Brittany M Charlton

• MSc, ScD
• Professor (Assistant) at Harvard Medical School

Background Emerging research suggests that lesbian, gay, bisexual, and queer (LGBQ) women face barriers to breast cancer screening. The authors sought to quantify sexual identity disparities in mammography screening, health care access, and lifestyle‐related risk factors using two national surveys. Methods Data from the 2018, 2019, and 2021 Nation...

Importance Sexual minority individuals have less access to high-quality reproductive health care—including contraceptive care—and have higher rates of unintended pregnancies than their heterosexual peers. Little is known about differences in abortion use by sexual orientation. Objective To quantify differences in abortion use by sexual orientation...

Purpose: Sexual minority (SM) women have more dementia risk factors than heterosexual women, but it remains unknown whether they experience increased symptoms of subjective cognitive decline (SCD)-a key predictor of dementia. Methods: We investigated sexual orientation-related disparities in SCD in Nurses' Health Study II (N = 70,772). Sexual orien...

This cross-sectional study explores the receipt of gender-affirming medications among transgender and gender-diverse adolescents in the US, analyzing these rates by age and sex assigned at birth.

Objective This study aimed to examine sexual orientation differences in natural menopause timing and symptoms between lesbian and bisexual women compared with heterosexual women. Methods We used longitudinal questionnaire data (1989-2015) from 92,314 women (858 lesbian, 375 bisexual) in the Nurses' Health Study II cohort. Women were 24-44 yr old a...

Background Evidence suggests sexual and gender minoritized (SGM) childbearing individuals and their infants experience more adverse obstetric and perinatal outcomes compared to their cisgender, heterosexual counterparts. This study aimed to comprehensively map obstetric and perinatal physical health literature among SGM populations and their infant...

Quality mentoring improves outcomes across career stages, including a sense of belonging, persistence, and productivity. However, the status quo in mentorship culture-including in epidemiology-is an ad hoc approach. This pervasive culture adversely affects individual mentees and the entire scientific research enterprise. Public health disciplines s...

Introduction Sexual and gender minority (SGM) youth have higher rates of nicotine vaping than other youth in the United States. While social media can be effective in reaching youth and discouraging vaping, informed cultural tailoring is necessary to ensure effective messaging to SGM youth. This study aimed to understand SGM youth perspectives on a...

Background Previous research has shown sexual minority women (SMW) are more likely to report multiple maternal and infant health outcomes compared to heterosexual women and that these outcomes are moderated by the policy environment. Little is known, however, about prenatal care use disparities or the social determinants of prenatal care use for SM...

Background Sexual minority (SM) individuals (e.g., those with same‐sex attractions/partners or who identify as lesbian/gay/bisexual) experience a host of physical and mental health disparities. However, little is known about sexual orientation‐related disparities in gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP; g...

OBJECTIVES To reduce health inequities for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexually and gender diverse (LGBTQIA+) people, healthcare professionals need increased access to education and training resources on LGBTQIA + health. Web-based, asynchronous, electronic learning (e-learning) resources are critical for...

This cross-sectional study uses a national dataset to examine the prevalence of gender-affirming surgical procedures among minors and adults in the US.

Introduction Cancer risk factors are more common among sexual minority populations (e.g., lesbian, bisexual) than their heterosexual peers, yet little is known about cancer incidence across sexual orientation groups. Methods The 1989–2017 data from the Nurses’ Health Study II, a longitudinal cohort of female nurses across the United States, were a...

Purpose: We investigated sexual orientation disparities in several obstetric and perinatal outcomes in Louisiana and examined whether these disparities differed among Black, Latine, and White populations. Methods: We analyzed cross-sectional vital records data on singleton live births in Louisiana (2016-2022). Same-sex relationships (SSR) vs. diffe...

Objectives. To describe longitudinal trends in the prevalence of mental distress across the first year of the COVID-19 pandemic (April 2020‒April 2021) among US women at the intersection of sexual orientation and racialized group. Methods. Participants included 49 805 cisgender women and female-identified people from the COVID-19 Sub-Study, a cohor...

Sexual minority women (SMW) experience worse health than their heterosexual counterparts but have largely been omitted from health services research. To address this gap, we conducted 25 semi-structured, in-depth interviews with SMW. Transcripts were analyzed using thematic analysis, and findings were organized using a modified socioecological fram...

STUDY QUESTION Does medically assisted reproduction (MAR) use among cisgender women differ among those with same-sex partners or lesbian/bisexual identities compared to peers with different-sex partners or heterosexual identities? SUMMARY ANSWER Women with same-sex partners or lesbian/bisexual identities are more likely to utilize any MAR but are...

Importance Extensive evidence documents health disparities for lesbian, gay, and bisexual (LGB) women, including worse physical, mental, and behavioral health than heterosexual women. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among LGB women and whether they differ by le...

We sought to examine cervical cancer screening barriers by sexual orientation among low-income women in North Carolina. The MyBodyMyTest-3 Trial recruited low-income women (< 250% of federal poverty level) aged 25–64 years who were 1+ year overdue for cervical cancer screening. We compared perceptions of cervical cancer screening among those who se...

While mentors can learn general strategies for effective mentoring, existing mentorship curricula do not comprehensively address how to support marginalized mentees, including LGBTQIA+ mentees. After identifying best mentoring practices and existing evidence-based curricula, we adapted these to create the Harvard Sexual and Gender Minority Health M...

Sexually minoritized women (SMW) may be at an increased risk of adverse perinatal mental health, though prior research is limited. We examined sexual orientation-related differences in perinatal mental health (i.e., stress and depression), and antidepressant utilization among those at different severities of clinically significant perinatal depress...

Purpose Although national medical organizations often neglect to include trans and gender diverse (TGD) people in their breast and cervical cancer screening recommendations, the World Profession Association of Transgender Health recommends that TGD people who are at risk for these cancers follow existing guidelines for cisgender women. Despite WPAT...

Background The metabolic changes that ultimately lead to gestational diabetes mellitus (GDM) likely begin before pregnancy. Cannabis use might increase the risk of GDM by increasing appetite or promoting fat deposition and adipogenesis. Objectives We aimed to assess the association between preconception cannabis use and GDM incidence. Methods We...

Purpose Although national medical organizations often neglect to include trans and gender diverse (TGD) people in their breast and cervical cancer screening recommendations, the World Profession Association of Transgender Health recommends that TGD people who are at risk for these cancers follow existing guidelines for cisgender women. Despite WPAT...

Background: The PrePARED consortium creates a novel resource for addressing preconception health by merging cohorts. We describe our data harmonization methods and results. Methods: Individual-level data from 12 prospective studies were pooled. The crosswalk-cataloging-harmonization procedure was used. The index pregnancy was defined as the firs...

Background: Fertility awareness-based methods have been linked to shorter time to conception; however, little is known about the predictors of fertility awareness-based method use among women who are currently or will soon be trying to conceive. Objective: To identify predictors of fertility awareness-based methods use among women trying to conc...

Importance: Pregnancy intention assessment is a key element of preconception and contraceptive care. The association between a single screening question and the incidence of pregnancy is unknown. Objective: To prospectively evaluate the dynamics of pregnancy intention and pregnancy incidence. Design, setting, and participants: This prospective...

Problem: Sexual and gender minority (SGM) populations face numerous health disparities. Medical school curricula lack adequate educational content preparing students for serving SGM patients, and medical students typically do not experience welcoming, inclusive educational environments conducive to learning about SGM health care. Approach: In 20...

LGBTQIA+ people across the U.S. are being warned by journalists and community members that because Roe v Wade has been overturned, "our rights could be next." But our rights are at risk right now. Cisgender women are more likely than cisgender men to identify as LGBQ (The Williams Institute, 2019). A sizable proportion of transgender and nonbinary...

ProblemLGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minorities) people have unique health care needs related to their sexual orientation, gender identity and expression, and sex development. However, medical education has historically excluded LGBTQIA + health-related content in formal curricula...

Purpose: For some transgender and gender-diverse (TGD) individuals, gender-affirming surgery may represent the last opportunity to engage in gamete banking (GB) and other forms of fertility preservation (FP). Previous research has assessed fertility intentions among TGD people initiating hormone therapy. The objective of this study was to describe...

Sexual health education experienced by lesbian, gay, and bisexual (LGB) youth varies widely in relevancy and representation. However, associations among sexual orientation, type of sex education, and exposure to affirming or disaffirming content have yet to be examined. Understanding these patterns can help to address gaps in LGB-sensitive sex educ...

Background Sexual minority (lesbian, bisexual, mostly heterosexual) young women face many sexual and reproductive health disparities, but there is scant information on their experiences of chronic pelvic pain, including an absence of information on prevalence, treatment, and outcomes. Aim The purpose of this study was to describe the characteristi...

Objective: To identify predictors of fertility awareness-based method use. Design: Ongoing, prospective internet-based cohort study. Setting: Nurses living in the United States and Canada. Population: Women trying to become pregnant or contemplating pregnancy. Methods: Multivariable negative binomial regression. Main Outcome Measures: Fertility awa...

Sexual minority men (e.g., gay, bisexual, queer) are more likely than heterosexual men to be involved in an adolescent pregnancy, but little research has been done on the context surrounding this disparity. To address this gap, and as part of the larger Sexual Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) Study, semi-structured in...

Purpose: We developed a multiyear database of sexual orientation- and gender identity-related U.S. state laws to advance sexual and gender minority (SGM) health research and practice and assessed variability in U.S. state laws from 1996 through 2016 across all U.S. states and D.C. Methods: Between 2014 and 2016, a multidisciplinary group of SGM hea...

We investigated how gender identity, sexual orientation, and race/ethnicity intersect to shape the social epidemiology of HPV vaccination initiation among U.S. college students. Cross-sectional survey data were from the National College Health Assessment (Fall, 2019-Spring, 2020; N = 65,047). We conducted an intersectional Multilevel Analysis of In...

Objective To interview healthcare providers who serve adolescent populations to learn their perspectives on the factors that influence the continuum of sexual and gender minority (SGM) youth’s pregnancy expaeriences, including decision-making about sex, relationships, and pregnancy. Methods As part of the SexuaL Orientation, Gender Identity, and P...

We conducted a scoping review to map the extent, range and nature of the scientific research literature on the reproductive health (RH) of transgender and gender diverse assigned female at birth and assigned male at birth persons. A research librarian conducted literature searches in Ovid MEDLINE®, Ovid Embase, the Cochrane Library, PubMed, Google...

Using data from the Fall 2015 through Spring 2018 National College Health Assessment, we examined receipt of pregnancy prevention information and unintended pregnancy by gender identity among participants aged 18–25 years who were assigned female at birth (n = 185 658). Non-binary students were more likely than cisgender students to report wanting...

IntroductionLimited research exists about how receiving/seeking sexual and reproductive health (SRH) information differs by sexual orientation. Our goal was to identify how sources and topics of SRH information differed by sexual orientation during adolescence in a sample of US women.MethodsA sample of 8541 US women ages 22–35 years from two cohort...

Purpose The aim of this study is to examine age at menarche across sexual orientation groups. Methods Data were obtained from 131,090 female participants, born 1947–2001, in 3 longitudinal studies—the Growing Up Today Study and Nurses’ Health Study 2 and 3. We estimated the association between sexual orientation and age at menarche using regressio...

Background: Sexual minority women may use contraception for various reasons but face notable barriers to contraceptive care, including stigma and discrimination. However, studies examining sexual orientation disparities in contraceptive care have largely relied on nonprobability samples of predominately White women and may thus not be generalizable...

Purpose: Extensive prior research has shown that sexual minority women are more likely to have a number of cancer risk factors, thereby putting them at higher risk for cancer than heterosexual women. However, there has been little research evaluating the association between sexual orientation and diet quality. Method: Data come from participants...

Objective Our goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection. Methods: Data were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses’ Health Study 3 between the follow-up period of 1996-2020. We used multivariable Poisso...

Study objective: Amenorrhea is a goal of many transgender and gender diverse adolescent and young adult (TGD AYA) patients on testosterone gender-affirming hormone therapy (T-GAHT). Breakthrough bleeding can contribute to worsening gender dysphoria. Our objective was to evaluate breakthrough bleeding in TGD AYA on T-GAHT. Design: IRB-approved re...

Study Objective Our objective was to describe sexual behavior and contraceptive use among assigned female cisgender and gender minority college students (i.e., those whose gender identity does not match their sex assigned at birth). Design Cross-sectional surveys administered as part of the Fall 2015 through Spring 2018 administrations of National...

Although most lesbian, gay, bisexual, transgender, and questioning youths are quite resilient and emerge from adolescence as healthy adults, the effects of stigma and heterosexism can contribute to health disparities. Part 2 of this first-of-its-kind 3-part series can help pediatric primary care providers become stronger allies for TGD patients and...

Although most lesbian, gay, bisexual, transgender, and questioning youths are quite resilient and emerge from adolescence as healthy adults, the effects of stigma and heterosexism can contribute to health disparities. Part 2 of this first-of-its-kind 3-part series can help pediatric primary care providers become stronger allies for TGD patients and...

Introduction Professional societies state that Transgender and gender expansive (TGE) adolescents and their families should be counseled about future family building options prior to initiating gender affirming therapy. While emerging data show that TGE adolescents have diverse desires regarding future family building, little is known regarding how...

Race-ethnic disparities in birth outcomes are well established, and new research suggests that there may also be important sexual identity disparities in birth weight and preterm birth. This study uses the National Longitudinal Study of Adolescent to Adult Health and is the first to examine disparities in birth outcomes at the intersection of race-...

Objective To assess differences in the relationship between violence factor exposure and tobacco product pattern use (exclusive and poly), we hypothesized that compared with heterosexuals, sexual minority youth would be more likely to report exclusive-tobacco and poly-tobacco use patterns, and controlling for violence factors would attenuate these...

The objective of this study was to examine the association between sexual orientation and seeking/receiving sexual and reproductive health (SRH) information from media sources during adolescence. We analysed data from male and female participants (aged 23–35 years) from the U.S.-based Growing Up Today Study (GUTS) in 2016. Sex-stratified, multivari...

Background Both sexual minority and racial/ethnic minority women are at increased risk of unintended pregnancy compared to their heterosexual and non‐Hispanic white peers, respectively. A recent study suggests the presence of negative interaction between sexual orientation and race/ethnicity, although it was not explicitly assessed. Objectives To...

Prior research shows the importance of internalized sexual prejudice and participation in health indicators for sexual minority people, yet no research has used prospective measures or differentiated sexual minority groups. Data come from the longitudinal cohort study Growing Up Today Study 1 (N = 6,606), limited to participants who provided inform...

Objectives To examine contraceptive methods used by adolescent/young adult women of diverse sexual orientations. Study design We collected data from 12,902 females, born 1982–1995, from the longitudinal Growing Up Today Study. Results Compared to heterosexuals, lesbians were half as likely to use contraceptives; other sexual minority subgroups (e...

Background Trans masculine people are more likely than cisgender peers to have a teen or unintended pregnancy, though little is known about the origins of these disparities. Aims This study aimed to describe teen and unintended pregnancy experiences among trans masculine people in order to elucidate risk factors and pregnancy-related needs. Metho...

Purpose: Little is understood about physiologic and psychologic correlates of erectile dysfunction (ED) among younger men. This study examined prevalence and correlates of ED in a large US sample of 18-31 year old men. Materials and methods: ED prevalence and severity (defined using the International Index of Erectile Function-5 scale) were exam...

Purpose: We investigated associations between maternal comfort with lesbian, gay, and bisexual (LGB) people during the participant's adolescence and their health indicators in adulthood. Methods: Data came from a prospective cohort, Growing Up Today Study (N = 7476), limited to men and women who provided information during their adulthood about re...

Purpose: Our goal was to examine sexual orientation identity disparities in mammography in relationship to race/ethnicity among U.S. women. Methods: Using nationally representative 2013-2017 National Health Interview Survey data, we used multivariable logistic regression to estimate the odds of receiving a mammogram in the past year in relationshi...

Purpose The purpose of the study was to test whether those who initiate tanning during adolescence are more likely to continue tanning in young adulthood, potentially increasing their risk for melanoma. Methods The study included prospective data from the Growing Up Today Study, a cohort study started in 1996 (N = 5,882). Results Among men and wo...

Background Although much has been published in recent years on differences in Papanicolaou (Pap) tests across sexual orientation, other aspects of cervical cancer prevention remain underexplored, such as human papillomavirus (HPV) vaccination, HPV co-tests, or abnormal Pap tests. Methods Data came from participants (aged 24–54 years) enrolled in a...

Purpose The purpose of this study is to quantify the prevalence of dyspareunia and its impact on quality of life (QOL) in adolescent and young adult women (AYA) diagnosed with endometriosis. Methods Eligible participants from the Women’s Health Study: From Adolescence to Adulthood, a longitudinal cohort study, were AYA 18–25 years who reported hav...

Background: Sexual minority adolescents face mental health disparities relative to heterosexual adolescents. We evaluated temporal changes in US adolescent reported sexual orientation and suicide attempts by sexual orientation. Methods: We used Youth Risk Behavioral Surveillance data from 6 states that collected data on sexual orientation identi...

Purpose: Several studies indicate that sexual minority (e.g., bisexual, lesbian) women may be at an increased risk for breast cancer. However, we know little about how risk factors, such as benign breast disease (BBD)-which can confer nearly a fourfold breast cancer risk increase-may vary across sexual orientation groups. Methods: Among Nurses'...

The objective of this study was to quantify sexual orientation differences in insurance access, healthcare utilization, and unmet needs for care. We analyzed cross-sectional data from three longitudinal U.S.-based cohorts (N=31,172) of adults ages 20-54 years in the Growing Up Today Study 1 and 2 and the Nurses’ Health Study 3 from 2015-2019. Adjus...

Objectives: We examined sexual orientation-related differences in various pregnancy outcomes (e.g., teen pregnancy, abortion) across the lifespan. Methods: We collected data from 124,710 participants in three U.S. longitudinal cohort studies, the Nurses' Health Study 2 and 3 and Growing Up Today Study 1, followed from 1989 to 2017. Multivariate...

Abstract: Sexual and/or gender minority (SGM) adolescents are at greater risk than their heterosexual, cisgender peers for adverse sexual and reproductive health outcomes, including teen pregnancy. SGM adolescents face a number of healthcare barriers (e.g., discrimination) that may contribute to teen pregnancy disparities. Previous research has no...

Objectives: This study aims to identify factors associated with the reproductive planning of trans-masculine adults. Study design: Between 2015 and 2016, providers enrolled 150 trans-masculine adults in a sexual health study assessing sociodemographics, social support, gender affirmation, sexual partnering, and reproductive history and planning....

The human papillomavirus (HPV) vaccination, sexually transmitted infection (STI) tests, and Papanicolaou (Pap) testing rates vary by sexual orientation, which may be due in part to healthcare providers (HCP) recommending this care unevenly. Data (N = 17,675) came from the Growing Up Today Study (GUTS) (N = 8039) and Nurses' Health Study 3 (NHS3) (N...

Introduction: Sexual minority female adolescents have worse reproductive health than heterosexual peers; research into the origins of these disparities is limited. Our objective was to examine whether exposure to structural stigma (e.g., societal-level conditions, cultural norms, institutional policies/practices that constrain the lives of the sti...

Objectives: Our objective was to explore how mothers' attitudes and relationships with their daughters may impact the cervical cancer prevention behaviors of daughters with diverse sexual orientations. Methods: We examined 8,143 mother-daughter dyads from the Nurses' Health Study 2 and Growing Up Today Study. During the daughter's adolescence, e...

Objectives: To examine contraceptive methods used across sexual orientation groups. Study design: We collected data from 118,462 female participants in two longitudinal cohorts-the Nurses' Health Study (NHS) 2 (founded in 1989, participants born 1947-1964) and NHS3 (founded in 2010, born 1965-1995). We used log-binomial models to estimate contra...

Study objective: Sexual minority women are more likely than heterosexual peers to have a teen pregnancy, though little is known about origins of this disparity. Our objective was to describe teen pregnancy experiences among sexual minority women and elucidate potential risk factors. Design: As a part of the SexuaL Orientation, Gender Identity, a...

Objective: To assess the characteristics of patients undergoing abortion in the United States according to sexual orientation and exposure to sexual and physical violence. Methods: Data for this observational study come from the Guttmacher Institute's 2014 Abortion Patient Survey, which obtained information from 8,380 individuals obtaining abort...

Objective To investigate sexual orientation-related disparities in employment and healthcare, including potential contributions to health-related quality of life (HRQL). Setting Growing Up Today Study, a USA-based longitudinal cohort that began in 1996; predominantly composed of participants who are white and of middle-to-high socioeconomic positi...

Aims We estimated sexual‐orientation differences in alcohol use trajectories during emerging adulthood, and tested whether alcohol use trajectories mediated sexual‐orientation differences in alcohol use disorders (AUDs). Design Longitudinal self‐reported survey data from the Growing Up Today Study. Setting USA. Participants 12,493 participants a...

Objectives: Young women who are sexual minorities (eg, bisexual and lesbian) are approximately twice as likely as those who are heterosexual to have a teen pregnancy. Therefore, we hypothesized that risk factors for teen pregnancy would vary across sexual orientation groups and that other potential risk factors exist that are unique to sexual mino...

Gender-based analysis in public health is a systematic examination of how population health is shaped by systems of gender relations, involving policies and laws, programs and services, research priorities, social norms and practices, and public discourse. To address the paucity of critical gender-based analysis training in most public health, medi...

PurposeGender nonconformity, that is, transgressing conventionally “masculine” vs. “feminine” characteristics, is often stigmatized. Stigmatization and discrimination are social stressors that raise risk of adverse mental and physical health outcomes and may drive health inequities. However, little is known about the relationship between such socia...

Introduction: Stigma against sexual minorities is well documented, but its long-term consequences for health-related quality of life (HRQL) are unknown. This study examined stigma-related predictors of sexual orientation disparities in HRQL and their contribution to young adult HRQL disparities. Methods: In 2013, participants (N=7,304, aged 18-3...

Purpose of review: Although teenage pregnancy is declining in many parts of the world, it remains associated with considerable social, health, and economic outcomes. Pregnancy prevention efforts focus primarily on young women, with minimal attention to young men. This review highlights recent literature pertaining to the role of young men in pregn...

Purpose: This study sought to examine how human papillomavirus (HPV) vaccination may differ across sexual orientation groups (e.g., bisexuals compared to heterosexuals)-particularly in boys and men, about whom little is known. Methods: Data were from a prospective cohort of 10,663 U.S. females and males enrolled in the Growing Up Today Study fol...

Objectives: To compare changes in self-reported sexual orientation of women living in states with any recognition of same-sex relationships (e.g., hospital visitation, domestic partnerships) with those of women living in states without such recognition. Methods: We calculated the likelihood of women in the Nurses' Health Study II (n = 69 790) ch...

PurposeTo examine the association between sexual orientation identity and human papillomavirus (HPV) vaccination initiation and completion among both women and men. Methods Using data from the 2013 and 2014 National Health Interview Survey, we estimated logistic regression models for the association between sexual orientation identity and HPV vacci...

Purpose: The influence of reproductive factors on colorectal cancer, including oral contraceptive (OC) use, has been examined, but less research is available on OC use and adenomas. Methods: Participants of the Nurses' Health Study who had a lower bowel endoscopy between 1986 (when endoscopies were first assessed) and 2008 were included in this...