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Although transgender and nonbinary (TNB) people can acquire human papillomavirus (HPV), research examining HPV vaccination in these populations is scarce. TNB individuals experience high levels of gender-related health care discrimination, which may undermine HPV vaccine uptake. Using data from a national online survey ( N =716), we found a negative association between gender-related health care discrimination and HPV vaccination among transgender women and nonbinary individuals who were assigned male at birth (AMAB; odds ratio [OR]=0.52; 95% confidence interval [CI]: 0.29-0.93). Addressing gender-related health care discrimination may facilitate HPV vaccination and help prevent HPV-related cancers among transgender women and nonbinary AMAB individuals., Competing Interests: No competing financial interests exist., (Copyright 2023, Mary Ann Liebert, Inc., publishers.)

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.

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.

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.)

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.)

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.)

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.)

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.

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.

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.)

The objective in this study was to examine the association between sexual orientation and seeking/receiving sexual and reproductive health (SRH) information from media sources during adolescence. We analysed data from male and female participants (aged 23-35 years) from the U.S.-based Growing Up Today Study (GUTS) in 2016. Sex-stratified, multivariable log-binomial models adjusted for age, cohort and race/ethnicity were used to examine sexual orientation differences in retrospective self-reported seeking/receipt of SRH media information before age 18. Sexual minority (e.g., mostly heterosexual, bisexual, gay) men and women were more likely than same-gender individuals who identified as completely heterosexual to seek/receive SRH information about contraceptive methods (e.g., condom use), sexually transmitted infections, and HIV and AIDS. Although lesbians were more likely than completely heterosexuals to seek/receive SRH information from media about each topic, they were the sexual minority subgroup with the smallest proportion seeking/receiving SRH information. Sexual minorities may passively and/or actively receive SRH information pertaining to a wide range of topics, including skills-based sex education, from media sources more frequently than heterosexuals, which may influence safe-sex decision-making. Lesbians in particular may benefit from media information dissemination focusing on their specific SRH needs, as current media sources do not seem to be well-utilised by this group., Competing Interests: Declaration of Interest Statement No potential competing interest was reported by the authors. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Gender diverse people are increasingly pursuing gender-affirming surgery, but little is known about their experiences on accessing care. As part of the baseline assessment for an ongoing longitudinal study, we examined the types of barriers and self-reported out-of-pocket costs associated with gender-affirming surgery most commonly endorsed by transmasculine chest (top) and genital (bottom) surgery patients at their initial surgical consultation., Methods: A brief survey was administered to a clinical sample of transmasculine patients (n = 160; age ≥15 years) seeking a gender-affirming surgery at the Center for Gender Surgery in Boston, Mass. from April 2018 to February 2020., Results: The barriers most commonly endorsed by top surgery patients were insurance coverage and age. For bottom surgery patients, the most commonly endorsed barriers were getting mental health letters and readiness for surgery. Bottom surgery patients were also more likely to report barriers of readiness for surgery and cost of/access to hair removal, than top surgery patients ( P s < 0.05). Bottom surgery patients were more likely to report out-of-pocket costs related to hair removal, surgical consultation, and surgery ( Ps < 0.05), whereas top surgery patients were more likely to report hormone treatment costs ( P = 0.01). Average out-of-pocket costs were high (mean = 2148.31) and significantly higher for bottom surgery patients ( b = 4140.30; β = 0.64; 95% confidence interval, 3064.6-5216.0)., Conclusions: Transmasculine patients experience a variety of barriers when seeking gender-affirming surgery. Presurgical requirements, insurance access, and high out-of-pocket costs may hinder access to care for many transmasculine people seeking bottom surgery., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

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.

The objective of this study was to quantify sexual orientation differences in insurance access, healthcare utilization, and unmet needs for care. We analyzed cross-sectional data from three longitudinal U.S.-based cohorts (N = 31,172) of adults ages 20-54 years in the Growing Up Today Studies 1 and 2 and the Nurses' Health Study 3 from 2015 to 2019. Adjusted log-binomial models examined sexual orientation differences (reference: completely heterosexual) in insurance access, healthcare utilization, and unmet needs for care. Compared to completely heterosexuals, mostly heterosexual and bisexual adults were more likely to report emergency departments as a usual source of care and less likely to be privately insured. Sexual minorities (mostly heterosexual, bisexual, gay/lesbian) were also more likely than completely heterosexuals to delay needed care for reasons of not wanting to bother a healthcare provider, concerns over cost/insurance, bad prior healthcare experiences, and being unable to get an appointment. Differences by sex and sexual orientation also emerged for healthcare utilization and unmet needs. For example, mostly heterosexual women were more likely than completely heterosexual women to delay care due to perceiving symptoms as not serious enough, while gay men were less likely than lesbian women to delay for this reason. Findings indicate that sexual minorities experience disparities in unmet needs for and continuity of care. Provider education should be attentive to how perceptions, like perceived severity, can shape healthcare access in tandem with socioeconomic barriers., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The human papillomavirus (HPV) vaccination, sexually transmitted infection (STI) tests, and Papanicolaou (Pap) testing rates vary by sexual orientation, which may be due in part to healthcare providers (HCP) recommending this care unevenly. Data (N = 17,675) came from the Growing Up Today Study (GUTS) (N = 8039) and Nurses' Health Study 3 (NHS3) (N = 9636). Among participants who met clinical guidelines to receive the care in question, we estimated the probability of an HCP encouraging participants to have the HPV vaccination, STI tests, or Pap test. Regardless of sexual orientation, participants whose HCP knew their sexual orientation were more likely to have been encouraged to get care compared to those whose HCP did not know the participant's sexual orientation. Sexual minority men and women were more likely to be encouraged to obtain HPV vaccination, STI tests, and Pap test than same-gender, completely heterosexuals with no same-sex partners, with some variation by gender and the care in question. Lesbian women were the sole sexual orientation subgroup that was less likely to be encouraged to receive care (HPV vaccination and Pap test) than their same gender, completely heterosexual counterparts with no same-sex partners (odds ratio [95% confidence interval]: 0.90 [0.80-1.00] and 0.94 [0.91-0.98], respectively). The differences across sexual orientation in HCPs' encouragement of care indicate a possible explanation for differences in utilization across sexual orientation. Across the US, HCPs under-encourage HPV vaccination, STI tests, and Pap test for all sexual orientation groups. Lesbian patients appear to be at high risk of under-encouragement for the Pap test., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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.

Introduction: Transgender (trans) and gender-nonconforming adults have reported reduced access to health care because of discrimination and lack of knowledgeable care. This study aimed to contribute to the nascent cancer prevention literature among trans and gender-nonconforming individuals by ascertaining rates of breast, cervical, prostate, and colorectal cancer screening behaviors by gender identity., Methods: Publicly available de-identified data from the 2014-2016 Behavioral Risk Factor Surveillance System surveys were utilized to evaluate rates of cancer screenings by gender identity, while controlling for healthcare access, sociodemographics, and survey year. Analyses were conducted in 2017., Results: Weighted chi-square tests identified significant differences in the proportion of cancer screening behaviors by gender identity among lifetime colorectal cancer screenings, Pap tests, prostate-specific antigen tests, discussing prostate-specific antigen test advantages/disadvantages with their healthcare provider, and up-to-date colorectal cancer screenings and Pap tests (p<0.036). Weighted logistic regressions found that although some differences based on gender identity were fully explained by covariates, trans women had reduced odds of having up-to-date colorectal cancer screenings compared to cisgender (cis) men (AOR=0.20) and cis women (AOR=0.24), whereas trans men were more likely to ever receive a sigmoidoscopy/colonoscopy as compared to cis men (AOR=2.76) and cis women (AOR=2.65). Trans women were more likely than cis men to have up-to-date prostate-specific antigen tests (AOR=3.19). Finally, trans men and gender-nonconforming individuals had reduced odds of lifetime Pap tests versus cis women (AOR=0.14 and 0.08, respectively), and gender-nonconforming individuals had lower odds of discussing prostate-specific antigen tests than cis men (AOR=0.09; all p<0.05)., Conclusions: The findings indicate that gender identity disparities in cancer screenings persist beyond known sociodemographic and healthcare factors. It is critical that gender identity questions are included in cancer and other health-related surveillance systems to create knowledge to better inform healthcare practitioners and policymakers of appropriate screenings for trans and gender-nonconforming individuals., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

This study examined the relationship between three types of social support and suicidal ideation and lifetime attempts among a national sample of ethnically diverse sexual minority women (SMW). Participants ( N = 150) completed measures of social support and suicidal ideation/attempts. After controlling for socioeconomic status, social support explained 12.3% of the variance in past suicidal ideation and 10.7% in lifetime suicide attempts. Social support from family and significant other were both inversely associated with suicidal ideation, and social support from family inversely with lifetime attempts. Interventions that strengthen family relationships could be a buffer of suicidality in this population., Competing Interests: The authors report no declarations of interest. output.txt

The purpose of the current study was to examine whether coping strategies are associated with past suicidal ideation and history of suicide attempts among sexual minority women (SMW). Participants were 150 racially and ethnically diverse lesbian, bisexual, queer, or "other" nonheterosexual-identified cisgender women who were recruited as part of a national online survey on the experiences of SMW. Simultaneous multiple regressions suggested that coping styles significantly explained 20.3% of the variance in past suicidal ideation and 30.4% of the variance in lifetime history of suicide attempts. Within these regressions, self-blame coping positively predicted past suicidal ideation, and religious coping and venting coping were associated with a higher lifetime history of suicide attempts. Based on these findings, directions for future research and interventions to reduce suicide risk among SMW are discussed.

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.