Disparities in Health Information-Seeking Behaviors and Fatalistic Views of Cancer by Sexual Orientation Identity: A Nationally Representative Study of Adults in the United States

Perceptions of patient-provider communications with healthcare providers among sexual and gender minority individuals in the United States

OBJECTIVES

To identify perceived differences in the key domains of patient-provider communications between sexual and gender minority (SGM) and non-SGM patients.

METHODS

We reviewed data from the Health Information National Trends Survey (HINTS) to assess patient perspectives on different domains of patient-provider communications in the ideological framework by Epstein and Street (2007) [1]. Between SGM-identified (N = 491) and cisgender, heterosexual respondents (N = 7426), we assessed the proportions of responses to survey questions about the six domains of patient-provider communications and calculated odds ratios (OR) with 95 % confidence intervals (CI) (N = 7917).

RESULTS

Overall, compared to cisgender, heterosexual individuals, fewer SGM individuals reported always experiencing optimal patient-provider communications across all domains, most notably in areas of emotional support (OR=0.70, 95 % CI: (0.51, 0.97)), patient self-management (OR=0.73, 95 % CI: (0.54, 0.99)), and managing uncertainty (OR=0.68, 95 % CI: (0.49, 0.94)).

CONCLUSION

Further research on detailed SGM patient perceptions of their relationships with healthcare providers is needed to understand why such differences in communication exist and provide practical recommendations to improve care delivery.

PRACTICE IMPLICATIONS

SGM patients perceive their current provider communications to be suboptimal, so we must improve emotional management training in future provider-based SGM competency trainings and encourage patient self-management during individual provider encounters.

Awareness of the causal association between human papillomavirus and anal cancer among US adults

PURPOSE

The incidence of anal cancer is on the rise in the US, especially among high-risk groups. This study examined the prevalence and determinants of awareness of the causal relationship between HPV and anal cancer among US adults.

METHODS

Study data was obtained from the 2017 to 2020 iterations of the Health Information National Trends Survey. The prevalence of awareness that HPV causes anal cancer was estimated among HINTS respondents who were aware of HPV in general. Survey weights were used to provide estimates representative of the adult US population. Multivariable logistic regressions were used to examine the associations between awareness that HPV causes anal cancer and cancer-related behaviors/perceptions and sociodemographic characteristics of respondents.

RESULTS

Two thousand six hundred and eighty four (27.2%) of the study population were aware that HPV caused anal cancer. Those of gay sexual orientation were more aware than heterosexuals [OR 2.27; 95% CI (1.24, 4.14)]. Compared to respondents with a high school diploma or less, individuals with some college education [OR 1.38; 95% CI (1.03, 1.85)] and those with at least a college degree [OR 1.52; 95% CI (1.17, 1.98)] were more likely to be aware. Participants who had positive cancer information seeking behavior were more aware of the HPV-anal cancer link compared to those who did not [OR 1.57; 95% CI (1.30, 1.89)].

CONCLUSION

Population-level awareness that HPV causes anal cancer remains critically low in the US. Sexual orientation, level of education and cancer information seeking behavior are associated with increased awareness of the causal relationship between HPV and anal cancer. Efforts should be directed toward addressing the awareness gap among individuals with lower education levels and promoting curiosity-driven information seeking behaviors.

Concept Analysis: LGBT+ Inclusive Health Care

Clients who identify as lesbian, gay, bisexual, transgender, queer/questioning (LGBT+) may experience barriers in health care access and services. LGBT+ clients want a welcoming, inclusive, and affirming encounter with nurses and other health care providers. This concept analysis used a modified Walker and Avant method to clarify the concept of LGBT+ inclusive health care. Antecedents, attributes, and consequences of LGBT+ inclusive health care were identified from the literature. The results of this concept analysis of LGBT+ inclusive health care can inform future research, policy, education, and practice to address the health care needs of this population.

Stress and Depression Are Associated with Sexual Function and Satisfaction in Young Men Who Have Sex with Men

Prior research suggests that better mental health and higher relationship quality are associated with better sexual function and satisfaction. Such insights can inform intervention development for mental, relationship, and sexual health concerns. This study examined the interactions among these variables in a racially and ethnically diverse group of young men who have sex with men (YMSM) in serious relationships (N = 348). Data were drawn from wave 5 of a longitudinal cohort study. We examined cross-sectional associations between depression and stress (predictors) and sexual function, sexual satisfaction, and anal discomfort (outcomes) and to what extent these associations were moderated by relationship quality. Higher endorsement of depression and stress was associated with worse sexual functioning, lower sexual satisfaction, and more anal discomfort. We also found that fewer negative interactions, stronger commitment, and higher relationship satisfaction were associated with better sexual functioning and higher sexual satisfaction. Higher relationship satisfaction and commitment were found to attenuate the association between stress and sexual satisfaction. Contrary to expectations, higher relationship satisfaction also showed a trend toward exacerbating the association between depression and sexual functioning. These results suggest that, for YMSM, high relationship satisfaction and commitment may protect sexual satisfaction from being negatively impacted by high stress. However, YMSM in highly satisfying relationships may experience poor sexual functioning associated with depression as particularly distressing. This study addressed a major gap in the literature by focusing on mental, relationship, and sexual health in a diverse sample. Future research should examine a wider range of sexual functioning outcomes and include minority stress in study design.

Investigating the Joint Effect of Allostatic Load among Lesbian, Gay, and Bisexual Adults with Risk of Cancer Mortality

Sexual minorities (SM) have higher chronic physiologic stress as indicated by allostatic load (AL), which may be explained in part by consistent experiences of discriminatory practices. This is one of the first studies to examine the joint effects of SM status and AL on the association with long-term risk for cancer death. Retrospective analyses were conducted on 12,470 participants using National Health and Nutrition Examination Survey (NHANES) from years 2001 through 2010 linked with the National Death Index through December 31, 2019. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) of cancer deaths between groups of SM (those reporting as gay, lesbian, bisexual, or having same-sex sexual partners) status and AL. SM adults living with high AL (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.55, 95% CI: 1.40-4.65) when compared to straight/heterosexual adults living with low AL (n = 6674). Among those living with high AL, SM (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.26, 95% CI: 1.33-3.84) when compared to straight/heterosexual adults with high AL (n = 4957). SM with high AL have an increased risk of cancer mortality. These findings highlight important implications for promoting a focused agenda on cancer prevention with strategies that reduce chronic stress for SM adults.

Relationship Between Sexual Orientation and Human Papillomavirus-Related Oral Cancer Knowledge and Awareness

Purpose: Human papillomavirus (HPV)-related oral cancers are increasing, and lesbian, gay, bisexual, and other people with a minority sexual orientation may be disproportionately impacted. This study examined the relationship between sexual orientation and HPV-related oral cancer knowledge. Methods: Data from 10,859 adult participants in the 2017-2019 Health Information National Trends Survey 5, cycles 1-3, were obtained. The three data sets were merged, and weighted multiple imputation (n = 15) was applied to address missingness. Weighted logistic regression analyses examined differences in HPV-related oral cancer knowledge between sexual minority versus heterosexual participants by sex, after adjustment for race, ethnicity, age, education, income, insurance, regular medical provider, and smoking status. Results: In this weighted sample, age ranged from 18 to 101 years (mean = 56.3 years); 42% were males, 5.2% were sexual minority men/women, and 94.8% were heterosexual/straight. Overall, only 19% of respondents were aware that HPV can cause oral cancer. After controlling for sociodemographic factors, there were no significant differences in HPV-related oral cancer knowledge for sexual minority men (adjusted odds ratio [AOR]: 1.10; 95% confidence interval [95% CI]: 0.86-1.42) or women (AOR: 0.98; 95% CI: 0.76-1.26) compared with those who were heterosexual/straight. Conclusion: Overall, knowledge of HPV-related oral cancer was low, regardless of sexual orientation. There were no differences in HPV-related oral cancer knowledge between sexual minority men and women compared with their heterosexual counterparts. Educational programs are needed to increase awareness of the HPV/oral cancer link. Further research on differences in HPV-related oral cancer knowledge and attitudes by sexual orientation and the intersection of other demographic factors is warranted.

Comparing access to sexual and reproductive health services among sexual minority youths and their peers: findings from a national survey in China

Background

Little is known about the access to measures of sexual and reproductive health (SRH) services among sexual minority communities in China, where sexuality-related stigma and discrimination remains high. The aim of this study is to investigate access to measures of SRH services among Chinese sexual minority youths (SMY) aged 17 to 24 years old.

Methods

This cross-sectional study utilizes data on 54,580 youths from the 2019–2020 National College Student Survey on Sexual and Reproductive Health, conducted across 31 provinces in mainland China. Multivariable logistic regression modelling was utilized to assess the access to SRH services among Chinese youth with different self-reported sexual orientation.

Results

The majority of respondents identified as heterosexual (77.6%). The remaining respondents identified as bisexual (9.0%), lesbian or gay (2.8%), others (3.02%), or unknown (7.51%). Gay men reported greater access to free contraceptives at health centers (OR 1.62, 95% CI: 1.32–1.99) and were more likely to have receive medical treatment for sexual and reproductive issues (OR 1.83, 95% CI: 1.26–2.63) compared to heterosexual men. Gay and bisexual men were also more likely to use condom at first sexual intercourse compared to heterosexual men (gay men: OR 1.38, 95% CI: 1.13–1.68; bisexual men: OR 1.33, 95% CI: 1.03–1.71). However, the associations were reversed among women (lesbians: OR 0.05, 95% CI: 0.03 to 0.08; bisexuals: 0.75, 95% CI: 0.65 to 0.86).

Conclusions

Although SMY reported higher utilization of SRH services compared to their heterosexual counterparts, access to SRH services remains low among Chinese youths. Greater focus should be placed on improving access to SMY-friendly SRH services among Chinese youths.

Reproductive Organ Pathology of Individuals Undergoing Gender-Affirming Surgery

As gender-affirming surgeries become more routine, it is increasingly important for pathologists to recognize the expected histologic changes seen in various tissues secondary to gender-affirming hormone therapy. For example, exogenous testosterone-related squamous atrophy or transitional cell metaplasia of the cervix may be confused for high-grade squamous intraepithelial lesion. In addition to distinguishing between benign and dysplastic/malignant features, pathologists should be mindful of the phrasing of their reports and aim to use objective, nongendered language.

Surgical Implications of LGBTQ+ Health Disparities: A Review

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) patients face challenging health care disparities. However, due to restrictions in reporting and collection of sexual orientation and gender identity (SOGI) demographic data, comprehensive studies of surgical disparities in the LGBTQ+ population are limited. This review aims to summarize the existing literature describing surgical disparities in LGBTQ+ patients and to identify areas of surgical care in which further studies are warranted. This review addresses the literature in infectious diseases, substance use disorders, bariatrics, cardiovascular medicine, oncology, and laryngology as relevant to surgical practice. Understanding the current landscape of knowledge in LGBTQ+ surgical disparities and the areas where gaps in research exist will help the surgeon to create a framework of practice to provide more equitable care to LGBTQ+ patients.

Cancer Risk Behaviors, Cancer Beliefs, and Health Information Seeking Among Under-Represented Populations in San Francisco: Differences by Sexual Orientation and Gender Identity

Purpose

Sexual and gender minority (SGM) individuals in the United States are at increased risk of cancer compared to the non-SGM population. Understanding how SGM persons perceive cancer risk and their practices and preferences for accessing health information is key for improving the preventive and health care services they receive.

Methods

In this cross-sectional study, we analyzed data from the San Francisco Health Information National Trends Survey. SGM individuals were identified by self-report. Differences in cancer risk factors, cancer beliefs, and health information seeking were evaluated by SGM status using multivariable logistic regression models.

Results

Out of 1027 participants, 130 (13%) reported being SGM individuals. Current smoking (odds ratio [OR]=1.93, 95% confidence interval [CI]=1.24-3.01) and alcohol use (OR=1.69, 95% CI=1.10-2.59) were more common among SGM persons than among non-SGM persons. No differences by SGM status were observed in health information seeking behaviors, preferences, and cancer beliefs, but SGM participants reported significantly higher odds of feeling frustrated (OR=1.78, 95% CI=1.20-2.64) and having concerns about the quality of the information (OR=1.54, 95% CI=1.03-2.31) during their most recent health information search.

Conclusions

Intervention efforts aimed at SGM individuals with current use of tobacco and/or alcohol should be expanded. SGM communities also need improved access to consistent, reliable, and accurate sources of health information. Their increased frustration when seeking health information and concerns about the quality of the information they find have important implications for SGM health and care, and the drivers of these differences merit further evaluation.

Information-seeking behaviours in Australian sexual minority men engaged in chemsex

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Participants engaged in chemsex over long periods of time and on a regular basis.

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Most know where to seek professional help and access harm reduction information.

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Many worry about being judged by health professionals and few seek out assistance.

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Participants feel uncomfortable discussing chemsex with most health professionals.

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Information from sexual health professionals is trusted the most.

Introduction

Chemsex refers to using illicit substances to facilitate sexual experiences in men who have sex with men. Chemsex has been linked to significant negative impacts on psychological, social, and physical wellbeing. Little is known about information-seeking behaviours in this population. This study aims to provide an in-depth understanding of seeking and engaging with health information.

Methods

Self-identified Australian sexual minority men who engage in chemsex (N = 184) participated in an anonymous cross-sectional survey. Variables included chemsex engagement, knowledge, perception and use of harm-reduction information, and associated health and support services. Pearson correlation and ANOVAs were conducted. Wilcoxon-Signed-Rank and Friedman tests were applied to analyse the perceived trustworthiness of information sources.

Results

Chemsex represented a meaningful part of sexual events. Most participants knew where to access professional help and harm-reduction information but worried about being judged. Most did not feel comfortable discussing chemsex with health professionals except with sexual health doctors/counsellors. Few users discussed health risks with a professional. Information on chemsex was received through multiple sources with significant differences in perceived relevance and trustworthiness, with sexual health doctors/nurses ranked the most trustworthy information. Interest in non-traditional sources of information was low except for formal peer networks and anonymous personal expert advice.

Conclusion

Engagement with health professionals and harm-reduction information is limited in this population, despite high risk and potentially significant adverse health outcomes. Results suggest that new and combined approaches are necessary to reach this population, including peer support networks, anonymous personal advice and changing community attitudes towards chemsex.

Online health information seeking, health literacy, and human papillomavirus vaccination among transgender and gender-diverse people

Objective

The purpose of this study is to describe online health information seeking among a sample of transgender and gender diverse (TGD) people compared with cisgender sexual minority people to explore associations with human papillomavirus (HPV) vaccination, and whether general health literacy and eHealth literacy moderate this relationship.

Materials and Methods

We performed a cross-sectional online survey of TGD and cisgender sexual minority participants from The PRIDE Study, a longitudinal, U.S.-based, national health study of sexual and gender minority people. We employed multivariable logistic regression to model the association of online health information seeking and HPV vaccination.

Results

The online survey yielded 3258 responses. Compared with cisgender sexual minority participants, TGD had increased odds of reporting HPV vaccination (aOR, 1.5; 95% CI, 1.1-2.2) but decreased odds when they had looked for information about vaccines online (aOR, 0.7; 95% CI, 0.5-0.9). TGD participants had over twice the odds of reporting HPV vaccination if they visited a social networking site like Facebook (aOR, 2.4; 95% CI, 1.1-5.6). No moderating effects from general or eHealth literacy were observed.

Discussion

Decreased reporting of HPV vaccination among TGD people after searching for vaccine information online suggests vaccine hesitancy, which may potentially be related to the quality of online content. Increased reporting of vaccination after using social media may be related to peer validation.

Conclusions

Future studies should investigate potential deterrents to HPV vaccination in online health information to enhance its effectiveness and further explore which aspects of social media might increase vaccine uptake among TGD people.

Characteristics of the health information seeking behavior of LGBTQ+ individuals: a systematic review on information types, information sources and influencing factors

Purpose

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) individuals' health information seeking is an important topic across multiple disciplines and areas. The aim of this systematic review is to create a holistic view of sexual and gender minority individuals' health information seeking reported in multidisciplinary studies, with regard to the types of health information LGBTQ+ individuals sought and information sources they used, as well as the factors influencing their health information seeking behavior.

Design/methodology/approach

The review is based on the literature search in 10 major academic databases. A set of inclusion and exclusion criteria was applied to identify studies that provide evidence on LGBTQ+ individuals' health information seeking behavior. The studies were first screened by title and abstract to determine whether they met the inclusion criteria. The full texts of each relevant study were obtained to confirm whether the exclusion criteria were met. The reference lists of the included studies were manually scanned. The relevant information was then extracted from selected articles and analyzed using thematic content analysis.

Findings

A seed set of 3,122 articles published between 1997 and 2020 was evaluated, and 46 total articles were considered for further analysis. The review results show that two major categories of health information sought by LGBTQ+ individuals were sexual and nonsexual, which were further classified into 17 specific types. In terms of health information sources, researchers have reported that online resources, interpersonal sources and traditional media were frequently used. Moreover, 25 factors affecting LGBTQ+ individuals' health information seeking were identified from the literature.

Originality/value

Through evidence-based understanding, this review preliminarily bridged the knowledge gap in understanding the status quo of studies on LGBTQ+ individuals' health information seeking and proposed the potential research directions that information science researchers could contribute to this important area.

Sexual Identity and Racial/Ethnic Differences in Awareness of Heart Attack and Stroke Symptoms: Findings From the National Health Interview Survey

PURPOSE

Investigate sexual identity and racial/ethnic differences in awareness of heart attack and stroke symptoms.

DESIGN

Cross-sectional.

SETTING

2014 and 2017 National Health Interview Survey.

SAMPLE

54 326 participants.

MEASURES

Exposure measures were sexual identity (heterosexual, gay/lesbian, bisexual, "something else") and race/ethnicity. Awareness of heart attack and stroke symptoms was assessed.

ANALYSIS

Sex-stratified logistic regression analyses to examine sexual identity and racial/ethnic differences in awareness of heart attack and stroke symptoms.

RESULTS

Gay men were more likely than heterosexual men to identify calling 911 as the correct action if someone is having a heart attack (adjusted odds ratio [AOR] = 2.16, 95% CI: 1.18-3.96). The majority of racial/ethnic minority heterosexuals reported lower rates of awareness of heart attack and stroke symptoms than White heterosexuals. Hispanic sexual minority women had lower awareness of heart attack symptoms than White heterosexual women (AOR = 0.43, 95% CI: 0.25-0.74), whereas Asian sexual minority women reported lower awareness of stroke symptoms (AOR = 0.25, 95% CI: 0.08-0.80). Hispanic (AOR = 0.52, 95% CI: 0.33-0.84) and Asian (AOR = 0.35, 95% CI: 0.14-0.84) sexual minority men reported lower awareness of stroke symptoms than White heterosexual men.

CONCLUSION

Hispanic and Asian sexual minorities had lower rates of awareness of heart attack and stroke symptoms. Health information technology may be a platform for delivering health education and targeted health promotion for sexual minorities of color.

Prediction of health information-seeking behavior components based on health anxiety among users of public libraries

INTRODUCTION

This study aimed to predict health information-seeking behavior (HISB) components based on health anxiety among users of public libraries.

MATERIALS AND METHODS

This research was a descriptive-correlational study. The statistical population consisted of users of public libraries. Data collection tools included the HISB questionnaire and the Short Form of Health Anxiety Inventory (SHAI).

RESULTS

The results indicated that health anxiety was a significant predictor of the components of HISB. The illness likelihood had a direct relationship with the components of the need for health information and the purposefulness of health information seeking, and it was inversely related to barriers to obtaining health information. In addition, the preoccupation with illness was directly related to the components of the need for health information, the diversity of health information sources, the time of referring to health information sources, the purposefulness of health information seeking, and evaluation of reasons for referring to the library.

CONCLUSION

Among the components of health anxiety, preoccupation to the disease has the highest role in the emergence of users' information-seeking behavior.