Demographic and Minority Stress Risk Factors for Obesity Among Sexual Minority Youth Assigned Female at Birth

Purpose: Sexual minority youth (adolescents and young adults) assigned female at birth (SM-AFAB) are at disproportionate risk of developing obesity compared with heterosexual cisgender youth AFAB. Grounded in minority stress theory, this study aimed to identify potential risk factors for obesity among SM-AFAB youth to inform the development of prevention and intervention efforts for this high-risk population. Methods: Data were collected in 2017 from 367 SM-AFAB youth (ages 16-20 years). Multinominal logistic regression was used to assess cross-sectional associations of race/ethnicity, sexuality, gender identity, household income, and sexual minority (SM) stressors (internalized stigma, microaggressions, and victimization) with weight status (normal, overweight, and obese). Results: Roughly half (53.1%) of participants' body mass index were in the normal weight range, with 24.8% in the overweight range and 22.1% in the obese range. Rates of obesity in Black and Latinx participants were 3-4.5 times those of White participants. Bisexual, pansexual, and queer individuals were at greater risk for obesity than gay/lesbian participants; only bisexual participants were at higher risk for overweight. Participants with a household income <$20,000 and between $20,000 and $39,000 were at greater risk for obesity than participants with household income >$80,000. Microaggressions were positively associated with obesity. Conclusion: Findings highlight risk for obesity among SM-AFAB youth, particularly for those who identify as racial minority, as low income, as being attracted to more than one gender, and for those who experience high levels of anti-SM microaggressions. Targeted obesity prevention and treatment programs should consider the unique needs, challenges, and strengths of SM-AFAB youth.

Mindfulness-Based Mobile Health to Address Unhealthy Eating Among Middle-Aged Sexual Minority Women With Early Life Adversity: Mixed Methods Feasibility Trial

BACKGROUND

Sexual minority women (lesbian, gay, bisexual, pansexual, queer, and other nonheterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma and psychological distress than their heterosexual peers. In addition, early life adversity (ELA) is prevalent among sexual minority women, which further increases risks for obesity, psychological distress, and poor cardiovascular health. App-based mindfulness interventions are potentially promising for this group in mitigating the adverse health effects of ELA, reducing food craving and unhealthy eating, addressing the risks associated with obesity.

OBJECTIVE

This mixed methods feasibility trial aimed to test a mindfulness-based mobile health approach for middle-aged sexual minority women (aged 30-55 years) with ELA and overweight or obesity (BMI ≥25 kg/m2) to improve health outcomes.

METHODS

The single-arm trial was advertised on social media and various lesbian, gay, bisexual, transgender, and queer web-based groups. At baseline, after the intervention (2 months), and at the 4-month follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). A standardized weight measure was mailed to participants for weight reporting. Feasibility and acceptability were assessed after the intervention via surveys and semistructured exit interviews.

RESULTS

We screened 442 individuals, among which 30 eligible sexual minority women (mean age 40.20, SD 7.15 years) from various US regions were enrolled in the study. At baseline, 86% (26/30) and 80% (24/30) of participants had elevated depressive and anxiety symptoms, respectively. Among the 30 enrolled participants, 20 (66%) completed all intervention modules, 25 (83%) were retained at the 2-month follow-up, and 20 (66%) were retained at the 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (Cohen d=1.64) and reward-based eating (Cohen d=1.56), whereas small effects were found with weight (Cohen d=0.20; 4.21 kg on average). Significant improvements were also found in the secondary outcomes (depression, Cohen d=0.98; anxiety, Cohen d=0.50; mindfulness, Cohen d=0.49; and emotion dysregulation, Cohen d=0.44; all P<.05). Participants with higher levels of parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported that the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers to engagement included the need for diverse teachers, individualized support, and body positive language.

CONCLUSIONS

This early phase feasibility trial provides proof-of-concept support for a mindfulness mobile health approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. The findings also suggest the need to address trauma and psychological health when addressing weight-related outcomes among sexual minority women.

Experiences of stigma, psychological distress, and facilitative coping among pregnant people with gestational diabetes mellitus

BACKGROUND

Gestational diabetes mellitus (GDM) has been rising in the United States, and it poses significant health risks to pregnant individuals and their infants. Prior research has shown that individuals with GDM also experience prevalent stress and mental health issues, which can further contribute to glucose regulation difficulties. Stigma associated with GDM may contribute to these mental health challenges, yet there is a lack of focused research on GDM-related stigma, its impact on psychological health, and effective coping mechanisms. Thus, this qualitative study aims to understand individuals' experiences related to GDM stigma, mental health, and facilitative coping.

METHODS

In-depth, semi-structured interviews were conducted with 14 individuals with a current or recent (within the last year) diagnosis of GDM. Thematic analysis was employed to guide data analysis.

RESULTS

Four themes emerged from data analysis: (1) experience of distal GDM stigma including stigmatizing provider interactions, stigma from non-medical spaces, and intersecting stigma with weight, (2) internalized GDM stigma, such as shame, guilt, and self-blame, (3) psychological distress, which included experiences of stress and overwhelm, excessive worry and fear, and loneliness and isolation, and (4) facilitative coping mechanisms, which included diagnosis acceptance, internet-based GDM community, active participation in GDM management, social and familial support, and time for oneself.

CONCLUSIONS

Findings demonstrate the relevance of GDM stigma in mental health among people with GDM and the need for addressing GDM stigma and psychological health in this population. Interventions that can reduce GDM stigma, improve psychological wellness, and enhance positive coping may facilitate successful GDM management and healthy birth outcomes. Future quantitative, theory-driven research is needed to understand the prevalence of GDM stigma experiences and mechanisms identified in the current study, as well as among marginalized populations (e.g., individuals of color, sexual and gender minorities).

Obesity in Sexual and Gender Minority Populations: Prevalence and Correlates

PURPOSE OF REVIEW

The purpose of this review is to explore the prevalence and correlates of obesity among members of sexual and gender minority (SGM) populations.

RECENT FINDINGS

Research overall finds higher rates of obesity among lesbian and bisexual women than heterosexual women, lower rates of obesity among gay and bisexual men than heterosexual men, and inconsistent findings on obesity among transgender individuals. Rates of mental health disorders and disordered eating are high among all SGM groups. Rates of comorbid medical conditions differ among groups. More research needs to be conducted within all SGM groups but particularly among transgender populations. All members of SGM encounter stigma, including when seeking healthcare, and this may lead to individuals avoiding healthcare. Therefore, it is important to educate providers about population-specific factors. This article serves as an overview of important considerations for providers treating individuals within SGM populations.

Factors that impact assigned female sexual minority individuals health care experiences: A qualitative descriptive study

This qualitative descriptive study identified factors that impact assigned female at birth (AFAB) cisgender and non-binary sexual minority individuals' decision to engage, or not engage, in health-seeking behaviors and receive preventative health care services. AFAB sexual minority individuals were asked to describe their health care experiences to determine modifiable factors that could improve their intention to seek care and improve their health care experiences. Purposive sampling was used to recruit AFAB sexual minority individuals between 18-30 years of age in the Chicago metropolitan area. Three main themes emerged from data acquired through individual interviews: (1) "ask the right questions"; main themes (2 lack of trust in health professionals; (3 the need for better sexual health education. An important finding was participants wanted to be asked about their sexual orientation, sexual behavior, and gender identity. Participants wanted to be able to share their sexual orientation and gender identity with health care professionals so they could receive appropriate care, accurate information, and feel comfortable sharing aspects about their life. Additionally, the results suggested that general and health sciences curricula should include content about diverse sexual and gender minority populations. Findings have important implications for health education and clinical practice.

A Call to Reconceptualize Obesity Treatment in Service of Health Equity: Review of Evidence and Future Directions

PURPOSE OF REVIEW

Rates of obesity and associated comorbidities are higher among Black and Latino adults compared to white adults. We sought to provide an overview of both structural and individual factors contributing to obesity inequities and synthesize available evidence regarding treatment outcomes in Black and Latino adults, with an eye towards informing future directions.

RECENT FINDINGS

Obesity disparities are influenced by myriad systemic issues, yet the vast majority of interventions target individual-level factors only, and most behavioral treatments fail to target drivers beyond eating and physical activity. Extant treatments are not equally accessible, affordable, or effective among Black and Latino adults compared with white counterparts. Asset-based, culturally relevant interventions that target the root causes of obesity and address intersectional stress-designed in partnership with intended beneficiaries-are urgently needed. Treatment trials must improve enrollment of Black and Latino adults and report treatment outcomes by race and ethnicity.

Comprehensive systematic review and meta-analysis on physical health conditions in lesbian- and bisexual-identified women compared with heterosexual-identified women

BACKGROUND

Sexual minority individuals experience discrimination, leading to mental health disparities. Physical health disparities have not been examined to the same extent in systematic reviews so far.

OBJECTIVES

To provide a systematic review and, where possible, meta-analyses on the prevalence of physical health conditions in sexual minority women (i.e. lesbian- and bisexual-identified women) compared to heterosexual-identified women.

DESIGN

The study design is a systematic review with meta-analyses.

DATA SOURCES AND METHODS

A systematic literature search in MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science databases was conducted on epidemiologic studies on physical health conditions, classified in the Global Burden of Disease project, published between 2000 and 2021. Meta-analyses pooling odds ratios were calculated.

RESULTS

In total, 23,649 abstracts were screened and 44 studies were included in the systematic review. Meta-analyses were run for arthritis, asthma, back pain, cancer, chronic kidney diseases, diabetes, headache disorders, heart attacks, hepatitis, hypertension, and stroke. Most significant differences in prevalence by sexual identity were found for chronic respiratory conditions, especially asthma. Overall, sexual minority women were significantly 1.5-2 times more likely to have asthma than heterosexual women. Furthermore, evidence of higher prevalence in sexual minority compared to heterosexual women was found for back pain, headaches/migraines, hepatitis B/C, periodontitis, urinary tract infections, and acne. In contrast, bisexual women had lower cancer rates. Overall, sexual minority women had lower odds of heart attacks, diabetes, and hypertension than heterosexual women (in terms of diabetes and hypertension possibly due to non-consideration of pregnancy-related conditions).

CONCLUSION

We found evidence for physical health disparities by sexual identity. Since some of these findings rely on few comparisons only, this review emphasizes the need for routinely including sexual identity assessment in health research and clinical practice. Providing a more detailed picture of the prevalence of physical health conditions in sexual minority women may ultimately contribute to reducing health disparities.

Medical mistrust among women with intersecting marginalized identities: a scoping review

The purpose of this scoping review is to synthesize knowledge about medical mistrust and health among women who occupy other marginalized identities; namely women who also belong to one or more of the following social groups: people of color, people of low socioeconomic status, people with disabilities, lesbian and bisexual women, and/or women who have sex with women. This scoping review is based on the methodological framework by Arksey and O'Malley (2005. "Scoping Studies: Towards a Methodological Framework." International Journal of Social Research Methodology 8: 19-32. doi:10.1080/1364557032000119616). Specific search terms were entered into selected databases. Based on a set of inclusion criteria, articles were screened and assessed for eligibility. Data from the selected articles were extracted and summarized. Forty studies were included. Thirty-one studies used quantitative methodology, of which more than half used the Group-Based Medical Mistrust Scale. The majority of studies (84%) investigated the intersection of gender with race and ethnicity. Breast cancer and HIV combined accounted for more than half of the included studies. Of those studies that examined the relationship between medical mistrust and a health outcome or health behavior, almost all reported that medical mistrust had a deleterious impact. Medical mistrust among women with intersecting marginalized identities is worthy of further study, and there is still a dearth of knowledge in the role of medical mistrust among a wide range of subgroups of women and health domains.

Some Aspects of Women’s Health in Republic of Macedonia

INTRODUCTION: Sex and gender "matters" in terms of the health status as well as a result of both biological and gender-related differences. AIM: To analyze sex and gender-based differences in North Macedonia through analysis of some aspects of mortality, the knowledge and attitudes related to women’s health. METHODS: Analysis of the general and age-standardized mortality patterns and CAPI (Computer-assisted personal interview) composed on different topics including women's health for the period 2017-2020 were used. RESULTS: Age-standardized mortality rates (all-causes of death, circulatory and respiratory diseases and neoplasms) are prevalent and higher in the male population in North Macedonia. A significantly higher all-cause mortality trend for both sexes was found in 2020 making this year hardly comparable with the previous years. A decreasing trend of malignant neoplasms rate of female genital organs and an increasing trend of breast cancer mortality is observed. The majority of the respondents (50.6%) rated their current health status as excellent with a statistically significant difference between the age and ethnical groups. One-third of the respondents reported regular physical activity, mostly on a daily basis. The majority (39.3%) are overweight and 27.5% belongs to the obesity class I without a significant difference in terms of ethnicity. Respondents (27%), reported that have high blood pressure, 20.2% vaginal infections, 19.9% allergies, heart issues 15.1%, anemia 11.7%, while diabetes and cancer 8.5% and 2.5% respectively. The youngest and oldest age group of Albanian women are the least informed about the early detection procedures of malignant compared to Macedonian women and other ethnic groups. CONCLUSIONS: Analyzing some aspects of women's health in North Macedonia through the mortality, knowledge and attitudes of Macedonian women, we provide some further evidence for the development and implementation of targeted interventions and policies aimed to reduce the sex and gender-based health inequalities in the country.

A population-based study of the intersection of sexual identity and race/ethnicity on physiological risk factors for CVD among U.S. adults (ages 18-59)

Objectives: Sexual minorities face significant psychosocial stressors (such as discrimination and violence) that impact their health. Several studies indicate that sexual minority women (SMW) and bisexual men may be at highest risk for cardiovascular disease (CVD), but limited research has examined physiological CVD risk or racial/ethnic differences. This study sought to examine racial/ethnic differences in physiological risk factors for CVD among sexual minority and heterosexual adults.Design: We analyzed data from the National Health and Nutrition Examination Survey (2001-2016) using sex-stratified multiple linear regression models to estimate differences in physiological CVD risk. We compared sexual minorities (gay/lesbian, bisexual, 'not sure') to heterosexual participants first without regard to race/ethnicity. Then we compared sexual minorities by race/ethnicity to White heterosexual participants.Results: The sample included 22,305 participants (ages 18-59). Lesbian women had higher body mass index (BMI) but lower total cholesterol than heterosexual women. Bisexual women had higher systolic blood pressure (SBP). Gay men had lower BMI and glycosylated hemoglobin (HbA1c) relative to heterosexual men. White and Black lesbian women and bisexual women of all races/ethnicities had higher BMI than White heterosexual women; Black bisexual women had higher SBP and HbA1c. Black sexual minority men had higher HbA1c relative to White heterosexual men. Latino 'not sure' men also had higher SBP, HbA1c, and total cholesterol than White heterosexual men.Conclusions: Given evidence of higher CVD risk in sexual minority people of color relative to White heterosexuals, there is a need for health promotion initiatives to address these disparities. Additional research that incorporates longitudinal designs and examines the influence of psychosocial stressors on CVD risk in sexual minorities is recommended. Findings have implications for clinical and policy efforts to promote the cardiovascular health of sexual minorities.

Income as a Predictor of Self-Efficacy for Managing Pain and for Coping With Symptoms Among Patients With Chronic Low Back Pain

OBJECTIVES

The purpose of this study was to evaluate pain self-efficacy (PSE) and coping self-efficacy (CSE) for people with chronic low back pain (CLBP), and to assess whether lower income may be associated with less PSE and CSE in the United States.

METHODS

We conducted a cross-sectional study using survey data collected between June 2016 and February 2017 from n = 1364 patients with CLBP from chiropractic clinics in the United States to measure the relationship between income and both types of self-efficacy. We created 4 multivariate models predicting PSE and CSE scores. We used both a parsimonious set of covariates (age, sex) and a full set (age, sex, education, neck pain comorbidity, catastrophizing, and insurance). We also calculated effect sizes (Cohen's d) for unadjusted differences in PSE and CSE score by income.

RESULTS

Lower income was associated with lower PSE and CSE scores across all 4 models. In the full models, the highest-income group had an average of 1 point (1-10 scale) higher PSE score and CSE score compared to the lowest income group. Effect sizes for the unadjusted differences in PSE and CSE scores between the highest and lowest income groups were 0.94 and 0.84, respectively.

CONCLUSIONS

Our findings indicate that people with lower income perceive themselves as less able to manage their pain, and that this relationship exists even after taking into account factors like health insurance and educational attainment. There is a need to further investigate how practitioners and policymakers can best support low-income patients with chronic pain.

What Is Successful Aging in Lesbian and Bisexual Women? Application of the Aging-Well Model

OBJECTIVES

Most evidence concerning aging ignores women's sexual orientation, yet sexual orientation-related discrimination across the life course may influence older lesbian and bisexual women's risk for poorer health. Understanding aging-well in this group is vital to development, testing, and implementation of evidence-based health promotion programming and services for aging sexual minority women.

METHOD

Data were from the Women's Health Initiative (N = 15,691; heterosexual n = 15,002, lesbian n = 440, bisexual n = 249) extension study. Multivariable linear and logistic regression tested associations between sexual orientation and indicators of successful, effective, and optimal aging-well in age-stratified groups of women (60-74 and 75+).

RESULTS

Lesbians aged 60-74 were more likely (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.16, 2.18) to report good self-mastery, more social support (b = 2.92, 95% CI, 1.99, 3.85), and greater likelihood of enjoying life (OR 1.46, 95% CI 1.06, 2.01) compared with heterosexual women. Bisexual women aged 75+ reported increased personal growth (b = 1.09, 95% CI 0.23, 1.95) compared to heterosexuals. While lesbians aged 75+ had greater likelihood of living in a nursing home (OR 1.96; 95% CI 1.01, 3.82) and were less likely to be happy at least most of the time (OR 0.68, 95% CI 0.49, 0.99), they reported greater self-mastery (OR 1.55; 95% CI 1.06, 2.26) than their heterosexual peers.

DISCUSSION

Aging-well is not the same for all women. Health promotion programs may consider maximizing sexual minority women's internal and external resources-including social supports, self-mastery, and personal growth-to promote wellness in older age.

Sexual and Gender Minority Health Care Disparities: Barriers to Care and Strategies to Bridge the Gap

Gender and sexual minority individuals face considerable physical and mental health disparities, health risk factors, and barriers to care. These disparities are rooted in systemic and interpersonal prejudice, discrimination, and violence toward lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) individuals and communities that place LGBTQ+ individuals at increased risk for negative social determinants of health. While also advocating for systemic change, individual providers and clinics have an ethical duty to promote an openly affirming, culturally competent health care environment that can help to address these disparities on an individual patient level.

Disparities in food insecurity at the intersection of race and sexual orientation: A population-based study of adult women in the United States

Food insecurity affects 1 in 8 American adults annually, and is more prevalent in Black and sexual minority women. We applied an intersectional approach to investigate food insecurity prevalence in women with intersecting minority race and sexual orientation. We used two United States surveillance systems-National Health Interview Survey (NHIS) 2013-2018 and National Health and Nutrition Examination Survey (NHANES) 2005-2014, to estimate how race and sexual orientation jointly influence food insecurity prevalence in women aged 18-59 years (NHIS: N = 47596; NHANES: N = 5106). All analyses were stratified for Supplemental Nutrition Assistance Program (SNAP) use. Relative measures estimated weighted prevalence ratios (PR) comparing Black and White sexual minority women (SMW) to heterosexual White women. Absolute prevalence measures estimated the excess prevalence of food insecurity due to multiple marginalization. Patterns of food insecurity prevalence were similar across NHIS and NHANES, and differed only for non-SNAP users. Relative prevalence of food insecurity was greater in Black SMW than heterosexual White women in NHIS (PR: 2.16; 95% confidence interval [CI], 1.41-3.30) and NHANES (PR: 2.79; 95% CI, 1.73-4.51). The strength of the association between multiple marginalization and food insecurity was stronger for Black SMW than White SMW. Absolute measures were significant only for NHIS and did not support our a priori hypothesis: For non-SNAP users, being Black and sexual minority reduced the joint disparity in food insecurity by approximately 50% (Synergy Index: 0.52; 95% CI, 0.11-0.93). Overall, our study illuminated population-level differences in food insecurity among women of diverse minority races and sexual orientations. Black SMW experienced high rates of food insecurity, which may contribute to chronic disease disparities. Yet, intersecting minority social positions (race and sexual orientation) reduced food insecurity; these findings are unexpected and must be further investigated. Increasing SNAP use among multiply marginalized women may attenuate food insecurity disparities.

Sexual orientation disparities in food insecurity and food assistance use in U.S. adult women: National Health and Nutrition Examination Survey, 2005-2014

Background

Nearly 40 million American adults report past year food insecurity. This is concerning, as food insecurity is associated with chronic disease morbidity and premature mortality. Women disproportionately experience food insecurity, and sexual minority women (i.e., lesbian, bisexual, and heterosexual women reporting same-sex behavior; SMW) may be at greater risk for experiencing food insecurity disparities. The purpose of this study was to investigate patterns and prevalence of food insecurity and food assistance use in sexual minority and exclusively heterosexual women using population-level health surveillance data.

Methods

Using pooled 2004–2014 National Health and Nutrition Examination Survey data (N = 7379), we estimated weighted point prevalence of past 12-month food insecurity, severe food insecurity, Supplemental Nutrition Assistance Program (SNAP) use, and emergency food assistance use. We then used Poisson regression with robust variance to estimate prevalence ratios comparing SMW to exclusively heterosexual women on all outcomes. Women were classified by sexual identity and lifetime same-sex behavior as lesbian (n = 88), bisexual (n = 251), heterosexual and reporting same-sex behavior (heterosexual WSW; n = 366), or exclusively heterosexual women (referent; n = 6674).

Results

Between 20.6–27.3% of lesbian, bisexual, and heterosexual WSW reported past 12-month food insecurity (versus 13.1% of exclusively heterosexual women). All SMW reported greater prevalence of past 12-month food insecurity and severe food insecurity than exclusively heterosexual women: prevalence ratios (PR) ranged from 1.34 (95% confidence interval [CI], 1.05–1.70) to 1.84 (95% CI, 1.13–3.01). No differences were found in SNAP participation by sexual orientation, but more lesbians and heterosexual WSW reported using emergency food assistance in the past 12-months (PR = 1.89; 95% CI, 1.29–2.79 and PR = 1.43; 95% CI, 1.03–2.00 respectively).

Conclusions

All SMW reported higher prevalence of food insecurity than exclusively heterosexual women. Lesbians and heterosexual WSW were also more likely to rely on emergency food assistance. This is problematic as SNAP use may reduce food insecurity over time, but emergency food resources (e.g., food pantries) do not. More evidence is needed to understand the multilevel factors driving food insecurity in this population to develop policy and community-based efforts to increase SNAP participation and decrease food insecurity.

Sexual Orientation Identity Disparities in Mammography Among White, Black, and Latina U.S. Women

Purpose: Our goal was to examine sexual orientation identity disparities in mammography in relationship to race/ethnicity among U.S. women. Methods: Using nationally representative 2013-2017 National Health Interview Survey data, we used multivariable logistic regression to estimate the odds of receiving a mammogram in the past year in relationship to sexual orientation identity among White, Black, and Latina U.S. women 40-75 years of age (N = 45,031) separately, adjusting for demographic factors. We also assessed whether socioeconomic and health care factors attenuated sexual orientation identity disparities in mammography across racial/ethnic groups. Results: Among White women, bisexual women had significantly lower adjusted odds of mammography compared to heterosexual women (odds ratio = 0.70, 95% confidence interval: 0.50-0.99). Among Black women, the adjusted odds of mammography were significantly higher among bisexual women relative to heterosexual women (2.53, 1.08-5.92). Black lesbian women appeared to have lower adjusted odds of mammography compared to their heterosexual counterparts; however, this difference was not statistically significant (0.80, 0.46-1.38). Similarly, among Latina women, lesbian women also seemed to have lower adjusted odds of mammography relative to heterosexual women, but this disparity was also not statistically significant (0.64, 0.37-1.13). Adding socioeconomic factors completely attenuated the disparity between White bisexual and heterosexual women (0.76, 0.52-1.10). Conclusions: Sexual orientation identity disparities in receiving a mammogram in the past year differed in relationship to race/ethnicity among White, Black, and Latina U.S. women. Additional research with larger samples of Black and Latina lesbian and bisexual women is needed to more accurately estimate and explain observed differences.

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.

Weight Stigma Among Sexual Minority Adults: Findings from a Matched Sample of Adults Engaged in Weight Management

OBJECTIVE

Despite elevated rates of obesity among some groups of sexual minority (SM) adults, research examining weight stigma in this population is scarce.

METHODS

Weight stigma and weight-related health correlates were assessed in SM adults (N = 658) versus heterosexual adults (N = 658) matched on sex, race/ethnicity, age, education, and BMI. Adults enrolled in WW (formerly Weight Watchers) completed digital questionnaires assessing experienced weight stigma, weight bias internalization (WBI), weight cycling, eating self-efficacy, eating to cope, physical activity, and health-related quality of life (HRQOL).

RESULTS

Survey response rates ranged from 0.8% to 3.5%. There were no differences in experienced weight stigma between SM and heterosexual participants; more than two-thirds experienced weight stigma, and more than 50% reported stigma from family, health care providers, teachers and classmates, and community members. Gay men endorsed higher WBI than heterosexual men (β = 0.22, P < 0.001). Regardless of sexual orientation, WBI was associated with poorer mental HRQOL, lower eating self-efficacy, and increased eating to cope, controlling for demographics and BMI.

CONCLUSIONS

Experiencing weight stigma is as common for SM adults as heterosexual adults engaged in weight management, and WBI is associated with maladaptive eating behaviors and poor mental HRQOL. Increased attention to weight stigma and its health implications in SM populations is warranted.

Racial/Ethnic Differences in Cardiometabolic Risk in a Community Sample of Sexual Minority Women

Purpose: To examine the intersection of sexual identity and race/ethnicity on self-reported cardiometabolic risk in sexual minority women (SMW). Methods: Data from the Chicago Health and Life Experiences of Women study were analyzed. Logistic regression models examined racial/ethnic differences in cardiometabolic risk (including obesity, hypertension, and diabetes) in SMW, accounting for psychosocial and behavioral factors. A variable accounting for the intersection of sexual identity and race/ethnicity was added to regression models (White lesbian women were the reference group). Results: The analytic sample included 601 SMW (237 White, 219 Black, 145 Latina). Black (adjusted odds ratio [AOR] 2.96, 95% confidence interval [CI]=1.48-5.94) and Latina (AOR 2.30, 95% CI=1.18-4.48) SMW had higher rates of lifetime trauma than White SMW. Black SMW reported higher rates of obesity (AOR 3.05, 95% CI=1.91-4.88), hypertension (AOR 1.99, 95% CI=1.08-3.66), and diabetes (AOR 3.77, 95% CI=1.46-9.74) relative to White SMW. Intersectional analyses revealed that Black lesbian (AOR 2.94, 95% CI=1.74-4.97) and Black bisexual (AOR 3.43, 95% CI=1.69-6.96) women were more likely to be obese than White lesbian women. Black lesbian women also reported higher rates of hypertension (AOR 2.09, 95% CI=1.08-4.04) and diabetes (AOR 3.31, 95% CI=1.26-8.67) than White lesbian women. No differences in cardiometabolic risk were found between Latina and White SMW. Conclusion: This study extends previous research on racial/ethnic differences in cardiometabolic risk among SMW. Prevention strategies are needed to reduce cardiometabolic risk in Black SMW. Findings highlight the need for cardiovascular disease research in SMW that incorporates longitudinal designs and objective measures.

Sexual Orientation and Diabetes During the Transition to Adulthood

Purpose: The purpose of this study was to examine how sexual orientation in adolescence and young adulthood was linked to diabetes risk. Methods: Data were drawn from the 1994-2008 National Longitudinal Study of Adolescent to Adult Health. The baseline sample included 4330 girls and 3510 boys ages 12-18. Guided by the life course approach, we considered both the timing and continuity of sexual orientation-broadly defined by sexual identity, sexual attraction, sexual contact, and romantic/sexual relationships-by differentiating respondents into four categories: sexual minority in both adolescence and adulthood, sexual minority in adulthood only, sexual minority in adolescence only, and heterosexual in both adolescence and young adulthood. Diabetes was identified using A1c and glucose biomarkers and self-reports of diabetes diagnosis or medication use. Results: Results from logistic regression models indicated that in comparison with their continuously heterosexual counterparts, respondents reporting sexual minority status in adulthood only or continuously in both adolescence and adulthood had higher diabetes risk in adulthood. However, respondents reporting sexual minority status in adolescence only were not different in diabetes risk in adulthood. The association between diabetes risk and continuous sexual minority status was stronger among women than among men. Conclusions: Sexual minority health disparities emerge early in the life course during adolescence and young adulthood. These findings highlight the importance of designing and implementing policies and public programs to alleviate minority stress early in life to reduce health disparities.