117. Identity Disclosure by Sexual and Gender Minority Adolescents in the Deep South and Recommendations to Promote Inclusive Clinical Environments

Sexual and gender minority (SGM) adolescents disproportionately experience barriers to healthcare and adverse health outcomes, especially in the Deep South, where multi-level systems of stigma and discrimination are evident. Affirming clinical environments are key components to promoting SGM adolescents’ health and wellbeing. This study explored delayed and foregone healthcare due to identity disclosure, frequency of prior identity disclosure to a health professional, and reasons for disclosure and non-disclosure among SGM in the Deep South as well as recommendations for promoting inclusive clinical environments. Between July 2021 and April 2022, we recruited 384 SGM adolescents in eight Deep South states using social media ads. Eligible participants were 13-17 years old, LGBTQIA+, and had at least one prior romantic or sexual partner. Participants completed an online survey, and a subset participated in semi-structured qualitative interviews (n=35). The survey assessed delayed or foregone health services due to sexual or gender identity, prior identity disclosure to a health professional, and factors facilitating or inhibiting disclosure in clinical settings. The qualitative interviews expanded upon the quantitative survey and solicited recommendations for promoting inclusive clinical environments. We used summary statistics to describe the prevalence of delayed care due to SGM identity, identity disclosure, and reasons for disclosure and non-disclosure. Grounded theory guided qualitative data analyses conducted by a diverse coding team that used MAXQDA and met regularly to reach consensus. Respondents were a mean age of 16.1 years and primarily female (45.6%, n=175), bisexual (38.0%, n=146), and non-Hispanic White (52.6%, n=202). Over one-fifth (22.1%, n=85) reported ever delaying or foregoing healthcare because of their SGM identity. Only about one-third (34.6%, n=133) had ever disclosed their SGM identity to a health professional. The most frequently reported reasons for disclosure included that the clinician made them feel comfortable (49.6%, n=66), disclosing was relevant to the care sought (48.1%, n=64), the discussion was perceived to be confidential (42.9%, n=57), the clinician directly asked (39.8%, n=53), and their parents were not present in the room (33.8%, n=45). Among the respondents who had never disclosed, the most frequent reasons included that the clinician never directly asked (76.5%, n=192), it was not relevant to the care sought (53.0%, n=133), their parents were present in the room (41.8%, n=105), medical history forms did not inquire about it (39.4%, n=99), and that there was no opportunity for discussion during the appointment (37.5%, n=94). Qualitative recommendations from adolescents to promote more inclusive clinical environments included public displays of affirming services and care, tailored materials for LGBTQIA+ patients, training all staff on avoiding microaggressions and heteronormative assumptions, using the patient’s correct name and pronouns, and allowing for individualized discussion without parents in the room. The vast majority of young adolescents living in the Deep South had never disclosed their SGM identity to a health professional. Environmental cues and direct discussions alone with providers may facilitate disclosure and promote adolescents’ perceptions of inclusive healthcare settings.