2016 Philadelphia Region of Pennsylvania
LGBTQA Community Health Needs Assessment Results
Study Purpose
This study assessed the prevalence of tobacco use, other chronic disease risk behaviors, and determinants of health in the lesbian, gay, bisexual, transgender, queer, and asexual (LGBTQA) communities in the Philadelphia region of Pennsylvania.
Method ology
Brief, anonymous, Internet-based surveys were completed by LGBTQA people in in the Philadelphia region of Pennsylvania, which included Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.
During a 9-week period from March through May 2016, LGBTQA participants were purposively sampled using both direct and indirect recruitment strategies. Direct recruitment strategies included sending personal emails and Facebook messages to LGBTQA people. Indirect recruitment strategies included geographically targeted and LGBTQA-targeted Facebook advertisements, as well as email blasts.
Participants were informed that the data they provided were being collected anonymously and that they could stop the survey or refuse to answer any questions at any time. At the conclusion of the survey, participants were given the option to be redirected to an unlinked database where they could input their contact information to be entered into a lottery drawing for one $50 gift card incentive.
Acknowledgements
This study was commissioned by the William Way LGBT Community Center with funding from the Pennsylvania Department of Health. Data were collected in partnership with the Mazzoni Center, Attic Youth Center, City of Brotherly Love Softball League, City of Philadelphia Department of Public Health, The COLOURS Organization, LGBT Elder Initiative, Stonewall Sports, and LGBTea Dances. Robert W.S. Coulter, M.P.H., served as the Statistical Data Analyst for this project: he conducted the data analyses and wrote the results. Scout, Ph.D., from LGBT Health Link, designed the questionnaire, helped guide survey administration, and drafted the recommendations for this report. Adrian Shanker from Bradbury- Sullivan LGBT Community Center provided technical assistance throughout the project.
Highlights
Sociodemographic Characteristics In total, 1,218 LGBTQA individuals completed this survey. Nearly three-quarters (72.2%) of the sample identified as gay/lesbian, 10.5% as bisexual, and 14.4% as queer or pansexual. Additionally, 15.3% of the participants were transgender, 53.4% were cisgender men, and 30.3% were cisgender women.
Health Care Access & Quality Health care coverage was highly prevalent in the sample (95.2%), and slightly higher than the prevalence of health care coverage among Pennsylvania adults (which was 89.9% according to the 2014 Behavioral Risk Factor Surveillance System [BRFSS]). About one-third (31.6%) of the sample had a health care provider react poorly to their LGBTQA status—and this varied by gender: transgender people (53.9%) were significantly more likely than cisgender women (31.9%) or men (25.2%) to have a provider react poorly. Additionally, transgender people (31.9%) were more likely than cisgender women (9.9%) and men (6.5%) to always or often fear a negative reaction by a health care provider. Nevertheless, most participants (89.0%) were out as LGBTQA to one or more of their health care providers. LGBTQA Acceptance LGBTQA participants thought their friends were the most LGBTQA-accepting (85.7% thought their friends were very LGBTQA-friendly). Second most accepting were participants’ workplaces (51.9% thought their workplaces were very LGBTQA-friendly), followed by schools and birth families (40.7% and 40.5%, respectively, thought these groups were very LGBTQA-friendly). Medical providers and neighborhoods were not terribly accepting overall (35.3% and 29.0%, respectively, thought these groups were very LGBTQA-friendly).
Overall Health In total, 69.2% of participants reported that their overall health status was good or very good. Importantly, participants’ self-reported overall health status was significantly greater if they reported greater overall LGBTQA acceptance across the domains specified above. Nearly all respondents were interested in incorporating more healthy living strategies into their lives.
Body Mass Index According to participants’ body mass index (BMI), 33.7% were obese and 33.6% were overweight; this did not significantly vary by gender. Among the general population of Pennsylvania adults, 30.2% of adults were obese and 33.9% were overweight (BRFSS, 2014), suggesting that the LGBTQA population in the Philadelphia Region may be slightly more obese than the general Pennsylvanian population. Importantly, about two-thirds of LGBTQA participants were interested in health eating (63.2%) and active living strategies (67.6%).
Mental Health Treatment In the past 12 months, 41.6% of participants received psychological counseling or treatment. In their lifetime, nearly two-thirds of the sample (63.7%) had taken medicine or received treatment for mental health problems.
HIV among Cisgender Men and Transgender People HIV prevalence was significantly higher for cisgender men (12.5%) than transgender people (1.6%). Regular HIV testing was low. Excluding HIV-positive participants, 52.4% of cisgender men and 52.5% of transgender people received their last HIV test over one year ago. The Centers for Disease Control and Prevention (CDC) recommends that at-risk groups test for HIV at least once per year, and more often for those who engage in high-risk behaviors.
Tobacco Use & Opinions In the past year, 34.3% of participants used any tobacco/nicotine products, and this significantly varied by gender: transgender people (46.2%) reported higher tobacco use than cisgender women (35.9%) and men (30.2%). Specifically, cigarette smoking was higher among LGBTQA participants than the general Pennsylvanian population (26.9% versus 19.9%, respectively; BRFSS, 2014). On a positive note, LGBTQA participants used smokeless tobacco (e.g., chew or snuff) less than the general Pennsylvanian population (1.1% vs. 4.3%; BRFSS, 2014). LGBTQA people had little knowledge about smoking disparities: 37.4% strongly or somewhat agreed that LGBTQA people smoke more than the general population. Among all LGBTQA participants 83.4% were strongly or somewhat unappreciative that the tobacco industry advertises to the LGBTQA community; and 50.6% strongly or somewhat agreed that pride celebrations should be smoke-free events. LGBTQA smokers overwhelmingly wanted to quit (89.8%), with the largest group of those wanting to quit within the next six months. When asked how they would quit, willingness to use effective cessation techniques was low: 32.0% of smokers would go to their health care provider, and 15.4% would enroll in a smoking cessation class or program; however, only 10.2% would use the quitline, and 17.7% of smokers did not know where to go for cessation assistance.
Cancer The lifetime prevalence of cancer was 10.4% among LGBTQA participants (and this did not significantly vary by gender). Nearly one-third (31.2%) of participants who were assigned female at birth reported not being up to date with cervical Pap smears. Among participants 50 years or older: 27.4% were not up to date with colonoscopies; 14.6% of those assigned female at birth were not up to date with mammograms; and 17.6% of those assigned male at birth were not up to date with prostate exams. Overall, 88.7% of transgender people, 87.5% of cisgender women, and 77.7% of cisgender men never had an anal Pap smear. LGBTQA participants thought there was a high need for a variety of LGBTQA- welcoming practices for cancer care, including survivor support groups, caregiver support groups, inclusive hospital policies, and legal planning at hospitals.
Perceptions of LGBTQA Community Health Issues Mental health, STDs/HIV, and suicide were perceived to be the top three health problems by LGBTQA participants.
Recommendations
Because tobacco use greatly affects the health of LGBTQA people, the lack of knowledge about LGBTQA smoking disparities and tobacco cessation programs are of particular concern. The following steps would help address this problem: . Create LGBTQA-tailored smoking cessation groups; . Train quitline providers to be LGBTQA friendly and affirming; . Create LGBTQA-tailored quitline promotion campaigns to raise awareness for this cessation resource; and . Create LGBTQA-tailored tobacco awareness campaigns to raise the knowledge level about LGBTQA smoking disparities and help people make healthier decisions.
Because many LGBTQA participants experienced LGBTQA-unfriendliness by a medical provider and perceived a high-need for LGBTQA-related cancer programs, enhancing the LGBTQA-friendliness of medical environments would have many benefits. The following steps would help address this need: . Train medical providers to be LGBTQA culturally competent and to provide LGBTQA competent health care; and . Design and disseminate LGBTQA-tailored materials that help make medical environments more LGBTQA-friendly.
To monitor the health of LGBTQA participants in the Philadelphia Region, LGBTQA health surveillance data should be routinely collected.
Results
In total, 1,218 LGBTQA individuals completed the survey. In this report, transgender is used as an umbrella term for the following individuals: . People who identified as a trans man/woman or trans masculine/feminine; . People who identified as agender, bigender, demigirl, fluid, non-conforming, non-binary, genderqueer, or Two-Spirit; and . People whose assigned sex at birth does not match their current gender identity (e.g., someone who was assigned male sex at birth and now identifies as female). Gender 100% 90% 80% 70% 60% 53.4% 50% 40% 30.3% 30% 20% 15.3%
10% 1.0% 0% Cisgender Women Cisgender Men Transgender Declined to State or Did Not Respond
Sociodemographic Characteristics
100% 90% 80% 72.2% 70% 60% Results 50% 40% 30% 20% 10.5% 10.0% 4.4% 10% 0.8% 1.4% 0.7% 0% Gay/Lesbian Bisexual Queer Pansexual Asexual Straight or Declined to Heterosexual State or Did Not Respond
WouldHow would you describe you describe your your neighborhood neighborhood? as: 100% 90% 80% 70% 59.3% 60% 50% 40% 28.1%
30% 20% 12.6% 10% 0% Urban Suburban Rural/Small town demographic Characteristics demographic
Age Socio
100% –
90% 80% 70% 60% 50.8% Results 50% 40% 28.6% 30% 20% 10.0% 10.1% 10% .4% 0% Less than 18 years 18-24 years 25-49 years 50-64 years 65 and older
What is your approximate average household income? 100%
90% 80% 70% 60% 50% 40% 27.6% 30% 21.4% 17.6% 17.6% 20% 15.7% 10% 0% Less than $25,000 $50,000 $75,000 $100,000 $25,000 to $49,999 to $74,999 to $99,999 and above
What is the highest level of education you have completed? 100% 90% 80% 71.9% 70% 60%
Sociodemographic Characteristics 50%
– 40%
30% 20% 16.7% 10% 4.8% 6.7%
Results 0% High school or less Some college Associate's or College degree Techical Degree or more Race 100% 84.5% 80%
60%
40%
20% 4.8% 5.0% 2.1% 0.2% 0.1% 3.3% 0% White Black Asian and American Middle Multiracial or Missing or Pacific Indian or Eastern or Mixed race Decline to Islander Alaska North Answer Native African
Hispanic or Latino Ethnicity 100% 88.0%
80%
60%
40%
20% 5.4% 6.6% 0% Not Hispanic or Latino/Latina Hispanic or Latino/Latina Missing or Decline to Answer Sociodemographic Characteristics
– Results Results
Health Care Photo
Do you have any kind of health coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare or Indian Health? 100% 95.2% 90% 80% 70% 60%
50% 40% 30% 20% 10% 4.8% 0% Yes No/Not sure Health Care Access Quality & Access Care Health
–
Are you out to your doctors/healthcare providers as an LGBTQA person? 100% 90% 80% 70% Results 60% 56.5% 50% 40% 32.5% 30% 20% 11.0% 10% 0% All of them Some of them None of them How knowledgeable are your providers about LGBTQ health? 100% 90% 80% 70% 60% 50% 40% 30% 22.4% 25.5% 24.8% 14.5% 20% 10.1% 10% 2.8%
0% Quality
Do you fear a negative reaction by a healthcare provider if you come out as LGBTQA? 100% 90% 80% 70%
60% 50% 40% 33.9% 30.8% 30% 23.8% 20% 7.2% 10% 4.2% 0%
Health Care Access Health Care & Never Rarely Sometimes Often Always
–
Has a health provider ever reacted poorly when they learned you were LGBTQA? 100% 90%
Results 80% 70% 64.1% 60% 50% 40% 30% 19.2% 20% 12.4% 10% 4.4% 0% Yes Somewhat No Do not know How LGBTQA-welcoming is your workplace? 100% How Accepting is Your Workplace? 90% 80% 70% 60% 51.9% 50% 40% 30% 24.2% 20% 12.4% 7.8% 10% 3.7% 0% Very Somewhat Neutral Somewhat Very
friendly friendly unfriendly unfriendly
How LGBTQA-welcoming is your school? 100% 90% 80% 70% 60% 50% 40.7% 40% 27.1% 30% 22.2% 20% 10% 5.8% 4.1% 0% Very Somewhat Neutral Somewhat Very
LGBTQA Acceptance friendly friendly unfriendly unfriendly
–
How LGBTQA-welcoming is your neighborhood? 100%
Results 90% 80% 70% 60% 50% 40% 29.0% 31.7% 30% 25.0% 20% 11.1% 10% 3.2% 0% Very Somewhat Neutral Somewhat Very friendly friendly unfriendly unfriendly How LGBTQA-welcoming is your birth family? 100% 90% 80% 70% 60% 50% 40.5% 40% 28.3% 30% 20% 12.7% 12.0% 10% 6.5% 0% Very Somewhat Neutral Somewhat Very friendly friendly unfriendly unfriendly
How LGBTQA-welcoming are your friends? 100% 90% 85.7% 80% 70% 60%
50% 40% 30% 20% 9.7% 10% 3.3% 1.0% 0.3% LGBTQA Acceptance 0%
– Very Somewhat Neutral Somewhat Very friendly friendly unfriendly unfriendly
How LGBTQA-welcoming is your medical provider? Results 100% 90% 80% 70% 60% 50% 40% 35.3% 33.5% 30% 25.4% 20% 10% 5.1% 0.7% 0% Very Somewhat Neutral Somewhat Very friendly friendly unfriendly unfriendly Average LGBTQA Acceptance Across All Domains 100% 90% 80%
70% 60% 48.9% 50% 40% 30.1% 30% 18.0% 20% 10% 2.5% 0.4% 0% Very Somewhat Neutral Somewhat Very friendly friendly unfriendly unfriendly
LGBTQA Acceptance
–
Results Top Health Issues for the LGBTQA Community
100%
80% 60.1% 60% 47.7%
40% 32.1% 31.6% 27.8% 22.9% 22.8% 22.6% 20.3% 20% 7.5% 4.1% 3.1% 2.6% 0% Wellness Wellness
& Health
Photo of a group of friends holding sign, Hands with rainbow Flag, group holding umbrellas, Community
– rainbow people over city,
yoga lady on wood, health level meter Results
COMMUNITY Self-reported Health Status 100% 90% 80% 70% 60% 47.4% 50% 40%
30% 24.6% 21.8%
20% 10% 5.7% 0.6% 0% Very Poor Poor Okay Good Very Good Wellness Wellness
& lth
Personal Hea
–
Results Have You Seen Wellness Campaigns Geared Toward LGBTQ Community? 100% 90% 80% 70% 60% 49.2% 50% 43.6% 40% 30% 20% 7.2% 10% 0% Never Sometimes Frequently
Wellness Wellness How interested are you in incorporating Healthy Living Strategies?
100% & 90% 80% 70% 60% 50% 42.1% 37.6% 40% 30% 18.7% 20%
10% 1.6% 0% Not at all Somewhat Very Extremely Personal Health
–
Are you interested in... 100% 90% 80% Results 67.6% 70% 63.2% 60% 50% 40% 30% 20% 12.6% 10% 0% Tobacco-Free Strategies Health Eating Strategies Active Living Strategies Are you now or have you ever taken medicine or received treatment for a mental health condition or emotional problem? 100% 90% 80%
70% 63.7% 60% 50% 40% 36.3% 30% 20% 10% 0% Yes No
In the past 12 months, did you receive psychological counseling or treatment? 100% 90% 80% 70% 58.4% 60% 50% 41.6% 40% 30%
20% 10% Mental Health 0% –
Yes No Results
Photo of a brain / neuron / nervous system, Guy with tangled brain lines, Tree in head shape brain growing,
How many minutes per week do you engage in moderate or vigorous exercise?
100% 90% 80% 70% 60% 50% 40% 27.4% 30% 23.6% 21.1% 17.6% 20% 7.0% 10% 3.3% 0% Unable to 0 minutes 1 to 49 minutes 50 to 99 100 to 149 150 minutes exercise minutes minutes and above
In the past week, how many glasses, bottles, or cans of sugar-sweetened drinks did you have? 100%
Physical Activity 90%
80% & 70% 60% 52.8% 50% 40% 33.6% 30% 20% 8.7% 10% 2.8% 2.1% 0% Zero 1-4 5-9 10-14 15 and above Healthy EatingHealthy
– On average, how many serving of vegetables do you consume per day (excluding potatoes)? 100% 90% 80%
Results 70% 60% 50% 40% 32.2% 27.2% 30% 20.3% 20% 9.6% 10% 4.9% 5.8% 0% 0 1 2 3 4 5+ Body Mass Index 100% 90% 80% 70% 60% 50%
40% 33.6% 33.7%
31.5% 30% 20% 10% 1.2% 0% Underweight Normal or Healthy Overweight Obese Weight Physical Activity
& Healthy EatingHealthy
–
Exercise Photo, Group stretch exercise, Lesbians running
Results
Have you ever been tested for HIV? 100% 90% 82.9% 80% 70% 60% 50% 40% 30% 20% 15.7% 10% 1.4% 0% Yes No Not Sure
Among those who had an HIV test, when was their last HIV test?
100% 90% 80% HIV
70% –
60% 50.4% 50% 40% 30% 20.9% Results 20% 14.7% 14.0% 10% 0% 0-3 Months Ago 4-6 Months Ago 7-12 Months Ago Over 12 Months Ago
What were the results of your last HIV test? 100% 90% 80% 76.9% 70% 60% 50% 40% 30% 20% 14.7% 10% 7.1% 1.3% 0% Negative Positive Don't know Never had one
Drug photo, Drug icons in hexagons, Cartoon with drug brains,
Substance Use Substance
–
Results
In the past year, how often did you consume 5 or more alcohol drinks/day? 100% 90% 80% 70% 60% 50% 47.2% 40% 30% 23.7% 14.7% 20% 11.7% 10% 2.7% 0% Never Once or twice Monthly Weekly Daily or almost daily
In the past year, how often have you used prescription drugs for non-medical reasons? 100% 90% 86.8% 80% 70% 60% 50%
40% 30% 20% 6.7% 10% 2.2% 1.5% 2.8% 0% Never Once or twice Monthly Weekly Daily or almost daily Substance Use Substance
– In the past year, how often have you used illegal drugs?
100% 90% 80% 71.0% 70% Results 60% 50% 40% 30% 20% 16.0% 6.4% 10% 3.4% 3.2% 0% Never Once or twice Monthly Weekly Daily or almost daily Have you used any tobacco products in the past year? 100% 90% 80% 70% 65.7% 60% 50% 40% 34.3% 30% 20% 10% 0%
No Yes
In the past year, how often have you used... 100% Not at all Some days Everyday 90% & Opinions&
80% 70% 60% Use 50% 40% 30% 14.2%
20% 12.7% 8.7% 8.2% 10% 5.7% 1.7% 0.7% 0.3% 0.3% 73.1% 90.1% 91.3% 94.0% 98.9% 0.0% 0% Cigarettes E-cigarettes Hookah Flavored Cigars Chew or Snuff Tobacco or Cigarillos –
On the days you smoke, how many cigarettes/cigars do you smoke? 100%
Results 90% 80% 70% 60% 56.8% 50% 40% 30% 20.7% 20% 15.4% 10% 4.1% 0.0% 2.9% 0% Less than One-half One pack One and a Two packs Not sure one-half pack pack half packs or more No Smoking Photo, Lady breaking cigarette, No smoking blue icon, Cigarette knot
Opinions How much do you agree with this statement: I’m grateful the tobacco industry advertises to LGBTQA communities 100% 90% 80% 75.5% 70% 60% 50% 40% 30% 20% 11.8% 7.9% 10% 1.5% 3.3% Tobacco Tobacco Use &
0% –
Strongly Somewhat Neutral Somewhat Strongly disagree disagree agree agree
How much do you agree with this statement:
Results LGBTQA people smoke more than the general population 100% 90% 80% 70% 60% 50% 41.0% 40% 30% 23.2% 20% 12.7% 14.2% 8.9% 10% 0% Strongly Somewhat Neutral Somewhat Strongly disagree disagree agree agree
Pride Event Photo, Gay flag in pride event, Gay rainbow balloons,
Opinions
Tobacco Tobacco Use &
–
How much do you agree with this statement: Pride celebrations should be smoke-free events Results 100% 90% 80% 70% 60% 50% 40% 33.1% 30% 26.2% 17.5% 20% 11.1% 12.2% 10% 0% Strongly Somewhat Neutral Somewhat Strongly disagree disagree agree agree
Calendar Smoking Photo, STOP sign with calendar and cig
Tobacco Tobacco Use Opinions &
–
If you smoke, what are your intentions to quit?
Results 100% 90% 80% 70% 60% 50% 43.9% 40% 29.7% 30% 20% 16.3% 10.2% 10% 0% Never expect to quit Might quit sometime, Want to quit in the Want to quit in the but not soon next year next six months E-CIG Photo Smoke floating
If you smoke, where would you most likely go for assistance to quit smoking? 100% 90% 80% Use Opinions & 70%
60% 50.0% 50% 40% 32.0% 30% 17.7% 20% 15.4% 7.5% 10.2% 10%
Tobacco 0%
Doctor or An LGBTQ Quitline Smoking I don't know I would not go – health care organization cessation class where to go anywhere provider or program
What is your best guess as to how LGBTQA welcoming your state quitline is?
Results 100% 90% 80% 70% 59.7% 60% 50% 40% 27.7% 30% 20% 8.8% 10% 3.8% 0% Very unwelcoming Somewhat Somewhat welcoming Very welcoming unwelcoming
Doctor with paperwork
Doc holding ipad Cancer Cancer
–
Results Among participants assigned female at birth, are you up to date with your cervical paps? 100% 90% 80% 70% 64.0% 60% 50% 40% 31.2% 30% 20% 10% 4.8% 0% Yes No I do not know the screening recommendations
Among participants assigned female at birth aged 50 years or older,
are you up to date with your mammography? 100% 90% 85.4% 80% 70% 60%
Cancer 50% 40% – 30% 20% 14.6% 10% 0.0% 0% Yes No I do not know the screening
Results recommendations
Among participants aged 50 years or older, are you up to date with your colonoscopy? 100% 90% 80% 71.9% 70% 60% 50% 40% 27.4% 30% 20% 10% 0.7% 0% Yes No I do not know the screening recommendations
Among participants assigned male at birth and aged 50 years or older, are you up to date with your prostate exams? 100% 90% 79.8% 80% 70% 60% 50% 40% 30% 17.6% 20%
10% 2.7% 0% Yes No I do not know the screening recommendations Cancer
– Among all participants, have you ever had an anal pap smear? 100% 90% 82.2% 80%
Results 70% 60% 50% 40% 30% 20% 12.2% 10% 5.6% 0% Yes No I don't know
Family in hospital AA lady doctor
Have you ever been a caregiver of someone with cancer? 100% 90% 80% 70.0% 70% 60% 50% 40% 30.0% 30% 20% 10% 0% Yes No
Have you ever been diagnosed with cancer? 100% 89.6% 90% 80% 70% 60% Cancer Cancer
50% –
40% 30% 20% 10.4% 10%
Results 0% Yes No
How much do you think LGBTQ welcoming providers are needed for cancer survivors? 100% 90% 80% 76.9% 70% 60% 50% 40% 30% 20% 12.7% 9.3% 10% 0.4% 0.6% 0% Not needed Little need Medium need High need Don't know Hospital Nurse Photo
How much do you think LGBTQ support groups are needed for cancer survivors? 100% 90% 80% 68.5% Cancer Cancer 70%
– 60%
50% 40% 30% 19.9% 20% 9.3% Results 10% 0.5% 1.8% 0% Not needed Little need Medium need High need Don't know
How much do you think LGBTQ-tailored cancer information are needed for cancer survivors? 100% 90% 80% 70% 58.5% 60% 50% 40% 30% 24.0% 20% 11.0% 5.2% 10% 1.3% 0% Not needed Little need Medium need High need Don't know How much do you think LGBTQ welcoming caregiver groups are needed for cancer survivors? 100% 90% 80% 71.2% 70% 60% 50% 40% 30% 20% 17.0% 9.7% 10% 0.3% 1.7% 0% Not needed Little need Medium need High need Don't know
How much do you think LGBTQ welcoming policies at hospitals are needed for cancer survivors? 100% 90% 79.3% 80% 70%
Cancer Cancer 60%
– 50%
40% 30% 20% 9.9% 9.6% 10% 0.2% 1.0% Results 0% Not needed Little need Medium need High need Don't know
How much do you think LGBTQ legal planning at hospitals are needed for cancer survivors? 100% 90% 79.7% 80% 70% 60% 50% 40% 30% 20% 10.3% 9.4% 10% 0.3% 0.3% 0% Not needed Little need Medium need High need Don't know