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Foley JD, Morris J, Shepard C, Potter J, Batchelder AW. Evaluating Food Intake Outcomes Among Sexual Minority Women: A Systematic Review. LGBT Health 2022; 9:447-462. [PMID: 35759375 PMCID: PMC9836681 DOI: 10.1089/lgbt.2021.0263] [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: 01/22/2023] Open
Abstract
Purpose: Sexual minority women (SMW) have a higher prevalence of obesity and weight-related health disparities when compared with heterosexual women that may be explained by differences in food intake. This systematic review had two primary aims: (1) synthesize the results for food intake outcomes among SMW, organized primarily according to the dietary risk assessment; and (2) identify possible theoretically informed moderators and mediators of the association between women's sexual identity and differences in food intake. Methods: The literature search was conducted using the PubMed and PsycInfo databases to identify articles published until March 23, 2021. Inclusion criteria were: (1) included a sample of adult SMW, (2) quantitatively assessed a food intake outcome, and (3) published in an English language peer-reviewed journal in the past 10 years. Thirteen articles were eligible and included in the review. Results: Overall, there were inconsistent findings comparing food intake between SMW and heterosexual women. There was some evidence to suggest that identity characteristics beyond sexual orientation (e.g., race and gender presentation) and place of residence (e.g., urban vs. rural settings) were plausible moderators. Only one variable pertaining to SMW's developmental history, mother's diet quality, was identified as a possible mediator. The main critiques of the literature include the predominance of convenience sampling, cross-sectional data, and inconsistencies in the measurement of sexual orientation and diet. Conclusion: This review highlights that further work is needed to consider additional hypotheses to explain disparities in obesity and weight-related health disparities among SMW to inform comprehensive behavioral intervention strategies.
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Affiliation(s)
- Jacklyn D. Foley
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Address correspondence to: Jacklyn D. Foley, PhD, Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA
| | - Jennifer Morris
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Caleigh Shepard
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abigail W. Batchelder
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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Foley JD, Stanton AM, Shepard C, Morris J, O'Cleirigh C, Potter J, Batchelder AW. Discrimination experiences, resilience, and cardiovascular disease risk factors among sexual minority women. J Behav Med 2022; 45:461-471. [PMID: 35503193 DOI: 10.1007/s10865-022-00320-7] [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: 06/01/2021] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
Resilience, or the process of adapting to adversity, may protect against the harmful effects of minority-related stressors on the cardiovascular health of sexual minority women (SMW). An online survey was conducted in a sample of cisgender, non-heterosexual women to evaluate resilience as a moderator of the association between discrimination experiences and key cardiovascular disease (CVD) risk factors: stress, tobacco-smoking, hazardous alcohol consumption, poor diet quality, physical inactivity, and sedentary behaviors. Overall, 191 women (mean age = 29.34, SD = 6.92; 84.5% White) completed the survey and met eligibility to be included in the data analysis. White race (b = - 6.71, SE = 2.49) and education (b = - 3.36, SE = 0.56) were each independently associated with fewer discrimination experiences. Latinx ethnicity was associated with more discrimination experiences (b = 9.34, SE = 2.61). Education was associated with greater resilience (b = 4.57, SE = 0.83). Multivariable regression models were adjusted for race, ethnicity, and education. Discrimination was associated with a higher likelihood of smoking in the past month (b = 0.04, SE = 0.02) and drinking at hazardous levels (b = 0.09, SE = 0.02). Resilience was associated with less stress (b = - 0.15, SE = 0.02), a lower likelihood of hazardous alcohol consumption (b = - 0.02, SE = 0.01) and less time spent engaging in sedentary behaviors (b = - 0.02, SE = 0.01). One moderation emerged, such that discrimination was negatively associated with stress for those low in resilience (b = - 1.75, SE = 0.58), and not associated with stress for those high in resilience. These findings may inform the development of CVD-risk reduction interventions for SMW, which could include both strategies to mitigate the effects of discrimination on substance use and coping skills to promote resilience.
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Affiliation(s)
- Jacklyn D Foley
- Massachusetts General Hospital/Harvard Medical School, Boston, USA. .,Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA, 02114, USA.
| | - Amelia M Stanton
- Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | | | | | - Conall O'Cleirigh
- Massachusetts General Hospital/Harvard Medical School, Boston, USA.,The Fenway Institute, Fenway Health, Boston, USA
| | | | - Abigail W Batchelder
- Massachusetts General Hospital/Harvard Medical School, Boston, USA.,The Fenway Institute, Fenway Health, Boston, USA
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Shaver J, Sharma A, Stephenson R. Rural Primary Care Providers' Experiences and Knowledge Regarding LGBTQ Health in a Midwestern State. J Rural Health 2018; 35:362-373. [PMID: 30203423 DOI: 10.1111/jrh.12322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE Health disparities among LGBTQ people have been documented across various settings and recent research has indicated that many disparities are heightened in the context of rurality. Among these disparities is the decreased rate of primary care utilization by rural LGBTQ individuals. Understanding and addressing provider knowledge and attitudes related to LGBTQ health provides a relevant avenue for addressing underutilization. METHODS The study presented was a mail-out survey regarding rural primary care providers' knowledge and experiences regarding LGBTQ health. Publicly available records were compiled to recruit a total sample of 113 primary care providers, at a response rate of 19.8%. FINDINGS A majority of respondents reported experience providing care to LGBTQ patients, while only slightly over half had received LGBTQ health education. Data analyses revealed significant associations between reported experiences and patient characteristics including religion, religiousness, age, length of time practicing in current provider role, and gender identity. Provider knowledge of LGBTQ health varied greatly across the items assessed. Provider profession (physician, nurse practitioner, physician assistant) and length of current county residence were significantly predictive of LGBTQ knowledge scores. CONCLUSION Results provide insight into rural health care for LGBTQ people. Preeminent findings were: (1) an existing need for LGBTQ health education, (2) variation in knowledge across content areas, and (3) association between knowledge, profession, and length of current county residence. Promotion of rural LGBTQ health may benefit by addressing identified gaps in current care.
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Affiliation(s)
- John Shaver
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
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Corliss HL, VanKim NA, Jun HJ, Austin SB, Hong B, Wang M, Hu FB. Risk of Type 2 Diabetes Among Lesbian, Bisexual, and Heterosexual Women: Findings From the Nurses' Health Study II. Diabetes Care 2018; 41:1448-1454. [PMID: 29720541 PMCID: PMC6014535 DOI: 10.2337/dc17-2656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/05/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Lesbian and bisexual (LB) women are more likely than heterosexual women to exhibit risk factors for type 2 diabetes, but studies estimating the burden of type 2 diabetes among LB women are uncommon and limited to cross-sectional designs. This study investigated incidence of type 2 diabetes in LB women and heterosexual women in a large, longitudinal U.S. cohort. RESEARCH DESIGN AND METHODS Women participating in the Nurses' Health Study II (NHS II) ages 24-44 years in 1989 were prospectively followed through 2013. Self-reported clinician diagnosis of type 2 diabetes was assessed every other year to identify incidence. Of the participants, 1,267 identified as lesbian or bisexual and 92,983 identified as heterosexual. Cox proportional hazards regression was used to model incidence of type 2 diabetes. RESULTS LB women had a 27% higher risk of developing type 2 diabetes than heterosexual women (adjusted incidence rate ratio [IRR] 1.27, 95% CI 1.05, 1.54). Differences between LB women and heterosexual women in risk of type 2 diabetes were greater during younger ages (sexual orientation-by-age interaction, P < 0.001). BMI mediated the relationship between sexual orientation and type 2 diabetes; the IRR was completely attenuated when BMI was added to the model (IRR 0.85, 95% CI 0.70, 1.03). CONCLUSIONS Findings indicate that LB women develop type 2 diabetes at younger ages than heterosexual women. Higher BMI in LB women is an important contributor to this disparity. Public health and clinical efforts to prevent, detect, and manage obesity and type 2 diabetes among LB women are warranted.
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Affiliation(s)
- Heather L Corliss
- Graduate School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego, CA .,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nicole A VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Hee-Jin Jun
- Graduate School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - S Bryn Austin
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Biling Hong
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Molin Wang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Frank B Hu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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A Systematic Scoping Review of Engagement in Physical Activity Among LGBTQ+ Adults. J Phys Act Health 2018; 15:226-232. [DOI: 10.1123/jpah.2017-0292] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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VanKim NA, Austin SB, Jun HJ, Corliss HL. Physical Activity and Sedentary Behaviors Among Lesbian, Bisexual, and Heterosexual Women: Findings from the Nurses' Health Study II. J Womens Health (Larchmt) 2017; 26:1077-1085. [PMID: 28816590 DOI: 10.1089/jwh.2017.6389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Lesbian and bisexual (LB) women are at greater risk of obesity than heterosexuals. However, few studies have examined sexual orientation differences in physical activity (PA) and even fewer have examined differences in sedentary behaviors. This study assessed PA more comprehensively than previous research by including aerobic PA, strengthening PA, and sitting time, to explore sexual orientation differences among adult women. METHODS Nearly 100,000 women from Nurses' Health Study II were included in multivariable-adjusted repeated measures analyses. PA and sedentary behaviors were assessed in 1989, 1991, 1997, 2001, 2005, and 2009 (age range: 24-64 years). Aerobic PA was converted to metabolic equivalent task (MET)-hours/week, whereas strengthening PA and sedentary behaviors were measured in hours/week. About 1.3% of the sample identified as lesbian (n = 926) or bisexual (n = 415). RESULTS On average over repeated measures, LB women reported engaging in 2-3 MET-hours/week more of total aerobic PA (β [95% confidence interval, CI]: lesbian: 2.0 MET-hours/week [0.6-3.4]; bisexual: 2.8 MET-hours/week [0.7-4.7]) than heterosexual women. Bisexual women reported engaging in 0.2 hours/week more of strengthening PA (95% CI: 0.06-0.42) than heterosexuals; there were no differences between lesbians and heterosexuals in strengthening PA. LB women reported sitting an average of 4-5 hours/week more than heterosexuals (lesbian: 4.1 hours/week [3.1-5.2]; bisexual: 5.1 hours/week [3.6-6.7]). CONCLUSIONS Interventions promoting less sitting time among LB women may be warranted. Additionally, findings highlight need for more research into other modifiable factors besides PA, such as minority stress or disordered eating behaviors that may contribute to greater obesity among LB women.
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Affiliation(s)
- Nicole A VanKim
- 1 Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts , Amherst, Massachusetts
| | - S Bryn Austin
- 2 Division of Adolescent and Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts.,3 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,4 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
| | - Hee-Jin Jun
- 5 Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University , San Diego, California
| | - Heather L Corliss
- 3 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,5 Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University , San Diego, California
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Dietary Patterns during Adulthood among Lesbian, Bisexual, and Heterosexual Women in the Nurses' Health Study II. J Acad Nutr Diet 2016; 117:386-395. [PMID: 27889314 DOI: 10.1016/j.jand.2016.09.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 09/26/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Lesbian and bisexual women are at greater risk of being obese than heterosexual women; however, there is little research on dietary intake among lesbian and bisexual women. OBJECTIVE This study estimated differences in dietary quality and intake during adulthood comparing heterosexual women to lesbian and bisexual women. DESIGN Biennial mailed questionnaires were used to collect data from a cohort between 1991 and 2011. Heterosexual-identified women were the reference group. PARTICIPANTS/SETTING More than 100,000 female registered nurses in the United States, aged 24 to 44 years, were recruited in 1989 to participate in the Nurses' Health Study II. More than 90% of the original sample are currently active in the study. About 1.3% identified as lesbian or bisexual. MAIN OUTCOME MEASURES Dietary measures were calculated from a 133-item food frequency questionnaire administered every 4 years. Measures included diet quality (Alternative Healthy Eating Index-2010 and Dietary Approaches to Stop Hypertension); calorie, fat, and fiber intake; and glycemic load and index. STATISTICAL ANALYSES Multivariable adjusted repeated measures linear regression models were fit. RESULTS On average, lesbian and bisexual women reported better diet quality (P<0.001) and diets lower in glycemic index (P<0.001) than heterosexual women. In the whole cohort, diet quality scores increased as participants aged, and were lower among women living in rural compared to urban regions. Comparisons in dietary intake across sexual orientation groups were generally similar across age and rurality status. However, differences between lesbian and heterosexual women in Alternative Healthy Eating Index-2010 were larger during younger compared to older ages, suggesting that diet quality estimates among sexual orientation groups converged as women aged. CONCLUSIONS Lesbian and bisexual women reported higher diet quality than heterosexuals. More research examining how diet affects risk for chronic conditions, such as diabetes, among sexual minorities is needed. Physical activity, sedentary behavior, disordered eating behaviors, and psychosocial and minority stress should be explored as potential contributors to higher rates of obesity among sexual minority women.
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Abstract
PURPOSE Lesbians are more likely to be obese compared to heterosexual women, but little research has examined correlates of obesity among lesbians. The purpose of this study was to examine the association of binge eating and overweight and obesity among lesbians. METHODS Self-identified lesbians (N = 377) between the ages of 18-30 completed an online survey. RESULTS Binge eating was a salient predictor of both overweight and obesity after controlling for demographic variables, outness, diet, and physical activity. CONCLUSION Health promotion and weight loss intervention programs for lesbians should assess binge eating behaviors as a possible contributor to overweight and obesity.
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Affiliation(s)
- Tyler B Mason
- Neuropsychiatric Research Institute , Fargo, North Dakota
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