Juno Obedin-Maliver, MD, MPH, MAS

Sexual orientation disparities in adverse pregnancy outcomes Sexual orientation disparities in adverse pregnancy outcomes Am J Obstet Gynecol. 2024 Mar 6:S0002-9378(24)00429-0. doi: 10.1016/j.ajog.2024.02.315. Online ahead of print. Authors Payal Chakraborty 1 , Ellis Schroeder 2 , Colleen A Reynolds 3 , Sarah McKetta 3 , Juno Obedin-Maliver 4 , S Bryn Austin 5 , Bethany Everett 6 , Sebastien Haneuse 7 , Brittany M Charlton 8 Affiliations 1 Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, 401 Park Dr, Suite 401 E, Boston, MA 02215; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA. Electronic address: pchakraborty@hsph.harvard.edu. 2 Druid Hills High School, Atlanta, GA. 3 Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA; Department of …

IntroductionThis study evaluated effects of exposure to culturally tailored anti-smoking ads versus control ads on quitting intentions, cigarette purchase intentions, and tobacco industry perceptions among young adult, cisgender and transgender, sexual minority women (SMW).Study DesignAn online randomized controlled experiment with 1-month longitudinal follow-up was conducted.Setting and ParticipantsAbout 2,214 U.S. SMW ages 18–30 were recruited via online survey panels (The PRIDE Study and Prolific), social media ads and posts, and HER dating app ads. Data were collected in 2021–2022.InterventionParticipants were randomly assigned to receive up to 20 tailored ads containing LGBTQ+ branding versus 20 control ads without LGBTQ+ branding over 4 weeks. Both conditions used identical anti-smoking statements and photographs (including several photographs of individuals who self-identified as …

IntroductionWhile trauma experiences and treatment-seeking are common among sexual and gender minority (SGM) individuals, little is known about their specific experiences in psychotherapy, including treatment types, characteristics (e.g., length, episodes), barriers, satisfaction, and microaggressions.MethodSGM individuals (N = 2,685) from a national cohort study completed a survey.ResultsThe majority (87%) of participants endorsed past therapy, including for trauma (56%). Ratings of therapy barriers and microaggressions were low and satisfaction with therapy was high. However, therapy experiences differed based on sexual orientation, gender, and if the therapy was focused on trauma.ConclusionEffective treatments for trauma should be informed by the needs of the diverse groups that comprise the SGM community.

Lesbian, gay, bisexual, transgender, queer, intersex, asexual, aromantic, and other sexual and/or gender minority (LGBTQIA+) communities are underrepresented in health research and subject to documented health disparities. In addition, LGBTQIA+ communities have experienced mistreatment, discrimination, and stigma in health care and health research settings. Effectively engaging LGBTQIA+ communities and individuals in health research is critical to developing representative data sets, improving health care provision and policy, and reducing disparities. However, little is known about what engagement approaches work well with LGBTQIA+ people. This paper describes the development of PRIDEnet (pridenet. org), a national network dedicated to catalyzing LGBTQIA+ community involvement in health research and built upon well-established community-engaged research (CEnR) principles. PRIDEnet’s …

BackgroundIn July 2023, the US Food and Drug Administration approved the first nonprescription oral contraceptive, a progestin-only pill, in the United States. Transgender, nonbinary, and gender-expansive people assigned female or intersex at birth face substantial contraceptive access barriers and may benefit from over-the-counter oral contraceptive access. However, no previous research has explored their perspectives on this topic.ObjectiveThis study aimed to measure interest in over-the-counter progestin-only pill use among transgender, nonbinary, and gender-expansive individuals assigned female or intersex at birth.Study DesignWe conducted an online, cross-sectional survey from May to September 2019 (before the US Food and Drug Administration approval of a progestin-only pill) among a convenience sample of transgender, nonbinary, and gender-expansive people assigned female or intersex at …

Objectives. To examine inequities in conversion practice exposure across intersections of ethnoracial groups and gender identity in the United States. Methods. Data were obtained from The Population Research in Identity and Disparities for Equality Study of sexual and gender minority people from 2019 to 2021 (n = 9274). We considered 3 outcomes: lifetime exposure, age of first exposure, and period between first and last exposure among those exposed to conversion practices. We used log-binomial, Cox proportional hazards, and negative binomial models to examine inequities by ethnoracial groups and gender identity adjusting for confounders. We considered additive interaction. Results. Conversion practice prevalence was highest among minoritized ethnoracial transgender and nonbinary participants (TNB; 8.6%). Compared with White cisgender participants, minoritized ethnoracial TNB participants had …

BACKGROUNDAlthough 10% to 20% of cisgender women aged 18 to 40 years have a sexual minority identity (eg, bisexual, lesbian, and queer), there is limited research on the family building and pregnancy experiences of sexual minority cisgender women. Improving our understanding of the family building and pregnancy experiences of cisgender sexual minority women is critical for improving the perinatal health of this population.OBJECTIVEThis study aimed to compare the mode of family building, past pregnancy experiences, and future pregnancy intentions among cisgender sexual minority women by sexual orientation.STUDY DESIGNThis is an observational study which was conducted using cross-sectional data collected in 2019 from a national sample of 1369 cisgender sexual minority women aged 18 to 45 years.RESULTSMost participants (n=794, 58%) endorsed multiple sexual orientations, most …

Sex related differences, without taking gender into account, in chronic pain have been widely researched over the past few decades in predominantly cisgender and heterosexual populations. Historically, chronic pain conditions have a higher incidence and prevalence in cisgender women, including but not limited to fibromyalgia, irritable bowel syndrome, and migraine. The goal of the present study was to identify and characterize the presence and characteristics of chronic pain in SM and GM persons using data from The PRIDE Study, which is the first large-scale, long-term national cohort health study of people who identify as lesbian, gay, bisexual, transgender, queer, or as another sexual or gender minority person. A total of 6189 adult participants completed The PRIDE Study 2022 Annual Questionnaire at the time of data analysis. A total of 2462 participants reported no chronic pain, leaving 2935 participants who reported experiencing chronic pain. The findings from this study highlight that chronic pain is present to a significant degree in sexual and gender minority adults who participated in The PRIDE Study with chronic spine pain being the most common location/region of pain. Notably, more than one-third of non-binary persons, transgender men, and people who selected another gender experienced chronic widespread pain, defined by having 3 or more total regions of chronic pain. The lowest prevalence of chronic widespread pain was among transgender women and cisgender men. When considering sexual orientation, the highest prevalence of widespread pain was in participants who selected another sexual orientation, followed by …

Purpose: Sexual and gender minority (SGM) people are at greater risk for substance use than heterosexual and cisgender people, but most prior work is limited by cross-sectional analyses or the examination of single substance use. This study examined substance use over time among SGM people to identify patterns of polysubstance use at the intersection of sex and gender. Methods: Data were collected annually over 4 years from SGM respondents (n = 11,822) in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Differences in substance use patterns (any prior 30-day use of 15 substances) by gender subgroup were examined with latent class analysis, and multinomial regression models tested relationships between gender subgroup and substance use. Results: Eight classes of substance use were observed. The three most common patterns were low substance use (49 …

We conducted a longitudinal randomized controlled experiment between September 2021 and May 2022 to evaluate whether anti-tobacco industry beliefs and attitudes mediate the effect of culturally tailored anti-smoking messages on quit intentions among US young adult sexual minority women (SMW) ages 18-30 who smoke. Participants were randomized to view up to a total of 20 tailored versus non-tailored messages over one month. Outcomes were assessed at baseline and one month follow-up. We fit a structural equation model testing the effect of LGBTQ+ community-tailored, anti-smoking messages on quit intentions and mediating roles of anti-industry attitudes and beliefs (n= 966). Anti-industry beliefs (indirect effect size= 0.024, 95% confidence interval [CI]=[0.040, 0.056]) and attitudes (indirect effect size= 0.034, 95% CI=[0.006, 0.077]) significantly mediated the effect of the tailored condition on quit intentions. These findings suggest that LGBTQ+ tailored cues in anti-smoking messaging may promote quit intentions indirectly through influencing young adult SMW’s beliefs and attitudes about the tobacco industry. Future campaigns to promote quitting among young adult SMW who smoke should consider incorporating themes to change their beliefs and attitudes about the tobacco industry.

To characterize current lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI +) health-related undergraduate medical education (UME) curricular content and associated changes since a 2011 study and to determine the frequency and extent of institutional instruction in 17 LGBTQI + health-related topics, strategies for increasing LGBTQI + health-related content, and faculty development opportunities. Deans of medical education (or equivalent) at 214 allopathic or osteopathic medical schools in Canada and the United States were invited to complete a 36-question, Web-based questionnaire between June 2021 and September 2022. The main outcome measured was reported hours of LGBTQI + health-related curricular content. Of 214 schools, 100 (46.7%) responded, of which 85 (85.0%) fully completed the questionnaire. Compared to 5 median hours dedicated to LGBTQI + health-related in a 2011 study, the 2022 median reported time was 11 h (interquartile range [IQR], 6–16 h, p < 0.0001). Two UME institutions (2.4%; 95% CI, 0.0%-5.8%) reported 0 h during the pre-clerkship phase; 21 institutions (24.7%; CI, 15.5%-33.9%) reported 0 h during the clerkship phase; and 1 institution (1.2%; CI, 0%-3.5%) reported 0 h across the curriculum. Median US allopathic clerkship hours were significantly different from US osteopathic clerkship hours (4 h [IQR, 1–6 h] versus 0 h [IQR, 0–0 h]; p = 0.01). Suggested strategies to increase content included more curricular material focusing on LGBTQI + health and health disparities at 55 schools (64.7%; CI, 54.6%-74.9%), more faculty willing and able to teach LGBTQI + -related …

ImportanceLimited data describe the health status of sexual or gender minority (SGM) people due to inaccurate and inconsistent ascertainment of gender identity, sex assigned at birth, and sexual orientation.ObjectiveTo evaluate whether the prevalence of 12 health conditions is higher among SGM adults in the All of Us Research Program data compared with cisgender heterosexual (non-SGM) people.Design, Setting, and ParticipantsThis cross-sectional study used data from a multidisciplinary research consortium, the All of Us Research Program, that links participant-reported survey information to electronic health records (EHR) and physical measurements. In total, 372 082 US adults recruited and enrolled at an All of Us health care provider organization or by directly visiting the enrollment website from May 31, 2017, to January 1, 2022, and were assessed for study eligibility.ExposuresSelf-identified gender …

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 …

BackgroundAlthough the Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms, evidence indicates potential limitations with its original factor structure and associated psychometric properties in a variety of populations, including sexual minority populations. The aims of the current investigation were to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of cisgender gay men and cisgender lesbian women.MethodsData were drawn from 1624 adults (1060 cisgender gay men, 564 cisgender lesbian women) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were …

Purpose Minority stress is related to short-term increases in substance use. This study identified patterns of cannabis use over four years among sexual and gender minority (SGM) people. We examined if cannabis use trajectories related to baseline minority stressors, and if differences by gender persisted after accounting for minority stress. Procedures Participants were 11,813 SGM people within The PRIDE Study who provided information about risk for cannabis use disorder via the National Institute on Drug Abuse Modified Alcohol, Smoking, and Substance Involvement Screening Test annually for up to four years. Latent class growth curve mixture models identified five cannabis use trajectories: ‘low or no risk’, ‘low moderate risk’, ‘high moderate risk’, ‘steep risk increase’, and ‘highest risk’. Results Participants (n = 5,673) who reported past-year discrimination and/or victimization at baseline had greater odds of membership in any cannabis risk category compared to the ‘low risk’ category (odds ratios [OR] 1.17-1.33). Internalized stigma was related to ‘high moderate’ and ‘highest risk’ cannabis use over time (ORs 1.27-1.38). After accounting for minority stress, gender expansive people and transgender men had higher odds than cisgender men to have ‘low moderate risk’ (ORs 1.61, 1.67) or ‘high moderate risk’ (ORs 2.09, 1.99). Transgender men had higher odds of having ‘highest risk’ (OR 2.36) cannabis use compared to the ‘low or no risk’ category. Conclusions Minority stress at baseline is related to prospective cannabis use risk trajectories, and gender expansive people and transgender men have greater cannabis use risk even after …

ObjectiveSexual and/or gender minority (SGM) people confront disparities in reproductive health care. Studies among non-SGM people have shown concerns about and delays in parenthood due to the COVID-19 pandemic. We aimed to describe factors among SGM people influencing the delay and return to family building in the COVID-19 pandemic.Study DesignData from participants in The PRIDE Study—a national, online, longitudinal cohort study of SGM people—who completed the 2022 COVID Family Building Survey, self-reported sexual orientation and gender identity and reported impact from COVID-19 on family building plans were included. We used chi-square and Fisher’s exact tests to compare family building decision making factors among SGM (cisgender, transgender, and gender expansive) groups.ResultsOur study included a total of 401 SGM participants with a median age of 32 years. A total of …

Approximately 50% of transmasculine people use testosterone for gender affirmation, yet very little is known about the effects of testosterone on future reproductive capacity. Moreover, there are no data to guide fertility specialists on how to manage testosterone leading up to or during ovarian stimulation. Most clinics require cessation of testosterone prior to ovarian stimulation in this setting of no data; however, the current literature does suggest a potential increase in dysphoria with cessation of testosterone and during stimulation. This divergence begs the question of whether clinicians may be doing more harm than good by enacting this requirement. Here, we present two cases of transmasculine individuals who were on testosterone prior to stimulation and maintained their testosterone dosage throughout stimulation as proof of concept, followed by a discussion of current clinical practice and providing some …

BackgroundThere is a growing demand for assisted reproductive technology (ART) among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) population. 1 Attrition in care among racial/ethnic minorities after initial consultation has been linked to lack of insurance coverage; however, almost no studies have investigated attrition factors among LGBTQ+ patients. 2ObjectiveTo identify risk factors for attrition after initial consultation for fertility care among LGBTQ+ patients.Materials and MethodsAll LGTBQ+ patients who presented to a single provider at a large academic REI practice from November 2020-July 2022 were included. Patients were categorized by whether they completed the initial diagnostic evaluation and attended a return visit (“completed workup”) or not and by insurance status. Reasons for not completing were recorded and themes identified. Time to critical milestones from their referral including …

Objectives. To examine the associations of self-reported disability status with health care access barriers for sexual and gender minority (SGM) people. Methods. The Population Research in Identity and Disparities for Equality (PRIDE) Study participants lived in the United States or its territories, completed the 2019 annual questionnaire (n = 4961), and self-reported their disability and health care access experiences, including whether they had a primary care provider, were uninsured, delayed care, and were unable to obtain care. We classified disabilities as physical, mental, intellectual, and other; compared participants to those without disabilities; and performed logistic regression to determine the associations of disability status and health care access barriers. Results. SGM people with disabilities were less likely to have a usual place to seek health care (69.0% vs 75.3%; P ≤ .001) and more often reported …

Sexual orientation and gender identity (SOGI) represent fundamental parts of a person's identity, yet these important demographic characteristics are not consistently asked on US-based health surveys (Patterson et al., 2017). As a result of inconsistent survey practices, sexual and gender minority (SGM) people–including but not limited to lesbian, gay, bisexual, transgender and queer (LGBTQ+) people–are often rendered invisible despite growing evidence of health disparities and differences, as well as differences in resilience patterns among these populations (Blosnich et al., 2014; Bockting et al., 2013; Cahill et al., 2016; Fredriksen-Goldsen et al., 2014; Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, 2011; Jaffee et al., 2016; Patterson et al., 2017). Gender minority people are transgender and gender diverse individuals …