LGBT Research Articles

Healthcare experiences among Black and White sexual and gender minority cancer survivors: a qualitative study.

The purpose of this study was to explore healthcare experiences of Black and White sexual and gender minority (SGM) cancer survivors across the cancer care continuum. This was a qualitative analysis of two focus groups and eight individual interviews completed as part of a larger initiative using a community-engaged research approach to reduce cancer disparities in marginalized communities. There was a total of 16 participants in the study (9 were White, 7 were Black) and data were collected between 2019 and 2020. Three main themes emerged from the thematic analysis: strategically coming out, provider preferences, and health system challenges. Participants noted that they often came out through their support system, decided to come out based on the relevance of their SGM identity that they perceived, and expressed a desire for privacy. Lack of an accessible and competent PCP was tied to delayed cancer diagnosis and many participants voiced a preference for consistency when they found a provider they liked. Providers across specialties can address barriers for SGM patients by not making assumptions about patient sexual orientation or gender identity. Institutions should systematically collect sexual orientation and gender identity information. Primary care providers should be aware that due to resistance to switching from trusted providers, they may need to take greater initiative to facilitate cancer screenings for their patients when appropriate or take special care when making referrals to ensure they are using SGM-affirming providers. SGM cancer survivors often benefit from a cultivating relationship with a trusted PCP or other provider.

Relationship quality, COVID stress, and mental health in sexual and gender minority young adults

Sexual and gender minority (SGM) individuals, particularly those assigned female at birth (AFAB), have shown poor mental health outcomes during the COVID-19 pandemic. This issue highlights the importance of identifying factors that may promote SGM-AFAB mental health during the pandemic and protect SGM-AFAB individuals against the negative psychological effects of COVID-related stress. Grounded in previous research and theory suggesting that high quality romantic relationships have promotive (i.e., main) and protective (i.e., stress-buffering) effects on partner’s mental health, we explored associations between relationship quality, COVID-related stress, and mental health among SGM-AFAB individuals. Specifically, we tested whether (1) higher relationship quality, as a promotive factor, was directly associated with fewer mental health problems (depressive and anxiety symptoms, problematic alcohol and cannabis use), and (2) relationship quality, as a protective factor, had a stress-buffering effect, reducing the negative effect of COVID stress on mental health within SGM-AFAB young people. Between May 2020-July 2021, 227 SGM-AFAB individuals (ages 19–35; M = 23.5) in current romantic relationships completed measures of pandemic-related stress, relationship quality, depressive and anxious symptoms, and problematic alcohol and cannabis use. As hypothesized, relationship quality was negatively associated with anxious and depressive symptoms and problematic cannabis use. Relationship quality attenuated the positive association between COVID stress and depression, but not the other mental health outcomes. Findings suggest that high-quality romantic relationships may promote mental health and have a stress-buffering effect for depressive symptoms among SGM-AFAB individuals during major society-wide stressors.

Non-linear changes in public opinion on LGBT in Estonia and Ukraine

Over the past few decades, the situation of lesbian, gay, bisexual and transgender (LGBT) people has improved significantly and attitudes towards these vulnerable social groups have become more favorable, but discrimination, hate speech and hate crimes based on sexual orientation and gender identity remain widespread. Based on the corpus of data obtained during 1991–2023 from series of representative international and national studies, changes in public opinion about LGBT people in two post-Soviet countries were analyzed. It is shown that despite the numerous differences between Estonian and Ukrainian societies, different legislative fields and other factors, the dynamics of attitudes towards LGBT issues in both countries have many common features (namely, the initial period of stable low public support for LGBT is replaced by its rapid growth, which, in in turn, passes into a period of stable high support), and the process of changes in public opinion over time can be described by a logistic equation. The nature of changes in public opinion described in the article is applied to most of the considered data, and the duration of the initial period of stable-low support (on average, 11 years for Estonia and about 20 years for Ukraine) is comparable to the period separating two generations. The applied mathematical model gives grounds for predicting that the maximum of public support for LGBT may be reached in Estonia at the end of the 2020s, and in Ukraine at the beginning of the 2030s. Unfortunately, social stigmatization of LGBT issues significantly limits the availability of data that can become basis of the analysis. The article discusses some possible factors of changes in public support for LGBT issues (the number and openness of LGBT people, instability in the respective societies / states, etc.), and outlines the heuristic value of the proposed model and directions for further development.

Abstract IA018: Sexual orientation and gender identity (SOGI) collection: Experiences at an NCI-Designated Cancer Center

Abstract Wide-spread collection of sexual orientation and gender identity (SOGI) data has been a barrier to conduct of research to identify disparities and inequitable cancer care among sexual and gender minority (SGM) populations. Additionally, lack of SOGI data in electronic health records (EHR) renders clinical care teams unable to integrate such information into appropriate and tailored care and treatment plans and may delay the establishment of respectful, affirming, and knowledgeable relationships between patients and their cancer care teams, and the institutions in which they receive health care. The absence of SOGI data in EHRs also prevents the identification of individuals from SGM groups for inclusion into clinical trials to improve and strengthen the evidence-base for clinical treatment of cancer, from prevention through survivorship. Despite many organizations urging improvement in evidence-based cancer care for SGM populations, satisfactory progress has not yet been achieved in part attributed to the lack of widespread SOGI collection in medical records. As a first step in identifying and remedying real-world disparities and inequity among SGM populations, the H. Lee Moffitt Cancer Center & Research Institute (Tampa, FL) began collecting sexual orientation in 2016 and gender identity in 2017 as standard-of-care demographic items for all new patients. Moffitt Cancer Center is one of the first NCI-Designated Cancer Centers to collect SOGI as standard-of-care demographics for all patients. All new patients are required to complete the web-based electronic patient questionnaire prior (EPQ) to, or on the day of, their first visit. EPQ data are integrated into the EHR, and available at the point of care. To date, SOGI demographics have been collected on over 150,000 patients and ~3.5% of our patient population are self-identified as a SGM. Leveraging this valuable and largely unique data resource among NCI-Designated Cancer Centers, we have already identified real-world disparities and inequity among SGM persons with cancer. Additional research is underway to address issues related to intersectionality and to identify barriers to improve SOGI disclosure. In this session, we will present our approach to implement institutional-side SOGI collection and dispel myths about the difficulties and barriers to implementing SOGI data collection. Citation Format: Matthew B. Schabath. Sexual orientation and gender identity (SOGI) collection: Experiences at an NCI-Designated Cancer Center [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA018.

Abstract C133: Identifying sexual and gender minority colorectal cancer screening disparities via the 2020 Behavioral Risk Factor Surveillance System

Abstract Introduction: Health disparities exist for US sexual and gender minorities (SGM) relative to the general population, including cancer screening disparities with variation across disease sites. Limited data exist to describe the frequency of guideline-concordant colorectal cancer screening (CRC) among SGM people, with few studies using nationally-representative samples. This study aims to assess CRC screening participation among SGM people leveraging nationally-representative US health survey data. Methods: Data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) were used to compare CRC screening participation among screening-eligible SGM to that of the straight, cisgender population. 86,519 individuals aged 50 and older without a lifetime cancer diagnosis and with complete information on demographics, health access, and sexual orientation and gender identity (collected in 33 of 53 participating US states/territories) were included in the analysis. Odds of lifetime CRC screening participation by test type (colonoscopy, sigmoidoscopy, blood stool test, stool DNA test, virtual colonoscopy) for gender minority (GM: transgender man, transgender woman, gender non-conforming) vs. cisgender individuals and sexual minority (SM: gay/lesbian, bisexual, something else) vs. straight individuals were compared via weighted logistic regression models adjusted for age, demographics, and health access. Results: Of the overall sample, 0.44% and 3.6% identified as GM and SM, respectively. Prevalence of lifetime CRC screening by any test was 65.4% vs. 78.9% for GM vs. cisgender individuals and 77.1% vs. 78.9% for SM vs. straight individuals. GM reported lower odds of screening participation relative to cisgender individuals in 4 of 5 test types: colonoscopy adjusted odds ratio (AOR) 0.38 (95% CI 0.13, 1.08); sigmoidoscopy 0.58 (0.28, 1.22); blood stool test 0.84 (0.31, 2.28); stool DNA test 0.52 (0.22, 1.20); virtual colonoscopy 1.36 (0.64, 2.90). SM reported lower odds of screening participation relative to straight individuals in 2 of 5 test types: colonoscopy 1.05 (0.83, 1.32); sigmoidoscopy 0.94 (0.74, 1.19); blood stool test 0.95 (0.77, 1.17); stool DNA test 1.11 (0.81, 1.51); virtual colonoscopy 1.12 (0.81, 1.53). None of the AORs were statistically significant. Conclusions: Disparities in CRC screening participation persist for GM relative to cisgender individuals. These findings suggest the need for additional subgroup analyses among GM, study replication in other data sources, and interventions to improve access to CRC screening for GM. Citation Format: Frank M. Wolf, Ash Alpert, Molly Schwalb, Danielle German. Identifying sexual and gender minority colorectal cancer screening disparities via the 2020 Behavioral Risk Factor Surveillance System [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C133.

Recent HIV infection and annualized HIV incidence rates among sexual and gender minorities in Brazil and Peru (ImPrEP seroincidence study): a cross-sectional, multicenter study

HIV incidence estimation is critical for monitoring the HIV epidemic dynamics and the effectiveness of public health prevention interventions. We aimed to identify sexual and gender minorities (SGM) with recent HIV infections, factors associated with recent HIV infection, and to estimate annualised HIV incidence rates. Cross-sectional multicentre study in HIV testing services in Brazil and Peru (15 cities). Inclusion criteria: 18+ years, SGM assigned male at birth, not using pre-/post-exposure prophylaxis. We identified recent HIV infection using the Maxim HIV-1 LAg-Avidity EIA assay as part of a recent infection testing algorithm (RITA). Annualized HIV incidence was calculated using the UNAIDS/WHO incidence estimator tool. Multivariable logistic regression models were used to estimate factors associated with recent HIV infection. Trial registration: NCT05674682. From 31-Jan-2021 to 29-May-2022, 6899 individuals participated [Brazil: 4586 (66.5%); Peru: 2313 (33.5%)]; 5946 (86.2%) cisgender men, 751 (10.9%) transgender women and 202 (2.9%) non-binary/gender diverse. Median age was 27 (IQR: 23-34) years. HIV prevalence was 11.4% (N=784/6899); 137 (2.0%) SGM were identified with recent HIV infection. The overall annualized HIV incidence rate was 3.88% (95% CI: 2.86-4.87); Brazil: 2.62% (95% CI: 1.78-3.43); Peru: 6.69% (95% CI: 4.62-8.69). Participants aged 18-24 years had higher odds of recent HIV infection compared to those aged 30+ years in both countries. Our results highlight the significant burden of HIV epidemic among SGM in large urban centres of Brazil and Peru. Public health policies and interventions to increase access to effective HIV prevention methods such as PrEP are urgently needed in Latin America. Unitaid, WHO (Switzerland), Ministry of Health from Brazil and Peru.

Abstract IA016: Best practice strategies for SOGI data collection: Lessons learned from conducting and implementing the Ask SOGI study

Abstract Background: Collection of reliable data on Sexual Orientation and Gender Identity (SOGI) is essential for improving cancer care for Sexual and Gender Minority (SGM) populations that experience health disparities. To address gaps in reliable SOGI data collection, the National Cancer Institute (NCI) funded a series of awards to enhance sexual orientation and gender identity (SOGI) data collection at cancer centers. In August 2022, we launched the “We Ask Because We Care: Enhancing Sexual Orientation and Gender Identity Data Collection in New Mexico Cancer Center” (Ask SOGI) research intervention at the University of New Mexico Comprehensive Cancer Center (UNMCCC). Methods: Our research team used a mixed methods framework that included a cancer center-wide readiness assessment survey and focus groups to: 1) identify potential barriers to the systematic collection of patient SOGI data, incorporate National Academy of Science Engineering Medicine (NASEM) recommended SOGI measures into the UNMCCC Electronic Health Records; 2) tailor future staff/provider-cultural competency/cultural humility educational interventions, and 3) design a patient-facing “We Ask Because We Care” campaign to encourage welcoming and comfortable care for SGM patients and their informal cancer caregivers. Results: Although the study is on-going, initial survey findings suggest that staff and provider concerns regarding the appropriate method and time for asking patients about their SOGI may inhibit data collection at the cancer center. Respondents desired cancer center led education and training for staff and faculty that would include appropriate points and methods for SOGI data collection, demonstrations of SOGI integration and utilization into the electronic health record, and strategies to encourage conversational confidence so staff and providers can engage patients and their caregivers in sensitive topics. Moreover, SGM patients and caregiver focus group participant reviewers of the emerging “We Ask Because We Care” campaign were positive about the visual images, and acknowledged the importance of such efforts for creating affirmative spaces for SGM persons experiencing cancer. Conclusion: Interventions that address multilevel staff and provider, as well as patient and caregiver concerns regarding discussions of sexual orientation and gender identity data collection may increase more consistent collection of SOGI data that can be used to enhance cancer care and health disparities research. Citation Format: Miria Kano, Dolores Guest, Amy Farnbach Pearson, Mikaela Kosich, Kendal A. Jacobson, Shiraz Mishra, Andrew Sussman, Bernard Tawfik, Zoneddy Dayao, NFN Scout, Cathleen Willging. Best practice strategies for SOGI data collection: Lessons learned from conducting and implementing the Ask SOGI study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA016.

Perilaku Seksual Lesbian, Gay, Biseksual,Transgender, dan Risikonya terhadap Infeksi Menular Seksual

Lesbian, gay, bisexual, transgender (LGBT) face many gaps in sexual health aspects, including an increased risk of human immunodeficiency virus (HIV infection), sexually transmitted infections (STIs), and pregnancy. LGBT often experience social stigmatization, isolation, and rejection, even from their respective parents. Risk of STIs is related to sexual orientation, sexual anatomy, and sexual behaviour. LGBTs sexual activity may vary and with multiple partners, who are vulnerable to transmission of STIs and HIV infection. Health care providers are responsible for an open discussion regarding sexual health issues; including sexual orientation, sexual behavior, and gender identity.

The virtual adaptation of Innovations in Dementia Empowerment and Action – IDEA

AbstractBackgroundIn contrast to their counterparts in the general population, sexual and gender minority (SGM) older adults and their care partners, have distinct susceptibilities that complicate living with dementia, including significant disparities in comorbid chronic conditions, social isolation, and systemic marginalization, such as discrimination and limited access to health services and supports. We developed a culturally responsive, psychosocial behavioral intervention for SGM older adults living with dementia and their care partners, the first‐ever randomized controlled clinical trial (RCT), Innovations in Dementia Empowerment and Action (IDEA). Initially designed to be delivered (and initially delivered) in‐person and in‐home, challenges associated with COVID‐19 (e.g., quarantining, socially isolating) also provided a unique opportunity to adapt and recalibrate IDEA to be fully delivered via virtual technologies.MethodWe were guided by principles of accessibility, quality, ease of delivery, and sustainability to ensure rigor during the adaptation process. Implementation needs included identifying a HIPPA‐compliant online virtual platform that was easy to use; adapting elements and materials in the intervention manual as needed; providing training for intervention coaches in best practices for virtual delivery; and training participants in the use of virtual technologies.ResultPreliminary findings suggest intervention coaches and most participants deemed the adapted intervention and virtual delivery to be acceptable. of IDEA. Only two of 22 dyads expressed discomfort with the virtual delivery to the degree they chose not to participate. Regarding difficulty in delivering the intervention virtually, 87% of coaches indicated that it was not at all or only a little difficult;12% somewhat difficult; and only 1% difficult. Virtual delivery also allowed us to expand beyond our initial 3‐site catchment area to 28 states, which also greatly increased access for rural and isolated SGM.ConclusionDelivering the adapted IDEA intervention virtually provided preliminary, potentially beneficial evidence to advance dementia interventions to address the growing, diverse population of people living with dementia and their care partners. Further systematic research is required to fully evaluate the benefits and limitations of virtual dementia interventions, including whether specific subgroups are better served by differing delivery modalities.

Identifying disparities in suicidal thoughts and behaviors among US adolescents during the COVID-19 pandemic

BackgroundSuicidal thoughts and behaviors (STBs) became more common among racial and ethnic minorities and sexual and gender minorities (SGM) during the COVID-19 pandemic relative to White and non-SGM adolescents. This study examines associations between pandemic-related stressors and STBs among a nationally representative sample of adolescents to identify vulnerable subpopulations. MethodsWe analyzed data from 6769 high school students using the 2021 Adolescent Behaviors and Experiences Survey. Pandemic-related stressors were assessed via seven items related to negative experiences (e.g., parent job loss; food insecurity) during the COVID-19 pandemic. Logistic regression analyses estimated the association between pandemic-related stressors and four outcomes: (1) sadness/hopelessness; (2) suicidal ideation; (3) suicide planning; and (4) recent suicide attempt (i.e., past 12 months). Interactions were modeled by sex, race/ethnicity, and sexual identity. ResultsA greater number of pandemic-related stressors was associated with higher odds for sadness and hopelessness (aOR: 1.55; 95% CI:1.44–1.67), suicidal ideation (aOR: 1.48; 95% CI:1.39–1.57), suicide planning (aOR:1.47; 95% CI: 1.36–1.59), and recent suicide attempt (aOR: 1.64; 95% CI:1.42–1.88). Pandemic-related stressors were also more strongly associated with some types of STBs in males (relative to females) and SGM females (relative to heterosexual females). ConclusionStudy findings indicate that pandemic-related stressors are associated with STBs within the US adolescent population, particularly among male and SGM female adolescents. Researchers are encouraged to use this knowledge to ensure nationwide suicide prevention efforts adequately address inequities in suicide risk.

LGBTQ and Consumption Trap: Sexual Minority and Rainbow Products—Why Do You Not Want to Buy Rainbow Products Anymore?

With the emergence and the development of the power of LGBTQ (lesbian, gay, bisexual, transgender, queer), some companies and brands have tried to promote their products under the banner of LGBTQ, or take advantage of LGBTQ-identifyling celebrities to endorse them. The products used in the promotion methods, known as rainbow products, have made a lot of profit in the past, although many individuals (including heterosexuals) now show distaste for such promotion strategies. The objective of this research is to examine what people think of rainbow products in a branding context, and why they do or do not want to purchase these specific products. By means of an empirical analysis, a quantitative method is used. Participants (n=229) from China(mainland) and Australia are given a survey to gauge their experiences and attitudes toward rainbow products. The results show that (1) most participants reported that they would not purchase any rainbow products if they only had a spiritual use. (2) The attitude toward rainbow products is more conservative. (3) When people want to purchase rainbow products, the majority pay much attention to the attributes of the products themselves, such as quality, price, and practicality, instead of spiritual use.

Discourse analysis on same-sex relationship through the lens of religious and social belief systems

Religious beliefs and systems have a profound impact on shaping individuals' attitudes towards same-sex relationships. There is a diverse range of perspectives within religious communities, with some individuals adhering to traditional teachings that condemn homosexuality, while others engage in a process of reinterpretation to support and accept same-sex relationships. This qualitative study aims to analyze the different perspectives about same-sex relationship from the lenses of religious and social belief systems. Purposive sampling was used to select the participants (n=16) who identify themselves as a member of Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) community (n=5) and religious people (n=11). Findings indicated the complexity of religious influence on social issues and emphasizes the role of individual engagement with faith in either hindering or facilitating acceptance to same-sex relationship. People who are inclined to their religious faith tend to condemn same-sex relationship. Notably, this study observed different interpretations of people about their religion and faith. While others believed it is against God’s will to engage in same-sex relationship, others interpret their belief in more holistic and inclusive way. Nevertheless, this study underscored the importance of understanding the evolving societal attitudes and the role of religion in fostering social discussion, tolerance, and inclusivity within diverse religious communities and society at large.

Factors Associated with Engaging in Bystander Intervention Behavior Among College Students.

Sexual violence (SV) is a well-documented and highly prevalent issue on college campuses that disproportionately impacts women, students of color, and students who identify as lesbian, gay, bisexual, transgender, queer (LGBTQ). In recent years, bystander intervention programming has emerged as a promising prevention strategy for colleges due to its success in preventing SV before it occurs using community involvement; however, little consideration has been given to the power, status, or position that a bystander has when deciding whether to intervene and weighing the potential consequences of their actions. In order to inform university campus bystander intervention programming and increase its effectiveness, more work is needed to understand specific student characteristics (e.g., race/ethnicity, gender identity, sexual orientation, history of SV) that may be associated with engaging in bystander behavior in SV risk situations. Using cross-sectional data from a large west-coast university, 592 students were surveyed about their SV-related experiences. Poisson regression models were utilized to determine the relative risk of engaging in bystander behavior by sociodemographic identities and history of SV victimization. Our fully adjusted model indicated that experiencing attempted and completed sexual assault was associated with engaging in bystander behavior; belonging to specific minority groups was differentially associated with engaging in bystander behavior, as was belonging to a minority group and having a history of SV. Personal histories, identities, and power inequity matter when deciding to engage in bystander behavior. Additional research is needed to create more well-rounded and population-specific bystander intervention programs that are inclusive of diverse student voices and experiences.

It takes more than rainbows: Supporting sexual and gender minority patients with trauma-informed cancer care.

The American Society of Clinical Oncology has called for an increased priority to improve cancer care for sexual and gender minority (SGM) populations because of heightened risk of receiving disparate treatment and having suboptimal experiences, including perceived discrimination. We demonstrate how integrating trauma-informed care (TIC) principles across the cancer continuum is a key strategy to improving care delivery and outcomes among SGM populations. This empirically informed perspective expands on the concepts generated through the American Society of Clinical Oncology position statement and uses the Substance Abuse and Mental Health Services Association's "Four Rs" Toward Trauma Informed Care: Realize, Recognize, Response, and Resist Traumatization. Recommendations for each component of TIC include: (1) Realize: Implement SGM cultural humility training, including modules on SGM-specific trauma, discrimination, harassment, and violence; (2) Recognize: Routinely screen for emotional distress using methods to ensure privacy, and/or normalize mental health screenings to cancer patients; (3) Respond: Create and widely disseminate policies and patients' rights that prohibit discrimination and ensure access to gender-neutral clinical environments; and (4) Resist Traumatization: Establish and respond to quality metrics (e.g., standardized patients, patient satisfaction surveys) that are informed by a community advisory board with the purpose of ensuring and maintaining quality care. Integrating TIC principles into cancer care for SGM populations is crucial to address disparities in treatment and clinical outcomes. Our recommendations offer practical approaches for oncology teams to implement TIC care and ensure equitable and inclusive cancer care for patients and their families.

Scoping Literature Review: Experiences of Sexual and Gender Minority Older Adults, With Diagnoses of Dementia, Who Use Residential Long-Term Services and Supports.

The number of sexual and gender minority (SGM) older adults utilizing residential long-term supports and services (LTSS) will increase in the forthcoming decades. Paradoxically, while requiring more LTSS services than their non-SGM counterparts, SGM older adults are less likely to access these services, partly due to fears of discrimination. Furthermore, SGM older adults living with Alzheimer's disease and related dementias (AD/ADRD) present unique challenges and opportunities for LTSS facilities. This article provides a scoping review on the intersection between experiences of SGM older adults with AD/ADRD who use residential LTSS. This review identified three themes: (1) the experiences of discrimination among SGM residents in LTSS facilities, (2) the need for comprehensive staff training in residential LTSS to ensure proper care of SGM populations, and (3) the crucial role of inclusive facility policies. As the number of SGM older adults is expected to increase, further research is necessary.

Is refugee experience in childhood a risk for poorer health in adulthood?-A Swedish national survey study.

Studies on experiences of migration in childhood and subsequent health in adulthood report conflicting results. While there is limited research on the long-term health outcomes of refugee children as they transition into adulthood, it is often observed that refugee children experience adverse health conditions upon their arrival in the host country. We examined whether adults with a childhood refugee experience were more likely to have poorer mental health, general health, and risk-behaviours compared to non-refugee migrants and Swedish-born peers We included a nationally representative sample of 18-64-year-olds who answered the Swedish National Public Health survey in 2018 or 2020. Using official register data, we categorized individuals as: 1) refugees in childhood (<age 18 years); 2) migrants in childhood; or 3) Swedish-born. Associations between childhood status (refugee, migrant, or Swedish-born) and all outcomes in adulthood were analyzed using logistic regression. The final model was adjusted for age, sexual- and gender-minority (SGM) identity, and stratified by sex. We also analysed the above and all outcomes stratified by age (18-25, 26-64), adjusted for sex and SGM-identity. We found that a childhood refugee experience was not associated with worse self-rated general or mental health, or more risk behaviours in adulthood, compared to non-refugee migrants or Swedish-born individuals. Additionally, adults with a childhood refugee experience had lower odds of at-risk alcohol use and substance use than Swedish-born peers. In general, a childhood refugee experience was not associated with worse self-rated health or risk behaviours in adulthood when considering age and sexual- and gender-minority status.

Palliative Care Professionals' Perceptions of Communication With Sexual and Gender Minority Patients.

For sexual and gender minority (SGM) individuals who identify as lesbian, gay, bisexual, transgender, queer, or any other sexual orientation or gender identity (LGBTQ+), the quality of palliative care can depend upon how clinicians view and communicate with this historically minoritized group. Prior literature has demonstrated that SGM patients access care at lower rates, and palliative care clinicians have suggested that SGM patients are more likely to experience discrimination than heterosexual patients. This study examined palliative care clinicians' perspectives and experiences regarding patient communication, care settings, the built environment, and inclusive care for SGM older adults with serious illness. The health disparities research framework informed a descriptive qualitative analysis of interview data with palliative care professionals (N = 20) across diverse healthcare settings within Colorado regarding their experiences and beliefs about communication and the care of SGM patients. Three main themes emerged: (1) Limited sexual orientation and gender identity (SOGI) data collection; (2) Organizational and environmental inclusivity, and the "neutral" space viewed as safe; (3) Missing training platforms regarding SGM patients and a lack of opportunity to identify and discuss SGM patient needs. Study findings illuminated the following barriers to providing SGM-inclusive care: perspectives around (1) limitations and preferences regarding collection of SOGI data, (2) organizational and environmental inclusivity, and (3) education and training regarding cultural humility and communication with SGM patients. Findings indicate the need for multidimensional research to better understand and address SGM health disparities and promote equitable care.

Sexual and Gender Minority Patients’ First Pelvic Examination Experiences: What Clinicians Need to Know

This study aims to identify factors that influence the first pelvic exam experiences of sexual and gender minority (SGM) adolescents and young adults who were assigned female at birth (AFAB). Using purposive sampling, we recruited SGM AFAB individuals, ages 18 to 24, who had at least one pelvic examination. Semi-structured interviews and an iterative approach allowed for the emergence of factors influencing the first pelvic exam experience. Items included in the final code directory had Krippendorff's alpha intercoder reliability score > 0.7. Interviews were analyzed using ATLAS.ti. Thirty participants completed interviews. Fourteen participants identified as bisexual, two gay, one lesbian, three pansexual, eight queer, and two straight/heterosexual. Sixteen participants identified as cisgender, nine genderqueer/gender nonconforming, and five transgender. Factors influencing the first pelvic exam experience were organized as patient or clinician level factors. Patient Level Factors: Gender identity, sexual orientation, history of sexual trauma, and participant's relationship to their body were central factors influencing the exam experience. Speculum insertion during the exam induced anxiety and pain for some. Clinician Level Factors: Clinicians' gender, age, and race or ethnicity influenced the exam experience. Most participants preferred detailed communication. Participants offered recommendations to ensure gender-affirming, patient-centered care during the first pelvic exam. SGM AFAB individuals identify patient and clinician-level factors influencing their first pelvic exam experiences. This study underscores the need for changes in medical education and health systems to ensure SGM AFAB individuals have their needs met and feel comfortable in reproductive health settings.

Underrepresented Groups and Perceived Educational Barriers for Residency and Fellowship Success.

The study aimed to compare barriers perceived by medical students and resident physicians identifying as of underrepresented groups in medicine (UIM) and/or as sexual and gender minorities (SGM) to individuals not identifying with these groups, especially for trainees with an interest in dermatology. Cross-sectional survey of medical students and resident physicians based in the United States from February 2021 to July 2021, with subgroup analysis of trainees with interest in dermatology. Among trainees interested in dermatology, the most notable barriers for the UIM group were 1) lack of home program in specialty/fellowship of interest (4.71&plusmn;1.73); 2) lack of connections/networking opportunities (4.14&plusmn;1.29); 3) lack of opportunity to obtain AOA membership (4.00&plusmn;1.96); 4) obtaining mentorship (4.00&plusmn;1.47); and lack of diversity in specialty/fellowship of interest (3.93&plusmn;1.14). Increasing focused mentorship programs and fostering environments that embrace diversity are key to reducing perceived barriers for minority candidates. J Drugs Dermatol. 2023;22(12):1210-1215. doi:10.36849/JDD.7528R1.

Health Care Stereotype Threat and Sexual and Gender Minority Well-Being.

Sexual and gender minorities (SGMs) have experienced progressive change over the last 50 years. However, this group still reports worse health and health care experiences. An innovative survey instrument that applies stereotype threat to the health care setting, health care stereotype threat (HCST), offers a new avenue to examine these disparities. We harmonized two national probability data sets of SGMs-Generations and TransPop-capturing 503 gay men, 297 lesbians, 467 bisexuals, and 221 trans people. Using these data, we, first, explored how HCST's association with self-rated health and psychological distress changed while considering more established constructs: discrimination and stigma. Second, we examined how HCST's association varied across SGM groups. Results suggest that HCST is a unique predictor net of the associations with discrimination and stigma. Furthermore, results highlight the more consequential associations for trans people on well-being compared to gay men. We discuss implications of these findings for future research and potential interventions.