Private Health Insurance Coverage Among Same-Sex Couples After Obergefell v. Hodges

Contextual Influences on Nonresponse to Health Survey Questions About Sexual Orientation and Gender Identity

Purpose: We examined the relationship between state context and survey nonresponse to sexual orientation (SO) and gender identity (GI) questions. Methods: We obtained data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Item nonresponse was defined as selecting "don't know/not sure" or "refused" for each of two questions about SO and GI. Nonresponse patterns included responding to both SO and GI questions; responding only to the SO question (nonresponse to GI); responding only to the GI question (nonresponse to SO); and responding to neither question. State-level contextual measures included legal protections for lesbian, gay, bisexual, transgender, or other sexual or gender minority (LGBT+) people, LGBT+ social movement strength, and public opinion regarding LGBT+ issues. Results: The analysis included 1,459,525 respondents from 44 states (190 state-years). On weighted analysis, 96.5% of adults answered both SO/GI questions, 2.4% responded only to GI, 0.4% responded only to SO, and 0.7% responded to neither. The demographic profile of individuals with GI-only nonresponse differed markedly from the profile of adults with SO-only nonresponse. An increasingly favorable legal climate for LGBT+ people was associated with greater rates of response to SO and GI questions. However, a more LGBT+ friendly state climate measured by social movement strength or public opinion was not consistently associated with reduced SO and GI question nonresponse. Conclusion: Contextual factors have mixed association with nonresponse to SO and GI question on BRFSS surveys. Our results warrant continued development of health survey questionnaires to elicit accurate information on respondents' SO and GI.

Examining perceived effects of same-sex marriage legalization among sexual minority women: Identifying demographic differences and factors related to alcohol use disorder, depression, and self-perceived health

Background

Reductions in structural stigma, such as gaining access to legalized same-sex marriage, is associated with positive psychological and physical health outcomes among sexual minorities. However, these positive outcomes may be less robust among sexual minority women (SMW).

Methods

This study examined how perceptions of the impact of legalized same-sex marriage among SMW may 1) differ by demographic characteristics and 2) predict alcohol use disorder, depression, and self-perceived health. A diverse sample of SMW (N=446) completed an online survey in 2020 assessing the perceived impact of legalized same-sex marriage across six social-ecological domains: 1) personal impact, 2) stigma-related concerns, 3) couple impact, 4) family support, 5) work/school impact, and 6) local social climate towards LGBTQ people.

Results

Perceived impact across multiple domains differed by relationship status and sexual identity (e.g., lesbian compared to bisexual identity); only family support differed by race/ethnicity. Stigma-related concerns (e.g., experiencing or witnessing hostility or discrimination because of sexual identity, despite legalized same-sex marriage) were associated with greater odds of depression and lower odds of reporting excellent, very good, or good health. Odds of depression were lower among participants who reported higher personal impact, a greater number of family members supportive of same-sex marriage, and a more positive local social climate. Family support also predicted self-perceived health. However, participants who perceived increased support in work/school contexts after legalized same-sex marriage had higher odds of alcohol use disorder.

Conclusions

Overall, findings underscore the importance of policy in improving health outcomes through reducing stigma-related concerns and improving social acceptance.

Pathways to fatherhood: clinical experiences with assisted reproductive technology in single and coupled intended fathers

Objective

To explore the cycle characteristics and outcomes of single and coupled intended fathers (SCIFs) using assisted reproductive technology.

Design

Cross-sectional study.

Setting

Multicenter, fertility practices from 2016 to 2020.

Patients

In this study, cycles among SCIFs with access to fertility coverage from 2016 to 2020 were included.

Interventions

None.

Main Outcome Measures

Our primary outcome was live birth rate. The secondary outcomes included the number of embryos transferred, miscarriage rate, and incidence of multifetal birth.

Results

Five single and 39 coupled intended fathers completed an in vitro fertilization cycle with a majority using egg donation and an agency-based gestational carrier (69.7%, 83/119). In most couples, both partners wanted to serve as the sperm source (64.4%, 29/45). The vast majority (97.7%, 43/44) also used preimplantation genetic testing for aneuploidy. Among the embryo transfer (ET) cycles (n = 27), most consisted of a single euploid ET (74.07%, 20/27), whereas the remaining consisted of a double euploid ET (25.92%, 7/27). The SCIFs had high rates of success, with a live birth rate of 85.19% (23/27). A mean of 1.26 ± 0.44 embryos were transferred, with a majority resulting in singleton birth (70.37%, 19/27).

Conclusions

Our study of SCIFs using assisted reproductive technology in the United States demonstrates that this population shares similar preferences for sperm source and the use of preimplantation genetic testing. Clinical outcomes suggest that this population is successful at achieving a live birth when using egg donation and a gestational carrier.

Prescription Drug Insurance and Cost-Related Medication Nonadherence Among Lesbian, Gay, and Bisexual Individuals in Canada

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.