Sexual And Gender Minority Populations Research Articles

Cancer screening in sexual and gender minority populations: A systematic review and meta-analysis.

10540 Background: The sexual and gender minority (SGM) populations experience a greater cancer burden than their heterosexual or cisgender counterparts. Screening rates for cancer within this cohort are frequently suboptimal, highlighting notable deficiencies in screening recommendations. Inadequate culturally competent care and screening guidelines may contribute to delays in cancer diagnosis and treatment, ultimately impacting survival and quality of life. We sought to investigate the existing disparities in cancer screening among SGM populations. Methods: We conducted a systematic review and meta-analysis to assess the cancer screening rates in SGM. The SGM population included in this study were gays, lesbians, bisexuals, transgender men, and transgender women. Two reviewers conducted a systematic search of numerous databases, including PubMed, PsycINFO, and CINAHL, and then extracted relevant information from eligible studies. For this study, we conducted a meta-analysis using a random-effects model. Pooled estimates of the odds ratio were calculated for any combination of outcomes and population when at least two studies had relevant data. Study heterogeneity was assessed using I² statistics. Meta-regression, accounting for the study weight, year, and latitude, was performed on variables potentially associated with heterogeneity. Newcastle-Ottawa Scale was used to assess the quality of selected studies. Results: We analyzed data from a total of 60 eligible studies with 65,315 patients. Pooled analysis showed that sexual minority groups were at lower risk for cancer screening such as breast cancer screening (OR: 0.79, 95% CI, 0.75-0.82; Chi2=835.23; p<0.001; I2=97%), cervical cancer screening (OR: 0.62, 95% CI, 0.56-0.72; Chi2=926.23; p<0.001; I2=96%), colorectal cancer screening (OR: 0.51, 95% CI, 0.45-0.61; Chi2=3272.21; p<0.001; I2=98%), and prostate cancer screening (OR: 0.71, 95% CI, 0.63-0.82; Chi2=1282.92; p<0.001; I2=99%). The prevalence of lung cancer (p<0.001) and anal cancer screening (p<0.001) were also lower in sexual minority groups. The analysis also showed no small study effects (Egger test: 1.33; 95% CI: −5.42, −0.63; p=0.182). All the subgroups (geographical location, screening procedure, screening period) had high between-study heterogeneity. Conclusions: Our findings indicate that cancer screening rates for breast, cervical, colorectal, prostate, lung, and anal cell cancer are significantly lower in SGM populations and emphasize the urgent need for targeted interventions, culturally competent care, and inclusive screening guidelines to address these disparities. Understanding and addressing these issues are crucial for reducing delays in cancer diagnosis and improving survival and quality of life for SGM population. Further research and comprehensive strategies are warranted to bridge these gaps in cancer screening accessibility and uptake.

Characteristics and Consequences of Violent Victimization in Sexual and Gender Minority Communities: An Analysis of the 2017-2021 National Crime Victimization Survey.

Purpose: This article investigates rates of violent victimization, subsequent help-seeking, and health-related consequences within sexual and gender minority (SGM) communities. Methods: Aggregate data from the 2017-2021 National Crime Victimization Survey were examined to determine nationally representative estimates of rates and distributions of violent victimization, help-seeking, and socioemotional consequences within those 16 years of age and older. Due to sample size, most analyses aggregated sexual orientation and gender identity to allow comparison of SGM persons to non-SGM persons and examine differences within the SGM population. Results: Persons who identified as lesbian, gay, or bisexual experienced violent victimization at rates two to six times higher than straight persons. Transgender persons were victimized more than three times as often than cisgender persons. SGM persons experienced higher rates of all types of violent victimization than non-SGM persons regardless of victim-offender relationship. There were differences by victim demographic characteristics, including sex, race and Hispanic origin, age, marital status, and household income. A higher proportion of SGM victims reported only problems with work/school or problems both at work/school and with family/friends. Finally, higher proportions of SGM victims reported socioemotional consequences when they were female, older, or experienced serious violent crime. Conclusion: The findings in this study continue to highlight high levels of violence experienced by SGM persons and disproportionate socioemotional consequences. There is an evident need to develop targeted interventions and provide services to address the consequences of victimization among this population. The analyses demonstrate the necessity of continued research to better understand the impact of violence on SGM communities.

Trust in Tobacco Control

Sexual and gender minority (SGM) groups experience nicotine and tobacco (NT) related inequities that persist despite reductions in NT use across the general population. Research suggests that institutional trust has important implications for how public health policies are received by various publics, yet few studies have explored trust in tobacco control institutions, especially among SGM communities. Analysing narrative data from open-ended interviews with 100 young adults in California who currently or formerly smoked tobacco and identify in ways that classify them as SGM, we examine participants’ perceptions of tobacco control efforts in relation to characteristics of trustworthy institutions. Our findings suggest that trust in tobacco control institutions may be compromised by some of the tactics used to denormalize NT use, abstinence-only approaches to NT-related messaging and policymaking, and distrust of the broader establishment of which tobacco control is perceived to be a part. Highlighting unintended consequences of some current mainstream approaches to tobacco control, these findings are important to consider in the development of community-informed messaging strategies and policy interventions to address tobacco-related inequities among SGM populations.

State of the Science: LGBTQ-Affirmative Psychotherapy

Sexual and gender minority (SGM) individuals experience significantly higher levels of depression, anxiety, and behavioral comorbidities (i.e., substance use, suicide) compared to heterosexual and cisgender individuals. LGBTQ-affirmative psychotherapy aims to ameliorate the adverse psychosocial processes, ultimately caused by stigma, that underlie this disparity. Over the past two decades, the mental health field has introduced professional guidelines and treatment protocols for LGBTQ-affirmative psychotherapy, and established their efficacy across distinct SGM populations, delivery modalities, and settings. This state of the science review outlines the history, current evidence, and future directions of LGBTQ-affirmative psychotherapy. It provides an historical account of clinically relevant research for SGM populations and outlines the factors that moved the field from pathologizing perspectives to affirmative approaches. It then discusses the current evidence for LGBTQ-affirmative psychotherapy, as well as studies identifying treatment moderators, including race/ethnicity and stigma exposure, as well as potential treatment mechanisms, including hypervigilance, shame, negative self-schemas, unassertiveness, and emotion dysregulation. SGM individuals can only benefit from LGBTQ-affirmative psychotherapy if protocols are widely available and used by therapists. To this end, the article presents current findings on implementation and dissemination, such as therapist training, and different treatment delivery modalities. Finally, the article outlines an agenda for future research to advance the field of LGBTQ-affirmative psychotherapy, including identifying treatment mechanisms, successfully implementing and disseminating treatment protocols, determining which contexts and client characteristics warrant adaptations to current protocols, and understanding how LGBTQ-affirmative psychotherapy can interact with structural and systemic conditions to exert the strongest possible impact on SGM mental health.

Knowledge, attitudes and perceptions of students on sexual health needs of sexual and gender minority individuals in a South African University of Kwa-Zulu Natal: A mixed methods study

There is scant literature available in South Africa that explores the knowledge, attitudes and perceptions of student nursing trainees and other healthcare workers who deliver sexual health services to sexual and gender minority (SGM) communities with unique health needs. An online, mixed-method, questionnaire-based survey was employed to conveniently sample 39/78 (50%) final-year Bachelor of Nursing students from the University of Kwa-Zulu Natal to understand their knowledge, attitudes and perceptions. Descriptive statistics were applied for quantitative results and thematic analysis was used for free-text qualitative data. Results suggested that over 67% of the participants lack the skills and knowledge to obtain a comprehensive history salient to the health needs of SGM populations. Students reported that social upbringing and religious beliefs impact the care they render, with many showing favourable attitudes toward the SGM community. Overall, students reported no content related to SGMs in the current nursing curriculum, however, students were receptive, highlighting the need to be clinically competent to provide relevant healthcare for SGM to meet their sexual health needs. It thus require that students must be trained and have included the SGM content in their curriculum to meet the sexual health needs of SGM population to enable non discriminatory, equitable health provision. being informed and having the necessary skills and knowledge obtained during training in the health institutions of higher learning can address the issues of greatest concern related to the HIV health needs of SGM populations.

Etiology Beliefs About Sexual and Gender Minority Youth (EB-SGM): Validation with College Students, Community Adults, and Pediatric Healthcare Providers

ABSTRACT Sexual and gender minority (SGM) youth are at risk for adverse health outcomes because of stigma and discrimination exposure. Individuals’ beliefs about the biological origin of SGM identity are linked to their negative attitudes and biases against SGM populations, which can also apply to pediatric healthcare providers. The current study outlines validation of the Etiology Beliefs about Sexual and Gender Minority Youth (EB-SGM) scale, a 12-item measure designed to assess adults’ beliefs about youths’ biological versus environmental SGM etiology. College students (N = 285; study 1), community adults (N = 258; study 2), and pediatric providers (N = 104; study 3) completed the EB-SGM and other self-report measures. Exploratory factor analysis (EFA) in study 1 revealed a three-factor structure: beliefs about gender nonconforming behavior, beliefs about gender identity, and beliefs about sexual attraction/behavior. Confirmatory factor analysis (CFA) in study 2 suggested a bi-factor structure, which was replicated in study 3. The EB-SGM demonstrated adequate concurrent and discriminant validity. We also examined bivariate correlations between etiology beliefs and sociodemographic characteristics across samples. Findings indicate that EB-SGM is a psychometrically sound instrument to measure adults’ etiology beliefs. The EB-SGM has the potential to be used as a screening measure to enhance pediatric healthcare providers’ SGM training.

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.

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.

Violence and Related Health Outcomes in Sexual and Gender Minority Communities: Introduction to the Special Issue.

Violence affects every community but is particularly prevalent among sexual and gender minority (SGM) people. Although research on violence within SGM populations is increasing, knowledge gaps remain that limit development of evidence-based policy, prevention, and intervention efforts to reduce the violence disparities the SGM community faces. In 2021, the National Institutes of Health (NIH) hosted a multiphase scientific workshop to identify and prioritize key research needs to further our understanding of violence affecting SGM communities and its health outcomes. In this perspective, we summarize the research needs identified. NIH supports this special issue as an outcome of the scientific workshop.

Neglected gaps in improving the health, wellbeing, and care for sexual and gender minority young people living in low- and lower-middle- income countries: a scoping review

BackgroundThere is a lack of reliable data on the size, characteristics, and experiences of sexual and gender minority (SGM) young people (ages 10–24) in low- and lower-middle- income countries (LMICs). This review examines the research conducted in the last thirteen years with and about SGM young people living in low-income settings and seeks to answer the question: What is known about the mental and physical health needs, safety, and wellbeing of SGM young people living in LMICs?MethodsWe conducted a scoping review informed by the methodological frameworks put forth by Arksey and O’Malley and the Joanna Briggs Institute. We systematically searched two general social science databases and one topic-specific database for peer-reviewed papers, of any research design, that included SGM young people or explored attitudes toward SGM young people in LMICs. We included papers that reported on factors influencing the health and wellbeing of SGM populations, including physical and mental health, healthcare-seeking behaviors, substance use, experiences of discrimination and/or stigma, experiences of violence and abuse (emotional, physical, and/or sexual), economically motivated paid sex practices, housing or economic security, and attitudes of others toward SGM populations.ResultsOf the 5,409 unique records identified, 79 papers drawing from data collected from 74 unique studies met the inclusion criteria. Only 50 of the 79 papers included SGM young people as participants, with just 13 focusing exclusively on SGM young people ages 10–24. The included papers were classified into three thematic groupings: attitudes toward SGM populations (n = 26), risks to health (n = 40), and experiences of stigma and discrimination (n = 13).ConclusionThe findings indicate that the health and wellbeing of SGM young people in LMICs has been historically under-researched. While SGM young people have received more attention from researchers in recent years, the body of literature as a whole is disjointed and sparse, and often studies are about SGM young people, rather than with and for them. Our review highlights the need for more and better research, more accurate and disaggregated demographic data, and leadership and participation of SGM-led community-based organizations in the co-design of studies that focus on SGM young people.

Understanding the relationship between casual substance use and sexual risk behaviors in sexual and gender minority emerging adults

Research has shown the heightened risk for sexually transmitted infections (STIs), sexual risk behavior, and substance use in sexual and gender minority (SGM) individuals. Further research is necessary to understand understudied sexual risk behaviors in a sample of casual substance users as the implications of substance use are not just experienced by individuals with substance use disorders. Many emerging adults (ages 18-29) experiment with substance use during the transition from adolescence to adulthood and the relationship with sexual risk behaviors are important to understand in this population. Data were collected online through Prolific from 75 participants between the ages of 18-29 who identified as being a SGM. Participants completed a survey in March 2020 indicating their substance use. In November 2021, participants indicated their risky sexual behaviors. A path analysis indicated that cannabis use at Time 1 was significantly associated with greater oral sex without a condom or dental dam, sex under the influence of alcohol and other substances at Time 2. Cocaine use at Time 1 was significantly associated with increased sex under the influence of alcohol and sex with a stranger. Results illustrate long-term implications of casual substance use in SGM populations and highlights understudied sexual risk behaviors.

Effects of Tobacco Versus Electronic Cigarette Usage on Nonsuicidal Self-Injury and Suicidality Among Chinese Youth: Cross-Sectional Self-Report Survey Study.

The increase in tobacco/conventional cigarette (CC) and electronic cigarette (EC) usage among Chinese youth has become a growing public health concern. This is the first large-scale study to compare the impact of CC and EC usage on risk for nonsuicidal self-injury (NSSI) and suicidality in cis-heterosexual and sexual and gender minority (SGM) youth populations in China. This study examines the CC and EC risks for NSSI and suicidality among Chinese youth and compares the extent to which SGM and cis-heterosexual youth's risks for NSSI and suicidality are influenced by their CC and EC usage and dependence. A total of 89,342 Chinese participants completed a cross-sectional self-report survey in 2021. Sociodemographic information, sexual orientations, gender identities, CC and EC usage, CC and EC dependence, and risks for suicidality and NSSI were assessed. The Mann-Whitney U test and chi-square test were performed for nonnormally distributed continuous variables and categorical variables, respectively. The multivariable linear regression model was used to examine both the influence of CC and EC usage and CC and EC dependence on NSSI and suicidality as well as the interaction effects of CC and EC usage and CC and EC dependence on NSSI and suicidality by group. The prevalence of CC usage (P<.001) and dependence (P<.001) among SGM participants was lower than that among their cis-heterosexual counterparts. However, the prevalence of EC usage (P=.03) and EC dependence (P<.001) among SGM participants was higher than that among their cis-heterosexual counterparts. The multivariable linear regression model showed that CC dependence and EC dependence had a unique effect on NSSI and suicidality (CCs: B=0.02, P<.001; B=0.09, P<.001; ECs: B=0.05, P<.001; B=0.14, P<.001, respectively). The interaction effects of (1) CC usage and group type on NSSI and suicidality (B=0.34, P<.001; B=0.24, P=.03, respectively) and dual usage and group type on NSSI and suicidality (B=0.54, P<.001; B=0.84, P<.001, respectively) were significant, (2) CC dependence and group type on NSSI were significant (B=0.07, P<.001), and (3) EC dependence and group type on NSSI and suicidality were significant (B=0.04, P<.001; B=0.09, P<.001, respectively). No significant interaction effect was observed between EC usage and group type on NSSI and suicidality (B=0.15, P=.12; B=0.33, P=.32, respectively) and between CC dependence and group type on suicidality (B=-0.01, P=.72). Our study shows evidence of intergroup differences in NSSI and suicidality risks between SGM and cis-heterosexual youth related to CC and EC usage. These findings contribute to the growing literature on CC and EC in cis-heterosexual and SGM populations. Concerted efforts are necessary at a societal level to curb the aggressive marketing strategies of the EC industry and media coverage and to maximize the impact of educational campaigns on EC prevention and intervention among the youth population.

Examining Measurement Invariance in the Personality Inventory for DSM-5 Brief Form Across Sexual and Gender Minority Status.

The Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Brief Form (PID-5-BF) was developed with an assumption of invariance across sexual and gender minority (SGM) individuals. This assumption has yet to be tested empirically. Using multigroup confirmatory factor analysis, we examined measurement invariance in the PID-5-BF across the SGM status in clinical (N = 1,174; n = 254 SGM) and nonclinical (N = 1,456; n = 151 SGM) samples. Measurement invariance was supported for the PID-5-BF structure, item thresholds, and factor loadings, but not at the item intercept level. SGM individuals endorsed higher negative affectivity, antagonism, disinhibition, and psychoticism domains in both samples. In the clinical sample, adjusting for partial invariance decreased detachment and antagonism levels for SGM persons. In the nonclinical sample, adjusting for partial invariance reduced antagonism disparities in the SGM group, even rendering original group differences null. Our results support the use of the PID-5-BF in SGM populations but indicate that some measurement bias may drive observed disparities in maladaptive trait domains and, in turn, personality disorder diagnosis.

Considerations and recommendations for mHealth interventions for substance use among Sexual and Gender Minority (SGM) individuals: A narrative review of the past 5years.

The prevalence of problematic substance use is disproportionately higher among sexual and gender minority (SGM) adults compared to adults in the general population. mHealth as a treatment modality could reduce barriers to accessing substance use treatments among SGM populations. Through a qualitative literature search, the current narrative review aimed to understand the lived experiences of SGM individuals who use substances and to synthesize recommendations made in the literature to inform future mHealth interventions. Positive and negative reinforcement motives were prominent reasons for substance use, which included SGM identity expression and conformity motives. Individual- and system-level treatment barriers included a lack of safe and nonjudgmental environment, shame and stigma, and limited knowledge about treatment options. Barriers were directly linked to the reported substance use treatment needs in this population. On-demand app features, real-time intervention and assessment, and anonymity should be considered in future mHealth trials. The online version contains supplementary material available at 10.1007/s40429-023-00497-0.

Indoor Tanning among Sexual and Gender Minority Adolescents and Adults: Results from the 2020 Pennsylvania LGBT Health Needs Assessment.

Sexual and gender minority (SGM) populations include individuals whose sexual orientation, gender identity, or reproductive development is characterized by nonbinary sexual constructs (e.g., lesbian, gay, bisexual, and transgender (LGBT) individuals). Previous research suggests that some SGM populations have higher rates of skin cancer. The purpose of this study was to assess the association of diverse SGM identities with indoor tanning, a risk factor for skin cancer, while exploring other relevant co-occurring risk factors. A secondary analysis was performed on the 2020 LGBT Health Needs Assessment collected by the Pennsylvania Department of Health. Measures included sexual orientation, gender identity, healthcare utilization, and cancer risk factors. Cisgender SGM men are more likely to use indoor tanning devices (adjusted odds ratio (aOR) = 1.79; 95% CI: 1.31-2.44) compared to other SGM subpopulations independent of sexual orientation. Indoor tanning was also associated with alcohol (aOR = 1.94; 95% CI: 1.50-2.51) and tobacco use (aOR = 1.64; 95% CI: 1.21-2.21). Findings suggest that targeted screening for skin cancer risk behaviors could accompany standard tobacco and alcohol screenings in clinical practice.

Obesity in Sexual and Gender Minority Populations: Prevalence and Correlates.

The purpose of this review is to explore the prevalence and correlates of obesity among members of sexual and gender minority (SGM) populations. Research overall finds higher rates of obesity among lesbian and bisexual women than heterosexual women, lower rates of obesity among gay and bisexual men than heterosexual men, and inconsistent findings on obesity among transgender individuals. Rates of mental health disorders and disordered eating are high among all SGM groups. Rates of comorbid medical conditions differ among groups. More research needs to be conducted within all SGM groups but particularly among transgender populations. All members of SGM encounter stigma, including when seeking healthcare, and this may lead to individuals avoiding healthcare. Therefore, it is important to educate providers about population-specific factors. This article serves as an overview of important considerations for providers treating individuals within SGM populations.

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

Promoting Sexual and Gender Minority Health Clinical Skills Training for All Medical Students.

Despite societal, legal, and cultural improvements in their well-being, sexual and gender minority (SGM) people in the United States still face substantial physical and mental health disparities that are exacerbated by physician stigma and lack of training. Although there have been efforts at medical schools nationwide to address these disparities and interweave SGM health education into existing preclerkship courses, opportunities to practice related clinical skills during the clerkship years remain largely elective. Furthermore, national survey data from 2020 indicate that SGM Americans continue to delay or avoid medical care because of physician discrimination. By providing predominantly opt-in opportunities for hands-on SGM health clinical training, educators risk perpetuating existing structural inequities and widening health disparities. In this article, the authors advocate for required SGM health clinical training for all undergraduate medical students, regardless of intended specialty. They highlight 3 types of elective SGM health clinical training models currently in use at medical schools across the country, including student-run clinics, advanced electives, and longitudinal scholarly concentrations. Using these examples, the authors then outline ways that educators can interweave required SGM health clinical training into undergraduate medical education, including with the recruitment and retention of SGM faculty, staff, and students; required SGM standardized patient experiences; the integration of SGM clinical opportunities throughout the core clerkships; and partnerships with SGM health centers. Using these methods, medical schools can mobilize passionate students, faculty, and leaders to both counter the bigotry and hate faced by SGM populations and develop innovative strategies to improve SGM patient health outcomes and expand opportunities for SGM health scholarship.

Recruiting and retaining sexual and gender minority couples in intervention research: Lessons learned from trials of tailored relationship education programs.

Relationship interventions, including healthy relationship education, couple therapy, and dyadic approaches to treating mental and physical health issues, hold promise for promoting relationship and individual health among sexual and gender minority (SGM) populations. Because SGM couples live within a context of societal stigma against their minority identities and relationships, they are likely to be best served by targeted, culturally sensitive relationship interventions that are affirming, free of hetero- and cis-normativity, and address the unique stigma-based challenges that they face. Therefore, a key goal for the field today is to conduct research evaluating and refining newly developed relationship interventions designed specifically for SGM couples. In this paper, we offer recommendations for effectively recruiting and retaining large, diverse samples of SGM couples for clinical trials of tailored relationship interventions, grounded in guidelines for psychological practice and conducting research with SGM populations. Throughout, we offer examples and lessons learned from our experiences conducting clinical trials of tailored SGM relationship education programs. We encourage the use of recruitment and retention strategies that involve members of the target SGM community from the outset, are informed by knowledge about SGM individuals and relationships, use currently preferred language for individual identities and relationships, attend to issues of confidentiality regarding sexual/gender identity or relationship involvement, and adhere to the norms of the particular community and recruitment venue.