Digital Commons Network^™

Promoting Mammography Screenings In African American Women: Media, Church, And Health Providers, Lasonya Little, Debra C. Wallace, K.Jay Poole

Journal of Health Disparities Research and Practice

Due to the underutilization of screening mammography, African American women (AAW) are more likely to experience negative health outcomes after receiving a late-stage breast cancer diagnosis than White Women (WW). The purpose of this article is to examine the roles of the media, health community and the African American church and pastor and their potential impact in AAW screening decisions. Fifteen AAW, ages 45 and older, were invited to participate in a semi-structured interview. Most women agreed the African American pastor and church as well as the health community, and media are an integral part of their lives. Therefore, specific …

Pili Pono Practice: A Qualitative Study On Reimagining Native Hawaiian Food Sovereignty Through Malama Backyard Aquaponics, Pahonu Coleman, Samantha Keaulana, J Kahaulahilahi Vegas, Phoebe W. Hwang, Leshay Keliiholokai, Jane J. Chung-Do, Ikaika Rogerson, Ilima Ho-Lastimosa

Journal of Health Disparities Research and Practice

Living in one of the most remote island chains in the world, Native Hawaiians developed sophisticated food cultivation systems that sustained a thriving and robust population for centuries. These systems were disrupted by colonization, which has contributed to the health disparities that Native Hawaiians face today. MALAMA, a culturally-grounded backyard aquaponics program, was developed to promote food sovereignty among Native Hawaiians. This study utilized participant interview and focus group data to identify how participating in the MALAMA program impacts the wellbeing. The findings demonstrate that MALAMA enhanced the participants’ pilina (relationship, connection) to traditional foods, land, cultural identity, family, and …

Building A Community-Academic Partnership To Improve Underrepresented Group Awareness Of Parkinson’S Disease And Research, Danielle N. Larson, Jennifer Adrissi, Madison Lyleroehr, Emily Zivin, Karen Williams, Tanya Simuni

Journal of Health Disparities Research and Practice

BACKGROUND: Members of underrepresented groups (URGs) are more likely to have delays in PD diagnosis and less likely to receive specialized care when compared to non-Hispanic Caucasians. URGs are not proportionately represented in PD clinical research. Barriers to optimal diagnosis and treatment and research participation are multifaceted but include insufficient community knowledge of PD and research.

OBJECTIVES: To establish a community-academic partnership (CAP) for increasing knowledge of Parkinson’s Disease (PD) and research opportunities in underrepresented Chicago communities. Here, we describe the development, structure, and outcomes of this pilot program.

METHODS: The Chicago Movement Coalition (CMC) was established with academic leaders …

Does Using Sofa Score For Ventilator Triage Among Covid 19 Patients Result In Suboptimal Allocation Of Medical Ventilators For The Bipoc Population?, Alexandrea Mp Masocco, Elisabeth Michel, Ebbin Dotson

Journal of Health Disparities Research and Practice

Introduction: Since the COVID-19 pandemic in the United States, Black, and Latinx populations have been disproportionately affected by the COVID-19 pandemic. It can be inferred with high confidence that those most vulnerable are the least likely to receive essential care. Kidney transplant allocation and COVID-19 triage protocols share commonalities in that both protocols involve using multivariate scored criteria with objective and subjective inputs. As such, the similar conclusion in outcomes is concerning. It is worth questioning whether the racial inequalities demonstrated in the COVID-19 pandemic related to access to life-saving ventilators were associated with triage protocols.

Methodology: Using an exploratory …

Perspectives On Flu Vaccination Advertisement Messaging In The Era Of Covid-19: Thematic Analysis Centering Adult Black Voices, Krissy Moehling Geffel, Stephanie N. Christian, Andrea D. Casas, Harika P. Dyer, Tiffany L. Gary-Webb, Hannah E. Hardy, Roderick Harris, Dara D. Mendez

Journal of Health Disparities Research and Practice

Influenza (flu) is an infectious, respiratory disease that causes substantial burden and mortality, and Non-Hispanic Black people experience profound disparities in flu disease burden in the United States. One contributor to flu disease disparities is lower flu vaccination rates among Black populations. This qualitative study was conducted during the COVID-19 pandemic and used the Public Health Critical Race Praxis framework to center and elicit Black adults’ perspectives of desired flu vaccine messaging. This work builds upon efforts to increase access to flu vaccinations and recommendations are provided to aid in tailoring flu vaccine messaging via a health equity lens. Recommendations …

Diabetes Related Distress And Co-Occurrence With Depressive Symptoms In Urban Low-Income African American And Hispanic/Latinx Adults With Type 2 Diabetes, Laurie Ruggiero, Sarah Williams Leng, Mary De Groot, Ben S. Gerber, Rosalba Hernandez, Lauretta Quinn

Journal of Health Disparities Research and Practice

Introduction. Burden of diabetes in the U.S. is greater in racial-ethnic minority populations than non-Hispanic Whites. Depression and diabetes-related distress (DRD) are recognized as relatively common and important psychosocial areas to address in people living with diabetes. Limited research in the U.S. has focused on DRD in racial-ethnic minority populations. The purpose of this study is to describe patterns of DRD and co-occurrence with depressive symptoms in urban low-income African American and Hispanic/Latinx adults with type 2 Diabetes Mellitus (T2DM).

Method. We examined the baseline data collected for a randomized clinical trial (RCT) studying the impact of a culturally tailored …

Supporting Minority Serving Institution Faculty To Enhance Biomedical Research: The Csulb Center For Health Equity Research Institute, Laura H. D'Anna, Thomas Alex Washington, Wendy Nomura

Journal of Health Disparities Research and Practice

Scientists from Minority Serving Institutions (MSIs) bring unique perspectives and experiences that enhance the potential for understanding factors that are associated with racial, ethnic, and social inequities in health and health status. However, inadequate research infrastructure and mentoring opportunities within MSIs limit faculty engagement in the research enterprise. Additionally, structural inequities embedded in the NIH grant funding process disproportionately disadvantage underrepresented minority (URM) faculty and faculty at MSIs. The foci of the intensive Center for Health Equity Research (CHER) Institute were to 1) increase the number of early career faculty members (with an emphasis on MSI faculty) who are better …

Socioeconomic Disparities Exist In Access To Rotator Cuff Repair Surgery, Justin Solarczyk, Heather Roberts Md, Stephanie Wong Md, Derek Ward Md

Journal of Health Disparities Research and Practice

Background: The relationship of socioeconomic disparity in access to rotator cuff repair (RCR) has not been well studied. Socioeconomic, racial, and ethnic disparities in access to surgical management of rotator cuff tears have previously been described in patients with commercial insurance. This study is a population-level analysis which investigates racial and ethnic disparities in access to surgical rotator cuff repair across multiple health insurance statuses.

Purpose: (1) Is non-white race and ethnicity associated with lower rates of RCR? (2) Do these associations change throughout different insurance statuses?

Methods: We used the Healthcare Cost and Utilization Project (HCUP) database to identify …

Adolescent Pregnancy Prevention: How Cultural Components Play A Role In Programs Tailored For Minority Youth, Sarah B. Maness, Shristi Bhochhibhoya, Marshall Cheney

Journal of Health Disparities Research and Practice

Introduction: Cultural tailoring of adolescent pregnancy prevention programs has been utilized as a way to reduce persisting racial and ethnic disparities. This study explored how cultural components are included in evidence-based adolescent pregnancy prevention programs.

Methods: This study qualitatively assessed curricula of six federally supported evidence-based adolescent pregnancy prevention programs specifically tailored for African American and/or Hispanic youth. Patterns were analyzed within and between programs by two independent coders.

Results: Cultural components fell into five major themes: cultural art forms, traditions, history, community, and language. The most commonly included area was traditions (i.e. values, pride).

Conclusions: Variations exist in …

Diabetes Self-Management Support Program In Predominantly Hispanic Faith Community Settings: A Pilot Study, Leah Carrillo, Summer R. Wilmoth, Raymundo Mendoza, Ashton Balarin, Meixia Pan, Elena Martinez,, Erica T. Sosa, Zenong Yin, Sarah Ullevig, Meizi He

Journal of Health Disparities Research and Practice

Objectives: This study aimed to assess the feasibility, facilitators, barriers, and impact of adopting the Self-Management Resource Center Diabetes Self-Management Program (SMRC DSMP) on diabetes-related outcomes.

Methods: The SMRC DSMP was implemented in five churches in San Antonio, Texas. A single group pre-post-test design was used to evaluate program effect on improving T2D outcomes. The primary outcome was glycohemoglobin (HbA1c) and secondary outcomes included Self-Efficacy for Diabetes, health-related quality of life (HRQOL), and patterns of eating and physical activity. Program feasibility, facilitators, and barriers were assessed through documentation and in-person interviews with participants.

Results: A total of 96 participants were …

Associated Factors With Colorectal Cancer (Crc) Screening Awareness In The Black Belt Region Of Alabama: A Comparison Among Three Types Of Crc Screening, Hee Yun Lee, Yan Luo, Chiahung Chou, Mi Hwa Lee, Marion Bennett

Journal of Health Disparities Research and Practice

Objective: The present study aims to assess the levels of awareness of three types of CRC screening tests (FIT or FBOT, sigmoidoscopy, and colonoscopy) among African Americans living in the Black Belt area, and examine the factors associated with awareness of CRC screening tests among this population.

Methods: The current study utilized a survey research design. Univariate analysis was used to assess the awareness of three types of colorectal cancer screening: FIT or FOBT, sigmoidoscopy, and colonoscopy. Three sets of logistic regression analyses were conducted to examine the factors associated with the awareness level of each of the three colorectal …

Advancing Health Equity In The Us Military, James D. Mancuso, John Young, Jennifer Rusiecki, Shauna Stahlman, Natasha Schvey, Toya Randolph, Candy Wilson, Catherine Witkop, Patrick Hyde, Althea Green, Patcho Santiago, Donald Shell, Tracy Sbrocco

Journal of Health Disparities Research and Practice

Eliminating health disparities and achieving health equity are central to US national health objectives and the Military Health System’s “quadruple aim,” which has readiness as its core aim. Because military service members enjoy universal eligibility for health care, it is sometimes assumed that health disparities do not exist in the Department of Defense (DoD). However, while some studies have shown that disparities have been attenuated or eliminated in the DoD, others suggest that significant disparities remain. Reasons these disparities may remain include that universal eligibility for care does not necessarily result in equal to access to care, and that equal …

Attitudes Toward Influenza, Pertussis, And Covid-19 Vaccines Among Economically Underserved Black Women/Birthing People: A Mixed-Methods Approach, Jasmine Cooper, Hanna Lebuhn, James D. Campbell, Stacey Stephens, Wendy G. Lane, Keerthana Kumar, Kathleen M. Neuzil

Journal of Health Disparities Research and Practice

Vaccination during pregnancy is critical to the health of birthing persons and infants. Yet, persistent racial disparities in vaccination threaten health outcomes in the U.S. (Lu et al., 2015). Vaccination coverage remains low among non-Hispanic Blacks and other racial minorities – a situation magnified by the COVID-19 pandemic (Freimuth, Jamison, An, Hancock, & Quinn, 2017; Stokes et al., 2020). Consequently, understanding vaccine attitudes for systemically disadvantaged groups is paramount to promoting public health. Illuminating barriers to vaccine uptake creates space for new strategies to reduce hesitancy.

To investigate Black women’s/birthing people attitudes toward influenza and pertussis vaccination during pregnancy, we …

A Cut Above The Rest: A Qualitative Study To Evaluate The Feasibility Of Implementing Early Childhood Mental Health Interventions Into Boston Black/African American Barbershops And Beauty Salons, Lauren Ansong-Depass

Journal of Health Disparities Research and Practice

Objective: This qualitative research aimed to fill a gap in literature by determining the feasibility of implementing early childhood mental health tools into Black/African American barbershops and beauty salons in three Boston neighborhoods: Dorchester, Mattapan, or Roxbury.

Methods: Qualitative data collection included key informant interviews with two African American pediatric mental health clinicians who worked with children and families that lived in Mattapan, Dorchester, and/or Roxbury neighborhoods (n=2), a barber who worked in Mattapan (n=1), and a focus group of an active parent council hosted by the city of Boston (n=9). Data was analyzed using descriptive and simultaneous coding methods …

Defining Birth Equity In Kansas, Oluoma Obi, Michelle L. Redmond, Joi Wickliffe, Sapphire Garcia-Lies, Sharla Smith

Journal of Health Disparities Research and Practice

Background: While some health outcomes improve in the United States, racial and ethnic disparities in pregnancy-related outcomes persist. In the United States and Kansas, Black women are three times more likely to die from a pregnancy-related complication than white women.

Description: The Kansas Birth Equity Network (KBEN), is an initiative developed to address racial disparities in maternal and child health outcomes. We used a community-centered approach to collect stakeholder perceptions of birth equity and develop a case definition of birth equity.

Methods: An open-ended online survey was designed to collect stakeholders’ definition of birth equity, their organization’s birth equity missions, …

Association Between Diagnosed Anxiety And Depression And Exposure To Life Stressors During The Covid-19 Pandemic, Emily Hallgren Phd, Don E. Willis Phd, Brett Rowland Ma, James P. Selig Phd, Pearl A. Mcelfish Phd

Journal of Health Disparities Research and Practice

Research suggests that mental health disorders heighten the risk of exposure to life stressors. Drawing on a sample of 754 adults from a survey distributed at six primary care clinics, we examine whether adults who reported ever being diagnosed with depression or anxiety were more likely to experience an employment disruption, a housing disruption, and/or report more COVID-19-related stressors during the COVID-19 pandemic. Individuals who reported ever being diagnosed with depression reported a greater burden (B=.75) of COVID-19-related stressors. Those who reported ever being diagnosed with anxiety had higher odds of experiencing an employment disruption (OR=1.90) and a housing disruption …

Social Support Needs Of Minority Breast Cancer Patients: Significance Of Racial Homogeneity And Kin Composition Of Social Networks, Ganga Vijayasiri, Garth H. Rauscher, Ifeanyi Beverly Chukwudozie, Richard T. Campbell, Richard Warnecke

Journal of Health Disparities Research and Practice

Social support from family and friends assists breast cancer patients navigate a life crisis, but more needs to be understood about specific social network characteristics that can benefit breast cancer patients. To address this need, the primary aim of this study was to identify social network factors that facilitate or reduce social support. Given racially patterned gaps in social support among breast cancer patients, a secondary goal was to identify network characteristics that are linked to gaps in support. We examined these research questions using data from a sample of 915 breast cancer patients (NHWhite=373; NHBlack=377; Hispanic=165) and 4,021 of …

The Role Of Socioeconomic Status, Race, And Gender In Patient-Reported Outcomes Following Total Hip Arthroplasty, Allyn M. Bove, James Porter, Aatif Sayeed, Clair Smith, Brian A. Klatt

Journal of Health Disparities Research and Practice

Background

Disparities in total joint arthroplasty are well-documented. However, much of the research regarding disparities in vulnerable populations receiving total hip arthroplasty (THA) have focused on short-term outcomes. The purpose of this study was to examine the effects of race, gender, and socioeconomic status (SES) on patient-reported outcomes six months following THA.

Methods

Electronic health record data were retrospectively analyzed for 269 individuals who underwent THA at a large urban hospital from 2013-16. Data retrieved included patient demographics, baseline health information, data regarding hospital length of stay when undergoing THA, post-operative complications, and patient-reported function, measured by the Harris Hip …

An Initiative To Improve Cultural Competence Among Gyn/Ob Providers, Lynn R. Mcdonald, Joshua L. Schwarz, Stephen J. Martin, Susan Brown Will, Shari M. Lawson, Tanesha Stokes, Shannon C. Riley, Katie Reynolds, Betty Chou

Journal of Health Disparities Research and Practice

Healthcare cultural competence is defined as a process of delivering care by meeting the social, cultural, and linguistic needs of diverse populations, and should be optimized at all organizational levels to reduce racial disparities and poor patient outcomes. The American College of Obstetrics and Gynecology (ACOG) recognizes the importance of cultural competence and states that research should be conducted to identify and combat barriers that impede equitable care. In this prospective, pre- and post-intervention study design, we used the Healthcare Provider Cultural Competence Instrument (HPCCI) to measure five dimensions of cultural competence within the Department of Gynecology and Obstetrics in …

Sociodemographic Factors Associated With Attendance To Brighter Bites, A School-Based Food Co-Op Nutrition Intervention For Low-Income Families, Melinda R. Rushing, Ru-Jye Chuang, Christine Markham, Shreela V. Sharma

Journal of Health Disparities Research and Practice

Participants: The analytic sample included 6,796 participants from five of the six cities in which Brighter Bites was implemented (Houston, Austin, Dallas, Washington, D.C., and Southwest Florida).

Main Outcome Measures: Predictor variables included child’s grade, gender, race/ethnicity, parent employment, and government assistance utilization. Outcome variable was a binary measure of attendance: 1=attendance at or above the threshold or 0=attendance below the threshold, where the threshold was operationalized as attending 75% of the distributions.

Analysis: A multi-level logistic regression and bivariate analysis were completed to measure the association between attendance and predictor variables.

Results: Results show, compared to Hispanics, Whites were …

Understanding Disparities In Clinical Trials For Native Hawaiian Men, Gabriela A. Layi, Kevin Cassel, Maile Taualii, Jeffrey L. Berenberg, Erin O. Bantum

Journal of Health Disparities Research and Practice

Understanding low rates of participation by minority populations in clinical trials is critical for reducing and eliminating disparities. We examined beliefs and attitudes of Native Hawaiian men related to illness and cancer to better understand their rates of participation in clinical trials. We conducted face-to-face interviews with Native Hawaiian key informants throughout the State of Hawai‘i using quota sampling methods to obtain a range of perspectives about attitudes towards health care seeking to provide insight into low clinical trials participation. Interviews were audio-taped, transcribed, and independently coded by researchers. Thematic analysis guided the extraction of relevant data from the discussions. …

Can Community Gardens With Workshops Increase Gardening Behavior? A Navajo Wellness Collaboration, Kevin A. Lombard Phd, India J. Ornelas Phd, Desiree Deschenie, Felix Nez, Sonia Bishop, Katie Osterbauer Ms, Eileen Rillamas-Sun Phd, Shirley A.A. Beresford Phd

Journal of Health Disparities Research and Practice

This paper seeks to evaluate the potential efficacy of a community gardening intervention on the Navajo Nation to increase gardening and healthy eating behaviors, which are potentially important in preventing obesity and related health conditions. Rates of obesity are high among American Indians, including those living on Navajo Nation land. Eating fresh fruits and vegetables is part of healthy eating. However, availability and access to fresh fruits and vegetables are severely limited on the Navajo Nation, due to distance and cost. One way to increase both availability and consumption of fresh fruits and vegetables is through community gardening, yet …

Health Disparities And Covid-19 Pandemic: Increasing Clinical Research Participation Among African Americans, Kashica J. Webber-Ritchey, Abbi D. Lane-Cordova

Journal of Health Disparities Research and Practice

Health disparities in African Americans is a persistent issue. Higher rates and severity of the novel coronavirus-19 [COVID-19] among African Americans only widens health disparities. Effective COVID-19 treatment options are imperative, requiring representation of African Americans in clinical research. However, low participation and under-representation of African Americans is complex in nature. This article describes health disparities, the impact of COVID-19, and participation in clinical research among African Americans. We offer strategies for researchers to enhance the inclusion of African Americans. We also offer strategies in conducting clinical research during COVID-19.

A Community-Based Participatory Research Project To Increase The Understanding Of The Health Concerns Of African Immigrant Communities In Urban Missouri., Rhonda Belue, Covenant Elenwo, Clayton Adams, Adaobi Anakwe, Kelly Taylor, Sunita Manu, Sidee Conteh

Journal of Health Disparities Research and Practice

Background

African immigrants and refugees experience unique mental and physical health care needs that may be a result of pre-migration history and the acculturation process. The purpose of this project was to collaborate with African immigrant and refugee communities to identify health needs of the communities and lay a foundation for future action.

Methods

Key-informant interviews with five West, East and Central African immigrant and refugee communities included community leaders (n=10) and listening sessions with larger groups of community members totaling approximately 150 participants to identify health care needs. Content analysis was employed to identify themes related to immigrant and …

Lessons From The Health Care Innovation Awards: Productively Engaging Vulnerable Populations To Address Social Determinants Of Health, Maysoun Freij, Megan Skillman, Caitlin Cross-Barnet, Rachel Friedman Singer, Christina Rotondo, Michelle Dougherty, Sarah Ruiz, Adil Moiduddin, Lynne Page Snyder

Journal of Health Disparities Research and Practice

Objectives: This paper examines productive interactions—a cornerstone of the Chronic Care Model—between health care providers and vulnerable populations with chronic illnesses and/or disabilities. Methods: We conducted qualitative analysis of 16 focus groups and 29 interviews with patients and/or caregivers and 195 interviews with program leadership and providers across 15 Health Care Innovation Awards that targeted vulnerable populations. We analyzed how awardees addressed health concerns and social determinants of health (SDOH), and identified key components of productive interactions. Results: Providers achieved productive interactions through four primary strategies: establishing trust and showing respect; solving problems; building accuracy in health …

Association Between Insurance Status And Hospital Outcomes Among Acute Kidney Failure Patients, Khoa Truong, Thuan Thai, Lingling Zhang, Lu Shi, C. Jason Wang

Journal of Health Disparities Research and Practice

Objectives: To investigate the relationship between insurance status and the risk of acute kidney failure (AKF) and consequential hospitalization outcomes.

Methods: A cross-sectional regression analysis was conducted for inpatients ages 18-64 in South Carolina 2012–2013. One dichotomous dependent variable - diagnosed with AKF at hospital admission, and two continuous dependent variables of hospital outcomes - total charge and length of stay, were examined. The key explanatory variable was the patient’s insurance status. Other covariates included patient’s age, gender, and race as well as AKF risk factors - Type 2 diabetic mellitus (T2DM), chronic kidney disease (CKD), hypertension, and proteinuria.

Results: …

Economic Insecurity As A Risk Factor During The Covid-19 Pandemic, Klaus E. Cavalhieri

Journal of Health Disparities Research and Practice

The novel coronavirus disease 2019 (COVID-19) is currently spreading at a rapid rate worldwide. The current pandemic may have several adverse effects on overall psychological functioning and health behaviors. Economic insecurity, operationalized as financial strain and employment uncertainty, can be a significant risk factor for both psychological outcomes and compliance with shelter-in-place recommendations (i.e., health behaviors). One hundred and twenty four participants answered survey data on economic security, fear of COVID-19, health care system distrust, anxiety, well-being, and compliance with CDC recommendations to curb the spread of COVID-19 (i.e., health behaviors; CDC, 2020). Economic security was significantly associated with well-being, …

Personal Internalization Of A Confederate Monument Removal Event Associated With Increased Depression, Anxiety, And Stress Among University Students, Erika M. Redding, Yucheng Hou, Riley E. Mulhern

Journal of Health Disparities Research and Practice

This study sought to determine the association between racialized events relating to the removal of a Confederate monument and mental health outcomes among students at a Southern state-university in the United States. After the removal of a Confederate monument located on the university’s campus, racialized protests and violent clashes with police forces ensued. To assess the impact of these events on student mental health outcomes, a cross-sectional survey was disseminated to 10,000 current students. Student mental health was measured using the 21-item Depression, Anxiety, and Stress Scale (DASS). The key exposure, personal internalization of the event, was measured using the …

Racial And Ethnic Disparities In Illinois Lung Cancer Incidence, Mortality Stage At Diagnosis, Surgical Treatment, And Screening, Ritika Golechha, Mickyas Hezekiel Eskender, David D. Odell, Joe Feinglass

Journal of Health Disparities Research and Practice

This study analyzes the extent of racial and ethnic disparities in lung cancer in Illinois as compared to national trends. Cancer registry data were used to compare lung cancer incidence, mortality and stage at diagnosis rates for non-Hispanic (NH) white, NH Black and Hispanic Illinois residents. Hospital discharge data were used to compare medical and surgical admission and screening rates. Smoking across race and ethnic groups was compared using data from the Illinois Behavioral Risk Factor Surveillance System to determine the extent to which disparities might be related to smoking prevalence. Rate ratios for NH Black and Hispanics compared to …

Are Binge Drinking Disparities By Sexual Identity Lower In U.S. States With Nondiscrimination Statutes That Include Sexual Orientation?, Naomi Greene, Renee M. Johnson, Joanne Rosen, Danielle German, Joanna E. Cohen

Journal of Health Disparities Research and Practice

Purpose Studies examining binge drinking disparities by sexual identity focus on intra- and inter-personal minority stressors experienced by lesbian, gay, and bisexual (LGB) populations. State-level statutes are powerful tools that can reduce health disparities. We examined how state-level nondiscrimination statutes that include sexual orientation as a protected ground (i.e., inclusive statutes) are associated with binge drinking disparities between LGB and straight adults. Methods We combined data from the 2015-2018 Behavioral Risk Factor Surveillance System (BRFSS), the Movement Advancement Project (MAP), and administrative data sources for information on binge drinking, sexual identity, nondiscrimination statutes, and individual and state-level factors. We included …