Journal articles on the topic 'Hispanic American lesbians'

This review seeks to synthesize the current state of knowledge regarding gender differences in rates of physical and psychological intimate partner violence (IPV) prevalence among the four largest racial/ethnic groups in the United States, compares rates of physical and psychological IPV between sexual minorities and heterosexuals and among subgroups of sexual minorities (gay men, lesbians, bisexuals), and summarizes correlates and risk factors that are associated with rates of IPV in both ethnic and sexual minorities.A systematic search of the published literature in the past 40 years using various search engines (e.g., PubMed, PsycINFO, and Web of Science) was conducted. The review identified 55 studies that met criteria. Few gender differences in rates of physical and psychological aggression were found among African American, Hispanic American, Asian American, and Native American men and women. Psychological aggression was most frequently reported. Bidirectional violence, which primarily took the form of minor aggression, was the most frequently reported form of physical violence. When unidirectional aggression was assessed, it was more likely to be female perpetrated, particularly among African Americans. These gender patterns were consistent across general population, student, and community studies. Respondents who reported a history of same-sex cohabitation and those who identified as sexual minorities reported higher rates of IPV than those who reported only a history of opposite-sex cohabitation and those who identified as heterosexual.Regarding sexual minority subgroup differences, bisexuals appeared to be at a greater risk of IPV, and victimization among transgendered individuals has largely been neglected in the literature. Substance abuse and use, marginalized socioeconomic status in the form of family and neighborhood poverty, and exposure to violence during childhood as a witness or victim of violence in the family of origin were consistently linked to elevated rates of IPV. Associations also were found between level of acculturation and minority stress in the form of internalized homophobia and frequency of discrimination based on sexual orientation. However, the complex association among these variables was less clear across racial groups and sexual orientation. Research limitations and future research directions are discussed.

Introduction: Low stress is one of many plausible mechanisms that may explain the health effects of educational attainment. However, Marginalization-related Diminished Returns (MDRs) refer to the weaker health effects of educational attainment for marginalized, compared to privileged, groups. We are unaware of any previous studies that have compared Asian and non-Hispanic White Americans for the effects of educational attainment on perceived economic stress. The aim was to compare Chinese and non-Hispanic White Americans for the association between educational attainment and perceived economic stress in a national sample of American adults. This is important given stress is a risk factor for poor health. Methods: This study analyzed cross-sectional data of 20,793 adults who participated in the National Health Interview Survey (NHIS 2015). From all participants, 403 individuals were Chinese Americans, and 20,390 were non-Hispanic Whites. Perceived economic stress was the outcome of interest. Years of education (educational attainment) was the predictor variable of interest. Gender, age, region, marital status, sexual orientation (i.e., lesbian, gay, bisexual, and transgender (LGBT)), and immigration status were covariates. Race/ethnicity was the effect modifier. Results: Overall, higher educational attainment was associated with lower levels of perceived economic stress. A statistically significant interaction showed that the effect of educational attainment on reducing perceived economic stress is smaller for Chinese Americans than Non-Hispanic Whites. Conclusion: Educational attainment is not similarly protective against perceived economic stress across all social groups. Thus, perceived economic stress may explain why ethnic minorities and immigrants gain decreased benefits from their educational attainment than the mainstream and privileged social group.

The epidemiology of the HIV/AIDS epidemic in the United States has focused research attention on lesbian, gay, bisexual and transgendered communities as well as on racial and ethnic minorities. Much of that attention has, however, been focused on specific racial and ethnic groups, and specific sexual minorities. We report on the results of a study that examined the association between condom use and partnership types among men from four major racial/ethnic groups. Self-reported data on sexual identity (homosexual, bisexual, and heterosexual) and condom use in the past three months were collected from 806 African Americans, Hispanic, Asian, and white men intercepted in public places in Houston, TX. Data indicated that condom use was lowest in African Americans and Hispanic men, bisexual men reported the highest levels of use, with heterosexual men reporting the lowest use. African Americans and Hispanic men reported generally that it was very difficult to use a condom during sexual contact, although the patterns for self-identified homosexual, heterosexual, and bisexual men varied across race/ethnicity. Homosexual African American men reported the least difficulty, and white homosexual men the most difficulty compared with heterosexual and bisexual peers. For homosexually identified men, there were considerable differences across race/ethnicity in the proportion of partners who never or rarely disagreed to use condoms, with Asians disagreeing least, and African Americans most. Within racial/ethnic groups, the levels of condom use and difficulty were similar for male and female partners, suggesting that it is sexual identity, rather than partner gender, that has impacted condom-use messages. These data suggest that racial/ethnic targeting of condom use is likely to be most efficacious in increasing condom use in men.

Background: Educational attainment is one of the strongest determinants of subjective health and well-being. Minorities’ Diminished Returns, however, suggests that such an effect may be smaller for the members of racial/ethnic minorities such as Blacks and Hispanics relative to non-Hispanic Whites. Only one study has previously shown that minorities’ diminished returns may also apply to lesbian, gay, and bisexual (LGB) individuals; however, that study has focused on other outcomes (i.e., obesity). Aims: To compare LGB and non-LGB American adults for the effects of educational attainment on subjective health and well-being. Methods: This cross-sectional study used baseline data of 31,480 adults in the Population Assessment of Tobacco and Health (PATH, 2013), a nationally representative study in the United States. The independent variable was educational attainment. The dependent variable was subjective health and well-being, measured using four items. Race, ethnicity, age, gender, poverty status, and employment were the covariates. LGB status was the moderator. Results: Overall, individuals with higher educational attainment had better subjective health and well-being. We found a significant interaction between LGB status and educational attainment which was suggestive of that the boosting effect of high educational attainment on better subjective health and well-being was systemically smaller for LGB than non-LGB individuals. Conclusions: In the United States, highly educated LGB adults experience poor subjective health and well-being, a status that is disproportionate to their educational attainment.

Abstract Introduction: Sexual and gender minorities, referred to here as LGBTQIA+ individuals, experience several barriers to healthcare, including: discrimination from healthcare providers based on their sexual orientation, historical and systematic stigmatization from the healthcare community, and a lack of understanding around gender-based healthcare concerns from their providers. Such structural barriers have been understudied when considering cancer prevention interventions, such as vaccinations or screening. Most importantly, there is limited research on how best to promote the uptake of these interventions among the LGBTQIA+ community while addressing these barriers in healthcare. This study explored provider-related communications around cervical cancer screening for LGBTQIA+ individuals with a cervix. Methods: Using social media and outreach through community partners, we recruited 22 participants from New Mexico’s LGBTQIA+ community and conducted five discussions in two online formats (an itracks discussion board and a zoom video call) with the following groups: (1) lesbians; (2) bisexual and non-binary individuals; and (3) transgender and genderqueer individuals. Discussions focused on preventive health care and cervical cancer screening. Each discussion was audio recorded and transcribed. Study team members used a grounded theory approach to identify emergent themes. Results: Of the 22 participants, most were in the 31-40-year age group and nine (40%) participants identified as either Hispanic or African American. Almost 80% said they had a primary care provider, and all but two participants had screened for cervical cancer. In analyzing their experience around cervical cancer screening, three key themes emerged. First, many participants acknowledged that cervical cancer screening tests are effective and an important prevention tool for reducing their risk from cancer, often reasoned through cancer experiences of their family and friends. Second, several participants noted uninformed, insensitive, and awkward experiences around cervical health. Participants recounted providers who told them that they “didn’t need screening as I was only sleeping with other women” or “every time I go to a provider, I have to explain what queer is” or providers making “inappropriate comments about my sex life.” Finally, participants noted that although the screening procedure can be “physically unpleasant,” having providers that acknowledge the discomfort, actively empathize with patients, ensure they are “feeling safe and having a comfortable space”, and give patients some control during the screening procedure (i.e., allowing patient to insert the speculum themselves or using different sized speculums) could reduce the barriers towards improving cervical cancer screenings. Conclusion: Study analyses reveal the need for supplementing ongoing provider trainings around sexual and gender minority health with specific information around cervical health, to reduce the misinformation and anxiety experienced by many LGBTQIA+ members in the community. Citation Format: Prajakta Adsul, Kendal Jacobson, Joe Rodman. How should providers communicate around cervical cancer screening with LGBTQIA+ individuals with a cervix? “Be real, be caring…and actually listen to me” [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B006.

Context: The 2022 United States mpox outbreak disproportionately affected racial and ethnic minority gay, bisexual, and other men who have sex with men. Program: We utilized surveillance data and vaccination registries to determine whether populations most impacted by mpox in Alameda County received JYNNEOS vaccines and tecovirimat (TPOXX) during June 1-October 31, 2022. Implementation: Alameda County Public Health Department responded to the mpox epidemic through partnerships with local health care providers who serve communities disproportionately affected by mpox. Evaluation: During June 1-October 31, 2022, a total of 242 mpox cases were identified in Alameda County. Mpox incidence rates per 100 000 were highest among Black/African American (35.7; 95% confidence interval [CI], 26.8-46.5) and Hispanic/Latinx (25.1; CI, 20.1-30.9) residents, compared to Asian (3.8; CI, 2.3-5.9) and White (10.5; CI, 7.7-13.9) residents. Most confirmed cases were identified as gay, lesbian, or same-gender-loving (134, 67.3%) and bisexual (31, 15.6%); 226 (93.8%) cases were male. Sixty-nine (28.5%) mpox patients received TPOXX. There were no statistically significant differences in demographic and clinical characteristics of mpox cases when compared by TPOXX receipt status. JYNNEOS vaccine was received by 8277 Alameda County residents. The largest proportion of vaccinees were White residents (40.2%). Administration rates per 100 000 men who have sex with men were lowest among Asian and Hispanic/Latinx individuals, at 8779 (CI, 8283-9296) and 14 953 (CI, 14 156-15 784), respectively. Black/African American and Hispanic/Latinx males had the lowest vaccination-to-case ratios at 16.7 and 14.8, respectively. Discussion: Mpox disproportionately affected Black/African American and Hispanic/Latinx men who have sex with men in Alameda County. Strong partnerships with local health care providers ensured that persons with mpox received TPOXX treatment when indicated. However, higher JYNNEOS vaccine uptake in Black and Latinx communities needs improvement through ongoing and meaningful engagement with Black/African American and Hispanic/Latinx gay, bisexual, and transgender communities.

Objectives We explored barriers to healthcare as perceived by members of medically and socially disenfranchised communities. Methods. We conducted focus groups with 28 women and 32 men from Northeast Ohio who identified themselves as African-American, Hispanic/Latino, lesbian/gay/bisexual/transgendered, and/or Russian immigrant. Results Participants described their experiences of waiting, things they won't tolerate, when they won't participate, and what they want from providers. They described behaviors, actions and relationship characteristics that they want from their providers and characteristics that they prefer in health systems. Conclusions The themes of Wait, Won't, and Want have healthcare practice and policy implications. Patient-provider interactions are known to be significant determinants of healthcare outcomes and these exploratory findings suggest that they might also affect patient self-management strategies. Future efforts should focus on developing and testing patient-centered strategies that address the themes identified to increase engagement to increase self-management of health.

Background: Education level is one of the strongest protective factors against high-risk behaviors such as cigarette smoking. Minorities’ Diminished Returns (MDRs), however, suggest that the protective effects of education level tend to be weaker for racial and ethnic minority groups relative to non-Hispanic White people. Only two previous studies have shown that MDRs may also apply to lesbian, gay, and bisexual (LGB) individuals; however, these studies have focused on outcomes other than tobacco use. Aims: To compare LGB and non-LGB American adults for the effects of education level on cigarette-smoking status. Methods: Population Assessment of Tobacco and Health (PATH; 2013) entered 31,480 American adults who were either non-LGB (n = 29,303, 93.1%) or LGB (n = 2,177; 6.9%). The independent variable was education level. The dependent variable was current established cigarette smoking. Race, ethnicity, age, gender, poverty status, employment, and region were the covariates. LGB status was the moderator. Results: Overall, individuals with higher education level (odds ratio (OR) = 0.69) had lower odds of current established smoking. We found a significant interaction between LGB status and education level suggesting that the protective effect of education level on smoking status is systemically smaller for LGB people than non-LGB individuals (OR for interaction = 1.19). Conclusions: Similar to the patterns that are shown for racial and ethnic minorities, MDRs can be observed for the effects of education level among sexual minorities. In the United States, highly educated LGB adults remain at high risk of smoking cigarettes, a risk which is disproportionate to their education level. In other terms, high education level better helps non-LGB than LGB individuals to avoid cigarette smoking. The result is a relatively high burden of tobacco use in highly educated LGB individuals.

ImportanceAn understanding of the intersectional effect of sexual identity, race, and ethnicity on disparities in cardiovascular health (CVH) has been limited.ObjectiveTo evaluate differences in CVH at the intersection of race, ethnicity, and sexual identity using the American Heart Association’s Life’s Essential 8 measure.Design, Setting, and ParticipantsThis cross-sectional study was conducted from July 27 to September 6, 2023, using National Health and Nutrition Examination Survey data from 2007 to 2016. Participants were noninstitutionalized, nonpregnant adults (aged 18-59 years) without cardiovascular disease or stroke.ExposuresSelf-reported sexual identity, categorized as heterosexual or sexual minority (SM; lesbian, gay, bisexual, or “something else”), and self-reported race and ethnicity, categorized as non-Hispanic Black (hereafter, Black), Hispanic, non-Hispanic White (hereafter, White), and other (Asian, multiracial, or any other race and ethnicity).Main Outcome and MeasuresThe primary outcome was overall CVH score, which is the unweighted mean of 8 CVH metrics, assessed from questionnaire, dietary, and physical examination data. Regression models stratified by sex, race, and ethnicity were developed for the overall CVH score and individual CVH metrics, adjusting for age, survey year, and socioeconomic status (SES) factors.ResultsThe sample included 12 180 adults (mean [SD] age, 39.6 [11.7] years; 6147 [50.5%] male, 2464 [20.2%] Black, 3288 [27.0%] Hispanic, 5122 [42.1%] White, and 1306 [10.7%] other race and ethnicity). After adjusting for age, survey year, and SES, Black (β, −3.2; 95% CI, −5.8 to −0.6), Hispanic (β, −5.9; 95% CI, −10.3 to −1.5), and White (β, −3.3; 95% CI, −6.2 to −0.4) SM female adults had lower overall CVH scores compared with their heterosexual counterparts. There were no statistically significant differences for female adults of other race and ethnicity (β, −2.8; 95% CI, −9.3 to 3.7) and for SM male adults of any race and ethnicity compared with their heterosexual counterparts (Black: β, 2.2 [95% CI, −1.2 to 5.7]; Hispanic: β, −0.9 [95% CI, −6.3 to 4.6]; White: β, 1.5 [95% CI, −2.2 to 5.2]; other race and ethnicity: β, −2.2 [95% CI, −8.2 to 3.8]).Conclusions and RelevanceIn this cross-sectional study, CVH differed across race and ethnicity categories in SM females, suggesting that different communities within the larger SM population require tailored interventions to improve CVH. Longitudinal studies are needed to identify the causes of CVH disparities, particularly in Black and Hispanic SM females and inclusive of other racial and ethnic identities.

11000 Background: Burnout is a concern in medicine with negative effects on physician wellbeing, workforce retention, and patient outcomes. Research has shown that rising burnout can lead to medical errors, lower patient satisfaction, and decreased professional work effort. The presence of burnout in oncology is well documented, however it is unclear if burnout affects all groups equally in academic oncology. Methods: We obtained national faculty data from the Association of American Medical Colleges StandPoint Faculty Engagement Survey, conducted 2017-2020 (overall response rate 64%). Burnout was considered any response endorsing at least “one or more symptoms of burnout”. Self-reported workplace culture was assessed for key factors: collegiality, diversity, faculty wellness, and recruitment/retention of underrepresented in medicine (UiM) faculty. Faculty demographics included age, sex, race/ethnicity, sexual orientation (heterosexual, bisexual, lesbian/gay), rank, degree, and any department or institutional leadership role. Multivariate analysis (MVA) identified factors associated with faculty burnout. Results: A total of 724 academic oncologists were identified. Most were male (58%) and identified as heterosexual (95%). Race/ethnicity were mostly White (65%), with 29% Asian, 2% Black, and 3% Hispanic/Latino; 7% were considered UiM. Most (53%) were senior faculty; 37% had a leadership role. Overall, 22% reported burnout. Self-identified lesbian/gay/bisexual faculty had the highest rate of burnout (43% vs 21%, p = 0.0005) followed by female faculty (31% vs 16% men, p = < 0.0001). Asian faculty had the lowest burnout rates (12%) followed by White and Hispanic (both 26%), Black (33%), and multi-racial physicians (50%, p = 0.003 for comparisons). Pooled UiM had numerically higher burnout but this was not statistically significant (30% vs 22%, p = NS). On MVA, lesbian/gay/bisexual (OR = 3.56, 95%CI 1.55-8.18, p = 0.003) and female (OR = 2.32, 95%CI 1.51-3.56, p < 0.0001) faculty had increased odds of burnout. Most agreed that their institution cultivates collegiality (80%), diversity (73%), and faculty wellness (53%); men were more likely to endorse positive diversity (77% vs 68% women, p = 0.004). Most agreed their institution was successful in recruiting (63%) and retaining (58%) UiM faculty, however non-UiM were more likely to agree with this for recruitment (64% vs 46% UiM, p = 0.01) and retention (50% vs 42% UiM, p = 0.01). Conclusions: Nearly 1 in 4 oncologists report burnout with self-identified female and lesbian/gay/bisexual faculty at the highest risk. Additionally, in general, men and non-UiM faculty were more likely to feel their workplace culture was favorable. Urgent and tailored interventions at the institutional and departmental level will be critical to address both drivers of faculty burnout and the impact of burnout on attrition and career trajectory for marginalized and minoritized groups.

This investigation was conducted through the support of the College Misericordia Diversity Institute and a grant from the Blue Ribbon Foundation of Blue Cross of Northeastern Pennsylvania. Focus group participants were 49 adults from seven minority populations residing in northeastern Pennsylvania’s Luzerne and Lackawanna counties. Data was collected by 11 focus group leaders who were members of a Blue Ribbon Grant Core Committee at College Misericordia in 2004. The seven populations studied were African Americans, Arabic Muslims, Asian-Chinese and Korean, Gay and Lesbian, Hispanic, Jewish, and Asian Indian. A 30-question survey was used to collect data during one to two hour focus group interviews. Through content analysis, six problematic issues faced by many of the participants were identified. All of the findings were validated by a review process. The six issues faced by the 7 groups were: 1) Economics, Education, and Employment Influence Life for Newcomers, 2) Customs and Traditions Sometimes Sacrificed- The Influence of American Culture, 3) Socialization Often Limited to Same Population Group, 4) Mixed Acceptance Level from Area Natives, 5) Bilingual Challenges Impede Optimal Inclusion, 6) Health Care Access Problems. The aforementioned cross-groups study is explored in this report. The study also yielded seven other reports (one for each diverse population) which provide a description of that particular focus group’s perspective on topics such as religion, food, family, customs, and health care (see Appendices A, B, C, D, E, F, and G). Findings of this study are being disseminated in a local effort to educate health care professionals. Future research will be needed to determine if progress is being made in fulfilling the health care needs of all diverse populations living in Luzerne and Lackawanna County, as well as other parts of northeastern Pennsylvania.

Abstract Body donation for medical education is voluntary and open to all; however, it is undetermined if the donors studied at UMass Medical School (UMMS) are demographically representative of the national patient population. If not, medical students are missing the opportunity of experiencing normal variation within the population, which may promote bias in their clinical years. This cross-sectional study compared data from the UMMS Anatomical Gift Program (AGP) with the Health and Retirement Study (HRS) population data. This study examined sex, race, ethnicity, veteran status, and sexual orientation. 5 years (n=540) of AGP data and 3 waves (n=5,037) of HRS data were examined. The results demonstrate that sex differences between the AGP and HRS populations (55% for females vs. 45% for males; p=.10) are NOT significant. A significant racial difference between populations is noted (p=.000), with 98.3% of the AGP vs. 72.7% of the HRS identifying as white. Veterans are overrepresented in the AGP (22.6% AGP vs. 9.6% HRS; p=.000). 12.3% of HRS participants report Hispanic ethnicity compared to 0% in the AGP. In 2016, HRS included sexual orientation, with 92.7% of respondents identifying as heterosexual, 2.6% gay or lesbian, 1.0% bisexual and 1.3% other. No data were collected by the AGP pertaining to sexual orientation and neither database ask about gender identity. Aging populations are not represented in the anatomy labs at UMMS and likely nationally. Efforts are needed to improve this and enhance the education of the medical professionals, while expanding the end-of-life options for all community members.

Background: Tecovirimat (TPOXX) is an antiviral drug only available via an Expanded Access Program (EAP) investigational new drug protocol and is recommended for treatment of select patients with monkeypox (mpox) infection. Alameda County Public Health Department prioritizes health equity but does not have a dedicated public health clinic. Therefore, we partnered closely with local healthcare providers that serve communities disproportionally impacted by mpox to ensure there was access to TPOXX. Using data collected during the outbreak we assessed whether populations in Alameda County most affected by mpox received treatment. Methods: We describe Alameda County patients with confirmed or probable mpox who received TPOXX during June–October 2022. Data were collected from case investigation interviews with patients and state-wide reportable disease database(s), which included demographic, clinical, and behavioral information. Confidence intervals (CIs) were calculated using the exact method for Poisson counts. We compared characteristics of mpox patients who received and did not receive TPOXX using the Pearson χ2 or Fisher exact test. P < .05 was considered significant. Results: Mpox case rates in Alameda County were highest among Black or African-American residents (35.6 per 100,000, 95% CI, 26.7–46.4) and Hispanic or Latinx residents (25.2, 95% CI, 20.2–31.0) compared to Asian residents (3.9, 95% CI, 2.3–6.1) and white residents (10.4, 95% CI, 7.7–13.9) residents. Among 242 mpox patients, 69 patients (28.5%) received TPOXX. The distribution of demographic and clinical characteristics among patients who received TPOXX was not significantly different than among those who did not, including residents aged 31–40 years (36.2% vs 34.7%), Black or African-American residents (20% vs 26.3%), Hispanic or Latinx residents (38.5% vs 41%), male residents (89.9% vs 95.3%), gay, lesbian, or same-gender loving residents (67.2% vs 67.4%) in the city of Oakland (63.2% vs 61.5%), or residents with human immunodeficiency virus infection (43.5% vs 36.6%). Conclusions: During the Alameda County mpox outbreak, nearly one-third of patients received TPOXX. Demographic and clinical characteristics were similar among TPOXX recipients and nonrecipients. A proactive approach to obtaining TPOXX in Alameda County and strong relationships with local providers may have allowed for treatment to be accessible to mpox patients. Regular review of outbreak data can inform public health activities, ensure health equity, and help refine local response efforts.Disclosures: None

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.

Abstract Objectives To describe food insecurity, diet quality, and barriers to healthy eating during the COVID-19 pandemic among adults who identify as lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI) and live in Newark, NJ. Methods This pilot study utilized a cross-sectional design with a web-based survey, and participants provided informed consent. Food insecurity was assessed using the United States Department of Agriculture's validated 6-item short-form food security module. Diet quality was assessed using the PrimeScreen questionnaire [score range 0–42, with higher scores indicating better diet quality]. Frequencies and percentages were used to describe the results. Results Of the 50 participants, 60% were &lt;30 years old; 81.6% were assigned male sex at birth, 56% identified as male, 36% were Hispanic, and 73.3% were Black or African American. A third (32%) were unemployed, and 56% reported a loss of finances due to the pandemic. Forty percent of the sample were food insecure, and 64% had low diet quality scores of between 11 and 20. More than half (68%) reported a worsening of their diet due to the pandemic, and 58% reported the cost of healthy food as a barrier. Conclusions High food insecurity and poor diet quality were observed in this study. Participants also identified the high cost of healthy food as a barrier to healthy eating. Funding Sources Research reported in this publication was supported by the National Center for Advancing Translational Sciences (NCATS), a component of the National Institute of Health (NIH) under award number UL1TR003017. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

Introduction: Studies of cardiovascular disease (CVD) in sexual minority (SM) women (i.e., lesbian, bisexual) vs. heterosexual women are limited by small sample sizes and lack of objective CVD ascertainment. Small samples also hinder study at the intersection of race and sexual orientation on CVD events. We used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender Electronic Health Record cohort to fill these knowledge gaps. Methods: We studied 132,571 female cisgender veterans who were free of prevalent CVD and classified as SM or non-SM by a natural language processing tool. We defined incident CVD as first instance of AMI, ischemic stroke, cardiac revascularization, or CVD death between baseline and date of death or 8/31/22. We stratified sample statistics by SM status and race. We used Cox proportional hazards regression to assess the intersection of sexual orientation and race with incident CVD; we adjusted for Hispanic ethnicity and age. Based on the minority stress model, non-SM White women were the referent. Results: Within races, traditional CVD risk factors were similarly distributed by SM status but SM women had greater prevalence of stress-associated characteristics like substance use, depression, and anxiety. Regardless of sexual orientation, Asian women had lower CVD risk than non-SM White women, while Black/African American women had persistently increased CVD risk ( Table ). White lesbians had increased CVD risk vs. their non-SM counterparts. Unclassified SM women of American Native race or multiple races also had increased CVD incidence vs. non-SM White women. Conclusion: This is one of the first studies to examine the intersection of sexual orientation and race on CVD risk in female veterans. CVD risk appears increased or decreased in certain racial groups regardless of sexual orientation but this is not always true and invites further study into the mechanisms by which stress results in inequitable CVD events across groups.

Introduction: As a psychosocial stressor, intersectional discrimination may contribute to adverse cardiovascular/stroke health for racial/ethnic LGBTQ (Caceres et al., 2019). This study tested this by examining the associations of intersectional discrimination and microaggressions as unique predictors of stroke risk in a sample of racial/ethnic LGBTQ. Method: Racial/ethnic LGBTQ ( N = 307) were recruited online and completed the LGBT PoC microaggression scale (LGBT-PCMS), the Intersectional Discrimination Index (InDI), and the Perceived Stroke Risk subscale of the ABCD Risk Questionnaire for this study. To account for high depression levels typically found in online samples (Ophir et al., 2019), depression (measured by the Patient Health Questionnaire-9) was included as a covariate. A hierarchical linear regression model was used, with depression (i.e., PHQ-9) in block 1, intersectional microaggressions subscales of the LGBT-PCMS in block 2, and intersectional discrimination subscales of the InDI in block 3 to predict stroke risk. Results: Participants were 19-68 years of age ( M = 34.63, SD = 9.91), majority Cisgender (92%), with 6% Transgender, and 2% Genderqueer/Gender Non-Conforming. Most were Bisexual (76%), with 14.6% identifying as Gay, 8.7% as Lesbian, and .7% as Heterosexual. The sample was 72% Hispanics, 17.2% non-Hispanics Black, 6.5% non-Hispanic Asians, 2.6% Native American/American Indians, and 1.7% identifying as two or more Hispanic groups. For block 1, depression was positively and significantly associated with stroke risk ( β = .612, p < .001). In block 2, above and beyond depression, the LGBT PoC heterosexism subscale of the LGBT-PCMS was positively and significantly associated with stroke risk ( β = .216, p =.015). In block 3, anticipated intersectional discrimination ( β =.241, p < .001) and major intersectional discrimination ( β =.265, p < .001) of the InDI were positively and significantly associated with stroke risk. Discussion: Findings provide evidence for overt and covert intersectional discrimination as unique predictors of perceived stroke risk for this racial/ethnic LGBTQ (majority Hispanic and Black Bisexual) sample.

BackgroundIn both Sweden and the USA, smokeless tobacco (ST) is legal and used predominantly by men. Starting in the 1970s, US tobacco companies attempted to expand the ST market to women, African Americans, Hispanic Americans and lesbian, gay, bisexual, transgender, queer and other sexual orientation (LGBTQ+) people.DesignWe analysed industry documents from the Truth Tobacco Industry Documents Library triangulating findings with recent ST advertising and publicly available literature.FindingsWe found tobacco companies used design innovations such as pouched moist snuff, snus and dissolvable products to expand the market. In addition, diverse advertising campaigns targeted women, people of colour (Hispanic, African American) and LGBTQ+ communities with identity-targeted messages emphasising novelty, convenience, cleanliness and use in smoke-free environments. However, stereotypes of ST users as rural white males endured, perpetuated by continued marketing aimed at this customer base, which created cognitive dissonance and stymied marketer’s hopes that pouch products would ‘democratize’ ST.ConclusionThese failed campaigns suggest novel products such as nicotine pouch products may provide a ‘clean slate’ to similarly target women and other low-ST-using groups. Based on this history, the risk of new tobacco and nicotine products to increase health disparities should be closely monitored.

AbstractNegative attitudes toward Lesbian, Gay, and Bisexual (LGB) individuals leads to a perceived inability of LGB individuals to foster ‘appropriate’ family relationships, inciting negative attitudes specifically toward same-sex parenting. Intergroup and interpersonal relationships play a critical role in fostering attitudes toward others wherein type of contact, frequency, degree of closeness in the relationship, and the positivity/negativity of interactions are potential mediator of these relations, Moreover, the mechanism behind co-constructing positive relationships with sexual and gender minorities is comfort with contact with LGB individuals. The present study explored the effects of interpersonal contact and the mediator role of comfort with LGB people in explaining attitudes toward same-sex parenting in Spanish-speaking countries in North, Central, and South America. These countries are of particular interest given the dearth of research in the region on attitudes toward same-sex parenting as well as the varying degrees of acceptance of and protections for same-sex parented families. A non-probabilistic sample of 1955 heterosexual cisgender participants from 14 countries was asked to complete a series of sociodemographic questions, a questionnaire about their interpersonal contact/comfort experiences with LGB people, and the Attitudes Toward Gay and Lesbian Parenting Scale. Results showed that comfort was vital in fostering accepting attitudes toward Same-Sex Parenting across countries. Findings also suggested that comfort with LGB people has a particularly powerful influence in regions with less legal and cultural acceptance of LGB individuals. Policies are not enough to instill widespread change: we must encourage, facilitate, and supervise the formation of relationships with LGB people.

Introduction: Disparities exist in cardiovascular health (CVH) by sexual identity and race/ethnicity separately, however an understanding of the intersectional effect of these identities has been limited. Objective: To evaluate differences in ideal CVH, as captured in the American Heart Association’s Life’s Essential 8 framework, across race/ethnicity and sexual identity. Methods: This study used data from the National Health and Nutrition Examination Survey (NHANES, 2007-2016). Non-institutionalized adults (18-59 years) without a history of cardiovascular disease/stroke and who were not pregnant at the time of the interview were included. Self-reported race/ethnicity was categorized as non-Hispanic Black (hereafter Black), Hispanic, non-Hispanic White (hereafter White), and another race. Self-reported sexual identity was categorized as straight and sexual minority (SM), which encompassed those who identified as lesbian, gay, bisexual, or something else. The primary outcome was total CVH score (range 0 -100), which is the unweighted average of 8 CVH components, assessed using questionnaire, dietary, and physical examination data. Sex-stratified regression models were developed for the overall CVH score and CVH components, adjusting for age and study year. Results: The sample included 12,256 adults (mean age 39.6 years [SD 11.7]). While Black (ß= -4.9, 95% CI -7.7, -2.0), Hispanic (ß= -4.9, 95% CI -9.6, -0.2), and White (ß = -5.9, 95% CI -8.8, -3.0) SM female adults had lower total CVH scores compared to their straight counterparts, female participants of another race and SM male adults of any race/ethnicity did not. Black SM female individuals had less favorable nicotine (ß= -20.9, 95% CI -32.3, -9.4) and blood pressure (ß= -7.2, 95% CI -13.8, -0.6) scores compared with Black straight females. Hispanic SM female individuals had less favorable body mass index scores (ß= -15.6, 95% CI -28.0, -3.2) compared with Hispanic straight females. Conclusions: CVH differed across racial/ethnic identities in SM females but not SM males. Longitudinal studies are needed to identify mechanisms driving CVH disparities in Black and Hispanic SM females.

Background: The lesbian, gay, bisexual, and transgender (LGBT) population makes up approximately 6% of the total United States (US) population. Levels and patterns of food insecurity in the LGBT population during the COVID-19 pandemic compared with the general population are unknown. This study examines prevalence and sociodemographic correlates of food insecurity among LGBT and straight/heterosexual adults in the US. Methods: Using the US Census Bureau’s Household Pulse Survey from July to October 2021 (N=372,542), differentials in food insecurity according to LGBT status were analyzed by multivariate logistic regression. Results: The prevalence of food insecurity during the pandemic was 25.6% for transgender adults aged ≥18, significantly higher than that for lesbian/gay adults (11.6%), bisexual adults (13.5%), and straight/heterosexual adults (7.8%). Compared with the straight/heterosexual population, LGBT adults had lower education and income levels and higher unemployment and were more likely to be non-Hispanic White and single. Transgender adults were particularly disadvantaged with respect to socioeconomic status, job loss, and lack of health insurance. After controlling for socioeconomic and demographic covariates, lesbian/gay, bisexual, and transgender adults experienced, respectively, 36%, 35%, and 157% higher odds of food insecurity than straight/heterosexual adults. Black/African American, Hispanic, and mixed-race/ethnicity, lower education and income, lack of homeownership, divorce/separation, lack of health insurance, and recent job loss were significant predictors of food insecurity among LGBT adults. Inequalities in food insecurity by LGBT status were similar in large metropolitan areas. Conclusions and Implication for Translation: Significant disparities in food insecurity exist withLGBT adults, particularly transgender adults, at substantially increased risk of experiencing food insecurity, economic hardship, and social disadvantage during the pandemic and likely in greater need of social and public assistance. Health policies aimed at improving the social and material conditions may lead to improved food security and health outcomes among LGBT adults and the general US population. Copyright © 2022 Singh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Abstract Background 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. Methods 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. Results 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. Conclusions 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.

Abstract Background The subspecialty of Hospital Medicine (HM) has grown rapidly since the mid-1990s. Diversity and inclusion are often studied in the context of healthcare equity and leadership. However, little is known about the factors potentially associated with choosing this career path among US medical students. Methods We analyzed the results of the Annual Association of American Medical Colleges Survey administered to Graduating medical students from US medical schools from 2018 to 2020. Results We analyzed 46,614 questionnaires. 19.3% of respondents (N = 8,977) intended to work as a Hospital Medicine [HM] (unchanged from 2018 to 2020), mostly combined with specialties in Internal medicine (31.5%), Pediatrics (14.6%), and Surgery (9.1%). Students interested in HM were significantly more likely to identify as female, sexual orientation minorities (Lesbian/Gay or Bisexual), Asian or Black/African-American, or Hispanic. Role models and the ability to do a fellowship were strong factors in choosing HM, as was higher median total debt ($170,000 vs. $155,000). Interest in higher salary and work/life balance negatively impacted the likelihood of choosing HM. There were significant differences between students who chose IM/HM and Pediatrics/HM. Conclusion About one in five US medical students is interested in HM. The probability of choosing future HM careers is higher for students who identify as sexual or racial minorities, with a higher amount of debt, planning to enter a loan forgiveness program, or are interested in doing a fellowship.

Abstract Background Bacterial Vaginosis (BV) is a common pathological vaginal condition in women and is disproportionately higher among Black (33%) and Hispanic women (31%) than among non-Hispanic White (23%) or Asian women (11%). BV can have highly distressing impacts on women, yet the role of social support has received limited attention. This paper aimed to explore women's experiences of social support for BV. Methods We conducted semi-structured interviews with women (n = 41) aged 18 years or older and who had a BV diagnosis in the past year. Interviews examined women's infection history and symptoms, BV management approaches, the impact of BV on women's lives, and BV clinical care experiences. Qualitative data were analyzed with an a priori coding framework based on key domains, followed by open-coding to uncover emergent themes. Results The majority of participants were Non-Hispanic Black/African American (63.4%). Nearly a quarter (22.0%) of participants identified as lesbian or bisexual or reported having sex with a woman in the past year. Most women with BV expressed feelings of shame. Many women noted a lack of social support, particularly from sexual partners, which might lead to relationship mistrust and blame for the infection. Sexual partners’ inadequate knowledge of BV resulted in women's reluctance to discuss their diagnosis and avoidance of sexual activities. Supportive partners or friends helped women recognize BV infection and seek treatment earlier, provided emotional support and reduced feelings of isolation. In addition, women reported receiving greater support and care from sexual health clinics than from other healthcare settings. Conclusions The study highlights the importance of social support in women's experiences of BV. Findings imply that enhancing sexual partners’ understanding of BV, fostering open-dialogues among women, and promoting empathetic healthcare systems can potentially improve women's emotional well-being and overall BV experiences. Key messages • The study highlights the importance of social support in women’s experiences of BV. • Enhancing sexual partners’ understanding of BV, fostering open-dialogues among women, and promoting empathetic healthcare systems can potentially improve women’s overall BV experiences.

Background: Although studies have found that cigarette smoking is more prevalent among persons who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) compared to persons who identify as heterosexual, limited research has examined tobacco use among LGBTQ individuals of different racial and ethnic backgrounds. Methods: During summer 2016, the AHA-Tobacco Regulation and Addiction Center (A-TRAC) Project 3 conducted 27 focus groups and 196 surveys in Chicago, New York City and San Diego with smokers and non-smokers. Study inclusion criteria were self-identifying as LGBTQ and White Non-Hispanic (WNH), African American (AA), or Hispanic/Latino (H/L). Our study aim is to examine potential differences in tobacco use by race/ethnicity and factors that may be associated with such differences. Chi-square tests were used for group comparisons using SAS version 9.4. Atlas ti.v 7.5 software was used for qualitative analyses. Results: Study participants were: 23% WNH, 16% AA, and 57% H/L; 60% identified as gay/lesbian, 20% as bisexual, and 20% as members of other groups. Socioeconomic status (SES) of the participants varied by smoking status. More smokers than nonsmokers lived in households with incomes under $20,000/year (50% of smokers vs. 39% of nonsmokers (p.001)) or were unemployed (34% vs. 19% (p.003)). Many participants suggested that easy access to tobacco products (e.g., cigarettes are “cheaper,” “you find single cigarettes sold everywhere") contributed to smoking initiation. Continued tobacco use was often mentioned as a way to deal with stress, such as the stress related to “coming out.” For racial minorities (AAs and H/Ls) compared to NHWs, sources of social stress included discrimination based on race, class, and sexual orientation as well as pressures to respond to community and cultural norms and expectations, such as gender roles (e.g., machismo). AAs and H/Ls also reported more heavy marketing of tobacco in their communities and indicated less knowledge about the risks associated with tobacco use. Racial minorities also expressed preferences for different tobacco products (e.g., cigarettes with menthol) than NHWs. Conclusion: Differences in knowledge, attitudes and perceptions related to tobacco use were found among LGBTQ individuals of diverse racial/ethnic backgrounds. These findings have implications for culturally tailoring health communication campaigns and educational programs for LGBTQs, as well as for low SES groups. The findings also suggest the need for additional tobacco regulatory efforts in populations most vulnerable to tobacco marketing.

Abstract Background Despite increasing studies on mental health among immigrants, there are limited studies using nationally representative samples to examine immigrants’ mental health and its potential biopsychosocial contributing factors, especially during the COVID-19 pandemic. We explored and estimated the influence of life satisfaction, social/emotional support, and other biopsychosocial factors on self-reported anxiety/depression symptoms among a nationally representative sample of first-generation immigrants in the U.S. Methods We conducted a secondary data analysis using the 2021 National Health Interview Survey among first-generation adults aged ≥ 18 years (n = 4295). We applied survey weights and developed multivariable logistic regression model to evaluate the study objective. Results The prevalence of daily, weekly, or monthly anxiety/depression symptoms was 10.22% in the first-generation immigrant population. There were 2.04% daily, 3.27% weekly, and 4.91% monthly anxiety/depression among the population: about 8.20%, 9.94%, and 9.60% experienced anxiety symptoms, whereas 2.49%, 3.54%, and 5.34% experienced depression symptoms daily, weekly, and monthly, respectively. The first-generation population aged 26–49 years were less likely to experience anxiety/depression daily, weekly, or monthly compared to those aged 18–25. Females (versus males) were more likely to experience anxiety/depression daily, weekly, or monthly. Those who identified as gay/lesbian had higher odds of experiencing anxiety/depression daily, weekly, or monthly compared to heterosexual persons. Relative to non-Hispanic White individuals, non-Hispanic Asian, Black/African American, and Hispanic individuals had lower odds, while other/multi-racial/ethnic groups were more likely to experience anxiety/depression daily, weekly, or monthly. A higher life satisfaction score was associated with lower odds of experiencing anxiety/depression daily, weekly, or monthly. Having social/emotional support sometimes/rarely or using healthcare within the past one/two years was associated with experiencing anxiety/depression daily, weekly, or monthly. Conclusions The findings reveal significant burden of anxiety and depression among first-generation population in the U.S., with higher risks among subgroups like young adults, females, sexual minorities, and non-Hispanic White and other/multi-racial individuals. Additionally, individuals with lower life satisfaction scores, limited social/emotional support, or healthcare utilization in the past one or two years present increased risk. These findings highlight the need for personalized mental health screening and interventions for first-generation individuals in the U.S. based on their diversity and health-related risks.

Introduction: Although cardiovascular health (CVH) disparities have been documented among sexual minority (e.g., gay/lesbian, bisexual) adults, research has been limited by a focus on sexual identity differences in individual, rather than composite, measures of CVH. Composite measures of CVH provide more comprehensive assessments of future cardiovascular disease risk. Methods: We analyzed data from the All of Us Research Program to examine sexual identity differences in CVH using the American Heart Association’s Life's Essential 8 measure of ideal CVH. Participants received a score from 0-100 for each CVH metric. We calculated an unweighted average to determine cumulative ideal CVH (range 0-100). Higher scores indicated a more favorable CVH profile. We used sex-stratified multiple linear regression models to estimate differences in individual CVH metrics and cumulative ideal CVH between sexual minority and heterosexual adults. All models were adjusted for age, race, ethnicity, household income, education, and insurance status Results: The sample included 6,597 participants with a mean age of 63.3 years (±13.89) of which 57% were female and 79% were Non-Hispanic White. Lesbian women (B = -7.43, 95% CI = -13.20, -1.65), gay men (B = -6.39, 95% CI = -10.17, -2.61), and bisexual men (B = -7.41, 95% CI = -14.71, -0.10) had less favorable nicotine exposure scores than their heterosexual counterparts of the same sex. Gay (B = -9.65, 95% CI = -16.60, -2.71) and bisexual men (B = -14.12, 95% CI = -27.53, -0.72) had less favorable physical activity scores than heterosexual men. Bisexual men also had lower cumulative ideal CVH scores than heterosexual men (B = -5.22, 95% CI = -9.16, -1.29). In contrast, gay men had more favorable body mass index scores (B = 6.23, 95% CI = 2.24, 10.22) than heterosexual men. Conclusions: This is the first study to examine ideal CVH in sexual minority adults in the All of Us Research Program. Findings have important implications for the development of interventions to promote optimal CVH among middle-aged and older sexual minority adults. Interventions to reduce nicotine exposure are needed for lesbian women and sexual minority men. Efforts to improve the CVH of sexual minority men should also focus on increasing physical activity.

The commercial sexual exploitation (CSE) of children is a consequential public health and criminal justice problem, but no CSE prevention programs have been evaluated. The Boston-based My Life My Choice (MLMC) program offers a multisession psychoeducation group to girls who are identified as “at-disproportionate-risk” for CSE victimization and trains other agencies throughout the U.S. to offer this curriculum. The curriculum was designed to improve knowledge about the commercial sex industry and shift-related attitudes and behaviors. The current project was a multi-year, multi-site evaluation to assess the effectiveness of the MLMC prevention group. Using a one-group longitudinal design, changes in participant behavior and CSE knowledge were measured at baseline ( n = 354), upon group completion ( n = 296), and 3 months after group completion ( n = 241). The sample was 95% female-identified, 28% Black/African American, 26% White/non-Hispanic, 25% Hispanic/Latina, and 22% other race. The mean age of participants was 15.6 years old. Approximately 28% identified as bisexual, and 10% identified as lesbian, asexual, pansexual, or other. In multivariable-adjusted models, participants reported fewer episodes of sexually explicit behavior at follow up as compared to baseline (relative risk [RR]: 0.52, 95% confidence interval [CI]: 0.37-0.72 at Follow-up 1, and 0.53, 95% CI: 0.35-0.82 at Follow-up 2). Participants were 24% less likely to report dating abuse at Follow-up 2 as compared to baseline ( p = .06). In addition, as compared to baseline, participants were 40% more likely to have given help or information about CSE to a friend at Follow-up 2, and participants demonstrated increased knowledge and awareness about CSE and its harms over the follow-up period. Although additional evaluation using a comparison group and long-term follow up would increase confidence that observed changes are attributable to the group instead of other factors, results suggest that the MLMC curriculum may be effective in reducing the risk of CSE and improving other conditions for youth who are at-disproportionate-risk of CSE.

Introduction: We evaluated internet platforms for distributing HIV self-tests (HIVSTs) to Black or African American (Black) and Hispanic or Latino men who have sex with men (MSM) and transgender women (TGW). Methods: We recruited MSM and TGW from general interest, dating, and Lesbian, Gay, Bisexual and Transgender platforms. Two HIVSTs were mailed to all MSM and TGW. Surveys (screening, baseline, 4-month, and results reporting) were completed online. After 4 months, participants were mailed another HIVST and a DBS card. All HIVST interpretations and images of HIVST devices were reported online. Results: Of 2093 MSM and 102 TGW, most were recruited via general interest and dating platforms. Over 50% were 18–29 years of age, most identified as gay or bisexual. 45% had not tested for HIV in the past 12 months. 9.1% of MSM reported a positive (reactive for HIV antibodies) result, with the highest percentage among Black MSM (11.5%). Dating platforms recruited higher percentages of MSM who recorded their HIVST result as positive compared with MSM from general interest platforms during the intervention period (11.9% vs 5.5% (p <0.0001)); and MSM who had never tested for HIV reported a greater percentage of positive results compared with MSM who had been tested for HIV before enrollment (16.1% vs. 7.1%; P<0.0001). MSM were able to correctly interpret and report HIVST results. Of TGW, 7% reported a positive result. Conclusion: Internet dating and general interest platforms can be key to increasing awareness of infection among BMSM, HMSM and TGW persons, including those who do not use existing HIV services.

AbstractAcross studies, intuitive eating is associated with many health indicators. The Intuitive Eating Scale-2 (IES-2), the instrument for measuring intuitive eating, had not previously been explored with a sample of sexual minority [Sexual minority refers to individuals who experience consensual sexual identity, attraction, or behavior that is non normative (typically sexual minority individuals are lesbian, gay, bisexual, queer, or non-heterosexual)] individuals despite the disparities in eating behaviors and stress that persist among this population. Further, past work suggests the context of being partnered can be both protective and harmful for eating behaviors, highlighting an important avenue for investigating intuitive eating at the dyad level. This study sought to investigate the factor structure of the IES-2 and to explore the associations between both partner’s mental health, relational quality, and interpersonal eating interactions within a dyadic sample of 228 married male sexual minority couples (88% white, 8.8% Latino or Hispanic, 5.3% African American or Black, and 5.9% in other racial or ethnic groups). The original four-factor solution did not fit the current sample; instead, a new, fifth factor emerged, which was labeled as Eating Not as Coping. Intuitive eating behaviors were dyadically associated with mental and relational health and partners’ health-related interactions with one another. Future use of the IES-2 is informed by present results which may also inform recommendations for practice with and study of health and relationships.

Abstract Background An estimated 94% of mpox cases in the United States have been acquired via male-to-male sexual contact, but non-sexual transmission has been documented. We compared demographics, clinical characteristics, and exposure information among mpox cases in California who did and did not report sexual exposure (SE) in the 21 days prior to infection. Methods All mpox cases reported in California from May - Oct 2022 were eligible for inclusion. SE was defined as reported sexual engagement and/or close intimate contact with another person within 21 days prior to symptom onset or having a reported first rash/lesion in the genital, perianal, or groin areas. Cases who neither reported SE nor first rash/lesion in those areas were defined as cases without SE. Cases with missing SE history were excluded. The California Healthy Places Index (HPI), a geospatial equity index, was used to evaluate social determinants of health in respondents’ communities of residence. Results Of 5278 cases reported in the study period, 4201 (79.6%) reported SE history data. Of those, 3661 (87.1%) reported SE (133 (3.6%) were identified by lesion location). A higher proportion of females (n=22, 22.9%, p&lt; 0.01) reported no SE compared to other gender identities. A higher proportion of Black/African American (n=93, 18.6%, p&lt; 0.0001) and Hispanic/Latino (n=280, 16.3%, p=0.0002) reported no SE compared to White (n=110, 8.6%, p&lt; 0.0001). A higher proportion of straight/heterosexual persons (n=100, 29.9%, p&lt; 0.0001) reported no SE compared to gay/lesbian persons (n=303, 10.0%, p&lt; 0.0001). Persons in HPI Q1 (least opportunities to lead healthy lives) had the highest percentage reporting no SE (n=40, 11.4%, p&lt; 0.001), while Q3 and Q4 (most opportunities to lead healthy lives) had the lowest SE reporting (n=27, 5.5% and n=42, 5.6%, respectively). Table 1 Characteristics of Mpox Cases that Reported Sexual Contact vs Those That Did Not Report Sexual Contact in the 21 days prior to symptom onset, California, May 17-Oct 12, 2022 Conclusion Females reporting Black/African American or Hispanic/Latino race/ethnicity identifying as straight/heterosexual, and persons living in HPI Q1 were less likely to report SE than their counterparts. Factors that may influence one’s willingness to disclose SE were not measured in this analysis. Nonetheless, variation in report of SE among confirmed mpox cases indicates that providers should consider mpox when clinically relevant, even in cases without reported SE. Disclosures All Authors: No reported disclosures

ObjectiveResearch surrounding firearm ownership is often contextualised within the perspectives of older white men. We expand this description using the perceptions of a diverse group of firearm-owning stakeholders.MethodsWe conducted semistructured interviews from October 2020 to May 2021 with Colorado/Washington State stakeholders representing (1) firearm ranges/retailers; (2) law enforcement agencies or (3) relevant state/national firearm organisations. Data were analysed using standard qualitative techniques and included 25 participants, representing varied sociocultural groups including racial and ethnic minorities, political minorities and sexual minorities.ResultsParticipants for this analysis were of different self-identified sociocultural groups including racial and ethnic minorities (African American, Hispanic and Asian), political minorities (liberal) and sexual minorities, defined as Lesbian, Gay, Bisexual, and Transgender (LGBT). Perspectives on firearm ownership included an idea of gun culture as a component of (1) personal identity, (2) an expression of full citizenship and (3) necessary for self-protection. A strong subtheme was the intersection of minority group and firearm owner identities, creating a need for divergent social communities because of ideas on traditional gun culture. These communities are a safe place for individuals belonging to minority groups to escape negative external and internal group associations with firearms.ConclusionPerspectives on firearms and firearm ownership in the secondary analysis were heterogeneous and related to personal experiences, external and internal group pressures that influence individual behaviour. Understanding the breadth of perspectives on firearm ownership is imperative to engaging individuals for risk reduction. This study adds to the literature by expanding an understanding of the motivation for firearm ownership among diverse communities.

The COVID-19 pandemic has negatively impacted healthcare access in the United States. This study sought to explore LGBTQ adults’ changes in access and adherence to pre-exposure prophylaxis (PrEP), human immunodeficiency virus (HIV) treatment, hormone replacement therapy (HRT), and contraception. This study employs data from a cross-sectional internet survey conducted between May and July 2020. The analysis was stratified by medications: PrEP (n= 147), HIV treatment (n= 78), HRT (n= 86), and contraception (n= 185). For people using PrEP, those between the ages of 18–29 and 30–39 and those with insurance did not report having difficulty accessing their medications; however, people between the ages of 30 and 39 did report that they had missed doses of this medication. For people using antiretroviral therapy (ART), cisgender (cis) gay men did not report trouble accessing medications, whereas lesbian cis women, respondents between 18–29 and 30–39, did report trouble accessing medications. For those using HRT, White non-Hispanic, Black, and Latinx individuals did not have trouble accessing medication; however, Asian, Native American, Pacific Islander, and Middle Eastern participants did experience trouble accessing medication. Finally, contraceptive users with insurance did not experience difficulty in accessing medication and did not miss doses of this medication. Changes to medication access and adherence during the COVID-19 pandemic can be used to develop new protocols to help meet the needs of vulnerable populations such as the LGBTQ community. New protocols that may ensure access, as well as privacy around access to medications, are insurance coverage for telehealth.

Introduction: Studies of cardiovascular disease (CVD) in sexual minority (SM) men (i.e., gay, bisexual) vs. heterosexual men are limited by small sample sizes and lack of objective CVD ascertainment. Small samples also hinder study at the intersection of race and sexual orientation on CVD events. We used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender Electronic Health Record cohort to fill these knowledge gaps. Methods: We studied 919,404 male cisgender veterans who were free of prevalent CVD and classified as SM or non-SM by a natural language processing tool. We defined incident CVD as first instance of AMI, ischemic stroke, cardiac revascularization, or CVD death between baseline and date of death or 8/31/22. We stratified sample statistics by SM status and race. We used Cox proportional hazards regression to assess the intersection of sexual orientation and race with incident CVD; we adjusted for Hispanic ethnicity and age. Based on the minority stress model, non-SM White men were the referent. Results: Within races, traditional CVD risk factors were similarly distributed by SM status but SM men had greater prevalence of stress-associated characteristics like substance use, depression, and anxiety. Heterosexual, gay, and bisexual Asian men had lower CVD risk than non-SM White men, while Black/African American and Multiracial men had persistently increased CVD risk ( Table ). White and American Native gay men had increased CVD risk vs. non-SM White men. With the exception of Asians, all unclassified SM men had increased CVD incidence vs. non-SM White men. Risk was highest in among Black or Multiracial SM men. Conclusion: This is one of the first studies to examine the intersection of sexual orientation and race on CVD risk in male veterans. CVD risk appears increased or decreased in certain racial groups regardless of sexual orientation but this is not always true and invites further study into the mechanisms by which stress results in inequitable CVD events across groups.

Introduction: Cardiovascular disease (CVD) is known to disproportionately burden lesbian, gay, bisexual, transgender, queer, (LGBTQ+) communities. Few physiology classrooms, however, incorporate population-specific mechanisms of CVD, including Minority Stress and associated psychological/physiological sequelae, when discussing disease mechanisms. Hypothesis: We hypothesized that baseline student measures of understanding regarding LGBTQ+ CVD burden and mechanisms would be low. Methods: Students enrolled in an undergraduate senior-level Cardiovascular Pathophysiology course were surveyed using Qualtrics. Likert-scale questions assessed agreement with understanding of LGBTQIA2S+ health disparity presence and mechanism. Open-ended prompts evaluated objective ability to explain understanding of CVD mechanisms in LGBTQ+ populations. Results: Of the 45 survey respondents, 12 (27.3%) identified as cisgender men, 30 (68.2%) identified as cisgender women, and 2 (4.5%) identified as non-binary. Regarding self-reported race/ethnicity, 7 respondents (15.9%) identify as Latine/Hispanic, 23 (48.9%) as White, 21 (44.7%) as Asian, 2 (4.25%) as Middle Eastern, and 1 (2.15%) preferred not to disclose. For sexuality, 32 (66.67%) identified as Straight/Heterosexual, 5 (10%) as lesbian/gay, 6 (13%) as bisexual, 1 (2%) as asexual, and 4 (8%) as queer. The majority of respondents (66%) reported “no previous” or “minimal previous” exposure to CVD disparity in LGBTQIA2S+ populations. Median Likert score (1-5, 1 representing high disagreement and 5 high agreement) for agreement with understanding that LGBTQ+ individuals face specific health disparities was 5.0 (interquartile range (IQR) 25%-75%: 4-5), median Likert score for agreement with understanding the mechanisms of LGBTQ+ health disparities was 2.0 (IQR 25%-75%: 2-4), and median Likert score for student agreement with understanding of how to intervene in LGBTQ+ specific health disparities was 3.0 (IQR 25%-75%: 2-4). The majority of students (70%) responded “I do not know” to the open-response prompt regardingthe mechanisms associating CVD with psychosocial stress in LGBTQ+ populations. Conclusion: Undergraduate students are aware of the CVD burden in LGBTQ+ populations, but lack understanding of the mechanisms behind the increased CVD risk or how to intervene. Curricularreform addressing LGBTQ+ specific CVD mechanismsand the biology ofpsychosocial stress is neededto foster understanding and creatediversely-educated future clinicians and scientists. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

PurposeAround 5% of United States (U.S.) population identifies as Sexual and Gender Diverse (SGD), yet there is limited research around cancer prevention among these populations. We present multi-pronged, low-cost, and systematic recruitment strategies used to reach SGD communities in New Mexico (NM), a state that is both largely rural and racially/ethnically classified as a “majority-minority” state.MethodsOur recruitment focused on using: (1) Every Door Direct Mail (EDDM) program, by the United States Postal Services (USPS); (2) Google and Facebook advertisements; (3) Organizational outreach via emails to publicly available SGD-friendly business contacts; (4) Personal outreach via flyers at clinical and community settings across NM. Guided by previous research, we provide detailed descriptions on using strategies to check for fraudulent and suspicious online responses, that ensure data integrity.ResultsA total of 27,369 flyers were distributed through the EDDM program and 436,177 impressions were made through the Google and Facebook ads. We received a total of 6,920 responses on the eligibility survey. For the 5,037 eligible respondents, we received 3,120 (61.9%) complete responses. Of these, 13% (406/3120) were fraudulent/suspicious based on research-informed criteria and were removed. Final analysis included 2,534 respondents, of which the majority (59.9%) reported hearing about the study from social media. Of the respondents, 49.5% were between 31-40 years, 39.5% were Black, Hispanic, or American Indian/Alaskan Native, and 45.9% had an annual household income below $50,000. Over half (55.3%) were assigned male, 40.4% were assigned female, and 4.3% were assigned intersex at birth. Transgender respondents made up 10.6% (n=267) of the respondents. In terms of sexual orientation, 54.1% (n=1371) reported being gay or lesbian, 30% (n=749) bisexual, and 15.8% (n=401) queer. A total of 756 (29.8%) respondents reported receiving a cancer diagnosis and among screen-eligible respondents, 66.2% reported ever having a Pap, 78.6% reported ever having a mammogram, and 84.1% reported ever having a colonoscopy. Over half of eligible respondents (58.7%) reported receiving Human Papillomavirus vaccinations.ConclusionStudy findings showcase effective strategies to reach communities, maximize data quality, and prevent the misrepresentation of data critical to improve health in SGD communities.

Photo by Sharon McCutcheon on Unsplash ABSTRACT COVID-19 highlighted a disproportionate impact upon marginalized communities that needs to be addressed. Specifically, a focus on equity rather than equality would better address and prevent the disparities seen in COVID-19. A distributive justice framework can provide this great benefit but will succeed only if the medical community engages in outreach, anti-racism measures, and listens to communities in need. INTRODUCTION COVID-19 disproportionately impacted communities of color and lower socioeconomic status, sparking political discussion about existing inequities in the US.[1] Some states amended their guidelines for allocating resources, including vaccines, to provide care for marginalized communities experiencing these inequities, but there has been no clear consensus on which guidelines states should amend or how they should be ethically grounded. In part, this is because traditional justice theories do not acknowledge the deep-seated institutional and interpersonal discrimination embedded in our medical system. Therefore, a revamped distributive justice approach that accounts for these shortcomings is needed to guide healthcare decision-making now and into the post-COVID era. BACKGROUND Three terms – health disparity, health inequities, and health equity – help frame the issue. A health disparity is defined as any difference between populations in terms of disease incidence or adverse health events, such as morbidity or mortality. In contrast, health inequities are health disparities due to avoidable systematic structures rooted in racial, social, and economic injustice.[2] For example, current data demonstrate that Black, Latino, Indigenous Americans, and those living in poverty suffer higher morbidity and mortality rates from COVID-19.[3] Finally, health equity is the opportunity for anyone to attain his or her full health potential without interference from systematic structures and factors that generate health inequities, including race, socioeconomic status, gender, ethnicity, religion, sexual orientation, or geography.[4] ANALYSIS Health inequities for people of color with COVID-19 have led to critiques of states that do not account for race in their resource allocation guidelines.[5] For example, the Massachusetts Department of Public Health revised its COVID-19 guidelines regarding resource allocation to patients with the best chance of short-term survival.[6] Critics have argued that this change addresses neither preexisting structural inequities nor provider bias that may have led to comorbidities and increased vulnerability to COVID-19. By failing to address race specifically, they argue the policy will perpetuate poorer outcomes in already marginalized groups. As the inequities in COVID-19 outcomes continue to be uncovered and the data continue to prove that marginalized communities suffered disproportionately, we, as healthcare providers, must reconsider our role in addressing the injustices. Our actions must be ethically grounded in the concept of justice. l. Primary Theories of Justice The principle of justice in medical ethics relates to how we ought to treat people and allocate resources. Multiple theories have emerged to explain how justice should be implemented, with three of the most prominent being egalitarianism, utilitarianism, and distributive. This paper argues that distributive justice is the best framework for remedying past actions and enacting systemic changes that may persistently prevent injustices. An egalitarian approach to justice states all individuals are equal and, therefore, should have identical access to resources. In the allocation of resources, an egalitarian approach would support a strict distribution of equal value regardless of one’s attributes or characteristics. Putting this theory into practice would place a premium on guidelines based upon first-come, first-served basis or random selection.[7] However, the egalitarian approach taken in the UK continues to worsen health inequities due to institutional and structural discrimination.[8] A utilitarian approach to justice emphasizes maximizing overall benefits and achieving the greatest good for the greatest number of people. When resources are limited, the utilitarian principle historically guides decision-making. In contrast to the egalitarian focus on equal distribution, utilitarianism focuses on managing distributions to maximize numerical outcomes. During the COVID-19 pandemic, guidelines for allocating resources had utilitarian goals like saving the most lives, which may prioritize the youthful and those deemed productive in society, followed by the elderly and the very ill. It is important to reconsider using utilitarian approaches as the default in the post-COVID healthcare community. These approaches fail to address past inequity, sacrificing the marginalized in their emphasis on the greatest amount of good rather than the type of good. Finally, a distributive approach to justice mandates resources should be allocated in a manner that does not infringe individual liberties to those with the greatest need. Proposed by John Rawls in a Theory of Justice, this approach requires accounting for societal inequality, a factor absent from egalitarianism and utilitarianism.[9] Naomi Zack elaborates how distributive justice can be applied to healthcare, outlining why racism is a social determinant of health that must be acknowledged and addressed.[10] Until there are parallel health opportunities and better alignment of outcomes among different social and racial groups, the underlying systemic social and economic variables that are driving the disparities must be fixed. As a society and as healthcare providers, we should be striving to address the factors that perpetuate health inequities. While genetics and other variables influence health, the data show proportionately more exposure, more cases, and more deaths in the Black American and Hispanic populations. Preexisting conditions and general health disparities are signs of health inequity that increased vulnerability. Distributive justice as a theoretical and applied framework can be applied to preventable conditions that increase vulnerability and can justify systemic changes to prevent further bias in the medical community. During a pandemic, egalitarian and utilitarian approaches to justice are prioritized by policymakers and health systems. Yet, as COVID-19 has demonstrated, they further perpetuate the death and morbidity of populations that face discrimination. These outcomes are due to policies and guidelines that overall benefit white communities over communities of color. Historically, US policy that looks to distribute resources equally (focusing on equal access instead of outcomes), in a color-blind manner, has further perpetuated poor outcomes for marginalized communities.[11] ll. Historical and Ongoing Disparities Across socio-demographic groups, the medical system exacerbates historical and current inequities. Members of marginalized races,[12] women,[13] LGBTQ people,[14] and poor people[15] experience trauma caused by discrimination, marginalization, and failure to access high-quality public and private goods. Through the unequal treatment of marginalized communities, these historic traumas continue. In the US, people of color do not receive equal and fair medical treatment. A meta-analysis found that Hispanics and Black Americans were significantly undertreated for pain compared to their white counterparts over the last 20 years.[16] This is partly due to provider bias. Through interviewing medical trainees, a study by the National Academy of Science found that half of medical students and residents harbored racist beliefs such as “Black people’s nerve endings are less sensitive than white people’s” or “Black people’s skin is thicker than white people’s skin.”[17] More than 3,000 Indigenous American women were coerced, threatened, and deliberately misinformed to ensure cooperation in forced sterilization.[18] Hispanic people have less support in seeking medical care, in receiving culturally appropriate care, and they suffer from the medical community’s lack of resources to address language barriers.[19] In the US, patients of different sexes do not receive the same quality of healthcare. Despite having greater health needs, middle-aged and older women are more likely to have fewer hospital stays and fewer physician visits compared to men of similar demographics and health risk profiles.[20] In the field of critical care, women are less likely to be admitted to the ICU, less likely to receive interventions such as mechanical ventilation, and more likely to die compared to their male ICU counterparts.[21] In the US, patients of different socioeconomic statuses do not receive the same quality of healthcare. Low-income patients are more likely to have higher rates of infant mortality, chronic disease, and a shorter life span.[22] This is partly due to the insurance-based discrimination in the medical community.[23] One in three deaths of those experiencing homelessness could have been prevented by timely and effective medical care. An individual experiencing homelessness has a life expectancy that is decades shorter than that of the average American.[24] lll. Action Needed: Policy Reform While steps need to be taken to provide equitable care in the current pandemic, including the allocation of vaccines, they may not address the historical failures of health policy, hospital policy, and clinical care to eliminate bias and ensure equal treatment of patients. According to an applied distributive justice framework, inequities must be corrected. Rather than focusing primarily on fair resource allocation, medicine must be actively anti-racist, anti-sexist, anti-transphobic, and anti-discriminatory. Evidence has shown that the health inequities caused by COVID-19 are smaller in regions that have addressed racial wealth gaps through forms of reparations.[25] Distributive justice calls for making up for the past using tools of allocation as well as tools to remedy persistent problems. For example, Brigham and Women’s Hospital in Boston, MA, began “Healing ARC,” a pilot initiative that involves acknowledgement, redress, and closure on an institutional level.[26] Acknowledgement entails informing patients about disparities at the hospital, claiming responsibility, and incorporating community ideas for redress. Redress involves a preferential admission option for Black and Hispanic patients to specialty services, especially cardiovascular services, rather than general medicine. Closure requires that community and patient stakeholders work together to ensure that a new system is in place that will continue to prioritize equity. Of note, redress could take the form of cash transfers, discounted or free care, taxes on nonprofit hospitals that exclude patients of color,[27] or race-explicit protocol changes (such as those being instituted by Brigham and Women’s Hospital that admit patients historically denied access to certain forms of medical care). In New York, for instance, the New York State Bar Association drafted the COVID-19 resolutions to ensure that emergency regulations and guidelines do not discriminate against communities of color, and even mandate that diverse patient populations be included in clinical trials.[28] Also, physicians must listen to individuals from marginalized communities to identify needs and ensure that community members take part in decision-making. The solution is not to simply build new health centers in communities of color, as this may lead to tiers of care. Rather, local communities should have a chance to impact existing hospital policy and should also use their political participation to further their healthcare interests. Distributive justice does not seek to disenfranchise groups that hold power in the system. It aims to transform the system so that those in power do not continue to obtain unfair benefits at the expense of others. The framework accounts for unjust historical oppression and current injustices in our system to provide equitable outcomes to all who access the system. In this vein, we can begin to address the flagrant disparities between communities that have always – and continue to – exist in healthcare today.[29] CONCLUSION As equality focuses on access, it currently fails to do justice. Instead of outcomes, it is time to focus on equity. A focus on equity rather than equality would better address and prevent the disparities seen in COVID-19. A distributive justice framework can gain traction in clinical decision-making guidelines and system-level reallocation of resources but will succeed only if the medical community engages in outreach, anti-racism measures, and listens to communities in need. There should be an emphasis on implementing a distributive justice framework that treats all patients equitably, accounts for historical harm, and focuses on transparency in allocation and public health decision-making. [1] APM Research Lab Staff. 2020. “The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S.” APM Research Lab. https://www.apmresearchlab.org/covid/deaths-by-race. [2] Bharmal, N., K. P. Derose, M. Felician, and M. M. Weden. 2015. “Understanding the Upstream Social Determinants of Health.” California: RAND Corporation 1-18. https://www.rand.org/pubs/working_papers/WR1096.html. [3] Yancy, C. W. 2020. “COVID-19 and African Americans.” JAMA. 323 (19): 1891-2. https://doi.org/10.1001/jama.2020.6548; Centers for Disease Control and Prevention. 2020. “COVID-19 in Racial and Ethnic Health Disparities.” Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html. [4] Braveman, P., E. Arkin, T. Orleans, D. Proctor, and A. Plough. 2017. “What is Health Equity?” Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html. [5] Bedinger, M. 2020 Apr 22. “After Uproar, Mass. Revises Guidelines on Who Gets an ICU Bed or Ventilator Amid COVID-19 Surge.” Wbur. https://www.wbur.org/commonhealth/2020/04/20/mass-guidelines-ventilator-covid-coronavirus; Wigglesworth, A. 2020 May 11. “Institutional Racism, Inequity Fuel High Minority Death Toll from Coronavirus, L.A. Officials Say.” Los Angeles Times. https://www.latimes.com/california/story/2020-05-11/institutional-racism-inequity-high-minority-death-toll-coronavirus. [6] Executive Office of Health and Human Services Department of Public Health. 2020 Oct 20. “Crises Standards of Care Planning and Guidance for the COVID-19 Pandemic.” Commonwealth of Massachusetts. https://www.mass.gov/doc/crisis-standards-of-care-planning-guidance-for-the-covid-19-pandemic. [7] Emanuel, E. J., G. Persad, R. Upshur, et al. 2020. “Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine 382: 2049-55. https://doi.org/10.1056/NEJMsb2005114. [8] Salway, S., G. Mir, D. Turner, G. T. Ellison, L. Carter, and K. Gerrish. 2016. “Obstacles to "Race Equality" in the English National Health Service: Insights from the Healthcare Commissioning Arena.” Social Science and Medicine 152: 102-110. https://doi.org/10.1016/j.socscimed.2016.01.031. [9] Rawls, J. A Theory of Justice (Revised Edition) (Cambridge, MA: Belknap Press of Harvard University Press, 1999). [10] Zack, N. Applicative Justice: A Pragmatic Empirical Approach to Racial Injustice (New York: The Rowman & Littlefield Publishing Group, 2016). [11] Charatz-Litt, C. 1992. “A Chronicle of Racism: The Effects of the White Medical Community on Black Health.” Journal of the National Medical Association 84 (8): 717-25. http://hdl.handle.net/10822/857182. [12] Washington, H. A. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Doubleday, 2006). [13] d'Oliveira, A. F., S. G. Diniz, and L. B. Schraiber. 2002. “Violence Against Women in Health-care Institutions: An Emerging Problem.” Lancet. 359 (9318): 1681-5. https://doi.org/10.1016/S0140-6736(02)08592-6. [14] Hafeez, H., M. Zeshan, M. A. Tahir, N. Jahan, and S. Naveed. 2017. “Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus 9 (4): e1184. https://doi.org/10.7759/cureus.1184; Drescher, J., A. Schwartz, F. Casoy, et al. 2016. “The Growing Regulation of Conversion Therapy.” Journal of Medical Regulation 102 (2): 7-12. https://doi.org/10.30770/2572-1852-102.2.7; Stroumsa, D. 2014. “The State of Transgender Health Care: Policy, Law, and Medical Frameworks.” American Journal of Public Health. 104 (3): e31-8. https://doi.org/10.2105/AJPH.2013.301789. [15] Stepanikova, I., and G. R. Oates. 2017. “Perceived Discrimination and Privilege in Health Care: The Role of Socioeconomic Status and Race.” American Journal of Preventative Medicine. 52 (1s1): S86-s94. https://doi.org/10.1016/j.amepre.2016.09.024; Swartz, K. “Health Care for the Poor: For Whom, What Care, and Whose Responsibility?” In Cancian, M., and S. Danziger (Eds.). Changing Poverty, Changing Policies (New York: Russell Sage Foundation Press, 2009), 69-74. [16] Meghani, S. H., E. Byun, and R. M. Gallagher. 2012. “Time to Take Stock: A Meta-analysis and Systematic Review of Analgesic Treatment Disparities for Pain in the United States.” Pain Medicine 13 (2): 150-74. https://doi.org/10.1111/j.1526-4637.2011.01310.x; Williams, D. R., and T. D. Rucker. 2000. “Understanding and Addressing Racial Disparities in Health Care.” Health Care Financing Review 21 (4): 75-90. https://scholar.harvard.edu/davidrwilliams/dwilliam/publications/understanding-and-addressing-racial-disparities-health. [17] Hoffman, K. M., S. Trawalter, J. R. Axt, and M. N. Oliver. 2016. “Racial Bias in Pain assessment and treatment recommendations, and false beliefs about biological Differences Between Blacks and Whites.” PNAS 113 (16): 4296-4301. https://doi.org/10.1073/pnas.1516047113. [18] Pacheco, C. M., S. M. Daley, T. Brown, M. Filipp, K. A. Greiner, and C. M. Daley. 2013. “Moving Forward: Breaking the Cycle of Mistrust Between American Indians and Researchers.” American Journal of Public Health. 103 (12): 2152-9. https://doi.org/10.2105/AJPH.2013.301480. [19] Velasco-Mondragon, E., A. Jimenez, A. G. Palladino-Davis, D. Davis, and J. A. Escamilla-Cejudo. 2016. “Hispanic Health in the USA: A Scoping Review of the Literature.” Public Health Reviews 37:31. https://doi.org/10.1186/s40985-016-0043-2. [20] Cameron, K. A., J. Song, L. M. Manheim, and D. D. Dunlop. 2010. “Gender Disparities in Health and Healthcare Use Among Older Adults.” Journal of Women’s Health (Larchmt) 19 (9): 1643-50. https://doi.org/10.1089/jwh.2009.1701. [21] Bierman, A. S. 2007. “Sex Matters: Gender Disparities in Quality and Outcomes of Care. Canadian Medical Association Journal 177 (12): 1520-1. https://doi.org/10.1503/cmaj.071541; Fowler, R. A., S. Sabur, P. Li, et al. 2007. “Sex-and Age-based Differences in the Delivery and Outcomes of Critical Care. Canadian Medical Association Journal 177 (12): 1513-9. https://doi.org/10.1503/cmaj.071112. [22] McLaughlin, D. K., and C. S. Stokes. 2002. “Income Inequality and Mortality in US Counties: Does Minority Racial Concentration Matter?” American Journal of Public Health 92 (1): 99-104. https://doi.org/.10.2105/ajph.92.1.99; Shea, S., J. Lima, A. Diez-Roux, N. W. Jorgensen, and R. L. 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Darity Jr., et al. 2021. “Reparations for Black American Descendants of Persons Enslaved in the U.S. and their Potential Impact on SARS-CoV-2 Transmission.” Social Science and Medicine 276: 113741. https://doi.org/10.1016/j.socscimed.2021.113741. [26] Wispelwey, B., and M. Morse. 2021. “An Antiracist Agenda for Medicine.” Boston Review. http://bostonreview.net/science-nature-race/bram-wispelwey-michelle-morse-antiracist-agenda-medicine. [27] Johnson, S. F., A. Ojo, and H. J. Warraich. 2021. “Academic Health Centers’ Antiracism Strategies Must Extend to their Business Practices.” Annals of Internal Medicine 174 (2): 254-5. https://doi.org/10.7326/M20-6203; Golub, M., N. Calman, C. Ruddock, et al. 2011. “A Community Mobilizes to End Medical Apartheid.” Progress in Community Health Partnerships: Research, Education, and Action 5 (3): 317-25. https://doi.org/10.1353/cpr.2011.0041. [28] New York State Bar Association. 2020. “New York State Bar Association House of Delegates: Revised COVID-19 Resolutions.” https://nysba.org/app/uploads/2020/10/Final-Health-Law-Section-COVID-19-Resolutions_10-8-20-1-1.pdf. [29] Egede, L. E. 2006. “Race, Ethnicity, Culture, and Disparities in Health Care.” Journal of General Internal Medicine 21 (6): 667-669. https://doi.org/10.1111%2Fj.1525-1497.2006.0512.x