Jennifer M. Jabson

A population-based study of cardiovascular disease risk in sexual-minority women.

OBJECTIVES We sought to determine if sexual-minority women were at greater risk for cardiovascular disease (CVD) than their heterosexual counterparts. METHODS We aggregated data from the 2001-2008 National Health and Nutrition Examination Surveys to examine differences in CVD risk between heterosexual and sexual-minority women by using the Framingham General CVD Risk Score to calculate a ratio of vascular and chronological age. We also examined differences in the prevalence of various CVD risk factors. RESULTS Sexual-minority women were more likely to be current or former smokers, to report a history of drug use, to report risky drinking, and to report a family history of CVD. On average, sexual-minority women were 13.9% (95% confidence interval [CI] = 8.5%, 19.3%) older in vascular terms than their chronological age, which was 5.7% (95% CI = 1.5%, 9.8%) greater than that of their heterosexual counterparts. Family history of CVD and history of drug use were unrelated to increased CVD risk, and this risk was not fully explained by either risky drinking or smoking. CONCLUSIONS Sexual-minority women are at increased risk for CVD compared with heterosexual women.

Skin care behaviors among melanoma survivors

Clinical recommendations for survivors of melanoma generally include skin care behaviors, including regular physician and skin self‐examination to identify any recurrences or second primary disease early, as well as sun protection. We measured skin care behaviors in a population‐based sample of melanoma survivors.

Scientific Bias Arising from Sampling, Selective Recruitment, and Attrition: The Case for Improved Reporting

In human research, the ability to generalize study findings is incumbent not only on an accurate understanding of the study protocol and measures but also on a clear understanding of the study population. Differential recruitment and attrition has the potential of introducing bias and threatening the generalizability of study findings; yet, relatively few scientific publications report data on sampling, subject exclusion, and dropout. A 4-month census sampling (September–December 2009) of research articles and short communications in this journal (n = 116) was no exception. Among articles in which such data were appropriate to report, only 44% documented response rates, 53% described subjects who were excluded, and 10% performed analyses on enrollee versus nonenrollee differences; moreover, of the 17 longitudinal or intervention studies evaluated, only 3 of 17 reported dropout rates, and of those, only 2 of 3 reported reasons for dropout or an analysis that compared the characteristics of dropouts with those of completers. Given Cancer Epidemiology, Biomarkers and Preventions mission to enhance the dissemination of unbiased scientific findings, we propose that guidelines regarding sample description, as defined by CONSORT, STROBE, or STREGA, be adopted by our journal for both observational and interventional studies that accurately describe the study population from the point of contact. Cancer Epidemiol Biomarkers Prev; 20(3); 415–8. ©2011 AACR.

Relationship Between Sexual Orientation and Quality of Life in Female Breast Cancer Survivors

BACKGROUND Some groups of breast cancer survivors bear a greater burden of diminished quality of life than others. Self-identified lesbians, or women who partner with other women in romantic and spousal relationships, are one group of women that has been hypothesized to experience and report poorer quality of life compared with heterosexual breast cancer survivors. METHODS A convenience sample of 204 breast cancer survivors (143 heterosexual and 61 self-identified lesbians) participated in this cross-sectional, online study by completing electronic surveys regarding their quality of life. RESULTS Multivariate linear regression indicated that quality of life was not related to sexual orientation (β=0.13, p=0.30). Quality of life scores were similar between heterosexual and self-identified lesbian breast cancer survivors. CONCLUSION Quality of life scores were similar between heterosexual and lesbian breast cancer survivors. Future survivorship research should include population-based sampling of lesbian breast cancer survivors for testing quality of life and reducing the healthy volunteer effect, and population-based methodologies should be made available to enhance researcher ability to study this rare population.

Gay Acres: Sexual Orientation Differences in Health Indicators Among Rural and Nonrural Individuals

Purpose Geographic location is a significant factor that influences health status and health disparities. Yet, little is known about the relationship between geographic location and health and health disparities among lesbian, gay, and bisexual (LGB) persons. This study used a US population-based sample to evaluate the associations of sexual orientation with health indicators by rural/nonrural residence. Methods Data were pooled from the 10 states that collected sexual orientation in the 2010 Behavioral Risk Factor Surveillance System surveys. Rural status was defined using metropolitan statistical area, and group differences by sexual orientation were stratified by gender and rural/nonrural status. Chi-square tests for categorical variables were used to assess bivariate relationships. Multivariable logistic regression models stratified by gender and rural/nonrural status were used to assess the association of sexual orientation to health indicators, while adjusting for age, race/ethnicity, education, and partnership status. All analyses were weighted to adjust for the complex sampling design. Findings Significant differences between LGB and heterosexual participants emerged for several health indicators, with bisexuals having a greater number of differences than gay men/lesbians. There were fewer differences in health indicators for rural LGB participants compared to heterosexuals than nonrural participants. Conclusions Rural residence appears to influence the pattern of LGB health disparities. Future work is needed to confirm and identify the exact etiology or rural/nonrural differences in LGB health.

Stress mediates the relationship between sexual orientation and behavioral risk disparities

BackgroundGrowing evidence documents elevated behavioral risk among sexual-minorities, including gay, lesbian, and bisexual individuals; however, tests of biological or psychological indicators of stress as explanations for these disparities have not been conducted.MethodsData were from the 2005-2010 National Health and Nutrition Examination Survey, and included 9662 participants; 9254 heterosexuals, 153 gays/lesbians and 255 bisexuals. Associations between sexual orientation and tobacco, alcohol, substance, and marijuana use, and body mass index, were tested using the chi-square test. Stress, operationalized as depressive symptoms and elevated C-reactive protein, was tested as mediating the association between sexual orientation and behavioral health risks. Multiple logistic regression was used to test for mediation effects, and the Sobel test was used to evaluate the statistical significance of the meditating effect.ResultsGays/lesbians and bisexuals were more likely to report current smoking (p < .001), a lifetime history of substance use (p < .001), a lifetime history of marijuana use (p < .001), and a lifetime period of risky drinking (p = .0061). The largest disparities were observed among bisexuals. Depressive symptoms partially mediated the association between sexual orientation and current smoking (aOR 2.04, 95% CI 1.59, 2.63), lifetime history of substance use (aOR 3.30 95% CI 2.20, 4.96), and lifetime history of marijuana use (aOR 2.90, 95% CI 2.02, 4.16), among bisexuals only. C-reactive protein did not mediate the sexual orientation/behavior relationship.ConclusionHigher prevalence of current smoking and lifetime history of substance use was observed among sexual minorities compared to heterosexuals. Among bisexuals, depressive symptoms accounted for only 0.9-3% of the reduction in the association between sexual orientation and marijuana use and tobacco use, respectively. More comprehensive assessments of stress are needed to inform explanations of the disparities in behavioral risk observed among sexual minorities.

Breast cancer survivorship: the role of perceived discrimination and sexual orientation

Breast cancer disproportionately affects sexual minority women (SMW) compared to heterosexual women and a small but growing literature indicates that SMW may have diminished survivorship outcomes; outcomes that are measurably and importantly different from heterosexual breast cancer survivors. However, it remains unknown how sexual orientation influences breast cancer survivorship outcomes such as quality of life. One possible route of influence is SMW’s perceived discrimination in the health care setting. This cross-sectional study examines SMW perceptions of discrimination as one of the multiple facets of the breast cancer survivorship process. This study assessed SMW breast cancer survivor’s perceptions of discrimination during their breast cancer treatment experience and secondarily, examined the role of this perceived discrimination on SMW’s quality of life. Sixty-eight purposefully sampled sexual minority breast cancer survivors completed assessments of quality of life, perceived discrimination, perceived social support and perceived stress via an online survey. Statistical analyses point to perceived discrimination and perceived social support as important indicators for predicting SMW’s quality of life. Future research on SMW’s breast cancer survivorship should include measures of perceived discrimination.

Perceived stress and sexual orientation among breast cancer survivors.

Little is known about the cancer survivorship experiences of sexual minority women (SMW). SMW breast cancer survivors are hypothesized to experience more stress compared to heterosexual breast cancer survivors. A convenience sample of 211 breast cancer survivors (68 SMW, 143 heterosexual women) participated in this cross-sectional online investigation of perceived stress. Regression analyses indicated significant differences in reported stress between heterosexual and SMW breast cancer survivors (β= -.15, p = .03). Our findings may reflect unique experiences had by sexual minority breast cancer survivors. Future research should explore the factors that contribute to elevated perceived stress in this group.

Representation of lesbian, gay, and bisexual people in clinical cancer trials

PURPOSE Clinical trials are important tools for advancing cancer treatment, prevention, and control. To identify and describe clinical effects relevant to underserved groups, their representation in clinical trials is necessary. Lesbian, gay, and bisexual (LGB) people have been identified as a medically underserved group and their representation in cancer clinical trials is unknown. This study sought to examine LGB cancer survivor representation in cancer clinical trials. METHODS Data were from the 2010, Behavioral Risk Factor Surveillance System, Cancer Survivorship Module. Data were from five states that included both the Cancer Survivorship module and an item asking self-identified LGB status. RESULTS Participation in cancer clinical trials was higher among LGB cancer survivors (12.5%) than among heterosexual cancer survivors (6.0%) (p = .005). In the multivariate, adjusted model, LGB cancer survivors were more than twice as likely, as heterosexual cancer survivors, to report participation in a clinical trial (AOR 2.17, 95% CI 1.21-3.90). CONCLUSION LGB cancer survivors had greater likelihood of cancer clinical trial participation than heterosexual cancer survivors and this was not explained by demographics. The finding was unexpected given the historic marginalization of this group. The small number of LGB cancer survivors limits the generalizability and statistical power. Findings should be interpreted cautiously, and further research is needed to clarify explanatory mechanisms.

Associations between non-discrimination and training policies and physicians’ attitudes and knowledge about sexual and gender minority patients: a comparison of physicians from two hospitals

BackgroundSome physicians lack knowledge and awareness about health issues specific to sexual and gender minority (SGM) individuals. To help improve this, hospitals have implemented policies that mandate non-discrimination and training to promote sexual and gender minority health. There is limited evidence about how such policies relate to physicians’ knowledge, attitudes, and gender and sexual minority affirmative practices.MethodA random sample of 1000 physicians was recruited from a complete list of physicians affiliated with one of two university Hospitals located in Tennessee and 180 physicians completed the survey concerning attitudes and knowledge about SGM individuals. Physicians were affiliated with either Hospital A that had not implemented policies for non-discrimination and training, or Hospital B that did.ResultsPhysicians held different attitudes about SGM patients than non-patients. Physicians affiliated with Hospital A held more negative attitudes about SGM individuals who were non-patients than physicians affiliated with Hospital B. There were no differences between the two hospitals in physicians’ attitudes and knowledge about SGM patients.ConclusionPolicies that mandate non-discrimination and training as they currently exist may not improve physicians’ attitudes and knowledge about SGM individuals. Additional research is needed to understand how these policies and trainings relate to physicians’ SGM affirmative practices.