{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:13:01Z","timestamp":1785417181867,"version":"3.56.0"},"reference-count":36,"publisher":"North Carolina Institute of Medicine","issue":"1","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec id=\"background\">\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Health inequities among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority populations (LGBTQ+) are driven by anti-LGBTQ+ stigma and discrimination. However, there is limited research on the manifestations of stigma and discrimination among LGBTQ+ cancer survivors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"methods\">\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Data were collected by the North Carolina Department of Health and Human Services via the 2023 North Carolina LGBTQ+ Health Needs Assessment. Differences in outcomes (i.e., discrimination, violence, homelessness, mental health, substance use, and overdose) between LGBTQ+ individuals by cancer history were assessed using Chi-squared tests. Further, multivariable logit models were used to generate predicted probabilities, average marginal effects (AME), and 95% confidence intervals (CI) of the association of cancer with each outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"results\">\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of N = 3170 LGBTQ+ individuals (n = 200 cancer survivors) took part in the survey. In adjusted analyses, cancer history was associated with an 8.1 to 19.1 percentage point increase in the probability of all discrimination, violence, and homelessness outcomes. The largest AME of cancer was with accidental overdose (AME: 22.5; 95% CI, 15.2\u201329.8), followed by homelessness (AME: 19.1; 95% CI, 11.6\u201326.6), spouse or family violence (AME: 16.7; 95% CI, 9.3\u201324.1), LGBTQ+ violence (AME: 15.1; 95% CI, 7.8\u201322.5), sexual assault (AME: 14.1; 95% CI, 6.0\u201322.2), as well as nicotine product (AME: 9.0; 95%CI, 1.6\u201316.5) and cocaine use (AME: 8.9; 95% CI, 3.8\u201314.1). The most common barriers to mental health services were cost (36.0%) and health insurance (33.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"limitations\">\n                    <jats:title>LIMITATIONS<\/jats:title>\n                    <jats:p>The needs assessment was a convenience-based study, which limits the generalizability of our findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"conclusions\">\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>LGBTQ+ cancer survivors in North Carolina experience an elevated burden of discrimination, violence, suicide attempt, substance use, and accidental overdose in comparison to LGBTQ+ individuals without a cancer history.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.18043\/001c.127405","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T16:27:23Z","timestamp":1742920043000},"source":"Crossref","is-referenced-by-count":0,"title":["Differences in Discrimination, Violence, Mental Health, and Substance Use Outcomes by Cancer History Among LGBTQ+ Individuals in North Carolina"],"prefix":"10.18043","volume":"86","author":[{"given":"Austin R.","family":"Waters","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0130frc33","id-type":"ROR","asserted-by":"publisher"}],"name":"University of North Carolina at Chapel Hill","department":["Department of Health Policy and Management"]},{"id":[{"id":"https:\/\/ror.org\/0130frc33","id-type":"ROR","asserted-by":"publisher"}],"name":"University of North Carolina at Chapel Hill","department":["Lineberger Comprehensive Cancer Center"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Echo L.","family":"Warner","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03r0ha626","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Utah","department":["College of Nursing"]},{"id":[{"id":"https:\/\/ror.org\/03v7tx966","id-type":"ROR","asserted-by":"publisher"}],"name":"Huntsman Cancer Institute","department":["Cancer Control and Population Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Wilson","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0293qmt12","id-type":"ROR","asserted-by":"publisher"}],"name":"NC Department of Health and Human Services","department":["Division of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald L.","family":"Rosenstein","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0130frc33","id-type":"ROR","asserted-by":"publisher"}],"name":"University of North Carolina at Chapel Hill","department":["Lineberger Comprehensive Cancer Center"]},{"id":[{"id":"https:\/\/ror.org\/0130frc33","id-type":"ROR","asserted-by":"publisher"}],"name":"University of North Carolina at Chapel Hill","department":["Department of Psychiatry"]},{"id":[{"id":"https:\/\/ror.org\/0130frc33","id-type":"ROR","asserted-by":"publisher"}],"name":"University of North Carolina at Chapel Hill","department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Will J.","family":"Hall","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0130frc33","id-type":"ROR","asserted-by":"publisher"}],"name":"University of North Carolina at Chapel Hill","department":["School of Social Work"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin E.","family":"Kent","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0130frc33","id-type":"ROR","asserted-by":"publisher"}],"name":"University of North Carolina at Chapel Hill","department":["Department of Health Policy and Management"]},{"id":[{"id":"https:\/\/ror.org\/0130frc33","id-type":"ROR","asserted-by":"publisher"}],"name":"University of North Carolina at Chapel Hill","department":["Lineberger Comprehensive Cancer Center"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"7507","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1158\/1055-9965.EPI-24-0166","article-title":"Chronic health conditions, disability, and physical and cognitive limitations among LGBTQ+ cancer survivors","volume":"33","author":"A. 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