Billy A. Caceres

Objectives: To examine the associations of medical discrimination with hypertension (HTN) outcomes. Materials and Methods: Using cross-sectional data from the All of Us Research Program (2018-2022), we defined elevated blood pressure (BP) as systolic BP ≥130 or diastolic BP ≥ 80 mm Hg. We defined HTN diagnosis as either (1) self-reported HTN or (2) a HTN billing code. Among participants with HTN, we assessed antihypertensive medication use and HTN control. Logistic regression models estimated the associations of medical discrimination (using the Discrimination in Medical Settings Scale) with each BP outcome. The full sample included 29 805 adults, of whom 10 359 adults had elevated BP. Results: Medical discrimination was associated with higher odds of elevated BP (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI], 1.02-1.08) and HTN diagnosis (AOR 1.06, 95% CI, 1.02-1.10). Among participants with HTN, medical discrimination was not associated with treatment or control. Discussion: Findings suggest that medical discrimination contributes to increased prevalence of elevated BP and HTN diagnosis. Conclusion: Researchers should examine mechanisms linking medical discrimination with HTN.

Aim: To assess LGBT‐related clinical competence among nurses and identify sociodemographic and occupational factors associated with overall competence and its domains of clinical preparedness, attitudes, and knowledge. Design: Nationwide cross‐sectional study. Methods: A nationwide online cross‐sectional study was conducted between January and May 2026 among 861 registered nurses. Participants completed the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT‐DOCSS) and a questionnaire assessing sociodemographic and occupational characteristics. Descriptive statistics and univariable and multivariable linear regressions identified factors associated with overall and domain‐specific LGBT‐related clinical competence. Reporting Method: This study followed the STROBE Statement. Results: The mean overall LGBT‐DOCSS score was 4.10 ± 0.53 on a 1–7 scale, with higher scores indicating greater competence. Nurses reported the highest average scores for attitudes (5.78 ± 0.86) and the lowest for clinical preparedness (2.48 ± 0.79). Rural residence was consistently associated with lower overall LGBT‐related clinical competence and lower competence across all three domains. Master's degree education was associated with higher overall competence and greater clinical preparedness. Nurses born in 1965–1994 reported lower clinical preparedness than those born in 1946–1964, whereas Generation Z nurses demonstrated higher knowledge. Working more than 200 h per month was associated with lower knowledge. Conclusion: Although nurses reported generally positive attitudes towards LGBT patients, important gaps in clinical preparedness and knowledge remain. Rural residence emerged as the strongest and most consistent predictor of lower LGBT‐related clinical competence. Implications for the Profession and/or Patient Care: Undergraduate nursing education and continuing professional development should strengthen LGBT health content, with particular emphasis on practical clinical skills and targeted educational support for nurses working in rural settings. Impact: The findings identify modifiable factors associated with LGBT‐related clinical competence among nurses and provide evidence to guide nursing education, continuing professional development, and workforce strategies that promote equitable, culturally competent care for LGBT patients worldwide.

Federal policy changes under the Trump administration led to the abrupt termination of hundreds of National Institutes of Health –funded projects, disproportionately affecting research on sexual and gender minority (SGM) health. This manuscript presents a structured reflective synthesis of contemporaneous field notes and facilitated summit discussions from the 2025 SGM National Nursing Summit, a national convening of nursing students, researchers, administrators, and clinicians. We synthesize the concerns, tensions, and priorities that surfaced as participants grappled with the implications of these changes for SGM research, education, and practice. Five interrelated areas emerged: generational differences in how the current moment is understood; experiences of institutional betrayal; uncertainty around whether to persist or redirect SGM-focused work; calls for greater intersectional solidarity; and growing career precarity. We conclude with practical recommendations for supporting researchers, strengthening professional networks, and sustaining SGM nursing scholarship, and offering insights for nursing leaders navigating policy and workforce challenges.

Background: Our objective was to assess the cardiovascular health of sexual and gender minority adults across the sex and gender spectrum. Methods: This was a cross‐sectional analysis of the American Heart Association Life's Essential 8 (LE8) score in sexual and gender minority adults in The PRIDE (Population Research in Identity and Disparities for Equality) Study. Using a validated algorithm, self‐reported gender identity was categorized: cisgender men, cisgender women, gender‐expansive people assigned female at birth, gender‐expansive people assigned male at birth, transgender men, and transgender women. We used linear regression to calculate the mean composite LE8 score (primary outcome) and mean LE8 component scores (secondary outcome) across groups. Results: Among the 4964 participants, the median age was 36.4 (interquartile range, 28.9–51.9) years, 49.7% (n=2398) were transgender or gender‐expansive, and 1100 (22.2%) respondents used gender‐affirming hormone therapy. Composite LE8 scores ranged from 70.3 (95% CI, 68.5–72.1) in transgender women to 72.9 (95% CI, 72.3–73.6) in gender‐expansive people assigned female at birth, with no difference by gender‐affirming hormone therapy use. Mean LE8 component scores differed significantly between groups, including a high prevalence of unfavorable body mass index scores in cisgender women and gender‐expansive people assigned female at birth, unfavorable nicotine scores in gender‐expansive people assigned male at birth and transgender men, and unfavorable sleep scores in transgender men and transgender women. Overall, participants had favorable physical activity and glucose scores and unfavorable diet scores. Conclusions: In this sample of sexual and gender minority adults, the significant differences in the prevalence of unfavorable LE8 component scores between groups highlight the importance of population‐specific interventions in future research.

Stigmatized adults in the United States experience significant hypertension disparities that may be influenced by greater exposure to discrimination. Altho

Purpose: Our aim was to expand existing evidence on structural determinants of cardiovascular health disparities among lesbian, gay, and bisexual (LGB) adults by examining sexual orientation differences in the impact of sexual orientation-related nondiscrimination laws on 30-year cardiovascular disease (CVD) risk. Methods: We analyzed data from Waves III (2001-2002), IV (2008-2009), and V (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health. Sexual orientation was categorized as exclusively heterosexual, mostly heterosexual, bisexual, or gay/lesbian. We categorized changes in sexual orientation-related nondiscrimination laws between Waves III-IV as no change (reference group), increased, or decreased. We assessed 30-year CVD risk at Wave V using the Framingham Risk Score. We ran sex-stratified regression models to examine whether the association between changes in sexual orientation-related nondiscrimination laws and 30-year CVD risk was moderated by sexual orientation. Results: The sample included 3768 participants (mean age [standard deviation] = 28.7 [±1.72] years) of whom approximately 77% were White, 11% Hispanic, and 51% female. Compared with exclusively heterosexual participants, an increase in nondiscrimination laws was associated with lower CVD risk among mostly heterosexual women (B = -5.05, 95% confidence interval [CI] = -8.50 to -1.59) and gay men (B = -10.22, 95% CI = -19.05 to -1.39). There were no significant differences for other LGB subgroups when compared with exclusively heterosexual adults. Conclusions: Increasing laws that prohibit sexual orientation-related discrimination may play an important role in reducing CVD risk among some LGB subgroups. These findings can inform structural-level interventions to reduce CVD risk among LGB adults.

Cardiovascular disease (CVD) remains the leading global cause of death and significant cardiovascular health disparities have been documented. There is growing evidence that sexual minority (SM; e.g. lesbian, gay, bisexual, queer, and other non-heterosexual) people are at higher risk of developing CVD compared to heterosexual people across the lifecourse. The minority stress model of cardiovascular health (CVH) theorizes that minority stressors across multiple levels influence CVD risk in SM people through mediated psychosocial, behavioural, and physiological mechanisms. These mechanisms remain understudied, which has hindered the development of clinical and public health interventions to reduce CVD risk among SM people. The purpose of this state-of-the-art review was to: (i) elucidate the potential mechanisms underlying CVH disparities among SM populations; (ii) analyse research gaps; and (iii) provide suggestions for improving cardiovascular care and identifying potential targets for clinical and public health interventions in this population. The authors identified multilevel determinants, such as minority stressors and interpersonal violence, that have been associated with tobacco use, alcohol use, sleep problems, obesity, and hypertension among SM populations. They conclude that studies investigating CVH disparities among SM people have considerable methodological limitations that must be addressed to improve our understanding of mechanisms underlying CVH disparities in this population. The authors subsequently provide suggestions for improving cardiovascular care and considerations for the development and implementation of interventions to reduce CVD risk among SM people. This review can help cardiovascular clinicians and researchers devise strategies to reduce CVH disparities among SM populations.

This study expands upon syndemics, structural vulnerability, and health care utilization frameworks by examining individual and social factors influencing help-seeking, care barriers, and treatment satisfaction among sexual minority women (SMW; e.g., bisexual, lesbian) aged 50+ from Wave 3 of a community-based longitudinal study, the Chicago Health and Life Experiences of Women Study. Wave 3 data were collected in 2010–2012 (May 2010 to August 2012). Bivariate analyses were conducted to examine associations among help-seeking behaviors, self-rated physical and mental health, relationship status, and social support. We used multivariate logistic regression models to examine (1) associations between sociodemographic characteristics and help-seeking, (2) associations between help-seeking and treatment satisfaction variables and sociodemographic characteristics, (3) self-rated physical health and self-rated mental health as predictors of help-seeking and treatment satisfaction, and (4) interpersonal factors as predictors of help-seeking and treatment satisfaction. Participants (N = 196) were, on average, 58.15 years of age (SD = 6.61). Physical health and issues related to depression, anxiety, memory, and eating are synergistic among older SMW. Those with insufficient household incomes and identifying as bisexual, Black, or younger were more likely to seek help. Black and Latinx SMW reported fewer help-seeking barriers than White SMW. Self-rated poorer mental health was associated with greater difficulty accessing services; sociodemographic variables weakened this association. Poorer mental health and lower social support were associated with treatment dissatisfaction. Results highlight the relevance of structural vulnerabilities and social determinants of health among older SMW, emphasizing the need for integrated, culturally competent care models that enhance access and improve treatment satisfaction.