Agency and fatalism in older Appalachian women's information seeking about gynecological cancer.

Researchers consider older women in rural Appalachia to have low levels of agency and high levels of fatalism regarding decision making about cancer treatment. Using the life course perspective, we examined older women's agency with information seeking about gynecological cancer. Semistructured interviews with 20 White women living in central Appalachia revealed four trajectories: Surrendering Control, Accepting Death, Self-Care, and Advocacy, each with its own forms of agency. Some women experienced personal transformation, increased self-efficacy, and a passion for community empowerment. Fatalism was not understood apart from placing trust in medical expertise. We implore researchers to further explore rural expressions of agency.

Health-Related Quality of Life Among Lesbian, Gay, and Bisexual Adults: The Burden of Health Disparities in 2016 Behavioral Risk Factor Surveillance System Data.

Purpose: Health-related quality of life (HRQoL) measures assess the burdens imposed by mental and physical health problems. We studied whether HRQoL disparities existed among lesbian, gay, and bisexual (LGB) adults. Methods: We examined HRQoL of LGB and heterosexual adults in 25 states (n = 195,378) using data from the 2016 Behavioral Risk Factor Surveillance System survey. We examined the number of days that mental or physical health was not good and days with activity limitations. We also examined frequent (≥14 days per month) mental and physical distress, frequent activity limitations (FALs), and general health status. Chi-square, linear regression, and logistic regression analyses were performed. Results: LGB adults reported significantly more days that their mental health was not good compared with heterosexual adults. Lesbian and bisexual females reported significantly more days with activity limitations than did heterosexual females. Bisexual females reported significantly more days that their physical health was not good; gay males reported significantly fewer days that their physical health was not good. Furthermore, gay and bisexual adults had significantly higher odds of reporting frequent mental distress (FMD). Specifically, gay and bisexual males had 1.6 and 1.7 higher odds of reporting FMD. Bisexual females had higher odds of reporting FMD (adjusted odds ratio [AOR] = 2.67), frequent physical distress (AOR = 1.32), FAL (AOR = 1.78), and poor or fair health (AOR = 1.55), compared with heterosexual females. Conclusions: These HRQoL analyses documented notable burdens of health disparities across sexual orientation identity, especially among bisexual females.

Sexual orientation and sleep difficulties: a review of research.

Is sexual orientation associated with sleep difficulties? In this article, we review empirical evidence that addresses this question. Stress is associated with sleep difficulties such as insomnia and, because members of sexual minorities experience greater stress, on average, than do others, lesbian, gay, and bisexual (LGB) individuals can be expected to report more sleep difficulties than their heterosexual peers. We reviewed 17 studies published since 1990, with data gathered from more than 600,000 individuals; some included data on both quantity and quality of sleep. In nine of 12 relevant studies, at least some sexual minority individuals reported shorter sleep duration than did heterosexual individuals, on average. In nine of 10 relevant studies, sexual minority individuals reported lower quality sleep, on average. Few data were available about other aspects of sleep as a function of sexual orientation. No investigators found LGB people to have fewer sleep difficulties than did heterosexual individuals. We conclude that, although research in this area is new and still limited in some respects, sleep difficulties are more common among LGB than heterosexual people. Our conclusion suggests the possibility that sleep difficulties may underlie known health disparities among members of sexual minorities. Further research is needed to evaluate differences in sleep difficulties among members of sexual minorities, and to explore treatment options for LGB individuals suffering from sleep difficulties.

Decisions, Decisions.

African American families' experiences with mild cognitive impairment (MCI) have received little attention in the research literature. Guided by the life-course perspective, we analyzed qualitative interview data from members of 27 African American families including the person with MCI (PwMCI), a relative or friend who was highly involved in the PwMCI's daily life, and if available, a relative or friend who had at least monthly contact with the PwMCI. Findings uncovered variability in families' MCI awareness, assessment, and need for role changes; the importance of reaching out to trusted others; and honoring PwMCI's care preferences (e.g., who should provide care). Families held varying beliefs about engaging outside support; some families insisted on keeping all care within the family while others were open to the use of external services. We showcase how diagnosis acceptance and family decision-making are at the heart of how African American families respond to MCI.