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Cholli PA, Buchacz KM, Harris NS, Crim SM, Yuan X, Tie Y, Koenig LJ, Beer L. Self-rated health and HIV outcomes among adults with diagnosed HIV - Medical Monitoring Project, United States. AIDS 2024; 38:1237-1247. [PMID: 38507582 DOI: 10.1097/qad.0000000000003890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVES To evaluate associations between self-rated health (SRH) and care outcomes among United States adults with diagnosed HIV infection. DESIGN We analyzed interview and medical record data collected during June 2020-May 2021 from the Medical Monitoring Project, a complex, nationally representative sample of 3692 people with HIV (PWH). Respondents reported SRH on a 5-point Likert type scale (poor to excellent), which we dichotomized into "good or better" and "poor or fair". We computed weighted percentages with 95% confidence intervals (CIs) and age-adjusted prevalence ratios (aPRs) to investigate associations between SRH and HIV outcomes and demographic, psychosocial, and behavioral characteristics. RESULTS Nationally, 72% of PWH reported "good or better" SRH. PWH with the following characteristics had a lower prevalence of "good or better" SRH, compared with those without: any missed HIV care appointment in the last 12 months (aPR 0.86, 95% CI: 0.81-0.91), symptoms of moderate or severe depression (aPR 0.51, 95% CI: 0.43-0.59) and anxiety (aPR 0.60, 95% CI: 0.54-0.68), unstable housing or homelessness (aPR 0.77, 95% CI: 0.71-0.82), and hunger or food insecurity (aPR 0.74, 95% CI: 0.69-0.80), as well as having a mean CD4 count <200 cells/mm 3 vs. CD4 + >500 cells/mm 3 (aPR 0.70, 95% CI: 0.57-0.86). CONCLUSIONS Though SRH is a holistic measure reflective of HIV outcomes, integrated approaches addressing needs beyond physical health are necessary to improve SRH among PWH in the United States. Modifiable factors like mental health, unstable housing or homelessness, and food insecurity warrant further study as potential high-yield targets for clinical and policy interventions to improve SRH among PWH.
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Affiliation(s)
- Preetam A Cholli
- Division of HIV Prevention, Centers for Disease Control and Prevention
- Epidemic Intelligence Service, Centers for Disease Control and Prevention
| | - Kate M Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Norma S Harris
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Stacy M Crim
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Xin Yuan
- DLH Corporation, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Linda J Koenig
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention
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Darvish S, Mahoney SA, Venkatasubramanian R, Rossman MJ, Clayton ZS, Murray KO. Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions. J Appl Physiol (1985) 2024; 137:194-222. [PMID: 38813611 DOI: 10.1152/japplphysiol.00188.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.
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Affiliation(s)
- Sanna Darvish
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Sophia A Mahoney
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | | | - Matthew J Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Kevin O Murray
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
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McKetta S, Jager J, Keyes K. Trends in binge drinking in the United States by LGBTQ+ identity, gender, and age, 2014-2022. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1122-1131. [PMID: 38622056 PMCID: PMC11178440 DOI: 10.1111/acer.15333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND People who identify as lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ+) have higher rates of risky drinking than their cisgender, heterosexual peers. It is unknown to what extent recent age and gender trends in binge drinking vary by LGBTQ+ identity. METHODS We used nationally representative, serial, cross-sectional surveys from men and women in the 2014-2022 Behavioral Risk Factor Surveillance System (N = 2,099,959) to examine trends in past-month binge drinking by LGBTQ+ identity, gender, and age (18-29, 30-44, 45 and older). We estimated stratum-specific prevalence ratios for an average 1-year increase in prevalence of past-month binge drinking using survey-weighted log-binomial models, controlling for education, race/ethnicity, marriage, and parenthood status. RESULTS In the beginning of the study period, LGBTQ+ women endorsed binge drinking at higher prevalences than their cisgender, heterosexual peers (i.e., 2014 predicted probability for women ages 30-44: 0.22 for LGBTQ+, 0.15 for cisgender, heterosexual). LGBTQ+ disparities in women's drinking attenuated over the study period among women in midlife (30-44 age group) due to increases in binge drinking among cisgender, heterosexual women (Prevalence Ratio [PR]: 1.025, 95% CI 1.018-1.033). Among men, we saw no evidence of LGBTQ+ disparities in binge drinking probabilities or in binge drinking trends across all age groups. CONCLUSIONS Disparities in mid-life binge drinking between LGBTQ+ and cisgender women have begun to diminish. These disparities are closing not because LGBTQ+ women are binge drinking less, but because cisgender, heterosexual women in midlife are binge drinking more.
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Affiliation(s)
- Sarah McKetta
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Justin Jager
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ
| | - Katherine Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Bayram E, Banks SJ. Risk of impairment in cognitive instrumental activities of daily living for sexual and gender minority adults with reported Parkinson's disease. Clin Neuropsychol 2024:1-22. [PMID: 38741341 DOI: 10.1080/13854046.2024.2350096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
Objective: To investigate the risk of impairment in cognitive instrumental activities of daily living (IADL) for people with Parkinson's (PwP) identifying as sexual and/or gender minorities (SGM). Method: Data were obtained from Fox Insight, an online, longitudinal study with self/informant-report questionnaires from PwP and people without Parkinson's. Groups consisted of PwP without cognitive IADL impairment at baseline, identifying as (1) SGM with female sex assigned at birth (SGM-F, n = 75); (2) cisgender, heterosexual with female sex assigned at birth (CH-F, n = 2046); (3) SGM with male sex assigned at birth (SGM-M, n = 84); (4) cisgender, heterosexual with male sex assigned at birth (CH-M, n = 2056). Impairment in cognitive IADL was based on Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15). Group differences for PDAQ-15 and impairment likelihood during follow-up were assessed with unadjusted models and adjusting for variables that differed between the groups. Results: SGM-F were the youngest at Parkinson's diagnosis; SGM-M had the lowest PDAQ-15 at baseline (p ≤ .014 for all). Scores declined more for males than females in unadjusted and adjusted models (p < .001 for both). In unadjusted models, SGM-M had a higher impairment risk than PwP identifying as cisgender and heterosexual (p ≤ .018). In adjusted models, females had a lower impairment risk than males (p < .001). Age, education, and discrimination level were significant moderators (p < .001 for all). Conclusions: SGM-M can be at a higher risk for impairment in cognitive IADL, associated with social determinants. Female sex assigned at birth may be associated with a lower level of impairment risk, although this advantage can disappear with social determinants.
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Affiliation(s)
- Ece Bayram
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Sarah J Banks
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
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Rodriguez-Diaz CE, Seager L, Navalta C, Lapointe L, Laino A, Wilhite D, Melin K, Varga L, Zea MC. Experiences of Latinx sexual and gender minorities with access to healthcare during COVID-19 stay-at-home orders. Am J Health Syst Pharm 2024; 81:297-305. [PMID: 38146952 PMCID: PMC10988101 DOI: 10.1093/ajhp/zxad330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic affected all social systems, but healthcare services were particularly disrupted. The pandemic also had a disproportionate impact on populations made socially vulnerable. In this study, we documented the experiences of Latinx sexual and gender minority (SGM) individuals with access to care during COVID-19 stay-at-home orders. METHODS Semistructured qualitative interviews assessing experiences during the stay-at-home orders in response to the COVID-19 pandemic and patients' experiences accessing healthcare during this period were conducted with 21 Latinx SGM individuals from the Washington, DC, area. Data were analyzed using rapid qualitative analysis (RQA), and salient themes were identified. RESULTS The RQA revealed 3 themes reflecting participants' experiences with pharmaceutical care during COVID-19 stay-at-home orders: (1) challenges in accessing HIV services; (2) community engagement; and (3) providers supporting access to care. Participants experienced problems with adherence to medication, transportation, and technology, as well as delays in care and miscommunication with providers. Latinx SGM individuals demonstrated engagement in response to this emergency as a community and valued their providers and their efforts to facilitate access to care. CONCLUSION The COVID-19 pandemic strained healthcare services. Findings from this study show that the impact of the pandemic on the provision of care increased the vulnerability of Latinx SGM people. Future research should explore the impact of public health emergencies on the health of populations historically made socially vulnerable, and innovative solutions should be identified to eliminate these barriers to health equity.
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Affiliation(s)
| | - Loxley Seager
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Cassandra Navalta
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Lauren Lapointe
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Alanna Laino
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Daniel Wilhite
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Kyle Melin
- School of Pharmacy, University of Puerto Rico, San Juan, PR, USA
| | - Leah Varga
- DC Department of Health, Washington, DC, USA
| | - Maria Cecilia Zea
- Department of Psychology and Brain Sciences, George Washington University, Washington, DC, USA
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Kinitz DJ, Ross LE, MacEachen E, Fehr C, Gesink D. "…full of opportunities, but not for everyone": A narrative inquiry into mechanisms of labor market inequity among precariously employed gay, bisexual, and queer men. Am J Ind Med 2024; 67:350-363. [PMID: 38374777 DOI: 10.1002/ajim.23574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND This study brings lesbian, gay, bisexual, transgender (trans), and queer (LGBTQ+) populations into scholarly discourse related to precarious employment through a political economy of queer struggle. METHODS Drawing on narrative inquiry, 20 gay, bisexual, and queer men shared stories of precarious employment that were analyzed using Polkinghorne's narrative analysis. RESULTS Results tell an overarching narrative in three parts that follow the trajectory of participants' early life experiences, entering the labor market and being precariously employed. Part 1: Devaluation of LGBTQ+ identities and adverse life experiences impacted participants' abilities to plan their careers and complete postsecondary education. Part 2: Participants experienced restricted opportunities due to safety concerns and learned to navigate white, cis, straight, Canadian ideals that are valued in the labor market. Part 3: Participants were without protections to respond to hostile treatment for fear of losing their employment. CONCLUSIONS These stories of precarious employment illustrate unique ways that LGBTQ+ people might be particularly susceptible to exploitative labor markets.
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Affiliation(s)
- David J Kinitz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ellen MacEachen
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Charles Fehr
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Boyd DT, Quinn CR, Jones KV, Waller B, Coker EJ, Duprey EB, Cerulli C, McCoy H. Building stronger bonds: The impact of family support and communication on suicidal behaviors among Black men who have sex with men. Suicide Life Threat Behav 2024. [PMID: 38488644 DOI: 10.1111/sltb.13072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/10/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION It has been well documented that men who identify with a sexual orientation other than heterosexual are at a greater risk for suicide-related outcomes. What is less known are the protective factors that can reduce such negative outcomes and contribute to their resilience. METHODS This study used data collected between December 1, 2021, and January 2022 to understand how family factors contribute to or prevent depression symptoms and suicide outcomes among young Black men who have sex with men (BMSM) ages 18 to 29 (N = 400). A path analysis was conducted to explore the direct and indirect effects of suicide attempts. RESULTS Surprisingly, there were nuanced findings that showed having a family member or friend die by suicide was indirectly associated with suicide planning and suicide attempts. It was also unexpectedly noted that there was a positive relationship between higher rates of depressive symptoms and higher levels of support from family members. CONCLUSIONS The population focused on in this study is understudied and has unique needs. Identifying familial support may not automatically reduce the thoughts and plans of young BMSM, which is an example of why their intersecting marginalized identities must be considered when conducting further research, creating interventions, and providing therapeutic services.
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Affiliation(s)
- Donte T Boyd
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Camille R Quinn
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Center for Equitable Family and Community Well-being, School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristian V Jones
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Bernadine Waller
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York City, New York, USA
| | - Evelyn Joy Coker
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erinn B Duprey
- Mt. Hope Family Center, Rochester, New York, USA
- Children's Institute, Rochester, New York, USA
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester, Rochester, New York, USA
- Community Engagement Core TRANSFORM Center, Mt. Hope Family Center, Rochester, New York, USA
| | - Henrika McCoy
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
- Texas Center for Equity Promotion, College of Education, The University of Texas at Austin, Austin, Texas, USA
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Green XA, Flores Tindall KJ, Flores Tindall AL, Anderson H, Hou MY. Assisted Reproduction for a Same-Sex Couple: Interdisciplinary Preclinical Active Learning Module Combining Case-Based Small Group Discussion and Patient Panel. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241257325. [PMID: 38799176 PMCID: PMC11119406 DOI: 10.1177/23821205241257325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Physicians often feel they are not equipped to serve the lesbian, gay, bisexual, and queer (LGBTQ) community, but integrating education that incorporates LGBTQ content and perspective into an already-condensed medical school curriculum is challenging. We developed a preclinical active learning module on assisted reproductive technologies (ART) in LGBTQ care, integrating clinical and basic science content with patient perspective. METHODS We created a module that combined a case-based small group discussion with a patient panel. We developed a case for discussion in collaboration with a female cis-gender same-sex couple who conceived through ART. A patient panel with the same couple followed the discussion. All first-year medical students attended both parts of the module. Prior to participation, students learned reproductive endocrinology and genetics concepts through lectures. After the module, students voluntarily completed an anonymous survey to evaluate self-perceived changes in familiarity and confidence with LGBTQ patients and satisfaction with the module. RESULTS Of the 126 students who attended, 72 (57%) completed the survey. Of these, 69 (95.8%) felt the module gave them better perspectives on LGBTQ patient experiences, and 66 to 69 (92-96%) agreed the small group discussion achieved its learning objectives on LGBTQ health barriers and the application of ART. Students valued the patient panel (84.7%) and cited a better understanding of reproductive barriers for LGBTQ patients as its most valuable point. CONCLUSION A preclerkship module combining a case-based small group discussion and patient panel on ART delivered in the context of a real-life LGBTQ patient experience provided an opportunity for the students to integrate basic science and clinical science knowledge to reflect on the healthcare needs of this patient population. Creating the case in collaboration with the same-sex couple and having them present their own experience provided an authentic perspective to students on reproductive healthcare issues and how they impact members of the LGBTQ community.
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Affiliation(s)
- Xochitl A. Green
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Kayla J. Flores Tindall
- Department of Adult and Family Medicine, Kaiser Permanente Santa Rosa, Santa Rosa, CA, USA
- North Bay LGBTQI Families, Santa Rosa, CA, USA
| | | | - Hana Anderson
- Department of Internal Medicine, Department of Cell Biology and Human Anatomy, University of California, Davis, Sacramento, CA, USA
| | - Melody Y. Hou
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
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Masa R, Shangani S, Baruah D, Operario D. The Association of Food Insecurity, Mental Health, and Healthcare Access and Use Among Lesbian, Gay, and Bisexual Adults in the United States: Results From the 2021 National Health Interview Survey. Am J Health Promot 2024; 38:68-79. [PMID: 37899588 PMCID: PMC10748451 DOI: 10.1177/08901171231211134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
PURPOSE We sought to describe the prevalence of food insecurity and its relationship with mental health, health care access, and use among lesbian, gay, and bisexual (LGB) adults in the U.S. DESIGN AND SETTING We analyzed data from the National Health Interview Survey (NHIS), a cross-sectional study of noninstitutionalized adults from all 50 states and the District of Columbia. SAMPLE The study sample was restricted to LGB adults ≥18 years (N = 1178) from the 2021 NHIS survey. MEASURES Food security was assessed using the 10-item U.S Adult Food Security Survey Module. Study outcomes were mental health (depression, anxiety, life satisfaction, and serious psychological distress), health care utilization, and medication adherence. ANALYSIS Descriptive statistics and linear and generalized linear regressions. RESULTS The study sample consisted of 69% White, 14% Hispanic/Latinx, 9% Black, and 8% people of other races. Approximately half (53%) identified as bisexual and 47% identified as gay or lesbian. Eleven percent were food insecure. Sexual orientation, income-to-poverty ratio, and health insurance were significant correlates of food insecurity. In multivariable analyses, food insecurity was significantly associated with mental illness (including depression, anxiety, and serious psychological distress), limited health care access and use (including inability to pay medical bills, delay in getting medical and mental health care, and going without needed medical and mental health care), and medication nonadherence (including skipping medication, taking less medication, delay filling prescription, and going without needed prescription). CONCLUSION Food insecurity is a constant predictor of adverse mental health and low medical and mental health care use rates among LGB adults in the United States. Achieving food security in LGB people requires improving their financial and nonfinancial resources to obtain food.
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Affiliation(s)
- Rainier Masa
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Dicky Baruah
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Don Operario
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Lee TH, Duong N, Sutha K, Simonetto DA, Paul S. Liver transplantation for people of minoritised sexual and gender identities in the USA. Lancet Gastroenterol Hepatol 2023; 8:1152-1162. [PMID: 37837981 DOI: 10.1016/s2468-1253(23)00238-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 10/16/2023]
Abstract
The number of people who report to be of minoritised sexual or gender identities in the USA, including lesbian, gay, bisexual, transgender, queer, and other sexuality-diverse and gender-diverse identities, has been increasing in the past decade. This diverse and unique population continues to experience not only health disparities but also psychosocial, economic, and legal disparities in accessing and receiving health care, including liver transplantations. As liver transplantation is life-saving for people with end-stage liver disease, understanding the factors that can affect access to and quality of liver transplantation care in people of minoritised sexual and gender identities in the USA, including differential social supports, insurance coverage, and medical and psychiatric comorbidities, is crucial. Actions, such as collecting sexual orientation and gender identity data, implementing inclusive language, recognising implicit biases, building diverse teams, providing a safer environment, and supporting further research to understand the unique health challenges are needed to ensure equitable access to high-quality liver transplantation care for people of minoritised sexual and gender identities.
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Affiliation(s)
- Tzu-Hao Lee
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Division of Abdominal Transplant, Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Nikki Duong
- Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Ken Sutha
- Division of Nephrology, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Sonali Paul
- Section of Gastroenterology, Hepatology, and Nutrition, Center for Liver Diseases and Transplant Institute, University of Chicago Medicine, Chicago, IL, USA
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Dornelles TM, de Brito ES, Pinheiro BHG, Santarem BDMC, Aguer SST, Camozzato A. Mental health assessment of the Brazilian LGBTQIAP+ population during the COVID-19 pandemic: a cross-sectional study. Rev Esc Enferm USP 2023; 57:e20230148. [PMID: 37695607 PMCID: PMC10476912 DOI: 10.1590/1980-220x-reeusp-2023-0148en] [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: 05/09/2023] [Accepted: 07/13/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE To investigate the association between the frequency and associated factors of non-psychotic mental disorders and anxiety symptoms in a Brazilian LGBTQIAP+ sample. METHOD Cross-sectional study, conducted from September to October 2020 using an online questionnaire, with instruments for sociodemographic characterization, the Generalized Anxiety Disorder Screener and the Self-Report Questionnaire. The analysis was performed using the Chi-square and Fisher's Exact tests. Poisson regression with robust variance was performed to estimate the effect of sociodemographic variables on mental health. RESULTS Positive screening for anxiety and non-psychotic disorders were identified in 85.2% and 60.2% of the participants, respectively. Younger age groups, who professed some religion, only had access to public health, and presented with medical conditions showed a higher risk for non-psychotic mental disorders. Individuals under 30 (1.33, 95%, CI = 1.17-1.52) presented a high risk for anxiety symptoms. CONCLUSION The prevalence of anxiety and non-psychotic disorders during the COVID pandemic was high. Implementation of health policies and interventions targeting identified risk factors is recommended.
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Affiliation(s)
| | | | | | | | | | - Analuiza Camozzato
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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Gonzales G, Lavey F. The Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults in Nashville, Tennessee. J Urban Health 2023; 100:459-467. [PMID: 37351727 PMCID: PMC10323052 DOI: 10.1007/s11524-023-00745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) populations experience widespread disparities in health outcomes, health behaviors, and access to care compared to their non-LGBT counterparts. Moreover, very few studies have either studied the social determinants of health (SDoH) of LGBT populations or LGBT health in large cities located in the US South. This study uses novel, community-informed, and representative data to study the SDoH of LGBT adults in Nashville and Davidson County, Tennessee. Compared to non-LGBT adults (n = 1583), LGBT adults (n = 128) in Nashville, Tennessee, were more likely to report being dissatisfied with life and feeling emotionally upset or physical symptoms as a result of how they were treated based on their race/ethnicity compared to non-LGBT adults. LGBT adults in Nashville were also less likely to keep a firearm in the home than their non-LGBT peers. This study documents new disparities in the SDoH for LGBT adults living in one of the largest and fastest growing cities in the southeastern US. More research on LGBT populations in urban centers located in the US South is critically needed. Meanwhile, locally based community organizations and public health leaders may consider developing and testing innovative solutions to enhance social networks and social supports among LGBT populations. Addressing the SDoH among LGBT adults in southern cities will be essential for achieving health equity for all LGBT populations in the USA.
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Affiliation(s)
- Gilbert Gonzales
- Department of Medicine, Health & Society, Department of Health Policy, Program for Public Policy Studies, LGBTQ+ Policy Lab, Vanderbilt University, 2301 Vanderbilt Place PMB #351665, Nashville, TN 37235-1665 USA
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Zuckerman MK, Malis SW, Dillon DD, Widrick KJ, Adams EJ, Hill ME, McKenna MK, Baumgartel OC, Willis HD. Sex, gender, and sexuality in paleopathology: Select current developments and pathways forward. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 41:8-21. [PMID: 36889217 DOI: 10.1016/j.ijpp.2023.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Overall, paleopathology trails behind related fields in exploring sex, gender, and sexuality in past societies. Here, we interrogatively synthesize scholarship on topics not included in similar reviews, focusing on sex estimation methods, and considering the social determinants of health; trauma; reproduction and family; and childhood - to highlight novel, social epidemiology- and social theory-informed frameworks and interpretive devices. CONCLUSIONS Many paleopathological interpretations focus on sex-gender differences relative to health, with increasing use of intersectionality. Others consistently project present-day ideologies about sex, gender, and sexuality (e.g., binary sex-gender systems) into paleopathological interpretations (i.e., presentism). SIGNIFICANCE Paleopathologists have an ethical imperative to generate scholarship that contributes to social justice initiatives focused on dismantling structural inequalities, especially relative to sex, gender, and sexuality (e.g., homophobia), such as through denaturalizing presentist binary systems. They also have a responsibility towards greater inclusivity relative to researcher identity and diversification of method and theory. LIMITATIONS In addition to material limitations complicating reconstructions of sex, gender, and sexuality relative to health and disease in the past, this review wasn't comprehensive. The review was also limited by the relative paucity of paleopathological work on these topics. SUGGESTIONS FOR FUTURE RESEARCH The outlook for paleopathological research on sex, gender, and sexuality is, however, positive; paleopathology is well situated to tackle these aspects of social identity. Future work should consider critical, self-reflective movement away from presentism; more robust contextualization; and further engagement with social theory and social epidemiology theory and approaches, including the Developmental Origins of Health and Disease (DOHaD), social determinants of health, and intersectionality.
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Affiliation(s)
- Molly K Zuckerman
- Department of Anthropology and Middle Eastern Cultures, Mississippi State University, 340 Lee Blvd, Mississippi State, MS 39762, USA.
| | - Sierra W Malis
- Department of Anthropology and Middle Eastern Cultures, Mississippi State University, 340 Lee Blvd, Mississippi State, MS 39762, USA; National Museum of Natural History, Smithsonian Institution, 10th St. & Constitution Ave. NW, Washington, DC 20560, USA.
| | - Daniel D Dillon
- Department of Anthropology and Middle Eastern Cultures, Mississippi State University, 340 Lee Blvd, Mississippi State, MS 39762, USA.
| | - Kerri J Widrick
- Department of Anthropology and Middle Eastern Cultures, Mississippi State University, 340 Lee Blvd, Mississippi State, MS 39762, USA.
| | - Elise J Adams
- Department of Anthropology and Middle Eastern Cultures, Mississippi State University, 340 Lee Blvd, Mississippi State, MS 39762, USA.
| | - Mary E Hill
- Department of Anthropology and Middle Eastern Cultures, Mississippi State University, 340 Lee Blvd, Mississippi State, MS 39762, USA.
| | - M Kathryn McKenna
- Department of Anthropology and Middle Eastern Cultures, Mississippi State University, 340 Lee Blvd, Mississippi State, MS 39762, USA.
| | - Olivia C Baumgartel
- Department of Anthropology and Middle Eastern Cultures, Mississippi State University, 340 Lee Blvd, Mississippi State, MS 39762, USA.
| | - Hannah D Willis
- Department of Anthropology and Middle Eastern Cultures, Mississippi State University, 340 Lee Blvd, Mississippi State, MS 39762, USA.
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Coelho LE, Torres TS, Jalil EM, Cardoso SW, Moreira RI, Calvet GA, Pacheco AG, Veloso VG, Grinsztejn B, Luz PM. Mortality rates by gender and sexual orientation reveal a disproportionally high mortality among cisgender men of unknown sexual orientation and men who have sex with women in a cohort of people living with HIV in Rio de Janeiro, Brazil. Braz J Infect Dis 2023; 27:102740. [PMID: 36736374 PMCID: PMC9931919 DOI: 10.1016/j.bjid.2023.102740] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/05/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Antiretroviral therapy use has led to a decline in HIV-related mortality yet disparities by gender and/or sexual orientation may exist. In this study, we estimated hazards of death in people living with HIV (PLWH) according to gender and sexual orientation. METHODS We included PLWH ≥ 18 years enrolled between 2000 and 2018 at INI/Fiocruz, Rio de Janeiro, Brazil. Participants were grouped as cisgender or transgender women, cisgender men who have sex with men (MSM) or men who have sex with women, or cisgender men with unknown sexual orientation. We assessed disparities in the hazard of death using Cox proportional hazards models. RESULTS Among 5,576 PLWH, median age at enrollment was 35 years, 39% were MSM, 28% cisgender women, 23% men who have sex with women, 5% transgender women, and 5% men with unknown sexual orientation. A total of 795 deaths occurred in 39,141 person-years of follow-up. Mortality rates per 1,000 person-years were: 82.4 for men with unknown sexual orientation, 24.5 for men who have sex with women, 18.3 for cisgender, 16.6 for transgender women, and 15.1 for MSM. Compared to MSM, men with unknown sexual orientation had the highest death hazard ratio (adjusted hazard ratio [aHR] 2.93, 95% confidence interval [CI] 2.35-3.81), followed by men who have sex with women (aHR 1.17, 95%CI 0.96, 1.43); death hazard ratios for cisgender and transgender women were not statistically different. CONCLUSION We observed disparities in the hazard of death for men with unknown sexual orientation and men who have sex with women despite universal access to antiretroviral therapy in Brazil. Future work should characterize and assist men with unknown sexual orientation with tailored policies and interventions. Increased hazard of death was not observed for transgender women, which probably results from interventions implemented in our service to reach, engage, retain, and support this population.
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Affiliation(s)
- Lara E Coelho
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
| | - Thiago S Torres
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Emilia M Jalil
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Sandra W Cardoso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Ronaldo I Moreira
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Guilherme A Calvet
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Antônio G Pacheco
- Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de Janeiro, RJ, Brazil
| | - Valdiléa G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
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Rosa WE, Roberts KE, Braybrook D, Harding R, Godwin K, Mahoney C, Mathew S, Atkinson TM, Banerjee SC, Haviland K, Hughes TL, Walters CB, Parker PA. Palliative and end-of-life care needs, experiences, and preferences of LGBTQ+ individuals with serious illness: A systematic mixed-methods review. Palliat Med 2022; 37:460-474. [PMID: 36475950 PMCID: PMC10171330 DOI: 10.1177/02692163221124426] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals experience discrimination throughout the care continuum, including during serious illness and at end of life. High-quality palliative care requires that health professionals deliver individualized services that reflect the needs, experiences, and preferences of LGBTQ+ persons. AIM To identify and appraise existing evidence related to the needs, experiences, and preferences for palliative and end of life care among LGBTQ+ individuals with serious illness. DESIGN Data-based convergent synthesis design reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES PubMed, Embase, Cochrane CENTRAL, PsycINFO, CINAHL, and Scopus from January 1, 2010 to November 6, 2020. RESULTS Of 4875 results captured, 69 articles underwent full-text review and 13 were retained for analysis. Most studies were from North America with trans individuals represented in 10 of 13 studies. Needs (n = 6) included increased social support, institutional safety, economic and legal supports, and advocacy to mitigate health barriers.Experiences (n = 12) were driven by fear and worry associated with discrimination/stigma,providers' hetero-/cisnormative assumptions, homophobia and transphobia, social isolation, and an undignified death. Preferences (n = 6) pertained to inclusion of chosen families in decision-making, disclosure of LGBTQ+ identity based on safety of the clinical environment, and a desire to maintain autonomy. CONCLUSIONS The robustness of the science has improved regarding the needs, experiences, and preferences of trans individuals. Actionable, inclusive policies coupled with sustained and integrated cultural sensitivity training for health workers are mandatory. Interventional research is critical to enhance tailored palliative care for LGBTQ+ people and their chosen families.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kailey E Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, England, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, England, UK
| | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cassidy Mahoney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shiyon Mathew
- Lienhard School of Nursing, College of Health Professions, Pace University, New York, NY, USA
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kelly Haviland
- Advanced Practice Provider Division, Professional Development, Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tonda L Hughes
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, NY, USA
| | - Chasity B Walters
- Patient Education & Engagement, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Batchelder AW, Foley JD, Stanton AM, Gorman KR, Morris JC, Scheer JR. Facets of Gender Expression and Discrimination in Relation to Alcohol and Other Drug Use Severity Among Sexual Minority Women and Gender Diverse Individuals Assigned Female at Birth. LGBT Health 2022; 10:191-201. [PMID: 36367714 PMCID: PMC10079249 DOI: 10.1089/lgbt.2022.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Sexual minority women and gender diverse individuals assigned female at birth (SMW+) consistently report more alcohol and other drug (AOD) use severity than heterosexual women, with greater disparities reported among bisexual plus (bi+) SMW (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity). Furthermore, emerging evidence suggests that SMW with masculine gender expression (e.g., SMW with masculine gender appearance) disproportionately experience problematic AOD use compared to those with feminine gender expression. The minority stress model, which has predominantly been investigated in relation to internalized homonegativity and sexuality-based discrimination, may also account for these AOD use disparities. This study examined gender expression, related discrimination, and AOD use severity among SMW+. Methods: In a 2020 sample of SMW+ (n = 236), we investigated AOD use severity in relation to gender expression (appearance, emotional expression, and gender roles) and gender expression-based discrimination after controlling for internalized homonegativity and sexuality-based discrimination through an online survey. Results: Masculine gender roles were associated with AOD use severity, whereas masculine appearance and emotional expression were not. In multivariable models, gender identity was inconsistently associated with alcohol use severity, sexuality-based discrimination was consistently associated with alcohol use severity and inconsistently associated with other drug use severity, and gender expression-based discrimination was associated with neither. Conclusion: This study emphasizes the importance of examining intersecting aspects of minority identity among SMW+, including facets of gender expression, in relation to AOD use severity.
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Affiliation(s)
- Abigail W. Batchelder
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Jacklyn D. Foley
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Amelia M. Stanton
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | | | - Jenna C. Morris
- Department of Internal Medicine, University of Rochester, Rochester, New York, USA
| | - Jillian R. Scheer
- Department of Psychology, Syracuse University, Syracuse, New York, USA
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17
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Desjardins G, Caceres BA, Juster RP. Sexual minority health and allostatic load in the National Health and Nutrition Examination Survey: A systematic scoping review with intersectional implications. Psychoneuroendocrinology 2022; 145:105916. [PMID: 36115322 DOI: 10.1016/j.psyneuen.2022.105916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
Understood largely from a minority stress framework, sexual minorities (SM) are hypothesized to suffer more physical and mental health burdens compared to their heterosexual counterparts. Several studies have used data from the National Health and Nutrition Examination Survey (NHANES) in the United States to assess SM health disparities and the 'wear and tear' of allostatic load. Because findings are generally mixed and sometimes contradictory with sexual minority stress theory, we endeavoured to explore existing NHANES studies of SM health. Our scoping review yielded a comprehensive analysis of all existing published articles (N = 43) that have used the NHANES to assess any outcome regarding SM health and well-being. Our synthesis confirms that SM sub-groups are significantly different from one another and from their heterosexual peers on several key health variables. Surprisingly, gay men appear to have the lowest allostatic load and no differences have yet been identified among women as a function of sexual identity/behavior. The existing literature suggests a need to use the NHANES more broadly and to include more psychosocial variables to better delineate sexual minority stress. This is especially important to consider at a physiological level in allostatic load research that should better include health behaviors available in NHANES and from other available datasets as moderators linking psychosocial exposures (e.g., minority stress) and health outcomes. Suggested future directions are proposed in an intersectional perspective that incorporates interactions among sex, gender, sexual identity/behaviors, race, ethnicity, age cohorts, socioeconomic status, and lived experiences.
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Affiliation(s)
- Gabriel Desjardins
- Center on Sex⁎Gender, Allostasis, and Resilience (CÉSAR), Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada.
| | - Billy A Caceres
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, NY, USA
| | - Robert-Paul Juster
- Center on Sex⁎Gender, Allostasis, and Resilience (CÉSAR), Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
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Sakharkar P, Friday K. Examining Health Disparities and Severity of Depression among Sexual Minorites in a National Population Sample. Diseases 2022; 10:diseases10040086. [PMID: 36278585 PMCID: PMC9624332 DOI: 10.3390/diseases10040086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Health disparities and mental health issues have not been fully explored among sexual minorities. This study aims to examine health disparities and severity of depression among sexual minorities using a nationally representative sample of the US population. Methods: The National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2016 were analyzed. The Patient Health Questionnaire (PHQ-9) was used to examine the severity of depression among sexual minorities compared to heterosexuals. Data were analyzed for descriptive statistics and associations using the Chi-squared test. A multivariate logistic regression analysis was used to quantify the magnitude of association between severity of depression and demographic characteristics. A p-value of <0.05 was considered statistically significant. Results: Among 7826 participants included, 426 (5.4%) were identified as a sexual minority. Moderately severe to severe depression was observed among 9.3% of sexual minorities with women having higher rates (64.2%) than men. Similarly, sexual minorities were two times more likely to have moderately severe to severe depression, two and half times more likely to see a mental health professional, and one and half times more likely to have genital herpes and be a user of illicit drugs than heterosexuals. In addition, they were less likely to be married and more likely to have been born in the United States, be a U.S. citizen, and earn less than USD 25,000 (p < 0.05). Conclusions: Sexual minorities are affected by a range of social, structural, and behavioral issues impacting their health. The screening of individuals with depression who are sexual minorities (especially females), illicit drug users, poor, or aged over 39 years may benefit from early intervention efforts.
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Affiliation(s)
- Prashant Sakharkar
- College of Science, Health and Pharmacy, Roosevelt University, Schaumburg, IL 60173, USA
- Correspondence: ; Tel.: +1-847-240-4077
| | - Kafi Friday
- College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC 27506, USA
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King M. Justice is not blind: We are. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100360. [PMID: 36777387 PMCID: PMC9903708 DOI: 10.1016/j.lana.2022.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Beckie TM, Lengacher C, Rodriguez C, Pares-Avila J, Turner D, Sanchez M, Nair US. A framework for addressing health inequities in sexual and gender diverse populations by nurses. Nurs Outlook 2022; 70:651-663. [DOI: 10.1016/j.outlook.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
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Zelaya DG, Guy AA, Surace A, Mastroleo NR, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Modeling the Impact of Race, Socioeconomic Status, Discrimination and Cognitive Appraisal on Mental Health Concerns Among Heavy Drinking HIV+ Cisgender MSM. AIDS Behav 2022; 26:3925-3938. [PMID: 35687187 DOI: 10.1007/s10461-022-03719-0] [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] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Prior research has attributed mental health disparities between marginalized and non-marginalized populations to socioeconomic differences (i.e., education, income, employment), stigma (e.g., HIV-related discrimination), and cognitive appraisal (i.e., optimism, hostility, satisfaction with life), but the relations among these variables have not been examined concomitantly. The current study utilized structural equation modeling to examine how race and socioeconomic status impact mental health outcomes through increased exposure to stigma and more negative cognitive appraisals. Data came from a randomized controlled trial of motivational interviewing to address heavy drinking in cisgender men with HIV who have sex with men (n = 180). We found that self-reported discrimination experiences related to race/ethnicity, sexual orientation, and HIV status significantly mediated the relation between socioeconomic status and mental health concerns, whereas cognitive appraisal did not. These findings suggest that, among heavy drinking men with HIV who have sex with men, having low socioeconomic resources may increase exposure to discrimination which, in turn, may worsen mental health. Interventions that address social determinants, like socioeconomic disadvantage, and that enhance coping resources related to stigma, may have positive effects on mental health.ClinicalTrials.gov Identifier NCT01328743. Date of Registration 09/09/2019.
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Affiliation(s)
- David G Zelaya
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Arryn A Guy
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, USA
| | - Anthony Surace
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | | | - David W Pantalone
- Fenway Health Boston, Boston, MA, USA
- University of Massachusetts, Boston, MA, USA
| | - Peter M Monti
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | - Kenneth H Mayer
- Fenway Health Boston, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher W Kahler
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, USA
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Dunbar MS, Siconolfi D, Rodriguez A, Seelam R, Davis JP, Tucker JS, D’Amico EJ. Alcohol and Cannabis Use Trajectories and Outcomes in a Sample of Hispanic, White, and Asian Sexual and Gender Minority Emerging Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042059. [PMID: 35206249 PMCID: PMC8871829 DOI: 10.3390/ijerph19042059] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/05/2023]
Abstract
Substance use disproportionately affects health and psychosocial outcomes for some racial/ethnic groups, but few longitudinal studies examine the extent to which sexual and gender minority (SGM) emerging adults of different racial/ethnic groups may experience disparities in outcomes at similar levels of alcohol or cannabis use. This study used five waves of annual survey data (spanning 2015 (average age 18) to 2020 (average age 23)) from an ongoing longitudinal cohort study of emerging adults. In the subset of 359 SGM emerging adults, separate sequelae of change models assessed differences in trajectories of alcohol or cannabis use (past 30-day frequency) and multiple health and psychosocial outcomes across Hispanic, Asian, and White individuals. White SGM emerging adults showed higher baseline levels of alcohol and cannabis frequency compared to Hispanic and Asian peers, but all groups showed similar rates of change (slope) over time. We observed few racial/ethnic differences in SGM emerging adult outcomes at the same levels of alcohol or cannabis use; that is, racial/ethnic groups showed similar patterns on most health and psychosocial outcomes; however, some differences emerged. For example, Asian respondents reported less engagement in sex with casual partners after using alcohol, marijuana, or other drugs compared to their White peers, at the same levels of alcohol use (β = −0.579, p = 0.03) or cannabis use (β = −0.737, p = 0.007). Findings underscore a need to consider multiple outcome domains and factors beyond additive stress in examining the effects of substance use across different groups of SGM individuals. More longitudinal studies with large, contemporary, and diverse samples of SGM emerging adults are needed to better characterize similarities and differences in patterns of substance use and use-related consequences in relation to intersecting SGM, racial/ethnic, and other identities.
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Affiliation(s)
- Michael S. Dunbar
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA;
- Correspondence:
| | - Daniel Siconolfi
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA;
| | | | - Rachana Seelam
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA; (R.S.); (J.S.T.); (E.J.D.)
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34th Street, Los Angeles, CA 90089, USA;
| | - Joan S. Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA; (R.S.); (J.S.T.); (E.J.D.)
| | - Elizabeth J. D’Amico
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA; (R.S.); (J.S.T.); (E.J.D.)
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23
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Ramchand R, Schuler MS, Schoenbaum M, Colpe L, Ayer L. Suicidality Among Sexual Minority Adults: Gender, Age, and Race/Ethnicity Differences. Am J Prev Med 2022; 62:193-202. [PMID: 35000689 DOI: 10.1016/j.amepre.2021.07.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Lesbian, gay, and bisexual individuals have elevated suicide risk, but there is little information available about how this risk may vary by gender, age, and race/ethnicity. METHODS This study examined past-year suicide thoughts, plans, and attempts among adult respondents to the 2015-2019 National Surveys on Drug Use and Health (pooled N=191,954). Logistic regression was used to examine the differences between lesbian, gay, and bisexual and heterosexual adults for each outcome, once by gender and age category and once by gender and race/ethnicity category, while controlling for core sociodemographic characteristics. Race/ethnicity and age differences were also estimated within sexual identity groups. RESULTS Suicide thoughts, plans, and attempts were more common among lesbian, gay, and bisexual adults in almost every age and race/ethnicity category relative to that among corresponding heterosexual adults. In some age and race/ethnicity categories, bisexual women were more likely to report suicidal thoughts than lesbian/gay women. Each outcome decreased significantly across age groups among women of all sexual identity groups and heterosexual men; yet, this age effect was less pronounced among gay and bisexual men. Black women had significantly lower rates of suicidal thoughts and plans than White women in all sexual identity groups. CONCLUSIONS In light of consistently elevated rates of suicide thoughts and behaviors, lesbian, gay, and bisexual adults may expressly benefit from enhanced prevention, identification, and treatment of suicide risk. Additional research is needed to assess the associations between sexual identity and suicide mortality as well as to understand the heterogeneity in suicide risk among lesbian, gay, and bisexual youth, particularly by race/ethnicity.
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Affiliation(s)
- Rajeev Ramchand
- National Institute of Mental Health, Bethesda, Maryland; RAND Corporation, Arlington, Virginia.
| | | | | | - Lisa Colpe
- National Institute of Mental Health, Bethesda, Maryland
| | - Lynsay Ayer
- National Institute of Mental Health, Bethesda, Maryland; RAND Corporation, Arlington, Virginia
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Schuler MS, Collins RL, Ramchand R. Disparities in Use/Misuse of Specific Illicit and Prescription Drugs among Sexual Minority Adults in a National Sample. Subst Use Misuse 2022; 57:461-471. [PMID: 35067155 DOI: 10.1080/10826084.2021.2019776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Compared to heterosexual adults, lesbian, gay, and bisexual (LGB) adults have higher rates of any illicit drug use and any prescription drug misuse, yet disparities regarding specific drugs remain poorly characterized. Methods: We examined disparities by sexual identity and sex for 8 illicit and prescription drugs using 2015-2019 National Survey on Drug Use and Health data. Outcomes included past-year use/misuse of cocaine/crack, hallucinogens, inhalants, methamphetamine, heroin, prescription opioids, prescription stimulants, prescription tranquilizers/sedatives, and level of polydrug use/misuse (2 substances; 3+ substances). For each outcome, odds ratios relative to heterosexual adults of same sex were estimated using logistic regression controlling for demographics; significant estimates were interpreted as a disparity. Results: Among gay men, significant disparities were present for all drugs except prescription stimulants and heroin; inhalant use was particularly elevated. Bisexual women exhibited significant disparities for every drug examined, as did bisexual men (except heroin). Among lesbian/gay women, disparities were only present for prescription opioids and stimulants. Relative to heterosexual peers, use of 3+ substances was 3 times higher among gay men and bisexual women and 2 times higher among bisexual men. Conclusions: Consistent with minority stress theory, prevalences of illicit and prescription drug use/misuse were 2-3 times higher among LGB adults than heterosexual adults. Illicit drug use should not be perceived as only impacting gay/bisexual men - bisexual women had similar - or higher - prevalences of hallucinogen, cocaine, methamphetamine, and heroin use. Yet, in contrast to bisexual women, lesbian/gay women did not exhibit disparities for any illicit drugs.
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Lindley KJ, Aggarwal NR, Briller JE, Davis MB, Douglass P, Epps KC, Fleg JL, Hayes S, Itchhaporia D, Mahmoud Z, Moraes De Oliveira GM, Ogunniyi MO, Quesada O, Russo AM, Sharma J, Wood MJ. Socioeconomic Determinants of Health and Cardiovascular Outcomes in Women: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 78:1919-1929. [PMID: 34736568 DOI: 10.1016/j.jacc.2021.09.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Socioeconomic disparities in cardiovascular risk factors and outcomes exist among women, particularly those of minority racial or ethnic backgrounds. Barriers to optimal cardiovascular health begin early in life-with inadequate access to effective contraception, postpartum follow-up, and maternity leave-and result in excess rates of myocardial infarction, stroke, and cardiovascular death in at-risk populations. Contributing factors include reduced access to care, low levels of income and social support, and lack of diversity among cardiology clinicians and within clinical trials. These barriers can be mitigated by optimizing care access via policy change and improving physical access to care in women with geographic or transportation limitations. Addressing structural racism through policy change and bolstering structured community support systems will be key to reducing adverse cardiovascular outcomes among women of racial and ethnic minorities. Diversification of the cardiology workforce to more closely represent the patients we serve will be beneficial to all women.
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Affiliation(s)
- Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/NitiCardio
| | - Joan E Briller
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. https://twitter.com/MelindaDavisMD
| | - Paul Douglass
- Division of Cardiology, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Kelly C Epps
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Jerome L Fleg
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Sharonne Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dipti Itchhaporia
- Jeffrey M. Carlton Heart & Vascular Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA
| | - Zainab Mahmoud
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Modele O Ogunniyi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. https://twitter.com/modeldoc
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA. https://twitter.com/odayme
| | - Andrea M Russo
- Cardiovascular Division, Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA. https://twitter.com/AndreaRussoEP
| | - Jyoti Sharma
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Malissa J Wood
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/drmalissawood
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