2.8.1 dr rhonda brown
•Download as PPTX, PDF•
0 likes•415 views
2.8.1 dr rhonda brown
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Similar to 2.8.1 dr rhonda brown
Similar to 2.8.1 dr rhonda brown (20)
More from Australian Women's Health Network - 7th Conference 2013
More from Australian Women's Health Network - 7th Conference 2013 (20)
Recently uploaded
Recently uploaded (20)
2.8.1 dr rhonda brown
- 1. Cancer Prevalence And Cancer Risk Factors Among Australian Sexual Minority Women Dr Rhonda Brown School of Nursing and Midwifery Deakin University CRICOS Provider Code: 00113B
- 2. Acknowledgments • Research Team • Dr Rhonda Brown – Deakin University • Assoc Prof Trish Livingston – Deakin University • Assoc Prof Ruth McNair – University of Melbourne • Prof Tonda Hughes – University of Illanois, Chicago • Assoc Prof Laura Szalacha – University of Ohio State University •We are grateful for funding support • Faculty of Health, Deakin University • Lesbian Health Fund, United State • Women’s Health Australia • for access to data from the Australian Longitudinal Study of Women’s Health CRICOS Provider Code: 00113B
- 3. CRICOS Provider Code: 00113B • A leading cause of disease burden • 46,000 people diagnosed with cancer each year • Over 12,700 with breast cancer - most commonly diagnosed cancer among women (1 in 9) – Other commonly diagnosed cancers skin (1 in 24 women), prostate cancer, bowel cancer (1 in 14 women) • While cancer mortality between 1982 and 2007 decreased in Australia (by 16%), lung cancer mortality in women increased by 56% (AIWA 2010) Cancer in Australia
- 4. Lesbian Cancer Research • Much of the research comes for the USA • Focus to date has been on risk factors • Data on the rates and incidence of cancer among lesbians and bisexual women not routinely collected • Unknown how prevalent cancer is among women of different sexual orientation • No Australian studies have specifically focused on sexual minority women and cancer risk factors CRICOS Provider Code: 00113B
- 5. Lesbian Risks for Cancer • Higher rates of smoking (Aaron, et al., 2001; Case, et al., 2004; Gruskin, Greenwood, Matevia, Pollack, & Bye, 2007; Gruskin, Hart, Gordon, & Ackerson, 2001; Matthers et al 2011) • Higher alcohol use (Brown & Tracy, 2008; Case et al., 2004; Drabble et al 2005; T. L. Hughes et al., 2006; McCabe et al, 2010; Wilsnack et al., 2008; Zaritsky & Dibble, 2010; *Hughes, Szulacha, McNair 2010; *Hillier , De Visser, Kavanagh, McNair, 2003) • Increased rates of obesity (Boehmer, Bowen, & Bauer, 2007; Case, et al., 2004; Cochran, et al., 2001; Yancey, Cochran, Corliss, & Mays, 2003) • Lower levels exercise and poorer diet (Case, Austin, Hunter, Manson, Malspeis, Willett, Spiegelman, 2004; Cochran et al., 2001) • Lifetime violence/victimisation (Brandenburg, et al., 2007; Case, et al., 2004; Cochran, 2001; Jorm, Korten, Rodgers, Jacomb, & Christensen, 2002; Matthews, Hughes, Johnson, Razano, & Cassidy, 2002; McNair, Kavanagh, Agius, & Tong, 2005; Meyer, 2003) CRICOS Provider Code: 00113B
- 6. Lesbian Risks for Cancer • Reduced rates of cancer screening • Pap test (Rankowand Tessaro, 1998; O’Hanlan, 1995; White and Dull, 1997) • Mammography although conflicting reports reduced rates CRICOS Provider Code: 00113B (Cochran et al., 2001), equal with heterosexual women (Diamant, Schuster, Lever, 2000), increased among lesbians (Arron, Marjovic, Danielson, Honnold, Janosky, Schmidt (2001). • Nulliparity and reduced contraceptive pill use (Cochran, et al., 2001; Dibble, et al., 2004) • Reduced access to routine health care as a result of concerns regarding discrimination in health care settings (Carroll, 1999; Roberts and Sorenson, 1995)
- 7. Recent Australian Study Recent study of the health status of young lesbian and bisexual women (LBW) aged 25-30 yrs CRICOS Provider Code: 00113B • more likely to report cancer diagnosis, representing 3.1% compared to 1.1% of heterosexual and 1% for bisexual women • also less likely to have ever had a Pap test and more likely to be under screened (McNair, Szalacha, & Hughes, 2011)
- 8. These risk factors potentiate a cumulative risk profile that CRICOS Provider Code: 00113B places lesbians at higher risk of developing cancer than heterosexual women (Brown and Tracy, 2008)
- 9. Cancer rates and risk factors among Australian lesbians and bisexual women (Brown, Livingston, McNair, Hughes, 2012) Aim: To examine rates of cancer, and related risk factors, among Australian mid-age women comparing “exclusive heterosexual” with sexual minority (lesbian, bisexual, and mainly heterosexual) women Method: Secondary data analysis of the Australian Longitudinal Study of Women’s Health (ALSWH) for those women born in 1946-1951 (n=10,845) CRICOS Provider Code: 00113B
- 10. Exclusively heterosexual CRICOS Provider Code: 00113B 10,200 94.1% Mostly heterosexual 117 1.1% Bi-sexual 18 0.2% Mostly 16 0.1% homosexual/lesbia n Exclusively lesbian 100 0.9% Did not know 61 0.6% Did not answer 333 3.1% TOTAL 10,845 100% As at the most recent survey from 2010 these women were aged 59 - 64 Heterosexual 10,200 Sexual minority 251 Total 10,451 The sample
- 11. Cancer incidence Diagnosed Cancer Past 3 yrs 1,526 18.0% 41 19.0% (df = 1) ns CRICOS Provider Code: 00113B Exclusively Heterosexual Sexual Minority χ2 Test (n =N 1 0 ,2%00) (n =N 2 5 1%) % ns = not significant *p<.05 **p<.01 ***p<.001
- 12. Cancer Screening - Breast CRICOS Provider Code: 00113B Exclusively Heterosexual Sexual Minority χ2 Test Self-Breast Exam 4,665 54.4% 102 46.8% (df = 1) 5.43* Clinical Breast Exam 5,228 61.3% 132 60.6% (df = 1) ns Mammogram In last 2 years 7,086 83.5% 168 77.4% Past 2-5 years 728 8.6% 17 7.8% More than 5 ears 361 4.3% 16 7.4% Never 269 3.2% 15 6.9% (df = 3) 14.91** Ever had mammogram 8,175 96.8% 201 93.1% (df = 1) 9.38*** Abnormal result from a mammogram 1,980 23.6 38 17.9% (df = 1) ns
- 13. Cancer screening - cervical Pap Smear CRICOS Provider Code: 00113B Exclusively Heterosexual Sexual Minority χ2 Test In last 2 years 5,013 59.3% 122 56.7% Past 2-5 years 1,011 12.0% 23 0.7% More than 5 years 1,996 23.6% 52 24.2% Never 146 1.7% 10 4.7% (df = 3) 10.57* Ever had pap smear 8,020 98.2% 197 95.2% (df = 1) 10.22*** Abnormal result from a pap smear 1,716 20.4% 48 22.5% (df = 1) ns Cancer Screening: Colon 2,889 33.9% 75 34.4% (df = 1) ns
- 14. Behavioural cancer risk factors Alcohol Drinking Pattern Abstainer 1,154 13.6% 32 14.7% Low Risk – drinks less than weekly 6,602 78.1% CRICOS Provider Code: 00113B 156 71.9% Low Risk– drinks more than weekly 125 1.5% 5 2.3% (df = 3) High Risk Drinker 572 6.8% 24 11.1% 7.87*
- 15. Behavioural cancer risk factors Tobacco Use: Smoking Status Never smoked 5,227 61.2% CRICOS Provider Code: 00113B 105 48.2% Ex-smoker 2,596 30.4% 80 36.7% Few than 10 cigarettes a day 175 2.1% 11 5.0% 10-19 cigarettes a day 249 2.9% 8 3.7% (df = 4) More than 20 cigarettes a day 287 3.8% 14 6.4% 23.88*** Ever smoked 14% 28%
- 16. Physical health CRICOS Provider Code: 00113B Exclusively Heterosexual M SD Sexual Minority M SD Independent T-test Statistic Physical Functioning 79.31 20.78 78.93 20.76 ns Role Physical 74.49 37.68 71.14 39.58 ns Pain Index 67.21 23.47 65.81 23.85 ns General Health 71.08 20.22 69.48 21.03 ns Vitality 61.02 20.98 59.98 20.31 ns
- 17. BMI CRICOS Provider Code: 00113B Exclusively Heterosexual Sexual Minority χ2 Test Underweight < 18.5 112 1.3% 3 1.4% Healthy weight 18.6-25.0 3009 36.0% 94 43.9% Overweight < 25.1-30.0 2892 34.6% 67 31.3% (df = 3) Obese >30.1 2354 28.1% 50 23.4% 6.00 ns Hormone Replacement (df = 1) Therapy - Current 1,014 11.9% 30 13.9% ns Physical health
- 18. Mental health CRICOS Provider Code: 00113B Exclusively Heterosexual M SD Sexual Minority M SD Independent T-test Statistic Social Functioning 84.05 23.00 79.36 25.86 t = 2.64** Role Emotional 84.39 31.68 78.50 24.56 t = 2.47* Mental Health Index 77.08 17.07 75.36 17.76 ns Life Satisfaction 3.17 .48 3.14 .44 ns Depression 5.39 5.10 6.44 5.46 t = 2.78** Stress .50 .42 .55 .44 ns Life Events .06 .06 .06 .06 ns Anxiety 3.59 2.65 3.58 2.66 ns
- 19. Experiences of violence CRICOS Provider Code: 00113B Exclusively Heterosexual N % Sexual Minority N % Chi-Square Statistic Past Year Pushed, grabbed, shoved, kicked or hit 74 .9 3 1.4 (df = 1) ns Forced unwanted sexual activity 27 .3 2 .9 (df = 1) ns Ever Pushed, grabbed, shoved, kicked or hit 432 5.1 22 10.1 (df = 1) X2 = 10.95*** Forced unwanted sexual activity 317 3.7 13 6.0 (df = 1) ns Been in violent relationship with a partner/spouse 1,091 12.8 53 27.2 (df = 1) X2 = 24.87*** Recently Uncomfortable with anyone in family 1,691 19.9 59 27.2 (df = 1) X2 = 6.90*** Forced you to do things you did not want to do 403 4.7 18 8.3 (df = 1) X2 = 5.83*** Anyone close tried to hurt or harm you 181 2.1 4 1.9 (df = 1) ns Anyone close called you names/put you down/made you feel bad 989 1.6 25 11.5 (df = 1) ns Afraid of anyone in your family 270 3.2 2 .9 (df = 1) ns
- 20. Overtime … CRICOS Provider Code: 00113B
- 21. Life Satisfaction CRICOS Provider Code: 00113B Heterosexual Sexual Minority
- 22. Depression CRICOS Provider Code: 00113B
- 23. Stress CRICOS Provider Code: 00113B
- 24. Limitations • Only asked sexual identity in Survey 3 • Questions in relation to cancer reporting on last three years • Focus on breast, cervical, skin and bowel CRICOS Provider Code: 00113B
- 25. In sum • Sexual minority women several increase cancer risk factors – has implications for health promotion and for health care providers • To date has not resulted in increased incidence of cancer - need to follow as they age • Important to include questions about sexuality in future research to understand more about the health disparities in this population CRICOS Provider Code: 00113B
Editor's Notes
- An to date no evidence of incidence and rates of cancer among lesbian and bisexual women While lesbians might have higher risk there is no evidence that cancer survival related to sexual orientation
- These women were asked sexual orientation at survey 3 – 2001 but not again, so we have had to use the data from 2001 to identify sexual minority women however, First population based sample Women were asked a number of questions about cancer e.g. cancer diagnosis in the past three years, cancer screening tests e.g. pap smear, mammogram, bowel test, cancer related treatment focus on breast, cervical, skin, bowel – also about physical and mental health Unique as we have been able to follow look at these women over 4 separate time frames from 2001 - 2010
- Almost 20% of the participants were recently diagnosed with a cancer and XX had ever been diagnosed with such. But we did find LBW to have increased rates of some cancer risk factors
- Exclusively heterosexual women were significantly more likely to conduct self-breast exams (54.4%), to have had a mammogram (96.8%), and to ever having had a pap smear (98.2%) than sexual minority women (See Table 2). Sexual minority women were significantly more likely to have never had a mammogram (6.9%)
- and to have never had a pap smear (4.7%).
- Sexual minority women were significantly more likely to be high risk drinkers (11.1% vs. 3.8% for exclusive heterosexual women) and,
- while only a small number, to smoke more than 20 cigarettes a day (6.4% vs. 3.8% for exclusive heterosexual women)
- There were no significant differences in BMI or current hormone replacement therapy (see Table 3).
- While there were no significant differences in health by sexual identity in the main, as measured by the mental health index, life satisfaction, stress or anxiety, sexual minority women reported significantly poorer social functioning (M = 79.4, SD = 25.9 vs M = 84.1, SD = 23.0), lower emotional role (M = 78.5, SD = 24.6 vs M = 84.4, SD = 31.7), and greater depression (M = 6.4, SD = 5.5 vs M = 5.4, SD = 5.1) than did exclusively heterosexual women
- Sexual minority women reported almost twice the level of violent experiences than did exclusively heterosexual women (See Table 5): 27.2% reported having been in violent relationship with a partner/spouse and being uncomfortable with a family member recently (vs. 12.8% and 19.9% respectively); 10.1% have been pushed, grabbed, shoved, kicked or hit (vs. 5.1%) and 8.3% have recently been forced to do things against their own will (vs. 4.7%).
- Only asked sexual ie