DO LGBT YOUTH HAVE CANCER DISPARITIES?

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Michael G. Bare
Program Coordinator
National LGBT Cancer Network 

Do LGBT youth have higher prevalence of cancer than other youth? To be honest, we don’t know. The lack of sexual orientation and gender identity (SOGI) on institutional intake forms across the medical professions has resulted in difficulty ascertaining LGBT health disparities, requiring researchers to establish studies to answer these sorts of questions. SOGI is also not recorded in cancer registries. What we do know is that LGBT adults do have higher cancer rates, and higher prevalence of cancer risk factors, many of which may be traced back to experiences and behaviors that began in adolescents. Recently, the head of the U.S. food and drug administration stated that smoking is a pediatric disease, because the majority of adult smokers started in adolescents and adolescents who reach adulthood without ever having smoked a cigarette have much lower rates of starting cigarette use later in life. I would argue that many LGBT health disparities, including cancer, may be traced to minority stress and behaviors linked to this form of stress as coping mechanisms. In fact one study, Dr. Rosario (who worked on the study) commented “Sexual minorities are at risk for cancer later in life, I suggest, from a host of behaviors that begin relatively early in life,” said Professor Rosario. “No sex or ethnic racial group is at greater risk or protected for these behaviors. Overall, the study underscores the need for early interventions.” (1)

 

Minority stress is a public health theory which explains that stress resulting from discrimination and stigmatization of minority groups affects the individuals health in a number of ways throughout the lifespan. Many studies of minority stress show that LGBT people experience this, which may be further compounded by racial minority status, disability, class or many other stigmatized identities an individual may hold while also being LGBT. Earlier this year a study found that LGB people who live in communities with high levels of anti-LGB prejudice had a 12 year reduction in life expectancy when compared to heterosexual peers in the same community who do not experience discrimination (2). In 2013 other studies found that LGB people who live in states without LGBT protective policies were 5X more likely than those in other states to have 2 or more mental disorders (3) and LGB people who experienced “prejudice-related major life events” were 3x more likely to suffer a serious physical health problem over the next year than people who had not experienced such events regardless of other factors such as age, gender, employment and health history (4).

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How would adult LGBT health change if LGBT youth were supported by their community and schools?

 

So how does this play out for LGBT youth specifically? One study found that, when asked about concerns, heterosexual high school students stated grades and classes as number 1 on their list, with college and careers, and financial pressures related to college or jobs coming second and third, while LGBT students reported more immediate, tangible issues such as non-accepting families, school bullying and fear of being out as their top 3 concerns (in that order) (5). We also know how stigma and discrimination leads to negative mental health outcomes. So, it is no surprise that mental health issues such as stress, depression and anxiety lead to higher levels of smoking, alcohol consumption, substance abuse and riskier sexual behavior. One study found that LGBT students had higher prevalence in 10 risk categories (these were: behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management) (6). The same study Dr. Rosario commented on earlier found that of “the 12 cancer-risk behaviors included tobacco use, drinking alcohol, early sex, multiple sexual partners, higher body mass index (BMI) and lack of exercise. The report found that for all 12, sexual minorities were more likely than heterosexuals to engage in the risky behavior (1). Other studies have linked psychological distress and LGBT victimization to high smoking prevalences (6).

 

So, while there is limited data on cancer among LGBT youth, it is clear that lifetime stressors related to LGBT status, instilled in adolescence, coupled with unhealthy coping mechanisms, are responsible for increased cancer incidence among LGBT adults. It is my opinion that the roots of these cancers may be traced to experiences of homophobia as a LGBT pediatric health disparity.

 

References:

  1. Rosario, M., Corliss, H. L., Everett, B. G., Reisner, S. L., Austin, S. B., Buchting, F. O., & Birkett, M. (2014). Sexual orientation disparities in cancer-related risk behaviors of tobacco, alcohol, sexual behaviors, and diet and physical activity: pooled Youth Risk Behavior Surveys. American journal of public health, 104(2), 245-254.
  2. Garcia, M. (2014). Study: Antigay communities lead to early LGB  death. Advocate.com. Retrieved fromhttp://www.advocate.com/health/2014/02/16/study-antigay-communities-lead-early-lgb-death
  3. Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. Journal of homosexuality. 2011;58(1):10-51.
  4. Durso, L. E., & Meyer, I. H. (2013). Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sexuality Research and Social Policy, 10(1), 35-42.
  5. GROWING UP LGBT IN AMERICA (HRC). (2012) http://www.hrc.org/youth
  6. 6.Kann, L., O’Malley Olsen, E., McManus, T., Kinchen, S., Chyen, D., Harris, W. A., & Wechsler, H. (2011). Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors among Students in Grades 9-12–Youth Risk Behavior Surveillance, Selected Sites, United States, 2001-2009. Morbidity and Mortality Weekly Report. Early Release. Volume 60. Centers for Disease Control and Prevention.

 

LGBT Wellness Roundup: September 12

As published on Huffington Post’s new LGBT Wellness blog, see original at: http://huff.to/1tWFZLB

Each week HuffPost Gay Voices, in a partnership with bloggers Liz Margolies and Scout, brings you a round up of some of the biggest LGBT wellness stories from the past seven days. For more LGBT Wellness, visit our page dedicated to the topic here. The weekly LGBT Wellness Roundup can also now be experienced as a video — check it out above.

LGBT Youth & College Student Substance Use

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LGB college students were found to have higher alcohol, tobacco and other drug use, compared to their heterosexual peers, with bisexual women reporting the highest use. While another study found LGBT high school students who lived in neighborhoods with higher rates of anti-LGBT hate crimes had significantly higher reported marijuana use than their peers.

For The Record

 

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A new study found that patients will generally accept sexual orientation and gender identity questions on medical intake forms, which the IOM and many advocates are pushing for so we can better collect data on LGBT health outcomes.

 

Across The Pond: More Of The Same

 

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In findings that mirror research in the U.S.A., a new journal article reports that LGB people in England have “poorer health and worse health care experiences” including depression and other poor mental health outcomes.

 

Trans, Global

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Denmark’s new law is lauded for allowing trans people to only fill out paperwork to change gender, without the need for permission by medical or psychological professionals; although criticism is reserved for the 18-years-old age requirement. While across the globe, Eliana Rubashkyn, writes about her experiences withtransgender discrimination and immigration laws in Hong Kong. U.S. researchers explain that trans women are over-represented in prison populations and have higher levels of victimization while incarcerated, numbers that are even higher for trans women of color.

 

GLMA Honors Sebelius

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The Gay and Lesbian Medical Association (GLMA) is presenting former U.S. Secretary of Health and Human Services, Kathleen Sebelius with an award, for promoting LGBT inclusive policies.

 

NYC PSA: LGBT Kids Are OK

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An NYC HIV prevention organization, CAMBA, has rolled out bus advertisements urging parents, guardians and families to accept their LGBT child, offering links to resources. The campaign is part of Project Accept LGBT Youth which hopes to reduce mental health, substance abuse and HIV rates among young LGBT people.

INFLUENZA VACCINATION AMONG LGBTT COMMUNITIES

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Juan Carlos Vega, Citizens Alliance Pro LGBTTA Health of Puerto Rico & LGBT HealthLink: the Network for Health Equity

 

 

Are LGBTT communities getting vaccinated against influenza? If you do a search on Google for “LGBT” and “vaccination”, most results refer to current important efforts towards Human Papillomavirus (HPV) vaccination. A few influenza vaccination campaigns targeting LGBTT communities appear scattered in the last two decades. A fabulous one occurred in Milwaukee, Wisconsin. The health events section in the Wisconsin GLBT History Project website reports that, “Flu Vaccination shots began to be offered annually to members of the LGBT community in approximately 1990, by the Gay and Lesbian Nurses Association. The effort was begun to target the especially at-risk population of the gay and lesbian community after the AIDS outbreak… For its first 16 years the vaccinations were given in the upstairs at the M&M Club, thanks to Bob Schmidt’s generosity. When the M&M Club closed early in 2006, the Nurses Association began the search for a new location for its 17th year.”

Of all the health problems LGBTT communities, why do we need to worry about influenza? Don’t we have more pressing matters like HIV increase, high smoking prevalence, and rejection to proper services due to stigma and discrimination, etcetera, etcetera? My knowledge on influenza and vaccination is limited but I compare the facts presented during the 3rd LGBTT Health Summit of Puerto Rico on April 4, 2014. According to the most recent statistics from the Behavioral Risk Factor Surveillance System (BRFSS), some of the most significant risk factors and health conditions prevalent among LGBTT communities in Puerto Rico are obesity and overweight (53.5%), tobacco use (23.8%), asthma (22.2%), and diabetes (13.1%). Later, in May 2014, the current Puerto Rico Secretary of Health, in alert, due to the increase on reported influenza cases, continued to encourage individuals with chronic diseases like obesity, asthma, and diabetes to get vaccinated. The high prevalence of HIV reported cases among LGBTT communities in Puerto Rico are certainly vulnerable as well to the flu.

It is a no brainer that LGBTT communities are at high risk and should get vaccinated. But then again, are LGBTT communities getting vaccinated? Are there any influenza vaccination efforts in our communities like the one by the Gay and Lesbian Nurses Association in Milwaukee in the 90’s happening today or in summer pride events? The CDC-funded National Influenza Vaccination Disparities Partnership reports that large metropolitan areas like Chicago, Latino-based Casa Ruby in Washington, DC, and the San Francisco LGBT Community Center are offering vaccination clinics and prevention services to LGBTT communities. Anybody else? Anyone has strategies and recommendations to implement influenza vaccination programs and services among LGBTT communities?

 

Through collaborations with the CDC-funded National Influenza Vaccination Disparities Partnership, the Vaccination Coalition of Puerto Rico (VOCES), and the School of Nursing at the University of Puerto Rico , the Citizens Alliance Pro LGBTTA Health was able to provide flu vaccines and education to Summit participants.

Through collaborations with the CDC-funded National Influenza Vaccination Disparities Partnership, the Vaccination Coalition of Puerto Rico (VOCES), and the School of Nursing at the University of Puerto Rico , the Citizens Alliance Pro LGBTTA Health was able to provide flu vaccines and education to Summit participants.

LGBT Wellness Roundup: September 5

As published on Huffington Post’s new LGBT Wellness blog, see original at: http://huff.to/1lRbvIm

Each week HuffPost Gay Voices, in a partnership with bloggers Liz Margolies and Scout, brings you a round up of some of the biggest LGBT wellness stories from the past seven days. For more LGBT Wellness, visit our page dedicated to the topic here. The weekly LGBT Wellness Roundup can also now be experienced as a video — check it out above.

Incarcerated and Unemployed: Confronting Trans Discrimination

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A new review of research and current policies regarding incarcerated transgender people discusses mental health needs, and the status of trans healthcare in prisons, also sites the overrepresentation of trans people in prison. Ontario’s cool community based participatory trans research project, TransPULSE, has come out with a new report showing trans people in Ontario have high rates of unemployment and underemployment, citing discrimination as a core reason. The links between unemployment and incarceration are not lost on us.

In Memory

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Andrew Cray, LGBT health advocate who worked for the Center for American Progress passed away from oral cancer last week. We all thank him for years of work, particularly his recent role in securing bulletins prohibiting insurance exclusions for trans care in DC and nine states. He’s memorialized elegantly by his friend, and coworker, Kellan Baker.

CVS Serving US Better

In March we blogged about the pending CVS changes to stop selling tobacco and what that means for the LGBT communities. Since then CVS has changed it’s name, ceased selling tobacco products (saying they can’t justify selling medicine and tobacco in the same location), and to top it off is now marketing themselves withLGBT inclusive advertisements.

When the Feds Fund LGBT Health The Right Wing Calls It Waste

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A federally funded study on sexual orientation and obesity is making headlines in right wing papers for wasteful spending. The Washington Post tries some basic support of the study, noting obesity is a major public health concern. We say kudos that NIH is making sure to include at least one study on us for one of the top public health crises today.

Lesbian? Out? Depressed?

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In a new study measuring the relationship between how “out” lesbians are and depression over 50% of participants reported lifetime history of depression at baseline and disclosure effects on depression varied by ethnic/racial identity, the authors urged more study of racial/ethnic variations.

Not So Safe At Home

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Two new studies show that LGBT people experience higher rates of domestic violence than the general population: triple the rate for men, and 75% more for women cohabitating with same sex partners, while 34.6 % of trans people reported history of domestic violence.

 

August 2014 UPDATES FROM LGBT HealthLink AND CANCER NETWORKS

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This month is we launched our re-branding; we are now LGBT HealthLink. We are busy getting all materials updated with the re-branding and rebuilding our social media followers. With the efforts of our consultant, Michael Bare, and an investment in advertising to boost our educational posts, we’re happy to report we have the following follower stats: Twitter: 724, Facebook: 2038, LinkedIn: 147.

As the Tips From Former Smokers campaign rolls into its last week on the air, we continue our associated social media push. LGBT HealthLink promoted Tips 26 times across social media (twice on Facebook, and 24 times on twitter, and one conversation with links on LinkedIn).The National LGBT Cancer Network promoted Tips 14 times across social media (twice on Facebook, 12 times on twitter).

Staff spent a week in Atlanta for the CDC Cancer meeting. This was our first chance to meet the fifty state cancer reps. We passed out a flyer to all fifty offering our services to help us integrate LGBT people more successfully into their programming.

Scout spent 2 days with Terry & Denise meeting on strategic planning.

We continue to prepare for our Steering Committee meeting in Las Vegas before the coming ED summit.

There are many projects in development right now with graphic designers and consultants. In the coming month expect to see: new brochure, new quit guide brochure, co-branded Tips posters, new state best practices excerpt.

We are happy to announce we’re working with Better World Advertising to relaunch the Cigarettes are My Greatest Enemy Campaign. Look for posters to be out at end of September.

Jessica Halem, our consultant continues to work with community center Executive Directors to create model wellness policies for adoption.

We scholarshipped three people to go to the LGBT Health Research Conference in Ohio, see our blog for great coverage of the event.

Media:

Scout was on Huffington Post live and was able to cover a wide range of topics from community center membership to tobacco to bisexuality, see full piece here:https://www.dropbox.com/s/sd3385k7om3d78q/Screenshot%202014-09-04%2016.27.21.png?dl=0

Tiny repost of the WashPost article: http://www.milehighgayguy.com/2014/08/lgbt-advocates-cry-foul-over-cdc-survey.html

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Cancer Network Subcontract:

  • Staff are busy on logistics for the first convening of the Cancer Best Practices advisory group. The meeting will happen directly prior to the Sept CenterLink Executive Director’s Summit in Las Vegas.
  • Staff are developing a short survey for state departments of health to assess their LGBT cancer programming, to be launched in September.
  • The Cancer Network continues to contact LGBT community centers to get uptake and cobranding of the LGBT Cancer Support Groups and Take Care of That Body (TCTB). We now have 7 centers promoting the Support groups and 8 promoting TCTB.
  • Liz provided technical assistance to the Idaho Department of Health and Welfare to expand their cancer fact sheets to include LGBT people.
  • Liz authored three pieces this month and was interviewed by several media outlets.

Blogs:

1.    Baldwin Wallace Presenting First LGBTI Health Conference with Class

2.    E.Shor Blogging From the LGBTI Health Research Conference

3.    Taking A Breath: First Night at the Conference on LGBTI Health Research

4.    Naming and Claiming Legacy: Day 2 At The Conference On LGBTI Health Research

5.    Intersectionality Redux And Revised: Day 3 At The Conference On LGBTI Health Research

6.    The Master’s House: Day 3 At The Conference On LGBTI Health Research

7.    Black Health: Final Thoughts On Conference On LGBTI Health Research

8.    #BWLGBTI Day 2: Perfect Time, Perfect Place

9.    #BWLBGTI Day 2 Post-Lunch: Revisiting Sexual Health

10. #BWLGBTI Day 3 Part 1: The IOM Report

11. #BWLGBTI Day 3 Part 2: Community-Based Research Is Still Important 

12. Putting The I In LGBTQI

13. Conference Reflections: Challenges In Data Collection

14. Yet Another Life Lost To Smoking

15. Announcing Our New Name – Lgbt Healthlink: The Network For Health Equity

16. Top Goals Of The Tobacco & Cancer Disparity Networks For Coming Year

17. Best And Promising Practices In Cancer In The LGBT Community

18. The Truth Comes Out: More Than A Quarter-Million Youth Who Had Never Smoked A Cigarette Have Used E-Cigarettes

Huffington Post Wellness Roundups for August:

LGBT Wellness News and Research Roundup August 1

LGBT Wellness News and Research Roundup August 8

LGBT Wellness News and Research Roundup August 15

LGBT Wellness News and Research Roundup August 22

 

50% HIGHER SMOKING RATES

We often quote numbers of LGBT individuals who smoke, or use tobacco. These numbers come from studies and surveys; one survey in particular the National Adult Tobacco Survey (NATS) asks individuals across types of tobacco products from smokeless tobacco (like snus or chewing tobacco), electronic cigarettes, waterpipes or hookah use, Cigars, cigarillos and filtered little cigars, and “any combustible tobacco product (this includes cigarettes). From these findings, and demographic information taken during the survey, we can see by race, gender, sexual orientation, age, region, education and income, how many people are smoking and what they are smoking.

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So how many LGBT people smoke? According to King, Dube and Tynan’s (2012) analysis of the 2009-2010 NATS reports LGBT people smoked at 52% higher rate than the general population when asked if they use “Any Tobacco” products. The 2012-2013 NATS found that LGBT people smoked at a 50% higher rate than the general population (Igaku, King, Husten, et al, 2014). It is a good start that the both groups decreased tobacco use, but LGBT people still smoke at twice the rate of the general population (see chart for details).

2009-2010 NATS 2012-2013 NATS
ANY TOBACCO USE
General Population 25.30% 20.50%
LGBT People 38.50% 30.80%
% Difference between LGBT and General Population 52% higher 50% higher

Sidenotes:In 2009-2010 and 2012-2013, consecutively, 16.6% and 24% of people who did not report their sexuality reported “any tobacco use;” it is curious why a 44% increase of individuals chose not to report their sexuality. A change in the way the question was asked between the two surveys is our best guess for this discrepancy.

Also, although many places the NATS report is reported as LGB, we’re reporting it as LGBT because even though questions about transgender status was asked in a poor way. While we will work at getting better measures used to describe transgender status and populations, we do not want to throw away this data at this point.

 

REFERENCES:

King, BA, Dube, SR & Tynan, MA. Brian A. (2012) Current Tobacco Use Among Adults in the United States: Findings From the National Adult Tobacco Survey. American Journal of Public Health: 102(11), e93-e100. doi: 10.2105/AJPH.2012.301002

Agaku, IT, King, BA, Husten CG, Bunnell, R, Ambrose, BK, Hu, SS,…Ray, HR. (2014). Tobacco Product Use Among Adults — United States, 2012–2013. MMWR: 63(25);542-547. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6325a3.htm

They Did It: They Got Mammograms Together

 

liz margolies

 

 

 

Founder and Executive Director,
National LGBT Cancer Network

As published on Huffington Post’s new LGBT Wellness blog, see original at: http://huff.to/1qMzWT9

When sorting through life’s chores and adventures, there are some things we automatically think to share with others, and some we simply plan alone. If I want to see a movie, I start by looking for a friend to accompany me, even though I am perfectly capable of going alone. The same goes for buying new eyeglasses or planning a vacation. On the other hand, I tend to exercise alone, buy groceries by myself and read a book solo.

I also go to the doctor alone, as do all my friends. We are a tight-knit group going back over 20 years; we share secrets, books and restaurant recommendations. I can tell you all their clothing and shoe sizes, yet I don’t know the names of most of their doctors. But of all things, medical care for LGBT people should absolutely be a community activity. We have more fear and more negative experiences with the healthcare system, and we could use additional support. Imagine trading the strained silence in the medical waiting room for the clamor of chatter among friends. Imagine how much easier it would be to come out to your doctor, knowing your friend is within shouting distance. Imagine the cumulative educational experience for healthcare providers when a succession of patients all come out to them on a given Tuesday morning.

The greater the fear, the more we need to have allies in attendance. My friend Jackie figured this out two years ago, after worrying aloud to her friend Barbara about her upcoming mammography appointment. (The dreaded squish is recommended every two years for women between the ages of 50 and 74, or younger for those with a family history of breast cancer.) It turned out that Barbara used the same radiologist as Jackie and had scheduled her own appointment for the following week. They vowed to go together this year; that appointment happened this past Tuesday.

Jackie and Barbara are both lesbians; they are also both white. As a group, lesbians have a cluster of risk factors that increase our likelihood of getting breast cancer. We drink more alcohol, smoke at significantly higher rates, are less likely to have had a biological child before the age of 30 (which would have offered some protection) and are more likely to be overweight. African-American women have a lower risk of getting breast cancer than white women but are, paradoxically, more likely to die from it.

The studies are mixed, but many show that despite the increased breast-cancer risk, lesbians are less likely to get the recommended mammograms, increasing the odds of having the cancer detected at a later stage. The reasons for avoidance of the healthcare system in general, and of mammograms in particular, are understandable. As a group, LGBT people have historically had lower rates of health insurance, although the Affordable Care Act is changing our access to coverage. Many lesbians and bisexual women underestimate their risks for breast cancer, and, taking into account the history of ignorance and/or discrimination by providers, they simply avoid the subject. Trans men without top surgery can add to the list a denial of the existence of body parts that don’t match their gender identity. But our health depends on our ability to push past all these barriers and fight for our lives.

I applaud Jackie and Barbara, both for their diligence in being screened and for hatching their plan of mutual support. Most of us complain that we don’t see our friends often enough, yet we fail to see this opportunity for catching up on our lives, instead sitting nervously alone in waiting rooms across the country, often for an hour or more. Yesterday in New York City, Jackie and Barbara gossiped, laughed, and squeezed each other’s hand after being called in. They also were there for each other when the radiologist read the results. Both sets of mammograms were clean. Shwooo!

I think we can all take our cue from Jackie and Barbara and turn medical appointments into a team sport. If we went as a gang, we would also be better able to encourage that friend who always avoids the doctor to come along with us. From annual physicals to recommended cancer screenings, make a day of it. A movie and a mammogram! Cocktails and colonoscopies! Pap smears and pasta! Our lives depend on it.