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Religious freedom laws may be linked to poorer self-reported health among sexual minorities

Religious freedom laws may be linked to poorer self-reported health among people who identify as lesbian, gay, bisexual or are unsure of their sexual orientation.



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Religious freedom laws may be linked to poorer self-reported health among people who identify as lesbian, gay, bisexual or are unsure of their sexual orientation – a group known as sexual minorities.

This is according to an analysis led by scientists at the University of Pittsburgh Graduate School of Public Health’s Center for LGBT Health Research. The study, published online in the American Journal of Orthopsychiatry, focused on Indiana in the US. It found that after the passage in Indiana of a Religious Freedom Restoration Act (RFRA) in 2015, sexual minorities increasingly reported poor health on a national survey. Such laws are often invoked by courts to support those who want to deny services to members of particular groups due to conflicts with their personal religious beliefs.

In the Philippines, for instance – and to contextualize – the Catholic Bishops’ Conference of the Philippines (CBCP) has been one of the staunchest opponents of passing an anti-discrimination law that will protect the human rights of LGBTQI people.

In 2015, it actually gave a “partial support” to the passage of an anti-discrimination bill (ADB). However, this support is limited by CBCP’s desire for it to still be allowed to discriminate, particularly in: 1) determining who should be admitted to priestly or religious formation, who should be ordained and received into Holy Order, or who should be professed as members of religious communities and orders; and 2) for Catholic schools to be allowed to discriminate on who they can admit or retain.

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The CBCP also stressed its “love the sinner, hate the sin” position by claiming its “disapproval of homosexual acts (that) remains part of the Church’s moral teaching.”

In the aforementioned American study, the researchers – which included John R. Blosnich, Ph.D., M.P.H., Robert W.S. Coulter, Ph.D., M.P.H., Jordan M. Sang, M.P.H., and Christina Mair, Ph.D. – used data from 21 states that participated in the Centers for Disease Control and Prevention’s (CDC) 2015 Behavioral Risk Factor Surveillance System survey. Across the participating states, the team focused on the health of the nearly 5,000 participants who identified as sexual minorities. In particular, the team analyzed the number of “unhealthy days,” which the CDC characterized as the total number of days in the past 30 that people reported that their physical and mental health were not good.

The researchers found that, among residents of the 21 states, only Indiana saw a significant increase in the percent of sexual minority people reporting unhealthy days over the course of 2015. In the first quarter of the year, 24.5% of sexual minorities surveyed reported that their health was poor for 14 or more days each month. In the final quarter of the year, following public discussion and Indiana’s passage of the RFRA, 59.5% of sexual minorities reported poor health in 14 or more days per month. By contrast, heterosexual people in Indiana did not have any increase in unhealthy days across the same period.

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Research shows that sexual minority populations have greater rates of poor mental health, including depression and anxiety, which are attributed to the discrimination, harassment and stigma that they often endure. They also face a higher risk of suicidal thoughts and behaviors.

“The Indiana case suggests that the character of the RFRA law might be an important factor in its broader impacts on public health,” study co-author Erin Cassese, Ph.D. was quoted as saying. “Some RFRAs are stronger than others, and Indiana’s RFRA law ‘has teeth’ in the sense that it can be used in private litigation, including cases where businesses wish to deny services to sexual minorities. It also permits courts to grant compensatory damages against whomever brings the suit – making a court challenge to a service denial a much riskier proposition.

In the end, this research adds to a growing body of research demonstrating that experiences of discrimination are associated with poor health outcomes in a range of minority populations, Cassese added. It also “suggests negative health outcomes might be a consequence of this type of policy, and thus warrant some consideration by policymakers.”

Health & Wellness

Bias may affect providers’ knowledge of trans health

According to a study, increased hours of education related to caring for transgender patients may not correlate to more competent care.



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As it is, transgender people already face many barriers in accessing health care, from dealing with issues with intake forms that use non-inclusive language, to challenges finding providers who are knowledgeable about transgender-specific health issues.

But a Michigan Medicine-led study is suggesting that more training may not be the answer to improving competent care, since this study found that more hours of education in the field was not associated with improved knowledge of transgender care among physicians and other providers.

Published in the journal Medical Education, the study found that nearly half of providers said they had cared for a transgender patient, but as many had received no training on the topic. What distinguished knowledgeable providers from those who were less so, however, appeared to have little to do with their medical education.

Transphobia, or a prejudice against people who are transgender, was the only predictor of provider knowledge.

“We were surprised to find that more hours of education about transgender health didn’t correlate with a higher level of knowledge about this topic among providers,” said lead author Daphna Stroumsa, M.D., MPH, an obstetrician gynecologist at University of Michigan’s Von Voigtlander Woman’s Hospital and a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation.

“Transgender and gender diverse individuals often face discrimination in health care settings and many are unable to find competent, knowledgeable and culturally-appropriate health care,” Stroumsa added. “Lack of provider knowledge is a significant barrier, but our findings suggest that simply increasing training may not be the solution.

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Because of this, “medical education may need to address transphobia and implicit bias in order to improve the quality of care transgender patients receive,” Stroumsa said.

Researchers surveyed 389 attending physicians, advanced practitioners and residents from the departments of internal medicine, family medicine and obstetrics and gynecology in a large urban health system.

It is worth noting that the study did not evaluate the content or format of the education providers were exposed to; but it is still likely that educational efforts that address unconscious bias would be more effective. Stroumsa noted that even in educational programs that address transgender health, the topic is usually presented as a separate section of provider education, rather than as an integral part of general medical education and training – a distinction which may further fuel “othering” of transgender patients.

Many providers – especially those traditionally considered “women’s health” professionals – likely need to be better prepared to care for transgender patients, Stroumsa said.

People who identify as transgender and non-binary may require many of the services provided by Ob/Gyns and other “women’s healthcare” providers, including prenatal and fertility care, cervical cancer screening, menstrual cycle management, as well as gender transition-related care (i.e. hormone therapy), and other routine Ob-Gyn care.

“We obviously have a lot of work to do in improving health outcomes for gender diverse people,” Stroumsa said. “We need to take a close look at our healthcare environments, practices and approaches to medical education. These are just beginning steps in reducing wide health disparities. Creating a safe, knowledgeable, trustworthy care environment will help us expand the care we provide to a broader more diverse patient population.”

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Health & Wellness

The amazing health benefits of using a gaming chair

When you are a frequent gamer, your playing experience shifts from one of seeking comfort to one of demanding comfort. With the long hours that you will spend in front of a screen playing different games, you will feel the pressure mount on your back.



Gaming has come a long way thanks to the advancements in technology. The population of gamers on the internet today is a lot higher than it has been in previous years. That said, there is quite the technology to support every aspect of gaming, be it diverse games, gaming accessories and peripherals, gaming chairs and tables, to mention a few.

Talking of gaming chairs, could it be that they had more benefits than meet the eye? Here are the fantastic health benefits of using a gaming chair.



The thing with gaming chairs is that they are made to support a lot more than your rear region, much as a sitting surface is for the comfort of your lower part of the body, you need equal support for the top part. Since gaming chairs have a high-back, your neck gets adequate support. This way, you do not need to worry about getting neck cramps from straining your neck too much.


When you are a frequent gamer, your playing experience shifts from one of seeking comfort to one of demanding comfort. With the long hours that you will spend in front of a screen playing different games, you will feel the pressure mount on your back. Most people fail to realize that when sited on any surface, a lot of pressure is directed in the rear region, but also on the back.

If you do not get a quality gaming chair like the omega gaming chair, then you may suffer a lot of back pain. A gaming chair will align your back and spinal column in the most comfortable and natural curve position, allowing your weight to balance out evenly across your body. This way, you do not pleasure in gaming at the expense of your back. Remember that your priority is in protecting your spinal column from any harm whatsoever.

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Posture happens to be a crucial health concern that most people take for granted. Not just in the gaming world, but in other scopes of life, a good sitting posture at all times has an added health advantage. Ideally, the regular chairs, or worse, sitting on the floor when gaming, does not allow for a proper sitting posture. The body will always try to adjust to a position of utmost comfort, even when it means compromising the sitting posture. That said, you will need a gaming chair to help with the posture. Since most gaming chairs are ergonomic, they are customized to adopt a better sitting posture than traditional chairs.

The best bit is that the gaming chairs have a reclining function that allows you to fashion a sitting posture that best suits the angle you want to sit while playing, not to mention, protects your spinal alignment.


Fatigue in the body is a factor that can not only cause your body to strain but accounts for the stress levels in your body. As a gamer, you may not have the privilege of enjoying social interaction and activities to help with coping with fatigue. Form the different sitting positions, slouching and postures you take up as your play; there is a high likelihood that your body will end up being fatally fatigued. Technically, the crucial body parts like the lower back, neck, shoulders, and even feet, require proper support.

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Without a gaming chair, most of your sitting positions will result in weakly feelings after extensive gaming. With time, muscles in some of your crucial body areas become weak, until you are too fatigued to play effectively and make your moves.


Another critical concern is that of proper blood circulation in the body at all times. Most of the health practices people take up, including drinking a lot of water, walking and stretching the body every once in a while, eating proper foods, among others, are all in support of better blood flow in your body.

When playing video games, a lot of time is spent sitting around, without much movement of the body. This means that the body may not enjoy a proper blood flow, especially in parts of the body like the feet, and the head. That said, with a regular chair, you will be exposing your body to the risk of reduction in lower body circulation.  To avoid such issues as dizziness, shortness of breath, among others, you must consider a gaming chair to ease the flow of blood throughout your system. The bottom and sides of a gaming chair are usually made in a way to keep the body in the correct posture that facilitates pumping of the blood to all parts of the body, even the legs.

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Health & Wellness

Negative messages about same-sex marriage linked to greater psychological distress

The study showed that the stigmatized social status of lesbian, gay and bisexual identity may be a source of stress, but could also serve as a source of resilience when it provides individuals with opportunities for social support.



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The fight for marriage equality shows the true colors of people around us. And we’re getting sick with the realization of how people really see us and our relationships.

This is the gist of a study done by psychologists at the University of Sydney, which showed that increased exposure to negative messages about same-sex marriage was associated with greater psychological distress for lesbian, gay and bisexual people (in this case in particular, Australians during the 2017 Australian Marriage Law Postal Survey).

Published in the Australian Psychological Society’s journal, Australian Psychologist, the study assessed the mental health of 1,305 Australians who identified as gay, lesbian, or bisexual during the Australian Marriage Law Postal Survey in 2017.

The research found increased exposure to homophobic campaign and media messages was related to increased levels of depression, anxiety and stress among same-sex attracted Australians.

“The findings highlight how political decision-making and legislative processes related to the rights of minority populations have the potential to negatively affect their mental health,” said lead author Stefano Verrelli, a doctoral candidate at the University of Sydney’s School of Psychology.

A silver lining: The study showed that the stigmatized social status of lesbian, gay and bisexual identity may be a source of stress, but could also serve as a source of resilience when it provides individuals with opportunities for social support.

The research also identified factors that can protect the mental health of same-sex attracted people during periods of intense public and political scrutiny.

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“The family and friends of same-sex attracted people appear to play an important role – and seem to even offset some of the harm done by the negative side of these debates – by openly supporting LGBT rights,” Verrelli said.

LGBT rights and mental-health organizations also have an important role to play by continuing their public support of minority issues. Their public messages of support appear to improve the psychological well-being of same-sex attracted people who require it most.

Verrelli and his research team in the School of Psychology – working with researchers at Macquarie University – used the minority stress model and surveys of mental health with lesbian, gay and bisexual Australians to reach their findings.

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Health & Wellness

Lesbian and bi women at increased risk of being overweight

Gay men however are less likely to be overweight than their straight counterparts, and more at risk of being underweight.



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Lesbian and bisexual women are at increased risk of being overweight or obese compared to heterosexual women, according to new research from the University of East Anglia and UCL.

Gay men however are less likely to be overweight than their straight counterparts, and more at risk of being underweight.

The study (‘Sexual orientation identity in relation to unhealthy body mass index (BMI): Individual participant data meta-analysis of 93,429 individuals from 12 UK health surveys’), published in the Journal of Public Health, is the first to investigate the relationship between sexual orientation and body mass index (BMI) using population data in the UK.

The findings support the argument that sexual identity should be considered as a social determinant of health.

The research team pooled data from 12 UK national health surveys involving 93,429 participants and studied the relationship between sexual orientation and BMI.

Lead researcher Dr. Joanna Semlyen, from UEA’s Norwich Medical School, said: “We found that women who identify as lesbian or bisexual are at an increased risk of being overweight or obese, compared to heterosexual women. This is worrying because being overweight and obese are known risk factors for a number of conditions including coronary heart disease, stroke, cancer and early death. Conversely, gay and bisexual men are more likely than heterosexual men to be underweight, and there is growing evidence that being underweight is linked to a range of health problems too, including excess deaths.”

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The study also found that gay men are significantly less likely than straight men to be overweight or obese.

According to the researchers, this study demonstrates that there is a relationship between sexual identity and BMI and that this link appears to be different for men and women.

“There are a number of possible explanations for these findings. We know that sexual minority groups are more likely to be exposed to psychosocial stressors, which impacts on their mental health and their health behaviours such as smoking and alcohol use and which may influence their health behaviours such as diet or physical activity,” Semlyen said. “These stressors include homophobia and heterosexism, negative experiences that are experienced by the lesbian, bisexual and gay population as a result of their sexual orientation identity and are known to be linked to health.”

Until 2008, sexual orientation wasn’t recorded in health surveys. This means that until recently it has not been possible to determine health inequalities affecting lesbian, gay and bisexual people.

The researchers hope that policy makers and clinicians will be able to use this evidence “to provide better healthcare and tailored advice and interventions for lesbian, gay and bisexual people.”

“We need longitudinal research to understand the factors underlying the relationship between sexual orientation and BMI, and research to understand more about being underweight, especially in this population,” Semlyen ended.

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Health & Wellness

Trans patients have 70% lower odds of breast cancer screening

Transgender patients had 70% lower odds of being screened for breast cancer, 60% lower odds of being screened for cervical cancer, and 50% lower odds of being screened for colorectal cancer.



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Patients who identify as transgender have lower odds of being screened for cancer. This was suggested by a new study from St. Michael’s Hospital, which also explored how doctors can address the disparity.

The study assessed screening rates for cervical, breast and colorectal cancer among 120 transgender patients eligible for screening and compared these with screening rates among the cisgender (i.e. non-transgender) patient population at the St. Michael’s Hospital Academic Family Health Team.

The study found that transgender patients had 70% lower odds of being screened for breast cancer, 60% lower odds of being screened for cervical cancer, and 50% lower odds of being screened for colorectal cancer. And this is even after accounting for other factors like age and the number of visits to the team.

“Our overall cancer screening rates were improving and if we hadn’t thought to look at this particular patient population we would have been happy with our results,” said Dr. Tara Kiran, a family physician and a researcher at the Centre for Urban Health Solutions of St. Michael’s. “This study stemmed from a realization that our system had the potential to miss patients whose gender had changed on their health card but who still required screening,” Dr. Kiran said. “Our findings have prompted us to develop a system to include transgender patients in the outreach we do to patients overdue for cancer screening so that we’re not missing anyone.”

Patients who have transitioned from female to male and still require cervical cancer screening are often missed when provincial agencies send reminders to those overdue.

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This analysis of cancer screening rates at the Family Health Team led Dr. Kiran and her colleagues to embark on a quality improvement project to learn more about perspectives towards cancer screening among transgender patients.

“In many cases, physicians had discussed cancer screening with patients and patients had made an informed decision not to get screened,” Kiran said. “That was really important for us to understand. For people who have transitioned from female to male, having a Pap test can be upsetting as it can sometimes be gender dysphoric.”

The research team is still investigating reasons to explain the lower rates of colorectal cancer screening among transgender patients.

Kiran and her team hope this research helps increase awareness among primary care providers of the unique health needs of transgender patients and helps prompt decision-makers to address systems that overlook these unique needs.

“This study shows the importance of an equity approach,” Kiran said. “Improvements in care may not reach everyone and we need to have targeted strategies to reach those with unique needs. Our research also highlights the importance of tracking not just whether patients have had a test but whether they have had an informed discussion… Improved shared decision-making may be a more appropriate quality improvement goal than increasing cancer screening rates. We are hopeful that engaging trans patients in our quality improvement efforts will help us challenge our assumptions and provide better care to the trans population.”

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Health & Wellness

Sexual minorities face significant health disparities

Sexual minorities were more likely to experience drug and alcohol use disorders, anxiety and depressive disorders, and cardiovascular disease, among other negative health outcomes. And increased stress stemming from discrimination and prejudice could be a potential reason for these disparities.



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Sexual minorities – or people who are attracted to members of the same sex or who identify as gay, lesbian or bisexual (LGB) – are at a higher risk for several different health problems at different points in their lives.

This is according to Penn State researchers who found that sexual minorities were more likely to experience drug and alcohol use disorders, anxiety and depressive disorders, and cardiovascular disease, among other negative health outcomes.

Cara Rice, assistant research professor in Penn State’s Methodology Center, said increased stress stemming from discrimination and prejudice could be a potential reason for these disparities.

“It’s generally believed that sexual minorities experience increased levels of stress throughout their lives as a result of discrimination, microaggressions, stigma and prejudicial policies,” Rice said. “Those increased stress levels may then result in poor health in a variety of ways, like unhealthy eating or excessive alcohol use.”

Stephanie Lanza, professor of biobehavioral health and director of the Edna Bennett Pierce Prevention Research Center, said the results — recently published in Annals of Epidemiology — help shed light on health risks that have been historically understudied.

“Discussions about health disparities often focus on the differences between men and women, across racial and ethnic groups, or between people of different socioeconomic backgrounds,” Lanza said. “However, sexual minority groups suffer substantially disproportionate health burdens across a range of outcomes including poor mental health and problematic substance use behaviors.”

While previous research has shown that sexual minorities are more likely to experience health problems like substance use disorders and mood or anxiety disorders, Rice said it is not as well known if those risks remain constant across age.

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“As we try to develop programs to prevent these disparities, it would be helpful to know which specific ages we should be targeting,” Rice said. “Are there ages where sexual minorities are more at risk for these health disparities, or are the disparities constant across adulthood?”

For the study, the researchers used data from about 30,999 participants between the ages of 18 and 65 from the National Epidemiologic Survey of Alcohol and Related Conditions-III. Data included information about past-year alcohol, tobacco, and drug use disorders, as well whether they had a history of depression, anxiety, sexually transmitted infections (STIs), or cardiovascular disease.

Lanza said the researchers used a method developed at Penn State, called time-varying effect modeling, to analyze the information.

“Using the time-varying effect model, we revealed specific age periods at which sexual minority adults in the U.S. were more likely to experience various poor health outcomes,” Lanza said, “even after accounting for one’s sex, race or ethnicity, education level, income, and region of the country in which they reside.”

The researchers found that overall, sexual minorities were more likely to experience all the health outcomes. Nearly a quarter — 24 percent — of sexual minorities had an alcohol use disorder in the year prior to the survey, compared to 15 percent of heterosexuals. Sexual minorities were also about twice as likely to experience anxiety, depression, and STIs in the previous year.

Additionally, risks for some health problems were higher at different ages. For example, the increased odds for anxiety and depression among sexual minorities was highest in their early twenties, while increased odds for poor cardiovascular health was higher in their forties and fifties.

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“We also observed that odds of substance use disorders remained constant across age for sexual minorities, while in the general population they tend to be concentrated in certain age groups,” Rice said. “We saw that sexual minorities were more likely to have these substance use disorders even in their forties and fifties when we see in the general population that drug use and alcohol use start to taper off.”

Rice said the findings could potentially be used to develop programs to help prevent these health problems before they start.

“A necessary first step was to understand how health disparities affecting sexual minorities vary across age,” Rice said. “These findings shed light on periods of adulthood during which intervention programs may have the largest public health impact. Additionally, future studies that examine possible drivers of these age-varying disparities, such as daily experiences of discrimination, will inform the development of intervention content that holds promise to promote health equity for all people.”

Sara A. Vasilenko, Syracuse University, and Jessica N. Fish, University of Maryland, also worked on this research.

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