BackgroundThere are many challenges in recruiting and engaging participants when conducting research, especially with HIV-positive individuals. Some of these challenges include geographical barriers, insufficient time and financial resources, and perceived HIV-related stigma.ObjectiveThis paper describes the methodology of a recruitment approach that capitalized on existing online social media venues and other Internet resources in an attempt to overcome some of these barriers to research recruitment and retention.MethodsFrom May through August 2013, a campaign approach using a combination of online social media, non-financial incentives, and Web-based survey software was implemented to advertise, recruit, and retain participants, and collect data for a survey study with a limited budget.ResultsApproximately US $5,000 was spent with a research staff designated at 20% of full-time effort, yielding 2034 survey clicks, 1404 of which met the inclusion criteria and initiated the survey, for an average cost of US $3.56 per survey initiation. A total of 1221 individuals completed the survey, yielding 86.97% retention.ConclusionsThese data indicate that online recruitment is a feasible and efficient tool that can be further enhanced by sophisticated online data collection software and the addition of non-financial incentives.

Despite growing social acceptance of lesbians, gay men, bisexuals, and transgender (LGBT) persons and the extension of marriage rights for same-sex couples, LGBT persons experience stigma and discrimination, including within the healthcare system. Each population within the LGBT umbrella term is likely at elevated risk for cancer due to prevalent, significant cancer risk factors, such as tobacco use and human immunodeficiency virus infection; however, cancer incidence and mortality data among LGBT persons are lacking. This absence of cancer incidence data impedes research and policy development, LGBT communities' awareness and activation, and interventions to address cancer disparities. In this context, in 2014, a 2-day National Summit on Cancer in the LGBT Communities was convened by a planning committee for the purpose of accelerating progress in identifying and addressing the LGBT communities' concerns and needs in the spheres of cancer research, clinical cancer care, healthcare policy, and advocacy for cancer survivorship and LGBT health equity. Summit participants were 56 invited persons from the United States, United Kingdom, and Canada, representatives of diverse identities, experiences, and knowledge about LGBT communities and cancer. Participants shared lessons learned and identified gaps and remedies regarding LGBT cancer concerns across the cancer care continuum from prevention to survivorship. This white paper presents background on each of the Summit themes and 16 recommendations covering the following: sexual orientation and gender identity data collection in national and state health surveys and research on LGBT communities and cancer, the clinical care of LGBT persons, and the education and training of healthcare providers.

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Young men who have sex with men (YMSM) may be at increased risk for mental health problems including depression, post-traumatic stress (PTSD), and suicidality. The overriding goal of the current investigation was to examine mental health and mental health services in a diverse sample of YMSM. We analyzed cross-sectional data from a cohort study of 598 YMSM, including sociodemographics, mental health, and mental health care. We then tested for bivariate associations, and used multivariable modeling to predict depression, PTSD, suicidality and mental health care utilization. Lower socioeconomic status, unstable housing, and school non-enrollment predicted depression and PTSD scores, while unstable housing and school non-enrollment predicted recent suicide attempt(s). These recent suicide attempt(s) also predicted current utilization of counseling or treatment, any history of psychiatric hospitalization, and any history of psychiatric diagnosis. Black and API men were less likely to have ever accessed mental health counseling or treatment. There were significant class-based differences with regard to mental health outcomes, but not mental health services. Further, recent crises (i.e., suicide attempt, hospitalization) were strong predictors of accessing mental health services. Improving the mental health of YMSM requires addressing the underlying structural factors that influence mental health outcomes and service access.

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126 Background: A growing body of evidence indicates that LGBT communities are disproportionately affected by cancer due to higher rates of traditional risk factors such as tobacco and alcohol, non-inclusion in educational campaigns, and minority stress. Due to the exclusion of sexual orientation and gender identity measures in national oncology databases, there has been difficulty documenting the extent of healthcare disparities that exist for LGBT cancer patients. However, an increasing number of studies describe the experiences of LGBT patients and their families at the end of life. Although societal attitudes and legal protections are shifting, the existing literature clearly indicates that LGBT patients in palliative and end-of-life care settings encounter unique barriers to quality care. For example, LGBT individuals may distrust specific members of palliative care teams, such as a pastor because of past rejections by faith-based communities. Other barriers include high levels of familial rejection, fear of revealing minority status, and a lack of legal protection. Methods: In 2014 and 2015, a CDC-funded multidisciplinary expert panel met to develop the best practices across the cancer care continuum for the LGBT community. The experts drew on available literature and clinical and community experience. They reached a consensus regarding recommendations that were later reviewed using a process that elicited comments from providers, patients, and community and national organizations. Results: Recommendations were made in 7 domains: 1) cancer prevention, 2) cancer screening, 3) diagnosis, 4) treatment, 5) survivorship, 6) palliative and end-of-life care, and 7) public health. Here we report the panel’s recommendations for improving palliative and end-of-life care for LGBT cancer patients. Conclusions: The barriers for LGBT cancer patients to access quality palliative and end-of-life care exist, and the subsequent healthcare disparities are often invisible to healthcare providers. Implementation of these national recommendations will help eliminate the disparities that LGBT patients and their families experience when facing cancer.