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Purpose: Our goal was to examine sexual orientation identity disparities in mammography in relationship to race/ethnicity among U.S. women. Methods: Using nationally representative 2013-2017 National Health Interview Survey data, we used multivariable logistic regression to estimate the odds of receiving a mammogram in the past year in relationship to sexual orientation identity among White, Black, and Latina U.S. women 40-75 years of age ( N  = 45,031) separately, adjusting for demographic factors. We also assessed whether socioeconomic and health care factors attenuated sexual orientation identity disparities in mammography across racial/ethnic groups. Results: Among White women, bisexual women had significantly lower adjusted odds of mammography compared to heterosexual women (odds ratio = 0.70, 95% confidence interval: 0.50-0.99). Among Black women, the adjusted odds of mammography were significantly higher among bisexual women relative to heterosexual women (2.53, 1.08-5.92). Black lesbian women appeared to have lower adjusted odds of mammography compared to their heterosexual counterparts; however, this difference was not statistically significant (0.80, 0.46-1.38). Similarly, among Latina women, lesbian women also seemed to have lower adjusted odds of mammography relative to heterosexual women, but this disparity was also not statistically significant (0.64, 0.37-1.13). Adding socioeconomic factors completely attenuated the disparity between White bisexual and heterosexual women (0.76, 0.52-1.10). Conclusions: Sexual orientation identity disparities in receiving a mammogram in the past year differed in relationship to race/ethnicity among White, Black, and Latina U.S. women. Additional research with larger samples of Black and Latina lesbian and bisexual women is needed to more accurately estimate and explain observed differences.

Purpose: We evaluated behavioral health histories and eligibility factors for patients seeking chest reconstruction. Methods: One hundred and fifty-eight consecutive transgender patients were seen for initial masculinizing top surgery consults between May 2017 and July 2019. Chart review was used to assess behavioral health and demographic factors, and eligibility factors related to the World Professional Association for Transgender Health (WPATH) Standards of Care. Univariate and age-adjusted regression models were used to examine the relationship between demographic and behavioral health factors and WPATH criteria. Results: The average age of patients at the time of their first consult was 18 (standard deviation = 3.3, range = 14-33). Eighty-five percent had at least one behavioral health diagnosis; 27% had three or more. Sixty-four percent endorsed a history of self-harm or suicidal ideation, 13% within the last 6 months. Thirty-two percent reported a history of marijuana use and 19% a history of nicotine use. For those prescribed testosterone, additional months on testosterone were significantly associated with male (vs. nonbinary) gender ( β  = 4.64, 95% confidence interval [CI] 0.37-8.90, p  = 0.033), age ( β  = 0.87, 95% CI 0.41-1.34, p  < 0.001), living as one's affirmed gender for over 1 year ( β  = 6.37, 95% CI 1.37-11.37, p  = 0.013), history of marijuana use ( β  = 4.54, 95% CI 1.10-7.98, p  = 0.010), and history of nicotine use ( β  = 6.23, 95% CI 2.22-10.26, p  = 0.003). Conclusion: Patients seeking gender-affirming masculinizing top surgery are behaviorally complex, in ways not necessarily associated with surgical eligibility. Involving a behavioral health provider in perioperative assessment can help identify and address potential risks to recovery and outcomes.

Purpose: Sexual minority women (SMW) are vulnerable to cervical cancer, yet there is a dearth of research on potential mediators of cervical cancer disparities. Medical heterosexism, which involves sexual orientation-based discrimination in medical contexts, and provider-patient communication quality and trust in providers may be important factors influencing the cancer prevention decisions of SMW. The purpose of this study was to examine how provider-patient communication quality, trust in providers, and perceived medical heterosexism are associated with cervical cancer screening among SMW., Methods: A dual-mode, one-time cross-sectional survey was administered to a community sample of SMW (N = 150), ages 21-53, in Richmond, Virginia, from December 2017 to February 2018., Results: It was hypothesized that provider-patient communication quality and trust in providers would mediate the relationship between perceived medical heterosexism and cervical cancer screening outcomes. The hypothesis was supported; trust in providers (b = 0.05, p = 0.001, 95% confidence interval [CI] 0.02-0.08) and provider-patient communication quality (b = 0.06, p = 0.003, 95% CI 0.02-0.10) were positively associated with future screening intention, and their total indirect effect mediated the relationship between perceived medical heterosexism and intention (b = -0.03, 95% CI -0.05 to -0.02, β = -0.25, 95% CI -0.39 to -0.15). Similarly, the total indirect effect of provider-patient communication quality mediated the relationship between perceived medical heterosexism and odds of routine screening (b = -0.03, 95% CI -0.06 to -0.01)., Conclusion: These findings point to the need for cancer prevention and control strategies for SMW to target provider education and policy interventions that improve SMW's relationships with their providers and improve cervical cancer screening rates.

Purpose: A growing body of research has begun to examine wellness behaviors in sexual minority women. While a number of constructs have been associated with wellness behaviors in this population, including outness, social support, and mental health, no research has attempted to forge the specific and unique connections among them. The aim of the current study was to construct a theoretical chain among these variables leading to wellness behaviors among an ethnically diverse sample of sexual minority women., Methods: A sample of 150 ethnically diverse, cisgender women identifying as lesbian, bisexual, queer, or an "other" non-heterosexual sexual orientation completed a web-administered national survey. Scales assessed participants' outness, social support, mental health, and wellness behaviors., Results: In a series of simultaneous, multiple regressions, outness to one's family was positively associated with wellness behavior and social support; social support from one's family and friends was positively associated with mental health; and depression was negatively associated with wellness behaviors. Two multiple mediational models generally suggested a cascading influence of outness to one's family on wellness behaviors through social support from one's family and depression., Conclusion: The study is one of the first to find potentially cascading links among personal, social, and mental health variables with health behaviors in a sample of diverse lesbian, bisexual, and queer (LBQ) women. It thereby illuminates a number of potential targets for health promotion interventions in this population.