LGBTQ Health Research Articles

Assessing and Addressing Cardiovascular Health in LGBTQ Adults: A Scientific Statement From the American Heart Association.

There is mounting evidence that lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adults experience disparities across several cardiovascular risk factors compared with their cisgender heterosexual peers. These disparities are posited to be driven primarily by exposure to psychosocial stressors across the life span. This American Heart Association scientific statement reviews the extant literature on the cardiovascular health of LGBTQ adults. Informed by the minority stress and social ecological models, the objectives of this statement were (1) to present a conceptual model to elucidate potential mechanisms underlying cardiovascular health disparities in LGBTQ adults, (2) to identify research gaps, and (3) to provide suggestions for improving cardiovascular research and care of LGBTQ people. Despite the identified methodological limitations, there is evidence that LGBTQ adults (particularly lesbian, bisexual, and transgender women) experience disparities across several cardiovascular health metrics. These disparities vary by race, sex, sexual orientation, and gender identity. Future research in this area should incorporate longitudinal designs, elucidate physiological mechanisms, assess social and clinical determinants of cardiovascular health, and identify potential targets for behavioral interventions. There is a need to develop and test interventions that address multilevel stressors that affect the cardiovascular health of LGBTQ adults. Content on LGBTQ health should be integrated into health professions curricula and continuing education for practicing clinicians. Advancing the cardiovascular health of LGBTQ adults requires a multifaceted approach that includes stakeholders from multiple sectors to integrate best practices into health promotion and cardiovascular care of this population.

Improving LGBTQ Cultural Competence of RNs Through Education

The health of lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) people is a national health priority. A barrier to culturally congruent LGBTQ care is the lack of knowledge about LGBTQ people. LGBTQ people face significant health disparities. This study established an understanding of the knowledge and attitudes of RNs about LGBTQ people and the impact of an educational intervention. RNs received a 1-hour educational intervention. Pre- and posttests were administered to establish baseline knowledge and attitude, as well as effectiveness. A statistically significant impact on the nurses' knowledge of LGBTQ health (p < .0001) happened after the intervention. Qualitative responses from nurses showed an overwhelming desire to have LGBTQ education for their nursing practice. Implications for practice include implementing LGBTQ cultural competence into initial and ongoing educational training for RNs within health care organizations and improved nursing care of LGBTQ people. [J Contin Educ Nurs. 2020;51(8):359-366.].

Moving Toward Equitable Health Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients: Education and Training in Physical Therapy Education

Introduction. Disparities in health and health care experienced by sexual and gender minorities in the United States (US) are well documented, and physical therapists (PTs) play a role in perpetuating them. This study aimed to determine to what degree lesbian, gay, bisexual, transgender, and queer (LGBTQ) health education and training is integrated into physical therapy education curricula. Studies in medicine and nursing have led to increased curricular attention to LGBTQ health topics; yet, similar physical therapy education research has not been published. Methods. A link to an anonymous Google Forms survey was emailed to Program Directors (PDs) of US physical therapist education programs accredited by the Commission on Accreditation in Physical Therapy Education for the academic years of 2015–2017. The survey gathered information on the current and optimal number of curricular hours spent on equitable care for LGBTQ patients and perceived barriers to inclusion of LGBTQ curriculum. Results. Seventy-two of 229 (31%) programs responded to the survey. Half of the respondents reported inclusion of LGBTQ-related topics in the curriculum. The average number of current hours was 1.43 per year. The average number of optimal hours was 2.82 per year. Eighty-nine percent reported that one or more curricular hours per year should be included. Barriers to LGBTQ health education and training include perceived lack of time and adequate faculty training. Discussion. Most PDs believe that more hours should be dedicated to LGBTQ health topics. Open-ended question responses reflect various perspectives held by PDs regarding the importance of including LGBTQ health topics and barriers to inclusion. The development of core competencies may facilitate the inclusion of LGBTQ-specific health education in Doctor of Physical Therapy program curricula. Conclusion. Resources to educate faculty and students on LGBTQ health topics are readily available. These topics may be effectively woven into existing curricula, making it an attainable goal to increase the competency of entry-level PTs to assist in meeting the American Physical Therapy Association's mandate to provide nondiscriminatory care.

Methods and strategies for effectively surveying the LGBTQ+ population.

The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) population is at a substantially elevated risk for myriad health complications, due in large part to structural and social inequities. As such, the LGBTQ population is an important demographic to survey regarding their health. As with many populations facing inequality, the LGBTQ population is often hard to sample. In light of this challenge, several approaches may be required in order to effectively surveying this population. Specifically, advances in sampling methodologies, leveraging community partnerships, and culturally aware question design appear to increase the likelihood of a successful LGBTQ-focused health survey. The Southern LGBTQ Health Study is examined as a case study in effectively conducting a large, multi-state LBTQ health survey. They used a simple snowball sampling strategy where their online health survey was distributed through a wide network of community organizations across several states. They also employed members of the LGBTQ community as "Survey Ambassadors" to help recruit their peers to participate in the study. This case study demonstrated several successful methods. Their combined sampling methodology resulted in almost 6000 respondents. Their question for sexual orientation ("Check all that apply") resulted in rich, easy to interpret data and was well received by the participants. However, this case study also provided valuable learning opportunities. Had they used a more formalized approach to their sampling, they would have had greater generalizability to their target population. Also, the use of an open-ended question regarding gender identity generated data that was not conducive to formal analysis without significant resources dedicated to cleaning the data.

Investigating Disparities by Sex and LGBTQ Identity: A Content Analysis of Sexual Health Information on College Student Health Center Websites

Student Health Centers (SHCs) are important resources on U.S. college campuses. In light of recent calls for creating more opportunities for health care services to young men and sexual/gender minorities, this content analytic study evaluated how sexual health information and resources are communicated on SHC websites. Utilizing a stratified random sample of 400 U.S. colleges/universities, we assessed how often sexual health is explicitly labeled for particular groups, the types of sexual health topics on SHC websites, the depth of sexual health information, and the sexual health resources offered on SHC websites. Our findings revealed that women’s health webpages far outnumbered men’s health webpages, sexual health topics were more common on women’s health webpages, and sexual health topics were covered at greater depth on women’s health webpages compared to men’s health webpages. Similar disparities were found for sexual/gender minorities. General sexual health webpages on SHC websites addressed significantly more sexual health topics in greater depth and offered more sexual health resources than LGBTQ health webpages. The practical implications for college student health and potential health disparities are discussed.

Factors associated with interest in and knowledge of pre-exposure prophylaxis (PrEP) among gay, bisexual, and other men who have sex with men (GBMSM) in the Region of Waterloo, Ontario, Canada: Insights from the OutLook Study

Pre-exposure prophylaxis (PrEP) is an effective HIV-prevention tool for gay, bisexual, and other men who have sex with men (GBMSM), a group known to be disproportionately affected by HIV/AIDS. We aimed to identify sociodemographic, psychosocial, and health factors associated with awareness of PrEP or interest in PrEP among GBMSM in a mid-sized Canadian city, where PrEP availability is arguably more scarce compared to larger metropolitan regions. The OutLook Study was a comprehensive online survey of LGBTQ health and well-being that collected data from sexual minorities aged 16+ in the Region of Waterloo, Ontario, Canada. Participants were cisgender MSM with an unknown or negative HIV status (n = 203). Bivariate logistic regression was performed to analyze factors associated with both awareness of PrEP and interest in PrEP. Multivariate logistic regression explored sexual behaviours in the past 12 months while controlling for sociodemographic and psychosocial variables. Increasing number of sexual partners (OR: 1.10; 95% CI: 1.03–1.53) was significantly associated with interest in PrEP and lifetime experiences of homophobia remained significant from the bivariate model (ORs ranged from 1.11–1.12). Since GBMSM with low educational attainment were shown to have less knowledge about PrEP, educational campaigns could be targeted in high schools rather than colleges, universities, and trade schools. Prevention initiatives should be aimed at places where single or non-monogamous GBMSM frequent due to these men being disproportionately affected by HIV/AIDS. These findings provide insights for potential interventions targeting MSM from mid-sized cities.

Improving LGBTQ Health and Well-Being.

Free, evidence-based resources for health care providers, individuals, and families.

PrEP (Pre-Exposure Prophylaxis) Education for Clinicians: Caring for an MSM Patient.

IntroductionGaps exist in educational materials addressing LGBTQ patient care and LGBTQ health. One such area is prescribing HIV pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM). PrEP awareness, familiarity, and comfort in prescribing are very important in the rollout and success of PrEP as a preventative measure. Our needs assessments showed a lack of familiarity and comfort among clinicians/medical students in prescribing PrEP. Furthermore, studies have shown that since its launch as an effective prevention method of HIV transmission, PrEP has not been widely prescribed to at-risk populations. Educating clinicians about PrEP may increase its use among high-risk MSM populations and reduce the incidence of HIV infections.MethodsFor medical students, we developed a didactic presentation and video recording discussing (1) a brief history of HIV prevention, (2) indications for PrEP prescription, (3) medical testing for PrEP onboarding, (4) common PrEP side effects, and (5) appropriate follow-up and testing for PrEP maintenance and discontinuation. We also developed a videotaped clinical encounter demonstrating communication skills used in PrEP counseling. Pre- and postworkshop surveys assessed participants’ PrEP attitudes and knowledge.ResultsAll 43 survey respondents were second- through fourth-year medical students. Pre- and postpresentation evaluation of questions assessing comfort demonstrated a statistically significant improvement in level of comfort with understanding when to prescribe PrEP and in level of knowledge in prescribing PrEP.DiscussionWorkshop participants acknowledged their training gaps in PrEP prescribing and acquired knowledge and comfort with prescribing PrEP for at-risk populations.

A knowledge, attitudes and practices survey for medical trainees about cancer in the LGBTQ community.

e19073 Background: The purpose of our study was to assess the extent of knowledge, attitudes and practices regarding cancer in the LGBTQ community among medical students and resident physicians at the Detroit Medical Centre/Wayne State University program. Methods: A 15 question validated survey was electronically provided to medical students and resident physicians. The survey included questions that assessed the knowledge, attitudes and practices regarding cancer in the LGBTQ community. Respondents selected a choice based on a 5 item rating scale that ranged from "strongly agree" to "strongly disagree." In addition, participant demographics including training level and gender/sexual identity were collected. Descriptive statistics (counts and percentages) were used to quantify survey responses. Results: A total of 110 responses were received. The respondents consisted of 77% medical students as well as 8.2% interns and 13.7% senior residents in the department of internal medicine. Five percent of the responders reported having rotations in Corktown Health Center, which is an LGBTQ clinic. Majority (82.7%) reported that they were heterosexual while the rest were homosexual, bisexual, pansexual or preferred not to say. In terms of knowledge, one third of the responders reported being well informed on the health needs of LGBTQ patients. While majority (82.1%) believed that LGBTQ patients avoid accessing healthcare, 7% of the respondents disagreed that transgender individuals are less likely to have health insurance. In terms of attitudes, majority (97%) agreed that the LGBTQ population has unique health risks. 82% of the responders believe that it is important to know the gender identity and the sexual orientation of the patients to provide the best care, however only 30% practiced actively inquiring about a patient’s sexual orientation when taking a history. One third of the responders assume that the patient is heterosexual upon first encounter. Ninety five percent of medical trainees agreed that formal education needs to be provided in medical school or as part of residency curriculum on LGBTQ health needs. Conclusions: Our survey shows that there is a gap in knowledge and practices of medical trainees about health needs of the LGBTQ population. Majority of the respondents believe that training about cancer in the LGBTQ population needs to be integrated into medical school or residency curriculum. Exclusion of LGBTQ- specific health needs from medical school and residency curricula contributes to cancer related health inequities faced by this population.

Clergy Attitudes About Ways to Support the Mental Health of Sexual and Gender Minorities.

This pilot study explored clergy members' attitudes about ways to support the mental health needs of sexual and gender minorities (SGM; e.g., lesbian, gay, bisexual, and transgender people). Participants (N = 86, 46% female, 26% SGMs) were US clergy members from a variety of religious faiths but mostly were leaders in Christian faith communities in the greater Chicago area. Clergy participants completed quantitative and qualitative items asking what types of resources (e.g., workshops, websites, consultations, or testimonies) and delivery format (online or in-person) they perceived as most helpful in supporting the mental health of SGM members in their faith communities. The results demonstrated that clergy members found all listed resources to be helpful to varying degrees, although suicide and homelessness prevention were prioritized above other resources. Clergy members also prioritized resources related to supporting gender minorities to be more informative, relative to resources for supporting sexual minorities. Finally, clergy member preferred information to be delivered in-person instead of online. The degree of openness to LGBTQ health promotion resources did not vary by clergy religious denomination.

Fertility Preservation in Transgender and Gender Non-conforming Adults [21A

INTRODUCTION: Obstetricians and gynecologists play an important role in providing care to all persons who desire parenthood. However, there are limited studies assessing the preferences of transgender adults in achieving parenthood. We aimed to examine the importance of parenthood and preferred means to achieve it in a transgender adult population. METHODS: A cross-sectional survey of patients aged ≥ 18 years and who self-identified as a gender minority at an urban academic medical center and outpatient primary care center specializing in LGBTQ health. RESULTS: Sixty-two people completed the survey, of which 7 (11.3%) were born male and 55 (88.7%) were born female. The average age of participants was 28.2. Only 2 (3.2%) participants had children, although 52 (88%) reported desiring parenthood. Of those who desired parenthood, 14 (29%) preferred to achieve this using their own gametes, 12 (24%) preferred adoption and 14 (29%) preferred to use a gestational carrier without using their gametes. Only 34 (56%) reported that a healthcare provider discussed oocyte cryopreservation prior to transition. The largest barriers identified to oocyte cryopreservation were desire (33%), cost (58%), and stopping cross-sex hormones (25%). 10 (16.4%) believed their ability to have children was decided without their consent. CONCLUSION: In this survey of adult transgender patients, the majority are desiring parenthood. Barriers previously identified in the literature such as physical examination and provocation of periods/penile tumescence were not viewed to be as significant as cost and stopping cross-sex hormones. This knowledge can improve clinical discussions and identify the barriers that transgender patients experience in achieving parenthood.

Filling the void in lesbian, gay, bisexual, transgender and queer (LGBTQ+) leadership training

PurposeLeadership training refers to the process of helping individuals develop skills to successfully perform in leadership positions. Existing leadership programs have several drawbacks, including the paucity of leadership programs designed for lesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals in health care. The authors addressed this gap by creating and hosting Q-Forward (formerly Q-Med), the first conference focused specifically on leadership development for LGBTQ+ health trainees.Design/methodology/approachIn this paper, the authors explain how a conference focused on leadership development for LGBTQ+ health trainees can have benefits for trainees, patients and the health-care system. The authors also report the conference proceedings, including planning, participants, guiding principles and programming.Originality/valueThis conference was the first conference for LGBTQ+ health trainees focused specifically on leadership training. The authors believe that the conference was unique, and that such training represents an essential step toward long-term improvements in the health of LGBTQ+ people and other populations.

Answering the Call: Educating Future Nurses on LGBTQ HealthCare

ABSTRACT The purpose of this population-focused educational strategy was to improve knowledge and attitudes of senior-level baccalaureate nursing students regarding LGBTQ health. Surveys were conducted to assess achievement in learning objectives: (a) understanding the prevalence and impact of health disparities among individuals who identify as LGBTQ, (b) understanding the ways to provide effective support for individuals who identify as LGBTQ, (c) identification of ways to engage with individuals who identify as LGBTQ in an active partnership for health promotion. The majority of students responded to survey questions acknowledging that communication skills and style changed as a result of the innovation, new or advanced knowledge was obtained and a better awareness upon which to base decisions/actions in the practice setting was gained. All health-care professionals are encouraged to practice open-mindedness and should welcome opportunities to be educated on best practice related to care of LGBTQ individuals.

Public and Population Health Perspectives of LGBTQ Health

Public and Population Health Perspectives of LGBTQ Health

Advancing LGBTQ Health Equity via Human-Centered Design.

Advancing LGBTQ Health Equity via Human-Centered Design.

Understanding the Unique Needs for Members of LGBTQ Community in the Hematopoietic Stem Cell Transplant (HSCT) Setting: Improving Staff Accountability and Comfort through Education

Topic Significance & Study Purpose/Background/Rationale The LGBTQ community faces significant barriers to healthcare in the United States. Battling a cancer diagnosis and committing to a HSCT is daunting to all; fighting as a LGBTQ individual can be even more overwhelming. LGBTQ patients may experience stigma and discrimination in the health care system. Many approach their treatment expecting continued misunderstanding from healthcare professionals. Methods, Intervention, & Analysis The aim of this project was to educate the HSCT multi-disciplinary staff about healthcare disparities experienced by the LGBTQ community and to engender sensitivity among staff. Tools for effective communication were provided in order to deliver exceptional care to all patients. With appropriate permissions, a PowerPoint from the online National LGBTQ Health Education Center was presented at multiple teaching sessions for day and night shift staff. Further independent training through the National LGBTQ Health Education Center was encouraged and multiple open discussions were held with staff over a 6-month period. An anonymous Qualtrics survey was distributed at the end of the 6-month period to evaluate the effectiveness of the education. Findings & Interpretation Fifty-three staff members participated in training and 28 surveys were returned. Only twenty-one percent of respondents considered themselves knowledgeable about LGBTQ healthcare needs prior to this education. After completing the course, eighty-nine percent of respondents rated themselves as knowledgeable and all indicated that they are likely to utilize these communication skills to provide care to future LGBTQ patients. Discussion & Implications Providing appropriate education to healthcare professionals can increase awareness of LGBTQ needs and improve accountability for meeting those needs. Education and open dialogue are important steps toward embracing the LGBTQ community and delivering safe, compassionate care to increasingly diverse patient populations.

A Novel Curriculum for Medical Student Training in LGBTQ Healthcare: A Regional Pathway Experience.

Background:Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals face considerable health disparities, often due to a lack of LGBTQ-competent care. Such disparities and lack of access to informed care are even more staggering in rural settings. As the state medical school for the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region, the University of Washington School of Medicine (UWSOM) is in a unique position to train future physicians to provide healthcare that meets the needs of LGBTQ patients both regionally and nationally.Objective:To describe our methodology of developing a student-driven longitudinal, region-wide curriculum to train medical students to provide high-quality care to LGBTQ patients.Methods:A 4-year LGBTQ Health Pathway was developed and implemented as a student-led initiative at the UWSOM. First- and second-year medical students at sites across the WWAMI region are eligible to apply. Accepted Pathway students complete a diverse set of pre-clinical and clinical components: online modules, didactic courses, longitudinal community service/advocacy work, a scholarly project, and a novel clinical clerkship in LGBTQ health developed specifically for this Pathway experience. Students who complete all requirements receive a certification of Pathway completion. This is incorporated into the Medical Student Performance Evaluation as part of residency applications.Results:The LGBTQ Health Pathway is currently in its fourth year. A total of 43 total students have enrolled, of whom 37.3% are based in the WWAMI region outside of Seattle. Pathway students have completed a variety of scholarly projects on LGBTQ topics, and over 1000 hours of community service/advocacy. The first cohort of 8 students graduated with a certificate of Pathway completion in spring 2020.Conclusions:The LGBTQ Health Pathway at UWSOM is a novel education program for motivated medical students across the 5-state WWAMI region. The diverse milestones, longitudinal nature of the program, focus on rural communities, and opportunities for student leadership are all strengths and unique aspects of this program. The Pathway curriculum and methodology described here serve as a model for student involvement and leadership in medical education. This program enables medical students to enhance their training in the care of LGBTQ patients and provides a unique educational opportunity for future physicians who strive to better serve LGBTQ populations.

Student Journal Club to Improve Cultural Humility with LGBTQ Patients.

Health degree programs provide opportunities to reduce disparities in care for LGBTQ patients by exposing students to LGBTQ communities and current health issues. However, LGBTQ content is mostly absent from medical school curricula. This mixed method assessment study, conducted during the 2018 to 2019 academic year, examined the feasibility of implementing a medical student journal club focused specifically on LGBTQ health issues as a complementary training tool to support efforts to create an inclusive educational environment. Compared to the pre-test, mean response scores increased for most of the parameters including familiarity with LGBTQ healthcare issues, confidence in the ability to identify harmful medical provider practices, and reading and assessing scientific literature. Qualitative data showed increased confidence, comfort and knowledge about LGBTQ health barriers. This study offers a framework for using a journal club to provide an effective platform for enhancing students’ LGBTQ cultural humility and research literacy.

Improving lesbian, gay, bisexual, transgender, and queer/questioning health: Using a standardized patient experience to educate advanced practice nursing students.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) persons account for 3.5% of the population. Nursing programs in the United States provide a median of 2.13 hours of formal content regarding LGBTQ health, which contributes to iatrogenic barriers to care. Patient experiences related to inadequate provider preparation include misguided treatment strategies, impedance of communication, and abuse. A pilot educational project was developed to provide advanced practice nursing (APRN) students meaningful clinical interactions with LGBTQ-identifying standardized patients (SPs) to better prepare them to care for LGBTQ patients with cultural humility. This project was determined to be Exempt by the Institutional Review Board at the University of Michigan. Implemented in an advanced health assessment course with 99 APRN students, components of the project included course readings, lecture content, laboratory activities, an SP experience, and both large and small debriefing sessions. The SP experience itself was a 15-minute clinical encounter with a patient presenting with "abdominal pain," with an emphasis on history-taking, communication, and cultural humility. Qualitative data analysis was performed using the constant comparison method to interpret the results from student evaluations and other written feedback. This pilot project has promise to inform future educational offerings and set the standard for LGBTQ health content and application for APRN students. Further research is needed to evaluate the quality of LGBTQ content in APRN curricula to improve the ability of APRN students to provide care to LGBTQ patients.

Associations of physical and sexual violence victimisation, homelessness, and perceptions of safety with suicidality in a community sample of transgender individuals

ABSTRACT Transgender and gender nonconforming (TGNC) individuals experience hardship and mistreatment. These experiences may contribute to mental health disparities faced by this community, including suicidality. The present study examined the associations between physical- and sexual-violence victimisation, homelessness, perception of safety, and suicidality among TGNC participants (N= 70) in an LGBTQ health needs assessment of the Central Savannah River Area. Half of the participants endorsed a history of sexual violence victimisation and 41.4% endorsed a history of partner physical violence. Just under one-third (30.3%) of the sample endorsed a history of homelessness. Over half of the sample (52.9%) endorsed a suicidal ideation history, while over one-third (37.1%) of the sample endorsed a suicide attempt history. Sexual violence victimisation was significantly correlated with suicidal ideation and attempt history. Hierarchical regression models including sexual violence victimisation, homelessness, and perception of safety significantly predicted histories of both suicidal ideation and suicide attempts; however, perception of safety was the only significant independent stressor in the models with suicidal ideation and suicide attempt as outcome variables. TGNC suicidality is a complex problem with multiple risk factors. Interventions that adopt an approach that helps to address intra- and interpersonal, social, familial, and community factors may be useful.