Sexual orientation based health disparities in Chile.

Numerous studies from Europe and North America have documented sexual orientation-based health disparities, but due to data limitations, very little is known about the health of sexual minorities (i.e., lesbians, gay men, bisexual individuals, and other non-heterosexual populations) in developing countries. This research note uses newly available nationally representative data from the Chilean Socio-Economic Characterization Survey (CASEN) to explore sexual orientation-based disparities in self-rated health, health insurance coverage, and healthcare utilization in Chile. Our findings indicate that sexual minority respondents report worse self-rated health and greater health care utilization, and that sexual minority men are more likely to have private health insurance relative to heterosexual men. These findings are important in facilitating continued efforts to reduce health disparities in Latin America.

Access to Health Care for Transgender and Gender-Diverse Adults in Urban and Rural Areas in the United States.

The objective of this study is to examine access to care based on gender identity in urban and rural areas, focusing on transgender and gender diverse (TGD) populations. Data on TGD (n = 1,678) and cisgender adults (n = 403,414) from the 2019 to 2020 Behavioral Risk Factor Surveillance System were used. Outcome measures were four barriers to care. We conducted bivariate and multivariable logistic regressions to assess associations between access, rurality, and gender identity. Bivariate results show that TGD adults were significantly more likely to experience three barriers to care. In multivariable models, TGD adults were more likely to delay care due to cost in the full sample (adjusted odds ratio [AOR]: 2.00, p < .001), rural subsample (AOR: 2.14, p < .01), and urban subsample (AOR: 1.97, p < .01). This study revealed greater barriers to care for TGD adults, with the most frequent barriers found among rural TGD adults. Increased provider awareness and structural policy changes are needed to achieve health equity for rural TGD populations.

Health Insurance Coverage and Access to Care by Sexual Orientation During the COVID-19 Pandemic: United States, January 2021-February 2022.

Objectives. To compare health insurance coverage and access to care by sex and sexual minority status during the COVID-19 pandemic and assess whether lack of insurance hindered access to care by sexual minority status. Methods. Using Behavioral Risk Factor Surveillance System data (January 2021-February 2022), we examined differences by sex and sexual orientation among 158 722 adults aged 18 to 64 years living in 34 states. Outcomes were health insurance coverage type and 3 access to care measures. Results. Sexual minority women were significantly more likely to be uninsured than were heterosexual women, and lack of insurance widened the magnitude of disparity by sexual minority status in all measures of access. Compared with heterosexual men with health insurance, sexual minority men with health insurance were significantly more likely to report being unable to afford necessary care. Conclusions. During the pandemic, 1 in 8 sexual minority adults living in 34 study states were uninsured. Among sexual minority women, lack of insurance widened inequities in access to care. There were inequities among sexual minority men with health insurance. Public Health Implications. Sexual minority adults may be disproportionately affected by the unwinding of the COVID-19 public health emergency and may require tailored efforts to mitigate insurance coverage loss. (Am J Public Health. 2024;114(1):118-128. https://doi.org/10.2105/AJPH.2023.307446).

Homelessness Among Sexual Minority Youth.

OBJECTIVES: This study examines the prevalence and types of homelessness experienced by sexual minority and heterosexual youth. Then, we examine whether state-level nondiscrimination policies and/or public attitudes on sexual diversity are associated with reduced homelessness among sexual minority youth. Finally, we investigate the differences in health risk behaviors at the intersections of sexual minority and homelessness status. METHODS: We conducted a secondary data analysis using a large population-based sample from 21 states collected in the 2017 and 2019 Youth Risk Behavior Surveys. Self-reported data were obtained from sexual minority (n = 28 405) and heterosexual (n = 136 232) youth through a survey administered in high schools. We assessed the prevalence of homelessness and the types of homelessness. Sexual minority-stratified bivariate and multivariable analyses assessed associations between homelessness, state-level policy and cultural environments, and health-risk behaviors. RESULTS: Sexual minority youth were significantly more likely (12%) to be homeless compared with heterosexual youth (4.1%). Greater acceptance of sexual diversity at the state-level was associated with reduced homelessness among both sexual minority and heterosexual youth. Finally, homeless sexual minority youth experienced a broad array of health risk behaviors in excess of both nonhomeless sexual minority youth and homeless heterosexual youth. CONCLUSIONS: Sexual minority high school students were more likely to experience homelessness than their heterosexual peers. Public attitudes and greater acceptance of sexual diversity were associated with lower levels of sexual minority homelessness. More research and public health programs are needed to prevent and address homelessness among sexual minority youth.

Sexual Orientation, High-Deductible Health Plans, And Financial Barriers To Care.

Among US adults in 2013-18, we found high-deductible health plan enrollment to be the lowest among heterosexual and gay/lesbian adults in families with incomes below 200 percent of the federal poverty level and the highest among bisexual adults in families with incomes at or above 400 percent of poverty. Gay/lesbian and bisexual adults in these plans experienced greater financial barriers to health care than heterosexual adults.

Sports Participation and Transgender Youths.

This Viewpoint describes recent legislation and recommendations from statewide athletic associations regarding sports participation for transgender children and adolescents.

The Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults in Nashville, Tennessee.

Lesbian, gay, bisexual, and transgender (LGBT) populations experience widespread disparities in health outcomes, health behaviors, and access to care compared to their non-LGBT counterparts. Moreover, very few studies have either studied the social determinants of health (SDoH) of LGBT populations or LGBT health in large cities located in the US South. This study uses novel, community-informed, and representative data to study the SDoH of LGBT adults in Nashville and Davidson County, Tennessee. Compared to non-LGBT adults (n = 1583), LGBT adults (n = 128) in Nashville, Tennessee, were more likely to report being dissatisfied with life and feeling emotionally upset or physical symptoms as a result of how they were treated based on their race/ethnicity compared to non-LGBT adults. LGBT adults in Nashville were also less likely to keep a firearm in the home than their non-LGBT peers. This study documents new disparities in the SDoH for LGBT adults living in one of the largest and fastest growing cities in the southeastern US. More research on LGBT populations in urban centers located in the US South is critically needed. Meanwhile, locally based community organizations and public health leaders may consider developing and testing innovative solutions to enhance social networks and social supports among LGBT populations. Addressing the SDoH among LGBT adults in southern cities will be essential for achieving health equity for all LGBT populations in the USA.

LGBTQ College student health and wellbeing at the onset of the pandemic: additional evidence and lessons learned from COVID-19.

BACKGROUND: The coronavirus (COVID-19) pandemic has killed more than six million people and disrupted health care systems globally. In the United States alone, more than one million people have died from COVID-19 infections. At the start of the pandemic, nearly all aspects of our lives paused to prevent the spread of the novel coronavirus. Many institutions of higher education transitioned to remote learning and enacted social distancing measures. This study examined the health needs and vulnerabilities of lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) college students at the start of the COVID-19 pandemic in the United States. METHODS: We fielded a rapid-response online survey between April and June of 2020. We recruited 578 LGBTQ-identifying college students aged 18 years and older by reaching out to LGBTQ-serving organizations on 254 college campuses and via targeted social media advertising. RESULTS: Approximately 40% of LGBTQ college students surveyed were dissatisfied with life at the start of the COVID-19 pandemic, and almost all (90%) were concerned that COVID-19 would threaten their mental health. Moreover, about 40% of LGBTQ college students reported unmet mental health needs, and 28% were worried about seeking care during the pandemic because of their LGBTQ identity. One out of four LGBTQ college students had to go back in the closet because of the pandemic, and approximately 40% were concerned about their finances or personal safety during the COVID-19 pandemic. Some of these adverse outcomes were prominent among younger students, Hispanic/Latinx students, and students with unsupportive families or colleges. CONCLUSIONS: Our study adds novel findings to the large body of research demonstrating that LGBTQ college students experienced distress and elevated mental health needs early in the pandemic. Future research should examine the long-term consequences of the pandemic among LGBTQ and other minoritized college students. Public health policymakers, health care providers, and college and university officials should provide LGBTQ students affirming emotional supports and services to ensure their success as the COVID-19 pandemic transitions to endemic.

Health Status and Health Care Access Among Lesbian, Gay, and Bisexual Adults in the US, 2013 to 2018.

This cross-sectional study evaluated data from a large US survey (2013-2018) to determine how health status and access have changed among lesbian, gay, and bisexual adults compared with heterosexual counterparts.

Gender Minority Youth Experiencing Homelessness and Corresponding Health Disparities.

PURPOSE: Pediatricians and youth service providers frequently interface with vulnerable populations, including gender minority youth (e.g., transgender, nonbinary, gender questioning, and other gender diverse individuals) and youth experiencing homelessness. The purposes of this study are to estimate the prevalence of homelessness and types of homelessness experienced among gender minority youth and their corresponding health outcomes. METHODS: Data for this study came from gender minority (n = 3,194) and cisgender (n = 93,337) high school students who answered questions on transgender status and homelessness status in the 2017 and 2019 Youth Risk Behavior Survey (YRBS). We compared the prevalence of homelessness between gender minority and cisgender youth and assessed where youth experiencing homelessness had slept in the prior month: shelters, nonparental homes, streets, hotel, or other locations. Finally, logistic regression models and marginal effects (ME) were used to examine health outcomes at the intersection of gender minority status and homelessness. RESULTS: 22% of gender minority youth reported homelessness during the prior month. Cisgender youth were significantly less likely to report being homeless (3%). Transgender youth experiencing homelessness were significantly more likely to live on the streets than cisgender youth experiencing homelessness (ME = 0.20; 95% CI = 0.10-0.30; p < .001). Gender minority youth experiencing homelessness reported elevated health-risk behaviors in excess of nonhomeless gender minority youth and cisgender youth experiencing homelessness. DISCUSSION: Public health campaigns, housing interventions, and youth service providers should consider and create tailored programs to secure housing and to promote the health of gender minority youth experiencing homelessness.

Sexual Behavior Change Among Gay and Bisexual Men During the First COVID-19 Pandemic Wave in the United States.

Background: After decades of navigating HIV and other sexually transmitted infections, gay and bisexual men are responding to new and uncertain risks presented by the coronavirus (COVID-19) pandemic by adapting their sexual behavior. Methods: This paper uses data from a national sample of 728 gay and bisexual men collected from April 10 to May 10, 2020, to examine changes to sexual behavior in response to the first wave of the pandemic in the USA. We also assess whether behavior modifications are associated with exposure to statewide public health measures, including Stay-at-Home orders. Results: Sexual minority men report significant changes to their sexual behavior and partner selection during the first wave. Nine out of 10 men reported having either one sexual partner or no sexual partner in the last 30 days at the time of interview, a decrease compared to just before the pandemic for nearly half of men surveyed. Reporting no sexual partners in the last 30 days was significantly predicted by increased exposure to a Stay-at-Home order. Sexual minority men also reduced interactions with casual partners, increased no-contact sexual behaviors (e.g., masturbation and virtual sex), and engaged in new strategies to reduce their risks of infection from partners. HIV-positive men were particularly likely to adopt strategies including avoiding casual partners and avoiding public transportation to meet sexual partners. Conclusion: Sexual minority men's behavior changes during the first wave may have reduced the impact of the coronavirus pandemic on their communities. Despite substantial changes in sexual behavior for most men in our sample during the initial first wave, we identify some concerns around the sustainability of certain behavioral changes over time and nondisclosure of COVID-19 symptoms to partners.

Effects of the affordable care Act's Medicaid expansion on health insurance coverage for individuals in same-sex couples.

OBJECTIVE: To examine whether the Affordable Care Act's (ACA's) Medicaid expansions affected health insurance coverage for individuals in same-sex couples. DATA SOURCES AND STUDY SETTING: We used data on adults aged 18-64 years in same-sex couples (n = 33,512) from the 2008-2018 American Community Survey (ACS). STUDY DESIGN: To estimate the effect of the impact of the state Medicaid expansions under the ACA on health insurance coverage for sexual minorities, we utilize a standard difference-in-differences approach to leverage the variation across geography and time in expanding Medicaid. DATA COLLECTION: Secondary and publicly available ACS data were obtained from IPUMS at the University of Minnesota. PRINCIPAL FINDINGS: We find that Medicaid expansion significantly increased health insurance coverage among low-income men and women in same-sex couples by 4.9 (standard error [SE] = 1.75) and 6.5 (SE = 1.96) percentage points, respectively. We find increases in the likelihood of having Medicaid and reductions in private health insurance from an employer or privately purchased insurance. Effects on Medicaid take-up are consistently larger for low-income women in same-sex couples as compared to low-income men in same-sex couples. CONCLUSIONS: We provide the first evidence on the relationship between state Medicaid expansions under the ACA and health insurance coverage among sexual minority adults, a group that has been understudied in past research. Our results confirm that sexual minority adults benefitted from the ACA's Medicaid expansions with respect to increased health insurance coverage.

Sexual Orientation, Mental Illness, and Substance Use Disorders Among Criminal Legal System-Involved Individuals.

OBJECTIVE: The purpose of this study was to examine the prevalence of mental illness, substance use disorders, and access to treatment among individuals from sexual minority groups who have been involved with the criminal legal system. METHODS: This study used data from 195,239 heterosexual adults and 14,995 sexual minority adults ages ≥18 years surveyed in the 2015-2019 National Survey on Drug Use and Health. The authors compared mental illness, substance use disorders, and access to treatment between sexual minority and heterosexual adults by using multivariable logistic regression models and controlling for sociodemographic characteristics. RESULTS: Approximately 9% of legal system-involved adults identified as belonging to a sexual minority group. Among legally involved individuals, sexual minority individuals were more likely than heterosexual individuals to have a serious mental illness, suicidal ideation, or depressive thoughts and to use inhalants, hallucinogens, alcohol, marijuana, or cocaine. Legally involved sexual minority individuals were also more likely than their heterosexual counterparts to receive treatment for mental illness or substance use disorders. The increased probability of receiving treatment for mental illness and substance use among sexual minority individuals was also observed when comparing sexual minority and heterosexual adults not involved with the criminal legal system. CONCLUSIONS: This study adds new population-based research to a limited body of evidence on the health disparities and mental health needs of legally involved sexual minority populations. More research and programmatic and policy interventions are needed to better support legally involved sexual minority groups in order to achieve mental health equity for this vulnerable population.

State Policies and Health Disparities between Transgender and Cisgender Adults: Considerations and Challenges Using Population-Based Survey Data.

CONTEXT: The authors examined the association between state-level policy protections and self-rated health disparities between transgender and cisgender adults. METHODS: They used data on transgender (n = 4,982) and cisgender (n = 1,168,859) adults from the 2014-2019 Behavioral Risk Factor Surveillance System. The authors estimated state-specific health disparities between transgender and cisgender adults, and they used multivariable logistic regression models to compare adjusted odds ratios between transgender and cisgender adults by state-level policy environments. FINDINGS: Transgender adults were significantly more likely to report poor/fair health, frequent mental distress, and frequent poor physical health days compared to cisgender adults. Disparities between transgender and cisgender adults were found in states with strengthened protections and in states with limited protections. Compared to transgender adults in states with limited protections, transgender adults in states with strengthened protections were marginally less likely to report frequent mental distress. CONCLUSIONS: Transgender adults in most states reported worse self-rated health than their cisgender peers. Much more research and robust data collection on gender identity are needed to study the associations between state policies and transgender health and to identify best practices for achieving health equity for transgender Americans.

LGBTQ+ Perspectives on Conducting Genomic Research on Sexual Orientation and Gender Identity.

We conducted in-depth, semi-structured interviews with LGBTQ+-identified individuals (n = 31) to explore the range of LGBTQ+ perspectives on genomic research using either sexual orientation or gender identity (SOGI) data. Most interviewees presumed that research would confirm genetic contributions to sexual orientation and gender identity. Primary hopes for such confirmation included validating LGBTQ+ identities, improved access to and quality of healthcare and other resources, and increased acceptance in familial, socio-cultural, and political environments. Areas of concern included threats of pathologizing and medicalizing LGBTQ+ identities and experiences, undermining reproductive rights, gatekeeping of health or social systems, and malicious testing or misuse of genetic results, particularly for LGBTQ+ youth. Overall, interviewees were divided on the acceptability of genomic research investigating genetic contributions to sexual orientation and gender identity. Participants emphasized researchers' ethical obligations to LGBTQ+ individuals and endorsed engagement with LGBTQ+ communities throughout all aspects of genomic research using SOGI data.

An algorithm using administrative data to measure adverse childhood experiences (ADM-ACE).

OBJECTIVE: To develop an algorithm using administrative data to measure adverse childhood experiences (ADM-ACE) within routinely collected health insurance claims and enrollment data. DATA SOURCES: We used claims and enrollment data from Tennessee's Medicaid program (TennCare) in 2018. STUDY DESIGN: We studied five types of ACEs: maltreatment and peer violence, foster care and family disruption, maternal mental illness, maternal substance use disorder, and abuse of the mother. We used diagnosis and procedure codes, prescription drug fills, and enrollment files to develop the ADM-ACE, which we applied to measure the prevalence of ACEs and to examine prevalence by demographic characteristics among our sample of children in TennCare. We compared ADM-ACE prevalence to child welfare records and survey results from Tennessee. DATA COLLECTION/EXTRACTION METHODS: Our study sample included children aged 0-17 years who were linked to their mothers if also enrolled in TennCare in 2018 (N = 763,836 children). PRINCIPAL FINDINGS: Approximately 19.2% of children in TennCare had indicators for ADM-ACEs. The prevalence of ACEs was higher among children who were younger (p < 0.001), non-Hispanic white or black (compared to Hispanic) (p < 0.001), and children residing in rural versus urban counties (p < 0.001). The prevalence of maltreatment identified through the ADM-ACE (1.6%) falls between the percent of children in Tennessee who were reported to child welfare authorities and the percent for whom reports of maltreatment were substantiated. Comparison with survey reports from Tennessee parents suggests an advantage in measuring maternal mental illness with the ADM-ACE using health insurance claims data. CONCLUSIONS: The ADM-ACE can be applied to health encounter data to study and monitor the prevalence of certain ACEs, their association with health conditions, and the effects of policies on reducing exposure to ACEs or improving health outcomes for children with ACEs.