In SF-HINTS, a total of 1027 participants were surveyed, and among them 130 (13%) were classified as SGM (lesbian/gay, n = 64; bisexual, n = 39; transgender, n = 14; queer/other, n = 13). Compared to non-SGM, SGM were significantly younger and more educated. Also, a significantly higher proportion of SGM reported being assigned male sex at birth, Hispanic, unemployed, and not having a partner (Table 1).
Table 1
Characteristics of participants in the San Francisco Health Information National Trends Survey by sexual orientation and gender identity
| All participants, n = 1027 | SGM, n = 130 | Non-SGM, n = 897 | p-value |
| n (%) | n (%) | n (%) | |
Sociodemographic characteristics | | | | |
Age | | | | |
Mean, sd | 47.4 (16.7) | 40.5 (13.3) | 48.4 (16.9) | < 0.001 |
Sex at birth | | | | |
Male | 488 (47.7) | 91 (70.5) | 397 (44.4) | < 0.001 |
Female | 536 (52.3) | 38 (29.5) | 498 (55.6) | |
Sexual orientation and gender identity | | | | |
Heterosexual men and women | 897 (87.3) | - | 897 (100) | - |
Gay/Lesbian men and women | 64 (6.2) | 64 (49.2) | - | |
Bisexual men and women | 39 (3.8) | 39 (30.0) | - | |
Transgender men and women | 14 (1.4) | 14 (10.8) | - | |
Queer/Other | 13 (1.3) | 13 (10.0) | - | |
Race/ethnicity | | | | |
Non-Hispanic White | 44 (4.3) | 4 (3.1) | 40 (4.5) | < 0.001 |
Non-Hispanic Black | 243 (23.7) | 19 (14.6) | 224 (25.0) | |
Hispanic | 365 (35.5) | 83 (63.9) | 282 (31.4) | |
Non-Hispanic Asian/Pacific-Islander | 317 (30.9) | 13 (10.0) | 304 (33.9) | |
Other | 58 (5.7) | 11 (8.5) | 47 (5.2) | |
Marital status | | | | |
Single/Divorced/Separated/Widowed | 682 (68.4) | 104 (81.9) | 578 (66.4) | < 0.001 |
Married/Domestic partnership/Living as married | 315 (31.6) | 23 (18.1) | 292 (33.6) | |
Education | | | | |
Less than HS | 236 (23.3) | 14 (10.9) | 222 (25.1) | < 0.001 |
Completed HS | 305 (30.2) | 28 (21.9) | 277 (31.4) | |
More than HS | 470 (46.5) | 86 (67.2) | 384 (43.5) | |
Employment status | | | | |
Unemployed | 299 (30.1) | 50 (39.4) | 249 (28.8) | < 0.001 |
Employed | 435 (43.9) | 60 (47.2) | 375 (43.4) | |
Retired | 137 (13.8) | 3 (2.4) | 134 (15.5) | |
Disabled | 121 (12.2) | 14 (11.0) | 107 (12.4) | |
Household income | | | | |
<$10k | 237 (26.6) | 29 (27.9) | 208 (26.5) | 0.84 |
$10k to <$20k | 274 (30.8) | 28 (26.9) | 246 (31.3) | |
$20k to < $50k | 221 (24.8) | 27 (26.0) | 194 (24.7) | |
≥$50k | 158 (17.8) | 20 (19.2) | 138 (17.6) | |
Born in the US | 482 (47.7) | 54 (43.2) | 428 (48.4) | 0.28 |
Access to health care | | | | |
Health insurance coverage | | | | |
None | 141 (14.4) | 20 (16.1) | 121 (14.2) | 0.25 |
Medicaid | 167 (17.1) | 19 (15.3) | 148 (17.3) | |
Medicare | 318 (32.5) | 36 (29.0) | 282 (33.0) | |
Private | 236 (24.1) | 27 (21.8) | 209 (24.4) | |
Other | 117 (12.0) | 22 (17.7) | 95 (11.1) | |
Usual place of care | 848 (88.3) | 110 (88.0) | 738 (88.4) | 0.90 |
Times received care in last 12 months (no ER) | | | | |
0 | 204 (19.9) | 23 (17.7) | 181 (20.2) | 0.72 |
1–2 | 356 (34.7) | 42 (32.3) | 314 (35.0) | |
3–4 | 258 (25.1) | 35 (26.9) | 223 (24.9) | |
≥ 5 | 209 (20.4) | 30 (23.1) | 179 (20.0) | |
SGM: Sexual and gender minorities; ER: Emergency room; HS: High school |
Results of the relationship between SGM status and cancer risk behaviors and beliefs are shown in Table 2. For cancer risk behaviors, 35% of the study population had history of smoking at least 100 cigarettes, 25% reported being current smokers, 9% said were using electronic devices to smoke, half of them used alcohol frequently and 23% reported not doing exercises during the last month. When evaluating these behaviors by SGM status using regression models, SGM had significantly higher odds of current smoking (OR = 1.72, 95% CI = 1.15, 2.56) and alcohol use (OR = 2.24, 95% CI = 1.50, 3.34) in unadjusted analysis. In multivariable models, results remained statistically significant for current smoking (OR = 1.62, 95% CI = 1.03, 2.54) but not for alcohol use (OR = 1.46, 95% CI = 0.95, 2.25).
Table 2
Relationship between sexual orientation and gender identity and cancer risk behaviors and cancer beliefs in the San Francisco Health Information National Trends Survey
| All participants, n = 1027 | SGM, n = 130 | Non-SGM, n = 897 | Unadjusted a | Adjusted ab |
| n (%) | n (%) | n (%) | OR (95% CI) | OR (95% CI) |
Cancer risk behaviors | | | | | |
Lifetime smoking, at least 100 cigarettes | 363 (35.4) | 53 (40.8) | 310 (34.6) | 1.30 (0.89, 1.90) | 1.05 (0.68, 1.62) |
Current smoking | 246 (25.3) | 44 (34.9) | 202 (23.8) | 1.72 (1.15, 2.56) | 1.62 (1.03, 2.54) |
Current use of e-cigarettes or other electronic products | 81 (8.6) | 16 (12.9) | 65 (7.9) | 1.72 (0.96, 3.08) | 1.24 (0.64, 2.41) |
Alcohol use c | 493 (51.8) | 87 (68.5) | 406 (49.3) | 2.24 (1.50, 3.34) | 1.46 (0.95, 2.25) |
Physical inactivity d | 226 (22.7) | 28 (22.1) | 198 (22.8) | 0.96 (0.61, 1.50) | 0.97 (0.60, 1.58) |
Cancer beliefs | | | | | |
Everything causes cancer | 582 (60.0) | 74 (57.8) | 508 (60.3) | 0.90 (0.62, 1.31) | 0.98 (0.65, 1.47) |
There is not much you can do to lower your chances of getting cancer | 387 (39.9) | 43 (34.1) | 344 (40.8) | 0.75 (0.51, 1.12) | 1.15 (0.75, 1.76) |
There are so many recommendations about preventing cancer, it is hard to know which ones to follow | 691 (70.2) | 81 (64.8) | 610 (71.0) | 0.75 (0.51, 1.12) | 0.93 (0.61, 1.42) |
Cancer is most often caused by behavior or lifestyle | 546 (55.7) | 68 (54.8) | 478 (55.8) | 0.96 (0.66, 1.41) | 1.23 (0.81, 1.87) |
When I think about cancer, I think about death | 632 (63.7) | 79 (61.7) | 553 (63.9) | 0.91 (0.62, 1.33) | 0.92 (0.61, 1.39) |
Boldface in estimates indicates statistical significance (p < 0.05). a Reference group: Non-SGM b Models adjusted for age, sex at birth, education and race/ethnicity c Everyday/weekly/monthly use of alcohol; reference group: non-use/once-a-year use d Did not exercise during last month in activities such as running, golf, gardening, walking, not work; reference group: exercised in last month SGM: Sexual and gender minorities |
A similar pattern in the acceptance of the five cancer beliefs was observed in SGM and non-SGM. These were the percentages in descending order of popularity among all participants: “There are so many recommendations about preventing cancer that it is hard to know which ones to follow” (70%); “When I think about cancer, I think about death” (64%); “Everything causes cancer” (60%); “Cancer is most often caused by behavior or lifestyle” (56%); and “There is not much you can do to lower your chances of getting cancer” (40%). Higher percentages of participants answering affirmatively to all these statements were observed in non-SGM, but no differences were observed by SGM status in regression models.
In Table 3 we present the results of the relationship between SGM status and health information-seeking preferences, behaviors and perceptions. Eighty-percent of study participants reported having looked for health information or medical topics in their lives, with similar frequency in SGM and non-SGM. When evaluating sources for getting health information, we found participants’ most preferred choice was the internet, followed by healthcare provider, family/friend/coworker and written materials (either brochures/pamphlets or books/magazines/newspapers). The same pattern of preferences was observed in all participants irrespective of SGM status, but their use was more prevalent among SGM, particularly internet. In unadjusted analysis, the odds of reporting internet use in SGM were two times as high as in non-SGM (OR = 2.13, 95% CI = 1.47, 3.09). In adjusted analysis SGM still had higher odds of reporting internet use, but results were not statistically significant (OR = 1.40, 95% CI = 0.92, 2.12).
Table 3
Relationship between sexual orientation and gender identity and health information seeking in the San Francisco Health Information National Trends Survey
| All participants, n = 1027 | SGM, n = 130 | Non-SGM, n = 897 | Unadjusted a | Adjusted ab |
| n (%) | n (%) | n (%) | OR (95% CI) | OR (95% CI) |
Have ever looked for health information/medical topics | 801 (80.4) | 111 (86.1) | 690 (79.6) | 1.58 (0.94, 2.67) | 1.57 (0.90, 2.74) |
Preferred source of health information | | | | | |
Internet | 402 (39.1) | 72 (55.4) | 330 (36.8) | 2.13 (1.47, 3.09) | 1.40 (0.92, 2.12) |
Healthcare provider | 369 (35.9) | 56 (43.1) | 313 (34.9) | 1.41 (0.97, 2.05) | 1.28 (0.85, 1.92) |
Family/Friend/Coworker | 251 (24.4) | 37 (28.5) | 214 (23.9) | 1.27 (0.84, 1.91) | 1.31 (0.84, 2.04) |
Brochure/Pamphlet | 211 (20.6) | 31 (23.9) | 180 (20.1) | 1.25 (0.81, 1.93) | 1.45 (0.91, 2.32) |
Book/Magazine/Newspaper | 217 (21.1) | 23 (17.7) | 194 (21.6) | 0.78 (0.48, 1.26) | 0.83 (0.50, 1.40) |
Preferences for getting health information from provider | | | | | |
Email | 425 (41.4) | 67 (51.5) | 358 (39.9) | 1.60 (1.11, 2.32) | 0.96 (0.63, 1.46) |
Brochure/Pamphlet | 409 (39.8) | 48 (36.9) | 361 (40.3) | 0.87 (0.59, 1.27) | 1.06 (0.70, 1.61) |
Text message | 271 (26.4) | 44 (33.9) | 227 (25.3) | 1.51 (1.02, 2.24) | 1.23 (0.80, 1.88) |
Patient portal | 120 (11.7) | 16 (12.3) | 104 (11.6) | 1.07 (0.61, 1.88) | 1.05 (0.57, 1.92) |
DVD mailed to home | 99 (9.6) | 18 (13.9) | 81 (9.0) | 1.62 (0.94, 2.80) | 1.58 (0.87, 2.86) |
Source used for getting health information from provider last year | | | | | |
Email | 318 (31.0) | 52 (40.0) | 266 (29.7) | 1.58 (1.08, 2.31) | 0.93 (0.60, 1.43) |
Text message/Instant message application | 254 (24.7) | 39 (30.0) | 215 (24.0) | 1.36 (0.91, 2.04) | 1.21 (0.78, 1.87) |
Other application on smartphone | 136 (13.2) | 28 (21.5) | 108 (12.0) | 2.01 (1.26, 3.19) | 1.40 (0.85, 2.31) |
Video conference | 41 (4.0) | 8 (6.2) | 33 (3.7) | 1.72 (0.78, 3.80) | 0.96 (0.39, 2.33) |
Fax | 29 (2.8) | 6 (4.6) | 23 (2.6) | 1.84 (0.73, 4.60) | 2.02 (0.73, 5.59) |
Perceptions most recent health information search | | | | | |
Lot of effort getting information | 466 (49.2) | 60 (48.8) | 406 (49.2) | 0.98 (0.67, 1.44) | 1.34 (0.89, 2.01) |
Felt frustrated getting information | 413 (42.9) | 62 (49.2) | 351 (41.9) | 1.34 (0.92, 1.95) | 1.71 (1.14, 2.56) |
Had concerns about quality of information | 550 (57.0) | 81 (64.3) | 469 (55.9) | 1.42 (0.96, 2.10) | 1.37 (0.90, 2.08) |
Information was hard to understand | 414 (43.6) | 47 (39.5) | 367 (44.2) | 0.83 (0.56, 1.22) | 1.19 (0.78, 1.81) |
Boldface in estimates indicates statistical significance (p < 0.05). a Reference group: Non-SGM b Models adjusted for age, sex at birth, education and race/ethnicity SGM: Sexual and gender minorities |
In terms of preferences for getting health information from providers, the favorite option for both SGM and non-SGM was email, followed by brochure/pamphlet, text message, patient portal and visual recorded material sent to their homes. In unadjusted models, SGM had significantly higher odds of reporting preferences for email (OR = 1.60, 95% CI = 1.11, 2.32) and text message (OR = 1.51, 95% CI = 1.02, 2.24) than non-SGM, but in adjusted analyses estimates were not statistically significant (OR = 0.96, 95% CI = 0.63, 1.46; and OR = 1.23, 95% CI = 0.80, 1.88, respectively).
When asked about last year use of sources for exchanging medical information with providers, the same pattern was reported by SGM and non-SGM. Email was the most used source, followed by text message/instant message applications, other applications on smartphones, video conference and fax. Although significantly higher odds of email (OR = 1.58, 95% CI = 1.08, 2.31) and non-instant messaging applications use (OR = 2.01, 95% CI = 1.26, 3.19) were reported by SGM in unadjusted analyses, these results were not statistically significant in multivariable models (OR = 0.93, 95% CI = 0.60, 1.43, for email; and OR = 1.40, 95% CI = 0.85, 2.31, for other applications). Finally, perceptions regarding the most recent search of health information was assessed and a high proportion of participants reported concerns with the following: quality of information (57%), lot of effort getting the information (49.2%), hard to understand information (43.6%) and frustration while getting the information (42.9%). When comparing these by SGM status, significantly greater odds of feeling frustration were reported by SGM in adjusted analyses (OR = 1.71, 95% CI = 1.14, 2.56).