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Baumann K, Matzke H, Peterson CE, Geller S, Flores R, Prachand NG, Holt HK. Sexual Orientation and Cervical Cancer Screening Among Cisgender Women. JAMA Netw Open 2024; 7:e248886. [PMID: 38709536 DOI: 10.1001/jamanetworkopen.2024.8886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Importance Lesbian, gay, and bisexual populations face barriers accessing health care in Chicago, Illinois. Objective To describe the prevalence of up-to-date cervical cancer screening among lesbian, gay, and bisexual vs heterosexual cisgender women in Chicago. Design, Setting, and Participants This retrospective, cross-sectional, population-based study of cisgender women residing in Chicago was completed from 2020 to 2022 using data from the Healthy Chicago Survey, which is conducted annually by the Chicago Department of Public Health. Participants included cisgender women aged 25 to 64 years with no history of hysterectomy. Respondents who self-identified as lesbian, gay, or bisexual or other than straight, lesbian, or bisexual were coded as lesbian, gay, or bisexual (LGB). Respondents who self-identified as straight were coded as heterosexual. Those who reported having a Papanicolaou test within the past 3 years were considered up-to-date with cervical cancer screening. Data analysis was performed from June to October 2023. Exposures The primary exposure was sexual orientation. Covariates included age, income level, race, ethnicity, having a primary care practitioner (PCP), and insurance coverage. Main Outcomes and Measures Prevalence ratios (PRs), log-based regression models, and interaction analysis were used to describe the association of sexual orientation with up-to-date screening. Results The sample included 5167 cisgender women (447 LGB and 4720 heterosexual), aged 25 to 64 years, with no history of hysterectomy. Among LGB cisgender women, 318 (71.14%) reported previous cervical cancer screening compared with 3632 (76.95%) heterosexual cisgender women. The prevalence of up-to-date screening was 10% lower in the LGB group compared with the heterosexual group (PR, 0.90; 95% CI, 0.82-1.00). In regression analysis, having a PCP (PR, 1.43; 95% CI, 1.29-1.59) was associated with up-to-date screening. In interaction analysis, LGB cisgender women with a PCP were 93% more likely to be up-to-date compared with those without a PCP (PR, 1.93; 95% CI, 1.37-2.72). Conclusions and Relevance In this cross-sectional study of cervical cancer screening rates between the heterosexual and LGB populations in Chicago, up-to-date cervical cancer screening was associated with having a PCP, regardless of sexual orientation, but this association was greater for LGB individuals. Although LGB populations were less likely to be screened, this disparity may be reduced with more consistent health care access and established care with PCPs.
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Affiliation(s)
- Kelley Baumann
- Department of Epidemiology and Biostatistics, University of Illinois Chicago, Chicago
| | - Hannah Matzke
- Chicago Department of Public Health, Chicago, Illinois
| | - Caryn E Peterson
- Department of Epidemiology and Biostatistics, University of Illinois Chicago, Chicago
| | - Stacie Geller
- Center for Research on Women and Gender, University of Illinois Chicago, Chicago
- Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago
| | - Rey Flores
- Department of Behavioral and Social Health Science, Brown University, Providence, Rhode Island
| | | | - Hunter K Holt
- Department of Family and Community Medicine, University of Illinois Chicago, Chicago
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2
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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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3
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Lin E, Sleboda P, Rimel BJ, Chen JT, Hernandez DV, Datta GD. Sexual orientation and gender identity inequities in cervical cancer screening by race and ethnicity. Cancer Causes Control 2024; 35:133-151. [PMID: 37599335 PMCID: PMC10764448 DOI: 10.1007/s10552-023-01771-2] [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: 02/25/2023] [Accepted: 07/30/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND In the United States, inequities in preventive health behaviors such as cervical cancer screening have been documented. Sexual orientation, gender identity, and race/ethnicity all individually contribute to such disparities. However, little work has investigated their joint impact on screening behavior. METHODS Using sampling weighted data from the 2016 and 2018 Behavioral Risk Factor Surveillance System, we assessed differences in two metrics via chi-square statistics: 1) lifetime uptake, and 2) up-to-date cervical cancer screening by sexual orientation and gender identity, within and across racial/ethnic classifications. RESULTS Within all races, individuals who identify as members of sexual and gender minority (SGM) communities reported higher rates of never being screened (except for Black transgender men) than straight or cisgender individuals (p < 0.0001). [*START* Across all races, the Asian/Pacific Islander transgender population (32.4%; weighted n (w.n.) = 1,313) had the lowest proportion of lifetime screening, followed by the Asian/Pacific Islander gay/lesbian (53.0%, w.n. = 21,771), Hispanic transgender (58.7%; w.n. = 24,780), Asian/Pacific Islander bisexual (61.8%, w.n. = 54,524), and Hispanic gay/lesbian (69.6%, w.n. = 125,781) populations. *END*] Straight or cisgender Non-Hispanic White (w.n. = 40,664,476) individuals had the highest proportion of lifetime screening (97.7% and 97.5%, respectively). However, among individuals who had been screened at least once in their lifetime, identifying as SGM was not associated with a decreased proportion of up-to-date screening within or between races. CONCLUSIONS Due to small sample sizes, especially among Asian/Pacific Islander and Hispanic populations, confidence intervals were wide. Heterogeneity in screening participation by SGM status within and across racial/ethnic groups were observed. IMPACT These screening disparities reveal the need to disaggregate data to account for intersecting identities and for studies with larger sample sizes to increase estimate reliability.
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Affiliation(s)
- Emmeline Lin
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
| | - Patrycja Sleboda
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
| | - Bobbie J Rimel
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School Of Public Health, Boston, MA, 02115, USA
| | - Diana V Hernandez
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
| | - Geetanjali D Datta
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA.
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
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Jodry D, Obedin-Maliver J, Flowers L, Jay N, Floyd S, Teoh D, Conageski C, Downs L, Khan MJ. Understanding Sexual and Gender Minority Populations and Organ-Based Screening Recommendations for Human Papillomavirus-Related Cancers. J Low Genit Tract Dis 2023; 27:307-321. [PMID: 37729043 PMCID: PMC10545069 DOI: 10.1097/lgt.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Sexual gender minority (SGM) populations are at risk for human papillomavirus (HPV)-related cancers of the anogenital tract and oropharynx and often face barriers to health care. The goals of this document are to clarify language to provide inclusive care for SGM populations and to provide recommendations for screening and prevention of HPV-related cancers in SGM populations. MATERIALS AND METHODS An expert committee convened by the American Society for Colposcopy and Cervical Pathology performed a narrative review of the literature through February 2023. A comprehensive MEDLINE database search was performed for relevant studies. The literature review was divided into categories by organ/topic and by SGM population. Given the variability in available data for several of the categories, recommendations were made based on national guidelines where appropriate or expert opinion where there were less data to support risk-based guidelines. RESULTS Definitions and terminology relevant to SGM populations are presented. The authors advocate the adoption of sexual orientation gender identity data collection and an organ-based screening approach, which is possible with knowledge of patient anatomy, sexual behaviors, and clinical history. This includes screening for cervical cancer per national recommendations, as well as screening for anal, vulvar, vaginal, penile, and oral cancers based on risk factors and shared clinical decision making. The authors recommend consideration of HPV vaccination in all SGM individuals up to age 45 years old who are at risk. CONCLUSIONS An organ-based screening approach is part of a global strategy to create an inclusive care environment and mitigate barriers to screening and prevention of HPV-mediated cancers in SGM populations.
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Affiliation(s)
| | | | - Lisa Flowers
- Emory University School of Medicine, Atlanta, GA
| | - Naomi Jay
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Serina Floyd
- Planned Parenthood of Metropolitan Washington, DC, Washington, DC
| | - Deanna Teoh
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | | | - Levi Downs
- Park Nicollet Health Services, Minneapolis, MN
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5
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Fazli Khalaf Z, Liow JW, Nalliah S, Foong ALS. When Health Intersects with Gender and Sexual Diversity: Medical Students' Attitudes Towards LGBTQ Patients. JOURNAL OF HOMOSEXUALITY 2023; 70:1763-1786. [PMID: 35285780 DOI: 10.1080/00918369.2022.2042662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A central tenet of the health professions is that of equitable access to health care. However, disparities in equitable healthcare provision continues to be a challenge in many societies due to prejudices against the LGBTQ community. This study was aimed at exploring the attitudes of medical students toward LGBTQ patients in Malaysia. A qualitative approach was adopted to seek depth of understanding of clinical year medical students' perceptions and attitudes toward LGBTQ patients. Data were collected in 2018 through individual interviews and focus group discussions with a total of 29 participants, using a semi-structured question guideline. Purposive sampling comprised representation from the three major ethnic groups in Malaysia. Thematic analysis using NVivo highlighted three main themes i.e., neutrality, in compliance with the Professional Code of Conduct; implicit biases and tolerance of an Odd Identity; explicit biases with prejudices and stereotyping. The lack of knowledge and understanding of the nature and issues of sexuality is problematic as found in this study. They are primarily biases and prejudices projected onto marginalized LGBTQ patients who must contend with multiple jeopardies in conservative societies such as in Malaysia. With some state policies framed around Islam the concern is with the belief among Malay/Islamic students for LGBTQ individuals to go through conversion 'therapies' to become cisgender and heterosexual.
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Affiliation(s)
- Zahra Fazli Khalaf
- Department of Psychology, College of Health and Human Sciences, North Carolina A&T State University, Greensboro, North Carolina, USA
| | - Jun Wei Liow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sivalingam Nalliah
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Andrew L S Foong
- College of Health & Medicine, University of Tasmania, Hobart, Australia
- Faculty of Social Sciences, Quest International University, Perak Darul Ridzuan, Ipoh, Malaysia
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Patel SR, Suero-Abreu GA, Ai A, Ramachandran MK, Meza K, Florez N. Inequity in care delivery in cardio-oncology: dissecting disparities in underrepresented populations. Front Oncol 2023; 13:1124447. [PMID: 37361603 PMCID: PMC10289233 DOI: 10.3389/fonc.2023.1124447] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/03/2023] [Indexed: 06/28/2023] Open
Abstract
It is well known that patients with cancer have a significantly higher cardiovascular mortality risk than the general population. Cardio-oncology has emerged to focus on these issues including risk reduction, detection, monitoring, and treatment of cardiovascular disease or complications in patients with cancer. The rapid advances in early detection and drug development in oncology, along with socioeconomic differences, racial inequities, lack of support, and barriers to accessing quality medical care, have created disparities in various marginalized populations. In this review, we will discuss the factors contributing to disparities in cardio-oncologic care in distinct populations, including Hispanic/Latinx, Black, Asian and Pacific Islander, indigenous populations, sex and gender minorities, and immigrants. Some factors that contribute to differences in outcomes in cardio-oncology include the prevalence of cancer screening rates, genetic cardiac/oncologic risk factors, cultural stressors, tobacco exposure rates, and physical inactivity. We will also discuss the barriers to cardio-oncologic care in these communities from the racial and socioeconomic context. Appropriate and timely cardiovascular and cancer care in minority groups is a critical component in addressing these disparities, and there need to be urgent efforts to address this widening gap.
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Affiliation(s)
- Shruti Rajesh Patel
- Department of Medicine, Division of Oncology, Stanford University and Stanford Cancer Institute, Stanford, CA, United States
| | | | - Angela Ai
- Olive View-University of California, Los Angeles Medical Center, Los Angeles, CA, United States
| | - Maya K. Ramachandran
- Department of Medicine, Division of Oncology, Stanford University and Stanford Cancer Institute, Stanford, CA, United States
| | - Kelly Meza
- Dana Farber Cancer Institute, Boston, MA, United States
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7
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Heer E, Peters C, Knight R, Yang L, Heitman SJ. Participation, barriers, and facilitators of cancer screening among LGBTQ+ populations: A review of the literature. Prev Med 2023; 170:107478. [PMID: 36921771 DOI: 10.1016/j.ypmed.2023.107478] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/13/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
The LGBTQ+ community is at higher risk of certain cancers but is less likely to participate in screening programs or engage with preventive healthcare. Despite this, the barriers and facilitators to cancer screening are not well understood in this population. We conducted a literature review of research related to LGBTQ+ participation in cancer screening, as well as barriers and facilitators to participation. Following abstract and full-text screening, 50 studies were included in the final synthesis. Compared to their heterosexual counterparts, lesbian and bisexual women were less likely to participate in cervical cancer screening and mammography, but gay and bisexual men were more likely to participate in anal and colorectal cancer screening. Transgender individuals had lower rates of screening than cisgender individuals for all cancer types. Barriers to participation were found at the individual-, provider-, and administrator-level, and good communication with a healthcare provider was the strongest facilitator. These results provide reasonable first steps toward improving participation rates for LGBTQ+ populations in cancer screening. Patient-centered approaches should draw on core guiding principles to inform the provision of care, including anticipating LGBTQ+ patients, improving knowledge about care for these patients, and confronting individually-held biases that may affect care, in order to improve care experiences and participation rates in preventive services.
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Affiliation(s)
- Emily Heer
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Cheryl Peters
- BCCDC, Population and Public Health, Vancouver, BC, Canada; BC Cancer, Prevention, Screening, and Hereditary Cancers, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Rod Knight
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Centre de Recherche en Santé Publique, Université de Montréal, Montréal, QC, Canada
| | - Lin Yang
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Steven J Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta, Canada
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8
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Berrut S, Descuves A, Romanens-Pythoud S, Jeannot E. Santé sexuelle et reproductive des femmes ayant des rapports sexuels avec des femmes en Suisse. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:133-143. [PMID: 37336727 DOI: 10.3917/spub.hs2.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Sexual and reproductive health (SRH) of lesbians and other women who have sex with women (WSW) remains largely unexplored in Switzerland. A cross-sectional web- and pa-per-based survey was conducted in 2012. PURPOSE OF RESEARCH The aim of this study was to gain more knowledge on the SRH of the WSW in French-speaking Switzerland in order to inform preventive activities and promote more adequate SRH services for these women. RESULTS Sexual practices between women are very diverse, some of them potentially risky in terms of transmitting various STIs, but 71% of WSW never practice safer sex or other risk reduction strategies for HIV and other STIs with their female partners. Only 69% have had a gynecological check-up in the last 3 years. 16% had one or more children. 29% reported having experienced violence in a lesbian relationship. CONCLUSIONS Specific information on SRH should be developed to match the specificities and needs of WSW and more research is needed on their SRH, their risk regarding breast cancer and ways to improve the cultural sensitivity and knowledge of gynecologists and other health care providers towards their lesbian, bisexual and other WSW patients.
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Poupon C, Poirier M, Blum Y, Lagarrigue S, Parléani C, Vibet MA, Winer N. Difference in Pap test uptake between women who have sex with women and other women in France: A comparative survey of 2032 women. Prev Med Rep 2022; 30:101990. [PMID: 36193090 PMCID: PMC9525892 DOI: 10.1016/j.pmedr.2022.101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 10/26/2022] Open
Abstract
The elimination of cervical cancer has been a priority of the World Health Organization since 2018. The number of these cancers induced by the human papillomavirus (HPV) could be drastically reduced through vaccination and regularly screening by Pap tests. Guidelines for cervical cancer screening apply to all women, including those who have sexual relations with women (WSW), as HPV can be transmitted during sex between two women. As far as we know, our study is the first that compare the Pap test rate between WSW and other women in France. We developed an 18-item questionnaire available on the internet for 15 days and finally analyzed the responses of 2032 women. Based on their responses about their self-definition of their sexual orientation and their sexual behavior, we classified them into three groups of women: exclusive WSW, mixed WSW, and non-WSW. For each question, we tested the statistical differences in responses between these three groups. Our study shows in a large sample representative of the French population that exclusive WSW undergo Pap tests significantly less often than either mixed WSW or non-WSW. Among the exclusive WSW, 28.9 % had never had a Pap test, compared with 9 % of the mixed WSW and 3.1 % of non-WSW (p < 0,001). The responses to our questionnaire contribute to an understanding of this disparity and thus help to envision solutions for better care of all women, regardless of their sexual orientation; this point is crucial for prevention of cervical cancer.
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Affiliation(s)
- Camille Poupon
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS)
| | - Maud Poirier
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS)
| | - Yuna Blum
- Univ Rennes, CNRS, INSERM, IGDR (Institut de Génétique et Développement de Rennes) – UMR6290, ERL U1305, 35000 Rennes, France
| | | | - Cécile Parléani
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS)
| | - Marie-Anne Vibet
- Methodology and Biostatistics Platform, Direction of Research and Innovation, University Hospital of Nantes, France
| | - Norbert Winer
- Medico-psychosocial Obstetrical and Gynecology unit (UGOMPS)
- Department of Gynaecology and Obstetrics, University Hospital of Nantes, NUN INRAE PhAN, UMR 1280, F-44000, France
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10
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Compton ML, Taylor SS, Weeks AG, Weiss VL, Hogan MM, Wang H, Ely KA. Cytology and LGBT+ health: establishing inclusive cancer screening programs. J Am Soc Cytopathol 2022; 11:241-252. [PMID: 35840516 PMCID: PMC10132263 DOI: 10.1016/j.jasc.2022.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/26/2022] [Accepted: 06/14/2022] [Indexed: 11/20/2022]
Abstract
There are substantial disparities in cancer screening for sexual minorities and gender non-conforming patients. In additional to patients having trauma due to negative experiences with the healthcare system, disparities may be heightened due to heteronormative and cisnormative design of screening programs and electronic medical record systems. Furthermore, there are morphologic challenges specific to certain specimen types from the LGBT + population, such as anal cytology samples, cervical cytology from transgender men taking testosterone, and neovaginal cytology samples. Men who have sex with men are at increased risk for anal cancer compared with the general population. While early detection of anal dysplasia decreases the risk of invasive carcinoma, screening programs are not widespread. Cervical cancer screening may be psychologically and physically challenging for transgender men and non-binary patients. The use of exogenous testosterone therapy causes atrophic changes in cervical cytology samples which mimic high-grade dysplasia. The rate of unsatisfactory samples are also increased in this population. Although HPV driven cancers have been reported in patients with neovaginas, there are currently no guidelines about appropriate screening for transgender women and intersex patients who have neovaginas. Cytopathologists can optimize the health of LGBT + patients in many ways including advocating for inclusive screening guidelines, validating self-collection for HPV and cytology samples, updating requisition forms to better capture the spectrum of gender expression, and recognizing the morphologic changes in cytology samples due to exogenous hormone use.
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Affiliation(s)
- Margaret L Compton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Shayne S Taylor
- Vanderbilt University Medical Center for Transgender Health, Nashville, Tennessee
| | - Amy G Weeks
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vivian L Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa M Hogan
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Huiying Wang
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kim A Ely
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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Alpert AB, Scout NFN, Schabath MB, Adams S, Obedin-Maliver J, Safer JD. Gender- and Sexual Orientation- Based Inequities: Promoting Inclusion, Visibility, and Data Accuracy in Oncology. Am Soc Clin Oncol Educ Book 2022; 42:1-17. [PMID: 35658501 DOI: 10.1200/edbk_350175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sexual and gender minority (SGM) people, including agender, asexual, bisexual, gay, gender diverse, genderqueer, genderfluid, intersex, lesbian, nonbinary, pansexual, queer, and transgender people, comprise approximately 10% or more of the U.S. population. Thus, most oncologists see SGM patients whether they know it or not. SGM people experience stigma and structural discrimination that lead to cancer disparities. Because of the lack of systematic and comprehensive data collection, data regarding SGM cancer incidence, outcomes, and treatment responses are limited. Collection of data regarding sexual orientation, gender identity, transgender identity and/or experience, anatomy, and serum hormone concentrations in oncology settings would drastically increase collective knowledge about the impact of stigma and biologic markers on cancer outcomes. Increasing the safety of oncology settings for SGM people will require individual, institutional, and systems changes that will likely improve oncologic care for all patients.
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Affiliation(s)
- Ash B Alpert
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - N F N Scout
- National LGBT Cancer Network, Providence, RI
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Spencer Adams
- School of Interdisciplinary Health Programs, Western Michigan University, Kalamazoo, MI
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA
| | - Joshua D Safer
- Division of Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY.,Mount Sinai Center for Transgender Medicine and Surgery, New York, NY
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12
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Mansour Y, Emerson A, Lipnicky A, Lorvick J, Comfort M, Mildrum Chana S, Ramaswamy M. Cervical Cancer Risk and Prevention Practices Among Sexual Minority Women with Criminal-Legal System Involvement. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2022; 3:98-110. [PMID: 37727363 PMCID: PMC10508889 DOI: 10.1891/lgbtq-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Women with criminal-legal system involvement bear a disproportionate burden of cervical cancer, indeed 4-5 times more than women without criminal-legal system involvement. While we also know that sexual minority identification (lesbian/gay, queer, bisexual, or not straight) is more common among women with criminal-legal system involvement, we lack understanding of the cervical cancer risk and prevention practices of this group of women. In 2019-2020, we used surveys to investigate cervical cancer risk and prevention practices among 510 women with criminal-legal system involvement in Kansas City (KS and MO), Oakland (CA), and Birmingham (AL). In a secondary data analysis, we compared sexual minority women (SMW defined as women who identified as lesbian/gay, bisexual, or other -19% of the sample) to women who identified as heterosexual or straight - 81% of sample). SMW were less likely to have ever gotten a cervical cancer screening test, compared to straight women. Having a provider whom women felt they could rely on was associated with having an up-to-date cervical cancer screening test among SMW. SMW with criminal-legal system involvement are missing out on necessary cancer screenings. Further study to understand why and interventions to ensure this group receives preventive care are needed to prevent cervical cancer and reduce disparities.
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Stenzel AE, Bustamante G, Sarkin CA, Harripersaud K, Jewett P, Teoh D, Vogel RI. The intersection of sexual orientation with race and ethnicity in cervical cancer screening. Cancer 2022; 128:2753-2759. [PMID: 35570647 DOI: 10.1002/cncr.34213] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cervical cancer screening is recommended for those with a cervix who are 21 to 65 years old, with specific timelines being dependent on individual risk. This study compared rates of ever undergoing Papanicolaou (Pap) testing at the intersection of self-reported sexual minority (SM) status and race/ethnicity. METHODS Data from the National Health Interview Survey (2015 and 2018) were used to examine cervical cancer screening disparities. Natal females without a history of hysterectomy who were 21 to 65 years old and had reported their sexual orientation and Pap testing history were included. Demographic and health characteristics were summarized with descriptive statistics. To adjust for differences in confounding variables between groups, propensity score-based inverse probability of treatment weighting (IPTW) was performed. IPTW-adjusted multivariable logistic regression models estimated odds of ever undergoing a Pap test by sexual orientation alone and with race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic). RESULTS SM persons (n = 877) had significantly reduced odds of ever undergoing Pap testing (odds ratio, 0.54; 95% confidence interval, 0.42-0.70) in comparison with heterosexual persons (n = 17,760). When the intersection of sexual orientation and race/ethnicity was considered, non-Hispanic White SM participants and Hispanic SM participants had reduced odds of ever undergoing Pap testing in comparison with non-Hispanic White heterosexual participants. No significant differences were observed between non-Hispanic White heterosexual participants and participants of non-Hispanic Black SM or Hispanic heterosexual identities. CONCLUSIONS SM participants were significantly less likely to have ever undergone a Pap test in comparison with heterosexual participants, with Hispanic SM participants having the lowest uptake. Future studies should further examine the roles of systemic discrimination and other key drivers of these disparities.
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Affiliation(s)
- Ashley E Stenzel
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota.,Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Gabriela Bustamante
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.,School of Public Health, Universidad San Francisco de Quito, Quito, Ecuador
| | - Courtney A Sarkin
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.,Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Katherine Harripersaud
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Patricia Jewett
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota.,Division of Hematology and Oncology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Deanna Teoh
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
| | - Rachel I Vogel
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota
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14
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Paviani G, Chrisostomo KR, Sandrin NM, Hilgert MR, Skare T, Nisihara R. Sexual orientation and gynecologic medical care: A cross-sectional study with Brazilian women. Int J Gynaecol Obstet 2022; 157:458-465. [PMID: 34418094 DOI: 10.1002/ijgo.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study a sample of Brazilian lesbian, bisexual, and heterosexual women concerning their gynecologic history and their experience with gynecologic care. METHODS An internet-based survey for women aged 18 years or older was conducted to gather epidemiologic data on sexual habits, primary gynecologic diseases, and patient-gynecologist relationships. RESULTS The survey was answered by 1201 women, with 571 reporting being heterosexual, 272 lesbian, and 358 bisexual. The lesbian/bisexual (LB) group contained fewer Caucasian individuals, used more public health resources, and had more individuals consuming tobacco, alcohol, and recreational drugs. No significant differences were found in the number of individuals with diabetes mellitus, obesity, hypertension, and sexually transmitted diseases. Depression was more common in the LB group. Endometriosis and vaginismus were more common in bisexual women, whereas polycystic ovary syndrome was more frequent in lesbians. Questions on the patient-gynecologist relationship revealed that most LB women felt uncomfortable and dissatisfied with the treatment received. CONCLUSION The LB group had different epidemiologic characteristics from the heterosexual group. Differences in morbid antecedents were found only in endometriosis, vaginismus, and polycystic ovary syndrome. Most LB Brazilian women are dissatisfied with treatment received from gynecologists.
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Affiliation(s)
- Gislaine Paviani
- Post Graduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Brazil
| | - Kadija R Chrisostomo
- Post Graduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Brazil
| | - Najila M Sandrin
- Department of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Mariana R Hilgert
- Department of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Thelma Skare
- Mackenzie Evangelical School of Medicine, Curitiba, Brazil
| | - Renato Nisihara
- Post Graduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Brazil
- Mackenzie Evangelical School of Medicine, Curitiba, Brazil
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15
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Chan C, Mann AK, Lee D, Nutkiewicz L, Watson KT, Kapp DS, Obedin-Maliver J. Human Papillomavirus Vaccination Over Time in Heterosexual and Sexual Minority Adults in the United States. Health Equity 2022; 6:307-312. [PMID: 35557550 PMCID: PMC9081066 DOI: 10.1089/heq.2021.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose We proposed to identify the factors that determine the trends in human papillomavirus (HPV) vaccination initiation and completion among heterosexual and sexual minority adults. Methods Using National Health and Nutrition Examination Survey database from 2007 to 2016, we performed chi-squared tests and multivariate logistic regression analysis. Results Heterosexual females initiated vaccination at 23.5% compared with sexual minority females at 34.6% (p<0.001). Although heterosexual males also had a lower vaccination initiation than sexual minority males (7.7% vs. 15.5%; p=0.12), their completion rate appeared higher (38% vs. 17%; p=0.14). Conclusion Interventions are needed to enhance support for completion rates of HPV vaccine among sexual minority individuals.
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Affiliation(s)
- Chloe Chan
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Amandeep K. Mann
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Danny Lee
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Lexi Nutkiewicz
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Kathleen T. Watson
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Juno Obedin-Maliver
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
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Puccinelli M, Seay J, Otto A, Garcia S, Crane TE, Benzo RM, Solle N, Mustanski B, Merchant N, Safren SA, Penedo FJ. An adapted cognitive behavioral stress and self-management (CBSM) intervention for sexual minority men living with HIV and cancer using the SmartManage eHealth platform: Study design and protocol. (Preprint). JMIR Res Protoc 2022; 11:e37822. [PMID: 35849435 PMCID: PMC9345025 DOI: 10.2196/37822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
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Affiliation(s)
- Marc Puccinelli
- Department of Psychology, University of Miami, Miami, FL, United States
| | - Julia Seay
- Naval Health Research Center, San Diego, CA, United States
| | - Amy Otto
- Department of Public Health Sciences, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Sofia Garcia
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tracy E Crane
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
- Department of Medicine, University of Miami, Miami, FL, United States
| | - Roberto M Benzo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Natasha Solle
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
- Department of Medicine, University of Miami, Miami, FL, United States
| | - Brian Mustanski
- Feinberg School of Medicine, Northwestern University, chicago, IL, United States
| | - Nipun Merchant
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, United States
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
- Department of Medicine, University of Miami, Miami, FL, United States
- Department of Psychology, University of Miami, Coral Gables, FL, United States
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17
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Waugh E, Myhre D, Beauvais C, Thériault G, Bell NR, Dickinson JA, Grad R, Singh H, Szafran O. Preventive screening in women who have sex with women. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:830-836. [PMID: 34772710 PMCID: PMC8589139 DOI: 10.46747/cfp.6711830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Earle Waugh
- Professor Emeritus and Emeritus Director of the Centre for Health and Culture in the Department of Family Medicine at the University of Alberta in Edmonton.
| | - Douglas Myhre
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary in Alberta
| | - Cassandre Beauvais
- Clinical Instructor in the Department of Family Medicine and Emergency Medicine at the University of Montreal in Laval, Que
| | - Guylène Thériault
- Academic Lead for the Physicianship Component and Director of Pedagogy at Outaouais Medical Campus in the Faculty of Medicine at McGill University in Montreal, Que
| | - Neil R Bell
- Professor of Research in the Department of Family Medicine at the University of Alberta
| | - James A Dickinson
- Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary
| | - Roland Grad
- Associate Professor in the Department of Family Medicine at McGill University
| | - Harminder Singh
- Associate Professor in the Department of Internal Medicine and the Department of Community Health Sciences at the University of Manitoba in Winnipeg and in the Department of Hematology and Oncology at CancerCare Manitoba
| | - Olga Szafran
- Associate Director of Research in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary
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18
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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19
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Cervical cancer screening among sexual minority women: findings from a national survey. Cancer Causes Control 2021; 32:911-917. [PMID: 33987774 DOI: 10.1007/s10552-021-01442-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Sexual minority women (SMW; lesbian, bisexual, and other women who have sex with women) are at risk for cervical cancer but less likely than non-SMW to receive regular cervical cancer screening (Pap- and/or HPV-testing). We examined factors contributing to receipt of guideline-based cervical cancer screening among SMW. METHODS During October 2019, we conducted an online survey of self-identified SMW aged 21-45 years living in the United States (n = 435). We estimated risk differences (RD) in women's likelihood of being within current cervical cancer screening guidelines by sociodemographic and health-related characteristics. RESULTS Overall, 75% of respondents were within current screening guidelines. Adjusting for other factors, SMW were more likely to be within guidelines if they were insured (aRD 0.26, 95% CI 0.13, 0.39), had a partner (aRD 0.18, 95% CI 0.09, 0.28), and were older (aRD 0.12, 95% CI 0.04, 0.20). Overall, the most common reasons for not being screened recently were lack of insurance/cost (42%) and perceiving it was unnecessary (28%). CONCLUSION Many SMW are not being screened for cervical cancer according to guidelines. Findings can inform efforts to improve screening among this population.
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20
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Kirubarajan A, Leung S, Li X, Yau M, Sobel M. Barriers and facilitators for cervical cancer screening among adolescents and young people: a systematic review. BMC Womens Health 2021; 21:122. [PMID: 33757512 PMCID: PMC7989022 DOI: 10.1186/s12905-021-01264-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Though cervical cancer is one of the leading causes of cancer-related death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening as this population has historically been under-screened. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines. The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening (CCS) among adolescents and young people globally. METHODS We conducted a systematic review following PRISMA guidelines of three key databases: Medline-OVID, EMBASE, and CINAHL. Supplementary searches were done through ClinicialTrials.Gov and Scopus. Databases were examined from 1946 until the date of our literature searches on March 12th 2020. We only examined original, peer-reviewed literature. Articles were excluded if they did not specifically discuss CCS, were not specific to individuals under the age of 35, or did not report outcomes or evaluation. All screening, extraction, and synthesis was completed in duplicate with two independent reviewers. Outcomes were summarized descriptively. Risk of bias for individual studies was graded using an adapted rating scale based on the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. RESULTS Of the 2177 original database citations, we included 36 studies that met inclusion criteria. The 36 studies included a total of 14,362 participants, and around half (17/36, 47.2%) of studies specifically targeted students. The majority of studies (31/36, 86.1%) discussed barriers and facilitators to Pap testing specifically, while one study analyzed self-sampling (1/36, 2.8%), one study targeted HPV DNA testing (1/36, 2.8%), and the remainder (4/36, 11.1%) were not specified. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and systemic barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. CONCLUSION There are unique barriers and facilitators that affect CCS rates in adolescents and young people. Health systems and healthcare providers worldwide should address the challenges for this unique population.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Shannon Leung
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
| | - Xinglin Li
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
| | - Matthew Yau
- Faculty of Medicine, University of Toronto, 1 Kings College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mara Sobel
- Department of Obstetrics and Gynecology, Sinai Health System, Toronto, ON, Canada
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21
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Haviland KS, Swette S, Kelechi T, Mueller M. Barriers and Facilitators to Cancer Screening Among LGBTQ Individuals With Cancer. Oncol Nurs Forum 2021; 47:44-55. [PMID: 31845916 DOI: 10.1188/20.onf.44-55] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PROBLEM IDENTIFICATION Cancer screening may reduce mortality and frequency of the disease. Lesbian, gay, bisexual, transgender, or queer (LGBTQ) individuals are less likely than non-LGBTQ individuals to present for cancer screening. LITERATURE SEARCH A literature search was performed using CINAHL®, PsycINFO®, and PubMed®. Articles were included if they were published in English from 2008 to 2018 and addressed barriers or facilitators to cancer screening in LGBTQ populations. DATA EVALUATION Data were organized by thematic matrix and classified according to the multilevel influences on the cancer care continuum framework. SYNTHESIS This integrative review found that the lack of cancer screening data and knowledge about screening guidelines by LGBTQ populations and providers were major barriers to cancer screening adherence. Provider-created welcoming environments and caregiver inclusion were facilitators. IMPLICATIONS FOR PRACTICE Determinants of health-seeking behavior included patients' and providers' lack of cancer screening knowledge, as well as perceived discrimination. Nurses are in a unique position to provide cancer screening information and culturally sensitive care for LGBTQ populations with adequate education.
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22
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Casanova-Perez R, Apodaca C, Bascom E, Mohanraj D, Lane C, Vidyarthi D, Beneteau E, Sabin J, Pratt W, Weibel N, Hartzler AL. Broken down by bias: Healthcare biases experienced by BIPOC and LGBTQ+ patients. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2021:275-284. [PMID: 35308990 PMCID: PMC8861755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Bias toward historically marginalized patients affects patient-provider interactions and can lead to lower quality of care and poor health outcomes for patients who are Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender and Gender Diverse (LGBTQ+). We gathered experiences with biased healthcare interactions and suggested solutions from 25 BIPOC and LGBTQ+ people. Through qualitative thematic analysis of interviews, we identified ten themes. Eight themes reflect the experience of bias: Transactional Care, Power Inequity, Communication Casualties, Bias-Embedded Medicine, System-level problems, Bigotry in Disguise, Fight or Flight, and The Aftermath. The remaining two themes reflect strategies for improving those experiences: Solutions and Good Experiences. Characterizing these themes and their interconnections is crucial to design effective informatics solutions that can address biases operating in clinical interactions with BIPOC and LGBTQ+ patients, improve the quality of patient-provider interactions, and ultimately promote health equity.
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Affiliation(s)
| | | | | | | | | | | | - Erin Beneteau
- University of Washington, Seattle, Washington
- University of California San Diego, San Diego, California
| | | | - Wanda Pratt
- University of Washington, Seattle, Washington
| | - Nadir Weibel
- University of California San Diego, San Diego, California
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Morris MC, Cooper RL, Ramesh A, Tabatabai M, Arcury TA, Shinn M, Im W, Juarez P, Matthews-Juarez P. Preparing Medical Students to Address the Needs of Vulnerable Patient Populations: Implicit Bias Training in US Medical Schools. MEDICAL SCIENCE EDUCATOR 2020; 30:123-127. [PMID: 34457650 PMCID: PMC8368413 DOI: 10.1007/s40670-020-00930-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Little is known about how medical students are trained to identify and reduce their own biases toward vulnerable patient groups. A survey was conducted among US medical schools to determine whether their curricula addressed physician implicit biases toward three vulnerable patient groups: lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals, persons experiencing homelessness, and migrant farmworkers. Of 141 US medical schools, 71 (50%) responded. Survey respondents indicated that implicit bias is not routinely addressed in medical education, and training specific to vulnerable populations is infrequent. Recommendations for incorporating implicit bias training in medical school curricula are discussed.
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Affiliation(s)
- Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS USA
| | - Robert Lyle Cooper
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN USA
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN USA
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN USA
| | - Thomas A. Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Marybeth Shinn
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN USA
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN USA
| | - Paul Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN USA
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24
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IPVS policy statement. Equity in cervical cancer prevention: for all and not just for some. PAPILLOMAVIRUS RESEARCH 2019; 9:100192. [PMID: 31809806 PMCID: PMC7217985 DOI: 10.1016/j.pvr.2019.100192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022]
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25
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Perceived Barriers to Mental Health Services Among Canadian Sexual and Gender Minorities with Depression and at Risk of Suicide. Community Ment Health J 2019; 55:1313-1321. [PMID: 31327106 DOI: 10.1007/s10597-019-00445-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
This study examines barriers to mental health services among sexual and gender minorities (SGM) who screened positive for depression and risk of suicide. Data from an online survey of SGM (N = 2778) are analyzed. 37.5% met criteria for depression and 73.6% screened for being at risk of suicide. The most frequently cited barriers to mental health services access were inability to pay (62.3%), insufficient insurance (52.2%), a preference for 'waiting' for the problems to go away (51.5%), discomfort discussing emotions (45.7%), and feeling embarrassed and ashamed about mental health challenges (42.5%). Policy and practices implications of these findings are discussed.
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Soinio JII, Paavilainen E, Kylmä JPO. Lesbian and bisexual women’s experiences of health care: “Do not say, ‘husband’, say, ‘spouse’”. J Clin Nurs 2019; 29:94-106. [DOI: 10.1111/jocn.15062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Eija Paavilainen
- Faculty of Social Sciences Nursing Science Tampere University Tampere Finland
- South Ostrobothnia Hospital District Seinäjoki Finland
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Socio-demographic Characteristics and Use of Pap Smear for Cervical Cancer Screening Among Women of Eastern Part of India. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Morris M, Cooper RL, Ramesh A, Tabatabai M, Arcury TA, Shinn M, Im W, Juarez P, Matthews-Juarez P. Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systematic review. BMC MEDICAL EDUCATION 2019; 19:325. [PMID: 31470837 PMCID: PMC6716913 DOI: 10.1186/s12909-019-1727-3] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/24/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals experience higher rates of health disparities. These disparities may be driven, in part, by biases of medical providers encountered in health care settings. Little is known about how medical, nursing, or dental students are trained to identify and reduce the effects of their own biases toward LGBTQ individuals. Therefore, a systematic review was conducted to determine the effectiveness of programs to reduce health care student or provider bias towards these LGBTQ patients. METHODS The authors performed searches of online databases (MEDLINE/PubMed, PsycINFO, Web of Science, Scopus, Ingenta, Science Direct, and Google Scholar) for original articles, published in English, between March 2005 and February 2017, describing intervention studies focused on reducing health care student or provider bias towards LGBTQ individuals. Data extracted included sample characteristics (i.e., medical, nursing, or dental students or providers), study design (i.e., pre-post intervention tests, qualitative), program format, program target (i.e., knowledge, comfort level, attitudes, implicit bias), and relevant outcomes. Study quality was assessed using a five-point scale. RESULTS The search identified 639 abstracts addressing bias among medical, nursing, and dental students or providers; from these abstracts, 60 articles were identified as medical education programs to reduce bias; of these articles, 13 described programs to reduce bias towards LGBTQ patients. Bias-focused educational interventions were effective at increasing knowledge of LGBTQ health care issues. Experiential learning interventions were effective at increasing comfort levels working with LGBTQ patients. Intergroup contact was effective at promoting more tolerant attitudes toward LGBTQ patients. Despite promising support for bias education in increasing knowledge and comfort levels among medical, nursing, and dental students or providers towards LGBTQ persons, this systematic review did not identify any interventions that assessed changes in implicit bias among students or providers. CONCLUSIONS Strategies for assessing and mitigating implicit bias towards LGBTQ patients are discussed and recommendations for medical, nursing, and dental school curricula are presented.
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Affiliation(s)
- Matthew Morris
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Boulevard, Nashville, TN 37208 USA
| | - Robert Lyle Cooper
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Boulevard, Nashville, TN 37208 USA
| | - Aramandla Ramesh
- Department of Biochemistry Cancer Biology Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN USA
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN USA
| | - Thomas A. Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Marybeth Shinn
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN USA
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Boulevard, Nashville, TN 37208 USA
| | - Paul Juarez
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Boulevard, Nashville, TN 37208 USA
| | - Patricia Matthews-Juarez
- Department of Family and Community Medicine, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Boulevard, Nashville, TN 37208 USA
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Langston ME, Fuzzell L, Lewis-Thames MW, Khan S, Moore JX. Disparities in Health Information-Seeking Behaviors and Fatalistic Views of Cancer by Sexual Orientation Identity: A Nationally Representative Study of Adults in the United States. LGBT Health 2019; 6:192-201. [PMID: 31107153 DOI: 10.1089/lgbt.2018.0112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose: A lack of national data makes it difficult to estimate, but LGB adults appear to have a higher risk of cancer. Although limited research exists to explain the disparity, we aimed to explore potential differences in access to and utilization of health information and in cancer-related beliefs and behaviors. Methods: We used data from the Health Information National Trends Survey 5, Cycle 1 conducted from January 25 through May 5, 2017. Using survey-weighted logistic regression, we explored potential differences in health information-seeking behavior, trusted sources of health care information, engagement with the health care system, awareness of cancer risk factors, cancer fatalism, cancer-related health behaviors, and historical cancer screening between 117 LGB and 2857 heterosexual respondents. Results: LGB respondents were more likely to report looking for information about health or medical topics than heterosexual respondents (adjusted odds ratio [aOR]: 3.12; confidence interval [95% CI]: 1.07-9.06), but less likely to seek health information first from a doctor (aOR: 0.17; 95% CI: 0.06-0.50) after adjusting for age, race, and sex. LGB persons were less likely to report that they trust receiving health or medical information from friends and family and more likely to be worried about getting cancer (aOR: 2.30; 95% CI: 1.04-5.05). Conclusions: Our findings indicate a growing need for the production of tailored cancer prevention and control materials for members of sexual minority groups. More work is needed to understand barriers that LGB populations face in accessing this health information and building informative social support networks.
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Affiliation(s)
- Marvin E Langston
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Lindsay Fuzzell
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Marquita W Lewis-Thames
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Saira Khan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Justin X Moore
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Johnson CA, James D, Marzan A, Armaos M. Cervical Cancer: An Overview of Pathophysiology and Management. Semin Oncol Nurs 2019; 35:166-174. [DOI: 10.1016/j.soncn.2019.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Tabaac AR, Benotsch EG, Barnes AJ. Mediation Models of Perceived Medical Heterosexism, Provider–Patient Relationship Quality, and Cervical Cancer Screening in a Community Sample of Sexual Minority Women and Gender Nonbinary Adults. LGBT Health 2019; 6:77-86. [DOI: 10.1089/lgbt.2018.0203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ariella R. Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Psychology and Virginia Commonwealth University, Richmond, Virginia
| | - Eric G. Benotsch
- Department of Psychology and Virginia Commonwealth University, Richmond, Virginia
| | - Andrew J. Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
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Clay JM, Daggy JK, Fluellen S, Tucker Edmonds B. Patient knowledge and attitudes toward cervical cancer screening after the 2012 screening guidelines. PATIENT EDUCATION AND COUNSELING 2019; 102:411-415. [PMID: 30314831 DOI: 10.1016/j.pec.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 09/05/2018] [Accepted: 10/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess women's attitudes and preferences related to recent changes in cervical cancer screening guidelines. METHODS We distributed 380 surveys in three University based and Community clinics. Study participants anonymously completed surveys, which included questions related to demographics, cervical cancer, screening practices, risk perception and attitudes towards changing practices. RESULTS 315 women agreed to participate (83%). 60% (185/310) of participants had some college education or higher and 12% (36/305) worked in the medical field. On average, participants answered 4.1 (SD = 1.3) of the 8 knowledge questions correctly. Knowledge scores significantly increased with education level (Kruskal-Wallis test p-value < 0.001). The majority (72%, n = 228) reported that they should be screened annually, and that screening should be initiated with the onset of sexual activity (63%, n = 197). Participants that were more knowledgeable of current screening practices were more comfortable extending screening intervals (Kruskal-Wallis test p < 0.001). CONCLUSION Even among a relatively highly educated population of women, participants had limited knowledge of cervical cancer and current screening guidelines. Many participants reported discomfort with less frequent screening intervals. PRACTICE IMPLICATIONS This study supports the need for improvement in cervical cancer prevention education especially with regards to the new screening guidelines.
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Affiliation(s)
- Jayanti M Clay
- Department of OB/GYN, Indiana University School of Medicine, Indianapolis, USA
| | - Joanne K Daggy
- Department of OB/GYN, Indiana University School of Medicine, Indianapolis, USA
| | - Sunetris Fluellen
- Department of OB/GYN, Indiana University School of Medicine, Indianapolis, USA
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Collecting Sexual Orientation and Gender Identity Information: Filling the Gaps in Sexual and Gender Minority Health. Med Care 2018; 56:205-207. [PMID: 29271823 DOI: 10.1097/mlr.0000000000000856] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Everett BG, Sanders JN, Myers K, Geist C, Turok DK. One in three: challenging heteronormative assumptions in family planning health centers. Contraception 2018; 98:270-274. [PMID: 29958851 PMCID: PMC6182298 DOI: 10.1016/j.contraception.2018.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To estimate the prevalence of sexual-minority women among clients in family planning centers and explore differences in LARC uptake by both sexual identity (i.e., exclusively heterosexual, mostly heterosexual, bisexual, lesbian) and sexual behavior in the past 12 months (i.e., only male partners, both male and female partners, only female partners, no partners) among those enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative. METHODS This survey categorized participants into groups based on reports of sexual identity and sexual behavior. We report contraceptive uptake by these factors, and we used logistic and multinomial logistic models to assess differences in contraceptive method selection by sexual identity and behavior. RESULTS Among 3901 survey respondents, 32% (n=1230) identified with a sexual-minority identity and 6% had had a female partner in the past 12 months. By identity, bisexual and mostly heterosexual women selected an IUD or implant more frequently than exclusively heterosexual women and demonstrated a preference for the copper T380 IUD. Exclusively heterosexual and lesbian women did not differ in their contraceptive method selection, however, by behavior, women with only female partners selected IUDs or implants less frequently than those with only male partners. CONCLUSION One in three women attending family planning centers for contraception identified as a sexual minority. Sexual-minority women selected IUDs or implants more frequently than exclusively heterosexual women. IMPLICATIONS Providers should avoid care assumptions based upon sexual identity. Sexual-minority women should be offered all methods of contraception and be provided with inclusive contraceptive counseling conversations.
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Affiliation(s)
- Bethany G Everett
- The University of Utah, Department of Sociology, 380 S 1530 E #301, Salt Lake City, UT 84112.
| | - Jessica N Sanders
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Kyl Myers
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Claudia Geist
- The University of Utah, Department of Sociology, 380 S 1530 E #301, Salt Lake City, UT 84112
| | - David K Turok
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
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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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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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Vahabi M, Lofters A. HPV self-sampling: A promising approach to reduce cervical cancer screening disparities in Canada. ACTA ACUST UNITED AC 2018; 25:13-18. [PMID: 29507479 DOI: 10.3747/co.25.3845] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Human papillomavirus (HPV) is the primary cause of cervical, anal, and other genital cancers, which are preventable through screening and early treatment. [...]
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Affiliation(s)
- M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Co- Director, Ryerson Centre for Global Health and Health Equity, Graduate Program in Immigration and Settlement Studies, Ryerson University, Toronto, ON
| | - A Lofters
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, and Department of Family and Community Medicine, University of Toronto, Toronto, ON
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Bowling J, Dodge B, Banik S, Bartelt E, Rawat S, Guerra-Reyes L, Hensel D, Herbenick D, Anand V. A multi-method study of health behaviours and perceived concerns of sexual minority females in Mumbai, India. Sex Health 2018; 15:29-38. [PMID: 28859730 PMCID: PMC8742246 DOI: 10.1071/sh17042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/28/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND This multi-method study explores the perceived health status and health behaviours of sexual minority (i.e. self-identifying with a sexual identity label other than heterosexual) females (i.e. those assigned female at birth who may or may not identify as women) in Mumbai, India, a population whose health has been generally absent in scientific literature. METHODS Using community-based participatory research approaches, this study is a partnership with The Humsafar Trust (HST). HST is India's oldest and largest LGBT-advocacy organisation. An online survey targeted towards sexual minority females was conducted (n=49), with questions about sexual identity, perceived health and wellbeing, physical and mental healthcare access and experiences, and health behaviours (including substance use). Additionally, photo-elicitation interviews in which participants' photos prompt interview discussion were conducted with 18 sexual minority females. RESULTS Sexual minority females face obstacles in health care, mostly related to acceptability and quality of care. Their use of preventative health screenings is low. Perceived mental health and experiences with care were less positive than that for physical health. Participants in photo-elicitation interviews described bodyweight issues and caretaking of family members in relation to physical health. Substance use functioned as both a protective and a risk factor for their health. CONCLUSION Our findings point to a need for more resources for sexual minority females. Education on screening guidelines and screening access for sexual minority females would also assist these individuals in increasing their rates of preventative health.
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Affiliation(s)
- Jessamyn Bowling
- University of North Carolina at Charlotte, 9201 University Circle Dr. Department of Public Health Sciences, Charlotte, NC, 28223, USA
| | - Brian Dodge
- Indiana University, Center for Sexual Health Promotion, 1025 E. 7th St, Bloomington, IN, 47401, USA
| | - Swagata Banik
- Baldwin Wallace University, Public Health Program, 725 Eastland Rd. Berea, OH, 44017, USA
| | - Elizabeth Bartelt
- Indiana University, Center for Sexual Health Promotion, 1025 E. 7th St, Bloomington, IN, 47401, USA
| | - Shruta Rawat
- The Humsafar Trust, 3rd floor, Manthan Plaza, Nehru Rd, Vakola, Santacruz East, Mumbai, India
| | - Lucia Guerra-Reyes
- Indiana University, Center for Sexual Health Promotion, 1025 E. 7th St, Bloomington, IN, 47401, USA
| | - Devon Hensel
- Indiana University, Department of Pediatrics, 705 Riley Hospital Dr., Indianapolis, IN 46202 and Department of Sociology, Indiana University-Purdue University, 425 University Blvd., Indianapolis, IN, 46202, USA
| | - Debby Herbenick
- Indiana University, Center for Sexual Health Promotion, 1025 E. 7th St, Bloomington, IN, 47401, USA
| | - Vivek Anand
- The Humsafar Trust, 3rd floor, Manthan Plaza, Nehru Rd, Vakola, Santacruz East, Mumbai, India
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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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Wolff M, Wells B, Ventura-DiPersia C, Renson A, Grov C. Measuring Sexual Orientation: A Review and Critique of U.S. Data Collection Efforts and Implications for Health Policy. JOURNAL OF SEX RESEARCH 2017; 54:507-531. [PMID: 28010119 DOI: 10.1080/00224499.2016.1255872] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The U.S. Department of Health and Human Services' (HHS) Healthy People 2020 goals sought to improve health outcomes among sexual minorities; HHS acknowledged that a dearth of sexual orientation items in federal and state health surveys obscured a broad understanding of sexual minority-related health disparities. The HHS 2011 data progression plan aimed to advance sexual orientation data collection efforts at the national level. Sexual orientation is a complex, multidimensional construct often composed of sexual identity, sexual attraction, and sexual behavior, thus posing challenges to its quantitative and practical measurement and analysis. In this review, we (a) present existing sexual orientation constructs; (b) evaluate current HHS sexual orientation data collection efforts; (c) review post-2011 data progression plan research on sexual minority health disparities, drawing on HHS survey data; (d) highlight the importance of and (e) identify obstacles to multidimensional sexual orientation measurement and analysis; and (f) discuss methods for multidimensional sexual orientation analysis and propose a matrix for addressing discordance/branchedness within these analyses. Multidimensional sexual orientation data collection and analysis would elucidate sexual minority-related health disparities, guide related health policies, and enhance population-based estimates of sexual minority individuals to steer health care practices.
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Affiliation(s)
- Margaret Wolff
- a Department of Community Health and Social Science , CUNY Graduate School of Public Health and Health Policy
| | - Brooke Wells
- b Center for Human Sexuality Studies , Widener University
| | - Christina Ventura-DiPersia
- a Department of Community Health and Social Science , CUNY Graduate School of Public Health and Health Policy
- c Department of Physician Assistant Studies , Hofstra University
| | - Audrey Renson
- d Department of Epidemiology and Biostatistics , CUNY Graduate School of Public Health and Health Policy
| | - Christian Grov
- a Department of Community Health and Social Science , CUNY Graduate School of Public Health and Health Policy
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Maragh-Bass AC, Torain M, Adler R, Schneider E, Ranjit A, Kodadek LM, Shields R, German D, Snyder C, Peterson S, Schuur J, Lau B, Haider AH. Risks, Benefits, and Importance of Collecting Sexual Orientation and Gender Identity Data in Healthcare Settings: A Multi-Method Analysis of Patient and Provider Perspectives. LGBT Health 2017; 4:141-152. [DOI: 10.1089/lgbt.2016.0107] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Allysha C. Maragh-Bass
- The Lighthouse Studies at Peer Point, Departments of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maya Torain
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rachel Adler
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eric Schneider
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anju Ranjit
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lisa M. Kodadek
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan Shields
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Danielle German
- The Lighthouse Studies at Peer Point, Departments of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Claire Snyder
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Peterson
- Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremiah Schuur
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brandyn Lau
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adil H. Haider
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Robinson K, Galloway KY, Bewley S, Meads C. Lesbian and bisexual women's gynaecological conditions: a systematic review and exploratory meta-analysis. BJOG 2017; 124:381-392. [PMID: 27862853 PMCID: PMC5363366 DOI: 10.1111/1471-0528.14414] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Little is known about the gynaecological health of lesbian and bisexual (LB) women. OBJECTIVES To examine differences in incidence and/or prevalence of gynaecological conditions in LB compared with heterosexual women. SEARCH STRATEGY The systematic review protocol was prospectively registered (PROSPERO-CRD42015027091) and searches conducted in seven databases. SELECTION CRITERIA Comparative studies published 2000-2015, reporting any benign (non-infectious) and/or malignant gynaecological conditions with no language or setting restrictions. DATA COLLECTION AND ANALYSIS Inclusions, data extraction and quality assessment were conducted in duplicate. Meta-analyses of condition prevalence rates were conducted where ≥3 studies reported results. MAIN RESULTS From 567 records, 47 full papers were examined and 11 studies of mixed designs included. No studies directly addressing the question were found. Two chronic pelvic pain studies reported higher rates in bisexual compared with heterosexual women (38.5 versus 28.2% and 18.6 versus 6.4%). Meta-analyses showed no statistically significant differences in polycystic ovarian syndrome, endometriosis and fibroids. There was a higher rate of cervical cancer in bisexual than heterosexual women [odds ratio (OR) = 1.94; 95% CI 1.46-2.59] but no difference overall (OR = 0.76; 95% CI 0.15-3.92). There was a lower rate of uterine cancer in lesbian than heterosexual women (OR = 0.28; 95% CI 0.11-0.73) and overall (OR = 0.36; 95% CI 0.13-0.97), but no difference in bisexual women (OR = 0.43; 95% CI 0.06-3.07). CONCLUSIONS More bisexual women may experience chronic pelvic pain and cervical cancer than heterosexual women. There is no information on potential confounders. Better evidence is required, preferably monitoring sexual orientation in research using the existing validated measure and fully reporting results. TWEETABLE ABSTRACT Lesbians have less uterine cancer than heterosexual women; bisexuals have more pelvic pain and cervical cancer.
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Affiliation(s)
- K Robinson
- Division of Women's HealthWomen's Health Academic CentreKing's College London and King's Health PartnersLondonUK
| | - KY Galloway
- Division of Women's HealthWomen's Health Academic CentreKing's College London and King's Health PartnersLondonUK
| | - S Bewley
- Division of Women's HealthWomen's Health Academic CentreKing's College London and King's Health PartnersLondonUK
| | - C Meads
- RAND EuropeWestbrook CentreCambridgeUK
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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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45
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Qualitative Study of Cervical Cancer Screening Among Lesbian and Bisexual Women and Transgender Men. Cancer Nurs 2016; 39:455-463. [DOI: 10.1097/ncc.0000000000000338] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Agénor M, Peitzmeier SM, Gordon AR, Charlton BM, Haneuse S, Potter J, Austin SB. Sexual orientation identity disparities in human papillomavirus vaccination initiation and completion among young adult US women and men. Cancer Causes Control 2016; 27:1187-96. [PMID: 27507284 PMCID: PMC5025383 DOI: 10.1007/s10552-016-0796-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/02/2016] [Indexed: 01/25/2023]
Abstract
PURPOSE To examine the association between sexual orientation identity and human papillomavirus (HPV) vaccination initiation and completion among both women and men. METHODS Using data from the 2013 and 2014 National Health Interview Survey, we estimated logistic regression models for the association between sexual orientation identity and HPV vaccination initiation (≥1 dose) and completion (≥3 doses) among US women and men in relation to sociodemographic and healthcare factors. Analyses were restricted to individuals for whom the HPV vaccine was recommended at some point in their lives, namely women aged 18-34 years (n = 9,734) and men aged 18-31 years (n = 6,812). RESULTS Among all women, bisexual women had higher adjusted odds of HPV vaccination initiation [(odds ratio) 1.71; (95 % confidence interval) 1.20-2.45] and completion (1.59; 1.05-2.42) than heterosexual women. No difference was observed in the odds of HPV vaccination initiation or completion between lesbian and heterosexual women. Among women who had initiated HPV vaccination, lesbians had lower adjusted odds of completion than heterosexual women (0.41; 0.19-0.90). Among all men, gay men had higher adjusted odds of initiating (2.07; 1.17-3.52) and completing (3.90; 1.68-9.06) HPV vaccination than heterosexual men. No difference was observed in the odds of HPV vaccination initiation or completion between bisexual and heterosexual men. Among men who had initiated HPV vaccination, gay (4.36; 1.28-14.83) and bisexual (20.92; 2.34-186.73) men had higher adjusted odds of completion than heterosexual men, although these results are unreliable and should be interpreted with caution. CONCLUSIONS Interventions are needed to promote HPV vaccination among all US women and men, regardless of sexual orientation identity.
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Affiliation(s)
- Madina Agénor
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, MA, 02115, USA.
| | - Sarah M Peitzmeier
- Department of Population, Family and Reproductive Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Allegra R Gordon
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Brittany M Charlton
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer Potter
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, 7th Floor, Boston, MA, 02115, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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47
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Chapman Lambert CL, Azuero A, Enah CC, McMillan SC. A psychometric examination of an instrument to measure the dimensions of Champion's Health Belief Model Scales for cervical cancer screening in women living with HIV. Appl Nurs Res 2016; 33:78-84. [PMID: 28096028 DOI: 10.1016/j.apnr.2016.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 09/12/2016] [Accepted: 09/17/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this paper was to examine the psychometric properties of Champion's Health Belief Model Scales for cervical cancer and screening among women living with HIV. METHODS A secondary data analysis was conducted using data from an exploratory cross-sectional study with a convenience sample of 300 women living with HIV receiving care at two HIV ambulatory care clinics in Florida. A 39-item adaptation of the Champion's Health Belief Model Scales was administered via paper and pencil. RESULTS The authors used internal consistency measures, confirmatory factor analysis, and ordinal item response theory (IRT) techniques to examine the psychometric properties of the instrument. The 39-item instrument had adequate internal consistency and factor structure. However, the IRT analyses suggested that the instrument could be reduced to 24-items (61.5%), without loss of relevant information. CONCLUSION A shortened 24-item instrument demonstrated good internal consistency among women living with HIV. Future work should include validating the properties of the reduced instrument in diverse samples of patients and conditions.
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Affiliation(s)
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35487, USA
| | - Comfort C Enah
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35487, USA
| | - Susan C McMillan
- College of Nursing, University of South Florida, Tampa, FL 33620, USA
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48
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Soto-Salgado M, Colón-López V, Perez C, Muñoz-Masso C, Marrero E, Suárez E, Ortiz AP. Same-Sex Behavior and its Relationship with Sexual and Health-Related Practices Among a Population-Based Sample of Women in Puerto Rico: Implications for Cancer Prevention and Control. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2016; 28:296-305. [PMID: 28286595 PMCID: PMC5341788 DOI: 10.1080/19317611.2016.1223250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This secondary data analysis aimed to estimate the prevalence of same-sex behavior and sexual and health-related practices of a population-based sample (n=560) of women aged 16-64 years in Puerto Rico (PR). Data collection included interviews and biologic samples. Seven percent of the sample had had sex with other women (WSW). Age-adjusted logistic regression models indicated that WSW had higher odds of history of cancer, having ≥ 7 lifetime sexual partners, using sex toys and sharing them, and use of tobacco and illicit drugs. Future research is needed to address the health needs of WSW, including cancer-related risk factors and sexual practices.
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Affiliation(s)
- Marievelisse Soto-Salgado
- Department of Social Sciences, Graduate School of Public
Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto
Rico
- UPR/MDACC Partnership for Excellence in Cancer Research,
University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Vivian Colón-López
- Cancer Control and Population Sciences Program, University
of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Evaluation
Program, Graduate School of Public Health, University of Puerto Rico Medical
Sciences Campus, San Juan, Puerto Rico
| | - Cynthia Perez
- Department of Biostatistics and Epidemiology, Graduate
School of Public Health, University of Puerto Rico Medical Sciences Campus, San
Juan, Puerto Rico
| | - Cristina Muñoz-Masso
- Cancer Control and Population Sciences Program, University
of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Edmir Marrero
- Cancer Control and Population Sciences Program, University
of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Erick Suárez
- Department of Biostatistics and Epidemiology, Graduate
School of Public Health, University of Puerto Rico Medical Sciences Campus, San
Juan, Puerto Rico
| | - Ana P. Ortiz
- Cancer Control and Population Sciences Program, University
of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Biostatistics and Epidemiology, Graduate
School of Public Health, University of Puerto Rico Medical Sciences Campus, San
Juan, Puerto Rico
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49
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Johnson MJ, Mueller M, Eliason MJ, Stuart G, Nemeth LS. Quantitative and mixed analyses to identify factors that affect cervical cancer screening uptake among lesbian and bisexual women and transgender men. J Clin Nurs 2016; 25:3628-3642. [DOI: 10.1111/jocn.13414] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Martina Mueller
- College of Nursing; Medical University of South Carolina; Charleston SC USA
| | - Michele J Eliason
- Department of Health Education; San Francisco State University; San Francisco CA USA
| | - Gail Stuart
- College of Nursing; Medical University of South Carolina; Charleston SC USA
| | - Lynne S Nemeth
- College of Nursing; Medical University of South Carolina; Charleston SC USA
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50
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Murphy J, Mark H, Anderson J, Farley J, Allen J. A Randomized Trial of Human Papillomavirus Self-Sampling as an Intervention to Promote Cervical Cancer Screening Among Women With HIV. J Low Genit Tract Dis 2016; 20:139-44. [PMID: 27015260 PMCID: PMC4808515 DOI: 10.1097/lgt.0000000000000195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Women living with HIV experience higher risk of cervical cancer, but screening rates in the United States are lower than recommended. The purpose of this study was to examine whether an intervention using self-sampling of cervicovaginal cells for human papillomavirus (HPV) with results counseling would increase cervical cytology ("Pap") testing among women with HIV. MATERIALS AND METHODS This was a randomized controlled trial to test the effectiveness of an intervention of self-sampling for HPV and results counseling. Participants were 94 women older than 18 years, with HIV infection, attending an HIV clinic for a primary care visit, whose last cervical cancer screening was 18 months or more before baseline. Women were assigned to the intervention or information-only group. The primary outcome was completion of cervical cytology testing within 6 months of baseline. The secondary outcome was the women's perceived threat of developing cervical cancer. RESULTS A total of 94 women were enrolled and analyzed in the study. The cytology completion rate overall was 35% by 6 months from baseline. There were no differences in comparing HPV-positive with HPV-negative women nor comparing them with the information-only group. In the intervention group, a positive HPV test increased perceived threat of cervical cancer. CONCLUSIONS The intervention did not improve cytology test attendance, although education about HPV and cervical cancer risk as part of study procedures was associated with testing for 35% of this group of women whose previous cytology occurred an average of 3.6 years before the baseline appointment. Self-sampling for HPV testing was feasible.
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