Sexual and Reproductive Health Disparities in a National Sample of Hispanic and Non-Hispanic White U.S. College Students

Hispanic students are the fastest growing minority population on U.S. college campuses. The purpose of this study was to examine differences in the sexual and reproductive health behaviors and outcomes between Hispanic and non-Hispanic White college students. Analyses utilized data from 15,518 non-married undergraduates (aged 18-24 years) responding to the Fall 2009 American College Health Association-National College Health Assessment II, a national sample of U.S. college students. Binary logistic regression analyses were used to examine disparities in sexual and reproductive health behaviors and outcomes, including sexual behavior, contraceptive and condom use, HIV testing, and STD and unintended pregnancy history, between Hispanic and non-Hispanic Whites. Hispanics had greater odds of reporting a past-year STD, although rates of reported sexual risk behaviors were no higher among Hispanics compared with non-Hispanic Whites. Compared to non-Hispanic Whites, fewer Hispanics reported using birth control pills. Hispanics were 2.5 times less likely to report using any method to prevent pregnancy, which may explain why Hispanics were more likely to report emergency contraceptive use in the past 12 months and a past-year unintended pregnancy. Important sexual health disparities exist among U.S. students, which have important practical implications for college health policy, practice, and intervention. Further research is warranted to understand the ethnic differences in the use of both hormonal and emergency contraceptives, particularly among college students

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

HPV Vaccine Decision-Making among Male Sexual Minorities: An Integrative Theoretical Framework for Vaccine Promotion

Men who have sex with men (MSM) are at increased risk of anal cancer as a result of anal HPV infection. Routine HPV vaccination is recommended for all MSM up through age 26; however, vaccine uptake among this population is low. The Integrative Model of Behavioral Prediction (IM) was used to identify, describe, and explain psychosocial factors related to HPV vaccine decision-making for young MSM. A sequential mixed-methods approach consisting of semi-structured interviews, a quantitative survey, and a qualitative open-ended survey was used to address the following aims: (1) Determine salient outcome, normative, efficacy, and control beliefs related to HPV-vaccination among young MSM; (2) Identify information needs and trusted sources of information regarding HPV vaccination among young MSM; and (3) Develop and test a structural equation model guided by the Integrated Model of Behavioral Prediction. The purpose and objectives of this research address priorities outlined in the Institute of Medicine\u27s report on health disparities among lesbian, gay, bisexual, and transgender (LGBT) populations. Results highlight the lack of information and knowledge regarding HPV prevention in this population. The majority of respondents had heard of the HPV vaccine but generally perceived it as a women\u27s health issue. Attitudes toward vaccination were generally positive, as was behavioral intention to get vaccinated within the next 12 moths. Salient behavioral beliefs described physical benefits such as lowering risk and promoting overall health. Psychological benefits were described as protecting sex partners and providing peace of mind. There was some concern regarding the risks of vaccination including contracting HPV from the vaccine, not knowing if it would be effective, and potential side effects. Normative influences on decision-making were minimal. Availability, cost, and convenience were among the most salient external control factors. Issues surrounding disclosure of sexual minority status influenced control factors including self-efficacy. Addressing the specific beliefs and concerns expressed by MSM can help to improve the effectiveness of health education interventions promoting vaccination. Empirical findings support the proposed behavioral model of vaccine decision-making

HPV vaccination and HIV preexposure prophylaxis (PrEP): Missed opportunities for anal cancer prevention among at risk populations

Gay, bisexual, and other men who have sex with men (GBM), in addition to transgender women who have sex with men (TW), are at disproportionate risk for anal cancer. Anal cancer can be prevented with HPV vaccination, but uptake among adult GBM/TW is low. Targeted HPV vaccination during the clinical management of pre-exposure prophylaxis (PrEP) is an unexplored strategy relevant to these populations. The purpose of this study was (1) to determine the need for HPV vaccination among GBM and transgender women PrEP users and (2) to identify correlates of HPV vaccination among PrEP users. Secondary analysis of the 2020 Pennsylvania LGBT Health Needs Assessment was conducted to estimate prevalence ratios of HPV vaccination among PrEP users. Overall, 43.8% of the sample had initiated HPV vaccination. Vaccine initiation was significantly lower among respondents 27 to 35 (PR = 0.64; 95% CI: 0.49–0.83) and 36 to 45 (PR = 0.38; 95% CI: 0.25–0.58). Respondents who had received Hepatitis A vaccination were significantly more likely to have had initiated HPV vaccination after adjusting for age (aPR = 2.60; 95% CI: 1.75–3.84). Overall, more than half of eligible GBM and TW engaged in PrEP care have not initiated HPV vaccination and represent potential missed opportunities for anal cancer prevention

It takes more than rainbows: Supporting sexual and gender minority patients with trauma‐informed cancer care

Background/purposeThe American Society of Clinical Oncology has called for an increased priority to improve cancer care for sexual and gender minority (SGM) populations because of heightened risk of receiving disparate treatment and having suboptimal experiences, including perceived discrimination. We demonstrate how integrating trauma-informed care (TIC) principles across the cancer continuum is a key strategy to improving care delivery and outcomes among SGM populations.MethodThis empirically informed perspective expands on the concepts generated through the American Society of Clinical Oncology position statement and uses the Substance Abuse and Mental Health Services Association's "Four Rs" Toward Trauma Informed Care: Realize, Recognize, Response, and Resist Traumatization.ResultsRecommendations for each component of TIC include: (1) Realize: Implement SGM cultural humility training, including modules on SGM-specific trauma, discrimination, harassment, and violence; (2) Recognize: Routinely screen for emotional distress using methods to ensure privacy, and/or normalize mental health screenings to cancer patients; (3) Respond: Create and widely disseminate policies and patients' rights that prohibit discrimination and ensure access to gender-neutral clinical environments; and (4) Resist Traumatization: Establish and respond to quality metrics (e.g., standardized patients, patient satisfaction surveys) that are informed by a community advisory board with the purpose of ensuring and maintaining quality care.Conclusions and implicationsIntegrating TIC principles into cancer care for SGM populations is crucial to address disparities in treatment and clinical outcomes. Our recommendations offer practical approaches for oncology teams to implement TIC care and ensure equitable and inclusive cancer care for patients and their families

Cross-national investigation of health indicators among sexual minorities in Norway and the United States

A cross-national study of young adult sexual minorities was conducted in order to explore the associations between sexual orientation and measures of depression, suicidality, and substance use. Two nationally representative data sets were explored from the United States (N = 14,335) and Norway (N = 2423). Results indicated that sexual minorities experienced multiple health disparities (depression, suicidality, and substance use) compared to their heterosexual counterparts. We found similar patterns of depression, suicidality, and substance use for sexual minorities in both the United States and Norway. The highest odds of substance use were among heterosexual-identified Norwegian youth who reported same-sex sexual activity, and the highest odds of suicidality were found for bisexual young adults in Norway. These findings have implications for how we consider culture and social policy as barriers and/or opportunities for sexual minorities

Cross-National Investigation of Health Indicators among Sexual Minorities in Norway and the United States

A cross-national study of young adult sexual minorities was conducted in order to explore the associations between sexual orientation and measures of depression, suicidality, and substance use. Two nationally representative data sets were explored from the United States (N = 14,335) and Norway (N = 2423). Results indicated that sexual minorities experienced multiple health disparities (depression, suicidality, and substance use) compared to their heterosexual counterparts. We found similar patterns of depression, suicidality, and substance use for sexual minorities in both the United States and Norway. The highest odds of substance use were among heterosexual-identified Norwegian youth who reported same-sex sexual activity, and the highest odds of suicidality were found for bisexual young adults in Norway. These findings have implications for how we consider culture and social policy as barriers and/or opportunities for sexual minorities.Applied Science, Faculty ofNon UBCNursing, School ofReviewedFacult

A Qualitative Comparative Analysis of Combined State Health Policies Related to Human Papillomavirus Vaccine Uptake in the United States.

Objectives. To examine how combinations of state policies, rather than single policies, are related to uptake of human papillomavirus (HPV) vaccine. Methods. Using publicly available records and the literature, we characterized policies for each US state and Washington, DC, in 2015 (n = 51), including (1) Medicaid expansion, (2) policies permitting HPV vaccination in pharmacies, (3) school-entry requirements, (4) classroom sex education mandates, and (5) parental education mandates. Using qualitative comparative analysis, we identified which existing combinations of these policies were necessary and sufficient for high HPV vaccine initiation among adolescents, with National Immunization Survey-Teen data. Results. No single policy was necessary or sufficient for high HPV vaccine uptake; however, 1 set of policies had consistently high HPV vaccine uptake: adoption of all policies except parental education mandates (girls: consistency = 1.00, coverage = 0.07; boys: consistency = 0.99, coverage = 0.08). Conclusions. We identified a set of polices related to high HPV vaccine uptake. Future studies should examine how these policies and others, individually and in combination, are associated with HPV vaccine uptake. Public Health Implications. This study provides insight into what sets of policies are consistently related to high HPV vaccine uptake. </jats:p

Abstract PO-257: Disparities in unawareness of hepatitis C virus among U.S. adults: An analysis of the 2019 Health Information National Trends Survey

Abstract Purpose Infection with Hepatitis C virus (HCV) is often asymptomatic and chronic infection may lead to liver cancer. In light of the 2020 USPSTF update to HCV screening guidelines to include all adults between 18-79 years old, our objective was to investigate demographic disparities in HCV unawareness with a specific interest in age and race/ethnicity. We estimated (1) HCV unawareness by demographic groups, (2) determinants of HCV unawareness, and (3) sources of health information among those with high HCV unawareness. Methods We used weighted nationally- representative data from the 2019 Health Information National Trends Survey(N=5438) to estimate frequencies of socio-demographic characteristics by HCV unawareness and determinants of HCV unawareness through multivariable logistic regression. We further estimated risk differences (RD) with 95% confidence intervals(CIs) of HCV unawareness by age and race/ethnicity compared to older non- Hispanic(NH)-Whites. Results Overall, 17.3% of adults were unaware of HCV. Younger adults <55 years (20.7%) were more likely to be unaware of HCV compared to older adults ≥55 years (11.6%, χ2 p<0.001). Multivariable analyses showed that younger age, low English fluency, and Hispanic or NH-Asian ethnicity were associated with HCV unawareness. When compared to NH-Whites ≥55 years, the largest differences in HCV unawareness was observed among NH-Asians (RD:25.6%,95%CI:8.2-43.1) and Hispanics (RD:17.1,95%CI:6.3-27.9) adults <55 years. Younger adults unaware of HCV reported primarily obtaining their health information from the internet (75.5%). Conclusions Younger adults, Hispanics, and NH-Asians are more likely to be unaware of HCV. Public health messaging should be targeted to these demographic groups to improve HCV screening coverage. Social media campaigns may increase reach as most young adults unaware of HCV obtain their health information on the internet. Citation Format: Jessica Y. Islam, Lisa Spees, Marlene Camacho-Rivera, Denise C. Vidot, Rina Yarosh, Christopher W. Wheldon. Disparities in unawareness of hepatitis C virus among U.S. adults: An analysis of the 2019 Health Information National Trends Survey [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-257