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Prev Med. 2019 Sep;126:105787. doi: 10.1016/j.ypmed.2019.105787. Epub 2019 Jul 30.

Sexual orientation inequalities during provider-patient interactions in provider encouragement of sexual and reproductive health care.

Author information

1
Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States of America; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Ave, Boston, MA 02115, United States of America. Electronic address: alexa.solazzo@childrens.harvard.edu.
2
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Ave, Boston, MA 02115, United States of America; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America. Electronic address: Ari.Tabaac@childrens.harvard.edu.
3
Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA 02155, United States of America; Tufts Clinical and Translational Science Institute, Tufts Medical Center, 35 Kneeland St, Boston, MA 02111, United States of America; The Fenway Institute, Fenway Health, Boston, MA, 1340 Boylston St, 02215, United States of America. Electronic address: Madina.Agenor@tufts.edu.
4
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Ave, Boston, MA 02115, United States of America; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States of America; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115, United States of America. Electronic address: Bryn.Austin@childrens.harvard.edu.
5
Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States of America; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 333 Longwood Ave, Boston, MA 02115, United States of America; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115, United States of America. Electronic address: bcharlton@mail.harvard.edu.

Abstract

The human papillomavirus (HPV) vaccination, sexually transmitted infection (STI) tests, and Papanicolaou (Pap) testing rates vary by sexual orientation, which may be due in part to healthcare providers (HCP) recommending this care unevenly. Data (N = 17,675) came from the Growing Up Today Study (GUTS) (N = 8039) and Nurses' Health Study 3 (NHS3) (N = 9636). Among participants who met clinical guidelines to receive the care in question, we estimated the probability of an HCP encouraging participants to have the HPV vaccination, STI tests, or Pap test. Regardless of sexual orientation, participants whose HCP knew their sexual orientation were more likely to have been encouraged to get care compared to those whose HCP did not know the participant's sexual orientation. Sexual minority men and women were more likely to be encouraged to obtain HPV vaccination, STI tests, and Pap test than same-gender, completely heterosexuals with no same-sex partners, with some variation by gender and the care in question. Lesbian women were the sole sexual orientation subgroup that was less likely to be encouraged to receive care (HPV vaccination and Pap test) than their same gender, completely heterosexual counterparts with no same-sex partners (odds ratio [95% confidence interval]: 0.90 [0.80-1.00] and 0.94 [0.91-0.98], respectively). The differences across sexual orientation in HCPs' encouragement of care indicate a possible explanation for differences in utilization across sexual orientation. Across the US, HCPs under-encourage HPV vaccination, STI tests, and Pap test for all sexual orientation groups. Lesbian patients appear to be at high risk of under-encouragement for the Pap test.

KEYWORDS:

Papanicolaou test; Papillomavirus vaccines; Physician-patient relations; Sexual and gender minorities; Sexually transmitted diseases

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