": sexual well-being in a sample of YA cancer survivors. J Cancer Surviv 2024; 18:186-195. [PMID: 36930436 PMCID: PMC10022557 DOI: 10.1007/s11764-023-01360-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Among young adult (YA) cancer survivors, sexual health is often exclusively focused on sexual functioning, or the completion of sexual tasks. However, it has become clear that there is another element of sexual health, sexual well-being-one's subjective experience of sex (e.g., body image or sexual/romantic relationship satisfaction)-that may be just as impaired as sexual functioning. In this study, we sought to elucidate potential themes that YA cancer survivors experience that cross both sexual functioning and well-being, thus encouraging more comprehensive sexual health education among those diagnosed with cancer. METHODS Semi-structured interviews were conducted as part of a larger qualitative study. Three codes developed by a team of coders-Social Isolation: Dating and Sex, Self-Evaluative Emotion: Shame in Dating and Relationships, and Self-Evaluative Emotion: Shame in Body Image/Physical Ability Concerns-included both sexual functioning and sexual well-being, and therefore guided this analysis. RESULTS Our sample consisted of thirty-five YA cancer survivors who were predominately female (86%) and non-Latino White (77%). Four themes emerged: missing out/aging out, inability to please (potential) partners, body image concerns, and unmet needs for social support. CONCLUSION While current research has identified sexual functioning as making up most of the sexual health education that cancer survivors receive, there is an interrelationship between sexual functioning and sexual well-being. IMPLICATIONS FOR CANCER SURVIVORS The clinical ramifications of the data are clear: more work must be done to address sexuality within both the couple and the individual survivor, and that work cannot be exclusively devoted to sexual functioning.
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Affiliation(s)
- Megan R Wirtz
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, USA.
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY, 10065, USA.
| | - Zeba N Ahmad
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, USA
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY, 10065, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Jennifer S Ford
- Program in Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, USA
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, New York, NY, 10065, USA
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4
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Stranges TN, Namchuk AB, Splinter TFL, Moore KN, Galea LAM. Are we moving the dial? Canadian health research funding trends for women's health, 2S/LGBTQ + health, sex, or gender considerations. Biol Sex Differ 2023; 14:40. [PMID: 37322516 PMCID: PMC10273719 DOI: 10.1186/s13293-023-00524-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Sex and gender impacts health outcomes and disease risk throughout life. The health of women and members of the Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (2S/LGBTQ +) community is often compromised as they experience delays in diagnosis. Distinct knowledge gaps in the health of these populations have prompted funding agencies to mandate incorporation of sex and gender into research. Sex- and gender-informed research perspectives and methodology increases rigor, promotes discovery, and expands the relevance of health research. Thus, the Canadian Institutes of Health Research (CIHR) implemented a sex and gender-based analysis (SGBA) framework recommending the inclusion of SGBA in project proposals in 2010 and then mandating the incorporation of SGBA into grant proposals in 2019. To examine whether this mandate resulted in increased mention of sex or gender in funded research abstracts, we searched the publicly available database of grant abstracts funded by CIHR to analyze the percentage of abstracts that mentioned sex or gender of the population to be studied in the funded research. To better understand broader health equity issues we also examined whether the funded grant abstracts mentioned either female-specific health research or research within the 2S/LGBTQ + community. RESULTS We categorized a total of 8,964 Project and Operating grant abstracts awarded from 2009 to 2020 based on their study of female-specific or a 2S/LGBTQ + populations or their mention of sex or gender. Overall, under 3% of grant abstracts funded by CIHR explicitly mentioned sex and/or gender, as 1.94% of grant abstracts mentioned sex, and 0.66% mentioned gender. As one of the goals of SGBA is to inform on health equity and understudied populations with respect to SGBA, we also found that 5.92% of grant abstracts mentioned female-specific outcomes, and 0.35% of grant abstracts focused on the 2S/LGBTQ + community. CONCLUSIONS Although there was an increased number of funded grants with abstracts that mentioned sex and 2S/LGBTQ + health across time, these increases were less than 2% between 2009 and 2020. The percentage of funded grants with abstracts mentioning female-specific health or gender differences did not change significantly over time. The percentage of funding dollars allocated to grants in which the abstracts mentioned sex or gender also did not change substantially from 2009 to 2020, with grant abstracts mentioning sex or female-specific research increasing by 1.26% and 3.47%, respectively, funding allocated to research mentioning gender decreasing by 0.49% and no change for 2S/LGBTQ +-specific health. Our findings suggest more work needs to be done to ensure the public can evaluate what populations will be examined with the funded research with respect to sex and gender to advance awareness and health equity in research.
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Affiliation(s)
- Tori N. Stranges
- Women’s Health Research Cluster, University of British Columbia, Vancouver, BC Canada
- School of Health and Exercise Sciences, University of British Columbia, Okanagan, Kelowna, BC Canada
| | - Amanda B. Namchuk
- Women’s Health Research Cluster, University of British Columbia, Vancouver, BC Canada
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, BC Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC Canada
| | | | - Katherine N. Moore
- Women’s Health Research Cluster, University of British Columbia, Vancouver, BC Canada
| | - Liisa A. M. Galea
- Women’s Health Research Cluster, University of British Columbia, Vancouver, BC Canada
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, BC Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC Canada
- Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
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Suarez S, Lupez E, Siegel J, Streed C. The Annual Examination for Lesbian, Gay, and Bisexual Patients. Prim Care 2021; 48:191-212. [PMID: 33985699 DOI: 10.1016/j.pop.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The annual examination is a comprehensive evaluation of patients in which all aspects of health and well-being are considered, including proper screening, appropriate preventive care, and recommendations and resources for healthy living. Clinicians commonly avoid certain topics with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients because they may be unprepared to address their health needs. Therefore, clinicians should learn how to conduct an LGBTQ-friendly annual examination in order to provide high-quality care. This article focuses on both the general and unique health needs of lesbian, gay, bisexual, and queer patients; care for transgender and gender-diverse patients is considered elsewhere.
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Affiliation(s)
- Sebastian Suarez
- Internal Medicine Residency Program, Boston University Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, USA.
| | - Emily Lupez
- Internal Medicine Residency Program, Boston University Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, USA. https://twitter.com/emily_lupez
| | - Jennifer Siegel
- Internal Medicine Residency Program, Boston University Medical Center, 72 East Concord Street, Evans 124, Boston, MA 02118, USA; Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA; Center for Transgender Medicine & Surgery, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor Room 2082, Boston, MA 02118, USA. https://twitter.com/siegenatorJS
| | - Carl Streed
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA; Center for Transgender Medicine & Surgery, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor Room 2082, Boston, MA 02118, USA. https://twitter.com/cjstreed
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6
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Rodrigues JL, Falcão MTC. Vivências de atendimentos ginecológicos por mulheres lésbicas e bissexuais: (in)visibilidades e barreiras para o exercício do direito à saúde. SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021181062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Embora lésbicas e mulheres bissexuais tenham sido incluídas nas políticas de saúde, na busca por uma atenção integral e que inclua o reconhecimento da diversidade sexual, a discriminação persiste nos espaços de atenção à saúde, especialmente nas consultas clínicas. Este trabalho, de vertente qualitativa, teve por objetivo discutir, a partir das percepções e vivências dessas mulheres, as relações estabelecidas nas consultas ginecológicas, abordando especificamente a (não) revelação da condição de lésbica/bissexual, as experiências com exames e orientações pertinentes à sexualidade e as dificuldades de negociação de condutas. A produção dos dados empíricos deu-se por meio de entrevistas semiestruturadas com doze lésbicas e cinco mulheres bissexuais. Os resultados apontam para a invisibilidade bissexual no contexto clínico, para as dificuldades na consulta ginecológica tanto para lésbicas quanto bissexuais e para o temor das mulheres quanto à exposição da orientação sexual, bem como o não reconhecimento de sua sexualidade. Nesse sentido, as consultas em ginecologia continuam centradas em pressupostos heteronormativos, preponderando aspectos reprodutivos em detrimento dos aspectos sexuais da vida.
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Charlton BM, Janiak E, Gaskins AJ, DiVasta AD, Jones RK, Missmer SA, Chavarro JE, Sarda V, Rosario M, Austin SB. Contraceptive use by women across different sexual orientation groups. Contraception 2019; 100:202-208. [PMID: 31082396 PMCID: PMC6699887 DOI: 10.1016/j.contraception.2019.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To examine contraceptive methods used across sexual orientation groups. STUDY DESIGN We collected data from 118,462 female participants in two longitudinal cohorts-the Nurses' Health Study (NHS) 2 (founded in 1989, participants born 1947-1964) and NHS3 (founded in 2010, born 1965-1995). We used log-binomial models to estimate contraceptive methods ever used across sexual orientation groups and cohorts, adjusting for age and race. RESULTS Lesbians were the least likely of all sexual orientation groups to use any contraceptive method. Lesbians in NHS2 were 90% less likely than heterosexuals to use long-acting reversible contraceptives (LARCs; adjusted risk ratio [aRR]; 95% confidence interval [CI]: 0.10 [0.04, 0.26]) and results were similar for other contraceptive methods and in the NHS3 cohort. Compared to the reference group of completely heterosexual participants with no same-sex partners, those who identified as completely heterosexual with same-sex partners, mostly heterosexual, or bisexual were generally more likely to use any method of contraception. Use of LARCs was especially striking across sexual minority groups, and, with the exception of lesbians, they were more likely to use LARCs; as one illustration, NHS3 bisexuals were more than twice as likely to use LARCs (aRR [95% CI]: 2.01 [1.67, 2.42]). CONCLUSIONS While certain sexual minority subgroups (e.g., bisexuals) were more likely than heterosexuals to use contraceptive methods such as LARCs, lesbians were less likely to use any method. IMPLICATIONS Many sexual minority patients need contraceptive counseling and providers should ensure to offer this counseling to patients in need, regardless of sexual orientation.
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Affiliation(s)
- Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.
| | - Elizabeth Janiak
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA; Planned Parenthood League of Massachusetts, 1055 Commonwealth Avenue, Boston, MA, USA
| | - Audrey J Gaskins
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA
| | - Amy D DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA
| | - Rachel K Jones
- Research Division, Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY, USA
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology College of Human Medicine, Michigan State University, 965 Fee Road, East Lansing, MI, USA
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, USA
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA
| | - Margaret Rosario
- Department of Psychology, City University of New York-City College and Graduate Center, 365 Fifth Avenue, New York, NY, USA
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
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8
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Andrade J, Ignácio MAO, Freitas APFD, Parada CMGDL, Duarte MTC. [Vulnerability to sexually transmitted infections of women who have sex with women]. CIENCIA & SAUDE COLETIVA 2019; 25:3809-3819. [PMID: 32997014 DOI: 10.1590/1413-812320202510.03522019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/22/2019] [Indexed: 11/22/2022] Open
Abstract
The scope of this study was to assess the degree of vulnerability to sexually transmitted infections of women who have sex with women. It involved a cross-sectional study of 150 women between 2015 and 2017. A structured questionnaire was applied, and a gynecological examination was performed to diagnose Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and papillomavirus. Blood tests were conducted to detect HIV, hepatitis B and syphilis. The outcome variable was sexual infection and the independent variables comprised the vulnerability level in the individual, social and programmatic dimensions. Data analyses were performed through logistic regression. The results showed a high prevalence of infections (47.3%) and only variables of individual vulnerability were associated with the outcome. The incidence of infection was four times higher among women who had had prior infections. The fact of never having had a blood test tripled the chance of having sexually transmitted infections. The fact of also having sexual intercourse with men in the previous 12-month-period increased the risk of the outcome by a factor of approximately nine. The conclusion drawn is that these women are vulnerable to sexually transmitted infections due to their individual vulnerability.
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Affiliation(s)
- Juliane Andrade
- Departamento de Enfermagem, Faculdade de Ciências da Saúde, Universidade de Brasília. Campus Universitário Darcy Ribeiro s/n, Asa Norte. 70910-900 Brasília DF Brasil.
| | - Mariana Alice Oliveira Ignácio
- Departamento de Saúde Pública, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp). Botucatu SP Brasil
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Charlton BM, Kahn JA, Sarda V, Katz-Wise SL, Spiegelman D, Missmer SA, Austin SB. Maternal Factors and Sexual Orientation-Related Disparities in Cervical Cancer Prevention. Womens Health Issues 2019; 29:238-244. [PMID: 30639277 DOI: 10.1016/j.whi.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Our objective was to explore how mothers' attitudes and relationships with their daughters may impact the cervical cancer prevention behaviors of daughters with diverse sexual orientations. METHODS We examined 8,143 mother-daughter dyads from the Nurses' Health Study 2 and Growing Up Today Study. During the daughter's adolescence, each mother reported her beliefs about the importance of regular Pap testing for her daughter, the frequency of communication with her daughter about Pap testing, her beliefs about Pap testing and human papillomavirus (HPV) vaccines, and her acceptance of sexual minorities (e.g., bisexuals, lesbians). Mothers and daughters separately reported relationship satisfaction. Log-binomial models were used to examine the longitudinal association between maternal factors and daughter's receipt of a Pap test and HPV vaccination. RESULTS Nearly all maternal factors predicted the daughter's likelihood to have a Pap test and HPV vaccination. Higher levels of acceptance for sexual minorities and better relationship quality were also positively associated with these cervical cancer prevention behaviors. Yet, after adjusting for the maternal factors, there was little attenuation of the existing sexual orientation-related disparities in Pap tests or HPV vaccination. CONCLUSIONS Mothers can play an important role in their daughters' cervical cancer prevention behaviors through novel processes like being more accepting of sexual minorities and having a good relationship quality. However, in this study, maternal factors did not explain much of the sexual orientation-related disparities in cervical cancer prevention. Efforts to ensure a mother is accepting of sexual minorities and has a good relationship quality with her daughter may improve that daughter's reproductive health.
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Affiliation(s)
- Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Jessica A Kahn
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Donna Spiegelman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Departments of Biostatistics, Nutrition, and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stacey A Missmer
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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10
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Greene MZ, Hughes TL, Hanlon A, Huang L, Sommers MS, Meghani SH. Predicting cervical cancer screening among sexual minority women using Classification and Regression Tree analysis. Prev Med Rep 2018; 13:153-159. [PMID: 30591857 PMCID: PMC6305684 DOI: 10.1016/j.pmedr.2018.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer screening is a critical preventive healthcare service for all women. Sexual minority women (SMW) in the United States experience multiple health disparities including decreased access to and use of cervical cancer screening. The mechanisms driving these disparities are not clear and SMW with multiple marginalized identities may be more likely to miss recommended cervical cancer screening. This study aimed to identify subgroups of SMW that are more and less likely to be screened for cervical cancer according to American Cancer Society guidelines. We used cross-sectional data from the latest (2010-2012) wave of the Chicago Health and Life Experiences of Women (CHLEW) Study (N = 691). Informed by intersectionality theory, we performed classification and regression tree (CART) modeling to construct a data-driven, predictive model of subgroups of SMW who were more and less likely to receive guideline-recommended screening. Notably, the CART model did not include commonly tested variables such as race/ethnicity or level of income or education. The model did identify subgroups with low likelihood of receiving screening and several novel variables that may be important in understanding SMW's use of cervical cancer screening; lifetime number of sexual partners, age at drinking onset, childhood physical abuse, and internalized homonegativity. Our results point to the importance of early life experiences and identity development processes in shaping patterns of preventive healthcare use among adult SMW. Our analysis also demonstrated the potential value of CART modeling techniques for evaluating how multiple variables interact in complex ways to predict cervical cancer screening.
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Affiliation(s)
- Madelyne Z Greene
- University of Wisconsin-Madison Department of Obstetrics and Gynecology, 610 Walnut St. Suite #667, Madison 53726, WI, USA
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York 10032, NY, USA
| | - Alexandra Hanlon
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
| | - Liming Huang
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
| | - Marilyn S Sommers
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
| | - Salimah H Meghani
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
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11
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Greene MZ, Meghani SH, Sommers MS, Hughes TL. Health Care-Related Correlates of Cervical Cancer Screening among Sexual Minority Women: An Integrative Review. J Midwifery Womens Health 2018; 63:10.1111/jmwh.12872. [PMID: 30251464 PMCID: PMC6433555 DOI: 10.1111/jmwh.12872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/20/2018] [Accepted: 04/28/2018] [Indexed: 02/06/2023]
Abstract
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.
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12
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Ruben MA, Fullerton M. Proportion of patients who disclose their sexual orientation to healthcare providers and its relationship to patient outcomes: A meta-analysis and review. PATIENT EDUCATION AND COUNSELING 2018; 101:1549-1560. [PMID: 29778500 DOI: 10.1016/j.pec.2018.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/20/2018] [Accepted: 05/01/2018] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Patient-centered care emphasizes the need to form a therapeutic and trusting relationship between patients and providers in which patients feel comfortable disclosing health-relevant and personal information. It is still unknown how many patients disclose their sexual orientation to providers, under what circumstances and what it is related to in terms of outcomes. METHOD The present meta-analysis and review sought to identify the overall proportion of sexual orientation disclosure to healthcare providers, facilitators and barriers of disclosure, patient populations less likely to disclose, and the relationship between disclosure and outcomes. Thirty-five studies met the inclusion criteria yielding 38 independent proportions. Characteristics of patients, providers, location, and disclosure were extracted. RESULTS Sexual orientation disclosure proportions to healthcare providers ranged from .29 to .98. The random-effects pooled estimate was .63 (95% CI: .58, .68). Disclosure compared to nondisclosure was related to more positive direct and indirect health outcomes including higher satisfaction, more healthcare seeking and screenings and better self-reported health and psychological wellbeing. CONCLUSION The overall proportion of disclosure to healthcare providers varied by patient, provider, location, and disclosure characteristics. PRACTICE IMPLICATIONS These findings emphasize the need for future interventions directed at facilitating disclosure among populations identified as less likely to disclose.
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Affiliation(s)
- Mollie A Ruben
- School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA, USA.
| | - Madeline Fullerton
- School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
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13
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Greene MZ, Hughes TL, Sommers MS, Hanlon A, Meghani SH. Association of Pregnancy History and Cervical Cancer Screening in a Community Sample of Sexual Minority Women. J Womens Health (Larchmt) 2018; 28:526-534. [PMID: 30118364 DOI: 10.1089/jwh.2018.6960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Madelyne Z Greene
- 1 Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Tonda L Hughes
- 2 School of Nursing, Columbia University, New York, New York
| | - Marilyn S Sommers
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
| | - Alexandra Hanlon
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
| | - Salimah H Meghani
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
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14
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LaVaccare S, Diamant AL, Friedman J, Singh KT, Baker JA, Rodriguez TA, Cohen SR, Dary FY, Pregler J. Healthcare Experiences of Underrepresented Lesbian and Bisexual Women: A Focus Group Qualitative Study. Health Equity 2018; 2:131-138. [PMID: 30283859 PMCID: PMC6071790 DOI: 10.1089/heq.2017.0041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: To understand the complex healthcare experiences of women identifying as lesbian or bisexual. who are also women of color, veterans, and/or 65 years of age and older. Methods: Inclusion criteria were age 25 or older, Los Angeles County resident, self-identification as a lesbian or bisexual woman, and as an African American, Latina, Asian-Pacific Islander, and/or a veteran. For the age 65 years and older group, participants were eligible regardless of their veteran status or race/ethnicity. Five focus groups were conducted (n=35) and the same questions were asked addressing their comfort interacting with healthcare providers, the provider knowing their sexual orientation, characteristics of a perfect provider, and barriers to care. Structured qualitative analyses were performed. Results: Participants identified concerns that providers often hold to heterosexual cultural norms. Participants varied on preferences for providers of the same race/ethnicity as themselves. Lesbians who are 65 years and older identified legal barriers as major concerns. All groups identified incorrect provider assumptions about sexual orientation and sexual practices as frequently compromising their care. Participants supported the idea of certification for providers skilled in lesbian, gay, bisexual, transgender, and queer (LGBTQ) health, but expressed skepticism that such programs would necessarily result in better care. Conclusion: Healthcare provider trainings need to address the specific concerns and experiences of underrepresented lesbian and bisexual women. Healthcare environments must be transformed to effectively address their needs. More research is needed on the separate healthcare experiences of specific marginalized populations related to their sexual orientation and/or gender identity.
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Affiliation(s)
- Sue LaVaccare
- Los Angeles County Lesbian and Bisexual Women's Health Collaborative, Los Angeles, California
| | - Allison L. Diamant
- Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Julie Friedman
- Iris Cantor-UCLA Women's Health Education and Research Center, Los Angeles, California
| | - Karen T. Singh
- Iris Cantor-UCLA Women's Health Education and Research Center, Los Angeles, California
| | - Jessica A. Baker
- Iris Cantor-UCLA Women's Health Education and Research Center, Los Angeles, California
| | - Tayler A. Rodriguez
- Iris Cantor-UCLA Women's Health Education and Research Center, Los Angeles, California
| | - Susan R. Cohen
- Department of Health Sciences, California State University, Northridge, Northridge, California
| | - Farina Y. Dary
- Project RENEW, Pathways by Molina, Costa Mesa, California
| | - Janet Pregler
- Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Iris Cantor-UCLA Women's Health Center, Los Angeles, California
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15
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Ela EJ, Budnick J. Non-Heterosexuality, Relationships, and Young Women's Contraceptive Behavior. Demography 2018; 54:887-909. [PMID: 28466434 DOI: 10.1007/s13524-017-0578-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women's higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.
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Affiliation(s)
- Elizabeth J Ela
- Population Studies Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48106-1248, USA.
| | - Jamie Budnick
- Population Studies Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48106-1248, USA
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16
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Cahill SR. Legal and Policy Issues for LGBT Patients with Cancer or at Elevated Risk of Cancer. Semin Oncol Nurs 2018; 34:90-98. [DOI: 10.1016/j.soncn.2017.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Cancer and the LGBTQ Population: Quantitative and Qualitative Results from an Oncology Providers' Survey on Knowledge, Attitudes, and Practice Behaviors. J Clin Med 2017; 6:jcm6100093. [PMID: 28991160 PMCID: PMC5664008 DOI: 10.3390/jcm6100093] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/05/2017] [Accepted: 09/25/2017] [Indexed: 01/14/2023] Open
Abstract
Background: Despite growing social acceptance, the LGBTQ population continues to face barriers to healthcare including fear of stigmatization by healthcare providers, and providers’ lack of knowledge about LGBTQ-specific health issues. This analysis focuses on the assessment of quantitative and qualitative responses from a subset of providers who identified as specialists that treat one or more of the seven cancers that may be disproportionate in LGBTQ patients. Methods: A 32-item web-based survey was emailed to 388 oncology providers at a single institution. The survey assessed: demographics, knowledge, attitudes, and practice behaviors. Results: Oncology providers specializing in seven cancer types had poor knowledge of LGBTQ-specific health needs, with fewer than half of the surveyed providers (49.5%) correctly answering knowledge questions. Most providers had overall positive attitudes toward LGBTQ patients, with 91.7% agreeing they would be comfortable treating this population, and would support education and/or training on LGBTQ-related cancer health issues. Conclusion: Results suggest that despite generally positive attitudes toward the LGBTQ population, oncology providers who treat cancer types most prevalent among the population, lack knowledge of their unique health issues. Knowledge and practice behaviors may improve with enhanced education and training on this population’s specific needs.
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18
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Youatt EJ, Harris LH, Harper GW, Janz NK, Bauermeister JA. Sexual Health Care Services among Young Adult Sexual Minority Women. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2017; 14:345-357. [PMID: 28989554 PMCID: PMC5626006 DOI: 10.1007/s13178-017-0277-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Young adult sexual minority women (YSMW) are at elevated risk for negative reproductive health outcomes, yet are less likely than heterosexual peers to utilize preventive health care. Medical and public health policy organizations advocate sexual orientation disclosure ("coming out") to health care providers as a strategy for increasing service utilization among YSMW. Limited research explores relationships between disclosure and receipt of sexual health services. YSMW (N=285) ages 21-24 participated in an online survey assessing their health behaviors and care utilization. We employed multivariable logistic regression models to examine the association between receipt of sexual health services and sexual orientation disclosure to provider, after adjusting for sociodemographic covariates. Thirty-five percent of YSMW were out to their provider. Less than half the sample had received Pap screening or STI testing in the previous year; approximately 15% had received at least one dose of the HPV vaccination. Disclosure was associated with increased likelihood of Pap screening (OR=2.66, p<.001) and HPV vaccination (OR=4.30, p<.001), but was not significantly associated with STI testing. Promoting coming out to providers may be a promising approach to increase sexual health care use among YSMW. Future research should explore causal relationships between these factors.
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Affiliation(s)
- Emily J. Youatt
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lisa H. Harris
- Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI
| | - Gary W. Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Nancy K. Janz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
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19
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Baptiste-Roberts K, Oranuba E, Werts N, Edwards LV. Addressing Health Care Disparities Among Sexual Minorities. Obstet Gynecol Clin North Am 2017; 44:71-80. [PMID: 28160894 DOI: 10.1016/j.ogc.2016.11.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is evidence of health disparities between sexual minority and heterosexual populations. Although the focus of lesbian, gay, bisexual, and transgender health research has been human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infection among men who have sex with men, there are health disparities among sexual minority women. Using the minority stress framework, these disparities may in part be caused by individual prejudice, social stigma, and discrimination. To ensure equitable health for all, there is urgent need for targeted culturally sensitive health promotion, cultural sensitivity training for health care providers, and intervention-focused research.
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Affiliation(s)
- Kesha Baptiste-Roberts
- Department of Public Health Analysis, School of Community Health & Policy, Morgan State University, 4530 Portage Avenue Campus, Suite 211, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA.
| | - Ebele Oranuba
- Department of Public Health Analysis, School of Community Health & Policy, Morgan State University, 4530 Portage Avenue Campus, Suite 211, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
| | - Niya Werts
- Department of Health Science, Towson University, 8000 York Road, Baltimore, MD 21252, USA
| | - Lorece V Edwards
- Department of Behavioral Health Science, School of Community Health & Policy, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
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20
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Charlton BM, Reisner SL, Agénor M, Gordon AR, Sarda V, Austin SB. Sexual Orientation Disparities in Human Papillomavirus Vaccination in a Longitudinal Cohort of U.S. Males and Females. LGBT Health 2017; 4:202-209. [PMID: 28467238 DOI: 10.1089/lgbt.2016.0103] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study sought to examine how human papillomavirus (HPV) vaccination may differ across sexual orientation groups (e.g., bisexuals compared to heterosexuals)-particularly in boys and men, about whom little is known. METHODS Data were from a prospective cohort of 10,663 U.S. females and males enrolled in the Growing Up Today Study followed from 1996 to 2014. Participants were aged 11-24 years when the vaccine was approved for females in 2006 and 14-27 years when approved for males in 2009. In addition to reporting sexual orientation identity/attractions, participants reported sex of lifetime sexual partners. Log-binominal models were used to examine HPV vaccination across sexual orientation groups. RESULTS Among females, 56% received ≥1 dose. In contrast, 8% of males obtained ≥1 dose; HPV vaccination initiation was especially low among completely heterosexual males. After adjusting for potential confounders, completely heterosexual (risk ratio [RR]; 95% confidence interval [CI]: 0.45 [0.30-0.68]) and mostly heterosexual (RR; 95% CI: 0.44 [0.25-0.78]) males were half as likely to have received even a single dose compared to gay males. Compared to lesbians, no differences were observed for completely heterosexual or bisexual females, but mostly heterosexual females were 20% more likely to have received at least one dose. CONCLUSIONS HPV vaccination rates in the U.S. are strikingly low and special attention is needed for boys and men, especially those who do not identify as gay. Vaccinating everyone, regardless of sex/gender and/or sexual orientation, will not only lower that individual's susceptibility but also decrease transmission to partners, females and/or males, to help eradicate HPV through herd immunity.
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Affiliation(s)
- Brittany M Charlton
- 1 Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts.,2 Department of Pediatrics, Harvard Medical School , Boston, Massachusetts
| | - Sari L Reisner
- 2 Department of Pediatrics, Harvard Medical School , Boston, Massachusetts.,3 Division of General Pediatrics, Boston Children's Hospital , Boston, Massachusetts.,4 The Fenway Institute , Fenway Health, Boston, Massachusetts.,5 Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
| | - Madina Agénor
- 6 Dana-Farber Cancer Institute , Boston, Massachusetts.,7 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
| | - Allegra R Gordon
- 1 Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts.,2 Department of Pediatrics, Harvard Medical School , Boston, Massachusetts
| | - Vishnudas Sarda
- 1 Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts
| | - S Bryn Austin
- 1 Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts.,2 Department of Pediatrics, Harvard Medical School , Boston, Massachusetts.,7 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, Massachusetts.,8 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts
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21
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Baldwin AM, Dodge B, Schick V, Sanders SA, Fortenberry JD. Sexual Minority Women's Satisfaction with Health Care Providers and State-level Structural Support: Investigating the Impact of Lesbian, Gay, Bisexual, and Transgender Nondiscrimination Legislation. Womens Health Issues 2017; 27:271-278. [PMID: 28233635 DOI: 10.1016/j.whi.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 01/08/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Structural discrimination is associated with negative health outcomes among sexual minority populations. Recent changes to state-level and national legislation provide both the opportunity and the need to further explore the impact of legislation on the health indicators of sexual minorities. Using an ecosocial theory lens, the present research addresses the relationship between structural support or discrimination and satisfaction with one's health care provider among sexual minority women. METHODS Data were drawn from an online survey of sexual minority women's health care experiences. Using the Andersen Behavioral Model of Health Services Utilization to operationalize the variables in our model, we examined the relationship between state-level nondiscrimination legislation and satisfaction with provider-a widely used measure of health care quality-through regression analysis. FINDINGS Participants in structurally supportive states (i.e., those with nondiscrimination legislation) were more likely to disclose their sexual identity to their providers and to report higher satisfaction with their providers. The absence of nondiscrimination legislation was associated negatively with satisfaction with providers. CONCLUSIONS Results of our study show that the external environment in which sexual minority women seek health care, characterized by structural support or lack thereof, is related to perceived quality of health care.
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Affiliation(s)
- Aleta M Baldwin
- Department of Kinesiology, California State University, Stanislaus, Turlock, California.
| | - Brian Dodge
- Department of Applied Health Science, Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana
| | - Vanessa Schick
- Department of Management, Policy & Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Stephanie A Sanders
- The Kinsey Institute for Research in Sex, Gender & Reproduction, Indiana University, Bloomington, Indiana
| | - J Dennis Fortenberry
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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22
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Solazzo AL, Gorman BK, Denney JT. Cancer Screening Utilization Among U.S. Women: How Mammogram and Pap Test Use Varies Among Heterosexual, Lesbian, and Bisexual Women. POPULATION RESEARCH AND POLICY REVIEW 2017. [DOI: 10.1007/s11113-017-9425-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Agénor M, Muzny CA, Schick V, Austin EL, Potter J. Sexual orientation and sexual health services utilization among women in the United States. Prev Med 2017; 95:74-81. [PMID: 27932056 PMCID: PMC5555111 DOI: 10.1016/j.ypmed.2016.11.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/18/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
Although sexual minority women are at risk of sexually transmitted infections (STIs) and cervical cancer, few nationally representative studies have assessed sexual orientation disparities in sexual health care among women. Using data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth, which provide a national probability sample of U.S. women aged 15-44years (N=11,300), we used multivariable logistic regression to examine the associations between sexual behavior and sexual identity (modeled separately) and STI testing in the past year, Pap test use in the last 3years, lifetime HIV testing, and lifetime human papillomavirus (HPV) testing. Women with male and female lifetime sexual partners had higher adjusted odds of being tested for STIs ([odds ratio:] 1.61; [95% confidence interval:] 1.37-1.89), HIV (1.66; 1.29-2.14), and HPV (1.79; 1.41-2.25) and similar adjusted odds of obtaining a Pap test (0.98; 0.76-1.27) than women with only male lifetime sexual partners. Self-identified bisexual women had higher adjusted odds of obtaining an STI (1.43; 1.10-1.86) and HIV (1.69; 1.24-2.30) test but lower adjusted odds of obtaining a Pap test in the last 3years (0.66; 0.47-0.93) than heterosexual-identified women. Women with only female lifetime sexual partners had lower adjusted odds of receiving an STI (0.14; 0.07-0.28) and Pap (0.10; 0.03-0.27) test than women with only male lifetime sexual partners. Results comparing self-identified lesbian and heterosexual women were similar. Health care facilities should monitor and address sexual orientation disparities in women's sexual health care and ensure the provision of high-quality sexual health services to all women.
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Affiliation(s)
- Madina Agénor
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Christina A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Vanessa Schick
- Center for Health Promotion and Prevention Research, Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Erika L Austin
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
| | - Jennifer Potter
- Division of Medicine, Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States; The Fenway Institute, Fenway Health, Boston, MA, United States
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24
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Using mammograms to predict preventive health services behavior and mortality in women. Prev Med Rep 2016; 5:27-32. [PMID: 27882293 PMCID: PMC5120261 DOI: 10.1016/j.pmedr.2016.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 09/17/2016] [Accepted: 10/24/2016] [Indexed: 11/24/2022] Open
Abstract
This study examined whether mammography receipt was associated with mortality due to causes other than breast cancer, hypothesizing that mammography screening was a proxy for the predisposition to seek preventive health behaviors. Using data on 89,574 women from the 2000 National Health Interview Survey and National Death Index, a discrete-time hazard model estimated the mortality from any cause except breast cancer as a function of screening status. Receiving a mammogram was associated with a 24% reduction in the likelihood of death all causes except breast cancer. These odds were reduced to 21.1% when demographic and socioeconomic variables are added and reduced further to 20.9% when health resource variables were added. The final adjusted model shows that women who received a mammogram had reduced their probability of death by 20%. These results suggest women who undergo mammograms may be more likely to seek other preventive health services or engage in healthy behaviors that affect mortality. While the use of mammograms to predict breast cancer mortality merits further consideration, if a proxy for a woman's predisposition for additional preventive screenings, encouraging mammography may be a pivotal pathway for preventing mortality due to other causes for women.
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25
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Fredericks E, Harbin A, Baker K. Being (in)visible in the clinic: A qualitative study of queer, lesbian, and bisexual women's health care experiences in Eastern Canada. Health Care Women Int 2016; 38:394-408. [PMID: 27428268 DOI: 10.1080/07399332.2016.1213264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this article, we examine the ways in which 18 queer, lesbian, and bisexual (QLB) women in Eastern Canada negotiated their visibility in interactions with primary care providers. QLB women patients used a number of strategies to determine risk and to be visible or invisible to their health care providers. We describe participants' disclosure decisions and strategies, and we argue that being visible and invisible requires work on the part of QLB patients in the context of institutionalized heteronormativity. Conceptualizing (in)visibility as work is required in efforts to account for and improve health care interactions across differences.
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Affiliation(s)
- Erin Fredericks
- a Department of Sociology , St. Thomas University , Fredericton , New Brunswick , Canada
| | - Ami Harbin
- b Departments of Philosophy and Women & Gender Studies , Oakland University , Rochester , Michigan , USA
| | - Kelly Baker
- c Department of Global Studies , Wilfrid Laurier University , Waterloo , Ontario , Canada
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Staley M, Hussey W, Roe K, Harcourt J(J, Roe K. In the Shadow of the Rainbow: Identifying and Addressing Health Disparities in the Lesbian, Gay, Bisexual, and Transgender Population— a Research and Practice Challenge. Health Promot Pract 2016. [DOI: 10.1177/152483990100200304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Matthew Staley
- Kern County Department of Public Health, Bakersfield, CA
| | | | | | | | - Kathleen Roe
- Community Health Education, San Jose State University, San Jose, CA; Department of Health Sciences at San Jose State University
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Primary care of women who have sex with women. Recommendations from the research. Nurse Pract 2016; 40:24-32. [PMID: 25757088 DOI: 10.1097/01.npr.0000431883.32986.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research on women who have sex with women has increased in the last decade. Attention has been brought to this group of women through the IOM report, which noted a lack of research related to their care. Most of the research has not been published in nursing literature. This article reviews this literature with recommendations for primary care practice.
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Lapinski J, Diaz KM. Single Accreditation System for Graduate Medical Education: An Opportunity for Lesbian, Gay, Bisexual, and Transgender Health Education Integration in Osteopathic Medicine. J Osteopath Med 2016; 116:76-8. [DOI: 10.7556/jaoa.2016.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Whitehead J, Shaver J, Stephenson R. Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations. PLoS One 2016; 11:e0146139. [PMID: 26731405 PMCID: PMC4701471 DOI: 10.1371/journal.pone.0146139] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/14/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. METHODOLOGY LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and "outness," and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals' demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. RESULTS Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. CONCLUSIONS The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients' disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.
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Affiliation(s)
- J. Whitehead
- Department of Pediatrics, School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - John Shaver
- Department of Health and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rob Stephenson
- Department of Health and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, United States of America
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Yemane RE, Brueggmann D, Brown N, Church T, Jaque JM. Perceptions and patterns of cervical cancer screening among predominately Hispanic women who have sex with women: a cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2015; 198:163-164. [PMID: 26704940 DOI: 10.1016/j.ejogrb.2015.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Affiliation(s)
- R E Yemane
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - D Brueggmann
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany.
| | - N Brown
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - T Church
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J M Jaque
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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31
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Lindau ST, Abramsohn EM, Matthews AC. A manifesto on the preservation of sexual function in women and girls with cancer. Am J Obstet Gynecol 2015; 213:166-74. [PMID: 25818667 PMCID: PMC4692159 DOI: 10.1016/j.ajog.2015.03.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 02/19/2015] [Accepted: 03/19/2015] [Indexed: 12/17/2022]
Abstract
Malignancies that affect females who survive cancer commonly originate in, invade, and/or metastasize to the sexual organs, including the ovaries, uterine corpus, uterine cervix, vagina, vulva, fallopian tubes, anus, rectum, breast(s), and brain. Females comprise most of the population (in number and proportion) with cancers that directly affect the sexual organs. Most females in the age groups most commonly affected by cancer are sexually active in the year before diagnosis, which includes most menopausal women who have a partner. Among female cancer survivors, the vast majority have cancers that are treated with local or systemic therapies that result in removal, compromise, or destruction of the sexual organs. Additionally, female cancer survivors often experience abrupt or premature onset of menopause, either directly with surgery, radiation, or other treatments or indirectly through disruption of female sex hormone or other neuroendocrine physiology. For many female patients, cancer treatment has short-term and long-lasting effects on other aspects of physical, psychological, and social functioning that can interfere with normal sexual function; these effects include pain, depression, and anxiety; fatigue and sleep disruption; changes in weight and body image; scars, loss of normal skin sensation, and other skin changes; changes in bodily odors; ostomies and loss of normal bowel and bladder function; lymphedema, and strained intimate partnerships and other changes in social roles. In spite of these facts, female patients who are treated for cancer receive insufficient counseling, support, or treatment to preserve or regain sexual function after cancer treatment.
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Affiliation(s)
- Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL; Department of Medicine-Geriatrics, University of Chicago, Chicago, IL.
| | - Emily M Abramsohn
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Amber C Matthews
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
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Murphy D, Klosky JL, Reed DR, Termuhlen AM, Shannon SV, Quinn GP. The importance of assessing priorities of reproductive health concerns among adolescent and young adult patients with cancer. Cancer 2015; 121:2529-36. [PMID: 26054052 DOI: 10.1002/cncr.29466] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/25/2015] [Accepted: 04/20/2015] [Indexed: 12/28/2022]
Abstract
Visions for the future are a normal developmental process for adolescents and young adults (AYAs) with and without cancer, and these visions often include expectations of sexual and romantic relationships. AYA cancer survivors indicate reproductive health is an issue of great importance and more attention is needed in the health care setting throughout the cancer experience, beginning at diagnosis. Various practice guidelines are predominately focused on fertility; are intended to influence survivorship care plans; and do not encompass the broad scope of reproductive health that includes romantic partnering, friendships, body image, sexuality, sexual identity, fertility, contraception, and more. Although interventions to reduce reproductive health-related sequelae from treatment are best approached as an evolving process, practitioners are not certain of the priorities of these various reproductive health content areas. Strategies incongruent with the reproductive health priorities of AYAs will likely thwart adequate follow-up care and foster feelings of isolation from the treatment team. Research is needed to identify these priorities and ensure discussions of diverse content areas. This review explored various domains of reproductive health and emphasized how understanding the priorities of the AYA cancer cohort will guide future models of care.
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Affiliation(s)
- Devin Murphy
- Jonathan Jaques Children's Cancer Center, Miller Children's & Women's Hospital, Long Beach, California
| | - James L Klosky
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Damon R Reed
- H. Lee Moffitt Cancer Center and Research Institute, Sarcoma Department, Tampa, Florida.,H Lee Moffitt Cancer Center and Research Institute, Adolescent Young Adult Oncology Program, Tampa, FL, USA
| | - Amanda M Termuhlen
- Jonathan Jaques Children's Cancer Center, Miller Children's & Women's Hospital, Long Beach, California
| | - Susan V Shannon
- Jonathan Jaques Children's Cancer Center, Miller Children's & Women's Hospital, Long Beach, California
| | - Gwendolyn P Quinn
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
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Logie CH, Lacombe-Duncan A, Weaver J, Navia D, Este D. A Pilot Study of a Group-Based HIV and STI Prevention Intervention for Lesbian, Bisexual, Queer, and Other Women Who Have Sex with Women in Canada. AIDS Patient Care STDS 2015; 29:321-8. [PMID: 25867642 DOI: 10.1089/apc.2014.0355] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Limited research has evaluated interventions to reduce HIV and sexually transmitted infection (STI) vulnerability among lesbian, bisexual, and queer (LBQ) women, and other women who have sex with women. The Queer Women Conversations (QWC) study examined the effectiveness of a group-based psycho-educational HIV/STI intervention with LBQ women in Toronto and Calgary, Canada. We conducted a nonrandomized cohort pilot study. Participants completed a pre-test, post-test, and 6-week follow-up. The primary outcome was sexual risk practices, while secondary objectives included intrapersonal (self-esteem, STI knowledge, resilient coping, depression), interpersonal (safer sex self-efficacy), community (community connectedness, social support), and structural (sexual stigma, access to healthcare) factors. The study was registered at http://clinicaltrials.gov. Forty-four women (mean age 28.7 years) participated in a weekend retreat consisting of six consecutive sessions tailored for LBQ women. Sessions covered a range of topics addressing behavioral and social-structural determinants of HIV/STI risk, including STI information, safer sex negotiation skills, and addressing sexual stigma. Adjusted for socio-demographic characteristics, sexual risk practices (β2=-2.96, 95% CI -4.43, -1.50), barrier use self-efficacy (β2=1.52, 95% CI 0.51, 2.53), STI knowledge (β2=4.41, 95% CI 3.52, 5.30), and sexual stigma (β2=-2.62, 95% CI -3.48, -1.75) scores showed statistically significant changes 6 weeks post-intervention. Initial increases in safer sex self-efficacy, social support, and community connectedness were not sustained at 6-week follow up, highlighting the need for booster sessions or alternative approaches to address social factors. Study results may inform HIV/STI prevention interventions, sexual health care provision, and support services tailored for LBQ women.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Ashley Lacombe-Duncan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - James Weaver
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Daniela Navia
- Department of Anthropology, University of Calgary, Calgary, Alberta, Canada
| | - David Este
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
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Agénor M, Bailey Z, Krieger N, Austin SB, Gottlieb BR. Exploring the Cervical Cancer Screening Experiences of Black Lesbian, Bisexual, and Queer Women: The Role of Patient-Provider Communication. Women Health 2015; 55:717-36. [PMID: 25909663 DOI: 10.1080/03630242.2015.1039182] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Few studies have focused on the health and health care of U.S. black lesbian, bisexual, and queer (LBQ) women. To understand the facilitators of and barriers to cervical cancer screening in this population, focus group discussions were conducted in Boston and Cambridge, Massachusetts between November and December 2012. Using purposive sampling methods, the authors enrolled 18 black LBQ women who participated in one of four focus groups. Using thematic analysis, patient-provider communication was identified, which consisted of four sub-themes--health care provider communication style and demeanor; heteronormative provider assumptions; heterosexism, racism, and classism; and provider professional and sociodemographic background--as the most salient theme. Participants reported fears and experiences of multiple forms of discrimination and preferred receiving care from providers who were knowledgeable about same-sex sexual health and shared their life experiences at the intersection of gender, race/ethnicity, and sexual orientation. The cervical cancer screening experiences of black LBQ women would be improved by training all health care providers in same-sex sexual health, offering opportunities for clinicians to learn about the effects of various forms of discrimination on women's health care, and increasing the presence of LBQ women of color in health care settings.
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Affiliation(s)
- Madina Agénor
- a Department of Social and Behavioral Sciences , Harvard T. H. Chan School of Public Health , Boston , Massachusetts , USA
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35
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Quinn GP, Schabath MB, Sanchez JA, Sutton SK, Green BL. The importance of disclosure: lesbian, gay, bisexual, transgender/transsexual, queer/questioning, and intersex individuals and the cancer continuum. Cancer 2014; 121:1160-3. [PMID: 25521303 DOI: 10.1002/cncr.29203] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 10/27/2014] [Accepted: 11/20/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Gwendolyn P Quinn
- Division of Population Sciences, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
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36
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Nguyen GT, Yehia BR. Documentation of sexual partner gender is low in electronic health records: observations, predictors, and recommendations to improve population health management in primary care. Popul Health Manag 2014; 18:217-22. [PMID: 25290634 DOI: 10.1089/pop.2014.0075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The 2011 Institute of Medicine report on LGBT health recommended that sexual orientation and gender identity (SO/GI) be documented in electronic health records (EHRs). Most EHRs cannot document all aspects of SO/GI, but some can record gender of sexual partners. This study sought to determine the proportion of patients who have the gender of sexual partners recorded in the EHR and to identify factors associated with documentation. A retrospective analysis was done of EHR data for 40 family medicine (FM) and general internal medicine (IM) practices, comprising 170,570 adult patients seen in 2012. The primary outcome was EHR documentation of sexual partner gender. Multivariate logistic regression assessed the impact of patient, provider, and practice factors on documentation. In all, 76,767 patients (45%) had the gender of sexual partners recorded, 4.3% of whom had same-gender partners (3.5% of females, 5.6% of males). Likelihood of documentation was independently higher for women; blacks; those with a preventive visit; those with a physician assistant, nurse practitioner, or resident primary care provider (vs. attending); those at urban practices; those at smaller practices; and those at a residency FM practice. Older age and Medicare insurance were associated with lower documentation. Sexual partner gender documentation is important to identify patients for targeted prevention and support, and holds great potential for population health management, yet documentation in the EHR currently is low. Primary care practices should routinely record the gender of sexual partners, and additional work is needed to identify best practices for collecting and using SO/GI data in this setting.
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Affiliation(s)
- Giang T Nguyen
- 1Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,2Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,3Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.,4Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,5Penn Medicine Program for LGBT Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Baligh R Yehia
- 2Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,3Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.,4Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.,5Penn Medicine Program for LGBT Health, University of Pennsylvania, Philadelphia, Pennsylvania.,6Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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37
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Amir H, Gophen R, Amir Levy Y, Hasson J, Gordon D, Amit A, Azem F. Obstetricians and gynecologists: which characteristics do Israeli lesbians prefer? J Obstet Gynaecol Res 2014; 41:283-93. [PMID: 25227636 DOI: 10.1111/jog.12512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/29/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to explore lesbians' preferences when choosing obstetricians/gynecologists. MATERIAL AND METHODS This cross-sectional study included 100 lesbian and 100 heterosexual women. A 40-item questionnaire assessed the correlation between a patient's sexual identity and her specific preferences for obstetricians/gynecologists. RESULTS The top five most important parameters for both groups in choosing obstetricians/gynecologists overlapped greatly. Four of those were experience, ability, knowledge and personality. Only one parameter differed: lesbians ranked 'sexually tolerant' as the third most important characteristic while heterosexuals ranked 'availability' as the fifth most important characteristic. Lesbians rated 'sexual tolerance' significantly higher than heterosexuals (P < 0.001). More lesbians (56%) preferred female obstetricians/gynecologists compared to heterosexuals (21%) (P < 0.001). When compared to heterosexuals, more lesbians preferred female obstetricians/gynecologists for intimate and non-intimate procedures (P < 0.001). But within the lesbian population, a higher percentage of subjects showed a preference for female obstetricians/gynecologists only for intimate procedures. Lesbians used the following to describe their preference for female obstetricians/gynecologists: feeling more comfortable; gentle; sympathetic; patient; more understanding of women's health; better physicians in general; and more sexually tolerant (P < 0.001 vs heterosexual). However, when we looked only at the lesbian population, the majority did not exhibit a preference for a female obstetrician/gynecologist for any of these reasons. The main reason given by the 56% of the lesbians who said they prefer female obstetricians/gynecologists was feeling more comfortable. CONCLUSION Overwhelmingly lesbians prefer sexually tolerant obstetricians/gynecologists regardless of their gender; however, only a small number of lesbian subjects in this study considered their obstetricians/gynecologists as displaying this characteristic.
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Affiliation(s)
- Hadar Amir
- Sara Racine IVF Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv, Israel
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38
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McRee AL, Katz ML, Paskett ED, Reiter PL. HPV vaccination among lesbian and bisexual women: Findings from a national survey of young adults. Vaccine 2014; 32:4736-42. [PMID: 25038312 PMCID: PMC4135468 DOI: 10.1016/j.vaccine.2014.07.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/04/2014] [Accepted: 07/05/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) infection and associated cervical disease are common among all women, regardless of sexual identity, yet limited research has examined HPV vaccination among lesbian and bisexual women. METHODS A national sample of lesbian and bisexual women ages 18-26 (n=543) completed our online survey during Fall 2013. We used multivariable logistic regression to identify correlates of HPV vaccine initiation (receipt of at least 1 dose) and completion (receipt of all 3 recommended doses among initiators). RESULTS Overall, 45% of respondents had initiated HPV vaccine and 70% of initiators reported completing the series. HPV vaccine initiation was higher among respondents who were students, had received a healthcare provider's recommendation, perceived greater positive social vaccination norms, or anticipated greater regret if they did not get vaccinated and later got HPV. Initiation was lower among those who perceived greater HPV vaccine harms or greater barriers to getting the vaccine (all p<.05). HPV vaccine completion was higher among initiators who had a college degree while it was lower among those who perceived a greater likelihood of acquiring HPV or who anticipated greater regret if they got the vaccine and fainted (all p<.05). Among HPV vaccine initiators who had not yet completed the series, about half (47%) intended to get the remaining doses. CONCLUSIONS Many lesbian and bisexual women are not getting vaccinated against HPV. Healthcare provider recommendations and women's health beliefs may be important leverage points for increasing vaccination among this population.
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Affiliation(s)
- Annie-Laurie McRee
- College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA.
| | - Mira L Katz
- College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA; Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Electra D Paskett
- College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA; Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Paul L Reiter
- College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA; Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA; Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Garland-Forshee RY, Fiala SC, Ngo DL, Moseley K. Sexual orientation and sex differences in adult chronic conditions, health risk factors, and protective health practices, Oregon, 2005-2008. Prev Chronic Dis 2014; 11:E136. [PMID: 25101493 PMCID: PMC4723300 DOI: 10.5888/pcd11.140126] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Research on lesbian, gay, and bisexual (LGB) individuals’ health and health practices has primarily consisted of convenience studies focused on HIV/AIDS, substance use, or mental illness. We examined health-related disparities among Oregon LGB men and women compared with heterosexual men and women using data from a population-based survey. Methods Data from the 2005 through 2008 Oregon Behavioral Risk Factor Surveillance System were used to examine associations between sexual orientation and chronic conditions, health limitations, health risk factors, and protective health practices. Results Compared with heterosexual women, lesbian and bisexual women were significantly more likely to smoke cigarettes, be obese, binge drink, and have chronic conditions, and less likely to engage in protective health practices. Compared with heterosexual men, gay men were significantly less likely to be obese, more likely to binge drink, and more likely to engage in protective health practices. Compared with heterosexual men, bisexual men were significantly more likely to have a physical disability, smoke cigarettes, binge drink, and more likely to get an HIV test. Conclusions Health disparities among Oregon LGB individuals were most prominent among lesbian and bisexual women. Gay men had the most protective health practices, but they were more likely than heterosexual men to engage in risky behaviors that lead to chronic diseases later in life. Targeted public health interventions should be provided in environments that avoid stigmatizing and discriminating against LGB individuals where they live, work, learn, and socialize.
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Affiliation(s)
- Rodney Y Garland-Forshee
- Oregon Health Authority, Oregon Public Health Division, 800 NE Oregon St, Suite 730, Portland OR 97232. E-mail:
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40
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Everett BG, Mollborn S. Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women. POPULATION RESEARCH AND POLICY REVIEW 2014; 33:553-577. [PMID: 25382887 PMCID: PMC4220559 DOI: 10.1007/s11113-013-9282-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen's health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen's model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.
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Marques AM, Oliveira JMD, Nogueira C. [The lesbian population in health studies: contributions for a critical reflection]. CIENCIA & SAUDE COLETIVA 2014; 18:2037-47. [PMID: 23827908 DOI: 10.1590/s1413-81232013000700019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 05/11/2012] [Indexed: 11/22/2022] Open
Abstract
For decades, lesbian sexuality was associated with pathology in the attitudes to and practices of health sciences and psychology. During the twentieth century that position changed gradually. This article analyzes these changes in a theoretical reflection on the domain of lesbian health, dominated by heteronormative and heterosexist concepts and practices both in research and in health care. By means of a critical contextualization of the literature, specific health needs of lesbians were identified and the interventions of health care professionals and services were questioned. Specific concrete actions are proposed in the fields of health promotion and in the eradication of discrimination and inequality in health care.
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Affiliation(s)
- António Manuel Marques
- Escola Superior de Saúde, Instituto Politécnico de Setúbal, Estefanilha, Setúbal, Portugal.
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42
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Marques AM, Nogueira C, de Oliveira JM. Lesbians on Medical Encounters: Tales of Heteronormativity, Deception, and Expectations. Health Care Women Int 2014; 36:988-1006. [PMID: 24498920 DOI: 10.1080/07399332.2014.888066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The experiences of lesbian women in medical encounters prove particularly relevant for understanding their difficulties in their relationship with professionals and health services. We carried out semistructured interviews with 30 women aged 21 to 63 years, who define themselves as lesbian. The analysis highlights the difficulties experienced in disclosure of sexuality in medical encounters, the tendency for doctors to come across as heteronormative, and also medical practices experienced as appropriate by interviewees. Analysis of participant experiences demonstrates the need for reflection and decision making to promote the recognition of the sexual citizenship of lesbian women and their empowerment.
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Affiliation(s)
- António Manuel Marques
- a Departamento de Ciências Sociais e Humanas, Escola Superior de Saúde do Instituto Politécnico de Setúbal , Setúbal , Portugal
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Cahill S, Makadon H. Sexual Orientation and Gender Identity Data Collection in Clinical Settings and in Electronic Health Records: A Key to Ending LGBT Health Disparities. LGBT Health 2014; 1:34-41. [DOI: 10.1089/lgbt.2013.0001] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sean Cahill
- Health Policy Research, The Fenway Institute, Boston, Massachusetts
- Wagner School of Public Service, New York University, New York, New York
| | - Harvey Makadon
- National LGBT Health Education Center, Fenway Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Mosack KE, Brouwer AM, Petroll AE. Sexual identity, identity disclosure, and health care experiences: is there evidence for differential homophobia in primary care practice? Womens Health Issues 2014; 23:e341-6. [PMID: 24183408 DOI: 10.1016/j.whi.2013.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/26/2013] [Accepted: 07/31/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Given extant health disparities among women who belong to the sexual minority, we must understand the ways in which access to and satisfaction with health care contribute to such disparities. The purpose of this study was to explore how sexual minority women's (SMW) health care experiences compared with those of their heterosexually identified counterparts. We also sought to investigate whether there were differences within SMW in this regard. Finally, we explored whether participant satisfaction and comfort with health care providers (HCPs) differed depending upon HCP knowledge of participants' sexual orientation. METHODS We administered surveys to 420 women including lesbian, gay, bisexual, or other "queer" identified women (n = 354) and heterosexually identified women (n = 66). FINDINGS Contrary to our expectations, we found that SMW were as likely to have had a recent health care appointment, to have been recommended and to have received similar diagnostic and preventive care, and to feel comfortable discussing their sexual health with their HCPs. They were, however, less likely to report being satisfied with their HCPs. We found no differences between lesbian SMW and non-lesbian SMW with respect to these indicators. We found important differences with respect to sexual orientation disclosure and health care satisfaction, however. Those participants whose HCPs purportedly knew of their minority sexual orientation reported greater satisfaction with their HCPs and greater comfort discussing their sexual health than those whose providers were presumably unaware. CONCLUSION We discuss important clinical and research implications of these findings.
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Affiliation(s)
- Katie E Mosack
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.
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45
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Orel NA. Investigating the needs and concerns of lesbian, gay, bisexual, and transgender older adults: the use of qualitative and quantitative methodology. JOURNAL OF HOMOSEXUALITY 2014; 61:53-78. [PMID: 24313253 PMCID: PMC4186699 DOI: 10.1080/00918369.2013.835236] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Extensive research on the specific needs and concerns of lesbian, gay, bisexual, and transgender (LGBT) older adults is lacking. This article describes the results of both quantitative studies (i.e., LGBT Elders Needs Assessment Scale) and qualitative studies (i.e., focus groups and in-depth interviews with lesbian, gay, or bisexual [LGB] older adults and LGB grandparents) that specifically sought to investigate the unique needs and concerns of LGBT elders. The results identified 7 areas (medical/health care, legal, institutional/housing, spiritual, family, mental health, and social) of concern and the recognition that the needs and concerns of LGBT older adults be addressed across multiple domains, rather than in isolation.
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Affiliation(s)
- Nancy A Orel
- a Gerontology Program, Bowling Green State University , Bowling Green , Ohio , USA
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Kerr DL, Ding K, Thompson AJ. A Comparison of Lesbian, Bisexual, and Heterosexual Female College Undergraduate Students on Selected Reproductive Health Screenings and Sexual Behaviors. Womens Health Issues 2013; 23:e347-55. [DOI: 10.1016/j.whi.2013.09.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 09/07/2013] [Accepted: 09/11/2013] [Indexed: 11/16/2022]
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Charlton BM, Corliss HL, Missmer SA, Frazier AL, Rosario M, Kahn JA, Austin SB. Influence of hormonal contraceptive use and health beliefs on sexual orientation disparities in Papanicolaou test use. Am J Public Health 2013; 104:319-25. [PMID: 23763393 DOI: 10.2105/ajph.2012.301114] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Reproductive health screenings are a necessary part of quality health care. However, sexual minorities underutilize Papanicolaou (Pap) tests more than heterosexuals do, and the reasons are not known. Our objective was to examine if less hormonal contraceptive use or less positive health beliefs about Pap tests explain sexual orientation disparities in Pap test intention and utilization. METHODS We used multivariable regression with prospective data gathered from 3821 females aged 18 to 25 years in the Growing Up Today Study (GUTS). RESULTS Among lesbians, less hormonal contraceptive use explained 8.6% of the disparities in Pap test intention and 36.1% of the disparities in Pap test utilization. Less positive health beliefs associated with Pap testing explained 19.1% of the disparities in Pap test intention. Together, less hormonal contraceptive use and less positive health beliefs explained 29.3% of the disparities in Pap test intention and 42.2% of the disparities in Pap test utilization. CONCLUSIONS Hormonal contraceptive use and health beliefs, to a lesser extent, help to explain sexual orientation disparities in intention and receipt of a Pap test, especially among lesbians.
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Affiliation(s)
- Brittany M Charlton
- Brittany M. Charlton is with the Department of Epidemiology, Harvard School of Public Health, Boston, MA. Heather L. Corliss and S. Bryn Austin are with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA. Stacey A. Missmer, is with Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. A. Lindsay Frazier is with the Dana-Farber Cancer Institute, Boston, MA. Margaret Rosario is with the City University of New York, City College and Graduate Center, New York, NY. Jessica A. Kahn is with the Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Tracy JK, Schluterman NH, Greenberg DR. Understanding cervical cancer screening among lesbians: a national survey. BMC Public Health 2013; 13:442. [PMID: 23642184 PMCID: PMC3693978 DOI: 10.1186/1471-2458-13-442] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 04/22/2013] [Indexed: 11/24/2022] Open
Abstract
Background Lesbians have low rates of cervical cancer screening, even though they are at risk of developing the disease. The aim of this study was to examine cervical cancer screening behaviors in a national sample of lesbians. Methods A standardized internet survey was sent to 3,000 self-identified lesbians to assess cervical cancer screening behaviors and barriers to screening. The sample consisted of 1,006 respondents. Results Sixty-two percent of the weighted sample of respondents were routine screeners. Lack of a physician referral (17.5%) and lack of a physician (17.3%) were the most commonly-cited top reasons for lack of screening. Adjusting for age, education, relationship status, employments status, and insurance status, women who had disclosed their sexual orientation to their primary care physician (adjusted odds ratio [OR] 2.84 [95% confidence interval 1.82-4.45]) or gynecologist (OR 2.30 [1.33-3.96]) had greater odds of routine screening than those who did not. Those who knew that lack of Pap testing is a risk factor for cervical cancer were also more likely to be routine screeners (OR 1.95 [1.30-2.91]), although no association with screening was apparent for women who had more knowledge of general cervical cancer risk factors. Physician recommendation appeared to be a potent determinant of regular screening behavior. Routine screeners perceived more benefits and fewer barriers to screening, as well as higher susceptibility to cervical cancer. Conclusions Some women who identify as lesbian are at a potentially elevated risk of cervical cancer because they are not routinely screened. Evidence-based interventions should be developed to address critical health beliefs that undermine participation in screening. Given the value placed on physician recommendation, patient-provider communication may serve as the optimal focus of effective intervention.
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Affiliation(s)
- J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 10 South Pine Street, MSTF 334-F, Baltimore, MD 21201, USA.
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Austin EL. Sexual Orientation Disclosure to Health Care Providers Among Urban and Non-Urban Southern Lesbians. Women Health 2013; 53:41-55. [DOI: 10.1080/03630242.2012.743497] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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50
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Daley AE. Becoming Seen, Becoming Known: Lesbian Women's Self-Disclosures of Sexual Orientation to Mental Health Service Providers. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2012. [DOI: 10.1080/19359705.2012.680547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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