Prevalence of Social Determinants of Health Among Sexual Minority Women and Men in 2017.

INTRODUCTION: Inequities in social determinants of health are plausible contributors to worse health of sexual minorities relative to heterosexuals. Sexual minorities may have higher rates of housing, food, and financial insecurity as adults owing to adverse childhood experiences or policies that induce social disadvantage. This study compares the prevalence of 3 types of social determinants of health among sexual minority and heterosexual adults. METHODS: Data were from the Behavioral Risk Factor Surveillance System 2017 survey of U.S. states that administered the optional Social Determinants of Health module and Sexual Orientation and Gender Identity modules. In August 2019, authors estimated the odds of food, housing, and financial insecurity among sexual minority men and women, compared with heterosexuals. RESULTS: Sexual minority women and men had higher odds of housing insecurity, housing instability, and food insecurity, but no differences were observed for perceived neighborhood safety. Sexual minority women had higher odds of financial insecurity than their heterosexual peers. CONCLUSIONS: Sexual minorities have more housing and food insecurity than heterosexuals, which may contribute to their risk for poorer health. Future research should address the causes and consequences of these differences.

Health of Transgender Adults in the U.S., 2014-2016.

INTRODUCTION: Transgender people experience significant interpersonal and structural discrimination and stigma. However, little is known about the health of transgender people, and even less about the health of specific groups-including male-to-female, female-to-male, and gender-nonconforming transgender populations-despite the variation in social and biological characteristics across groups. METHODS: Data are from the 2014-2016 Behavioral Risk Factor Surveillance System, analyzed in 2017. The study population included 2,221 transgender and 523,080 cisgender respondents from 31 states and one territory. The authors estimated the prevalence and adjusted odds of chronic health conditions, health-related quality of life, disabilities, health behaviors, and health utilization among three transgender groups, when compared separately with cisgender males and cisgender females. RESULTS: An estimated 0.24% (95% CI=0.21, 0.27) identified as male-to-female; 0.14% (95% CI=0.12, 0.17) identified as female-to-male; and 0.10% (95% CI=0.08, 0.12) identified as gender-nonconforming. All transgender groups experience worse mental health and disabilities; few differences in healthcare access and utilization were observed. Gender-nonconforming people had higher odds of multiple chronic conditions, poor quality of life, and disabilities than both cisgender males and females. Female-to-male people had a higher odds of no exercise and cardiovascular disease compared with cisgender females. CONCLUSIONS: Given the high burden of disabilities; poor mental health; and multiple chronic conditions among transgender (particularly gender-nonconforming) populations, supportive services and care coordination may be consequential levers for improving transgender health.

Food Environment and Weight Change: Does Residential Mobility Matter?: The Diabetes Study of Northern California (DISTANCE).

Associations between neighborhood food environment and adult body mass index (BMI; weight (kg)/height (m)2) derived using cross-sectional or longitudinal random-effects models may be biased due to unmeasured confounding and measurement and methodological limitations. In this study, we assessed the within-individual association between change in food environment from 2006 to 2011 and change in BMI among adults with type 2 diabetes using clinical data from the Kaiser Permanente Diabetes Registry collected from 2007 to 2011. Healthy food environment was measured using the kernel density of healthful food venues. Fixed-effects models with a 1-year-lagged BMI were estimated. Separate models were fitted for persons who moved and those who did not. Sensitivity analysis using different lag times and kernel density bandwidths were tested to establish the consistency of findings. On average, patients lost 1 pound (0.45 kg) for each standard-deviation improvement in their food environment. This relationship held for persons who remained in the same location throughout the 5-year study period but not among persons who moved. Proximity to food venues that promote nutritious foods alone may not translate into clinically meaningful diet-related health changes. Community-level policies for improving the food environment need multifaceted strategies to invoke clinically meaningful change in BMI among adult patients with diabetes.