Heterosexual Respondents Research Articles

Characterizing hospitalists’ comfort and familiarity with LGBTQ clinical topics

ABSTRACT Objectives Evidence has shown that lesbian, gay, bisexual, queer (LGBQ) and transgender patients (LGBTQ) experience disparities in health care delivery and clinical outcomes. As the predominant U.S. inpatient provider workforce, this paper’s objective was to understand hospitalists’ comfort with LGBTQ health. Methods A 58-question anonymous online survey was distributed in 2019 to practicing hospitalists through the Society of Hospital Medicine regarding their experiences in caring for hospitalized LGBTQ patients. Results Two hundred and eighteen hospitalist providers completed the entire survey. While hospitalists reported high levels of comfort in caring for these populations (LGBQ: 90.6%, Transgender: 77.8%), they acknowledged feeling less confident in their clinical competence (LGBQ: 71.6%, Transgender: 51.2%). Hospitalist providers who were themselves LGBQ reported more comfort with most aspects of LGBQ patient clinical care than heterosexual respondents (p < 0.05 for 4 of 6 comfort variables). Seventy-four percent of hospitalists wanted training to advance their knowledge and skills in working with LGBTQ patients. Conclusions Hospitalist clinicians are regularly exposed to LGBTQ patients yet their comfort and expertise in caring for this vulnerable population is highly variable. Educational interventions that include reflective practice may serve to optimize hospitalists’ ability to more confidently and competently serve LGBTQ patients.

State-Level LGBTQ + Policies and Experiences of Interpersonal Discrimination among Sexual and Gender Minority People

ObjectivesTo quantify the role of state-level lesbian, gay, bisexual, transgender, and queer (LGBTQ+)-related policies on experiences of discrimination in a population-representative sample of partnered individuals.MethodsAn adjusted multilevel random-intercept logistic regression model with individuals (level-1) nested within states (level-2) and a cross-level interaction term between gender/sexual identity and policy score was used to estimate the predicted probability of any experiences of discrimination for cisgender heterosexual, transgender and non-binary, and cisgender sexual minority respondents.ResultsExperiences of discrimination in the past month were more common amongst transgender and non-binary (90.2%) respondents compared to their cisgender sexual minority (74.0%) or cisgender heterosexual (73.2%) counterparts. When compared to cisgender heterosexual respondents, the interaction term was found to be statistically significant for only transgender and non-binary (OR = 0.93, 95% CI [0.88, 0.98]) but not cisgender sexual minority respondents (OR = 0.99, 95% CI [0.97, 1.01]). Indicating that as state policy environments became more protective the odds of experiencing discrimination decreased at a more substantial rate for transgender and non-binary respondents when compared to cisgender sexual minority or cisgender heterosexual respondents.ConclusionsTransgender and non-binary individuals experience more discrimination compared to their cisgender sexual minority or cisgender heterosexual counterparts. State-level LGBTQ + policy protections amplified the relationship between gender identity and experiences of discrimination.

Depression and Anxiety Among Sexual Minorities in the United States: A Cross-Sectional Analysis of the National Health Interview Survey.

Background and objective Sexual minorities experience large-scale mental health disparities, yet recent national data on them remains scarce. This study aimed to examine the prevalence of depressive and anxiety symptoms by sexual orientation in a nationally representative sample of adults in the United States (US). Methods This cross-sectional analysis utilized data from 26,311 adults in the 2022 National Health Interview Survey. Sexual orientation was classified as sexual minority (gay/lesbian, bisexual, or other non-heterosexual identity) or heterosexual. Self-reported depression was assessed using the eight-item Patient Health Questionnaire (PHQ-8), and anxiety was evaluated using the seven-item Generalized Anxiety Disorder Scale (GAD-7). Logistic regression models were employed to compare mental health outcomes between sexual minority and heterosexual respondents. Results Sexual minorities comprised 6.6% of the weighted sample. Compared to heterosexuals, sexual minorities were younger, more often female, unmarried, and had higher poverty despite greater employment (all p<0.001). Approximately half of sexual minorities screened positive for depression (49.0%) and anxiety (44.3%), compared to 19.5% and 16.4% of heterosexuals, respectively. After covariate adjustment, sexual minorities had over three-fold higher odds of depression [odds ratio (OR): 3.27; 95% confidence interval (CI): 2.86-3.73] and anxiety (OR: 2.97; 95% CI: 2.57-3.42). The prevalence was highest among sexual minority youth, with depression in 54.9-61.1% and anxiety in 49.0-59.2%, depending on income levels. Conclusions In this nationally representative study, sexual minorities demonstrated a high burden of depression and anxiety symptoms compared to heterosexuals. Sexual orientation independently predicted mental health disparities beyond other sociodemographic characteristics. Targeted interventions are recommended to address psychiatric disease disparities that disproportionately impact vulnerable sexual minority subgroups.

Medicare Eligibility and Changes in Coverage, Access to Care, and Health by Sexual Orientation and Gender Identity

Medicare provides nearly universal insurance coverage at age 65 years. However, how Medicare eligibility affects disparities in health insurance coverage, access to care, and health status among individuals by sexual orientation and gender identity is poorly understood. To assess the association of Medicare eligibility with disparities in health insurance coverage, access to care, and self-reported health status among individuals by sexual orientation and by gender identity. This cross-sectional study used the age discontinuity for Medicare eligibility at age 65 years to isolate the association of Medicare with health insurance coverage, access to care, and self-reported health status, by their sexual orientation and by their gender identity. Data were collected from the Behavioral Risk Factor Surveillance System for respondents from 51 to 79 years old from 2014 to 2021. Data analysis was performed from September 2022 to April 2023. Medicare eligibility at age 65 years. Proportions of respondents with health insurance coverage, usual source of care, cost barriers to care, influenza vaccination, and self-reported health status. The study population included 927 952 individuals (mean [SD] age, 64.4 [7.7] years; 524 972 [56.6%] females and 402 670 [43.4%] males), of whom 28 077 (3.03%) identified as a sexual minority-lesbian, gay, bisexual, or another sexual minority identity (LGB+) and 3286 (0.35%) as transgender or gender diverse. Respondents who identified as heterosexual had greater improvements at age 65 years in insurance coverage (4.2 percentage points [pp]; 95% CI, 4.0-4.4 pp) than those who identified as LGB+ (3.6 pp; 95% CI, 2.3-4.8 pp), except when the analysis was limited to a subsample of married respondents. For access to care, improvements in usual source of care, cost barriers to care, and influenza vaccination were larger at age 65 years for heterosexual respondents compared with LGB+ respondents, although confidence intervals were overlapping and less precise for LGB+ individuals. For self-reported health status, the analyses found larger improvements at age 65 years for LGB+ respondents compared with heterosexual respondents. There was considerable heterogeneity by state in disparities by sexual orientation among individuals who were nearly eligible for Medicare (close to 65 years old), with the US South and Central states demonstrating the highest disparities. Among the top-10 highest-disparities states, Medicare eligibility was associated with greater increases in coverage (6.7 pp vs 5.0 pp) and access to a usual source of care (1.4 pp vs 0.6 pp) for LGB+ respondents compared with heterosexual respondents. The findings of this cross-sectional study indicate that Medicare eligibility was not associated with consistently greater improvements in health insurance coverage and access to care among LGBTQI+ individuals compared with heterosexual and/or cisgender individuals. However, among sexual minority individuals, Medicare may be associated with closing gaps in self-reported health status, and among states with the highest disparities, it may improve health insurance coverage, access to care, and self-reported health status.

(085) Investigating the Relationship Between Experiences of Sexual Health Education and Sexual Health Outcomes

Abstract Introduction Young people (16–24-year-olds) experience the highest diagnosis rates of STIs. Lack of engagement, public awareness, lack of training, and long-standing, widespread stigma around STIs remain barriers to greater and more effective use of interventions such as sexual health education and other services. Whilst relationship and sexual health education (RSE) has been part of many school curriculums for generations, young people’s experiences of RSE can vary widely. Objective This research aims to provide insight into the experiences of sexual health education, sexual health behaviours and recommendations to improve engagement and sexual health outcomes amongst adolescents. Methods An online quantitative survey was conducted between June and July 2021 (n=5,457). 855 respondents were recruited from a market research panel (answering a 20-minute survey) and a further 4,602 respondents were recruited via public links (answering a cut-down survey). All respondents were living in the UK and aged 18+. Data were analysed using descriptive statistics and adjusted to reflect the sample size of LGBTQ+ and heterosexual respondents. Results 90% of respondents received formal sex education, however, only 12% agreed sex education had a positive long-lasting effect on their sexual life. Reproductive biology, pregnancy, safe sex, and avoiding STIs were the core pillars of sex education, whilst different sexualities, pleasurable intimate relations, gender identity and trans-specific topics were covered less than 13% of the time. Although 90% of respondents declared they have a good understanding of sexual health risks, sexual health outcomes in this group were sub-optimal; safe sex was only consistently practiced by 43% of respondents and regular testing only carried out by 25% of respondents. Conclusions Whilst most participants reported receiving sexual health education, their experiences varied. Despite a high self-reported understanding of sexual health risks, sexual health outcomes were sub-optimal. This research highlights the potential beneficial effects of an exhaustive sexual health education on attitude, knowledge, and behaviours among adolescents to improve the long-term sexual health outcomes. Recommendations include designing programmes based on young people’s experiences of sexual education, reviewing current guidance and practices adding on key topics outside the main pillars of sexual education, increasing guidance and training for educational institutions and supporting RSE provisions in alliance with external educators and services. Disclosure Yes, this is sponsored by industry/sponsor: Reckitt. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Reckitt.

Telehealth use in 2022 among US adults by sexual orientation.

To address a lack of research documenting telehealth use and experiences among sexual minority individuals during the COVID-19 pandemic and inform health care policies beyond the pandemic. Secondary analysis of the 2022 Health Information National Trends Survey (HINTS), a cross-sectional survey representative of US adults. We estimated multivariable probit regressions to understand how sexual orientation was associated with reporting telehealth use, modality (video only, telephone only, both), and experiences, including the reason for, subject of most recent, and quality of the telehealth visit. We adjusted estimates based on respondents' self-reported demographics and health status. Analyses were weighted to represent the US adult population and used full information maximum likelihood to account for missing data. Among all HINTS respondents, having a telehealth visit within the past year was more common among sexual minority respondents than heterosexual respondents. Among telehealth users, sexual minority respondents were more likely than heterosexual respondents to say that they used telehealth because it was convenient and minimized their exposure to illnesses and that the subject of the most recent telehealth visit was mental health. They were less likely to say the subject was minor/acute care. Modality use and quality were comparable between sexual minority respondents and heterosexualrespondents. The findings show greater demand for telehealth, especially for mental health care, among sexual minority adults. Knowledge of factors driving patterns in health care utilization within minoritized communities and the implications for both telehealth access and quality are necessary to create policies that have a broad positiveimpact.

Pandemic-related changes in alcohol use among LGB+ people with and without mental health and neurodevelopmental conditions: a multinational cross-sectional study

PurposeUsing data from 36,981 respondents to the Global Drug Survey (GDS) COVID-19 Special Edition, this study aims to compare changes, following the first “lockdown,” in alcohol consumption between lesbian, gay, bisexual and other sexual minority (LGB+) and heterosexual respondents with and without lifetime mental health and neurodevelopmental (MHND) conditions.Design/methodology/approachCharacteristics and drinking behavior of respondents to GDS who disclosed their sexual orientation and past 30-day alcohol use were described and compared. LGB+ participants with and without MHND conditions were compared, and logistic regression models identified correlates of increased drinking among LGB+ people. The impact of changed drinking on the lives of LGB+ participants with and without MHND conditions was assessed.FindingsLGB+ participants who reported that they were “not coping well at all” with the pandemic had twofold greater odds of reporting increased binge drinking. LGB+ participants with MHND conditions were significantly more likely than those without to report increased drinking frequency (18.7% vs 12.4%), quantity (13.8% vs 8.8%) and that changed drinking had impacted their lives.Originality/valueThis study, which has a uniquely large and international sample, explores aspects of alcohol use not considered in other COVID-19 alcohol use research with LGB+ people; and to the best of the authors’ knowledge, this is the first study to explore alcohol use among LGB+ people with MHND conditions.

Emotional support among partnered sexual minority and heterosexual individuals during the COVID-19 pandemic

Emotional support, particularly support from family and friends, is essential to health outcomes especially for marginalized communities. Although emotional support is recognized as a critical resource, especially during the COVID-19 pandemic, to date no research has examined access to support during the pandemic for sexual diverse populations. This study aims to apply minority stress theory by drawing on a new population-based data source of 3,642 respondents, the National Couples’ Health and Time Study (NCHAT), which oversampled sexual and gender diverse populations during the pandemic. We focus on two sources of emotional support: family members and friends. Exclusively heterosexual respondents relied more on emotional support from family than respondents who identified as exclusively gay/lesbian, bisexual including pan, omni, and queer, and those reporting another sexual identity or multiple sexual identities. However, respondents who did not identify as heterosexual relied more on emotional support from friends compared to exclusively heterosexual respondents. There were no significant differences among respondents with sexual minority identities in regard to family or friend support. Other factors, such as outness to friends and family, identity centrality, aggressions, and relationship satisfaction are found to be associated support from friends and family. The findings presented here add to a growing body of work on social support while adding sexual minority-specific factors that may affect receipt of, need for, and outcomes relating to support. This work contributes to understanding of the social climate and resources available to sexual diverse populations during a major public health crisis.

Beyond Mortality: The Social and Health Impacts of COVID-19 among Older (55+) BIPOC and LGBT Respondents in a Canada-Wide Survey.

This study focused on the effects of the COVID-19 pandemic on the marginalized populations-specifically Black and Indigenous people as well as People of Color (BIPOC) compared to White older adults and LGBT individuals compared to heterosexual older adults. Data were derived from our national online survey of Canadians aged 55+, conducted from 10 August to 10 October 2020. The survey explored the influence of COVID-19 on lifestyle changes, well-being, and planning for the future. Our sample comprised 4292 respondents. We compared sets of dichotomous variables with White vs. BIPOC, LGBT vs. heterosexual, and LGBT White vs. LGBT BIPOC respondents. Significantly more BIPOC than White individuals reported changes in accessing food (44.3% vs. 33.2%) and in family income (53.9% vs. 38.9%) and fewer reported feeling accepted and happy, and more felt isolated and judged. Significantly more LGBT than heterosexual respondents reported changes in routines and in accessing social support, medical and mental health care and more feeling depressed, lonely, anxious, and sad. More LGBT-BIPOC than LGBT-White respondents reported changes in access to food (66.7 vs. 30.6, p < 0.001); in family income (66.7 vs. 41.5, p < 0.005); and in access to mental health care (38.5 vs. 24.0, p < 0.05). The only difference in emotional response to COVID-19 was that more BIPOC-LGBT than White-LGBT respondents reported feeling judged (25.9 vs. 14.5, p < 0.05). These findings reflect a complex mix of the effects of marginalization upon BIPOC and LGBT older adults, revealing both hardship and hardiness and warranting further research.

Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine

The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). To evaluate academic medical culture, faculty mental health, and their relationship. A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.

Cannabis Use and Sharing Practices Among Sexual Minority and Heterosexual Individuals During the COVID-19 Pandemic.

Purpose: Cannabis behaviors during the COVID-19 pandemic among sexual minority (SM) individuals in the United States remain understudied. This study assessed the prevalence and correlates of cannabis use and cannabis sharing, a potential risk for COVID-19 transmission, among SM and heterosexual-identified individuals in the United States during the COVID-19 pandemic. Methods: This cross-sectional study used data from an anonymous, US-based web survey on cannabis-related behaviors from August to September 2020. Included participants reported past-year nonmedical cannabis use. Associations between frequency of cannabis use and sharing behaviors by sexual orientation were evaluated using logistic regression analysis. Results: Overall, 1112 respondents reported past-year cannabis use; mean age 33 years (standard deviation = 9.4), 66% male identified (n = 723), and 31% SM identified adults (n = 340). Increased cannabis use during the pandemic was similar among SM (24.7%; n = 84) and heterosexual (24.9%; n = 187) respondents. Any sharing during the pandemic was 81% for SM adults (n = 237) and 73% for heterosexual adults (n = 486). In the fully adjusted models, the odds of daily/weekly cannabis use and the odds of any cannabis sharing among SM respondents were 0.56 (95% confidence interval [CI] = 0.42-0.74) and 1.60 (95% CI = 1.13-2.26), respectively, compared with heterosexual respondents. Conclusions: SM respondents were less likely to use cannabis with high frequency during the pandemic but more likely to share cannabis compared with heterosexual respondents. Sharing cannabis was high overall, which may increase COVID-19 risk. Public health messaging around sharing may be important during COVID-19 surges and respiratory pandemics especially as cannabis becomes more widely available in the United States.

(041) LGBTQ+ Young Adult Males’ Views on Antidepressants and Conversations About Sexual Dysfunction

Abstract Introduction Mental illness among US young adults has risen dramatically among LGBTQ+ people. LGBTQ+ young adults are also at a notably higher risk for suicide. Selective Serotonin Reuptake Inhibitors (SSRIs), the first-line treatment for anxiety and depression, are believed to cause sexual dysfunction in many users. Previous studies indicate a low percentage of patients who experience iatrogenic sexual dysfunction discuss these issues with physicians. This lack of open communication is particularly of concern for sexual minority people because of preexisting societal prejudice. Despite this, there is a paucity of research characterizing the willingness of LGBTQ+ people to discuss sexual dysfunction with peers or care providers and their opinions about antidepressants. Objective To assess if LGBTQ+ young adult males endorse different attitudes towards disclosure of sexual dysfunction and preference for sexual-sparing antidepressants compared to heterosexual young adult males. Methods An anonymous questionnaire was distributed to biological males ages 18 to 35 via social media. The questionnaire assessed demographic information, sexual identity, the Patient Health Questionnaire-8 (PHQ-8), the General Anxiety Disorder-7 (GAD-7), and attitudes towards antidepressants. Participants were asked to indicate their perceptions of three deidentified antidepressants (SSRIs, Bupropion, and Mirtazapine) after being prompted with their most common side effects. Conversations about sexual health were analyzed using a 5-point Likert scale (1= strongly disagree; 5 = strongly agree). Participants also ranked their top three most difficult discussion topics with doctors across seven areas of health (ie. mental, libido, erectile function); a “difficulty score” was given for each selection (unranked = 0; 1st choice = 3). Results Of the 665 questionnaires distributed, 505 were received (76% response rate). Nineteen responses were excluded due to extremely low duration of time to completion. Of the 486 responses included, 100 participants identified as LGBTQ+ (Table 1). LGBTQ+ males scored significantly higher on PHQ-8 and GAD-7 surveys compared to heterosexuals and had higher rates of previously diagnosed mental health illness (Table 2). While our overall sample displayed a strong preference for atypical antidepressants over SSRIs, LGBTQ+ males displayed an even greater preference for these sexual-sparing agents compared to heterosexuals (p = 0.023). Compared to heterosexual respondents, LGBTQ+ males were reportedly less embarrassed to talk about general sexual problems with friends and doctors (p = 0.0197; p = 0.0099) yet reported greater difficulty specifically in discussing with a doctor their ability to have sex with a partner (p = 0.0010) (Table 3). Conclusions Our data supports previous evidence that LGBTQ+ young adults report greater levels of mental illness and use of antidepressants compared to heterosexual peers. Our LGBTQ+ respondents’ stronger preference for sexual sparing antidepressants and lower levels of embarrassment in talking about sexual problems may reflect the open, sex-positive culture fostered within the LGBTQ+ community. Despite these findings, pervasive societal stigmatization of sexual minority people may contribute to why some topics of sexual function were more difficult to broach with a provider compared to heterosexual respondents. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dadi, Teleflex, Lina

Patient Attitudes on Collection of Sexual Orientation and Gender Identity Data in a Women's Health Clinic with an Embedded Transgender Medicine Program.

Purpose: We examined patient attitudes about the collection of sexual orientation and gender identity (SOGI) data in a mixed sample of sexual and gender minority (SGM) and cisgender heterosexual people. Methods: SOGI questions and an evaluation questionnaire were administered to a convenience sample of patients presenting at an academic women's health clinic with an embedded transgender medicine program. Clinic census is ∼10,000 patients, which includes some 1000 cisgender males and 800 transgender patients. Bivariate and multivariate analyses were performed. Our methods expand on prior study in this area through implementing an analysis which divides the sample into three groups; cisgender heterosexual, cisgender sexual minority, and transgender respondents, and includes an intersectional approach to the analysis by income and age range, race/ethnicity, and presence of a non-English language spoken at home. Results: Some 231 respondents participated out of 291 approached, including 149 cisgender heterosexual respondents, 26 cisgender sexual minority respondents, and 56 transgender people of any sexuality. Scores were high regarding ease and accuracy of the SOGI questionnaire, and willingness to answer SOGI questions. Among those identifying as cisgender/heterosexual, non-White respondents had an odds ratio of 5.48 of being offended by sexual behavior questions compared with White respondents. Respondents overwhelmingly preferred to complete questionnaires through confidential electronic or pen-and-paper means. Conclusion: Patients were overwhelmingly willing to complete SOGI data questionnaires in a clinic setting, and preferred to do so using confidential means rather than by live interview by staff or providers.

Expectations for family building, assisted reproduction, and adoption among lesbians in the National Survey of Family Growth, 2017–2019

To characterize the family-building goals and experiences of lesbians compared with those of heterosexual females in the United States. Secondary analysis of nationally representative, cross-sectional survey data. National Survey of Family Growth 2017-2019. 159 reproductive-age lesbian respondents and 5,127 reproductive-age heterosexual respondents. We characterized family-building goals and the use of assisted reproduction and adoption among lesbians using nationally representative female respondent data from the 2017-2019 National Survey of Family Growth. We performed bivariate analyses examining variations in these outcomes between lesbian and heterosexual individuals. Wantedness of children, use of assisted reproductive technology, and pursuit of adoption among reproductive-age lesbian and heterosexual participants. We identified 159 reproductive-age lesbian respondents of the National Survey of Family Growth, representing 2.3% or approximately 1.75 million US individuals of reproductive age. The lesbian respondents were younger, less religious, and less likely to have children than heterosexual respondents. These groups did not differ significantly by race/ethnicity, education, or income. More than half of the individuals reported wanting a child in the future, with proportions similar between the lesbian and heterosexual individuals (48% vs. 51%, respectively; P = .52). Accordingly, 18% of both the lesbian and heterosexual individuals reported that they would be greatly bothered if they were unable to have children. Nevertheless, health care providers reportedly asked the lesbians about their desire to get pregnant less frequently than they asked the heterosexual individuals (21% vs. 32%, respectively; P = .04). Only 26% of the lesbians had ever been pregnant compared with 64% of the heterosexual individuals (P<.01). Approximately one third (31%) of lesbians with medical insurance were seeking reproductive services compared with 10% of heterosexual individuals (P = .05). Lesbians were significantly more likely to be seeking adoption than heterosexual individuals (7.0% vs. 1.3%, respectively; P = .01), although they were more likely to report being turned down (17% vs. 10%, respectively; P=.03), not knowing why they were unable to adopt (19% vs. 1%, respectively; P = .02), and quitting because of the adoption process (100% vs. 45%, respectively; P = .04). Approximately half of US females of reproductive age desire to have a child, a proportion that is not different between lesbian and heterosexual individuals. However, fewer lesbians are asked about their desires to get pregnant, and fewer ever become pregnant. Lesbians are significantly more likely to pursue assisted reproductive services when covered by insurance and more likely to seek adoption. Unfortunately, lesbians are more likely to face challenges with adoption.

Associations between the Self-Reported Likelihood of Receiving the COVID-19 Vaccine, Likelihood of Contracting COVID-19, Discrimination, and Anxiety/Depression by Sexual Orientation.

There is limited evolving literature on COVID-19 vaccine uptake and its barriers among sexual minority populations (lesbian, gay, bisexual, transgender, and queer [LGBTQ]), despite their increased COVID-19 risk factors. We assessed the differences in intention to receive the COVID-19 vaccine by self-reported likelihood of contracting COVID-19, anxiety/depression, discrimination frequency, social distancing stress, and sociodemographic factors across sexual orientation. An online national cross-sectional survey was conducted in the United States between 13 May 2021, and 9 January 2022, among adults aged ≥18 (n = 5404). Sexual minority individuals had a lower intention of receiving the COVID-19 vaccine (65.62%) than heterosexual individuals (67.56%). Disaggregation by sexual orientation, however, showed that gay participants had a higher intention of COVID-19 vaccination (80.41%) and lesbian (62.63%), bisexual (64.08%), and non-heterosexual, non-LGB sexual minority (56.34%) respondents had lower intentions of receiving the COVID-19 vaccine than heterosexual respondents. Sexual orientation significantly moderated the association between the perceived likelihood of receiving the COVID-19 vaccine and the self-reported likelihood of contracting COVID-19, anxiety/depression symptoms, and discrimination. Our findings further underline the importance of improving vaccination efforts and access among sexual minority individuals and other vulnerable groups.

Gender in mental health: Relationship of spirituality, social support, and COVID-19-related fear among heterosexual and LGBTQ+ youth.

The youth is a vulnerable population to COVID-19-related fear. Among them, those with LGBTQ+ identities are at higher risk. Given the posited protective effects of spirituality and social support on fear, this study explored their effects on COVID-19-related fear among heterosexual and LGBTQ+ youth. This cross-sectional study recruited 137 respondents Filipinos aged 18-30 years old. The respondents answered a survey containing a sociodemographic questionnaire, 12-items Multidimensional Scale of Perceived Social Support (MSPSS), 20-items Core Dimensions of Spirituality Questionnaire (CDSQ), and 7-items Fear of COVID-19 Scale (FCS). After, the data were analyzed using means, frequencies, Mann-Whitney U-tests, and correlation coefficients. Social support from friends was negatively correlated with COVID-19-related fear among heterosexual respondents, R = -0.219, p = 0.029. Search for meaning positively correlated with COVID-19-related fear among LGBTQ+ respondents, R = 0.395, p = 0.016. Heterosexual respondents also have a higher belief in God (U = 1,004, p < 0.001) and feelings of security (U = 1,110.5, p < 0.001) than their LGBTQ+ counterparts. These findings suggest that social support from friends is protective against COVID-19-related fear among heterosexual youth but not among LGBTQ+. In addition, a high search for meaning can heighten COVID-19-related fear among LGBTQ+. Finally, these findings can be explained by the higher rates of discrimination against LGBTQ+ than heterosexual youth. Thus, gender-responsive mental healthcare is needed to address the youth's fears as society recovers from the pandemic.

P045Sexual orientation among a national sample of people obtaining abortions in 2021–2022

<h3>Objectives</h3> To understand the diversity of sexual orientation among people obtaining abortions in the US. <h3>Methods</h3> The Guttmacher Patient Study recruited a sample of 58 US abortion-providing facilities to ask people obtaining abortions to fill out a 10-minute electronic survey. Fielding took place from June 2021 to June 2022. We assess characteristics of people obtaining abortions by sexual orientation. <h3>Results</h3> Our analytic sample consists of 5,146 individuals obtaining abortions in 41 states. Some 83% of respondents identified as heterosexual or straight. About 12% of respondents reported identifying as bisexual and 2% as pansexual. Respondents were more likely to identify as "something else" (n=75) than as lesbian or gay (n=14). Compared with heterosexual respondents, sexual minority (eg, non-heterosexual) individuals were more likely to be under age 25, non-Hispanic White, and to have had no prior births. While sexual minority respondents did not differ from heterosexual respondents in their poverty levels, they were slightly more likely to report difficulty paying for the abortion (36% vs. 41%). Sexual minority individuals were more likely than respondents who identified as heterosexual to indicate that the pregnancy was the result of forced sex (4% vs.1%). On a separate item asking about sexual identity, 62 respondents identified as transgender, non-binary or something else, and these individuals were obtaining care in all four regions of the country. <h3>Conclusions</h3> There has been a substantial increase in the proportion of individuals obtaining abortions who identify as something other than straight or heterosexual. However, this group remains at increased risk of sexual violence.

Physical Activity as a Mediator for Health Outcomes Among Sexual Minority Adults.

Purpose: This study aimed to examine physical activity (PA) as a protective measure of health outcomes among sexual minority (SM) and heterosexual adults. Methods: Using data from the 2018 National Health Interview Survey, differences in key health outcomes between three groups (heterosexual, SM, and "other") and the mediating effects of PA were explored. Chi-square tests were used to examine group differences. Multinomial logistic regression models were fit to examine associations between PA and health outcomes (body mass index [BMI], psychological distress, health status, and use of alcohol, cigarettes, and e-cigarettes). Results: Compared with heterosexual respondents, "other" adults had higher levels of BMI above 24.9 and were less active; SM respondents had elevated levels of alcohol use, smoking, binge drinking, and psychological distress, and reported worse overall health status. Unadjusted models showed that PA served as a protective factor for BMI above 30 and health status for all groups. PA was also protective for BMI below or above 18.5-24.9, smoking, psychological distress, and health status for both heterosexual and SM groups. Alternatively, PA behaved as a risk factor for alcohol use and binge drinking for all groups. Adjusted modeling removed PA as a risk factor for light alcohol use and binge drinking for SM respondents and added a protective factor for e-cigarette use for heterosexual respondents. Conclusion: This study adds to current literature on health disparities affecting SM populations and the health benefits associated with PA. Further research is needed to explore tailored PA intervention for SM populations and those who mark "other," "something else," "don't know," or refuse to answer questions on sexual orientation.

Parenting Beyond the Binary? An Empirical Test of Norm-Centered Stigma Theory and the Stigmatization of Nonbinary Parents

Currently, there are more than 150,000 nonbinary parents in the US yet the rigidity of the gender dichotomy when it comes to parenting remains a dominant trope. Nonbinary parenting experiences are especially important to address because nonbinary parents face unique strains due to their violations of hetero-cis-normativity and culturally reinforced binary scripts about “moms” and “dads.” To investigate stigma toward nonbinary parents, an intersectional investigation of Norm-Centered Stigma Theory (NCST) and a sample of U.S. adults aged 18–64 stratified by U.S. census categories of age, gender, race/ethnicity and census region collected from online panelists (N = 2,912) are utilized. Specifically, social power axes including gender identity (cisgender woman, cisgender man, trans woman, trans man; nonbinary people were excluded from the current study), sexual identity (heterosexual, gay/lesbian, bisexual), and interactions among these axes of social power are investigated as they moderate the relationships between hetero-cis-normativity and stigmatizing perspectives toward nonbinary parents in efforts to more deeply understand negativities directed toward nonbinary people and their families. Findings indicate that hetero-cis-normativity is strongly related to negativity toward parenting beyond the binary and that heterosexual respondents, and particularly hetero cis men, exhibit greater negativity toward nonbinary parents than others. Implications for these findings are also provided.

Stigma, Mental Health, and Health care Use Among Rural Sexual and Gender Minority Individuals.

Sexual and gender minorities (SGM) frequently experience depression and health care-related stigma. Health care satisfaction is important for seeking care, but little is known about SGM health care satisfaction, and especially as it relates to depression among rural SGM. From May 25 to July 2, 2021, we surveyed rural Illinois (IL) individuals aged ≥18 years on the topics of demographics, depression, health care satisfaction, past health care experiences, internalized stigma, and victimization. Among the 398 respondents, the gender identity distribution included cisgender males and females (171 and 203, respectively) and transgender males and females (8 and 7, respectively), while sexual orientation included heterosexuals (114), gay/lesbians (143), and other orientations (141). Analyses were conducted with respect to both identity and orientation (and their interaction). In univariate analysis, transgender individuals were more likely than cisgender to screen positive for depression and less likely to report feeling accepted by their medical provider. Compared to heterosexual respondents, gay/lesbians and other orientations were more likely to screen positive for depression. In logistic regression, factors associated with increased risk of depression included nonheterosexual orientation and past poor health care experiences. In linear regression, factors most commonly associated with the seven satisfaction subscales include: sexual orientation, past poor experiences, and employment. There were significant differences in depression across both sexual orientation and gender identity, and in health care satisfaction by sexual orientation. Rural SGMs are more vulnerable to depression and less likely to report satisfactory care. As health care engagement is critical for screening and care adherence, engaging rural SGM in a routine and satisfactory fashion is needed.