Evaluating social inclusion: An adaptable measure for use on college campuses

Improving the Experiences of Sexual and Gender Minority-Identifying Trainees in Gastroenterology and Hepatology

Sexual and gender minorities (SGM) experience detriments across many physical and mental health outcomes compared with heterosexual and cisgender people. But little is known about health outcomes for those who are both gender minorities and sexual minorities. Motivated by theories of double disadvantage and leveraging advancements in data collection and measurement, we examine physical and mental health disparities across sexual and gender minority statuses: cisgender heterosexuals, gender minority heterosexuals, cisgender sexual minorities, and people who are both gender and sexual minorities. Using Gallup's National Health and Well-Being Index (N = 93,144) and the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (N = 543,717), we estimate multivariable logistic regression models to examine how sexual and gender minority statuses are associated with poor/fair self-rated health, functional limitations, and diagnosed depression. Regression models adjusting for sociodemographic characteristics show marked physical and mental health disparities: people who are both gender and sexual minorities report greater odds of poor/fair self-rated health, functional limitations, and depression relative to cisgender heterosexuals and, in some cases, relative to gender minority heterosexuals and cisgender sexual minorities. Our results add to a growing body of research documenting the association between multiple disadvantaged statuses and health and provide novel information on SGM health disparities.

The purpose of the current study was threefold: (a) compare rates of self-reported anorexia nervosa (AN), self-reported bulimia nervosa (BN), and eating pathology-specific academic impairment (EAI) by gender identity (cisgender men, cisgender women, transgender or genderqueer) and sexual orientation (gay or lesbian, bisexual, unsure, other), (b) examine associations between gender identity, sexual orientation, and eating outcomes, and (c) identify for whom rates of eating disorder diagnosis and impairment is greatest. The study includes a sample of Minnesota students (n = 13,906) who participated in the College Student Health Survey from 2015 to 2018. Chi-square tests with bootstrapping examined differences in eating pathology rates between groups. Adjusted logistic regressions tested the association between gender identity, sexual orientation, and self-reported eating outcomes. Chi-square results revealed heightened rates of self-reported AN, self-reported BN, and EAI in cisgender women, transgender or genderqueer, and sexual minority (e.g., lesbian or bisexual) students. Logistic regression analyses in cisgender men and cisgender women revealed higher odds of self-reported AN, self-reported BN, and EAI in sexual minority students relative their heterosexual peers. Chi-square analyses indicated that bisexual cisgender women reported heightened rates of all three eating pathology measures relative to other sexual and/or gender (e.g., transgender) minority students. Individuals with marginalized gender and/or sexual orientation identities report heightened rates of eating pathology, with cisgender bisexual women reporting the poorest outcomes relative to individuals from other marginalized identities. Preventive efforts and more research are needed to understand the mechanisms driving this disparity and to reduce prevalence among marginalized groups.

Introduction: Sexual minority (SM) and gender minority (GM) students make up a growing portion of medical student bodies and face unique challenges that shape their career decisions. Identifying what specialties draw interest from SM and GM medical students is crucial for anticipating the composition of an increasingly diverse clinical workforce and understanding what contribution these students could make to addressing health disparities faced by LGBTQIA+ patient populations.Aim and objective: To study specialty choices and intent to work in underserved contexts among graduating SM and GM medical students in the United States and determine whether these differed from their heterosexual and cisgender counterparts.Methods: We completed a secondary analysis of data from the 2022-2024 American Association of Medical Colleges’ Graduation Questionnaire (GQ), which included responses from 50,185 graduating allopathic medical school students. Respondents were stratified by gender identity, as well as sexual orientation and sex. Descriptive statistics were calculated to examine the specialty choices of SM and GM students. χ2 tests were used to compare intention to pursue primary care or surgical specialties and intention to work in underserved areas or with underserved populations.Results: GM and SM medical students were more likely to intend to work in underserved areas (GM: n = 241/473, 50.95% vs. cisgender: n = 13,378/46,413, 28.82%; p < 0.001; SM: n = 2,205/5,713, 38.60% vs. heterosexual: n = 11,308/40,796, 27.72%, p < 0.001) and with underserved populations (GM: n = 326/473, 68.92% vs. cisgender: n = 18,454/46,409, 39.76%, p < 0.001; SM: n = 3,070/5,719, 53.68% vs. heterosexual: n = 15,563/40,787, 38.16%, p < 0.001) than their cisgender and heterosexual peers. GM and SM students were also less likely to pursue surgical specialties than their cisgender and heterosexual peers (GM: n = 96/469, 20.47% vs. cisgender: n = 12,120/46,117, 26.28%. p < 0.01; SM: n = 1,312/5,660, 23.18% vs. heterosexual: n = 10,812/40,553, 26.66%, p < 0.001). Family medicine (n = 93, 19.70%) and psychiatry (n = 69, 14.62%) were the most popular preferred specialties among graduating GM students, while internal medicine (n = 848, 14.85%) and psychiatry (n = 685, 11.99%) were most popular among SM students.Conclusion: These results illustrate how GM and SM medical students are drawn toward specialties such as family medicine and psychiatry, which may be informed by these fields' perception as inclusive spaces. In addition, our findings demonstrate a decreased interest in surgical fields among GM and SM medical students. GM and SM students showed a greater propensity for intending to work in underserved clinical contexts and may become a core part of the clinical workforce supporting communities in need, such as LGBTQIA+ patients.

Experiencing sexual violence is an important risk factor for trauma symptoms, and these symptoms significantly impair psychosocial functioning. Sexual and gender minority university students are more likely than their heterosexual and cisgender peers to experience sexual violence (e.g., sexual harassment, unwanted sexual contact, or sexual coercion) while attending university, but research on the consequences of these experiences is needed to inform service provision to these vulnerable populations. Using a large-scale study of university-based sexual violence in Quebec, the current study examined how gender and sexual minority status were associated with the severity of trauma symptoms among students who experienced sexual violence (N = 1,196). Findings indicated that compared with their cisgender peers, gender minority students experienced significantly higher levels of trauma symptoms as a result of sexual violence, controlling for the severity of sexual violence behaviors experienced and other variables. Among cisgender women, but not cisgender men, sexual minority identity was also associated with higher levels of trauma symptoms, controlling for severity of sexual violence behaviors experienced and other variables. Furthermore, gender of perpetrator and amount of sexual violence moderated the associations between sexual identity and trauma symptoms among cisgender women. These findings not only suggest that gender minority and some sexual minority university students are more likely to experience sexual violence, but that they are also more likely to experience negative psychological sequelae as a consequence of these experiences. Ultimately, these findings may suggest the need for services that are more supportive of the specific needs of gender and sexual minority students with regard to sexual violence.

"Religious conscience" or "healthcare denial" policies allow healthcare providers and institutions to refuse to provide services in the name of religious freedom. Denial policies are a form of structural stigma that could impede access to healthcare for sexual and gender minority (SGM) populations, particularly SGM young adults. This study describes SGM university students' response to policies permitting healthcare providers to deny care based on their religious beliefs. Data were obtained from 8,322 SGM students at 38 colleges and universities who participated in the spring 2020 Healthy Minds Study. Descriptive statistics are reported for the level of distress due to the denial policies and likelihood to avoid identity disclosure. Over 90% of SGM students report distress knowing about denial policies (sexual minority: 6.95/10; gender minority: 8.05/10). Students also reported similarly high distress imagining that they had been denied care (sexual minority: 8.05/10; gender minority: 8.57/10). The majority of sexual (69.2%) and gender minority (82.2%) students agreed the policy would make them less likely to disclose their identity to a new provider. Experiencing, or even anticipating, discrimination in healthcare settings through denial policies has negative impacts on the health of SGM populations and has the potential to exacerbate existing mental health disparities for SGM young adults.

Sexual and gender minority (SGM) groups have been historically underrepresented in neurologic research, and their brain health disparities are unknown. We aim to evaluate whether SGM persons are at higher risk of adverse brain health outcomes compared with cisgender straight (non-SGM) individuals. We conducted a cross-sectional study in the All of Us Research Program, a US population-based study, including all participants with information on gender identity and sexual orientation. We used baseline questionnaires to identify sexual minority (lesbian, gay, bisexual, diverse sexual orientation; nonstraight sexual orientation) and gender minority (gender diverse and transgender; gender identity different from sex assigned at birth) participants. The primary outcome was a composite of stroke, dementia, and late-life depression, assessed using electronic health record data and self-report. Secondarily, we evaluated each disease separately. Furthermore, we evaluated all subgroups of gender and sexual minorities stratified by sex assigned at birth. We used multivariable logistic regression (adjusted for age, sex assigned at birth, race/ethnicity, cardiovascular risk factors, other relevant comorbidities, and neighborhood deprivation index) to assess the relationship between SGM groups and the outcomes. Of 413,457 US adults enrolled between May 31, 2017, and June 30, 2022, we included 393,041 participants with available information on sexual orientation and gender identity (mean age 51 [SD 17] years), of whom 39,632 (10%) belonged to SGM groups. Of them, 38,528 (97%) belonged to a sexual minority and 4,431 (11%) to a gender minority. Compared with non-SGM, SGM persons had 15% higher odds of the brain health composite outcome (odds ratio [OR] 1.15, 95% CI 1.08-1.22). In secondary analyses, these results persisted across sexual and gender minorities separately (all 95% CIs > 1). Assessing individual diseases, all SGM groups had higher odds of dementia (SGM vs non-SGM: OR 1.14, 95% CI 1.00-1.29) and late-life depression (SGM vs non-SGM: OR 1.27, 95% CI 1.17-1.38) and transgender women had higher odds of stroke (OR 1.68, 95% CI 1.04-2.70). In a large US population study, SGM persons had higher odds of adverse brain health outcomes. Further research should explore structural causes of inequity to advance inclusive and diverse neurologic care.

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

Although college students who are sexual and gender minorities (SGM) experience higher rates of sexual victimization than their peers who identify as heterosexual and cisgender, there is a paucity in the literature investigating how college campuses can address the needs of SGM college students in violence prevention and response. The present research examines a subset of data from the Healthy Minds Survey (HMS), a national web-based survey administered across two universities from 2016 to 2017. We examined the role of SGM status in the rates of sexual violence, perceptions of their college/university's institutional response to reports of sexual violence (e.g., taking a report seriously and taking corrective action), and the perceived impact of reporting sexual violence (e.g., students would support the person making a report). Logistic regression analyses revealed higher rates of sexual victimization among sexual minority students (compared to heterosexual), women (compared to men), and transgender and gender diverse (TGD) students (compared to cisgender). In addition, sexual minority (compared to heterosexual), women (compared to men), and TGD (compared to cisgender) students were more likely to perceive their institution would have a poor response to reports of sexual violence. Women and sexual minority students were also likely to believe that students who report sexual violence would suffer academically. These findings highlight the need for continued efforts to enhance sexual assault prevention and response efforts on college campuses, especially for SGM students.

Sexual Violence on Campus: Differences Across Gender and Sexual Minority Status

Effective Screening and Treatment to Reduce Suicide Risk Among Sexual and Gender Minority Youth.

To assess identity disclosure among sexual and gender minority (SGM) students pursuing undergraduate medical training in the United States and Canada. From 2009 to 2010, a survey was made available to all medical students enrolled in the 176 MD- and DO-granting medical schools in the United States and Canada. Respondents were asked about their sexual and gender identity, whether they were "out" (i.e., had publicly disclosed their identity), and, if they were not, their reasons for concealing their identity. The authors used a mixed-methods approach and analyzed quantitative and qualitative survey data. Of 5,812 completed responses (of 101,473 eligible respondents; response rate 5.7%), 920 (15.8%) students from 152 (of 176; 86.4%) institutions identified as SGMs. Of the 912 sexual minorities, 269 (29.5%) concealed their sexual identity in medical school. Factors associated with sexual identity concealment included sexual minority identity other than lesbian or gay, male gender, East Asian race, and medical school enrollment in the South or Central regions of North America. The most common reasons for concealing one's sexual identity were "nobody's business" (165/269; 61.3%), fear of discrimination in medical school (117/269; 43.5%), and social or cultural norms (110/269; 40.9%). Of the 35 gender minorities, 21 (60.0%) concealed their gender identity, citing fear of discrimination in medical school (9/21; 42.9%) and lack of support (9/21; 42.9%). SGM students continue to conceal their identity during undergraduate medical training. Medical institutions should adopt targeted policies and programs to better support these individuals.

BackgroundPeople identifying as sexual and gender minorities (SGM) may have higher risk for subjective cognitive decline and Alzheimer’s disease, although the risk for Parkinson’s disease dementia (PDD) has not been investigated. Male sex is associated with a higher risk for PDD, it is unclear whether SGM status impacts the risk.MethodsData were obtained from Fox Insight on April 5th, 2023. The analysis included people (1) with adult‐onset Parkinson’s, (2) responding to questions on sex assigned at birth, gender identity, sexual orientation, (3) with at least one available Penn Parkinson’s Daily Activities Questionnaire‐15 (PDAQ‐15), (4) without dementia at baseline, based on the first PDAQ‐15 (&gt;43). Groups consisted of people identifying as (1) SGM with female sex assigned at birth (SGM‐F, n = 75); (2) cisgender, heterosexual women (CHW, n = 2,046); (3) SGM with male sex assigned at birth (SGM‐M, n = 84); (4) cisgender, heterosexual men (CHM, n = 2,056). Sex assigned at birth and SGM status effects on dementia likelihood during follow‐up were assessed with generalized linear mixed models.ResultsOut of 159 people identifying as SGM, eight (5.0%) identified as gender minorities, 144 (90.6%) identified as sexual minorities, seven (4.4%) identified as both gender and sexual minorities. At baseline, people with female sex had better PDAQ‐15 scores than people with male sex assigned at birth; SGM‐M had the lowest scores. SGM‐M had a higher dementia likelihood compared to people not identifying as SGM. After adjusting for age, education, employment status, income, perceived discrimination level, age at Parkinson’s diagnosis, baseline PDAQ‐15 scores, that differed across groups at baseline, dementia likelihood was lower for CHW compared to people with male sex assigned at birth.ConclusionsFor PDD, SGM‐M can be at a higher risk than CHM; people with female sex can have a lower risk than people with male sex assigned at birth. Socioeconomic disadvantages can alter the sex effect on PDD risk, by putting SGM‐M at a higher risk and females at a similar risk level compared to people with male sex assigned at birth, as shown in unadjusted models. Socioeconomic disadvantages should be acknowledged and addressed to support the well‐being of SGM with Parkinson’s.

Research on sexual and gender minority student achievement indicates that such students report lowered achievement relative to other students. Increased victimization and less school belonging, amongst other factors, have been identified as contributing to these inequalities. However, supportive schooling structures and caregiver support may support their achievement. A nationally representative survey of secondary school students was used to identify specific factors that support achievement for sexual minority (n = 485), gender minority (n = 298), and heterosexual cisgender (where one's sex assigned at birth "matches" a binary gender identity, i.e., a male assigned at birth identifies as a boy/man, n = 7064) students in New Zealand. While reported victimization did not affect achievement for sexual and gender minority students, school belonging, and teacher expectations of success, emerged as significant factors. Differences emerged between sexual minority and gender minority achievement factors, suggesting a range of detailed policy implications and recommendations.

Compared to the general student population, gender and sexual minority (GSM) students are at increased risk of low academic achievement, poor attendance, and not completing high school with their cohort. One construct that has the potential to identify GSM students at increased risk for negative educational outcomes is school engagement. Based on self-report data from 411 middle and high school GSM students who attended community sexual minority youth support programming, this study utilized statistical stepwise regression to develop a model of behavioral and demographic variables that predicted a sexual minority student’s engagement with school. Confirmatory hierarchical regression found that school grades, feeling unsafe, and presence of a school-based Gay/Straight Alliance support group accounted for 31% of the variance seen in student school engagement scores. Recommendations for supporting the engagement of GSM students and future research are given.