600 - The Relationship between Sexual Orientation and Gender Identity Discrimination in Children in the U.S. with Family-Centered Care and Beneficial Healthcare Utilization, Health, and Resiliency

Poster Number: 600
Publication Number: 600.32

Michael Arenson, UMass Chan Medical School, Worcester, MA, United States; Anne Fuller, McMaster University, Hamilton, ON, Canada; Julia Zelinsky, Boston University School of Public Health, Hatboro, PA, United States; sarabeth broder-fingert, University of Massachusetts Medical School, Worcester, MA, United States; Yorghos Tripodis, Boston University School of Public Health, Boston, MA, United States; Heather Forkey, UMass Chan Medical School, Worcester, MA, United States; Arvin Garg, UMass Chan Medical School/UMass Memorial Health, Worcester, MA, United States

Background: Family-Centered Care (FCC) is a collaborative healthcare approach grounded in mutually beneficial partnerships among healthcare professionals, patients, and families. FCC facilitates the development of epistemic trust (i.e., the ability to trust appropriately in cultural sources of new knowledge) in the pediatric clinician, which may uniquely benefit families with children experiencing discrimination based on sexual orientation or gender identity (DSG).

Objective: Among children in the US, we examined the relationships between DSG and FCC with healthcare utilization, health, and resilience.

Design/Methods: This study was a secondary analysis of the combined 2020 National Survey of Children's Health (NSCH). Data were available for 32,222 children who had a personal doctor or nurse (PDN). Our primary exposure was FCC, defined according to the NSCH codebook. Our outcomes represented healthcare utilization, child health, and resilience. We used multivariable logistic regression to measure associations between FCC and outcomes, controlling for sociodemographic characteristics, and using DSG as a moderator.

Results: Of 19,058 children with a PDN, 88.8% had FCC and 1.2% experienced DSG. Children with FCC were not more or less likely to experience DSG than children without FCC (1.1% vs. 1.3%, p = 0.59). In total, 322 children experienced DSG, of which 18.4% were 6-11 years old vs. 81.6% were 12-17 years old. In multivariable logistic regression, FCC was significantly associated with having one or more preventive medical visits (aOR 1.70 [95% CI: 1.04, 2.78]), having one or more providers that act as a usual source of sick care (aOR 1.41 [95% CI: 1.00, 1.98]), parental assessment of overall health as “excellent/very good” (aOR 1.68 [95% CI: 1.20, 2.37]), family resilience “all/most of the time” to all 4 items (aOR 2.03 [95% CI: 1.55, 2.67]), and child flourishing for 6-17-year-olds (aOR 1.88 [95% CI: 1.46, 2.42]). DSG attenuated having one or more preventive care visits (“Yes” DSG aOR 0.15 [95% CI: 0.02, 0.90] versus “No” DSG aOR 1.74 [95% CI: 1.06, 2.85]).

Conclusion(s): FCC is associated with more beneficial healthcare utilization patterns, better parental assessment of child health, child flourishing in 6–17-year-olds, and family resilience. DSG did not attenuate FCC for most outcomes of interest except preventive care visits (having one or more). Our results suggest that FCC via epistemic trust may be a therapeutic stance that can support LGBTQ+ youth at-risk for discrimination.