title: Differences in Healthcare Access, Use, and Experiences Within a Community Sample of Racially Diverse Lesbian, Gay, Bisexual, Transgender, and Questioning Emerging Adults.
abstract: Health services research involving lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) individuals has focused on differences in healthcare access, use, and experiences between cisgender, heterosexual adults and LGBTQ adults. Yet these factors may differ within the LGBTQ community and have not been well-studied among emerging adults (18-29 years), a group with unique barriers to healthcare. We sought to characterize healthcare challenges within a sample of LGBTQ emerging adults.
  
  
  
  From 2012 to 2013, 206 participants aged 18-27 (86% racial/ethnic minority, 10% transgender) completed questionnaires assessing healthcare access, use, and experiences during a longitudinal study. Descriptive statistics established patterns of healthcare access, use, and experiences, and nonparametric tests examined differences related to sociodemographic variables, HIV status, sexual orientation identity, and gender identity.
  
  
  
  Overall, 68% of participants reported relatively easy access to care. White and bisexual participants reported higher rates of insurance than racial/ethnic minority (P = 0.01) and gay or lesbian participants (P = 0.005), respectively. Although most participants did not report having negative experiences in healthcare settings related to their LGBTQ identity, transgender participants were more likely to delay care (P < 0.001) and report negative effects of disclosure to their provider (P < 0.001) compared with cisgender participants. Participants who identified as queer or were questioning their sexual orientation identity reported negative healthcare experiences more frequently than LGB-identified participants (P = 0.001).
  
  
  
  Although LGBTQ emerging adults experienced fewer barriers to care than observed in previous studies on LGBTQ adults, the results suggest that queer, questioning, and transgender individuals may face additional healthcare challenges compared with their LGB and cisgender counterparts.
authors.affiliation: 1 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University , Chicago, Illinois.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Macapagal
authors.affiliation: 2 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine , Chicago, Illinois.|3 Division of STI/HIV, Chicago Department of Public Health , Chicago, Illinois.
authors.forename: Ramona
authors.initials: R
authors.lastname: Bhatia
authors.affiliation: 1 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University , Chicago, Illinois.
authors.forename: George J
authors.initials: GJ
authors.lastname: Greene
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005783:Gender Identity; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D012725:Sexual Behavior; D000072339:Sexual and Gender Minorities; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: discrimination; health services; healthcare disparities; minority health; young adult