O (des)cuidado em saúde às pessoas LGBTQIAP+ dispensado por profissionais em unidades básicas de saúde / The (lack of)health care provided to LGBTQIAP+ people by professionals in primary care centers / El (des)cuidado en salud a las personas LGBTQIAP+ dispensado por profesionales en unidades básicas de salud

Objetivo: compreender o cuidado em saúde dispensado às pessoas LGBTQIAP+ por profissionais em Unidades Básicas de Saúde, a partir do referencial teórico da Política Nacional de Saúde LGBT (PNSILGBT) estabelecida pelo Sistema Único de Saúde (SUS). Método: estudo descritivo, com abordagem qualitativa, que entrevistou 12 profissionais de saúde da Atenção Básica. Os dados coletados passaram pela Análise Lexical utilizando-se do software IRAMUTEQ. Resultados: emergiram três categorias temáticas que possibilitaram compreender que os profissionais reconhecem as violências praticadas na assistência a essa população, as barreiras no acesso e as dificuldades enfrentadas por pessoas LGBTQIAP+. Considerações finais: o desconhecimento das políticas e a não percepção das consequências dessas ações para a saúde dessa população remete muito mais ao (des)cuidado do que efetivamente ao cuidado condizente as suas reais necessidades em saúde.

Objective: to understand the health care provided to LGBTQIAP+ people by professionals in Primary Care Centers, based on the theoretical framework of the National LGBT Health Policy (PNSILGBT) established by the Unified Health System (SUS). Method: a descriptive study with a qualitative approach, which interviewed 12 primary care health professionals. The data collected was subjected to Lexical Analysis using the IRAMUTEQ software. Results: Three thematic categories emerged which made it possible to understand that professionals recognize the violence practiced in assisting this population, the barriers to access and the difficulties faced by LGBTQIAP+ people. Final considerations: the lack of knowledge of the policies and the lack of perception of the consequences of these actions for the health of this population leads much more to (lack of)care than to care in line with their real health needs.

Objetivo: comprender el cuidado en salud brindado a las personas LGBTQIAP+ por profesionales en Unidades Básicas de Salud, partiendo del marco teórico de la Política Nacional de Salud LGBT (PNSILGBT) establecida por el Sistema Único de Salud (SUS). Método: estudio descriptivo, con enfoque cualitativo, que entrevistó a 12 profesionales de salud de la Atención Básica. Los datos recogidos fueron analizados mediante Análisis Léxico utilizando el software IRAMUTEQ. Resultados: surgieron tres categorías temáticas que permitieron comprender que los profesionales reconocen las violencias ejercidas en la asistencia a esta población, las barreras en el acceso y las dificultades enfrentadas por personas LGBTQIAP+. Consideraciones finales: el desconocimiento de las políticas y la no percepción de las consecuencias de estas acciones para la salud de esta población reflejan mucho más el (des)cuido que efectivamente el cuidado acorde a sus reales necesidades en salud.

Factors Influencing Kidney Transplantation Experiences for Patients From Culturally and Linguistically Diverse Backgrounds: A Qualitative Study.

BACKGROUND: Disparities in aspects of chronic kidney disease progression and management exist for patients from culturally and linguistically diverse (CALD) backgrounds, including with treatment and outcomes for kidney transplantation. OBJECTIVE: This study aimed to explore factors that impact kidney transplant outcomes from the perspective of kidney transplant recipients (KTRs) from CALD backgrounds and their family caregivers. METHODS: A descriptive qualitative design was utilised. Participants were recruited from two tertiary hospitals in Victoria, Australia. Semi-structured interviews were conducted with KTRs who were born overseas in countries where English is not the primary language. Interviews were also conducted with family caregivers. Analysis was guided by the Framework Method, and emergent subcategories were mapped into the categories identified in Andersen's Health Service Utilisation Model. RESULTS: Data from 21 KTRs and five caregivers were grouped under the categories of Population Characteristics, Environment, Health Behaviour and Outcomes. KTRs believed that neither culture nor religious beliefs impacted how they managed their transplant or healthcare utilisation. KTRs expressed satisfaction with their care, felt no inequity with how they were treated by health professionals and expressed gratitude for the Australian healthcare system. Language did not necessarily impact transplant outcomes, but there was a reliance on interpreters for non-English-speaking patients as most written information was in English. Caregivers were instrumental in providing support but discussed the challenges involved. CONCLUSION: This study explored factors influencing kidney transplantation for KTRs from a CALD background. The study provided insight into how to deliver quality healthcare to these patients, highlighting the importance of health services providing information that is written in the patient's own language and respectively asking KTRs about their health beliefs or customs. Caregivers were instrumental in supporting KTRs, but there is a need to better prepare them for this role. PATIENT OR PUBLIC CONTRIBUTION: Patient and public involvement was integrated into the design and delivery of the study. KTRs from CALD backgrounds assisted with framing the research questions and offering advice on the recruitment and data collection process.

Dermatological care of gender-diverse patients in Australia.

In recent years, there has been an increasing recognition of the unique healthcare needs of gender-diverse patients in Australia. With the continuous growth of referrals to gender health services, there is an increased demand for specialised dermatological care. There is still a significant knowledge gap and a lack of guidelines specifically tailored to this patient group. In this article, we will provide a brief overview of the journey of Transgender and Gender Diverse (TGD) individuals as they embark on psychological and pharmacologic treatment for gender dysphoria in Australia. We endeavour to contribute to the existing body of knowledge by examining the evidence surrounding the treatment of skin, hair and nail issues for TGD patients. This article will outline how dermatologists can assist in the care of the gender-diverse patient. Although puberty blockade (stage 1 treatments) has minimal dermatological impact, gender-affirming pharmacotherapy (stage 2 treatments) can lead to many dermatological issues including acne, patterned hair loss (PHL) and dermatitis. The dermatologist may also play a role in stage 3 treatments which include surgical or procedural interventions for gender affirmation.

Secondhand tobacco smoke exposure in homes and vehicles in youth: disparities among racial, and sexual and gender minorities.

Background: Secondhand smoke exposure (SHSe) among youth is a serious public health concern, leading to an increased risk of conditions such as asthma and respiratory infections. However, there is little research on SHSe among vulnerable populations, such as racial and sexual minorities. Understanding the factors associated with youth SHSe in homes and vehicles is crucial to developing better protective policies. Methods: This study utilized 2020 data from the National Youth Tobacco Survey, a representative sample of middle- and high-school students in the US. The primary outcomes were youth SHSe at home and while riding in a vehicle. Multinomial regression models were used to assess factors associated with SHSe. Results: The data included 9,912 students enrolled in grades 6 through 12 in the United States who reported never using any form of tobacco. Non-Hispanic Black students living with someone who does not use any form of tobacco products were significantly more likely to experience moderate [OR = 2.1 (1.1-3.9), p = 0.03] and severe [OR = 5.1 (2.2-11.7), p < 0.001] secondhand smoke exposure (SHSe) in homes compared to their non-Hispanic White counterparts. Heterosexual female students had lower odds of reporting moderate SHSe in the home compared to heterosexual males [OR = 0.7 (0.6-0.99), p = 0.02], whereas bisexual females had two-fold increased odds of severe SHSe in homes [OR = 2.0 (1.2-3.4), p = 0.01]. Conclusion: Significant efforts are needed to develop targeted interventions to reduce SHSe in homes and vehicles, particularly in these vulnerable populations.

Factors Associated with HIV Pre-Exposure Prophylaxis Use Among Transmasculine People Who Have Sex with Cisgender Men, at a Federally Qualified Health Center in Chicago, Illinois.

Transmasculine individuals who have sex with cisgender men (TMSM) remain an understudied population regarding pre-exposure prophylaxis (PrEP). We used electronic medical record data to assess PrEP eligibility and initiation in TMSM in a large LGBTQ+ focused federally qualified health center in Chicago, Illinois. We examined a sample of 430 TMSM from January 1, 2015 to December 31, 2019, and used logistic regression to model PrEP eligibility and initiation. Overall, 37% of participants were eligible for and 18% initiated PrEP. Eligibility was not associated with initiation. National PrEP guidance should be tailored to include transmasculine people.

Qualitative exploration of uterine cancer care for lesbian, gay, bisexual, trans and queer (LGBTQ+) patients in the UK: shifting from equality to equity.

OBJECTIVE: Patients identifying as lesbian, gay, bisexual, transgender and/or queer/questioning (LGBTQ+) report significant disparities in cancer care and are disproportionally affected by a cancer diagnosis on a number of health-related indicators. This study aimed to explore uterine cancer (UC) care from the perspectives of LGBTQ+ patients and stakeholders, to identify this population's care needs, which have been underprioritised thus far. METHODS AND ANALYSIS: Qualitative interview data were collected from three cohorts of participants: LGBTQ+ UC patients, partners of UC patients and stakeholders who provide advocacy and/or support within the UC care pathway, including healthcare professionals (HCPs). Semi-structured qualitative interviews were conducted and data were analysed using inductive reflexive thematic analysis. RESULTS: Fifteen participants (three patients, one partner, eight HCPs and three cancer support charity representatives) were recruited. Data analysis identified themes which represented participants' reflections on the relevance and opportunities for identity disclosure during the diagnostic pathway; feelings and implications of not fitting into the gynaecological cancer environment and, opportunities and challenges surrounding HCP education, and protocolled sexual and gender identity data collection. CONCLUSION: UC patients who identify as LGBTQ+ have specific care needs and considerations, particularly related to transvaginal procedures and survivorship. Opportunities for disclosure of patients' LGBTQ+ identity during the UC care pathway are essential for these needs to be recognised. Despite this, there are conflicting agendas between HCPs and stakeholders on the best approach to integrate disclosure processes. The current findings highlight the need for public health agendas and clinical services to address the needs of LGBTQ+ UC patients.

Health and social care experience and research perception of different ethnic minority populations in the East Midlands, United Kingdom (REPRESENT study).

INTRODUCTION: Ethnic minority populations experience significant health and social care disparities; despite experiencing a greater burden of diseases, these groups are underrepresented in health and social care research. Consequently, related research can be less applicable to these population groups. The REPRESENT study aims to explore the health and social care experiences of ethnic minorities and other minoritised populations, their research interests and appropriate research practices. METHODS: Focus groups and semistructured interviews were conducted between May and September 2022 with members of a number of ethnic minority communities in England. Data were audio recorded, transcribed and thematically coded using NVivo 12. Rigour was determined through extensive sampling, iterative data collection and analysis. FINDINGS: Fifty-two ethnic minority members were engaged in group interviews and one-to-one interviews. Participants included representatives of the following groups: African Caribbean, Eastern European, Gypsy Travellers, Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual+, Refugee/Asylum Seekers, Somali and South Asian communities. Interviews were also conducted with ethnic minority healthcare providers and researchers. Three overarching categories were identified: health information, medical service experiences, health and social care concerns and health research. Health and social care services challenges were mostly attributed to discrimination, delayed services, poor cultural relevance and language and cultural barriers. The most influential information sources were local community organisations and word-of-mouth. The main health and social care concerns were chronic long-term health conditions, mental health, maternal health and child development. Recommendations for research involved understanding the motivations for participation, improving communication and empowering communities. Top research priorities were long-term health conditions, health promotion and education, early care interventions and understanding community needs. INTERPRETATION: Discrimination and bias in health and social care provision have severe implications for worsening ethnic health inequalities. Healthcare commissioning authorities and policymakers can leverage the preference of ethnic minority groups for pharmacy services and community organisations to improve access to care. Improving research interest and engagement requires understanding individual community needs, community sensitivity, research relevance and cultural appropriateness. PATIENT OR PUBLIC CONTRIBUTION: Members of ethnic minority Patient and Public Involvement and Engagement group and Community Advisory Board supported the REPRESENT study design, conceptualisation and report development.

Common and Unique Risk Factors for Intimate Partner Violence Victimization Among Sexual and Gender Minority Individuals Assigned Female at Birth.

Sexual and gender minority youth assigned female at birth (SGM-AFAB) are at disproportionately high risk for intimate partner violence victimization (IPVV), yet remain understudied. Using two time points of data collected from 367 SGM-AFAB young people (aged 16-31 years), we tested whether common, general population risk factors (childhood violence, depression, alcohol and cannabis use, and low social support) and unique stigma-related factors (enacted stigma, microaggressions, and internalized stigma) prospectively predicted psychological, physical, sexual, and identity abuse IPVV in the following 6 months. Results indicated that some traditional risk factors, including child abuse, depression, cannabis use, and low social support, raise IPVV risk among SGM-AFAB youth. Microaggressions and internalized stigma represent additional, unique IPVV risk factors in this population. SGM-affirmative efforts to prevent IPVV should address these common and SGM-specific risk factors.

Vaccine effectiveness against anal HPV among men who have sex with men aged 18-45 years attending sexual health clinics in three United States cities, 2018-2023.

BACKGROUND: We assessed human papillomavirus (HPV) vaccine effectiveness (VE) against anal HPV among men who have sex with men (MSM) in 2018-2023. METHODS: Residual anal specimens from MSM without HIV ages 18-45 years were tested for HPV. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between vaccination (≥1 dose) and quadrivalent vaccine (4vHPV)-type prevalence adjusting for city, race/ethnicity, and non-vaccine-type HPV prevalence, stratified by age group (18-26, 27-45). VE was calculated as (1-aPR)x100. RESULTS: Among 2802 persons aged 18-26, 4vHPV-type prevalence was lower in those vaccinated at age <18 (aPR=0.13, CI: 0.08-0.22, VE=87%) and those vaccinated ≥2 years before specimen collection (aPR=0.52, CI: 0.42-0.64, VE=48%), compared with unvaccinated persons. Among 3548 persons aged 27-45, 4vHPV-type prevalence was lower in those vaccinated at ages 18-26 (aPR=0.68, CI: 0.57-0.82, VE=32%) and those vaccinated ≥2 years before specimen collection (aPR=0.66, CI: 0.57-0.77, VE=33%), compared with unvaccinated persons. While we observed no VE in persons vaccinated at age >26 overall, 4vHPV-type prevalence was lower in the subgroup vaccinated ≥2 years before specimen collection (aPR=0.71, CI: 0.56-0.89, VE=29%). CONCLUSIONS: We found high VE against anal 4vHPV-type prevalence among MSM aged 18-26 who were vaccinated at age <18. Lower VE was observed among MSM ages 27-45 who were vaccinated at age 18-26 or ≥2 years before specimen collection. While ideally vaccination should be given at younger ages, vaccination can prevent some future infections in this population.

Why Did Our Trial Not Work Out? A Qualitative Analysis.

Background: An online self-help programme for the treatment of depression called Hap-pas-Hapi was tested among Albanian-speaking immigrants in Switzerland and Germany, and two different levels of cultural adaptation were compared. Despite a massive recruitment effort, an insufficient number of participants could be recruited, and the drop-out rate was over 90%. Aims: We conducted a qualitative study to better understand the reasons for the non-use of Hap-pas-Hapi. Method: Eleven interviews were conducted with 17 Albanian-speaking participants aged 19-59. Participants were recruited for the purpose of this study and were not participants from the trial. They went through the recruitment material and the Hap-pas-Hapi introduction module, commented on the graphic design, usability, content, and shared their views about mental health and self-help. Results: Participants criticised the lack of a "design system" (i.e., a clearly identifiable and consistent graphic design) on social media for Hap-pas-Hapi, and the recruitment messages were unclear. The programme itself was perceived to be important and helpful for the community at large, but most participants said that they would not use it for themselves. The younger generation would have preferred an application in German or French, while the older generation did not see a benefit in using an online self-help programme to manage their psychological distress. Negative beliefs about mental disorders and psychological interventions were perceived to be common in this target group. Discussion: A professional recruitment strategy, a more careful selection of the target population (e.g., age groups) and different kinds of adaptations might have resulted in a better acceptance of the intervention. At the same time, anti-stigma campaigns and psychoeducation are needed to enhance treatment motivation.

Household Income and Offspring Education Explain Blacks' Diminished Returns of Parental Education.

Background: High parental education promotes various aspects of offspring well-being including reducing their risk of depression/anxiety, criminal justice involvement, and welfare reliance. However, according to minorities' diminished returns, these benefits are not equal across racial groups, with Black families experiencing diminished returns of parental education compared to White families. This study explores the role of household income and offspring educational attainment as potential serial pathways that operate as mechanisms underlying diminished returns of parental education on offspring outcomes in Black families. Gender differences in these effects were also explored. Methods: Utilizing data from the Future of Families and Child Wellbeing Study (FFCWS) over a 22-year follow-up period (seven waves), we examined the serial mediation by household income and offspring educational attainment in explaining the relationship between parental education and offspring outcomes namely depression, anxiety, criminal justice involvement, and welfare reliance [Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP)]. We used structural equation modeling (SEM) with household income as the first mediator and young adult education as the second mediator. Multi-group models were used to explore gender differences in these paths. Results: The study confirmed the role of our proposed serial mediators for Blacks' weaker effects of parental education on offspring outcomes. We observed weaker effects of first affects household income, with this effect being for Black families compared to White families, which then impacted educational attainment of the offspring. The findings indicate that household income plays a crucial mediating role, but its effect is weaker in Black families. Additionally, the educational attainment of offspring from highly educated Black parents is less effective in improving outcomes compared to their White peers, further contributing to diminished returns. Some gender differences were observed for the effects of educational attainment on economic and health outcomes of young adults. Conclusions: The study underscores the need to reconsider traditional assumptions about the comparability of family conditions and outcomes across racial groups with similar levels of parental education. The findings highlight the importance of targeted policies and interventions aimed at enhancing the economic stability and educational outcomes of Black families to address these disparities. Policies should focus on promoting the economic well-being of highly educated Black parents and improving the educational outcomes of their children.

Measurement invariance of the Intuitive Eating Scale-2 across country, ethnicity, sex, and sexual orientation: A cross-cultural study between Brazil and the U.S.

Intuitive eating is defined as being connected to internal hunger, satiety, and appetitive cues and flexibly using these cues to determine when, what, and how much to eat. The Intuitive Eating Scale-2 (IES-2) is a widely used measure of facets of intuitive eating. However, the scale has shown unstable factor structure in several validation studies and there is a lack of studies investigating the measurement invariance of the IES-2 beyond sex. We aimed to evaluate the psychometric properties of the IES-2, testing several factor structures among Brazilian and U.S. samples of men and women; to test measurement invariance across country of origin, ethnicity, sex, and sexual orientation; and to evaluate its internal consistency. Three models of the latent structure of the IES-2 were tested using confirmatory factor analyses (CFA) in a total of 1072 young adults (452 Brazilians and 620 Americans), aged 18-35 years. Results demonstrated that only a 3-factor solution with 11 items of the IES-2 showed adequate fit to the data for both countries. This model demonstrated scalar invariance across sex and sexual orientation, but only configural invariance was found across country of origin and ethnicity. Good internal consistencies were found for both the Brazilian and American samples. The present study provides support for a 3-factor solution with 11 items of the IES-2, to Brazilian and American samples. The study also offers evidence of internal consistency, and invariance between sex (i.e., male and female) and sexual orientation (i.e., heterosexual participants and sexual minority participants).

Heterogeneous Trajectories in Post-Disaster Drug Use Across Different Race/Ethnicity and Income Strata: Focus on Natural Hazards During COVID-19.

During the COVID-19 pandemic, climate-related natural hazards, such as wildfires, storms/hurricanes, and others (e.g., earthquakes, tornadoes), further disrupted the normal functioning of US residents. The co-occurrence of natural disasters and COVID-19 created unprecedentedly elevated levels of stress, especially to the racial/ethnic minorities and lower-income households. This study examines how natural disasters related to recreational drug use during COVID-19 and whether the relation is heterogeneous across different subgroups categorized by race/ethnicity and household income. This study used the data from the biweekly online surveys of the Understanding America Study (UAS) and analyzed the drug use behaviors of 966 US adults between April 29 and December 31, 2020. This study found that middle-income adults (household income ranging from $50,000 to $149,999), serving as the reference group, generally exhibited a significant reduction in drug consumption during or after disaster events. However, compared to the middle-income group, White and Black adults with household income lower than $50,000 showed 142% and 88% more frequent drug use when experiencing storms/hurricanes. This disparity widened in the following weeks. Additionally, lower-income Hispanics showed 74% more frequent drug use compared to the middle-income group in the weeks following wildfire incidents. The study's findings shed light on the risk of drug misuse during the co-occurrence of climate and public health crises, emphasizing the disproportionate risk among lower-income racial/ethnic minorities amid the pandemic and natural disasters.

Gynecologic health care for LGBTQIA+ people.

Gender relations are a set of socially determined norms and rules that assign values, characteristics, and expectations to individuals based on their biological sex. These aspects also influence the clinician-patient relationship, since it has been for a long time based on cisheteronormativity. However, this attitude alienated the LGBTQIA+ community from health services. Global and specific gynecologic care needs to be offered to the LGBTQIA+ population, which has demands for sexual and reproductive health care. In this narrative review, we bring conceptual aspects, gender identity and expression, sexual history, screening for cancer and other care to the community.

Faculty Training on Navigating Gender and Sex in Medical Education.

Introduction: Language that assumes gender and sex are binary and aligned is pervasive in medicine and is often used when teaching on physiology and pathology. Information presented through this lens oversimplifies disease mechanisms and poorly addresses the health of gender and sexually diverse (GSD) individuals. We developed a training session to help faculty reference gender and sex in a manner that would be accurate and inclusive of GSD health. Methods: The 1-hour session for undergraduate and graduate medical educators highlighted cisgender and binary biases in medical teachings and introduced a getting-to-the-root mindset that prioritized teaching the processes underlying differences in disease profiles among gender and sex subpopulations. The training consisted of 30 minutes of didactic teaching and 20 minutes of small-group discussion. Medical education faculty attended and self-reported knowledge and awareness before and after the training. Results were compared using paired t tests. Expenses included fees for consultation and catering. Results: Forty faculty participated (pretraining survey n = 36, posttraining survey n = 21). After the training, there was a significant increase in self-reported awareness of the difference between gender and sex (p = .002), perceived relevance of gender to teachings (p = .04), and readiness to discuss physiological drivers of sex-linked disease (p = .005). Discussion: Participants reported increased understanding and consideration of gender and sex in medical education; feedback emphasized a desire for continued guidance. This easily adaptable session can provide an introduction to a series of medical teachings on gender and sex.

A Chinese Dance Therapy Framework.

Genuine Chinese dance therapy is in the ascendant and psychiatric approaches that involve a broad spectrum of principles such as ontological identity, social inclusion and collective support, aestheticisation and expressive catharsis, symbolic exorcism, trance and Buddhist mindfulness. Its models are based on a wealth of Chinese dance genres originating from various dynasties as well as cultural traditions of ethnic minorities. Due to different epistemological backgrounds of Western diagnostic manuals and traditional Chinese views of mental diseases, complex understanding of pathologies and therapeutic dynamics is needed. Therefore, this opinion piece suggests a theoretical framework that encourages interdisciplinary approaches as well as inclusive transcultural psychiatry and related philosophy of science.

A Scoping Review of Culturally Adapted Mindfulness-Based Interventions for Communities of Color.

Introduction: Mindfulness-based interventions (MBIs) are effective in improving mental health outcomes, including depression, anxiety, and post-traumatic stress disorder (PTSD). However, research on how MBIs have been tailored for racial and ethnic minoritized communities is limited. To address this gap, this scoping review utilizes the Ecological Validity Framework to systematically explore cultural adaptations in MBIs for communities of color. Concurrently, this review examines the effectiveness of culturally adapted MBIs. Methods: Following PRISMA guidelines, the authors conducted a search on MEDLINE, PsycINFO, and Embase databases from 2010 to 2023. Inclusion criteria required studies to be published in English, accessible in full-text, and peer-reviewed, focusing primarily on communities of color or diverse non-White populations (comprising 75% or more of the sample). Exclusion criteria were studies primarily centered on behavioral interventions other than MBIs, studies lacking primary outcomes, and studies not explicitly addressing cultural adaptations. Results: Search results identified 371 publications, 13 of which met the inclusion criteria. The most frequently reported cultural adaptations were surface-level adaptations, which can enhance the relevance of MBIs by modifying the language, content, format, or intervention delivery. MBIs with surface-level adaptations reported significant improvements in mental health outcomes, including depression, anxiety, and stress levels. Conclusion: Findings from this review indicate that culturally adapted MBIs for communities of color could potentially make them more relevant and acceptable. Surface-level and deep structure adaptations are both necessary to ensure MBIs are responsive, relevant, and sustainable across diverse contexts and populations.

Informing inclusive and affirmative hospital pharmacy services for 2SLGBTQ+ patients.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Two-spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) people disproportionally experience health disparities, and hospital pharmacists, given their accessibility and expertise in medication management, are ideally positioned to provide care to this vulnerable population. This study investigated the barriers and facilitators faced by hospital pharmacists when providing care to 2SLGBTQ+ patients, with the goal of informing enhancement of quality care provided to these patients. METHODS: A mixed-methods triangulation design was utilized, comprising an online survey and qualitative interviews with Canadian hospital pharmacists. The survey used the lens of systemic oppression as a framework and assessed pharmacists' perceptions and knowledge. Survey data were analyzed using descriptive statistics, and interviews were analyzed using thematic analysis. RESULTS: A total of 129 individuals participated in the survey, and 15 participants were interviewed. Eleven themes were identified, and findings revealed a complex web of individual, interpersonal, and systemic barriers and facilitators. Pharmacists expressed a lack of proficiency and confidence in discussing 2SLGBTQ+ health topics, further compounded by an apprehension to engage and a fear of causing harm. Pharmacists desired support from their leadership teams and organizations in the form of access to resources, time to engage in training, and workplace environments that encourage discussions about 2SLGBTQ+ health. CONCLUSION: Hospital pharmacists in Canada are willing to provide inclusive care to 2SLGBTQ+ patients but face significant barriers. These findings highlight the need for comprehensive education, supportive workplace cultures, and accessible resources to address health disparities and improve care for 2SLGBTQ+ individuals.

Influence of Medical Mistrust on Prevention Behavior and Decision-Making Among Minoritized Youth and Young Adults During the COVID-19 Pandemic.

BACKGROUND: Medical mistrust (MM) is seen as a barrier to assessing healthcare needs and addressing health disparities; however, limited literature has focused on assessing MM for vulnerable populations, especially racial/ethnic minority and sexual/gender minority youth and young adults (YYA). METHODS: Between February 2021 and March 2022, we conducted the Youth and Young Adults COVID-19 Study, a prospective cohort of minoritized YYA aged 14 to 24 years (n = 1027), within the United States and its territories. Participants were recruited through a combination of paid social media ads, outreach with organizations serving marginalized youth, and an existing registry, targeting racial and ethnic minority and LGBTQ + youth for a study on COVID-19 health behaviors. Multiple multinomial logistic regression models were developed to examine associations between demographics and three dimensions of MM including healthcare experience, government information, and scientific information. RESULTS: Most participants were between the ages of 18 and 21 years (48.3%), identified as Hispanic (33.3%) or white (22.5%), and bisexual or pansexual (34.3%). Queer YYA had higher odds of reporting worse personal healthcare experiences than their straight peers. The odds of gay/lesbian YYA that reported somewhat or extreme trust in doctor's sources were two times higher than their straight peers. Except for those who identified as Asian, racial/ethnic minority YYA were less likely to report somewhat or extreme trust in the CDC's general information or its COVID-19 data than white YYA. Transgender and gender diverse YYA were more than twice as likely to report being very or extremely influenced by statistics of the dangers of COVID-19 than cisgender YYA. CONCLUSIONS: Our study indicated the importance of incorporating marginalized identities into the assessment of medical mistrust to better understand YYA's health prevention and treatment behaviors and to develop public health prevention and treatment strategies, especially for minoritized communities.

Lesbian and bisexual breast cancer survivors' post-treatment resource needs.

PURPOSE: The purpose of our study was to identify and describe determinants of lesbian and bisexual breast cancer survivors' post-treatment resources. METHODS: We used a cross-sectional descriptive study design. The data reported here were gathered as part of OUT: The National Cancer Survey, administered electronically from September 2020 to March 2021 via social media and community partners. We used descriptive statistics, Fisher's exact tests, and thematic analysis to analyze survivor perceptions of information availability, treatment environment, care plans, social support, and health. RESULTS: Of those who participated in the survey, (N =430) 366 identified as lesbian, and 64 identified as bisexual. Mean age was 58.6 years (range 21 - 91 years). Fewer than 11% of our sample indicated they could find helpful information about being a queer person with cancer during their treatment. Over 75% of our sample that received a cancer survivorship care plan indicated that their plan did not include resources for queer individuals. CONCLUSIONS: Affirming cancer treatment environments and resources tailored to the needs of lesbian and bisexual breast cancer survivors are critical for reducing disparities. IMPLICATIONS FOR CANCER SURVIVORS: Survivorship care plans should include resources for queer individuals as a part of holistic cancer care.