LGBT health最新文献

{"title":"Treating Transgender and Gender-Diverse Veterans in the Veterans Health Administration: 23 Years of Findings.","authors":"Laurel A Copeland, Hill L Wolfe, Sarah S Jackson, Neda Buljubasic, Michael R Kauth, Leila Hashemi","doi":"10.1089/lgbt.2024.0314","DOIUrl":"https://doi.org/10.1089/lgbt.2024.0314","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Many transgender and gender-diverse (TGD) people experience significant barriers to health care access, facing disparities in care, limited payments for gender-affirming services, or insufficient training and knowledge among providers. Given validation studies reporting increasing rates of TGD-related status, we documented health care types used by TGD veterans to signal whether engagement in Veterans Health Administration (VHA) care increased or decreased following documentation of a TGD-related diagnosis code. <b><i>Methods:</i></b> The cohort was defined by receipt of a TGD-related diagnosis code in the VHA Corporate Data Warehouse from October 1, 1999, through September 30, 2021 (fiscal years 2000 through 2021). Data were summarized in two 1-year periods before and after TGD-related diagnosis. Logistic regression estimated predictors of VHA care post-TGD-related diagnosis as well as filling gender-affirming prescriptions in the VHA. <b><i>Results:</i></b> Over the 23-year study period, 9894 transgender veterans were identified. Among the 91% using VHA both before and after TGD diagnosis, visits for primary, specialty, and mental and behavioral health care increased whereas emergency care did not change. Factors associated with discontinuing VHA care were Black/African American and another race, married status, older age, and service in recent versus earlier eras. Younger, highly disabled from military service veterans and those in the West (vs. South) were more likely to fill gender-affirming prescriptions in the VHA. <b><i>Conclusion:</i></b> This study established high levels of disability and apparent willingness to continue with care in the VHA following establishment of TGD status. The role of interpersonal, provider, and policy in VHA retention remains to be examined.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minority Stress Clusters and Health and Cancer Care Outcomes of Sexual and Gender Minority Cancer Survivors.","authors":"Oscar Y Franco-Rocha, Ashley M Henneghan, Shelli R Kesler, Christopher W Wheldon","doi":"10.1089/lgbt.2024.0311","DOIUrl":"https://doi.org/10.1089/lgbt.2024.0311","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Structural factors affect the health of sexual and gender minority (SGM) cancer survivors, yet how people experience minority stress within their social and health care systems remains unclear. We explored experiences of minority stress across health care and sociocultural contexts and their impact on health and cancer outcomes. <b><i>Methods:</i></b> We conducted a K-medoid cluster analysis (grouping technique) using data from 2519 participants (training subset = 2015, testing subset = 504) from OUT: The National Cancer Survey (2020-2021). Cluster differences in the testing subset were assessed using chi-square, analysis of variance, and nonparametric tests. Regression models examined associations between cluster membership and health (mentally unhealthy days) and cancer outcomes (perceived welcomeness after identity disclosure and treatment satisfaction), adjusting for demographic and clinical factors. <b><i>Results:</i></b> Five clusters emerged, differing in demographics, mental and social health outcomes, SGM identity disclosure, and perceived welcomeness after disclosure (0.017 < <i>p</i> < 0.001). Cluster one experienced poorer mental health than cluster five (odds ratio [OR] = 1.182, 95% confidence interval [CI] = 1.003-1.392), lower cancer care satisfaction than all other clusters (1.177 < OR <1.265; 1.091 < 95% CI <1.389), and perceived less welcoming or unchanged environments after SGM identity disclosure than all other clusters (1.278 < OR <1.314; 1.161 < 95% CI <1.431). <b><i>Conclusion:</i></b> The study highlights the impact of minority stress across different contexts. The findings emphasize the need for targeted interventions to address the unique vulnerabilities of SGM individuals, particularly in health care contexts, to improve their overall health and cancer care experiences.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Analysis of Gender-Affirming Care Offerings on United States Pediatric Hospital Websites: Exploring the Impact of State Legislative Bans.","authors":"Isabelle C Band, Bethany Dubois, Atoosa Ghofranian, Katrina S Nietsch, Joseph A Lee, Jenna Friedenthal, Alan B Copperman, Samantha L Estevez","doi":"10.1089/lgbt.2024.0214","DOIUrl":"https://doi.org/10.1089/lgbt.2024.0214","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This longitudinal study compared the presence of information about gender-affirming care (GAC) on U.S. pediatric hospital websites in March 2022, when bans on the provision of pediatric GAC had been passed in two states, versus in October 2023, when bans had been passed in 22 states and implemented in 15 states without court blockage. <b><i>Methods:</i></b> All U.S. pediatric hospitals, sourced from online databases, excluding specialty hospitals (e.g., rehabilitation) were included (<i>n</i> = 149). In March 2022 and October 2023, two independent reviewers systematically reviewed each hospital website for GAC information. The presence of GAC information on websites was analyzed based on: 1) GAC legal status (legal, banned, or proposed ban blocked by court) in the hospital's state, (2) geographic location using the U.S. Census regions (Northeast, Midwest, South, and West), (3) the presence of hospital affiliation with a U.S. medical school, and (4) presence of hospital religious affiliation. <b><i>Results:</i></b> A total of 149 pediatric hospital websites were surveyed. In 2022, 105 (70%) hospital websites published content about GAC offerings versus 87 (58%) in 2023 (<i>p</i> = 0.001). This decrease in available information was significant in states where GAC bans had been passed without court blockage (60% vs. 29%, <i>p</i> = 0.001) and in the Southern region (63% vs. 39%, <i>p</i> = 0.004). Academic and secular hospitals were also more likely to include GAC information on websites. <b><i>Conclusion:</i></b> Legislation may hinder the ability of transgender youth and/or their parents to access previously available information about GAC and to identify local transgender care providers.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking Down Barriers for Same-Sex Female Couples Building Families: <i>In Vitro</i> Fertilization Utilization Following the Enactment of 2021 Legislation in New York State.","authors":"Katrina S Nietsch, Bethany Dubois, Isabelle Band, Shawn Kripalani, Dmitry Gounko, Joseph A Lee, Eric Flisser, Alan B Copperman, Samantha L Estevez","doi":"10.1089/lgbt.2024.0199","DOIUrl":"https://doi.org/10.1089/lgbt.2024.0199","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> In 2021, New York State passed legislation that eliminated the requirement that same-sex female couples needed up to 12 months of intrauterine insemination with donor sperm to meet the medical definition of infertility and qualify for insurance coverage. This study compared the duration of time from consultation to utilization of <i>in vitro</i> fertilization (IVF) by same-sex female couples before and after the New York legislative change. <b><i>Methods:</i></b> Same-sex female couples who underwent IVF or reciprocal IVF between 2010 and 2023 in New York City were categorized into pre- and postlegislation cohorts based on when they sought initial treatment. The primary outcome was time from consultation to initiation of IVF or reciprocal IVF. Secondary outcomes included time from consultation to clinical pregnancy with discharge to obstetrical care. <b><i>Results:</i></b> Overall, 239 couples were included. The postlegislation cohort had a shorter median length of time from consultation to initiation of IVF (173 vs. 297 days, <i>p</i> < 0.001; hazard ratio 2.36, <i>p</i> < 0.001) and a significant increase in the proportion of couples initiating treatment less than 1 year after consultation (86% vs. 57%, <i>p</i> = 0.01). They also had a decreased median time to discharge with ongoing pregnancy (383 vs. 535 days, <i>p</i> = 0.006). Same-sex female couples had 136% increased chances of initiating IVF after consultation compared with before the legislation. <b><i>Conclusion:</i></b> After the expansion of fertility insurance coverage, same-sex couples at a single New York City institution initiated IVF treatment and achieved pregnancy more rapidly after consultation than prior to the expansion.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Health Care Discrimination and Medical Mistrust Among Black Assigned Female at Birth Adults with Minoritized Sexual and Gender Identities in the United States.","authors":"Madeline Noh, Neil Mehta, Chloe Kim, Keosha Bond, Megan Threats, John W Jackson, Nkiru Nnawulezi, Madina Agénor","doi":"10.1089/lgbt.2024.0263","DOIUrl":"https://doi.org/10.1089/lgbt.2024.0263","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Black sexually and gender minoritized (SGM) people who were assigned female at birth (AFAB) experience compounding health care inequities, barriers to equitable care, and disproportionately adverse health outcomes. Given prior literature indicating that both experienced and/or anticipated reported health care discrimination and medical mistrust may shape these health care experiences of Black SGM AFAB people, we sought to investigate the specific interplay between these two factors to bolster understanding of their relationship. <b><i>Methods:</i></b> In January and February 2023, we conducted a cross-sectional online survey of 156 Black SGM AFAB adults in the United States (U.S.) assessing their reported lifetime experiences of all-cause and gender-, race/ethnicity-, and weight-based discrimination in health care settings, in addition to their ratings of medical mistrust on the Medical Mistrust Index (MMI). Univariate statistics, analysis of variance, <i>post hoc</i> pairwise tests, and multivariable linear regression were conducted to assess measures of health care discrimination, medical mistrust, and covariates and their associations among the analytic sample (<i>n</i> = 130). <b><i>Results:</i></b> Most participants reported prior experiences of health care discrimination. Adjusting for demographic, socioeconomic, and health care factors, we identified an association between experiencing any-cause-, race/ethnicity-, or weight-based discrimination and significantly higher MMI scores. The association for gender-based discrimination was not statistically significant. <b><i>Conclusion:</i></b> Black SGM AFAB people who experience any-cause-, race/ethnicity-, or weight-based discrimination may be more likely to experience higher levels of medical mistrust. Identifying interventions and pathways to tackle health care discrimination and the systemic and structural drivers of medical mistrust will be critical to augmenting health care outcomes and experiences of Black SGM communities.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives of Gender-Diverse Youth and Caregivers Facing Gender-Affirming Medical Intervention Bans.","authors":"Richard A Brandon-Friedman, Ali Tabb, Teresa M Imburgia, Tayon R Swafford, J Dennis Fortenberry, Meredith Canada, Kelly L Donahue","doi":"10.1089/lgbt.2024.0079","DOIUrl":"10.1089/lgbt.2024.0079","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> In the past 2 years, nearly all 50 states have debated bills seeking to ban minors' access to gender-affirming medical interventions, with many being passed into law. This study documents gender-diverse youths' (GDY) and their caregivers' experiences as they grapple with how such laws impact their families. <b><i>Methods:</i></b> Sixteen GDY and 16 caregivers participating in a longitudinal study of the impact of gender-affirming care on GDYs' well-being were interviewed about how the legal and social discourse was impacting them and their families. When interviewed, some participants had completed only the initial intake, others had completed the intake and an initial medical consultation, and a few had recently started gender-affirming hormones. Thematic analysis was used to identify common threads in the youths' and caregivers' experiences. <b><i>Results:</i></b> Four main themes were identified: Direct effects of losing access to gender-affirming medical interventions, reflecting how losing access to care would impact well-being; growing hostility toward the gender-diverse community, noting increasing social negativity; personal and social upheaval, reflecting the many aspects of families' lives affected; and galvanization into social action, documenting drives to effect social change. <b><i>Conclusion:</i></b> Laws banning gender-affirming medical interventions impact GDY and their families beyond limiting access to medical care. They increase the social stressors, cause social network disruptions, increase hostility toward the gender-diverse community, and lead some GDY and caregivers to engage more politically to protect their community. Gender-affirming health care providers need to recognize how the social and political environment impact GDY and their families to provide high-quality, person-centered care.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":" ","pages":"108-115"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Concealment of Health Information at the Intersection of Sexual Orientation and Race.","authors":"Soocheol Cho, Robert T Gallagher","doi":"10.1089/lgbt.2023.0423","DOIUrl":"10.1089/lgbt.2023.0423","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Sexually and racially minoritized people often have mistrust toward the healthcare system due to both perceived and actual experiences of discrimination. This may result in increased privacy concerns and a reluctance to share health-related information with health care providers. Drawing upon minority stress and an intersectionality framework, this study examines how rates of concealing health information differ between non-Hispanic White heterosexual people, non-Hispanic White lesbian, gay, and bisexual (LGB) people, racially minoritized heterosexual people, and those who are both sexually and racially minoritized. <b><i>Methods:</i></b> Using nationally representative cross-sectional data from the Health Information National Trends Survey from 2017 and 2018 (<i>n</i> = 4575), we fit logistic regression models to examine (1) whether sexually and racially minoritized people conceal health information from their providers more than their counterparts and (2) whether this tendency increases for those with multiple marginalized identities. Furthermore, we fit linear regression models to examine whether and how concealing health information from providers are linked to health outcomes. <b><i>Results:</i></b> Sexually and racially minoritized people had higher odds of concealing health information from providers than their counterparts. Those with multiple marginalized identities had even higher odds of withholding health information than other groups. Finally, we found a significant negative association between concealing health information and mental health. <b><i>Conclusion:</i></b> Our findings underscore the need to consider how the intersection of multiple marginalized identities shape health experiences and concerns over privacy in health care matters. We call for further research to better understand the complex dynamics of patient-provider relationships for marginalized populations.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":" ","pages":"134-143"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersectional Oppression-Based Stress, Drinking to Cope Motives, and Alcohol Use and Hazardous Drinking Among Sexual and Gender Minority Adolescents Who Are Black, Indigenous, and People of Color.","authors":"Ethan H Mereish, Jessica R Abramson, Hyemin Lee, Ryan J Watson","doi":"10.1089/lgbt.2024.0023","DOIUrl":"10.1089/lgbt.2024.0023","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This study examined the associations between intersectional oppression-based stress and recent alcohol use and hazardous drinking among sexual and gender minority (SGM; e.g., queer or transgender) adolescents who were Black, Indigenous, and People of Color (BIPOC), also known as queer and transgender BIPOC (QTBIPOC) adolescents, and the mediating role of coping motives (i.e., drinking to cope) on these associations. <b><i>Methods:</i></b> Data were from a subsample of QTBIPOC adolescents who used alcohol in the past year (<i>n</i> = 1365) from a national U.S. sample of SGM adolescents aged 13-18 years. <b><i>Results:</i></b> Intersectional oppression-based stressors were associated with greater odds of recent alcohol use and hazardous drinking, as well as greater coping motives. Coping motives mediated the associations between intersectional-based stressors and both recent alcohol use and hazardous drinking among the aggregate sample of QTBIPOC adolescents, as well as among some subgroups of BIPOC adolescents. <b><i>Conclusions:</i></b> The results of this study highlight that intersectional oppression-based stressors are prevalent among QTBIPOC adolescents and serve as a risk factor for alcohol use and hazardous drinking. Multilevel interventions are needed to target and dismantle intersectional oppressions to address alcohol inequities impacting QTBIPOC adolescents. Drinking to cope motives mediated the associations between intersectional oppression-based stress and drinking outcomes, underscoring another important mechanism to target within a context of oppression in drinking interventions.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":" ","pages":"125-133"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acknowledgment of Reviewers 2024.","authors":"","doi":"10.1089/lgbt.2024.45673.revack","DOIUrl":"https://doi.org/10.1089/lgbt.2024.45673.revack","url":null,"abstract":"","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":"12 2","pages":"163-164"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of Suicide Prevention Interventions for Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Individuals.","authors":"Cindy J Chang, Nicholas A Livingston, Katerine T Rashkovsky, Kelly L Harper, Kevin S Kuehn, Chandra Khalifian, Melanie S Harned, Raymond P Tucker, Colin A Depp","doi":"10.1089/lgbt.2023.0262","DOIUrl":"10.1089/lgbt.2023.0262","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This scoping review summarizes the literature on suicide-specific psychological interventions among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people to synthesize existing findings and support future intervention research and dissemination. <b><i>Methods:</i></b> Electronic databases PsycInfo and PubMed were searched for reports of psychological intervention studies with suicide-related outcome data among LGBTQ+ people. A total of 1269 articles were screened, and 19 studies met inclusion criteria (<i>k</i> = 3 examined suicide-specific interventions tailored to LGBTQ+ people, <i>k</i> = 4 examined nontailored suicide-specific interventions, <i>k</i> = 11 examined minority stress- or LGBTQ+ interventions that were not suicide-specific, and <i>k</i> = 1 examined other types of interventions). <b><i>Results:</i></b> Synthesis of this literature was made challenging by varied study designs, and features limit confidence in the degree of internal and external validity of the interventions evaluated. The only established suicide-specific intervention examined was Dialectical Behavior Therapy, and minority stress- and LGBTQ-specific interventions rarely targeted suicidal thoughts and behaviors (STBs). Nevertheless, most interventions reviewed demonstrated support for feasibility and/or acceptability. Only five studies tested suicide-related outcome differences between an LGBTQ+ group and a cisgender/heterosexual group. These studies did not find significant differences in STBs, but certain subgroups such as bisexual individuals may exhibit specific treatment disparities. <b><i>Conclusion:</i></b> Given the dearth of research, more research examining interventions that may reduce STBs among LGBTQ+ people is critically needed to address this public health issue.</p>","PeriodicalId":18062,"journal":{"name":"LGBT health","volume":" ","pages":"89-107"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}