Minority Respondents Research Articles

Sexual Orientation and Hypertension Risk Reduction Behaviors Among Adults with High Blood Pressure.

Hypertension is a significant modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the U.S. Evidence is emerging showing disparities in CVD risk between sexual minorities and heterosexuals. Engagement in CVD risk reduction behaviors may account for differences. We examined CVD risk reduction for hypertension between sexual minorities and heterosexuals using data from the 2017 Behavioral Risk Factor Surveillance System. Using bivariate and multivariable logistic regression analyses, we compared medical advice and actions taken (taking medicine, changing eating habits, cutting down on sale, reducing alcohol and exercising) to control blood pressure in sexual minority and heterosexual respondents. Analyses were conducted in 2019. Approximately 35% of the sample indicated being told by a health professional they had high blood pressure. Sexual minorities were less likely to report reduced alcohol intake to lower their blood pressure (AOR=.515, 95% CI=.300, .883). One sex specific difference between sexual minority women and heterosexual women was found; sexual minority women were less likely to indicate being advised by a health professional to take medications to lower blood pressure when compared to heterosexual women. Strategies are needed to reduce alcohol consumption in sexual minority individuals. Uncovering the reasons for the lack of adherence by both sexual minority patients and health care providers can guide future interventions to improve adherence and reduce hypertension as a CVD risk.

Atezolizumab plus stereotactic ablative therapy for medically inoperable patients with early-stage non-small cell lung cancer.

9011 Background: Stereotactic ablative radiation therapy (SABR) is the standard-of-care for medically inoperable, early stage non-small cell lung cancer (NSCLC), but regional and distant failures remain problematic. Based on our in vivo data showing synergy between radiation and immune checkpoint inhibitors (ICI) and the known efficacy and mild toxicity profile of ICI in NSCLC, we conducted a phase I study to determine the maximum tolerated dose of neoadjuvant, concurrent, and adjuvant atezolizumab with SABR for early stage NSCLC patients (pts). Methods: Eligible pts had histologically confirmed T1-3 NSCLC with at least one feature predictive of increased recurrence risk: diameter ≥1 cm, SUV ≥6.2 on PET, or moderately/poorly differentiated histology, were medically inoperable or refused surgery and had a Zubrod PS ≤2. Patients received 6 cycles of atezolizumab. A 3+3 dose finding design was employed with 3 dose levels: 3 mg/kg, 10 mg/kg, and 1200 mg flat dosing. SABR was delivered starting cycle 3 to 50 Gy over 4-5 fractions. Dose limiting toxicity (DLT) was assessed during the first 9 weeks. Results: 20 pts were enrolled, 15 pts in the dose finding and 5 pts at the recommended phase II dose (RP2D). Patient factors: MedIan age 77; 45% male, 85% smoking history, 85% PS 0-1 and 35% squamous. One pt on dose level 2 had a DLT – a grade 3 rash. Atezolizumab 1200 mg flat dosing was the RP2D. Grade 3 pneumonitis was not observed. Partial responses after 2 cycles were seen in 3/17 evaluable pts (18%) and 1 pt had a minor response. No patient progressed on treatment. PD-L1 expression was 0% 8/13 (62%), >1% - 50% 4/13 (31%), >50% 1/13 (8%) in pts with sufficient tissue. Of 5 pts with PD-L1 expression 3 (60%) were responders and 1 (12.5%) of 8 pts with 0% PD-L1 expression responded. Multi-plex Quantitative Immunofluorescence (QIF) using a T cell activation panel demonstrated to correlate with ICI response was performed on 9 samples (including 2 responders, 1 minor responder). The CD3 QIF score was > two-fold higher in the responders compared to non-responders, and the levels of proliferating and activated T cells were likewise > two-fold higher. Comprehensive stool and serial blood analyses have been completed. Correlative endpoints will be reported along with additional efficacy outcomes. Conclusions: Atezolizumab plus SABR is feasible, safe and shows an efficacy signal in medically inoperable early stage NSCLC. This combination will be tested in a randomized phase III trial SWOG/NRG S1914. Funding: This work was supported by the DOD CDMRP W81XWH-15-2-0063 and Genentech. Clinical trial information: NCT02599454.

Thalidomide for Patients with β-Thalassemia: A Multicenter Experience.

ObjectiveThis study focused on the efficacy and safety of thalidomide for patients with β-thalassemia in a multicenter trial.MethodsPatients with non-transfusion-dependent thalassemia (NTDT) or transfusion-dependent thalassemia (TDT), who were unable to pursue conventional therapy with transfusion and chelation, were recruited over 3 years in three centers in southern China. We evaluated the efficacy and safety of thalidomide in the short-term (three months) and long-term follow-up (12 and 24 months). Response to thalidomide was defined as follows: Main Responder (MaR) showing an increase in hemoglobin (Hb) level of >2.0 g/dl or free from blood transfusion and Minor Responder (MiR) achieving elevated Hb level of 1.0–2.0 g/dl or ≥50% reduction in blood transfusion frequency.ResultsThe overall response rate (ORR) was 93.5%, with MaR and MiR rates accounting for 62.9% and 30.6% in short-term follow-up. For patients with NTDT, the Hb level increased from a baseline mean of 6.8±1.1 g/dl to 9.7±1.9 g/dl (P<0.001). Elevated Hb was mainly attributable to increased fetal hemoglobin (HbF) levels. Among patients with TDT, while an increase in the average Hb concentration was observed, there was a significant drop in yearly transfusions from 20.7±7.7 to 5.8±6.8 blood units per year (P<0.001). The response of patients in both categories was sustained even after an average follow up of 14.6±9.6 months (3–37 months). Minimal side-effects were documented throughout, except peripheral neurotoxicity in one patient. Logistic regression analysis identified the ratio of HbF at baseline (P=0.038, OR=1.111, 95% CI: 1.006–1.226) as an independent risk factor for the primary response to thalidomide.ConclusionThalidomide had significant therapeutic effects on patients with β-thalassemia with a sustained response. Peripheral neuropathy is one of the most feared complications. While these preliminary results support the potential long-term efficacy of thalidomide as a therapeutic agent for β-thalassemia, several issues need to be addressed before its application in the clinic.

Intersectionality, Contextual Specificity, and Everyday Discrimination: Assessing the Difficulty Associated With Identifying a Main Reason for Discrimination Among Racial/Ethnic Minority Respondents

The Everyday Discrimination Scale is the most commonly used instrument to assess discrimination. The survey asks respondents about a range of negative interpersonal experiences and then asks them to provide a single main reason for all these experiences. Theories of intersectionality cast doubt on the idea that marginalized individuals generally perceive a single reason for the discrimination they encounter. We analyze data from 23 cognitive interviews with racial/ethnic minority adults to assess the degree of difficulty respondents have in assessing the main reason for their mistreatment, the sources of this difficulty, and potential consequences. Of the 21 respondents who reported experiencing some form of everyday discrimination, 43 percent encountered some difficulty in identifying a single main reason for their experiences; 42 percent of women who perceived some form of discrimination evidence significant frustration in identifying a main reason. Analyses show that, by requiring respondents to identify a single reason for their experiences of discrimination, the resulting data likely provide underestimates—and potentially biased estimates—of particular forms of discrimination.

Sexual Orientation Differences in Gun Ownership and Beliefs About Gun Safety Policy, General Social Survey 2010-2016.

The aim of this study was to investigate sexual orientation differences in gun ownership and gun safety beliefs among U.S. adults. We used information from the General Social Survey (2010-2016) to assess presence of guns in the household, personal gun ownership, and endorsement of a gun safety law among sexual minority (n = 195) versus heterosexual (n = 4359) respondents. Methods employed multivariate logistic regression analyses adjusted for confounding including gender, age, race/ethnicity, education level, size of household, urbanicity, military veteran status, and political views. Gay/bisexual men were more likely to endorse a gun safety law (adjusted odds ratio [aOR] = 3.24, 95% confidence interval [CI] = 1.79-5.88) and less likely to report guns in the household (aOR = 0.34, 95% CI = 0.18-0.65) than heterosexual men. In contrast, lesbian/bisexual and heterosexual women similarly endorsed a gun safety law and reported household guns. However, among women reporting a household gun, lesbian/bisexual women were more likely to be the personal gun owner (aOR = 3.97, 95% CI = 1.43-11.03). Attitudes toward a gun safety law and gun ownership differ by sexual orientation, but patterns vary by gender. We recommend that clinicians inquire about gun ownership and gun storage practices with both heterosexual and sexual minority patients.

An Innovative Approach to the Design of a National Probability Sample of Sexual Minority Adults.

Purpose: Sampling lesbian, gay, and bisexual (LGB) people to recruit a national probability sample is challenging for many reasons, including the low base rate of LGB people in the population. To address this challenge, researchers have relied on diverse approaches to sampling LGB people. We aimed to test an innovative method to assemble a U.S. national probability sample of non-transgender sexual minority adults. Methods: Our approach used two phases. In Phase 1, we identified LGBT respondents in a probability general population sample. These respondents were then queried about their sexual orientation and gender identity using short screening questions to identify non-transgender sexual minority respondents. In Phase 2, the identified sexual minority respondents completed the targeted survey online or on a mailed questionnaire. Results: In Phase 1, using random-digit dialing, a nationally representative sample of 366,644 respondents were screened in a brief telephone interview. Of them, 3.5% (n = 12,837) identified as LGB or transgender. In Phase 2, eligible respondents were asked to participate in a self-administered survey questionnaire. Eligibility was based on gender identity, age, race and ethnicity, and educational restrictions. Of the 3525 who were eligible, 81% (n = 2840) agreed to participate in the study (78% agreed to use the web version and 22% the mailed questionnaire), and 49% of web surveys and 46% of mailed surveys were completed. The final sample included 1331 respondents. Conclusion: The benefits of this approach include the ability to assess sexual minority-specific content in a national probability sample; challenges include high cost and low base rates for Asian and American Indian or Alaska Native individuals in the United States.

Gender and sexual minorities in astronomy and planetary science face increased risks of harassment and assault

Lesbian, gay, bisexual, transgender, queer/questioning, pansexual, asexual, and/or nonbinary (LGBTQPAN) people are a vulnerable, yet understudied group in the American STEM workplace. Only recently have efforts been made to assess their workplace experiences and levels of representation in STEM. In this paper, we sought to explore the experiences of LGBTQPAN individuals in the astronomy and planetary science community. We conducted an internet-based survey of the workplace experiences of 474 astronomers and planetary scientists. We hypothesized LGBTQPAN women and gender minority respondents in our sample would observe negative remarks or directly experience verbal or physical harassment in higher proportion compared to cisgender, straight women, a more commonly studied group. We found support for this hypothesis. LGBTQPAN women and gender minorities also observed more homophobic and transphobic remarks from their peers, and were more likely to feel unsafe at work due to their race, sexual orientation, and gender identity, compared to cisgender, straight women. They were more likely to be verbally harassed due to sexual orientation and gender identity, and were fully twice as likely to be physically harassed due to gender or sex. Based on our sample, we suggest that LGBTQPAN women and gender minorities experience a more hostile workplace climate in astronomy and planetary science compared to cisgender, straight women.Keywords: gender minorities, sexual minorities, harassment, assault, planetary science, astronomy

The ANES Child Rearing Scale: Is It a Measure of Authoritarianism?

Objective: The objective of the research reported in this paper is to determine the meaning of the scores yielded by an administration of the ANES Child Rearing Scale. Methods: An argument is developed that the CRS is scale is measuring “Autonomy versus Conformity”. In support of this claim, scores on the CRS scale for a national sample of United States adults are analyzed using Gutman scaling, correlation, factor, and regression analyses. The overall sample is divided into White respondents on one hand, and Black, Hispanic, and Asian-American respondents on the other on the basis of evidence that CRS scores have different meaning for White respondents in contrast to minority respondents. Results: The results point to the conclusion that the CRS is not a measure of authoritarianism for either White or minority respondents. The results are consistent with the alternative conjecture that the CRS is a measure of “Autonomy versus Conformity.” Results also point to the conclusion that the scores on the CRS have different meanings for White respondents on one hand and minorities on the other. It is concluded that White and minority respondents be treated separately when using the CRS. It is also argued-with supporting empirical evidence-that the CRS is actually measuring liberal/conservatism. Conclusion: It is concluded that the CRS scale is surplus to the analysis of individual differences in attitudes and behaviors with the possible exception of certain circumstances. *The data used for the research reported in this paper are drawn from the ANES 2016 time series study. All calculations were completed using Stata 13. Any errors are the responsibility of the author alone.

Equity in Access to Outdoor Recreation—Informing a Sustainable Future

Despite an increasingly ethnically and racially diverse population in the United States (U.S.), growing evidence indicates that minorities are underrepresented in national forest visitation. Many reasons for continuing underrepresentation have been examined, involving research reaching back multiple decades. In the current study, a random sample of residents (n = 1977) from four large metropolitan statistical areas in California was involved in a telephone survey about forest visitation. Analysis revealed a continuing pattern of inequities in lifetime visitation to a national forest, as well as recency of visitation. Constraints to national forest visitation show similarities among groups. Lack of time was the most often mentioned constraint, with resource-related constraints more frequently cited by minority respondents. In contrast to prior studies, a lack of information or concerns about discrimination were not cited by survey respondents, though the open-ended approach to top constraints may underpin some of this variation from prior research. The primary information source for outdoor recreation used most frequently and most trusted was the Internet, followed closely by social networks (family and friends). In the presentation of U.S. outdoor recreation information, natural resource management agencies, use groups, and opportunity providers would benefit from incorporating culturally relevant messaging and images to affirm the message of inclusion and welcome.

Contrast-Enhanced Ultrasound for Early Prediction of Response of Breast Cancer to Neoadjuvant Chemotherapy

Abstract Purpose To evaluate the time-intensity curve (TIC) parameters on contrast-enhanced ultrasound (CEUS) for early prediction of the response of breast cancer to neoadjuvant chemotherapy (NAC). Materials and Methods This prospective study included 41 patients with breast cancer. CEUS was performed before and after the first cycle of NAC. TIC parameters were analyzed for different regions of interest (ROIs). ROI 1 targeted the hotspot area of greatest enhancement, ROI 2 delineated the area of hyperenhancement, ROI 3 included the entire tumor on grayscale ultrasound, and ROI 4 encircled the normal parenchyma. The TIC perfusion values for ROI 1, 2, and 3 were divided by the ROI 4 value. Results 11 (26.8 %) of the 41 patients showed a good response (Miller-Payne score 4 or 5) and 30 (73.2 %) showed a minor response (Miller-Payne score 1, 2, or 3). There were significant differences in the wash-out area under the curve, the wash-in and wash-out areas under the curve on ROI 1/4 after the first cycle of NAC, pre-NAC mean transit time local (mTTl) on ROI 2/4, and pre-NAC mTTl on ROI 3/4 between good and minor responders (area under the receiver-operating characteristic curve &gt; 0.70, p &lt; 0.05). Conclusion Some TIC parameters obtained by CEUS may allow prediction of the response of breast cancer to NAC at a very early time point.

Sexual orientation, peer relationships, and depressive symptoms: Findings from a sociometric design

Sexual minority youth report poorer mental health than heterosexual youth. According to the minority stress framework, this results from sexual minority individuals being societally marginalized, which for sexual minority youth may include being poorly integrated in the peer context. A sociometric approach was used to test whether peer relationships, measured broadly as friendship, acceptance, disliking, and bullying relationships, mediated the link between a sexual minority orientation and depressive symptoms in adolescence. Analyses were conducted across three samples from the Netherlands and Belgium (N = 352; N = 1848; N = 263). Sexual minority respondents reported higher levels of depressive symptoms than heterosexual respondents, yet sexual orientation differences in peer relationships were small. Moreover, no link between peer relationships and depressive symptoms was found. Consequently, indirect effects were small too.

Police integration and support for anti-government violence in divided societies: Evidence from Iraq

How does the demographic makeup of the police affect violent conflict in divided societies? I argue that following a shift in relative group power, integrating the police rank-and-file addresses incentives to rebel by solving a commitment problem between the powerful state and a weaker group. I test this argument using a survey experiment of 800 Baghdad residents. Providing Sunni (minority) respondents with an informational prime that the police are integrated reduces support for anti-government violence. Consistent with the commitment mechanism, Sunnis, but not Shias, who receive the prime are less fearful of future repression by the government. The key mechanism is the way in which officers are distributed. It is more difficult for the state to renege on inclusion when minority officers serve in mixed units rather than being isolated in minority-only units. Patrol-level heterogeneity makes it difficult for the government to withhold equipment or information from officers on the basis of group identity, and makes the state reliant on officers from all groups to serve all parts of the country. Among survey respondents in Baghdad, I find that those who perceive the police as mixed between Sunnis and Shias, but not those who perceive officers to be primarily members of their own sect, are less expectant that the government will try to harm them. This article contributes to research on institutions in divided societies by identifying a form of inclusion which is self-enforcing, improving long-term prospects for peace by resolving underlying insecurities in the shadow of historical conflict.

Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans

ObjectiveTo examine reported experiences of discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly contribute to poor health outcomes.Data Source and Study DesignData came from a national, probability‐based telephone survey of US adults, including 489 LGBTQ adults (282 non‐Hispanic whites and 201 racial/ethnic minorities), conducted January‐April 2017.MethodsWe calculated the percentages of LGBTQ adults reporting experiences of discrimination in health care and several other domains related to their sexual orientation and, for transgender adults, gender identity. We report these results overall, by race/ethnicity, and among transgender adults only. We used multivariable models to estimate adjusted odds of discrimination between racial/ethnic minority and white LGBTQ respondents.Principal FindingsExperiences of interpersonal discrimination were common for LGBTQ adults, including slurs (57 percent), microaggressions (53 percent), sexual harassment (51 percent), violence (51 percent), and harassment regarding bathroom use (34 percent). More than one in six LGBTQ adults also reported avoiding health care due to anticipated discrimination (18 percent), including 22 percent of transgender adults, while 16 percent of LGBTQ adults reported discrimination in health care encounters. LGBTQ racial/ethnic minorities had statistically significantly higher odds than whites in reporting discrimination based on their LGBTQ identity when applying for jobs, when trying to vote or participate in politics, and interacting with the legal systemConclusionsDiscrimination is widely experienced by LGBTQ adults across health care and other domains, especially among racial/ethnic minorities. Policy and programmatic efforts are needed to reduce these negative experiences and their health impact on sexual and/or gender minority adults, particularly those who experience compounded forms of discrimination.

The Effects of Neighbourhood Disorder on Life Satisfaction of Ethnic Majority and Minority Group Members: Evidence From 12 Central-Eastern European Countries

While research has shown a negative relation between neighbourhood disorder and indicators of well-being, this evidence comes predominantly from Western European countries, relies on subjective measures of disorder, and is indifferent to ethnic specificities. In this paper, we examine the relationship between neighbourhood disorder and life satisfaction across neighbourhoods in 12 Central-Eastern European countries. We use an exogenous measure of disorder, and account for the presence of respondents’ own ethnic group in the neighbourhood, as we propose that it may condition the effect of disorder on life satisfaction. Using survey data covering 18,743 residents of 897 local areas across 12 countries, we found that neighbourhood disorder was negatively related to life satisfaction for both ethnic majority and minority respondents, over and above individual and neighbourhood characteristics. This effect was, however, differently moderated by ethnic in-group share in the neighbourhood for ethnic majorities and minorities. Among ethnic majority members, disorder had a negative effect on their life satisfaction only when there were high levels of co-ethnics' presence in the neighbourhood, but not at low levels. By contrast, for minority members, the negative effect of neighbourhood disorder was significant at lower of levels of co-ethnic concentration, but not at its higher levels. These results suggest that whereas for minority groups the presence of co-ethnics buffers the negative effects of the aversive environment on well-being, for ethnic majority members it plays an opposite role. We argue that members of the dominant, majority population find having to attribute disorder to their in-group problematic, which results in lower life satisfaction.

Perceived discrimination south of the equator: Reassessing the Brazilian Explicit Discrimination Scale.

To reassess the Explicit Discrimination Scale (EDS; Bastos, Faerstein, Celeste, & Barros, 2012), an instrument developed in Brazil to examine intersecting forms of discrimination, with particular attention to the number of underlying dimensions, residual correlations, share of explained item variance, and stability of the configural and metric structure in broader populations. Data from two cross-sectional studies and one cohort investigation were used. Although the cross-sectional studies were conducted among racially diverse undergraduate students (n = 1,022, 45% women, mean age = 23 years; n = 424, 59% women, mean age = 22 years), the cohort study included a probabilistic sample of community residents with 18% racial/ethnic minority respondents (n = 1,187, 57% women, mean age = 42 years). A series of exploratory models, exploratory structural equation models, and confirmatory factor analyses models was estimated. The EDS items might be best represented by a 3-factor model, which includes a second-order factor. Although only 1 pair of correlated residuals emerged, at least 4 different items with a sizable share of error variance were observed. The revised scale structure had an excellent fit to the data and was consistent among both undergraduate students and community residents. As well as demonstrating that discrimination may be structured by proximal, medial, and distal experiences with mistreatment, we suggest that the EDS has the potential to enhance research on the intersectional health impacts of discrimination. Future studies are required to assess scalability and provide scholars with a shortened version of the instrument. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Diversifying the police applicant pool: motivations of women and minority candidates seeking police employment

ABSTRACTGiven the media attention to police killings of unarmed men of color, police agencies have increased their focus on the diversity of their applicant pools. Despite their efforts, policing leaders across the United States have cited challenges in recruiting a diverse police force and are exploring evidence-based solutions. However, the bulk of the literature on motivation to seek a career in policing is dated and includes small samples of women and minority respondents. The purpose of this study is to provide contemporary insight into reasons of women and minority candidates for applying to a police department. Thus, this study focuses on women and minority applicants to a large policing agency in the northeastern United States, asking respondents an open-ended question about their motivation to apply. Policing as a childhood dream, making a difference in the community and the opportunity to help people, and believing policing was a good transition from military to civilian life were the most commonly cited reasons for applying. Salary, benefits and job security were the least cited reasons for applying for a police position. Other findings and policy implications are discussed.

Preference for in-person psychotherapy versus digital psychotherapy options for depression: survey of adults in the U.S

Several barriers complicate access to psychotherapy for depression, including time commitment, location of services, and stigma. Digital treatment has the potential to address these barriers, yet long term use of digital psychotherapy is poor. This paper presents data from a mixed-methods, online survey to document concerns patients with depression face when given the choice of in-person psychotherapy and digital psychotherapy. Participants were 164 adults living in the United States who had previously used or considered psychotherapy for depression. Rural-dwelling and racial/ethnic minority (Native American, African American, and Spanish-speaking) respondents were purposively sampled. Participants were asked their preferences for and opinions about four treatment modalities: self-guided digital, peer-supported digital, expert-guided digital, or in-person psychotherapy. Less than half (44.5%) of participants preferred in-person psychotherapy, 25.6% preferred self-guided digital treatment, 19.7% preferred expert-guided digital treatment, and 8.5% peer-supported digital treatment. Principal themes extracted from qualitative analysis centered on the efficacy of digital treatment, access to digital treatment, concerns about peer-supported care, confidentiality and privacy concerns, preference for in-person treatment, skepticism about self-guided therapy, and the impact of social anxiety on the use of video-chat based care. Future development of digital psychotherapy will need to address concerns regarding efficacy, privacy, data security, and methods to enhance motivation to use these treatments.

Educational attainment predicts negative perceptions women have of their own climate change knowledge.

Education may encourage personal and collective responses to climate change, but climate education has proven surprisingly difficult and complex. Self-perception of knowledge and intelligence represent one factor that may impact willingness to learn about climate change. We explored this possibility with a case study in Raleigh, North Carolina in 2015 (n = 200). Our goal was to test how gender and ethnicity influenced perceptions people had of their own climate change knowledge. Survey respondents were asked how strongly they agreed with the statement “I feel knowledgeable about climate change” (1 = strongly disagree, and 5 = strongly agree). Our survey instrument also included demographic questions about race, age, income, gender, and education, as well as respondent’s experience with natural disasters and drought. We observed an interaction between education and gender where women’s self-perceived knowledge was higher than men among people with low levels of educational attainment, but was higher for men than women among people with high levels of educational attainment. In addition, minority respondents self-reported lower perceived climate change knowledge than white respondents, regardless of educational attainment. This study enhances our understanding of the gender gap in self-perceptions of climate knowledge by suggesting it is contingent on educational attainment. This could be the result of stereotype-threat experienced by women and minorities, and exacerbated by educational systems. Because people who question their knowledge are often more able to learn, particularly in ideologically charged contexts, highly educated women and minorities may be more successful learning about climate change than white men.

Severity of Alcohol, Tobacco, and Drug Use Disorders Among Sexual Minority Individuals and Their "Not Sure" Counterparts.

Sexual minority individuals have heightened risk for substance use; however, previous studies have not assessed severity of alcohol use disorders (AUDs), tobacco use disorders (TUDs), and drug use disorders (DUDs) among lesbian/gay and bisexual individuals and those "not sure" of their sexual identity compared with heterosexual individuals. This study examined how three dimensions of sexual orientation (identity, attraction, and behavior) relate to severity of AUD, TUD, and DUD. This study used cross-sectional national data (N = 36,309) from the National Epidemiologic Survey on Alcohol and Related Conditions-III, and well-validated alcohol, tobacco, and drug measures that align with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Data were collected through in-person interviews in 2012-2013. Sexual minority respondents, based on sexual identity, had higher odds of severe AUD or TUD than heterosexual respondents. Opposite- and same-sex behavior was a predictor of severe AUD (adjusted odds ratio [AOR] = 2.44; 95% confidence interval [CI] = 1.24-4.79) and TUD (AOR = 2.16; 95% CI = 1.19-3.93), but not DUD. Those "not sure" of their sexual identity had higher odds of severe AUD, TUD, and DUD: AUD (AOR = 5.05; 95% CI = 2.78-9.16), TUD (AOR = 4.18; 95% CI = 2.29-7.64), and DUD (AOR = 4.40; 95% CI = 1.72-11.2), than heterosexual respondents. There were few significant differences between "not sure" and bisexual respondents. These findings provide strong evidence that bisexual and "not sure" U.S. adults are more likely to have a severe AUD and TUD. They also demonstrate the importance of treatment strategies that address sexual minority-specific risks, particularly for bisexual individuals and those "not sure" of their sexual identity.

Exploring affordability and healthcare-seeking behaviour for delivery and antenatal care among the poor and ethnic minorities in rural Northwestern Viet Nam

ABSTRACTBackground: Health insurance (HI) has been introduced to achieve universal health coverage. In Viet Nam, mandatory HI for the poor and the minorities has been strengthened since 2012.Objective: The study explored affordability and healthcare-seeking behaviour for delivery and antenatal care (ANC) among the poor and ethnic minority women after HI-reform in rural Northwestern Viet Nam.Methods: A cross-sectional study was conducted in 2014 in Luong Son District, where the ethnic Muong live. Stratified simple random sampling was used to select 315 participants who had delivered a baby in the previous year.Results: The HI coverage was 72.7% (229/315) and 30.9% of the mothers were living on less than USD 1.25 per household person per day. HI enrolment was predicted by ethnic minority status (Muong, aOR 18.3, 95% CI 6.4–52.6), rather than the household income. More than 80% of majority and minority respondents selected the institution by their trust in the quality of its care.The institutional delivery was 100%, irrespective of HI status. The out-of-pocket expenses for normal delivery were significantly smaller for the insured than the uninsured (p < 0.001). The total cost of normal delivery proved to be a catastrophic payment (households spending > 5% of annual household income) for 17.6% and 31.7% of the insured and uninsured, respectively. The average number of ANC visits was more than four times for all quartiles, irrespective of the mothers’ HI status; however, all quartiles demonstrated more frequent visits to private clinics than commune health centres (public facility).Conclusions: The results indicated that Vietnamese HI reform reduced the economic burden for both the poor and ethnic minorities in rural villages. However, further HI reforms should consider ways to reduce the catastrophic payments, fix the role of private facilities for appropriate resource mobilisation, and enhance the move towards universal health coverage.