Sexual and gender minority health research in nursing.

BACKGROUND: Sexual and gender minorities (SGMs) experience substantial health disparities. Evidence suggests nurses may be unprepared to work with these populations. A previous literature review of top-ranked nursing journals found that 0.16% of published articles addressed SGM health. PURPOSE: To evaluate changes in coverage of SGM health in the top-ranked nursing journals since the earlier review using a scoping approach. METHODS: Electronic search of articles published between December 2009 and December 2017 in 20 nursing journals with the highest 5-year impact factors. FINDINGS: Thirty-three articles (0.19%) in the top-ranked nursing journals focused on SGM health. There is increasing attention to SGM health recently, evidenced by the numbers of empirical and nonempirical research articles published, as well as nonresearch articles about SGM health. DISCUSSION: In light of well-documented health disparities affecting SGM people, it is essential that nurses continue to conduct and disseminate research related to the health of these populations.

Development of an LGB-specific health literacy scale.

No studies to date have examined health literacy among lesbian, gay, and bisexual (LGB) individuals, nor considered whether LGB-specific health literacy might be a contributing factor to well-documented health disparities in LGB populations. This pilot study gathered online survey data from a national convenience sample of 232 LGB adults age 40 and older. A scale developed specifically for this study had 10 items related to general health literacy and 10 items related to LGB-specific health information and skills. Factor analysis revealed that the two subscales were distinct and internally consistent, and accounted for 66% of the variance. Higher LGB health literacy was associated with greater likelihood of coming out to the healthcare provider, reporting better overall health, and having healthcare providers who were knowledgeable about LGBT issues. Greater age was associated with lower general health literacy, but was not associated with LGB literacy. Respondents who had worked in healthcare settings had higher levels of both LGB and general health literacy. Potential differences by gender on sociodemographic and health variables were identified that need to be examined in larger, more diverse samples.

Quantitative and mixed analyses to identify factors that affect cervical cancer screening uptake among lesbian and bisexual women and transgender men.

AIMS AND OBJECTIVES: The purposes of this study were to measure the prevalence of, and identify factors associated with, cervical cancer screening among a sample of lesbian, bisexual and queer women, and transgender men. BACKGROUND: Past research has found that lesbian, bisexual and queer women underuse cervical screening service. Because deficient screening remains the most significant risk factor for cervical cancer, it is essential to understand the differences between routine and nonroutine screeners. DESIGN: A convergent-parallel mixed methods design. METHODS: A convenience sample of 21- to 65-year-old lesbian and bisexual women and transgender men were recruited in the USA from August-December 2014. Quantitative data were collected via a 48-item Internet questionnaire (N = 226), and qualitative data were collected through in-depth telephone interviews (N = 20) and open-ended questions on the Internet questionnaire. RESULTS: Seventy-three per cent of the sample was routine cervical screeners. The results showed that a constellation of factors influence the use of cervical cancer screening among lesbian, bisexual and queer women. Some of those factors overlap with the general female population, whereas others are specific to the lesbian, bisexual or queer identity. Routine screeners reported feeling more welcome in the health care setting, while nonroutine screeners reported more discrimination related to their sexual orientation and gender expression. Routine screeners were also more likely to 'out' to their provider. The quantitative and qualitative factors were also compared and contrasted. CONCLUSIONS: Many of the factors identified in this study to influence cervical cancer screening relate to the health care environment and to interactions between the patient and provider. RELEVANCE TO CLINICAL PRACTICE: Nurses should be involved with creating welcoming environments for lesbian, bisexual and queer women and their partners. Moreover, nurses play a large role in patient education and should promote self-care behaviours among lesbian women and transgender men.

Inside/out: Challenges of conducting research in lesbian communities.

Conducting research within one's own community can present challenges that are rarely addressed by graduate education, articles, or books on research design. Binary notions of insider and outsider are too simplistic; rather insider/outsider positions exist on a continuum. This article explores how the researcher's shifting position affects every aspect of a study of lesbian, bisexual, and/or queer women. Helpful theoretical frameworks include feminist research principles and intersectionality, and the article ends with lessons learned about tackling taboo topics, sensitivity to language, embracing diversity, researcher reputation, and looking upstream for solutions.

Queer Faculty in the Academy: Is It Getting Better?

This paper weaves the author's personal experience as an out lesbian researcher of LGBTQ health with contemporary research on LGBTQ faculty members' experiences. It also draws from the literature on other marginalized faculty members' experiences (women, faculty of color) to identify common themes that prevent the full inclusion of diverse faculty in higher education. Structural oppression is often invisible and university's focus on values of meritocracy, individual effort, competition, and elitism create unspoken barriers to faculty success. The paper discusses three general themes: the paradox of visibility (including being out on faculty, doing LGBTQ research, and being an advocate/activist), curricular issues, and internalizing of oppression. The final section outlines strategies for overcoming some of the barriers, including LGBTQ-specific organizing and community building and creating coalitions across marginalized faculty groups.

Healthcare Providers' Pregnancy Prevention Counseling of Trans and Non-Binary Assigned Female at Birth (TNB/AFAB) Patients.

Transgender and non-binary people assigned female at birth (TNB/AFAB) have unintended pregnancies, but there is a dearth of information about effective pregnancy prevention care for this population. This needs assessment study aimed at discerning pregnancy prevention care best practices involved interviews of 20 healthcare providers solicited for experience providing pregnancy counseling with this group. Findings were organized via the ecological model, revealing four layers of themes. 1) Social structural level themes related to the gender binary system and other forms of oppression (racism, sexism, heterosexism); 2) the systems level theme related to access to and barriers to care; 3) provider level themes included lack of formal education, need to provide trauma-informed care, and provider discomfort or assumptions; and 4) patient-level themes included the fact that patients do not usually raise issues related to contraception and that TNB/AFAB patients have unique contraception needs. Implications of the findings are discussed.

Introduction to Special Issue: Impacts of the COVID-19 Pandemic on LGBTQ+ Health and Well-Being.

This special issue on the impacts of COVID-19 on LGBTQ+ health and well-being reports findings from nine articles with varied study designs, including data from multiple countries and all segments of LGBTQ+ communities. Key findings included the observation that pre-COVID mental health disparities predispose LGBTQ+ people to poorer outcomes; that technological communication aids are essential in maintaining some sense of community; and that substance use is perceived by sexual minority women as a means of coping with fears, stress, loneliness, and boredom. Studies in this special issue also document that community support is still a critical need, particularly among those who are sheltering at home with families of origin. Findings underscore the importance of addressing structural inequities, including advocating for rights; providing financial support for LGBTQ+ community organizations and networks; ensuring access to competent and affirming healthcare; and including vulnerable communities in disaster response and planning.

A new classification system for lesbians: the Dyke Diagnostic Manual.

There has been a long-standing need for a diagnostic manual that documents the unique pathological behaviors of lesbians. The Dyke Diagnostic Manual (DDM) is meant to supplement mainstream classification systems used to identify problematic behaviors in heterosexuals. This article presents thirteen uniquely lesbian conditions that are nowhere to be found in heterosexist diagnostic systems. The DDM may help to reduce the pain and suffering found in many lesbian relationships where one or both partners are afflicted.

Differential Influence of Weight Status on Chronic Diseases by Reported Sexual Orientation Identity in Men.

PURPOSE: This study examined whether the association between weight status and four chronic diseases (heart disease, hypertension, lifetime asthma, and type 2 diabetes) varied according to sexual orientation identity among adult men, controlling for demographic, socioeconomic, and other factors. METHODS: Pooled data from male adult participants (n = 72,214) in the 2003-2012 California Health Interview Survey were used along with logistic regression models to estimate whether the associations between weight status and chronic diseases varied by sexual orientation identity. RESULTS: Weight status was positively associated with each of the chronic diseases (hypertension, heart disease, asthma, and diabetes) among both gay and bisexual men and heterosexual men; however, the associations varied significantly by sexual orientation identity. Among gay and bisexual men, the associations were stronger and statistically significant-with the exception of lifetime asthma-particularly for men in the obese classifications, before and after controlling for age, marital status, race/ethnicity, education, income, health insurance status, food security level, smoking, and nativity. CONCLUSIONS: Weight status had stronger detrimental associations with chronic disease among gay and bisexual men despite these men having greater socioeconomic advantage and lower body mass index than heterosexual men. Future research should examine mechanisms, including stress related to minority status, which may lead to greater risks for chronic diseases among sexual minority men.

Sexual issues in special populations: lesbian and gay individuals.

OBJECTIVES: To provide an overview of health care needs and related sexuality issues of lesbian and gay patients. DATA SOURCES: Research articles, books, clinical experience. CONCLUSION: Attitudes of health professionals as well as patients impact care in relation to sexuality and sexual issues. Oncology nurses using a framework of awareness, sensitivity, and knowledge can obtain and apply the essential information needed to provide culturally appropriate nursing care to this population. IMPLICATIONS FOR NURSING PRACTICE: Lesbian and gay patients need nurses as allies in their fight with cancer. This is particularly true in assessment and managing concerns about sexuality and sexual issues.

Coping With Stress as an LGBTQ+ Health Care Professional.

Lesbian, gay, bisexual, transgender, queer, and other sexual/gender minority (LGBTQ+) health care providers face both general work-related stresses and working in heteronormative settings with ill-informed or hostile coworkers and patients, yet there has been little study of whether the coping strategies are specific to LGBTQ+ stress. We analyzed qualitative data from 277 health care professionals. Sources of stress included religiously and politically conservative coworkers, coworker/patient lack of knowledge, stresses of being closeted, and concerns about being out to patients. Consequences of being out as LGBTQ+ included lack of promotions, gossip, refusals of tenure, and anti-LGBTQ+ comments and behaviors in the workplace. Respondents showed mostly positive coping strategies to deal with stress, including becoming educators/advocates and self-care activities. Self-care options were common in rural areas with few LGBTQ+ social resources. Negative coping strategies were reported by 18% of respondents. The study highlights the extra burden of stress on LGBTQ+ health care providers.

Chronic illness care for lesbian, gay, & bisexual individuals.

Nurses provide care for lesbian, gay, and bisexual (LGB) patients on regular basis, whether they know it or not. Education of health care workers routinely has excluded discussion of patient sexuality, rendering LGB patients invisible or stigmatized, and has offered few tools to nurses to provide quality care for their LGB patients with chronic illnesses. This chapter provides basic information about LGB chronic health care to increase awareness and sensitivity about this marginalized patient population and focuses on providing specific information to help nurses care for these individuals.

Choosing "Something Else" as a Sexual Identity: Evaluating Response Options on the National Health Interview Survey.

PURPOSE: Researchers struggle to find effective ways to measure sexual and gender identities to determine whether there are health differences among subsets of the LGBTQ+ population. METHOD: This study examines responses on the National Health Interview Survey (NHIS) sexual identity questions among 277 LGBTQ+ healthcare providers. RESULTS: Eighteen percent indicated that their sexual identity was "something else" on the first question, and 57% of those also selected "something else" on the second question. Half of the genderqueer/gender variant participants and 100% of transgender-identified participants selected "something else" as their sexual identity. CONCLUSION: The NHIS question does not allow all respondents in LGBTQ+ populations to be categorized, thus we are potentially missing vital health disparity information about subsets of the LGBTQ+ population.

Relationships between Sexual Orientation, Weight, and Health in a Population-Based Sample of California Women.

BACKGROUND: Most biomedical research has reported associations between weight and physical health problems; little is known about whether those associations vary by sexual identity. METHODS: Pooled data from the 2003 through 2013 waves of the California Health Interview Survey was used to construct logistic regression models to examine whether the associations between weight and four chronic conditions (type 2 diabetes, hypertension, heart disease, and asthma) varied by sexual identity. RESULTS: A total of 97,720 heterosexual and 2,822 lesbian/bisexual women comprised the analytic sample. There was a significant interaction between weight status and sexual identity (p < .001) for all four chronic diseases. Among lesbian/bisexual women, weight status was positively associated with heart disease, hypertension, asthma, and diabetes, although the associations between any weight status and heart disease, and between overweight and asthma, were not statistically significant. Among heterosexual women, weight status was positively and significantly associated with heart disease, hypertension, asthma, and diabetes. Except for overweight and heart disease, these associations remained significant after adjustment for covariates. CONCLUSION: This study underscores the importance of disaggregating analyses by sexual identity in studies that examine weight-chronic disease associations.

Comparing women with and without disabilities in five-site "Healthy Weight" interventions for lesbian/bisexual women over 40.

BACKGROUND: Lesbian/bisexual women with physical disabilities (LBPD) are an under-studied population. OBJECTIVES: This study compared LBPD to LB women without physical disabilities as defined by the Americans with Disabilities Act on socio-demographic variables, health characteristics, and quality of life, physical activity, weight, and nutrition outcomes following a health intervention. METHODS: Data came from the Healthy Weight in Lesbian and Bisexual Women Study (HWLB) where 376 LB women were recruited into five geographically dispersed interventions. Baseline data were examined to compare women with and without physical disabilities as defined by the ADA, and pre/post intervention data were analyzed for differences in treatment outcomes including quality of life, physical activity, nutrition, and body size. RESULTS: Compared to women without disability, LBPD were more likely to be bisexual or another sexual identity than lesbian, single, report poor or fair health status, postmenopausal, and had a higher body mass index and waist circumference to height ratio. LBPD women were less likely to work and to drink heavily, and reported reduced physical and mental health quality of life. In spite of these differences, after the intervention, LBPD had similar outcomes to women without disabilities on most measures, and were more likely to show improvements in physical quality of life and consumption of fruits/vegetables. CONCLUSIONS: Although different from women without disabilities on many socio-demographic and health variables at baseline, the study suggests that LBPD have similar outcomes to women without disabilities, or may even do better, in group health interventions.

Nurses' Knowledge About Transgender Patient Care: A Qualitative Study.

This study explored practicing nurses' knowledge of the needs of transgender patients. Structured interviews were conducted with 268 nurses in the San Francisco Bay Area. This study focused on the responses to 1 item in the 16-item interview, "Describe health care issues that are particular to transgender patients." Three themes emerged from the data: discomfort, transition, and harsh consequences of being transgender. These findings revealed nurses' discomfort and lack of knowledge about transgender people and their health care needs. Nursing curricula must challenge the gender binary to better prepare nurses to provide quality care for patients of all genders.

The "Something Else" of Sexual Orientation: Measuring Sexual Identities of Older Lesbian and Bisexual Women Using National Health Interview Survey Questions.

BACKGROUND: Terminology related to sexuality and gender is constantly evolving, and multiple factors are at play when individuals answer questions on surveys. METHODS: We examined patterns of responding to the National Health Interview Survey (NHIS) sexual identity questions in a multisite health intervention study for lesbian and bisexual women aged 40 to 84 years. RESULTS: Of 376 participants, 80% (n = 301) chose "lesbian or gay," 13% (n = 49) selected "bisexual," 7% (n = 25) indicated "something else," and 1 participant chose "don't know the answer." In response to the follow-up question for women who said "something else" or "don't know," most (n = 17) indicated that they were "not straight, but identify with another label." One participant chose "transgender, transsexual, or gender variant," five chose "You do not use labels to identify yourself," and three chose "you mean something else." Lesbian, bisexual, and "something else" groups were compared across demographic and health-related measures. Women who reported their sexual identity as "something else" were younger, more likely to have a disability, more likely to be in a relationship with a male partner, and had lower mental health quality of life than women who reported their sexual identity as lesbian or bisexual. CONCLUSIONS: Respondents who answer "something else" pose challenges to analysis and interpretation of data, but should not be discarded from samples. Instead, they may represent a subset of the community that views sexuality and gender as fluid and dynamic concepts, not to be defined by a single label. Further study of the various subsets of "something else" is warranted, along with reconsideration of the NHIS question options.

Qualitative Study of Cervical Cancer Screening Among Lesbian and Bisexual Women and Transgender Men.

BACKGROUND: Lesbian, bisexual, and queer (LBQ) women, as well as transgender men, are less likely than their heterosexual and female-identifying counterparts to access cervical cancer screening services. Although numerous factors that influence receipt of cervical screening have been identified, several gaps in research and knowledge merit additional research. OBJECTIVE: The aims of this study were to examine cervical cancer screening behaviors of LBQ women and transgender men using American Cancer Society guidelines as the standards for comparison and to determine factors that influence participation in cervical cancer screening. METHODS: A convenience sample of 21- to 65-year-old LBQ women and transgender men was recruited from the Internet and community events. Qualitative data were collected through in-depth telephone interviews and open-ended questions on an online questionnaire. A deductive-inductive content analysis approach was used. RESULTS: The sample was mostly non-Hispanic white women who identified as lesbian. Most were routine cervical cancer screeners. Eighteen factors/themes were identified in the data and were contextualized within a health services theoretical framework. CONCLUSIONS: This study showed that although some factors overlap with the general female population, there are other areas that are specific to LBQ women and transgender men. Creating welcoming and inclusive healthcare environments is particularly important to facilitating cervical screening among LBQ women. IMPLICATIONS FOR PRACTICE: Nurse leaders can modify clinical environments, and clinical nurses can be educated to provide safe care for LBQ women and transgender men.