The Importance of Community Voice: Using Community-Based Participatory Research to Understand the Experiences of African American, Native American, and Latinx People During a Pandemic.

INTRODUCTION: Although the disproportionate impact of COVID-19 infection, hospitalization, and death rates on racial and ethnic minority communities in the US is known, information about how COVID-19 has affected these communities and how community context and perceptions can inform a better response to future health crises needs further exploration. To help achieve these objectives, we used a community-based participatory research approach to gain a better insight into African American, Native American, and Latinx communities. METHODS: From September through December 2020, we conducted 19 focus groups and recruited 142 participants. Participants were selected via a purposeful sampling technique. We used a phenomenology study design to conduct semistructured interviews, thematic analysis to code qualitative data, and descriptive statistics to summarize demographic data. RESULTS: Data analysis revealed the following 3 themes: 1) COVID-19 exacerbated mistrust, anxiety, and fear in racial and ethnic minority populations, affecting their mental health, 2) understanding sociocultural context is essential for emergency response, and 3) adapting communication strategies can help address community concerns. CONCLUSION: Amplifying the voices of people disproportionately affected by the COVID-19 pandemic can help to inform a better response to future health crises and ultimately reduce health inequity among racial and ethnic minority populations.

Spatial analysis of HIV infection and the associated correlates among transgender persons in the United States.

Identifying the geographic hotspots of HIV infection among high-risk populations such as transgender people is critical to ending the HIV epidemic in the United States (U.S.). This study examined the spatial pattern of HIV positivity rate and the associated correlates among transgender persons in the 48 contiguous states and the District of Columbia in the U.S. The data source was the 2015 U.S. Transgender Survey (n = 27,715). We conducted spatial analyses, with state as the unit of analysis. We fitted a spatial lag regression model to assess demographic, social, and behavioral risk variables associated with HIV. The HIV positivity rate ranged by state from 0.5% to 17.1%, with a mean of 2.9%. There was a significant positive global spatial autocorrelation (global Moran's I = 0.42, p = 0.001). The identified spatial clusters of high values (hot spots i.e., states with high HIV positivity rates surrounded by states with similarly high rates) included five neighboring states (Arkansas, Louisiana, Mississippi, Alabama, and Tennessee) in the Southern region. HIV positivity rate was positively associated with the percentage of transgender persons who were non-Hispanic Black, had no high school education, living in poverty, and engaged in sex work. Structural interventions are needed to address education, poverty, racial discrimination, and sex work that predispose transgender persons to HIV.

Spatial variations in family planning demand to limit childbearing and the demand satisfied with modern methods in sub-Saharan Africa.

BACKGROUND: There is an increasing demand for family planning to limit childbearing in sub-Saharan Africa (SSA). However, limited studies have quantified the spatial variations. This study examined: (i) the spatial patterns in the demand for family planning to limit childbearing and satisfied with modern methods, and (ii) the correlates of the demand for family planning to limit childbearing satisfied with modern methods in SSA. METHODS: This study analyzed secondary data on 306,080 married/in-union women obtained from Demographic Health Surveys conducted between 2010 and 2019 in 33 sub-Saharan African countries. We conducted exploratory spatial data analysis, with countries as the unit of analysis. We also performed regression analysis to determine the factors associated with demand for family planning to limit childbearing satisfied with modern methods in SSA. RESULTS: The mean percentage of women who demanded for family planning to limit childbearing by country was 20.5% while the mean prevalence of demand for family planning to limit childbearing satisfied with modern methods by country was 46.5%. There was a significant positive global spatial autocorrelation in the demand for family planning to limit childbearing (global Moran's I = 0.3, p = 0.001). The cluster map showed the concentration of cold spots (low-low clusters) in western and central Africa (WCA), while hot spots (high-high clusters) were concentrated in eastern and southern Africa (ESA). Also, the demand for family planning to limit childbearing satisfied with modern methods showed significant positive global spatial autocorrelation (global Moran's I = 0.2, p = 0.004) and concentration of cold spots in WCA. In the final multivariable regression model the joint family planning decision making (ß = 0.34, p < 0.001), and antenatal care (ß = 13.98, p < 0.001) were the significant factors associated with the demand for family planning to limit childbearing satisfied by modern methods. CONCLUSIONS: There are significant spatial variations in the demand for family planning to limit childbearing and the demand satisfied by modern methods, with cold spots concentrated in WCA. Promoting joint decision making by partners and increasing uptake of antenatal care may improve the demand for family planning to limit childbearing satisfied with modern methods.

In sub-Saharan Africa (SSA), studies have shown that the proportion of married women who want to stop having children has been increasing as well as the proportion using modern contraceptive methods among them. These studies also indicated that this proportion of women are higher in certain regions of Africa than the others. To extend these previous findings, we performed geographical analysis to assess how the proportion of married/in-union women who want to stop having children and the ones using modern methods among them differ geographically. Our findings indicated that neighboring countries where the proportion of married/in-union women who want to stop having children was higher than the overall average were concentrated in eastern and southern Africa (ESA), while neighboring countries in which the proportion of married/in-union women who want to stop having children was lower than the overall average were concentrated in western and central Africa (WCA). Similarly, the results also showed that neighboring countries where the proportion of married/in-union women using modern contraceptive methods among those who want to stop having children was lower than the overall average were concentrated in WCA. Our findings suggest that increasing joint decision making on family planning and uptake of antenatal care in SSA may improve the use of modern contraceptive methods among married/in-union women who want to stop childbearing.

The demand for family planning to limit childbearing satisfied with female permanent contraception in Sub-Saharan Africa: a meta-analysis of demographic and health surveys.

OBJECTIVE: To assess the percentage of the demand for family planning to limit childbearing satisfied with female permanent contraception (FPC) in sub-Saharan Africa (SSA) and the disparities by sociodemographic characteristics (educational status, wealth, religion, and area of residence). STUDY DESIGN: This study was a secondary data analysis of Demographic and Health Surveys conducted in SSA. Countries with a standard DHS conducted between 2010 and 2019 were eligible for inclusion. We performed a meta-analysis with a random-effects model to estimate the percentage of the demand for family planning to limit childbearing satisfied with FPC and differences by sociodemographic characteristics. RESULTS: Demographic and Health Surveys (2010-2018) of 33 countries, with a total of 67,476 women with a demand for family planning to limit childbearing were included in this study. The pooled percentage of the demand for family planning to limit childbearing satisfied with FPC was 4.13% (95%CI = 2.43-6.23%, I = 99.36%, p = 0.001). The percentage ranged from 0.26% (95%CI = 0.10-0.67) in Angola to 26.85% (95%CI = 25.86-27.85%) in Malawi. The demand for family planning to limit childbearing satisfied with FPC was significantly higher in women from rich households (PR = 1.41, 95%CI = 1.21-1.65, p < 0.001). However, the differences by educational status, religion, or area of residence were not statistically significant. CONCLUSIONS: The uptake of FPC among women with a demand for family planning to limit childbearing is low in many countries in SSA. Multilevel interventions are needed to address the barriers that may be limiting informed and voluntary uptake of FPC in SSA.

Changes in body mass index among people living with HIV who are new on highly active antiretroviral therapy: a systematic review and meta-analysis.

In the era of highly active antiretroviral therapy (HAART), obesity is increasingly being reported among people living with HIV (PLHIV). In this study, we reviewed published literature on body mass index (BMI) changes among treatment-naïve adult PLHIV who started HAART and remained on treatment for at least six months. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, four databases were searched, and results of included studies were synthesized to describe the BMI trend among PLHIV on treatment. The search generated 4948 studies, of which 30 were included in the qualitative synthesis and 18 were eligible for the meta-analysis. All the studies showed an increase in group BMI. HAART was associated with increase in BMI (pooled effect size [ES] = 1.58 kg/m2; 95% CI: 1.36, 1.81). The heterogeneity among the 18 studies was high (I2 = 85%; p < .01). Subgroup analyses showed pooled ES of 1.54 kg/m2 (95% CI: 1.21, 1.87) and 1.63 kg/m2 (95% CI: 1.34, 1.91) for studies with follow-up ≤1 year and >1 year, respectively. We conclude that the greatest gain in BMI is in the initial 6-12 months on treatment, with minor gains in the second and subsequent years of treatment.

Changes in Depression and Physical Activity Among College Students on a Diverse Campus After a COVID-19 Stay-at-Home Order.

The numerous negative health impacts of COVID-19, which include expected changes to psychiatric illness and physical activity (PA), are disproportionately distributed in the United States. Mental illnesses and physical inactivity are prevalent among U.S. college students. This study examined whether there was a change in minutes of PA and depression scores after a stay-at-home order and examined predictors of these changes. An online survey was sent to all undergraduate and graduate students attending a large, diverse university via an electronic newsletter. The survey requested information about demographic and academic data, cardiorespiratory fitness, and depression symptoms. Paired t-tests and logistic regression were employed. Our sample (n = 194) was predominantly female (73%), young (mean age of 25), not a sexual minority (82%), and had a mean 3.4 GPA. Students reported worse depression scores (p < 0.01) and fewer minutes of PA (p = 0.01) after the stay-at-home order. There was a small but significant (p = 0.04) correlation between changes in total minutes of PA and depression scores. Senior (p = 0.05) and Hispanic (p = 0.03) students were less likely to report worsening depression scores than freshmen and white students, respectively. Asian students were significantly more likely than white students to report decreased PA. This study suggests that COVID-19 and its consequences may be contributing to reduced PA and greater depression symptoms in college students and that sub-groups have been affected differently. Targeted interventions to promote PA and support mental health may bolster the ability for resilience of college students.

Health care Providers' Perceptions About Overweight and Obesity Among People Living With Human Immunodeficiency Virus in Nigeria.

HIV infection was associated with significant weight loss before the advent of potent antiretroviral therapy (ART). Weight gain while on treatment was seen as a clinical indicator of treatment success. Perceptions of health care providers (HCPs) about obesity among people living with (PLHIV) were examined. We conducted 16 key informant interviews with HCPs in two states in southeastern Nigeria, which were then coded thematically. The respondents included seven physicians, four nurses, three adherence counselors, and two pharmacists. The analysis revealed three key themes: HCPs do not see excess weight gain as a problem; there are several challenges in managing obesity among PLHIV; and comorbidities play a role in the management of obesity among PLHIV. We conclude that obesity among PLHIV is an important clinical issue that HCPs need to address with the commencement of ART.

HIV testing among men in Nigeria: a comparative analysis between young people and adults.

HIV testing among men is critical to ending the HIV epidemic in sub-Saharan Africa. Using the Multiple Indicator Cluster Survey, 2016/2017, we examined the uptake and determinants of HIV testing among sexually active men in Nigeria. A total of 1254 young people (15-24 years) and 7866 adults (25-49 years) were included in the analysis. We conducted binary logistic regression analyses to estimate the odds ratio (OR) and adjusted OR for testing for HIV in the last 12 months preceding the survey. Approximately 18.7% of men had tested for HIV (young people [17%] vs. adult [19%], p=0.125). The overall adjusted model showed that the likelihood of HIV testing was significantly higher among those with at least primary education, currently married, who used condom at last sexual intercourse, who drank alcohol one month preceding the survey, with no discriminatory attitudes towards people living with HIV (PLHIV), exposed to media, in the rich and richest quintiles, and in the North Central Zone. Education, geopolitical zone, and discriminatory attitudes towards PLHIV were the significant factors common to both age groups. Our results suggest that HIV testing among sexually active men in Nigeria is low, and the determinants vary between young people and adults.

The use of social marketing campaigns to increase HIV testing uptake: a systematic review.

Social marketing campaigns have been increasingly used in HIV prevention efforts to address barriers to HIV testing. The purpose of this review is to evaluate the social marketing campaigns in the past ten years (2008-2017) that have targeted HIV testing or intent to test as an outcome, and synthesize the results to determine which campaigns work or do not work. The search was conducted using PubMed, Scopus, PsycINFO, EMBASE, and ABI/Inform. The quality assessment tool for quantitative studies developed by the Effective Public Health Practice Project was used to assess study quality. The search generated 373 articles, of which 13 articles met the inclusion criteria. These articles were from 13 distinct campaigns carried out in 9 countries, twelve of which were in high income countries. Sixty-nine percent (n = 9) of the campaigns targeted MSM, gay men, or MSMW, 23% (n = 3) targeted the general population, while 8% (n = 1) focused on African-American women. The study designs for evaluating the campaigns were predominantly cross-sectional, with 4 of the articles combining two or three study designs to evaluate their campaign. Overall, 38% (n = 5) of the campaigns had an increase in HIV testing outcomes, 23% (n = 3) reported no change in HIV testing outcomes, and the remaining 38% (n = 5) of the studies reported mixed outcomes. The results of the quality rating showed that 69% (n = 9) of the papers had weak global ratings, while 31% (n = 4) had moderate rating. None of the articles had a strong rating. This review displayed that social marketing campaigns intended to increase HIV testing uptake were effective in some context. Social marketing practitioners will need to come up with a standardized way of communicating the results of campaign exposure and impact so as to enhance comparison among the multitude of campaigns.

Health Disparities Among Sexual Gender Minority Women in the United States: A Population-Based Study.

There is a paucity of population-based research to identify health disparities experienced by sexual gender minority (SGM) women. The purpose of this study was to use a population-based data set to understand disparities in access to healthcare, preventive care, and health risk behaviors of lesbian and bisexual women compared to their straight counterparts and to each other. This was a cross-sectional study using the 2016 Behavioral Risk Factor Surveillance System data. SPSS with complex samples was used to calculate weighted descriptive statistics. Logistic regression was used to calculate odds and adjusted odds ratios. 9016 women were included in the analyses. Women who identified as lesbian were more likely to be from a minority group. Bisexual women were more likely to be in the younger age groups and were less likely to be college graduates or report a higher income. Lesbian and bisexual women were more likely to report depression, smoking, and heavy/binge drinking compared to straight women. They were also less likely to have received a pap test. Compare to lesbian women, bisexual women were more likely to report depression and poorer health. SGM women are at greater risk of depression and risky coping behaviors such as smoking and heavy/binge drinking. Within the SGM subgroup, bisexual women have a higher risk for depression and worse general health. Health promotion programs and interventions must be tailored to account for the unique stressors SGM women encounter and associated negative health outcomes.

Effects of Peer Sexual Health Education on College Campuses: A Systematic Review.

Objective. College peer health education groups have grown in popularity to provide information about health and wellness topics. The purpose of this systematic review was to evaluate the effectiveness of peer education groups on reducing sexual health risks and increasing sexual health knowledge on a college campus. Method. The Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed in searching, extracting, appraising, and synthesizing the evidence. A quality assessment was also conducted. The review was conducted in April 2017. Results. The initial search yielded 2,503 records. After critical appraisal, eight articles remained. Peer education was beneficial for increasing knowledge of sexual health topics and creating some behavior change such as increased condom use and HIV testing. Additionally, interventions developed specifically for women were effective. Conclusions. Peer education is an effective way to disseminate sexual health information and can be a reliable resource for college students.

Developing a Theoretical Framework for a Complex Maternal-Child Health Intervention: Health Beginning Initiative.

A theoretical framework serves as a roadmap for the implementation and application of a complex, health promotion intervention; is used to test hypotheses; and guides analysis and evaluation of the intervention. The purpose of this article is to demonstrate how a theoretical framework was developed and used to guide the implementation of Healthy Beginning Initiative (HBI) to promote uptake of HIV services in a low-income country. We used the guide for developing a theoretical framework published in Health Promotion Practice. Developing the theoretical framework included seven steps: (1) identifying the essential elements of the intervention; (2) identifying the variables and the context; (3) listing the postulated mechanisms, mediating variables, and postulated outcomes; (4) identifying existing theoretical models supporting the theoretical framework underdevelopment; (5) scripting the theoretical framework into either a figure or sets of statements; (6) conducting content and face validation of the theoretical framework; and (7) revising the theoretical framework. The theoretical framework was developed and used to evaluate HBI's impact on HIV testing, linkage to care and retention in care for pregnant women, their male partners, and newborns. The theoretical framework will also be adapted for other screenings and other settings while remaining true to the essential elements of HBI.

Interventions to Reduce Loss to Follow-up During All Stages of the HIV Care Continuum in Sub-Saharan Africa: A Systematic Review.

The continuum of care for successful HIV treatment includes HIV testing, linkage, engagement in care, and retention on antiretroviral therapy (ART). Loss to follow-up (LTFU) is a significant disruption to this pathway and a common outcome in sub-Saharan Africa. This review of literature identified interventions that have reduced LTFU in the HIV care continuum. A search was conducted utilizing terms that combined the disease state, stages of the HIV care continuum, interventions, and LTFU in sub-Saharan Africa and articles published between January 2010 and July 2015. Thirteen articles were included in the final review. Use of point of care CD4 testing and community-supported programs improved linkage, engagement, and retention in care. There are few interventions directed at LTFU and none that span across the entire continuum of HIV care. Further research could focus on devising programs that include a series of interventions that will be effective through the entire continuum.

Effective interventions to improve young adults' linkage to HIV care in Sub-Saharan Africa: a systematic review.

HIV/AIDS remains a major public health problem despite the efforts to prevent and decrease its spread. Sub-Saharan Africa (SSA) represents 70% of the global number of people living with HIV and 73% of all HIV/AIDS-related deaths. Young adults age 15-24 years are disproportionately impacted by HIV/AIDS in SSA with 34% of people living with HIV (PLWHIV) and 37% of newly diagnosed individuals being in this age group. It is important that PLWHIV be linked to care to facilitate antiretroviral therapy (ART) initiation and limit the spread of infection. We conducted a systematic literature review to identify effective interventions designed to improve linkage to care among HIV-infected young adults in SSA. One hundred and forty-six titles and abstracts were screened, 28 full-texts were reviewed, and 6 articles met the inclusion and exclusion criteria. Home-based HIV counseling and testing, home-based HIV self-testing, and mobile HIV counseling and testing followed by proper referral of HIV-positive patients to HIV care were effective for improving linkage of young adults to care. Other factors such as referral forms, transportation allowance, home initiation of HIV care, and volunteer escort to the HIV treatment clinic were effective in reducing time to linkage to care. There is a vast need for research and interventions that target HIV-positive young adults in SSA which aim to improve their linkage and access to HIV care. The results of this study illustrate effective interventions in improving linkage to care and reducing time to linkage to care of young adults in SSA.

Increasing HIV testing among pregnant women in Nigeria: evaluating the traditional birth attendant and primary health center integration (TAP-In) model.

Engaging Traditional Birth Attendants (TBAs) may be critical to preventing mother-to-child transmission of HIV (PMTCT) in Nigeria. We integrated TBAs into Primary Health Centers (PHCs) and provided the TBAs with HIV counseling and testing (HCT) training for PMTCT (TAP-In). The purpose of this study was to evaluate the impact of TAP-In on HCT uptake among pregnant women. A quasi-experimental design was used for this study. Twenty PHCs were assigned to the intervention group that integrated TAP-In and 20 were assigned to the control group. Data were collected six months prior to the initiation of TAP-In and six months post, using antenatal clinic registries. Intervention PHCs more than doubled the number of pregnant women who received HCT in their catchment area post TAP-In while control PHCs had no significant change. After initiating TAP-In, intervention PHCs provided almost three times more HCT than the control PHCs (p < 0.01) with TBA provided over half of the HCT post TAP-In. The TAP-In model was effective for increasing HCT among pregnant women.

Retrospective case series analysis of characteristics and trends in unintentional pharmaceutical drug poisoning by methadone, opioid analgesics, antidepressants and benzodiazepines in Clark County, NV 2009-13.

Background: Poisoning has become the leading cause of injury death in the USA-with opioid analgesic involved in more fatal poisonings than any other drug, including cocaine and heroin. The epidemic of prescription drug poisonings is a public health concern. This study aimed to define potential high-risk groups for unintentional prescription drug poisoning by methadone, opioid analgesics, antidepressants or benzodiazepines. Methods: A hospital-based retrospective case series analysis of admissions related to prescription drug poisonings associated with methadone, opioid analgesics, antidepressants or benzodiazepines for hospitals in Clark County, Nevada between 2009 and 2013 was employed. Results: There were 7414 admissions with a primary diagnosis of an unintentional poisoning due to methadone, opioid analgesics, antidepressants or benzodiazepines. Women had the highest rate of admissions particularly in the 45-54 age group. Higher rates of admissions were also found among non-Hispanic whites, single and uninsured populations. There were concerning increases in admissions among 65+ and Native American/Alaskan Native subgroups in 2013. Benzodiazepines and opioid analgesics were the most prevalent drug categories for prescription drug poisoning admissions. Conclusion: Public health professionals can utilize hospital data to identify populations at risk and in need of targeted interventions.

Protective and Risk Factors for Suicidal Ideation and Behavior Among Sexual Minority Women in the United States: A Cross-Sectional Study.

Purpose: The purpose of this study was to understand the factors associated with suicidal ideation and behavior and serious suicidal ideation and behavior among sexual minority women (SMW), including resilience, discrimination, mental health, and sociodemographic characteristics. Methods: Web-based surveys were conducted with SMW from across the United States during January-February, 2022 using psychometric valid tools. Bivariate, hierarchical regression, and logistic regression analyses were used to analyze the data. Results: Of 497 participants, 70% were identified as bisexual and 30% as lesbian. The mean scores for anxiety, depression, and stress were significantly higher among bisexual women compared to their lesbian counterparts (p < 0.05). The proportion of serious suicidal ideation and behavior was higher among bisexual women compared to lesbian women (53.9% vs. 41.2%, p = 0.012). Conversely, the mean scores of resilience were lower among bisexual women compared to lesbian women (139.7 ± 33.4 vs. 147.5 ± 33.6, p = 0.024). Lesbian women had nearly 57.4% lower odds of having serious suicidal ideation and behavior as compared to bisexual women (adjusted odds ratio = 0.426; p = 0.023). Experiencing anxiety, depression, victimization distress, and family discrimination distress were positively associated with serious suicidal ideation and behavior, whereas personal resilience and family cohesion were negatively associated with serious suicidal ideation and behavior. Conclusions: Tackling structural inequities such as racism and homophobia remains vital to improving the mental health of SMW. Interventions to strengthen social and familial supports may be particularly impactful, especially at the family level.

Moderated Mediation Analysis of Structural Stigma and Suicidal Ideation and Behaviors Among Sexual and Gender Minority Adults.

Purpose: This study aimed to conduct a moderated mediation analysis to understand further the complex pathways through which structural stigma in the form of transgender sports bans was associated with suicidal ideation and behaviors among sexual and gender minority (SGM) adults. Methods: A cross-sectional survey of 1033 adults who identified as SGM from across the 50 U.S. states and Washington, DC was conducted between January 28 and February 7, 2022. Distal discrimination distress was the mediation variable; individual resilience and social resources were the moderation variables. Familiarity with transgender sports bans represented structural stigma. The conditional process analysis was applied to build a moderated mediation model. Both conditional direct and indirect effects were computed by estimated coefficients. All models were based on linear regression. Results: Our final model explained nearly half (46%) of the variation in suicidal ideation and behaviors between those SGM adults familiar and those not familiar with transgender sports bans. Social resources significantly moderated the conditional indirect effect of distal discrimination distress (adjusted estimate = -0.23; 95% confidence interval = -0.37 to -0.08). Conclusion: Both discrimination distress and social resources influenced the association between structural stigma as measured by familiarity with transgender sports bans and suicidal ideation and behaviors among SGM adults. Findings support the need for future research examining the pathway between structural stigma and suicidal ideation and behaviors among SGM adults and how minority stress, social safety, and other constructs shape this pathway.

Intrapersonal Predictors of Physical Violence Toward and Sexual Assault of Lesbian and Bisexual Women and the Associated Mental Health Outcomes: A Cross-Sectional Analysis.

Purpose: The purpose of the present study was to identify the prevalence and intrapersonal predictors of physical violence toward and sexual assault of lesbian and bisexual women and the associated mental health outcomes. Methods: This cross-sectional study included 497 U.S.-based lesbian and bisexual women, who completed an online survey during January-February 2022, to investigate physical violence and sexual assault and mental health outcomes. Chi-square, independent-samples t-tests, logistic regression, and multiple linear regression were utilized. Results: More than 25% of the sample reported being the victim of physical violence or sexual assault because of their sexual orientation in the past 12 months. Social support decreased the probability and being out increased the probability of all forms of physical violence and sexual assault (all p < 0.01). Having less educational attainment increased the probability of being punched, hit, kicked, or beaten; assaulted with a weapon; or being sexually assaulted, while living in the Northeast increased the probability of being punched, hit, kicked, or beaten; assaulted with a weapon; or having objects thrown at them (all p < 0.05). Significantly higher mean scores for suicidal ideation were reported by those who had been victims of sexual assault because of their sexual orientation in the past 12 months (p < 0.001). Conclusion: Interventions to address physical violence toward and sexual assault of lesbian and bisexual women should include increasing social support and protections for those who are out about their sexual orientation. In addition, lesbian and bisexual women who experience sexual assault may need resources to address suicidal ideation.

Investigating the Psychosocial Impact of COVID-19 Among the Sexual and Gender Minority Population: A Systematic Review and Meta-Analysis.

Purpose: The purpose of this study was to utilize a systematic review and meta-analysis to assess the existing body of literature to understand the mental health impacts of the coronavirus disease-19 (COVID-19) pandemic among sexual and gender minority (SGM) people. Methods: The search strategy was developed by an experienced librarian and used five bibliographical databases, specifically PubMed, Embase, APA PsycINFO (EBSCO), Web of Science, and LGBTQ+ Source (EBSCO), for studies (published 2020 to June, 2021) examining the psychological impact of the COVID-19 pandemic among SGM people. Articles were screened by two reviewers. The quality of the articles was assessed using the National Institutes of Health quality assessment tool for observational studies. A double extraction method was used for data abstraction. Heterogeneity among studies was assessed by I2 statistic. The random-effects model was utilized to obtain the pooled prevalence. Publication bias was assessed by Funnel plot and Egger's linear regression test. Results: Of a total of 37 studies, 15 studies were included in the meta-analysis with 17,973 SGM participants. Sixteen studies were U.S. based, seven studies were multinational studies, and the remaining studies were from Portugal, Brazil, Chile, Taiwan, the United Kingdom, France, Italy, Canada, and several other countries. A majority of studies used psychometric valid tools for the cross-sectional surveys. The pooled prevalence of anxiety, depression, psychological distress, and suicidal ideation was 58.6%, 57.6%, 52.7%, and 28.8%, respectively. Conclusions: Findings of this study serve as evidence to develop appropriate interventions to promote psychological wellbeing among vulnerable population subgroups, such as SGM individuals.