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Spencer JC, Zhang H, Charlton BM, Schnarrs PW, Kuehne F, Siebert U, Trentham-Dietz A, Shokar NK, Kim JJ, Pignone MP. Cervical cancer screening and risk factor prevalence by sexual identity: A comparison across three national surveys in the United States. Prev Med 2025; 194:108262. [PMID: 40096895 DOI: 10.1016/j.ypmed.2025.108262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 03/09/2025] [Accepted: 03/10/2025] [Indexed: 03/19/2025]
Abstract
OBJECTIVES Women identifying as lesbian, gay, bisexual, or queer (LGBQ) have lower cervical cancer screening use and differences in care access. Less known about how differences vary by data sources and within LGBQ subgroups. We evaluated LGBQ disparities in cervical cancer screening use and risk factors across three national surveys in the United States. METHODS Data were from the 2019 and 2021 National Health Interview Survey, the 2018 and 2020 Behavioral Risk Factor Surveillance Survey, and the 2017-2019 National Survey of Family Growth. We meta-analyzed self-reported cervical cancer screening to estimate pooled relative risks (pRR), comparing those identifying as LGBQ to those identifying as straight/heterosexual. We also evaluated differences in care access and behavioral risk factors by sexual identity. RESULTS Despite demographic differences across surveys, all three surveys demonstrated a small reduction in up-to-date cervical cancer screening for LGBQ vs. straight/heterosexual women (pRR = 0.91 [CI 0.89-0.93]). The screening gap was larger for gay/lesbian (pRR: 0.90 [0.85-0.94]) than bisexual women (pRR: 0.94 [0.92-0.97]) and largest at younger ages (pRR age 21-29: 0.89 [CI 0.85-0.93]). LGBQ women reported consistently lower access to care across multiple measures. Risk factors were mixed, including higher smoking rates and higher HPV vaccination coverage for LGBQ women vs. straight. DISCUSSION LGBQ women are less likely to be screened for cervical cancer. Closing disparities in care access and identifying feasible and acceptable screening interventions will help reduce these disparities. We must also ensure high-quality data collection to monitor disparities across and within key subgroups.
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Affiliation(s)
- Jennifer C Spencer
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America; Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America; Texas Institute for Sexual and Gender Minority Health Research, Austin, TX, United States of America.
| | - Hanwen Zhang
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States of America
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, United States of America; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Phillip W Schnarrs
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America; Texas Institute for Sexual and Gender Minority Health Research, Austin, TX, United States of America
| | - Felicitas Kuehne
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall I.T., Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall I.T., Austria; Center for Health Decision Sciences, Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, United States of America; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Amy Trentham-Dietz
- Carbone Cancer Center and Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Navkiran K Shokar
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, United States of America
| | - Jane J Kim
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Michael P Pignone
- Department of Medicine, Duke Cancer Institute, and Margolis Institute for Health Policy, Duke University, Durham, NC, United States of America
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Robinson L, Matamoros C. Applied patient-level palliative care interventions designed to meet the needs of sexual and gender minorities: A scoping review and qualitative content analysis of how to support sexual and gender minorities at end of life. Palliat Med 2024; 38:69-84. [PMID: 38062858 PMCID: PMC10798012 DOI: 10.1177/02692163231214123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Sexual and gender minorities experience considerable health disparities across the life span. End of life presents unique challenges for this population, further exacerbating existing disparities. AIM We aimed to identify applied patient-level palliative care interventions for sexual and gender minorities and describe how said interventions met the needs of these populations at end of life. DESIGN We conducted a scoping review in keeping with the updated Arksey and O'Malley Framework. All included reports were analyzed qualitatively to describe the intervention and summarize thematically how it met the needs of sexual and gender minorities at end of life. DATA SOURCES We conducted searches in MEDLINE, EMBASE, PsychInfo, and CINAHL from 1946 to June 10, 2023. Reports were eligible for inclusion if they described a palliative care intervention delivered to sexual and gender minorities, and if the palliative care intervention responded to at least one specific need of the sexual and gender minority population(s) in question. RESULTS We included and summarized 27 reports. We identified three overarching themes describing how palliative care interventions responded to the needs of sexual and gender minorities at end of life. CONCLUSIONS This review responds to a need to improve palliative care delivery for sexual and gender minorities. Recommendations derived from these interventions, including how to center and advocate for sexual and gender minorities at end of life, can be applied by any interdisciplinary palliative care provider.
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Affiliation(s)
- Lilian Robinson
- Temmy Latner Centre for Palliative Care, Sinai Health System, Scarborough Health Network, Toronto, ON, Canada
| | - Cam Matamoros
- Scarborough Health Network, Scarborough Center for Healthy Communities, Department of Family and Community Medicine, Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
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Jodry D, Obedin-Maliver J, Flowers L, Jay N, Floyd S, Teoh D, Conageski C, Downs L, Khan MJ. Understanding Sexual and Gender Minority Populations and Organ-Based Screening Recommendations for Human Papillomavirus-Related Cancers. J Low Genit Tract Dis 2023; 27:307-321. [PMID: 37729043 PMCID: PMC10545069 DOI: 10.1097/lgt.0000000000000763] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Sexual gender minority (SGM) populations are at risk for human papillomavirus (HPV)-related cancers of the anogenital tract and oropharynx and often face barriers to health care. The goals of this document are to clarify language to provide inclusive care for SGM populations and to provide recommendations for screening and prevention of HPV-related cancers in SGM populations. MATERIALS AND METHODS An expert committee convened by the American Society for Colposcopy and Cervical Pathology performed a narrative review of the literature through February 2023. A comprehensive MEDLINE database search was performed for relevant studies. The literature review was divided into categories by organ/topic and by SGM population. Given the variability in available data for several of the categories, recommendations were made based on national guidelines where appropriate or expert opinion where there were less data to support risk-based guidelines. RESULTS Definitions and terminology relevant to SGM populations are presented. The authors advocate the adoption of sexual orientation gender identity data collection and an organ-based screening approach, which is possible with knowledge of patient anatomy, sexual behaviors, and clinical history. This includes screening for cervical cancer per national recommendations, as well as screening for anal, vulvar, vaginal, penile, and oral cancers based on risk factors and shared clinical decision making. The authors recommend consideration of HPV vaccination in all SGM individuals up to age 45 years old who are at risk. CONCLUSIONS An organ-based screening approach is part of a global strategy to create an inclusive care environment and mitigate barriers to screening and prevention of HPV-mediated cancers in SGM populations.
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Affiliation(s)
| | | | - Lisa Flowers
- Emory University School of Medicine, Atlanta, GA
| | - Naomi Jay
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Serina Floyd
- Planned Parenthood of Metropolitan Washington, DC, Washington, DC
| | - Deanna Teoh
- Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | | | - Levi Downs
- Park Nicollet Health Services, Minneapolis, MN
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Bristowe K, Timmins L, Braybrook D, Marshall S, Pitman A, Johnson K, Day E, Clift P, Rose R, Yi D, Yu P, Gao W, Roach A, Almack K, King M, Harding R. LGBT+ partner bereavement and appraisal of the Acceptance-Disclosure Model of LGBT+ bereavement: A qualitative interview study. Palliat Med 2023; 37:221-234. [PMID: 36428276 PMCID: PMC9896255 DOI: 10.1177/02692163221138620] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Support from social networks is vital after the death of a partner. Lesbian, gay, bisexual and/or transgender (LGBT+) people can face disenfranchisement and isolation in bereavement. The Acceptance-Disclosure Model (of LGBT+ bereavement) posits that experiences are shaped by the extent to which individuals feel able to disclose their bereavement to others, and whether that loss is acknowledged appropriately. AIM To explore LGBT+ specific experiences of partner bereavement; determine decision-making processes regarding disclosure of relationships/identities; and appraise the Acceptance-Disclosure Model using primary qualitative data. DESIGN Exploratory in-depth qualitative interview study positioned within a social constructivist paradigm. Data were analysed using inductive and deductive reflexive thematic analysis. SETTING/PARTICIPANTS 21 LGBT+ people from across England bereaved of their civil partner/spouse. RESULTS Participants described LGBT+ specific stressors in bereavement: lack of recognition of their loss; inappropriate questioning; unwanted disclosure of gender history; and fears of discrimination when accessing support. Disclosure of LGBT+ identities varied across social networks. Some participants described hiding their identities and bereavement to preserve relationships, and challenging intersections between LGBT+ identities and other aspects of culture or self. These findings provide primary evidence to support the Acceptance-Disclosure Model. CONCLUSIONS LGBT+ people face additional stressors in bereavement. Not all LGBT+ people want to talk directly about their relationships/identities. Sensitive exploration of support needs, aligned with preferences around disclosure of identities, can help foster trust. Five recommendations for inclusive practice are presented. Further research should consider whether the Acceptance-Disclosure Model has utility to explain bereavement experiences for other isolated or disenfranchised groups.
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Affiliation(s)
- Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | | | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Steve Marshall
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St. Pancras Hospital, London, UK
| | - Katherine Johnson
- Social and Global Studies Centre, Royal Melbourne Institute of Technology, Melbourne, VIC, Australia
| | | | - Paul Clift
- Patient and Public Involvement, London, UK
| | - Ruth Rose
- Patient and Public Involvement, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Peihan Yu
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Anna Roach
- Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, London, UK
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
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Rahman M, Fikslin RA, Matthews E, Vazquez Sanchez MA, Ahn GO, Kobrak PH, Lovinger ES, Golub SA. Exploring Factors Affecting Patient-Provider Interactions and Healthcare Engagement Among a Diverse Sample of Women Who Have Sex with Women in New York City. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:833-849. [PMID: 36478134 PMCID: PMC9886640 DOI: 10.1007/s10508-022-02478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 06/17/2023]
Abstract
Women who have sex with women (WSW) have lower rates of engagement in health care and preventive screenings than women who have sex exclusively with men. Existing literature provides limited insight into how intersecting and overlapping identities, such as race, ethnicity, sexual orientation, gender identity, and identities related to gender expression, may shape individuals' experiences within health care. We conducted qualitative interviews in New York City with 30 people who identified as women, reported sex with people who identify as women, were age 18-65, and were diverse in race, ethnicity, and sexual orientation and gender identity. The semi-structured questionnaire asked participants about positive and negative healthcare experiences to elicit what could encourage or prevent seeking care, with a focus on provider-related factors. Factors that led to positive healthcare experiences included having a provider who was knowledgeable about LGBTQ experience and health and who affirmed their sexuality, gender identity, and other intersecting identities. Factors that contributed to negative healthcare experiences included poor interactions with providers, and providers' perceived heteronormativity and lack of awareness of WSW healthcare needs. WSW of different races, ethnicities, sexual orientations, and gender identities seek validating healthcare experiences that acknowledge and affirm their identities. We present a visual summary of the main thematic factors that contributed to positive and negative WSW healthcare experiences. Increasing access to care requires training providers on how to engage WSW patients, including WSW of diverse race/ethnicity and gender identity and expression.
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Affiliation(s)
- Musarrat Rahman
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA.
| | - Rachel A Fikslin
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA
- Hunter Alliance for Research and Translation (HART), New York, NY, USA
| | - Eugene Matthews
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
- Hunter Alliance for Research and Translation (HART), New York, NY, USA
| | - Maria A Vazquez Sanchez
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
| | | | - Paul H Kobrak
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
| | | | - Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA
- Hunter Alliance for Research and Translation (HART), New York, NY, USA
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Herriges MJ, Pinkhasov R, Lehavot K, Shapiro O, Jacob JM, Sanford T, Liu N, Bratslavsky G, Goldberg H. The association of sexual orientation with prostate, breast, and cervical cancer screening and diagnosis. Cancer Causes Control 2022; 33:1421-1430. [PMID: 36085431 DOI: 10.1007/s10552-022-01624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Data on heterogeneity in cancer screening and diagnosis rates among lesbians/gays and bisexuals (LGBs) is lacking. Recent studies showed that LGBs have decreased healthcare utilization compared to heterosexual counterparts. Few studies have examined how sexual orientation impacts cancer screening and prevalence. We, therefore, investigated the association between sexual orientation and prevalent sex-specific cancer including prostate (PCa), breast (BC), and cervical (CC) cancer. METHODS This was a cross-sectional survey-based US study, including men and women aged 18 + from the Health Information National Trends Survey (HINTS) database between 2017 and 2019. The primary endpoint was individual-reported prostate, breast, and cervical cancer screening and prevalence rates among heterosexual and LGB men and women. Multivariable logistic regression analyses assessed association of various covariates with undergoing screening and diagnosis of these cancers. RESULTS Overall, 4,441 and 6,333 heterosexual men and women, respectively, were compared to 225 and 213 LGB men and women, respectively. LGBs were younger and less likely to be screened for PCa, BC, and CC than heterosexuals. A higher proportion of heterosexual women than lesbian and bisexual women were screened for CC with pap smears (95.36% vs. 90.48% and 86.11%, p ≤ 0.001) and BC with mammograms (80.74% vs. 63.81% and 45.37%, p ≤ 0.001). Similarly, a higher proportion of heterosexual men than gay and bisexual men were screened for PCa with PSA blood tests (41.27% vs. 30.53% and 27.58%, p ≤ 0.001). CONCLUSION There were more heterosexuals than LGBs screened for CC, BC, and PCa. However, no association between sexual orientation and cancer diagnosis was found. Healthcare professionals should be encouraged to improve cancer screening among LGBs.
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Affiliation(s)
| | - Ruben Pinkhasov
- Urology department, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Oleg Shapiro
- Urology department, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Joseph M Jacob
- Urology department, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Thomas Sanford
- Urology department, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Nick Liu
- Urology department, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Hanan Goldberg
- Urology department, SUNY Upstate Medical University, Syracuse, NY, USA.
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Pratt-Chapman ML. Learning Outcomes of Diverse Oncology Professionals After the TEAM Cultural Competency Training. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:662-667. [PMID: 32902787 PMCID: PMC9205792 DOI: 10.1007/s13187-020-01865-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 05/29/2023]
Abstract
Racial, ethnic, sexual, and gender minorities are more likely to report challenges with oncology provider communication and quality of care. The Together-Equitable-Accessible-Meaningful (TEAM) training was developed to improve health equity across cancer care organizations by guiding teams of interprofessional learners through planning and implementation of quality improvements to advance equitable, accessible, and patient-centered cancer care. This study compared changes to self-reported cultural competence as measured by the Cultural Competency Assessment (CCA); Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS); and Interprofessional Socialization and Valuing Scale (ISVS). The primary aim of the study was to assess changes to self-reported cultural competence; the secondary aim was to examine changes to interprofessional valuation from baseline to post-intervention. Results indicated statistically significant improvements in self-reported Cultural Competency Behaviors (p = .055), a subscale of the CCA, and Attitudinal Awareness toward sexual and gender minorities (p = .046), a subscale of the LGBT-DOCSS, using p < .10 as statistically significant. These subscale results drove statistically significant improvements for their respective composite scales. No other statistically significant results were found. This study suggests that cultural competency training among interprofessional oncology health care professionals can be effective. Given the growing diversity within the USA, additional opportunities for cultural competency training are needed.
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Affiliation(s)
- Mandi L Pratt-Chapman
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- The GW Cancer Center, The George Washington University, 2600 Virginia Ave, #324, Washington, DC, 20037, USA.
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Dean LT, Greene N, Adams MA, Geffen SR, Malone J, Tredway K, Poteat T. Beyond Black and White: race and sexual identity as contributors to healthcare system distrust after breast cancer screening among US women. Psychooncology 2021; 30:1145-1150. [PMID: 33689190 PMCID: PMC8273081 DOI: 10.1002/pon.5670] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Healthcare system distrust (HCSD) has been linked to poor breast cancer outcomes. Previous HSCD analyses have focused on Black-White disparities; however, focusing only on race ignores the complex set of factors that form identity. We quantified the contributions of race and sexual minority (SM) identity to HCSD among US women who had received breast cancer screening. METHODS This cross-sectional study used intersectionality decomposition methods to assess the degree to which racial and SM identity contributed to disparate responses to the validated 9-item HCSD Scale. The sample included online survey participants identifying as a Black or White woman living in the US, with a self-reported abnormal breast cancer screening result in the past 24 months and/or breast cancer diagnosis since 2011. RESULTS Of 649 participants, 49.4% of Black SM women (n = 85) were in the highest HCSD tertile, followed by 37.4% of White SM women (n = 123), 24.4% of Black heterosexual women (n = 156), and 19% of White heterosexual women. Controlling for age, 72% of the disparity in HCSD between Black SM women and White heterosexual women was due to SM status, 23% was due to racial identity, and 3% was due to both racial and SM identity. CONCLUSIONS SM identity emerged as the largest driver of HCSD disparities; however, the combined racial and SM disparity persisted. Excluding sexual identity in HCSD studies may miss an important contributor. Interventions designed to increase the HCS's trustworthiness at the provider and system levels should address both racism and homophobia.
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Affiliation(s)
- Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Naomi Greene
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization of Black Lesbians on Aging, East Point, Georgia, USA
| | - Sophia R. Geffen
- Center for Health Equity Education & Advocacy, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Jowanna Malone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristi Tredway
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Social Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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Greene N, Malone J, Adams MA, Dean LT, Poteat T. "This is some mess right here": Exploring interactions between Black sexual minority women and health care providers for breast cancer screening and care. Cancer 2021; 127:74-81. [PMID: 32990978 PMCID: PMC7865953 DOI: 10.1002/cncr.33219] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/13/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Few studies have explored how the intersection of race and sexual identity contribute to breast cancer disparities for Black sexual minority women (SMW). Issues within patient-provider relationships, including bias, contribute to health disparities for minority groups. The authors used constructs from self-determination theory (SDT) to explore the nature of health care provider interactions in breast cancer screening and care among Black SMW. METHODS Participants were sampled nationally through social media, targeted emails, and referrals. Qualitative, in-depth interviews were conducted with 15 Black cisgender SMW, ages 38 to 64 years, who had a breast cancer diagnosis or recent abnormal mammogram. Interviews were conducted face-to-face or online, audio-recorded, and transcribed verbatim. Two analysts coded the interviews. Codes were analyzed across interviews to identify themes salient to SDT. RESULTS Themes aligned with the SDT constructs of relatedness and autonomy. Some participants discussed feeling most understood by Black and/or female providers who shared at least 1 of their identities. Feeling understood through shared identity contributed to participants feeling seen and heard by their providers. Participants who discussed negative experiences with providers believed that the provider made negative assumptions about them based on their race and/or sexual orientation. CONCLUSIONS When interacting with health care providers for breast cancer screening and care, Black SMW face specific challenges related to their multiply marginalized social position. Reducing health care provider bias toward Black SMW may improve patients' desires to continue in care. Providing equitable care while acknowledging and respecting women with multiply marginalized identities may improve the nature of these interactions.
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Affiliation(s)
- Naomi Greene
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society
| | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization of Black Lesbians on Aging
| | - Lorraine T. Dean
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology
- Sidney Kimmel Cancer Center, Department of Oncology
| | - Tonia Poteat
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology
- University of North Carolina Chapel Hill School of Medicine, Department of Social Medicine
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10
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Thompson T, Heiden-Rootes K, Joseph M, Gilmore LA, Johnson L, Proulx CM, Albright EL, Brown M, McElroy JA. The support that partners or caregivers provide sexual minority women who have cancer: A systematic review. Soc Sci Med 2020; 261:113214. [PMID: 32738634 PMCID: PMC8171311 DOI: 10.1016/j.socscimed.2020.113214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/22/2020] [Accepted: 07/10/2020] [Indexed: 12/31/2022]
Abstract
RATIONALE Intimate partners and other informal caregivers provide unpaid tangible, emotional, and decision-making support for patients with cancer, but relatively little research has investigated the cancer experiences of sexual minority women (SMW) with cancer and their partners/caregivers. OBJECTIVE This review addressed 4 central questions: 1) What social support do SMW with cancer receive from partners/caregivers? 2) What effect does cancer have on intimate partnerships or caregiving relationships of SMW with cancer? 3) What effects does cancer have on partners/caregivers of SMW with cancer? 4) What interventions exist to support partners/caregivers of SMW or to strengthen the patient-caregiver relationship? METHOD This systematic review, conducted in 2018 and updated in 2020, was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent coders screened abstracts and articles. RESULTS In total, 550 unique records were screened; 42 articles were assessed for eligibility, and 18 were included in a qualitative synthesis. Most studies were U.S.-based, involved breast cancer, included intimate partners, had primarily white/Caucasian samples, and were cross-sectional. Sexual minority female participants reported that partners/caregivers often provide important social support, including emotional support, decision-making support, and tangible support. Effects of cancer on relationships with partners/caregivers were mixed, with some studies finding relationships remained stable and others finding cancer either increased closeness or disrupted relationships. Participants reported partners/caregivers often experience distress and may experience discrimination, discomfort disclosing sexual orientation, and a lack of sexual minority-friendly services. No studies involved an intervention targeting partners/caregivers or the dyadic relationship. CONCLUSIONS More work is needed to understand SMW with cancers other than breast cancer, and future work should include more racially, ethnically, and economically diverse samples. Longitudinal research will allow an examination of patterns of mutual influence and change in relationships. These steps will enable the development of interventions to support SMW with cancer and people close to them.
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11
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Williams AD, Bleicher RJ, Ciocca RM. Breast Cancer Risk, Screening, and Prevalence Among Sexual Minority Women: An Analysis of the National Health Interview Survey. LGBT Health 2020; 7:109-118. [DOI: 10.1089/lgbt.2019.0274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | - Richard J. Bleicher
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Robin M. Ciocca
- Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
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Charlton BM, Farland LV, Boehmer U, Tamimi RM, Collins LC, VanKim NA, Bertone-Johnson ER, Potter J, Sarda V, Austin SB. Sexual orientation and benign breast disease in a cohort of U.S. women. Cancer Causes Control 2020; 31:173-179. [PMID: 31894493 DOI: 10.1007/s10552-019-01258-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Several studies indicate that sexual minority (e.g., bisexual, lesbian) women may be at an increased risk for breast cancer. However, we know little about how risk factors, such as benign breast disease (BBD)-which can confer nearly a fourfold breast cancer risk increase-may vary across sexual orientation groups. METHODS Among Nurses' Health Study II participants followed from 1989 to 2013 (n = 99,656), we investigated whether bisexual and lesbian women were more likely than heterosexual women to have breast cancer risk factors including a BBD diagnosis (self-reported biopsy or aspiration confirmed, n = 11,021). Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Compared to heterosexuals, sexual minority participants more commonly reported certain breast cancer risk factors including increased alcohol intake and nulliparity. However, sexual minority participants were more likely than heterosexuals to have certain protective factors including higher body mass index and less oral contraceptive use. When evaluating age- and family history-adjusted rates of BBD diagnoses across sexual orientation groups, bisexual (HR 1.04, 95% CI [0.78, 1.38]) and lesbian (0.99 [0.81, 1.21]) women were just as likely as heterosexuals to have a BBD diagnosis. Results were similar after adjusting for other known breast cancer risk factors. CONCLUSIONS In this cohort of women across the U.S., sexual minorities were more likely than heterosexuals to have some breast cancer risk factors-including modifiable risk factors such as alcohol intake. Heterosexual, bisexual, and lesbian women were equally as likely to have a BBD diagnosis.
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Affiliation(s)
- Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 North Martin Avenue, Tucson, Az, 85724, USA
| | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Laura C Collins
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Nicole A VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Jennifer Potter
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Division of General Internal Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.,The Fenway Institute, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02115, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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13
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Kent EE, Wheldon CW, Smith AW, Srinivasan S, Geiger AM. Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review. Cancer 2019; 125:4371-4379. [PMID: 31593319 DOI: 10.1002/cncr.32388] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/07/2022]
Abstract
Sexual and gender minorities (SGMs) face a disproportionate burden of cancer, yet little is known about the experiences and specific needs of these underserved populations in cancer care delivery. The authors conducted a scoping review to characterize the literature on cancer care delivery, health outcomes, and health care experiences for patients with cancer and survivors identifying as SGM. In total, 1176 peer-reviewed citations were identified after a systematic search of the PubMed/Medline, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Sciences databases without restriction on publication date. The details captured included study aims, design, population, cancer site, and main findings. Thirty-seven studies published from 1998 to 2017 met the study criteria. Most studies were conducted in the post-treatment survivorship phase of the continuum (n = 30), and breast cancer was the most common cancer site (n = 20). There were only 2 intervention studies. The studies reviewed were classified under the following areas of focus: 1) disclosure of sexual orientation and gender identity, 2) quality of care, 3) psychosocial impact of/ adjustment to cancer, 4) social support, 5) sexual functioning, and 6) health risks/health behavior. Very little research reported an assessment of gender minority status or included a focus on gender minorities (n = 7). This review revealed substantial research gaps given a lack of population-based data and small sample sizes, likely related to the absence of systematic collection of sexual orientation and gender identity information in the cancer care context. Deficient research in this area likely perpetuates health disparities. Further research is needed to identify and remove the barriers to delivering high-quality care to SGM individuals with cancer.
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Affiliation(s)
- Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
- ICF, Inc, Fairfax, Virginia
| | - Christopher W Wheldon
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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14
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Modifiers of Cancer Screening Prevention Among Sexual and Gender Minorities in the Behavioral Risk Factor Surveillance System. J Am Coll Radiol 2019; 16:607-620. [PMID: 30947895 DOI: 10.1016/j.jacr.2019.02.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Increasing social acceptance of sexual and gender minorities may not translate to parity in health care access and health outcomes. Sexual orientation and gender identity (SOGI) may continue to contribute to differences in preventive health behavior including cancer screening. Our purpose was to estimate the independent effect of SOGI on breast, cervical, and colorectal cancer screening adherence. METHODS We used sampling weighted data from 2016 Behavioral Risk Factor Surveillance System. We defined breast, cervical, and colorectal cancer screening using the US Preventive Services Task Force guidelines. All survey data were self-reported including demographic and medical information. We calculated the prevalence of screening by sexual orientation (straight, lesbian or gay, bisexual) and gender identity (cisgender, transgender). The term "sexual and gender minorities" in our study refers to lesbian or gay, bisexual, and transgender individuals. Logistic regression models assessed independent effect of SOGI on screening adherence. RESULTS Prevalence of breast, cervical, and colorectal cancer screening varied significantly by SOGI. After adjusting for other variables, bisexual persons had significantly lower odds (odds ratio [OR] = 0.60, 95% confidence interval [CI] = 0.38-0.93) of breast cancer screening adherence. Lesbian or gay persons had significantly decreased likelihood (OR = 0.53, 95% CI = 0.29-0.95) of cervical cancer screening adherence. Although rate of colorectal cancer screening adherence varied significantly by SOGI, we did not find an independent effect of SOGI and colorectal cancer screening adherence after adjusting for other variables. No independent effect of gender identity categories on breast, cervical, and colorectal cancer screening adherence was detected. Social determinants of health, such as health care access and insurance, that disproportionately disadvantaged bisexual individuals independently influenced screening adherence. CONCLUSIONS SOGI can affect cancer screening adherence. Bisexual individuals had worse health care access and socioeconomic hardships among sexual and gender minorities. Given the independent effects of social determinants of health on cancer screening adherence, more attention needs to be paid to sexual and gender minorities, especially bisexual population.
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15
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Malone J, Snguon S, Dean LT, Adams MA, Poteat T. Breast Cancer Screening and Care Among Black Sexual Minority Women: A Scoping Review of the Literature from 1990 to 2017. J Womens Health (Larchmt) 2019; 28:1650-1660. [PMID: 30882262 PMCID: PMC6919240 DOI: 10.1089/jwh.2018.7127] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Black women are more likely to be diagnosed at later stages of breast cancer compared with White women due to lower frequency of screening and lack of timely follow-up after abnormal screening results. Disparities in breast cancer screening, risk, and mortality are present within both Black women and sexual minority communities; however, there exists limited research concerning breast cancer care among Black sexual minority women. Materials and Methods: This scoping review examines the literature from 1990 to 2017 of the breast cancer care continuum among Black sexual minority women, including behavioral risk factors, screening, treatment, and survivorship. A total of 91 articles were identified through PubMed, PsycINFO, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Fifteen articles were selected for data extraction, which met the criteria for including Black/African American women, discussing breast cancer care among both racial and sexual minorities, and being a peer-reviewed article. Results: The 15 articles were primarily within urban contexts, and defined sexual minorities as lesbian or bisexual women. Across all the studies, Black sexual minority women were highly under-represented, and key conclusions are not fully applicable to Black sexual minority women. Sexual minority women had a higher prevalence of breast cancer risk factors (i.e., nulliparity, fewer mammograms, higher alcohol intake, and lower oral contraceptive use). Furthermore, some studies noted homophobia from health providers as potential barriers to engagement in care for sexual minority women. Conclusions: The lack of studies concerning Black sexual minority women in breast cancer care indicates the invisibility of a group that experiences multiple marginalized identities. More research is needed to capture the dynamics of the breast cancer care continuum for Black sexual minority women.
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Affiliation(s)
- Jowanna Malone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sevly Snguon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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16
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Langston ME, Fuzzell L, Lewis-Thames MW, Khan S, Moore JX. Disparities in Health Information-Seeking Behaviors and Fatalistic Views of Cancer by Sexual Orientation Identity: A Nationally Representative Study of Adults in the United States. LGBT Health 2019; 6:192-201. [PMID: 31107153 DOI: 10.1089/lgbt.2018.0112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose: A lack of national data makes it difficult to estimate, but LGB adults appear to have a higher risk of cancer. Although limited research exists to explain the disparity, we aimed to explore potential differences in access to and utilization of health information and in cancer-related beliefs and behaviors. Methods: We used data from the Health Information National Trends Survey 5, Cycle 1 conducted from January 25 through May 5, 2017. Using survey-weighted logistic regression, we explored potential differences in health information-seeking behavior, trusted sources of health care information, engagement with the health care system, awareness of cancer risk factors, cancer fatalism, cancer-related health behaviors, and historical cancer screening between 117 LGB and 2857 heterosexual respondents. Results: LGB respondents were more likely to report looking for information about health or medical topics than heterosexual respondents (adjusted odds ratio [aOR]: 3.12; confidence interval [95% CI]: 1.07-9.06), but less likely to seek health information first from a doctor (aOR: 0.17; 95% CI: 0.06-0.50) after adjusting for age, race, and sex. LGB persons were less likely to report that they trust receiving health or medical information from friends and family and more likely to be worried about getting cancer (aOR: 2.30; 95% CI: 1.04-5.05). Conclusions: Our findings indicate a growing need for the production of tailored cancer prevention and control materials for members of sexual minority groups. More work is needed to understand barriers that LGB populations face in accessing this health information and building informative social support networks.
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Affiliation(s)
- Marvin E Langston
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Lindsay Fuzzell
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Marquita W Lewis-Thames
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Saira Khan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Justin X Moore
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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17
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Nathan ML, Ormond KE, Dial CM, Gamma A, Lunn MR. Genetic Counselors' and Genetic Counseling Students' Implicit and Explicit Attitudes toward Homosexuality. J Genet Couns 2019; 28:91-101. [PMID: 30168102 DOI: 10.1007/s10897-018-0295-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/15/2018] [Indexed: 11/25/2022]
Abstract
Members of the lesbian, gay, and bisexual (LGB) community experience significant health disparities. Widespread preferences for heterosexual over homosexual people among healthcare providers are believed to contribute to this inequity, making recognition (and ultimately reduction) of healthcare providers' sexual prejudices of import. The present study sought to characterize North American genetic counselors' and genetic counseling students' implicit and explicit attitudes toward homosexuality. During January 2017, 575 participants completed a Web-based survey and Sexuality Implicit Association Test (SIAT). A majority of participants (60.2%) harbored implicit preferences for heterosexual over homosexual people. Mean implicit attitude score (0.24) indicated a slight automatic preference for heterosexual over homosexual people, while mean explicit attitude score (0.033) indicated no preference for either group. Although participants' implicit and explicit attitudes were positively correlated (p < 0.001), there was greater implicit bias for heterosexual over homosexual people than suggested by explicit attitude scores (p < 0.001). Implicit attitudes differed across self-reported sexual orientation (p < 0.001), but not across gender, race, or genetic counseling specialty. Education has been demonstrated to be moderately effective at reducing sexual prejudices, and almost all participants (95.8%) indicated that they would support the implementation of genetic counseling curricula addressing lesbian, gay, bisexual, and transgender (LGBT) issues. The study's combined findings suggest that North American genetic counselors and genetic counseling students support, and may benefit from, the implementation of genetic counseling curricula addressing LGBT issues.
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Affiliation(s)
- Megan L Nathan
- Cancer Center Genetics Department, Providence St. Joseph Health, Anchorage, AK, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Amber Gamma
- Division of Medical Genetics, Northwell Health, Great Neck, NY, USA
| | - Mitchell R Lunn
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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18
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Greene MZ, Hughes TL, Hanlon A, Huang L, Sommers MS, Meghani SH. Predicting cervical cancer screening among sexual minority women using Classification and Regression Tree analysis. Prev Med Rep 2018; 13:153-159. [PMID: 30591857 PMCID: PMC6305684 DOI: 10.1016/j.pmedr.2018.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer screening is a critical preventive healthcare service for all women. Sexual minority women (SMW) in the United States experience multiple health disparities including decreased access to and use of cervical cancer screening. The mechanisms driving these disparities are not clear and SMW with multiple marginalized identities may be more likely to miss recommended cervical cancer screening. This study aimed to identify subgroups of SMW that are more and less likely to be screened for cervical cancer according to American Cancer Society guidelines. We used cross-sectional data from the latest (2010-2012) wave of the Chicago Health and Life Experiences of Women (CHLEW) Study (N = 691). Informed by intersectionality theory, we performed classification and regression tree (CART) modeling to construct a data-driven, predictive model of subgroups of SMW who were more and less likely to receive guideline-recommended screening. Notably, the CART model did not include commonly tested variables such as race/ethnicity or level of income or education. The model did identify subgroups with low likelihood of receiving screening and several novel variables that may be important in understanding SMW's use of cervical cancer screening; lifetime number of sexual partners, age at drinking onset, childhood physical abuse, and internalized homonegativity. Our results point to the importance of early life experiences and identity development processes in shaping patterns of preventive healthcare use among adult SMW. Our analysis also demonstrated the potential value of CART modeling techniques for evaluating how multiple variables interact in complex ways to predict cervical cancer screening.
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Affiliation(s)
- Madelyne Z Greene
- University of Wisconsin-Madison Department of Obstetrics and Gynecology, 610 Walnut St. Suite #667, Madison 53726, WI, USA
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York 10032, NY, USA
| | - Alexandra Hanlon
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
| | - Liming Huang
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
| | - Marilyn S Sommers
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
| | - Salimah H Meghani
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia 19126, PA, USA
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Greene MZ, Meghani SH, Sommers MS, Hughes TL. Health Care-Related Correlates of Cervical Cancer Screening among Sexual Minority Women: An Integrative Review. J Midwifery Womens Health 2018; 63:10.1111/jmwh.12872. [PMID: 30251464 PMCID: PMC6433555 DOI: 10.1111/jmwh.12872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/20/2018] [Accepted: 04/28/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Sexual minority women (SMW; lesbian, bisexual, nonheterosexual women) may have lower rates of cervical cancer screening than heterosexual women. Health care-related factors may explain some of the variation in cervical cancer screening rates among SMW. We aimed to synthesize published evidence of health care-related correlates of cervical cancer screening among SMW. METHODS We searched PubMed, CINAHL, and PsycINFO databases for English-language studies published between January 2000 and March 2017 that 1) assessed sexual identity or the sexual partners of female participants, 2) included cervical cancer screening as a main outcome of interest, and 3) measured at least one health care-related variable in addition to cervical cancer screening. We excluded articles that 1) reported on non-US samples or 2) did not report original research. We reviewed the sample, methods, and findings of 17 studies. We then summarized current knowledge about health care-related factors across 3 categories and generated recommendations for clinical practice and future research. RESULTS Several health care-related factors such as previous contraception use, having a primary care provider, knowledge of screening recommendations, and disclosing sexual orientation to providers were consistently positively associated with cervical cancer screening. Three groups of factors-previous health care use, health care provider-related factors, and belief-related factors-account for a substantial part of the variation in cervical cancer screening among SMW. DISCUSSION Several gaps in knowledge remain that could be addressed by recruiting more diverse samples of SMW with improved generalizability. Clinicians and clinical institutions can address factors associated with low rates of screening among SMW by preventing sexual orientation-based discrimination, inviting sexual orientation disclosure, and offering cervical cancer screening to SMW at a variety of health care encounters. Future research should examine how the location of care and health care provider type affect SMW's cervical cancer screening behaviors and should test the effectiveness of health care interventions designed to address sexual orientation-related disparities.
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20
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Social Inequalities in Palliative Care for Cancer Patients in the United States: A Structured Review. Semin Oncol Nurs 2018; 34:303-315. [PMID: 30146346 DOI: 10.1016/j.soncn.2018.06.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To identify patterns of access to and use or provision of palliative care services in medically underserved and vulnerable groups diagnosed with cancer. DATA SOURCES Google Scholar, PubMed, MEDLINE, and Web of Science were searched to identify peer-reviewed studies that described palliative care in medically underserved or vulnerable populations diagnosed with cancer. CONCLUSION Disparities in both access and referral to palliative care are evident in many underserved groups. There is evidence that some groups received poorer quality of such care. IMPLICATIONS FOR NURSING PRACTICE Achieving health equity in access to and receipt of quality palliative care requires prioritization of this area in clinical practice and in research funding.
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21
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Greene MZ, Hughes TL, Sommers MS, Hanlon A, Meghani SH. Association of Pregnancy History and Cervical Cancer Screening in a Community Sample of Sexual Minority Women. J Womens Health (Larchmt) 2018; 28:526-534. [PMID: 30118364 DOI: 10.1089/jwh.2018.6960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sexual minority women (SMW) face barriers to healthcare that may result in lower utilization of cervical cancer screening. Previous experiences with the healthcare system-specifically reproductive health-related encounters-have the potential to affect future use of screening services. This study aimed to examine the association between pregnancy history and cervical cancer screening in a diverse sample of SMW. Anderson's Behavioral Model of Health Services Use guided the selection of variables included in the study. METHODS We performed a secondary analysis of cross-sectional data from the third wave of the Chicago Health and Life Experiences of Women (CHLEW) Study, a longitudinal study of SMW in the Midwestern United States. We performed multivariable logistic regression to address the study aims, restricting the sample to women ages 21-45 (n = 430). RESULTS Reporting a previous pregnancy was consistently positively associated with past-year Pap testing. In the multivariable model, bisexual identity and disclosing one's sexual orientation to healthcare providers were also positively associated with past-year Pap test. CONCLUSIONS This analysis provides preliminary evidence that SMW who have been pregnant are more likely to receive Pap testing and that multiple sociodemographic factors are likely to impact screening in this population. Clinicians should screen all patients with a cervix for cervical cancer and should encourage screening for all SMW. Future studies should prioritize longitudinal analyses to examine the temporality of reproductive history and healthcare seeking, focus on where SMW seek care, and understand how intersecting components of identity may shape the healthcare utilization of this population.
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Affiliation(s)
- Madelyne Z Greene
- 1 Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Tonda L Hughes
- 2 School of Nursing, Columbia University, New York, New York
| | - Marilyn S Sommers
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
| | - Alexandra Hanlon
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
| | - Salimah H Meghani
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
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22
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Matthews AK, McCabe SE, Lee JGL, Veliz P. Differences in smoking prevalence and eligibility for low-dose computed tomography (LDCT) lung cancer screening among older U.S. adults: role of sexual orientation. Cancer Causes Control 2018; 29:769-774. [PMID: 29948516 PMCID: PMC6045449 DOI: 10.1007/s10552-018-1044-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/25/2018] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to determine the past-year prevalence estimates of cigarette smoking and eligibility for low-dose computed tomography (LDCT) lung cancer screening among older U.S. adults and examine potential variations in these estimates by sexual orientation. Data were from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) and included in-person interviews with a nationally representative sample of non-institutionalized adults aged 18 and older. Eligibility for LDCT was based on U.S. Centers for Medicare and Medicaid Services (CMS) guidelines. Analyses included participants aged 55-77 (n = 9,635). Overall, 17.5% of older adult respondents reported past-year smoking. Overall rates of past-year cigarette smoking were influenced by sex and sexual orientation with males reporting higher rates compared to females. Among both males and females, smoking was most prevalent among bisexual individuals. Eligibility for LDCT was also higher among males compared to females and among bisexually identified adults relative to homosexual and heterosexual-identified adults. Overall, 11.2% of older U.S. adults met eligibility for LDCT lung cancer screening. Eligibility for LDCT lung screening is associated with sexual orientation; the highest rates of eligibility are among bisexual women and men (26.9 and 24.5%, respectively). The current study found variations in cigarette smoking and eligibility for LDCT lung cancer screening (a proxy for chronic high-risk smoking) among older U.S. adults based on sexual orientation. Efforts to increase screening should take into account these differences.
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Affiliation(s)
- Alicia K Matthews
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, Chicago, IL, 60612, USA.
| | - Sean Esteban McCabe
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Phil Veliz
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI, 48109, USA
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Bazzi AR, Clark MA, Winter M, Tripodis Y, Boehmer U. Recruitment of breast cancer survivors and their caregivers: implications for dyad research and practice. Transl Behav Med 2018; 7:300-308. [PMID: 27154790 DOI: 10.1007/s13142-016-0400-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Breast cancer survivors' informal caregivers experience adverse health outcomes and could benefit from interventions. Studies of caregivers' participation in research, to date, have assumed heterosexuality. The aim of this study is to identify factors associated with caregiver participation among survivors with diversity in sexual orientation. We recruited breast cancer survivors into a telephone survey and asked them to invite a caregiver. Logistic regression identified factors associated with caregivers' participation. Among 297 survivors, 12 (4 %) had no caregivers, 82 (28 %) refused to provide caregiver information, 203 (68 %) provided caregiver contact, and 167 (56 %) had caregivers participate. Caregiver participation was more likely among sexual minority than heterosexual survivors (aOR: 1.89; 95 % CI: 1.08, 3.32), dyads with higher cohesion, and among caregivers who were partners. Caregiver participation was less likely among survivors with lower education and higher comorbidity. Findings provide insight into recruitment of diverse dyads into cancer survivorship research that will ultimately inform intervention design.
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Affiliation(s)
- Angela Robertson Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA
| | - Melissa A Clark
- Warren Alpert School of Medicine and School of Public Health, Brown University, Providence, RI, USA
| | - Michael Winter
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA, 02118, USA.
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Bristowe K, Hodson M, Wee B, Almack K, Johnson K, Daveson BA, Koffman J, McEnhill L, Harding R. Recommendations to reduce inequalities for LGBT people facing advanced illness: ACCESSCare national qualitative interview study. Palliat Med 2018; 32:23-35. [PMID: 28502218 PMCID: PMC5758934 DOI: 10.1177/0269216317705102] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual and/or trans (LGBT) people have higher risk of certain life-limiting illnesses and unmet needs in advanced illness and bereavement. ACCESSCare is the first national study to examine in depth the experiences of LGBT people facing advanced illness. AIM To explore health-care experiences of LGBT people facing advanced illness to elicit views regarding sharing identity (sexual orientation/gender history), accessing services, discrimination/exclusion and best-practice examples. DESIGN Semi-structured in-depth qualitative interviews analysed using thematic analysis. SETTING/PARTICIPANTS In total, 40 LGBT people from across the United Kingdom facing advanced illness: cancer ( n = 21), non-cancer ( n = 16) and both a cancer and a non-cancer conditions ( n = 3). RESULTS In total, five main themes emerged: (1) person-centred care needs that may require additional/different consideration for LGBT people (including different social support structures and additional legal concerns), (2) service level or interactional (created in the consultation) barriers/stressors (including heteronormative assumptions and homophobic/transphobic behaviours), (3) invisible barriers/stressors (including the historical context of pathology/criminalisation, fears and experiences of discrimination) and (4) service level or interactional facilitators (including acknowledging and including partners in critical discussions). These all shape (5) individuals' preferences for disclosing identity. Prior experiences of discrimination or violence, in response to disclosure, were carried into future care interactions and heightened with the frailty of advanced illness. CONCLUSION Despite recent legislative change, experiences of discrimination and exclusion in health care persist for LGBT people. Ten recommendations, for health-care professionals and services/institutions, are made from the data. These are simple, low cost and offer potential gains in access to, and outcomes of, care for LGBT people.
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Affiliation(s)
- Katherine Bristowe
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
| | | | - Bee Wee
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kathryn Almack
- Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-Life Care, The University of Nottingham, Nottingham, UK
| | - Katherine Johnson
- School of Applied Social Science, University of Brighton, Brighton, UK
| | - Barbara A Daveson
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
| | - Jonathan Koffman
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
| | | | - Richard Harding
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, UK
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Cancer and the LGBTQ Population: Quantitative and Qualitative Results from an Oncology Providers' Survey on Knowledge, Attitudes, and Practice Behaviors. J Clin Med 2017; 6:jcm6100093. [PMID: 28991160 PMCID: PMC5664008 DOI: 10.3390/jcm6100093] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/05/2017] [Accepted: 09/25/2017] [Indexed: 01/14/2023] Open
Abstract
Background: Despite growing social acceptance, the LGBTQ population continues to face barriers to healthcare including fear of stigmatization by healthcare providers, and providers’ lack of knowledge about LGBTQ-specific health issues. This analysis focuses on the assessment of quantitative and qualitative responses from a subset of providers who identified as specialists that treat one or more of the seven cancers that may be disproportionate in LGBTQ patients. Methods: A 32-item web-based survey was emailed to 388 oncology providers at a single institution. The survey assessed: demographics, knowledge, attitudes, and practice behaviors. Results: Oncology providers specializing in seven cancer types had poor knowledge of LGBTQ-specific health needs, with fewer than half of the surveyed providers (49.5%) correctly answering knowledge questions. Most providers had overall positive attitudes toward LGBTQ patients, with 91.7% agreeing they would be comfortable treating this population, and would support education and/or training on LGBTQ-related cancer health issues. Conclusion: Results suggest that despite generally positive attitudes toward the LGBTQ population, oncology providers who treat cancer types most prevalent among the population, lack knowledge of their unique health issues. Knowledge and practice behaviors may improve with enhanced education and training on this population’s specific needs.
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Stewart K, O'Reilly P. Exploring the attitudes, knowledge and beliefs of nurses and midwives of the healthcare needs of the LGBTQ population: An integrative review. NURSE EDUCATION TODAY 2017; 53:67-77. [PMID: 28448883 DOI: 10.1016/j.nedt.2017.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 02/27/2017] [Accepted: 04/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To explore current literature surrounding the knowledge, beliefs and attitudes of nurses and midwives of the healthcare needs of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) patients and their influence on equal and non-discriminatory care for LGBTQ individuals. DESIGN Systematic integrative review. DATA SOURCES CINAHL, MEDLINE, PubMed, InterNurse. REVIEW METHODS This integrative review used Wakefield's (2014) framework to establish the knowledge, beliefs and attitudes of nurses and midwives of the healthcare needs of LGBTQ patients. Qualitative, quantitative and mixed methods primary studies carried out between 2006 and 2015 from 7 countries were included. Four databases were searched and 98 studies were screened for eligibility by two researchers. Level of evidence was assessed by the Scottish Intercollegiate Guidelines Network (SIGN, 2010) criteria and quality was assessed by a screening tool adapted from Noyes and Popay (2007) for qualitative papers and Quality Assessment Tool for Quantitative Studies adapted from the Effective Public Health Practice Project (EPHPP, 2010). Following PRISMA guidelines, this integrative review analysed and synthesised evidence using thematic analysis to generate themes. RESULTS 24 papers were included in the final synthesis which revealed four primary themes: Heteronormativity across Healthcare; Queerphobia; Rainbow of Attitudes; Learning Diversity. CONCLUSIONS Nurses and midwives possess a wide spectrum of attitudes, knowledge and beliefs which impact the care received by LGBTQ patients. Many issues of inadequate care appear to be due to a culture of heteronormativity and a lack of education on LGBTQ health. Further research is needed on interventions which could facilitate disclosure of sexual orientation and interrupt heteronormative assumptions by staff. It is recommended that LGBTQ issues be included within undergraduate nursing and midwifery education or as part of continued professional development.
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Affiliation(s)
- Kate Stewart
- Department of Nursing and Midwifery, University of Limerick, Ireland.
| | - Pauline O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Ireland.
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Mattingly AE, Kiluk JV, Lee MC. Clinical Considerations of Risk, Incidence, and Outcomes of Breast Cancer in Sexual Minorities. Cancer Control 2017; 23:373-382. [PMID: 27842326 DOI: 10.1177/107327481602300408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast cancer is a leading cause of cancer-related mortality in women. Limited research exists on the impact of sexual orientation on overall risk of and mortality from breast cancer. We sought to summarize the medical literature on breast cancer in sexual minority women and identify possible disparities in this population. METHODS A comprehensive literature search was conducted for English-language studies in peer-reviewed medical journals that referenced breast cancer and sexual minority, lesbian, bisexual, or transgender individuals. Articles published between January 2000 and November 2015 were included. They were reviewed for relevance to breast cancer risk stratification, breast cancer mortality, breast reconstruction, and transgender issues. RESULTS Behavioral risks, reproductive risks, and risks associated with decreased access to health care may all affect outcomes for sexual minorities with breast cancer. Limited studies have mixed results regarding mortality associated with breast cancer in sexual minorities due to an inconsistent reporting of sexual orientation. CONCLUSIONS Overall, the research examining breast cancer in sexual minority women remains limited. This finding is likely due to limitations in the reporting of sexual orientation within large databases, thus making broader-scale research difficult.
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Affiliation(s)
- Anne E Mattingly
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, FL, USA.
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28
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Agénor M, Muzny CA, Schick V, Austin EL, Potter J. Sexual orientation and sexual health services utilization among women in the United States. Prev Med 2017; 95:74-81. [PMID: 27932056 PMCID: PMC5555111 DOI: 10.1016/j.ypmed.2016.11.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/18/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
Although sexual minority women are at risk of sexually transmitted infections (STIs) and cervical cancer, few nationally representative studies have assessed sexual orientation disparities in sexual health care among women. Using data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth, which provide a national probability sample of U.S. women aged 15-44years (N=11,300), we used multivariable logistic regression to examine the associations between sexual behavior and sexual identity (modeled separately) and STI testing in the past year, Pap test use in the last 3years, lifetime HIV testing, and lifetime human papillomavirus (HPV) testing. Women with male and female lifetime sexual partners had higher adjusted odds of being tested for STIs ([odds ratio:] 1.61; [95% confidence interval:] 1.37-1.89), HIV (1.66; 1.29-2.14), and HPV (1.79; 1.41-2.25) and similar adjusted odds of obtaining a Pap test (0.98; 0.76-1.27) than women with only male lifetime sexual partners. Self-identified bisexual women had higher adjusted odds of obtaining an STI (1.43; 1.10-1.86) and HIV (1.69; 1.24-2.30) test but lower adjusted odds of obtaining a Pap test in the last 3years (0.66; 0.47-0.93) than heterosexual-identified women. Women with only female lifetime sexual partners had lower adjusted odds of receiving an STI (0.14; 0.07-0.28) and Pap (0.10; 0.03-0.27) test than women with only male lifetime sexual partners. Results comparing self-identified lesbian and heterosexual women were similar. Health care facilities should monitor and address sexual orientation disparities in women's sexual health care and ensure the provision of high-quality sexual health services to all women.
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Affiliation(s)
- Madina Agénor
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Christina A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Vanessa Schick
- Center for Health Promotion and Prevention Research, Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Erika L Austin
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
| | - Jennifer Potter
- Division of Medicine, Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States; The Fenway Institute, Fenway Health, Boston, MA, United States
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Bennett K, Ricks JM, Howell BM. "It's just a way of fitting in:" Tobacco use and the lived experience of lesbian, gay, and bisexual appalachians. J Health Care Poor Underserved 2016; 25:1646-66. [PMID: 25418233 DOI: 10.1353/hpu.2014.0186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Lesbian, gay, and bisexual (LGB) people are affected by multiple health disparities and risk factors, including tobacco use. Few studies to date have examined tobacco use specifically in rural LGB populations, and none has investigated the intersections of identity, rural LGB culture, and tobacco. The purpose of this study was to explore the perspective of Appalachian LGB people regarding tobacco use. METHODS . Nineteen LGB-identified Appalachian residents participated in audiotaped, semi-structured interviews. Two authors analyzed and coded transcripts through constant comparison, and determined themes through consensus. RESULTS Five themes emerged: the convergence of Appalachian and LGB identities, tacit awareness of LGB identity by others, culture and tobacco use, perceived associations with tobacco use, and health beliefs and health care. CONCLUSIONS LGB Appalachians connect stress and culture to tobacco, but seem less aware that partial concealment of their identity might be a source of the stress that could influence their smoking.
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Bristowe K, Marshall S, Harding R. The bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner: A systematic review, thematic synthesis and modelling of the literature. Palliat Med 2016; 30:730-44. [PMID: 26944532 PMCID: PMC4984311 DOI: 10.1177/0269216316634601] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Socially excluded populations have poorer access to care; however, little attention has been paid to lesbian, gay, bisexual and/or trans* people. Lesbian, gay, bisexual and/or trans* people are at increased risk of certain life-limiting illnesses and may not receive the care and support they need at the end of life and into bereavement. AIM To identify and appraise the evidence of the bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner and develop an explanatory model of lesbian, gay, bisexual and/or trans* partner bereavement. DESIGN Systematic review (in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) and thematic synthesis with assessment of reporting and rigour. Quantitative or qualitative articles reporting bereavement experiences of lesbian, gay, bisexual and/or trans* partners were included, excluding articles reporting multiple losses in the context of HIV or AIDS. DATA SOURCES PsycINFO, MEDLINE, Web of Science, Scopus, Cochrane Library. Inclusion dates: database inception - 30 April 2015. RESULTS A total of 23 articles reporting on 13 studies were identified. Studies described universal experiences of the pain of losing a partner; however, additional barriers and stressors were reported for lesbian, gay, bisexual and/or trans* people, including homophobia, failure to acknowledge the relationship, additional legal and financial issues and the 'shadow' of HIV or AIDS. A novel model was developed to explain how the experience for lesbian, gay, bisexual and/or trans* people is shaped by whether the relationship was disclosed and acknowledged in life and into bereavement and how this impacts upon needs and access to care. CONCLUSION There is a need for healthcare providers to avoid hetero-normative assumptions; be mindful of additional stressors in bereavement for lesbian, gay, bisexual and/or trans* people; and consider additional sources of support to deliver individualised holistic care.
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Affiliation(s)
- Katherine Bristowe
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
| | - Steve Marshall
- Department of Palliative Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Richard Harding
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK
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31
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Legere LE, MacDonnell JA. Meaningful support for lesbian and bisexual women navigating reproductive cancer care in Canada: An exploratory study. J Res Nurs 2016. [DOI: 10.1177/1744987116640582] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Health inequities for sexual minorities are well documented, but there is a gap in nursing research addressing the specific experiences faced by lesbian and bisexual women with reproductive cancers. This critical feminist study explored interactions between sexual minority women with reproductive cancers and their health care providers and how these interactions enable and create barriers to meaningful support. Purposeful convenience sampling was used to recruit lesbian and bisexual reproductive cancer survivors from Ontario, Canada and providers who have cared for this population. Five lesbian and one bisexual woman who were reproductive cancer survivors participated, as well as one registered nurse who was not a survivor but who has cared for sexual minority women with reproductive cancers. Face-to-face interviews were conducted and conventional content analysis was used to analyze the data. The authors report on findings related to meaningful support, interactions with providers and organisational environments. Narratives showed that an understanding of gender norms influenced women’s perceptions of supportive and inclusive care, such as the acknowledgment of social supports and barriers to supportive care that included disclosure of sexual orientation. There are implications for nursing education and policy change to enhance inclusive interactions and environments for diverse sexual minority women with reproductive cancers.
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Affiliation(s)
- Laura E Legere
- Nursing Research Associate, Registered Nurses’ Association of Ontario, Canada
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Ramos-Pibernus AG, Rodríguez-Madera SL, Padilla M, Varas-Díaz N, Vargas Molina R. Intersections and evolution of 'Butch-trans' categories in Puerto Rico: Needs and barriers of an invisible population. Glob Public Health 2016; 11:966-80. [PMID: 27142002 DOI: 10.1080/17441692.2016.1180703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Public health research among transgender populations globally has primarily focused on HIV/AIDS. However, trans men remain outside of this conceptual framework, with distinct but overlapping social contexts and needs. In Puerto Rico (PR), the trans men population has remained largely hidden within the 'butch' lesbian community. The objective of this article is to document the identity construction of trans men and 'buchas' (local term to refer to butch lesbians) in PR and its relation to their bodily practices and overall health. We conducted an exploratory qualitative study with 29 trans men and buchas based on ethnographic observation, focus groups, audio-recorded in-depth interviews, and critical discourse analysis. Findings emphasise two domains to be addressed by health policies and initiatives: (1) bodily representations and gender performance, and (2) the meanings of female biological processes. This small-scale ethnographic study represents an initial step towards understanding the social context of this 'invisible' community and significant implications for their health and well-being. We provide several recommendations to address public health concerns of this understudied, marginalised community.
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Affiliation(s)
- Alíxida G Ramos-Pibernus
- a Department of Social Science , University of Puerto Rico-Medical Sciences Campus , San Juan , Puerto Rico
| | - Sheilla L Rodríguez-Madera
- a Department of Social Science , University of Puerto Rico-Medical Sciences Campus , San Juan , Puerto Rico
| | - Mark Padilla
- b Global and Sociocultural Studies , Florida International University , Miami , FL , USA
| | - Nelson Varas-Díaz
- c Institute for Psychological Research, University of Puerto Rico , San Juan , Puerto Rico
| | - Ricardo Vargas Molina
- a Department of Social Science , University of Puerto Rico-Medical Sciences Campus , San Juan , Puerto Rico
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Fear of cancer recurrence in survivor and caregiver dyads: differences by sexual orientation and how dyad members influence each other. J Cancer Surviv 2016; 10:802-13. [PMID: 26899851 DOI: 10.1007/s11764-016-0526-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 02/13/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to identify explanatory factors of fear of recurrence (FOR) in breast cancer survivors of different sexual orientations and their caregivers and to assess the directionality in the survivor and caregiver dyads' FOR. METHODS We recruited survivors of non-metastatic breast cancer of different sexual orientations and invited their caregivers into this study. Using a telephone survey, we collected data from 167 survivor and caregiver dyads. Using simultaneous equation models and a stepwise selection process, we identified the significant determinants of survivors' and caregivers' FOR and determined the directionality of survivors' and caregivers' FOR. Weighting the model by the inverse propensity score ensured that differences by sexual orientation in age and proportion of life in the caregiver-survivor relationship were accounted for. RESULTS Caregivers' FOR predicted survivors' FOR, and sexual orientation had a significant effect on survivors' FOR, in that sexual minority women reported less FOR than heterosexual women. Other determinants of survivors' FOR included their medical characteristics, coresidence with caregivers, and caregivers' social support and use of counseling. Caregivers' FOR was related to their social support and survivors' medical characteristics. CONCLUSIONS This study suggests a need for caregiver interventions. Because survivors' FOR is affected by caregivers' FOR, caregiver interventions will likely benefit survivors' FOR. IMPLICATIONS FOR CANCER SURVIVORS Both sexual minority and heterosexual breast cancer survivors' FOR are affected by their caregivers' FOR, which suggests that the caregivers of breast cancer survivors are central for the survivors' well-being and shall therefore be integrated into the care process.
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Burkhalter JE, Margolies L, Sigurdsson HO, Walland J, Radix A, Rice D, Buchting FO, Sanchez NF, Bare MG, Boehmer U, Cahill S, Griebling TL, Bruessow D, Maingi S. The National LGBT Cancer Action Plan: A White Paper of the 2014 National Summit on Cancer in the LGBT Communities. LGBT Health 2016. [PMCID: PMC4770841 DOI: 10.1089/lgbt.2015.0118] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Despite growing social acceptance of lesbians, gay men, bisexuals, and transgender (LGBT) persons and the extension of marriage rights for same-sex couples, LGBT persons experience stigma and discrimination, including within the healthcare system. Each population within the LGBT umbrella term is likely at elevated risk for cancer due to prevalent, significant cancer risk factors, such as tobacco use and human immunodeficiency virus infection; however, cancer incidence and mortality data among LGBT persons are lacking. This absence of cancer incidence data impedes research and policy development, LGBT communities' awareness and activation, and interventions to address cancer disparities. In this context, in 2014, a 2-day National Summit on Cancer in the LGBT Communities was convened by a planning committee for the purpose of accelerating progress in identifying and addressing the LGBT communities' concerns and needs in the spheres of cancer research, clinical cancer care, healthcare policy, and advocacy for cancer survivorship and LGBT health equity. Summit participants were 56 invited persons from the United States, United Kingdom, and Canada, representatives of diverse identities, experiences, and knowledge about LGBT communities and cancer. Participants shared lessons learned and identified gaps and remedies regarding LGBT cancer concerns across the cancer care continuum from prevention to survivorship. This white paper presents background on each of the Summit themes and 16 recommendations covering the following: sexual orientation and gender identity data collection in national and state health surveys and research on LGBT communities and cancer, the clinical care of LGBT persons, and the education and training of healthcare providers.
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Affiliation(s)
- Jack E. Burkhalter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Hrafn Oli Sigurdsson
- Nursing Professional Development, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Walland
- The Office of General Counsel, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York
| | | | - Francisco O. Buchting
- Buchting Consulting, Oakland, California; Horizons Foundation, San Francisco, California
| | - Nelson F. Sanchez
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | | | - Tomas L. Griebling
- Department of Urology, School of Medicine, University of Kansas, Kansas City, Kansas
| | | | - Shail Maingi
- St. Peter's Health Partners Cancer Care, Troy, New York
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Rosario M, Li F, Wypij D, Roberts AL, Corliss HL, Charlton BM, Frazier AL, Austin SB. Disparities by Sexual Orientation in Frequent Engagement in Cancer-Related Risk Behaviors: A 12-Year Follow-Up. Am J Public Health 2016; 106:698-706. [PMID: 26794176 DOI: 10.2105/ajph.2015.302977] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We examined sexual-orientation disparities in frequent engagement in cancer-related risk indicators of tobacco, alcohol, diet and physical activity, ultraviolet radiation, and sexually transmitted infections (STIs). METHODS We used longitudinal data from the national Growing Up Today Study (1999-2010). Of the analytic sample (n = 9958), 1.8% were lesbian or gay (LG), 1.6% bisexual (BI), 12.1% mostly heterosexual (MH), and 84.5% completely heterosexual (CH). RESULTS More sexual minorities (LGs, BIs, and MHs) than CHs frequently engaged in multiple cancer-related risk behaviors (33%, 29%, 28%, and 19%, respectively). Sexual-minority young women, especially BI and MH, more frequently engaged over time in substance use and diet and physical activity risk than CH women. More young gay than CH men frequently engaged over time in vomiting for weight control (odds ratio [OR] = 3.2; 95% confidence interval [CI] = 1.1, 9.4), being physically inactive (OR = 1.7; 95% CI = 1.2, 2.4), and using tanning booths (OR = 4.7; 95% CI = 3.0, 7.4), and had a higher prevalence of ever having an STI (OR = 3.5; 95% CI = 2.0, 6.4). Individual analyses were generally comparable to the group-level analyses. CONCLUSIONS Young sexual minorities are at risk for cancer through frequent exposure to cancer-related risk behaviors over time. Long-term, longitudinal studies and surveillance data are essential and warranted to track frequent engagement in the risk behaviors and cancer-related morbidity and mortality.
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Affiliation(s)
- Margaret Rosario
- Margaret Rosario is with Department of Psychology, City University of New York-City College and Graduate Center, New York, NY. Fei Li and David Wypij are with Department of Biostatistics, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. David Wypij, Brittany M. Charlton, A. Lindsay Frazier, and S. Bryn Austin are with Department of Pediatrics, Harvard Medical School (HMS), Boston. David Wypij is also with Department of Cardiology, Boston's Children's Hospital, Boston. Andrea L. Roberts is with Department of Social and Behavioral Sciences, HSPH. Heather L. Corliss is with Division of Health Promotion and Behavioral Science at San Diego State University, San Diego, CA. Brittany M. Charlton and S. Bryn Austin are also with Division of Adolescent and Young Adult Medicine, Boston Children's Hospital. A. Lindsay Frazier is also with Dana-Farber Cancer Institute, Boston, and Department of Epidemiology, HSPH. A. Lindsay Frazier and S. Bryn Austin are also with Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, HMS
| | - Fei Li
- Margaret Rosario is with Department of Psychology, City University of New York-City College and Graduate Center, New York, NY. Fei Li and David Wypij are with Department of Biostatistics, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. David Wypij, Brittany M. Charlton, A. Lindsay Frazier, and S. Bryn Austin are with Department of Pediatrics, Harvard Medical School (HMS), Boston. David Wypij is also with Department of Cardiology, Boston's Children's Hospital, Boston. Andrea L. Roberts is with Department of Social and Behavioral Sciences, HSPH. Heather L. Corliss is with Division of Health Promotion and Behavioral Science at San Diego State University, San Diego, CA. Brittany M. Charlton and S. Bryn Austin are also with Division of Adolescent and Young Adult Medicine, Boston Children's Hospital. A. Lindsay Frazier is also with Dana-Farber Cancer Institute, Boston, and Department of Epidemiology, HSPH. A. Lindsay Frazier and S. Bryn Austin are also with Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, HMS
| | - David Wypij
- Margaret Rosario is with Department of Psychology, City University of New York-City College and Graduate Center, New York, NY. Fei Li and David Wypij are with Department of Biostatistics, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. David Wypij, Brittany M. Charlton, A. Lindsay Frazier, and S. Bryn Austin are with Department of Pediatrics, Harvard Medical School (HMS), Boston. David Wypij is also with Department of Cardiology, Boston's Children's Hospital, Boston. Andrea L. Roberts is with Department of Social and Behavioral Sciences, HSPH. Heather L. Corliss is with Division of Health Promotion and Behavioral Science at San Diego State University, San Diego, CA. Brittany M. Charlton and S. Bryn Austin are also with Division of Adolescent and Young Adult Medicine, Boston Children's Hospital. A. Lindsay Frazier is also with Dana-Farber Cancer Institute, Boston, and Department of Epidemiology, HSPH. A. Lindsay Frazier and S. Bryn Austin are also with Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, HMS
| | - Andrea L Roberts
- Margaret Rosario is with Department of Psychology, City University of New York-City College and Graduate Center, New York, NY. Fei Li and David Wypij are with Department of Biostatistics, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. David Wypij, Brittany M. Charlton, A. Lindsay Frazier, and S. Bryn Austin are with Department of Pediatrics, Harvard Medical School (HMS), Boston. David Wypij is also with Department of Cardiology, Boston's Children's Hospital, Boston. Andrea L. Roberts is with Department of Social and Behavioral Sciences, HSPH. Heather L. Corliss is with Division of Health Promotion and Behavioral Science at San Diego State University, San Diego, CA. Brittany M. Charlton and S. Bryn Austin are also with Division of Adolescent and Young Adult Medicine, Boston Children's Hospital. A. Lindsay Frazier is also with Dana-Farber Cancer Institute, Boston, and Department of Epidemiology, HSPH. A. Lindsay Frazier and S. Bryn Austin are also with Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, HMS
| | - Heather L Corliss
- Margaret Rosario is with Department of Psychology, City University of New York-City College and Graduate Center, New York, NY. Fei Li and David Wypij are with Department of Biostatistics, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. David Wypij, Brittany M. Charlton, A. Lindsay Frazier, and S. Bryn Austin are with Department of Pediatrics, Harvard Medical School (HMS), Boston. David Wypij is also with Department of Cardiology, Boston's Children's Hospital, Boston. Andrea L. Roberts is with Department of Social and Behavioral Sciences, HSPH. Heather L. Corliss is with Division of Health Promotion and Behavioral Science at San Diego State University, San Diego, CA. Brittany M. Charlton and S. Bryn Austin are also with Division of Adolescent and Young Adult Medicine, Boston Children's Hospital. A. Lindsay Frazier is also with Dana-Farber Cancer Institute, Boston, and Department of Epidemiology, HSPH. A. Lindsay Frazier and S. Bryn Austin are also with Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, HMS
| | - Brittany M Charlton
- Margaret Rosario is with Department of Psychology, City University of New York-City College and Graduate Center, New York, NY. Fei Li and David Wypij are with Department of Biostatistics, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. David Wypij, Brittany M. Charlton, A. Lindsay Frazier, and S. Bryn Austin are with Department of Pediatrics, Harvard Medical School (HMS), Boston. David Wypij is also with Department of Cardiology, Boston's Children's Hospital, Boston. Andrea L. Roberts is with Department of Social and Behavioral Sciences, HSPH. Heather L. Corliss is with Division of Health Promotion and Behavioral Science at San Diego State University, San Diego, CA. Brittany M. Charlton and S. Bryn Austin are also with Division of Adolescent and Young Adult Medicine, Boston Children's Hospital. A. Lindsay Frazier is also with Dana-Farber Cancer Institute, Boston, and Department of Epidemiology, HSPH. A. Lindsay Frazier and S. Bryn Austin are also with Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, HMS
| | - A Lindsay Frazier
- Margaret Rosario is with Department of Psychology, City University of New York-City College and Graduate Center, New York, NY. Fei Li and David Wypij are with Department of Biostatistics, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. David Wypij, Brittany M. Charlton, A. Lindsay Frazier, and S. Bryn Austin are with Department of Pediatrics, Harvard Medical School (HMS), Boston. David Wypij is also with Department of Cardiology, Boston's Children's Hospital, Boston. Andrea L. Roberts is with Department of Social and Behavioral Sciences, HSPH. Heather L. Corliss is with Division of Health Promotion and Behavioral Science at San Diego State University, San Diego, CA. Brittany M. Charlton and S. Bryn Austin are also with Division of Adolescent and Young Adult Medicine, Boston Children's Hospital. A. Lindsay Frazier is also with Dana-Farber Cancer Institute, Boston, and Department of Epidemiology, HSPH. A. Lindsay Frazier and S. Bryn Austin are also with Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, HMS
| | - S Bryn Austin
- Margaret Rosario is with Department of Psychology, City University of New York-City College and Graduate Center, New York, NY. Fei Li and David Wypij are with Department of Biostatistics, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. David Wypij, Brittany M. Charlton, A. Lindsay Frazier, and S. Bryn Austin are with Department of Pediatrics, Harvard Medical School (HMS), Boston. David Wypij is also with Department of Cardiology, Boston's Children's Hospital, Boston. Andrea L. Roberts is with Department of Social and Behavioral Sciences, HSPH. Heather L. Corliss is with Division of Health Promotion and Behavioral Science at San Diego State University, San Diego, CA. Brittany M. Charlton and S. Bryn Austin are also with Division of Adolescent and Young Adult Medicine, Boston Children's Hospital. A. Lindsay Frazier is also with Dana-Farber Cancer Institute, Boston, and Department of Epidemiology, HSPH. A. Lindsay Frazier and S. Bryn Austin are also with Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, HMS
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Taylor ET, Bryson MK. Cancer's Margins: Trans* and Gender Nonconforming People's Access to Knowledge, Experiences of Cancer Health, and Decision-Making. LGBT Health 2015; 3:79-89. [PMID: 26789402 PMCID: PMC4770847 DOI: 10.1089/lgbt.2015.0096] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Research in Canada and the United States indicates that minority gender and sexuality status are consistently associated with health disparities and poor health outcomes, including cancer health. This article investigates experiences of cancer health and care, and access to knowledge for trans* and gender nonconforming people diagnosed with and treated for breast and/or gynecologic cancer. Our study contributes new understandings about gender minority populations that will advance knowledge concerning the provision of culturally appropriate care. This is the first study we are aware of that focuses on trans* and gender nonconforming peoples' experiences of cancer care and treatment, support networks, and access to and mobilization of knowledge. METHODS This article analyzes trans* and gender nonconforming patient interviews from the Cancer's Margins project ( www.lgbtcancer.ca ): Canada's first nationally-funded project that investigates the complex intersections of sexual and/or gender marginality, cancer knowledge, treatment experiences, and modes of the organization of support networks. RESULTS Our analysis documents how different bodies of knowledge relative to cancer treatment and gendered embodiment are understood, accessed, and mobilized by trans* and gender nonconforming patients. Findings reported here suggest that one's knowledge of a felt sense of gender is closely interwoven with knowledge concerning cancer treatment practices; a dynamic which organizes knowledge mobilities in cancer treatment. CONCLUSIONS The findings support the assertion that cisgender models concerning changes to the body that occur as a result of biomedical treatment for breast and/or gynecologic cancer are wholly inadequate in order to account for trans* and gender nonconforming peoples' experiences of cancer treatments, and access to and mobilization of related knowledge.
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Affiliation(s)
- Evan T Taylor
- Department of Language and Literacy Education, Faculty of Education, University of British Columbia , Canada
| | - Mary K Bryson
- Department of Language and Literacy Education, Faculty of Education, University of British Columbia , Canada
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Quinn GP, Sanchez JA, Sutton SK, Vadaparampil ST, Nguyen GT, Green BL, Kanetsky PA, Schabath MB. Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA Cancer J Clin 2015; 65:384-400. [PMID: 26186412 PMCID: PMC4609168 DOI: 10.3322/caac.21288] [Citation(s) in RCA: 292] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/29/2015] [Accepted: 06/02/2015] [Indexed: 12/11/2022] Open
Abstract
This article provides an overview of the current literature on seven cancer sites that may disproportionately affect lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. For each cancer site, the authors present and discuss the descriptive statistics, primary prevention, secondary prevention and preclinical disease, tertiary prevention and late-stage disease, and clinical implications. Finally, an overview of psychosocial factors related to cancer survivorship is offered as well as strategies for improving access to care.
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Affiliation(s)
- Gwendolyn P. Quinn
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Corresponding Author: Gwendolyn P. Quinn, Ph.D, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive MRC-CANCONT, Tampa, FL 33612, | Fax: 1-813-449-8019
| | - Julian A. Sanchez
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Steven K. Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
| | - Giang T. Nguyen
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - B. Lee Green
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Diversity and Communication Relations, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Peter A. Kanetsky
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Department of Cancer Epidemiology; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Matthew B. Schabath
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida
- Department of Cancer Epidemiology; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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38
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Cancer Risk Factors, Diagnosis and Sexual Identity in the Australian Longitudinal Study of Women's Health. Womens Health Issues 2015; 25:509-16. [DOI: 10.1016/j.whi.2015.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 03/29/2015] [Accepted: 04/06/2015] [Indexed: 11/20/2022]
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Matthews AK, Hotton A, Li CC, Miller K, Johnson A, Jones KW, Thai J. An Internet-Based Study Examining the Factors Associated with the Physical and Mental Health Quality of Life of LGBT Cancer Survivors. LGBT Health 2015; 3:65-73. [PMID: 26789396 DOI: 10.1089/lgbt.2014.0075] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE The purpose of this study was to examine factors associated with the quality of life of lesbian, gay, bisexual, and transgender (LGBT) cancer survivors. METHODS Data were collected via a nationally advertised online short-form health survey. RESULTS Factors associated with lower physical quality of life included younger age at diagnosis, cancer type, medical co-morbidities, being overweight or obese, recurrence, and current cancer treatment. Lower mental quality of life was associated with younger age, smoking, lower perceived quality of care, lower perceived support, and higher cancer-related worry. CONCLUSIONS Findings highlight a need for health promotion interventions specifically for LGBT cancer survivors.
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Affiliation(s)
- Alicia K Matthews
- 1 College of Nursing, University of Illinois at Chicago, Chicago, Illinois.,2 Howard Brown Health Center , Chicago, Illinois
| | - Anna Hotton
- 3 Department of Infectious Diseases, John H. Stroger Hospital , Chicago, Illinois
| | - Chien-Ching Li
- 4 Department of Health Systems Management, College of Health Sciences, Rush University , Chicago, Illinois
| | - Katherine Miller
- 5 Jane Addams College of Social Work, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Amy Johnson
- 6 School of Public Health, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Kyle W Jones
- 2 Howard Brown Health Center , Chicago, Illinois.,7 Department of Psychology, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Jennie Thai
- 2 Howard Brown Health Center , Chicago, Illinois
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Daniel H, Butkus R. Lesbian, Gay, Bisexual, and Transgender Health Disparities: Executive Summary of a Policy Position Paper From the American College of Physicians. Ann Intern Med 2015; 163:135-7. [PMID: 25961598 DOI: 10.7326/m14-2482] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this position paper, the American College of Physicians examines the health disparities experienced by the lesbian, gay, bisexual, and transgender (LGBT) community and makes a series of recommendations to achieve equity for LGBT individuals in the health care system. These recommendations include enhancing physician understanding of how to provide culturally and clinically competent care for LGBT individuals, addressing environmental and social factors that can affect their mental and physical well-being, and supporting further research into understanding their unique health needs.
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Affiliation(s)
- Hilary Daniel
- From the American College of Physicians, Washington, DC
| | - Renee Butkus
- From the American College of Physicians, Washington, DC
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41
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Lick DJ, Durso LE, Johnson KL. Minority Stress and Physical Health Among Sexual Minorities. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2015; 8:521-48. [PMID: 26173210 DOI: 10.1177/1745691613497965] [Citation(s) in RCA: 433] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Lesbian, gay, and bisexual (LGB) individuals suffer serious mental health disparities relative to their heterosexual peers, and researchers have linked these disparities to difficult social experiences (e.g., antigay victimization) and internalized biases (e.g., internalized homophobia) that arouse stress. A recent and growing body of evidence suggests that LGB individuals also suffer physical health disparities relative to heterosexuals, ranging from poor general health status to increased risk for cancer and heightened diagnoses of cardiovascular disease, asthma, diabetes, and other chronic conditions. Despite recent advances in this literature, the causes of LGB physical health problems remain relatively opaque. In this article, we review empirical findings related to LGB physical health disparities and argue that such disparities are related to the experience of minority stress-that is, stress caused by experiences with antigay stigma. In light of this minority stress model, we highlight gaps in the current literature and outline five research steps necessary for developing a comprehensive knowledge of the social determinants of LGB physical health.
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Affiliation(s)
- David J Lick
- Department of Psychology, University of California, Los Angeles
| | - Laura E Durso
- The Williams Institute, University of California, Los Angeles
| | - Kerri L Johnson
- Department of Psychology, University of California, Los Angeles Department of Communication Studies, University of California, Los Angeles
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42
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Recruiting rural and urban LGBT populations online: differences in participant characteristics between email and Craigslist approaches. HEALTH AND TECHNOLOGY 2015. [DOI: 10.1007/s12553-015-0112-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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43
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Agénor M, Bailey Z, Krieger N, Austin SB, Gottlieb BR. Exploring the Cervical Cancer Screening Experiences of Black Lesbian, Bisexual, and Queer Women: The Role of Patient-Provider Communication. Women Health 2015; 55:717-36. [PMID: 25909663 DOI: 10.1080/03630242.2015.1039182] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Few studies have focused on the health and health care of U.S. black lesbian, bisexual, and queer (LBQ) women. To understand the facilitators of and barriers to cervical cancer screening in this population, focus group discussions were conducted in Boston and Cambridge, Massachusetts between November and December 2012. Using purposive sampling methods, the authors enrolled 18 black LBQ women who participated in one of four focus groups. Using thematic analysis, patient-provider communication was identified, which consisted of four sub-themes--health care provider communication style and demeanor; heteronormative provider assumptions; heterosexism, racism, and classism; and provider professional and sociodemographic background--as the most salient theme. Participants reported fears and experiences of multiple forms of discrimination and preferred receiving care from providers who were knowledgeable about same-sex sexual health and shared their life experiences at the intersection of gender, race/ethnicity, and sexual orientation. The cervical cancer screening experiences of black LBQ women would be improved by training all health care providers in same-sex sexual health, offering opportunities for clinicians to learn about the effects of various forms of discrimination on women's health care, and increasing the presence of LBQ women of color in health care settings.
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Affiliation(s)
- Madina Agénor
- a Department of Social and Behavioral Sciences , Harvard T. H. Chan School of Public Health , Boston , Massachusetts , USA
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44
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Ussher JM, Perz J, Gilbert E. Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study. BMC Cancer 2015; 15:268. [PMID: 25885443 PMCID: PMC4407322 DOI: 10.1186/s12885-015-1243-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 03/23/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Previous research on cancer and sexuality has focused on physical aspects of sexual dysfunction, neglecting the subjective meaning and consequences of sexual changes. This has led to calls for research on cancer and sexuality to adopt an "integrative" approach, and to examine the ways in which individuals interpret sexual changes, and the subjective consequences of sexual changes. METHOD This study examined the nature and subjective experience and consequences of changes to sexual well-being after cancer, using a combination of quantitative and qualitative analysis. Six hundred and fifty seven people with cancer (535 women, 122 men), across a range of reproductive and non-reproductive cancer types completed a survey and 44 (23 women, 21 men) took part in an in-depth interview. RESULTS Sexual frequency, sexual satisfaction and engagement in a range of penetrative and non-penetrative sexual activities were reported to have reduced after cancer, for both women and men, across reproductive and non-reproductive cancer types. Perceived causes of such changes were physical consequences of cancer treatment, psychological factors, body image concerns and relationship factors. Sex specific difficulties (vaginal dryness and erectile dysfunction) were the most commonly reported explanation for both women and men, followed by tiredness and feeling unattractive for women, and surgery and getting older for men. Psychological and relationship factors were also identified as consequence of changes to sexuality. This included disappointment at loss of sexual intimacy, frustration and anger, sadness, feelings of inadequacy and changes to sense of masculinity of femininity, as well as increased confidence and self-comfort; and relationship strain, relationship ending and difficulties forming a new relationship. Conversely, a number of participants reported increased confidence, re-prioritisation of sex, sexual re-negotiation, as well as a strengthened relationship, after cancer. CONCLUSION The findings of this study confirm the importance of health professionals and support workers acknowledging sexual changes when providing health information and developing supportive interventions, across the whole spectrum of cancer care. Psychological interventions aimed at reducing distress and improving quality of life after cancer should include a component on sexual well-being, and sexual interventions should incorporate components on psychological and relational functioning.
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Affiliation(s)
- Jane M Ussher
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Janette Perz
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Emilee Gilbert
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
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Traa MJ, Braeken J, De Vries J, Roukema JA, Slooter GD, Crolla RMPH, Borremans MPM, Den Oudsten BL. Sexual, marital, and general life functioning in couples coping with colorectal cancer: a dyadic study across time. Psychooncology 2015; 24:1181-8. [PMID: 25800938 DOI: 10.1002/pon.3801] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study evaluated the following: (a) levels of sexual, marital, and general life functioning for both patients and partners; (b) interdependence between both members of the couple; and (c) longitudinal change in sexual, marital, and general life functioning and longitudinal stress-spillover effects in these three domains from a dyadic perspective. METHODS Couples (n = 102) completed the Maudsley Marital Questionnaire preoperatively and 3 and 6 months postoperatively. Mean scores were compared with norm scores. A multivariate general linear model and a multivariate latent difference score - structural equation modeling (LDS-SEM), which took into account actor and partner effects, were evaluated. RESULTS Patients and partners reported lower sexual, mostly similar marital, and higher general life functioning compared with norm scores. Moderate to high within-dyad associations were found. The LDS-SEM model mostly showed actor effects. Yet the longitudinal change in the partners' sexual functioning was determined not only by their own preoperative sexual functioning but also by that of the patient. Preoperative sexual functioning did not spill over to the other two domains for patients and partners, whereas the patients' preoperative general life functioning influenced postoperative change in marital and sexual functioning. Health care professionals should examine potential sexual problems but have to be aware that these problems may not spill over to the marital and general life domains. In contrast, low functioning in the general life domain may spill over to the marital and sexual domains. The interdependence between patients and partners implies that a couple-based perspective (e.g., couple-based interventions/therapies) to coping with cancer is needed.
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Affiliation(s)
- Marjan J Traa
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Johan Braeken
- Research Methodology Group, Wageningen University and Research Centre, Wageningen, The Netherlands.,CEMO - Centre for Educational Measurement, University of Oslo, Oslo, Norway
| | - Jolanda De Vries
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, Tilburg, The Netherlands
| | - Jan A Roukema
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Gerrit D Slooter
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Surgery, Maxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
| | | | | | - Brenda L Den Oudsten
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Reiter PL, McRee AL. Cervical cancer screening (Pap testing) behaviours and acceptability of human papillomavirus self-testing among lesbian and bisexual women aged 21-26 years in the USA. ACTA ACUST UNITED AC 2014; 41:259-64. [PMID: 25385868 DOI: 10.1136/jfprhc-2014-101004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/25/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Lesbian and bisexual women are at risk for human papillomavirus (HPV) infection and cervical disease. We examined cervical cancer screening (Pap testing) behaviours among these women and their acceptability of HPV self-testing at home, a potential cervical cancer screening strategy. METHODS We analysed data from a national sample of lesbian and bisexual women aged 21-26 years (n=418) who completed our online survey in Autumn 2013. Logistic regression identified correlates of (1) having had a Pap test in the last 3 years and (2) willingness to use an HPV self-test at home. RESULTS About 70% of women had undergone a Pap test in the last 3 years. Pap testing was more common among women who had disclosed their sexual orientation to their health care provider [odds ratio (OR)=2.01, 95% confidence interval (CI) 1.02-3.95] and less common among women who self-identified as lesbian (OR=0.48, 95% CI 0.25-0.93). Just over half the women (51%) were willing to use an HPV self-test at home. Women were more willing to use an HPV self-test at home if they were older (OR=1.16, 95% CI 1.03-1.30) or reported higher levels of worry about getting an HPV-related disease (OR=1.28, 95% CI 1.01-1.63). The most common concerns about HPV self-testing at home were using the test incorrectly (70%) and test accuracy (64%). CONCLUSIONS Many young lesbian and bisexual women have not had a recent Pap test. HPV self-testing at home may be a promising future strategy for reaching and screening these women. Findings highlight beliefs and concerns that could be addressed by self-test programmes.
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Affiliation(s)
- Paul L Reiter
- Assistant Professor, Division of Cancer Prevention and Control, College of Medicine, The Ohio State University; Comprehensive Cancer Center, The Ohio State University; and College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Annie-Laurie McRee
- Assistant Professor, Comprehensive Cancer Center, The Ohio State University; and College of Public Health, The Ohio State University, Columbus, OH, USA
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Eliason MJ. Chronic Physical Health Problems in Sexual Minority Women: Review of the Literature. LGBT Health 2014; 1:259-68. [PMID: 26789854 DOI: 10.1089/lgbt.2014.0026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although there is substantial literature about sexual minority women's mental health and use of alcohol, tobacco, and other drugs (ATOD), only recently has attention been focused on chronic physical health disorders thought to stem from stress and exposure to ATOD use. The most extensively studied aspect of physical health has been weight, with the majority of studies reporting higher prevalence of overweight and obesity. In addition, many studies report higher levels of stressful experiences in both childhood and adulthood for sexual minority women. In this paper, the hypothesized relationship between stress, unhealthy behaviors, and five common chronic physical health disorders is explored via review of the literature. Only asthma appeared to be consistently more common in sexual minority women, and few or no differences in diabetes, hypertension, cardiovascular disease, and most cancers were found. The limitations of these studies are reviewed, and the need for studies that directly address the relationships among stress, health-damaging practices, and chronic disorder is emphasized. However, if these findings hold up, and sexual minority women are not more prone to these disorders, the field may need better theoretical frameworks from which to explore potential differences in the manifestation of mental versus chronic physical health disparities.
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Affiliation(s)
- Michele J Eliason
- Department of Health Education, San Francisco State University , San Francisco, California
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48
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Ussher JM, Perz J, Gilbert E. Women's Sexuality after Cancer: A Qualitative Analysis of Sexual Changes and Renegotiation. WOMEN & THERAPY 2014. [DOI: 10.1080/02703149.2014.897547] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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49
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Agénor M, Krieger N, Austin SB, Haneuse S, Gottlieb BR. At the intersection of sexual orientation, race/ethnicity, and cervical cancer screening: assessing Pap test use disparities by sex of sexual partners among black, Latina, and white U.S. women. Soc Sci Med 2014; 116:110-8. [PMID: 24996219 DOI: 10.1016/j.socscimed.2014.06.039] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 06/17/2014] [Accepted: 06/23/2014] [Indexed: 01/06/2023]
Abstract
Understanding how various dimensions of social inequality shape the health of individuals and populations poses a key challenge for public health. Guided by ecosocial theory and intersectionality, we used data from the 2006-2010 National Survey of Family Growth, a national probability sample, to investigate how one dimension of sexual orientation, sex of sexual partners, and race/ethnicity jointly influence Pap test use among black, Latina and white U.S. women aged 21-44 years (N = 8840). We tested for an interaction between sex of sexual partners and race/ethnicity (p = 0.015) and estimated multivariable logistic regression models for each racial/ethnic group, adjusting for socio-demographic factors. The adjusted odds of Pap test use for women with only female sexual partners in the past year were significantly lower than for women with only male sexual partners in the past year among white women (odds ratio [OR] = 0.25, 95% confidence interval [CI]: 0.12,0.52) and may be lower among black women (OR = 0.32, 95% CI: 0.07,1.52); no difference was apparent among Latina women (OR = 1.54, 95% CI: 0.31,7.73). Further, the adjusted odds of Pap test use for women with no sexual partners in the past year were significantly lower than for women with only male sexual partners in the past year among white (OR = 0.30, 95% CI: 0.22,0.41) and black (OR = 0.23, 95% CI: 0.15,0.37) women and marginally lower among Latina women (OR = 0.63, 95% CI: 0.38,1.03). Adding health care indicators to the models completely explained Pap test use disparities for women with only female vs. only male sexual partners among white women and for women with no vs. only male sexual partners among Latina women. Ecosocial theory and intersectionality can be used in tandem to conceptually and operationally elucidate previously unanalyzed health disparities by multiple dimensions of social inequality.
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Affiliation(s)
- Madina Agénor
- Department of Social and Behavioral Sciences, Harvard School of Public Health, USA.
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard School of Public Health, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard School of Public Health, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, USA; Department of Pediatrics, Harvard Medical School, USA
| | | | - Barbara R Gottlieb
- Department of Social and Behavioral Sciences, Harvard School of Public Health, USA; Harvard Medical School, USA; Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, USA
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Austin SB, Pazaris MJ, Wei EK, Rosner B, Kennedy GA, Bowen D, Spiegelman D. Application of the Rosner-Wei risk-prediction model to estimate sexual orientation patterns in colon cancer risk in a prospective cohort of US women. Cancer Causes Control 2014; 25:999-1006. [PMID: 24852207 DOI: 10.1007/s10552-014-0399-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 05/13/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined whether lesbian and bisexual women may be at greater risk of colon cancer (CC) than heterosexual women. METHODS Working with a large cohort of US women ages 25-64 years, we analyzed 20 years of prospective data to estimate CC incidence, based on known risk factors by applying the Rosner-Wei CC risk-prediction model. Comparing to heterosexual women, we calculated for lesbian and bisexual women the predicted 1-year incidence rate (IR) per 100,000 person-years and estimated incidence rate ratios (IRR) and 95 % confidence intervals (CI), based on each woman's comprehensive risk factor profile. RESULTS Analyses included 1,373,817 person-years of data from 66,257 women. For each sexual orientation group, mean predicted 1-year CC IR per 100,000 person-years was slightly over 12 cases for each of the sexual orientation groups. After controlling for confounders in fully adjusted models and compared with heterosexuals, no significant differences in IRR were observed for lesbians (IRR 1.01; 95 % CI 0.99, 1.04) or bisexuals (IRR 1.01; 95 % CI 0.98, 1.04). CONCLUSIONS CC risk is similar across all sexual orientation subgroups, with all groups comparably affected. Health professionals must ensure that prevention, screening, and treatment programs are adequately reaching each of these communities.
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Affiliation(s)
- S Bryn Austin
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA,
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