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2019 HSR&D/QUERI National Conference Abstract

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1138 — Development and Implementation of a Sexual and Gender Minority Inclusive Survey to Identify Differences in Military Trauma and Infertility

Lead/Presenter: Kenda Stewart Steffensmeier,  COIN - Iowa City
All Authors: Stewart Steffensmeier KR (Center for Access & Delivery Research and Evaluation (CADRE) Iowa City Veterans Affairs Health Care System, 601 Hwy 6 W, Iowa City, IA), Chasco EE (Center for Access & Delivery Research and Evaluation (CADRE), , Department of Internal Medicine, University of Iowa Carver College of Medicine) Edmonds SW (Center for Access & Delivery Research and Evaluation (CADRE)) O'Shea AMJ (Center for Access & Delivery Research and Evaluation (CADRE), Department of Internal Medicine, University of Iowa Carver College of Medicine) Mengeling MA (Center for Access & Delivery Research and Evaluation (CADRE), Department of Internal Medicine, University of Iowa Carver College of Medicine) Kolder VEB (Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine) Nevins JL Stern JE (Department of Obstetrics and Gynecology, Dartmouth-Hitchcock, Lebanon, NH) Torner JC (Department of Epidemiology, University of Iowa College of Public Health) Sadler AG (Center for Access & Delivery Research and Evaluation (CADRE), Department of Psychiatry, University of Iowa Carver College of Medicine) Ryan GL (Center for Access & Delivery Research and Evaluation (CADRE), Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine)

Objectives:
To identify differences between sexual and gender minorities (SGM) vs. non-SGM Veterans (i.e., heterosexual cisgender) on military trauma histories and infertility employing SGM-inclusive items.

Methods:
As part of a survey administered to a national sample of 1813 Veterans ages 21-45 designed to capture histories of sexual assault, military-related exposures and injuries, and reproductive health history, an interdisciplinary team of experts designed and tested innovative questions and skip patterns to capture sex assigned at birth, current and past gender identity, sexual orientation, and medical history. To assess gender identity, we included questions with 20 options informed by VA's LGBTQ Glossary. We queried reproductive health based on sex assigned at birth, gender identity, whether the Veteran had ever had a functional penis or uterus, and willingness to answer questions as "male" or "female," respectively.

Results:
Over 99% of respondents agreed to answer questions about sexual orientation, gender identity, and reproductive health based on functional anatomy, including 113 SGM individuals (7.3% of the total sample). SGM Veterans differed significantly from non-SGM Veterans in risk factors associated with infertility. SGM Veterans were more likely to have experienced homelessness (23.3% vs 15.7%, p = 0.023), have PTSD (59.4% vs. 47.9%, p-value = 0.0108), or a mental health diagnosis (69.9% vs. 52.8%, p-value < 0.001), and reported a lifetime sexual assault experience at double the rate of non-SGM participants (53.4% vs. 25.0%, p-value < 0.0001).

Implications:
Our SGM-inclusive instrument, designed and administered with sensitivity, provided a nuanced assessment of sexual orientation and gender identity thus generating data about this subgroup that "typical" methods may have missed. This is important because significant differences were found that may indicate other disparities in health or experiences that cannot be ascertained with current dichotomous measures of sex and gender.

Impacts:
VHA has prioritized SGM-inclusive care through policy directives, education, and establishment of program offices. Inclusive instruments teach us more about previously invisible populations broadening and informing reproductive health policy and services that improve health care for all Veterans.