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1.  The Association of Multiple Identities with Self-directed Violence and Depression among Transgender Individuals 
Transgender individuals have a high prevalence of self-directed violence; however, there is scant literature focusing on their unique experiences. This study examined the differences in self-harm, suicidal ideation, suicide attempt, and depression based on racial/ethnic identity and sexual orientation among transgender individuals. Data were gathered from the Fall 2008 and Spring 2009 National College Health Assessment. Across racial/ethnic identities, greater proportions of transgender students endorse self-directed violence than their cisgender peers. Among transgender individuals, sexual minorities were more likely to report suicidal ideation than their heterosexual peers, and racial/ethnic minorities had higher odds of attempting suicide than non-Hispanic white individuals.
doi:10.1111/sltb.12234
PMCID: PMC5087282  PMID: 26916366
2.  Gay Acres: Sexual Orientation Differences in Health Indicators Among Rural and Non-rural Individuals 
Purpose
Geographic location is a significant factor that influences health status and health disparities. Yet, little is known about the relationship between geographic location and health and health disparities among lesbian, gay, and bisexual (LGB) persons. This study used a US population-based sample to evaluate the associations of sexual orientation with health indicators by rural/non-rural residence.
Methods
Data were pooled from the 10 states that collected sexual orientation in the 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Rural status was defined using metropolitan statistical area (MSA), and group differences by sexual orientation were stratified by gender and rural/non-rural status. Chi-square tests for categorical variables were used to assess bivariate relationships. Multivariable logistic regression models stratified by gender and rural/non-rural status were used to assess the association of sexual orientation to health indicators, while adjusting for age, race/ethnicity, education, and partnership status. All analyses were weighted to adjust for the complex sampling design.
Findings
Significant differences between LGB and heterosexual participants emerged for several health indicators, with bisexuals having a greater number of differences than gay men/lesbians. There were fewer differences in health indicators for rural LGB participants compared to heterosexuals than non-rural participants.
Conclusions
Rural residence appears to influence the pattern of LGB health disparities. Future work is needed to confirm and identify the exact etiology or rural/non-rural differences in LGB health.
doi:10.1111/jrh.12161
PMCID: PMC4887433  PMID: 26625172
bisexuality; health disparities; homosexuality; rural health; sexual orientation
3.  Health Care Use, Health Behaviors, and Medical Conditions Among Individuals in Same-Sex and Opposite-Sex Partnerships 
Medical care  2016;54(6):547-554.
Background
Prior research documents disparities between sexual minority and nonsexual minority individuals regarding health behaviors and health services utilization. However, little is known regarding differences in the prevalence of medical conditions.
Objectives
To examine associations between sexual minority status and medical conditions.
Research Design
We conducted multiple logistic regression analyses of the Medical Expenditure Panel Survey (2003–2011). We identified individuals who reported being partnered with an individual of the same sex, and constructed a matched cohort of individuals in opposite-sex partnerships.
Subjects
A total of 494 individuals in same-sex partnerships and 494 individuals in opposite-sex partnerships.
Measures
Measures of health risk (eg, smoking status), health services utilization (eg, physician office visits), and presence of 15 medical conditions (eg, cancer, diabetes, arthritis, HIV, alcohol disorders).
Results
Same-sex partnered men had nearly 4 times the odds of reporting a mood disorder than did opposite-sex partnered men [adjusted odds ratio (aOR) = 3.96; 95% confidence interval (CI), 1.85–8.48]. Compared with opposite-sex partnered women, same-sex partnered women had greater odds of heart disease (aOR =2.59; 95% CI, 1.19–5.62), diabetes (aOR= 2.75; 95% CI, 1.10–6.90), obesity (aOR =1.92; 95% CI, 1.26–2.94), high cholesterol (aOR = 1.89; 95% CI, 1.03–3.50), and asthma (aOR=1.90; 95% CI, 1.02–1.19). Even after adjusting for sociodemographics, health risk behaviors, and health conditions, individuals in same-sex partnerships had 67% increased odds of past-year emergency department utilization and 51% greater odds of ≥3 physician visits in the last year compared with opposite-sex partnered individuals.
Conclusions
A combination of individual-level, provider-level, and system-level approaches are needed to reduce disparities in medical conditions and health care utilization among sexual minority individuals.
doi:10.1097/MLR.0000000000000529
PMCID: PMC5137194  PMID: 26974678
sexual orientation; health disparities; health care utilization; minority health
4.  Suicidality and sexual orientation: Characteristics of symptom severity, disclosure, and timing across the life course 
This investigation explored suicide-related characteristics and help-seeking behavior by sexual orientation. Population-based data are from the California Quality of Life Surveys, which included 1,478 sexual minority (lesbian, gay, bisexual, and homosexually experienced individuals) and 3,465 heterosexual individuals. Bisexual women had nearly 6-fold increased risk of lifetime suicide attempts than heterosexual women (RR=5.88, 95%CI: 3.89–8.90), and homosexually experienced men had almost 7 times higher risk of lifetime suicide attempts than heterosexual men (RR=6.93, 95%CI: 3.65–13.15). Sexual minority men and women were more likely than heterosexual men and women to have disclosed suicide attempts to a medical professional (RR=1.48 and RR=1.44, respectively). Among persons who ever attempted suicide, sexual minority women had a younger age of index attempt than heterosexual women (15.9 versus 19.6 years of age, respectively). Health care professionals should be aware of suicidal risk heterogeneity among sexual minority individuals, including vulnerable points of risk and evidenced-based treatments.
doi:10.1037/ort0000112
PMCID: PMC4720972  PMID: 26752446
mental disorders; gay; lesbian; bisexual; sexual minority; suicide
5.  Mental Health and Self-directed Violence Among Student Service Members/Veterans in Postsecondary Education 
Objectives
Using a sample of student service members/veterans, the current study aimed to examine the prevalence of psychiatric diagnoses and suicide-related outcomes and the association of hazardous duty with mental health.
Participants
Data are from the Fall 2011 National College Health Assessment (n=27,774).
Methods
Logistic regression was used to examine (1) the association of student service member/veteran status with mental health outcomes and (2) the association of hazardous duty with mental health outcomes among student service members/veterans (n=706).
Results
Student service members/veterans had higher odds of self-harm than students without military experience. Among student service members/veterans, hazardous duty was positively associated (OR=2.00, 95% CI: 1.30–3.07) with having a psychiatric diagnosis but negatively associated (OR=0.41, 95% CI: 0.20–0.85) with suicidal ideation.
Conclusions
Self-harm may be a unique phenomenon among service members/veterans. Suicide prevention with this population should include information about self-harm, and future research should explore whether suicidal intent underlies self-harm.
doi:10.1080/07448481.2014.931282
PMCID: PMC4263812  PMID: 24918517
veterans health; mental health; suicidal ideation; attempted suicide; self injurious behavior
6.  Adverse Childhood Experiences and Adult Health Outcomes Among Veteran and Non-Veteran Women 
Journal of Women's Health  2015;24(9):723-729.
Abstract
Background: Women veterans represent a vulnerable population with unique health needs and disparities in access to care. One constellation of exposures related to subsequent poor health includes adverse childhood experiences (ACEs; e.g., physical and sexual child abuse), though research on impacts of ACEs among women veterans is limited.
Methods: Data were drawn from the 2010 Behavioral Risk Factor Surveillance System for the 11 states that included the ACE module (n=36,485). Weighted chi-squared tests and multivariable logistic regression were used to assess the prevalence of ACEs among women veterans compared with women non-veterans and differences in the following outcomes, controlling for ACEs: social support, inadequate sleep, life satisfaction, mental distress, smoking, heavy alcohol use, obesity, diabetes, cardiovascular disease symptoms, asthma, and disability.
Results: Women veterans (1.6% of the total sample) reported a higher prevalence of 7 out of 11 childhood adversities and higher mean ACE score than women non-veterans. Women veterans were more likely to be current smokers and report a disability, associations which were attenuated when controlling for ACE.
Conclusions: Despite women veterans' higher prevalence of ACE, their health outcomes did not differ substantially from non-veterans. Further research is needed to understand the intersections of traumatic experiences and sources of resilience over the lifecourse among women veterans.
doi:10.1089/jwh.2014.4997
PMCID: PMC4589327  PMID: 26390379
7.  Differences in Alcohol Use and Alcohol-Related Problems between Transgender- and Nontransgender-identified Young Adults 
Drug and alcohol dependence  2015;154:251-259.
Background
Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED).
Methods
Cross-sectional surveys were completed by 75,192 students aged 18–29 years attending 120 post-secondary educational institutions in the United States from 2011–2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females.
Results
Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk=1.42; p=0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28–0.43; p-values<0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24–0.45; p-values<0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR=3.21, p=0.011) or verbally threatened (IRR=2.42, p=0.021) in the past year had greater HED days than those who did not experience those forms of victimization.
Conclusions
Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people.
doi:10.1016/j.drugalcdep.2015.07.006
PMCID: PMC4536098  PMID: 26210734
Transgender; alcohol use; heavy episodic drinking; alcohol-related problems; violence
8.  Associations of Racial/Ethnic Identities and Religious Affiliation with Suicidal Ideation among Lesbian, Gay, Bisexual, and Questioning Individuals 
Background
Our aim was to examine the associations of racial/ethnic identity and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning (LGBQ) and heterosexual college students. An additional aim was to determine the prevalence of passive suicidal ideation (i.e., death ideation) and active suicidal ideation among culturally diverse LGBQ individuals.
Methods
Data from the National Research Consortium probability-based sample of college students from 70 postsecondary institutions (n=24,626) were used to examine active and passive suicidal ideation in the past 12-months and lifetime active suicidal ideation among students by sexual orientation, racial/ethnic identity, and religious affiliation.
Results
Across most racial/ethnic groups and religious affiliations, LGBQ students were more likely to report active suicidal ideation than non-LGBQ individuals. Among LGBQ students, Latino individuals had lower odds of reporting both past 12-month passive and active suicidal ideation than their non-Hispanic white LGBQ counterparts. Compared to Christian LGBQ students, Agnostic/Atheist LGBQ individuals had greater odds of reporting past 12-month passive suicidal ideation, and Jewish LGBQ students were less likely to endorse past 12-month passive and active suicidal ideation.
Limitations
Cross-sectional design and self-reported data.
Conclusions
Results corroborate previous research showing elevated prevalence of suicidal ideation among LGBQ individuals in comparison to their heterosexual counterparts. These findings are among the first to document prevalence differences within the LGBQ population based on intersectional identities (race/ethnicity and religious affiliation). Providers should recognize that LGBQ individuals might need support in negotiating the complex relationship between multiple identities, especially due to their elevated prevalence of suicidal ideation.
doi:10.1016/j.jad.2014.07.039
PMCID: PMC4397160  PMID: 25795534
Suicidal Ideation; LGBT; Race/Ethnicity; Religious Affiliation
9.  Thursday’s child: The role of adverse childhood experiences in explaining mental health disparities among lesbian, gay, and bisexual U.S. adults 
This study examined how Adverse Childhood Experiences (ACE) may explain disparities in poor mental health between lesbian, gay, and bisexual (LGB) and heterosexual adults. Data are from three U.S. states’ 2010 Behavioral Risk Factor Surveillance System surveys (n=20,060) that included sexual orientation, ACE inventory, and mental distress. LGB status was significantly associated with mental distress (OR=1.85 [1.14–3.02]). Once incorporating ACE scores into the multiple regression analysis, LGB status was no longer associated with mental distress (OR=1.28 [0.76–2.16]). The results corroborate previous research that LGB individuals report greater prevalence of childhood adversity than their heterosexual peers, which may explain LGB adulthood health disparities.
doi:10.1007/s00127-014-0955-4
PMCID: PMC4512235  PMID: 25367679
10.  Out smoking on the big screen: Tobacco use in LGBT movies, 2000–2011 
Tobacco control  2013;23(0):e156-e158.
Objective
Lesbian, gay, bisexual, and transgender (LGBT) people have significantly higher smoking prevalence than heterosexual people in the United States. The reasons for this disparity remain unclear. Tobacco use in movies has a substantial influence on tobacco use behaviours, particularly among youth. Yet, no research has examined tobacco use in movies for LGBT audiences or containing LGBT characters.
Methods
We identified 81 U.S. movies from 2000–2011 with a theatre release and with LGBT themes or characters. We then selected a random sample of these movies (n = 45) for quantitative content analysis to examine the proportion of movies with depictions of tobacco use and the number of occurrences of tobacco use.
Results
Tobacco use was depicted in 87%(95% confidence interval [CI]: 80%–94%) of movies with an average of 4 occurrences of tobacco use per hour (95% CI: 3–5). Only 15% (95% CI: 8%–23%) of movies and 3% of all depictions of tobacco use conveyed any harms of tobacco use.
Conclusions
Viewers of movies with LGBT themes or characters are exposed, on average, to one depiction of tobacco use for every 15 minutes of movie run-time. As a major component of the entertainment media environment, movies may contribute to smoking among LGBT people.
doi:10.1136/tobaccocontrol-2013-051288
PMCID: PMC4032800  PMID: 24277775
tobacco use dependence; smoking; motion pictures as topic; homosexuality; communications media
11.  The Influence of Intersecting Identities on Self-Harm, Suicidal Behaviors, and Depression among Lesbian, Gay, and Bisexual Individuals 
Individuals with lesbian, gay, and bisexual (LGB) identities have higher prevalence of self-directed violence, but very little is known about racial/ethnic differences among LGB populations. This study aimed to examine racial/ethnic differences in self-harm, suicidal ideation, suicide attempt, and depression among LGB and heterosexual emerging adults. Data are compiled from the Fall 2008 and Spring 2009 National College Health Assessment and limited to respondents within emerging adulthood (ages 18-24) who indicated their sexual orientation and racial/ethnic identities (n=89,199). Within each racial/ethnic group, LGB individuals were significantly more likely to report self-harm, suicidal ideation, suicide attempt, and depression than non-LGB individuals.
PMCID: PMC4176776  PMID: 25250405
12.  Health Inequalities Among Sexual Minority Adults 
Background
Improving the health of lesbian, gay, and bisexual (LGB) individuals is a Healthy People 2020 goal; however, the IOM highlighted the paucity of information currently available about LGB populations.
Purpose
To compare health indicators by gender and sexual orientation statuses.
Methods
Data are from Behavioral Risk Factor Surveillance System surveys conducted January–December of 2010 with population-based samples of non-institutionalized U.S. adults aged over 18 years (N=93,414) in ten states that asked about respondents’ sexual orientation (response rates=41.1%–65.6%). Analyses were stratified by gender and sexual orientation to compare indicators of mental health, physical health, risk behaviors, preventive health behaviors, screening tests, health care utilization, and medical diagnoses. Analyses were conducted in March 2013.
Results
Overall, 2.4% (95% CI=2.2, 2.7) of the sample identified as LGB. All sexual minority groups were more likely to be current smokers than their heterosexual peers. Compared with heterosexual women, lesbian women had over 30% decreased odds of having an annual routine physical exam, and bisexual women had over 2.5 times the odds of not seeking medical care owing to cost. Compared with heterosexual men, gay men were less likely to be overweight or obese, and bisexual men were twice as likely to report a lifetime asthma diagnosis.
Conclusions
This study represents one of the largest samples of LGB adults and finds important health inequalities, including that bisexual women bear particularly high burdens of health disparities. Further work is needed to identify causes of and intervention for these disparities.
doi:10.1016/j.amepre.2013.11.010
PMCID: PMC4102129  PMID: 24650836
13.  Operational Definitions of Sexual Orientation and Estimates of Adolescent Health Risk Behaviors 
LGBT health  2013;1(1):42-49.
Purpose
Increasing attention to the health of lesbian, gay, and bisexual (LGB) populations comes with requisite circumspection about measuring sexual orientation in surveys. However, operationalizing these variables also requires considerable thought. This research sought to document the consequences of different operational definitions of sexual orientation by examining variation in health risk behaviors.
Methods
Using Massachusetts Youth Risk Behavior Survey data, we examined how operational definitions of sexual behavior and sexual identity influenced differences among three health behaviors known to disparately affect LGB populations: smoking, suicide risk, and methamphetamine use. Sexual behavior and sexual identity were also examined together to explore if they captured unique sources of variability in behavior.
Results
Estimates of health disparities changed as a result of using either sexual behavior or sexual identity. Youth who reported their sexual identity as “not sure” also had increased odds of health risk behavior. Disaggregating bisexual identity and behavior from same-sex identity and behavior frequently resulted in the attenuation or elimination of health disparities that would have otherwise been attributable to exclusively same-sex sexual minorities. Finally, sexual behavior and sexual identity explained unique and significant sources of variability in all three health behaviors.
Conclusion
Researchers using different operational definitions of sexual orientation could draw different conclusions, even when analyzing the same data, depending upon how they chose to represent sexual orientation in analyses. We discuss implications that these manipulations have on data interpretation and provide specific recommendations for best-practices when analyzing sexual orientation data collected from adolescent populations.
PMCID: PMC4123795  PMID: 25110718
adolescents; data analysis; health behavior; measurement; sexual orientation
14.  Physical health indicators among lesbian, gay, and bisexual U.S. Veterans 
Annals of epidemiology  2013;23(7):448-451.
Purpose
To provide information about lesbian, gay and bisexual (LGB) veterans’ health status, diagnoses, and health screening behaviors compared with heterosexual veterans.
Methods
Data are from ten states’ 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys that contained sexual orientation data for veterans (n=11,665). Chi-square tests and multiple logistic regression were used to examine outcomes among LGB and heterosexual veterans.
Results
More LGB veterans than heterosexual veterans reported current smoking, not seeking medical care due to cost, and activity limitations. Compared with heterosexual veterans, LGB veterans had greater odds of ever having an HIV test (OR=5.42; 95%CI: 3.28–8.96) but lower odds of diabetes diagnosis (0.55 (0.34–0.89).
Conclusions
Findings from this sample suggest patterns of health behaviors and outcomes among LGB veterans that are both unique from and similar to results from general samples of LGB persons. With the formal end of the “Don’t Ask, Don’t Tell” policy that discriminated against LGB people in the military, institutions such as the Department of Veterans Affairs (VA) are likely to see an increase in its current population of LGB veterans. The VA stands in a unique place to meet the health equity needs of this minority population.
doi:10.1016/j.annepidem.2013.04.009
PMCID: PMC3698572  PMID: 23688720
15.  Health Disparities Among Sexual Minority Women Veterans 
Journal of Women's Health  2013;22(7):631-636.
Abstract
Background
Lesbian and bisexual (i.e., sexual minority) identity is more common among women veterans than among male veterans. Unique health issues have been identified among women veterans and among sexual minority women, but little is known about women who are both sexual minorities and veterans. This study aimed to compare demographic and health information from sexual minority women veterans with sexual minority women non-veterans and heterosexual women veterans.
Methods
Behavioral Risk Factor Surveillance Survey data were pooled from ten U.S. states that elected to ask sexual identity during 2010. The analytic sample was comprised of women who identified both their sexual identity and veteran status (n=1,908). Mental health indicators were frequent mental distress, sleep problems, low social/emotional support, and low satisfaction with life. Health risk indicators included current smoking, overweight, and obesity. Physical health status was defined by three components: disability requiring assistive equipment, >14 days of poor physical health in the past 30 days, and activity limitations.
Results
Compared with heterosexual women veterans, sexual minority women veterans had higher odds of mental distress (odds ratio [OR]=3.03, 95% confidence interval [CI]: 1.61–5.70) and smoking (OR=2.31, 95%CI: 1.19–4.48). After adjusting for demographic correlates, sexual minority women veterans had three times the odds of poor physical health (OR=3.01, 95%CI: 1.51–5.99) than their sexual minority non-veteran peers.
Conclusions
Results suggest sexual minority women veterans may experience unique health disparities relevant to provision of care in both Veterans Affairs (VA) and non-VA healthcare systems. Future research requires availability of data that include sexual minority status.
doi:10.1089/jwh.2012.4214
PMCID: PMC3761433  PMID: 23746281
16.  A systematic review of the aetiology of tobacco disparities for sexual minorities 
Tobacco control  2011;22(2):66-73.
Objective
To conduct a systematic review of the literature examining risk factors/correlates of cigarette smoking among lesbian, gay and bisexual (ie, sexual minority) populations.
Methods
Sets of terms relevant to sexual minority populations and cigarette smoking were used in a simultaneous search of 10 databases through EBSCOhost. The search was limited to the peer-reviewed literature up to January 2011, using no geographic or language limits. For inclusion, the paper was required to: (1) have been written in English, (2) have sexual minorities (defined by either attraction, behaviour, or identity) included in the study population and (3) have examined some form of magnitude of association for risk factors/correlates of any definition of cigarette smoking. A total of 386 abstracts were reviewed independently, with 26 papers meeting all inclusion criteria. Abstracts were reviewed and coded independently by authors JB and JGLL using nine codes derived from the inclusion/exclusion criteria.
Results
Studies used various measures of sexual orientation and of smoking. Risk factors that could be considered unique to sexual minorities included internalised homophobia and reactions to disclosure of sexual orientation. Some studies also indicated common smoking risk factors experienced at higher rates among sexual minorities, including stress, depression, alcohol use and victimisation.
Conclusions
This review identified risks that were associated with sexual minority status and common to the general population but experienced at potentially higher rates by sexual minorities. Government and foundation funds should be directed towards research on the origins of this disparity.
doi:10.1136/tobaccocontrol-2011-050181
PMCID: PMC3779881  PMID: 22170335
17.  Health Care Utilization and Health Indicators Among a National Sample of U.S. Veterans in Same-Sex Partnerships 
Military medicine  2013;178(2):207-212.
Objectives
To examine health indicators of same-sex partnered veterans as compared with their opposite-sex partnered veteran and nonveteran peers.
Methods
Same-sex partner status was derived by self-reported same-sex partnerships in data from the 2004 Behavioral Risk Factor Surveillance System. Outcome variables included health risk disparities associated with sexual minority status (e.g., frequent mental distress) and veteran status (e.g., firearm ownership). Stratified multiple logistic regression models were used to examine the association of same-sex partnered veteran status with health indicators.
Results
Same-sex partnered veterans had higher odds of being overweight and keeping firearms in the house compared with same-sex partnered nonveterans. Same-sex partnered veterans were less likely than opposite-sex partnered veterans to be overweight, and they were more than twice as likely to be current smokers when compared with opposite-sex partnered nonveterans.
Conclusions
Findings suggest both that some health disparities patterns identified by same-sex partnership status among the general population also exist among veteran populations, and that some unique distinctions may exist, particularly related to BMI and firearm ownership. Collection of information about sexual minority status within Department of Veterans Affairs data sources is needed to more accurately assess the health of this minority population.
PMCID: PMC3725588  PMID: 23495467
18.  Suicide acceptability among U.S. Veterans with active duty experience: Results from the 2010 General Social Survey 
Objectives
To examine whether U.S. Veterans more frequently indicate suicide acceptability than non-Veterans.
Methods
The 2010 General Social Survey, which employed a probability-based sample of U.S. adults, was analyzed by self-reported Veteran status on suicide acceptability in four, separate hypothetical situations regarding ending one’s life (i.e., incurable illness, bankruptcy, bringing dishonor/shame upon family; tired of living and ready to die).
Results
Veterans were no more likely to endorse suicide as acceptable than their non-Veteran counterparts.
Conclusions
Results suggest that attitudes approving of suicide are not different among Veterans in general and non-Veterans. However, future research may need to examine if subpopulations of Veterans with elevated risk for suicide may report differential attitudes about suicide.
doi:10.1080/13811118.2013.748415
PMCID: PMC3601790  PMID: 23387403
suicide; veterans health
19.  Up in Smoke: Vanishing Evidence of Tobacco Disparities in the Institute of Medicine's Report on Sexual and Gender Minority Health 
American journal of public health  2012;102(11):2041-2043.
The Institute of Medicine (IOM) released a groundbreaking report on lesbian, gay, bisexual, and transgender (LGBT) health in 2011, finding limited evidence of tobacco disparities. We examined IOM search terms and used 2 systematic reviews to identify 71 articles on LGBT tobacco use. The IOM omitted standard tobacco-related search terms. The report also omitted references to studies on LGBT tobacco use (n = 56), some with rigorous designs. The IOM report may underestimate LGBT tobacco use compared with general population use.
doi:10.2105/AJPH.2012.300746
PMCID: PMC3477969  PMID: 22994185
20.  Representation of lesbian, gay, and bisexual people in clinical cancer trials 
Annals of epidemiology  2012;22(11):821-823.
Purpose
Clinical trials are important tools for advancing cancer treatment, prevention, and control. To identify and describe clinical effects relevant to underserved groups, their representation in clinical trials is necessary. Lesbian, gay, and bisexual (LGB) people have been identified as a medically underserved group and their representation in cancer clinical trials is unknown. This study sought to examine LGB cancer survivor representation in cancer clinical trials.
Methods
Data were from the 2010, Behavioral Risk Factor Surveillance System, Cancer Survivorship Module. Data were from five states that included both the Cancer Survivorship module and an item asking self-identified LGB status.
Results
Participation in cancer clinical trials was higher among LGB cancer survivors (12.5%) than among heterosexual cancer survivors (6.0%) (p = .005). In the multivariate, adjusted model, LGB cancer survivors were more than twice as likely, as heterosexual cancer survivors, to report participation in a clinical trial (AOR 2.17, 95% CI 1.21–3.90).
Conclusion
LGB cancer survivors had greater likelihood of cancer clinical trial participation than heterosexual cancer survivors and this was not explained by demographics. The finding was unexpected given the historic marginalization of this group. The small number of LGB cancer survivors limits the generalizability and statistical power. Findings should be interpreted cautiously, and further research is needed to clarify explanatory mechanisms.
doi:10.1016/j.annepidem.2012.08.006
PMCID: PMC3746336  PMID: 23062888
Clinical cancer trials; Gay/lesbian/bisexual; Cancer survivors
21.  Gender differences in cigarette smoking, social correlates and cessation among adolescents 
Addictive Behaviors  2012;37(6):739-742.
Background
Despite well-established gender differences in adult smoking behaviors, relatively little is known about gender discrepancies in smoking behaviors among adolescents, and even less is known about the role of gender in smoking cessation among teen populations.
Method
The present study examined gender differences in a population of 755 adolescents seeking to quit smoking through the American Lung Association’s Not-On-Tobacco (N-O-T) program. All participants enrolled in the N-O-T program between 1998 and 2009. All participants completed a series of questionnaires prior to and immediately following the cessation intervention. Analyses examined gender differences in a range of smoking variables, cessation success and direct and indirect effects on changes in smoking behaviors.
Results
Females were more likely to have a parents, siblings and romantic partners who smokes, perceive those around them will support a cessation effort, smoke more prior to intervention if they have friends who smoke, and to have lower cessation motivation and confidence if they have a parent who smokes. Conversely, males were more likely to have lower cessation motivation and confidence and be less likely to quit if they have a friend who smokes.
Conclusions
Gender plays an important role in adolescent smoking behavior and smoking cessation. Further research is needed to understand how these differences may be incorporated into intervention design to increase cessation success rates among this vulnerable population of smokers.
doi:10.1016/j.addbeh.2012.02.007
PMCID: PMC3334461  PMID: 22405835
22.  Disparities in Adverse Childhood Experiences among Sexual Minority and Heterosexual Adults: Results from a Multi-State Probability-Based Sample 
PLoS ONE  2013;8(1):e54691.
Background
Adverse childhood experiences (e.g., physical, sexual and emotional abuse, neglect, exposure to domestic violence, parental discord, familial mental illness, incarceration and substance abuse) constitute a major public health problem in the United States. The Adverse Childhood Experiences (ACE) scale is a standardized measure that captures multiple developmental risk factors beyond sexual, physical and emotional abuse. Lesbian, gay, and bisexual (i.e., sexual minority) individuals may experience disproportionately higher prevalence of adverse childhood experiences.
Purpose
To examine, using the ACE scale, prevalence of childhood physical, emotional, and sexual abuse and childhood household dysfunction among sexual minority and heterosexual adults.
Methods
Analyses were conducted using a probability-based sample of data pooled from three U.S. states’ Behavioral Risk Factor Surveillance System (BRFSS) surveys (Maine, Washington, Wisconsin) that administered the ACE scale and collected information on sexual identity (n = 22,071).
Results
Compared with heterosexual respondents, gay/lesbian and bisexual individuals experienced increased odds of six of eight and seven of eight adverse childhood experiences, respectively. Sexual minority persons had higher rates of adverse childhood experiences (IRR = 1.66 gay/lesbian; 1.58 bisexual) compared to their heterosexual peers.
Conclusions
Sexual minority individuals have increased exposure to multiple developmental risk factors beyond physical, sexual and emotional abuse. We recommend the use of the Adverse Childhood Experiences scale in future research examining health disparities among this minority population.
doi:10.1371/journal.pone.0054691
PMCID: PMC3553068  PMID: 23372755
23.  Drivers of Disparity: Differences in Socially-Based Risk Factors of Self-injurious and Suicidal Behaviors Among Sexual Minority College Students 
Lesbian, gay, and bisexual (i.e., sexual minority) populations have increased prevalence of both self-injurious and suicidal behaviors, but reasons for these disparities are poorly understood.
Objective
To test the association between socially-based stressors (e.g., victimization, discrimination) and self-injurious behavior, suicide ideation, and suicide attempt.
Participants
A national sample of college-attending 18- to 24-year-olds.
Methods
Random or census samples from post-secondary educational institutions that administered the National College Health Assessment during the Fall 2008 and Spring 2009 semesters.
Results
Sexual minorities reported more socially-based stressors than heterosexuals. Bisexuals exhibited greatest prevalence of self-injurious and suicidal behaviors. In adjusted models, intimate partner violence was most consistently associated with self-injurious behaviros.
Conclusions
Sexual minorities' elevated risks of self-injurious and suicidal behaviors may stem from higher exposure to socially-based stressors. Within-group differences among sexual minorities offer insight to specific risk factors that may contribute to elevated self-injurious and suicidal behaviors in sexual minority populations.
doi:10.1080/07448481.2011.623332
PMCID: PMC3340564  PMID: 22316411
Community Health; Health Education; Mental Health
24.  Associations of Discrimination and Violence With Smoking Among Emerging Adults: Differences by Gender and Sexual Orientation 
Nicotine & Tobacco Research  2011;13(12):1284-1295.
Introduction:
Lesbian, gay, and bisexual (i.e., sexual minority) populations have higher smoking prevalence than their heterosexual peers, but there is a lack of empirical study into why such disparities exist. This secondary analysis of data sought to examine associations of discrimination and violence victimization with cigarette smoking within sexual orientation groups.
Methods:
Data from the Fall 2008 and Spring 2009 National College Health Assessments were truncated to respondents of 18–24 years of age (n = 92,470). Since heterosexuals comprised over 90% of respondents, a random 5% subsample of heterosexuals was drawn, creating a total analytic sample of 11,046. Smoking status (i.e., never-, ever-, and current smoker) was regressed on general (e.g., not sexual orientation–specific) measures of past-year victimization and discrimination. To examine within-group differences, two sets of multivariate ordered logistic regression analyses were conducted: one set of models stratified by sexual orientation and another set stratified by gender-by-sexual-orientation groups.
Results:
Sexual minorities indicated more experiences of violence victimization and discrimination when compared with their heterosexual counterparts and had nearly twice the current smoking prevalence of heterosexuals. After adjusting for age and race, lesbians/gays who were in physical fights or were physically assaulted had higher proportional odds of being current smokers when compared with their lesbian/gay counterparts who did not experience those stressors.
Conclusions:
When possible, lesbian/gay and bisexual groups should be analyzed separately, as analyses revealed that bisexuals had a higher risk profile than lesbians/gays. Further research is needed with more nuanced measures of smoking (e.g., intensity), as well as examining if victimization may interact with smoking cessation.
doi:10.1093/ntr/ntr183
PMCID: PMC3223581  PMID: 21994344

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