Disparities in cancer incidence by sexual orientation.

INTRODUCTION: Cancer risk factors are more common among sexual minority populations (e.g., lesbian, bisexual) than their heterosexual peers, yet little is known about cancer incidence across sexual orientation groups. METHODS: The 1989-2017 data from the Nurses' Health Study II, a longitudinal cohort of female nurses across the United States, were analyzed (N = 101,543). Sexual orientation-related cancer disparities were quantified by comparing any cancer incidence among four sexual minority groups based on self-disclosure-(1) heterosexual with past same-sex attractions/partners/identity; (2) mostly heterosexual; (3) bisexual; and (4) lesbian women-to completely heterosexual women using age-adjusted incidence rate ratios (aIRR) calculated by the Mantel-Haenszel method. Additionally, subanalyses at 21 cancer disease sites (e.g., breast, colon/rectum) were conducted. RESULTS: For all-cancer analyses, there were no statistically significant differences in cancer incidence at the 5% type I error cutoff among sexual minority groups when compared to completely heterosexual women; the aIRR was 1.17 (95% CI,0.99-1.38) among lesbian women and 0.80 (0.58-1.10) among bisexual women. For the site-specific analyses, incidences at multiple sites were significantly higher among lesbian women compared to completely heterosexual women: thyroid cancer (aIRR, 1.87 [1.03-3.41]), basal cell carcinoma (aIRR, 1.85 [1.09-3.14]), and non-Hodgkin lymphoma (aIRR, 2.13 [1.10-4.12]). CONCLUSION: Lesbian women may be disproportionately burdened by cancer relative to their heterosexual peers. Sexual minority populations must be explicitly included in cancer prevention efforts. Comprehensive and standardized sexual orientation data must be systematically collected so nuanced sexual orientation-related cancer disparities can be accurately assessed for both common and rare cancers.

Differences in medically assisted reproduction use by sexual identity and partnership: a prospective cohort of cisgender women.

STUDY QUESTION: Does medically assisted reproduction (MAR) use among cisgender women differ among those with same-sex partners or lesbian/bisexual identities compared to peers with different-sex partners or heterosexual identities? SUMMARY ANSWER: Women with same-sex partners or lesbian/bisexual identities are more likely to utilize any MAR but are no more likely to use ART (i.e. IVF, reciprocal IVF, embryo transfer, unspecified ART, ICSI, and gamete or zygote intrafallopian transfer) compared to non-ART MAR (i.e. IUI, ovulation induction, and intravaginal or intracervical insemination) than their different-sex partnered and completely heterosexual peers. WHAT IS KNOWN ALREADY: Sexual minority women (SMW) form families in myriad ways, including through fostering, adoption, genetic, and/or biological routes. Emerging evidence suggests this population increasingly wants to form genetic and/or biological families, yet little is known about their family formation processes and conception needs. STUDY DESIGN, SIZE, DURATION: The Growing Up Today Study is a US-based prospective cohort (n = 27 805). Participants were 9-17 years of age at enrollment (1996 and 2004). Biennial follow-up is ongoing, with data collected through 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Cisgender women who met the following criteria were included in this sample: endorsed ever being pregnant; attempted a pregnancy in 2019 or 2021; and endorsed either a male- or female-sex partner OR responded to questions regarding their sexual identity during their conception window. The main outcome was any MAR use including ART (i.e. procedures involving micromanipulation of gametes) and non-ART MAR (i.e. nonmanipulation of gametes). Secondary outcomes included specific MAR procedures, time to conception, and trends across time. We assessed differences in any MAR use using weighted modified Poisson generalized estimating equations. MAIN RESULTS AND THE ROLE OF CHANCE: Among 3519 participants, there were 6935 pregnancies/pregnancy attempts and 19.4% involved MAR. A total of 47 pregnancies or pregnancy attempts were among the same-sex partnered participants, while 91 were among bisexual participants and 37 among lesbian participants. Participants with same-sex, compared to different-sex partners were almost five times as likely to use MAR (risk ratio [95% CI]: 4.78 [4.06, 5.61]). Compared to completely heterosexual participants, there was greater MAR use among lesbian (4.00 [3.10, 5.16]) and bisexual (2.22 [1.60, 3.07]) participants compared to no MAR use; mostly heterosexual participants were also more likely to use ART (1.42 [1.11, 1.82]) compared to non-ART MAR. Among first pregnancies conceived using MAR, conception pathways differed by partnership and sexual identity groups; differences were largest for IUI, intravaginal insemination, and timed intercourse with ovulation induction. From 2002 to 2021, MAR use increased proportionally to total pregnancies/pregnancy attempts; ART use was increasingly common in later years among same-sex partnered and lesbian participants. LIMITATIONS, REASONS FOR CAUTION: Our results are limited by the small number of SMW, the homogenous sample of mostly White, educated participants, the potential misclassification of MAR use when creating conception pathways unique to SMW, and the questionnaire's skip logic, which excluded certain participants from receiving MAR questions. WIDER IMPLICATIONS OF THE FINDINGS: Previous studies on SMW family formation have primarily focused on clinical outcomes from ART procedures and perinatal outcomes by conception method, and have been almost exclusively limited to European, clinical samples that relied on partnership data only. Despite the small sample of SMW within a nonrepresentative study, this is the first study to our knowledge to use a nonclinical sample of cisgender women from across the USA to elucidate family formation pathways by partnership as well as sexual identity, including pathways that may be unique to SMW. This was made possible by our innovative approach to MAR categorization within a large, prospective dataset that collected detailed sexual orientation data. Specifically, lesbian, bisexual, and same-sex partnered participants used both ART and non-ART MAR at similar frequencies compared to heterosexual and different-sex partnered participants. This may signal differential access to conception pathways owing to structural barriers, emerging conception trends as family formation among SMW has increased, and a need for conception support beyond specialized providers and fertility clinics. STUDY FUNDING/COMPETING INTEREST(S): The research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH), under award number R01MD015256. Additionally, KRSS is supported by NCI grant T32CA009001, AKH by the NCI T32CA057711, PC by the NHLBI T32HL098048, BM by the Stanford Maternal Child Health Research Institute Clinical Trainee Support Grant and the Diversity Fellowship from the American Society for Reproductive Medicine Research Institute, BGE by NICHD R01HD091405, and SM by the Thomas O. Pyle Fellowship through the Harvard Pilgrim Health Care Foundation and Harvard University, NHLBI T32HL098048, NIMH R01MH112384, and the William T. Grant Foundation grant number 187958. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The first author recently had a leadership role in the not-for-profit program, The Lesbian Health Fund, a research fund focused on improving the health and wellbeing of LGBTQ+ women and girls. The fund did not have any role in this study and the author's relationship with the fund did not bias the findings of this manuscript. TRIAL REGISTRATION NUMBER: N/A.

Sexual orientation disparities in gestational diabetes and hypertensive disorders of pregnancy.

BACKGROUND: Sexual minority (SM) individuals (e.g., those with same-sex attractions/partners or who identify as lesbian/gay/bisexual) experience a host of physical and mental health disparities. However, little is known about sexual orientation-related disparities in gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP; gestational hypertension [gHTN] and preeclampsia). OBJECTIVE: To estimate disparities in GDM, gHTN and preeclampsia by sexual orientation. METHODS: We used data from the Nurses' Health Study II-a cohort of nurses across the US enrolled in 1989 at 25-42 years of age-restricted to those with pregnancies ≥20 weeks gestation and non-missing sexual orientation data (63,518 participants; 146,079 pregnancies). Our primary outcomes were GDM, gHTN and preeclampsia, which participants reported for each of their pregnancies. Participants also reported their sexual orientation identity and same-sex attractions/partners. We compared the risk of each outcome in pregnancies among heterosexual participants with no same-sex experience (reference) to those among SM participants overall and within subgroups: (1) heterosexual with same-sex experience, (2) mostly heterosexual, (3) bisexual and (4) lesbian/gay participants. We used modified Poisson models to estimate risk ratios (RR) and 95% confidence intervals (CI), fit via weighted generalised estimating equations, to account for multiple pregnancies per person over time and informative cluster sizes. RESULTS: The overall prevalence of each outcome was ≤5%. Mostly heterosexual participants had a 31% higher risk of gHTN (RR 1.31, 95% CI 1.03, 1.66), and heterosexual participants with same-sex experience had a 31% higher risk of GDM (RR 1.31, 95% CI 1.13, 1.50), compared to heterosexual participants with no same-sex experience. The magnitudes of the risk ratios were high among bisexual participants for gHTN and preeclampsia and among lesbian/gay participants for gHTN. CONCLUSIONS: Some SM groups may be disparately burdened by GDM and HDP. Elucidating modifiable mechanisms (e.g., structural barriers, discrimination) for reducing adverse pregnancy outcomes among SM populations is critical.

Structural Discrimination against and Structural Support for Lesbian, Gay, and Bisexual People as a Predictor of Late HIV Diagnoses among Black Men who Have Sex with Men.

Black men who have sex with men (MSM) have been consistently reported to have the highest estimated HIV incidence and prevalence among MSM. Despite broad theoretical understanding that discrimination is a major social and structural determinant that contributes to disparate HIV outcomes among Black MSM, relatively little extant research has empirically examined structural discrimination against sexual minorities as a predictor of HIV outcomes among this population. The present study therefore examines whether variation in policies that explicitly discriminate against lesbian, gay, and bisexual (LGB) people and variation in policies that explicitly protect LGB people differentially predict metropolitan statistical-area-level variation in late HIV diagnoses among Black MSM over time, from 2008 to 2014. HIV surveillance data on late HIV diagnoses among Black MSM in each of the 95 largest metropolitan statistical areas in the United States, from 2008 to 2014, were used along with data on time-varying state-level policies pertaining to the rights of LGB people. Results from multilevel models found a negative relationship between protective/supportive laws and late HIV diagnoses among Black MSM, and a positive relationship between discriminative laws and late HIV diagnoses among Black MSM. These findings illuminate the potential epidemiological importance of policies pertaining to LGB populations as structural determinants of HIV outcomes among Black MSM. They suggest a need for scrutiny and elimination of discriminatory policies, where such policies are currently in place, and for advocacy for policies that explicitly protect the rights of LGB people where they do not currently exist.

Structural transphobia is associated with psychological distress and suicidality in a large national sample of transgender adults.

PURPOSE: Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults' psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity. METHODS: We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18-100) residing in 45 US states and the District of Columbia (DC). RESULTS: Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts. CONCLUSION: Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia's multifaceted nature and negative mental health consequences.

Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses.

Importance: Extensive evidence documents health disparities for lesbian, gay, and bisexual (LGB) women, including worse physical, mental, and behavioral health than heterosexual women. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among LGB women and whether they differ by lesbian or bisexual identity. Objective: To examine differences in mortality by sexual orientation. Design, Setting, and Participants: This prospective cohort study examined differences in time to mortality across sexual orientation, adjusting for birth cohort. Participants were female nurses born between 1945 and 1964, initially recruited in the US in 1989 for the Nurses' Health Study II, and followed up through April 2022. Exposures: Sexual orientation (lesbian, bisexual, or heterosexual) assessed in 1995. Main Outcome and Measure: Time to all-cause mortality from assessment of exposure analyzed using accelerated failure time models. Results: Among 116 149 eligible participants, 90 833 (78%) had valid sexual orientation data. Of these 90 833 participants, 89 821 (98.9%) identified as heterosexual, 694 (0.8%) identified as lesbian, and 318 (0.4%) identified as bisexual. Of the 4227 deaths reported, the majority were among heterosexual participants (n = 4146; cumulative mortality of 4.6%), followed by lesbian participants (n = 49; cumulative mortality of 7.0%) and bisexual participants (n = 32; cumulative mortality of 10.1%). Compared with heterosexual participants, LGB participants had earlier mortality (adjusted acceleration factor, 0.74 [95% CI, 0.64-0.84]). These differences were greatest among bisexual participants (adjusted acceleration factor, 0.63 [95% CI, 0.51-0.78]) followed by lesbian participants (adjusted acceleration factor, 0.80 [95% CI, 0.68-0.95]). Conclusions and Relevance: In an otherwise largely homogeneous sample of female nurses, participants identifying as lesbian or bisexual had markedly earlier mortality during the study period compared with heterosexual women. These differences in mortality timing highlight the urgency of addressing modifiable risks and upstream social forces that propagate and perpetuate disparities.

Structural Correlates of Mental Health Support Access among Sexual Minority Youth of Color during COVID-19.

Many youth with mental health needs cannot access treatment, with multiply-marginalized youth, such as sexual minority youth of Color (SMYoC), experiencing both structural and identity-related barriers to care. The COVID-19 pandemic threatens to exacerbate multi-level treatment access barriers facing SMYoC youth nationwide. However, little large-scale research has examined access to mental health care among SMYoC across the United States, either during or prior to the pandemic. Such work is critical to understanding and ameliorating barriers in this domain. Using data from adolescents who self-identified as SMYoC and who endorsed a desire for mental health support during the COVID-19 pandemic (N = 470, ages 13-16, from 43 U.S. states), we examined associations between state-level, structural factors (income inequality; mental health-care provider shortage; anti-Black racism; homophobia; and the interaction between anti-Black racism and homophobia) and SMYoC mental health treatment access. Multinomial logistic regressions revealed state-level mental health-care provider shortage as the only significant predictor of SMYoC reporting they never (versus always) accessed mental health support during the COVID-19 pandemic. SMYoC living in areas with both lower homophobia and lower anti-Black racism were more likely to report always (versus sometimes) accessing mental health treatment. Results highlight the critical importance of considering diverse structural factors and applying an intersectional lens when exploring barriers to mental health treatment among multiply-marginalized youth. In locations where provider shortages are less severe, cultural stigma - including anti-Black racism and homophobia - may still pose challenges for SMYoC in need of mental health care.

State-Level Regulations Regarding the Protection of Sexual Minorities and Birth Outcomes: Results From a Population-Based Cohort Study.

OBJECTIVE: We leverage state-level variability in social policies that confer legal protections for sexual minorities (e.g., employment nondiscrimination acts) and examine their association with birth outcomes among sexual minority women. METHODS: We link measures of structural protections (i.e., social policies) to a prospective, population-based cohort of US adults-the National Longitudinal Study of Adolescent to Adult Health ( n = 7913 total singleton births, n = 274 singleton births to bisexual women, n = 53 singleton births to lesbian women)-which includes measurement of key risk factors for birth outcomes over the life course. RESULTS: Lesbian, gay, bisexual (LGB) policy protections were associated with better birth outcomes for lesbian women. For example, among lesbian women, the predicted birth weight for infants in states with no policy protections was 3.01 kg (95% confidence interval = 2.71-3.30) but was 3.71 kg (95% confidence interval = 3.46-3.96) in states with three or four policy protections. In negative control analyses, there was no association between LGB policy protections and birth outcomes among the nonstigmatized group (i.e., heterosexual women), providing evidence of specificity. Furthermore, in states with the most LGB policy protections, lesbian women were at lower risk for preterm births and had infants with higher birth weights than heterosexual and bisexual women. These associations remained robust after adjusting for 13 risk factors, including demographics, prior and current indicators of socioeconomic status, preconception and perinatal risk factors, and neighborhood characteristics. CONCLUSIONS: These results provide novel evidence that sexual orientation-related policy protections, measured at the state level, are associated with a decreased risk for adverse birth outcomes among lesbian women.

Wage theft and life expectancy inequities in the United States: A simulation study.

Wage theft - employers not paying workers their legally entitled wages and benefits - costs workers billions of dollars annually. We tested whether preventing wage theft could increase U.S. life expectancy and decrease inequities therein. We obtained nationally representative estimates of the 2001-2014 association between income and expected age at death for 40-year-olds (40 plus life expectancy at age 40) compiled from tax and Social Security Administration records, and estimates of the burden of wage theft from several sources, including estimates regarding minimum-wage violations (not paying workers the minimum wage) developed from Current Population Survey data. After modeling the relationship between income and expected age at death, we simulated the effects of scenarios preventing wage theft on mean expected age at death, assuming a causal effect of income on expected age at death. We simulated several scenarios, including one using data suggesting minimum-wage violations constituted 38% of all wage theft and caused 58% of affected workers' losses. Among women in the lowest income decile, mean expected age at death was 0.17 years longer in the counterfactual scenario than observed (95% confidence interval [CI]: 0.11-0.22), corresponding to 528,685 (95% CI: 346,018-711,353) years extended in the total 2001-2014 age-40 population. Among men in the lowest decile, the estimates were 0.12 (95% CI: 0.07-0.17) and 380,502 (95% CI: 229,630-531,374). Moreover, among women, mean expected age at death in the counterfactual scenario increased 0.16 (95% CI: 0.06-0.27) years more among the lowest decile than among the highest decile; among men, the estimate was 0.12 (95% CI: 0.03-0.21).

Dimensions of sexual experiences reflected through adjective selection: findings from a US nationally representative survey.

BACKGROUND: A growing body of research focuses on the quality of sexual experiences, such as the importance of sexual pleasure, comfort, and intimacy for overall health. Building upon this work, this study aims to develop a deeper understanding of the dimensions of sexual experiences using data from 2897 adult participants from the 2018 National Survey of Sexual Health and Behavior (NSSHB; 1314 men, 1583 women). METHODS: We conducted an exploratory factor analysis (EFA) to examine the extent to which 20 adjectives describing adults' most recent sexual experience (e.g. boring, playful, romantic, etc.) formed a coherent factor or several factors. Next, we explored how different scores on each factor were associated with sexual outcomes for women and men. RESULTS: Our EFA generated two explanatory factors that mapped onto two underlying components: sexual pleasure and sexual danger. These two factors were correlated with sexual health outcomes including sexual wantedness, orgasm, self-rated sexual health, meaningfulness of sex and pain during sex. CONCLUSIONS: We found that the innovative list of adjectives used in the 2018 NSSHB provided important and reliable insight into latent dimensions of sex. Specifically, we found that the pleasure dimension was important for both genders, and especially for women, in experiences where the sex was wanted, orgasmic, meaningful, healthy, and without pain. Implications for sexual experiences and suggestions for future research are discussed.

The Serpent of Their Agonies: Exploitation as Structural Determinant of Mental Illness.

BACKGROUND: Social stratification is a well-documented determinant of mental health. Traditional measures of stratification (e.g., socioeconomic status) reduce dynamic social processes to individual attributes downstream of mechanisms that generate stratification. In this study, we measure one process theorized to generate and reproduce social stratification-economic exploitation-and explore its association with mental health. METHODS: Data are from the 1983 to 2017 waves of the Panel Study of Income Dynamics, a nationally representative cohort study (baseline N = 3059). We operationalized "unconcealed exploitation" as the percentage of individuals' labor income they were hypothetically not paid for productive hours. We ascertained psychologic distress and mental illness with the Kessler-6 (K6) scale. RESULTS: We fit inverse probability-weighted marginal structural models and found that for each unit increase in unconcealed exploitation, psychologic distress increased by 1.6 points (95% confidence interval = 0.71, 2.5) on the K6 scale and the odds of mental illness tripled (odds ratio = 3.0, 95% confidence interval = 1.5, 6.1). Results were not driven entirely by overwork and were robust to different inverse probability-weighted estimation strategies and sensitivity analyses. CONCLUSIONS: Exploitation is associated with mental illness. Focusing on exploitation rather than its consequences (e.g., socioeconomic status), shifts attention to a structural process that may be a more appropriate explanatory mechanism, and a more pragmatic intervention target, for mental illness.

Trends in US Alcohol Consumption Frequency During the First Wave of the SARS-CoV-2 Pandemic.

BACKGROUND: The SARS-CoV-2 pandemic created disruptions and stressors which may have influenced alcohol consumption frequency trends. Varying COVID-19 health burden and alcohol policies may have contributed to different consumption trends between states. The aim of this study is to assess trends in alcohol consumption and moderation by state of residence. METHODS: We examined trends in adult drinking days, during the first wave of the pandemic (March 10 to June 8) using longitudinal data from the Understanding America Study (N = 6,172 unique participants; N = 28,059 observations). Because state mandates were responsive to disease burden, we modeled the interaction of time by COVID-19 burden, defined as whether the state had the median (or higher) daily incidence of COVID-19 cases on the survey date, and state random effects. We controlled for individual sociodemographics, perceived personal/familial COVID-19 burden, mental health symptomology, and risk avoidance. RESULTS: Drinking days increased throughout the duration (incidence risk ratio [IRR] for drinking per increase in one calendar day = 1.003, 95% CI 1.001, 1.004); trends were heterogeneous by disease burden, with individuals living in states with lower COVID-19 burden increasing (IRR = 1.005, 95% CI 1.003, 1.007) faster than those living in states with higher COVID-19 burden (IRR = 1.000, 95% CI 0.998, 1.002). Trends were heterogeneous between states, but there was no evidence of systematic geographic clustering of state trends. CONCLUSIONS: Drinking days increased during the first months of the COVID-19 pandemic, particularly among residents of states with lower disease burden.

Police killings of Black people and rates of sexually transmitted infections: a cross-sectional analysis of 75 large US metropolitan areas, 2016.

OBJECTIVES: Emerging literature shows that racialised police brutality, a form of structural racism, significantly affects health and well-being of racial/ethnic minorities in the USA. While public health research suggests that structural racism is a distal determinant of sexually transmitted infections (STIs) among Black people, no studies have empirically linked police violence to STIs. To address this gap, our study measures associations between police killings and rates of STIs among Black residents of US metropolitan statistical areas (MSAs). METHODS: This cross-sectional ecological analysis assessed associations between the number of Black people killed by police in 2015 and rates of primary and secondary syphilis, gonorrhoea and chlamydia per 100 000 Black residents of all ages in 2016 in 75 large MSAs. Multivariable models controlled for MSA-level demographic and socioeconomic characteristics, police expenditures, violent crime, arrest and incarceration rates, insurance rates and healthcare funding. RESULTS: In 2015, the median number of Black people killed by police per MSA was 1.0. In multivariable models, police killings were positively and significantly associated with syphilis and gonorrhoea rates among Black residents. Each additional police killing in 2015 was associated with syphilis rates that were 7.5% higher and gonorrhoea rates that were 4.0% higher in 2016. CONCLUSIONS: Police killings of Black people may increase MSA-level risk of STI infections among Black residents. If future longitudinal analyses support these findings, efforts to reduce STIs among Black people should include reducing police brutality and addressing mechanisms linking this violence to STIs.

Structural Determinants of Black MSM HIV Testing Coverage (2011-2016).

Over 30 years into the US HIV/AIDS epidemic, Black men who have sex with men (BMSM) continue to carry the highest burden of both HIV and AIDS cases. There is then, an urgent need to expand access to HIV prevention and treatment for all gay and bisexual men, underscoring the importance of the federal initiative 'Ending the Epidemic: A Plan for America'. This research examines structural factors associated with BMSM HIV testing coverage over time (2011-2016) in 85 US Metropolitan Statistical Areas (MSAs). We calculated MSA-specific annual measures of BMSM HIV testing coverage (2011-2016). Variables suggested by the Theory of Community Action (i.e., need, resource availability, institutional opposition and organized support) were analyzed as possible predictors of coverage using multilevel modeling. Relationships between BMSM HIV testing and the following covariates were positive: rates of BMSM living with HIV (b = 0.28), percent of Black residents employed (b = 0.19), Black heterosexual testing rate (b = 0.46), health expenditures per capita (b = 0.16), ACT UP organization presence in 1992 (b = 0.19), and syringe service presence (b = 0.12). Hard drug arrest rates at baseline (b = - 0.21) and change since baseline (b = - 0.10) were inversely associated with the outcome. Need, resources availability, organized support and institutional opposition are important determinants of place associated with BMSM HIV testing coverage. Efforts to reduce HIV incidence and lessen AIDS-related disparities among BMSM in the US require improved and innovative HIV prevention approaches directed toward BMSM including a fuller understanding of structural factors that may influence place variation in BMSM testing patterns and risk behavior in places of high need.

Race and socioeconomic status in pediatric allogeneic hematopoietic cell transplantation for nonmalignant conditions.

BACKGROUND: Survival disparities by race/ethnicity and socioeconomic status (SES) are observed in a wide range of pediatric treatment settings including oncology and solid organ transplantation. To date, few studies have examined the effects of race and SES on outcomes in pediatric allogeneic hematopoietic cell transplantation (HCT). We explored whether survival differed by race/ethnicity or SES in children receiving HCT for nonmalignant conditions at a single institution serving a diverse patient population. PROCEDURES: The Kaplan-Meier method was used to estimate overall survival (OS) with the log-rank test for between-group comparisons. Cox proportional hazards models were used to identify risk factors for OS, adjusting for treatment- and disease-related factors. RESULTS: Of 133 subjects, 0 to 21 years, 19% were non-Hispanic (NH) white, 34% were NH black, 40% were Hispanic, and 7% were Asian. Sixty-seven percent of the subjects had public insurance; 49% lived in neighborhoods with poverty rate ≥20%. Primary diagnoses included hemoglobinopathies (56%), bone marrow failure (22%), and other conditions (22%). Median follow-up was 5.8 years (range 0.1-14.5). Analysis revealed no difference in OS by race, insurance type, or neighborhood SES. CONCLUSIONS: Findings from this single-institution study suggest that in pediatric patients undergoing HCT for nonmalignant conditions, treatment at a tertiary care center with a multidisciplinary approach may mitigate drivers of disparities observed in other settings. Additional studies are now needed to further elucidate the complex interrelationships among race, SES, and clinical outcomes for children undergoing HCT.

Heavy and binge alcohol drinking and parenting status in the United States from 2006 to 2018: An analysis of nationally representative cross-sectional surveys.

BACKGROUND: Binge and heavy drinking are preventable causes of mortality and morbidity. Alcohol consumption by women who parent is damaging to child health, and it is concerning that women in the United States in their reproductive years have experienced increased drinking over the past decade. Although media attention has focused on the drinking status of women who are child-rearing, it remains unclear whether binge and heavy drinking vary by parenting status and sex. METHODS AND FINDINGS: We examined national trends in binge drinking, defined as 5 or more drinks in a single day for men and 4 or more drinks for women, and heavy drinking, defined as 60 or more days with binge episodes in a year. We used survey-weighted logistic regression from the 2006-2018 waves of the cross-sectional National Health Interview Survey (NHIS, N = 239,944 eligible respondents) to study time trends in drinking outcomes by sex, age, and parenting status. Binge drinking increased for both sexes in nearly all age groups, with the largest increase among women ages 30-44 without children (from 21% reporting binge drinking in 2006 to 42% in 2018); the exception was young men (ages 18-29) with children, among whom binge drinking declined. By 2012, the prevalence of binge drinking among young men with children (38.5%) declined to below that of young women without children (39.2%) and stayed lower thereafter. Despite widespread increases in binge drinking, heavy drinking declined or remained stable for all groups except older women (ages 45-55) without children (odds ratio [OR] for heavy drinking each year = 1.06, 95% CI 1.02-1.10) and women ages 30-44, regardless of parenting status. For binge drinking outcomes only, we saw evidence of interaction in drinking trends by parenting status, but this was shown to be confounded by sex and age. Men and women with children reported consistently lower levels of drinking than those without children. Rates of abstention mirrored trends in binge outcomes for both sexes, limiting concerns about invariance. Study limitations include self-reported data and measurement invariance in binge drinking cutoffs across study years. CONCLUSIONS: This study demonstrated that trends in binge and heavy drinking over time were not differential by parenting status for women; rather, declines and increases over time were mainly attributable to sex and age. Women both with and without children are increasing binge and heavy drinking; men, regardless of parenting status, and women without children consumed more alcohol than women with children. Regardless of impact on child health, increased drinking rates in the past decade are concerning for adult morbidity and mortality: binge drinking has increased among both sexes, and heavy drinking has increased among older women. Men and women of all ages and parenting status should be screened for heavy alcohol use and referred to specialty care as appropriate.

Mental illness, drinking, and the social division and structure of labor in the United States: 2003-2015.

BACKGROUND: We draw on a relational theoretical perspective to investigate how the social division and structure of labor are associated with serious and moderate mental illness and binge and heavy drinking. METHODS: The Panel Study of Income Dynamics and the Occupational Information Network were linked to explore how occupation, the productivity-to-pay gap, unemployment, the gendered division of domestic labor, and factor-analytic and theory-derived dimensions of work are related to mental illness and drinking outcomes. RESULTS: Occupations involving manual labor and customer interaction, entertainment, sales, or other service-oriented labor were associated with increased odds of mental illness and drinking outcomes. Looking for work, more hours of housework, and a higher productivity-to-pay gap were associated with increased odds of mental illness. Physical/risky work was associated with binge and heavy drinking and serious mental illness; technical/craft work and automation were associated with binge drinking. Work characterized by higher authority, autonomy, and expertise was associated with lower odds of mental illness and drinking outcomes. CONCLUSIONS: Situating work-related risk factors within their material context can help us better understand them as determinants of mental illness and identify appropriate targets for social change.

Trends in binge drinking in the United States by LGBTQ+ identity, gender, and age, 2014-2022.

BACKGROUND: People who identify as lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ+) have higher rates of risky drinking than their cisgender, heterosexual peers. It is unknown to what extent recent age and gender trends in binge drinking vary by LGBTQ+ identity. METHODS: We used nationally representative, serial, cross-sectional surveys from men and women in the 2014-2022 Behavioral Risk Factor Surveillance System (N = 2,099,959) to examine trends in past-month binge drinking by LGBTQ+ identity, gender, and age (18-29, 30-44, 45 and older). We estimated stratum-specific prevalence ratios for an average 1-year increase in prevalence of past-month binge drinking using survey-weighted log-binomial models, controlling for education, race/ethnicity, marriage, and parenthood status. RESULTS: In the beginning of the study period, LGBTQ+ women endorsed binge drinking at higher prevalences than their cisgender, heterosexual peers (i.e., 2014 predicted probability for women ages 30-44: 0.22 for LGBTQ+, 0.15 for cisgender, heterosexual). LGBTQ+ disparities in women's drinking attenuated over the study period among women in midlife (30-44 age group) due to increases in binge drinking among cisgender, heterosexual women (Prevalence Ratio [PR]: 1.025, 95% CI 1.018-1.033). Among men, we saw no evidence of LGBTQ+ disparities in binge drinking probabilities or in binge drinking trends across all age groups. CONCLUSIONS: Disparities in mid-life binge drinking between LGBTQ+ and cisgender women have begun to diminish. These disparities are closing not because LGBTQ+ women are binge drinking less, but because cisgender, heterosexual women in midlife are binge drinking more.