Exploring lesbian health disparities: social and structural predictors of adiposity and the metabolic syndrome

Lesbians in the U.S. are disproportionately affected by overweight and obesity compared to heterosexual women. However, there is little public health research examining the possible explanations for the disparity. In addition, there are few studies that have examined the related sequelae of obesity, such as metabolic syndrome. Three studies were conducted using the Epidemiologic Study of HEalth Risk Among Women (ESTHER), a cross-sectional cardiovascular risk study of lesbian and heterosexual women from Pittsburgh, PA and surrounding areas. Study 1 examined the influence of gender nonconformity on body image and satisfaction as well as weight. Butch lesbians reported a smaller difference between their current and ideal figure compared to femme lesbians, lesbians who were “neither” butch nor femme, and heterosexual women, although we did not note any significant differences between the lesbian subgroups in terms of ideal figure. Butch lesbians had significantly higher odds of both overweight and obesity (AOR = 2.15 and 5.57, respectively). Study 2 explored predictors of waist-to-hip ratio (WHR) and BMI status. We did not find any difference between lesbians and heterosexuals in terms of WHR. The odds of lesbians being obese compared to normal weight were 1.63 times higher than the odds of heterosexuals being obese compared to normal weight (p=0.013). Being in a committed relationship was associated with significantly lower odds of overweight and obesity for heterosexual women but not for lesbians. Importantly, lesbians who reported gender discrimination had over three times higher odds of being obese (AOR = 3.122, p < 0.001). Study 3 extended the lesbian health disparities literature by quantifying the differential risk of the metabolic syndrome between lesbians and heterosexuals. After controlling for several factors, lesbians had a 44% higher risk of having the metabolic syndrome than heterosexuals. Future research is needed to examine potential mediators and additional moderators of the relationship between gender nonconformity, sexual orientation, and obesity and the metabolic syndrome. Given the serious public health consequences of both obesity and the metabolic syndrome, public health should commit greater resources to studying these health disparities among lesbians

Evidence of Syndemics and Sexuality-Related Discrimination Among Young Sexual-Minority Women

Purpose: Syndemics, or the co-occurrence and interaction of health problems, have been examined extensively among young men who have sex with men, but their existence remain unexamined, to our knowledge, among sexual-minority (i.e., lesbian, gay, and bisexual) women. Thus, we investigated if syndemics were present among young sexual-minority women, and if sexual-orientation discrimination was an independent variable of syndemic production. Methods: A total of 467 sexual-minority women between the ages of 18 and 24 completed a cross-sectional online survey regarding their substance use, mental health, sexual behaviors, height, weight, and experiences of discrimination. We used structural equation modeling to investigate the presence of syndemics and their relationship to sexual-orientation discrimination. Results: Heavy episodic drinking, marijuana use, ecstasy use, hallucinogen use, depressive symptoms, multiple sexual partners, and history of sexually transmitted infections (STIs) comprised syndemics in this population (chi-square=24.989, P=.201; comparative fit index [CFI]=0.946; root mean square error of approximation [RMSEA]=0.023). Sexual-orientation discrimination is significantly and positively associated with the latent syndemic variable (unstandardized coefficient=0.095, P.05). Conclusions: Syndemics appear to be present and associated with sexual-orientation discrimination among young sexual-minority women. Interventions aimed at reducing discrimination or increasing healthy coping may help reduce substance use, depressive symptoms, and sexual risk behaviors in this population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140158/1/lgbt.2014.0063.pd

Professional agency vs consumer directed care workers: Outcomes in managed care

Direct care workers are a major part of the long-term services and supports (LTSS) needed to address the health of individuals and accounted for $112 billion in United States spending in 2015. Direct care workers are hired within professional agency models (PAMs) or consumer-directed models (CDMs) where workers (including family) are contracted by the individual to obtain services. We sought to identify differences in cost and utilisation outcomes between PAM and CDM participants. Data were obtained from the University of Pittsburgh Medical Center (UPMC) Insurance Services Division from the participants enrolled in UPMC Community HealthChoices in Pennsylvania during 2018. A retrospective, observational cohort study design was performed using claims data. Utilisation outcomes were assessed using multivariate logistic regression and cost outcomes by linear regression. The 3,232 participants met the inclusion criteria. Of these, 69% (N = 2,217) were in a PAM, 23% (N = 752) were in a CDM, and 8% (N = 263) used a combination of services. PAM groups were older (mean 62.4 years vs 54.1 years), more likely to be women (69.0% vs 62.8%), and had more healthcare needs. Hospital utilisation was the same among groups. However, total cost was lower in CDM groups due to differences in LTSS costs between CDM and PAM services. Among dually eligible Medicare and Medicaid beneficiaries receiving LTSS, there are significant differences in age, gender, race and health needs. While hospital utilisation was not different between groups, CDM groups had lower total costs of care compared to PAM. These findings have implications for families, policymakers and insurers in helping to govern community LTSS while supporting member autonomy

Harm reduction principles for healthcare settings

Abstract Background Harm reduction refers to interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely. The vast majority of the harm reduction literature focuses on the harms of drug use and on specific harm reduction strategies, such as syringe exchange, rather than on the harm reduction philosophy as a whole. Given that a harm reduction approach can address other risk behaviors that often occur alongside drug use and that harm reduction principles have been applied to harms such as sex work, eating disorders, and tobacco use, a natural evolution of the harm reduction philosophy is to extend it to other health risk behaviors and to a broader healthcare audience. Methods Building on the extant literature, we used data from in-depth qualitative interviews with 23 patients and 17 staff members from an HIV clinic in the USA to describe harm reduction principles for use in healthcare settings. Results We defined six principles of harm reduction and generalized them for use in healthcare settings with patients beyond those who use illicit substances. The principles include humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination. For each of these principles, we present a definition, a description of how healthcare providers can deliver interventions informed by the principle, and examples of how each principle may be applied in the healthcare setting. Conclusion This paper is one of the firsts to provide a comprehensive set of principles for universal harm reduction as a conceptual approach for healthcare provision. Applying harm reduction principles in healthcare settings may improve clinical care outcomes given that the quality of the provider-patient relationship is known to impact health outcomes and treatment adherence. Harm reduction can be a universal precaution applied to all individuals regardless of their disclosure of negative health behaviors, given that health behaviors are not binary or linear but operate along a continuum based on a variety of individual and social determinants