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Everett BG, Bergman Z, Charlton BM, Barcelona V. Sexual Orientation-Specific Policies Are Associated With Prenatal Care Use in the First Trimester Among Sexual Minority Women: Results From a Prospective Cohort Study. Ann Behav Med 2024:kaae037. [PMID: 38990643 DOI: 10.1093/abm/kaae037] [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: 07/13/2024] Open
Abstract
BACKGROUND Previous research has shown sexual minority women (SMW) are more likely to report multiple maternal and infant health outcomes compared to heterosexual women and that these outcomes are moderated by the policy environment. Little is known, however, about prenatal care use disparities or the social determinants of prenatal care use for SMW. PURPOSE To examine the relationship between sexual orientation-specific policies that confer legal protections (e.g., hate crime protections, housing discrimination, same-sex marriage) and prenatal care use among women using a prospective, population-based data set. METHODS Using the National Longitudinal Study of Adolescent to Adult Health and logistic regression, we link measures of state policies to the use of prenatal care in the first trimester among women who had live births. The use of prospective data allows us to adjust for covariates associated with preconception care use prior to pregnancy (n = 586 singleton births to SMW; n = 4,539 singleton births to heterosexual women). RESULTS Sexual orientation-specific policies that conferred protections were associated with increased use of prenatal care among pregnancies reported by SMW (OR = 1.86, 95% CI 1.16, 2.96). In fact, in states with zero protections, we found no differences in prenatal care use by sexual minority status; however, in states with two or more protective policies, SMW were more likely to access prenatal care in the first trimester than heterosexual women. There was no relationship between sexual orientation-specific policy environments and prenatal care use among pregnancies reported by heterosexual women. CONCLUSIONS Recent research has documented that SMW are more likely to have adverse perinatal and obstetrical outcomes than their heterosexual peers. These findings suggest that Lesbian/Gay/Bisexual-specific policy protections may facilitate the use of prenatal care among SMW, a potentially important pathway to improve reproductive health among this population.
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Affiliation(s)
- Bethany G Everett
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Zoë Bergman
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Cambridge, MA, USA
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2
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Chakraborty P, Schroeder E, Reynolds CA, McKetta S, Obedin-Maliver J, Austin SB, Everett B, Haneuse S, Charlton BM. Sexual orientation disparities in adverse pregnancy outcomes. Am J Obstet Gynecol 2024; 231:e34-e43. [PMID: 38453134 PMCID: PMC11194147 DOI: 10.1016/j.ajog.2024.02.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Payal Chakraborty
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 401 Park Dr, Suite 401 E, Boston, MA 02215; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
| | | | - Colleen A Reynolds
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sarah McKetta
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford School of Medicine, Palo Alto, CA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Bethany Everett
- Department of Sociology, University of Utah, Salt Lake City, UT
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
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3
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Seiger KW, McNamara B, Berrahou IK. Gynecologic Care for Sexual and Gender Minority Patients. Obstet Gynecol Clin North Am 2024; 51:17-41. [PMID: 38267126 DOI: 10.1016/j.ogc.2023.10.001] [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: 01/26/2024]
Abstract
Sexual and gender minority (SGM) people, including lesbian, gay, bisexual, transgender, and queer individuals, are a diverse population with a wide spectrum of gynecologic needs. Institutionalized cisheteronormativity, stigmatization, lack of provider training, and fear of discrimination contribute to health disparities in this patient population. In this article, we review key topics in the gynecologic care of SGM patients and provide strategies to enable gynecologists to provide SGM people with equitable and inclusive full spectrum reproductive health care.
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Affiliation(s)
- Kyra W Seiger
- Yale University School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA
| | - Blair McNamara
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Iman K Berrahou
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, Suite 302 FMB, New Haven, CT 06520-806, USA.
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4
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De Genna NM, Coulter RWS, Goldschmidt L, Boss N, Hossain F, Richardson GA. Prenatal Substance Use Among Young Pregnant Sexual Minority People. LGBT Health 2024; 11:74-79. [PMID: 37410511 DOI: 10.1089/lgbt.2023.0026] [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: 07/07/2023] Open
Abstract
Purpose: Sexual minority (SM) youth have higher rates of substance use and pregnancy but are absent from the prenatal substance use literature. We modeled the impact of SM identity and syndemic factors on prenatal substance use among 14- to 21-year-olds. Methods: Pregnant people completed an online survey (n = 357). Prenatal substance use was regressed on SM identity, controlling for other syndemic factors (e.g., depressive symptoms, intimate partner violence) and household substance use. Results: Pregnant SM participants (n = 125) were primarily bisexual and were more likely to use tobacco and illicit drugs than heterosexual participants (n = 232). The association between SM identity and prenatal tobacco use was not attenuated by syndemic factors, prenatal cannabis use, or household tobacco use. Conclusion: SM people need increased support for smoking cessation to redress health inequities in tobacco use, prevent prenatal exposures to tobacco, and limit the long-term consequences of tobacco use on health.
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Affiliation(s)
- Natacha M De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Nicole Boss
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Fahmida Hossain
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gale A Richardson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
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5
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Huang AK, Soled KRS, Chen L, Schulte AR, Hall MFE, McLaughlin C, Srinivasan S, Jahan AB, Mita C, Charlton BM. Mapping the scientific literature on obstetrical and perinatal health among sexual and gender minoritised (SGM) childbearing people and their infants: a scoping review protocol. BMJ Open 2023; 13:e075443. [PMID: 37963699 PMCID: PMC10649461 DOI: 10.1136/bmjopen-2023-075443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/03/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Sexual and gender minoritised (SGM) populations are disproportionately impacted by multilevel risk factors for obstetrical and perinatal outcomes, including structural (eg, stigma, discrimination, access to care) and individual risk factors (eg, partner violence, poor mental health, substance use). Emerging evidence shows SGM childbearing people have worse obstetrical outcomes and their infants have worse perinatal outcomes, when compared with their cisgender and heterosexual counterparts; this emerging evidence necessitates a comprehensive examination of existing literature on obstetrical and perinatal health among SGM people. The goal of this scoping review is to comprehensively map the extent, range and nature of scientific literature on obstetrical and perinatal physical health outcomes among SGM populations and their infants. We aim to summarise findings from existing literature, potentially informing clinical guidelines on perinatal care, as well as highlighting knowledge gaps and providing directions for future research. METHODS AND ANALYSIS We will follow the Joanna Briggs Institute (JBI) scoping review framework and report findings according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. We will conduct a broad systematic search in Medline/PubMed, Embase, CINAHL and Web of Science Core Collection. Eligible studies will include peer-reviewed, empirical, English-language publications pertaining to obstetrical and perinatal physical health outcomes of SGM people or their infants. No temporal or geographical limitations will be applied to the search. Studies conducted in all settings will be considered. Records will be managed, screened and extracted by two independent reviewers. Study characteristics, key findings and research gaps will be presented in tables and summarised narratively. ETHICS AND DISSEMINATION Ethical approval is not required as primary data will not be collected. The findings of this scoping review will be disseminated through a peer-reviewed journal and conference presentations. PROTOCOL REGISTRATION Open Science Framework https://osf.io/6fg4a/.
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Affiliation(s)
- Aimee K Huang
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Kodiak Ray Sung Soled
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura Chen
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Alison R Schulte
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mary-Frances E Hall
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Claire McLaughlin
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Sanjana Srinivasan
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Aava B Jahan
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Carol Mita
- Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Beck D, Hall S, Costa DK, Admon L. Leveraging Population Health Datasets to Advance Maternal Health Research. Matern Child Health J 2023; 27:1683-1688. [PMID: 37294462 PMCID: PMC10251319 DOI: 10.1007/s10995-023-03695-4] [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] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Maternal mortality is a public health crisis in the U.S., with no improvement in decades and worsening disparities during COVID-19. Social determinants of health (SDoH) shape risk for morbidity and mortality but maternal structural and SDoH are under-researched using population health data. To expand knowledge of those at risk for or who have experienced maternal morbidity and inform clinical, policy, and legislative action, creative use of and leveraging existing population health datasets is logical and needed. METHODS We review a sample of population health datasets and highlight recommended changes to the datasets or data collection to better inform existing gaps in maternal health research. RESULTS Across each of the datasets we found insufficient representation of pregnant and postpartum individuals and provide recommendations to enhance these datasets to inform maternal health research. CONCLUSIONS Pregnant and postpartum individuals should be oversampled in population health data to facilitate rapid policy and program evaluation. Postpartum individuals should no longer be hidden within population health datasets. Individuals with pregnancies resulting in outcomes other than livebirth (e.g., abortion, stillbirth, miscarriage) should be included, or asked about these experiences.
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Affiliation(s)
- Dana Beck
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA.
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Stephanie Hall
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Deena Kelly Costa
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
- Yale University, School of Nursing, New Haven, CT, USA
| | - Lindsay Admon
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Harper T, Kuohung W, Sayres L, Willis MD, Wise LA. Optimizing preconception care and interventions for improved population health. Fertil Steril 2023; 120:438-448. [PMID: 36516911 DOI: 10.1016/j.fertnstert.2022.12.014] [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: 08/19/2022] [Revised: 11/18/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
There is growing literature indicating that optimal preconception health is associated with improved reproductive, perinatal, and pediatric outcomes. Given that preconception care is recommended for all individuals planning a pregnancy, medical providers and public health practitioners have a unique opportunity to optimize care and improve health outcomes for reproductive-aged individuals. Knowledge of the determinants of preconception health is important for all types of health professionals, including policy makers. Although some evidence-based recommendations have already been implemented, additional research is needed to identify factors associated with favorable health outcomes and to ensure that effective interventions are made in a timely fashion. Given the largely clinical readership of this journal, this piece is primarily focused on clinical care. However, we acknowledge that optimizing preconception health for the entire population at risk of pregnancy requires broadening our strategies to include population-health interventions that consider the larger social systems, structures, and policies that shape individual health outcomes.
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Affiliation(s)
- Teresa Harper
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Wendy Kuohung
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
| | - Lauren Sayres
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Mary D Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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8
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Barcelona V, Jenkins V, Britton LE, Everett BG. Adverse pregnancy and birth outcomes in sexual minority women from the National Survey of Family Growth. BMC Pregnancy Childbirth 2022; 22:923. [PMID: 36482391 PMCID: PMC9733239 DOI: 10.1186/s12884-022-05271-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Few studies have examined how multiple marginalized identities are associated with adverse pregnancy and birth outcomes, especially for Black and Hispanic sexual minority women. Sexual minorities are people who identify as lesbian, gay, bisexual or transgender (LGBT). The purpose of this study was to examine differences in adverse pregnancy (i.e., miscarriage) and birth outcomes (i.e., preterm birth, low birthweight, and stillbirth) in a national sample of women by race and ethnicity, and sexual minority status (LGBT identification and same-sex sexual behavior). METHODS We conducted a cross-sectional analysis of the National Survey of Family Growth (NSFG). The unit of analysis was pregnancy, not participants. In this study, we examined pregnancies to participants who identified as heterosexual, lesbian, and bisexual, by race and Hispanic ethnicity. We also studied sexual behaviors to categorize participants as women who have sex with women (WSW) and women who have sex with men (WSM). Outcomes included preterm birth, low birthweight, miscarriage, and stillbirth. We employed logistic and linear regression analyses for analyses using STATA. RESULTS We studied 53,751 pregnancies, and 9% of these occurred in people who identified as heterosexual, but had engaged in sexual activity with a female partner (heterosexual-WSW), 7% in those identifying as bisexual, and 1% to women who identified as lesbian. Pregnancies ended in preterm birth (10.7%) and low birthweight (9.0%), stillbirths (2-4%), and miscarriages (17-21%) in sexual minority women. We observed that pregnancies reported by Hispanic lesbian women had a higher birthweight (β = 10.71, SE = 4.1, p-value = 0.01) compared to infants born to Hispanic heterosexual-WSM. Pregnancies to lesbian women were significantly more likely to end in stillbirth (aRR = 3.58, 95% CI 1.30,9.79) compared to heterosexual-WSM. No significant differences were noted in risk of adverse birth outcomes by sexual orientation for NH Black or Hispanic women. CONCLUSION In this sample, preterm births were less likely to occur among heterosexual-WSW than in heterosexual-WSM. Pregnancies to lesbians and bisexual women were more likely to end in miscarriage or stillbirth than heterosexual WSM. Lesbian Hispanic women reported higher birthweights compared to heterosexual-WSM Hispanic women. More research should be done to further understand these findings.
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Affiliation(s)
- Veronica Barcelona
- grid.21729.3f0000000419368729Columbia University School of Nursing, 560 W 168thStreet, Mail Code 6, New York, NY USA
| | - Virginia Jenkins
- grid.223827.e0000 0001 2193 0096The University of Utah, Salt Lake City, UT USA
| | - Laura E. Britton
- grid.21729.3f0000000419368729Columbia University School of Nursing, 560 W 168thStreet, Mail Code 6, New York, NY USA
| | - Bethany G. Everett
- grid.223827.e0000 0001 2193 0096The University of Utah, Salt Lake City, UT USA
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Everett BG, Bos H, Carone N, Gartrell N, Hughes TL. Examining Differences in Alcohol and Smoking Behaviors between Parenting and Nonparenting Lesbian Women. Subst Use Misuse 2022; 57:1442-1449. [PMID: 35765721 PMCID: PMC10625674 DOI: 10.1080/10826084.2022.2091145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The transition to parenthood is a significant life event that has implications for health behaviors and health. Few studies have examined alcohol use and smoking by parenthood status (nonparent vs. parent) among women who identify as lesbian. METHODS This study used data from two longitudinal studies, the Chicago Health and Life Experiences of Women Study (n = 135) and the U.S. National Longitudinal Lesbian Family Study (n = 116), to compare problem drinking and cigarette smoking trajectories among lesbian-identified women by parenthood status. We used mixed models to investigate differences in problem drinking and cigarette smoking in three waves of data in each study. RESULTS Lesbian parents reported significantly less problem drinking, but not cigarette smoking, than nonparent lesbian women. When considering the interaction between parental status and time, problem drinking was significantly higher among nonparents than parents at each time interval. CONCLUSIONS Parenthood was associated with positive changes in drinking among lesbian women; however, more research is needed to understand how to support smoking cessation among parenting lesbian women.
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Affiliation(s)
| | - Henny Bos
- Research Institute Child Development and Education, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicola Carone
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Nanette Gartrell
- Visiting Distinguished Scholar, Williams Institute, UCLA School of Law, and Guest Appointee, University of Amsterdam, Amsterdam, Netherlands
| | - Tonda L. Hughes
- School of Nursing and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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Mollborn S, Limburg A, Everett BG. Mothers' Sexual Identity and Children's Health. POPULATION RESEARCH AND POLICY REVIEW 2022; 41:1217-1239. [PMID: 35934998 PMCID: PMC9355333 DOI: 10.1007/s11113-021-09688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
Sexual minority women face a plethora of structural, socioeconomic, and interpersonal disadvantages and stressors. Research has established negative associations between women's sexual minority identities and both their own health and their infants' birth outcomes. Yet a separate body of scholarship has documented similarities in the development and well-being of children living with same-sex couples relative to those living with similarly situated different-sex couples. This study sought to reconcile these literatures by examining the association between maternal sexual identity and child health at ages 5-18 using a US sample from the full population of children of sexual minority women, including those who identify as mostly heterosexual, bisexual, or lesbian, regardless of partner sex or gender. Analyses using data from the National Longitudinal Study of Adolescent to Adult Health (N=8,978) followed women longitudinally and examined several measures of their children's health, including general health and specific developmental and physical health conditions. Analyses found that children of mostly heterosexual and bisexual women experienced health disadvantages relative to children of heterosexual women, whereas the few children of lesbian women in our sample evidenced a mixture of advantages and disadvantages. These findings underscore that to understand sexual orientation disparities and the intergenerational transmission of health, it is important to incorporate broad measurement of sexual orientation that can capture variation in family forms and in sexual minority identities.
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Affiliation(s)
- Stefanie Mollborn
- Department of Sociology, Stockholm University
- Institute of Behavioral Science, University of Colorado Boulder
| | - Aubrey Limburg
- Institute of Behavioral Science, University of Colorado Boulder
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11
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Leonard SA, Berrahou I, Zhang A, Monseur B, Main EK, Obedin-Maliver J. Sexual and/or gender minority disparities in obstetrical and birth outcomes. Am J Obstet Gynecol 2022; 226:846.e1-846.e14. [PMID: 35358492 DOI: 10.1016/j.ajog.2022.02.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many sexual and/or gender minority individuals build families through pregnancy and childbirth, but it is unknown whether they experience different clinical outcomes than those who are not sexual and/or gender minority individuals. OBJECTIVE To evaluate obstetrical and birth outcomes comparing couples who are likely sexual and/or gender minority patients compared with those who are not likely to be sexual and/or gender minority patients. STUDY DESIGN We performed a population-based cohort study of live birth hospitalizations during 2016 to 2019 linked to birth certificates in California. California changed its birth certificate in 2016 to include gender-neutral fields such as "parent giving birth" and "parent not giving birth," with options for each role to specify "mother," "father," or "parent." We classified birthing patients in mother-mother partnerships and those who identified as a father in any partnership as likely sexual and/or gender minority and classified birthing patients in mother-father partnerships as likely not sexual and/or gender minority. We used multivariable modified Poisson regression models to estimate the risk ratios for associations between likely sexual and/or gender minority parental structures and outcomes. The models were adjusted for sociodemographic factors, comorbidities, and multifetal gestation selected by causal diagrams. We replicated the analyses after excluding multifetal gestations. RESULTS In the final birthing patient sample, 1,483,119 were mothers with father partners, 2572 were mothers with mother partners, and 498 were fathers with any partner. Compared with birthing patients in mother-father partnerships, birthing patients in mother-mother partnerships experienced significantly higher rates of multifetal gestation (adjusted risk ratio, 3.9; 95% confidence interval, 3.4-4.4), labor induction (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3), postpartum hemorrhage (adjusted risk ratio, 1.4; 95% confidence interval, 1.3-1.6), severe morbidity (adjusted risk ratio, 1.4; 95% confidence interval, 1.2-1.8), and nontransfusion severe morbidity (adjusted risk ratio, 1.4; 95% confidence interval, 1.1-1.9). Severe morbidity was identified following the Centers for Disease Control and Prevention "severe maternal morbidity" index. Gestational diabetes mellitus, hypertensive disorders of pregnancy, cesarean delivery, preterm birth (<37 weeks' gestation), low birthweight (<2500 g), and low Apgar score (<7 at 5 minutes) did not significantly differ in the multivariable analyses. No outcomes significantly differed between father birthing patients in any partnership and birthing patients in mother-father partnerships in either crude or multivariable analyses, though the risk of multifetal gestation was nonsignificantly higher (adjusted risk ratio, 1.5; 95% confidence interval, 0.9-2.7). The adjusted risk ratios for the outcomes were similar after restriction to singleton gestations. CONCLUSION Birthing mothers with mother partners experienced disparities in several obstetrical and birth outcomes independent of sociodemographic factors, comorbidities, and multifetal gestation. Birthing fathers in any partnership were not at a significantly elevated risk of any adverse obstetrical or birth outcome considered in this study.
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Affiliation(s)
- Stephanie A Leonard
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA; California Maternal Quality Care Collaborative, Palo Alto, CA.
| | - Iman Berrahou
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA
| | - Adary Zhang
- Department of Medicine, Stanford University, Stanford, CA
| | - Brent Monseur
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Elliott K Main
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA; California Maternal Quality Care Collaborative, Palo Alto, CA
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA; Department of Epidemiology and Population Health, Stanford University, Stanford, CA
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12
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Silveri G, Schimmenti S, Prina E, Gios L, Mirandola M, Converti M, Fiorillo A, Pinna F, Ventriglio A, Galeazzi GM, Sherriff N, Zeeman L, Amaddeo F, Paribello P, Pinna F, Giallanella D, Gaggiano C, Ventriglio A, Converti M, Fiorillo A, Galeazzi GM, Marchi M, Arcolin E, Fiore G, Mirandola M, Schimmenti S, Silveri G, Prina E, Amaddeo F, Bragazzi NL. Barriers in care pathways and unmet mental health needs in LGBTIQ + communities. Int Rev Psychiatry 2022; 34:215-229. [PMID: 36151825 DOI: 10.1080/09540261.2022.2075256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.
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Affiliation(s)
- Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of integrated activity of Mental Health and Pathological Dependencies, USL-IRCSS company of Reggio Emilia, Reggio Emilia, Italy
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Laetitia Zeeman
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Pasquale Paribello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Giallanella
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Costanza Gaggiano
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Arcolin
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Fiore
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
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Kirubarajan A, Barker LC, Leung S, Ross LE, Zaheer J, Park B, Abramovich A, Yudin MH, Lam JSH. LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review. BJOG 2022; 129:1630-1643. [PMID: 35048502 DOI: 10.1111/1471-0528.17103] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND The perinatal period may uniquely impact the mental health and wellbeing of lesbian, gay, bisexual, transgender, queer, and Two-Spirit (LGBTQ2S+) childbearing individuals. OBJECTIVES To characterise and synthesise the experiences of LGBTQ2S+ childbearing individuals regarding perinatal mental health, including symptomatology, access to care and care-seeking. SEARCH STRATEGY We conducted and reported a systematic review following PRISMA guidelines of eight databases (EMBASE, MEDLINE-OVID, CINAHL, Scopus, Web of Science: Core Collection, Sociological Abstracts, Social Work Abstract, and PsycINFO) from inception to 1 March 2021. SELECTION CRITERIA Original, peer-reviewed research related to LGBTQ2S+ mental health was eligible for inclusion if the study was specific to the perinatal period (defined as pregnancy planning, conception, pregnancy, childbirth, and first year postpartum; includes miscarriages, fertility treatments and surrogacy). DATA COLLECTION AND ANALYSIS Findings were synthesised qualitatively via meta-aggregation using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI), and the ConQual approach. MAIN RESULTS Our systematic search included 26 eligible studies encompassing 1199 LGBTQ2S+ childbearing participants. Using the JBI SUMARI approach, we reported 65 results, which we synthesised as six key findings. The studies described unique considerations for LGBTQ2S+ individuals' perinatal mental health, including heteronormativity, cisnormativity, isolation, exclusion from traditional pregnancy care, stigma, and distressing situations from the gendered nature of pregnancy. Many participants described a lack of knowledge from healthcare providers related to care for LGBTQ2S+ individuals. In addition, LGBTQ2S+ individuals described barriers to accessing mental healthcare and gaps in health systems. Strategies to improve care include provider education, avoidance of gendered language, documentation of correct pronouns, trauma-informed practices, cultural humility training and tailored care for LGBTQ2S+ people. CONCLUSIONS Pregnancy, postpartum, and the perinatal period uniquely impacts the mental health and wellbeing of LGBTQ2S+individuals, largely due to systems-level inequities and exclusion from perinatal care. Healthcare providers should implement the identified strategies to improve perinatal care and address inequities.
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Affiliation(s)
- Abirami Kirubarajan
- University of Toronto Faculty of Medicine, Toronto, ON, Canada.,University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada
| | - Lucy C Barker
- University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada.,University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada
| | - Shannon Leung
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Lori E Ross
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Juveria Zaheer
- University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Bomi Park
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Alex Abramovich
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Mark H Yudin
- University of Toronto Department of Obstetrics and Gynaecology, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, Unity Health, St Michael's Hospital, Toronto, ON, Canada
| | - June Sing Hong Lam
- University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada.,University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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14
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Beck DC, Veliz PT, McCabe SE, Boyd CJ, Evans-Polce R. Cigarette, e-cigarette, and dual use during the third trimester of pregnancy in a national sample of heterosexual and sexual minority women. Am J Addict 2021; 30:593-600. [PMID: 34472675 DOI: 10.1111/ajad.13217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/15/2021] [Accepted: 08/11/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Research investigating e-cigarettes/e-products and dual use with cigarettes among pregnant sexual minority individuals in the United States is lacking. This study addresses this gap using a national sample. METHODS Two waves of national panel data (2015-2018) from the Population Assessment of Tobacco and Health study were used. The sample included 1842 women, 237 identified as sexual minorities (n = 17 lesbian, n = 177 bisexual, n = 43 something else), who indicated pregnancy during the past 12 months at Waves 3 or 4. Covariates included race, ethnicity, past-year income, and education. Cigarette, e-cigarette, or dual use was examined during the last trimester. RESULTS Sexual minorities had higher adjusted odds of cigarette use during their last trimester of pregnancy relative to heterosexual women (adjusted odds ratio [AOR] = 1.55, 95% confidence interval [CI] = 1.08, 2.23). Bisexual women had higher odds of smoking cigarettes during their third trimester compared with heterosexual women (AOR = 1.82, 95% CI = 1.21, 2.72). Lesbian women were more likely to use e-cigarettes/e-products (AOR = 9.15, 95% CI = 2.29, 36.5) and indicate dual use (AOR = 6.00, 95% CI = 1.43, 25.1) during their third trimester of pregnancy compared with heterosexual women. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Maternal health among US sexual minority women would benefit from clinicians equipped to provide accurate information and support for Food and Drug Administration-approved smoking cessation, information about e-cigarettes/e-products, and dual use. This study is the first to examine cigarette, e-cigarette, and dual use during the third trimester of pregnancy using a national sample, with specific attention to differences in sexual orientation.
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Affiliation(s)
- Dana C Beck
- National Clinician Scholars Program, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Phil T Veliz
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Sean E McCabe
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Rebecca Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
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15
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Hartnett CS, Butler Z, Everett BG. Disparities in smoking during pregnancy by sexual orientation and race-ethnicity. SSM Popul Health 2021; 15:100831. [PMID: 34169137 PMCID: PMC8207226 DOI: 10.1016/j.ssmph.2021.100831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022] Open
Abstract
The intersection between sexual orientation and race-ethnicity is emerging as an important dynamic for health. Prior research indicates that sexual orientation can have very different health implications for White, Black, and Latina individuals and that these patterns are unpredictable. Here we use U.S. data from the National Survey of Family Growth (2006-2019, n = 15,163 pregnancies) to examine how an important health indicator - smoking during pregnancy - is shaped jointly by sexual orientation and race-ethnicity. Smoking during pregnancy was more common among sexual minority women (both bisexual-identified and heterosexual-identified who expressed same-gender attraction/behavior), compared to heterosexual women. Second, the association between sexual orientation and smoking during pregnancy differed by race-ethnicity: sexual minority status was more strongly associated with smoking among Latina women, compared to White women. Finally, the subgroup with the highest rates of smoking during pregnancy was bisexual White women. These findings indicate that smoking rates among pregnant sexual minority women warrant attention (regardless of race-ethnicity), particularly as births within this group are rising. It is important to address structural factors that may create more stress for sexual minority women, since smoking is often a response to stress. These findings also highlight the role of heterogeneity: low smoking rates among pregnant Latina women mask within-group disparities.
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Affiliation(s)
- Caroline Sten Hartnett
- Department of Sociology, Sloan College #321, University of South Carolina, Columbia, SC, 29205, USA
| | - Zackery Butler
- Department of Sociology, Sloan College #321, University of South Carolina, Columbia, SC, 29205, USA
| | - Bethany G. Everett
- Department of Sociology, 380 S 1530 E Room 301, University of Utah, Salt Lake City, UT, 84112, USA
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16
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Everett BG, Limburg A, Charlton BM, Downing JM, Matthews PA. Sexual Identity and Birth Outcomes: A Focus on the Moderating Role of Race-ethnicity. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:183-201. [PMID: 33687305 PMCID: PMC10368195 DOI: 10.1177/0022146521997811] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Race-ethnic disparities in birth outcomes are well established, and new research suggests that there may also be important sexual identity disparities in birth weight and preterm birth. This study uses the National Longitudinal Study of Adolescent to Adult Health and is the first to examine disparities in birth outcomes at the intersection of race-ethnicity and sexual identity. We use ordinary least sqaures and logistic regression models with live births (n = 10,318) as the unit of analysis clustered on mother ID (n = 5,105), allowing us to adjust for preconception and pregnancy-specific perinatal risk factors as well as neighborhood characteristics. Results show a striking reversal in the effect of lesbian or bisexual identity on birth outcomes across race-ethnicities: For white women, a bisexual or lesbian identity is associated with better birth outcomes than their white heterosexual counterparts, but for Black and Latina women, it is associated with worse birth outcomes than their heterosexual peers.
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Affiliation(s)
| | | | - Brittany M Charlton
- Boston Children's Hospital, Boston, MA, USA
- Harvard University, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Jae M Downing
- Oregon Health and Science University, Portland, OR, USA
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17
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Nall M, Walker IC, Likos KDS. Building reproductive justice into the safety net. Public Health Nurs 2020; 38:239-247. [PMID: 33249620 DOI: 10.1111/phn.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022]
Abstract
The University of Florida Mobile Outreach Clinic (MOC) is a free primary care clinic serving vulnerable communities and citizens without health insurance in Gainesville, Florida, and surrounding areas. This paper describes the approach taken by MOC to offer sexual and reproductive health (SRH) services to underserved patients within a reproductive justice framework.
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Affiliation(s)
- Michelle Nall
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA.,Mobile Outreach Clinic, University of Florida, Gainesville, FL, USA
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18
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Stroumsa D, Johnson TRB. Improving Preconception Health Among Sexual Minority Women. J Womens Health (Larchmt) 2020; 29:745-747. [PMID: 32096677 DOI: 10.1089/jwh.2020.8319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daphna Stroumsa
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Timothy R B Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.,Department of Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan
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