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Sexual Minority Disparities in Healthcare Use for Cervical Cancer Prevention

Brittany Charlton, ScD
Harvard Medical School
Award Year: 2014

Initial Abstract

While cervical cancer rates have been steadily decreasing in the U.S., certain groups like sexual minorities [e.g., lesbian, gay, bisexual (LGB)] may have not experienced these declines equally. National cancer registries like the Surveillance, Epidemiology, and End Results (SEER) Program do not collect information on sexual orientation but preliminary studies indicate that sexual minority women may be disproportionately burdened by a number of cancers including cervical cancer. Existing research has focused on risk factors such as smoking, which is more common among sexual minorities. However, a more nuanced understanding of various risk factors, including healthcare use, across the lifespan using detailed, longitudinal data is needed to inform prevention strategies. This research is in line with GLMA’s priorities by aiming to achieve health equity and eliminate disparities.
Identifying risk factors in specific developmental periods may offer insight into different interventions. For example, sexual minority youth may not access the human papillomavirus (HPV) vaccine as much as their heterosexual peers whereas in adulthood different issues may arise; sexual minority adults may not get as much routine healthcare as heterosexuals while different subgroups (e.g., bisexuals vs. lesbians) may seek care in different settings. For example, while lesbians may seek care at LGB community health centers equipped to do targeted cervical cancer prevention, bisexuals may go to general private practices and not benefit from this targeted intervention. It is imperative to examine differences in heterosexual and sexual minorities while exploring within subgroup differences while looking across the lifecourse to inform public health strategies.
To address these research gaps, we will analyze national data from four longitudinal cohorts: the Nurses’
Health Study (NHS) 2 and 3 as well as the Growing Up Today Study (GUTS) 1 and 2. These cohorts include nearly 200,000 girls and women with detailed sexual orientation measures. The prospective data spans from the prenatal period through adulthood and on the most recent GUTS1/2 questionnaire, 83% (N=8,762) of participants identified as completely heterosexual and the remaining identified as a sexual minority [13% (N=1,349) as mostly heterosexual, 3% (N=249) as bisexual, and 1% (N=142) as mostly/completely homosexual], giving ample statistical power in addition to the participants in NHS2 and 3. We will use these data to classify differences in healthcare use that helps prevent, screen, or treat cervical cancer among girls/women of diverse sexual orientations. We hypothesize that in comparison to heterosexuals, sexual minorities will:
1) Use less healthcare (e.g., regular physical exams), delay seeking care, not disclose their sexual orientation to their clinicians, and be less likely to have been encouraged by clinicians to have regular cervical cancer screenings;
2) Be less likely to initiate and complete the HPV vaccine series; and
3) See providers in different settings such as a community health center versus private practice, with further differences by subgroups (e.g., bisexuals will be less likely than lesbians to seek care at an LGB-focused clinic).
The data to which we will have access is unmatched, and our findings help highlight new avenues for intervention and health equity.

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