Does Level of Equality in State of Residence Relate to LGBT Health? An Analysis of Adults Aged 50+ Years from 34 US States

Lesbian, gay, bisexual, and transgender (LGBT) health disparities have been well documented in previous research. This study examined whether the level of equality in state of residence (high, medium, fair, poor, or negative), determined by tallied LGBT-related laws and policies, was associated with health outcomes for LGBT adults. This study consisted of 3486 LGB and 959 transgender adults ages 50+ as well as 1:1 propensity matched heterosexual and cisgender participants from the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Separate logistic regression analyses for the LGB, transgender, heterosexual, and cisgender groups were conducted to assess health differences by state equality ranking. Results indicated that LGB participants in fair ranked states were more likely to report fair/poor general health (aOR=1.4, 95% CI=1.1-1.8) and 14 or more days of poor mental health in the past 30 days (aOR=1.4, 95% CI=1.1-1.9) compared to LGB in high ranked states. LGB participants in a low or negative ranked state were more likely to report fair/poor health (aOR=1.6, 95% CI=1.3-2.0), 14 days or more of poor physical health (aOR=1.5, 95% CI=1.1-1.8), and 14 or more days of poor mental health (aOR=1.3, 95% CI=1.0-1.7) in the past 30 days. Transgender participants in medium and low/negative ranked states were more likely to report fair/poor health (lowest aOR=1.75, 95% CI=1.3-2.5) compared to transgender individuals in high equality states. Similar results were not found for the matched heterosexual and cisgender groups. These results suggest that LGBT-related laws and policies may play a role in LGBT health.

Teaching LGBT+ Health and Gender Education to Future Doctors: Implementation of Case-Based Teaching

Improving the education of medical students and physicians can address the disparities in LGBT+ (lesbian, gay, bisexual, transgender, and others) health care. This study explored how teachers used case-based teaching to teach medical students about gender and LGBT+ health care and discussed the implementation and effectiveness of case-based teaching from the perspective of the teachers and students. This study employed the case study method and collected data through semi-structured interviews. This study used two gender courses in clinical psychiatric education as case studies. Two teachers and 19 medical students were recruited as participants. The findings of this study were as follows: (1) effective cases links theory to clinical practice and competency learning; (2) experience sharing by LGBT+ is highly effective; (3) discussions promote the effectiveness of case-based teaching; and (4) the challenges of case-based teaching included time limitations, the multiplexity of the cases, and multilevel learning. This study also found that using narrative cases is a form of narrative pedagogy, which can help students to integrate medicine, gender, and LGBT+ competency education. A successful narrative case–based teaching strategy involves teachers integrating knowledge related to gender, guiding students through the cases to understand the importance of these cases, and reflecting on the medical profession to make improvements. However, teachers face challenges in this approach, such as changes in the school’s teaching culture and a lack of institutional support.

Que(e) rying undergraduate medical curricula: a cross-sectional online survey of lesbian, gay, bisexual, transgender, and queer content inclusion in UK undergraduate medical education

Background Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals are more likely to have negative healthcare experiences and worse health outcomes when compared with their heterosexual and cisgender counterparts. A key recommendation of the 2018 Stonewall-commissioned “LGBT in Britain” report was that the curricula, standards, and training provided by medical schools should be reviewed in order to encompass mandatory teaching about LGBT health inequalities and discrimination, LGBT-inclusive care and the use of appropriate language. The aim of our study was to conduct an in-depth national review of the content of LGBT teaching within the curricula of UK Medical Schools. Methods Course leads at all 37 UK Medical Schools with students currently enrolled in a primary undergraduate medical training course were asked between December 2019–March 2020 to complete a cross-sectional online survey comprised of 30 questions; divided into three sections relating to the current LGBT teaching (Part 1), any planned or future LGBT teaching (Part 2), and the opinions of the survey respondent about the coverage of LGBT topics (Part 3) at their institution. Responses were analysed using descriptive statistics. Results Questionnaires were received from 19/37 institutions (response rate: 51%). The median estimated number of hours of LGBT-teaching across the entire undergraduate course was 11.0 (IQR: 12.25). Teaching on LGBT mental health, gender identity, sexual orientation, awareness of LGBT-health inequalities, and LGBT discrimination in healthcare were reported by almost all respondents, whilst maternity and childbirth, chronic disease and LGBT adolescent health were least represented within the curriculum. Almost all (18 medical schools; 95%) responding institutions were considering implementing new LGBT teaching within the next three academic years. A lack of space within the curriculum is a universally reported barrier to the implementation of LGBT teaching. Only 5 (26%) survey respondents consider their institution’s current coverage of LGBT topics to be “Good” or “Very good”. Conclusion Our study demonstrates a significant variation in the amount and breadth of content within the undergraduate curricula of UK medical schools. Recommendations for increasing the quantity and quality of LGBT content are provided, based upon areas of good practice.

The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review

This scoping review of UK evidence aimed to describe what is known about Lesbian, Gay, Bisexual, and Trans (LGBT+) health inequalities in relation to cancer, mental health, and palliative care to inform research, policy and public health interventions. Using a scoping review methodology, we identified studies from database searches, citation tracking, and expert consultation. The in/exclusion criteria was based on the PICOS framework. The data were charted and then summarised to map the theoretical approaches and the main types of evidence and identify knowledge gaps. In total, 279 articles were screened and 83 were included in the final review. We found that there is limited UK research examining LGBT+ health inequality in cancer, mental health and palliative care. We would argue that this thin evidence base is partly due to national policy discussions of LGBT+ health inequality that are framed within a depoliticised ‘it’s getting better’ narrative, and an unwillingness to adequately acknowledge the unjust social and economic relations that produce LGBT+ health inequality. In addition, LGBT+ health inequality is depoliticised by existing public health explanatory theories, models and frameworks that exclude sexual orientation and gender diversity as dimensions of power that interlock with those of socio-economic, race and ethnicity. This is a barrier to developing public health interventions that can successfully tackle LGBT+ health inequality

Educational Knowledge, Attitude and LGBT Inclusive Training in an Academic Setting: A Mixed Methods Case Study of Faculty and Healthcare Students in Nigeria.

Background: The highest quality of appropriate care is required to achieve the UN’s Sustainable Development Goals and improve the health of the LGBT population in the global south. This study assessed the training, knowledge, beliefs, attitudes and practice of Nigerian healthcare students and faculty living, working and learning within the constraints of religious, legal and cultural barriers for LGBT people.Methods: This study was carried out among all the tutors in the faculty of clinical sciences, year five medical and nursing students in the College of Medicine, University of Lagos. The sequential mixed methods study design was guided by the socio-ecological model of health. Quantitative data were collected with an adapted questionnaire. The results were used to generate prompts for the qualitative component consisting of In-depth interviews with 21 of the respondents. Transcripts were analysed using thematic analysis. The quantitative and qualitative data were subsequently integrated and, using the socio-ecological model, synthesized.Results: The response rate was 88.2% (medical students), 66.2% (nursing students) and 60.7% (tutors). Themes uncovered were: knowledge of LGBT terminologies; teaching and learning about LGBT health topics; ethics, professionalism and personal beliefs. A fifth of tutors reported teaching related topics or using LGBT examples in class. Students were more knowledgeable of LGBT terminologies than tutors. Facilitators and barriers to LGBT inclusion in healthcare education settings were identified within the following socio-ecological domains: globalization, policy, community, institution, intrapersonal and individual. Conclusion: Ongoing advocacy with policy makers and educational leaders on the right to health for all citizens was recommended. A multilevel intervention by non LGBT and LGBT individuals is required for inclusion of LGBT health in educational curriculum of healthcare students and professionals.

State Involvement in LGBT+ Health and Social Support Issues in Canada

For the first time, the broad health issues, needs and concerns of LGBT+ people in Canada were taken up by the federal government’s Standing Committee on Health in 2019. The findings of their consultations with LGBT+ Canadians produced a report that at once captures the breadth of input received, and provides an opportunity for accountable state response to LGBT+ health needs in the form of research, education, policy, funding and programming, yet questions arise as to the socio-political approach that will ultimately be taken. This focus on the health of LGBT+ Canadians follows decades of grassroots and sometimes state-funded research on this very issue. This study undertook a critical content analysis, premised on the queer liberation theory of The Health of LGBTQIA2 Communities in Canada report issued by the Standing Committee on Health. Although the report, for the most part, covers a breadth of broad LGBT+ health issues (a noted shift from the predominance of HIV/AIDS), the depth to which the Standing Committee took up and absorbed such issues is far less apparent. The heavy emphasis on entry-level recommendations by which to take up important LGBT+ health issues undermines a more progressive, liberationist approach that would more effectively address these concerns.