{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:09:01Z","timestamp":1791356941415,"version":"4.3.1"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals in the US face significant health inequities driven by structural stigma. However, the health impacts of LGBTQ+\u00a0stigma and hypervigilance among LGBTQ+\u00a0individuals who are also a cancer caregiver are understudied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>LGBTQ+\u00a0adults in the US who provided unpaid care to a cancer patient (\u00a03\u00a0years prior) were recruited for an online survey. Survey domains\/measures included sociodemographics, State Equality Index, Sexual Stigma Scale (adapted), Riggle Hypervigilance Measure, as well as health outcomes (PROMIS anxiety, depression, sleep disturbance, and fatigue). Latent class analysis (LCA) was used to group participants based on LGBTQ+\u00a0stigma and hypervigilance scores. Multivariable linear regression models tested the association between LCA classes and each PROMIS measure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 332 LGBTQ+\u00a0cancer caregivers, LCA identified four distinct classes: 1. Low stigma and hypervigilance (31.0%), 2. Moderate stigma and behavioral hypervigilance (21.7%), 3. Moderate contextual hypervigilance and scanning (19.3%), and 4. High stigma and hypervigilance (28.0%). In multivariable linear regression models, class 4 was associated with a 10.43\u2010unit higher anxiety T\u2010score (95% CI: 7.75\u201313.11), a 9.61 unit higher depression T\u2010score (95% CI: 6.67\u201312.54), a 9.50\u2010unit higher sleep disturbance T\u2010score (95% CI: 7.02\u201311.98), and a 12.11\u2010unit higher fatigue T\u2010score (95% CI: 8.88\u201315.35) in comparison to class 1. Similar, but lower magnitude, trends were seen across the associations of classes 2 and 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings of this study algin with the LGBTQ+\u00a0literature and suggest that among LGBTQ+\u00a0cancer caregivers, increased levels of LGBTQ+\u00a0stigma and the resulting hypervigilance drive health inequities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70379","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T14:19:46Z","timestamp":1768918786000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of Multi\u2010Level LGBTQ+ Stigma and Hypervigilance With Health Outcomes Among LGBTQ+ Cancer Caregivers"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9947-8535","authenticated-orcid":false,"given":"Austin R.","family":"Waters","sequence":"first","affiliation":[{"name":"Division of Population Sciences Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"},{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute  Boston Massachusetts USA"},{"name":"Health Policy and Management Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany M.","family":"Charlton","sequence":"additional","affiliation":[{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute  Boston Massachusetts USA"},{"name":"Department of Epidemiology Harvard TH Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille R.","family":"Murray","sequence":"additional","affiliation":[{"name":"Health Policy and Management Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun R.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5998-9744","authenticated-orcid":false,"given":"Echo L.","family":"Warner","sequence":"additional","affiliation":[{"name":"College of Nursing University of Utah  Salt Lake City Utah USA"},{"name":"Cancer Control and Population Sciences Huntsman Cancer Institute  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1096-8974","authenticated-orcid":false,"given":"Lorinda A.","family":"Coombs","sequence":"additional","affiliation":[{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"School of Nursing University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi S.","family":"Donovan","sequence":"additional","affiliation":[{"name":"Department of Health and Community Systems School of Nursing University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"UPMC Hillman Cancer Center  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhirui","family":"Deng","sequence":"additional","affiliation":[{"name":"Office of Research and Scholarship School of Nursing University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianxu","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Health and Community Systems School of Nursing University of Pittsburgh  Pittsburgh Pennsylvania USA"},{"name":"Office of Research and Scholarship School of Nursing University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara L.","family":"Fredrickson","sequence":"additional","affiliation":[{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Department of Psychology and Neuroscience University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel B.","family":"Nichols","sequence":"additional","affiliation":[{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin E.","family":"Kent","sequence":"additional","affiliation":[{"name":"Health Policy and Management Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4289-3188","authenticated-orcid":false,"given":"Kelly R.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Health and Community 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