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Gupta A, Salway T, Jessani A. Cost-related avoidance of oral health service utilization among lesbian, gay, and bisexual individuals in Canada. J Public Health Dent 2023; 83:254-264. [PMID: 37329179 DOI: 10.1111/jphd.12574] [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: 12/03/2021] [Revised: 04/12/2023] [Accepted: 05/17/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES This study estimates the frequency of cost-related oral health service avoidance (CROHSA) among lesbian, gay, and bisexual (LGB) individuals in Canada relative to heterosexual persons. METHODS Heterosexual and sexual minority individuals in Canada were compared using the national probability-based Canadian Community Health Survey 2017-2018. Logistic regression was used to quantify associations between LGB status and CROHSA. Mediators were tested following Andersen's behavioral model of health service utilization and included partnership status, oral health status, presence of dental pain, educational attainment, insurance status, smoking status, general health status, and personal income. RESULTS From our sample of 103,216 individuals, 34.8% of LGB individuals reported avoiding oral health care due to cost compared to 22.7% of heterosexual persons. Disparities were most pronounced among bisexual individuals (odds ratio [OR] 2.29 95% confidence interval [CI] 1.42, 3.49). Disparities persisted despite adjustment for confounding using age, gender/sex, and ethnicity (OR 2.23 95% CI 1.42, 3.49). Disparities were fully mediated by eight hypothesized mediators namely, educational attainment, smoking status, partnership status, income, insurance status, oral health status, and the presence of dental pain (OR 1.69 95% CI 0.94, 3.03). In contrast, lesbian/gay individuals did not have elevated odds of experiencing CROHSA compared to heterosexual individuals (OR 1.27 95% CI 0.84, 1.92). CONCLUSION CROHSA is elevated for bisexual individuals relative to heterosexual individuals. Targeted interventions should be explored to improve oral healthcare access among this population. Future research should assess the role of minority stress and social safety on oral health inequities among sexual minority groups.
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Affiliation(s)
- Amit Gupta
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Abbas Jessani
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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Pachankis JE, Jackson SD. A Developmental Model of the Sexual Minority Closet: Structural Sensitization, Psychological Adaptations, and Post-closet Growth. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1869-1895. [PMID: 35978203 PMCID: PMC9935753 DOI: 10.1007/s10508-022-02381-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/11/2022] [Accepted: 07/11/2022] [Indexed: 05/15/2023]
Abstract
Across the lifespan, most sexual minority individuals experience the closet-a typically prolonged period in which no significant others know their sexual identity. This paper positions the closet as distinct from stigma concealment given its typical duration in years and absolute removal from sources of support for an often-central identity typically during a developmentally sensitive period. The Developmental Model of the Closet proposed here delineates the vicarious learning that takes place before sexual orientation awareness to shape one's eventual experience of the closet; the stressors that take place after one has become aware of their sexual orientation but has not yet disclosed it, which often takes place during adolescence; and potential lifespan-persistent mental health effects of the closet, as moderated by the structural, interpersonal, cultural, and temporal context of disclosure. The paper outlines the ways in which the model both draws upon and is distinct from earlier models of sexual minority identity formation and proposes several testable hypotheses and future research directions, including tests of multilevel interventions.
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Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, Suite 316, New Haven, CT, 06510, USA.
| | - Skyler D Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Hill AO, Cook T, McNair R, Amos N, Carman M, Hartland E, Lyons A, Bourne A. Demographic and psychosocial factors associated with recent suicidal ideation and suicide attempts among trans and gender diverse people in Australia. Suicide Life Threat Behav 2023; 53:320-333. [PMID: 36786221 DOI: 10.1111/sltb.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/15/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Correlates of suicidal ideation and suicide attempts among a large cross-section of trans and gender diverse populations in Australia were examined. METHODS A national survey was conducted that included 1466 trans and gender diverse participants aged 18+ years. Multivariable regressions identified factors associated with recent suicidal ideation and suicide attempts. RESULTS Overall, 62.4% reported suicidal ideation and 9.5% suicide attempt in the past 12 months. The likelihood of suicidal ideation was higher for younger participants or those who felt treated unfairly or socially excluded due to their gender identity in the past 12 months. It was lower for those with a postgraduate degree, who felt accepted by family or work, or who felt their gender identity was respected when accessing a mainstream medical clinic in the past 12 months. The likelihood of suicide attempts was greater for those aged younger or who had recently experienced sexual harassment based on their sexual orientation or gender identity, and lower for those who were non-binary. CONCLUSION Urgent attention for suicide prevention is necessary for trans and gender diverse communities. These findings point to a range of risk and protective factors, which may help inform the targeting and design of suicide prevention strategies.
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Affiliation(s)
- Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Teddy Cook
- ACON Health, Surry Hills, New South Wales, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | | | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,Kirby Institute, UNSW, Sydney, New South Wales, Australia
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Bränström R, Tognetti A. Comment l’évolution de l’opinion publique et des réformes législatives influence-t-elle la satisfaction de vie des minorités sexuelles ? SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:169-178. [PMID: 37336731 DOI: 10.3917/spub.hs2.0169] [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 Structural stigma in the form of legal discrimination and population acceptance of same-sex relationships vary greatly across European countries. Previous cross-sectional research has linked such county variation in stigma with life-satisfaction among sexual minorities, but the consequences of the past decade's improvement in legal recognition and social acceptance of same-sex relationships are unknown. In the current study, we, therefore, examined the change in life-satisfaction among sexual minorities between 2012 and 2019 in France, Sweden, and Poland - three countries for which the legal situation and social acceptance of sexual minorities have changed in different directions during the past decade. METHOD Between April and July 2012, and again between May and July 2019, the European Union Agency for Fundamental Rights conducted web-based surveys to monitor the fundamental rights situation affecting lesbian, gay, and bisexual (LGB) individuals, living in 28 European countries. For the current study, we analyzed data from all LGB respondents in France, Sweden, and Poland, with no history of migration in 2012 (n = 12,357) and 2019 (n = 21,858). RESULTS Regression models adjusted for age, gender, education, and relationship status, showed a strong and significant improvement in life-satisfaction among sexual minorities in France between 2012 and 2019 (β = 0.397, 95 % CI: 0.337, 0.457, p < .001), a country that had experienced improvements in legal recognition (e.g., same-sex marriage legislation in 2013) and improved social acceptance during the same period. In Sweden, which had a high degree of legal recognition and social acceptance in place already in 2012, we found a small increase life-satisfaction among sexual minorities between 2012 and 2019 (β = 0.188, 95 % CI: 0.042, 0.333, p = .012). In Poland, who had experienced deteriorating social acceptance between 2012 and 2019, we found a declined in life-satisfaction among sexual minorities (β = - 0.289, 95 % CI: - 0.385, - 0.193, p < .001). CONCLUSIONS Although life satisfaction has increased during the past decade among sexual minorities living in Europe, there are significant variations across countries largely due to the structural stigma and degree of legal recognition of same-sex relationships of those countries. The findings highlight the importance of further efforts to reduce structural stigma by improving legal recognition and social acceptance of same-sex relationships to promote equitable life satisfaction.
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Salway T, Rich AJ, Ferlatte O, Gesink D, Ross LE, Bränström R, Sadr A, Khan S, Grennan T, Shokoohi M, Brennan DJ, Gilbert M. Preventable mortality among sexual minority Canadians. SSM Popul Health 2022; 20:101276. [PMID: 36337988 PMCID: PMC9634359 DOI: 10.1016/j.ssmph.2022.101276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/02/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background Epidemiologic studies point to multiple health inequities among sexual minority people, but few studies have examined mortality. Some causes of death are more preventable than others, and access to prevention is theorized to follow patterns of access to social and material resources. The objective of this study is to compare estimates of preventable mortality between sexual minority (SM)-i.e., bisexual, lesbian, gay-and heterosexual adults in Canada. Methods A population-based retrospective cohort with 442,260 (unweighted N) Canadian adults, ages 18-59 years, was drawn from the Canadian Community Health Survey/Canadian Mortality Database linked database (2003-2017). The Rutstein preventability rating index was used to classify cause-specific mortality (low/high). Longitudinal analyses were conducted using Cox proportional hazards models. Results SM respondents had higher hazard of all-cause mortality (unadjusted hazard ratio [uHR] 1.28, 95% CI 1.06, 1.55). The uHR increased when the outcome was limited to highly-preventable causes of mortality (uHR 1.43, 95% CI 1.14, 1.80). The uHR further increased in sensitivity analyses using higher thresholds of the Rutstein index. SM respondents had higher hazard of cause-specific mortality for heart disease (uHR 1.53, 95% CI 1.03, 2.29), accidents (uHR 1.97, 95% CI 1.01, 3.86), HIV (uHR 75.69, 95% CI 18.77, 305.20), and suicide (uHR 2.22, 95% CI 0.93, 5.30) but not for cancer (uHR 0.86, 95% CI 0.60, 1.25). The adjusted HR (aHR) for highly-preventable mortality was not attenuated by adjustment for confounders (aHR 1.57, 95% CI 1.20, 2.05) but was reduced by adjustment for hypothesized mediators relating to access to social and material resources (marital status, children, income, education; aHR 1.11, 95% CI 0.78, 1.58). Conclusions Preventable mortality was elevated for SM Canadians compared to heterosexuals. Early and broad access to sexual minority-affirming primary and preventive healthcare should be expanded.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Corresponding author. Blusson Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Ashleigh J. Rich
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal, Montréal, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lori E. Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Richard Bränström
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aida Sadr
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Syma Khan
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada
- Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Marti-Pastor M, German D, Perez G, Bartoll X, Diez E, Pont A, Garín O, Alonso J, Hernandez G, Mayoral K, Zamora V, Vilagut G, Ferrer M. Health Inequalities by Sexual Orientation: Results from the 2016-2017 Barcelona Health Survey. LGBT Health 2022; 9:496-511. [PMID: 35802488 PMCID: PMC9639238 DOI: 10.1089/lgbt.2021.0171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of this study was to assess health inequalities by sexual attraction in the 2016-2017 Barcelona population, stratifying by sex. Methods: Data came from the 2016-2017 Barcelona Health Survey, where 3362 adults answered among other instruments the EuroQol-5 dimensions-5 levels (EQ-5D-5L), which measures five dimensions and summarizes health-related quality of life into a single utility index score. To assess health differences by sexual attraction, we constructed Tobit models for the EQ-5D index score and Poisson regression models for the EQ-5D dimensions. Nested models were constructed to examine the mediating role of discrimination and health-related variables. Results: After adjusting for sociodemographic variables, women feeling attraction to more than one sex showed a lower EQ-5D index score (worse health) than those with only other sex attraction (-0.042, p = 0.012), and higher prevalence of problems with mobility, usual activities, and anxiety/depression with the following adjusted prevalence ratios (aPR) and confidence intervals (CIs): 1.79 (95% CI 1.05-3.05), 1.84 (95% CI 1.05-3.21), and 1.76 (95% CI 1.27-2.43). Women feeling attraction only to their same sex also presented higher prevalence of anxiety/depression (aPR = 1.46, CI 95% 1.10-1.92). In contrast, differences were not observed for men. Conclusion: Women, but not men, feeling attraction to more than one sex and only same-sex attraction in Barcelona in 2016-2017 presented worse health than those feeling only other sex attraction, with discrimination playing a mediating role in explaining such inequalities. These results among women indicate the need to develop public health strategies in Barcelona addressed to lesbian and bisexual women, considering the intersection of gender and sexual orientation.
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Affiliation(s)
- Marc Marti-Pastor
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventative Medicine, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gloria Perez
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Agency of Barcelona, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
- Health Inequalities Research Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Xavier Bartoll
- Public Health Agency of Barcelona, Barcelona, Spain
- Health Inequalities Research Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Elia Diez
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Agency of Barcelona, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
- Health Inequalities Research Group, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Angels Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Olatz Garín
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Jordi Alonso
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Gimena Hernandez
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CAP Vila Olimpica, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Karina Mayoral
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventative Medicine, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Victor Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventative Medicine, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Gemma Vilagut
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventative Medicine, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
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Kabátek J, Perales F, Ablaza C. Evidence of a Fraternal Birth Order Effect on Male and Female Same-Sex Marriage in the Dutch Population: A Reply to Blanchard and Semenyna, Gómez Jiménez & Vasey. JOURNAL OF SEX RESEARCH 2022; 59:697-703. [PMID: 35040372 DOI: 10.1080/00224499.2021.2002798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Jan Kabátek
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne
- ARC Centre of Excellence for Children and Families over the Life Course
- Institute of Labor Economics (IZA)
- CentER, Tilburg University
| | - Francisco Perales
- ARC Centre of Excellence for Children and Families over the Life Course
- School of Social Science, Faculty of Humanities and Social Sciences, The University of Queensland
| | - Christine Ablaza
- ARC Centre of Excellence for Children and Families over the Life Course
- School of Social Science, Faculty of Humanities and Social Sciences, The University of Queensland
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Gupta AK, Salway T. Prescription Drug Insurance and Cost-Related Medication Nonadherence Among Lesbian, Gay, and Bisexual Individuals in Canada. LGBT Health 2022; 9:426-435. [PMID: 35537531 DOI: 10.1089/lgbt.2021.0273] [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: 11/12/2022] Open
Abstract
Purpose: This study estimates the frequency of uninsurance for prescription drugs and cost-related medication nonadherence (CRNA) among lesbian, gay, and bisexual (LGB) persons in Canada, compared with the heterosexual population. Methods: Logistic regression was used to quantify associations between sexual orientation, insurance status, and CRNA within the national probability-based Canadian Community Health Survey, 2015-2016. This sample included 98,413 individuals aged 15-80 years, including 2803 LGB individuals. Results: From our sample of Canadians, 22.2% of LGB respondents reported being uninsured for prescription drugs, compared with 20.0% of heterosexual persons (unadjusted odds ratio [UOR] 1.00, 95% confidence interval [CI] 0.75-1.33). LGB individuals had more than twice the odds of reporting CRNA compared with heterosexual individuals (UOR 2.48, 95% CI 1.99-3.10). This disparity was most pronounced among bisexual respondents, who had over three times the odds of reporting CRNA in comparison to heterosexual respondents (UOR 3.45, 95% CI 2.65-4.51). The odds ratio (OR) for CRNA comparing bisexual with heterosexual individuals remained statistically significant after adjustment for race/ethnicity, gender/sex, and age (OR 2.67, 95% CI 1.97-3.61) and was further attenuated with adjustment for partnership status, employment status, income, educational attainment, prescription drug insurance status, general health status, and immigration status (OR 2.09, 95% CI 1.51-2.89). Conclusion: LGB Canadians reported more CRNA but comparable prescription drug insurance frequencies to heterosexual persons. Factors pertaining to medication access (e.g., income, partnership status) and health needs appear to be the most important contributors to disparities.
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Affiliation(s)
- Amit K Gupta
- British Columbia Centre for Disease Control, Vancouver, Canada.,Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, Canada
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Hill AO, Lyons A, Power J, Amos N, Ferlatte O, Jones J, Carman M, Bourne A. Suicidal Ideation and Suicide Attempts Among Lesbian, Gay, Bisexual, Pansexual, Queer, and Asexual Youth: Differential Impacts of Sexual Orientation, Verbal, Physical, or Sexual Harassment or Assault, Conversion Practices, Family or Household Religiosity, and School Experience. LGBT Health 2022; 9:313-324. [PMID: 35420458 DOI: 10.1089/lgbt.2021.0270] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This article examines factors associated with suicidal ideation and suicide attempts in the past 12 months among lesbian, gay, bisexual, pansexual, queer, asexual, or other non-heterosexual identifying youth (LGBQA+). Methods: A national Australian cross-sectional online survey was conducted involving 4370 cisgender LGBQA+ participants aged 14-21 years from September to October 2019. Multivariable logistic regression analyses were performed to examine significant factors associated with suicidal ideation and suicide attempts in the past 12 months. Research ethics approval for the WTI4 study was granted by the La Trobe University Human Research Ethics Committee and the ACON Research Ethics Review Committee. Results: Overall, 56.4% of participants reported suicidal ideation and 8.9% a suicide attempt in the past 12 months. Multivariable regression results show that participants aged younger than 18 years, lesbian (compared with gay) identifying, those living in rural or remote locations (compared with inner city), those reporting any verbal, physical, or sexual harassment or assault based on sexual orientation or gender identity, or who had a religious family or household, or had experienced conversion practices in the past 12 months reported higher levels of suicidal ideation or suicide attempts. Those who reported feeling part of their school reported lower levels of suicidal ideation and suicide attempts. Conclusion: High levels of suicidal ideation and suicide attempts among young LGBQA+ people in Australia highlight a need for the ongoing inclusion of LGBQA+ youth as a priority population for suicide prevention. The findings illustrate key factors associated with a greater risk of suicidality among young LGBQA+ people. These findings can be used to inform the provision of tailored support services, including culturally safe suicide prevention programs and efforts to address stigma, discrimination, and conversion practices.
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Affiliation(s)
- Adam O Hill
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Olivier Ferlatte
- École de Santé Publique de l'Université de Montréal, Montreal, Canada.,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Jami Jones
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Kirby Institute, University of New South Wales, Sydney, Australia
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10
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St-Jean M, Closson K, Salway T, Card K, Patterson TL, Hogg RS, Lima VD. Sexual minority status modifies the association between HIV risk behavior and prevalent mood or anxiety disorders in British Columbia, Canada. Soc Psychiatry Psychiatr Epidemiol 2022; 57:207-218. [PMID: 34279694 DOI: 10.1007/s00127-021-02141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed at determining to what extent sexual minority status modifies the association between HIV risk behavior and prevalent mood or anxiety disorder diagnosis in British Columbia (BC), Canada, using a population-based survey. METHODS This analysis was based on the cross-sectional 2013-2014 Canadian Community Health Survey. The sample was restricted to respondents in BC with valid responses to the survey items considered. A multivariable logistic model, where the behavioral HIV risk score exposure was nested into the sexual minority status modifier, estimated the odds of having a prevalent mood or an anxiety disorder. The behavioral HIV risk score (0, 1, 2, ≥ 3) included the following five measures: (1) age at first intercourse < 14 years, (2) condom use during last intercourse, (3) history of sexually transmitted infections, (5) number of sexual partners in the past 12 months (< 4, ≥ 4), and substance use in the past 12 months. RESULTS Of the weighted sample (2,521,252), 97% (95% confidence interval (CI) 97-98) were heterosexual, while 3% (95% CI 2-3) were lesbian, gay, and bisexual (LGB). The prevalence of a mood or anxiety disorder diagnosis was 12% (95% CI 11-13). For every 1-level increment in the behavioral HIV risk score, the adjusted odds ratio of having a prevalent mood or anxiety disorder diagnosis was 1.29 (95% CI 1.03-1.54) for heterosexual respondents and 2.37 (95% CI 1.84-2.90) for LGB respondents. CONCLUSION Sexual minority status modified the relationship between HIV risk behavior and prevalent mood or anxiety disorders, with a stronger association among LGB respondents. Healthcare providers should prioritize integrated care that addresses the intersectionality between sexual risk, substance use, and mood or anxiety disorders.
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Affiliation(s)
- Martin St-Jean
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,Division of Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Kiffer Card
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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11
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Chen D, Watson RJ, Caputi TL, Shover CL. Proportion of U.S. Clinics Offering LGBT-Tailored Mental Health Services Decreased Over Time: A Panel Study of the National Mental Health Services Survey. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2021; 2:174-184. [PMID: 34901933 DOI: 10.1891/lgbtq-2020-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Our objective was to characterize the proportion of U.S. mental health clinics that offered LGBT-tailored mental health services between 2014 and 2018. We used data from the National Mental Health Services Survey (NMHSS) to construct a mixed logistic model of availability of LGBT-tailored mental health services over time, by region (Northeast, South, Midwest and West), and by facility type (Veterans Administration, inpatient/residential, outpatient, community mental health centers and mixed). Our results show that the overall proportion of mental health clinics that offered LGBT-tailored services decreased from 2014 to 2018. Our results also indicate that Veteran Affairs clinics and facilities in the West and Northeast were most likely to offer LGBT-tailored mental health services. Given the temporal, regional, and facility gaps in LGBT-tailored mental health services availability, more effort should be dedicated to addressing this disparity.
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Affiliation(s)
- Derek Chen
- Stanford University School of Humanities and Sciences, Program in Feminist, Gender and Sexuality Studies, Stanford, CA
| | - Ryan J Watson
- University of Connecticut, Department of Human Development & Family Sciences, CT, USA
| | | | - Chelsea L Shover
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, CA, USA
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12
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Gibb JK, Shokoohi M, Salway T, Ross LE. Sexual orientation-based disparities in food security among adults in the United States: results from the 2003-2016 NHANES. Am J Clin Nutr 2021; 114:2006-2016. [PMID: 34551071 DOI: 10.1093/ajcn/nqab290] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/11/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Access to sufficient, safe, culturally appropriate, and nutritious food is essential for maintaining both physical and mental health. Despite a growing body of evidence suggesting that sexual minority (SM) people experience significant disparities in socioeconomic and material resource security, there remains a paucity of empirical studies examining the prevalence of food insecurity among SM people relative to their heterosexual peers. OBJECTIVES To determine the prevalence of adult and household food insecurity across sexual orientation groups in the United States after adjusting for multiple covariates. METHODS We combined 7 cycles of US NHANES, 2003-2016 (N = 21,300) to examine sexual orientation-based disparities in adult food security among lesbian/gay (n = 373), bisexual (n = 606), same-sex experienced (SSE, n = 693), other sexual minorities (OSMs, n = 88), and heterosexual (n = 19,540) people. Food (in)security was measured using the US Food Security Survey Module and categorized as secure, marginally insecure, moderately insecure, and severely insecure. RESULTS Severe adult food insecurity was higher among bisexuals (17.16%; 95% CI: 14.36, 20.38), SSE (13.71%; 95% CI: 11.34, 16.48), OSMs (12.50%; 95% CI: 7.04, 21.24), and lesbians/gays (13.14%; 95% CI: 10.07, 16.97) compared with heterosexuals (8.23%; 95% CI: 7.85, 8.62). Multivariable multinomial logistic regression analysis adjusting for gender, race/ethnicity, age, citizenship, education, household size, income, cycle year, emergency food use, and Supplemental Nutrition Assistance Program participation showed that bisexuals, OSMs, SSE, and lesbians/gays were more likely to experience moderate to severe food insecurity compared with heterosexuals. CONCLUSIONS SM people are significantly more likely to experience increased likelihood of food insecurity relative to their heterosexual peers.
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Affiliation(s)
- James K Gibb
- Department of Health & Society, University of Toronto, Scarborough, Ontario, Canada.,Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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13
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Greene N, Johnson RM, Rosen J, German D, Cohen JE. Exploring the relationship between the alcohol policy environment and nondiscrimination laws: Implications for binge drinking disparities among LGB adults in the United States. Drug Alcohol Depend 2021; 225:108749. [PMID: 34049096 PMCID: PMC8282708 DOI: 10.1016/j.drugalcdep.2021.108749] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Alcohol policies reduce population-level binge drinking; however, they may not reduce binge drinking disparities between different populations. We examined the association between the alcohol policy environment and binge drinking among Lesbian, Gay and Bisexual (LGB) and heterosexual adults in the presence and absence of state laws protecting LGB people from discrimination. METHODS The 2015-2018 Behavioral Risk Factor Surveillance System (BRFSS) provided information about individual-level binge drinking, sexual identity, and individual-level covariates. The Alcohol Policy Scale (APS) score measures the strength of the alcohol policy environment. Presence of state-level nondiscrimination protections based on sexual orientation came from the Movement Advancement Project. Logistic regression models were used to test whether nondiscrimination statutes modified the association between the alcohol policy environment and binge drinking and whether this interaction differed for LGB and heterosexual adults. RESULTS Among women, a 10 percentage-point increase in APS score was significantly associated with 7% lower odds of binge drinking in states with inclusive nondiscrimination laws (aOR: 0.93 [95% CI: 0.89-0.97; p = 0.0003]) but was not associated with binge drinking in states without inclusive laws (aOR: 0.98 [95% CI: 0.93-1.03] p = 0.4781). Moreover, binge drinking disparities comparing lesbian/bisexual women with heterosexual women were narrower in states with inclusive nondiscrimination laws. No significant association was found among men. CONCLUSIONS Binge drinking disparities between lesbian and heterosexual women are negligible in states with inclusive laws and strong alcohol policy environments. Inclusive nondiscrimination laws are an indicator of less structural stigma directed at lesbian and bisexual women.
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Affiliation(s)
- Naomi Greene
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway Street, Baltimore, MD, 21205, United States.
| | - Renee M. Johnson
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 624 N. Broadway Street, Baltimore, MD 21205
| | - Joanne Rosen
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway Street, Baltimore, MD, 21205, United States.
| | - Danielle German
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway Street, Baltimore, MD, 21205, United States.
| | - Joanna E. Cohen
- Department of Health, Behavior and Society; Bloomberg School of Public Health, Johns Hopkins University; 624 N. Broadway Street, Baltimore, MD 21205
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14
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Freedman MS, Beer L, Mattson CL, Sullivan PS, Skarbinski J. Behavioral and Clinical Characteristics of Self-Identified Bisexual Men Living with HIV Receiving Medical Care in the United States-Medical Monitoring Project, 2009-2013. JOURNAL OF HOMOSEXUALITY 2021; 68:1223-1241. [PMID: 31173564 PMCID: PMC11301764 DOI: 10.1080/00918369.2019.1621553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Nationally representative data comparing demographic, risk, and clinical information among bisexual men with other MSM or heterosexuals are lacking. We described differences in demographic characteristics, behaviors, and clinical outcomes among self-identified HIV-positive bisexual, gay, and heterosexual men receiving HIV medical care in the United States. We analyzed data from the 2009-2013 cycles of the Medical Monitoring Project (MMP), a surveillance system that provides nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in medical care. Altogether, 10% (95% confidence interval [CI] 9-11) of men self-identified as bisexual, 56% (CI 51-61) as gay, and 32% (CI 28-37) as heterosexual. We observed significant differences in demographic factors, clinical outcomes, drug use, and sexual behavior among bisexual men compared with gay and heterosexual men. Providers should consider sexual identities as well as sexual behaviors when developing and implementing prevention programs.
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Affiliation(s)
- Mark S. Freedman
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda Beer
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christine L. Mattson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jacek Skarbinski
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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15
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Becerra MB, Rodriquez EJ, Avina RM, Becerra BJ. Experiences of violence and mental health outcomes among Asian American transgender adults in the United States. PLoS One 2021; 16:e0247812. [PMID: 33662045 PMCID: PMC7932064 DOI: 10.1371/journal.pone.0247812] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/15/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We addressed prevalence and factors associated with mental health outcomes (suicidal behavior and psychological distress) among Asian Americans (AA), who identify as transgender, a key group among sexual and gender minorities that is overlooked and understudied. METHODS We used data from 2015 United States Transgender Survey during 2019-2020 with our population as census defined AA. Outcomes included suicidal ideation, suicidal thoughts, and serious psychological distress (SPD). Independent variables included any abuse, partner abuse, bathroom-related abuse, and additional covariates. Adjusted odds ratio and 95% confidence interval (aOR; 95% CI) for each outcome are adjusted for age, marital status, citizenship status, education level, employment status, as well as poverty status. RESULTS Nearly 67% reported experiencing any abuse, 52% reported abuse from romantic/sexual partner(s), while 29% reported harassment/abuse when trying to use bathrooms. Moreover, 82% reported suicidal thoughts, 40% reported suicidal attempts, and 39% had SPD. Results demonstrated that any abuse/violence had higher odds of suicidal thoughts (adjusted odds ratio [aOR] = 2.67, 95% confidence interval (CI):[1.98-3.58], suicidal attempts (aOR = 2.83, 95% CI:[2.18-3.68]), and SPD (aOR = 1.56, 95% CI:[1.20, 2.04]). Abuse from romantic/sexual partners had higher odds of suicidal thoughts (aOR = 2.47, 95% CI:[1.76-3.47]), suicidal attempts (aOR = 2.17, 95% CI:[1.68-2.80]), and SPD (aOR = 2.72, 95% CI:[2.03-3.63]). Experience of harassment/abuse during bathroom use had increased odds of suicidal attempts (aOR = 1.81, 95% CI:[1.41-2.31]). CONCLUSION Exposure to violence is common among AA transgender individuals and related to negative mental health outcomes. Initiatives to reduce exposure to abuse and providing resources for trauma-informed care are imperative to improve health outcomes.
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Affiliation(s)
- Monideepa B. Becerra
- Department of Health Science and Human Ecology, California State University, San Bernardino, California, United States of America
- Center for Health Equity, California State University, San Bernardino, California, United States of America
| | - Erik J. Rodriquez
- Division of Intramural Research, National Heart, Lung, Blood Institute, Bethesda, Maryland, United States of America
| | - Robert M. Avina
- Department of Health Science and Human Ecology, California State University, San Bernardino, California, United States of America
- Center for Health Equity, California State University, San Bernardino, California, United States of America
| | - Benjamin J. Becerra
- Center for Health Equity, California State University, San Bernardino, California, United States of America
- Department of Information and Decision Sciences, California State University, San Bernardino, California, United States of America
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16
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Greene N, Johnson RM, German D, Rosen J, Cohen JE. State-Level Alcohol Environments and Sexual Identity Disparities in Binge Drinking in the Behavioral Risk Factor Surveillance System. LGBT Health 2021; 8:190-200. [PMID: 33538642 DOI: 10.1089/lgbt.2020.0182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Purpose: Binge drinking disparities by sexual identity are well documented. Stronger alcohol policy environments reduce binge drinking in the general population. We examined whether state-level alcohol policy environments have the same association with binge drinking among lesbian, gay, and bisexual (LGB) adults as among heterosexual adults. Methods: Binge drinking, sexual identity, and demographic characteristics were extracted from the 2015 to 2018 Behavioral Risk Factor Surveillance System. The strength of the alcohol policy environment was measured by using the Alcohol Policy Scale (APS) score. We estimated the association between APS score and binge drinking by using logistic regression and included an interaction term between APS score and sexual identity. Results: The interaction between APS score and sexual identity was not significant, and findings differed between women and men. Among women, a higher APS score was associated with lower odds of binge drinking (adjusted odds ratio [aOR]: 0.96, 95% confidence interval [CI]: 0.94-0.99). Differences in binge drinking by sexual identity remained after adjusting for individual and state-level factors (e.g., the percentage of LGB adults in the state). Compared with heterosexual women, the odds of binge drinking were 43% higher (aOR: 1.43, 95% CI: 1.17-1.75) among lesbian women and 58% higher (aOR: 1.58, 95% CI: 1.40-1.79) among bisexual women. A higher APS score was not associated with binge drinking among men. Conclusion: Stronger state-level alcohol policy environments were associated with lower binge drinking among women. Lesbian and bisexual women were still more likely to engage in binge drinking compared with heterosexual women even in states with stronger alcohol policy environments.
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Affiliation(s)
- Naomi Greene
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Renee M Johnson
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Danielle German
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joanne Rosen
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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17
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Salway T, Gesink D, Ferlatte O, Rich AJ, Rhodes AE, Brennan DJ, Gilbert M. Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: detection of a second peak in middle adulthood. Soc Psychiatry Psychiatr Epidemiol 2021; 56:283-294. [PMID: 32789562 DOI: 10.1007/s00127-020-01946-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Sexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orientation suicide inequity, and such patterns must be carefully interpreted in light of correlated period and cohort effects. We, therefore, combined US and Canadian data (1985-2017) from primary (two pooled multi-year national surveys, N = 15,477 and N = 126,463) and secondary (published, meta-analytic, N = 122,966) sources to separately estimate age, period, and cohort trends in self-reported suicide attempts among sexual minorities. METHODS Age- and gender-stratified cross-sectional data were used to infer age and cohort effects. Age-collapsed meta-analyzed data were used to infer period effects among sexual minorities of all genders. RESULTS We identified a bimodal age distribution in recent suicide attempts for sexual minorities across genders, though more pronounced among sexual minority men: one peak in adolescence (18-20 years of age for both genders) and one peak nearing mid-life (30-35 years of age for men; 35-40 years of age for women). This pattern was also apparent using recall data within birth cohorts of sexual minority men, suggesting it is not an artifact of birth cohort effects. Finally, we observed decreasing trends in lifetime suicide attempt prevalence estimates for both sexual minorities and heterosexuals, though these decreases did not affect the magnitude of the sexual orientation disparity. CONCLUSION In the context of exclusively adolescent-focused suicide prevention interventions for sexual minorities, tailored suicide prevention for sexual minority adults should be pursued throughout the life course.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. .,Centre for Gender and Sexual Health Equity, 1190 Hornby Street, 11th Floor, Vancouver, BC, V6Z 2K5, Canada.
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, ON, M5T 3M7, Canada
| | - Olivier Ferlatte
- École de santé Publique, Université de Montréal, 7101 Park Avenue, Montreal, QC, H3N 1X9, Canada.,Centre de Recherche en santé Publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, 1301, rue Sherbrooke Est, Montreal, QC, H3L 1M3, Canada
| | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Anne E Rhodes
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, ON, M5T 3M7, Canada.,Department of Psychiatry, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration-B3, 100 West 5th, Hamilton, ON, L8N 3K7, Canada.,Offord Centre for Child Studies, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - David J Brennan
- Factor-Inwentash School of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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18
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Pachankis JE, Mahon CP, Jackson SD, Fetzner BK, Bränström R. Sexual orientation concealment and mental health: A conceptual and meta-analytic review. Psychol Bull 2020; 146:831-871. [PMID: 32700941 PMCID: PMC8011357 DOI: 10.1037/bul0000271] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Identity concealment affects all sexual minority individuals, with potentially complex mental health implications. Concealing a sexual minority identity can simultaneously generate the stress of hiding, protect against the stress of discrimination, and keep one apart from sexual minority communities and their norms and supports. Not surprisingly, existing studies of the association between sexual orientation concealment and mental health problems show contradictory associations-from positive to negative to null. This meta-analysis attempts to resolve these contradictions. Across 193 studies (n = 92,236) we find a small positive association between sexual orientation concealment and internalizing mental health problems (i.e., depression, anxiety, distress, problematic eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The association between concealment and internalizing mental health problems was larger for those studies that assessed concealment as lack of open behavior, those conducted recently, and those with younger samples; it was smaller in exclusively bisexual samples. Year of data collection, study location, and sample gender, education, and racial/ethnic composition did not explain between-study heterogeneity. Results extend existing theories of stigma and sexual minority mental health, suggesting potentially distinct stress processes for internalizing problems versus substance use problems, life course fluctuations in the experience of concealment, distinct experiences of concealment for bisexual individuals, and measurement recommendations for future studies. Small overall effects, heavy reliance on cross-sectional designs, relatively few effects for substance use problems, and the necessarily coarse classification of effect moderators in this meta-analysis suggest future needed methodological advances to further understand the mental health of this still-increasingly visible population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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19
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Dickerson-Amaya N, Coston BM. Invisibility Is Not Invincibility: The Impact of Intimate Partner Violence on Gay, Bisexual, and Straight Men's Mental Health. Am J Mens Health 2020; 13:1557988319849734. [PMID: 31092110 PMCID: PMC6537270 DOI: 10.1177/1557988319849734] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Intimate partner violence (IPV) is a critical public health problem. However,
there is limited research conducted on and about men who are survivors. This
project extends previous research by examining the post-traumatic impact of
diverse forms of IPV (sexual, physical, emotional, control, and stalking) on the
internalized and externalized mental health of gay, bisexual, and straight men.
Using data from the National Intimate Partner and Sexual Violence Survey (2011;
N = 18,957), we find that all men are equally likely to
report emotional victimization and controlling tactics (with between 50% and 70%
doing so), while bisexual men are significantly more likely to report physical
and sexual violence and gay men are significantly more likely to report intimate
stalking. Due to these experiences, gay men are significantly more likely to
report missing school or work, but bisexual men are significantly more likely to
rate their current overall mental health as poor. Around 10% of all men,
regardless of sexual orientation, report post-traumatic stress disorder
symptomology and 30% of all men report difficulty sleeping. This research
suggests that sexual orientation is a critical area of focus in the study of
violence and mental health for men and that we can no longer ignore the voices
and needs of men survivors: Invisibility is not invincibility.
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Affiliation(s)
- Natasha Dickerson-Amaya
- 1 Department of Rehabilitation and Mental Health Counseling, School of Allied Health; Virginia Commonwealth University, Richmond, VA, USA
| | - Bethany M Coston
- 2 Gender, Sexuality and Women's Studies; Virginia Commonwealth University, Richmond, VA, USA
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20
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Spatial-Temporal Epidemiology of the Syphilis Epidemic in Relation to Neighborhood-Level Structural Factors in British Columbia, 2005-2016. Sex Transm Dis 2020; 46:571-578. [PMID: 31259854 DOI: 10.1097/olq.0000000000001034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Spatial clusters of syphilis have been observed within several jurisdictions globally; however, the degree to which they are predicted by the spatial distributions of gay, bisexual, and other men who have sex with men (GBM) and testing remains unknown. We sought to describe the spatial-temporal epidemiology of infectious syphilis and identify associations between neighborhood-level factors and rates of syphilis, in British Columbia, Canada. METHODS We used ArcGIS to map infectious syphilis cases among men (2005 to 2016), SaTScan to detect areas with significantly elevated rates of syphilis, and spatial regression to identify associations between neighborhood-level factors and rates of syphilis. RESULTS Five clusters were identified: a core in downtown Vancouver (incidence rate ratio [IRR], 18.0; 2007-2016), 2 clusters adjacent to the core (IRR, 3.3; 2012-2016; and IRR, 2.2; 2013-2016), 1 cluster east of Vancouver (IRR, 2.1; 2013-2016), and 1 cluster in Victoria (IRR, 4.3; 2015-2016). Epidemic curves were synchronized across cluster and noncluster regions. Neighborhood-level GBM population estimates and testing rates were both associated with syphilis rates; however, the spatial distribution of syphilis was not fully explained by either of these factors. CONCLUSIONS We identified two novel ecologic correlates of the spatial distribution of infectious syphilis-density of GBM and rates of syphilis testing-and found that these factors partially, though not entirely, explained the spatial distribution of clusters. Residual spatial autocorrelation suggests that greater syphilis testing coverage may be needed and low-barrier GBM-affirming testing should be expanded to regions outside the core.
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21
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Henderson ER, Blosnich JR, Herman JL, Meyer IH. Considerations on Sampling in Transgender Health Disparities Research. LGBT Health 2019; 6:267-270. [PMID: 31295043 DOI: 10.1089/lgbt.2019.0069] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Collection of gender identity data in national probability-based surveys began in 2014, an important first step toward the inclusion of gender identity measurements in public health surveillance. However, the findings about health disparities from probability-based samples do not align with those from nonprobability samples traditionally used to study transgender populations. These contradictions have yet to be understood fully. In this article, we suggest that the truth about disparities lies somewhere between nonprobability and probability samples. We discuss why generalizability from studies using probability sampling may remain limited for transgender populations and describe potential improvements in sampling methodology for transgender populations.
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Affiliation(s)
- Emmett R Henderson
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John R Blosnich
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jody L Herman
- The Williams Institute, School of Law, University of California, Los Angeles, Los Angeles, California
| | - Ilan H Meyer
- The Williams Institute, School of Law, University of California, Los Angeles, Los Angeles, California
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22
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Salway TJ, Morgan J, Ferlatte O, Hawkins B, Lachowsky NJ, Gilbert M. A Systematic Review of Characteristics of Nonprobability Community Venue Samples of Sexual Minority Individuals and Associated Methods for Assessing Selection Bias. LGBT Health 2019; 6:205-215. [DOI: 10.1089/lgbt.2018.0241] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Travis J. Salway
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jeffrey Morgan
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Olivier Ferlatte
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Blake Hawkins
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan J. Lachowsky
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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23
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Pachankis JE, Bränström R. How many sexual minorities are hidden? Projecting the size of the global closet with implications for policy and public health. PLoS One 2019; 14:e0218084. [PMID: 31194801 PMCID: PMC6564426 DOI: 10.1371/journal.pone.0218084] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 05/26/2019] [Indexed: 11/19/2022] Open
Abstract
Because sexual orientation concealment can exact deep mental and physical health costs and dampen the public visibility necessary for advancing equal rights, estimating the proportion of the global sexual minority population that conceals its sexual orientation represents a matter of public health and policy concern. Yet a historic lack of cross-national datasets of sexual minorities has precluded accurate estimates of the size of the global closet. We extrapolated the size of the global closet (i.e., the proportion of the global sexual minority population who conceals its sexual orientation) using a large sample of sexual minorities collected across 28 countries and an objective index of structural stigma (i.e., discriminatory national laws and policies affecting sexual minorities) across 197 countries. We estimate that the majority (83.0%) of sexual minorities around the world conceal their sexual orientation from all or most people and that country-level structural stigma can serve as a useful predictor of the size of each country's closeted sexual minority population. Our analysis also predicts that eliminating structural stigma would drastically reduce the size of the global closet. Given its costs to individual health and social equality, the closet represents a considerable burden on the global sexual minority population. The present projection suggests that the surest route to improving the wellbeing of sexual minorities worldwide is through reducing structural forms of inequality. Yet, another route to alleviating the personal and societal toll of the closet is to develop public health interventions that sensitively reach the closeted sexual minority population in high-stigma contexts worldwide. An important goal of this projection, which relies on data from Europe, is to spur future research from non-Western countries capable of refining the estimate of the association between structural stigma and sexual orientation concealment using local experiences of both.
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Affiliation(s)
- John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
- * E-mail:
| | - Richard Bränström
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Lyons BH, Walters ML, Jack SPD, Petrosky E, Blair JM, Ivey-Stephenson AZ. Suicides Among Lesbian and Gay Male Individuals: Findings From the National Violent Death Reporting System. Am J Prev Med 2019; 56:512-521. [PMID: 30898221 PMCID: PMC6886000 DOI: 10.1016/j.amepre.2018.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Information regarding the epidemiology of suicide among lesbian and gay male individuals is limited, and comprehensive information is needed. This study seeks to describe the characteristics and precipitating circumstances of suicide among lesbian and gay male decedents when compared with non-lesbian and non-gay male decedents. METHODS An analysis was conducted of National Violent Death Reporting System data from 18 U.S. states for the years 2003-2014. Sociodemographic characteristics and precipitating circumstances of suicide among lesbian and gay male decedents were compared with non-lesbian and non-gay male decedents. Logistic regression analysis was conducted to examine the association between precipitating circumstances and suicide by sexual orientation. The analysis was conducted in December 2017. RESULTS There were a total of 123,289 suicide decedents from 18 states participating in National Violent Death Reporting System during 2003-2014; of those, 621 (0.5%) were identified as lesbian, gay, bisexual, or transgender. The majority of lesbian, gay, bisexual, or transgender decedents were identified as gay male (53.9%), followed by lesbian (28.0%), transgender (10.4%), and bisexual (7.5%). The analysis revealed several differences by age, mechanism of injury, and precipitating circumstances, including intimate partner problems among lesbian decedents, suicide planning and intent for both lesbian and gay male decedents, and mental health problems among gay male decedents. CONCLUSIONS Findings highlight differences in the characteristics of suicide among lesbian and gay male and non-lesbian and non-gay male decedents. It is important for suicide prevention efforts to be culturally sensitive and consider the needs of sexual minority populations.
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Affiliation(s)
- Bridget H Lyons
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Mikel L Walters
- Extramural Research Program Office, Office of the Associate Director for Science, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shane P D Jack
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emiko Petrosky
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet M Blair
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Asha Z Ivey-Stephenson
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Stupplebeen DA, Eliason MJ, LeBlanc AJ, Sanchez-Vaznaugh EV. Differential Influence of Weight Status on Chronic Diseases by Reported Sexual Orientation Identity in Men. LGBT Health 2019; 6:126-133. [PMID: 30916609 PMCID: PMC6477578 DOI: 10.1089/lgbt.2018.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study examined whether the association between weight status and four chronic diseases (heart disease, hypertension, lifetime asthma, and type 2 diabetes) varied according to sexual orientation identity among adult men, controlling for demographic, socioeconomic, and other factors. METHODS Pooled data from male adult participants (n = 72,214) in the 2003-2012 California Health Interview Survey were used along with logistic regression models to estimate whether the associations between weight status and chronic diseases varied by sexual orientation identity. RESULTS Weight status was positively associated with each of the chronic diseases (hypertension, heart disease, asthma, and diabetes) among both gay and bisexual men and heterosexual men; however, the associations varied significantly by sexual orientation identity. Among gay and bisexual men, the associations were stronger and statistically significant-with the exception of lifetime asthma-particularly for men in the obese classifications, before and after controlling for age, marital status, race/ethnicity, education, income, health insurance status, food security level, smoking, and nativity. CONCLUSIONS Weight status had stronger detrimental associations with chronic disease among gay and bisexual men despite these men having greater socioeconomic advantage and lower body mass index than heterosexual men. Future research should examine mechanisms, including stress related to minority status, which may lead to greater risks for chronic diseases among sexual minority men.
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Affiliation(s)
- David A. Stupplebeen
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, Hawai‘i
| | - Michele J. Eliason
- Department of Health Education, College of Health and Social Sciences, San Francisco State University, San Francisco, California
| | - Allen J. LeBlanc
- Department of Sociology, College of Health and Social Sciences, San Francisco State University, San Francisco, California
- Health Equity Institute, College of Health and Social Sciences, San Francisco State University, San Francisco, California
| | - Emma V. Sanchez-Vaznaugh
- Department of Health Education, College of Health and Social Sciences, San Francisco State University, San Francisco, California
- Health Equity Institute, College of Health and Social Sciences, San Francisco State University, San Francisco, California
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Salway T, Plöderl M, Liu J, Gustafson P. Effects of Multiple Forms of Information Bias on Estimated Prevalence of Suicide Attempts According to Sexual Orientation: An Application of a Bayesian Misclassification Correction Method to Data From a Systematic Review. Am J Epidemiol 2019; 188:239-249. [PMID: 30188991 DOI: 10.1093/aje/kwy200] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
Multiple epidemiologic studies demonstrate a disparity in suicide risk between sexual minority (lesbian, gay, bisexual) and heterosexual populations; however, both "exposure" (sexual minority status) and outcome (suicide attempts) may be affected by information bias related to errors in self-reporting. We therefore applied a Bayesian misclassification correction method to account for possible information biases. A systematic literature search identified studies of lifetime suicide attempts in sexual minority and heterosexual adults, and frequentist meta-analysis was used to generate unadjusted estimates of relative risk. A Bayesian model accounting for prior information about sensitivity and specificity of exposure and outcome measures was used to adjust for misclassification biases. In unadjusted frequentist analysis, the relative risk of lifetime suicide attempt comparing sexual minority with heterosexual groups was 3.38 (95% confidence interval: 2.65, 4.32). In Bayesian reanalysis, the estimated prevalence was slightly reduced in heterosexual adults and increased in sexual minority adults, yielding a relative risk of 4.67 (95% credible interval: 3.94, 5.73). The disparity in lifetime suicide attempts between sexual minority and heterosexual adults is greater than previously estimated, when accounting for multiple forms of information bias. Additional research on the impact of information bias in studies of sexual minority health should be pursued.
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Affiliation(s)
- Travis Salway
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, Paracelsus Medical University, Salzburg, Austria
- Department of Clinical Psychology, University Clinic of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Juxin Liu
- Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
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Salway T, Ross LE, Fehr CP, Burley J, Asadi S, Hawkins B, Tarasoff LA. A Systematic Review and Meta-Analysis of Disparities in the Prevalence of Suicide Ideation and Attempt Among Bisexual Populations. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:89-111. [PMID: 29492768 DOI: 10.1007/s10508-018-1150-6] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/24/2017] [Accepted: 01/07/2018] [Indexed: 05/12/2023]
Abstract
Sexual minorities are at increased risk of suicide; however, it is unclear whether there are within-sexual minority differences in risk across specific sexual identities-notably between bisexual and lesbian/gay subgroups. We therefore conducted a systematic review and meta-analysis to quantify associations between bisexual identity and self-reported suicide ideation and attempt and the moderation of these associations by gender/sex, age, sampling strategy, and measurement of sexuality. Abstracts and full texts were independently screened by two reviewers, resulting in a total of 46 studies that met inclusion criteria and reported 12-month or lifetime prevalence estimates for suicide ideation or attempt. A consistent gradient was observed across all four outcomes, whereby bisexual respondents reported the highest proportion of suicide ideation or attempt, lesbian/gay respondents the next highest proportion, and heterosexual respondents the lowest proportion. Random-effects meta-analysis comparing bisexual individuals with lesbian/gay individuals yielded odds ratios (ORs) ranging between 1.22-1.52 across the four outcomes examined. Between-study variability in ORs was large. Thirty-one percent of heterogeneity was explained by sample type (e.g., probability vs. non-probability) and 17% by gender/sex. ORs were consistently larger for women (range: 1.48-1.95, all statistically significant at p < .05) than for men (range: 1.00-1.48, all p > .05), suggesting that gender/sex moderates the association between bisexual identity and suicide risk. Within-sexual minority differences in suicide risk may be attributed to structural and interpersonal experiences of monosexism, bisexual erasure and invisibility, or lack of bisexual-affirming social support, each of which may be experienced differently across gender/sex identities.
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Affiliation(s)
- Travis Salway
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Charles P Fehr
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joseph Burley
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shayan Asadi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Blake Hawkins
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Lesley A Tarasoff
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Rich AJ, Armstrong HL, Cui Z, Sereda P, Lachowsky NJ, Moore DM, Hogg RS, Roth EA. Sexual orientation measurement, bisexuality, and mental health in a sample of men who have sex with men in Vancouver, Canada. JOURNAL OF BISEXUALITY 2018; 18:299-317. [PMID: 31462896 PMCID: PMC6713462 DOI: 10.1080/15299716.2018.1518181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 05/24/2023]
Abstract
This cross-sectional study used a validated index (i.e., Hospital Anxiety and Depression Scale) to measure anxiety and depression (caseness score: ≥8) among men who have sex with men recruited via respondent-driven sampling in Vancouver, Canada (n=774), and investigated whether differences in mental health outcomes varied by sexual orientation measure (i.e., identity, attraction, behavior). Of the sample, 15.5% identified as bisexual, 33.4% reported any bisexual attraction, and 22.7% reported any bisexual sexual activity. More bisexual than gay men met the case definition for anxiety and depression, across all sexual orientation measures. In adjusted multivariable models, bisexual men had higher odds of anxiety by attraction and identity and higher odds of depression by identity. Findings highlight the value of measuring multiple sexual orientation dimensions in surveys and routine surveillance, and the need to ensure sexual minority groups and sexual orientation dimensions are not considered commensurate for mental health prevention and treatment.
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Affiliation(s)
- Ashleigh J. Rich
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Heather L. Armstrong
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Zishan Cui
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nathan J. Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - David M. Moore
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Robert S. Hogg
- Epidemiology & Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A. Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
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Caceres BA, Brody AA, Halkitis PN, Dorsen C, Yu G, Chyun DA. Sexual Orientation Differences in Modifiable Risk Factors for Cardiovascular Disease and Cardiovascular Disease Diagnoses in Men. LGBT Health 2018; 5:284-294. [PMID: 29889585 PMCID: PMC6034400 DOI: 10.1089/lgbt.2017.0220] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Despite higher rates of modifiable risk factors for cardiovascular disease (CVD) in gay and bisexual men, few studies have examined sexual orientation differences in CVD among men. The purpose of this study was to examine sexual orientation differences in modifiable risk factors for CVD and CVD diagnoses in men. METHODS A secondary analysis of the National Health and Nutrition Examination Survey (2001-2012) was conducted. Multiple imputation was performed for missing values. Differences across four distinct groups were analyzed: gay-identified men, bisexual-identified men, heterosexual-identified men who have sex with men (MSM), and heterosexual-identified men who denied same-sex behavior (categorized as exclusively heterosexual). Multiple logistic regression models were run with exclusively heterosexual men as the reference group. RESULTS The analytic sample consisted of 7731 men. No differences between heterosexual-identified MSM and exclusively heterosexual men were observed. Few differences in health behaviors were noted, except that, compared to exclusively heterosexual men, gay-identified men reported lower binge drinking (adjusted odds ratio [AOR] 0.58, 95% confidence interval [CI] = 0.37-0.85). Bisexual-identified men had higher rates of mental distress (AOR 2.39, 95% CI = 1.46-3.90), obesity (AOR 1.69, 95% CI = 1.02-2.72), elevated blood pressure (AOR 2.30, 95% CI = 1.43-3.70), and glycosylated hemoglobin (AOR 3.01, 95% CI = 1.38-6.59) relative to exclusively heterosexual men. CONCLUSIONS Gay-identified and heterosexual-identified MSM demonstrated similar CVD risk to exclusively heterosexual men, whereas bisexual-identified men had elevations in several risk factors. Future directions for sexual minority health research in this area and the need for CVD and mental health screenings, particularly in bisexual-identified men, are highlighted.
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Affiliation(s)
- Billy A. Caceres
- School of Nursing, Columbia University, New York, New York
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Abraham A. Brody
- Rory Meyers College of Nursing, New York University, New York, New York
- Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York, New York
| | - Perry N. Halkitis
- Department of Biostatistics, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey
- Departments of Health Education and Behavioral Science, Rutgers University, Piscataway, New Jersey
- Center for Health, Identity, Behavior and Prevention Studies, College of Global Public Health, New York University, New York, New York
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
| | - Caroline Dorsen
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Deborah A. Chyun
- Rory Meyers College of Nursing, New York University, New York, New York
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Drabble LA, Trocki KF, Korcha RA, Klinger JL, Veldhuis CB, Hughes TL. Comparing substance use and mental health outcomes among sexual minority and heterosexual women in probability and non-probability samples. Drug Alcohol Depend 2018; 185:285-292. [PMID: 29482053 PMCID: PMC5889720 DOI: 10.1016/j.drugalcdep.2017.12.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/24/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine similarities and differences in demographics and key substance use and mental health outcomes in a probability sample of heterosexual women and two samples of sexual minority women (SMW), one recruited using probability and the other using non-probability methods. METHODS Using data from four waves of the National Alcohol Survey (NAS; n = 315 SMW; 10,523 heterosexual women) and Wave 3 of the Chicago Health and Life Experiences of Women (CHLEW; n = 688 SMW) study, we examined hazardous drinking, drug use, tobacco use, depression, and help-seeking for alcohol or other drug problems. RESULTS Compared to SMW in the probability sample, SMW in the non-probability sample were older, more likely to be college educated, and more likely to be in a partnered relationship. Compared to heterosexuals, SMW in both the probability and non-probability samples had greater odds of past-year hazardous drinking, marijuana use, and other drug use. We found similar results for lifetime help-seeking for alcohol or drug problems, past week depression, and co-occurring hazardous drinking and depression. In comparisons with heterosexual women, the magnitude of difference for drug use was greater for the SMW non-probability sample; for tobacco use, the difference was greater for the SMW probability sample. CONCLUSION Given the difficulties recruiting probability samples of SMW, researchers will continue to use non-probability samples in the foreseeable future. Thus, understanding how findings may differ between probability and non-probability samples is critically important in advancing research on sexual-orientation-related health disparities.
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Affiliation(s)
- Laurie A. Drabble
- School of Social Work San José State University, One Washington Square, San José, CA 95192-0124
| | - Karen F. Trocki
- Alcohol Research Group, 6001 Shellmound St,, Suite 450, Emeryville CA 94608
| | - Rachael A. Korcha
- Alcohol Research Group, 6001 Shellmound St,, Suite 450, Emeryville CA 94608
| | - Jamie L. Klinger
- Alcohol Research Group, 6001 Shellmound St,, Suite 450, Emeryville CA 94608
| | - Cindy B. Veldhuis
- School of Nursing, Columbia University, 630 West 168th Street, Mail Box Code 6, New York, NY 10032
| | - Tonda L. Hughes
- School of Nursing, Columbia University, 630 West 168th Street, Mail Box Code 6, New York, NY 10032,Department of Psychiatry, Columbia University, 630 West 168th Street, Mail Box Code 6, New York, NY 10032
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Marti-Pastor M, Perez G, German D, Pont A, Garin O, Alonso J, Gotsens M, Ferrer M. Health-related quality of life inequalities by sexual orientation: Results from the Barcelona Health Interview Survey. PLoS One 2018; 13:e0191334. [PMID: 29364938 PMCID: PMC5783362 DOI: 10.1371/journal.pone.0191334] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/03/2018] [Indexed: 11/18/2022] Open
Abstract
Background Studies on health-related quality of life (HRQoL) inequalities according to sexual orientation are scarce. The aim of this study was to assess HRQoL inequalities between lesbian, gay, and bisexual (LGB) people and heterosexuals in the 2011 Barcelona population, to describe the extent to which sociodemographic characteristics, health-related behaviors, and chronic conditions could explain such inequalities, and to understand if they are sexual orientation inequities. Methods In the 2011 Barcelona Health Interview Survey 3277 adults answered the EQ-5D, which measures five dimensions of HRQoL summarized into a single utility index (1 = perfect health, 0 = death). To assess HRQoL differences by sexual orientation we constructed Tobit models for the EQ-5D index, and Poisson regression models for the EQ-5D dimensions. In both cases, nested models were constructed to assess the mediator role of selected variables. Results After adjusting by socio-demographic variables, the LGB group presented a significantly lower EQ-5D index than heterosexuals, and higher prevalence ratios of problems in physical EQ-5D dimensions among both genders: adjusted prevalence ratio (aPR) = 1.70 for mobility (p = 0.046) and 2.11 for usual activities (p = 0.019). Differences in mental dimensions were only observed among men: aPR = 3.15 for pain/discomfort (p = 0.003) and 2.49 for anxiety/depression (p = 0.030). All these differences by sexual orientation disappeared after adding chronic conditions and health-related behaviors in the models. Conclusion The LGB population presented worse HRQoL than heterosexuals in the EQ-5D index and most dimensions. Chronic conditions, health-related behaviors and gender play a major role in explaining HRQoL differences by sexual orientation. These findings support the need of including sexual orientation into the global agenda of health inequities.
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Affiliation(s)
- Marc Marti-Pastor
- IMIM (Hospital del Mar Medical Research Institute), Health Services Research Group, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Gloria Perez
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Agency of Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Angels Pont
- IMIM (Hospital del Mar Medical Research Institute), Health Services Research Group, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Olatz Garin
- IMIM (Hospital del Mar Medical Research Institute), Health Services Research Group, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Alonso
- IMIM (Hospital del Mar Medical Research Institute), Health Services Research Group, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Mercè Gotsens
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Agency of Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Montse Ferrer
- IMIM (Hospital del Mar Medical Research Institute), Health Services Research Group, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
- * E-mail:
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