Michele Eliason

Terminology related to sexuality and gender is constantly evolving, and multiple factors are at play when individuals answer questions on surveys. We examined patterns of responding to the National Health Interview Survey (NHIS) sexual identity questions in a multisite health intervention study for lesbian and bisexual women aged 40 to 84 years. Of 376 participants, 80% (n = 301) chose "lesbian or gay," 13% (n = 49) selected "bisexual," 7% (n = 25) indicated "something else," and 1 participant chose "don't know the answer." In response to the follow-up question for women who said "something else" or "don't know," most (n = 17) indicated that they were "not straight, but identify with another label." One participant chose "transgender, transsexual, or gender variant," five chose "You do not use labels to identify yourself," and three chose "you mean something else." Lesbian, bisexual, and "something else" groups were compared across demographic and health-related measures. Women who reported their sexual identity as "something else" were younger, more likely to have a disability, more likely to be in a relationship with a male partner, and had lower mental health quality of life than women who reported their sexual identity as lesbian or bisexual. Respondents who answer "something else" pose challenges to analysis and interpretation of data, but should not be discarded from samples. Instead, they may represent a subset of the community that views sexuality and gender as fluid and dynamic concepts, not to be defined by a single label. Further study of the various subsets of "something else" is warranted, along with reconsideration of the NHIS question options.

Adult lesbian and bisexual (LB) women are more likely to be obese than adult heterosexual women. Achieving a healthy weight reduces health risks and improves quality of life, but the evidence based on successful weight interventions is limited. To inform a national initiative, a metasynthesis (a form of qualitative meta-analysis) of focus group data was conducted to gather lesbian and bisexual womens' perspectives. Analysis used de-identified transcripts and narrative reports from 11 focus groups guided by different semi-structured discussion guides with 65 participants from five locations. A literature search was conducted to identify existing themes in published literature and unpublished reports. Six key themes were identified: aging; physical and mental health status; community norms; subgroup differences; family and partner support; and awareness and tracking of diet and physical activity. Participants expressed feeling unprepared for age-related changes to their health and voiced interest in interventions addressing these issues. Their perspectives on community acceptance of body size shifted as they aged. Participants cited age, class, race, ethnicity, sexual identity, and gender expression as potential characteristics that may influence participation in interventions. Families were both a barrier to and a facilitator of health behaviors. Awareness and tracking of dietary habits, stressors, and physical activity levels emerged as a theme in more than half of the groups. An unsolicited, overarching theme was aging and its influence on the participants' perspectives on health and weight. Interventions should be tailored to the needs, goals, and community norms of LB women.

Nurses provide care for lesbian, gay, and bisexual (LGB) patients on regular basis, whether they know it or not. Education of health care workers routinely has excluded discussion of patient sexuality, rendering LGB patients invisible or stigmatized, and has offered few tools to nurses to provide quality care for their LGB patients with chronic illnesses. This chapter provides basic information about LGB chronic health care to increase awareness and sensitivity about this marginalized patient population and focuses on providing specific information to help nurses care for these individuals.

The purpose of this study was to selectively review the nursing literature for publications related to lesbian, gay, bisexual, and transgender health, using (1) a key word search of CINAHL, the database of nursing and allied health publications; (2) from the top-10 nursing journals by 5-year impact factor from 2005 to 2009, counting articles about lesbian, gay, bisexual, and transgender issues; and (3) content analysis of the articles found in those journals. Only 0.16% of articles focused on lesbian, gay, bisexual, and transgender health (8 of nearly 5000 articles) and were biased toward authors outside of the United States. We discuss the impact of this silence.

The field of lesbian, gay, bisexual, and transgender (LGBT) health has emerged in fits and starts over the past 30 years. Prior to 1970, most of the articles in the health care literature were about the pathology or deviance of homosexuality and included psychiatric theories about the causes of or proposed treatments to cure homosexuality. Stereotypes about disease and contagion abounded even in the scientific literature. By the 1970s, around the time that homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders (Drescher, 2012), a few articles began to appear about providing compassionate care to sexual minority individuals, especially adolescents, and articles that proposed homosexuality as deviance or advocated for cures declined (Snyder, 2011). Psychology led the way, though, and many more articles about mental health (depression and suicide in particular) and counseling of lesbians and gay men were published than articles about any physical health concerns, at least until the mid-1980s, with the explosion of research on HIV/AIDS. AIDS was to dominate both publication and funding of LGBT health for the next three decades and, since about 1984, articles about men who have sex with men

ABSTRACT Lesbian, gay, bisexual, transgender, queer, and other sexual/gender minority (LGBTQ+) health care providers face both general work-related stresses and working in heteronormative settings with ill-informed or hostile coworkers and patients, yet there has been little study of whether the coping strategies are specific to LGBTQ+ stress. We analyzed qualitative data from 277 health care professionals. Sources of stress included religiously and politically conservative coworkers, coworker/patient lack of knowledge, stresses of being closeted, and concerns about being out to patients. Consequences of being out as LGBTQ+ included lack of promotions, gossip, refusals of tenure, and anti-LGBTQ+ comments and behaviors in the workplace. Respondents showed mostly positive coping strategies to deal with stress, including becoming educators/advocates and self-care activities. Self-care options were common in rural areas with few LGBTQ+ social resources. Negative coping strategies were reported by 18% of respondents. The study highlights the extra burden of stress on LGBTQ+ health care providers.

Lesbian/bisexual women with physical disabilities (LBPD) are an under-studied population. This study compared LBPD to LB women without physical disabilities as defined by the Americans with Disabilities Act on socio-demographic variables, health characteristics, and quality of life, physical activity, weight, and nutrition outcomes following a health intervention. Data came from the Healthy Weight in Lesbian and Bisexual Women Study (HWLB) where 376 LB women were recruited into five geographically dispersed interventions. Baseline data were examined to compare women with and without physical disabilities as defined by the ADA, and pre/post intervention data were analyzed for differences in treatment outcomes including quality of life, physical activity, nutrition, and body size. Compared to women without disability, LBPD were more likely to be bisexual or another sexual identity than lesbian, single, report poor or fair health status, postmenopausal, and had a higher body mass index...

The purposes of this study were to measure the prevalence of, and identify factors associated with, cervical cancer screening among a sample of lesbian, bisexual, and queer women and transgender men. Past research has found that lesbian, bisexual and queer women underutilize cervical screening service. Because deficient screening remains the most significant risk factor for cervical cancer, it is essential to understand the differences between routine and non-routine screeners. A convergent-parallel mixed methods design. A convenience sample of 21-65 year old lesbian and bisexual women and transgender men were recruited in the United States from August to December 2014. Quantitative data were collected via a 48-item Internet questionnaire (N = 226), and qualitative data were collected through in-depth telephone interviews (N = 20) and open-ended questions on the Internet questionnaire. Seventy-three percent of the sample were routine cervical screeners. The results showed that a con...

Purpose: Adult lesbian and bisexual (LB) women are more likely to be obese than adult heterosexual women. Achieving a healthy weight reduces health risks and improves quality of life, but the evidence based on successful weight interventions is limited. To inform a national initiative, a metasynthesis (a form of qualitative meta-analysis) of focus group data was conducted to gather lesbian and bisexual womens' perspectives. Methods: Analysis used de-identified transcripts and narrative reports from 11 focus groups guided by different semi-structured discussion guides with 65 participants from five locations. A literature search was conducted to identify existing themes in published literature and unpublished reports. Results: Six key themes were identified: aging; physical and mental health status; community norms; subgroup differences; family and partner support; and awareness and tracking of diet and physical activity. Participants expressed feeling unprepared for age-related ...

... Cleft lip and palate (CLP) and cleft palate only (CPO) appear to be etiologically distinct disorders (Fogh-Anderson, 1974). ... ory training strategies (Brady, 1987) as well as in distinguishing different reading disability subtypes (Wood, Richman, & Eliason, 1989). ...

The performance of 90 learning disabled (LD) children on two measures of behavior and attentional skills was examined: (a) the Revised Behavior Problem Checklist (RBPC, Quay & Peterson, 1987) is a parent-rated multivariate behavior scale; and (b) the Continuous Performance Test (CPT, Lindgren & Lyon, 1983) is a laboratory vigilance / impulsivity measure. As a group, the LD subjects exceeded normative standards on every measure of both scales. However, when the data were examined individually, approximately 30% of the children accounted for the majority of behavioral problems. The most common difficulties were noted on attention, cognitive processing, anxiety, and excessive motor activity.

... Michele J. Eliason and Lynn C. Richman ... Anderson, Halcomb, & Doyle, 1973; Koppell, 1973; Tarver & Hallahan, 1974; Vrana & Pihl, 1980), whereas other studies have found no significant attentional difficulties in LD samples (Lovrich & Stamm, 1983; Pelham, 1979; Swanson ...

This paper examines the gay, lesbian, and bisexual persons as subcultures of the dominant Anglo-American culture in the United States of America in relation to influences on their access to and use of health care systems and resources. Nurses need to be aware of the unique health needs of such clients, and examine their own cultural belief systems about same-sex relationships. Negative attitudes or misinformation can lead to poor quality of care and disrupt nurse-client relationships.

Many psychological studies of lesbian identity have described linear stages in a process of achieving an identity or isolating “types” of lesbians. A select few of these models are critiqued. Linear models have clearly defined beginnings and endings, are rarely grounded in the historical and social contexts in which women grow, and focus on sexual identity to the exclusion of other important human traits. The author proposes a cyclical model that attempts to integrate sexuality with other aspects of a woman’s sense of self.

A sample of approximately 200 undergraduate students beginning their nursing education responded to questionnaire items concerning experience and levels of comfort working with diverse client groups. Students reported little discomfort with racial/ethnic groups, but reported they would have considerable difficulty working with lesbian, gay, or bisexual clients, and patients with human immunodeficiency virus. Their reasons for discomfort were examined.

This study examined immediate memory processes in specific reading disability subtypes. Three subgroups (n = 15 in each subgroup) of reading disabled children were examined: (a) perceptual-motor disorder, (b) verbal disorder-general, and (c) verbal disorder-specific (memory). The three groups were matched for age and full scale IQ. All children received a memory-for-colors task (Color Span Test) designed to evaluate intra- and intermodal serial memory functioning. Comparison of memory profiles for the three reading disability subtypes revealed that patterns varied depending on mode of stimulus presentation or response. Although all three groups performed considerably below normative levels on each of the four subtests of the Color Span Test, all subjects performed significantly better on verbally presented items than on visually presented items. The findings were interpreted to suggest that these reading disabled children may not consistently utilize verbal strategies for coding or retrieval of information when stimuli are visually presented.

Over the past 20 years, a growing literature has demonstrated that sexual minority women have greater weight than heterosexual women, prompting concern that they may be at high risk for disparities in physical disorders. In 2008, Bowen et al. published a review of the existing research on sexual minority women and obesity, finding no methodologically strong studies with representative sampling procedures. We conducted a systematic review of the literature covering the period of July 2006 to February 2014 on the relationship between sexual orientation and weight. The review includes 20 population-based and 17 nonprobability sample studies. The majority of these studies found that lesbian and bisexual women had significantly greater body mass index (BMI) or a higher percentage with a BMI over 30 than heterosexual women. The difference in BMI was fairly consistent across the lifespan, with the weight differences beginning in adolescence. The studies, however, did not show a higher prevalence of physical disorders thought to be associated with weight. This potentially paradoxical finding warrants further research to compare prevalence of chronic disease by BMI category and sexual orientation.

This study explored practicing nurses' knowledge of the needs of transgender patients. Structured interviews were conducted with 268 nurses in the San Francisco Bay Area. This study focused on the responses to 1 item in the 16-item interview, " Describe health care issues that are particular to transgender patients. " Three themes emerged from the data: discomfort, transition, and harsh consequences of being transgender. These findings revealed nurses' discomfort and lack of knowledge about transgender people and their health care needs. Nursing curricula must challenge the gender binary to better prepare nurses to provide quality care for patients of all genders.

Background: Very little research has addressed issues of recruitment and participation of lesbian and bisexual (LB) women, aged 40 and older, into research studies. This study is based on a larger cross-site intervention study that recruited women from five geographic regions in the United States for culturally specific LB healthy weight programs, lasting 12 or 16 weeks. Methods: Principal investigators (PIs) of the five intervention programs completed a questionnaire on recruitment and participation strategies and barriers. Participant data on completion and sociodemographic variables were compiled and analyzed. Results: The recruitment strategies the programs' PIs identified as most useful included word-of-mouth participant referrals, emails to LB participants' social networks, and use of electronic health records (at the two clinic-based programs) to identify eligible participants. Flyers and web postings were considered the least useful. Once in the program, participation and completion rates were fairly high (approximately 90%), although with varying levels of engagement in the different programs. Women who were younger or single were more likely to drop out. Women with disabilities had a lower participation/completion rate (82%) than women without any disability (93%). Dropouts were associated with challenges in scheduling (time of day, location) and changes in health status. Conclusions: Implementation of key strategies can improve both recruitment and participation, but there is a great need for further study of best practices to recruit and promote participation of LB women for health intervention research.

Background: Lesbian and bisexual women are more likely to be overweight or obese than heterosexual women, leading to increased weight-related health risks. Methods: Overweight women aged 40 or older who self-identified as lesbian, bisexual, or " something else " participated in five pilot interventions of 12 or 16 weeks' duration. These tailored interventions took place at lesbian and bisexual community partner locations and incorporated weekly group meetings, nutrition education, and physical activity. Three sites had non-intervention comparison groups. Standardized questionnaires assessed consumption of fruits and vegetables , sugar-sweetened beverages, alcohol, physical activity, and quality of life. Weight and waist-to-height ratio were obtained through direct measurement or self-report. Analytical Plan: Within-person changes from pre-intervention to post-intervention were measured using paired comparisons. Participant characteristics that influenced the achievement of nine health objectives were analyzed. Achievement of health objectives across three program components (mindfulness approach, gym membership, and pedometer use) was compared with the comparison group using generalized linear models. Results: Of the 266 intervention participants, 95% achieved at least one of the health objectives, with 58% achieving three or more. Participants in the pedometer (n ¼ 43) and mindfulness (n ¼ 160) programs were more likely to increase total physical activity minutes (relative risk [RR], 1.67; 95% confidence interval [CI], 1.18–2.36; p ¼ .004; RR, 1.38; 95% CI, 1.01– 1.89; p ¼ .042, respectively) and those in the gym program (n ¼ 63) were more likely to decrease their waist-to-height ratio (RR, 1.89; 95% CI, 0.97–3.68, p ¼ .06) compared with the comparison group (n ¼ 67). Conclusion: This effective multisite intervention improved several healthy behaviors in lesbian and bisexual women and showed that tailored approaches can work for this population.