Juno Obedin-Maliver

All Publications

• Sexual Orientation-Related Disparities in Neonatal Outcomes. Obstetrics and gynecology Chakraborty, P., Reynolds, C. A., McKetta, S., Soled, K. R., Huang, A. K., Monseur, B., Corman, J. D., Obedin-Maliver, J., Eliassen, A. H., Chavarro, J. E., Austin, S. B., Everett, B., Haneuse, S., Charlton, B. M. 2024

  Abstract

  OBJECTIVE: To evaluate whether disparities exist in adverse neonatal outcomes among the offspring of lesbian, gay, bisexual, and other sexually minoritized (LGB+) birthing people.METHODS: We used longitudinal data from 1995 to 2017 from the Nurses' Health Study II, a cohort of nurses across the United States. We restricted analyses to those who reported live births (N=70,642) in the 2001 or 2009 lifetime pregnancy questionnaires. Participants were asked about sexual orientation identity (current and past) and same-sex attractions and partners. We examined preterm birth, low birth weight, and macrosomia among 1) completely heterosexual; 2) heterosexual with past same-sex attractions, partners, or identity; 3) mostly heterosexual; 4) bisexual; and 5) lesbian or gay participants. We used log-binomial models to estimate risk ratios for each outcome and weighted generalized estimating equations to account for multiple pregnancies per person over time and informative cluster sizes.RESULTS: Compared with completely heterosexual participants, offspring born to parents in all LGB+ groups combined (groups 2-5) had higher estimated risks of preterm birth (risk ratio 1.22, 95% CI, 1.15-1.30) and low birth weight (1.27, 95% CI, 1.15-1.40) but not macrosomia (0.98, 95% CI, 0.94-1.02). In the subgroup analysis, risk ratios were statistically significant for heterosexual participants with past same-sex attractions, partners, or identity (preterm birth 1.25, 95% CI, 1.13-1.37; low birth weight 1.32, 95% CI, 1.18-1.47). Risk ratios were elevated but not statistically significant for lesbian or gay participants (preterm birth 1.37, 95% CI, 0.98-1.93; low birth weight 1.46, 95% CI, 0.96-2.21) and bisexual participants (preterm birth 1.29, 95% CI, 0.85-1.93; low birth weight 1.24, 95% CI, 0.74-2.08).CONCLUSION: The offspring of LGB+ birthing people experience adverse neonatal outcomes, specifically preterm birth and low birth weight. These findings highlight the need to better understand health risks, social inequities, and health care experiences that drive these adverse outcomes.

  View details for DOI 10.1097/AOG.0000000000005747

  View details for PubMedID 39361956

• Conversion practice recall and mental health symptoms in sexual and gender minority adults in the USA: a cross-sectional study. The lancet. Psychiatry Tran, N. K., Lett, E., Cassese, B., Streed, C. G., Kinitz, D. J., Ingram, S., Sprague, K., Dastur, Z., Lubensky, M. E., Flentje, A., Obedin-Maliver, J., Lunn, M. R. 2024

  Abstract

  Conversion practices are associated with psychological morbidity, yet few studies have evaluated differences between efforts to change gender identity, sexual orientation, or both. We aimed to examine the individual and joint association of conversion practice recall targeted at gender identity or sexual orientation, or both, with current mental health symptoms among sexual and gender minority people.This cross-sectional study used data from The PRIDE Study, a US-based, online, prospective cohort study of sexual and gender minority adults who were recruited through social media, digital advertisements, and sexual and gender minority community-based events and organisations. For this analysis, we included participants who completed a lifetime questionnaire in 2019-20 and a subsequent annual questionnaire in 2020-21 without missing outcome data. All questionnaires were in English. The exposure was lifetime recall of conversion practice targeting gender identity alone, sexual orientation alone, or both (versus no conversion practice). Mental health outcomes were continuous measures: Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire 9-item (depression) scale, Post-Traumatic Stress Disorder Checklist 6-item scale, and Suicide Behaviors Questionnaire-Revised scale. We used linear regression to analyse the associations of conversion practice recall and mental health symptoms, controlling for demographic and childhood factors and stratified between cisgender and transgender and gender diverse groups. Sensitivity analyses evaluated the potential impact of unmeasured confounding. Analyses were conducted in R. We included people with related lived experience in the design and implementation of this study.Of 6601 participants who completed the lifetime questionnaire in 2019-20, 4440 completed the subsequent annual questionnaire in 2020 or 2021, and 4426 did not have missing outcome data. Of the 4426 included participants, 4073 (92·0%) identified as White (either alone or in combination with other ethnoracial options), 460 (10·4%) identified with multiple ethnoracial identities, and 1923 (43·4%) were transgender and gender diverse. Participants' age ranged from 18 years to 84 years (median 31·7 years, IQR 25·5-44·1). 149 (3·4%) participants reported sexual orientation-related conversion practice alone, 43 (1·0%) reported gender identity-related conversion practice alone, and 42 (1·0%) reported both. Recalling both forms of conversion practice was most strongly associated with greater post-traumatic stress disorder (PTSD; β 2·84, 95% CI 0·94-4·74) and suicidality (2·14, 0·95-3·32) symptoms. Recall of only sexual orientation-related conversion practice was associated with greater symptoms of PTSD (1·10, 0·22-1·98). Recall of gender identity-related conversion practice alone was most strongly associated with greater depressive symptoms (3·24, 1·03-5·46). Only associations for suicidality differed between cisgender and transgender and gender diverse participants, although the latter showed higher mental health symptoms overall. Findings were moderately robust to potential sources of unmeasured confounding in sensitivity analysis.Recall of conversion practice exposure was associated with a range of mental health symptoms among sexual and gender minority people. These findings support calls to ban conversion practices because of their effects as a structural determinant of mental health.Gill Foundation, Dona Rockstand, and Patient-Centered Outcomes Research Institute.

  View details for DOI 10.1016/S2215-0366(24)00251-7

  View details for PubMedID 39362229

• Contraceptive use among transgender men and gender diverse individuals in the United States: reasons for use, non-use, and methods used for pregnancy prevention. Contraception Obedin-Maliver, J., Snow, A., Ragosta, S., Fix, L., Hastings, J., Lubensky, M. E., Capriotti, M. R., Dastur, Z., Flentje, A., Lunn, M. R., Moseson, H. 2024: 110719

  Abstract

  To describe contraceptive use for pregnancy prevention among transgender men and gender diverse (TGD) individuals assigned female or intersex at birth (AFIAB) and explore whether contraceptive use differs by testosterone use.We analyzed data from a cross-sectional, online survey of N=1,694 TGD individuals AFIAB recruited in 2019 through a community-facing website and a national community-engaged cohort study of sexual and/or gender minority (SGM) adults in the US. Descriptive and regression analyses characterized the current and ever use of contraceptive methods for pregnancy prevention, stratified by testosterone use, and described reasons for contraceptive use/non-use.Most respondents (71.0%) had used contraception before with 49.4% using it for pregnancy prevention. The methods for pregnancy prevention that were most frequently ever used for pregnancy prevention included: external condoms (91.8%), combined hormonal contraceptive pills (63.0%), and withdrawal (45.9%). The methods most frequently currently used for pregnancy prevention included: external condoms (35.4%), hormonal IUD (24.8%), and abstinence (19.2%). Some reported formerly (n=55, 6.6%) or currently (n=30, 3.6%) relying on testosterone for pregnancy prevention. Only 4 of the 33 reasons for contraceptive use and non-use differed by testosterone use group. The most reported reasons for never using contraception were not engaging in penis-in-vagina sex (5.7%) or no sex with individuals who produce sperm (4.8%).Most TGD individuals AFIAB have used contraception, and almost half for pregnancy prevention. The most used methods require minimal and/or non-invasive healthcare system interaction. Some respondents relied on testosterone as birth control, despite a lack of efficacy evidence.

  View details for DOI 10.1016/j.contraception.2024.110719

  View details for PubMedID 39341444

• Does cancer clinical trial enrollment for sexual and gender minority people differ from heterosexual, cisgender people? Contemporary clinical trials Alpert, A. B., Obedin-Maliver, J., Gjelsvik, A., Amanullah, S., Shireman, T. I., Blosnich, J. R. 2024: 107695

  Abstract

  Sexual and gender minority (SGM) people experience cancer disparities compared to heterosexual and cisgender (non-SGM) people and likely have barriers to cancer clinical trial enrollment. Data are sparse, however, regarding cancer clinical trial enrollment for SGM versus non-SGM people.Using data from the 2020 Behavioral Risk Factor Surveillance Survey (BRFSS), we applied a logistic regression to assess associations between SGM status and clinical trial enrollment for 346 SGM and 9441 non-SGM people diagnosed with cancer. The model was adjusted for age at diagnosis, race/ethnicity, partnership status, education, employment, and sex assigned at birth.SGM individuals had 94 % greater odds than non-SGM individuals to report participation in a clinical trial (aOR 1.94; 95 % CI 1.02-3.68) after adjusting for other factors.Data from the BRFSS suggest that SGM people with cancer have higher odds of clinical trial enrollment compared to non-SGM people with cancer. Future work is needed to prospectively track oncology treatment, including clinical trial participation, and outcomes of SGM people versus non-SGM people with cancer. Other studies will be needed to develop and implement systematic, consistent, and non-stigmatizing sexual orientation and gender identity data collection methods.

  View details for DOI 10.1016/j.cct.2024.107695

  View details for PubMedID 39303766

• Levels and outcomes of 12-step participation among sexual and gender minority subgroups. Journal of substance use and addiction treatment McGeough, B. L., Zemore, S. E., Dastur, Z., Neilands, T. B., Lisha, N. E., Lunn, M. R., Obedin-Maliver, J., Lubensky, M. E., Flentje, A. 2024: 209519

  Abstract

  Sexual minority (e.g., bisexual, gay, lesbian, queer) and gender minority (e.g., transgender, non-binary, gender expansive) individuals (SGMI) experience higher rates of alcohol and other substance use disorders than their heterosexual and cisgender (i.e., non-transgender) counterparts. 12-Step programs are currently the most common source of support for alcohol and other substance use-related problems in the United States. Little is known about rates and levels of participation and outcomes of SGMI in 12-Step programs. Examining SGMI with a lifetime alcohol or other substance use disorder, this study aims to: 1) describe lifetime attendance rates (any vs. none) and levels of participation (number of program activities) in 12-Step groups among SGMI overall and compare rates of attendance and levels of participation across sexual and gender minority identities and 2) determine how lifetime level of participation in 12-Step programs relates to past-year alcohol and other substance use outcomes.We used data collected through The PRIDE Study, a national, large-scale, longitudinal health study of adult SGMI, administering supplemental questions to assess alcohol and other substance use disorders and 12-step participation. Zero-Inflated Negative Binomial models (N = 1353) run with sexual and gender identities as predictors of lifetime 12-step attendance (yes/no) and level of 12-Step participation determine if greater levels of 12-Step participation were associated with lower levels of past-year Alcohol and Substance Use Disorder (AUD & SUD) symptoms. The study ran models for those with lifetime AUD (n = 1074) and SUD (n = 659) separately.Participants who engaged in greater levels of 12-Step participation had lower levels of past-year AUD and SUD symptoms. Gay and queer respondents with AUD were more likely and lesbian respondents with SUD were less likely than other participants to have ever participated in 12-Step programs. All other associations between sexual/gender identities and 12-Step participation disappeared when age was added to the model.This study provides preliminary evidence that 12-Step participation may be an effective resource for reducing AUD and SUD symptoms among SGMI. Younger SGMI and SGMI holding sexual/gender identities other than gay and queer may require additional support to initiate participation in 12-Step programs.

  View details for DOI 10.1016/j.josat.2024.209519

  View details for PubMedID 39260805

• Pathways to parenthood among transgender men and gender diverse people assigned female or intersex at birth in the United States: analysis of a Cross-Sectional 2019 Survey. AJOG global reports Bane, S. S., Obedin-Maliver, J., Ragosta, S., Hastings, J., Lunn, M. R., Flentje, A., Capriotti, M. R., Lubensky, M. E., Tordoff, D. M., Moseson, H. 2024; 4 (3): 100381

  Abstract

  To assess pathways to parenthood, pregnancy outcomes, future pregnancy desire, and fertility counseling experiences among a cross-sectional sample of transgender men and gender diverse individuals assigned female or intersex at birth in the United States.Participants were recruited from The Population Research in Identity and Disparities for Equality (PRIDE) Study and the general public. Eligible participants for this analysis were able to read and understand English, assigned female or intersex at birth, US residents, 18+ years old, and identified as transgender, nonbinary, or gender diverse. We analyzed responses to close-ended survey questions, overall and stratified by gender identity, race/ethnicity, and testosterone use. We also qualitatively assessed open-text responses on fertility counseling.Among the 1694 participants, median age was 27 years (range: 18-72), 12% had ever been pregnant, and 12% were parents. Carrying a pregnancy where the individual was the egg source (36%) was the most common pathway to parenthood. Individuals with an exclusively binary gender identity (ie, transgender man or man) more often reported becoming parents through adoption than individuals with gender diverse identities (19% vs 12%). A third of individuals did not receive fertility counseling prior to initiating testosterone; individuals who exclusively reported nonbinary identities were recommended to investigate fertility preservation options less often (36%) compared to transgender men (50%).Transgender men and gender diverse individuals who were assigned female or intersex at birth build their families through a variety of pathways, including pregnancy, stepparenting, and adoption. Clinicians should avoid making assumptions about reproductive desires in these populations based on gender identities or testosterone use and should provide consistent fertility counseling prior to and after hormone initiation.

  View details for DOI 10.1016/j.xagr.2024.100381

  View details for PubMedID 39253027

  View details for PubMedCentralID PMC11381974

• Parenthood and the Physical and Mental Health of Sexual and Gender Minority Parents: A Cross-Sectional, Observational Analysis from The PRIDE Study. Annals of epidemiology Tordoff, D. M., Lunn, M. R., Snow, A., Monseur, B., Flentje, A., Lubensky, M. E., Dastur, Z., Kaysen, D., Leonard, S. A., Obedin-Maliver, J. 2024

  Abstract

  To compare the physical and mental health of sexual and gender minority (SGM) parents to SGM non-parents.A cross-sectional analysis using 2018-2020 data from The PRIDE Study, a national longitudinal cohort of SGM adults. We used Poisson regression adjusted for age, gender, relationship status, race/ethnicity, household income, and education to assess the association between parental status and each outcome.Among 9,625 SGM participants, 1,460 (15%) were parents. Older participants were more likely to be parents: 2% of participants aged 18-30, 18% aged 30-39, and 38% aged 40+ were parents. In adjusted analyses, parenthood was associated with greater depression, anxiety, and post-traumatic stress symptoms as well as ever cigarette smoking. Among individuals assigned female sex at birth, parents were twice as likely to have been diagnosed with pelvic inflammatory disease compared to non-parents. There was no association between parenthood status and alcohol use, substance use, diabetes, HIV, hypertension, or autism.In this national cohort of SGM adults, parenthood was associated with differences in physical and mental health measures. Understanding how parenthood influences the health and well-being of the estimated 3 million SGM parents in the US will help our health systems support diverse families.

  View details for DOI 10.1016/j.annepidem.2024.07.046

  View details for PubMedID 39038746

• Chronic pelvic pain among transgender men and gender diverse adults assigned female at birth. Andrology Tordoff, D. M., Lunn, M. R., Flentje, A., Atashroo, D., Chen, B., Dastur, Z., Lubensky, M. E., Capriotti, M., Obedin-Maliver, J. 2024

  Abstract

  There are limited data on pelvic pain among transgender men and gender diverse people, and the impact of testosterone on pelvic pain is poorly understood.Characterize the prevalence and correlates of chronic pelvic pain (CPP) among transgender men and gender diverse people and examine the association between testosterone use and CPP.We used 2020-2022 data from The Population Research in Identity and Disparities for Equality (PRIDE) Study, an online prospective cohort study of sexual and gender minority adults in the United States, to conduct complementary cross-sectional and longitudinal analyses. Our primary outcome was self-reported CPP lasting 3 months or longer measured using the Michigan Body Map.Among 2579 transgender men and gender diverse people assigned female at birth included in our sample, 457 (18%) reported CPP. CPP correlates included: inflammatory bowel disease, irritable bowel syndrome (IBS), kidney stones, pelvic inflammatory disease, polycystic ovary syndrome (PCOS), uterine fibroids, current hormonal intrauterine device use, prior pregnancy, vaginal delivery, hysterectomy, and oophorectomy. Individuals with CPP reported a high prevalence of IBS (37%), PCOS (20%), uterine fibroids (9%), post-traumatic stress disorder (51%), and severe depression and anxiety symptoms (42% and 25%, respectively). Current testosterone use was associated with a 21% lower prevalence of CPP (adjusted prevalence ratio (aPR) 0.79, 95% confidence interval [CI]: 0.65-0.96). In longitudinal analyses (N = 79), 15 (19%) participants reported any CPP after initiating testosterone: eight (56%) of whom reported CPP prior to testosterone initiation, and seven (47%) who reported new-onset CPP.The relationship between CPP and testosterone is complex. Although testosterone use was associated with a lower prevalence of CPP, some transgender and gender diverse individuals experienced new-onset pelvic pain after testosterone initiation. Given the significant impact that CPP can have on mental health and quality of life, future research must examine the role of testosterone in specific underlying etiologies of CPP and identify potential therapies.

  View details for DOI 10.1111/andr.13703

  View details for PubMedID 39011578

• Sexual orientation disparities in gestational diabetes and hypertensive disorders of pregnancy. Paediatric and perinatal epidemiology Chakraborty, P., Everett, B. G., Reynolds, C. A., Hoatson, T., Stuart, J. J., McKetta, S. C., Soled, K. R., Huang, A. K., Chavarro, J. E., Eliassen, A. H., Obedin-Maliver, J., Austin, S. B., Rich-Edwards, J. W., Haneuse, S., Charlton, B. M. 2024

  Abstract

  Sexual minority (SM) individuals (e.g., those with same-sex attractions/partners or who identify as lesbian/gay/bisexual) experience a host of physical and mental health disparities. However, little is known about sexual orientation-related disparities in gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP; gestational hypertension [gHTN] and preeclampsia).To estimate disparities in GDM, gHTN and preeclampsia by sexual orientation.We used data from the Nurses' Health Study II-a cohort of nurses across the US enrolled in 1989 at 25-42 years of age-restricted to those with pregnancies ≥20 weeks gestation and non-missing sexual orientation data (63,518 participants; 146,079 pregnancies). Our primary outcomes were GDM, gHTN and preeclampsia, which participants reported for each of their pregnancies. Participants also reported their sexual orientation identity and same-sex attractions/partners. We compared the risk of each outcome in pregnancies among heterosexual participants with no same-sex experience (reference) to those among SM participants overall and within subgroups: (1) heterosexual with same-sex experience, (2) mostly heterosexual, (3) bisexual and (4) lesbian/gay participants. We used modified Poisson models to estimate risk ratios (RR) and 95% confidence intervals (CI), fit via weighted generalised estimating equations, to account for multiple pregnancies per person over time and informative cluster sizes.The overall prevalence of each outcome was ≤5%. Mostly heterosexual participants had a 31% higher risk of gHTN (RR 1.31, 95% CI 1.03, 1.66), and heterosexual participants with same-sex experience had a 31% higher risk of GDM (RR 1.31, 95% CI 1.13, 1.50), compared to heterosexual participants with no same-sex experience. The magnitudes of the risk ratios were high among bisexual participants for gHTN and preeclampsia and among lesbian/gay participants for gHTN.Some SM groups may be disparately burdened by GDM and HDP. Elucidating modifiable mechanisms (e.g., structural barriers, discrimination) for reducing adverse pregnancy outcomes among SM populations is critical.

  View details for DOI 10.1111/ppe.13101

  View details for PubMedID 38949425

• Cannabis use trajectories over time in relation to minority stress and gender among sexual and gender minority people. Addictive behaviors Flentje, A., Sunder, G., Ceja, A., Lisha, N. E., Neilands, T. B., Aouizerat, B. E., Lubensky, M. E., Capriotti, M. R., Dastur, Z., Lunn, M. R., Obedin-Maliver, J. 2024; 157: 108079

  Abstract

  Substance use disparities among sexual and gender minority (SGM) people are attributed to minority stress, but few studies have examined minority stress and cannabis use over time or investigated differences in cannabis use trajectories by less-studied gender subgroups. We examined if longitudinal cannabis use trajectories are related to baseline minority stressors and if gender differences persisted after accounting for minority stress. Cannabis use risk was measured annually over four years (2017-2021) within a longitudinal cohort study of SGM adults in the United States (N = 11,813). Discrimination and victimization, internalized stigma, disclosure and concealment, and safety and acceptance comprised minority stress (n = 5,673). Latent class growth curve mixture models identified five cannabis use trajectories: 'low or no risk', 'low moderate risk', 'high moderate risk', 'steep risk increase', and 'highest risk'. Participants who reported past-year discrimination and/or victimization at baseline had greater odds of membership in any cannabis risk category compared to the 'low risk' category (odds ratios [OR] 1.17-1.33). Internalized stigma was related to 'high moderate' and 'highest risk' cannabis use (ORs 1.27-1.38). After accounting for minority stress, compared to cisgender men, gender expansive people and transgender men had higher odds of 'low moderate risk' (ORs 1.61, 1.67) or 'high moderate risk' (ORs 2.09, 1.99), and transgender men had higher odds of 'highest risk' (OR 2.36) cannabis use. This study indicates minority stress is related to prospective cannabis use risk trajectories among SGM people, and transgender men and gender expansive people have greater odds of trajectories reflecting cannabis use risk.

  View details for DOI 10.1016/j.addbeh.2024.108079

  View details for PubMedID 38878644

• Intimate partner violence is related to future alcohol use among a nationwide sample of LGBTQIA+ people: Results from The PRIDE Study. Drug and alcohol dependence Metheny, N., Tran, N. K., Scott, D., Dastur, Z., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2024; 260: 111342

  Abstract

  Lesbian, gay, bisexual, transgender, queer, intersex, aromantic and asexual (LGBTQIA+) communities in the United States experience higher rates of alcohol use than the general population. While experiencing intimate partner violence (IPV) is thought to lead to increased alcohol use in LGBTQIA+ people, little research has investigated the temporal relationship between IPV and alcohol use in this population.Data from two annual questionnaires of The Population Research in Identity and Disparities for Equality Study (The PRIDE Study) longitudinal cohort (n=3,783) were included. Overall IPV and three sub-types (physical, sexual, and emotional) - measured in 2021 using the extended Hurt, Insult, Threaten, Scream (E-HITS) screening tool - was examined as a predictor of Alcohol Use Disorders Identification Test (AUDIT) score in 2022 using multivariable linear regression to assess linear and quadratic associations. Models were adjusted for sociodemographic characteristics and history of alcohol use.One-quarter (24.7%) of respondents reported experiencing past-year IPV in 2021. The mean AUDIT score in 2022 was 3.52 (SD = 4.13). In adjusted models, both linear (B: 0.26, 95% CI: 0.14, 0.38) and quadratic (B: -0.03, 95% CI: -0.04, -0.01) terms for overall IPV were significantly associated with next-year AUDIT score. These patterns were mirrored in each IPV sub-type, were not attenuated when accounting for relationship characteristics, and were heterogeneous across gender identity groups.These results provide evidence of a temporal relationship between IPV and alcohol use in LGBTQIA+ communities, suggesting that efforts to prevent and mitigate IPV may help reduce alcohol use disparities in this population.

  View details for DOI 10.1016/j.drugalcdep.2024.111342

  View details for PubMedID 38820909

• Sexual and gender minority content in undergraduate medical education in the United States and Canada: current state and changes since 2011. BMC medical education Streed, C. G., Michals, A., Quinn, E., Davis, J. A., Blume, K., Dalke, K. B., Fetterman, D., Garcia, G., Goldsmith, E., Greene, R. E., Halem, J., Hedian, H. F., Moring, I., Navarra, M., Potter, J., Siegel, J., White, W., Lunn, M. R., Obedin-Maliver, J. 2024; 24 (1): 482

  Abstract

  To characterize current lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI +) health-related undergraduate medical education (UME) curricular content and associated changes since a 2011 study and to determine the frequency and extent of institutional instruction in 17 LGBTQI + health-related topics, strategies for increasing LGBTQI + health-related content, and faculty development opportunities.Deans of medical education (or equivalent) at 214 allopathic or osteopathic medical schools in Canada and the United States were invited to complete a 36-question, Web-based questionnaire between June 2021 and September 2022. The main outcome measured was reported hours of LGBTQI + health-related curricular content.Of 214 schools, 100 (46.7%) responded, of which 85 (85.0%) fully completed the questionnaire. Compared to 5 median hours dedicated to LGBTQI + health-related in a 2011 study, the 2022 median reported time was 11 h (interquartile range [IQR], 6-16 h, p < 0.0001). Two UME institutions (2.4%; 95% CI, 0.0%-5.8%) reported 0 h during the pre-clerkship phase; 21 institutions (24.7%; CI, 15.5%-33.9%) reported 0 h during the clerkship phase; and 1 institution (1.2%; CI, 0%-3.5%) reported 0 h across the curriculum. Median US allopathic clerkship hours were significantly different from US osteopathic clerkship hours (4 h [IQR, 1-6 h] versus 0 h [IQR, 0-0 h]; p = 0.01). Suggested strategies to increase content included more curricular material focusing on LGBTQI + health and health disparities at 55 schools (64.7%; CI, 54.6%-74.9%), more faculty willing and able to teach LGBTQI + -related content at 49 schools (57.7%; CI, 47.1%-68.2%), and more evidence-based research on LGBTQI + health and health disparities at 24 schools (28.2%; CI, 18.7%-37.8%).Compared to a 2011 study, the median reported time dedicated to LGBTQI + health-related topics in 2022 increased across US and Canadian UME institutions, but the breadth, efficacy, or quality of instruction continued to vary substantially. Despite the increased hours, this still falls short of the number of hours based on recommended LGBTQI + health competencies from the Association of American Medical Colleges. While most deans of medical education reported their institutions' coverage of LGBTQI + health as 'fair,' 'good,' or 'very good,' there continues to be a call from UME leadership to increase curricular content. This requires dedicated training for faculty and students.

  View details for DOI 10.1186/s12909-024-05469-0

  View details for PubMedID 38693525

• Inequities in Conversion Practice Exposure at the Intersection of Ethnoracial and Gender Identities. American journal of public health Tran, N. K., Lett, E., Flentje, A., Ingram, S., Lubensky, M. E., Dastur, Z., Obedin-Maliver, J., Lunn, M. R. 2024; 114 (4): 424-434

  Abstract

  Objectives. To examine inequities in conversion practice exposure across intersections of ethnoracial groups and gender identity in the United States. Methods. Data were obtained from The Population Research in Identity and Disparities for Equality Study of sexual and gender minority people from 2019 to 2021 (n = 9274). We considered 3 outcomes: lifetime exposure, age of first exposure, and period between first and last exposure among those exposed to conversion practices. We used log-binomial, Cox proportional hazards, and negative binomial models to examine inequities by ethnoracial groups and gender identity adjusting for confounders. We considered additive interaction. Results. Conversion practice prevalence was highest among minoritized ethnoracial transgender and nonbinary participants (TNB; 8.6%). Compared with White cisgender participants, minoritized ethnoracial TNB participants had twice the prevalence (prevalence ratio = 2.16; 95% confidence interval [CI] = 1.62, 2.86) and risk (hazard ratio = 2.04; 95% CI = 1.51, 2.69) of conversion practice exposure. Furthermore, there was evidence of a positive additive interaction for age of first exposure. Conclusions. Minoritized ethnoracial TNB participants were most likely to recall experiencing conversion practices. Public Health Implications. Policies banning conversion practices may reduce the disproportionate burden experienced by minoritized ethnoracial TNB participants. (Am J Public Health. 2024;114(4):424-434. https://doi.org/10.2105/AJPH.2024.307580).

  View details for DOI 10.2105/AJPH.2024.307580

  View details for PubMedID 38478865

• TAILORED ANTI-SMOKING MESSAGES INCREASE QUIT INTENTIONS AMONG SEXUAL MINORITY WOMEN BY CHANGING ANTI-INDUSTRY PERCEPTIONS Zulkiewicz, B., Chen, J. T., Hanby, E., Potter, J., Gordon, B., Applegate, J., Obedin-Maliver, J., Tan, A. L. OXFORD UNIV PRESS INC. 2024: S258

  View details for Web of Science ID 001271352800517

• Localized and widespread chronic pain in sexual and gender minority people-an analysis of the PRIDE study. Pain medicine (Malden, Mass.) Chadwick, A. L., Lisha, N. E., Lubensky, M. E., Dastur, Z., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2024

  View details for DOI 10.1093/pm/pnae023

  View details for PubMedID 38530776

• Sexual orientation disparities in adverse pregnancy outcomes. American journal of obstetrics and gynecology Chakraborty, P., Schroeder, E., Reynolds, C. A., McKetta, S., Obedin-Maliver, J., Austin, S. B., Everett, B., Haneuse, S., Charlton, B. M. 2024

  View details for DOI 10.1016/j.ajog.2024.02.315

  View details for PubMedID 38453134

• Mental health treatment experiences among sexual and gender minority individuals: Trauma exposure, barriers, microaggressions, and treatment satisfaction JOURNAL OF GAY & LESBIAN MENTAL HEALTH Artime, T. M., Rosenfeld, E. A., Ong, L., Lisha, N. E., Dilley, J. W., Shumway, M., Edward, D., Ceja, A., Einhorn, L., Lubensky, M. E., Dastur, Z., Lunn, M. R., Obedin-Maliver, J., Cloitre, M., Flentje, A. 2024

  View details for DOI 10.1080/19359705.2024.2315976

  View details for Web of Science ID 001176136600001

• Interest in over-the-counter progestin-only pills among transgender, nonbinary, and gender-expansive individuals in the United States. American journal of obstetrics and gynecology Grindlay, K., Obedin-Maliver, J., Ragosta, S., Hastings, J., Lunn, M. R., Flentje, A., Capriotti, M. R., Dastur, Z., Lubensky, M. E., Moseson, H. 2024

  Abstract

  In July 2023, the US Food and Drug Administration approved the first non-prescription oral contraceptive, a progestin-only pill, in the United States. Transgender, nonbinary, and gender-expansive people assigned female or intersex at birth face substantial contraceptive access barriers and may benefit from over-the-counter oral contraceptive access. However, no prior research has explored their perspectives on this topic.To measure interest in over-the-counter progestin-only pill use among transgender, nonbinary, and gender-expansive individuals assigned female or intersex at birth.We conducted an online, cross-sectional survey from May-September 2019 (before Food and Drug approval of a progestin-only pill) with a convenience sample of transgender, nonbinary, and gender-expansive people assigned female or intersex at birth, aged 18-49 years, from across the United States. Using descriptive statistics and logistic regression analyses, we estimated interest in over-the-counter progestin-only pill use (our outcome) overall and by sociodemographic and reproductive health characteristics (our exposures). We ran separate logistic regression models for each exposure. In each model, we included the minimally sufficient adjustment set to control for confounding pathways between the exposure and outcome. For the model for age, we ran a univariable logistic regression model; for all other exposures, we ran multivariable logistic regression models.Among 1,415 participants in our sample (median age: 26 years), 45.0% (636/1,415; 95% CI: 42.3-47.6%) were interested in over-the-counter progestin-only pill use. In separate logistic regression models for each exposure, there were higher odds of interest among participants who were aged 18-24 years (OR 1.67, 95% CI: 1.33-2.10; versus aged 25-34 years), uninsured (aOR 1.91, 95% CI: 1.24-2.93; versus insured), currently using oral contraceptives (aOR 1.69, 95% CI: 1.17-2.44; versus non-users), had ≤high school degree (aOR 3.02, 95% CI: 1.94-4.71; versus college degree), had ever used progestin-only pills (aOR 2.32, 95% CI: 1.70-3.17; versus never-users), and who wanted to avoid estrogen generally (aOR 1.32, 95% CI: 1.04-1.67 versus those who did not want to avoid estrogen generally) or specifically because they viewed it as a "feminizing" hormone (aOR 1.72, 95% CI: 1.36-2.19; versus those who did not want to avoid estrogen because they viewed it as a "feminizing" hormone). There were lower odds of interest among participants with a graduate or professional degree (aOR 0.70, 95% CI: 0.51-0.96; versus college degree), who were sterilized (aOR 0.31, 95% CI: 0.12-0.79; versus not sterilized), and who had ever used testosterone for gender affirmation (aOR 0.72, 95% CI: 0.57-0.90; versus never-users).Transgender, nonbinary, and gender-expansive individuals are interested in over-the-counter progestin-only pill access, and its availability has the potential to improve contraceptive access for this population.

  View details for DOI 10.1016/j.ajog.2024.02.006

  View details for PubMedID 38365096

• Family building and pregnancy experiences of cisgender sexual minority women. AJOG global reports Tordoff, D. M., Moseson, H., Ragosta, S., Hastings, J., Flentje, A., Capriotti, M. R., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. 2024; 4 (1): 100298

  Abstract

  Although 10% to 20% of cisgender women aged 18 to 40 years have a sexual minority identity (eg, bisexual, lesbian, and queer), there is limited research on the family building and pregnancy experiences of sexual minority cisgender women. Improving our understanding of the family building and pregnancy experiences of cisgender sexual minority women is critical for improving the perinatal health of this population.This study aimed to compare the mode of family building, past pregnancy experiences, and future pregnancy intentions among cisgender sexual minority women by sexual orientation.This is an observational study which was conducted using cross-sectional data collected in 2019 from a national sample of 1369 cisgender sexual minority women aged 18 to 45 years.Most participants (n=794, 58%) endorsed multiple sexual orientations, most commonly queer (n=641, 47%), lesbian (n=640, 47%), and/or bisexual (n=583, 43%). There were 243 (18%) cisgender sexual minority women who were parents. Pregnancy was used by 74% (181/243) of women to build their families. Among participants who used pregnancy, 60% (108/181) became pregnant through sexual activity with another parent of the child, whereas 27% (64/243) of women used donor sperm. An additional 10% (n=24) became parents through second-parent adoption, 10% (n=25) through adoption, and 14% (n=35) through step-parenting. Bisexual women more often used sexual activity to become parents (61/100, 61%) compared with queer (40/89, 45%) and lesbian women (40/130, 31%). In contrast, lesbian (50/130, 39%) and queer (25/89, 27%) women more often used donor sperm to become parents compared with bisexual women (11/100, 11%). Among the 266 (19%) cisgender sexual minority women who had ever been pregnant, there were 545 pregnancies (mean, 2.05 pregnancies per woman). Among those pregnancies, 59% (n=327) resulted in live birth, 23% (n=126) resulted in miscarriage, 15% (n=83) resulted in abortion, and 2% (n=9) resulted in ectopic pregnancy. A quarter of women had future pregnancy intentions, with no differences by sexual orientation. Overall, few participants (16%) reported that all of their healthcare providers were aware of their sexual orientation.Cisgender sexual minority women primarily built their families through pregnancy and a quarter have future pregnancy desires. In addition, there were important differences in family building methods used by sexual orientation. Providers should be aware of the pregnancy and family-building patterns, plans, and needs of cisgender sexual minority women.

  View details for DOI 10.1016/j.xagr.2023.100298

  View details for PubMedID 38269079

  View details for PubMedCentralID PMC10806344

• Substance Use Over Time Among Sexual and Gender Minority People: Differences at the Intersection of Sex and Gender. LGBT health Flentje, A., Sunder, G., Ceja, A., Lisha, N. E., Neilands, T. B., Aouizerat, B. E., Lubensky, M. E., Capriotti, M. R., Dastur, Z., Lunn, M. R., Obedin-Maliver, J. 2024

  Abstract

  Purpose: Sexual and gender minority (SGM) people are at greater risk for substance use than heterosexual and cisgender people, but most prior work is limited by cross-sectional analyses or the examination of single substance use. This study examined substance use over time among SGM people to identify patterns of polysubstance use at the intersection of sex and gender. Methods: Data were collected annually over 4 years from SGM respondents (n = 11,822) in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Differences in substance use patterns (any prior 30-day use of 15 substances) by gender subgroup were examined with latent class analysis, and multinomial regression models tested relationships between gender subgroup and substance use. Results: Eight classes of substance use were observed. The three most common patterns were low substance use (49%), heavy episodic alcohol use (≥5 alcoholic drinks on one occasion) with some cannabis and tobacco use (14%), and cannabis use with some tobacco and declining heavy episodic alcohol use (13%). Differences observed included lower odds of patterns defined by heavy episodic alcohol use with some cannabis and tobacco use in all gender subgroups relative to cisgender men and persons with low substance use (odds ratios [ORs] 0.26-0.60). Gender expansive people assigned female at birth, gender expansive people assigned male at birth, and transgender men had greater odds of reporting cannabis use with small percentages of heavy episodic alcohol and tobacco use (ORs: 1.41-1.60). Conclusion: This study suggests that there are unique patterns of polysubstance use over time among gender subgroups of SGM people.

  View details for DOI 10.1089/lgbt.2023.0055

  View details for PubMedID 38206680

• Our Needs Have Been Ignored for a Long Time: Factors Affecting the Willingness of Black and Hispanic/Latinx Sexual and Gender Minority Communities to Donate Biospecimens Annals of LGBTQ Public and Population Health Ceja, A., Bruno, V., Panyanouvong, N., Aguilar, J., Raygani, S., Lubensky, M. E., Dastur, Z., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2024

  View details for DOI 10.1891/LGBTQ-2023-0022

• An Automated Algorithm for Classifying Expansive Responses for Gender Identity Psychology of Sexual Orientation and Gender Diversity Ceja, A., Raygani, S., Conner, B. T., Lisha, N. E., Bryan-Lees, K. B., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J., Flentje, A. 2024

  View details for DOI 10.1037/sgd0000762

• Active Social Media Use and Health Indicators Among Sexual and Gender Minority Adults. LGBT health Vogel, E. A., Flentje, A., Lunn, M. R., Obedin-Maliver, J., Capriotti, M. R., Ramo, D. E., Prochaska, J. J. 2023

  Abstract

  Purpose: Sexual and gender minority (SGM) individuals may receive social support through active use of social media (i.e., posting and interacting). This study examined associations between active social media use, social support, and health indicators in a large sample of SGM adults in the United States. Methods: Data were derived from the 2017 wave of The PRIDE Study, a national cohort study of SGM health. SGM-identified adults reporting social media use (N = 5995) completed measures of active social media use, social support, depressive symptoms, cigarette smoking, hazardous drinking, sleep, and physical activity. Regression models examined main and interactive effects of active social media use and social support on health indicators. Results: The sample reported a moderate level of active social media use (mean [M] = 3.2 [1.0], scale = 1-5) and relatively high social support (M = 16.7 [3.3], scale = 4-20); 31.8% reported moderate-to-severe depressive symptoms. Participants with greater active social media use were more likely to experience depressive symptoms (adjusted odds ratio [AOR] = 1.18, 95% confidence interval [CI] = 1.10-1.26), cigarette smoking (AOR = 1.11, 95% CI = 1.01-1.22), insufficient sleep (AOR = 1.13, 95% CI = 1.06-1.21), and physical inactivity (AOR = 1.09, 95% CI = 1.02-1.15) than those with less active social media use. Active social media use did not significantly interact with social support to predict any health indicators (p values >0.159). Conclusions: Among SGM adults, active social media use was associated with several negative health indicators. Active social media use may increase health risks, or SGM adults with poor health may actively use social media to maintain social connections. Moderate active social media use may be compatible with health.

  View details for DOI 10.1089/lgbt.2023.0170

  View details for PubMedID 38153392

• Culturally tailored anti-smoking messages: A randomized trial with U.S. sexual minority young women. American journal of preventive medicine Tan, A. S., Chen, J. T., Keen, R., Scout, N., Gordon, B., Applegate, J., Machado, A., Hanby, E., Liu, S., Zulkiewicz, B., Ramanadhan, S., Obedin-Maliver, J., Lunn, M. R., Viswanath, K., Potter, J. 2023

  Abstract

  This study evaluated effects of exposure to culturally tailored anti-smoking ads versus control ads on quitting intentions, cigarette purchase intentions, and tobacco industry perceptions among young adult, cisgender and transgender, sexual minority women (SMW).An online randomized controlled experiment with 1-month longitudinal follow-up was conducted.2,214 U.S. SMW ages 18-30 were recruited via online survey panels (The PRIDE Study and Prolific), social media ads and posts, and HER dating app ads. Data were collected in 2021-2022.Participants were randomly assigned to receive up to 20 tailored ads containing LGBTQ+ branding versus 20 control ads without LGBTQ+ branding over 4 weeks. Both conditions used identical anti-smoking statements and photographs (including several photographs of individuals who self-identified as SMW).1-month follow-up intention to purchase cigarettes, intention to quit, marketing receptivity, pro-industry attitudes, and pro-industry beliefs were measured. Analyses were conducted in 2022-2023. Linear regression models predicted outcomes at 1-month follow-up with the randomized arm, adjusted for baseline measures of each outcome and stratified by smoking status (those who currently smoked and those who did not smoke).Among those who smoked, follow-up intention to quit increased and intention to purchase cigarettes, marketing receptivity, pro-industry attitudes, and pro-industry beliefs decreased versus baseline in both arms. Follow-up pro-industry beliefs were significantly lower (B=-0.331, 95% CI -0.652, -0.010, p=0.043) in the tailored versus control arm, adjusted for baseline beliefs. Among those who did not smoke, marketing receptivity, pro-industry attitudes, and pro-industry beliefs decreased versus baseline in both arms. Follow-up outcomes did not differ significantly between arms.These findings can inform future anti-smoking campaign development to reduce cigarette smoking-related disparities among young adult, cisgender and transgender, sexual minority women and serve as the basis for developing similar ads for other LGBTQ+ audiences.This study was registered in ClinicalTrials.gov (NCT04812795) .

  View details for DOI 10.1016/j.amepre.2023.12.001

  View details for PubMedID 38065403

• Asking sexual orientation and gender identity on health surveys: Findings from cognitive interviews in the United States across sexual orientations and genders SSM-QUALITATIVE RESEARCH IN HEALTH Pho, A. T., Bates, N., Snow, A., Zhang, A., Logan, R., Dastur, Z., Lubensky, M. E., Flentje, A., Lunn, M. R., Obedin-Maliver, J. 2023; 4

  View details for DOI 10.1016/j.ssmqr.2023.100344

  View details for Web of Science ID 001114510200001

• Acceptability of Biospecimen Collection Among Sexual and/or Gender Minority Adults in the United States. Annals of LGBTQ public and population health Cicero, E. C., Lunn, M. R., Obedin-Maliver, J., Sunder, G., Lubensky, M. E., Capriotti, M. R., Flentje, A. 2023; 4 (4): 311-344

  Abstract

  Health studies using biospecimens have an underrepresentation of sexual and/or gender minority (SGM) participants, making it difficult to use data to advance SGM health knowledge. This study examined: 1) the willingness of SGM adults to provide research biospecimens, 2) if SGM groups differ in their willingness, 3) the relationship of demographic characteristics with willingness, and 4) the ideas/concerns of SGM adults toward providing research biospecimens. Data collected in 2018-2019 from The Population Research in Identity and Disparities for Equality Study were analyzed. Regressions examined willingness to provide biospecimens (blood, buccal swab, hair, saliva, and urine) across SGM groups (cisgender sexual minority [SM] men, cisgender SM women, gender-expansive, transfeminine, and transmasculine adults; N = 4,982) and the relationship of demographics with a willingness to provide each biospecimen type. A thematic analysis of an open-ended item elucidated SGM adults' (N = 776) perspective toward providing biospecimens. Most SGM adults were willing to provide biospecimens. Cisgender SM women were less willing to provide some types (blood 54% and urine 63%) than the other groups. Cisgender SM men were most willing to provide all types. Older age, identifying as pansexual, and income >$50,000/year were associated with increased odds of providing biospecimen(s). Gender identity was a significant predictor for all biospecimen types. A gender identity other than cisgender man was associated with 1.6-2.4× lower odds of providing biospecimen(s). Participants expressed concerns about data confidentiality and privacy, data access and misuse, research purposes, and inadvertent disclosure of SGM status. SGM adults' concerns about donating biospecimens can be used to create an affirming and inclusive methodology.

  View details for DOI 10.1891/lgbtq-2022-0021

  View details for PubMedID 39234441

  View details for PubMedCentralID PMC11374103

• Understanding Sexual and Gender Minority Populations and Organ-Based Screening Recommendations for Human Papillomavirus-Related Cancers. Journal of lower genital tract disease Jodry, D., Obedin-Maliver, J., Flowers, L., Jay, N., Floyd, S., Teoh, D., Conageski, C., Downs, L., Khan, M. J. 2023; 27 (4): 307-321

  Abstract

  Sexual gender minority (SGM) populations are at risk for human papillomavirus (HPV)-related cancers of the anogenital tract and oropharynx and often face barriers to health care. The goals of this document are to clarify language to provide inclusive care for SGM populations and to provide recommendations for screening and prevention of HPV-related cancers in SGM populations.An expert committee convened by the American Society for Colposcopy and Cervical Pathology performed a narrative review of the literature through February 2023. A comprehensive MEDLINE database search was performed for relevant studies. The literature review was divided into categories by organ/topic and by SGM population. Given the variability in available data for several of the categories, recommendations were made based on national guidelines where appropriate or expert opinion where there were less data to support risk-based guidelines.Definitions and terminology relevant to SGM populations are presented. The authors advocate the adoption of sexual orientation gender identity data collection and an organ-based screening approach, which is possible with knowledge of patient anatomy, sexual behaviors, and clinical history. This includes screening for cervical cancer per national recommendations, as well as screening for anal, vulvar, vaginal, penile, and oral cancers based on risk factors and shared clinical decision making. The authors recommend consideration of HPV vaccination in all SGM individuals up to age 45 years old who are at risk.An organ-based screening approach is part of a global strategy to create an inclusive care environment and mitigate barriers to screening and prevention of HPV-mediated cancers in SGM populations.

  View details for DOI 10.1097/LGT.0000000000000763

  View details for PubMedID 37729043

• Investigating the factor structure and measurement invariance of the eating disorder examination questionnaire (EDE-Q) among cisgender gay men and lesbian women from the United States. Journal of eating disorders Compte, E. J., McGuire, F. H., Brown, T. A., Lavender, J. M., Murray, S. B., Capriotti, M. R., Flentje, A., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J., Nagata, J. M. 2023; 11 (1): 164

  Abstract

  Although the Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms, evidence indicates potential limitations with its original factor structure and associated psychometric properties in a variety of populations, including sexual minority populations. The aims of the current investigation were to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of cisgender gay men and cisgender lesbian women.Data were drawn from 1624 adults (1060 cisgender gay men, 564 cisgender lesbian women) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach's alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated.A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q from Grilo et al. (Obes Surg. 23:657-662, 2013), consistently evidenced the best fit across cisgender gay men and lesbian women. The internal consistencies of the three subscales were adequate in both groups, and measurement invariance across the groups was supported.Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in cisgender gay men and lesbian women. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse sexual minority samples across race, ethnicity, socioeconomic status, and age ranges.

  View details for DOI 10.1186/s40337-023-00880-2

  View details for PubMedID 37736682

  View details for PubMedCentralID 7566158

• Testosterone Use and Sexual Function among Transgender Men and Gender Diverse People Assigned Female at Birth. American journal of obstetrics and gynecology Tordoff, D. M., Lunn, M. R., Chen, B., Flentje, A., Dastur, Z., Lubensky, M. E., Capriotti, M., Obedin-Maliver, J. 2023

  Abstract

  Testosterone use among transgender people likely impacts their experience of sexual function and vulvovaginal pain via several complex pathways. Testosterone use is associated with decreased estrogen in the vagina and atrophic vaginal tissue, which may be associated with decreased vaginal lubrication and/or discomfort during sexual activity. At the same time, increased gender affirmation through testosterone use may be associated with improved sexual function. However, data on pelvic and vulvovaginal pain among transgender men and nonbinary people assigned female at birth is scarce.To assess the association between testosterone and sexual function, with a focus on symptoms that are commonly associated with vaginal atrophy.We conducted a cross-sectional analysis of 1,219 participants ages 18-72 years old using 2019-2021 data from an online, prospective, longitudinal, cohort study of sexual and/or gender minority people in the US (The PRIDE Study). Our analysis included adult transgender men and gender diverse participants assigned female at birth who were categorized as never, current, and former testosterone users. Sexual function was measured across eight Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual Function and Satisfaction (SexFS) domains.Overall, 516 (42.3%) had never used testosterone and 602 (49.4%) currently used testosterone. Median duration of use was 37.7 months (range 7 days to >27 years). Most participants (64.6%) reported genital pain/discomfort during sexual activity in the past 30 days, most commonly in the vagina/frontal genital opening (52.2%), followed by the clitoris (29.1%) and labia (24.5%). Current testosterone use was associated with higher interest in sexual activity (β=6.32, 95% CI: 4.91-7.74) and more vaginal pain/discomfort during sexual activity (β=1.80, 95% CI: 0.61-3.00). No associations were observed between current testosterone use and satisfaction with sex life, lubrication, labial pain/discomfort, or orgasm pleasure.Testosterone use among transgender men and gender diverse people was associated with a higher interest in sexual activity and ability to orgasm as well as vaginal pain/discomfort during sexual activity. Notably, the available evidence demonstrates that >60% of transgender men experience vulvovaginal pain during sexual activity. The causes of pelvic and vulvovaginal pain are poorly understood but are likely multifactorial and include physiological (e.g., testosterone-associated vaginal atrophy) and psychological factors (e.g., gender affirmation). Given this high burden, there is an urgent need to identify effective and acceptable interventions for this population.

  View details for DOI 10.1016/j.ajog.2023.08.035

  View details for PubMedID 37678647

• Societal stigma and mistreatment in healthcare among gender minority people: a cross-sectional study. International journal for equity in health Clark, K. D., Lunn, M. R., Bosse, J. D., Sevelius, J. M., Dawson-Rose, C., Weiss, S. J., Lubensky, M. E., Obedin-Maliver, J., Flentje, A. 2023; 22 (1): 162

  Abstract

  Gender minority (GM; individuals whose gender is not aligned with that traditionally associated with the sex that was assigned to them at birth) people have widely reported mistreatment in healthcare settings. Mistreatment is enacted by individuals within society who hold stigmatizing beliefs. However, the relationship between healthcare mistreatment and societal stigma (i.e., the degree to which society disapproves of GM people) is unclear and not measured consistently.We analyzed data from 2,031 GM participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study's 2019 Annual Questionnaire to determine whether societal stigma was associated with participants' past-year reports of mistreatment (defined as denial of healthcare services and/or lower quality care) in medical or mental healthcare settings. We created a proxy measure of societal stigma by incorporating variables validated in existing literature. Participants reported whether they had experienced mistreatment in medical and mental health settings independently.Healthcare denial and/or lower quality care during the past year was reported by 18.8% of our sample for medical settings and 12.5% for mental health settings. We found no associations between the societal stigma variables and past-year reports of healthcare denial and/or lower quality care in medical or mental healthcare settings.Although a high proportion of GM people reported past-year healthcare mistreatment in both medical and mental health settings, mistreatment had no relationship with societal stigma. Factors other than societal stigma may be more important predictors of healthcare mistreatment, such as healthcare workers' knowledge of and attitudes toward GM people. However, other measures of societal stigma, or different types of mistreatment, may show stronger associations. Identifying key factors that contribute to mistreatment can serve as targets for intervention in communities and healthcare settings.

  View details for DOI 10.1186/s12939-023-01975-7

  View details for PubMedID 37620832

  View details for PubMedCentralID 8297154

• Self-Reported Barriers to Care Among Sexual and Gender Minority People With Disabilities: Findings From The PRIDE Study, 2019-2020. American journal of public health Lamba, S., Obedin-Maliver, J., Mayo, J., Flentje, A., Lubensky, M. E., Dastur, Z., Lunn, M. R. 2023: e1-e10

  Abstract

  Objectives. To examine the associations of self-reported disability status with health care access barriers for sexual and gender minority (SGM) people. Methods. The Population Research in Identity and Disparities for Equality (PRIDE) Study participants lived in the United States or its territories, completed the 2019 annual questionnaire (n = 4961), and self-reported their disability and health care access experiences, including whether they had a primary care provider, were uninsured, delayed care, and were unable to obtain care. We classified disabilities as physical, mental, intellectual, and other; compared participants to those without disabilities; and performed logistic regression to determine the associations of disability status and health care access barriers. Results. SGM people with disabilities were less likely to have a usual place to seek health care (69.0% vs 75.3%; P ≤ .001) and more often reported being mistreated or disrespected as reasons to delay care (29.0% vs 10.2%; P ≤ .001). SGM people with disabilities were more likely to delay care (adjusted odds ratio [AOR] = 3.28; 95% confidence interval [CI] = 2.83, 3.81) and be unable to obtain care (AOR = 3.10; 95% CI = 2.59, 3.71). Conclusions. Future work should address culturally competent health care to ameliorate disparities for the SGM disability community. (Am J Public Health. Published online ahead of print July 20, 2023:e1-e10. https://doi.org/10.2105/AJPH.2023.307333).

  View details for DOI 10.2105/AJPH.2023.307333

  View details for PubMedID 37471680

• Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program. JAMA network open Tran, N. K., Lunn, M. R., Schulkey, C. E., Tesfaye, S., Nambiar, S., Chatterjee, S., Kozlowski, D., Lozano, P., Randal, F. T., Mo, Y., Qi, S., Hundertmark, E., Eastburn, C., Pho, A. T., Dastur, Z., Lubensky, M. E., Flentje, A., Obedin-Maliver, J. 2023; 6 (7): e2324969

  Abstract

  Limited data describe the health status of sexual or gender minority (SGM) people due to inaccurate and inconsistent ascertainment of gender identity, sex assigned at birth, and sexual orientation.To evaluate whether the prevalence of 12 health conditions is higher among SGM adults in the All of Us Research Program data compared with cisgender heterosexual (non-SGM) people.This cross-sectional study used data from a multidisciplinary research consortium, the All of Us Research Program, that links participant-reported survey information to electronic health records (EHR) and physical measurements. In total, 372 082 US adults recruited and enrolled at an All of Us health care provider organization or by directly visiting the enrollment website from May 31, 2017, to January 1, 2022, and were assessed for study eligibility.Self-identified gender identity and sexual orientation group.Twelve health conditions were evaluated: 11 using EHR data and 1, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), using participants' physical measurements. Logistic regression (adjusting for age, income, and employment, enrollment year, and US Census division) was used to obtain adjusted odds ratios (AORs) for the associations between each SGM group and health condition compared with a non-SGM reference group.The analytic sample included 346 868 participants (median [IQR] age, 55 [39-68] years; 30 763 [8.9%] self-identified as SGM). Among participants with available BMI (80.2%) and EHR data (69.4%), SGM groups had higher odds of anxiety, depression, HIV diagnosis, and tobacco use disorder but lower odds of cardiovascular disease, kidney disease, diabetes, and hypertension. Estimated associations for asthma (AOR, 0.39 [95% CI, 0.24-0.63] for gender diverse people assigned male at birth; AOR, 0.51 [95% CI, 0.38-0.69] for transgender women), a BMI of 25 or higher (AOR, 1.65 [95% CI, 1.38-1.96] for transgender men), cancer (AOR, 1.15 [95% CI, 1.07-1.23] for cisgender sexual minority men; AOR, 0.88 [95% CI, 0.81-0.95] for cisgender sexual minority women), and substance use disorder (AOR, 0.35 [95% CI, 0.24-0.52] for gender diverse people assigned female at birth; AOR, 0.65 [95% CI, 0.49-0.87] for transgender men) varied substantially across SGM groups compared with non-SGM groups.In this cross-sectional analysis of data from the All of Us Research Program, SGM participants experienced health inequities that varied by group and condition. The All of Us Research Program can be a valuable resource for conducting health research focused on SGM people.

  View details for DOI 10.1001/jamanetworkopen.2023.24969

  View details for PubMedID 37523187

• Reproductive endocrinologist and infertility specialists' knowledge, skills, behaviors, and attitudes regarding the care for transgender and gender-diverse individuals. F&S reports Lipkin, P., Monseur, B., Mayo, J., Moravek, M., Nahata, L., Amato, P., Alvero, R., Obedin-Maliver, J. 2023; 4 (2): 213-223

  Abstract

  Objective: To investigate associations between reproductive endocrinology and infertility (REI) providers' prior training and current knowledge, skills, attitudes, and behaviors regarding fertility preservation and family building for transgender and gender-diverse (T/GD) patients.Design: The survey was distributed to members of the Society for Reproductive Endocrinology and Infertility, the REI-physician-focused professional body within the American Society for Reproductive Medicine, with additional participants recruited through snowball sampling.Results: Participants (n = 206) reported on training in T/GD care; 51% endorsed prior training. Most participants (93%) believed T/GD individuals were as fit for parenthood as cisgender individuals. Prior training was associated with an increased likelihood of offering T/GD health resources and more frequent consultations with specialist colleagues.Common barriers to providing care indicated by respondents included cost, delays in gender-affirming care, and lack of knowledge of the potential impact of hormonal interventions. Common facilitators included education and training, prior experience, and affordability of services.Conclusions: Most REI providers believed T/GD individuals are fit for parenthood and agreed that prior training facilitates care for T/GD patients. The lack of provider knowledge emerged as a barrier to care. Although training helped facilitate some components of care, systemic barriers such as the cost and variability of patient population characteristics/experiences are important considerations when serving T/GD individuals.

  View details for DOI 10.1016/j.xfre.2023.03.009

  View details for PubMedID 37398621

• Reports of Negative Interactions with Healthcare Providers among Transgender, Nonbinary, and Gender-Expansive People assigned Female at Birth in the United States: Results from an Online, Cross-Sectional Survey. International journal of environmental research and public health Inman, E. M., Obedin-Maliver, J., Ragosta, S., Hastings, J., Berry, J., Lunn, M. R., Flentje, A., Capriotti, M. R., Lubensky, M. E., Stoeffler, A., Dastur, Z., Moseson, H. 2023; 20 (11)

  Abstract

  Over one million people in the United States are transgender, nonbinary, or gender expansive (TGE). TGE individuals, particularly those who have pursued gender-affirming care, often need to disclose their identities in the process of seeking healthcare. Unfortunately, TGE individuals often report negative experiences with healthcare providers (HCPs). We conducted a cross-sectional online survey of 1684 TGE people assigned female or intersex at birth in the United States to evaluate the quality of their healthcare experiences. Most respondents (70.1%, n = 1180) reported at least one negative interaction with an HCP in the past year, ranging from an unsolicited harmful opinion about gender identity to physical attacks and abuse. In an adjusted logistic regression model, those who had pursued gender-affirming medical care (51.9% of the sample, n = 874) had 8.1 times the odds (95% CI: 4.1-17.1) of reporting any negative interaction with an HCP in the past year, compared to those who had not pursued gender-affirming care, and tended to report a higher number of such negative interactions. These findings suggest that HCPs are failing to create safe, high-quality care interactions for TGE populations. Improving care quality and reducing bias is crucial for improving the health and well-being of TGE people.

  View details for DOI 10.3390/ijerph20116007

  View details for PubMedID 37297611

• Debunking Sex and Disentangling Gender From Oncology. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Alpert, A. B., Rivers, L., Manzano, C., Ruddick, R., Adams, S., Obedin-Maliver, J., Harvey, R. D., Griggs, J. J., Operario, D. 2023: JCO2202037

  View details for DOI 10.1200/JCO.22.02037

  View details for PubMedID 37235816

• Investigating the factor structure and measurement invariance of the Eating Disorder Examination-Questionnaire (EDE-Q) in a community sample of gender minority adults from the United States. The International journal of eating disorders Nagata, J. M., Compte, E. J., McGuire, F. H., Brown, T. A., Lavender, J. M., Murray, S. B., Capriotti, M. R., Flentje, A., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. 2023

  Abstract

  The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms. However, evidence indicates potential problems with its original factor structure and associated psychometric properties in a variety of populations, including gender minority populations. The aim of the current investigation was to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of gender minority adults.Data were drawn from 1567 adults (337 transgender men, 180 transgender women, and 1050 gender-expansive individuals) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach's alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated.A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q consistently evidenced the best fit across gender minority groups (transgender men, transgender women, gender-expansive individuals). The internal consistencies of the three subscales were adequate in all groups, and measurement invariance across the groups was supported.Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in gender minority populations. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse gender minority samples across race, ethnicity, socioeconomic status, and age ranges.Although transgender individuals have greater risk of developing an eating disorder, the factor structure of the Eating Disorder Examination-Questionnaire, one of the most widely used eating disorder assessment measures, has not been explored in transgender adults. We found that a seven-item model including three factors of dietary restraint, shape and weight overvaluation, and body dissatisfaction had the best fit among transgender and nonbinary adults.

  View details for DOI 10.1002/eat.23978

  View details for PubMedID 37163420

• "We're always an afterthought"- Designing tobacco control campaigns for dissemination with and to LGBTQ +-serving community organizations: a thematic analysis. Cancer causes & control : CCC Ramanadhan, S., Salvia, M., Hanby, E., Revette, A. C., Rivard, M. K., Scout, N. F., Applegate, J., Gordon, B., Machado, A., Lunn, M. R., Obedin-Maliver, J., Potter, J., Chen, J. T., Tan, A. S. 2023

  Abstract

  Evidence-based health communication campaigns can support tobacco control and address tobacco-related inequities among lesbian, gay, bisexual, transgender, and queer (LGBTQ +) populations. Community organizations focused on LGBTQ + health (e.g., nonprofits, community centers, and community health centers) can be prime channels for delivering evidence-based health communication campaigns. However, it is unclear how to balance the goals of a) designing campaigns to support broad adoption/uptake and b) adaptation addressing the needs of diverse communities and contexts. As part of an effort to support "designing for dissemination," we explored the key challenges and opportunities staff and leaders of LGBTQ + -serving community organizations encounter when adopting or adapting evidence-based health communication campaigns.A team of researchers and advisory committee members conducted this study, many of whom have lived, research, and/or practice experience with LGBTQ + health. We interviewed 22 staff members and leaders of community organizations serving LGBTQ + populations in the US in early 2021. We used a team-based, reflexive thematic analysis approach.The findings highlight the challenges of attempting to use health communication campaigns misaligned with the assets and needs of organizations and community members. The three major themes identified were as follows: (1) available evidence-based health communication campaigns typically do not sufficiently center LGBTQ + communities, (2) negotiation regarding campaign utilization places additional burden on practitioners who have to act as "gatekeepers," and (3) processes of using health communication campaigns often conflict with organizational efforts to engage community members in adoption and adaptation activities.We offer a set of considerations to support collaborative design and dissemination of health communication campaigns to organizations serving LGBTQ + communities: (1) develop campaigns with and for LGBTQ + populations, (2) attend to the broader structural forces impacting campaign recipients, (3) support in-house testing and adaptations, and (4) increase access to granular data for community organizations.

  View details for DOI 10.1007/s10552-023-01706-x

  View details for PubMedID 37160611

  View details for PubMedCentralID 8885914

• The Value and Process of Inclusion: Using Sensitive, Respectful, and Inclusive Language and Images in NCCN Content. Journal of the National Comprehensive Cancer Network : JNCCN Freedman-Cass, D. A., Fischer, T., Alpert, A. B., Obedin-Maliver, J., Kunz, P. L., Koh, W. J., Carlson, R. W. 2023; 21 (5): 434-441

  Abstract

  A core component of NCCN's mission is to improve and facilitate equitable cancer care. Inclusion and representation of diverse populations are essential toward this goal of equity. Within NCCN's professional content, inclusivity increases the likelihood that clinicians are prepared to provide optimal oncology care to all patients; within NCCN's patient-facing content, it helps ensure that cancer information is relevant and accessible for all individuals. This article describes changes that have been made in the language and images used in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) and the NCCN Guidelines for Patients to promote justice, respect, and inclusion for all patients with cancer. The goals are to use language that is person-first, nonstigmatizing, inclusive of individuals of all sexual orientations and gender identities, and anti-racist, anti-classist, anti-misogynist, anti-ageist, anti-ableist, and anti-fat-biased. NCCN also seeks to incorporate multifaceted diversity in images and illustrations. NCCN is committed to continued and expanding efforts to ensure its publications are inclusive, respectful, and trustworthy, and that they advance just, equitable, high-quality, and effective cancer care for all.

  View details for DOI 10.6004/jnccn.2023.7025

  View details for PubMedID 37156485

• Reproductive health in transgender and gender diverse individuals: A narrative review to guide clinical care and international guidelines. International journal of transgender health Rodriguez-Wallberg, K., Obedin-Maliver, J., Taylor, B., Van Mello, N., Tilleman, K., Nahata, L. 2023; 24 (1): 7-25

  Abstract

  Hormonal treatments and surgical interventions practiced with the aim to affirm gender identity in transgender and gender diverse patients may impact their future reproductive ability, family building, and family planning options. Whereas it is recommended by international guidelines to discuss the potential risks of infertility and to present fertility preservation (FP) options to transgender individuals and their families prior to initiating any of these treatments, many barriers still remain. Further, transgender and gender diverse individuals often experience barriers to accessing contraception, abortion, pre-conception care, and comprehensive perinatal care.In this review we summarize the current literature on reproductive healthcare issues reported in transgender people including fertility issues, fertility preservation (FP), contraception, pregnancy and lactation and perinatal health.A narrative literature search of major databases (Pubmed, Medline, PsycInfo, Google Scholar, Web of Science) was conducted. Given the paucity and heterogeneity of studies, summative review tactics were not available. The literature was critically reviewed by international experts in the field with focus on the impact of gender-affirming medical interventions on future fertility, current FP options and reproductive health issues in transgender people.The current literature supports that transgender and gender diverse individuals may wish to have genetically related children in the future, rendering the issue of FP relevant to this patient group. The cryopreservation of mature gametes is an efficacious option for FP for post-pubertal adolescents and adults. It is recommended to discuss these options at time of planning for gender-affirming hormonal therapy (GAHT) or engaging with other gender-affirming procedures that can limit future fertility. Discontinuation of GAHT may allow individuals to undergo FP later, but data are limited and there is the concern of symptoms and consequences of stopping GAHT. For pre-pubertal and early pubertal children, FP options are limited to the cryopreservation of gonadal tissue. At present the tissue can become functional only after re-transplantation, which might be undesirable by transgender individuals in the future. Preconception counseling, prenatal surveillance, perinatal support, contraceptive, and pregnancy termination related healthcare need to be meaningfully adapted for this patient population, and many knowledge gaps remain.Specialized FP reproductive healthcare for transgender and gender diverse individuals is in early evolution. Research should be conducted to examine effects of medical interventions on fertility, timing of FP, gamete preservation and outcome of the fertility treatments. Strategies to inform and educate transgender and gender diverse patients can lead to optimization of reproductive care and counseling and decision making of FP for this population.

  View details for DOI 10.1080/26895269.2022.2035883

  View details for PubMedID 36713139

  View details for PubMedCentralID PMC9879176

• Our pride, our joy: An intersectional constructivist grounded theory analysis of resources that promote resilience in SGM communities. PloS one Edwards, O. W., Lev, E., Obedin-Maliver, J., Lunn, M. R., Lubensky, M. E., Capriotti, M. R., Garrett-Walker, J. J., Flentje, A. 2023; 18 (2): e0280787

  Abstract

  Sexual and gender minority (SGM) communities, including lesbian, gay, bisexual, transgender, queer, intersex, asexual, and Two-Spirit people, have historically been researched from a deficits-based approach that fails to highlight the ways communities survive and thrive in the face of adversity. This study endeavored to create a model of resources that promote SGM resilience using a sample that amplified traditionally underrepresented perspectives, including individuals from racial and/or ethnic minority groups, trans and/or gender diverse individuals, individuals on the asexual spectrum, and older adults.Participant responses to three open-ended questions from The PRIDE Study's (an online national longitudinal cohort study of SGM people) 2018 Annual Questionnaire were analyzed using constructivist grounded theory. These questions examined what brings people joy and what they appreciate most about their SGM identity. Participants (n = 315) were randomly selected from a larger sample of people who had responded to demographic questions and at least one open-ended question (N = 4,030) in a manner to ensure diverse representation across race/ethnicity, gender identity, sexual orientation, age, and region of residence.The proposed model includes social resources (Connecting with Others, Cultivating Family, Helping Others, Participating in Culture and Spirituality), affective generative resources (Engaging in Enriching Pursuits, Accessing Economic Resources), and introspective resources (Exploring One's Authentic Self, Persevering through Hardship) that are theorized to contribute to SGM resilience across the life course.SGM communities may tap into various resources to promote resilience. As public health practitioners, we can help to foster this resilience by resourcing and supporting initiatives that foster social connection, create spaces for community members to engage with various types of enrichment, facilitate access to economic resources, and provide support and inclusion for all SGM community members.

  View details for DOI 10.1371/journal.pone.0280787

  View details for PubMedID 36735687

• Understanding the social and community support experiences of sexual and gender minority individuals in 12-Step programs. Journal of gay & lesbian social services McGeough, B. L., Paceley, M., Zemore, S. E., Lunn, M. R., Obedin-Maliver, J., Lubensky, M. E., Flentje, A. 2023; 35 (4): 398-419

  Abstract

  Sexual and gender minority individuals (e.g., gay, bisexual, non-binary, transgender; SGMI) are 2-6 times as likely as cisgender heterosexual individuals to experience alcohol or other substance use disorders. SGMI participate in 12-Step groups, such as Alcoholics Anonymous (AA), at high rates. Though social support is an established mechanism through which 12-Step programs support reductions in substance use, little is known about SGMI's experiences of the social support in 12-Step programs. This qualitative study aims to understand the experiences of social and community support among SGMI involved in 12-Step programs. This study employed thematic analysis to interpret open-ended responses from 302 SGMI who had participated in 12-Step programs. Data was from The PRIDE Study, a large, national, online. longitudinal, cohort study of SGMI. Two themes emerged about how SGMI experienced social and community support in 12-Step programs: beneficial connections and harmful environments. Beneficial connections included a sense of community, shared experiences, and skills provision. Harmful environments included marginalization, oppression, violence, and bullying. This study highlights the variability of experiences of SGMI participating in 12-Step programs. These findings suggest that many SGMI may benefit from 12-Step programs but may need support in coping with potential harms that can emerge through participation.

  View details for DOI 10.1080/10538720.2023.2172759

  View details for PubMedID 38152636

  View details for PubMedCentralID PMC10752627

• Understanding the social and community support experiences of sexual and gender minority individuals in 12-Step programs JOURNAL OF GAY & LESBIAN SOCIAL SERVICES McGeough, B. L., Paceley, M., Zemore, S. E., Lunn, M. R., Obedin-Maliver, J., Lubensky, M. E., Flentje, A. 2023

  View details for DOI 10.1080/10538720.2023.2172759

  View details for Web of Science ID 000918390600001

• Management of testosterone around ovarian stimulation in transmasculine patients: challenging common practices to meet patient needs-2 case reports. Human reproduction (Oxford, England) Moravek, M. B., Dixon, M., Pena, S. M., Obedin-Maliver, J. 2023

  Abstract

  Approximately 50% of transmasculine people use testosterone for gender affirmation, yet very little is known about the effects of testosterone on future reproductive capacity. Moreover, there are no data to guide fertility specialists on how to manage testosterone leading up to or during ovarian stimulation. Most clinics require cessation of testosterone prior to ovarian stimulation in this setting of no data; however, the current literature does suggest a potential increase in dysphoria with cessation of testosterone and during stimulation. This divergence begs the question of whether clinicians may be doing more harm than good by enacting this requirement. Here, we present two cases of transmasculine individuals who were on testosterone prior to stimulation and maintained their testosterone dosage throughout stimulation as proof of concept, followed by a discussion of current clinical practice and providing some rationale to support continuation of testosterone throughout stimulation.

  View details for DOI 10.1093/humrep/dead003

  View details for PubMedID 36644915

• Birth includes us: Development of a community-led survey to capture experiences of pregnancy care among LGBTQ2S+ families. Birth (Berkeley, Calif.) Altman, M. R., Cragg, K., van Winkle, T., Julian, Z., Obedin-Maliver, J., Tarasoff, L. A., Eagen-Torkko, M. K., Ferrell, B. L., Rubashkin, N. A., Lusero, I., Vedam, S. 2023

  Abstract

  BACKGROUND: Limited research captures the intersectional and nuanced experiences of lesbian, gay, bisexual, transgender, queer, two-spirit, and other sexual and gender-minoritized (LGBTQ2S+) people when accessing perinatal care services, including care for pregnancy, birth, abortion, and/or pregnancy loss.METHODS: We describe the participatory research methods used to develop the Birth Includes Us survey, an online survey study to capture experiences of respectful perinatal care for LGBTQ2S+ individuals. From 2019 to 2021, our research team in collaboration with a multi-stakeholder Community Steering Council identified, adapted, and/or designed survey items which were reviewed and then content validated by community members with lived experience.RESULTS: The final survey instrument spans the perinatal care experience, from preconception to early parenthood, and includes items to capture experiences of care across different pregnancy roles (eg, pregnant person, partner/co-parent, intended parent using surrogacy) and pregnancy outcomes (eg, live birth, stillbirth, miscarriage, and abortion). Three validated measures of respectful perinatal care are included, as well as measures to assess experiences of racism, discrimination, and bias across intersections of identity.DISCUSSION AND CONCLUSIONS: By centering diverse perspectives in the review process, the Birth Includes Us instrument is the first survey to assess the range of experiences within LGBTQ2S+ communities. This instrument is ready for implementation in studies that seek to examine geographic and identity-based perinatal health outcomes and care experiences among LGBTQ2S+ people.

  View details for DOI 10.1111/birt.12704

  View details for PubMedID 36625538

• Factors contributing to delay in family building among sexual/gender minority people in the COVID19 pandemic Waldrop, A. R., Zhang, J., Flentje, A., Lunn, M. R., Lubensky, M. E., Leonard, S. A., Dastur, Z., Obedin-Maliver, J. MOSBY-ELSEVIER. 2023: S434

  View details for Web of Science ID 000909337401223

• Community-generated solutions to cancer inequity: recommendations from transgender, non-binary and intersex people on improving cancer screening and care. BMJ oncology Ragosta, S., Berry, J., Mahanaimy, M., Fix, L., Gomez, A. M., Obedin-Maliver, J., Moseson, H. 2023; 2 (1)

  Abstract

  Objective: Transgender, non-binary and intersex people are less likely to receive appropriate cancer screening for their bodies and have a higher incidence of certain cancers than cisgender people. We aimed to elicit community-generated solutions to improve cancer screening for these populations.Methods and analysis: We conducted six online, asynchronous focus groups in English and Spanish with transgender, non-binary, intersex and cisgender participants who were at least 15 years of age from across the USA. Participants shared their experiences with cancer screening and related conversations with healthcare providers and recommendations for making screening practices more inclusive of their bodies and experiences. Focus group data were exported into transcripts and analysed with thematic analysis.Results: The 23 participants represented a diversity of races, genders, sexualities, ages and geographical locations. Transgender, non-binary and intersex participants, particularly Black, Indigenous and/or people of colour, reported having to self-advocate to receive necessary care by initiating conversations about screening with their providers, requesting specific screenings and educating providers about the appropriate care for their body. Notably, no white or cisgender participants described having to request relevant screenings or initiate conversations with their providers. Participants recommended that forms ask about body parts and allow for self-identification.Conclusion: The ability to properly screen patients can have a direct impact on cancer outcomes. More inclusive intake forms may alleviate the need for transgender, non-binary and intersex patients to self-advocate to receive necessary care. More work should be done to educate providers on cancer risk for transgender, non-binary and intersex individuals.

  View details for DOI 10.1136/bmjonc-2022-000014

  View details for PubMedID 37581106

• CANCER SCREENING IN BISEXUAL WOMEN IN THE UNITED STATES: IS THERE A DISPARITY? - A US BRFSS STUDY Chan, A., Somasegar, S., Liao, C., Richardson, M., Chan, C., Johnson, C., Kapp, D., Obedin-Maliver, J. BMJ PUBLISHING GROUP. 2022: A197

  View details for DOI 10.1136/ijgc-2022-igcs.443

  View details for Web of Science ID 000899252300409

• CANCER SCREENING IN TRANSGENDER MEN IN THE UNITED STATES: IS THERE A DISPARITY? - A US BRFSS STUDY Chan, C., Liao, C., Richardson, M., Somasegar, S., Chan, A., Johnson, C., Kapp, D., Obedin-Maliver, J. BMJ PUBLISHING GROUP. 2022: A14

  View details for DOI 10.1136/ijgc-2022-igcs.25

  View details for Web of Science ID 000899252300024

• Web-Based Mindfulness-Based Interventions for Well-being: Randomized Comparative Effectiveness Trial. Journal of medical Internet research Sylvia, L. G., Lunn, M. R., Obedin-Maliver, J., McBurney, R. N., Nowell, W. B., Nosheny, R. L., Mularski, R. A., Long, M. D., Merkel, P. A., Pletcher, M. J., Tovey, R. E., Scalchunes, C., Sutphen, R., Martin, A. S., Horn, E. J., O'Boyle, M., Pitch, L., Seid, M., Redline, S., Greenebaum, S., George, N., French, N. J., Faria, C. M., Puvanich, N., Rabideau, D. J., Selvaggi, C. A., Yu, C., Faraone, S. V., Venkatachalam, S., McCall, D., Terry, S. F., Deckersbach, T., Nierenberg, A. A. 2022; 24 (9): e35620

  Abstract

  Mindfulness can improve overall well-being by training individuals to focus on the present moment without judging their thoughts. However, it is unknown how much mindfulness practice and training are necessary to improve well-being.The primary aim of this study was to determine whether a standard 8-session web-based mindfulness-based cognitive therapy (MBCT) program, compared with a brief 3-session mindfulness intervention, improved overall participant well-being. In addition, we sought to explore whether the treatment effects differed based on the baseline characteristics of the participants (ie, moderators).Participants were recruited from 17 patient-powered research networks, web-based communities of stakeholders interested in a common research area. Participants were randomized to either a standard 8-session MBCT or a brief 3-session mindfulness training intervention accessed on the web. The participants were followed for 12 weeks. The primary outcome of the study was well-being, as measured by the World Health Organization-Five Well-Being Index. We hypothesized that MBCT would be superior to a brief mindfulness training.We randomized 4411 participants, 3873 (87.80%) of whom were White and 3547 (80.41%) of female sex assigned at birth. The mean baseline World Health Organization-Five Well-Being Index score was 50.3 (SD 20.7). The average self-reported well-being in each group increased over the intervention period (baseline to 8 weeks; model-based slope for the MBCT group: 0.78, 95% CI 0.63-0.93, and brief mindfulness group: 0.76, 95% CI 0.60-0.91) as well as the full study period (ie, intervention plus follow-up; baseline to 20 weeks; model-based slope for MBCT group: 0.41, 95% CI 0.34-0.48; and brief mindfulness group: 0.33, 95% CI 0.26-0.40). Changes in self-reported well-being were not significantly different between MBCT and brief mindfulness during the intervention period (model-based difference in slopes: -0.02, 95% CI -0.24 to 0.19; P=.80) or during the intervention period plus 12-week follow-up (-0.08, 95% CI -0.18 to 0.02; P=.10). During the intervention period, younger participants (P=.05) and participants who completed a higher percentage of intervention sessions (P=.005) experienced greater improvements in well-being across both interventions, with effects that were stronger for participants in the MBCT condition. Attrition was high (ie, 2142/4411, 48.56%), which is an important limitation of this study.Standard MBCT improved well-being but was not superior to a brief mindfulness intervention. This finding suggests that shorter mindfulness programs could yield important benefits across the general population of individuals with various medical conditions. Younger people and participants who completed more intervention sessions reported greater improvements in well-being, an effect that was more pronounced for participants in the MBCT condition. This finding suggests that standard MBCT may be a better choice for younger people as well as treatment-adherent individuals.ClinicalTrials.gov NCT03844321; https://clinicaltrials.gov/ct2/show/NCT03844321.

  View details for DOI 10.2196/35620

  View details for PubMedID 36094813

• Geographic practice preferences of sexual minority medical students in the United States Gupta, R., Lunn, M. R., Obedin-Maliver, J. MOSBY-ELSEVIER. 2022: AB62

  View details for Web of Science ID 000891793200243

• Pride in STEM worldwide CELL Obedin-Maliver, J., Ochu, E., Zhong, F., Shaikh, A., Hanna, J. H., Foley, E. 2022; 185 (17): 3070-3072

  Abstract

  Cell asked LGBTQ+ scientists around the world about how their identity shapes their experiences in STEM. Here we share six unique perspectives of researchers highlighting how their area of expertise, research focus, institutions, and geographical location have played a role in this regard. We thank them for sharing their voices and continued efforts toward making science more inclusive.

  View details for DOI 10.1580/cell.058.0231

  View details for Web of Science ID 000848609200003

  View details for PubMedID 35985282

• State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People. International journal of environmental research and public health Clark, K. D., Lunn, M. R., Lev, E. M., Trujillo, M. A., Lubensky, M. E., Capriotti, M. R., Hoffmann, T. J., Obedin-Maliver, J., Flentje, A. 2022; 19 (16)

  Abstract

  Legislation has been passed in some states to reduce discrimination and victimization toward sexual and gender minority people (SGM; people who are not solely heterosexual and/or whose gender identity is not equal to what is socially associated with sex assigned at birth). The purpose of these analyses is to test whether state-level policy environments are associated with past-year discrimination and victimization among SGM people. Cross-sectional data from The Population Research in Identity and Disparities for Equality (PRIDE) Study annual questionnaire (collected 2018-2019), a national study of the health of SGM adults in the USA, were used for these analyses. Measures included related to discrimination, victimization, and demographic characteristics. State-level policy environments were measured using data from the Movement Advancement Project. Logistic regression analyses evaluated state-level policy environment scores and past-year discrimination and victimization among gender identity categories. In this sample, 7044 people (gender minority n = 2530) were included. Cisgender sexual minority (odds ratio [OR] = 1.007, p = 0.041) and the gender expansive subgroup of gender minority people (OR = 1.010, p = 0.047) in states with more protective policy environments had greater odds of discrimination. The gender expansive subgroup was found to have greater odds of victimization in states with more protective policy environments (OR = 1.003, p < 0.05). There was no relationship between state-level policy environments and victimization among any other study groups. SGM people may experience increased risk for discrimination and victimization despite legislative protections, posing continued risks for poor health outcomes and marginalization. Evaluation of factors (e.g., implementation strategies, systems of accountability) that influence the effectiveness of state-level polices on the reported experiences of discrimination and victimization among SGM people is needed.

  View details for DOI 10.3390/ijerph19169916

  View details for PubMedID 36011548

• Subjective Cognitive Decline Associated with Discrimination in Medical Settings among Transgender and Nonbinary Older Adults. International journal of environmental research and public health Lambrou, N. H., Gleason, C. E., Obedin-Maliver, J., Lunn, M. R., Flentje, A., Lubensky, M. E., Flatt, J. D. 2022; 19 (15)

  Abstract

  Transgender and nonbinary (TNB) individuals report greater subjective cognitive decline (SCD) compared to non-TNB people. SCD involves self-reported problems with memory and thinking and is a potential risk for Alzheimer's disease and related dementias (ADRD). We explored psychosocial factors, such as discrimination in medical settings, associated with SCD in a sample of TNB older adults.We utilized cross-sectional data on aging health, SCD (memory complaints and worsening memory in the past year), and discrimination in medical settings from The PRIDE Study for LGBTQ+ adults aged 50+ including TNB adults (n = 115). Associations were tested using multivariate logistic regression.Nearly 16% of TNB participants rated their memory as poor/fair, and 17% reported that their memory was worse than a year ago. TNB older adults with SCD were more likely to report experiencing discrimination in medical settings. After adjustment, those reporting discrimination in medical settings had 4.5 times higher odds of reporting worsening memory than those who did not (OR: 4.5; 95%-CI: 1.5-13.2; p = 0.006), and 7.5 times more likely to report poor/fair memory (OR: 7.49; 95%-CI: 1.7-32.8; p = 0.008); Conclusions: TNB older adults reported high frequencies of SCD and discrimination in medical settings. Further research exploring affirmative cognitive screening and healthcare services is needed.

  View details for DOI 10.3390/ijerph19159168

  View details for PubMedID 35954522

• Healthcare Mistreatment, State-Level Policy Protections, and Healthcare Avoidance Among Gender Minority People. Sexuality research & social policy : journal of NSRC : SR & SP Clark, K. D., Luong, S., Lunn, M. R., Flowers, E., Bahalkeh, E., Lubensky, M. E., Capriotti, M. R., Obedin-Maliver, J., Flentje, A. 2022; 19 (4): 1717-1730

  Abstract

  This study examined whether past experiences of mistreatment in healthcare were associated with greater healthcare avoidance due to anticipated mistreatment among gender minority (GM) people. We evaluated whether state-level healthcare policy protections moderated this relationship.Data from the 2018 Annual Questionnaire of The PRIDE Study, a national longitudinal study on sexual and gender minority people's health, were used in these analyses. Logistic regression modeling tested relationships between lifetime healthcare mistreatment due to gender identity or expression and past-year healthcare avoidance due to anticipated mistreatment among GM participants. Interactions between lifetime healthcare mistreatment and state-level healthcare policy protections and their relationship with past-year healthcare avoidance were tested.Participants reporting any lifetime healthcare mistreatment had greater odds of past-year healthcare avoidance due to anticipated mistreatment among gender expansive people (n = 1290, OR = 4.71 [CI]: 3.57-6.20), transfeminine people (n = 263, OR = 10.32 [CI]: 4.72-22.59), and transmasculine people (n = 471, OR = 3.90 [CI]: 2.50-6.13). Presence of state-level healthcare policy protections did not moderate this relationship in any study groups.For GM people, reporting lifetime healthcare mistreatment was associated with healthcare avoidance due to anticipated mistreatment. State-level healthcare policy protections were not a moderating factor in this relationship. Efforts to evaluate the implementation and enforcement of state-level policies are needed. Continued efforts to understand instances of and to diminish healthcare mistreatment of GM people are recommended.The online version contains supplementary material available at 10.1007/s13178-022-00748-1.

  View details for DOI 10.1007/s13178-022-00748-1

  View details for PubMedID 36458212

  View details for PubMedCentralID PMC9701649

• Migraine, Migraine Disability, Trauma, and Discrimination in Sexual and Gender Minority Individuals. Neurology Rosendale, N., Guterman, E. L., Obedin-Maliver, J., Flentje, A., Capriotti, M. R., Lubensky, M. E., Lunn, M. R. 2022

  Abstract

  OBJECTIVE: This study sought to describe migrainous headache frequency and severity and to examine the relationship between trauma, discrimination, and migraine-associated disability in a sample of sexual and/or gender minority (SGM) adults.METHODS: We performed a cross-sectional study of SGM people in The Population Research in Identity and Disparities for Equality (PRIDE) Study from August-October 2018. The primary exposure was any trauma or discrimination, regardless of attribution. The primary outcome was moderate-severe migraine disability, as defined by a Migraine Disability Assessment (MIDAS) Questionnaire score ≥11. We performed descriptive analysis comparing respondents with any migrainous headache to those without. Multivariable logistic regression examined the association between trauma/discrimination and migraine disability, controlling first for sociodemographic and clinical factors and then for psychiatric comorbidities.RESULTS: Of the 3,325 total respondents, 1,126 (33.9%) screened positive for migrainous headache by ID-Migraine criteria. Most people with migraine self-reported moderate (n=768, 68.2%) or severe (n=253, 22.5%) intensity. The median MIDAS score was 11 (interquartile range [IQR] 5-25). Most respondents with migraine (n=1055, 93.7%) reported a history of trauma or discrimination. In unadjusted analysis, exposure to both trauma and discrimination was associated with higher odds of moderate-severe disability (OR 1.76, 95% CI 1.34-2.32). After adjustment for self-reported psychiatric comorbidities of anxiety, depression, and post-traumatic stress disorder, this association lost statistical significance.CONCLUSION: Migrainous headache is common among our sample of SGM adults, and prior experiences with trauma and discrimination is associated with increased migraine disability. Our findings suggest that psychiatric comorbidities play a significant role in this relationship, identifying a potentially modifiable risk factor for disability in SGM people with migraine.

  View details for DOI 10.1212/WNL.0000000000200941

  View details for PubMedID 35817570

• Psychometric evaluation of the muscle dysmorphic disorder inventory (MDDI) among gender-expansive people. Journal of eating disorders Compte, E. J., Cattle, C. J., Lavender, J. M., Brown, T. A., Murray, S. B., Capriotti, M. R., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R., Nagata, J. M. 2022; 10 (1): 95

  Abstract

  Muscle dysmorphia is generally classified as a specific form of body dysmorphic disorder characterized by a pathological drive for muscularity and the preoccupation that one is too small or not sufficiently muscular. The majority of research on the condition has been conducted in cisgender men with a paucity of literature on gender minority people, a population that is at risk for muscle dysmorphia. One of the most widely used measures of muscle dysmorphia symptoms, the Muscle Dysmorphic Disorder Inventory (MDDI), has not been psychometrically validated for use in gender minority samples, the aim of the present study.We evaluated the psychometric properties of the MDDI in a sample of 1031 gender-expansive individuals (gender minority people whose gender identity differs from that assumed for their sex assigned at birth and is not exclusively binary man or woman) aged 18-74 who were part of The PRIDE Study, a large-scale, U.S., longitudinal cohort study.Using a two-step, split-sample exploratory and confirmatory factor analytic approach, we found support for the original three-factor structure of the measure. The subscales showed adequate internal consistency, and convergent validity was supported based on significant associations of the MDDI subscale scores with theoretically related scores on a widely used measure of disordered eating.These findings provided novel support for adequate psychometric properties of the MDDI in a sample of gender-expansive individuals, facilitating the use of this measure in future research on muscle dysmorphia in this understudied and at-risk population.

  View details for DOI 10.1186/s40337-022-00618-6

  View details for PubMedID 35794647

• Psychometric validation of the Muscle Dysmorphic Disorder Inventory (MDDI) among U.S. transgender men. Body image Nagata, J. M., Compte, E. J., McGuire, F. H., Lavender, J. M., Murray, S. B., Brown, T. A., Capriotti, M. R., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2022; 42: 43-49

  Abstract

  Muscle dysmorphia (MD) is characterized by a pervasive belief or fear of insufficient muscularity and an elevated drive for muscularity, representing the pathological and extreme pursuit of muscularity. Psychometric properties of one of the most widely used measures of MD symptoms-the Muscle Dysmorphic Disorder Inventory (MDDI)-have yet to be evaluated in transgender men despite emerging evidence suggesting differential risk for MD symptoms in this population. In this study, we assessed the psychometric properties of the MDDI in a sample of 330 transgender men ages 18-67 years who participated in a large-scale national longitudinal cohort study of sexual and gender minority adults in the U.S. Using a two-step, split-sample approach, an initial exploratory factor analysis supported a three-factor structure and a subsequent confirmatory factor analysis of a re-specified three-factor model demonstrated good overall fit (χ2/df = 1.84, CFI =0.94, TLI =0.92, RMSEA =0.07 [90% CI =0.05,.09], SRMR =0.08). Moreover, results supported the internal consistency and convergent validity of the MDDI subscales in transgender men. Findings inform the use of the MDDI among transgender men and provide a foundation to support further work on the MDDI and MD symptoms among gender minority populations.

  View details for DOI 10.1016/j.bodyim.2022.05.001

  View details for PubMedID 35653965

• COVID-19 News and Its Association with the Mental Health of Sexual and Gender Minority Adults: A Cross-Sectional Study. JMIR public health and surveillance Clark, K. D., Lunn, M. R., Sherman, A. D., Bosley, H. G., Lubensky, M. E., Obedin-Maliver, J., Dastur, Z., Flentje, A. 2022

  Abstract

  BACKGROUND: Sexual and gender minority (SGM; people whose sexual orientation is not heterosexual and/or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and significant disparities in anxiety and post-traumatic stress disorder (PTSD). Exposure to traumatic stressors, such as news related to COVID-19, may be associated with symptoms of anxiety and PTSD.OBJECTIVE: to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States (US).METHODS: Data were collected between March 23 and August 2, 2020 from The PRIDE Study, a national, longitudinal, cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and (1) symptoms of anxiety using the General Anxiety Disorder (GAD) 7-item Scale and (2) symptoms of COVID-related PTSD using the Impact of Events Scale-Revised (IES-R).RESULTS: Our sample included a total of 3,079 SGM participants. Each unit increase in COVID-19-related news exposure was associated with greater anxiety symptoms (OR=1.77,95% CI [1.63, 1.93], P<.001) and 1.93 greater odds of PTSD (95% CI [1.74, 2.14], P<.001).CONCLUSIONS: Our study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities.CLINICALTRIAL:

  View details for DOI 10.2196/34710

  View details for PubMedID 35486805

• DESIGNING FOR ADOPTION AND ADAPTATION OF EVIDENCE-BASED ANTI-TOBACCO MESSAGING BY ORGANIZATIONS SERVING LGBTQ plus COMMUNITIES Salvia, M. G., Ramanadhan, S., Applegate, J., Chen, J. T., Hanby, E., Machado, A., Roberts, J., Sanders-Jackson, A., Viswanath, K., Lunn, M., Obedin-Maliver, J., Gordon, B., Scout, N. N., Potter, J., Tan, A. L. OXFORD UNIV PRESS INC. 2022: S491

  View details for Web of Science ID 000788118601400

• Sexual and/or Gender Minority Parental Structures among California Births, 2016-2020. American journal of obstetrics & gynecology MFM Berrahou, I. K., Leonard, S. A., Zhang, A., Main, E. K., Obedin-Maliver, J. 2022: 100653

  Abstract

  BACKGROUND: Sexual and/or gender minority (SGM) people account for roughly 7.1% of the U.S. population, and an estimated one-third are parents. Little is known about SGM people who become pregnant, despite this population having documented health care disparities that may impact pregnancy.OBJECTIVES: Our objective was to describe parental structures among birth parents and the pre-pregnancy characteristics of parents giving birth in likely sexual and/or gender minority (SGM) parental structures from California birth certificates.STUDY DESIGN: We conducted a population-based study using birth certificate data from all live births in California from 2016 through 2020 (n = 2,257,974). The state amended its birth certificate in 2016 to enable the recording of more diverse parental roles. Now, parents on birth certificates are classified as "parent giving birth" and "parent not giving birth" and people in either role can identify as "mother," "father," or "parent." We examined all potential combinations of parenting roles and grouped parental structures of "mother-mother" and all structures designating a "father" as the "parent giving birth" into likely SGM groups. We assessed the distribution of pre-pregnancy characteristics across parental structure groups ("mother-father," "SGM," "mother only," "unclassified," and "missing both parental roles").RESULTS: SGM parents accounted for 6,802 (0.3%) of live births in California over the 5-year study period. The most common SGM parental structures were "mother-mother" (n=4,310; 63% of the group) and "father-father" (n=1,486; 22% of the group). Compared with "parents giving birth" in the "mother-father" structure (n=2,055,038; 91%), a higher proportion of "parents giving birth" in the "SGM" group were 35 years or older, white, college-educated, and had commercial health insurance. In addition, a higher proportion had a high pre-pregnancy body mass index. Although likely underreported overall, the proportion who used assisted reproductive technology was much higher among those in the "SGM" group (1.4%) than in the "mother-father" group (0.05%). Cigarette smoking in the three months prior to pregnancy was similar in both groups.CONCLUSION: Changes to the California birth certificate have revealed a multiplicity of parental structures. Our findings suggest that SGM parents differ from other parental structures and from the general SGM population and warrant further research.

  View details for DOI 10.1016/j.ajogmf.2022.100653

  View details for PubMedID 35462057

• Human Papillomavirus Vaccination Over Time in Heterosexual and Sexual Minority Adults in the United States. Health equity Chan, C., Mann, A. K., Lee, D., Nutkiewicz, L., Watson, K. T., Kapp, D. S., Obedin-Maliver, J. 2022; 6 (1): 307-312

  Abstract

  We proposed to identify the factors that determine the trends in human papillomavirus (HPV) vaccination initiation and completion among heterosexual and sexual minority adults.Using National Health and Nutrition Examination Survey database from 2007 to 2016, we performed chi-squared tests and multivariate logistic regression analysis.Heterosexual females initiated vaccination at 23.5% compared with sexual minority females at 34.6% (p<0.001). Although heterosexual males also had a lower vaccination initiation than sexual minority males (7.7% vs. 15.5%; p=0.12), their completion rate appeared higher (38% vs. 17%; p=0.14).Interventions are needed to enhance support for completion rates of HPV vaccine among sexual minority individuals.

  View details for DOI 10.1089/heq.2021.0058

  View details for PubMedID 35557550

  View details for PubMedCentralID PMC9081066

• Gender- and Sexual Orientation- Based Inequities: Promoting Inclusion, Visibility, and Data Accuracy in Oncology. American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting Alpert, A. B., Scout, N. F., Schabath, M. B., Adams, S., Obedin-Maliver, J., Safer, J. D. 2022; 42: 1-17

  Abstract

  Sexual and gender minority (SGM) people, including agender, asexual, bisexual, gay, gender diverse, genderqueer, genderfluid, intersex, lesbian, nonbinary, pansexual, queer, and transgender people, comprise approximately 10% or more of the U.S. population. Thus, most oncologists see SGM patients whether they know it or not. SGM people experience stigma and structural discrimination that lead to cancer disparities. Because of the lack of systematic and comprehensive data collection, data regarding SGM cancer incidence, outcomes, and treatment responses are limited. Collection of data regarding sexual orientation, gender identity, transgender identity and/or experience, anatomy, and serum hormone concentrations in oncology settings would drastically increase collective knowledge about the impact of stigma and biologic markers on cancer outcomes. Increasing the safety of oncology settings for SGM people will require individual, institutional, and systems changes that will likely improve oncologic care for all patients.

  View details for DOI 10.1200/EDBK_350175

  View details for PubMedID 35658501

• Appearance and performance-enhancing drugs and supplements, eating disorders, and muscle dysmorphia among gender minority people. The International journal of eating disorders Nagata, J. M., McGuire, F. H., Lavender, J. M., Brown, T. A., Murray, S. B., Greene, R. E., Compte, E. J., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2022

  Abstract

  OBJECTIVE: Appearance and performance-enhancing drugs and supplements (APEDS) can be used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among gender minority people.METHOD: Participants were 1653 gender minority individuals (1120 gender-expansive [defined as a broad range of gender identities that are generally situated outside of the woman-man gender binary, e.g., genderqueer, nonbinary] people, 352 transgender men, and 181 transgender women) recruited from The Population Research in Identity and Disparities for Equality Study in 2018. Regression analyses stratified by gender identity examined associations of any APEDS use with eating disorder and muscle dysmorphia symptom scores.RESULTS: Lifetime APEDS use was common across groups (30.7% of gender-expansive people, 45.2% of transgender men, and 14.9% of transgender women). Protein supplements and creatine supplements were the most commonly used APEDS. Among gender-expansive people and transgender men, lifetime use of any APEDS was significantly associated with higher eating disorder scores, dietary restraint, binge eating, compelled/driven exercise, and muscle dysmorphia symptoms. Any APEDS use was additionally associated with laxative use among gender-expansive people. Among transgender women, use of any APEDS was not significantly associated with eating disorder or muscle dysmorphia symptoms.DISCUSSION: APEDS use is common and associated with eating disorder and muscle dysmorphia symptoms in gender-expansive people and transgender men, thus highlighting the importance of assessing for these behaviors and symptoms among these populations, particularly in clinical settings.PUBLIC SIGNIFICANCE: This study aimed to examine APEDS use among gender minority people. We found that 30.7% of gender-expansive (e.g., nonbinary) people, 45.2% of transgender men, and 14.9% of transgender women reported lifetime APEDS use, which was associated with eating disorder and muscle dysmorphia symptoms in transgender men and gender-expansive people. Clinicians should assess for these behaviors in gender minority populations.

  View details for DOI 10.1002/eat.23708

  View details for PubMedID 35352378

• Comparison of depressive symptoms and inflammation between sexual minorities and heterosexuals using NHANES study of 8538 participants. Scientific reports Mann, A., Chan, A., Rohatgi, A., Caesar, M. A., Obedin-Maliver, J., Kapp, D. S. 2022; 12 (1): 3792

  Abstract

  The present study aims to compare the rate of depressive symptoms and inflammation levels between sexual minorities and heterosexuals. Data were obtained from the National Health and Nutrition Examination Survey from 2005 to 2010. Depressive-related symptoms were measured using the Patient Health Questionnaire-9 scoring system. C-reactive protein was analyzed with the Behring Nephelometer. Of 8538 participants, 95.8% self-reported as heterosexual and 4.2% as sexual minority. Depressive symptoms were reported in 7.1% of heterosexuals compared to 15.8% in sexual minorities (P=0.001). In heterosexuals, C-reactive protein was higher in those with depressive symptoms compared to those without (P<0.001). In sexual minorities, similar results were found, however, it was statisticallyinsignificant. The intersection group of black sexual minority females reported the highest rate of depressive symptoms at 33.4%. We found that depressive symptoms were higher in sexual minorities compared to heterosexuals. Furthermore, systemic inflammation was highest in the intersection group of black sexual minority females.

  View details for DOI 10.1038/s41598-022-07702-6

  View details for PubMedID 35260636

• Sexual and/or gender minority disparities in obstetric and birth outcomes. American journal of obstetrics and gynecology Leonard, S. A., Berrahou, I., Zhang, A., Monseur, B., Main, E. K., Obedin-Maliver, J. 2022

  Abstract

  Many sexual and/or gender minority individuals build families through pregnancy and childbirth, but it is unknown whether they experience different clinical outcomes than non-sexual and/or gender minority individuals.To evaluate obstetric and birth outcomes among likely sexual and/or gender minority patients in comparison with likely non-sexual and/or gender minority patients.We performed a population-based cohort study of live birth hospitalizations during 2016-2019 linked to birth certificates in California. California changed its birth certificate in 2016 to include gender-neutral fields "parent giving birth" and "parent not giving birth," with options for each role to specify "mother," "father," or "parent." We classified birthing patients in mother-mother partnerships and those who identified as a father in any partnership as likely sexual and/or gender minority, and classified birthing patients in mother-father partnerships as likely not sexual and/or gender minority. We used multivariable modified Poisson regression models to estimate risk ratios for associations between likely sexual and/or gender minority parental structures and outcomes. Models were adjusted for sociodemographic factors, comorbidities, and multifetal gestation selected by causal diagrams. We replicated analyses after excluding multifetal gestations.In the final birthing patient sample, 1,483,119 were mothers with father partners, 2,572 were mothers with mother partners, and 498 were fathers with any partner. Compared with birthing patients in mother-father partnerships, birthing patients in mother-mother partnerships experienced significantly higher rates of multifetal gestation (aRR 3.9, 95% CI 3.4-4.4), labor induction (aRR 1.2, 95% CI 1.1-1.3), postpartum hemorrhage (aRR 1.4, 95% CI 1.3-1.6), severe morbidity (aRR 1.4, 95% CI 1.2-1.8), and non-transfusion severe morbidity (aRR 1.4, 95% CI 1.1-1.9). Severe morbidity was identified following the Centers for Disease Control and Prevention "severe maternal morbidity" index. Gestational diabetes mellitus, hypertensive disorders of pregnancy, cesarean birth, preterm birth (<37 weeks' gestation), low birthweight (<2,500 g), and low Apgar score (<7 at 5 minutes) did not significantly differ in multivariable analyses. No outcomes significantly differed between father birthing patients in any partnership and birthing patients in mother-father partnerships in either crude or multivariable analyses, although the risk of multifetal gestation was non-significantly higher (aRR 1.5, 95% CI 0.9-2.7). Adjusted risk ratios for outcomes were similar after restriction to singleton gestations.Birthing mothers with mother partners experienced disparities in several obstetric and birth outcomes, independent of sociodemographic factors, comorbidities, and multifetal gestation. Birthing fathers in any partnership were not at significantly elevated risk of any adverse obstetric or birth outcome considered in this study.

  View details for DOI 10.1016/j.ajog.2022.02.041

  View details for PubMedID 35358492

• Perinatal considerations for care of transgender and nonbinary people: a narrative review. Current opinion in obstetrics & gynecology McCracken, M., DeHaan, G., Obedin-Maliver, J. 1800

  Abstract

  PURPOSE OF REVIEW: The visibility of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities, specifically the transgender and nonbinary (TGNB) communities, continues to grow. However, there is little description, much less guidance toward optimizing, the pregnancy-related care of TGNB people. The overarching goal of this paper is to provide guidance that aids in reimagining obstetrics to include people of all genders.RECENT FINDINGS: This article will review current literature and provide recommendations specific to the hospital birthing environment to help address the lack of knowledge regarding pregnancy-related care of TGNB individuals. This care is further divided into three main times: (1) preconception, antepartum care, and triage, (2) intrapartum, and (3) postpartum. We also discuss considerations for the general medical care of TGNB individuals.SUMMARY: Understanding facilitators and barriers to gender affirming pregnancy-related care of TGNB individuals are first steps toward providing a respectful, affirming, and evidence-based environment for all patients, especially TGNB individuals. Here we provide context, discussion, and resources for providers and TGNB patients navigating pregnancy-related care. Lastly, this review challenges researchers and clinicians with future directions for the care of TGNB individuals in this continually expanding field.

  View details for DOI 10.1097/GCO.0000000000000771

  View details for PubMedID 35102108

• Reproductive health in transgender and gender diverse individuals: A narrative review to guide clinical care and international guidelines INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH Rodriguez-Wallberg, K., Obedin-Maliver, J., Taylor, B., Van Mello, N., Tilleman, K., Nahata, L. 2022

  View details for DOI 10.1080/26895269.2022.2035883

  View details for Web of Science ID 000754982700001

• Risk Factors for Dual Burden of Severe Maternal Morbidity and Preterm Birth by Insurance Type in California. Maternal and child health journal El Ayadi, A. M., Baer, R. J., Gay, C., Lee, H. C., Obedin-Maliver, J., Jelliffe-Pawlowski, L., Lyndon, A. 1800

  Abstract

  OBJECTIVES: Among childbearing women, insurance coverage determines degree of access to preventive and emergency care for maternal and infant health. Maternal-infant dyads with dual burden of severe maternal morbidity and preterm birth experience high physical and psychological morbidity, and the risk of dual burden varies by insurance type. We examined whether sociodemographic and perinatal risk factors of dual burden differed by insurance type.METHODS: We estimated relative risks of dual burden by maternal sociodemographic and perinatal characteristics in the 2007-2012 California birth cohort dataset stratified by insurance type and compared effects across insurance types using Wald Z-statistics.RESULTS: Dual burden ranged from 0.36% of privately insured births to 0.41% of uninsured births. Obstetric comorbidities, multiple gestation, parity, and birth mode conferred the largest risks across all insurance types, but effect magnitude differed. The adjusted relative risk of dual burden associated with preeclampsia superimposed on preexisting hypertension ranged from 9.1 (95% CI 7.6-10.9) for privately insured to 15.9 (95% CI 9.1-27.6) among uninsured. The adjusted relative risk of dual burden associated with cesarean birth ranged from 3.1 (95% CI 2.7-3.5) for women with Medi-Cal to 5.4 (95% CI 3.5-8.2) for women with other insurance among primiparas, and 7.0 (95% CI 6.0-8.3) to 19.4 (95% CI 10.3-36.3), respectively, among multiparas.CONCLUSIONS: Risk factors of dual burden differed by insurance type across sociodemographic and perinatal factors, suggesting that care quality may differ by insurance type. Attention to peripartum care access and care quality provided by insurance type is needed to improve maternal and neonatal health.

  View details for DOI 10.1007/s10995-021-03313-1

  View details for PubMedID 35041142

• Representation of Sexual and Gender Minority People in Patient Nondiscrimination Policies of Cancer Centers in the United States. Journal of the National Comprehensive Cancer Network : JNCCN Berrahou, I. K., Snow, A., Swanson, M., Obedin-Maliver, J. 2022: 1-7

  Abstract

  Sexual and gender minority (SGM) people are an underserved population who face high rates of discrimination in healthcare, including receipt of cancer treatment. Several national organizations have identified the importance of patient nondiscrimination policies that explicitly recognize SGM people in creating safe healthcare environments.We performed a web-based analysis of NCI-designated Cancer Centers to evaluate the landscape of patient nondiscrimination policies in major cancer centers with regard to representation of SGM people.We found that 82% of cancer centers had a patient nondiscrimination policy on their website. The most commonly mentioned SGM-related term was "sex" (n=48; 89%), followed by "sexual orientation" (n=37; 69%) and "gender identity" (n=36; 67%). None of the policies included "sex assigned at birth" or "LGBTQ/SGM identity." Of the policies reviewed, 65% included protections for both sexual orientation and gender identity. Cancer centers with academic affiliations were significantly more likely to have policies that included both of these protections compared with nonacademic institutions (100% vs 79%; P=.005).Our study shows that patient nondiscrimination policies across NCI-designated Cancer Centers are not always accessible to patients and their families online and do not consistently represent SGM people in their content. Because the SGM population is both at higher risk for cancer and for discrimination in the healthcare setting, it is crucial to create inclusive, safe, and equitable cancer care environments for this group. Administrators and clinicians should view the patient nondiscrimination policy as an opportunity to offer expansive protections to SGM people that extend beyond those offered in federal and state laws. Additionally, the patient nondiscrimination policy should be visible and accessible to patients seeking cancer care as a signal of safety and inclusion.

  View details for DOI 10.6004/jnccn.2021.7078

  View details for PubMedID 35168202

• Associations among romantic and sexual partner history and muscle dysmorphia symptoms, disordered eating, and appearance- and performance-enhancing drugs and supplement use among cisgender gay men. Body image Nagata, J. M., DeBenedetto, A. M., Brown, T. A., Lavender, J. M., Murray, S. B., Capriotti, M. R., Flentje, A., Lubensky, M. E., Cattle, C. J., Obedin-Maliver, J., Lunn, M. R. 2022; 41: 67-73

  Abstract

  This study examined relationship status (e.g., single versus not single) and number of sexual partners in relation to muscularity- and disordered eating-related attitudes and behaviors among 1090 cisgender gay men enrolled in The PRIDE Study in 2018. Participants completed measures assessing muscle dysmorphia (MD) symptoms, disordered eating attitudes and behaviors, and appearance- and performance-enhancing drug or supplement (APEDS) use. In linear regression models adjusting for theoretically relevant covariates, neither relationship status nor number of past-month sexual partners was associated with disordered eating attitudes. In terms of MD symptoms, single (versus not single) relationship status was associated with greater appearance intolerance, and a greater number of sexual partners was associated with greater drive for size and functional impairment. In adjusted logistic regression models, a greater number of past-month sexual partners was associated with use of anabolic-androgenic steroids, synthetic performance-enhancing substances, protein supplements, and creatine supplements, as well as greater likelihood of engaging in compelled/driven exercise. Across all associations, effect sizes were generally small. Overall, results support that inquiring about sexual partners may have utility in evaluating risk for muscularity-oriented attitudes and behaviors among cisgender gay men. Future work will need to replicate these findings, particularly in more diverse samples.

  View details for DOI 10.1016/j.bodyim.2022.02.004

  View details for PubMedID 35228105

• Healthcare Mistreatment, State‐Level Policy Protections, and Healthcare Avoidance Among Gender Minority People Sexuality Research and Social Policy Clark, K. D., Luong, S., Lunn, M. R., Flowers, E., Bahalkeh, E., Lubensky, M. E., Capriotti, M. R., Obedin-Maliver, J., Flentje, A. 2022

  View details for DOI 10.1007/s13178-022-00748-1

• Do Ask, Tell, and Show: Contextual Factors Affecting Sexual Orientation and Gender Identity Disclosure for Sexual and Gender Minority People. LGBT health Suen, L. W., Lunn, M. R., Sevelius, J. M., Flentje, A., Capriotti, M. R., Lubensky, M. E., Hunt, C., Weber, S., Bahati, M., Rescate, A., Dastur, Z., Obedin-Maliver, J. 2022

  Abstract

  Purpose: Sexual and gender minority (SGM) people-including members of lesbian, gay, bisexual, transgender, and queer communities-remain underrepresented in health research due to poor collection of sexual orientation and gender identity (SOGI) data. We sought to understand the contextual factors affecting how SGM research participants interact with SOGI questions to enhance participant experience and increase the accuracy and sensitivity of research findings. Methods: We recruited SGM adults for in-person semi-structured focus groups or online cognitive interviews from 2016 to 2018. During focus groups and cognitive interviews, we asked participants to respond to SOGI question sets. We employed template analysis to describe the contextual factors that affected SGM participants' responses to SOGI questions. Results: We had a total of 74 participants, including 55 participants organized into nine focus groups and 19 participants in cognitive interviews. Most self-identified as a sexual minority person (88%), and 51% identified as a gender minority person. Two main themes were: (1) the need to know the relevance (of why SOGI questions are asked) and (2) the importance of environmental and contextual cues (communicating physical safety and freedom from discrimination that influenced SOGI disclosure). Conclusions: Contextualizing the relevance of SOGI data sought could help improve the accuracy and sensitivity of data collection efforts. Environmental cues that communicate acceptance and safety for SGM individuals in research settings may support disclosure. Researchers should consider these contextual factors when designing future studies to improve research experiences for SGM individuals and increase the likelihood of future participation.

  View details for DOI 10.1089/lgbt.2021.0159

  View details for PubMedID 35073205

• Appearance and performance-enhancing drugs and supplements (APEDS): Lifetime use and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people. Eating behaviors Nagata, J. M., McGuire, F. H., Lavender, J. M., Brown, T. A., Murray, S. B., Compte, E. J., Cattle, C. J., Flentje, A., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2022; 44: 101595

  Abstract

  Appearance and performance-enhancing drugs and supplements (APEDS) are used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people.Participants were cisgender sexual minority people (1090 gay men, 100 bisexual plus men, 564 lesbian women, and 507 bisexual plus women) recruited from The PRIDE Study in 2018 who reported lifetime APEDS use and completed the Eating Disorder Examination-Questionnaire (EDE-Q) and the Muscle Dysmorphic Disorder Inventory (MDDI). Regression analyses stratified by gender and sexual orientation examined associations of any APEDS use with EDE-Q and MDDI scores.Lifetime APEDS use was common across the four groups of cisgender sexual minority people (44% of gay men, 42% of bisexual plus men, 29% of lesbian women, and 30% of bisexual plus women). Protein supplements and creatine supplements were the most commonly used APEDS. Any APEDS use was associated with higher EDE-Q scores on one or more subscales in all sexual minority groups. Further, any APEDS use was associated with higher MDDI Total Scores in all groups; any APEDS use was associated with all MDDI subscale scores in cisgender gay men only.APEDS use is common and associated with eating disorder and muscle dysmorphia symptoms in sexual minority men and women, thus highlighting the importance of assessing for these behaviors and symptoms among these populations in clinical settings.

  View details for DOI 10.1016/j.eatbeh.2022.101595

  View details for PubMedID 35066385

• Obstetric and birth outcomes among sexual and/or gender minority patients, California, 2016-2019 Leonard, S. A., Berrahou, I., Zhang, A., Main, E. K., Obedin-Maliver, J. MOSBY-ELSEVIER. 2022: S69-S70

  View details for Web of Science ID 000737459400074

• Birth registration policies in the United States and their relevance to sexual and/or gender minority families: Identifying existing strengths and areas of improvement. Social science & medicine (1982) Zhang, A., Berrahou, I., Leonard, S. A., Main, E. K., Obedin-Maliver, J. 1800; 293: 114633

  Abstract

  Birth certificates are some of the most critical identity documents available to current residents of the United States, yet sexual and gender minority (SGM) parents frequently face barriers in obtaining accurate documents for their children. It is essential for SGM parents to have accurate birth certificates for their children at the time of birth registration so that they do not experience undue burden in raising their children and establishing their status as legal parents. In this analysis, we focused on the birth registration process in the US as they apply to SGM family-building and the assignation of parentage on birth certificates at the time of a child's birth. We utilized keyword-based search criteria to identify, collect, and tabulate official state policies related to birth registration. Birth registration policies rely on gendered, heteronormative assumptions about the sex and gender of a child's parents in all but three states when identifying the birthing person and in all but eight states when identifying the non-birthing person. We found additional barriers for SGM parents who give birth outside of a marriage or legal union. These barriers leave SGM parents particularly vulnerable to inaccuracies on their children's identity documents and incomplete recognition of their parental roles and rights. Existing birth registration policies also do little to ensure the inclusion of diverse family structures in administrative data collection. There are many ways to modify existing birth registration policies and enhance the inclusion of SGM parents within governmental administrative structures. We conclude with suggestions to improve upon existing birth registration systems by de-linking parental sex and gender from birthing role, parental role, and contribution to the pregnancy.

  View details for DOI 10.1016/j.socscimed.2021.114633

  View details for PubMedID 34933243

• Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey. International journal of transgender health Moseson, H., Fix, L., Hastings, J., Stoeffler, A., Lunn, M. R., Flentje, A., Lubensky, M. E., Capriotti, M. R., Ragosta, S., Forsberg, H., Obedin-Maliver, J. 2021; 22 (1-2): 30-41

  Abstract

  Background: Transgender, nonbinary, and gender-expansive (TGE) people experience pregnancy. Quantitative data about pregnancy intentions and outcomes of TGE people are needed to identify patterns in pregnancy intentions and outcomes and to inform clinicians how best to provide gender-affirming and competent pregnancy care. Aims: We sought to collect data on pregnancy intentions and outcomes among TGE people assigned female or intersex at birth in the United States. Methods: Collaboratively with a study-specific community advisory team, we designed a customizable, online survey to measure sexual and reproductive health experiences among TGE people. Eligible participants included survey respondents who identified as a man or within the umbrella of transgender, nonbinary, or gender-expansive identities; were 18 years or older; able to complete an electronic survey in English; lived in the United States; and were assigned female or intersex at birth. Participants were recruited through The PRIDE Study - a national, online, longitudinal cohort study of sexual and gender minority people - and externally via online social media postings, TGE community e-mail distribution lists, in-person TGE community events, and academic and community conferences. We conducted descriptive analyses of pregnancy-related outcomes and report frequencies overall and by racial and ethnic identity, pregnancy intention, or testosterone use. Results: Out of 1,694 eligible TGE respondents who provided reproductive history data, 210 (12%) had been pregnant. Of these, 115 (55%) had one prior pregnancy, 47 (22%) had two prior pregnancies, and 48 (23%) had three or more prior pregnancies. Of the 433 pregnancies, 169 (39%) resulted in live birth, 142 (33%) miscarried, 92 (21%) ended in abortion, two (0.5%) ended in stillbirth, two (0.5%) had an ectopic pregnancy, and seven (2%) were still pregnant; nineteen pregnancies (4%) had an unknown outcome. Among live births, 39 (23%) were delivered via cesarean section. Across all pregnancies, 233 (54%) were unintended. Fifteen pregnancies occurred after initiation of testosterone, and four pregnancies occurred while taking testosterone. Among all participants, 186 (11%) wanted a future pregnancy, and 275 (16%) were unsure; 182 (11%) felt "at risk" for an unintended pregnancy. Discussion: TGE people in the United States plan for pregnancy, experience pregnancy (intended and unintended) and all pregnancy outcomes, and are engaged in family building. Sexual and reproductive health clinicians and counselors should avoid assumptions about pregnancy capacity or intentions based on a patient's presumed or stated gender or engagement with gender-affirming hormone therapy.

  View details for DOI 10.1080/26895269.2020.1841058

  View details for PubMedID 34796363

  View details for PubMedCentralID PMC8040680

• Sexual Wellness in Cisgender Lesbian, Gay, and Bisexual People. The Urologic clinics of North America Stark, B. A., Obedin-Maliver, J., Shindel, A. W. 2021; 48 (4): 461-472

  Abstract

  Cisgender sexual minority persons have sexual wellness needs that go well beyond disease prevention. Despite historical asymmetries in research and clinical attention to sexual wellness in cisgender lesbian, gay, and bisexual persons, a growing body of evidence exists on how to optimally care for these populations. Additional research and development is warranted.

  View details for DOI 10.1016/j.ucl.2021.06.005

  View details for PubMedID 34602168

• From 'Shark-Week' to 'Mangina': An Analysis of Words Used by People of Marginalized Sexual Orientations and/or Gender Identities to Replace Common Sexual and Reproductive Health Terms. Health equity Ragosta, S., Obedin-Maliver, J., Fix, L., Stoeffler, A., Hastings, J., Capriotti, M. R., Flentje, A., Lubensky, M. E., Lunn, M. R., Moseson, H. 2021; 5 (1): 707-717

  Abstract

  Purpose: To explore sexual and reproductive health (SRH)-related word-use among sexual and gender minority (SGM) individuals in the United States. Methods: In 2019, we fielded an online quantitative survey on the SRH experiences of SGM adults. Eligible participants included transgender, nonbinary, and gender-expansive (TGE) people assigned female or intersex at birth, and cisgender sexual minority women (CSMW) in the United States. The survey asked participants to indicate if they used each of nine SRH terms, and if not, to provide the word(s) they used. We analyzed patterns in replacement words provided by respondents and tested for differences by gender category with tests of proportions. Results: Among 1704 TGE and 1370 CSMW respondents, 613 (36%) TGE respondents and 92 (7%) CSMW respondents replaced at least 1 SRH term (p-for-difference <0.001). Many (23%) replacement words/phrases were entirely unique. For six out of the nine terms, TGE respondents indicated that use of the provided term would depend on the context, the term did not apply to them, or they did not have a replacement word/phrase that worked for them. Conclusions: SRH terms commonly used in clinical and research settings cause discomfort and dysphoria among some SGM individuals. To address inequities in access to and quality of SRH care among SGM individuals, and to overcome long standing fear of mistreatment in clinical settings, more intentional word-use and elicitation from providers and researchers could increase the quality and affirming nature of clinical and research experiences for SGM people.

  View details for DOI 10.1089/heq.2021.0022

  View details for PubMedID 34909540

  View details for PubMedCentralID PMC8665782

• Sexual Orientation Diversity and Specialty Choice Among Graduating Allopathic Medical Students in the United States. JAMA network open Mori, W. S., Gao, Y., Linos, E., Lunn, M. R., Obedin-Maliver, J., Yeung, H., Mansh, M. D. 2021; 4 (9): e2126983

  View details for DOI 10.1001/jamanetworkopen.2021.26983

  View details for PubMedID 34591110

• From 'Shark-Week' to 'Mangina': An Analysis of Words Used by People of Marginalized Sexual Orientations and/or Gender Identities to Replace Common Sexual and Reproductive Health Terms HEALTH EQUITY Ragosta, S., Obedin-Maliver, J., Fix, L., Stoeffler, A., Hastings, J., Capriotti, M. R., Flentje, A., Lubensky, M. E., Lunn, M. R., Moseson, H. 2021; 5 (1): 707-717

  View details for DOI 10.1089/heq.2021.0022

  View details for Web of Science ID 000702517000002

• You miss 100% of the shots you don't take: time to push boundaries in fertility care of transgender people. Fertility and sterility Moravek, M. B., Obedin-Maliver, J. 2021

  View details for DOI 10.1016/j.fertnstert.2021.06.020

  View details for PubMedID 34247760

• Endometrial findings among transgender and gender nonbinary people using testosterone at the time of gender-affirming hysterectomy. Fertility and sterility Hawkins, M., Deutsch, M. B., Obedin-Maliver, J., Stark, B., Grubman, J., Jacoby, A., Jacoby, V. L. 2021

  Abstract

  OBJECTIVE: To describe clinical characteristics and associated endometrial findings of transgender and gender nonbinary people using gender-affirming testosterone.DESIGN: Retrospective case series.SETTING: Academic medical center and public safety net hospital.PATIENT(S): Eighty-one patients using gender-affirming testosterone therapy undergoing hysterectomy for the indication of gender affirmation from 2000 to2018.INTERVENTION(S): None.MAIN OUTCOME MEASURE(S): Preoperative clinical characteristics and endometrium surgical pathology diagnoses.RESULT(S): Median age was 31 years (interquartile range [IQR] 27-40), and median body mass index 27 kg/m2 (IQR 24-30). Six patients (7%) were parous and 60 (74%) had amenorrhea. Thirty-three patients (40%) had proliferative and 40 (50%) atrophic endometrium. Endometrial polyps were found in nine patients (11%) of the sample. Endometrial findings were similar in the subgroup of 60 patients with preoperative amenorrhea. There were no cases of endometrial hyperplasia or malignancy. In bivariate analysis, those with proliferative endometrium were found to be, on average, 5.6 years younger than those with atrophic endometrium. There were no clinical factors associated with having proliferative versus atrophic endometrium in multivariable models.CONCLUSION(S): People using gender-affirming testosterone may have either proliferative or atrophic endometrium, including people who present with amenorrhea. Further study is needed to develop evidence-based guidelines for appropriate screening for endometrial hyperplasia or cancer in this population.

  View details for DOI 10.1016/j.fertnstert.2020.11.008

  View details for PubMedID 33583596

• Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States. BMJ sexual & reproductive health Moseson, H. n., Fix, L. n., Gerdts, C. n., Ragosta, S. n., Hastings, J. n., Stoeffler, A. n., Goldberg, E. A., Lunn, M. R., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J. n. 2021

  Abstract

  Transgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.In 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.Of 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.These data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.

  View details for DOI 10.1136/bmjsrh-2020-200966

  View details for PubMedID 33674348

• Online health information seeking, health literacy, and human papillomavirus vaccination among transgender and gender-diverse people. Journal of the American Medical Informatics Association : JAMIA Pho, A. T., Bakken, S., Lunn, M. R., Lubensky, M. E., Flentje, A., Dastur, Z., Obedin-Maliver, J. 2021

  Abstract

  The purpose of this study is to describe online health information seeking among a sample of transgender and gender diverse (TGD) people compared with cisgender sexual minority people to explore associations with human papillomavirus (HPV) vaccination, and whether general health literacy and eHealth literacy moderate this relationship.We performed a cross-sectional online survey of TGD and cisgender sexual minority participants from The PRIDE Study, a longitudinal, U.S.-based, national health study of sexual and gender minority people. We employed multivariable logistic regression to model the association of online health information seeking and HPV vaccination.The online survey yielded 3258 responses. Compared with cisgender sexual minority participants, TGD had increased odds of reporting HPV vaccination (aOR, 1.5; 95% CI, 1.1-2.2) but decreased odds when they had looked for information about vaccines online (aOR, 0.7; 95% CI, 0.5-0.9). TGD participants had over twice the odds of reporting HPV vaccination if they visited a social networking site like Facebook (aOR, 2.4; 95% CI, 1.1-5.6). No moderating effects from general or eHealth literacy were observed.Decreased reporting of HPV vaccination among TGD people after searching for vaccine information online suggests vaccine hesitancy, which may potentially be related to the quality of online content. Increased reporting of vaccination after using social media may be related to peer validation.Future studies should investigate potential deterrents to HPV vaccination in online health information to enhance its effectiveness and further explore which aspects of social media might increase vaccine uptake among TGD people.

  View details for DOI 10.1093/jamia/ocab150

  View details for PubMedID 34383916

• Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender sexual minority men and women. BMC psychiatry Nagata, J. M., Compte, E. J., Cattle, C. J., Lavender, J. M., Brown, T. A., Murray, S. B., Flentje, A., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2021; 21 (1): 297

  Abstract

  Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of elevated body image-related concerns among sexual minority populations, little is known about the degree of muscle dysmorphia (MD) symptoms among sexual minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to examine the nature and severity of MD symptoms in cisgender sexual minority men and women and provide community norms of the MDDI for these populations.Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people from the United States, were examined. Participants included cisgender gay men (N = 1090), cisgender bisexual plus (bisexual, pansexual, and/or polysexual) men (N = 100), cisgender lesbian women (N = 563), and cisgender bisexual plus women (N = 507). We calculated means, standard deviations (SD), and percentiles for the MDDI total and subscale scores for cisgender sexual minority men and women. We compared MDDI scores by sexual orientation using linear regression models, both unadjusted and adjusted for sociodemographics.Overall, the sample was 85.2% White, 3.0% Asian or Pacific Islander, 2.0% Black, 0.5% Native American, 3.9% multiracial, and 6.6% Hispanic/Latino/a. The mean age was 38.6 (SD = 14.3) and 69.4% had a college degree or higher. Means (SD) for the MDDI total score were 27.4 (7.7) for cisgender gay men, 26.4 (6.4) for cisgender bisexual plus men, 24.3 (6.1) for cisgender lesbian women, and 24.6 (5.5) for cisgender bisexual plus women. There were no significant differences in MDDI scores between cisgender gay and bisexual plus men, or between cisgender lesbian women and bisexual plus women in unadjusted or adjusted models.These normative data provide insights into the experience of MD symptoms among cisgender sexual minority men and women and can aid researchers and clinicians in the evaluation of MD symptoms and interpretation of MDDI scores in sexual minority populations.

  View details for DOI 10.1186/s12888-021-03302-2

  View details for PubMedID 34103034

• Understanding co-occurring depression symptoms and alcohol use symptoms among cisgender sexual minority women JOURNAL OF GAY & LESBIAN SOCIAL SERVICES McGeough, B. L., Aguilera, A., Capriotti, M. R., Obedin-Maliver, J., Lubensky, M. E., Lunn, M. R., Flentje, A. 2021; 33 (4): 427-450

  View details for DOI 10.1080/10538720.2021.1886214

  View details for Web of Science ID 000750624600002

• Minority Stress, Structural Stigma, and Physical Health Among Sexual and Gender Minority Individuals: Examining the Relative Strength of the Relationships. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine Flentje, A., Clark, K. D., Cicero, E., Capriotti, M. R., Lubensky, M. E., Sauceda, J., Neilands, T. B., Lunn, M. R., Obedin-Maliver, J. 2021

  Abstract

  Sexual and gender minority (SGM; i.e., non-heterosexual and transgender or gender-expansive, respectively) people experience physical health disparities attributed to greater exposure to minority stress (experiences of discrimination or victimization, anticipation of discrimination or victimization, concealment of SGM status, and internalization of stigma) and structural stigma.To examine which components of minority stress and structural stigma have the strongest relationships with physical health among SGM people.Participants (5,299 SGM people, 1,902 gender minority individuals) were from The Population Research in Identity and Disparities for Equality (PRIDE) Study. Dominance analyses estimated effect sizes showing how important each component of minority stress and structural stigma was to physical health outcomes.Among cisgender sexual minority women, transmasculine individuals, American Indian or Alaskan Native SGM individuals, Asian SGM individuals, and White SGM individuals a safe current environment for SGM people had the strongest relationship with physical health. For gender-expansive individuals and Black, African American, or African SGM individuals, the safety of the environment for SGM people in which they were raised had the strongest relationship with physical health. Among transfeminine individuals, victimization experiences had the strongest relationship with physical health. Among Hispanic, Latino, or Spanish individuals, accepting current environments had the strongest relationship with physical health. Among cisgender sexual minority men prejudice/discrimination experiences had the strongest relationship with physical health.Safe community environments had the strongest relationships with physical health among most groups of SGM people. Increasing safety and buffering the effects of unsafe communities are important for SGM health.

  View details for DOI 10.1093/abm/kaab051

  View details for PubMedID 34228052

• Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among gender minority populations. Journal of eating disorders Nagata, J. M., Compte, E. J., McGuire, F. H., Lavender, J. M., Brown, T. A., Murray, S. B., Flentje, A., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2021; 9 (1): 87

  Abstract

  Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of heightened body image-related concerns among gender minority populations, little is known about the degree of MD symptoms among gender minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to assess community norms of the MDDI in gender-expansive people, transgender men, and transgender women.Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people, were examined. We calculated means, standard deviations, and percentiles for the MDDI total and subscale scores among gender-expansive people (i.e., those who identify outside of the binary system of man or woman; n = 1023), transgender men (n = 326), and transgender women (n = 177). The Kruskal-Wallis test was used to assess group differences and post hoc Dunn's tests were used to examine pairwise differences.Transgender men reported the highest mean MDDI total score (30.5 ± 7.5), followed by gender-expansive people (27.2 ± 6.7), then transgender women (24.6 ± 5.7). The differences in total MDDI score were driven largely by the Drive for Size subscale and, to a lesser extent, the Functional Impairment subscale. There were no significant differences in the Appearance Intolerance subscale among the three groups.Transgender men reported higher Drive for Size, Functional Impairment, and Total MDDI scores compared to gender-expansive people and transgender women. These norms provide insights into the experience of MD symptoms among gender minorities and can aid researchers and clinicians in the interpretation of MDDI scores among gender minority populations.

  View details for DOI 10.1186/s40337-021-00442-4

  View details for PubMedID 34261536

• Psychometric evaluation of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender gay men and cisgender lesbian women. Body image Compte, E. J., Cattle, C. J., Lavender, J. M., Murray, S. B., Brown, T. A., Capriotti, M. R., Flentje, A. n., Lubensky, M. E., Obedin-Maliver, J. n., Lunn, M. R., Nagata, J. M. 2021; 38: 241–50

  Abstract

  Despite increasing empirical interest in muscle dysmorphia (MD), a dearth of research has assessed this construct in sexual minority populations. In particular, the psychometric properties of one of the most widely used measures of MD symptoms-the Muscle Dysmorphic Disorder Inventory (MDDI)-have not been evaluated in sexual minority populations despite emerging evidence suggesting differential risk for MD symptoms across sexual orientation groups. In this study, we assessed the psychometric properties of the MDDI in a sample of 715 cisgender gay men and 404 cisgender lesbian women ages 18-50 years who participated in a large-scale national longitudinal cohort study of sexual and gender minority adults. The factor structure of the MDDI was examined in each sample using a two-step, split-sample exploratory and confirmatory factor analytic approach. Exploratory factor analysis supported a three-factor structure in both samples, which were confirmed by confirmatory factor analysis. Moreover, results supported the internal consistency reliability and convergent validity of the MDDI subscales in both samples. Cumulatively, these findings suggest that the MDDI is an appropriate measure of MD symptoms among cisgender gay men and cisgender lesbian women.

  View details for DOI 10.1016/j.bodyim.2021.04.008

  View details for PubMedID 33962223

• Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH Moseson, H., Fix, L., Hastings, J., Stoeffler, A., Lunn, M. R., Flentje, A., Lubensky, M. E., Capriotti, M. R., Ragosta, S., Forsberg, H., Obedin-Maliver, J. 2020

  View details for DOI 10.1080/26895269.2020.1841058

  View details for Web of Science ID 000592692400001

• Prepregnancy Counseling for People of All Genders: Enhancing Safe and Accessible Family Building for Transgender, Gender Diverse, and Non-binary Individuals CURRENT OBSTETRICS AND GYNECOLOGY REPORTS Martinez, E., Klein, A., Obedin-Maliver, J. 2020

  View details for DOI 10.1007/s13669-020-00298-6

  View details for Web of Science ID 000544551600001

• Stakeholder Perceptions and Experiences Regarding Access to Contraception and Abortion for Transgender, Non-Binary, and Gender-Expansive Individuals Assigned Female at Birth in the U.S. Archives of sexual behavior Fix, L., Durden, M., Obedin-Maliver, J., Moseson, H., Hastings, J., Stoeffler, A., Baum, S. E. 2020

  Abstract

  Sexual and reproductive health (SRH) care often excludes the needs and experiences of transgender, non-binary, and gender-expansive (TGE) individuals. This study aimed to collect diverse stakeholder perspectives on barriers and facilitators to contraception and abortion for TGE individuals assigned female at birth (AFAB), assess knowledge and attitudes about unintended pregnancy prevention in these populations, and identify recommendations for improving SRH services for people of all genders. Between October 2017 and January 2018, we conducted 27 in-depth interviews with SRH stakeholders, including five TGE individuals who had obtained contraception or abortion care, and 22 clinicians, researchers, and advocates experienced in transgender healthcare. We iteratively developed a codebook and conducted thematic analysis to capture the spectrum of perspectives across interviews. Stakeholders reported a range of barriers to contraception and abortion access for TGE people AFAB, including inability to afford services, lack of gender-affirming clinicians, difficulty obtaining insurance coverage, and misconceptions about fertility and unplanned pregnancy risk. Deterrents to care-seeking included gendered healthcare environments, misgendering, and discrimination. Stakeholders described provider knowledge gaps and a perceived lack of medical education relevant to the SRH needs of TGE people. Recommendations included using gender-inclusive language and gender-affirming patient education materials and improving provider training on gender-affirming SRH care. Stakeholders identified substantial barriers to high-quality contraception and abortion care for TGE AFAB people in the U.S. They recommended specific interventions at the provider and institutional levels to improve experiences with care for TGE people and ensure broader access to gender-affirming SRH services.

  View details for DOI 10.1007/s10508-020-01707-w

  View details for PubMedID 32385584

• Contraceptive counseling for transgender and gender diverse people who were female sex assigned at birth. Contraception Bonnington, A., Dianat, S., Kerns, J., Hastings, J., Hawkins, M., De Haan, G., Obedin-Maliver, J. 2020

  Abstract

  Everyone of reproductive potential, no matter sex or gender, may have contraceptive needs. However, with no professional society guidelines and scant data on contraceptive use for transgender and gender-diverse (TGD) populations, clinicians' abilities to counsel patients on use, safety, side effects, and efficacy is severely limited. We know very little about how estrogen- and progestin-containing contraceptive methods interact with gender-affirming testosterone therapy. Consequently, providers must extrapolate from data on use of hormonal contraceptive methods in presumed cisgender women and rely on clinical expertise. Based on available literature and expert opinion, there are important considerations for each method that can help guide contraceptive counseling with TGD patients. Specific considerations include differential experience of side-effects in TGD patients, barriers to access, and potential misconceptions regarding menstruation and reproductive capacity. When counseling a TGD person about their contraception options, providers should engage in shared decision-making, acknowledging the spectrum of identities and experiences within these communities. In order to support gender-affirming patient-centered care, providers should also create a space that is welcoming, use language that promotes inclusivity, and perform physical exams that consider the potential physical and emotional discomforts specific to these patients. Given the lack of population-specific data and guidelines, we encourage providers to integrate what is known about contraceptive use in cisgender women with the unique needs of TGD persons to apply a shared decision-making contraceptive counseling approach with members of these communities.

  View details for DOI 10.1016/j.contraception.2020.04.001

  View details for PubMedID 32304766

• The Imperative for Transgender and Gender Nonbinary Inclusion: Beyond Women's Health. Obstetrics and gynecology Moseson, H., Zazanis, N., Goldberg, E., Fix, L., Durden, M., Stoeffler, A., Hastings, J., Cudlitz, L., Lesser-Lee, B., Letcher, L., Reyes, A., Obedin-Maliver, J. 2020

  Abstract

  We aim to make evident that solely referencing cisgender women in the context of sexual and reproductive health-particularly pregnancy planning and care-excludes a diverse group of transgender and gender nonbinary people who have sexual and reproductive health needs and experiences that can be similar to but also unique from those of cisgender women. We call on clinicians and researchers to ensure that all points of sexual and reproductive health access, research, sources of information, and care delivery comprehensively include and are accessible to people of all genders. We describe barriers to sexual and reproductive health care and research participation unique to people of marginalized gender identities, provide examples of harm resulting from these barriers, and offer concrete suggestions for creating inclusive, accurate, and respectful care and research environments-which will lead to higher quality health care and science for people of all genders.

  View details for DOI 10.1097/AOG.0000000000003816

  View details for PubMedID 32282602

• Providing Patient-Centered Perinatal Care for Transgender Men and Gender-Diverse Individuals: A Collaborative Multidisciplinary Team Approach In Reply OBSTETRICS AND GYNECOLOGY Hahn, M., Sheran, N., Weber, S., Cohan, D., Obedin-Maliver, J. 2020; 135 (2): 484–85

  View details for Web of Science ID 000524416100046

• Characterization of substance use among underrepresented sexual and gender minority participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Substance abuse Barger, B. T., Obedin-Maliver, J. n., Capriotti, M. R., Lunn, M. R., Flentje, A. n. 2020: 1–12

  Abstract

  Background: Profiles of substance use among less commonly described subgroups of sexual and gender minority (SGM) people (e.g., queer, genderqueer) remain largely unknown. Objective(s): To identify substance use differences among less commonly described SGM identity-based subgroups. Methods: The PRIDE Study is a national, online, longitudinal cohort study of self-identified SGM adults living in the U.S. Between 2015-2017, an iPhone application was used to administer three cross-sectional health questionnaires to participants, one of which included questions about binge alcohol, marijuana, and other drug use (substance use). This study was a secondary data analysis of participant responses to substance use survey items. Logistic regression and generalized linear modeling assessed relationships between sexual orientation or gender and use of or reported problems with substances within the past year. Results: Among the 1790 participants included in this study, 51.0% reported binge alcohol use, 39.8% reported marijuana use, and 19.7% reported other drug use (65.9% endorsed use of one or more of these) within the past year. Over 30% indicated substance use had been a problem in their life. Asexual individuals had lower odds of reporting past year binge alcohol and marijuana use (aOR: 0.27, 95% CI: 0.12-0.61; aOR: 0.38, 95% CI: 0.15-0.96, respectively), and queer participants had higher odds of reporting past year marijuana use (aOR: 2.52, 95% CI: 1.58-4.03) compared to lesbian participants. Gender nonbinary participants had lower odds of reporting past year binge alcohol use (aOR: 0.48, 95% CI: 0.32-0.71) and transmasculine participants had higher odds of reporting past year marijuana use (aOR: 2.18, 95% CI: 1.10-4.31) compared to cisgender women. Conclusions: Substance use heterogeneity exists between SGM groups. Comprehensive assessment of sexual orientation and gender may improve understanding of substance use and increase equity within support and treatment services for SGM populations.HighlightsWe examined substance use among less represented sexual and gender minority groups.Alcohol and other drug use were examined by both sexual orientation and gender identity.Analyses included identities such as queer, pansexual, genderqueer and nonbinary.Alcohol use differed across asexual, genderqueer and gender nonbinary groups.Marijuana use differed across queer, asexual and transmasculine groups.

  View details for DOI 10.1080/08897077.2019.1702610

  View details for PubMedID 32032500

• Screening gender minority people for harmful alcohol use. PloS one Flentje, A. n., Barger, B. T., Capriotti, M. R., Lubensky, M. E., Tierney, M. n., Obedin-Maliver, J. n., Lunn, M. R. 2020; 15 (4): e0231022

  Abstract

  This study identifies how to screen for harmful alcohol use among gender minority (e.g., transgender and gender-expansive) people using brief screening methods and identifies which screening methods perform best among gender-expansive, transfeminine, and transmasculine subgroups, as screening recommendations are not currently available. Using 2018 Annual Questionnaire data from The PRIDE Study, area under the curve (AUC) values were compared to identify which screening methods ("4 or more" or "5 or more" drinks on one occasion in the past year, or one or more items from the Alcohol Use Disorders Identification Test [AUDIT]) best predicted (i) harmful alcohol use and (ii) one or more past year alcohol dependence symptoms or consequences. Among 1892 participants, "5 or more" drinks on one occasion (AUC ranges: 0.82-0.86) performed better than "4 or more" drinks (AUC ranges: 0.78-0.81) in predicting harmful drinking. The screening methods "4 or more" drinks, "5 or more" drinks, and the consumption items of the AUDIT (AUDIT-C) using a cutoff score of 3 all maximized sensitivity and specificity to predict alcohol dependence symptoms or consequences in gender minority people overall (AUC: 0.77-0.78). Screening for "5 or more" drinks on one occasion within the past year performed as well as or better than other screening methods to detect both harmful drinking and alcohol dependence-related symptoms or consequences. This single-item screening method can identify if more extensive alcohol use assessment is warranted with gender minority people.

  View details for DOI 10.1371/journal.pone.0231022

  View details for PubMedID 32255781

• Meeting the Patient Care, Education, and Research Missions: Academic Medical Centers Must Comprehensively Address Sexual and Gender Minority Health. Academic medicine : journal of the Association of American Medical Colleges Streed, C. G., Lunn, M. R., Siegel, J. n., Obedin-Maliver, J. n. 2020

  Abstract

  While sociopolitical advances have improved the rights of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer [LGBTQ+] persons), they continue to face a health system that discriminates against them and does not provide competent, comprehensive care. Despite calls for advancing research, there remains limited sexual and gender minority health research funding, mentorship, and institutional support. Academic medical centers are best suited to systematically tackle disparities and improve care for all sexual and gender minority people through their tripartite missions of patient care, education, and research. In this article, the authors outline discrimination experienced by LGBTQ+ persons and highlight the unique disparities they experience across access and outcomes. The authors posit that by systematically improving clinical care of, incorporating education and training about, and research with LGBTQ+ people into their core missions, academic medical centers can dramatically change the health care landscape. Academic medical centers can eliminate health disparities, expand necessary research endeavors about sexual and gender minorities, and prepare the health care workforce to address the unique needs of these overlooked populations.

  View details for DOI 10.1097/ACM.0000000000003703

  View details for PubMedID 32852319

• Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among transgender men and women. Eating behaviors Nagata, J. M., Murray, S. B., Compte, E. J., Pak, E. H., Schauer, R. n., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. n. 2020; 37: 101381

  Abstract

  Transgender men and women may be at risk for eating disorders, but prior community norms of the Eating Disorders Examination Questionnaire (EDE-Q) are based on presumed cisgender men and woman and have not intentionally included transgender people. The objective of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in transgender men and women using the EDE-Q. Participants were 312 transgender men and 172 transgender women participants in The PRIDE Study, an existing cohort study of sexual and gender minority people. We present mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in transgender men and women. Transgender men and women reported any occurrence (≥1/week) of dietary restraint (25.0% and 27.9%), objective binge episodes (11.2% and 12.8%), excessive exercise (8.0% and 8.1%), self-induced vomiting (1.6% and 1.7%), and laxative misuse (.3% and .6%), respectively. Compared to a prior study of presumed cisgender men 18-26 years (Lavender, De Young, & Anderson, 2010), our age-matched subsample of transgender men reported lower rates of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18-42 years (Mond, Hay, Rodgers, & Owen, 2006), we found that an age-matched sample of transgender women reported higher rates of dietary restraint but lower rates of excessive exercise. These norms should aid clinicians in applying and researchers in investigating and interpreting the EDE-Q scores of transgender men and women.

  View details for DOI 10.1016/j.eatbeh.2020.101381

  View details for PubMedID 32416588

• Development of an affirming and customizable electronic survey of sexual and reproductive health experiences for transgender and gender nonbinary people. PloS one Moseson, H. n., Lunn, M. R., Katz, A. n., Fix, L. n., Durden, M. n., Stoeffler, A. n., Hastings, J. n., Cudlitz, L. n., Goldberg, E. n., Lesser-Lee, B. n., Letcher, L. n., Reyes, A. n., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J. n. 2020; 15 (5): e0232154

  Abstract

  To address pervasive measurement biases in sexual and reproductive health (SRH) research, our interdisciplinary team created an affirming, customizable electronic survey to measure experiences with contraceptive use, pregnancy, and abortion for transgender and gender nonbinary people assigned female or intersex at birth and cisgender sexual minority women. Between May 2018 and April 2019, we developed a questionnaire with 328 items across 10 domains including gender identity; language used for sexual and reproductive anatomy and events; gender affirmation process history; sexual orientation and sexual activity; contraceptive use and preferences; pregnancy history and desires; abortion history and preferences; priorities for sexual and reproductive health care; family building experiences; and sociodemographic characteristics. Recognizing that the words people use for their sexual and reproductive anatomy can vary, we programmed the survey to allow participants to input the words they use to describe their bodies, and then used those customized words to replace traditional medical terms throughout the survey. This process-oriented paper aims to describe the rationale for and collaborative development of an affirming, customizable survey of the SRH needs and experiences of sexual and gender minorities, and to present summary demographic characteristics of 3,110 people who completed the survey. We also present data on usage of customizable words, and offer the full text of the survey, as well as code for programming the survey and cleaning the data, for others to use directly or as guidelines for how to measure SRH outcomes with greater sensitivity to gender diversity and a range of sexual orientations.

  View details for DOI 10.1371/journal.pone.0232154

  View details for PubMedID 32365110

• What Sexual and Gender Minority People Want Researchers to Know About Sexual Orientation and Gender Identity Questions: A Qualitative Study. Archives of sexual behavior Suen, L. W., Lunn, M. R., Katuzny, K. n., Finn, S. n., Duncan, L. n., Sevelius, J. n., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Hunt, C. n., Weber, S. n., Bibbins-Domingo, K. n., Obedin-Maliver, J. n. 2020

  Abstract

  Sexual and gender minority (SGM) people-including members of the lesbian, gay, bisexual, transgender, and queer communities-are understudied and underrepresented in research. Current sexual orientation and gender identity (SOGI) questions do not sufficiently engage SGM people, and there is a critical gap in understanding how SOGI questions reduce inclusion and accurate empirical representation. We conducted a qualitative study to answer the question, "For SGM people, what are the major limitations with current SOGI questions?" Focus groups probed reactions to SOGI questions adapted from prior national surveys and clinical best practice guidelines. Questions were refined and presented in semi-structured cognitive interviews. Template analysis using a priori themes guided analysis. There were 74 participants: 55 in nine focus groups and 19 in cognitive interviews. Participants were diverse: 51.3% identified as gender minorities, 87.8% as sexual minorities, 8.1% as Hispanic/Latinx, 13.5% as Black or African-American, and 43.2% as Non-white. Two major themes emerged: (1) SOGI questions did not allow for identity fluidity and complexity, reducing inclusion and representation, and (2) SOGI question stems and answer choices were often not clear as to which SOGI dimension was being assessed. To our knowledge, this represents the largest body of qualitative data studying SGM perspectives when responding to SOGI questions. We present recommendations for future development and use of SOGI measures. Attention to these topics may improve meaningful participation of SGM people in research and implementation of such research within and for SGM communities.

  View details for DOI 10.1007/s10508-020-01810-y

  View details for PubMedID 32875381

• Depression and Anxiety Changes Among Sexual and Gender Minority People Coinciding with Onset of COVID-19 Pandemic. Journal of general internal medicine Flentje, A. n., Obedin-Maliver, J. n., Lubensky, M. E., Dastur, Z. n., Neilands, T. n., Lunn, M. R. 2020

  View details for DOI 10.1007/s11606-020-05970-4

  View details for PubMedID 32556877

• Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among gender-expansive populations. Journal of eating disorders Nagata, J. M., Compte, E. J., Cattle, C. J., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Murray, S. B., Obedin-Maliver, J. n., Lunn, M. R. 2020; 8 (1): 74

  Abstract

  Gender-expansive individuals (i.e., those who identify outside of the binary system of man or woman) are a marginalized group that faces discrimination and have a high burden of mental health problems, but there is a paucity of research on eating disorders in this population. This study aimed to describe the community norms for the Eating Disorder Examination Questionnaire (EDE-Q) in gender-expansive populations.The participants were 988 gender-expansive individuals (defined as neither exclusively cisgender nor binary transgender) from The PRIDE study, an existing longitudinal cohort study of health outcomes in sexual and gender minority people.We present the mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in this group as a whole and stratified by sex assigned at birth. Gender-expansive individuals reported any occurrence (≥1/28 days) of dietary restraint (23.0%), objective binge episodes (12.9%), excessive exercise (7.4%), self-induced vomiting (1.4%), or laxative misuse (1.2%). We found no statistically significant differences by sex assigned at birth. Compared to a prior study of transgender men and women, there were no significant differences in eating attitudes or disordered eating behaviors noted between gender-expansive individuals and transgender men. Transgender women reported higher Restraint and Shape Concern subscale scores compared to gender-expansive individuals. Compared to a prior study of presumed cisgender men 18-26 years, our age-matched gender-expansive sample had higher Eating, Weight, and Shape Concern subscales and Global Score, but reported a lower frequency of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18-25 years, our age-matched gender-expansive sample had a higher Shape Concern subscale score, a lower Restraint subscale score, and lower frequencies of self-induced vomiting, laxative misuse, and excessive exercise.Gender-expansive individuals reported lower Restraint and Shape Concern scores than transgender women; higher Eating, Weight, and Shape Concern scores than presumed cisgender men; and lower Restraint but higher Shape Concern scores than presumed cisgender women. These norms can help clinicians in treating this population and interpreting the EDE-Q scores of their gender-expansive patients.

  View details for DOI 10.1186/s40337-020-00352-x

  View details for PubMedID 33292636

• Abortion experiences and preferences of transgender, nonbinary, and gender-expansive people in the United States. American journal of obstetrics and gynecology Moseson, H. n., Fix, L. n., Ragosta, S. n., Forsberg, H. n., Hastings, J. n., Stoeffler, A. n., Lunn, M. R., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J. n. 2020

  Abstract

  Transgender, nonbinary, and gender-expansive (TGE) people who were assigned female or intersex at birth experience pregnancy and have abortions. No data have been published on individual abortion experiences or preferences of this understudied population.To fill existing evidence gaps on the abortion experiences and preferences of TGE people in the United States to inform policies and practices to improve access to and quality of abortion care for this population.In 2019, we recruited TGE people assigned female or intersex at birth and aged 18 years and older from across the United States to participate in an online survey about sexual and reproductive health recruited through The PRIDE Study and online postings. We descriptively analyzed closed- and open-ended survey responses related to pregnancy history, abortion experiences, preferences for abortion method, recommendations to improve abortion care for TGE people, and respondent sociodemographic characteristics.The majority of the 1,694 respondents were less than 30 years of age. Respondents represented multiple gender identities and sexual orientations and resided across all four United States Census Regions. Overall, 210 (12%) respondents had ever been pregnant; these 210 reported 421 total pregnancies, of which 92 (22%) ended in abortion. For respondents' most recent abortion, 41 (61%) were surgical, 23 (34%) were medication, and 3 (4.5%) used another method (primarily herbal). Most recent abortions took place at or before nine weeks gestation (n=41, 61%). If they were to need an abortion today, respondents preferred medication abortion to surgical abortion three to one (n=703 versus n=217), but 514 (30%) respondents did not know which method they would prefer. Reasons for medication abortion preference among the 703 respondents included a belief that it is the least invasive method (n=553, 79%) and the most private method (n=388, 55%). To improve accessibility and quality of abortion care for TGE patients, respondents most frequently recommended that abortion clinics adopt gender-neutral or gender-affirming intake forms, that providers utilize gender-neutral language, and that greater privacy be incorporated into the clinic.These data contribute significantly to the evidence base on individual experiences of and preferences for abortion care for TGE people. Findings can be used to adapt abortion care to better include and affirm the experiences of this underserved population.

  View details for DOI 10.1016/j.ajog.2020.09.035

  View details for PubMedID 32986990

• Community norms for the eating disorder examination questionnaire (EDE-Q) among cisgender bisexual plus women and men. Eating and weight disorders : EWD Nagata, J. M., Compte, E. J., Murray, S. B., Schauer, R. n., Pak, E. n., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. n. 2020

  Abstract

  Cisgender bisexual plus (including bisexual, pansexual, and polysexual) women and men experience unique health concerns including eating disorders. The purpose of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in cisgender bisexual plus women and men using the Eating Disorders Examination Questionnaire (EDE-Q).Participants were cisgender bisexual plus women (n = 462) and men (n = 93) participants in The PRIDE Study, an existing study of sexual and gender minority people.Mean and standard deviation of EDE-Q scores among cisgender bisexual plus women and men, respectively, were: Global (1.75 ± 1.26, 1.56 ± 1.18), Restraint (1.34 ± 1.44, 1.42 ± 1.53), Eating Concern (0.96 ± 1.13, 0.63 ± 0.96), Weight Concern 2.27 ± 1.55, 1.89 ± 1.46), and Shape Concern 42 ± 1.62, 2.30 ± 1.57). Among cisgender bisexual plus women and men, respectively, 27.5% and 22.6% scored in the clinically significant range on the Global score. Bisexual plus women and men reported any occurrence (≥ 1/28 days) of dietary restraint (19.3%, 23.7%), objective binge episodes (11.1%, 10.8%), excessive exercise (4.5%, 5.4%), self-induced vomiting (1.7%, 0.0%), and laxative misuse (0.4%, 1.1%), respectively. A lower percentage of age-matched cisgender bisexual plus women (18-25 years) reported any occurrence of objective binge episodes, self-induced vomiting, laxative misuse, and excessive exercise than previously published in young women. Age-matched cisgender bisexual plus men (18-26 years) reported higher weight concern subscale scores than previously published in young men.These norms should aid clinicians in applying and interpreting the EDE-Q scores of cisgender bisexual plus women and men.Level V: cross-sectional descriptive study.

  View details for DOI 10.1007/s40519-020-01070-8

  View details for PubMedID 33270173

• Eating disorder attitudes and disordered eating behaviors as measured by the Eating Disorder Examination Questionnaire (EDE-Q) among cisgender lesbian women. Body image Nagata, J. M., Murray, S. B., Flentje, A. n., Compte, E. J., Schauer, R. n., Pak, E. n., Capriotti, M. R., Lubensky, M. E., Lunn, M. R., Obedin-Maliver, J. n. 2020; 34: 215–20

  Abstract

  The Eating Disorder Examination Questionnaire (EDE-Q) is a measure of eating disorder attitudes and disordered eating behaviors. Prior descriptive studies of the EDE-Q for women either did not assess or omitted reporting sexual orientation. This study's objective was to assess eating disorder attitudes and disordered eating behaviors as measured by the EDE-Q among cisgender lesbian women. We present mean scores and standard deviations for the EDE-Q among 563 self-identified cisgender lesbian women ages 18-77 who were recruited from The PRIDE Study in 2018. Among cisgender lesbian women, 3.4 % scored in the clinically significant range on the Restraint, 1.6 % on the Eating Concern, 9.1 % on the Weight Concern, 13.9 % on the Shape Concern, and 3.9 % on the Global Score scales of the EDE-Q. We found that 13.5 % of participants reported any occurrence (≥1/28 days) of dietary restriction, 8.7 % for objective binge episodes, 5.3 % for excessive exercise, .4% for self-induced vomiting, and .4% for laxative misuse. Participants reported a current (1.8 %) or lifetime (7.1 %) diagnosis of an eating disorder by a clinician. These EDE-Q descriptive data capture eating disorder attitudes and disordered eating behaviors among cisgender lesbian women and may aid clinicians and researchers in interpreting the EDE-Q in this specific population.

  View details for DOI 10.1016/j.bodyim.2020.06.005

  View details for PubMedID 32652490

• Response to Letter. Obstetrics and gynecology Hahn, M. U., Sheran, N. n., Weber, S. n., Cohan, D. n., Obedin-Maliver, J. n. 2020; 135 (2): 484–85

  View details for DOI 10.1097/AOG.0000000000003691

  View details for PubMedID 31977791

• Supporting sexual and gender minority health: Research priorities from mental health professionals JOURNAL OF GAY & LESBIAN MENTAL HEALTH Clark, K. D., Capriotti, M. R., Obedin-Maliver, J., Lunn, M. R., Lubensky, M. E., Flentje, A. 2019

  View details for DOI 10.1080/19359705.2019.1700865

  View details for Web of Science ID 000503440300001

• Providing Patient-Centered Perinatal Care for Transgender Men and Gender-Diverse Individuals: A Collaborative Multidisciplinary Team Approach. Obstetrics and gynecology Hahn, M., Sheran, N., Weber, S., Cohan, D., Obedin-Maliver, J. 2019; 134 (5): 959-963

  Abstract

  Little is documented about the experiences of pregnancy for transgender and gender-diverse individuals. There is scant clinical guidance for providing prepregnancy, prenatal, intrapartum, and postpartum care to transgender and gender-diverse people who desire pregnancy.Our team provided perinatal care to a 20-year-old transgender man, which prompted collaborative advocacy for health care systems change to create gender-affirming patient experiences in the perinatal health care setting.Systems-level and interpersonal-level interventions were adopted to create gender-affirming and inclusive care in and around pregnancy. Basic practices to mitigate stigma and promote gender-affirming care include staff trainings and query and use of appropriate name and pronouns in patient interactions and medical documentation. Various factors are important to consider regarding testosterone therapy for transgender individuals desiring pregnancy.

  View details for DOI 10.1097/AOG.0000000000003506

  View details for PubMedID 31599839

  View details for PubMedCentralID PMC6814572

• Community norms for the Eating Disorder Examination Questionnaire among cisgender gay men. European eating disorders review : the journal of the Eating Disorders Association Nagata, J. M., Capriotti, M. R., Murray, S. B., Compte, E. J., Griffiths, S. n., Bibbins-Domingo, K. n., Obedin-Maliver, J. n., Flentje, A. n., Lubensky, M. E., Lunn, M. R. 2019

  Abstract

  Prior norms of the Eating Disorders Examination Questionnaire (EDE-Q) among men have not considered sexual orientation. This study's objective was to assess EDE-Q community norms among cisgender gay men.Participants were 978 self-identified cisgender gay men from The PRIDE Study recruited in 2018.We present mean scores and standard deviations for the EDE-Q among cisgender gay men ages 18-82. Among cisgender gay men, 4.0% scored in the clinically significant range on the global score, 5.7% on the restraint, 2.1% on the eating concern, 10.5% on the weight concern, and 21.4% on the shape concern subscales of the EDE-Q. The global score as well as weight and shape concerns in a young adult subsample (18-26 years) from The PRIDE Study were higher than previously reported norms in young men (Lavender, 2010). Participants reported any occurrence (≥1/28 days) of dietary restraint (19.8%), objective binge episodes (10.9%), excessive exercise (10.1%), laxative misuse (1.1%), and self-induced vomiting (0.6%). Binge eating, excessive exercise, and self-induced vomiting in The PRIDE Study subsample were lower than previously reported in young men.We provide EDE-Q norms among cisgender gay men, which should aid clinicians and researchers to interpret the EDE-Q scores of cisgender gay men.

  View details for DOI 10.1002/erv.2708

  View details for PubMedID 31793119

• The "All of Us" Research Program. The New England journal of medicine Denny, J. C., Rutter, J. L., Goldstein, D. B., Philippakis, A. n., Smoller, J. W., Jenkins, G. n., Dishman, E. n. 2019; 381 (7): 668–76

  Abstract

  Knowledge gained from observational cohort studies has dramatically advanced the prevention and treatment of diseases. Many of these cohorts, however, are small, lack diversity, or do not provide comprehensive phenotype data. The All of Us Research Program plans to enroll a diverse group of at least 1 million persons in the United States in order to accelerate biomedical research and improve health. The program aims to make the research results accessible to participants, and it is developing new approaches to generate, access, and make data broadly available to approved researchers. All of Us opened for enrollment in May 2018 and currently enrolls participants 18 years of age or older from a network of more than 340 recruitment sites. Elements of the program protocol include health questionnaires, electronic health records (EHRs), physical measurements, the use of digital health technology, and the collection and analysis of biospecimens. As of July 2019, more than 175,000 participants had contributed biospecimens. More than 80% of these participants are from groups that have been historically underrepresented in biomedical research. EHR data on more than 112,000 participants from 34 sites have been collected. The All of Us data repository should permit researchers to take into account individual differences in lifestyle, socioeconomic factors, environment, and biologic characteristics in order to advance precision diagnosis, prevention, and treatment.

  View details for DOI 10.1056/NEJMsr1809937

  View details for PubMedID 31412182

• More Similarities Than Differences? An Exploratory Analysis Comparing the Sexual Complaints, Sexual Experiences, and Genitourinary Health of Older Sexual Minority and Sexual Majority Adults. The Journal of Sexual Medicine Obedin-Maliver, J., LIsha, N., Breyer, B., Subak, L., Huang, A. 2019; 16 (3): 347-350

  View details for DOI 10.1016/j.jsxm.2019.01.308

• Opening the Ob/Gyn Door to Sexual and Gender Minority Patients Light, A., Obedin-Maliver, J. Contemporary Ob/Gyn. Volume 64, No 01. 2019 11–15
• A digital health research platform for community engagement, recruitment, and retention of sexual and gender minority adults in a national longitudinal cohort study--The PRIDE Study. Journal of the American Medical Informatics Association : JAMIA Lunn, M. R., Lubensky, M. n., Hunt, C. n., Flentje, A. n., Capriotti, M. R., Sooksaman, C. n., Harnett, T. n., Currie, D. n., Neal, C. n., Obedin-Maliver, J. n. 2019

  Abstract

  Sexual and gender minority (SGM) people are underrepresented in research. We sought to create a digital research platform to engage, recruit, and retain SGM people in a national, longitudinal, dynamic, cohort study (The PRIDE Study) of SGM health.We partnered with design and development firms and engaged SGM community members to build a secure, cloud-based, containerized, microservices-based, feature-rich, research platform. We created PRIDEnet, a national network of individuals and organizations that actively engaged SGM communities in all stages of health research. The PRIDE Study participants were recruited via in-person outreach, communications to PRIDEnet constituents, social media advertising, and word-of-mouth. Participants completed surveys to report demographic as well as physical, mental, and social health data.We built a secure digital research platform with engaging functionality that engaged SGM people and recruited and retained 13 731 diverse individuals in 2 years. A sizeable sample of 3813 gender minority people (32.8% of cohort) were recruited despite representing only approximately 0.6% of the population. Participants engaged with the platform and completed comprehensive annual surveys- including questions about sensitive and stigmatizing topics- to create a data resource and join a cohort for ongoing SGM health research.With an appealing digital platform, recruitment and engagement in online-only longitudinal cohort studies are possible. Participant engagement with meaningful, bidirectional relationships creates stakeholders and enables study cocreation. Research about effective tactics to engage, recruit, and maintain active participation from all communities is needed.This digital research platform successfully recruited and engaged diverse SGM participants in The PRIDE Study. A similar approach may be successful in partnership with other underrepresented and vulnerable populations.

  View details for DOI 10.1093/jamia/ocz082

  View details for PubMedID 31162545

• Resilience Against Depression Disparities (RADD): a protocol for a randomised comparative effectiveness trial for depression among predominantly low-income, racial/ethnic, sexual and gender minorities. BMJ open Vargas, S. M., Wennerstrom, A. n., Alfaro, N. n., Belin, T. n., Griffith, K. n., Haywood, C. n., Jones, F. n., Lunn, M. R., Meyers, D. n., Miranda, J. n., Obedin-Maliver, J. n., Pollock, M. n., Sherbourne, C. D., Springgate, B. F., Sugarman, O. K., Rey, E. n., Williams, C. n., Williams, P. n., Chung, B. n. 2019; 9 (10): e031099

  Abstract

  Depression is the leading cause of adult disability and common among sexual and gender minority (SGM) adults. The current study builds on findings showing the effectiveness of depression quality improvement (QI) and delivery of cognitive behavioural therapy (CBT) skills provided by community health workers in reducing depression. Depression QI approaches across healthcare and social/community services in safety-net settings have shown improvements in mental wellness, mental health quality of life and depression over 12 months. Further, a randomised study showed improved depression among low-income racial/ethnic minorities enrolled in a CBT-informed resiliency class (Building Resilience and Increasing Community Hope (B-RICH)). The current protocol describes a comparativeness effectiveness study to evaluate whether predominantly low-income, SGM racial/ethnic minority adults randomised to a CBT-informed resiliency class have improvements in depressive symptoms over and above community-engaged QI resources and training only.The study approached three clusters of four to five programs serving predominantly SGM and racial/ethnic minority communities in the USA: two clusters in Los Angeles, California, and one in New Orleans, Louisiana. Clusters are comprised of one primary care, one mental health and two to three community agencies (eg, faith-based, social services/support, advocacy). All programs received depression QI training. The current study employed a community-partnered participatory research model to adapt the CBT-informed resiliency class, B-RICH+, to SGM communities. Study participants were screened and recruited in person from participating programs, and will complete baseline, 6- and 12-month survey follow-ups. Participants were depressed adults (8-item Patient Health Questionnaire ≥10; ≥18 years of age) who provided contact information. Enrolled participants were individually randomised to B-RICH+ or depression QI alone. Primary outcomes are depressive symptoms; secondary outcomes are mental health quality of life, mental wellness and physical health quality of life. Data collection for this study is ongoing.The current study was approved by the UCLA Institutional Review Board. Study findings will be disseminated through scientific publications and community conferences.https://clinicaltrials.gov/ct2/show/NCT02986126.

  View details for DOI 10.1136/bmjopen-2019-031099

  View details for PubMedID 31641001

• Using mobile technology to engage sexual and gender minorities in clinical research. PloS one Lunn, M. R., Capriotti, M. R., Flentje, A. n., Bibbins-Domingo, K. n., Pletcher, M. J., Triano, A. J., Sooksaman, C. n., Frazier, J. n., Obedin-Maliver, J. n. 2019; 14 (5): e0216282

  Abstract

  Historical and current stigmatizing and discriminatory experiences drive sexual and gender minority (SGM) people away from health care and clinical research. Being medically underserved, they face numerous disparities that make them vulnerable to poor health outcomes. Effective methods to engage and recruit SGM people into clinical research studies are needed.To promote health equity and understand SGM health needs, we sought to design an online, national, longitudinal cohort study entitled The PRIDE (Population Research in Identity and Disparities for Equality) Study that enabled SGM people to safely participate, provide demographic and health data, and generate SGM health-related research ideas.We developed an iPhone mobile application ("app") to engage and recruit SGM people to The PRIDE Study-Phase 1. Participants completed demographic and health surveys and joined in asynchronous discussions about SGM health-related topics important to them for future study.The PRIDE Study-Phase 1 consented 18,099 participants. Of them, 16,394 provided data. More than 98% identified as a sexual minority, and more than 15% identified as a gender minority. The sample was diverse in terms of sexual orientation, gender identity, age, race, ethnicity, geographic location, education, and individual income. Participants completed 24,022 surveys, provided 3,544 health topics important to them, and cast 60,522 votes indicating their opinion of a particular health topic.We developed an iPhone app that recruited SGM adults and collected demographic and health data for a new national online cohort study. Digital engagement features empowered participants to become committed stakeholders in the research development process. We believe this is the first time that a mobile app has been used to specifically engage and recruit large numbers of an underrepresented population for clinical research. Similar approaches may be successful, convenient, and cost-effective at engaging and recruiting other vulnerable populations into clinical research studies.

  View details for DOI 10.1371/journal.pone.0216282

  View details for PubMedID 31048870

• Urinary Incontinence in a National Cohort of Older Women: Implications for Caregiving and Care Dependence JOURNAL OF WOMENS HEALTH Yang, E., Lisha, N. E., Walter, L., Obedin-Maliver, J., Huang, A. J. 2018; 27 (9): 1097–1103

  Abstract

  Urinary incontinence (UI) can interfere with older women's ability to perform activities of daily living (ADLs), but little is known about factors that predispose incontinent women to become functionally dependent or compromise their ability to serve as caregivers to others.UI, caregiving, and care-receiving behaviors were assessed by questionnaire in a national sample of community-dwelling older women. Multivariable models evaluated associations between incontinence and care dependence, assessed factors associated with care dependence among incontinent women, and compared health among female caregivers with and without incontinence.Of the 1703 women, 27% reported weekly or more incontinence and 13% monthly incontinence. Women with weekly or more incontinence were more likely than women without incontinence to report receiving care for ADLs (AOR = 2.39, CI = 1.61-3.56) or instrumental ADLs (AOR = 1.94, CI = 1.42-2.63). Compared to 46% of women without incontinence, 60% of women with monthly or weekly incontinence reported unmet care needs (p = 0.0002). Factors associated with care dependence included more frequent incontinence, older age, marital status, and fair/poor health (p < 0.05 for all). Overall, 15% of women served as a caregiver for another adult, which did not differ by incontinence status (p = 0.84), but female caregivers with incontinence reported worse health than those without incontinence (p = 0.0004).In this national cohort, older women with incontinence were more likely to be functionally dependent and have unmet care needs than those without incontinence, after adjustment for other factors. At least one in ten incontinent women served as caregivers, despite having worse health than female caregivers without incontinence.

  View details for DOI 10.1089/jwh.2017.6891

  View details for Web of Science ID 000435559200001

  View details for PubMedID 29902123

  View details for PubMedCentralID PMC6148721

• The new era of precision population health: insights for the All of Us Research Program and beyond. Journal of translational medicine Lyles, C. R., Lunn, M. R., Obedin-Maliver, J. n., Bibbins-Domingo, K. n. 2018; 16 (1): 211

  Abstract

  Although precision medicine has made advances in individualized patient treatments, there needs to be continued attention on tailored population health and prevention strategies (often termed "precision population health"). As we continue to link datasets and use "big data" approaches in medicine, inclusion of diverse populations and a focus on disparities reduction are key components within a precision population health framework. Specific recommendations from the All of Us Research Program and the Precision Public Health Summit provide examples for moving this field forward.

  View details for DOI 10.1186/s12967-018-1585-5

  View details for PubMedID 30053823

  View details for PubMedCentralID PMC6062956

• From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers BMC PREGNANCY AND CHILDBIRTH Hoffkling, A., Obedin-Maliver, J., Sevelius, J. 2017; 17: 332

  Abstract

  Some transgender men retain their uterus, get pregnant, and give birth. However, societal attitudes about gender have erected barriers to openly being pregnant and giving birth as a transgender man. Little research exists regarding transgender men's reproductive needs. Anecdotal observations suggest that social change and increasing empowerment of transgender men may result in increasing frequency and openness about pregnancy and birth. Specific needs around conception, pregnancy, and newborn care may arise from transphobia, exogenous testosterone exposure, or from having had (or desiring) gender-affirming surgery. We undertook a qualitative study to understand the needs of transgender men who had given birth.We interviewed 10 transgender men who had been recruited for a recently published online cross-sectional survey of individuals (n = 41). Subjects had given birth while identifying as male. Interviews were recorded, transcribed, and systematically coded. Analysis used a priori and emergent codes to identify central themes and develop a framework for understanding participant experiences.Participants reported diverse experiences and values on issues including prioritization and sequencing of transition versus reproduction, empowerment in healthcare, desire for external affirmation of their gender and/or pregnancy, access to social supports, and degree of outness as male, transgender, or pregnant. We identified structural barriers that disempowered participants and describe healthcare components that felt safe and empowering. We describe how patients' strategies, and providers' behaviors, affected empowerment. Anticipatory guidance from providers was central in promoting security and empowerment for these individuals as patients.Recognizing diverse experiences has implications in supporting future patients through promoting patient-centered care and increasing the experiential legibility. Institutional erasure creates barriers to transgender men getting routine perinatal care. Identifying this erasure helps shape recommendations for how providers and clinics can provide appropriate care. Specific information regarding reproduction can be helpful to patients. We provide recommendations for providers' anticipatory guidance during the pre-transition, pre-conception, prenatal, and postpartum periods. Ways to support and bring visibility to the experience of transgender men are identified. Improving clinical visibility and affirming gender will likely enhance patient experience and may support patient-centered perinatal healthcare services.

  View details for DOI 10.1186/s12884-017-1491-5

  View details for Web of Science ID 000415331900002

  View details for PubMedID 29143629

  View details for PubMedCentralID PMC5688401

• Gynecologic Care for Transgender Adults CURRENT OBSTETRICS AND GYNECOLOGY REPORTS Obedin-Maliver, J., de Haan, G. 2017; 6 (2): 140–48

  View details for DOI 10.1007/s13669-017-0204-4

  View details for Web of Science ID 000402082800008

• Feasibility of Vaginal Hysterectomy for Female-to-Male Transgender Men. Obstetrics and gynecology Obedin-Maliver, J., Light, A., de Haan, G., Jackson, R. A. 2017; 129 (3): 457-463

  Abstract

  To describe the hysterectomy data among a cohort of transgender men and nontransgender (ie, cisgender) women with a particular goal to evaluate the feasibility of vaginal hysterectomy among transgender men.This cohort study includes all hysterectomies performed for benign indications on transgender men and cisgender women at a single academic county hospital from 2000 to 2012. Hysterectomy cases and patient gender were identified by billing records and confirmed by review of medical records. Primary study outcome was the hysterectomy route among transgender men compared with cisgender women. We also examined risk factors and operative outcomes. Student two-sided t tests, χ analysis, and descriptive statistics are presented; sensitivity analyses using regression techniques were performed.Hysterectomies for benign gynecologic procedures were performed in 883 people: 33 on transgender men and 850 on cisgender women. Transgender men were younger, had fewer pregnancies and deliveries, and smaller uteri. The leading indication for hysterectomy differed significantly: pain (85%) was most common among transgender men (compared with 22% in cisgender women; P<.001), whereas leiomyomas (64%) was most common for cisgender women (compared with 21% in transgender men; P<.001). Vaginal hysterectomies were performed in 24% transgender men and 42% of cisgender women. Estimated blood loss was less among transgender men (P=.002), but when uterine size and route of hysterectomy were considered, the difference between gender groups was no longer significant. There was no difference in patients experiencing complications between the groups.Transgender men and cisgender women have different preoperative characteristics and surgical indications. Vaginal hysterectomies have been successfully completed among transgender men. Because vaginal hysterectomy is a viable procedure for this population, it should be considered in surgical planning for transgender men.

  View details for DOI 10.1097/AOG.0000000000001866

  View details for PubMedID 28178042

• Contraceptive use and pregnancy intentions among transgender men presenting to a clinic for sex workers and their families in San Francisco CONTRACEPTION Cipres, D., Seidman, D., Cloniger, C., Nova, C., O'Shea, A., Obedin-Maliver, J. 2017; 95 (2): 186–89

  Abstract

  Although many transgender men may be able to conceive, their reproductive health needs are understudied.We retrospectively reviewed charts of transgender men presenting to a clinic for sex workers to describe the proportion at risk for pregnancy, pregnancy intentions, and contraceptive use.Of 26 transgender men identified, half were at risk for pregnancy. Most desired to avoid pregnancy but used only condoms or no contraception. Two individuals desired pregnancy, were taking testosterone (a teratogen), and not using contraception.Further research is needed to explore how to best provide family planning services including preconception and contraception care to transgender men.

  View details for DOI 10.1016/j.contraception.2016.09.005

  View details for Web of Science ID 000392895300011

  View details for PubMedID 27621044

• Transgender men and pregnancy OBSTETRIC MEDICINE Obedin-Maliver, J., Makadon, H. J. 2016; 9 (1): 4–8

  View details for DOI 10.1177/1753495X15612658

  View details for Web of Science ID 000383118000002

• Lesbian, Gay, Bisexual, and Transgender Patient Care: Medical Students' Preparedness and Comfort. Teaching and learning in medicine White, W., Brenman, S., Paradis, E., Goldsmith, E. S., Lunn, M. R., Obedin-Maliver, J., Stewart, L., Tran, E., Wells, M., Chamberlain, L. J., Fetterman, D. M., Garcia, G. 2015; 27 (3): 254-263

  Abstract

  Phenomenon: Lesbian, gay, bisexual, and transgender (LGBT) individuals face significant barriers in accessing appropriate and comprehensive medical care. Medical students' level of preparedness and comfort caring for LGBT patients is unknown.An online questionnaire (2009-2010) was distributed to students (n = 9,522) at 176 allopathic and osteopathic medical schools in Canada and the United States, followed by focus groups (2010) with students (n = 35) at five medical schools. The objective of this study was to characterize LGBT-related medical curricula, to determine medical students' assessments of their institutions' LGBT-related curricular content, and to evaluate their comfort and preparedness in caring for LGBT patients.Of 9,522 survey respondents, 4,262 from 170 schools were included in the final analysis. Most medical students (2,866/4,262; 67.3%) evaluated their LGBT-related curriculum as "fair" or worse. Students most often felt prepared addressing human immunodeficiency virus (HIV; 3,254/4,147; 78.5%) and non-HIV sexually transmitted infections (2,851/4,136; 68.9%). They felt least prepared discussing sex reassignment surgery (1,061/4,070; 26.1%) and gender transitioning (1,141/4,068; 28.0%). Medical education helped 62.6% (2,669/4,262) of students feel "more prepared" and 46.3% (1,972/4,262) of students feel "more comfortable" to care for LGBT patients. Four focus group sessions with 29 students were transcribed and analyzed. Qualitative analysis suggested students have significant concerns in addressing certain aspects of LGBT health, specifically with transgender patients. Insights: Medical students thought LGBT-specific curricula could be improved, consistent with the findings from a survey of deans of medical education. They felt comfortable, but not fully prepared, to care for LGBT patients. Increasing curricular coverage of LGBT-related topics is indicated with emphasis on exposing students to LGBT patients in clinical settings.

  View details for DOI 10.1080/10401334.2015.1044656

  View details for PubMedID 26158327

• Sexual and Gender Minority Identity Disclosure During Undergraduate Medical Education: "In the Closet" in Medical School ACADEMIC MEDICINE Mansh, M., White, W., Gee-Tong, L., Lunn, M. R., Obedin-Maliver, J., Stewart, L., Goldsmith, E., Brenman, S., Tran, E., Wells, M., Fetterman, D., Garcia, G. 2015; 90 (5): 634-644

  Abstract

  To assess identity disclosure among sexual and gender minority (SGM) students pursuing undergraduate medical training in the United States and Canada.From 2009 to 2010, a survey was made available to all medical students enrolled in the 176 MD- and DO-granting medical schools in the United States and Canada. Respondents were asked about their sexual and gender identity, whether they were "out" (i.e., had publicly disclosed their identity), and, if they were not, their reasons for concealing their identity. The authors used a mixed-methods approach and analyzed quantitative and qualitative survey data.Of 5,812 completed responses (of 101,473 eligible respondents; response rate 5.7%), 920 (15.8%) students from 152 (of 176; 86.4%) institutions identified as SGMs. Of the 912 sexual minorities, 269 (29.5%) concealed their sexual identity in medical school. Factors associated with sexual identity concealment included sexual minority identity other than lesbian or gay, male gender, East Asian race, and medical school enrollment in the South or Central regions of North America. The most common reasons for concealing one's sexual identity were "nobody's business" (165/269; 61.3%), fear of discrimination in medical school (117/269; 43.5%), and social or cultural norms (110/269; 40.9%). Of the 35 gender minorities, 21 (60.0%) concealed their gender identity, citing fear of discrimination in medical school (9/21; 42.9%) and lack of support (9/21; 42.9%).SGM students continue to conceal their identity during undergraduate medical training. Medical institutions should adopt targeted policies and programs to better support these individuals.

  View details for DOI 10.1097/ACM.0000000000000657

  View details for Web of Science ID 000353879700027

  View details for PubMedID 25692563

• Time for OBGYNs to Care for People of All Genders JOURNAL OF WOMENS HEALTH Obedin-Maliver, J. 2015; 24 (2): 109–11

  View details for DOI 10.1089/jwh.2015.1518

  View details for Web of Science ID 000349322700001

  View details for PubMedID 25682814

• Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstetrics and gynecology Light, A. D., Obedin-Maliver, J., Sevelius, J. M., Kerns, J. L. 2014; 124 (6): 1120-7

  Abstract

  To conduct a cross-sectional study of transgender men who had been pregnant and delivered after transitioning from female-to-male gender to help guide practice and further investigation.We administered a web-based survey from March to December 2013 to inquire about demographics, hormone use, fertility, pregnancy experience, and birth outcomes. Participants were not required to have been on hormone therapy to be eligible. We used a mixed-methods approach to evaluate the quantitative and qualitative data.Forty-one self-described transgender men completed the survey. Before pregnancy, 61% (n=25) had used testosterone. Mean age at conception was 28 years with a standard deviation of 6.8 years. Eighty-eight percent of oocytes (n=36) came from participants' own ovaries. Half of the participants received prenatal care from a physician and 78% delivered in a hospital. Qualitative themes included low levels of health care provider awareness and knowledge about the unique needs of pregnant transgender men as well as a desire for resources to support transgender men through their pregnancy.Transgender men are achieving pregnancy after having socially, medically, or both transitioned. Themes from this study can be used to develop transgender-appropriate services and interventions that may improve the health and health care experiences of transgender men.

  View details for DOI 10.1097/AOG.0000000000000540

  View details for PubMedID 25415163

• Lesbian, Gay, Bisexual, and Transgender Health and Medical Education Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Lunn, M. R., Obedin-Maliver, J. 2011; 306 (21): 2326–27

  View details for DOI 10.1001/jama.2011.1783

  View details for Web of Science ID 000297680300014

• Lesbian, Gay, Bisexual, and Transgender-Related Content in Undergraduate Medical Education JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., Wells, M., Fetterman, D. M., Garcia, G., Lunn, M. R. 2011; 306 (9): 971-977

  Abstract

  Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health and health care disparities and have specific health care needs. Medical education organizations have called for LGBT-sensitive training, but how and to what extent schools educate students to deliver comprehensive LGBT patient care is unknown.To characterize LGBT-related medical curricula and associated curricular development practices and to determine deans' assessments of their institutions' LGBT-related curricular content.Deans of medical education (or equivalent) at 176 allopathic or osteopathic medical schools in Canada and the United States were surveyed to complete a 13-question, Web-based questionnaire between May 2009 and March 2010.Reported hours of LGBT-related curricular content.Of 176 schools, 150 (85.2%) responded, and 132 (75.0%) fully completed the questionnaire. The median reported time dedicated to teaching LGBT-related content in the entire curriculum was 5 hours (interquartile range [IQR], 3-8 hours). Of the 132 respondents, 9 (6.8%; 95% CI, 2.5%-11.1%) reported 0 hours taught during preclinical years and 44 (33.3%; 95% CI, 25.3%-41.4%) reported 0 hours during clinical years. Median US allopathic clinical hours were significantly different from US osteopathic clinical hours (2 hours [IQR, 0-4 hours] vs 0 hours [IQR, 0-2 hours]; P = .008). Although 128 of the schools (97.0%; 95% CI, 94.0%-99.9%) taught students to ask patients if they "have sex with men, women, or both" when obtaining a sexual history, the reported teaching frequency of 16 LGBT-specific topic areas in the required curriculum was lower: at least 8 topics at 83 schools (62.9%; 95% CI, 54.6%-71.1%) and all topics at 11 schools (8.3%; 95% CI, 3.6%-13.0%). The institutions' LGBT content was rated as "fair" at 58 schools (43.9%; 95% CI, 35.5%-52.4%). Suggested successful strategies to increase content included curricular material focusing on LGBT-related health and health disparities at 77 schools (58.3%, 95% CI, 49.9%-66.7%) and faculty willing and able to teach LGBT-related curricular content at 67 schools (50.8%, 95% CI, 42.2%-59.3%).The median reported time dedicated to LGBT-related topics in 2009-2010 was small across US and Canadian medical schools, but the quantity, content covered, and perceived quality of instruction varied substantially.

  View details for Web of Science ID 000294542600015

  View details for PubMedID 21900137