Eastern Kentucky Pride

There has been a rise in state policies targeting the rights of lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority (LGBTQIA+) people in the United States. Although large-scale studies have quantified associations between these policies and LGBTQIA+ people's mental health, less research has centered the first-hand accounts of LGBTQIA+ people. To examine LGBTQIA+ people's accounts of how they perceive these policies to be impacting their mental health. From July to October 2024, 1-hour, semistructured, virtual interviews were conducted with LGBTQIA+ adults living in states that had recently proposed or enacted state LGBTQIA+-targeted policies. The state policies included: (1) gender-affirming care restrictions; (2) sports bans for transgender and nonbinary (TNB) people; (3) public bathroom bans for TNB people; (4) school restrictions of sexual orientation and/or gender identity discussions; and (5) religious exemptions, which permit individuals and service organizations to withhold services from LGBTQIA+ people for religious reasons. Transcripts were analyzed using thematic analysis, focusing on participants' perceptions of the mental health impacts of these policies. Interviews with the 61 adult participants in the sample (median [IQR] age, 35 [30-48] years; 13 cisgender men [21.3%], 19 cisgender women [31.1%], 16 nonbinary people [26.2%], 8 transgender men [13.1%], 2 transgender women [3.3%], and 3 people with another gender identity [4.9%]) revealed that LGBTQIA+ people perceive these policies to negatively impact their mental health. These perceived impacts were organized into 3 themes: (1) chronic worry and hypervigilance, (2) social isolation, and (3) hopelessness and powerlessness. A fourth cross-cutting theme was also identified: participants perceived these policies' mental health impacts to be unequal and more pronounced for those most frequently targeted by these policies (eg, youths, TNB people), racially and ethnically minoritized people, those without social and financial resources, and those living in rural areas. In this qualitative study, LGBTQIA+ adults in the United States perceived LGBTQIA+-targeted policies to have profound and unequal impacts on their mental health. As LGBTQIA+-targeted policies increase in number, multilevel resources and supports are necessary to support LGBTQIA+ people's well-being.

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

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

Ontological OppressionThe construction of otherness because of assumptions about personhood-otherwise known as ontological oppression 1 -excludes or misrepresents bodies or identities on the basis of preset categories.Ontologic constructs of gender in oncology encompass the notions that gender is inseparable from and synonymous with sex assigned at birth (henceforth sex), that gender is a static social concept across history or a fixed identity across the personal life course, and that sex is an objective and fixed category that can be easily assessed by a clinician.In addition to sex being conflated with gender, sex is used to make assumptions about a person's anatomy, chromosomes, and/or endogenous hormones. 2 The presence of transgender and intersex people therefore challenges unquestioned assumptions and conflated concepts that are pervasive in medicine and particularly salient in oncology for several reasons.First, discourses regarding specific cancers (eg, ovarian, endometrial, prostate) are often conflated with gender.Second, cancer epidemiology is often linked to a conflated sex/gender marker (eg, breast cancer incidence described specifically for women or men).Third, oncology subspecialty care is often gendered, and in the context of cancer treatment, occupying exclusively gendered spaces may be particularly painful.Last, mistakes regarding laboratory values or chemotherapeutic dosing may be particularly hazardous.Conflated conceptions of bodies and selfhood are interwoven throughout oncology training, algorithms, and epidemiological and other biomedical analyses.Cancer epidemiology (eg, women have higher rates of cholangiocarcinoma than men), differential diagnoses, and many other core aspects of oncology rely on conflated concepts of gender and anatomy.These conflations render invisible and pathologic transgender and intersex people whose anatomy, chromosomes, or hormones do not match categorical expectations.Such ontological oppression has many consequences including stigma and substandard care.This analytic essay, authored by queer and transgender academic clinicians, researchers, nonacademic community members, and allies, proposes a systems-based approach to degendering oncology, which we define as the conscious and explicit disentangling of gender, anatomy, hormonal milieu, karyotype and other biological factors in oncologic diagnoses, epidemiological analysis, and knowledge production along with eliminating sex from our conceptual framework of bodies and disease.We provide examples of the implementation of degendering oncology, including steps that can be taken immediately by clinicians, researchers, and administrators.

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

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

Sexual and gender minority (SGM) people experience significant disparities in mental health and substances use disorders. This study reached out to mental health professionals (MHPs) who treat SGM people to determine mental health priorities for research that would better inform their clinical practice. MHPs were surveyed and asked to rate items based on a likert-type scale. Open-ended questions were also queried and analyzed qualitatively. Five items had the highest mean scores: “stressors related to SGM status,” “lifestyle factors that support emotional resilience and wellbeing,” “depression,” “intimate relationships,” and “suicide.” Intersecting identities and sexual relationships emerged as qualitative themes.

Sexual and gender minority (SGM) people are underrepresented in research. We sought to create a digital research platform to engage, recruit, and retain SGM people in a national, longitudinal, dynamic, cohort study (The PRIDE Study) of SGM health. We partnered with design and development firms and engaged SGM community members to build a secure, cloud-based, containerized, microservices-based, feature-rich, research platform. We created PRIDEnet, a national network of individuals and organizations that actively engaged SGM communities in all stages of health research. The PRIDE Study participants were recruited via in-person outreach, communications to PRIDEnet constituents, social media advertising, and word-of-mouth. Participants completed surveys to report demographic as well as physical, mental, and social health data. We built a secure digital research platform with engaging functionality that engaged SGM people and recruited and retained 13731 diverse individuals in 2 years. A sizeable sample of 3813 gender minority people (32.8% of cohort) were recruited despite representing only approximately 0.6% of the population. Participants engaged with the platform and completed comprehensive annual surveys- including questions about sensitive and stigmatizing topics- to create a data resource and join a cohort for ongoing SGM health research. With an appealing digital platform, recruitment and engagement in online-only longitudinal cohort studies are possible. Participant engagement with meaningful, bidirectional relationships creates stakeholders and enables study cocreation. Research about effective tactics to engage, recruit, and maintain active participation from all communities is needed. This digital research platform successfully recruited and engaged diverse SGM participants in The PRIDE Study. A similar approach may be successful in partnership with other underrepresented and vulnerable populations.