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OBJECTIVE In 2019, the Youth Risk Behavioral Survey (YRBS) collected sexual orientation data for the first time in Kentucky. Tobacco use behaviors and mental health status among Lesbian, Gay, and Bisexual (LGB) youth is infrequently documented in southern states such as Kentucky. This study aimed to analyze self-reported tobacco use and mental health in youth by sexual orientation. DESIGN Cross-sectional survey. SAMPLE All participants, aged 12-19, of the 2019 Kentucky YRBS that indicated a sexual orientation. MEASUREMENTS Differences in response distributions for tobacco use and mental health measures were analyzed via chi square by sexual orientation, with additional stratification by sex. RESULTS A total of n = 1996 respondents were 12.8% LGB-identified and 82.1% heterosexual-identified. No disparities between LGB and heterosexual youth were observed in tobacco-related behaviors for male students, but disparities were persistent for female students (p = .005 for "tried tobacco before age 13"; p = .007 for "current smoking", p = .012 for "ever smoked"). Mental health disparities between LGB and heterosexual youth were significant for males and females (p

Tobacco use is a leading preventable cause of adverse maternal and child health outcomes. However, many women in the United States still report smoking during the third trimester of pregnancy. Smoking rates during pregnancy are particularly high among vulnerable women, such as those who experience mental illness, substance use disorder, homelessness, or interpersonal violence. The Tobacco Control Vaccine is a model based on population-level, evidence-based practices to reduce tobacco use. The four elements of the Tobacco Control Vaccine are access to treatment for tobacco dependence, smoke-free policies, increased tobacco taxes, and media campaigns. The purpose of this commentary is a call to action for health care providers to advocate for increased access to treatment for tobacco dependence; stay up-to-date on innovative, tailored treatment practices; and advocate for comprehensive, smoke-free policies, higher tobacco taxes, and media campaigns to help pregnant women quit smoking and avoid relapse in the postpartum period.

Purpose Transformation of care teaching is often didactic and conceptual instead of practical and operational. Clinical environments, slow to transform, limit student exposure to key experiences that characterize transformed care. We describe the design and implementation of TEAM Clinic (Teach students, Empower patients, Act collaboratively, Meet health goals) - an early clinical learning experience to address this gap. Methods The TEAM Clinic curriculum was based on a review of existing curricula and best practice recommendations for the transformation of care. Three key elements were selected as the focus for a low-volume, high-service clinic: patient centeredness, interprofessional collaboration and team-based care. Learners and medically and socially complex patients were recruited for voluntary participation and completed anonymous surveys about the experience during and afterward. Results Nine first-year medical students, two first-year social work students and one pharmacy resident were integrated into the interprofessional team. Students were assigned roles adapted to their level and skill set; deliberate interprofessional pairing was assigned to broaden perspectives on scope and role of team members. Upon completion of this two-semester experience, 11 of the 12 learners returned surveys; all rated the experience as positive (strongly agree or agree) on the Authentic Clinical Interprofessional Experience - Evaluation of Interprofessional Site tool. Patient surveys indicated satisfaction with multiple aspects of the visit. Conclusion TEAM Clinic provided a practical example of transformation of care teaching in a not-yet-transformed environment. Logistical barriers included space, schedule and staffing. Facilitators included alignment with the goals of core curricula and faculty. Limitations included that this description of these curricula and this pilot come early in our longitudinal development of TEAM Clinic, constraining our ability to measure behavioral changes around interprofessional education, teamwork or patient centeredness. Next steps would examine the trajectory to these outcomes in the preclinical student group.

In this chapter, we describe how primary care providers (PCPs) play a crucial role in delivering high quality, cost-effective, patient-centered care for lesbian, gay, bisexual, and transgender (LGBT) patients. We discuss the importance of PCPs recognizing patient autonomy in self-identification as the basis for an open and trusting patient–provider relationship. We emphasize how that relationship promotes whole-person care and describe how PCPs can utilize effective verbal and written communication that reflect sensitivity to LGBT patients. We describe evidence-based health promotion and preventive health recommendations for LGBT patients, including physical, mental, and emotional health considerations, immunizations, and screening tests. We explain the need for PCPs to critically evaluate and apply current and emerging medical information to optimize care for LGBT patients. We emphasize that PCPs must be aware of the emotional and mental health impacts of societal stigma, recognize that many LGBT patients define family broadly, and advocate for quality care. We provide several advocacy strategies such as identifying consultants who are knowledgeable about and sensitive to LGBT patient care needs, as well as coordinating patient care within the health system by collaborating with LGBT community resources.

Many lesbian, gay, bisexual, and transgender (LGBT) patients may avoid or delay accessing healthcare. The barriers to care are multifactorial and occur on a systems level as well as in the exam room between the provider and patient. In this chapter, we describe the evidence behind barriers to care and argue that establishing a medical home for LGBT patients is an essential step to closing the healthcare gap. GLMA: Health Professionals Advancing LGBT Equality, a health advocacy organization, suggests a number of strategies employed by practices successful at providing LGBT patients with competent care in a patient-centered environment. We describe these strategies as a way to establish a patient-centered medical home or patient-centered practice to facilitate access for LGBT patients. One of the challenges for the PCP attempting to be welcoming to LGBT patients is that of identifying who they are. We provide specific language and questions that can be applied in a culturally sensitive and accurate method to assess sexual orientation and gender identity of patients as appropriate to the clinical context.

Despite many recent advances in rights for sexual and gender minorities in the United States, bias against lesbian, gay, bisexual, and transgender (LGBT) people still exists. In this Commentary, the author briefly reviews disparities with regard to LGBT health, in both health care and medical education, and discusses the implications of Burke and colleagues’ study of implicit and explicit biases against lesbian and gay people among heterosexual first-year medical students, published in this issue of Academic Medicine. Emphasis is placed on the ways in which physicians’ implicit bias against LGBT people can create a cycle that perpetuates a professional climate reinforcing the bias. The hidden curriculum in academic health centers is discussed as both a cause of this cycle and as a starting point for a research and intervention agenda. The findings from Burke and colleagues’ study, as well as other evidence, support raising awareness of LGBT discrimination, increasing exposure to LGBT individuals as colleagues and role models in academic health centers, and modifying medical education curricula as methods to break the cycle of implicit bias in medicine.