88 results on '"Charlton BM"'
Search Results
2. Uptake of Home-Based HIV Testing, Linkage to Care, and Community Attitudes about ART in Rural KwaZulu-Natal, South Africa: Descriptive Results from the First Phase of the ANRS 12249 TasP Cluster-Randomised Trial
- Author
-
Edet B, Bonilla-Escobar Fj, Creanga Aa, François Dabis, Claire Rekacewicz, Uduak Okomo, Collins Iwuji, Tiggelaar Sm, Charlton Bm, Anthony Nardone, Adelufosi A, Aquaisua E, Marie-Louise Newell, Esu E, Joanna Orne-Gliemann, Kuhlmann Aks, Ejemot-Nwadiaro R, Ellie J Ricketts, Frank Tanser, Zhao H, Jones Lf, Joseph Larmarange, Cam McNulty, Rodolphe Thiébaut, Town K, Wu E, Rugman C, Ogugbue M, Msiska Tw, Gullo S, Jiang T, Thomas Hartney, Kate Folkard, Bello S, M Chibuzor, Nonhlanhla Okesola, Ortega-Loubon C, Galavotti C, Donna M. Lecky, Borus J, Wu R, Ortega-Lenis D, Xu F, Rojas-Mirquez Jc, Iwara Arikpo, Martin M Meremikwu, Dachi Arikpo, Okoye I, Vargas G, DARMIGNY, Sandrine, Research Department of Infection and Population Health [London], University College of London [London] (UCL), Africa Centre for Health and Population Studies, University of KwaZulu-Natal [Durban, Afrique du Sud] (UKZN)-Medical Research Council of South Africa, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), University of KwaZulu-Natal [Durban, Afrique du Sud] (UKZN), Agence Nationale de Recherches sur le Sida et les Hépatites Virales (ANRS), Human Health and Development, University of Southampton, University of KwaZulu-Natal (UKZN)-Medical Research Council of South Africa, Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence nationale de recherches sur le sida et les hépatites virales, ANRS France Recherche Nord & sud Sida-hiv hépatites, Global Health Research Institute, Hopkins Marine Station [Stanford], Stanford University, University College of London [London] ( UCL ), University of KwaZulu-Natal ( UKZN ) -Medical Research Council of South Africa, Institut de Santé Publique, d'Epidémiologie et de Développement ( ISPED ), Centre population et développement ( CEPED - UMR_D 196 ), Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ), Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale ( INSERM ), ANRS, University of Southampton [Southampton], HOPKINS MARINE STATION, Stanford University [Stanford], 12249, The French National Agency for Aids and Viral Hepatitis Research (ANRS), 81151938, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, International Initiative for Impact Evaluation, Merck, Gilead Sciences, and 097410/Z/11/Z, Wellcome Trust
- Subjects
RNA viruses ,Questionnaires ,Male ,Rural Population ,0301 basic medicine ,Epidemiology ,[SDV]Life Sciences [q-bio] ,lcsh:Medicine ,HIV Infections ,Human sexuality ,Pathology and Laboratory Medicine ,Public opinion ,Geographical locations ,South Africa ,0302 clinical medicine ,Immunodeficiency Viruses ,Health care ,Medicine and Health Sciences ,Medicine ,Public and Occupational Health ,030212 general & internal medicine ,ComputingMilieux_MISCELLANEOUS ,media_common ,education.field_of_study ,AIDS Serodiagnosis ,virus diseases ,HIV diagnosis and management ,[ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie ,General Medicine ,Continuity of Patient Care ,Middle Aged ,Vaccination and Immunization ,3. Good health ,Abortion law ,[SDV] Life Sciences [q-bio] ,Sexual Partners ,Medical Microbiology ,Research Design ,HIV epidemiology ,Viral Pathogens ,Viruses ,Cluster Trials ,Female ,Health education ,Pathogens ,Attitude to Health ,Research Article ,Adult ,Drug Research and Development ,Anti-HIV Agents ,media_common.quotation_subject ,Immunology ,HIV prevention ,Population ,Antiretroviral Therapy ,Research and Analysis Methods ,Microbiology ,Young Adult ,03 medical and health sciences ,Antiviral Therapy ,Nursing ,Retroviruses ,Humans ,Clinical Trials ,education ,Microbial Pathogens ,Conscience ,Pharmacology ,Survey Research ,[ SDV ] Life Sciences [q-bio] ,business.industry ,Lentivirus ,lcsh:R ,Organisms ,Biology and Life Sciences ,HIV ,030112 virology ,Mental health ,Diagnostic medicine ,Self Care ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Law ,Africa ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Preventive Medicine ,Clinical Medicine ,People and places ,business - Abstract
Background The 2015 WHO recommendation of antiretroviral therapy (ART) for all immediately following HIV diagnosis is partially based on the anticipated impact on HIV incidence in the surrounding population. We investigated this approach in a cluster-randomised trial in a high HIV prevalence setting in rural KwaZulu-Natal. We present findings from the first phase of the trial and report on uptake of home-based HIV testing, linkage to care, uptake of ART, and community attitudes about ART. Methods and Findings Between 9 March 2012 and 22 May 2014, five clusters in the intervention arm (immediate ART offered to all HIV-positive adults) and five clusters in the control arm (ART offered according to national guidelines, i.e., CD4 count ≤ 350 cells/μl) contributed to the first phase of the trial. Households were visited every 6 mo. Following informed consent and administration of a study questionnaire, each resident adult (≥16 y) was asked for a finger-prick blood sample, which was used to estimate HIV prevalence, and offered a rapid HIV test using a serial HIV testing algorithm. All HIV-positive adults were referred to the trial clinic in their cluster. Those not linked to care 3 mo after identification were contacted by a linkage-to-care team. Study procedures were not blinded. In all, 12,894 adults were registered as eligible for participation (5,790 in intervention arm; 7,104 in control arm), of whom 9,927 (77.0%) were contacted at least once during household visits. HIV status was ever ascertained for a total of 8,233/9,927 (82.9%), including 2,569 ascertained as HIV-positive (942 tested HIV-positive and 1,627 reported a known HIV-positive status). Of the 1,177 HIV-positive individuals not previously in care and followed for at least 6 mo in the trial, 559 (47.5%) visited their cluster trial clinic within 6 mo. In the intervention arm, 89% (194/218) initiated ART within 3 mo of their first clinic visit. In the control arm, 42.3% (83/196) had a CD4 count ≤ 350 cells/μl at first visit, of whom 92.8% initiated ART within 3 mo. Regarding attitudes about ART, 93% (8,802/9,460) of participants agreed with the statement that they would want to start ART as soon as possible if HIV-positive. Estimated baseline HIV prevalence was 30.5% (2,028/6,656) (95% CI 25.0%, 37.0%). HIV prevalence, uptake of home-based HIV testing, linkage to care within 6 mo, and initiation of ART within 3 mo in those with CD4 count ≤ 350 cells/μl did not differ significantly between the intervention and control clusters. Selection bias related to noncontact could not be entirely excluded. Conclusions Home-based HIV testing was well received in this rural population, although men were less easily contactable at home; immediate ART was acceptable, with good viral suppression and retention. However, only about half of HIV-positive people accessed care within 6 mo of being identified, with nearly two-thirds accessing care by 12 mo. The observed delay in linkage to care would limit the individual and public health ART benefits of universal testing and treatment in this population. Trial registration ClinicalTrials.gov NCT01509508, Collins Iwuji and colleagues report implementation indicators and early health outcomes from the first phase of a cluster-randomized trial of immediate antiretroviral therapy to all HIV-positive individuals in rural KwaZulu-Natal, South Africa., Author Summary Why Was This Study Done? A study in stable sexual partners in which one partner was HIV-positive and the other partner was HIV-negative (and both partners had disclosed to each other) showed that if the HIV-positive partner was on antiretroviral therapy, there was a 96% reduction in HIV transmission from the HIV-positive partner to the HIV-negative partner. However, we do not know if antiretroviral therapy prescribed to HIV-positive individuals in the general population—and where individuals might not disclose their HIV status to sexual partners—would have a similar impact on HIV transmission. It is important to determine whether prescribing antiretroviral therapy to all HIV-positive individuals is more effective at decreasing HIV transmission than starting individuals on antiretroviral therapy only once their HIV has progressed to the point at which local HIV treatment guidelines currently recommend that HIV-positive individuals start treatment. What Did the Researchers Do and Find? We designed an experiment to investigate whether antiretroviral therapy can reduce new HIV infections in the general population, and piloted the trial in ten communities in KwaZulu-Natal, South Africa, to check whether starting HIV-positive individuals on antiretroviral therapy directly after diagnosis is feasible and acceptable. We visited people in their homes, offered HIV rapid tests every six months to all individuals 16 years and older, and referred identified HIV-positive individuals to trial clinics, where they were offered antiretroviral therapy either regardless of their CD4 count (intervention group) or when they were treatment-eligible per current national guidelines (control group). During the two-year study, we contacted 9,927 (77%) of 12,894 eligible individuals and ascertained the HIV status of 80% of contacted women and 75% of contacted men. HIV-positive status was ascertained for 1,339 adults who were not previously in care; 1,177 were followed in the trial at least 6 mo after referral, of whom 559 (47.5%) engaged with care within this period. What Do These Findings Mean? Our findings show good acceptance of home-based HIV testing in rural South Africa but highlight the challenges in reaching adequate numbers of people to offer HIV tests to, especially among men. We also found that linkage to care was slower than expected, but amongst those who reached the clinics, uptake of antiretroviral therapy was high, with the majority of individuals achieving good control of the virus. Our study informs health care professionals, planners, and policy makers about the challenges that need to be addressed to achieve the UNAIDS target of 90% of people living with HIV aware of their HIV diagnosis, 90% on antiretroviral therapy, and 90% achieving good control of the virus, with testing and treatment offered to all.
- Published
- 2016
3. Effective and inclusive mentorship in the field of epidemiology.
- Author
-
Charlton BM, Wright DR, Driver-Linn E, Fox MP, and Wise LA
- Abstract
Quality mentoring improves outcomes across career stages, including a sense of belonging, persistence, and productivity. However, the status quo in mentorship culture-including in epidemiology-is an ad hoc approach. This pervasive culture adversely affects individual mentees and the entire scientific research enterprise. Public health disciplines such as epidemiology bear a distinct responsibility to foster an inclusive mentorship culture, ensuring the next generation is equipped not only with methodological expertise but also with a commitment to diversity, equity, inclusion, and the principles of public health. In this commentary, we outline the primary attributes of effective mentors, core competencies, and the evidence base underlying how mentors can improve their skills with comprehensive training. We call on mentors, as well as institutional leaders, to make personal and structural changes, such as requiring mentor training, implementing evidence-based tools (e.g., individual development plans), and regularly evaluating mentorship quality. Institutional leaders can remove barriers (e.g., costs to enroll in mentor training) and facilitate mentorship in non-monetary ways, for example, by making it a formal part of the promotion process. Mentors and leaders must champion these changes, fortifying not only individual career trajectories but also advancing scientific integrity, inclusivity, and justice within the epidemiologic community., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2024
- Full Text
- View/download PDF
4. Perspectives of Sexual and Gender Minority Youth on Anti-Vaping Messages in Social Media.
- Author
-
Theis RP, Pilla J, Okker-Edging K, Pluta K, LeLaurin JH, Hanby E, Zulkiewicz BA, Clark D, Bteddini D, Wright SE, Fahnlander AM, Katz-Wise SL, Lydon-Staley DM, Maziak W, Charlton BM, Scout, Machado AM, Gordon B, Applegate JM, Potter JE, Strasser AA, Liu S, Salloum RG, and Tan ASL
- Abstract
Introduction: Sexual and gender minority (SGM) youth have higher rates of nicotine vaping than other youth in the United States. While social media can be effective in reaching youth and discouraging vaping, informed cultural tailoring is necessary to ensure effective messaging to SGM youth. This study aimed to understand SGM youth perspectives on anti-vaping social media messages and tailoring approaches., Methods: In-depth, qualitative videoconference interviews were conducted from February to July 2022 with 34 SGM youth recruited in the United States via social media ads. The interview guide addressed participants' beliefs about vaping, the context of vaping, perspectives on tailoring messages, and responses to examples of social media anti-vaping messages. Coding and thematic analysis followed a team-based approach., Results: SGM youth perspectives fell into four categories - representation and diversity, facts and evidence, empowering messages, and source credibility. Participants stressed the importance of accurate, genuine representation of SGM youth in messages, but also noted that more overt representation may be seen as tokenizing. Participants recommended partnering with known LGBTQ+ influencers who can promote or share anti-vaping messages on social media platforms. They also recommended using culturally tailored language, including statistics specific to SGM youth, and invoking themes of empowerment to improve the relevance, reach, and effectiveness of anti-vaping campaigns., Conclusions: Findings can inform future efforts to develop anti-vaping messages for SGM youth with effective reach through social media. Nuanced perspectives on SGM representation in messages suggest a careful approach to tailoring. Concerns around inauthenticity may be minimized by ensuring SGM youth are included in message development and dissemination., Implications: This study describes the importance of being attentive to the tailoring preferences among the current generation of sexual and gender minority youth. Findings will inform social media-based messaging strategies that discourage nicotine vaping tailored for SGM youth in health campaign material design and evaluation, ensuring that tailored messages are designed in ways that avoid unintended consequences. The study also describes methods for effectively engaging SGM youth in research to improve the relevance of health education materials for this population and increase reach, which in turn can lead to reduction in vaping practices among SGM youth., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
- Published
- 2024
- Full Text
- View/download PDF
5. Sexual Orientation-Specific Policies Are Associated With Prenatal Care Use in the First Trimester Among Sexual Minority Women: Results From a Prospective Cohort Study.
- Author
-
Everett BG, Bergman Z, Charlton BM, and Barcelona V
- Subjects
- Humans, Female, Pregnancy, Adult, Prospective Studies, Young Adult, Adolescent, Longitudinal Studies, Sexual Behavior statistics & numerical data, Prenatal Care statistics & numerical data, Prenatal Care legislation & jurisprudence, Sexual and Gender Minorities legislation & jurisprudence, Sexual and Gender Minorities statistics & numerical data, Pregnancy Trimester, First
- Abstract
Background: Previous research has shown sexual minority women (SMW) are more likely to report multiple maternal and infant health outcomes compared to heterosexual women and that these outcomes are moderated by the policy environment. Little is known, however, about prenatal care use disparities or the social determinants of prenatal care use for SMW., Purpose: To examine the relationship between sexual orientation-specific policies that confer legal protections (e.g., hate crime protections, housing discrimination, same-sex marriage) and prenatal care use among women using a prospective, population-based data set., Methods: Using the National Longitudinal Study of Adolescent to Adult Health and logistic regression, we link measures of state policies to the use of prenatal care in the first trimester among women who had live births. The use of prospective data allows us to adjust for covariates associated with preconception care use prior to pregnancy (n = 586 singleton births to SMW; n = 4,539 singleton births to heterosexual women)., Results: Sexual orientation-specific policies that conferred protections were associated with increased use of prenatal care among pregnancies reported by SMW (OR = 1.86, 95% CI 1.16, 2.96). In fact, in states with zero protections, we found no differences in prenatal care use by sexual minority status; however, in states with two or more protective policies, SMW were more likely to access prenatal care in the first trimester than heterosexual women. There was no relationship between sexual orientation-specific policy environments and prenatal care use among pregnancies reported by heterosexual women., Conclusions: Recent research has documented that SMW are more likely to have adverse perinatal and obstetrical outcomes than their heterosexual peers. These findings suggest that Lesbian/Gay/Bisexual-specific policy protections may facilitate the use of prenatal care among SMW, a potentially important pathway to improve reproductive health among this population., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)
- Published
- 2024
- Full Text
- View/download PDF
6. Sexual orientation disparities in adverse pregnancy outcomes.
- Author
-
Chakraborty P, Schroeder E, Reynolds CA, McKetta S, Obedin-Maliver J, Austin SB, Everett B, Haneuse S, and Charlton BM
- Subjects
- Humans, Female, Pregnancy, Adult, Sexual Behavior, Sexual and Gender Minorities statistics & numerical data, Pregnancy Complications epidemiology, Health Status Disparities, United States epidemiology, Pregnancy Outcome
- Published
- 2024
- Full Text
- View/download PDF
7. Sexual orientation disparities in gestational diabetes and hypertensive disorders of pregnancy.
- Author
-
Chakraborty P, Everett BG, Reynolds CA, Hoatson T, Stuart JJ, McKetta SC, Soled KRS, Huang AK, Chavarro JE, Eliassen AH, Obedin-Maliver J, Austin SB, Rich-Edwards JW, Haneuse S, and Charlton BM
- Abstract
Background: Sexual minority (SM) individuals (e.g., those with same-sex attractions/partners or who identify as lesbian/gay/bisexual) experience a host of physical and mental health disparities. However, little is known about sexual orientation-related disparities in gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP; gestational hypertension [gHTN] and preeclampsia)., Objective: To estimate disparities in GDM, gHTN and preeclampsia by sexual orientation., Methods: We used data from the Nurses' Health Study II-a cohort of nurses across the US enrolled in 1989 at 25-42 years of age-restricted to those with pregnancies ≥20 weeks gestation and non-missing sexual orientation data (63,518 participants; 146,079 pregnancies). Our primary outcomes were GDM, gHTN and preeclampsia, which participants reported for each of their pregnancies. Participants also reported their sexual orientation identity and same-sex attractions/partners. We compared the risk of each outcome in pregnancies among heterosexual participants with no same-sex experience (reference) to those among SM participants overall and within subgroups: (1) heterosexual with same-sex experience, (2) mostly heterosexual, (3) bisexual and (4) lesbian/gay participants. We used modified Poisson models to estimate risk ratios (RR) and 95% confidence intervals (CI), fit via weighted generalised estimating equations, to account for multiple pregnancies per person over time and informative cluster sizes., Results: The overall prevalence of each outcome was ≤5%. Mostly heterosexual participants had a 31% higher risk of gHTN (RR 1.31, 95% CI 1.03, 1.66), and heterosexual participants with same-sex experience had a 31% higher risk of GDM (RR 1.31, 95% CI 1.13, 1.50), compared to heterosexual participants with no same-sex experience. The magnitudes of the risk ratios were high among bisexual participants for gHTN and preeclampsia and among lesbian/gay participants for gHTN., Conclusions: Some SM groups may be disparately burdened by GDM and HDP. Elucidating modifiable mechanisms (e.g., structural barriers, discrimination) for reducing adverse pregnancy outcomes among SM populations is critical., (© 2024 John Wiley & Sons Ltd.)
- Published
- 2024
- Full Text
- View/download PDF
8. Addressing Gaps in Access to LGBTQIA + Health Education Resources: A Novel E-Learning Platform.
- Author
-
Srinivasan S, Goldhammer H, Charlton BM, McKenney T, and Keuroghlian AS
- Abstract
Objectives: To reduce health inequities for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexually and gender diverse (LGBTQIA+) people, healthcare professionals need increased access to education and training resources on LGBTQIA + health. Web-based, asynchronous, electronic learning (e-learning) resources are critical for expanding the availability of LGBTQIA + health programs. This article presents the design and utilization outcomes of a novel e-learning platform for engaging healthcare professionals in LGBTQIA + health online continuing education., Methods: As of December 2022, the e-learning platform consisted of 293 resources within 17 topic domains. Modalities included: learning modules, recorded webinars, publications, videos, and toolkits. We conducted a descriptive analysis of the e-learning platform's website traffic and user engagement data. Google Universal Analytics and event tracking were used to measure website traffic, user locations, and publication downloads. Learning module and webinar completions were exported from the learning management system and run as frequencies., Results: Between January 1, 2020, and December 31, 2022, over 650,000 people from all U.S. states, 182 countries, and 31 territories visited the website. Platform users downloaded publications 66,225 times, and completed 29,351 learning modules and 24,654 webinars., Conclusion: The broad reach and high user engagement of the e-learning platform indicate acceptability of web-based, asynchronous online continuing education in LGBTQIA + health, and suggest that this platform is filling a need in health professional education. Remote, online learning opportunities may be especially important in jurisdictions with bans on medical care for transgender and gender diverse youth. Future growth of the platform, paired with in-person and other online learning opportunities, has the potential to reduce gaps in LGBTQIA + health training, and mitigate LGBTQIA + health inequities., Competing Interests: A. S. Keuroghlian declares royalties as editor of a McGraw Hill textbook on transgender and gender diverse health care and an American Psychiatric Association Publishing textbook on gender-affirming psychiatric care. The other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)
- Published
- 2024
- Full Text
- View/download PDF
9. Differences in medically assisted reproduction use by sexual identity and partnership: a prospective cohort of cisgender women.
- Author
-
Soled KRS, Hoatson T, Monseur B, Everett B, Chakraborty P, Reynolds CA, Huang AK, McKetta S, Haneuse S, and Charlton BM
- Subjects
- Humans, Female, Prospective Studies, Adult, Pregnancy, Male, Heterosexuality statistics & numerical data, Heterosexuality psychology, Reproductive Techniques, Assisted, Sexual and Gender Minorities statistics & numerical data, Sexual and Gender Minorities psychology, Sexual Partners psychology
- Abstract
Study Question: Does medically assisted reproduction (MAR) use among cisgender women differ among those with same-sex partners or lesbian/bisexual identities compared to peers with different-sex partners or heterosexual identities?, Summary Answer: Women with same-sex partners or lesbian/bisexual identities are more likely to utilize any MAR but are no more likely to use ART (i.e. IVF, reciprocal IVF, embryo transfer, unspecified ART, ICSI, and gamete or zygote intrafallopian transfer) compared to non-ART MAR (i.e. IUI, ovulation induction, and intravaginal or intracervical insemination) than their different-sex partnered and completely heterosexual peers., What Is Known Already: Sexual minority women (SMW) form families in myriad ways, including through fostering, adoption, genetic, and/or biological routes. Emerging evidence suggests this population increasingly wants to form genetic and/or biological families, yet little is known about their family formation processes and conception needs., Study Design, Size, Duration: The Growing Up Today Study is a US-based prospective cohort (n = 27 805). Participants were 9-17 years of age at enrollment (1996 and 2004). Biennial follow-up is ongoing, with data collected through 2021., Participants/materials, Setting, Methods: Cisgender women who met the following criteria were included in this sample: endorsed ever being pregnant; attempted a pregnancy in 2019 or 2021; and endorsed either a male- or female-sex partner OR responded to questions regarding their sexual identity during their conception window. The main outcome was any MAR use including ART (i.e. procedures involving micromanipulation of gametes) and non-ART MAR (i.e. nonmanipulation of gametes). Secondary outcomes included specific MAR procedures, time to conception, and trends across time. We assessed differences in any MAR use using weighted modified Poisson generalized estimating equations., Main Results and the Role of Chance: Among 3519 participants, there were 6935 pregnancies/pregnancy attempts and 19.4% involved MAR. A total of 47 pregnancies or pregnancy attempts were among the same-sex partnered participants, while 91 were among bisexual participants and 37 among lesbian participants. Participants with same-sex, compared to different-sex partners were almost five times as likely to use MAR (risk ratio [95% CI]: 4.78 [4.06, 5.61]). Compared to completely heterosexual participants, there was greater MAR use among lesbian (4.00 [3.10, 5.16]) and bisexual (2.22 [1.60, 3.07]) participants compared to no MAR use; mostly heterosexual participants were also more likely to use ART (1.42 [1.11, 1.82]) compared to non-ART MAR. Among first pregnancies conceived using MAR, conception pathways differed by partnership and sexual identity groups; differences were largest for IUI, intravaginal insemination, and timed intercourse with ovulation induction. From 2002 to 2021, MAR use increased proportionally to total pregnancies/pregnancy attempts; ART use was increasingly common in later years among same-sex partnered and lesbian participants., Limitations, Reasons for Caution: Our results are limited by the small number of SMW, the homogenous sample of mostly White, educated participants, the potential misclassification of MAR use when creating conception pathways unique to SMW, and the questionnaire's skip logic, which excluded certain participants from receiving MAR questions., Wider Implications of the Findings: Previous studies on SMW family formation have primarily focused on clinical outcomes from ART procedures and perinatal outcomes by conception method, and have been almost exclusively limited to European, clinical samples that relied on partnership data only. Despite the small sample of SMW within a nonrepresentative study, this is the first study to our knowledge to use a nonclinical sample of cisgender women from across the USA to elucidate family formation pathways by partnership as well as sexual identity, including pathways that may be unique to SMW. This was made possible by our innovative approach to MAR categorization within a large, prospective dataset that collected detailed sexual orientation data. Specifically, lesbian, bisexual, and same-sex partnered participants used both ART and non-ART MAR at similar frequencies compared to heterosexual and different-sex partnered participants. This may signal differential access to conception pathways owing to structural barriers, emerging conception trends as family formation among SMW has increased, and a need for conception support beyond specialized providers and fertility clinics., Study Funding/competing Interest(s): The research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH), under award number R01MD015256. Additionally, KRSS is supported by NCI grant T32CA009001, AKH by the NCI T32CA057711, PC by the NHLBI T32HL098048, BM by the Stanford Maternal Child Health Research Institute Clinical Trainee Support Grant and the Diversity Fellowship from the American Society for Reproductive Medicine Research Institute, BGE by NICHD R01HD091405, and SM by the Thomas O. Pyle Fellowship through the Harvard Pilgrim Health Care Foundation and Harvard University, NHLBI T32HL098048, NIMH R01MH112384, and the William T. Grant Foundation grant number 187958. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The first author recently had a leadership role in the not-for-profit program, The Lesbian Health Fund, a research fund focused on improving the health and wellbeing of LGBTQ+ women and girls. The fund did not have any role in this study and the author's relationship with the fund did not bias the findings of this manuscript., Trial Registration Number: N/A., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2024
- Full Text
- View/download PDF
10. Prevalence of Gender-Affirming Surgical Procedures Among Minors and Adults in the US.
- Author
-
Dai D, Charlton BM, Boskey ER, Hughes LD, Hughto JMW, Orav EJ, and Figueroa JF
- Subjects
- Humans, Female, United States, Adult, Male, Adolescent, Prevalence, Young Adult, Child, Transgender Persons statistics & numerical data, Transgender Persons psychology, Middle Aged, Sex Reassignment Surgery statistics & numerical data, Cross-Sectional Studies, Gender Dysphoria surgery, Gender Dysphoria psychology, Minors statistics & numerical data
- Published
- 2024
- Full Text
- View/download PDF
11. Disparities in Mortality by Sexual Orientation in a Large, Prospective Cohort of Female Nurses.
- Author
-
McKetta S, Hoatson T, Hughes LD, Everett BG, Haneuse S, Austin SB, Hughes TL, and Charlton BM
- Subjects
- Adult, Female, Humans, Middle Aged, Bisexuality statistics & numerical data, Heterosexuality statistics & numerical data, Homosexuality, Female statistics & numerical data, Mortality trends, Prospective Studies, Sexual Behavior, United States epidemiology, Health Status Disparities, Mortality, Premature, Nurses statistics & numerical data, Sexual and Gender Minorities statistics & numerical data
- Abstract
Importance: Extensive evidence documents health disparities for lesbian, gay, and bisexual (LGB) women, including worse physical, mental, and behavioral health than heterosexual women. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among LGB women and whether they differ by lesbian or bisexual identity., Objective: To examine differences in mortality by sexual orientation., Design, Setting, and Participants: This prospective cohort study examined differences in time to mortality across sexual orientation, adjusting for birth cohort. Participants were female nurses born between 1945 and 1964, initially recruited in the US in 1989 for the Nurses' Health Study II, and followed up through April 2022., Exposures: Sexual orientation (lesbian, bisexual, or heterosexual) assessed in 1995., Main Outcome and Measure: Time to all-cause mortality from assessment of exposure analyzed using accelerated failure time models., Results: Among 116 149 eligible participants, 90 833 (78%) had valid sexual orientation data. Of these 90 833 participants, 89 821 (98.9%) identified as heterosexual, 694 (0.8%) identified as lesbian, and 318 (0.4%) identified as bisexual. Of the 4227 deaths reported, the majority were among heterosexual participants (n = 4146; cumulative mortality of 4.6%), followed by lesbian participants (n = 49; cumulative mortality of 7.0%) and bisexual participants (n = 32; cumulative mortality of 10.1%). Compared with heterosexual participants, LGB participants had earlier mortality (adjusted acceleration factor, 0.74 [95% CI, 0.64-0.84]). These differences were greatest among bisexual participants (adjusted acceleration factor, 0.63 [95% CI, 0.51-0.78]) followed by lesbian participants (adjusted acceleration factor, 0.80 [95% CI, 0.68-0.95])., Conclusions and Relevance: In an otherwise largely homogeneous sample of female nurses, participants identifying as lesbian or bisexual had markedly earlier mortality during the study period compared with heterosexual women. These differences in mortality timing highlight the urgency of addressing modifiable risks and upstream social forces that propagate and perpetuate disparities.
- Published
- 2024
- Full Text
- View/download PDF
12. Disparities in cancer incidence by sexual orientation.
- Author
-
Huang AK, Hoatson T, Chakraborty P, McKetta S, Soled KRS, Reynolds CA, Boehmer U, Miranda AR, Streed CG Jr, Maingi S, Haneuse S, Young JG, Kang JH, Austin SB, Eliassen AH, and Charlton BM
- Abstract
Introduction: Cancer risk factors are more common among sexual minority populations (e.g., lesbian, bisexual) than their heterosexual peers, yet little is known about cancer incidence across sexual orientation groups., Methods: The 1989-2017 data from the Nurses' Health Study II, a longitudinal cohort of female nurses across the United States, were analyzed (N = 101,543). Sexual orientation-related cancer disparities were quantified by comparing any cancer incidence among four sexual minority groups based on self-disclosure-(1) heterosexual with past same-sex attractions/partners/identity; (2) mostly heterosexual; (3) bisexual; and (4) lesbian women-to completely heterosexual women using age-adjusted incidence rate ratios (aIRR) calculated by the Mantel-Haenszel method. Additionally, subanalyses at 21 cancer disease sites (e.g., breast, colon/rectum) were conducted., Results: For all-cancer analyses, there were no statistically significant differences in cancer incidence at the 5% type I error cutoff among sexual minority groups when compared to completely heterosexual women; the aIRR was 1.17 (95% CI,0.99-1.38) among lesbian women and 0.80 (0.58-1.10) among bisexual women. For the site-specific analyses, incidences at multiple sites were significantly higher among lesbian women compared to completely heterosexual women: thyroid cancer (aIRR, 1.87 [1.03-3.41]), basal cell carcinoma (aIRR, 1.85 [1.09-3.14]), and non-Hodgkin lymphoma (aIRR, 2.13 [1.10-4.12])., Conclusion: Lesbian women may be disproportionately burdened by cancer relative to their heterosexual peers. Sexual minority populations must be explicitly included in cancer prevention efforts. Comprehensive and standardized sexual orientation data must be systematically collected so nuanced sexual orientation-related cancer disparities can be accurately assessed for both common and rare cancers., (© 2024 American Cancer Society.)
- Published
- 2024
- Full Text
- View/download PDF
13. Adverse Obstetric and Perinatal Outcomes Among Birthing People in Same-Sex and Different-Sex Relationships in Louisiana.
- Author
-
Vilda D, Agénor M, Wallace ME, Lian IB, Charlton BM, Reynolds CA, and Harville EW
- Abstract
Purpose: We investigated sexual orientation disparities in several obstetric and perinatal outcomes in Louisiana and examined whether these disparities differed among Black, Latine, and White populations. Methods: We analyzed cross-sectional vital records data on singleton live births in Louisiana (2016-2022). Same-sex relationships (SSR) vs. different-sex relationships (DSR) were classified based on the sex of the parents listed on the birth certificate. Using modified Poisson regression, we estimated adjusted risk ratios and 95% confidence intervals among birthing persons in SSR vs. DSR for preterm birth (PTB), low birthweight (LBW), spontaneous labor, Cesarean delivery, gestational hypertension, and gestational diabetes. We examined within and across group disparities in models stratified by sexual orientation and race/ethnicity. Results: In the total birthing population, those in SSR experienced higher risk of gestational hypertension and gestational diabetes and were less likely to have spontaneous labor compared with persons in DSR. The risk of PTB and LBW was two-fold higher among Black birthing people in SSR compared with White birthing people in SSR and DSR. Latine birthing people in SSR experienced higher risk of gestational hypertension and gestational diabetes compared with their peers in DSR and White people in DSR. Some of these disparities were partially explained by including socioeconomic and health risk factors. Conclusion: Sexual orientation-related disparities exist across and within racial/ethnic groups among birthing people in Louisiana. Adopting an intersectional approach that considers the mutually constituted nature of heterosexism and racism is critical to addressing sexual orientation-related inequities in reproductive and perinatal health.
- Published
- 2024
- Full Text
- View/download PDF
14. Trajectories of Mental Distress Among US Women by Sexual Orientation and Racialized Group During the First Year of the COVID-19 Pandemic.
- Author
-
Beccia AL, Zubizarreta D, Austin SB, Raifman JR, Chavarro JE, and Charlton BM
- Subjects
- Adult, Female, Humans, Pandemics, Sexual Behavior psychology, Heterosexuality psychology, COVID-19 epidemiology, Mental Disorders, Sexual and Gender Minorities
- Abstract
Objectives. To describe longitudinal trends in the prevalence of mental distress across the first year of the COVID-19 pandemic (April 2020‒April 2021) among US women at the intersection of sexual orientation and racialized group. Methods. Participants included 49 805 cisgender women and female-identified people from the COVID-19 Sub-Study, a cohort of US adults embedded within the Nurses' Health Studies 2 and 3 and the Growing Up Today Study. We fit generalized estimating equation Poisson models to estimate trends in depressive and anxiety symptoms by sexual orientation (gay or lesbian, bisexual, mostly heterosexual, completely heterosexual); subsequent models explored further differences by racialized group (Asian, Black, Latine, White, other or unlisted). Results. Relative to completely heterosexual peers, gay or lesbian, bisexual, and mostly heterosexual women had a higher prevalence of depressive and anxiety symptoms at each study wave and experienced widening inequities over time. Inequities were largest for sexual minority women of color, although confidence intervals were wide. Conclusions. The COVID-19 pandemic may have exacerbated already-glaring mental health inequities affecting sexual minority women, especially those belonging to marginalized racialized groups. Future research should investigate structural drivers of these patterns to inform policy-oriented interventions. ( Am J Public Health . 2024;114(5):511-522. https://doi.org/10.2105/AJPH.2024.307601).
- Published
- 2024
- Full Text
- View/download PDF
15. Barriers to Cervical Cancer Screening by Sexual Orientation Among Low-Income Women in North Carolina.
- Author
-
Spencer JC, Charlton BM, Pretsch PK, Schnarrs PW, Spees LP, Hudgens MG, Barclay L, Wheeler SB, Brewer NT, and Smith JS
- Subjects
- Humans, Female, North Carolina, Middle Aged, Adult, Sexual Behavior, Sexual and Gender Minorities statistics & numerical data, Sexual and Gender Minorities psychology, Patient Acceptance of Health Care statistics & numerical data, Patient Acceptance of Health Care psychology, Mass Screening statistics & numerical data, Uterine Cervical Neoplasms diagnosis, Early Detection of Cancer statistics & numerical data, Poverty, Health Services Accessibility statistics & numerical data
- Abstract
We sought to examine cervical cancer screening barriers by sexual orientation among low-income women in North Carolina. The MyBodyMyTest-3 Trial recruited low-income women (< 250% of federal poverty level) aged 25-64 years who were 1+ year overdue for cervical cancer screening. We compared perceptions of cervical cancer screening among those who self-identified as lesbian, gay, bisexual, or queer (LGBQ; n = 70) to straight/heterosexual women (n = 683). For both LGBQ and straight respondents, the greatest barriers to screening were lack of health insurance (63% and 66%) and cost (49% and 50%). LGBQ respondents were more likely than straight respondents to report forgetting to screen (16% vs. 8%, p = .05), transportation barriers (10% vs. 2%, p = .001), and competing mental or physical health problems (39% vs. 27%, p = .10). Addressing access remains important for improving cervical cancer screening among those under-screened. For LGBQ women, additional attention may be needed for reminders, co-occurring health needs, and transportation barriers., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
16. Breast and cervical cancer screenings across gender identity: results from the Behavioral Risk Factor Surveillance System before and during the COVID-19 pandemic.
- Author
-
Berzansky I, Reynolds CA, and Charlton BM
- Subjects
- Humans, Female, Male, Adult, Middle Aged, Transgender Persons statistics & numerical data, Transgender Persons psychology, United States epidemiology, Aged, Young Adult, SARS-CoV-2 isolation & purification, COVID-19 epidemiology, Early Detection of Cancer statistics & numerical data, Early Detection of Cancer psychology, Uterine Cervical Neoplasms epidemiology, Uterine Cervical Neoplasms diagnosis, Breast Neoplasms epidemiology, Breast Neoplasms diagnosis, Behavioral Risk Factor Surveillance System, Gender Identity
- Abstract
Purpose: Although national medical organizations often neglect to include trans and gender diverse (TGD) people in their breast and cervical cancer screening recommendations, the World Profession Association of Transgender Health recommends that TGD people who are at risk for these cancers follow existing guidelines for cisgender women. Despite WPATH's recommendations, TGD people are less likely to get screened in large part due to discrimination. The COVID-19 pandemic has limited access to cancer screenings among cisgender people, but it is unknown how this has impacted TGD people., Methods: Using national survey data from the Behavioral Risk Factors Surveillance System (BRFSS), we examined differences in cervical and breast cancer screening noncompliance across gender identity at two time points: before and during the COVID-19 pandemic., Results: Screening noncompliance increased during the COVID-19 pandemic among cisgender and TGD people (e.g., transgender men, gender non-conforming people). Compared to cisgender women, transgender men and gender non-conforming respondents had higher odds of breast cancer screening noncompliance before and during COVID-19. Transgender men had lower odds of cervical cancer screening noncompliance than cisgender women before COVID-19, but higher odds during the pandemic. Gender non-conforming respondents also had lower odds of cervical cancer screening noncompliance during COVID-19 compared to cisgender women., Conclusions: Screening noncompliance for breast and cervical cancer was more common among TGD people than cisgender women; while these disparities existed before the COVID-19 pandemic, they were exacerbated during the pandemic. Future work should move beyond descriptive statistics and elucidate underlying causes to inform interventions., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
- Published
- 2024
- Full Text
- View/download PDF
17. Restrictive abortion legislation and adverse mental health during pregnancy and postpartum.
- Author
-
McKetta S, Chakraborty P, Gimbrone C, Soled KRS, Hoatson T, Beccia AL, Reynolds CA, Huang AK, and Charlton BM
- Subjects
- Female, Humans, Pregnancy, Mental Health, Postpartum Period, Pregnancy, Unplanned, Abortion, Induced psychology, Abortion, Spontaneous
- Abstract
Purpose: To determine the impact of abortion legislation on mental health during pregnancy and postpartum and assess whether pregnancy intention mediates associations., Methods: We quantified associations between restrictive abortion laws and stress, depression symptoms during and after pregnancy, and depression diagnoses after pregnancy using longitudinal data from Nurses' Health Study 3 in 2010-2017 (4091 participants, 4988 pregnancies) using structural equation models with repeated measures, controlling for sociodemographics, prior depression, state economic and sociopolitical measures (unemployment rate, gender wage gap, Gini index, percentage of state legislatures who are women, Democratic governor)., Results: Restrictive abortion legislation was associated with unintended pregnancies (β = 0.127, p = 0.02). These were, in turn, associated with increased risks of stress and depression symptoms during pregnancy (total indirect effects β = 0.035, p = 0.03; β = 0.029, p = 0.03, respectively, corresponding <1% increase in probability), but not after pregnancy., Conclusions: Abortion restrictions are associated with higher proportions of unintended pregnancies, which are associated with increased risks of stress and depression during pregnancy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
18. Development of a mentor training curriculum to support LGBTQIA+ health professionals.
- Author
-
Charlton BM, Potter J, Keuroghlian AS, Dalrymple JL, Katz-Wise SL, Guss CE, Phillips WR, Jarvie E, Maingi S, Streed C, Anglemyer E, Hoatson T, and Birren B
- Abstract
While mentors can learn general strategies for effective mentoring, existing mentorship curricula do not comprehensively address how to support marginalized mentees, including LGBTQIA+ mentees. After identifying best mentoring practices and existing evidence-based curricula, we adapted these to create the Harvard Sexual and Gender Minority Health Mentoring Program. The primary goal was to address the needs of underrepresented health professionals in two overlapping groups: (1) LGBTQIA+ mentees and (2) any mentees focused on LGBTQIA+ health. An inaugural cohort ( N = 12) of early-, mid-, and late-career faculty piloted this curriculum in spring 2022 during six 90-minute sessions. We evaluated the program using confidential surveys after each session and at the program's conclusion as well as with focus groups. Faculty were highly satisfied with the program and reported skill gains and behavioral changes. Our findings suggest this novel curriculum can effectively prepare mentors to support mentees with identities different from their own; the whole curriculum, or parts, could be integrated into other trainings to enhance inclusive mentoring. Our adaptations are also a model for how mentorship curricula can be tailored to a particular focus (i.e., LGBTQIA+ health). Ideally, such mentor trainings can help create more inclusive environments throughout academic medicine., Competing Interests: As a part of this work, Brittany Charlton became a Certified Facilitator through the Center for the Improvement of Mentored Experiences in Research. Sabra Katz-Wise is a diversity consultant for Paramount Global. Alex Keuroghlian and Jennifer Potter report royalties as editors of a McGraw Hill textbook on transgender and gender-diverse health care. The authors report no relevant conflicts of interest., (© The Author(s) 2024.)
- Published
- 2024
- Full Text
- View/download PDF
19. The association between preconception cannabis use and gestational diabetes mellitus: The Preconception Period Analysis of Risks and Exposures Influencing health and Development (PrePARED) consortium.
- Author
-
Pan K, Jukic AM, Mishra GD, Mumford SL, Wise LA, Schisterman EF, Ley SH, Charlton BM, Chavarro JE, Hart JE, Sidney S, Xiong X, Barbosa-Leiker C, Schliep KC, Shaffer JG, Bazzano LA, and Harville EW
- Subjects
- Pregnancy, Female, Humans, Prospective Studies, Risk Factors, Demography, Body Mass Index, Diabetes, Gestational epidemiology, Diabetes, Gestational etiology, Cannabis adverse effects
- Abstract
Background: The metabolic changes that ultimately lead to gestational diabetes mellitus (GDM) likely begin before pregnancy. Cannabis use might increase the risk of GDM by increasing appetite or promoting fat deposition and adipogenesis., Objectives: We aimed to assess the association between preconception cannabis use and GDM incidence., Methods: We analysed individual-level data from eight prospective cohort studies. We identified the first, or index, pregnancy (lasting ≥20 weeks of gestation with GDM status) after cannabis use. In analyses of pooled individual-level data, we used logistic regression to estimate study-type-specific odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential confounders using random effect meta-analysis to combine study-type-specific ORs and 95% CIs. Stratified analyses assessed potential effect modification by preconception tobacco use and pre-pregnancy body mass index (BMI)., Results: Of 17,880 participants with an index pregnancy, 1198 (6.7%) were diagnosed with GDM. Before the index pregnancy, 12.5% of participants used cannabis in the past year. Overall, there was no association between preconception cannabis use in the past year and GDM (OR 0.97, 95% CI 0.79, 1.18). Among participants who never used tobacco, however, those who used cannabis more than weekly had a higher risk of developing GDM than those who did not use cannabis in the past year (OR 2.65, 95% CI 1.15, 6.09). This association was not present among former or current tobacco users. Results were similar across all preconception BMI groups., Conclusions: In this pooled analysis of preconception cohort studies, preconception cannabis use was associated with a higher risk of developing GDM among individuals who never used tobacco but not among individuals who formerly or currently used tobacco. Future studies with more detailed measurements are needed to investigate the influence of preconception cannabis use on pregnancy complications., (© 2023 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)
- Published
- 2024
- Full Text
- View/download PDF
20. Health Care Utilization and Care-seeking Behavior Among Vulnerabilized Sexual Minority Women: A Social-ecological Approach.
- Author
-
Huang AK, Nguyen M, German D, Alexander K, Charlton BM, and Glick JL
- Subjects
- Humans, Female, Adult, Middle Aged, Young Adult, Social Support, Qualitative Research, Health Services Accessibility, Interviews as Topic, Sexual and Gender Minorities psychology, Patient Acceptance of Health Care ethnology, Patient Acceptance of Health Care psychology, Patient Acceptance of Health Care statistics & numerical data, Social Stigma
- Abstract
Sexual minority women (SMW) experience worse health than their heterosexual counterparts but have largely been omitted from health services research. To address this gap, we conducted 25 semi-structured, in-depth interviews with SMW. Transcripts were analyzed using thematic analysis, and findings were organized using a modified socioecological framework. Key themes at each socioecological level include (1) structural: stigma, sociocultural norms, health infrastructure; (2) organizational: stigma, patient-provider relationship, hours and location, linkage to care and co-location of services; (3) interpersonal: stigma and social support; (4) individual: internalized stigma, self-efficacy, socioeconomic status, health literacy, and intersecting identities. Stigma is the central theme affecting vulnerabilized SMW's experiences accessing care. Anti-stigma initiatives and factors that lead to personal resilience and can mitigate care access barriers were identified at each level. Interventions should focus on building inclusive policies/infrastructure and using SMW's unique social networks to empower and improve care access and health outcomes among vulnerabilized SMW.
- Published
- 2024
21. Mapping the scientific literature on obstetrical and perinatal health among sexual and gender minoritised (SGM) childbearing people and their infants: a scoping review protocol.
- Author
-
Huang AK, Soled KRS, Chen L, Schulte AR, Hall ME, McLaughlin C, Srinivasan S, Jahan AB, Mita C, and Charlton BM
- Subjects
- Female, Humans, Infant, Pregnancy, Evidence Gaps, Research Design, Systematic Reviews as Topic, Infant, Newborn, Adult, Pregnancy Complications, Sexual and Gender Minorities
- Abstract
Introduction: Sexual and gender minoritised (SGM) populations are disproportionately impacted by multilevel risk factors for obstetrical and perinatal outcomes, including structural (eg, stigma, discrimination, access to care) and individual risk factors (eg, partner violence, poor mental health, substance use). Emerging evidence shows SGM childbearing people have worse obstetrical outcomes and their infants have worse perinatal outcomes, when compared with their cisgender and heterosexual counterparts; this emerging evidence necessitates a comprehensive examination of existing literature on obstetrical and perinatal health among SGM people. The goal of this scoping review is to comprehensively map the extent, range and nature of scientific literature on obstetrical and perinatal physical health outcomes among SGM populations and their infants. We aim to summarise findings from existing literature, potentially informing clinical guidelines on perinatal care, as well as highlighting knowledge gaps and providing directions for future research., Methods and Analysis: We will follow the Joanna Briggs Institute (JBI) scoping review framework and report findings according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. We will conduct a broad systematic search in Medline/PubMed, Embase, CINAHL and Web of Science Core Collection. Eligible studies will include peer-reviewed, empirical, English-language publications pertaining to obstetrical and perinatal physical health outcomes of SGM people or their infants. No temporal or geographical limitations will be applied to the search. Studies conducted in all settings will be considered. Records will be managed, screened and extracted by two independent reviewers. Study characteristics, key findings and research gaps will be presented in tables and summarised narratively., Ethics and Dissemination: Ethical approval is not required as primary data will not be collected. The findings of this scoping review will be disseminated through a peer-reviewed journal and conference presentations., Protocol Registration: Open Science Framework https://osf.io/6fg4a/., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
- Full Text
- View/download PDF
22. Large-Scale Data Harmonization Across Prospective Studies.
- Author
-
Pan K, Bazzano LA, Betha K, Charlton BM, Chavarro JE, Cordero C, Gunderson EP, Haggerty CL, Hart JE, Jukic AM, Ley SH, Mishra GD, Mumford SL, Schisterman EF, Schliep K, Shaffer JG, Sotres-Alvarez D, Stanford JB, Wilcox AJ, Wise LA, Yeung E, and Harville EW
- Subjects
- Pregnancy, Humans, Female, Child, Preschool, Prospective Studies, Risk Factors, Health Status
- Abstract
The Preconception Period Analysis of Risks and Exposures Influencing Health and Development (PrePARED) Consortium creates a novel resource for addressing preconception health by merging data from numerous cohort studies. In this paper, we describe our data harmonization methods and results. Individual-level data from 12 prospective studies were pooled. The crosswalk-cataloging-harmonization procedure was used. The index pregnancy was defined as the first postbaseline pregnancy lasting more than 20 weeks. We assessed heterogeneity across studies by comparing preconception characteristics in different types of studies. The pooled data set included 114,762 women, and 25,531 (22%) reported at least 1 pregnancy of more than 20 weeks' gestation during the study period. Babies from the index pregnancies were delivered between 1976 and 2021 (median, 2008), at a mean maternal age of 29.7 (standard deviation, 4.6) years. Before the index pregnancy, 60% of women were nulligravid, 58% had a college degree or more, and 37% were overweight or obese. Other harmonized variables included race/ethnicity, household income, substance use, chronic conditions, and perinatal outcomes. Participants from pregnancy-planning studies had more education and were healthier. The prevalence of preexisting medical conditions did not vary substantially based on whether studies relied on self-reported data. Use of harmonized data presents opportunities to study uncommon preconception risk factors and pregnancy-related events. This harmonization effort laid the groundwork for future analyses and additional data harmonization., (Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2023.)
- Published
- 2023
- Full Text
- View/download PDF
23. Latino? Latinx? Latine? A Call for Inclusive Categories in Epidemiologic Research.
- Author
-
Miranda AR, Perez-Brumer A, and Charlton BM
- Subjects
- Humans, Epidemiologic Studies, Gender Identity, Hispanic or Latino, Transgender Persons, Terminology as Topic
- Abstract
Use of the word "Latinx" has risen in popularity among both academics and nonacademics to promote a gender-inclusive alternative to otherwise linguistically gendered terms of "Latino/a." While critics claim the term is inappropriate for populations without gender-diverse individuals, or those of unknown demographic composition, increasing usage and among younger communities signals an important shift in centering the intersectional experiences of transgender and gender-diverse people. Amid these shifts, what are the implications for epidemiologic methods? We provide some brief historical context for the origin of the word "Latinx" along with its alternative "Latine" and discuss the potential consequences of its use for participant recruitment and study validity. Additionally, we provide suggestions for the best use of "Latino" compared with "Latinx/e" in several contextual circumstances. We recommend using "Latinx" or "Latine" in large populations, even without detailed data on gender, since there is likely gender diversity in the population, albeit unmeasured. In participant-facing recruitment or study documents, additional context is needed to determine which identifier is most appropriate., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2023
- Full Text
- View/download PDF
24. Predictors of Fertility-Awareness-Based Method Use Among Women Trying to Conceive and Women Contemplating Pregnancy.
- Author
-
Pérez Capotosto M, Lee CS, Jurgens CY, Wang S, Mitsunami M, Charlton BM, and Chavarro JE
- Subjects
- Pregnancy, Female, Humans, Research Design, Fertility, Fertilization
- Abstract
Background: Fertility-awareness-based methods have been linked to shorter time to conception; however, little is known about the predictors of fertility-awareness-based method use among women who are currently or will soon be trying to conceive., Objectives: The aim of this study was to identify predictors of fertility-awareness-based methods use among women trying to conceive or contemplating pregnancy within the next year., Methods: Women participating in the Nurses' Health Study 3 were asked if they were trying to become pregnant or contemplating pregnancy and whether they are using fertility-awareness-based methods. Multivariable negative binomial regression was used to identify predictors for a number of fertility-awareness-based methods used., Results: Among the 23,418 women asked about pregnancy intention since 2015, 955 were trying to conceive, and 2,282 were contemplating pregnancy within the next year. The three most used fertility-awareness-based methods among women trying to conceive were menstrual cycle tracking, ovulation prediction kits, and cervical mucus monitoring. Among women contemplating pregnancy, the three most commonly used methods were menstrual cycle tracking, cervical mucus monitoring, and basal body temperature monitoring. The ongoing duration of pregnancy attempts and gravidity were associated with the number of methods used among women actively trying to conceive. When compared with women who were trying for 2 months or less, the number of methods was 29% higher when trying for 3-5 months, 45% higher when trying for 6-12 months, and 38% higher when trying for more than 1 year. Compared with nulligravid women, the number of methods was lower for women with a history of two or more pregnancies. Among women contemplating pregnancy, those who were married or in a domestic partnership used more fertility-awareness-based methods than unpartnered women. No other significant predictors of fertility-awareness-based method use were identified., Discussion: Duration of ongoing pregnancy attempt and gravidity were the only significant predictors for the number of fertility-awareness-based methods used among women actively trying to conceive, whereas partnership was the only significant predictor of the number of fertility-awareness-based methods among women contemplating pregnancy., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
25. Integrating LGBTQIA + Community Member Perspectives into Medical Education.
- Author
-
Katz-Wise SL, Jarvie EJ, Potter J, Keuroghlian AS, Gums JN, Kosciesza AJ, Hanshaw BD, Ornelas A, Mais E, DeJesus K, Ajegwu R, Presswood W, Guss CE, Phillips R, Charlton BM, Kremen J, Williams K, and Dalrymple JL
- Abstract
Problem LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minorities) people have unique health care needs related to their sexual orientation, gender identity and expression, and sex development. However, medical education has historically excluded LGBTQIA + health-related content in formal curricula. It is common for medical students to interact with diverse patient populations through clinical rotations; however, access to and knowledge about LGBTQIA + patients is inconsistently prioritized in medical schools. This is especially true for LGBTQIA + patients with intersecting historically marginalized identities, such as people of color and people with disabilities. Learning from and listening to medically underserved community members can help both medical students and educators better understand the unique health needs of these communities, and address implicit biases to improve health care and outcomes for their patients. Intervention : To address the lack of LGBTQIA + health-related content in medical education and improve access to and knowledge about LGBTQIA + patients, LGBTQIA + community members' perspectives and lived experiences were integrated into undergraduate medical education via four primary methods: Community Advisory Groups, community panel events, standardized patients, and community member interviews. Context : LGBTQIA + community members' perspectives and lived experiences were integrated into medical education at Harvard Medical School (HMS) as part of the HMS Sexual and Gender Minority Health Equity Initiative. Impact : LGBTQIA + community members' perspectives and lived experiences were successfully integrated into multiple aspects of medical education at HMS. During this process, we navigated challenges in the following areas that can inform similar efforts at other institutions: representation of diverse identities and experiences, meeting and scheduling logistics, structural barriers in institutional processes, and implementation of community member recommendations. Lessons Learned : Based on our experiences, we offer recommendations for integrating LGBTQIA + community members' perspectives into medical education. Engaging community members and integrating their perspectives into medical education will better enable medical educators at all institutions to teach students about the health care needs of LGBTQIA + communities, and better prepare medical students to provide affirming and effective care to their future patients, particularly those who are LGBTQIA+.
- Published
- 2023
- Full Text
- View/download PDF
26. Pregnancy Intention, Changes in Pregnancy Intention, and Pregnancy Incidence Among Female Nurses in North America.
- Author
-
Wang S, Minguez-Alarcon L, Capotosto MP, Mitsunami M, Gaskins AJ, Charlton BM, Hart JE, Rich-Edwards JW, and Chavarro JE
- Subjects
- Pregnancy, Female, Humans, Adult, Cohort Studies, Incidence, Prospective Studies, North America, Intention
- Abstract
Importance: Pregnancy intention assessment is a key element of preconception and contraceptive care. The association between a single screening question and the incidence of pregnancy is unknown., Objective: To prospectively evaluate the dynamics of pregnancy intention and pregnancy incidence., Design, Setting, and Participants: This prospective cohort study (the Nurses' Health Study 3) was conducted from June 1, 2010, to April 1, 2022, in 18 376 premenopausal, nonpregnant female nurses aged 19 to 44 years., Main Outcomes and Measures: Pregnancy intention and pregnancy status were assessed at baseline and approximately every 3 to 6 months thereafter. Cox proportional hazards regression models were used to estimate the association between pregnancy intention and pregnancy incidence., Results: A total of 18 376 premenopausal, nonpregnant women (mean [SD] age, 32.4 [6.5] years) participated in the study. At baseline, 1008 women (5.5%) were trying to conceive, 2452 (13.3%) were contemplating pregnancy within 1 year, and the remaining 14 916 (81.2%) were neither trying to conceive nor thought they would be pregnant within 1 year. A total of 1314 pregnancies were documented within 12 months of pregnancy intention assessment. The cumulative incidence of pregnancy was 38.8% in women actively trying to conceive (median [IQR] time to pregnancy, 3.3 [1.5-6.7] months), 27.6% in women contemplating pregnancy (median [IQR] time to pregnancy, 6.7 [4.2-9.3] months), and 1.7% in women neither trying to conceive nor contemplating pregnancy (median [IQR] time to pregnancy, 7.8 [5.2-10.5] months) among those who became pregnant. Women who were actively trying to conceive were 23.1 times (95% CI, 19.5-27.4 times) and women who were contemplating pregnancy were 13.0 times (95% CI, 11.1-15.2 times) more likely to conceive within 12 months than women who were neither attempting nor contemplating pregnancy. Among women contemplating pregnancy at baseline who did not get pregnant during follow up, 18.8% were actively trying and 27.6% were not trying by 12 months. Conversely, only 4.9% of women neither trying to conceive nor contemplating pregnancy within 1 year at baseline changed pregnancy intention during follow up., Conclusions and Relevance: In this cohort study of reproductive-aged nurses in North America, pregnancy intention was highly fluid among women who were contemplating pregnancy but relatively stable among women trying to conceive and women who were neither trying to conceive nor contemplating pregnancy. Pregnancy intention was strongly associated with pregnancy incidence, but the median time to pregnancy points to a relatively short time window to initiate preconception care.
- Published
- 2023
- Full Text
- View/download PDF
27. Associations between sexual orientation, sex education curriculum, and exposure to affirming/disaffirming LGB content in two US-based cohorts of adolescents.
- Author
-
Tabaac AR, Johns MM, Zubizarreta D, Haneuse S, Tan ASL, Austin SB, Potter J, Lindberg L, and Charlton BM
- Abstract
Sexual health education experienced by lesbian, gay, and bisexual (LGB) youth varies widely in relevancy and representation. However, associations among sexual orientation, type of sex education, and exposure to affirming or disaffirming content have yet to be examined. Understanding these patterns can help to address gaps in LGB-sensitive sex education. Our goal in this study was to examine the prevalence and associations among abstinence-only until marriage (AOUM) and comprehensive sex education with LGB-affirming and -disaffirming content sought/received before age 18 (from 1999-2014) by sexual orientation (completely heterosexual with same-sex contact, completely heterosexual with no same-sex contact, mostly heterosexual, bisexual, gay/lesbian) in a sample of 12,876 US young adults from the Growing Up Today Study. Compared to completely heterosexual referents, LGB participants who received AOUM sex education were more likely to encounter LGB-disaffirming content, and this effect was largest among sexual minority participants. Conversely, exposure to comprehensive sex education was associated with receipt of LGB-affirming information. Overall, participants commonly reported receiving AOUM sex education, which may lead to deficits and potential harm to sexual minorities.
- Published
- 2023
- Full Text
- View/download PDF
28. Clinical outcomes and considerations of gender-affirming care for transgender and gender-diverse pediatric and young adult patients with cancer.
- Author
-
Kempf AM, Burns ZT, Guss CE, Millington K, Pilcher S, Boyle PJ, Charlton BM, Haas-Kogan DA, and Liu KX
- Subjects
- Humans, Young Adult, Child, Transgender Persons, Neoplasms therapy
- Published
- 2023
- Full Text
- View/download PDF
29. Harvard Medical School's Sexual and Gender Minority Health Equity Initiative: Curricular and Climate Innovations in Undergraduate Medical Education.
- Author
-
Keuroghlian AS, Charlton BM, Katz-Wise SL, Williams K, Jarvie EJ, Phillips R, Kremen J, Guss CE, Dalrymple JL, and Potter J
- Subjects
- Female, Humans, Schools, Medical, Curriculum, Education, Medical, Undergraduate, Health Equity, Sexual and Gender Minorities, Students, Medical
- Abstract
Problem: Sexual and gender minority (SGM) populations face numerous health disparities. Medical school curricula lack adequate educational content preparing students for serving SGM patients, and medical students typically do not experience welcoming, inclusive educational environments conducive to learning about SGM health care., Approach: In 2018, Harvard Medical School (HMS) launched the 3-year Sexual and Gender Minority Health Equity Initiative to integrate SGM health content throughout the longitudinal core medical curriculum and cultivate an educational climate conducive for engaging students and faculty in SGM health education. The initiative employed innovative strategies to comprehensively review existing SGM health curricular content and climate; integrate content across courses and clerkships; lead with LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minorities) community engagement; adopt an intersectional approach that centers racial equity; cultivate safe, affirming educational environments for LGBTQIA+ and non-LGBTQIA+ students and staff; ensure all graduating students are prepared to care for SGM patients; enhance faculty knowledge, skills, attitudes, and confidence teaching SGM health; evaluate effectiveness and impact of SGM health curricular innovations; prioritize sustainability of curricular innovations; and publicly share and disseminate SGM health curricular products and tools., Outcomes: Key outcomes of the initiative focused on 5 areas: development of 9 SGM health competencies, stakeholder engagement (HMS students and faculty, national SGM health experts, and LGBTQIA+ community members), student life and educational climate (increased LGBTQIA+ student matriculants, enhanced mentorship and support), curriculum development (authentic LGBTQIA+ standardized patient experiences, clerkship toolkit design), and faculty development (multimedia curriculum on content and process to teach SGM health)., Next Steps: In addition to refining curricular integration, evaluating interventions, and implementing comprehensive antiracist and gender-affirming educational policies, the next phase will involve dissemination by translating best practices into feasible approaches that any school can adopt to meet local needs with available resources., Competing Interests: Other disclosures: Alex S. Keuroghlian and Jennifer Potter report royalties as editors of a McGraw Hill textbook on transgender and gender diverse health care. Sabra L. Katz-Wise is a diversity consultant for McGraw Hill and Viacom/CBS. The authors report no relevant conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.)
- Published
- 2022
- Full Text
- View/download PDF
30. Sexual Minority Men's Perspectives and Experiences of Adolescent Pregnancy Risk and Pregnancy Prevention Behaviors.
- Author
-
Tabaac AR, Godwin EG, Reynolds CA, Katz-Wise SL, and Charlton BM
- Subjects
- Adolescent, Adult, Bisexuality psychology, Female, Gender Identity, Heterosexuality psychology, Humans, Male, Middle Aged, Pregnancy, Sexual Behavior psychology, United States, Pregnancy in Adolescence prevention & control, Sexual and Gender Minorities
- Abstract
Sexual minority men (e.g., gay, bisexual, queer) are more likely than heterosexual men to be involved in an adolescent pregnancy, but little research has been done on the context surrounding this disparity. To address this gap, and as part of the larger Sexual Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) Study, semi-structured interviews and descriptive surveys were conducted with 10 cisgender sexual minority men, ages 29-49, from across the United States. Interview transcripts were analyzed using immersion/crystallization and template organizing style methods, and themes were organized into a conceptual model describing sexual minority men's debut sexual activity and decision-making experiences during adolescence. This model depicts three themes: 1) partnership and negotiation of sexual experiences, 2) psychological processes related to development, pregnancy, and sexuality, and 3) cultural and environmental contexts. These three themes are contextualized by a throughline of transformative life events (i.e., the existence and chronology of life-impacting events). Findings indicate a complex interplay of psychological (e.g., developmental processes surrounding sexuality and sexual orientation), social (e.g., personal relationships), and policy-level factors (e.g., sex education) influence sexual minority men's sexuality and pregnancy prevention decision-making during adolescence. Care should be taken to consider and include sexual minority men in pregnancy prevention messaging and education.
- Published
- 2022
- Full Text
- View/download PDF
31. Assessing Fertility Intentions in Patients Presenting for Gender-Affirming Surgery.
- Author
-
Mehra G, Boskey ER, Peters CJ, Njubigbo C, Charlton BM, and Ganor O
- Subjects
- Child, Hormones, Humans, Infant, Newborn, Intention, Male, Retrospective Studies, Fertility Preservation, Sex Reassignment Surgery, Transgender Persons
- Abstract
Purpose: For some transgender and gender-diverse (TGD) individuals, gender-affirming surgery may represent the last opportunity to engage in gamete banking (GB) and other forms of fertility preservation (FP). Previous research has assessed fertility intentions among TGD people initiating hormone therapy. The objective of this study was to describe the fertility intentions of patients seeking gender-affirming surgery. Methods: A retrospective chart review was conducted for 233 patients seeking chest or genital surgery between 2017 and 2019. Data abstracted included interest in having children (biological or non-biological) and GB, and barriers to FP. Associations between fertility intentions, sex assigned at birth, and surgical procedure sought were assessed. Results: Of the 233 records reviewed, 162 (70%) documented information about fertility intentions for patients without a history of sterilizing surgery. At initial consultation, 94% were receiving hormone therapy. Among the 60 patients seeking genital surgery, 30% expressed interest in GB and 38% were not interested in biological children. Among the 102 patients seeking chest surgery, 11% expressed interest in GB and 47% were not interested in biological children. Patients assigned male at birth were more likely to have already completed GB ( p < 0.001). Among the patients interested in FP, 41% reported barriers to access. Conclusion: Many TGD people in our study expressed no interest in biological parenthood; however, 30% of patients seeking genital surgery expressed interest in GB. This suggests that some who defer FP when starting hormones may wish to pursue it later in life. Ongoing assessment of fertility intentions and reducing barriers to FP are integral to caring for TGD people.
- Published
- 2022
- Full Text
- View/download PDF
32. Healthcare providers' perspectives on pregnancy experiences among sexual and gender minority youth.
- Author
-
Tabaac AR, Godwin EG, Jonestrask C, Charlton BM, and Katz-Wise SL
- Subjects
- Adolescent, Female, Health Personnel, Health Services Accessibility, Humans, Male, Pregnancy, Sexual Behavior, Gender Identity, Sexual and Gender Minorities
- Abstract
Objective: To interview healthcare providers who serve adolescent populations to learn their perspectives on the factors that influence the continuum of sexual and gender minority (SGM) youth's pregnancy expaeriences, including decision-making about sex, relationships, and pregnancy., Methods: As part of the SexuaL Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) Study, semi-structured interviews were conducted with 10 U.S.-based healthcare providers who had experience providing care for both SGM youth and pregnant youth. Interview questions examined providers' experiences caring for this population, including their perceptions of the risk and protective factors influencing SGM youth's pregnancy prevention, avoidance, and decision-making processes. Audio-recorded interview data were analyzed using immersion/crystallization and thematic analysis methods., Results: Three themes were identified from the healthcare providers' transcripts1) Cultural norms about adolescent pregnancy and sexuality, 2) Interpersonal relationships and family support, 3) Sex education, sexual and reproductive healthcare access, and sexual health equity., Conclusion: In conjunction with sexual health education and healthcare access, healthcare providers described many social contexts-like peers, family, and communities-that interact with each other and with adolescent development to shape pre-conception practices and pregnancy decision-making processes. Future research, practice, and sexual health messaging about adolescent pregnancy would benefit from acknowledging the complex interplay among social identities and positions, structural prejudice, and the nuanced diversity in community and interpersonal factors-including those in sexual healthcare settings, like provider-patient communication and sex education delivery-that shape SGM youth's dating and sexuality experiences., (Copyright © 2022 Elsevier B.V. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
33. Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States.
- Author
-
Tabaac AR, Chwa C, Sutter ME, Missmer SA, Boskey ER, Austin SB, Grimstad F, and Charlton BM
- Subjects
- Adult, Bisexuality, Cross-Sectional Studies, Female, Heterosexuality, Humans, Male, Pelvic Pain epidemiology, Prevalence, Sexual Behavior, United States epidemiology, Young Adult, Quality of Life, Sexual and Gender Minorities
- Abstract
Background: Sexual minority (lesbian, bisexual, mostly heterosexual) young women face many sexual and reproductive health disparities, but there is scant information on their experiences of chronic pelvic pain, including an absence of information on prevalence, treatment, and outcomes., Aim: The purpose of this study was to describe the characteristics of chronic pelvic pain experiences of young women by sexual orientation identity and gender of sexual partners., Methods: The analytical sample consisted of a nationwide sample of 6,150 U.S. young women (mean age = 23 years) from the Growing Up Today Study who completed cross-sectional questionnaires from 1996 to 2007., Outcomes: Age-adjusted regression analyses were used to examine groups categorized by sexual orientation identity (completely heterosexual [ref.], mostly heterosexual, bisexual, lesbian) and gender of sexual partner (only men [ref.], no partners, both men, and women). We examined differences in lifetime and past-year chronic pelvic pain symptoms, diagnosis, treatment, and quality of life outcomes. Sensitivity analyses also examined the role of pelvic/gynecologic exam history and hormonal contraceptive use as potential effect modifiers., Results: Around half of all women reported ever experiencing chronic pelvic pain, among whom nearly 90% had past-year chronic pelvic pain. Compared to completely heterosexual women, there was greater risk of lifetime chronic pelvic pain among mostly heterosexual (risk ratio [RR] = 1.30, 95% confidence interval [CI]: 1.22-1.38), bisexual (RR = 1.30, 95% CI: 1.10-1.52), and lesbian (RR = 1.23, 95% CI: 1.00-1.52) young women. Additionally, compared to young women with only past male sexual partners, young women who had both men and women as past sexual partners were more likely to report chronic pelvic pain interfered with their social activities (b = 0.63, 95% CI: 0.25-1.02), work/school (b = 0.55, 95% CI: 0.17-0.93), and sex (b = 0.53, 95% CI: 0.05-1.00)., Clinical Implications: Healthcare providers, medical education, and field-wide standards of care should be attentive to the way sexual orientation-based healthcare disparities can manifest into differential prognosis and quality of life outcomes for women with chronic pelvic pain (particularly bisexual women)., Strengths & Limitations: Our study is the first to examine a variety of chronic pelvic pain outcomes in a nationwide U.S. sample across different outcomes (ie, past-year and lifetime). Though limited by sample homogeneity in terms of age, race, ethnicity, and gender, findings from this article provide foundational insights about chronic pelvic pain experiences of sexual minority young women., Conclusion: Our key finding is that sexual minority women were commonly affected by chronic pelvic pain, and bisexual women face pain-related quality of life disparities. Tabaac AR, Chwa C, Sutter ME, et al. Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States. J Sex Med 2022;19:1012-1023., (Copyright © 2022 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
34. Human papillomavirus vaccination disparities among U.S. college students: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA).
- Author
-
Zubizarreta D, Beccia AL, Trinh MH, Reynolds CA, Reisner SL, and Charlton BM
- Subjects
- Adolescent, Bayes Theorem, Cross-Sectional Studies, Ethnicity, Female, Gender Identity, Humans, Male, Minority Groups, Multilevel Analysis, Students, Vaccination, Alphapapillomavirus, Papillomavirus Infections prevention & control, Papillomavirus Vaccines therapeutic use
- Abstract
We investigated how gender identity, sexual orientation, and race/ethnicity intersect to shape the social epidemiology of HPV vaccination initiation among U.S. college students. Cross-sectional survey data were from the National College Health Assessment (Fall, 2019-Spring, 2020; N = 65,047). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy by nesting participants within 36 social strata defined using gender identity, sexual orientation, and race/ethnicity. Bayesian multilevel logistic regression models with random intercepts for social strata were fit for HPV vaccination initiation. Intersectional models adjusted for the additive main effects to isolate intersectional interactions, controlling for age and geographic region. Social strata that included cisgender men, transgender women, and non-binary assigned-male-at-birth individuals and strata that included racial/ethnic minorities had a significantly lower likelihood of HPV vaccination initiation relative to strata including cisgender women and non-Hispanic White individuals, respectively, while strata including lesbian/gay and bisexual/pansexual/queer individuals had a significantly higher likelihood of HPV vaccination initiation relative to strata including heterosexual individuals. We also observed substantial between-stratum inequities in the predicted prevalence of HPV vaccination initiation, with estimates ranging from 59.2% for heterosexual, racial/ethnic minority, cisgender men to 87.1% for bisexual/pansexual/queer, racial/ethnic minority, non-binary assigned-female-at-birth individuals. That being said, the majority of the observed between-stratum variance was driven by additive rather than intersectional interaction effects and the discriminatory accuracy of intersectional stratification with respect to predicting HPV vaccination initiation was low. Collectively, our findings point to a need for more universal guidelines and clinician recommendations that promote HPV vaccine uptake for all adolescents, regardless of race/ethnicity, gender identity, sex-assigned-at-birth, or sexual orientation; however, utilizing an intersectional lens will ensure that resulting public health interventions address inequities and center the needs and experiences of multiply marginalized adolescents., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
35. Assessing Variations in Sexual Orientation- and Gender Identity-Related U.S. State Laws for Sexual and Gender Minority Health Research and Action, 1996-2016.
- Author
-
Agénor M, Pérez AE, Solazzo AL, Beccia AL, Samnaliev M, Wu J, Charlton BM, and Austin SB
- Subjects
- Female, Gender Identity, Human Rights, Humans, Male, Sexual Behavior, Sexual and Gender Minorities, Transgender Persons
- Abstract
Purpose: We developed a multiyear database of sexual orientation- and gender identity-related U.S. state laws to advance sexual and gender minority (SGM) health research and practice and assessed variability in U.S. state laws from 1996 through 2016 across all U.S. states and D.C. Methods: Between 2014 and 2016, a multidisciplinary group of SGM health researchers and legal experts used secondary and primary legal sources and policy surveillance methods to systematically develop a state-level legal database of 30 sexual orientation- and gender identity-related U.S. state laws in 9 legal domains from 1996 through 2016. We calculated descriptive statistics and created maps to observe the distribution of these laws over both time and space. Results: Although progress has occurred in some domains, such as same-sex marriage, adoption, and employment discrimination, significant challenges to SGM rights remain, especially with regard to HIV criminalization, transgender rights, and discrimination in health care settings. Further, notable variation exists in the presence of protective lesbian, gay, bisexual, transgender, queer (LGBTQ) state laws across U.S. states and D.C. Conclusion: Efforts to repeal harmful U.S. state laws are needed, as are new laws, policies, regulations, practices, and norms that advance social justice and health equity for all SGM people.
- Published
- 2022
- Full Text
- View/download PDF
36. The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations.
- Author
-
Tabaac AR, Sutter ME, Haneuse S, Agénor M, Bryn Austin S, Guss CE, and Charlton BM
- Subjects
- Female, Humans, Communication, Reproductive Health, Sexual Behavior, Sexual and Gender Minorities, Sexual Health
- Abstract
Objective: Our goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection., Methods: Data were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses' Health Study 3 between the follow-up period of 1996-2020. We used multivariable Poisson regression models adjusted for race/ethnicity, age in years, study cohort, and region of residence to obtain risk ratio (RR) associations and 95% confidence intervals (CI)., Results: Provider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use (RRs ranging from 1.11 to 1.63) and lifetime STI diagnosis (RRs ranging from 1.18 to 1.96). Completely heterosexual women with no same-sex partners (referent) were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their SRH. Significant interactions emerged between sexual minority status and provider-patient communication. Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year (p < .0001)., Conclusion: Provider-patient communication may benefit sexual minority women's contraceptive practices and engagement with STI testing., Practice Implications: Differences in provider-patient SRH discussion by sexual orientation indicate lesbian women are not receiving the same attention in clinical encounters., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
37. Sexual Orientation and Age at Menarche in Three U.S. Longitudinal Cohorts.
- Author
-
Charlton BM, Carwile JL, Chavarro JE, DiVasta AD, Ziyadeh NJ, and Austin SB
- Subjects
- Female, Humans, Bisexuality, Heterosexuality, Longitudinal Studies, Sexual Behavior, Menarche, Sexual and Gender Minorities
- Abstract
Purpose: The aim of this study is to examine age at menarche across sexual orientation groups., Methods: Data were obtained from 131,090 female participants, born 1947-2001, in 3 longitudinal studies-the Growing Up Today Study and Nurses' Health Study 2 and 3. We estimated the association between sexual orientation and age at menarche using regression models adjusted for age, race/ethnicity, birthweight, height, and body mass index., Results: Compared to heterosexual participants, sexual minorities were younger at menarche. Sexual minorities were more likely to have early menarche (≤11 years) and less likely to have late menarche (≥14 years) compared to heterosexual girls. As an example of this pattern, Nurses' Health Study 3 bisexual participants were >30% more likely than heterosexuals to have early versus average menarche (odds ratio 1.37, 95% confidence interval 1.09-1.72)., Conclusion: Sexual minority girls have a younger age at menarche than heterosexual girls and may benefit from screening for adverse outcomes associated with early menarche., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
38. Mapping the scientific literature on reproductive health among transgender and gender diverse people: a scoping review.
- Author
-
Agénor M, Murchison GR, Najarro J, Grimshaw A, Cottrill AA, Janiak E, Gordon AR, and Charlton BM
- Subjects
- Female, Humans, Infant, Newborn, Male, Reproductive Health, Transgender Persons
- Abstract
We conducted a scoping review to map the extent, range and nature of the scientific research literature on the reproductive health (RH) of transgender and gender diverse assigned female at birth and assigned male at birth persons. A research librarian conducted literature searches in Ovid MEDLINE®, Ovid Embase, the Cochrane Library, PubMed, Google Scholar, Gender Studies Database, Gender Watch, and Web of Science Core Collection. The results were limited to peer-reviewed journal articles published between 2000 and 2018 involving human participants, written in English, pertaining to RH, and including disaggregated data for transgender and gender diverse people. A total of 2197 unique citations with abstracts were identified and entered into Covidence. Two independent screeners performed a title and abstract review and selected 75 records for full-text review. The two screeners independently extracted data from 37 eligible articles, which were reviewed, collated, summarised, and analysed using a numerical summary and thematic analysis approach. The existing scientific research literature was limited in terms of RH topics, geographic locations, study designs, sampling and analytical strategies, and populations studied. Research is needed that: focuses on the full range of RH issues; includes transgender and gender diverse people from the Global South and understudied and multiply marginalised subpopulations; is guided by intersectionality; and uses intervention, implementation science, and community-based participatory research approaches. Further, programmes, practices, and policies that address the multilevel barriers to RH among transgender and gender diverse people addressed in the existing scientific literature are warranted.
- Published
- 2021
- Full Text
- View/download PDF
39. Pregnancy prevention and unintended pregnancy across gender identity: a cross-sectional study of college students.
- Author
-
Reynolds CA and Charlton BM
- Subjects
- Adolescent, Adult, Cross-Sectional Studies, Female, Humans, Infant, Newborn, Male, Pregnancy, Sexual Behavior, Students psychology, Young Adult, Gender Identity, Pregnancy, Unplanned
- Abstract
Using data from the Fall 2015 through Spring 2018 National College Health Assessment, we examined receipt of pregnancy prevention information and unintended pregnancy by gender identity among participants aged 18-25years who were assigned female at birth (n=185658). Non-binary students were more likely than cisgender students to report wanting (adjusted risk ratio [ARR]: 1.12; 95% CI: 1.08-1.16), receiving (ARR: 1.09; 95% CI: 1.04-1.13), and having an unmet need for (ARR: 1.10; 95% CI: 1.02-1.19) pregnancy prevention information from their school. Transmasculine students did not significantly differ from cisgender students for these outcomes. Non-binary and transmasculine students were as likely as cisgender students to have a past-year unintended pregnancy. Non-binary and transmasculine young people are at risk for unintended pregnancy and need access to comprehensive sexual education, reproductive health counseling, and care.
- Published
- 2021
- Full Text
- View/download PDF
40. Unintended and teen pregnancy experiences of trans masculine people living in the United States.
- Author
-
Charlton BM, Reynolds CA, Tabaac AR, Godwin EG, Porsch LM, Agénor M, Grimstad FW, and Katz-Wise SL
- Abstract
Background: Trans masculine people are more likely than cisgender peers to have a teen or unintended pregnancy, though little is known about the origins of these disparities., Aims: This study aimed to describe teen and unintended pregnancy experiences among trans masculine people in order to elucidate risk factors and pregnancy-related needs., Methods: As a part of the United States-based SexuaL Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) study, in-depth, semi-structured interviews were conducted between March 2017 and August 2018 with 10 trans masculine people, ages 20-59 years, who experienced a teen or unintended pregnancy. Audio-recorded interviews were professionally transcribed, then analyzed using immersion/crystallization and thematic analysis approaches. The themes were contextualized using sociodemographic survey data., Results: The four themes that were developed from participants' narratives highlighted: 1) how trans masculine people navigated having a pregnant body (e.g., heightened gender dysphoria due to being pregnant); 2) the importance of the cultural environment in shaping experiences as a trans masculine pregnant person (e.g., pregnancy and gender-related job discrimination); 3) the development of the pregnancy over time (e.g., decision-making processes); and 4) how pregnancy (and gender identity) affected relationships with other people (e.g., adverse family of origin experiences)., Discussion: This study identified a number of risk factors for teen and unintended pregnancies among trans masculine people including physical and sexual abuse as well as ineffective use of contraception. This research also identifies unique needs of this population, including: relieving gender dysphoria, combating discrimination, and ensuring people feel visible and welcome, particularly in reproductive healthcare spaces. Public health practitioners, healthcare providers, and support networks (e.g., chosen family) can be key sources of support. Attention to risk factors, unique needs, and sources of support will improve reproductive healthcare and pregnancy experiences for trans masculine people., Competing Interests: No potential conflict of interest was reported by the authors., (© 2020 Taylor & Francis Group, LLC.)
- Published
- 2021
- Full Text
- View/download PDF
41. Breakthrough Bleeding in Transgender and Gender Diverse Adolescents and Young Adults on Long-Term Testosterone.
- Author
-
Grimstad F, Kremen J, Shim J, Charlton BM, and Boskey ER
- Subjects
- Adolescent, Child, Female, Gender Identity, Humans, Retrospective Studies, Testosterone, Young Adult, Metrorrhagia, Transgender Persons
- Abstract
Study Objective: Amenorrhea is a goal of many transgender and gender diverse adolescent and young adult (TGD AYA) patients on testosterone gender-affirming hormone therapy (T-GAHT). Breakthrough bleeding can contribute to worsening gender dysphoria. Our objective was to evaluate breakthrough bleeding in TGD AYA on T-GAHT., Design: Institutional review board-approved retrospective cohort., Setting: Tertiary-care children's hospital., Participants: TGD AYA on T-GAHT >1 year., Interventions: None; observational., Main Outcome Measures: Presence of, and risk factors for, breakthrough bleeding., Results: Of the 232 patients who met inclusion criteria, one-fourth (n = 58) had 1 or more episodes of breakthrough bleeding, defined as bleeding after more than 1 year on T-GAHT. In comparing patients with breakthrough bleeding to those without, there were no significant differences between age of initiation, body mass index (BMI), race/ethnicity, testosterone type used, use of additional menstrual suppression, serum testosterone, or estradiol levels. Patients with breakthrough bleeding patients were on T-GAHT longer (37.3 ± 17.0 vs 28.5 ± 14.6 months, P < .001) and were more likely to have endometriosis (P = .049). Breakthrough bleeding began at a mean of 24.3 ± 17.2 months after T-GAHT initiation. Of those with breakthrough bleeding, 46 (79.3%) had no known cause, 10 (17.2%) bled only with missed T-GAHT doses, and 2 (3.4%) bled only when withdrawing from concomitant menstrual suppression. No breakthrough bleeding management method was found to be superior., Conclusion: Breakthrough bleeding is relatively common (25%) on T-GAHT despite early amenorrhea. Most cases do not have an identifiable cause. Our data did not show superiority of any 1 method for managing breakthrough bleeding on T-GAHT., (Copyright © 2021 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
42. Contraceptive Care Disparities Among Sexual Orientation Identity and Racial/Ethnic Subgroups of U.S. Women: A National Probability Sample Study.
- Author
-
Agénor M, Pérez AE, Wilhoit A, Almeda F, Charlton BM, Evans ML, Borrero S, and Austin SB
- Subjects
- Ethnicity, Female, Humans, Racial Groups, Sampling Studies, Sexual Behavior, Contraceptive Agents, Sexual and Gender Minorities
- Abstract
Background: Sexual minority women may use contraception for various reasons but face notable barriers to contraceptive care, including stigma and discrimination. However, studies examining sexual orientation disparities in contraceptive care have largely relied on nonprobability samples of predominately White women and may thus not be generalizable to U.S. women overall or Black and Latina women in particular. Materials and Methods: Using data from the 2006 to 2017 National Survey of Family Growth, a large national probability sample of U.S. women 15-44 years of age ( N = 25,473), we used multivariable logistic regression to estimate adjusted odds ratios for receiving a contraceptive method or prescription and contraceptive counseling from a health care provider in the past year among sexual orientation identity and racial/ethnic subgroups of heterosexual, bisexual, and lesbian White, Black, and Latina women relative to White heterosexual women. Results: Among women overall, 33.9% had received contraception and 18.3% had obtained contraceptive counseling. Black (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.65-0.82) and Latina (OR = 0.73, 95% CI: 0.64-0.82) heterosexual women, White (OR = 0.80, 95% CI: 0.65-0.99) and Black (OR = 0.43, 95% CI: 0.32-0.58) bisexual women, and White (OR = 0.23, 95% CI: 0.13-0.43), Black (OR = 0.19, 95% CI: 0.09-0.40), and Latina (OR = 0.08, 95% CI: 0.03-0.22) lesbian women had significantly lower adjusted odds of receiving contraception compared with White heterosexual women. White (OR = 0.36, 95% CI: 0.15-0.85), Black (OR = 0.42, 95% CI: 0.18-0.98), and Latina (OR = 0.22, 95% CI: 0.09-0.53) lesbian women also had significantly lower adjusted odds of obtaining contraceptive counseling relative to White heterosexual women. Conclusions: Policies, programs, and practices that facilitate access to person-centered contraceptive care among marginalized sexual orientation identity and racial/ethnic subgroups of U.S. women are needed to promote reproductive health equity.
- Published
- 2021
- Full Text
- View/download PDF
43. Sexual and reproductive health information: Disparities across sexual orientation groups in two cohorts of U.S. women.
- Author
-
Tabaac AR, Haneuse S, Johns M, Tan ASL, Austin SB, Potter J, Lindberg L, and Charlton BM
- Abstract
Introduction: Limited research exists about how receiving/seeking sexual and reproductive health (SRH) information differs by sexual orientation. Our goal was to identify how sources and topics of SRH information differed by sexual orientation during adolescence in a sample of U.S. women., Methods: A sample of 8,541 U.S. women ages 22-35 years from two cohorts of the Growing Up Today Study completed a 2016 questionnaire measure about receiving/seeking SRH information before age 18 years. Adjusted log-linear models assessed differences in SRH information topics and sources by reported sexual orientation (completely heterosexual with no same-sex partners [reference]; completely heterosexual with same-sex partners; mostly heterosexual; bisexual; lesbian)., Results: Compared to the referent, most sexual minority subgroups were more likely to receive/seek information from peers, media, and other sources (e.g., community centers). With the exception of lesbians, sexual minority subgroups were more likely to receive/seek information about contraception, and mostly heterosexual and bisexual women were more likely to receive information about sexually transmitted infections. Conclusions: Findings indicate women of diverse sexual orientations need access to SRH information from sources like schools, peers, and media. Sexual minority women receive/seek information about many SRH topics, which indicates that opportunities to tailor educational resources within and outside of schools are needed so SRH benefits to these populations are maximized., Policy Implications: Specifying sexual minority-sensitive educational materials in sex education policy can meet information needs and aid sexual minority women in making informed sexual health decisions., Competing Interests: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institutes of Health. The authors have no conflicts of interest to report. The corresponding author confirms that all authors have contributed significantly to this work. This study has not previously been presented at any local, national, or international meetings.
- Published
- 2021
- Full Text
- View/download PDF
44. Sexual Behavior and Contraceptive Use Among Cisgender and Gender Minority College Students Who Were Assigned Female at Birth.
- Author
-
Reynolds CA and Charlton BM
- Subjects
- Adolescent, Adult, Cross-Sectional Studies, Female, Gender Identity, Humans, Male, Students psychology, Students statistics & numerical data, United States epidemiology, Young Adult, Contraception Behavior statistics & numerical data, Sexual Behavior statistics & numerical data, Transgender Persons statistics & numerical data
- Abstract
Study Objective: Our objective was to describe sexual behavior and contraceptive use among assigned female cisgender and gender minority college students (ie, those whose gender identity does not match their sex assigned at birth)., Design: Cross-sectional surveys administered as part of the fall 2015 through spring 2018 administrations of the National College Health Assessment., Setting: Colleges across the United States., Participants: A total of 185,289 cisgender and gender minority assigned females aged 18-25 years., Main Outcome Measures: Recent vaginal intercourse; number and gender of sexual partners; use of contraception; use of protective barriers during vaginal intercourse., Results: Both gender minority and cisgender students often reported having male sexual partners, but gender minority students were more likely to report having partners of another gender identity (eg, women, trans women). Gender minorities were less likely than cisgender students to report having vaginal intercourse (adjusted odds ratio [AOR]: 0.86; 95% confidence interval [95% CI]: 0.80, 0.93). Gender minorities were less likely than cisgender students to report using any contraceptive methods (AOR: 0.86; 95% CI: 0.73, 1.03), and were less likely to consistently use barrier methods (AOR: 0.72; 95% CI: 0.64, 0.81) or emergency contraception (AOR: 0.56; 95% CI: 0.48, 0.65). However, gender minorities were more likely to use Tier 1 and Tier 3 contraceptive methods than cisgender women., Conclusions: Providers must be trained to meet the contraceptive counseling needs of cisgender and gender minority patients. Providers should explicitly ask all patients about the sex/gender of the patients' sexual partners and the sexual behaviors in which they engage, to assess sexual risk and healthcare needs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
45. Multiple marginalisation and unintended pregnancy among racial/ethnic and sexual minority college women.
- Author
-
Reynolds CA, Beccia A, and Charlton BM
- Subjects
- Adolescent, Adult, Cross-Sectional Studies, Female, Humans, Minority Groups, Pregnancy, Pregnancy, Unplanned, Young Adult, Ethnicity, Sexual and Gender Minorities
- Abstract
Background: Both sexual minority and racial/ethnic minority women are at increased risk of unintended pregnancy compared to their heterosexual and non-Hispanic white peers, respectively. A recent study suggests the presence of negative interaction between sexual orientation and race/ethnicity, although it was not explicitly assessed., Objectives: To characterise the burden of unintended pregnancy across groups defined by intersecting sexual orientation and race/ethnicity and to explore for potential intersectional interaction between social identities., Methods: We analysed cross-sectional survey data from the National College Health Assessment collected between Fall 2015 and Spring 2018. The relative risk (RR) of unintended pregnancy among college-attending women aged 18-25 was estimated using multivariable log-binomial regression (n = 177 592). We estimated multiplicative- and additive-scale (relative risk due to interaction, RERI) interaction between race/ethnicity and sexual orientation on the risk of unintended pregnancy; 95% confidence intervals (CI) were estimated using 500 bootstrap replicates., Results: Unintended pregnancy was rare across all intersecting identity groups (≤1.5%). Compared to heterosexual non-Hispanic white women, all groups of sexual minorities and/or racial/ethnic minorities had a higher risk of unintended pregnancy. This was consistent within strata of sexual orientation and race/ethnicity. We did not find strong evidence of additive-scale interaction between sexual orientation and race/ethnicity (RERI -0.19, 95% CI -0.67, 0.28), but we did find negative multiplicative-scale interaction (interaction RR 0.76, 95% CI 0.59, 0.96)., Conclusions: These findings illustrate that interactions, which are typically used to quantify intersectional effects, are scale-dependent. This has implications regarding how risk estimates for multiply marginalised groups are interpreted. More broadly, our findings suggest the need to move beyond multiple jeopardy approaches to quantitative intersectional research and consider the upstream factors that may uniquely shape the health status of groups at the nexus of particular social identities., (© 2020 John Wiley & Sons Ltd.)
- Published
- 2021
- Full Text
- View/download PDF
46. Variation in diet quality across sexual orientation in a cohort of U.S. women.
- Author
-
Solazzo AL, Arvizu M, VanKim NA, Chavarro J, Tabaac AR, and Charlton BM
- Subjects
- Adult, Bisexuality psychology, Bisexuality statistics & numerical data, Cohort Studies, Diet psychology, Diet standards, Female, Heterosexuality psychology, Heterosexuality statistics & numerical data, Homosexuality, Female psychology, Homosexuality, Female statistics & numerical data, Humans, Longitudinal Studies, Middle Aged, Neoplasms epidemiology, Nurses psychology, Nurses statistics & numerical data, Risk Factors, Sexual Behavior psychology, Sexual and Gender Minorities psychology, Sexual and Gender Minorities statistics & numerical data, Surveys and Questionnaires, United States, Young Adult, Diet statistics & numerical data, Sexual Behavior statistics & numerical data
- Abstract
Purpose: Extensive prior research has shown that sexual minority women are more likely to have a number of cancer risk factors, thereby putting them at higher risk for cancer than heterosexual women. However, there has been little research evaluating the association between sexual orientation and diet quality., Method: Data come from participants (aged 24-54 years) enrolled in Nurses' Health Study 3, an ongoing, U.S.-based cohort study (N = 15,941). We measured diet using recommendations from the Dietary Approach to Stop Hypertension (DASH) and American Health Association (AHA) 2020 Strategic Impact Goals., Results: We found limited evidence of differences across diet quality by sexual orientation. When examining predicted DASH scores, mostly heterosexual [predicted mean score (95% confidence interval), 24.0 (23.8, 24.3)] and lesbian [24.3 (23.8, 24.9)] women had healthier predicted DASH scores than the reference group of completely heterosexual women with no same-sex partners [23.6 (23.5, 23.7)]. Even though certain sexual minority women had overall healthier predict DASH scores, their consumption of certain food groups-low-fat dairy and fruit-was lower than completely heterosexual women with no same-sex partners. When measuring AHA scores, most sexual minority groups (completely heterosexual women with same-sex partners, mostly heterosexual women, and lesbian women) had higher diet quality compared to the reference group of completely heterosexual women with no same-sex partners., Conclusion: Sexual minority women, particularly mostly heterosexual women and lesbian women, had healthier diet quality than completely heterosexual women with no same-sex partners. These data suggest that cancer risk factors (e.g., smoking, drinking, and inactivity) other than diet would drive higher cancer rates among sexual minority compared to heterosexual women. Nonetheless, it is critical for all women to improve their diet quality since diet quality was poor among participants of all sexual orientations.
- Published
- 2021
- Full Text
- View/download PDF
47. Differences in Tobacco Product Use by Sexual Orientation and Violence Factors Among United States Youth.
- Author
-
Tabaac AR, Charlton BM, Tan ASL, Cobb CO, and Sutter ME
- Subjects
- Adolescent, Female, Follow-Up Studies, Humans, Incidence, Male, Retrospective Studies, Sexual Partners, United States epidemiology, Sexual Behavior psychology, Sexual and Gender Minorities statistics & numerical data, Students, Tobacco Products adverse effects, Tobacco Use epidemiology, Violence statistics & numerical data
- Abstract
Objective: To assess differences in the relationship between violence factor exposure and tobacco product pattern use (exclusive and poly), we hypothesized that compared with heterosexuals, sexual minority youth would be more likely to report exclusive-tobacco and poly-tobacco use patterns, and controlling for violence factors would attenuate these associations., Study Design: Data from 27 513 US high-school youth were analyzed from the Centers for Disease Control and Prevention's Youth Risk Factor Surveillance System from 2015 and 2017. We fit sex-stratified, weighted, adjusted log-Poisson models to compare past 30-day exclusive combustible, exclusive e-cigarette, and poly-tobacco use in across sexual orientation. Then, models were adjusted for past-year experiences of physical fighting, bullying, attempting suicide, and physical and sexual dating violence., Results: Compared with heterosexual girls with other-sex partners, sexual minority girls were more likely to use exclusive combustible, exclusive e-cigarette, or poly-tobacco products. When adjusting for violence factors, most tobacco use associations were partially attenuated for all sexual minority girls, and completely attenuated for exclusive e-cigarette use among all sexual minority girls., Conclusions: Sexual minority girls have greater exclusive- and poly-tobacco use compared with heterosexual girls. Tobacco interventions for sexual minority youth should address the risks of poly-tobacco use as well as violence-based risk factors., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
48. Sexual Identity and Birth Outcomes: A Focus on the Moderating Role of Race-ethnicity.
- Author
-
Everett BG, Limburg A, Charlton BM, Downing JM, and Matthews PA
- Subjects
- Adolescent, Adult, Ethnicity, Female, Gender Identity, Humans, Infant, Newborn, Longitudinal Studies, Pregnancy, Premature Birth, Sexual and Gender Minorities
- Abstract
Race-ethnic disparities in birth outcomes are well established, and new research suggests that there may also be important sexual identity disparities in birth weight and preterm birth. This study uses the National Longitudinal Study of Adolescent to Adult Health and is the first to examine disparities in birth outcomes at the intersection of race-ethnicity and sexual identity. We use ordinary least sqaures and logistic regression models with live births (n = 10,318) as the unit of analysis clustered on mother ID (n = 5,105), allowing us to adjust for preconception and pregnancy-specific perinatal risk factors as well as neighborhood characteristics. Results show a striking reversal in the effect of lesbian or bisexual identity on birth outcomes across race-ethnicities: For white women, a bisexual or lesbian identity is associated with better birth outcomes than their white heterosexual counterparts, but for Black and Latina women, it is associated with worse birth outcomes than their heterosexual peers.
- Published
- 2021
- Full Text
- View/download PDF
49. Family building desires among transgender and gender expansive adolescents: A longitudinal family-level analysis.
- Author
-
Stark B, Nagle SA, Hunter A, Charlton BM, and Katz-Wise SL
- Abstract
Introduction: Professional societies state that Transgender and gender expansive (TGE) adolescents and their families should be counseled about future family building options prior to initiating gender affirming therapy. While emerging data show that TGE adolescents have diverse desires regarding future family building, little is known regarding how these preferences are developed in a larger ecological context., Aim: The current study used Ecological Systems Theory as a framework to describe the family building attitudes of TGE adolescents, their caregivers, and their siblings., Methods: Participants were recruited from community-based venues in the New England region of the U.S. to participate in the TTFN Project, a longitudinal community-based mixed methods study. The sample for the current study included 84 family members from 30 families (30 TGE adolescents, 11 siblings, 44 caregivers). All participants completed a semi-structured qualitative interview about family building attitudes and desires for TGE and cisgender adolescents at two waves across 6-8 months. Interview transcripts were analyzed using a combination of immersion/crystallization, thematic analysis, and template organizing style approaches. The Transgender Youth Fertility Attitudes Questionnaire (TYFAQ) was employed to quantitatively describe the family building attitudes of TGE adolescents and their families., Results: Eight themes corresponding to the levels of the ecological systems model - individual-level (perceived reproductive potential, reproductive identity), family-level (communication about family building, familial experiences and expectations), community-level (community support and role models; community expectations and norms), and societal/institutional-level (medicalization of family building, external sociopolitical factors) - were developed from the interviews. Results from the TYFAQ indicated that compared to cisgender adolescents, TGE adolescents were less likely to value having biological children and more likely to consider adoption in comparison to their cisgender siblings., Discussion: Findings emphasize the importance of using Ecological Systems Theory to understand the family building attitudes and desires of TGE adolescents and their families., Competing Interests: The authors declare that they have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The authors are willing to allow the journal to review their data if requested. Raw data were generated at Boston Children’s Hospital. Derived data supporting the findings of this study are available from the corresponding author SKW on request., (© 2021 Taylor & Francis Group, LLC.)
- Published
- 2021
- Full Text
- View/download PDF
50. Sexual orientation-related differences in contraceptive use: A brief report based on a cohort of adolescent and young women.
- Author
-
Charlton BM, Reynolds CA, Janiak E, DiVasta AD, Jones RK, Chavarro JE, Sarda V, and Austin SB
- Subjects
- Adolescent, Adult, Contraceptive Agents, Female, Heterosexuality, Humans, Sexual Behavior, Young Adult, Homosexuality, Female, Sexual and Gender Minorities
- Abstract
Objectives: To examine contraceptive methods used by adolescent/young adult women of diverse sexual orientations., Study Design: We collected data from 12,902 females, born 1982-1995, from the longitudinal Growing Up Today Study., Results: Compared to heterosexuals, lesbians were half as likely to use contraceptives; other sexual minority subgroups (e.g., bisexuals) were more likely to use contraceptives, particularly long-acting reversible contraceptives., Conclusions: Many sexual minority women use contraception throughout adolescence/young adulthood, though use is low among lesbians., Implications: With limited contraception use, lesbians miss opportunities for care and need to be brought into the healthcare system in other ways., (Copyright © 2020. Published by Elsevier Inc.)
- Published
- 2021
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.