Faculty Bibliography

Lesbian, gay, bisexual, transgender and queer (LGBTQ) populations experience health and healthcare disparities that may place them at higher risk for developing cancer. In addition, LGBTQ communities have psychosocial factors, such as fear of discrimination, that have substantial impacts on their medical care. As a result, these populations have specific needs with regard to cancer screening, treatment and support that must be addressed by cancer care providers. Although much has been done to address cancer care in the general population, more improvement is needed in the care of LGBTQ patients. We aim to present an overview of the current state of LGBTQ cancer care, opportunities for improvement and how cancer centers and providers can create a better future for the care of LGBTQ cancer patients.

BACKGROUND: Lesbian/bisexual women with physical disabilities (LBPD) are an under-studied population. OBJECTIVES: This study compared LBPD to LB women without physical disabilities as defined by the Americans with Disabilities Act on socio-demographic variables, health characteristics, and quality of life, physical activity, weight, and nutrition outcomes following a health intervention. METHODS: Data came from the Healthy Weight in Lesbian and Bisexual Women Study (HWLB) where 376 LB women were recruited into five geographically dispersed interventions. Baseline data were examined to compare women with and without physical disabilities as defined by the ADA, and pre/post intervention data were analyzed for differences in treatment outcomes including quality of life, physical activity, nutrition, and body size. RESULTS: Compared to women without disability, LBPD were more likely to be bisexual or another sexual identity than lesbian, single, report poor or fair health status, postmenopausal, and had a higher body mass index and waist circumference to height ratio. LBPD women were less likely to work and to drink heavily, and reported reduced physical and mental health quality of life. In spite of these differences, after the intervention, LBPD had similar outcomes to women without disabilities on most measures, and were more likely to show improvements in physical quality of life and consumption of fruits/vegetables. CONCLUSIONS: Although different from women without disabilities on many socio-demographic and health variables at baseline, the study suggests that LBPD have similar outcomes to women without disabilities, or may even do better, in group health interventions.

Purpose: Transgender individuals (TGI), who identify their gender as different from their sex assigned at birth, continue facing widespread discrimination and mistreatment within the healthcare system. Providers often lack expertise in adequate transgender (TG) care due to limited specialized training. In response to these inadequacies, and to increase evidence-based interventions effecting TG-affirmative healthcare, we implemented and evaluated a structural-level intervention in the form of a comprehensive Provider Training Program (PTP) in TG health within a New York City-based outpatient clinic serving primarily individuals of color and of low socioeconomic status. This pilot intervention aimed to increase medical staff knowledge of TG health and needs, and to support positive attitudes toward TGI. Methods: Three 2-h training sessions were delivered to 35 clinic staff across 4 months by two of the authors experienced in TG competency training; the training sessions included TG-related identity and barriers to healthcare issues, TG-specialized care, and creating TG-affirmative environments, medical forms, and billing procedures. We evaluated changes through pre-post intervention surveys by trainees. Results: Compared to pre-training scores, post-training scores indicated significant (1) decreases in negative attitudes toward TGI and increases in TG-related clinical skills, (2) increases in staff's awareness of transphobic practices, and (3) increases in self-reported readiness to serve TGI. The clinic increased its representation of general LGBT-related images in the waiting areas, and the staff provided highly positive training evaluations. Conclusion: This PTP in TG health shows promise in leading to changes in provider attitudes and competence, as well as clinic systems, especially with its incorporation in continuing education endeavors, which can, in turn, contribute to health disparities reductions among TG groups.

Transgender medicine presents a particular challenge for the development of evidence-based guidelines, due to limitations in the available body of evidence as well as the exclusion of gender identity data from most public health surveillance activities. The guidelines that have been published are often based on expert opinion, small studies, and data gathered outside the US. The existence of guidelines, however, helps legitimate the need for gender-affirming medical and surgical interventions. Research conducted on transgender populations should be grounded in gender-affirming methodologies and focus on key areas such as health outcomes after gender-affirming interventions.