Madina ​Agénor

Brown University School of Public Health

Background: Lesbians and bisexual women are at risk for human papillomavirus (HPV) infection from female and male sexual partners. Objective: To examine the association between sexual orientation identity and HPV vaccination among U.S. women and girls. Design: Cross-sectional, using 2006–2010 National Survey of Family Growth data. Setting: U.S....

Sexual minority women are more likely than heterosexual women to have ever experienced intimate partner violence (IPV). Although IPV is associated with sexual risk and poor reproductive health outcomes among US women overall, little is known about whether IPV is related to sexual and reproductive health indicators among sexual minority women in par...

Full text available at: http://www.tandfonline.com/eprint/TjmtUeKFjzmWGjRZd4NW/full. Few studies have focused on the health and health care of U.S. black lesbian, bisexual, and queer (LBQ) women. To understand the facilitators of and barriers to cervical cancer screening in this population, we conducted focus group discussions in Boston and Cambr...

Understanding how various dimensions of social inequality shape the health of individuals and populations poses a key challenge for public health. Guided by ecosocial theory and intersectionality, we used data from the 2006-2010 National Survey of Family Growth, a national probability sample, to investigate how one dimension of sexual orientation,...

We investigated sexual orientation disparities in Papanicolau (Pap) screening among US women aged 21 to 44 years (n = 9581) in the 2006 to 2010 National Survey of Family Growth. The odds ratios for lesbian versus heterosexual women and women with no versus only male sexual partners were 0.40 and 0.32, respectively, and were attenuated after adjustm...

Most evaluations of health equity policy have focused on the effects of individual laws. However, multiple laws' combined effects better reflect the crosscutting nature of structurally racist legal regimes. To measure the combined effects of multiple laws, we used latent class analysis, a method for detecting unobserved "subgroups" in a population,...

Background: Young adults who are transgender and/or nonbinary (TNB) experience discrimination, violence, and other social stressors as a result of cissexism, the system of power relations that marginalizes people whose genders diverge from sociocultural expectations for the sex they were assigned at birth. However, variation in TNB young adults' e...

Researchers have identified inequities in health insurance and usual source of care in relation to either race/ethnicity or sexual orientation among U.S. women and men. However, intersectionality suggests that racism and heterosexism may have a compounding negative impact on health care outcomes in relation to both race/ethnicity and sexual orienta...

Objectives. To assess changes in minor consent laws for sexually transmitted infection (STI) and HIV testing, treatment, and prevention services in all 50 US states and the District of Columbia from 1900 to 2021. Methods. We coded laws into minor consent for (1) health care generally; (2) STI testing, treatment, and prevention; (3) HIV testing, tre...

Objective: To ascertain the impact of Affordable Care Act (ACA) state Medicaid expansion on human papillomavirus (HPV) vaccination among both adolescent and young adult U.S. women. Data sources: We used state-level data on ACA Medicaid expansion and individual-level data on U.S. women aged 15-25 years living at or below 138% of the federal pover...

Background: Sexually transmitted infections (STIs) cause a major burden of disease in the United States (US)-especially among structurally marginalized populations, including transgender and nonbinary people, individuals assigned female at birth (AFAB), Black and Latinx/e individuals, and young adults. Although screening can help detect and preven...

Prior research suggests that prejudice and structural disadvantage (e.g., cissexism, racism, sexism) put transgender and nonbinary (TNB) young adults at risk for adverse romantic relationship experiences, yet supportive romantic relationships may help TNB young adults cope with these stressors and promote their psychological wellbeing. Accordingly,...

Background: Black women and sexual minority women are more likely to report adverse maternal health. Little research has investigated maternal health disparities at the intersection of race/ethnicity and sexual orientation or the mechanisms that contribute to these disparities. Materials and Methods: We analyzed data from the National Longitudinal...

Improved access to infrastructure is commonly viewed as a critical step to increase women’s labor force participation and promote economic growth in developing countries. This positive relationship is first established in a basic gender-based, overlapping generations model with collective households and congestion costs. The model is then extended...

HIV prevalence and engagement in sexual behaviors associated with HIV transmission are high among transgender people of color. Per intersectionality, this disproportionate burden may be related to both interpersonal and structural racism and transphobia. The goal of this study was to estimate the association between interpersonal and structural dis...

Limited research has been conducted on factors contributing to HIV testing among sexual minority populations in South Korea (hereafter, Korea), where stigma against homosexuality and HIV/AIDS is pervasive. We used a nationwide cross-sectional survey of 907 Korean cisgender gay and bisexual (GB) men who were HIV-negative or HIV-unknown in 2016. Rega...

Although transgender and nonbinary (TNB) people can acquire human papillomavirus (HPV), research examining HPV vaccination in these populations is scarce. TNB individuals experience high levels of gender-related health care discrimination, which may undermine HPV vaccine uptake. Using data from a national online survey (N=716), we found a negative...

Background Social science theories suggest that the legalization of same-sex marriage may lead to improved economic opportunities among sexual minorities. However, empirical evidence pertaining to this issue is scarce. We examined the association between state-level same-sex marriage legalization between 2004 and 2014 and employment outcomes among...

Background Gendered inequities in disordered eating are well-documented, yet few studies have examined their structural drivers. We investigated whether cumulative exposure to state-level structural sexism from childhood through young adulthood potentiates differences in disordered eating risk between cisgender girls/women and boys/men. Methods Pa...

Background Research shows that transmasculine people experience discrimination based on their gender identity and/or expression (i.e., cissexism) while obtaining health care. However, studies examining the experience of other forms of discrimination in health care settings among diverse subgroups of transmasculine individuals, including those from...

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 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...

Research focusing on the specific and unique sexual and reproductive health care experiences of transmasculine young adults of color are extremely scarce. We conducted five focus group discussions with 19 Black, Latinx, Asian, Native, and other transmasculine individuals of color aged 18–25 years in the greater Boston area. Using thematic analysis,...

Background Differential sexual history assessment, whereby certain groups are more or less likely to be asked questions about their sexual behavior by a health care provider, may lead to differential sexual health care and counseling. Methods Using nationally representative data from the 2013 through 2019 waves of the National Survey of Family Gro...

Nonbinary young adults (who do not identify with a binary male or female identity and may hold diverse gender identities, including genderqueer, nonbinary and agender) may have unique and unmet sexual healthcare needs compared to binary transgender and cisgender people. However, there is limited knowledge about the sexual health and healthcare need...

Background: Because of concerns about sexual minorities' poor cancer survivorship, this study compared cancer survivors' health outcomes in relation to multiple intersecting social positions, namely gender, sexual orientation, and race/ethnicity. Methods: This secondary data analysis used 2014-2019 Behavior Risk Factor Surveillance Survey data....

Background Young adult sexual minority women (SMW) have unique sexual health needs and higher rates of some poor sexual health outcomes compared to their heterosexual peers. Unequal access to relevant sexual health information may contribute to sexual orientation disparities in sexual health among women, but research on sexual health communication...

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...

Background Fatal police violence in the United States disproportionately affects Black, Native American, and Hispanic people, and for these groups it is a racially oppressive population-level stressor that we hypothesize increases the risk of pregnancy loss. Focusing on core based statical areas (CBSAs) surrounding small and large urban centers, we...

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...

Part 1 of this first-of-its-kind 3-part series can help show how to break down the cycles of ignorance, shame, and toxic stress that harm children who identify as LGBTQ+ and improve their chances of leading happy, healthy adult lives. https://shop.aap.org/pediatric-collections-lgbtq-support-and-care-part-1-combatting-stigma-and-discrimination/

Objectives Although US state laws shape population health and health equity, few studies have examined how state laws affect the health of marginalized racial/ethnic groups (eg, Black, Indigenous, and Latinx populations) and racial/ethnic health inequities. A team of public health researchers and legal scholars with expertise in racial equity used...

Objective: Describe the array of gender identities among procedural abortion patients. Study design: Cross-sectional survey of abortion patients in three clinics in Massachusetts. Following aspiration abortion procedures and prior to discharge, patients self-administered a survey on a tablet. Results: From November 2017 through July 2018, 1,55...

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 National monitoring of police–public contact does not extend below age 16 and few studies have examined associations with adolescent mental health. Methods We describe the distribution of police stops in a nationally representative cross-sectional sample of adolescents ages 12 to 18 years in the Panel Study of Income Dynamics Child Deve...

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...

Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals. Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations. Search Method...

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...

Background: Uptake and completion of the HPV vaccine is suboptimal. This study assessed the feasibility of implementing a one-month Twitter campaign to promote knowledge about the human papillomavirus (HPV) vaccine among low-income women living in public housing. Methods: We recruited a convenience sample (n = 35) of women ages 18-26 years resid...

Introduction: Human papillomavirus (HPV) vaccination, which is recommended for U.S. women and girls aged 11–26 years, effectively prevents cervical cancer. Researchers have identified HPV vaccination disparities among groups of women and girls defined in relation to sexual orientation identity or race/ethnicity. However, no study has used an inters...

Intersectionality, an analytical approach rooted in Black feminist theory and praxis, has become more widely used in population health research. The majority of quantitative population health studies have used intersectionality as a theoretical framework to investigate how multiple social identities rather than social inequalities simultaneously in...

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...

The purposes of this study were to identify the sexuality-related topics parents and gay, bisexual, or queer (GBQ) adolescent males discussed at home and to describe the topics GBQ adolescent males recommend for parents to discuss with future cohorts of GBQ youth. Minimal research on parent-child sex communication with sexual minority adolescents p...

Jail incarceration is widely prevalent in the United States, with disproportionate impacts on communities of color, yet little research has quantified its health consequences for communities. We assess county-level jail incarceration as a contextual stressor for individual-level preterm birth among non-Hispanic Black and White U.S. women, the vast...

Context: Transmasculine people-that is, individuals who were assigned female at birth and have a male or masculine gender identity-can experience unintended pregnancy. Yet research on contraception among transmasculine individuals is extremely limited. Methods: Participants were recruited online; from community-based organizations, health center...

This study explores the body image ideals among a racially/ethnically diverse sample of gay and bisexual men in the United States. Furthermore, it examines the role body image ideals play on mobile dating applications (“dating apps”) for gay and bisexual men. Guided by Objectification Theory and Minority Stress Theory, 30 semi-structured interviews...

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...

Objective: To examine the effect of the 2010 Affordable Care Act (ACA) extended dependent coverage and no cost-sharing provisions on human papillomavirus (HPV) vaccination in relation to sexual orientation identity among U.S. women. Data sources: 2006-2010 and 2011-2015 National Survey of Family Growth. Study design: We used an interrupted tim...

Transmasculine people are at risk of cervical cancer but have lower rates of cervical cancer screening than cisgender women. Disaffirmation of the patient’s gender and unequal power dynamics between patient and provider during screening contribute to patient unwillingness to be screened. The mechanisms by which the balance of power may be shifted b...

Objectives This study assessed the feasibility of implementing a one-month Twitter campaign to promote knowledge about the human papillomavirus (HPV) vaccine among low-income women living in public housing. Methods We recruited a convenience sample (n=35) of women ages 18-26 years who resided in public housing in Massachusetts. We assessed the feas...

Purpose: We examined differences in lifetime human immunodeficiency virus (HIV) testing in relation to both sexual orientation identity and race/ethnicity among U.S. women and men. Methods: We used 2013-2017 National Health Interview Survey data and multivariable logistic regression to assess the distribution of lifetime HIV testing across and wit...

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...

Background: Online dating has become increasingly popular over the years. Few research studies have examined the association between dating apps and disordered eating. In this study, we evaluated the association between dating app use and unhealthy weight control behaviors (UWCBs) among a sample of U.S. adults. Methods: Our sample includes 1769...

Background: Transgender and gender nonbinary adolescents experience high rates of peer victimization, but the prevalence of sexual assault in this population has not been established. Some schools restrict transgender and nonbinary students from using restrooms and locker rooms that match their gender identity, with unknown effects on sexual assau...

CONTEXT Some sexual minority women may be less likely than other women to engage in human papillomavirus (HPV) prevention behaviors. Although risk perceptions have been found to be associated with health behaviors, HPV risk perceptions among U.S. sexual minority women have not been examined. METHODS In 2016–2017, in‐depth interviews were conducted...

Background: Health care providers are an important source of sexually transmitted infection (STI) prevention information for young adult sexual minority women (SMW). However, very few studies have described patient-provider STI communication in this understudied and underserved population. We explore sexual minority women's experiences communicati...

Background Overall, foreign-born women are less likely than U.S.-born women to have initiated human papillomavirus (HPV) vaccination. However, foreign-born women are a racially/ethnically diverse population, and race/ethnicity is an independent predictor of HPV vaccination. Methods Using 2011–2015 National Health Interview Survey data, we used mult...

Introduction: Human papillomavirus (HPV) vaccination, which is recommended for U.S. women and girls aged 11-26 years, effectively prevents cervical cancer. Researchers have identified HPV vaccination disparities among groups of women and girls defined in relation to sexual orientation identity or race/ethnicity. However, no study has used an inter...

The 1996 welfare reform legislation sought to discourage poor women from childbearing by allowing a family-cap policy prohibiting an increase in cash assistance when a new child is born. We conducted key-informant interviews with officials from all 24 family-cap states on the policy’s status, implementation, opinions regarding its effectiveness, be...

Purpose: We examined the association of psychosocial stressors (depressive symptoms, incarceration, and intimate partner violence [IPV]) with sexual behaviors, sexually transmitted infection (STI) history, and STI diagnoses among African American women who have sex with women (AAWSW). Methods: This was a secondary analysis from a study of AAWSW...

Objective: To ascertain the magnitude and potential mechanisms of racial/ethnic disparities in initiating and completing the 3-dose human papillomavirus (HPV) vaccine among U.S. women in the post-Affordable Care Act era. Design: Using 2015 National Health Interview Survey data, we used logistic regression to estimate odds ratios (OR) and 95% confid...

Background: Strong Women Strong Girls (SWSG) supports positive mentoring relationships between college women and preadolescent girls in underserved communities. Harvard T.H. Chan School of Public Health (HSPH) seeks to advance population health through learning, discovery, and communication. Objective: To establish a community-academic partnersh...

Background Research has shown that sexual minorities (SMs) (e.g. lesbian, gay, and bisexual individuals), compared to their heterosexual counterparts, may engage in riskier health behaviors, are at higher risk of some adverse health outcomes, and are more likely to experience reduced health care access and utilization. However, few studies have exa...

Introduction: Several studies have identified disparities in human papillomavirus (HPV)-related outcomes by nativity status (i.e., U.S.- versus foreign-born). However, few studies have explored whether vaccination differences exist by nativity status. Vaccination disparities have the potential to exacerbate HPV-related cancer disparities in the lo...

Transmasculine (i.e., female-to-male transgender) individuals have lower rates of cervical cancer screening than nontransgender women and often report negative experiences with the Pap test. Deciding to undergo screening and the test experience itself are characterized by the following processes: negotiating identity as the patient, provider, and i...

Purpose: Trans-masculine (TM, i.e., persons who have a masculine spectrum gender identity, but were assigned female sex at birth) individuals face disparities in cervical cancer screening rates compared to cisgender women. Some unique barriers to screening in this population are specific to Pap tests. Introduction of self-collected frontal (i.e.,...

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...

Despite growing interest in understanding how social factors drive poor health outcomes, many academics, policy makers, scientists, elected officials, journalists, and others responsible for defining and responding to the public discourse remain reluctant to identify racism as a root cause of racial health inequities. In this conceptual report, the...

Although sexual minority women are at risk of sexually transmitted infections (STIs) and cervical cancer, few nationally representative studies have assessed sexual orientation disparities in sexual health care among women. Using data from the 2011–2013 and 2013–2015 waves of the National Survey of Family Growth, which provide a national probabilit...

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...

Background: Research on the sexual and reproductive health of sexual minority women, especially those of color, is limited. Methods: Using multivariable Poisson regression, we estimated risk ratios for the association between two dimensions of sexual orientation (sexual identity and sexual behavior) and five sexual and reproductive health indica...

Background Research shows that sexual minorities (e.g., lesbian, gay, and bisexual individuals) experience higher levels of discrimination, stigma, and stress and are at higher risk of some poor health outcomes and health behaviors compared to their heterosexual counterparts. However, the majority of studies have examined sexual orientation dispari...

Transmasculine people (individuals assigned a female sex at birth who identify as male or masculine) are at risk of cervical cancer. Despite low rates of Pap test use in this population, research examining the determinants of cervical cancer screening among transmasculine individuals is scarce. We conducted in-depth interviews and focus groups with...

We greatly appreciate Dr. Sterling’s thoughtful comment on our paper, to which we respond below. First, we would like to clarify our paper’s main findings. Our analyses suggest that lesbian women and girls aged 15–25 years who had heard of the HPV vaccine were significantly less likely to have initiated HPV vaccination compared to their heterosexu...