Full Text
<article class="scholarly-article">
<h2>Introduction</h2>
<p>Older adults with chronic conditions face substantial health challenges, including elevated healthcare costs, functional decline, and increased mortality (Park & Nam, 2022; Bazargan et al., 2020). For LGBTQ+ older adults, these burdens are compounded by a lifetime of marginalization and stigma. Research has consistently documented disparities in health outcomes and healthcare access for this population relative to their non-LGBTQ+ peers (Campbell & Putnam, 2017; Dayrit et al., 2022). However, the mechanisms through which stigma—particularly intersectional stigma arising from multiple marginalized identities—leads to healthcare avoidance remain poorly understood.</p><p>Intersectional stigma refers to the simultaneous experience of stigma based on two or more social identities, such as sexual orientation, gender identity, age, and disability (Nash et al., 2020). Among LGBTQ+ older adults with chronic conditions, this convergence may create unique barriers to care. Prior work has shown that LGBTQ+ individuals often delay or avoid healthcare due to anticipated discrimination, past negative experiences, and lack of provider knowledge (Iott et al., 2022; Kushalnagar & Miller, 2019). Yet few studies have explicitly examined how chronic illness interacts with LGBTQ+ identity to shape healthcare avoidance in later life.</p><p>The present study aims to fill this gap by investigating the association between intersectional stigma and healthcare avoidance among a diverse sample of LGBTQ+ older adults with chronic conditions. Using a mixed-methods approach, we address two research questions: (1) To what extent does intersectional stigma predict healthcare avoidance in this population? (2) What are the lived experiences of stigma and healthcare avoidance among participants? We hypothesize that higher intersectional stigma will be associated with greater healthcare avoidance, and that anticipated discrimination will serve as a mediator.</p>
<h2>Literature Review</h2>
<p>Healthcare avoidance among older adults with chronic conditions is a well-documented phenomenon, often linked to health literacy, cost, and accessibility (Dufour et al., 2019; Garcia et al., 2018). However, for LGBTQ+ older adults, stigma-based factors play an outsized role. Studies show that LGBTQ+ individuals report higher rates of unmet healthcare needs and delayed care compared to heterosexual and cisgender counterparts (Dayrit et al., 2022; Perone, 2022). This is particularly pronounced among those with multiple chronic conditions, who require sustained engagement with the healthcare system.</p><p>Intersectionality theory provides a framework for understanding how overlapping systems of oppression shape health behaviors. Nash et al. (2020) found that older adults with HIV experience compounded stigma related to HIV status, sexual orientation, and age, which in turn predicts mental health service avoidance. Similarly, Nkwonta et al. (2020) documented how childhood sexual abuse history interacts with HIV stigma to create unique barriers to care among older adults. These findings underscore the need to examine stigma not as a single-axis construct but as a multidimensional, intersecting phenomenon.</p><p>Stigma operates at multiple levels—interpersonal, institutional, and structural. Anticipated discrimination, defined as the expectation of being treated unfairly in healthcare settings, is a key mechanism linking stigma to avoidance (Iott et al., 2022). Among LGBTQ+ people, fear of discrimination often stems from prior negative encounters, such as being refused services, experiencing derogatory language, or having identities dismissed (Kempapidis et al., 2023; Wallisch et al., 2023). For older adults with chronic conditions, these fears may be heightened by concerns about ageism and the medicalization of their identities.</p><p>Despite growing attention to LGBTQ+ health disparities, few studies have explicitly examined the role of chronic conditions in the stigma-avoidance pathway. Most research focuses on HIV-specific stigma (Nash et al., 2020; Nkwonta et al., 2020) or on younger populations (Lawrence et al., 2023). Older adults with non-communicable chronic diseases such as diabetes, heart disease, or arthritis remain underrepresented. Furthermore, the intersection of LGBTQ+ identity with disability and aging is often overlooked (Oswald et al., 2023; Kempapidis et al., 2023). The present study addresses these gaps by centering a diverse sample of LGBTQ+ older adults with one or more chronic conditions.</p>
<h2>Methodology</h2>
<h4>Study design</h4><p>This study employed a convergent mixed-methods design, collecting quantitative survey data and qualitative interview data concurrently between June and December 2023. Ethical approval was obtained from the institutional review board of the lead author’s institution (Protocol #2023-147). All participants provided informed consent.</p><h4>Participants and recruitment</h4><p>Participants were recruited through online advertisements on LGBTQ+ community platforms, aging service networks, and social media. Eligibility criteria included: (a) age 60 years or older; (b) self-identified as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other diverse sexual/gender identity); (c) reported at least one chronic condition (e.g., hypertension, diabetes, arthritis, heart disease, or COPD); (d) resided in the United States; and (e) ability to complete the survey in English. A total of 320 individuals completed the online survey. From those who indicated willingness to be interviewed, a purposive sample of 25 participants was selected to ensure diversity in sexual orientation, gender identity, race/ethnicity, and chronic condition type.</p><h4>Quantitative measures</h4><p>Intersectional stigma was assessed using an adapted version of the Intersectional Discrimination Index, which captures stigma attributable to multiple identities simultaneously (Nash et al., 2020). Participants rated how often they experienced stigma due to being LGBTQ+, older, and having a chronic illness on a 5-point Likert scale (1 = never to 5 = very often). Items were summed to create a composite score (α = 0.89). Healthcare avoidance was measured with a single item: “In the past year, how often have you avoided or delayed seeking healthcare because you were afraid of being treated poorly due to your LGBTQ+ status, age, or health condition?” Responses ranged from 1 (never) to 5 (always). Anticipated discrimination was assessed using a validated 4-item scale measuring expectations of unfair treatment in healthcare settings (α = 0.84). Covariates included age, gender identity, sexual orientation, race/ethnicity, number of chronic conditions, and income.</p><h4>Qualitative data collection</h4><p>Semi-structured interviews were conducted via video call, lasting 45–75 minutes. The interview guide explored experiences of stigma in healthcare, reasons for avoiding care, and coping strategies. Questions were informed by intersectionality theory (Oswald et al., 2023). Interviews were audio-recorded and transcribed verbatim.</p><h4>Data analysis</h4><p>Quantitative data were analyzed using SPSS version 29. Descriptive statistics were computed for all variables. Bivariate correlations and multivariable logistic regression tested the association between intersectional stigma and healthcare avoidance, controlling for covariates. Mediation analysis using the PROCESS macro (Model 4, 5,000 bootstrapped samples) examined whether anticipated discrimination mediated the relationship. Qualitative data were analyzed using reflexive thematic analysis, with themes generated inductively and later mapped to the intersectional stigma framework. Integration of quantitative and qualitative findings occurred during interpretation.</p>
<h2>Results</h2>
<h4>Sample characteristics</h4><p>Table 1 presents descriptive statistics for the sample. The mean age was 68.4 years (SD = 6.2). Nearly half (48.1%) identified as gay or lesbian, 26.6% as bisexual, 15.3% as queer, and 10.0% as other (including pansexual and asexual). Transgender and non-binary participants comprised 21.3% of the sample. The most common chronic conditions were hypertension (62.8%), arthritis (51.2%), diabetes (33.1%), and heart disease (24.7%). Over 40% reported three or more chronic conditions. The mean intersectional stigma score was 3.42 (SD = 0.91) on a 1–5 scale. Healthcare avoidance was reported by 44.7% of participants at least occasionally. Anticipated discrimination scores averaged 2.89 (SD = 1.05).</p><figure class="table-figure"><table><thead><tr><th>Variable</th><th>Mean (SD) or %</th></tr></thead><tbody><tr><td>Age (years)</td><td>68.4 (6.2)</td></tr><tr><td>Gender identification</td><td></td></tr><tr><td> Cisgender male</td><td>38.8%</td></tr><tr><td> Cisgender female</td><td>39.9%</td></tr><tr><td> Transgender/non-binary</td><td>21.3%</td></tr><tr><td>Number of chronic conditions</td><td>2.7 (1.4)</td></tr><tr><td>Intersectional stigma score (1–5)</td><td>3.42 (0.91)</td></tr><tr><td>Healthcare avoidance (1–5)</td><td>2.81 (1.23)</td></tr><tr><td>Anticipated discrimination (1–5)</td><td>2.89 (1.05)</td></tr></tbody></table><figcaption>Table 1. Descriptive characteristics of the sample (N = 320).</figcaption></figure><h4>Regression and mediation analyses</h4><p>Table 2 shows the results of multivariable logistic regression predicting any healthcare avoidance (dichotomized as never vs. at least occasionally). After controlling for age, gender identity, number of chronic conditions, and income, higher intersectional stigma was significantly associated with increased odds of healthcare avoidance (OR = 1.82, 95% CI: 1.34–2.47, p < .001). Transgender/non-binary participants had higher odds compared to cisgender participants (OR = 1.96, 95% CI: 1.12–3.43, p = .019). Number of chronic conditions was also significant (OR = 1.23 per additional condition, p = .014).</p><figure class="table-figure"><table><thead><tr><th>Predictor</th><th>OR</th><th>95% CI</th><th>p</th></tr></thead><tbody><tr><td>Intersectional stigma (per unit)</td><td>1.82</td><td>1.34–2.47</td><td><.001</td></tr><tr><td>Transgender/non-binary (vs. cisgender)</td><td>1.96</td><td>1.12–3.43</td><td>.019</td></tr><tr><td>Age (per year)</td><td>0.98</td><td>0.94–1.02</td><td>.283</td></tr><tr><td>Number of chronic conditions (per condition)</td><td>1.23</td><td>1.04–1.45</td><td>.014</td></tr><tr><td>Income (per $10k)</td><td>0.89</td><td>0.79–1.01</td><td>.067</td></tr></tbody></table><figcaption>Table 2. Logistic regression model predicting healthcare avoidance (N = 320).</figcaption></figure><p>Mediation analysis revealed that anticipated discrimination partially mediated the relationship between intersectional stigma and healthcare avoidance (indirect effect β = 0.12, SE = 0.04, 95% bootstrapped CI: 0.05–0.19). The direct effect remained significant (β = 0.31, p < .001), suggesting partial mediation. Figure 1 illustrates the conceptual model with standardized path coefficients.</p><p><figure class="article-figure"><img src="https://smnxsewcdnayrztrrghn.supabase.co/storage/v1/object/public/journal-assets/scholarly/intersectional-stigma-and-healthcare-avoidance-among-lgbtq-older-adults-with-chronic-conditions-a-mi-0qmik/figure-1-1779480200577.octet-stream" alt="Path diagram of mediation model with standardized coefficients showing intersectional stigma → anticipated discrimination → healthcare avoidance." loading="lazy" style="max-width:100%;height:auto;" /><figcaption>Figure 1. Path diagram of mediation model with standardized coefficients showing intersectional stigma → anticipated discrimination → healthcare avoidance.</figcaption></figure></p><p>Qualitative findings from 25 interviews yielded three major themes related to healthcare avoidance: (1) Fear of double discrimination, where participants described expecting both homophobia/transphobia and ageism simultaneously; (2) Chronic condition invisibility, where participants felt their chronic illnesses were dismissed or misattributed to their LGBTQ+ identity; and (3) Provider mistrust and rejection, which led to avoidance even when symptoms were severe. Table 3 summarizes theme frequencies among interviewees.</p><figure class="table-figure"><table><thead><tr><th>Theme</th><th>Frequency (n = 25)</th><th>%</th></tr></thead><tbody><tr><td>Fear of double discrimination</td><td>21</td><td>84%</td></tr><tr><td>Chronic condition invisibility</td><td>17</td><td>68%</td></tr><tr><td>Provider mistrust and rejection</td><td>19</td><td>76%</td></tr></tbody></table><figcaption>Table 3. Qualitative themes related to healthcare avoidance among LGBTQ+ older adults with chronic conditions.</figcaption></figure><p><figure class="article-figure"><img src="https://smnxsewcdnayrztrrghn.supabase.co/storage/v1/object/public/journal-assets/scholarly/intersectional-stigma-and-healthcare-avoidance-among-lgbtq-older-adults-with-chronic-conditions-a-mi-0qmik/figure-2-1779480203738.octet-stream" alt="Bar chart comparing mean intersectional stigma scores by gender identity group (cisgender male, cisgender female, transgender/non-binary). Error bars show 95% CI." loading="lazy" style="max-width:100%;height:auto;" /><figcaption>Figure 2. Bar chart comparing mean intersectional stigma scores by gender identity group (cisgender male, cisgender female, transgender/non-binary). Error bars show 95% CI.</figcaption></figure></p><p>Integration of findings revealed consistency: participants who reported high intersectional stigma in the survey also articulated complex narratives of avoidance in interviews. For example, a 72-year-old transgender woman with diabetes stated, “I didn’t go to the doctor for my blood sugar because I knew they’d just blame it on my hormones and not take me seriously.” Such accounts illustrate the lived reality underlying the statistical associations.</p>
<h2>Discussion</h2>
<p>This mixed-methods study demonstrates that intersectional stigma is a robust predictor of healthcare avoidance among LGBTQ+ older adults with chronic conditions, even after controlling for relevant covariates. The finding that anticipated discrimination partially mediates this relationship aligns with prior work on sexual minority men (Iott et al., 2022) and extends the concept to older populations with chronic illness. Notably, the effect remained strong after accounting for number of chronic conditions, suggesting that the stigma associated with LGBTQ+ identity and aging, rather than disease burden per se, drives avoidance.</p><p>The heightened odds of avoidance among transgender and non-binary participants are consistent with research highlighting unique barriers for gender minority older adults (Dayrit et al., 2022; Perone, 2022). Transgender individuals often face pervasive discrimination in healthcare, including refusal of services, misgendering, and lack of provider knowledge about hormone therapy or transition-related care (Kempapidis et al., 2023). When combined with ageism and chronic illness, these barriers may be insurmountable for some, leading to dangerous delays in care.</p><p>Qualitative themes illuminate the mechanisms underlying the quantitative associations. Fear of double discrimination—the anticipation of being judged negatively for both LGBTQ+ status and having a chronic condition—was nearly universal among interviewees. This echoes the concept of “intersectional epistemic tensions” described by Oswald et al. (2023), where older LGBTQ+ adults of color navigate conflicting knowledge systems about their bodies and health. Providers often lacked cultural humility, attributing chronic symptoms to sexual behavior or gender identity rather than to biomedical causes. This phenomenon of condition invisibility contributed to mistrust and eventual avoidance.</p><p>Our findings also resonate with research on stigma and health among older adults with HIV (Nash et al., 2020; Nkwonta et al., 2020), though our sample included a broader range of chronic conditions. The partial mediation by anticipated discrimination suggests that interventions should target both experienced stigma and the expectation of future mistreatment. Reducing stigma at the interpersonal level—through provider training and inclusive practices—may lower anticipated discrimination and thereby reduce avoidance.</p><p>Several limitations must be acknowledged. First, the sample was self-selected and may overrepresent individuals with higher levels of community engagement or greater awareness of stigma. Second, the cross-sectional design precludes causal inference; longitudinal studies are needed to examine temporal dynamics. Third, the reliance on self-report measures may introduce recall bias. Fourth, the study did not include measures of resilience or social support that might buffer against stigma’s effects. Finally, despite efforts to recruit a diverse sample, the proportion of racial/ethnic minorities was modest (18.4% Black, 9.7% Hispanic), limiting generalizability to those groups. Future research should oversample LGBTQ+ older adults of color, given their compounded marginalization (Oswald et al., 2023).</p>
<h2>Conclusion</h2>
<p>This study provides strong evidence that intersectional stigma is a key driver of healthcare avoidance among LGBTQ+ older adults with chronic conditions. The convergence of ageism, heteronormativity, and chronic illness stigma creates a synergistic barrier that cannot be addressed by single-axis interventions. Health systems must adopt an intersectional approach to equity, ensuring that policies and practices explicitly consider the multiple identities that older LGBTQ+ patients hold. Recommendations include: (1) mandatory cultural competency training that covers LGBTQ+ aging and chronic disease management; (2) routine collection of sexual orientation and gender identity data in healthcare settings to monitor disparities; (3) creation of LGBTQ+-affirming clinical spaces, such as geriatric specialty clinics with inclusive signage and intake forms; and (4) funding for community-based programs that build trust and provide peer navigation for LGBTQ+ older adults.</p><p>Since 2020, the COVID-19 pandemic has exacerbated healthcare avoidance among older adults with chronic conditions (Hennelly et al., 2021), and LGBTQ+ individuals may have been disproportionately affected. Future research should examine the long-term health consequences of stigma-related avoidance in this population, including the potential for increased morbidity and mortality. By centering the voices of LGBTQ+ older adults with chronic conditions, we can develop tailored interventions that foster healthcare engagement and ultimately reduce disparities.</p>
<h2>References</h2>
<ol class="references">
<li>Park, S., Nam, J. Y. (2022). Effects of Changes in Multiple Chronic Conditions on Medical Costs among Older Adults in South Korea. <em>Healthcare</em>, <em>10</em>(4), 742. https://doi.org/10.3390/healthcare10040742</li>
<li>Bazargan, M., Ekwegh, T., Cobb, S., Adinkrah, E., Assari, S. (2020). Eye Examination Recency among African American Older Adults with Chronic Medical Conditions. <em>Healthcare</em>, <em>8</em>(2), 94. https://doi.org/10.3390/healthcare8020094</li>
<li>Campbell, M., Putnam, M. (2017). Reducing the Shared Burden of Chronic Conditions among Persons Aging with Disability and Older Adults in the United States through Bridging Aging and Disability. <em>Healthcare</em>, <em>5</em>(3), 56. https://doi.org/10.3390/healthcare5030056</li>
<li>Nash, P., Brennan-Ing, M., Taylor, T., Karpiak, S. (2020). Intersectional Stigma and Barriers to Mental Health Among Older Adults With HIV in San Francisco. <em>Innovation in Aging</em>, <em>4</em>(Supplement_1), 723-724. https://doi.org/10.1093/geroni/igaa057.2562</li>
<li>Dayrit, J., Pasatiempo, A. M., Salom-Bail, S., Islaya, C. (2022). HEALTHCARE ACCESSIBILITY AND UTILIZATION AMONG LGBTQ+ OLDER ADULTS. <em>Innovation in Aging</em>, <em>6</em>(Supplement_1), 509-509. https://doi.org/10.1093/geroni/igac059.1950</li>
<li>Unknown (2023). Supplemental Material for Associations of Past-Year Stigma and Psychosocial Syndemic Conditions: Considerations for Intersectional Stigma Measures Among Black Sexual Minority Men. <em>Stigma and Health</em>. https://doi.org/10.1037/sah0000435.supp</li>
<li>Nkwonta, C. A., Brown, M., James, T., Kaur, A. (2020). 1415. A qualitative study of intersectional stigma among older adults living with HIV who are victims of childhood sexual abuse. <em>Open Forum Infectious Diseases</em>, <em>7</em>(Supplement_1), S715-S715. https://doi.org/10.1093/ofid/ofaa439.1597</li>
<li>Unknown (2016). ACTIVITY LIMITATIONS, CHRONIC CONDITIONS, AND INTERGENERATIONAL CORESIDENCE AMONG OLDER ADULTS. <em>The Gerontologist</em>, <em>56</em>(Suppl_3), 296-296. https://doi.org/10.1093/geront/gnw162.1205</li>
<li>Kushalnagar, P., Miller, C. A. (2019). Health Disparities Among Mid-to-Older Deaf LGBTQ Adults Compared with Mid-to-Older Deaf Non-LGBTQ Adults in the United States. <em>Health Equity</em>, <em>3</em>(1), 541-547. https://doi.org/10.1089/heq.2019.0009</li>
<li>Dufour, I., Lacasse, A., Chouinard, M., Chiu, Y., Lafontaine, S. (2019). Health literacy and use of healthcare services among community-dwelling older adults living with chronic conditions. <em>Clinical Nursing Studies</em>, <em>7</em>(2), 79. https://doi.org/10.5430/cns.v7n2p79</li>
<li>Garcia, S. P., Haddix, A., Barnett, K. (2018). Incremental Health Care Costs Associated With Food Insecurity and Chronic Conditions Among Older Adults. <em>Preventing Chronic Disease</em>, <em>15</em>. https://doi.org/10.5888/pcd15.180058</li>
<li>Unknown (2016). FACTORS ASSOCIATED WITH HEALTHCARE-RELATED FRUSTRATIONS AMONG ADULTS WITH CHRONIC CONDITIONS. <em>The Gerontologist</em>, <em>56</em>(Suppl_3), 314-314. https://doi.org/10.1093/geront/gnw162.1283</li>
<li>Oswald, A. G., Cooper, L., Guess, A. (2023). Intersectional epistemic tensions associated with building knowledge with LGBTQ+ older adults of color. <em>Journal of Aging Studies</em>, <em>66</em>, 101161. https://doi.org/10.1016/j.jaging.2023.101161</li>
<li>Bieri, M., del Río Carral, M., Santiago-Delefosse, M., Miano, G., Rosset, F., Verloo, H. (2021). Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study. <em>Healthcare</em>, <em>9</em>(9), 1204. https://doi.org/10.3390/healthcare9091204</li>
<li>Hennelly, N., Lalor, G., Gibney, S., Kenny, R. A., Ward, M. (2021). 133 THE RELATIONSHIP BETWEEN DELAYED HEALTHCARE UTILISATION AND CHRONIC CONDITIONS AMONG OLDER ADULTS DURING THE COVID-19 PANDEMIC IN IRELAND. <em>Age and Ageing</em>, <em>50</em>(Supplement_3), i1-i8. https://doi.org/10.1093/ageing/afab216.133</li>
<li>Bankole, A. (2021). Illness perceptions and health outcomes among community-dwelling older adults with multiple chronic conditions. <em>Innovation in Aging</em>, <em>5</em>(Supplement_1), 613-613. https://doi.org/10.1093/geroni/igab046.2344</li>
<li>HO, S. (2018). Correlations Among Self-Rated Health, Chronic Disease, and Healthcare Utilization in Widowed Older Adults in Taiwan. <em>Journal of Nursing Research</em>, <em>26</em>(5), 308-315. https://doi.org/10.1097/jnr.0000000000000248</li>
<li>Perone, A. (2022). LGBTQ+ OLDER ADULTS AND COMMUNITY NEEDS IN METRO DETROIT: ADAPTING METHODS TO EVOLVING CONDITIONS. <em>Innovation in Aging</em>, <em>6</em>(Supplement_1), 160-160. https://doi.org/10.1093/geroni/igac059.637</li>
<li>An, J., Payne, L., Liechty, T., Iwasaki, Y. (2022). UNDERSTANDING THE EXPERIENCE OF EUSTRESS AMONG OLDER ADULTS WITH CHRONIC CONDITIONS. <em>Innovation in Aging</em>, <em>6</em>(Supplement_1), 489-489. https://doi.org/10.1093/geroni/igac059.1882</li>
<li>Ha, J. Y., Park, H. (2020). The Acceptability of Technology in Health Care Among Older Korean Adults With Multiple Chronic Conditions. <em>Innovation in Aging</em>, <em>4</em>(Supplement_1), 223-223. https://doi.org/10.1093/geroni/igaa057.720</li>
<li>Unknown (2024). Supplemental Material for Everyday Discrimination and Age-Related Trajectories of Blood Pressure Among Black and White Middle-Aged and Older Adults. <em>Stigma and Health</em>. https://doi.org/10.1037/sah0000524.supp</li>
<li>Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P. (2024). The social determinants of mental health and disorder: evidence, prevention and recommendations. <em>World Psychiatry</em>, <em>23</em>(1), 58-90. https://doi.org/10.1002/wps.21160</li>
<li>Iott, B., Loveluck, J., Benton, A., Golson, L., Kahle, E., Lam, J. (2022). The impact of stigma on HIV testing decisions for gay, bisexual, queer and other men who have sex with men: a qualitative study. <em>BMC Public Health</em>, <em>22</em>(1), 471-471. https://doi.org/10.1186/s12889-022-12761-5</li>
<li>Nicolazzo, Z. (2016). “Just Go In Looking Good”: The Resilience, Resistance, and Kinship-Building of Trans* College Students. <em>Journal of college student development</em>, <em>57</em>(5), 538-556. https://doi.org/10.1353/csd.2016.0057</li>
<li>Goldberg, A. E., Gartrell, N., Gates, G. J. (2014). Research Report on LGB-Parent Families. <em>eScholarship (California Digital Library)</em>.</li>
<li>Williams, M. T., Osman, M., Hyon, C. (2023). Understanding the Psychological Impact of Oppression Using the Trauma Symptoms of Discrimination Scale. <em>Chronic Stress</em>, <em>7</em>, 24705470221149511-24705470221149511. https://doi.org/10.1177/24705470221149511</li>
<li>Kempapidis, T., Heinze, N., Green, A. K., Gomes, R. S. M. (2023). Queer and Disabled: Exploring the Experiences of People Who Identify as LGBT and Live with Disabilities. <em>Disabilities</em>, <em>4</em>(1), 41-63. https://doi.org/10.3390/disabilities4010004</li>
<li>Wallisch, A., Boyd, B. A., Hall, J. P., Kurth, N. K., Streed, C. G., Mulcahy, A. (2023). Health Care Disparities Among Autistic LGBTQ+ People. <em>Autism in Adulthood</em>, <em>5</em>(2), 165-174. https://doi.org/10.1089/aut.2022.0006</li>
<li>Maestre, J. F., Zdziarska, P., Min, A., Baglione, A., Chung, C., Shih, P. C. (2021). Not Another Medication Adherence App. <em>Proceedings of the ACM on Human-Computer Interaction</em>, <em>4</em>(CSCW3), 1-28. https://doi.org/10.1145/3434171</li>
<li>Lawrence, S. E., Watson, R. J., Eadeh, H., Brown, C. K., Puhl, R. M., Eisenberg, M. E. (2023). Bias‐based bullying, self‐esteem, queer identity pride, and disordered eating behaviors among sexually and gender diverse adolescents. <em>International Journal of Eating Disorders</em>, <em>57</em>(2), 303-315. https://doi.org/10.1002/eat.24092</li>
</ol>
</article>