Gender Minority Research Articles

Cultural humility training interventions for healthcare students to improve care for gender and sexual minority groups: Protocol for a systematic review and a proposed meta-analysis

Introduction: To deliver comprehensive and efficient care, it is crucial to understand and address the unique healthcare needs of gender and sexual minority (GSM) groups. Implementing cultural humility training may enhance healthcare students' sensitivity, awareness, and proficiency in serving patients. However, there's a necessity to thoroughly evaluate the impact and effectiveness of these interventions, especially in relation to addressing the distinct healthcare requirements of GSM groups. This protocol describes the steps in conducting a systematic review (SR) to investigate if cultural humility training interventions for medical students enhance care of GSM groups. This SR aims to guide the creation of focused interventions and instructional plans to support fair healthcare delivery for GSM populations.Methods and Analysis: The objective of this SR encompass a comprehensive examination across multiple databases such as PubMed (NCBI), Scopus (Elsevier), Cochrane (Wiley), Web of Science (Clarivate). Using keywords and MeSH phrases, the search method will find relevant research from each database's launch from January 1, 2000, until August 30, 2024, emphasizing English-language publications. To ensure comprehensiveness, reference lists of qualifying papers will be thoroughly reviewed. We shall extract the data and use the appropriate Joanna Briggs Institute (JBI) checklist to evaluate the quality of the included study. By synthesizing the data, the findings will illuminate the value and efficacy of cultural humility training interventions for medical students in enhancing GSM group care. This synthesis will incorporate quantitative studies, to ensure a comprehensive understanding of the interventions' impacts.Ethics and dissemination: Ethics approval is not sought as the review will only synthesize data from published studies. The findings will be presented at conferences and published in peer-reviewed journals.PROSPERO registration number: CRD42024533825Strengths and limitations of this study:•Our study examines cultural humility training, emphasizing self-reflection and power dynamics, specifically relevant for gender and sexual minority (GSM) groups.•We focus on healthcare students, exploring how early cultural humility training can impact future practice and GSM care.•This is the first systematic review and meta-analysis of cultural humility training for GSM groups, addressing a gap in existing literature.•Our findings aim to inform curriculum and educational policies, addressing a significant need in medical training.•Limiting the review to English-language studies may exclude important research conducted in other languages, potentially missing valuable perspectives and findings that could enhance the understanding of cultural humility training's global applicability.•The review may face challenges in measuring the long-term impact of cultural humility training interventions on healthcare students' competency and attitudes, as existing studies might have a limited follow-up period

Des triangles diffus, entre échec queer et Anti-Œdipe : technique, métapsychologie et politique psychanalytique

ContextThis article explores the interactions between psychoanalysis, queer theory, and the political and clinical implications of critiques against the Oedipus complex, particularly through the works of Deleuze, Guattari, and Halberstam. It aims to analyze how alternative theoretical perspectives, drawn from social and cultural criticism, can renew classical psychoanalytic approaches, particularly in addressing traditional symbolic structures. ObjectivesThe main objective of the article is to question the current relevance of the Oedipus complex in psychoanalytic practice, in light of critiques from queer and post-structuralist theories. It seeks to demonstrate that the failure of the Oedipal paradigm can be seen not as an obstacle but as a path toward theoretical and clinical renewal, opening up new perspectives on subjectivities and social dynamics. MethodThe author employs a theoretical analysis, based on a cross-reading of Deleuze and Guattari's works, notably Anti-Oedipus, and Jack Halberstam's studies on failure in queer culture. The article integrates examples from both popular culture and philosophical reflections to illustrate how failure and non-conformity can become critical tools within the framework of psychoanalysis and clinical practice. ResultsThe analysis shows that the critique of Oedipus, as elaborated by Deleuze and Guattari, and the valorization of failure by Halberstam, offer relevant perspectives for rethinking psychoanalytic practice. By rejecting developmental teleology and normative success, these theories allow for an expansion of psychoanalytic praxis, opening it up to more fluid forms of existence and subjectivity, less bound by heteronormative and capitalist expectations. They also facilitate the inclusion of subjects traditionally marginalized, such as sexual and gender minorities, within a more inclusive vision of psychic care. InterpretationThe article argues that psychoanalysis, if it remains anchored in a rigid reading of the Oedipus complex, risks becoming entrenched in a conservative framework that limits its clinical scope. However, an openness to radical critiques, particularly those emerging from queer theory and social critiques of family and gender, can revitalize psychoanalytic practice and enable it to address contemporary issues. Failure, rather than being seen as a shortcoming of the subject or therapy, can be embraced as a critical stance that challenges social norms and opens up possibilities for subjective and collective reinvention.

HPV Vaccine Awareness and Uptake Among Sexually Transmitted Infections Clinic Users: A Cross-Sectional Study in Bologna, Italy

Human Papillomavirus (HPV) infection poses a significant health risk, particularly for high-risk groups such as men who have sex with men (MSM), people living with HIV (PLHIV), and transgender individuals. Despite the availability of effective vaccines, uptake among these groups remains suboptimal due to various social and behavioral barriers (BeSD). A cross-sectional survey was conducted at the Sexually Transmitted Infections (STIs) clinic in Bologna, Italy, from 8 April to 12 April 2024 using a paper questionnaire, investigating HPV vaccine uptake and BeSD factors influencing vaccination decisions. Statistical analyses included descriptive statistics and multivariate logistic regression. Among the 236 respondents, PLHIV and transgender individuals demonstrated lower uptake rates (60.0% and 15.6%) if compared to women under 30 years old (72.7%). Concern about HPV infection varied significantly across groups, with MSM showing the highest worry (48.7%). Perceptions of vaccine safety and access were mixed, influencing vaccination decisions. Multivariate analysis indicated that age inversely correlated with infection worry (OR: 0.94, 95% CI: 0.91–0.98), while being a woman under 30 (OR: 164.0, 95% CI: 17.2–1560.18) or MSM (OR: 3.53, 95% CI: 1.37–9.11) was positively associated with vaccine uptake. The study identifies disparities in HPV vaccine uptake among STI clinic users in Bologna, Italy, emphasizing the need for targeted public health campaigns. These campaigns could engage STI clinics and address awareness, safety perceptions, and access barriers to enhance vaccination coverage among sexual and gender minorities.

Factors Associated with Mental Health Care among Adolescents in Southern California.

Mental health care is critical to improving mental health but factors associated with student utilization are poorly understood. Data were from high school students (N = 2933; mean age = 15.7 ± .6) enrolled in a California cohort. We examined associations of sociodemographic factors, substance use, and mental health symptoms at baseline (Fall 2021) with mental health care at follow-up (Spring 2022). At follow-up, 7.7% of students reported out-of-school therapy, and 16.0% reported in-school counseling. Generally, therapy was more common for female and gender minority (vs male), some sexual minority youth (vs heterosexual), black, non-Hispanic white, and multi-ethnic (vs Asian), and English language speakers. Higher socioeconomic status was associated with greater use of out-of-school therapy, but not in-school counseling. Students with clinical levels of mental health symptoms, or alcohol or e-cigarette use had greater odds of mental health care (ORs = 1.42-2.61;ps <.05), though utilization was less than 20% for out-of-school therapy and less than 30% for in-school counseling among these students. Mental health care is underutilized, and disproportionately used by certain student sub-groups. Findings indicate a need to increase mental health care utilization in- and out-of-school.

Heterogeneous Associations Between Pandemic-Induced Socioeconomic Hardships and COVID-19 Vaccine Uptake by Sexual Orientation and Gender Identity: A Nationally Representative Analysis in the United States

Background/Objectives: Socioeconomic hardship during the COVID-19 pandemic was associated with lower vaccine uptake. Since the pandemic has exacerbated socioeconomic challenges faced by sexual and gender minority populations, including employment income loss, housing instability, food insufficiency, and household expense difficulty, this study investigated the disparities in COVID-19 vaccine uptake among these populations. Methods: Using the U.S. Census Bureau Household Pulse Survey, a nationally representative sample of 1,767,966 individuals (6% gay or lesbian, 4.2% bisexual, 1.6% something else, and 90.6% heterosexual respondents), we quantified the COVID-19 vaccine uptakes among sexual and gender minorities, as well as the effect measure modifications by socioeconomic hardships. Results: Despite higher vaccine uptake rates among sexual and gender minorities compared to their heterosexual counterparts, socioeconomic hardships triggered by the pandemic among these populations were associated with decreased vaccine uptake. Importantly, the effect measure modifications by socioeconomic hardships were more pronounced among sexual and gender minority status compared to heterosexual individuals. Conclusions: These results highlight the critical need to address socioeconomic hardships among sexual and gender minorities to enhance vaccine uptake, along with the pre-existing and exacerbated social and economic disadvantages during the COVID-19 pandemic.

Academic Physician and Trainee Occupational Well-Being by Sexual and Gender Minority Status.

Few studies have explored the association between sexual and gender minority (SGM) status and occupational well-being among health care workers. To assess the prevalence of burnout, professional fulfillment, intent to leave, anxiety, and depression by self-reported SGM status. This cross-sectional survey study collected data from October 2019 to July 2021, from 8 academic medical institutions participating in the Healthcare Professional Well-Being Academic Consortium. The survey, including questions on SGM status, was administered to attending physicians and trainees. Statistical analyses were performed from June 1, 2023, to February 29, 2024. SGM status was determined via self-reported sexual orientation and gender identity. Primary outcomes measured were the Professional Fulfillment Index (burnout and professional fulfillment), intent to leave, and self-reported anxiety and depression using the Patient-Reported Outcomes Measurement Information System short-form 4-item measure. Of 20 541 attendings and 6900 trainees, 8376 attendings and 2564 trainees responded and provided SGM status. Of these respondents, 386 attendings (4.6%) and 212 trainees (8.3%) identified as SGM. Compared with their non-SGM peers, SGM attendings had a lower prevalence of professional fulfillment (133 of 386 [34.5%] vs 3200 of 7922 [40.4%]) and a higher prevalence of burnout (181 of 382 [47.4%] vs 2791 of 7883 [35.4%]) and intent to leave (125 of 376 [33.2%] vs 2433 of 7873 [30.9%]) (all P < .001). Compared with their non-SGM peers, SGM trainees had a lower prevalence of professional fulfillment (63 of 211 [29.9%] vs 833 of 2333 [35.7%]) and a higher prevalence of burnout (108 of 211 [51.2%] vs 954 of 2332 [40.9%]) (both P < .001). After adjusting for age and race and ethnicity, SGM attendings had higher odds of burnout than their non-SGM peers (adjusted odds ratio, 1.57 [95% CI, 1.27-1.94]; P < .001). Results for burnout were similar among the SGM trainees compared with their non-SGM peers (adjusted odds ratio, 1.47 [1.10-1.96]; P = .01). In this cross-sectional survey study of academic physicians and trainees, SGM attendings and trainees had higher levels of burnout and lower levels of professional fulfillment. SGM attendings had greater intent to leave than their non-SGM peers, but trainees did not. These disparities represent an opportunity for further exploration to retain SGM health care workers.

Burnout Among Sexual and Gender Minority Physicians-From Recognition to Intervention.

Burnout Among Sexual and Gender Minority Physicians-From Recognition to Intervention.

Trans experiences of epistemic recognition against the backdrop of the Finnish trans act reform

Gender recognition law reforms, proposing greater trans equality and agency, are pivotal moments of hope for gender minorities, but they can also result in harmful public debates. Pairing the theories of recognition and epistemic injustice, we examine trans experiences of epistemic recognition in relation to the Finnish Trans Act reform debate. Through thematic analysis of 31 semi-structured interviews with trans and non-binary individuals, we show that the denial of epistemic recognition and respect in the context of – sometimes demeaning or hostile – public debate can harm trans individuals’ social trust. This can erode their sense of safety and trust in daily social encounters but also amplify distrust towards epistemic institutions they perceive to deny their epistemic recognition. While increased media interest can provide opportunities for epistemic empowerment, trans individuals might, due to the loss of social trust, disengage with mainstream media and refrain from participating in public discourse concerning their own rights.

Abstract 4138484: Exploring medical students’ clinical preparedness to provide cardiovascular care for sexual and gender minorities

Sexual and gender minorities (SGM) have unique risk factors for cardiovascular disease (CVD). A higher likelihood of tobacco use, inadequate exercise, diabetes, dyslipidemia, hypertension, and obesity have been found, driven by increased psychosocial stressors across the lifespan. Specific treatments, especially gender-affirming hormone therapy, can also increase the CVD risk. Even though SGM-related issues have been introduced into medical education, students’ expertise regarding cardiovascular care for SGM populations has not been studied. The present study examines the clinical preparedness, attitudes, and basic knowledge of medical students regarding cardiovascular care for SGM populations. Medical students from Germany were recruited to take part in an online survey. Additionally, medical students from the UK and the USA will be recruited in the future. We used a variety of channels for recruitment (e.g., mailing lists of student councils, social medical groups). The LGBT-DOCSS was used to assess SGM-related clinical competency. Based on prior work of our research group, we developed items to assess the knowledge of SGM-related cardiovascular care and educational needs. We calculated descriptive statistics to describe the outcomes of interest. Currently, 217 medical students (20% final-year) from 5 German medical schools participated in the study. Regarding general SGM-related clinical competency, participants scored below average on clinical preparedness (3.4/7.0), above average on basic knowledge about SGM-specific healthcare (5.1/7.0), and low on explicit bias and prejudice towards SGM individuals (6.4/7.0). 84 % of the participants reported not feeling appropriately prepared to deliver cardiovascular care for SGM populations. Most participants (72 %) only knew about one or two SGM-specific CVD risk factors. There was a high interest in learning about cardiovascular care for SGM populations (96%) and a preference to implement the issue in medical school curricula (93%). Additional data from Germany, the USA, and the UK will be presented at the time of the conference presentation. The present study provides insights into the clinical preparedness of medical students regarding cardiovascular care for SGM populations. Despite showing a high interest in learning about SGM-specific cardiovascular care, most medical students feel underprepared on the issue. Implementing SGM-specific cardiovascular health into medical school curricula could close this gap.

Characterizing Event-Driven PrEP Use and Investigating its Association with Experiences of PrEP-Related Barriers Among a US National Sample of PrEP Users.

After a decade of implementation in the US, PrEP uptake remains underutilized by communities that would greatly benefit from it. Event-Driven (ED) PrEP is a potential avenue to increase uptake, however very little is known about its use in the US. We analyzed data derived from Together 5000, an internet-based U.S. national cohort of Sexual and Gender Minority (SGM) individuals aged 16-49years and at risk for HIV. First, we looked at predictors of ED PrEP use using a framework based on current US-based PrEP implementation-related variables. Then, we explored whether experiencing certain types of barriers were associated with choice of ED PrEP over daily PrEP using logistic regression analysis. Our findings showed that variables related to education and sexual behaviors were associated with ED PrEP choice, while experiencing barriers to daily PrEP had no effect. We found a gradient effect with education, where individuals who reported having some college had 3 times the odds of taking ED PrEP, those reporting a bachelor's degree had 3.25 times the odds, and those with graduate school education had 7.56 times the odds of choosing ED PrEP compared to those with a high school diploma or less. Individuals who reported having 2 or more hours of lead time for sex had 3.35 times the odds of using ED PrEP (aOR = 3.35, 95% CI 2.23-5.47). Participants who reported having an STI within the last 6months had 60% lower odds of using ED PrEP (aOR = 0.4, 95% CI 0.2-0.72). The use of ED PrEP is a promising pathway for expanding PrEP due to its success and protection levels. Our studies indicated that educational background and behavior influence PrEP choice. Ensuring PrEP candidates and users have access to information about new PrEP types may increase uptake and support implementation efforts.

Prepared, Protected, EmPowered (P3): Primary Results of a Randomized Controlled Trial Using a Social Networking, Gamification, and Coaching App to Promote Pre-exposure Prophylaxis (PrEP) Adherence for Sexual and Gender Minority (SGM) Youth Living in the United States.

The population-level reductions in HIV incidence attributed to pre-exposure prophylaxis (PrEP) have not been fully realized among sexual, gender, and racial/ethnic minority youth. P3 (Prepared, Protected, emPowered) is a comprehensive mobile application (app) intervention developed to support PrEP adherence through gamification, medication tracking, and social engagement. A randomized controlled trial was conducted with 246 young men who have sex with men (YMSM) and young transgender women who have sex with men (YTWMSM) currently on or planning to begin PrEP. Participants were randomized in a 1:1:1 ratio to: standard of care (SOC), P3 app (P3), or P3 app plus in-app adherence coaching (P3+). Adherence was measured at 3- and 6- months post enrollment by emtricitabine-triphosphate (FTC-TP) and tenofovir-diphosphate (TFV-DP) levels in dried blood spots consistent with PrEP use > 4 days/week. The primary outcome was the difference in the proportion adherent comparing P3/P3+ to SOC. P3/P3+ was associated with a higher proportion adherent compared to SOC for both outcome measures. At 3 months, the estimated increase in the proportion adherent was 0.13 (95% CI: 0.00, 0.27, p: 0.05) and 0.12 (95% CI: -0.03, 0.26, p: 0.11) for TFV-DP and FTC-TP, respectively. Estimated adherence was higher, but not statistically different, in P3+ compared to P3, for both TFV-DP and FTC-TP. Receipt of P3 (P3 or P3+) is associated with an increase in PrEP adherence among YMSM and YTWSM at 3 months. Additional analyses to discern the role of app usage and sociodemographic and behavioral factors on intervention effects are warranted.

Abstract 4125691: A machine learning approach to examining the associations of minority stressors and physical activity among sexual and gender minority adults

Introduction: Physical activity (PA) is an important modifiable factor for cardiovascular disease (CVD). Sexual and gender minority (SGM; e.g., lesbian/gay, bisexual, transgender) adults face higher risks of inadequate PA and CVD due to increased exposure to minority stressors, such as experienced and anticipated discrimination, which may influence SGM adults’ willingness to engage in PA. To our knowledge, researchers have not investigated the impact of minority stressors on objectively-measured PA among SGM adults. Goal: Using k-means clustering, we sought to identify whether clusters characterized by greater exposure to minority stressors were associated with lower moderate and vigorous PA (MVPA) and higher sedentary behavior among SGM adults. Methods: This daily diary study included an online sample of SGM adults living in the United States. Participants completed daily surveys about personally experienced discrimination and anticipated discrimination (i.e., expectation of experiencing discrimination) and wore wrist accelerometers for 28 days to objectively measure PA. We used k-means clustering to identify clusters based on reports of experienced and anticipated discrimination. We first determined the optimal number of clusters using established partition criteria. Next, we ran linear regression models (adjusted for demographic factors) to examine the associations of minority stress clusters with MVPA and sedentary time per week. Results: Among 42 SGM adults (mean age 27.0±7.7 years) with 1133 person-days of accelerometry data (~3% missing data), we identified four minority stress clusters: low anticipated/low experienced (LALE; reference group); low anticipated/high experienced (LAHE); high anticipated/low experienced (HALE); and high anticipated/high experienced discrimination (HAHE). Participants in the HALE cluster (n=12) engaged in 202 fewer minutes of MVPA than those in the LALE cluster (n=7). Participants in the LAHE cluster (n=10) had 123 fewer minutes of vigorous PA than those in the LALE cluster. No differences were identified for sedentary time. Conclusions: This is the first study to examine the association of minority stressors with objective PA among SGM adults. Participants in the HALE and LAHE clusters engaged in significantly lower PA than those with low levels of both experienced and anticipated discrimination. Findings underscore the importance of assessing minority stressors and the need for interventions to improve PA among SGM adults.

Abstract 4125679: Physical activity among gender minority adults: A systematic review

Introduction: Gender minority (GM; e.g., transgender, non-binary) adults have a higher prevalence of cardiovascular disease (CVD) than their cisgender (i.e., non-transgender) counterparts. Physical activity (PA) is associated with a lower risk of CVD and all-cause mortality. Compared to cisgender adults, GM adults face unique challenges (e.g., discrimination, lack of safe spaces) to meeting aerobic and muscle-strengthening PA recommendations, which may negatively impact their overall health and well-being. There is also limited evidence on factors associated with lower PA among GM adults. Goal: To understand differences in the prevalence of PA between GM and cisgender adults and to identify factors associated with PA among GM adults. Methods: Following the PRISMA guidelines, we performed a comprehensive search using five databases (PubMed, Embase, Web of Since, CINAHL, and Scopus). We included peer-reviewed, English-language, quantitative empirical studies focused on PA among GM adults published between 2004 and 2024. We excluded qualitative studies, reviews, editorials, conference abstracts, and grey literature. We performed quality appraisal using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Results: A total of 5,163 articles were retrieved and 24 met inclusion criteria. The included studies had a low to moderate risk of bias. Methodological weaknesses of the included studies were an overreliance on self-reported PA with no objective assessment using accelerometry, use of non-validated PA measures, and limited assessment of muscle-strengthening PA. Most studies (n = 15) reported lower aerobic and muscle-strengthening PA among GM adults compared to their cisgender counterparts. Two studies found that GM adults with higher perceived psychological stress reported lower PA. One study found that GM adults who were on gender-affirming hormone therapy reported higher PA than GM adults who were not. Conclusions: Findings highlight that GM adults report lower aerobic and muscle-strengthening PA than cisgender adults. There is a need for more comprehensive research to understand these disparities and their impact on GM adults’ cardiovascular health. This systematic review can inform future research and the development of tailored interventions to increase PA among GM adults.

DISP-03. HEALTH DISPARITIES IN NEURO-ONCOLOGY

Abstract Significant disparities in diagnosis, research, and treatment exist in neuro-oncology. Patients who identify as racial or ethnic minorities, sexual or gender minorities, elderly, rural, or have low socioeconomic status are more likely to have adverse outcomes. Using PubMed and expert opinion, we summarized the existing literature on health disparities in neuro-oncology. We categorized disparities based on primary central nervous system tumors (CNS), secondary CNS tumors, pediatric neuro-oncology, clinical trial enrollment and diversity, and financial toxicity. For patients with primary CNS tumors, we found that marginalized groups faced delays in diagnosis, lower rates of resection, and lower rates of postoperative radiation. For secondary CNS tumors, marginalized groups had lower rates of indicated cancer screening, less access to genetic testing, less access to advanced imaging, and lower rates of stereotactic radiosurgery and targeted therapies. Pediatric neuro-oncology patients had differences in morbidity and mortality based on socioeconomic status and race and faced substantial delays in diagnosis. Financial toxicity, the side effects of the high financial cost of a cancer diagnosis, disproportionately affects marginalized populations. This may be further exacerbated by the use of long-term medications such as IDH inhibitors. There is also unequal representation of diverse populations in neuro-oncology clinical trials. Compared to other cancer subspecialties, there is less available data on disparities, however, the types of disparities such as delays in diagnosis and outcomes are similar. Notably, there are not many interventions focused on mitigating these disparities. There needs to be additional research on health disparities in neuro-oncology, including both descriptions of existing disparities, but also on methods and interventions to address these disparities.

Protocol for a randomized controlled trial with a stepped care approach, utilizing PrEP navigation with and without contingency management, for transgender women and sexual minority men with a substance use disorder: Assistance Services Knowledge-PrEP (A.S.K.-PrEP)

BackgroundIn the United States, most (~ 70%) annual newly diagnosed HIV infections are among substance-using sexual minority men (SMM) and gender minority transgender women (trans women). Trans women and SMM are more likely to report or be diagnosed with a substance use disorder (SUD) than their cisgender or heterosexual counterparts and the presence of an SUD substantially increases the risk of HIV infection in both groups. Although Pre-Exposure Prophylaxis (PrEP) is highly effective, initiation, adherence, and persistence are exclusively behavioral outcomes; thus, the biomedical benefits of PrEP are abrogated by substance use. SUD is also associated with reduced quality-of-life, and increased overdose deaths, utilization of high-cost healthcare services, engagement in a street economy, and cycles of incarceration.ObjectiveTo determine the optimal (considering efficacy and cost-effectiveness) strategy for advancement along the PrEP Care Continuum among trans women and SMM with an SUD.MethodsThis study will implement a randomized controlled trial, evaluating two Stepped Care approaches involving A.S.K.-PrEP vs. standard of care (SOC) to determine optimal intervention strategies for trans women and SMM with an SUD (N = 250; n = 83 trans women; n = 167 SMM) for advancement along the PrEP Care Continuum. Participants will be randomized (3:1) to Stepped Care (n = 187) or SOC (n = 63). Participants in the Stepped Care arm will be assessed at 3-months for intervention response; responders will be maintained in A.S.K.-PrEP, while non-responders will receive added attention to their SUD via Contingency Management (CM). Non-responders will be re-randomized (1:1) to either (a) receive A.S.K.-PrEP + CM, or (b) shift the primary focus to their SUD (CM alone).ResultsRecruitment and enrollment began in May 2023. Recruitment will span approximately 36 months. Data collection, including all follow-up assessments, is expected to be completed in April 2027.DiscussionTrans women and SMM with an SUD have the two highest HIV prevalence rates in the United States, which underscores the urgent need for effective measures to develop scalable behavioral interventions that can encourage advancement along the PrEP Care Continuum. To improve public health, researchers must identify scalable and cost-effective behavioral interventions to promote PrEP initiation, adherence, and persistence among trans women and SMM who use substances.Trial registrationThis trial has been registered at ClinicalTrials.gov under the number NCT05934877.

Reporting Sex and Gender Differences in Cardiovascular Research

Incorporating sexual orientation, gender identity, and expression (SOGIE) data into cardiovascular research design is necessary to reduce cardiovascular healthcare disparities among sexual and gender minority (SGM) people. To achieve this, researchers should not only understand appropriate terminology, but also implement inclusive survey tools that respect privacy and cultural nuances, as the benefit of obtaining SOGIE information is critical to tailoring cardiovascular interventions and ensuring equitable healthcare outcomes. In order to address potential concerns related to disclosing SOGIE information, we must prioritize sensitivity training for healthcare professionals to foster an inclusive environment for data collection, ethical considerations, and confidentiality safeguards. This review aims to develop and inform critical thinking about sex and gender and to identify strategic mechanisms to include SOGIE data in cardiovascular research, thus improving cardiovascular health outcomes for SGM individuals. By embracing a more comprehensive and inclusive approach to data collection, cardiovascular research can contribute significantly to advancing personalized and inclusive healthcare practices and medical education, and ultimately promote better health outcomes for all SGM individuals.

Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients.

Purpose: Sex differences in cardiac arrhythmias are well established. This study aimed to explore the prevalence of arrhythmias in transgender and nonbinary (TGNB) adults. Methods: This cross-sectional study utilized electronic medical records from a center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups: TGNB (transgender men, transgender women, nonbinary [NB]-assigned male at birth, NB-assigned female at birth), cisgender men, and cisgender women. The primary outcome was any arrhythmia using age- and race-adjusted regression models comparing transgender patients with cisgender men and cisgender women. Prevalence of arrhythmias was explored in transgender people with a gender-affirming hormone therapy (GAHT) prescription. Results: The sample included 49,862 adults, with 7121 (14%) TGNB persons. Median age was 28 years. Prevalence of arrhythmias was low (0.7-1.4% NB persons, 1.4-1.5% transgender persons). After adjustment, transgender women and transgender men had similar odds of any arrhythmia compared with cisgender men (transgender women: adjusted odds ratio [aOR] 0.89, 95% confidence interval [CI] 0.63-1.24, p = 0.52; transgender men: aOR 1.17, 95% CI 0.82-1.62, p = 0.37), but higher odds of any arrhythmia compared with cisgender women (transgender women: aOR 1.65, 95% CI 1.13-2.34, p = 0.01; transgender men: aOR 2.15, 95% CI 1.48-3.04, p < 0.001). Prevalence of arrhythmias appeared similar among transgender adults regardless of GAHT use (transgender men: 1.5% vs 1.9%, transgender women: 1.2% vs 2.1%). Conclusion: Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.

A paradox of public engagement: The discursive politics of environmental justice in Canada's Chemical Valley

AbstractFor over a decade, members of the Aamjiwnaang Nation have continued to fight for the recognition and redress of their unique environmental health concerns in a region known as Canada's Chemical Valley. From a critical policy studies lens, this article addresses the discursive policy challenges faced by those who are most affected by the toxic policy assemblage of enduring pollution exposure. In response to the research question: how can the voices and lived experiences of those living in pollution hotspots like Chemical Valley contribute to the theory and practice of environmental justice, this article draws upon findings from extensive field‐work in the surrounding region of Lambton County as well as policy advocacy including participation in Senate of Canada hearings. This analysis examines how the omission of community‐based knowledge and expertise reproduces inequities. The article concludes with strategies for improved environmental justice and lessons learned for policy justice in Canada and beyond.Related ArticlesAl‐Kohlani, Sumaia A., Heather E. Campbell, and Stephen Omar El‐Khatib. 2023. “Minority Faith and Environmental Justice.” Politics &amp; Policy 51(6): 1069–96. https://doi.org/10.1111/polp.12564.Ash, John. 2010. “New Nuclear Energy, Risk, and Justice: Regulatory Strategies for an Era of Limited Trust.” Politics &amp; Policy 38(2): 255–84. https://doi.org/10.1111/j.1747‐1346.2010.00237.x.Dilmaghani, Maryam, and Jeremy Dias. 2023. “In or Out? Citizenship Outcomes of Working Sexual and Gender Minority People of Canada.” Politics &amp; Policy 51(5): 868–97. https://doi.org/10.1111/polp.12557.

Associations Between Alcohol Delivery Policy and Pandemic Alcohol Use Among Sexual and Gender Minority Youth and Young Adults

Associations Between Alcohol Delivery Policy and Pandemic Alcohol Use Among Sexual and Gender Minority Youth and Young Adults

Cancer disparities by age: a focus on sexual and gender minorities.

The purpose of this study is to examine the age at which sexual and gender minorities are diagnosed with cancer relative to heterosexual cisgender individuals. We use population-based representative Behavioral Risk Factor Surveillance Survey data with self-reported sexual orientation, gender identity, cancer diagnoses, and the age at diagnosis. We determined the mean age at diagnosis and used logistic regression modeling to obtain odds ratios, reporting significant differences defined as p < 0.05. Separately, we adjusted for race/ethnicity and corrected for underlying differences in the age of survey respondents. Compared to heterosexual cisgender populations, sexual and gender minorities are diagnosed about 4-11years earlier, with bisexual women and transgender individuals reporting the youngest age, 43.9 and 52.1years, respectively. When focusing on select cancer types, lesbian and bisexual women are diagnosed earlier with breast, melanoma, other skin cancers, and leukemia & lymphoma. Gay and bisexual men are diagnosed earlier with colorectal cancers, and transgender individuals earlier with breast, prostate, melanoma, and other skin cancers compared to heterosexual men and women. These findings suggest that sexual and gender minorities experience earlier onset of cancer and many of these age differences remained even after adjustments were made. These findings need to be confirmed in oncology settings that have cancer incidence and sexual orientation and gender identity data and call for greater attention to sexual and gender minorities in cancer research.