"Treat us with dignity": a qualitative study of the experiences and recommendations of lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients with cancer.

PURPOSE: Despite indications that lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients have unique needs when seeking healthcare, the experiences of LGBTQ patients in the context of cancer care have not been fully explored. This qualitative study investigated recommendations offered by LGBTQ patients with cancer for improving cancer care. METHODS: Two hundred seventy-three LGBTQ people across the USA who had been diagnosed with cancer completed an online survey that included open-ended questions. Using responses to these questions, two researchers independently conducted open coding. A code book was generated collaboratively and the data were coded independently. Codes were clustered and refined and the data were independently re-coded. RESULTS: Five themes emerged. LGBTQ patients with cancer: (1) are affected by providers' LGBTQ-specific knowledge and skills, assumptions, and mistreatment; (2) negotiate disclosure of identities based on safety of clinical encounters; (3) have differing experiences based on multiple intersecting identities; (4) receive more effective care when members of their support networks are included; and (5) are self-advocates and undergo transformative experiences in the face of morbidity and marginalization. CONCLUSIONS: LGBTQ cancer survivors report challenges accessing competent cancer treatment. To address this, cancer care providers should provide safe clinical encounters, inquire about and respond professionally to patients' identities and identifiers, include chosen support people, provide care relevant to patients' gender identities, and address treatments' effects on sexuality. Training providers about diverse LGBTQ communities and acknowledging the strengths of LGBTQ patients with cancer may improve provider/patient relationships. Provider training could be created based on these principles.

The Role of the School Nurse in Social-Emotional Assessment and Intervention Using the MTSS Framework.

Mental health needs in school are increasing and can affect every student. School nurses are in a perfect position to support social-emotional learning and implement coping strategies to aid in student success. This article features the implementation of social-emotional interventions in the school health office for all students using the multitiered systems of support (MTSS) framework. MTSS is an evidence-based framework that integrates prevention and tiered intervention with data-based problem-solving to meet the academic and behavioral needs of students. Through a tiered approach, all students receive the support they need to understand their emotions, recognize how strong emotions affect physical health, and how to cope. Because maladaptive coping can have an adverse effect on academics, social-emotional wellness is essential for students to be healthy, safe, and ready to learn.

Adult Children of Gay and Lesbian Parents: Religion and the Parent-Child Relationship.

Previous scholars have explored various challenges facing children of gay and lesbian individuals, and some have explored the impact of a parent's sexual orientation on the parent-child relationship. However, the impact of religion on the parent-child relationships of adult children with a gay or lesbian parent has been overlooked. In this study, 10 adult children with both a gay or lesbian parent and a heterosexual parent were interviewed and asked to retrospectively explore how religion impacted their parent-child relationships. The following themes emerged from phenomenological analysis of the interviews: (a) family break-up more difficult than the parents' coming out; (b) discovery that parent was gay or lesbian; (c) initial shame over having gay or lesbian parent; (d) positive aspects of having a gay or lesbian parent; (e) redefined relationship with religion; and (f) impact of culture on how gay and lesbian individuals are viewed.

Exploring the Intersectionality of Bisexual, Religious/Spiritual, and Political Identities from a Feminist Perspective.

While there is a small but growing body of work that examines the religious and spiritual lives of bisexuals, there is a strong need for additional research that further explores the intersectionality of these distinct identities. Motivated by the feminist notions that the personal is political and that individuals are the experts of their own experiences (Unger, 2001), the specific aim of this study is to better understand the intersection of multiple identities experienced by bisexual individuals. Relying upon data collected by Herek, Glunt, and colleagues during their Northern California Health Study, in this exploratory study we examine the intersection of bisexual, religious/spiritual, and political identities by conducting an archival secondary analysis of 120 self-identified bisexual individuals. Among the significant findings, results suggest that higher LGB self-esteem scores and openness about sexual orientation correlated with higher levels of spirituality. Further, attraction to same sex partners was associated with perceiving sexual orientation as a choice, identifying as bisexual at a younger age, more likely to disclose one's sexual orientation, less likely to view religion as being socially important, and a higher score on the belief statement. We discuss the implications of these results and make suggestions for future research on the role of religion and spirituality in bisexual lives.

Entrepreneurial training for girls empowerment in Lesotho: A process evaluation of a model programme.

A Girls Empowerment Programme held in 2010 in Lesotho, Sub-Saharan Africa, focused on HIV/AIDS risk reduction and prevention, life skills and entrepreneurial training (income-generating activities). Entrepreneurial training was a crucial part of equipping the camp attendees with basic skills to help them develop sustainable livelihoods. Such skills and financial independence are essential to enable rural girls to complete their secondary schooling (in a fee-based educational system) and to pursue a career, as well as to further help them be less susceptible to transactional sex and its significant risks. The results of a brief process evaluation with some nested supporting data showed considerable improvement in the girls' knowledge about income-generating activities. In addition, almost half of the camp attendees participated in further entrepreneurial training and about half of these girls went on to develop small businesses. Replication of this model of camp training is recommended and being explored in other African countries.

Offering a Health Empowerment Program in a Faith-Based Community Clinic.

Introduction. Given the excess burden of overweight/obesity in low-income communities, the objective of this pilot study was to examine the feasibility and effectiveness of a healthy living program (Health Empowerment Program) for improving physical activity, eating habits, and mental health outcomes. Adapted from the Diabetes Prevention Program (DPP), a 7-week biopsychosocial intervention that included spirituality was created. Methods. Participants (n = 153) recruited from a faith-based neighborhood health center were assessed using self-report measures for depressive and anxiety symptoms, self-regulation, physical activity, and eating habits at baseline, postintervention, and 3-month follow-up. Results. Participants had significant decreases in depressive symptoms (ß = -1.21; SE = 0.27; P < .001) and anxiety symptoms (ß = -0.69; SE = 0.24; P = .005) and significant increases in self-regulation (ß = 2.42; SE = 0.82; P = .003), time spent in physical activity (ß; = 3.56; SE = 1.48; P = .016), and total healthy eating habits (ß = 0.97; SE = 0.16; P < .001). Conclusion. Although including spirituality in a healthy living program is feasible and is associated with improvements in outcomes, future research needs to consider how best to incorporate a modified DPP into community settings allowing access to all community members.

I'm not putting on that floral gown: Enforcement and resistance of gender expectations for transgender people with cancer.

OBJECTIVES: Understanding barriers to care for transgender people with cancer is necessary to increase oncologic care access. Little has been published regarding the experiences of transgender people with cancer. We sought to explore these experiences, assess barriers to oncologic care, and elucidate potential solutions. METHODS: Using an interpretive descriptive approach, we conducted two group interviews with transgender people who had been diagnosed with cancer and one with physicians who treat patients with cancer. Two investigators independently analyzed verbatim transcripts and, together, refined themes, resolving disagreements with consensus. Member checking and peer debriefing were used to confirm and elaborate on findings. RESULTS: Seven people who had been diagnosed with cancer and five physicians who treat people with cancer participated in group interviews. Themes included: (a) experiences with cancer may uniquely impact transgender people; (b) enforcement of clinician and systemic gender expectations creates barriers to cancer care; and (c) resistance to gender expectations may facilitate care. CONCLUSIONS: Gender expectations create barriers to oncologic care, which can be resisted by patients, clinicians, and institutions. IMPLICATIONS FOR PRACTICE: Clinicians and institutions should create gender-inclusive oncologic spaces, demonstrate allyship, and support patient autonomy to decrease barriers to care for transgender people with cancer.

The Role of the School Nurse in Increasing Instructional Time Using Multi-Tiered Systems of Support for Behavior (MTSS-B): A Quality Improvement Project.

Frequent visits to the health office can lead to considerable time spent out of the classroom along with affecting relationships and health office resources and staffing. This article features the practice component of continuous quality improvement in the principal of quality improvement in the Framework for the 21st Century School Nursing Practice™ and is the third in a series focusing on the Framework. The article discusses how using multi-tiered systems of support for behavior (MTSS-B) to create expectations for the health office environment, along with intense, individualized plans for specific students, were successful in decreasing health office visits across the school district, with the ultimate goal of increasing instructional time. Outcome data revealed reductions in health office visits with a district-wide decrease of 4.1% one-year postimplementation of the project. More importantly, school nurses are providing better trauma-informed care with intentionality while still meeting the needs of students.

Help-seeking behaviors and attitudes of emerging adults: How college students reporting recent suicidal ideation utilize the internet compared to traditional resources.

Objective: Suicide is the second leading cause of death among emerging adults, yet little is known regarding their online help-seeking. Participants: The National Research Consortium of Counseling Centers in Higher Education's dataset (N=26,292). Methods: Students across the United States were recruited from 73 four-year institutions to participate during the 2010-2011 school year. Results: Observed the effectiveness of online and traditional help-seeking stratified by recent suicidal ideation related to their most distressful period in the past year. Females and younger students endorsed both types of help-seeking, yet those with recent ideation were less likely to disclose any help-seeking. Among those reporting recent ideation, only females reported that traditional supports were more than moderately helpful. Regardless of whether students endorsed ideation, students who were younger, engaged in risky behaviors and identified as females reported that online resources were more than moderately helpful. Conclusions: Online resources could potentially bridge barriers to traditional help-seeking for those reluctant to seek out care, yet traditional resources were reported to be the most effective among this sample.

Questions of faith: Religious affiliations and suicidal ideation among sexual minority young adults.

OBJECTIVE: To examine how the associations of specific religious affiliations with recent suicidal ideation vary by sexual orientation among young adults. METHOD: This project was a cross-sectional secondary analysis of data from the 2006 and 2011 surveys of the National Research Consortium of Counseling Centers in Higher Education. The analytic sample was restricted to persons between the ages of 18-29 (n = 40,150). Multiple logistic regression analyses were used to examine associations of religious affiliations with recent suicidal ideation between heterosexual and sexual minority (e.g., gay, lesbian, bisexual, questioning) young adults. RESULTS: Approximately 6.7% of the sample self-identified as sexual minority. Compared to heterosexuals, sexual minorities were more likely to report recent suicidal ideation (aOR = 4.52, 95% CI = 3.97-5.16). Among heterosexuals, Unspecified Christian and Catholic denominations were associated with 24% and 37% reduced odds of recent suicidal ideation compared to agnostic/atheist heterosexuals. However, among sexual minorities, Unspecified Christian and Catholic denominations were associated with 68% and 77% increased odds of recent suicidal ideation compared to agnostic/atheist sexual minorities. Unspecified Christian and Catholic sexual minorities had 184% and 198% increased odds of recent suicidal ideation compared to Unitarian/Universalist sexual minorities. CONCLUSIONS: Although protective for heterosexuals, religious affiliation may not be globally protective against suicidal ideation among sexual minorities.

Association of Religiosity With Sexual Minority Suicide Ideation and Attempt.

INTRODUCTION: The purpose of this study is to explore how the associations between importance of religion and recent suicide ideation, recent suicide attempt, and lifetime suicide attempt vary by sexual orientation. METHODS: Survey data were collected from the 2011 University of Texas at Austin's Research Consortium data from 21,247 college-enrolled young adults aged 18-30 years. Respondents reported sexual identity as heterosexual, gay/lesbian, bisexual, or questioning. Two sets of multivariable models were conducted to explore the relations of religious importance and sexual orientation with the prevalence of suicidal behavior. The first model was stratified by sexual orientation and the second model was stratified by importance of religion. To explore potential gender differences in self-directed violence, the models were also stratified by gender identity. The main outcome measures were recent suicidal ideation, recent suicide attempt, and lifetime suicide attempt. RESULTS: Overall, increased importance of religion was associated with higher odds of recent suicide ideation for both gay/lesbian and questioning students. The association between sexual orientation and self-directed violence were mixed and varied by strata. Lesbian/gay students who viewed religion as very important had greater odds for recent suicidal ideation and lifetime suicide attempt compared with heterosexual individuals. Bisexual and questioning sexual orientations were significantly associated with recent suicide ideation, recent attempt, and lifetime attempt across all strata of religious importance, but the strongest effects were among those who reported that religion was very important. CONCLUSIONS: Religion-based services for mental health and suicide prevention may not benefit gay/lesbian, bisexual, or questioning individuals. Religion-based service providers should actively assure their services are open and supportive of gay/lesbian, bisexual, or questioning individuals.

Suicidal and Help-Seeking Behaviors Among Youth in an Online Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Social Network.

LGBTQ youth have a great burden for suicidal ideation/behavior compared to their non-LGBTQ peers. While scholars have explored risk factors for suicidal behaviors, little is known about protective factors among LGBTQ youth, let alone within group differences in terms of help-seeking. Data were collected from 203 TrevorSpace (e.g., a social network for LGBTQ youth) users via online survey to examine suicidal and help-seeking behaviors among LGBTQ individuals. Among participants who reported suicidal ideation/behavior, a large proportion did not seek help (73.1% of gay men, 33.3% of bisexual men, 42.9% of bisexual women, 14.3% of lesbian women, 41.2% of queer individuals) when they considered or attempted suicide. Among those who sought support, reaching out to a friend was most common. However, family support was associated with fewer suicidal behaviors. Our findings underscore the need to examine the effectiveness of specific sources of help and the impact of exposure to social connectedness.

Suicide Acceptability and Sexual Orientation: Results from the General Social Survey 2008-2014.

Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of lifetime suicide ideation and attempt than their heterosexual peers, but less is known about differences in suicide acceptability (i.e., believing suicide is a viable answer to a problem). The purpose of this study was to examine if LGB adults had greater suicide acceptability than heterosexual adults. A total of 4 items in the General Social Surveys from 2008 to 2014 assessed whether a nationally representative sample of U.S. adult respondents (n = 5,037) thought it acceptable for individuals to kill themselves if one: goes bankrupt, dishonors their family, is tired of living, or has an incurable disease. Multiple logistic regression analyses were used to assess the association of sexual orientation with suicide acceptability items after adjusting for confounding factors. Compared with heterosexuals, lesbians/gays had higher odds of reporting suicide acceptability if one goes bankrupt (OR = 1.92; 95% CI: 1.06, 3.46), dishonors family (OR = 1.83; 95% CI: 1.01, 3.28), or is tired of living (OR = 2.25; 95% CI: 1.30, 3.90). Bisexual and heterosexual groups were largely similar across the 4 suicide acceptability items. No sexual orientation differences were observed for reporting acceptability of suicide in the instance of an incurable disease. Post hoc analyses revealed significant interactions between sex and sexual orientation, such that differences in suicide acceptability seemed to be driven by sexual minority women rather than by sexual minority men. Suicide acceptability differs by sexual orientation, and community-level interventions around changing norms about suicide may be a prevention strategy for sexual minority individuals.

The Association of Multiple Identities with Self-Directed Violence and Depression among Transgender Individuals.

Transgender individuals have a high prevalence of self-directed violence; however, there is scant literature focusing on their unique experiences. The differences in self-harm, suicidal ideation, suicide attempt, and depression based on racial/ethnic identity and sexual orientation were examined among transgender individuals. Data were gathered from the Fall 2008 and Spring 2009 National College Health Assessment. Across racial/ethnic identities, greater proportions of transgender students endorsed self-directed violence than their cisgender peers. Among transgender individuals, sexual minorities were more likely to report suicidal ideation than their heterosexual peers, and racial/ethnic minorities had higher odds of attempting suicide than non-Hispanic White individuals.

Understanding Discourse on Work and Job-Related Well-Being in Public Social Media.

We construct a humans-in-the-loop supervised learning framework that integrates crowdsourcing feedback and local knowledge to detect job-related tweets from individual and business accounts. Using data-driven ethnography, we examine discourse about work by fusing language-based analysis with temporal, geospational, and labor statistics information.

Introduction to Special Issue: The Retirement Career Phase across Cultures.

Increasingly, older workers in the United States remain in the workforce beyond retirement age, meaning the term "retirement" might include at least some form of workforce participation. Although the proportions of women and individuals from racial and ethnic minority groups working past the age of 65 has significantly increased (Wegman & McGee, 2004); few scholars have examined the retirement career phase from a multicultural perspective. This special issue will critically review vocational literature as well as provide specific recommendations for research and practice with the aim of helping scholars and practitioners conceptualize the current concerns older adults across cultures (e.g., women and racial/ethnic minorities, among others) face during retirement planning.

Social Cognitive Career Theory, the Theory of Work Adjustment, and Work Satisfaction of Retirement-Age Adults.

Despite a recent increase in the number of adults who work past traditional retirement age, existing theories of vocational behavior have not yet received adequate empirical support. In a large sample of adults age 60-87, we evaluated the relationship between theorized predictors of work satisfaction proposed by Social Cognitive Career Theory (SCCT), work satisfaction as a predictor of continued work, as proposed by the Theory of Work adjustment (TWA), as well as the influence of reported experiences of discrimination on these relationships. While the results supported most of the predicted relationships, the effects of discrimination were stronger than the variables proposed by either SCCT or TWA for the present sample.

Career and Retirement Theories: Relevance for Older Workers Across Cultures.

This paper reviews selected career development theories as well as theories specifically focused on retirement, with an emphasis on their application to retirement decisions and vocational behavior in multicultural populations. Theories are evaluated based on whether: (a) retirement was considered a stage of working life, (b) work satisfaction, motivation, and other work variables at retirement age were addressed, (c) work choices at retirement age were included, and (d) cultural and other minority status issues were either directly considered in the work/retirement decision or if the model could be reasonably applied to retirement across cultures. We provide specific recommendations for research and practice with the aim of helping practitioners and scholars conceptualize the current concerns older adults face in their working lives and during retirement planning.

Cigarette Smoking Disparities among Sexual Minority Cancer Survivors.

OBJECTIVE: Sexual minority (i.e., lesbian, gay, and bisexual) adults smoke cigarettes at higher rates than heterosexual adults. Smoking after receiving a cancer diagnosis is a major health concern, yet risk of continued smoking among sexual minority cancer survivors is as yet unknown. The current study examines current smoking among sexual minority vs. heterosexual adult cancer survivors. METHOD: Data drawn from the 2010 Behavioral Risk Factor Surveillance System survey in five states (Alaska, California, Massachusetts, New Mexico, and Wisconsin) included items about sexual orientation, cancer diagnosis, and tobacco use. The analytic sample included 124 sexual minority and 248 propensity score matched heterosexual adult cancer survivors. RESULTS: Bivariate analysis showed that sexual minority cancer survivors had twice the odds of current smoking as their heterosexual counterparts (OR=2.03, 95%CI:1.09-3.80). In exploratory analyses stratified by sex, sexual minority disparities in prevalence of smoking post-cancer showed a trend toward significance among females, not males. CONCLUSION: The current study offers preliminary evidence that sexual minority status is one variable among many that must be taken into account when assessing health behaviors post-cancer diagnosis. Future research should identify mechanisms leading from sexual minority status to increased rates of smoking and develop tailored smoking cessation interventions.

Mindfulness-based stress reduction to enhance psychological functioning and improve inflammatory biomarkers in trauma-exposed women: A pilot study.

This study examined the effects of a mindfulness-based stress reduction (MBSR) program on psychological functioning and inflammatory biomarkers in women with histories of interpersonal trauma. The 8-week MBSR program was conducted at a community-based health center and participants (N = 50) completed several measures of psychological functioning at study entry as well as 4 weeks, 8 weeks, and 12 weeks later. Inflammatory biomarkers were assayed from blood collected at each assessment. A series of linear mixed-model analyses were conducted to measure the effect of attendance and time on the dependent variables. Time was associated with significant decreases in perceived stress, depression, trait and state anxiety, emotion dysregulation, and posttraumatic stress symptoms, as well as increases in mindfulness. Session attendance was associated with significant decreases in interleukin (IL)-6 levels. This pilot study demonstrated the potential beneficial effects of MBSR on psychological functioning and the inflammatory biomarker IL-6 among trauma-exposed and primarily low-income women. Decreases in inflammation have implications for this population, as interpersonal trauma can instigate chronic physiological dysregulation, heightened morbidity, and premature death. This study's preliminary results support efforts to investigate biological remediation with behavioral interventions in vulnerable populations.