Adverse Childhood Experiences, Perceived Discrimination, and Mental Health in Sexual and Gender Minoritized Adults: Comparing Stress Accumulation and Stress Sensitization Models.

Purpose: The purpose of this study was to assess the relationship between adverse childhood experiences (ACEs) exposure, perceived discrimination, and anxiety and depressive symptoms in sexual and gender minoritized (SGM) adults in the United States. Methods: Respondents (n = 4445) from a national Qualtrics research panel completed a web-based survey. Guided by the stress proliferation (mediation model) and stress sensitization (moderation model) models, we examined the relationships between ACEs and perceived discrimination and the severity of anxiety and depressive symptoms in adulthood. Results: Cumulative ACEs exposure was positively associated with everyday discrimination scale (EDS) scores. ACEs and EDS scores had a significant direct association with anxiety and depressive symptoms. We found support for EDS as a mediator for anxiety (ß = 0.12, p < 0.001) and depressive symptoms (ß = 0.14, p < 0.001) and for ACEs as a moderator of the relationship between EDS and anxiety (ß = -0.04, p = 0.004) and depressive (ß = -0.05, p = 0.001) symptoms. Conclusions: These findings suggest that both stress proliferation and stress sensitization likely contribute to disparities in anxiety and depressive symptoms in SGM adults. This finding supports the integration of social safety and minority stress perspectives regarding health disparities in SGM populations. Exposure to early life adversity likely alters neurodevelopment, which in turn increases awareness of the lack of social safety in adulthood, reduces capacity to cope with minority stress exposure, and ultimately contributes to increased anxiety and depressive symptoms. Prevention efforts should focus on building positive and compensatory childhood experiences.

Therapeutic donor insemination for LGBTQ+ families: a systematic review.

IMPORTANCE: Lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) families deserve evidence-based care within environments designed for their unique needs; however, care provided in fertility clinics has been reported to fall short, most notably for assigned female at birth recipients of therapeutic donor insemination (TDI). OBJECTIVE: To identify the aspects of routine infertility care that are clinically appropriate for this unique patient population, specifically those seeking pregnancy with donor sperm. The research question was posed, "What screening and treatment protocols are supported by the evidence regarding TDI care for LGBTQ+ families?" EVIDENCE REVIEW: High quality, prospective studies specific to and/or inclusive of this patient population in assisted reproductive care contexts is limited, however evidence regarding age-informed prognosis, screening guidelines, treatment outcomes, insemination timing, number of inseminations per cycle, when to refer, and safety of the procedure were found. FINDINGS: Findings indicate that compared with routine infertility care protocols, a low-tech, low-intervention model of care for ovulatory LGBTQ+ individuals renders equal or higher success rates without increasing risk. CONCLUSION: Given the current evidence, TDI for LGBTQ+ families can, with support and training, be provided appropriately in a variety of contexts, including community-based and primary care settings as well as in fertility clinics. RELEVANCE: This review establishes the current state of the evidence supporting TDI for LGBTQ+ families, expanding access to care for recipients as well as their care providers and outlining areas for further study.

Moving beyond vulnerability and focusing on resilience: An intersectional posttraumatic growth model for LGBTQ+ people of color.

In the context of the legacy of deficit-focused research and application of theoretical models in research on minoritized groups that are underrepresented in the literature, we explored the strengths-based literature among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people of color to develop a more inclusive and relevant understanding of how posttraumatic growth (PTG) occurs in this population. Our intersectional PTG model is tailored to the experiences of LGBTQ+ people of color that builds upon previous models of PTG, intersectionality theory, and empirical findings of trauma and PTG among LGBTQ+ people of color. Our intersectional PTG model incorporates the unique intrapersonal, interpersonal, institutional, and cultural factors that are unique to this population and contribute to PTG. We challenge the limited scope of Criterion A traumatic events and emphasize empirical findings that support that LGBTQ+ people of color often experience posttraumatic stress after oppression and discrimination. Our model also recognizes the impact of intersecting risk factors, such as gendered racism, that may occur on various levels. Our model acknowledges that LGBTQ+ people of color have often demonstrated PTG in the face of adversity. Intrapersonal factors such as cognitive flexibility, interpersonal factors such as social support, and institutional and cultural factors such as identity-related activism are identified as key contributors to resilience. We discuss practice implications, highlighting that clinicians should recognize limitations of traditional trauma frameworks and adopt culturally sensitive approaches when working with LGBTQ+ people of color. Overall, our model provides a foundation for strengths-based interventions and research, emphasizing resiliency and potential for PTG in this population.

Culturally-sensitive and Inclusive IBD Care.

As the prevalence of inflammatory bowel disease (IBD) increases within historically disadvantaged communities, it is imperative to better understand how intersectionality-defined as the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism) - intersect and social determinants of health influence the patient's experiences within the medical system when navigating their disease. Culturally-sensitive care is characterized by the ability to deliver patient-centered care that recognizes how the intersectionality of an individual's identities impacts their disease journey. An intentional consideration and sensitivity to this impact play important roles in providing an inclusive and welcoming space for historically disadvantaged individuals living with IBD and will help address health inequity in IBD. Cultural competence implies mastery of care that understands and respects values and beliefs across cultures, while cultural humility involves recognizing the complexity of cultural identity and engaging in an ongoing learning process from individual patient experiences. Heightening our patient care goals from cultural competence to cultural sensitivity allows healthcare professionals and the systems in which they practice to lead with cultural humility as they adopt a more inclusive and humble perspective when caring for patient groups with a diverse array of identities and cultures and to avoid maintaining the status quo of implicit and explicit biases that impede the delivery of quality IBD care. In this article, we will review the literature on IBD care in historically disadvantaged communities, address culturally-sensitive care, and propose a framework to incorporating cultural humility in IBD practices and research.

Patient voices and student insights into LGBTQ+ healthcare: a call for equitable healthcare through medical education.

PURPOSE: Lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals have health needs specific to their identities. However, they face discrimination and cis-heteronormativity in most patient-provider interactions, which often translate into poor healthcare. Evidence suggests doctors are inadequately trained to care for LGBTQ+ patients. Medical students are well-placed as the future workforce to establish affirming behaviours. This study garners LGBTQ+ patients' healthcare experiences, where limited qualitative evidence exists, and explores whether students have insight into these experiences. METHOD: Thirty LGBTQ+ patients and twenty students, evenly divided between Singapore and the United Kingdom (UK), two legally and culturally different countries, consented to semi-structured interviews in 2022 to evaluate their LGBTQ+ healthcare perceptions. Thematic analysis was conducted using a collaborative, iterative process involving five investigators, with frequent auditing of data interpretation. RESULTS: Most patients described implicit biases with a lack of support and professionalism from doctors, hindering health outcomes. Patients experienced misgendering and a lack of recognition of sexual and gender diversity; students appreciated the need to acknowledge patient identity. Although perceptions surrounding certain themes were similar between patients and students in both countries, patients' voices on the complexity and dissatisfaction of gender-diverse care contrasted with students' lack of insight on these themes. Singapore patients were more concerned with sociolegal acceptance affecting health needs, whilst UK patients noted more nuanced barriers to healthcare. Although many students were unsure about specific health needs and perceived a lack of training, they expressed willingness to create an equitable healthcare environment. CONCLUSIONS: LGBTQ+ patients provided powerful narratives on discrimination surrounding their healthcare needs. To address these, medical students must be encouraged by healthcare educators to develop identity-affirming behaviours as future change-makers and challenge cis-heteronormative views. Alongside vital institutional changes tailored to each country, patients' and students' collective action would create meaningful educational opportunities to reach culture change.

Heteroprofessionalism: The power of the gender/sex binary in the workplace.

LGBTQ + people continue to face bias and discrimination in the workplace. In this article, we focus on one subtle yet insidious manifestation of such bias: heteroprofessionalism. In workplace contexts, professionalism is generally encouraged. However, what is considered professional is subjective and often shaped by those with high status identities such as cis-heterosexuality. LGBTQ + identities are thus labelled unprofessional and inappropriate for the workplace context. We discuss (1) how heteroprofessionalism can be viewed as a manifestation of assimilation ideology that is employed to reinforce the gender/sex binary and (2) the negative consequences heteroprofessionalism has for members of the LGBTQ + community. We discuss future research directions and end with recommendations for combatting heteroprofessionalism and its harmful consequences.

'All the dykes I know drink beer': Sexuality and gender performance through alcohol consumption among lesbian, bisexual, and queer women in Australia.

This article explores the relationship between gender, sexuality and alcohol consumption among lesbian, bisexual, and queer (LBQ) women in Australia. On average, LBQ women consume alcohol at a higher rate than heterosexual women, yet the use of alcohol and its gendered meanings in this population remain under-explored. We conducted semi-structured interviews with 42 cisgender women, 10 transgender women, and 8 non-binary people who identify as lesbian, bisexual, and/or queer. Participants were aged 18-72. Interviews explored participants' experiences with alcohol, gender, and sexuality. Interviews were thematically analysed, informed by a critical alcohol and other drug scholarship lens. While 'minority stress' is often cited as a key factor in explaining LBQ women's high rates of alcohol consumption, our findings suggest a more complex relationship between drinking, gender and sexuality. Drinking is gendered for LBQ women, enabling both performance of and resistance to gendered norms. Additionally, alcohol emerged as a tool for navigating gendered vulnerability in public spaces, with some participants shaping their alcohol intake to their environment. Our findings highlight the need for approaches to LBQ women's health that recognise alcohol as a social tool that can facilitate confidence, pleasure, and community connection. Rather than focusing solely on risk and vulnerability, policies and health promotion efforts should consider the diverse ways in which LBQ women use alcohol to navigate their identities and social environments.

Physiotherapy students hold varying attitudes, beliefs and learning preferences regarding LGBTQIA+ healthcare: a mixed methods study.

QUESTIONS: What are physiotherapy students' attitudes and beliefs towards providing care for lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related identities (LGBTQIA+) individuals? What education have students received on LGBTQIA+ healthcare needs? What are students' preferences for receiving this content? DESIGN: Mixed-methods design using a purpose-built online survey. PARTICIPANTS: Australian undergraduate and postgraduate physiotherapy students. METHODS: Participants were invited to complete an online survey. Data were collected on: personal, clinical, professional and educational exposure to LGBTQIA+ identities and topics; heteronormative attitudes and beliefs via the modified Heteronormative Attitudes and Beliefs Scale (mHABS); and perspectives about LGBTQIA+ care. Welch's t-test and analysis of variance were used to analyse differences in mHABS and subscale scores between groups based on personal, clinical, professional and educational exposure. Open text responses were analysed thematically. Quantitative and qualitative data were first analysed separately and then cross-validated for integration in the results. RESULTS: The survey was completed by 324 eligible students. Cross-comparison of data generated four key themes pertaining to students' perspectives about working with the LGBTQIA+ community and education about LGBTQIA+ health: students with closer personal relationships to the LGBTQIA+ community demonstrated more inclusive attitudes and beliefs about LGBTQIA+ care and education; there are cis/heteronormativity and negative views towards LGBTQIA+ health; students who are ambivalent about LGBTQIA+ care hold egalitarian beliefs; and integrated education on LGTBQIA+ health delivered by members of the community is important. CONCLUSION: Physiotherapy students' attitudes and beliefs about the LGBTQIA+ community were diverse, with cis/heteronormativity prevalent in respondents. Students with closer relationships to the LGBTQIA+ community demonstrated more inclusive attitudes and beliefs. The lack of understanding of LGBTQIA+ needs and relevance to physiotherapy highlights the need for improved LGBTQIA+ education in physiotherapy curricula.

Social cure model: testing the link between identity centrality and body appreciation in diverse sexual orientation and gender identity groups.

BACKGROUND: The level of experienced sociocultural pressure to have an idealized body can vary depending on a person's gender identity and sexual orientation. The current study explored whether differences in levels of body appreciation among people with different sexual orientations and gender identities vary because of differing levels of experienced pressure by in-group members and varying levels of experienced hostile behaviors because of their looks or body. Thereby, the study tests the social cure model, according to which high levels of identity centrality are associated with better mental health. METHODS: An online cross-sectional questionnaire study was conducted with 1,587 people (51.3% cisgender women, 39.3% cisgender men, 9.5% non-binary; 52.9% identified as heterosexual, 27.7% identified as bisexual/pansexual, 11.2% identified as gay/lesbian, 8.2% identified as asexual/demi/queer; Mage = 32.9, SD = 12.6) from German-speaking countries. Variables were assessed with German-language versions of the Multidimensional and Multicomponent Measure of Social Identification, Body Appreciation Scale-2, the Perceived Stigmatization Questionnaire, and the Sociocultural Attitudes Towards Appearance Questionnaire-4, revised. A manifest-path model was calculated. RESULTS: Non-binary persons reported lower levels of body appreciation than did cisgender men and sexual minority persons reported lower levels of body appreciation than did heterosexual persons. Furthermore, sexual minority persons experienced more hostile behaviors directed towards them because of their looks or body than did heterosexual persons. Similarly, non-binary persons experienced more hostile behaviors than did men. Non-binary persons were subjected to lower levels of in-group pressure than were men. Gay/lesbian persons and asexual persons were subjected to lower levels of in-group pressure than were heterosexual persons. More hostile behaviors and stronger in-group pressure were related to lower body appreciation. In cisgender women and men indirect links revealed associations between strong identity centrality and low levels of body appreciation through the mediator of high in-group pressure. CONCLUSIONS: Data in sexual minority individuals or non-binary persons supported the social cure model, according to which persons can find support and validation for their looks and body from in-group members. In cisgender women and men, strong identification as a woman or man can be related to stronger in-group pressure and in turn to lower body appreciation.

Chemsex Session Typologies and Associated Sociodemographic Factors in Sexual Minority Men: Latent Class Analysis From a Cultural Perspective Using a Cross-Sectional Survey.

Background: Chemsex prevalence is still not well known, and both the lack of homogeneity and cultural component of chemsex practices are usually overlooked. Objective: This study aims to estimate the proportion of sexual minority men (SMM) engaging in chemsex sessions, while understanding the cultural dimension of chemsex, and to analyze distinct session typologies with potential risk differences and the sociodemographic factors associated with engaging in them. Methods: A total of 5711 SMM residing throughout Spain participated in an anonymous web-based survey that assessed chemsex session engagement and characteristics, drug use, and sociodemographic variables. We measured the association of sociodemographic factors with engaging in chemsex sessions by calculating adjusted prevalence ratios, using multivariate Poisson regression analysis. Chemsex typologies were analyzed using latent class analysis, and sociodemographic factors were associated with the different risk classes. Results: Our results determined that 21.1% (1205/5711; 95% CI 20.0%-22.1%) of SMM engaged in chemsex sessions during their lifetime. Participating in sessions was significantly associated with being a migrant, not having a comfortable financial situation, openly living their sexuality, residing in bigger municipalities, older age, using steroids, and living with HIV (adjusted prevalence ratio: range 1.17-2.01; all P values <.05). Three typologies of sessions with different risks were identified with latent class analysis, with 23.2% of SMM engaging in sessions taking part in higher-risk ones, which was associated with younger age, using steroids, living in bigger municipalities, openly living their sexuality, and living with HIV, compared to SMM engaging in lower-risk sessions (odds ratio: range 2.75-4.99). Conclusions: Chemsex is relatively common among SMM in Spain, but it is important to differentiate typologies of sessions with varying risks, and the proportion of SMM engaging in high-risk sessions is low. Chemsex is highly associated with sociodemographic factors. Chemsex should be prioritized in public health programs, which should consider the different forms of sessions with their varying risks and prevalence, while also considering the cultural dimension inherent to chemsex.

Beyond stigma: Clinician bias in contraceptive counseling to sexual and gender minority youth.

OBJECTIVES: Sexual and gender minority (SGM) youth experience disparities in sexual and reproductive health; however, little is known about how clinicians engage in contraceptive counseling with this patient population. This study describes pediatric clinician patterns and biases in contraceptive counseling with SGM youth. STUDY DESIGN: We conducted 16 in-depth interviews with a convenience sample of clinicians who counsel adolescents on contraception. Participants were recruited and interviewed in-person at the American Academy of Pediatrics National Conference in October 2022. We used codebook thematic analysis. RESULTS: When discussing contraceptive counseling among SGM youth, three major themes emerged: (1) participants' acceptance of SGM youth identities varied from support to suspicion and rejection; (2) participants' conceptualizations of their SGM youth patients' identities circumscribed the scope of the contraceptive care they provided; and (3) participants described using a universal approach to contraceptive counseling that disregarded the relevance of SGM youth identities. For transgender patients, many clinicians focused on menstrual regulation and overlooked potential pregnancy risk. When discussing sexual minority patients, clinicians overemphasized pregnancy prevention and encouraged the use of highly effective contraceptive methods rather than taking a shared decision-making approach to contraceptive care. CONCLUSION: Many clinicians demonstrated bias in approaches to contraceptive care provision to SGM youth patients by holding patients accountable to normative assumptions in transgender medicine and family planning. Training and support for adolescent-facing clinicians in bias recognition and comprehensive contraceptive care are necessary to provide person-centered reproductive health care to SGM youth.

Impact of the Coronavirus Disease 2019 Pandemic on Substance Use Disorder Risk Among People Living With Human Immunodeficiency Virus (HIV) Enrolled in HIV Care in the United States: An Interrupted Time Series Analysis.

Background: Rising overdose deaths globally and increased social isolation during the coronavirus disease 2019 (COVID-19) pandemic may have disproportionately impacted people with human immunodeficiency virus (PWH) with substance use disorders (SUD). We examined trends in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate. Methods: Data were collected between 2018 and 2022 among PWH enrolled across 8 US sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We evaluated changes in moderate/high SUD risk after SIP using interrupted time series analyses. Results: There were 7126 participants, including 21 741 SUD assessments. The median age was 51 (interquartile range, 39-58) years; 12% identified as Hispanic or Latino/Latina, 46% Black/African American, and 46% White. Moderate/high SUD risk increased continuously after the pandemic's onset, with 43% (95% confidence interval [CI], 40%-46%) endorsing moderate/high SUD risk post-SIP, compared to 24% (95% CI, 22%-26%) pre-SIP (P < .001). There were increases in the use of heroin, methamphetamine, and fentanyl, and decreases in prescription opioids and sedatives post-SIP. Further, there was a decrease in reported substance use treatment post-SIP compared to pre-SIP (P = .025). Conclusions: The rising prevalence of SUD through late 2022 could be related to an increase in isolation and reduced access to substance use and HIV treatment caused by disruptions due to COVID-19. A renewed investment in integrated substance use treatment is vital to address the combined epidemics of substance use and HIV following the COVID-19 pandemic and to support resilience in the face of future disruptions.

Twenty Years of Legal Marriage for Same-Sex Couples in the United States: Evidence Review and New Analyse.

Twenty years ago, the United States was divided by heated debates over legalizing marriage for same-sex couples. Those in favor argued that granting same-sex couples access to marriage would strengthen commitment for same-sex couples, extend the financial benefits of marriage to same-sex households, and improve outcomes for children raised by same-sex parents. Those who were opposed argued that granting legal status to marriages between same-sex partners would alter the foundation of marriage and diminish its value for different-sex couples, ultimately harming children by making them less likely to be raised in stable, two-parent families. It has now been 20 years since Massachusetts became the first state to issue marriage licenses to same-sex couples in May 2004. The consequences of extending legal recognition to same-sex couples need no longer be a topic of speculation and debate; researchers have had two decades to study the consequences of legalizing marriage for same-sex couples on lesbian, gay, bisexual, and transgender (LGBT) individuals; their children; and the general public. The broad goal of this study is to document those consequences. The authors pursued this goal in two ways. First, they conducted a comprehensive review of the existing research literature on the effects of legalizing marriage for same-sex couples. Second, they conducted new analyses to evaluate the prediction that rates of marriage, cohabitation, and divorce and attitudes toward marriage would be adversely affected by granting same-sex couples access to legal marriage.

LGBTQ+ family building: progress but lots more to do.

Great strides have been made in society and in reproductive endocrinology and infertility in support of lesbian, gay, bisexual, transgender, and queer/questioning. Although many of the concepts used in heterosexual reproduction can be applied to the lesbian, gay, bisexual, transgender, and queer/questioning plus community, there are specific differences that should be understood to provide the highest level of care to this community.

A Scoping Review on the Impact of COVID 19 on Vulnerable Populations: LGBTQ+ Persons, Persons Experiencing Homelessness, and Migrant Farm Workers in the US.

Purpose: The goal of the National Center for Medical Education Development and Research Center (NCMEDR) is to support the education and training of medical students in the care of vulnerable populations. Access to primary care services in the US is fundamental to the health and wellness of all people regardless of their socioeconomic status. LGBQ+ persons, (lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority), Persons Experiencing Homelessness (PEH), and Migrant Farm Workers (MFW) are among the most underserved, marginalized, and socially vulnerable groups in the US. NCMEDR in the Department of Family and Community Medicine at Meharry Medical College was established in part, with funding from the Department of Health and Human Services (DHHS) and the Health Resources and Services Administration (HRSA). NCMEDR was developed to provide educational pathways for transforming medical education and clinical practice in the US by ascertaining whether medical students were being trained to provide primary care, and behavioral health services to LGBTQ+ persons, PEH, and MFW. Here we focus on the impact of the COVID-19 pandemic on these specific populations because they represent marginalized groups that have been heavily impacted by the pandemic, have poor social determinants of health (SDOH), and are more likely to be uninsured, and are less likely to engage primary care providers outside of emergency room care. Methods: In this study, a scoping literature review was conducted to assess the impact of COVID-19 on primary care of LQBTQ+ persons, PEH, and MFW. Results and Discussion: The pandemic provided a serious health disparities gap for the defined vulnerable populations under review by the NCMEDR. The pandemic identified the need for transformative measures for clinical practices, medical education, and health care policies required for implementation to improve health care for vulnerable groups. We make recommendations for interventions with defined populations that may influence clinical, environmental health, and SDOH in the COVID era. Conclusions: The COVID pandemic directed the need for medical schools, health care and social organizations to intervene in new and different ways in vulnerable and marginalized communities. The recommendations provide a model for advancing health equity, access, quality, utilization, care coordination, and treatment.

An assessment of the attitudes, knowledge, and education regarding the health care needs of LGBTQ patients with cancer: results of an ESMO/SIOPE global survey.

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals with cancer have specific and unique health issues and needs. Reports persist of inequalities in the care provided for these patients, making it important to assess the attitudes and knowledge of LGBTQ needs among those who provide care. MATERIALS AND METHODS: The European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOP Europe) Adolescents and Young Adults Working Group designed this survey comprising 67 questions covering demographics, knowledge, and education of LGBTQ health needs, and attitudes regarding LGBTQ patients with cancer. RESULTS: Among the 672 respondents, a majority do not ask about sexual orientation and gender identity during first visit (64% and 58%, respectively). Only a minority of the respondents considered themselves well informed regarding gay/lesbian and transgender patients' health (44% and 25%, respectively) and psychosocial needs (34%). There was high interest in receiving education regarding the unique health needs of LGBTQ patients (73%). CONCLUSIONS: Survey respondents indicated a willingness to provide care to LGBTQ patients, but a lack of confidence in the knowledge of the health issues and needs of LGBTQ individuals. Lack of training provided in medical schools and postgraduate training programmes and strong interest for additional education on these issues were reported.

Vaccination uptake in LGBTQ adults in two US states: Findings from the QVax study.

OBJECTIVES: Lesbian, gay, bisexual, transgender, queer and other (LGBTQ+) individuals face numerous health disparities, including higher rates of chronic diseases and sexually transmitted infections, partly due to marginalization, discrimination, and a healthcare system often unprepared to meet their specific needs. Despite the importance of vaccination in preventing these health issues, vaccination patterns in LGBTQ+ populations remain under-researched, with limited data available due to the absence of sexual orientation and gender identity information on most healthcare forms. As such, we sought to understand vaccine uptake among LGBTQ+ individuals living in New Jersey and New York for 7 primary adult vaccines. METHODS: Participants were 768 LGBTQ+ adults living in New Jersey and New York, US. We recruited this convenience sample through community centers and events, social media, and listservs of local professional organizations. The online survey examined uptake for 7 adult vaccines. RESULTS: Of the 7 adult vaccines, human papilloma virus (HPV) had the lowest proportion of participants who were fully/partially vaccinated (54.4 %), followed by hepatitis A (59.8 %), hepatitis B (63.0 %), meningitis B (63.7 %), seasonal influenza during the COVID-19 pandemic (70.2 %), seasonal influenza before the COVID-19 pandemic (70.3 %), and nearly all participants (99.2 %) received at least one dose of the COVID-19 vaccine. For Shingles virus, among participants age 50+, 63.8 % were fully/partially vaccinated. In adjusted models, age was the strongest predictor of vaccination uptake in HPV, hepatitis A, hepatitis B, meningitis B, and seasonal influenza before and during the COVID-19 pandemic. Younger participants were more likely to be vaccinated for 4 of the 6 vaccines, excluding Shingles (<0.001), whereas older adults were more likely to be vaccinated for seasonal influenza before and during the COVID-19 pandemic (<0.010). CONCLUSIONS: This study highlights the differences in uptake across different vaccines. It also draws attention to differences within LGBTQ+ populations which is important to consider when ensuring more equitable vaccine access.

Patient comfort with sexual orientation and gender identity questions in adult congenital cardiology clinics.

BACKGROUND: Lack of sexual orientation and gender identity (SOGI) data creates barriers for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people in health care. Barriers to SOGI data collection include physician misperception that patients do not want to answer these questions and discomfort asking SOGI questions. This study aimed to assess patient comfort towards SOGI questions across five quaternary care adult congenital heart disease (ACHD) centres. METHODS: A survey administered to ACHD patients (≥18 years) asked (1) two-step gender identity and birth sex, (2) acceptance of SOGI data, and (3) the importance for ACHD physicians to know SOGI data. Chi-square tests were used to analyse differences among demographic groups and logistic regression modelled agreement with statement of patient disclosure of SOGI improving patient-physician communication. RESULTS: Among 322 ACHD patients, 82% identified as heterosexual and 16% identified as LGBTQ+, across the age ranges 18-29 years (39.4%), 30-49 years (47.8%), 50-64 years (8.7%), and > 65 years (4.0%). Respondents (90.4%) felt comfortable answering SOGI questions. Respondents with bachelor's/higher education were more likely to "agree" that disclosure of SOGI improves patient-physician communication compared to those with less than bachelor's education (OR = 2.45; 95% CI 1.41, 4.25; p = .0015). CONCLUSION: These findings suggest that in this largely heterosexual population, SOGI data collection is unlikely to cause patient discomfort. Respondents with higher education were twice as likely to agree that SOGI disclosure improves patient-physician communication. The inclusion of SOGI data in future studies will provide larger samples of underrepresented minorities (e.g. LGBTQ+ population), thereby reducing healthcare disparities within the field of cardiovascular research.

Assessing the Conceptualizations of Coping and Resilience in LGBTQ2S+ People with Cancer: Working towards Greater Awareness in Cancer Care.

People with cancer may suffer negative psychosocial outcomes due to the challenges of cancer. LGBTQ2S+ people routinely experience negative psychosocial outcomes in health care settings, but have showcased resilience in the face of discrimination; however, this has never been studied in a cancer context. Thus, this study aims to assess coping and resilience in LGBTQ2S+-identifying people diagnosed with cancer using a strengths-based approach. A qualitative exploratory design was used. Ten self-identified LGBTQ2S+ people who have completed their cancer treatment were recruited. Participants completed clinical, health, and demographic questionnaires and, subsequently, semi-structured qualitative interviews. Conceptualizations of coping and resilience in the semi-structured interviews were analyzed using interpretative phenomenological analysis (IPA). Participants were members of various gender identities and sexual orientations. In addition to identifying needed LGBTQ2S+-specific resources, four narratives emerged: support networks, regaining control in life, conflicting identities, and traditional coping methods. Most participants' cancer journeys were characterized by a 'Second Coming-Out' phenomenon, where LGBTQ2S+ people with cancer use coping strategies, similar to those used when coming out, to produce resilience throughout their cancer journey. This work provides exploratory insight into LGBTQ2S+ people with cancer, but more research is required with a larger sample.

Does It Take a Village? The Impact of LGBTQ+ Community and Geographic Location on Associations among Parenting Stress, Parent Mental Health, and Child Adjustment.

While LGBTQ+-parented families share many similarities with their cis-het parent counterparts, they still experience unique factors exclusive to them. One such factor is access to the LGBTQ+ community. Utilizing a diverse sample of LGBTQ+ parents with adolescents in the U.S., primarily living in Southern and Midwest states, we examined the potential moderating impact of a parent's sense of LGBTQ+ community on the relationship between parenting stress, parent mental health, and child adjustment. Regression analyses demonstrated a series of positive associations between LGBTQ+ parent stress, parent mental health concerns, and child adjustment issues. However, sense of community failed to moderate these associations. Parent sexual identity, age, and recruitment method were found to have unique associations with outcome variables. Implications for policy, clinical practice, and future research are discussed.