background:  In the United States, sexual minorities are disproportionately affected by disparities in HIV, other STIs, substance use and mental health problems. Current literature focusing on sexual minority health disparities has examined differences between heterosexual and non-heterosexuals. This research investigates gender differences among sexual minorities in the US.

methods: We analyzed nationally representative data from adults ages 20 to 49 who participated in the 2001 to 2010 waves of the National Health and Nutrition Examination Survey (NHANES) (N = 5,287). We estimated the weighted prevalence of HIV, herpes simplex virus type-2 (HSV-2), human papillomavirus, chlamydia, hepatitis-B and hepatitis-C, as well as mental health, alcohol, smoking, and illicit drug use. All models were adjusted for key sociodemographic variables.

results: After adjustment for sociodemographic characteristics, sexual minority men had higher prevalence of biologically confirmed HIV and HSV-2 and self-reported lifetime diagnoses of gonorrhea and chlamydia compared to heterosexual men. Sexual minority women were more likely to test positive for Hepatitis C, report more drinks per day, lifetime heavy use of alcohol, use of marijuana, lifetime cocaine/heroin/methamphetamine use, and injection drug use compared to heterosexual women. Both sexual minority men and women were more likely to report greater mental health problems compared to their heterosexual counterparts.

conclusions: Findings provide further confirmation of the increased risk of adverse health outcomes faced by sexual minorities in the United States.  Many health risks faced by sexual minorities are specific to gender. Our results demonstrate the need to develop gender-appropriate public health interventions for sexual minorities. 

Introduction: Collecting information about sexual orientation and gender identity (SO/GI) during emergency department (ED) admissions would enable investigation of disparities and could enhance patient-centered care. We examined patient, provider, and registrar perspectives and preferences for SO/GI data collection in EDs to inform best practices.   

Methods: Semi-structured interviews conducted 2014-2015 with a diverse purposive sample of heterosexual, lesbian, gay, bisexual, and transgender patients (n=52) and ED nurses, physicians, and registrars (n=35) in a major metropolitan area. Interviews were recorded, transcribed verbatim, and analyzed by multiple coders using constant comparative methods.

Results: A trajectory of the ED care encounter emerged showing key points for collection and SO/GI relevance, with preferences and considerations at each. Comfort and willingness hinged upon data collection purpose (individual medical relevance vs. population health), mode of collection (form-based vs. verbal), privacy protections, interpersonal and environmental cues to safety, and use and flow of information during care encounter. Medical relevance perceptions varied between patients and providers, with greater overall appreciation for GI relevance. Form-based methods were more acceptable across points of care, yet electronic health records posed unique concerns. Participants highlighted that SO/GI information also contextualizes patient relationship/family status and acknowledges LGBT personhood.

Conclusions: Collection of SO/GI in the ED requires attention to patient, provider, and registrar input on methods, operational and institutional aspects, and contexts of data collection and utilization. Ensuring cultural competency, environmental cues to safety, and appropriate use and protections of information will be key considerations as institutions respond to policy recommendations for SO/GI data collection.

LGBT communities may be disproportionately affected by cancer due to higher rates of traditional risk factors such as tobacco and alcohol; barriers to cancer screening (e.g., healthcare-related stigma and discrimination);  non-inclusion in education campaigns; and minority stress.  Earlier this year, a CDC-funded expert panel convened twice to develop the best and most promising practices throughout the cancer care continuum for the LGBT community. The experts drew upon available literature, clinical and community experience and reached a consensus regarding initial recommendations. The panel developed LGBT-focused best practices for cancer screening, cancer diagnosis, cancer treatment, palliative and end-of-life care. In this presentation, the panel’s recommendations will be reviewed with an in-depth discussion of how they impact and intersect with current public health policies. We look forward to the opportunity to share the first national guidelines for cancer care for the LGBT community with APHA and lead a discussion the public health implications.

Objectives. The likelihood of cancer morbidity increases with frequent exposure over time to a known carcinogen or cancer-related risk behavior. We examined sexual-orientation disparities in frequent engagement in cancer-related risk behaviors of tobacco, alcohol, diet and physical activity, ultraviolet radiation, and sexually transmitted infections.

Methods. We used longitudinal data spanning 11 years from the Growing Up Today Study. Of the analytic sample (N=9,958), 1.8% identified as lesbian/gay (LG), 1.6% bisexual (BI), 12.1% mostly heterosexual (MH), and 84.5% completely heterosexual (CH) in 2010.

Results. More sexual minorities (LG, BI, and MH) frequently engaged in multiple cancer-related risk behaviors than did CH. Sex stratified repeated measures analyses, adjusting for age and ethnicity/race, found disparities in frequent engagement over time in substance use and diet and physical activity risk for sexual-minority women relative to CH women. These group-level analyses found that gay young men relative to CH men reported frequent engagement in vomiting food, physical inactivity, and use of tanning booths, and a higher prevalence of ever having an STI. Individual analyses of persistence over time in frequent engagement were generally comparable to the group-level analyses.

Conclusions. Sexual minorities are likely at risk for long-term poor health outcomes, such as cancer, given their frequent engagement in cancer-related risk behaviors over time. Therefore, data on sexual orientation-disparities in cancer-related morbidity and mortality are needed, as are interventions to reduce the potential burden of cancer in sexual minorities.

Objectives: High schools increasingly include sexual orientation, and to a lesser extent gender identity, in non-discrimination policies (GLSEN, 2012). These policies, however, often exclude gender-specific discrimination seen as unrelated to these identities, such as the policing of masculinity or femininity. The current study examined the role of gender-specific discrimination in predicting psychopathology.

Methods: Participants were 681 cisgender women and men, including 63 LGB-identified individuals, who took part in an online study that examined correlates among different dimensions of identities, stigma, and mental health. Participants were asked if they experienced various forms of discrimination in high school, including being hit or teased by peers or teachers, because they were not seen as masculine or feminine enough. A hierarchical regression was calculated to examine the additive impact of gender-specific discrimination in predicting psychopathology, controlling for global experiences of victimization, as well as ethnicity, gender, and sexual orientation.

Results: Gender-specific harassment predicted symptoms of psychopathology above and beyond a model that accounts for age, gender, ethnicity, sexual orientation, and gender non-specific victimization (DR² = .069, p < .001), contributing to an overall model that predicted 18.3% of the variance in psychopathology scores.

Conclusion: Individuals targeted on the basis of their gender expression in schools are especially psychologically impacted. Gender-based discrimination that occurred at school accounted for nearly twice as much variance in psychopathology, relative to global experiences of victimization. These findings suggest that gender inclusive education, and policy changes, are needed in school settings.