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Internalized sexual stigma is an important contributor to LGBT mental health disparities. In Thailand, the absence of validated instruments represents a research barrier. The study's purpose was to translate and evaluate the psychometric properties of the Revised Internalized Homophobia (IHP-R) scale. Based on the cross-cultural principle, team translation was applied. The IHP-R was translated by the principal author and reviewed by bilingual Thai nurses, and clarifications were made. Multidisciplinary experts provided back translation and reconciled the finalized Thai version. The psychometric properties were established in 412 Thai LGBT individuals. Data was collected via online and paper-pencil surveys and analyzed using SPSS. Most participants were male, age ranged 18–53, with moderate levels of internalized homophobia (M = 2.3, SD = 1.04). The inter-item and item-total correlations were.38-.63 and.55-.68. The content validity index was high (I-CVI, S-CVI/UA/Ave = 1). The exploratory factor analysis confirmed one construct of internalized sexual self-stigma (factor loading =.702–.816). Scores on IHP-R were correlated with stress and experiences of discrimination (r =.14 and.12). Internal consistency reliability was also high (Cronbach's alpha coefficient =.83). The IHP-R Thai version has high psychometric properties and is appropriate for LGBT research in Thailand. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the relationship between discrimination in healthcare settings and psychological distress. This study utilized a retrospective cross-sectional study design. The dataset was obtained from 2015-2017 California Health Interview Survey (CHIS). Healthcare discrimination experience (yes, no) was measured using the following question "Over your entire lifetime, how often have you been treated unfairly when getting medical care (never, rarely, sometimes, often)?". Psychological distress was the study outcome and was measured using the Kessler Psychological Distress Scale. A composite score (0-24) was created for psychological distress for the prior 30 days and for the worse most in the past 12 months. A hierarchical multivariate linear regression was conducted to examine the influence of healthcare discrimination experience on psychological distress after adjusting for other covariates. Study participants (weighted N = 1,360,487) had a mean age of 64.35 years (SD = 0.61), were primarily female (54.93%), heterosexual (96.61%), and married or living with a partner (73.37%). About 10.00% of older Asian Americans ever perceived healthcare discrimination over their entire lifetime. Perceived discrimination was associated with higher levels of psychological distress for the past 30 days (beta= 2.107, SE = 0.662, p < 0.05) and for the worst month in the past year (beta= 2.099, SE = 0.697, p < 0.05) after controlling for covariates. Self-reported discrimination was relatively low in this sample of older Asian American adults. However, consistent with prior research, perceived discrimination in the healthcare setting was associated with increased psychological distress. The findings have implications for improving the quality of health care services received. [ABSTRACT FROM AUTHOR]

Despite higher rates of tobacco use and smoking-related diseases among sexual minorities, tobacco cessation treatment-seeking behaviors (e.g., medication, nicotine replacement products) remain poorly understood across sexual orientation subgroups. This study examines tobacco cessation treatment-seeking behaviors associated with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition tobacco use disorder (TUD) across the three major sexual orientation dimensions (identity, attraction, behavior) in U.S. adults. Prevalence estimates reflect data collected from a 2012-2013 national sample of adults 18 years and older. More than three-fourths of U.S. adults with TUD had never engaged in tobacco cessation treatment-seeking behaviors, regardless of sexual orientation. Despite having the highest rates of TUD, bisexual men and women had some of the lowest rates of tobacco cessation treatment-seeking. Men who identified as gay, reported same-sex attraction, or reported same-sex behaviors had the highest rates of tobacco cessation treatment-seeking. In contrast, women with same-sex attraction or same-sex behavior had higher rates of TUD but were less likely to engage in tobacco cessation treatment-seeking behaviors than women with only other-sex attraction or other-sex behavior, respectively. Heterosexual women were more likely to engage in tobacco cessation treatment-seeking than heterosexual men; this sex difference was not present for sexual minorities. Medications and nicotine replacement therapy products were the most prevalent forms of treatment-seeking. There were notable differences in tobacco cessation treatment-seeking behaviors based on sex and sexual orientation. Findings highlight the underutilization of tobacco cessation treatment-seeking among all U.S. adults and point to important factors to consider when working with sexual minorities who are trying to reduce or stop using tobacco. [ABSTRACT FROM AUTHOR]

Prior research has demonstrated poorer patient-provider communication ratings among African American compared to White patients. The quality of patient-provider communication has been shown to impact treatment outcomes among cancer patients. A secondary data analysis design was used to determine the relationship of six patient-provider communication variables on the physical health quality of life (PHQOL) and mental health quality of life (MHQOL) of African American and White cancer patients (N = 479). We also examined whether the relationship between communication patterns and QOL differed based on race/ethnicity. Mean physical and mental health QOL scores for the sample were 69.8 and 77.6, respectively. After controlling for significant sociodemographic, clinical, and hospital variables, results showed that patients who experienced fewer interpersonal communication barriers who were more satisfied with the information given by providers had higher PHQOL and MHQOL scores. Additionally, patients who felt more comfort in asking questions or had fewer unmet information needs had higher MHQOL. A stratified analysis showed that the relationship of overall satisfaction with information on MHQOL was stronger among African American patients than White patients. Future research should focus on the development of interventions to improve patient-provider communication as a means for enhancing QOL outcomes among cancer survivors. [ABSTRACT FROM AUTHOR]

Purpose: Innovation will be required to improve the informed consent process in research. We aimed to obtain input from key stakeholders—research participants and those responsible for obtaining informed consent—to inform potential development of a multimedia informed consent “app.”Methods: This descriptive study used a mixed-methods approach. Five 90-minute focus groups were conducted with volunteer samples of former research participants and researchers/research staff responsible for obtaining informed consent. Participants also completed a brief survey that measured background information and knowledge and attitudes regarding research and the use of technology. Established qualitative methods were used to conduct the focus groups and data analysis.Results: We conducted five focus groups with 41 total participants: three groups with former research participants (totaln= 22), and two groups with researchers and research coordinators (totaln= 19). Overall, individuals who had previously participated in research had positive views regarding their experiences. However, further discussion elicited that the informed consent process often did not meet its intended objectives. Findings from both groups are presented according to three primary themes: content of consent forms, experience of the informed consent process, and the potential of technology to improve the informed consent process. A fourth theme, need for lay input on informed consent, emerged from the researcher groups.Conclusions: Our findings add to previous research that suggests that the use of interactive technology has the potential to improve the process of informed consent. However, our focus-group findings provide additional insight that technology cannot replace the human connection that is central to the informed consent process. More research that incorporates the views of key stakeholders is needed to ensure that multimedia consent processes do not repeat the mistakes of paper-based consent forms. [ABSTRACT FROM PUBLISHER]

Objectives:Our two study objectives were: (1) to understand the relationship between the perception of a previous negative health-care experience and race/ethnicity, and how socio-demographic, access-to-health-care, and self-reported health variables modified this relationship; and (2) to assess how many behaviors participants reported changing as a result of experiencing a perceived negative health-care experience, which behaviors they changed, and if there were differences in patterns of change across racial/ethnic groups. Design:We conducted a cross-sectional survey of a convenience sample of 600 African-American, Mexican-Hispanic, and white adults in socioeconomically diverse neighborhoods in Chicago, IL. We used multivariable logistic regression to analyze the relationship between a perceived negative health-care experience in the last 5 years and race/ethnicity. We summed and then calculated the percentage of people who changed each of the 10 behaviors and evaluated whether or not there were differences in behavior change across racial/ethnic groups. Principal findings:More than 32% of participants reported a perceived negative health-care experience in the past 5 years. Participants who had a bachelor’s degree or above (OR: 2.95, 95%CI: 1.01–8.63), avoided needed care due to cost (OR: 1.84, 95%CI: 1.11–3.06), or who reported fair/poor health (OR: 3.58, 95%CI: 1.66–7.80) had significantly increased odds of reporting a negative health-care experience. Of these people, 88% reported ‘sometimes/always’ changing at least one health-seeking behavior. There were no racial/ethnic differences in reporting negative experiences or in patterns of behavior change. Conclusions:Race/ethnicity was not related to reporting a perceived negative health-care experience or reported patterns of behavior change in response to that experience. However, those who avoided care due to cost were more highly educated, or who indicated poorer health status reported having a negative experience more often. Our findings suggest that the perception of a previous negative experience may influence subsequent health-care-seeking behaviors. [ABSTRACT FROM AUTHOR]

This study evaluates the feasibility and acceptability of an online peer support group intervention for women with metastatic breast cancer (MBC). Feasibility, participation rates, participant satisfaction, and preliminary outcomes are examined from a 1999 to 2000 study of online peer support groups for women with MBC. Thirty women with MBC were randomly assigned to either an immediate online support condition or a waitlisted control condition. For practical and ethical reasons, the waitlist period was limited to 2 months. Six monthly assessments were collected using standardized measurement instruments. Intervention retention rates (73%), assessment completion rates (range = 100%-86% in retained participants) and support group participation (M = 5.9 days per week) were high compared to other published studies on this population. Reported satisfaction with the intervention was also high. An online support intervention study is feasible using a waitlist control. Despite the feasibility and acceptability of the study procedures, the study design and small sample size precluded definitive conclusions about intervention effectiveness. As such, study procedures should be replicated with a larger more representative sample to examine the effectiveness of the intervention. [ABSTRACT FROM AUTHOR]

Although lesbians are believed to be at disproportionately high risk for smoking, few published studies have focused on smoking rates in this population. We examined and compared rates and demographic correlates of smoking among 550 lesbians and 279 heterosexual women in Chicago, Minneapolis/St. Paul, and in New York City in 1994-1996 using a self-administered survey questionnaire. African-American lesbians were more likely than African-American heterosexual women or White lesbians to be current smokers. For the sample as a whole, education was the most robust predictor of both current and lifetime smoking. Racial/ethnic minority lesbians with high school education or less were most likely to report both current and lifetime cigarette smoking. The study's limitations are noted. [ABSTRACT FROM AUTHOR]

Objectives: Using data collected as part of the Multisite Women's Health Study, we examined the differences between lesbians and heterosexual women on objective breast cancer risk calculations using the Gail Model. Health risk behaviors and screening behaviors for breast cancer were also examined. It was hypothesized that lesbians would have higher objective cancer risk estimates and report more behavioral and screening risk factors for breast cancer than heterosexual women. Methods: Secondary data analyses were conducted using data from a study of women's health conducted from 1994 to 1996. Using a cross sectional design, a convenience sample of lesbian (n = 550) and heterosexual (n = 279) women was recruited from Chicago, New York City and Minneapolis-St. Paul. Data were collected using a self-administered questionnaire. Results: Estimates of 5-year and lifetime breast cancer risk were higher for lesbians compared to heterosexual women. Groups did not differ in self-perceptions of being overweight, but more lesbians reported heavier drinking and more reported abstinence from alcohol. Group differences in adherence to breast cancer screening were not significant. Conclusions: Findings suggest a small hut statistically significant difference in the calculated breast cancer risk estimates of lesbian and heterosexual women, which seem to he largely accounted for by differences in reproductive risk factors. [ABSTRACT FROM AUTHOR]

The current study aimed to identify rates and predictors (demographic, treatment, and psychological variables) of state and cancer-specific anxiety among survivors of breast cancer. Data were collected through a structured telephone interview with 120 women who were at least one year posttreatment. Rates of state anxiety were substantially lower than were the norms for general medical patients. Cancer-specific anxiety was also mild. In hierarchical regression analyses, higher levels of trait anxiety were associated with state and cancer-specific anxiety (β =.73, p<.001, and β =.34, p<.001, respectively). Higher levels of risk perception were associated only with greater cancer-specific anxiety (β =.03, p=.057). The findings suggest the need for specificity in assessing anxiety among women with a history of breast cancer. [ABSTRACT FROM AUTHOR]

Presents a study that examined committed relationships of lesbians and heterosexual women. Predictors of relationship satisfaction in lesbian couples; Issues concerning relationship and satisfaction; Congruency of values of heterosexual women and lesbians; Frequency and satisfaction with sexual activity.

Presents a study that assessed similarities and differences in indicators of psychological distress, risk factors for distress and methods of coping in African American lesbians and heterosexual women. Factors that place African American women at risk for mental health problems; Causes of increased rates of psychological distress for African American lesbians; Strategies used by African American lesbians in coping with psychological distress.

Qualitative research methods were used to explore factors that may affect medical information seeking, treatment engagement, and emotional adjustment among African American cancer patients. Focus group findings suggest that an array of cultural and socioeconomic factors plays important roles in the behavior of African American cancer patients. Participants described a number of important barriers and facilitators of medical information seeking and treatment participation. Factors linked to the health care-related behaviors and adjustment of African American cancer patients included limited knowledge and misinformation about cancer, mistrust of the medical community, concerns about privacy, lack of insurance, religious beliefs, and emotional issues such as fear and stigma associated with seeking emotional support. Recommendations are made that may assist mental and physical health providers in improving patient information and mental and physical health outcomes of African American cancer patients. [ABSTRACT FROM AUTHOR]

Identification of the genes BRCA1 and BRCA2 offers individuals at high risk for breast, ovarian, colon, or prostate cancer the opportunity to learn if they are genetically predisposed to these diseases. The department of Medicine at the University of Chicago Medical Center has a program that provides genetic testing for people with a family history of these cancers. However, African Americans do not participate in genetic testing at the same rate European Americans do. Thus, focus groups were conducted to learn more about the factors influencing the participation of African Americans in genetic testing. The findings indicated that several factors influence their participation, including perceptions about cancer survivability and lack of awareness about the role of genetic testing. The article discusses these factors and provides specific recommendations for improving African Americans' access and response to genetic testing. [ABSTRACT FROM AUTHOR]

Although establishing sexual relationships is viewed as an important developmental milestone for adults, sexual functioning has been a neglected area of investigation for survivors of gynecological cancer. This article describes the long-term effects of clear-cell adenocarcinoma, with a specific focus on sexual functioning as a major quality-of-life concern. The authors hypothesized that respondents with multiple factors that interfered with their sexual functioning would report greater sexual dysfunction, poorer adjustment, and relationship difficulties. Two additional goals were to describe late psychological effects, such as depressive symptoms, and to explore the relationship between health status, coping behavior, social support variables, and depressive symptoms. The findings provide preliminary support for a complex relationship between medical complications, sexual dysfunction, emotional adjustment, and marital/partner relationships: 38% of the respondents reported physical and psychosexual factors interfering with their sexual functioning. Although chronic sexual dysfunction is a legitimate concern by itself, the findings also suggest that sexual difficulties are associated with diverse problems involving mood, quality of life, and adjustment. [ABSTRACT FROM AUTHOR]

In this article, I discuss clinical issues addressed while conducting support groups for lesbians with cancer. For group participants, issues relating to sexual orientation affected comfort levels with treatment interventions, communication with health care providers, ability to obtain emotional support, and coping. For example, assistance in information processing, decision making, and emotional support during treatment are typically provided by spouses of individuals with cancer. However, many women reported experiencing additional anxiety because of their decision to reveal their sexual orientation to medical providers. Fear of stigmatization and the possibility of compromised care contributed to anxiety about disclosure of sexual orientation. Whenever possible, differences in women's experiences based on race are also highlighted. The findings can begin to inform our assessment, problem conceptualization, and treatment approaches for lesbians with cancer. [ABSTRACT FROM AUTHOR]