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[(M)13.9(e)0(a)19.6(n)0(i)18.4(n)0(g)17.5(f)12.2(ul)-441.2(us)22.6(e)]TJ
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[(gu)19.5(id)18.8(el)21.9(in)18.4(es)-285.7(f)12.2(o)0(r)-288(i)0(m)24.2(p)0(l)14.1(e)12.8(me)15.2(nt)21.4(a)13.1(t)0(i)15(o)0(n)-284.4(o)0(f)-281.5(t)0(h)15.1(e)-290.8(EH)16(R)-288.8(a)0(l)15.9(r)0(e)18.4(a)13.1(dy)-285.6(i)15.4(n)0(c)16.3(l)0(u)20.4(d)0(e)-287.4(r)0(e)24.7(-)]TJ
T*
[(qu)19.5(ir)21.1(em)15.2(e)12.7(n)0(t)15.1(s)-285.8(fo)15.7(r)-291.6(d)0(a)22.8(t)0(a)-284.5(c)13.4(ol)19(le)15.5(c)13.4(t)0(i)15(o)0(n)-278(a)0(b)21.4(o)0(u)14.8(t)-291.3(ra)18.8(c)13.4(e)-290.7(an)16.1(d)-287.5(e)0(t)18.6(h)0(n)18.5(i)0(c)16.2(i)15.4(ty)14.1(.)]TJ
1.1128 -1.2266 TD
[(The)-221.3(Health)-228.1(Research)-229.5(and)-220.9(Education)-225(Trust)-228.1(Disparities)-225.2(Tool-)]TJ
-1.1128 -1.2203 TD
[(kit,)-333.8()55()0(a)-330.2(toolkit)-334.1(for)-332.7(collecting)-336.3(race,)-331.1(ethnicity,)-331.1(and)-334.7(primary)-330.2(lan-)]TJ
T*
[(guage)-370(information)-372.2(from)-368.2(patients,)48.5()-368.6(states)-369.7(that)-370.6()55()]TJ
/F9 1 Tf
21.0616 0 TD
(Disparities)Tj
/F4 1 Tf
4.7548 0 TD
(in)Tj
-25.8164 -1.2203 TD
[(health)-345.3(care)]TJ
/F9 1 Tf
5.1911 0 TD
[(can)-337.5(be)-345.7(addressed)]TJ
/F4 1 Tf
7.1196 0 TD
[(through)-345.3(a)-340.9(quality)-339.7(of)-344.7(care)-340.8(frame-)]TJ
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(work)Tj
/F9 1 Tf
2.5608 0 TD
[(if)-250.4(data)-251.5(on)-250.3(race)]TJ
/F4 1 Tf
5.5895 0 TD
[(,)-249.5(ethnicity,)-248.9(and)-252.5(primary)-248.1(language)]TJ
/F9 1 Tf
14.8209 0 TD
[(are)-247.3(avail-)]TJ
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(able)Tj
/F4 1 Tf
1.5554 0 TD
[()55()-330.7(\(emphasis)-330.8(added\).)]TJ
6.7246 0 0 5.9768 156.1889 72.5669 Tm
(9)Tj
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[(A)-330.2(report)-334.7(by)-331.3(Physicians)-330.9(for)-332.7(Human)]TJ
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[(Rights)-346.1(on)-335(racial)-341.2(and)-341(ethnic)-345.1(disparities)-347(in)-335.7(medical)-341.4(care)-340.8(notes)]TJ
27.9978 74.5535 TD
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0 -1.2203 TD
[(ing)-302.2(quality)-301.8(of)-300.4(care)-302.9(and)-303.1(access)-304.1(to)-300.4(care:)]TJ
1.3341 -2.5545 TD
[([D]ata)-305.3(on)-303.3(race)-302.9(and)-303.1(ethnicity)-302.9(may)-305(be)-301.5(used)-302.7(for)-301.1(a)-303(variety)]TJ
0 -1.2266 TD
[(of)-218.2(possible)-214.1(purposes)-212.4(beyond)-213.9(the)-218.7(detection)-215(of)-211.9(disparities)]TJ
0 -1.2203 TD
[(in)-310.4(the)-307.3(quality)-308.1(of)-306.7(clinical)-306.5(care,)-305.8(such)-308.8(as)-304.3(who)-311.3(is)-302(accessing)]TJ
T*
[(health)-421.2(services,)-414.3(the)-421.1(health)-414.9(status)-415.4(of)-420.6(different)-416.5(popula-)]TJ
T*
[(tions,)-393.8(utilization)-394.7(rates)-393.9(of)-388.9(services)-392.4(to)-395.3(which)-390.6(racial)-391.8(and)]TJ
0 -1.2266 TD
[(ethnic)-288.2(groups)-283.8(do)-284(have)-288.1(access,)-288.1(the)-282(effectiveness)-295.1(of)-281.5(pub-)]TJ
0 -1.2203 TD
[(lic)-284.6(health)-288.4(interventions)-289.1(among)-279.5(different)-290(racial)-284.3(and)-277.8(eth-)]TJ
T*
[(nic)-208.5(groups,)-210.8(and)-208.2(of)-211.9(course)-207.7(racial)-214.7(and)-208.2(ethnic)-206(disparities)-214.2(in)]TJ
0 -1.2266 TD
[(diagnosis)-307.3(and)-296.8(treatment.)]TJ
6.7246 0 0 5.9768 423.0424 608.5983 Tm
(10)Tj
8.9663 0 0 8.9663 323.0361 585.6376 Tm
[(The)-480.5(Joint)-484.9(Commissions)-478.7(2010)-478.6(report,)]TJ
/F9 1 Tf
17.2236 0 TD
[(Advancing)-484.3(Effective)]TJ
-18.3364 -1.2203 TD
[(Communication,)-365.4(Cultural)-358.7(Competence,)-354.4(and)-357.3(Patient-)-358.5(and)-357.3(Family-)]TJ
T*
[(Centered)-220.1(Care:)-222.8(A)-217.8(Roadmap)-217.5(for)-216.9(Hospitals)]TJ
/F4 1 Tf
16.1361 0 TD
[(,)-217.9(also)-215.8(stresses)-227.5(the)-218.7(impor-)]TJ
-16.1361 -1.2203 TD
[(tance)-306(of)-300.4(gathering)-304.3(race)-302.9(and)-296.8(ethnicity)-309.2(data:)]TJ
1.3341 -2.3395 TD
[(Hospitals)-336.3(must)-335.8(collect)-337.6(patient-level)-339.2(demographic)-331.6(data)]TJ
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T*
[(patients)-262.9(and)-258.8(to)-256.2(eliminate)-257.9(disparities)-258.4(in)-259.8(the)-256.7(patient)-261.5(pop-)]TJ
T*
[(ulation.)-213.5(These)-216.2(critical)-212.2(data)-211.2(provide)-214.3(hospitals)-213.2(with)-211.3(infor-)]TJ
0 -1.2266 TD
[(mation)-310.7(on)-309.7(the)-313.6(potential)-312.1(cultural)-306.9(needs)-311(of)-306.7(each)-311.9(patient,)]TJ
0 -1.2203 TD
[(as)-563.6(well)-565(as)-563.6(an)-559.3(opportunity)-566.4(to)-566(monitor)-561.3(and)-562.3(analyze)]TJ
T*
[(health)-307.4(disparities)-302.7(at)-303.5(the)-300.9(population)-304.6(level.)]TJ
6.7246 0 0 5.9768 487.2188 470.0975 Tm
[(11\()-10(p11\))]TJ
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[(All)-280.3(of)-275.1(these)-283.2(purposes)-282(for)-275.8(which)-276.8(race/ethnicity)-286.3(data)-274.4(can)-280.4(be)]TJ
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[(less)-366.5(likely)-367.1(to)-363.6(be)-364.7(insured)-360.9(than)-367.2(heterosexual)-369(women)]TJ
6.7246 0 0 5.9768 515.1117 427.2377 Tm
(2)Tj
8.9663 0 0 8.9663 521.7448 423.2692 Tm
[(and)-366.3(are)]TJ
-23.2746 -1.2203 TD
[(less)-259(likely)-259.6(to)-256.2(use)-261.8(preventive)-263.5(health)-256.8(services,)-262.5(such)-258.3(as)-253.7(mammo-)]TJ
0 -1.2266 TD
(grams.)Tj
6.7246 0 0 5.9768 339.8172 405.3542 Tm
(12)Tj
8.9663 0 0 8.9663 349.7952 401.329 Tm
[(Gathering)-368.1(data)-362.9(on)-366.6(SOGI)-362.8(in)-367.3(clinical)-363.4(settings)-368.9(and)-366.3(in)]TJ
-4.0972 -1.2203 TD
[(EHRs)-242.5(helps)-243.4(us)-242.9(better)-239.8(understand)-243.7(LGBT)-241.7(health,)-240.7(including)-240.4(dis-)]TJ
T*
[(parities)-320.1(in)-310.4(insurance)-315.9(coverage,)-313.6(access)-316.7(to)-313.1(care,)-312.1(diagnosis,)-316.6(and)]TJ
0 -1.2267 TD
[(treatment.)-599.6(These)-595.5(data,)-593.4(coupled)-599.2(with)-590.7(race/ethnicity)-602.5(data,)]TJ
0 -1.2203 TD
[(would)-410.6(also)-411.8(allow)-409.3(us)-407.3(to)-407.9(better)-410.5(understand)-414.4(racial)-410.7(disparities)]TJ
T*
[(within)-306.8(LGBT)-298.6(health.)]TJ
1.1128 -1.2203 TD
[(As)16.3(ki)23.7(ng)-254.4(ab)21.4(ou)14.8(t)-259.7(a)0(n)16.1(d)-262.2(g)14.5(a)0(t)19(h)0(e)15.7(r)0(i)21.1(n)0(g)-254.4(i)0(n)18.4(f)12.2(or)15.5(ma)21.9(t)12.2(i)0(o)19(n)-262.6(on)-259.1(S)14.2(O)0(G)17.2(I)-261.3(is)-251.4(cr)19(uc)18.3(ia)15.9(l)]TJ
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[(if)-206.3(i)15.4(n)0(d)18.9(i)0(v)14.7(i)0(d)25.1(u)0(a)18.1(l)-212.2(pr)23.2(ov)15.5(id)18.8(e)12.7(r)0(s)-204.3(a)13.1(re)-202.9(t)12.2(o)-211.4(pr)16.9(ov)21.8(id)18.8(e)-208.6(a)0(f)19()0(r)21.6(m)0(a)15.6(t)12.2(iv)21(e)-214.9(a)13.1(nd)-202.4(in)18.4(c)13.4(l)0(u)20.4(s)0(i)14.1(v)0(e)]TJ
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[(he)15.7(al)22.2(th)-364.3(ca)20.2(re)-367.3(t)12.2(o)-375.8(LG)23.5(BT)-366.4(pe)17.7(op)21.2(le)15.5(.)-369.6(K)0(n)19.1(o)0(w)20.9(l)0(e)15.5(d)0(g)24.2(e)-373(of)-363.6(a)-372.6(p)0(a)18.1(t)0(i)15(e)12.8(nt)15.1(s)-363.6(S)14.2(O)0(G)17.2(I)]TJ
T*
[(ca)13.9(n)-262.6(b)0(e)-250.9(e)0(s)17.8(s)0(e)17.8(n)0(t)15.1(i)15.4(al)-256(to)-256.2(un)20.5(de)16.1(rs)23.3(ta)19(nd)18.9(in)18.4(g)-263.7(a)-265.1(pa)18.1(t)12.2(i)0(e)15.5(n)0(t)21.4()0(s)-256.1(h)0(i)18.4(s)0(t)17.2(o)0(r)21.8(y)-263.7(a)13.1(n)0(d)-259.3(c)13.4(li)18.2(ni)18.4(-)]TJ
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[(ca)13.9(l)-186.9(c)0(a)13.9(r)0(e)-177.6(n)0(e)15.7(e)0(d)16.1(s)0(.)-181.3(T)0(h)18.9(e)12.7(se)-184.6(da)16.5(t)12.2(a)-195.5(a)13.1(l)0(l)18.2(o)0(w)-181.4(p)0(r)16.9(o)0(v)21.8(i)0(d)18.8(e)0(r)18.4(s)-191(to)-186.6(co)16.9(m)15.1(p)0(a)18.1(r)0(e)-184(c)0(a)20.2(r)0(e)-184(o)0(u)21.2(t)0(-)]TJ
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T*
[(an)16.1(d)-395(n)0(o)19.1(n)0(t)15.1(r)0(a)18.8(n)0(s)20.6(g)0(e)21(n)0(d)18.9(e)0(r)18.4(,)-394.9(or)-389.2(ci)16.2(sg)19.6(e)12.8(n)0(d)18.9(e)0(r)18.4(,)-394.9(pa)18.1(ti)21.3(en)15.7(t)12.2(s)0(.)-389.9(T)0(h)18.9(e)0(y)-390(a)13.1(ls)20.5(o)-401.1(a)13.1(ll)18.2(ow)]TJ
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0 -1.2203 TD
[(th)15.1(e)-499.4(s)0(t)23.5(a)0(n)16.1(d)0(a)22.8(r)0(d)-490.6(o)0(f)-490.1(c)13.4(ar)18.8(e)-499.4(f)12.2(or)-490.3(LG)23.5(BT)-492.9(pa)24.4(ti)15(e)12.7(n)0(t)15.1(s)0(.)-484.8(A)0(s)-489.6(E)0(H)22.3(R)-497.4(da)16.5(t)12.2(a)-499(a)13.1(r)0(e)]TJ
T*
[(sh)14.3(a)13.1(r)0(e)18.4(d)-540.4(t)12.2(h)0(r)14.9(o)0(u)21.2(g)0(h)-526.3(s)0(t)17.2(a)0(t)19(e)-537.3(He)19.1(al)15.9(t)12.2(h)-540.8(In)19.8(f)12.2(o)0(r)15.5(m)0(a)21.9(t)12.2(io)19(n)-540.8(E)0(x)20.1(c)0(h)16.3(a)13.1(ng)17.5(e)12.7(s)0(,)-529(t)0(h)15.1(e)12.8(se)]TJ
T*
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[(un)14.2(de)22.4(rs)17(t)12.2(a)0(n)16.1(d)-287.5(ca)20.2(re)-285.1(ut)17.1(i)15.4(l)0(i)18.2(z)0(a)19.9(t)0(i)15(o)0(n)-278(f)0(o)15.7(r)-285.2(LG)17.2(BT)-277.9(po)14.8(pu)22.6(la)15.9(t)12.2(i)0(o)19(n)0(s)14.3(.)]TJ
/F1 1 Tf
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[(Inclusion)-307.6(of)-298.6(SOGI)-298.4(in)-306.4(Meaningful)-301.5(Use)-296.2(Guidelines)]TJ
/F4 1 Tf
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[(The)-398.3(20)13.6(11)-397.4(IOM)13.1(s)-399.7(repo)14.2(rt)-399.5(on)-398.2(LGB)14.2(T)-401.3(heal)12.6(th)-395.9(rec)12.8(omm)14.7(end)12.7(s)-406(the)]TJ
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[(col)13.4(lect)15.8(ion)-408(of)-414.2(SOG)12.4(I)-413.1(dat)16(a)-416.8(i)0(n)-411.6(EHR)11.8(s)-418.6(a)0(s)-411.8(par)17.4(t)-417.8(o)0(f)-414.2(the)-408.4(mea)15.7(ning)16.9(ful)]TJ
T*
[(use)-350.3(obj)13.2(ect)13(ive)14.8(s)-355.4(for)-345.4(the)-351.5(Of)18.8(ce)-353.3(of)-351(the)-351.5(Na)13.2(tio)12.2(nal)-347.9(Coo)13.3(rdi)18.1(nato)12.8(r)-354.8(for)]TJ
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T*
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[(LGB)14.2(T)-350.8(p)0(e)11.4(opl)11.3(e.)]TJ
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(13)Tj
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(6)Tj
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[(Gat)13.9(heri)17.8(ng)-380.9(LGB)14.2(T)-388.7(dat)16(a)]TJ
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T*
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(14)Tj
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(2)Tj
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[(CAHILL)-301.5(AND)-299.3(MAKADON)]TJ
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T*
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T*
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T*
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(17)Tj
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[(Patients)-566.4(who)-564.2(disclose)-564.7(their)-564.4(sexual)-564.2(orientation)-570.5(identity)-562.5(to)]TJ
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[(health)-383.2(care)-385.1(providers)-380.7(may)-380.9(feel)-383.2(safer)-381.3(discussing)-382.9(their)-381(health)]TJ
T*
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(18)Tj
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[(A)-444(sample)-439.5(of)-439.5(New)-437.8(York)-442.1(City)]TJ
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T*
[(61%)-259.9(had)-265.1(not)-259.5(disclosed)-264.2(their)-260.9(same-sex)-261.4(orientation)-267(or)-262.7(behavior)]TJ
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[(to)-224.5(their)-216.6(medical)-221.3(providers.)-219.3(White)-221.3(MSM)-223.7(and)-214.6(native)-222.5(born)-219.9(MSM)]TJ
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[(were)-267.7(more)-260.2(likely)-259.6(to)-262.5(have)-262.8(disclosed)-264.2(than)-266(Black,)-259.3(Latino,)-262.2(Asian,)]TJ
T*
[(and)-271.5(immigrant)-263.6(MSM.)-270.9(Disclosure)-268(of)-268.8(same-sex)-267.7(behavior)-267.9(corre-)]TJ
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[(lated)-284.6(with)-280.9(having)-286.9(tested)-283.3(for)-282.1(HIV,)-279.7(an)-281.1(example)-282.1(of)-287.8(how)-279.7(discus-)]TJ
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[(sing)-215(sexual)-216.4(orientation)-216.4(can)-217.2(lead)-214.6(to)-211.9(addressing)-216.1(health)-218.8(concerns)]TJ
T*
[(that)-307.3(disproportionately)-307.4(affect)-303.6(gay)-299.2(and)-296.8(bisexual)-306.6(men.)]TJ
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(19)Tj
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[(The)-300.2(Challenges)]TJ
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[(In)-429.1(2012,)-430.9(the)-433.7(Center)-434.5(for)-433.9(Medicare)-434.6(and)-429.5(Medicaid)-434.2(Services)]TJ
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[(\(CMS\))-238.7(and)-239.8(the)-237.7(ONCHIT)-235.9(considered)-238.1(including)-240.4(SOGI)-236.3(data)-236.4(col-)]TJ
T*
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[(requested)-529.4(public)-525.6(comment)-525.7(on)-531(this)-520.9(issue.*)-529.5(ONCHIT)-526.8(is)-523.3(an)]TJ
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[(agency)-352.4(within)-351.1(the)-357.8(U.S.)-347.2(Department)-352.4(of)-351(Human)-355.9(Services)-351.6(that)]TJ
28.0042 62.9446 TD
[(is)-327.3(tasked)-331.1(with)-325.2(developing)-332.4()55()0(a)-330.2(nationwide)-331(health)-326.3(information)]TJ
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[(technology)-429(infrastructure)-430.5(that)-427.5(allows)-429.6(for)-421.3(the)-427.4(electronic)-430.1(use)]TJ
T*
[(and)-581.3(exchange)-587.3(of)-585(information.)53()]TJ
6.7246 0 0 5.9768 439.0865 708.2076 Tm
(20)Tj
8.9663 0 0 8.9663 451.0487 704.2392 Tm
[(The)-581.7(Health)-588.5(Information)]TJ
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[(ONCHIT)-362.4()55(on)-362.1(a)-366.2(policy)-362.7(framework)-361.7(for)-364.3(the)-364.2(development)-366.6(and)]TJ
T*
[(adoption)-370.9(of)-370(a)-366.2(nationwide)-375.2(health)-370.6(information)-378.5(infrastructure,)]TJ
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[(including)-208.8(standards)-214.5(for)-212.6(the)-206.1(exchange)-214.3(of)-211.9(patient)-211(medical)-215(infor-)]TJ
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[(mation.)-465.4(The)-461.5(American)-460.5(Recovery)-467.2(and)-461.1(Reinvestment)-470.1(Act)-462.7(of)]TJ
T*
[(2009)-377.4(provides)-380(that)-376.9(the)-383.1(Health)-379.8(IT)-378.2(Policy)-381.6(Committee)-381.7(shall)-378(at)]TJ
T*
[(least)-497.9(make)-500.9(recommendations)-501.9(on)-499.3(the)-503.3(areas)-494.1(in)-500.1(which)-504.4(stan-)]TJ
0 -1.2266 TD
[(dards,)-269.7(implementation)-282.4(specications,)-274.5(and)-271.5(certications)-276.4(crite-)]TJ
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[(ria)-300.9(are)-297.3(needed)-306.3(in)-297.8(eight)-302.6(specic)-304.8(areas.)51.2()]TJ
6.7246 0 0 5.9768 461.4802 609.562 Tm
(21)Tj
8.9663 0 0 8.9663 320.8251 594.6519 Tm
[(While)-395.1(many)-396.9(leading)-396.7(health)-402.2(care)-397.7(and)-397.9(LGBT)-399.8(groups)-397.6(com-)]TJ
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[(mented)-383.6(in)-386.3(support)-382.4(of)-382.6(collecting)-386.8(SOGI)-388.1(data)-381.9(in)-380(EHR,)]TJ
6.7246 0 0 5.9768 519.1369 587.6786 Tm
(22)Tj
8.9663 0 0 8.9663 529.2849 583.6534 Tm
(some)Tj
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[(opposed)-372.9(the)-376.8(collection)-378.9(of)-376.3(such)-372.1(data,)-372.1(arguing)-377.7(that)-376.9(collecting)]TJ
T*
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0 -1.2266 TD
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6.7246 0 0 5.9768 348.5479 554.7967 Tm
(23)Tj
8.9663 0 0 8.9663 358.3558 550.7715 Tm
[(Commenters)-338.9(questioned)-342.5(the)-338.9(clinical)-344.4(signicance)]TJ
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[(of)-420.6(collecting)-424.8(and)-423.2(recording)-422.4(SOGI)-426(data)-419.8(in)-424.2(the)-421.1(demographic)]TJ
T*
[(section)-219.3(of)-224.5(EHR,)-218.8(saying)-218.9(it)-225.3(would)-220.9(provide)-220.7(no)-221.1(additional)-218.3(clinical)]TJ
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[(benet.)-210(They)-206.7(also)-203.1(portrayed)-208.8(data)-204.8(collection)-214.5(and)-201.9(reporting)-213.2(as)-203.2(a)]TJ
0 -1.2203 TD
[(burden.)-470.9(In)-467.1(deciding)-469(not)-474.5(to)-464.8(include)-475.6(SOGI)-464(questions)-473.7(in)-468.5(the)]TJ
T*
[(Stage)-300(2)-303(meaningful)-301.6(use)-299.7(guidelines,)-305(CMS)-300.9(stated:)]TJ
1.3341 -2.2257 TD
[(Considering)-310.6(the)-307.3(lack)-303.9(of)-313.1(consensus)-311.2(for)-307.4(the)-307.3(denition)-313.8(of)]TJ
0 -1.2203 TD
[(the)-364.2(concept)-373.2(of)-370(gender)-365.4(identity)-372.8(and/or)-366.5(sexual)-368.2(orienta-)]TJ
T*
[(tion)-364.2(as)-361.2(well)-362.7(as)-361.2(for)-364.3(a)-359.9(standard)-365(measure)-367(of)-363.6(the)-364.2(concept)]TJ
0 -1.2266 TD
[(and)-379(where)-384.9(it)-383.4(would)-379(be)-383.7(most)-381.5(appropriate)-390.5(to)-376.3(store)-384.5(the)]TJ
0 -1.2203 TD
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[(da)-3.5(ta)-243.7(w)-16.6(i)9.9(t)-4.4(h)-1(in)-247.6(th)-16.6(e)-234.9(E)-.6(H)-3.9(R)-1.9(,)-247.1(w).7(e)-244.1(w)-16.6(i)9.9(l)-1.2(l)-247.8(a)2.9(w)-16.6(a)13.9(it)-251(fu)-16.6(r)13(t)-4.4(he)-3.9(r)-244.9(d)-.6(e)-3.8(v)-16.6(e)8.1(l)-1.2(opme)-3.9(nt)]TJ
T*
-.0152 Tc
[(of)-224.3(a)-217(c)-1.8(on)-15.2(s)11.7(e)-2.5(ns)-15.2(u)13.7(s)-225.2(fo)-15.2(r)-208.4(t)-3(he)-223.8(goal)-221.1(and)-220.5(s)2.5(tandar)-15.2(d)-208.6(o)1(f)-224.3(m)-.1(eas)-15.2(u)13.7(r)-15.2(e)15.8(ment)]TJ
T*
0 Tc
[(f)18.5(o)0(r)-376.5(g)14.6(e)19.1(n)0(d)25.2(e)19.1(r)-386.4(i)0(d)25.1(e)12.7(n)15.6(t)18.5(it)27.6(y)-390.1(a)19.5(nd)25.2(/)16(o)16.2(r)-386.4(s)0(e)30.4(x)0(u)28.1(a)13.1(l)-389.2(o)16.2(r)18.3(i)15.4(e)12.8(n)15.6(t)12.2(a)13.1(t)12.2(i)15.4(o)16.2(n)]TJ
/F8 1 Tf
19.8792 0 TD
(.)Tj
/F4 1 Tf
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-.0135 Tc
[([M)6.7(]any)]TJ
-20.8656 -1.2266 TD
0 Tc
[(c)19.7(o)0(m)25(m)15.1(e)19.1(n)0(t)27.8(e)12.7(rs)-210.7(r)18.3(a)13.1(i)15.4(s)0(e)30.4(d)-224.3(c)13.4(o)16.2(nc)28.9(e)12.8(r)0(n)27.5(s)-222.6(a)13.1(s)-222.6(t)12.2(o)-217.8(wh)26.6(e)12.8(t)18.5(he)28.3(r)-228.3(s)17.7(uc)31(h)-224.7(d)16(a)13.1(t)12.2(a)-220.8(c)13.4(o)16.2(l)15.4(-)]TJ
0 -1.2203 TD
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[(lection)-303.7(i)-.4(s)-301.6(n)-15.8(e)12.5(c)-2.4(ess)-15.8(a)8.7(ry)-304.7(fo)-15.8(r)-291.2(a)-2.7(ll)-297.5(E)-15.8(P)11.5(s)-301.6([)-3.6(Eligible)-306.6(Pr)-15.8(o)12.3(v)-15.8(i)11.5(d).2(ers)-15.8(])14(,)-303.2(e)-3(ligi-)]TJ
T*
0 Tc
[(b)14.6(l)15.4(e)-613.2(h)0(o)25.5(s)17.7(pi)26.7(t)12.2(a)19.5(l)15.4([)12.2(s])29.8(,)-616.2(a)13.1(n)15.6(d)-616.3([)12.2(r)0(u)29.6(r)0(a)31.4(l)-623.2(C)18.8(r)0(i)27.4(t)12.2(i)15.4(c)19.7(a)13.1(l)-616.9(Ac)30.9(c)13.4(e)12.8(ss)-603.3(H)12.7(o)16.2(sp)28.9(i)15.4(t)12.2(a)13.1(l)15.4(s)17.7(])]TJ
0 -1.2266 TD
[(r)18.3(e)12.7(g)14.5(a)13.1(r)18.3(d)16(l)15.4(e)12.7(ss)-274.5(o)16.2(f)-285(sp)28.9(e)12.7(c)13.4(i)15.4(a)19.5(lt)27.6(y)14.6(.)]TJ
6.7246 0 0 5.9768 409.8896 370.4881 Tm
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(24)Tj
8.9663 0 0 8.9663 320.8251 345.5432 Tm
0 Tc
[(As)-249.3(a)-258.7(r)0(e)18.4(s)0(u)16.3(l)0(t)21.3(,)-262.2(t)12.2(h)0(e)-256.2(g)14.6(at)19(he)15.7(ri)21.1(ng)-254.4(of)-249.8(SO)17.4(GI)-247.5(da)16.5(t)12.2(a)-265.1(wa)24.1(s)-260.5(n)0(o)12.8(t)-259.7(in)18.4(c)13.4(l)0(u)14.1(d)0(e)22.4(d)-262.2(in)]TJ
-1.1128 -1.2203 TD
[(t)12.2(h)0(e)-357.4(c)0(o)16.9(r)0(e)-361(d)16(em)15.2(og)18.1(ra)25.1(ph)14.2(ic)-356.9(se)17.8(c)13.4(t)0(i)15(o)0(n)-353.9(o)0(f)-357.3(E)0(H)16(R)-364.6(in)-361(St)20(ag)21.4(e)-366.6(2)-366.2(me)15.2(a)13.1(n)0(i)18.4(n)0(g)17.5(f)12.2(ul)]TJ
T*
[(us)22.6(e)-341.3(g)0(u)19.5(i)0(d)18.8(e)0(l)15.5(i)0(n)18.4(e)12.7(s,)-333(wh)20.3(ic)22.5(h)-344.8(w)0(i)20.1(l)0(l)-329.5(b)0(e)-333.1(i)0(m)24.2(p)0(l)14.1(e)12.7(me)15.2(nt)21.4(ed)-331.7(in)-329.4(20)20(14)19.9(.)]TJ
6.7246 0 0 5.9768 513.2975 327.6283 Tm
[(24)22(,)]TJ
/F10 1 Tf
1.214 0 TD
({)Tj
/F4 1 Tf
8.9663 0 0 8.9663 527.8676 323.6598 Tm
[(Th)18.9(er)18.4(e)]TJ
-24.2041 -1.2266 TD
[(is)-333.6(st)17.2(il)18.2(l)-345(t)12.2(he)-338.4(po)21.2(ss)16.3(i)15.4(b)0(i)17.3(l)0(i)18.2(t)12.2(y)-345.9(o)0(f)-338.4(i)0(n)18.4(c)13.4(lu)20.4(si)14.1(on)-334.9(of)-332(SO)17.4(GI)-336(qu)19.5(e)12.7(s)0(t)17.2(i)0(o)19(n)0(s)-339.8(i)15.4(n)-344.8(S)0(t)13.7(a)13.1(ge)]TJ
0 -1.2203 TD
[(3)-555.9(g)14.5(ui)20.4(de)16.1(li)18.2(ne)22(s,)-548(wh)20.3(ic)16.2(h)-553.5(O)0(N)22.3(C)0(H)18.8(I)0(T)-548.9(i)0(s)-542.3(c)0(o)16.9(n)0(s)20.6(i)0(d)18.8(e)0(r)18.4(i)0(n)18.4(g)-554.5(in)-544.4(2)13.1(0)0(1)19.9(3)0(.)-546.2(T)0(h)18.9(e)]TJ
T*
[(H)12.7(e)0(a)19.6(l)0(t)15(h)-186.7(In)19.8(fo)15.7(rm)20.7(a)13.1(t)0(i)15(o)0(n)-176.9(T)0(e)16.1(c)13.4(hn)18.5(ol)19(og)18.1(y)-187.8(P)0(o)14.8(l)0(i)18.2(c)13.4(y)-187.8(C)0(o)16(m)0(m)23.8(i)0(t)15(t)12.2(ee)-183.2(is)-175.6(re)18.4(vi)14.7(e)12.8(w)0(i)20.1(n)0(g)]TJ
0 -1.2267 TD
[(re)18.4(c)13.4(o)0(m)18.6(m)0(e)21.5(n)0(d)18.9(a)0(t)19(i)0(o)19(n)0(s)-270.3(f)12.2(or)-262.7(St)13.7(a)13.1(g)0(e)-263.5(3)-277.7(g)14.6(u)0(i)14.1(d)0(e)22.4(l)0(i)18.2(n)0(e)15.7(s)0(,)-263.5(a)13.1(nd)-265.6(wi)20.1(ll)-266.3(ma)21.9(ke)-263.6(a)-277.7(r)0(e)18.4(c)13.4(-)]TJ
0 -1.2203 TD
[(om)18.6(m)15.1(e)0(n)15.7(d)0(a)22.8(t)0(i)15(o)0(n)-195.8(t)12.2(o)-211.4(O)0(N)22.3(C)0(H)18.8(I)0(T)-194.8(i)0(n)-202.9(f)12.2(a)13.1(l)0(l)-196.8(2)0(0)20(1)0(3)19.9(.)-205.3(ON)15.9(C)12.5(H)0(I)16.9(T)-205.3(an)16.1(d)-205.3(C)12.5(MS)-199.6(wi)20.1(ll)]TJ
T*
[(t)12.2(h)0(e)15.7(n)-502.9(pu)22.6(bl)17.3(is)20.4(h)-502.9(d)0(r)21.6(a)0(f)19(t)-500(an)16.1(d)-502.5()0(n)18.9(a)13.1(l)-503(r)0(e)18.4(g)14.6(ul)14.1(a)13.1(t)0(i)21.3(o)0(n)12.8(s)0(.)]TJ
/F11 1 Tf
6.7246 0 0 5.9768 475.54 261.8645 Tm
({)Tj
/F4 1 Tf
8.9663 0 0 8.9663 483.3636 257.896 Tm
[(Th)18.9(es)17.8(e)-505.7(g)14.6(ui)20.4(de)16.1(li)18.2(ne)22(s)]TJ
-19.2406 -1.2203 TD
[(wo)20.9(ul)20.4(d)-293.8(b)14.5(e)-290.7(i)0(m)17.9(p)0(l)20.4(e)0(m)15.2(e)12.7(nt)15.1(e)12.7(d)-293.9(i)15.4(n)-294.2(2)13.1(0)0(1)19.9(6)-290.4(an)16.1(d)-287.5(b)0(e)21(y)0(o)18.1(n)0(d)18.9(.)]TJ
1.1128 -1.3088 TD
[(While)-363.5(some)-368.3(of)-363.6(the)-370.5(concerns)-370.4(expressed)-369.9(by)-362.9(commenters)-369.6(to)]TJ
-1.1128 -1.2203 TD
[(CMS)-237.7(during)-237.7(Stage)-236.7(2)-233.5(are)-240.4(valid,)-234.5(we)-235.5(believe)-239.5(that)-237.8(they)-235.8(are)-240.4(not)-234.2(in-)]TJ
0 -1.2266 TD
[(surmountable)-338.8(obstacles,)-337.9(but)-335(rather)-333.5(important)-338.6(issues)-337.5(to)-338.4(keep)]TJ
0 -1.2203 TD
[(in)-398.9(mind)-405.8(when)-400.3(implementing)-404.2(SOGI)-400.7(data)-407.2(collection.)-400.8(Clinical)]TJ
T*
[(staff)-318.4(and)-315.7(providers)-317.5(can)-312(be)-320.5(trained)-314(in)-316.7(how)-317.6(to)-313.1(ask)-315.1(these)-321.1(ques-)]TJ
T*
[(tions)-277(in)-278.8(sensitive)-286(and)-277.8(culturally)-283.3(appropriate)-283.1(ways)-278.8(to)-275.1(guaran-)]TJ
0 -1.2266 TD
[(tee)-253.2(privacy)-249.8(and)-252.5(condentiality)-257.8(and)-252.5(to)-256.2(explain)-253.6(to)-256.2(patients)-256.5(that)]TJ
0 -1.2203 TD
[(these)-359.1(data,)-359.5(like)-352.8(race/ethnicity)-362.2(and)-360(other)-361.3(demographic)-356.9(data,)]TJ
ET
q
1 i
59.754 148.309 m
298.885 148.309 l
298.885 57.543 l
59.754 57.543 l
W n
0 0 0 RG
1 J 1 j .227 w 10 M []0 d
q 1 0 0 1 59.754 148.309 cm 0 0 m
490.677 0 l
S
Q
Q
BT
7.9702 0 0 7.9702 67.748 138.274 Tm
[(*Meaningfu)10.7(l)-451.7(use)-450.7(is)-455.3(a)-453.2(set)-451.4(of)-452.9(standard)12.1(s)-451.8(created)-450.8(by)-446.7(the)-459(CMS)-445.5(that)]TJ
-1.003 -1.1239 TD
[(providers)-431.2(must)-440.1(meet)-434.9(in)-434.5(order)-433.8(to)-438.7(receive)-437.8(EHR)-433.2(incentiv)9.5(e)-442.5(payment)12.4(s)]TJ
0 -1.131 TD
[(from)-316.8(CMS.)-309.3(The)-312.1(goal)-309.7(of)-317.8(meaning)14.5(ful)-319.1(use)-308.4(guidelines)-313.8(is)-313.1(to)-310.7(promote)-308.2(the)]TJ
0 -1.1239 TD
[(transition)-310.6(to)-310.7(EHR)-305.1(to)-310.7(improve)-306.8(health)-308.1(care)-308.4(in)-306.4(the)-309.6(United)-304.8(States.)-310.5(Stage)]TJ
T*
[(1)-353.6(guidelines)-349.4(were)-342.7(rolled)-349.3(out)-350.7(in)-356.2(2011)-347.3(and)-351.3(2012)-347.3(and)-344.1(focused)-353.4(on)-352.3(data)]TJ
T*
[(capture)-678.3(and)-671.3(sharing.)-668.8(Stage)-675.3(2)-673.7(guidelines)-676.6(focuse)10(d)-676.4(o)0(n)-679.5(advanced)]TJ
T*
[(clinical)-742.7(processe)10.9(s)-743.4(and)-742.5(will)-742.5(be)-736.9(implemente)10.4(d)-747.5(i)0(n)-740.3(2014.)-737.5(Stage)-739.3(3)]TJ
T*
[(guidelines,)-327(currently)-329.8(under)-337.1(developmen)11.8(t)-332.4(and)-337(to)-332(be)-338.6(implement)11.9(ed)-336.4(in)]TJ
T*
[(2016,)-972.3(focus)-977.3(on)-971.2(improved)-969(health)-969.6(outcomes)-971.2(and)-970.1(improving)]TJ
0 -1.131 TD
[(population)-297.4(health.)]TJ
ET
q
1 i
310.847 148.309 m
549.921 148.309 l
549.921 57.543 l
310.847 57.543 l
W n
0 0 0 RG
1 J 1 j .227 w 10 M []0 d
q 1 0 0 1 310.847 148.309 cm 0 0 m
490.677 0 l
S
Q
Q
BT
/F10 1 Tf
5.9774 0 0 5.3127 318.7841 141.7889 Tm
({)Tj
/F4 1 Tf
7.9702 0 0 7.9702 321.7889 138.274 Tm
[(ONCHIT)-311.7(decided)-318.2(not)-314.8(to)-324.9(require)-317.9(a)-318(functionalit)9.2(y)-322.9(t)0(o)-317.8(collect)-320.1(data)-314.6(in)]TJ
-1.3728 -1.1239 TD
[(EHR)-433.2(as)-442.6(part)-433.5(of)-438.7(meaningful)-432.7(use)-436.4(because)-435.6(CMS)-431.3(had)-436.6(decided)-439.1(not)-435.8(to)]TJ
0 -1.131 TD
[(require)-794.5(SOGI)-792.7(data)-798.3(collectio)11.1(n)-800.8(i)0(n)-797.3(its)-802(Stage)-796.2(2)-801.7(meaning)14.5(ful)-802.8(use)]TJ
0 -1.1239 TD
[(guidelin)11.4(es.)-701.2(It)-696.5(is)-697.2(up)-691.9(to)-701.9(CMS)-694.5(to)-694.8(require)-694.9(SOGI)-693.1(data)-691.6(collection.)]TJ
T*
[(ONCHIT)-361.5(can)-368.9(require)-367.7(SOGI)-373(functio)9.3(nality)-372.8(in)-370.5(an)-372(EHRthe)-361.6(ability)-367.9(to)]TJ
T*
[(input)-334.9(and)-337(track)-336.3(SOGI)-337.5(databut)-330.1(not)-343.3(the)-338(SOGI)-337.5(data)-336(collecti)10.7(on)-345.2(itself.)]TJ
T*
[(Only)-296.5(CMS)-289(can)-297.7(do)-299(that.)]TJ
/F11 1 Tf
5.9774 0 0 5.3127 318.7841 79.0299 Tm
({)Tj
/F4 1 Tf
7.9702 0 0 7.9702 321.7889 75.5149 Tm
[(CMS)-232.1(could)-239.9(say,)-231(again,)-232.9(that)-240.1(it)-243.5(will)-230.3(not)-243.7(require)-232.5(SOGI)-230.8(data)-236.4(collection)]TJ
-1.3728 -1.1239 TD
[(in)-228.2(the)-231.3(Stage)-227.2(3)-225.5(guidelines.)-227.4(ONCHIT)-219.2(could)-225.7(still)-232.9(require)-225.4(EHRs)-223.5(to)-232.4(be)-231.9(able)]TJ
0 -1.131 TD
[(to)-296.4(track)-293.6(SOGI)-294.8(data)-300.4(in)-299.3(order)-291.6(to)-303.6(be)-295.9(certied)-293.5(for)-295.6(meaningful)-290.4(use.)]TJ
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[(with)-420(efforts)-417.1(to)-420.5(gather)-413.1(data)-419.8(that)-414.8(can)-419.5(be)-415.3(useful,)-415.5(pooled,)-420.9(and)]TJ
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[(compared)-307.6(to)-300.4(understand)-300.6(trends)-305.9(in)-304.1(population)-304.6(health.)]TJ
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[(Ideally,)-429.9(patients)-427.2(would)-429.6(be)-421.6(asked)-425.5(about)-432.2(their)-425.3(sexual)-431.4(and)]TJ
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[(gender)-504.5(identity)-505.6(on)-499.3(intake)-504.4(forms.)-505.3(Questions)-504(should)-502.2(be)-503.8(in-)]TJ
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[(tions)-213.8(about)-210.9(race,)-211(sex,)-208.6(and)-208.2(date)-205.2(of)-211.9(birth.)-211.4(Patients)-212.3(should)-211.4(also)-209.5(be)]TJ
T*
[(assured)-247.4(that)-244.1(this)-242.6(information)-245.7(will)-246.2(be)-238.3(kept)-246.4(condential)-243.1(and)-239.9(al-)]TJ
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[(lows)-224.2(health-care)-231.4(providers)-222.7(to)-224.5(provide)-220.7(them)-228.9(with)-224(the)-218.7(most)-223.4(rel-)]TJ
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[(evant)-522.5(prevention)-528.3(information)-523.9(and)-524.4(screen)-523(them)-519.8(for)-522.4(health)]TJ
T*
[(conditions)-308(disproportionately)-307.4(affecting)-302.3(members)-304.9(of)-300.4(their)-298.8(de-)]TJ
T*
[(mographic)-417.2(group.)-411.9(Examples)-413(of)-407.9(such)-410(health)-414.9(conditions)-415.5(that)]TJ
0 -1.2266 TD
[(correlate)-322.9(with)-312.5(race,)-318.5(culture,)-319.3(sex,)-316.1(or)-313.3(sexual)-317.6(orientation)-317.6(can)-312(be)]TJ
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[(given,)-299.4(such)-289.9(as)-298(sickle)-290.2(cell)-297.1(anemia,)-290.9(Taysachs)-298.2(disease,)-289.6(or)-294.3(cervi-)]TJ
T*
[(cal)-305.8(cancer.)]TJ
1.1128 -1.2266 TD
[(Community-based)-329.7(groups)-328.1(and)-328.4(public)-323.3(health)-326.3(departments)]TJ
-1.1128 -1.2203 TD
[(should)-382.1(educate)-382.8(LGBT)-380.8(patients)-383(about)-381.6(why)-382.5(its)-380.2(a)-378.9(good)-379.7(thing)]TJ
T*
[(to)-325.7(discuss)-327.3(ones)-325.4(sexual)-330.2(orientation)-330.3(or)-319.6(gender)-327.4(identity)-328.5(with)-325.2(a)]TJ
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[(provider,)-407.6(and)-410.6(how)-406.1(such)-403.7(data)-407.2(will)-404.2(assist)-405.8(efforts)-410.8(to)-401.6(improve)]TJ
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[(quality)-371.3(care)-366.1(and)-366.3(reduce)-370.9(disparities.)-368.8(Some)-371.8(LGBT)-368.2(groups)-366(en-)]TJ
T*
[(couraged)-580(cohabiting)-581.1(same-sex)-583.8(couples)-578.6(to)-578.6(self-identify)-587.1(on)]TJ
T*
[(the)-389.5(U.S.)-391.4(Census)-386.8(in)-386.3(2000.)-386.7(While)-388.7(many)-384.3(were)-387.8(concerned)-391(with)]TJ
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[(giving)-450(such)-447.9(information)-454.4(to)-445.8(a)-442.1(government)-449.5(that)-452.8(had)-442.2(passed)]TJ
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[(several)-321.7(antigay)-312.4(laws)-315.8(and)-309.4(policies,)-321.6(advocates)-316.3(argued)-312.4(that)-313.7(the)]TJ
T*
[(benets)-467.6(of)-464.8(being)-470.9()55(out)54.9()-463.5(outweighed)-469.3(the)-465.3(risks)-466.5(and)-461.2(stressed)]TJ
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[(the)-560.2(condentiality)-561.3(protections)-559.7(in)-557(place.)-556.6(As)-559.1(a)-555.9(result,)-554(four)]TJ
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[(times)-331.6(as)-323.3(many)-327.4(same-sex)-330.9(couples)-325.7(self-identied)-335.2(in)-329.4(2000)-320.5(as)-329.6(in)]TJ
T*
[(1990,)-595.3(the)-591.8(rst)-593.5(time)-595.8(same-sex)-590.2(couples)-597.5(could)-591.7(self-identify.)]TJ
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[(Same-sex)-429.3(couples)-420.5(were)-425.8(found)-422(to)-426.9(live)-418.7(in)-424.2(more)-424.6(than)-424.1(99%)-418(of)]TJ
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[(U.S.)-423(counties.)]TJ
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(29)Tj
8.9663 0 0 8.9663 378.255 145.3039 Tm
[(This)-422.2(was)-426.1(helpful)-424.5(in)-417.9(quantifying)-427.2(the)-421.1(demo-)]TJ
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[(graphic)-322(impact)-324.2(of)-319.4(pro-)-321.4(and)-322(anti-gay)-325.5(family)-318.9(recognition)-321.3(poli-)]TJ
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[(cies,)-304.1(which)-302.1(proliferated)-306.7(in)-297.8(the)-307.3(mid-2000s.)]TJ
6.7246 0 0 5.9768 476.0503 127.3889 Tm
(30)Tj
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[(Inevitably,)-303.2(some)-298.7(LGBT)-298.6(people)-299.7(will)-303.1(refuse)-300.8(to)-300.4(disclose)-299.2(their)]TJ
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[(SOGI)-350.2(in)-342(clinical)-344.4(settings.)-346.5(This)-346.4(is)-346.3(also)-342.2(certainly)-343.5(the)-345.2(case)-347.8(with)]TJ
T*
[(population-level)-477.1(surveys)-471.3(that)-471.7(ask)-466.8(these)-472.9(questions,)-470.3(such)-473.2(as)]TJ
0 -1.2266 TD
[(the)-263(Massachusetts)-260.9(BRFSS.)-258.1(Some)-258(same-sex)-261.4(cohabiting)-258.7(couples)]TJ
0 -1.2203 TD
[(dont)-460.4(disclose)-457.2(their)-456.9(relationship)-459.7(status)-459.7(to)-458.5(the)-459(U.S.)-454.6(Census.)]TJ
T*
[(While)-597.4(the)-598.1(data)-596.9(gathered)-599.3(by)-596.9(BRFSS)-596.6(and)-593.9(the)-598.1(Census)-601.8(are)]TJ
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(4)Tj
43.0401 0 TD
[(CAHILL)-301.5(AND)-299.3(MAKADON)]TJ
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[(sets)-281.2(that)-282(help)-280.1(us)-280.9(better)-284.1(understand)-281.6(LGBT)-279.6(health)-282.1(and)-277.8(demog-)]TJ
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[(raphy.)-296.8(Providers)-304.9(should)-293.6(make)-298.6(sure)-294.1(that)-301(patients)-300.8(understand)]TJ
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[(that)-440.1(they)-431.8(can)-432.1(refuse)-439.9(to)-433.2(disclose)-438.3(the)-433.7(information)-435.4(requested,)]TJ
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[(even)-395.9(as)-399.2(they)-393.9(explain)-399.1(how)-393.5(a)-391.5(providers)-401.6(knowledge)-396(of)-395.3(a)-397.8(pa-)]TJ
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[(tients)-320.8(SOGI)-318.5(can)-318.3(improve)-322.7(quality)-314.4(of)-319.4(care.)-318.5(Some)-314.9(patients)-319.8(will)]TJ
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[(cord,)-305.9(and)-296.8(providers)-304.9(should)-306.2(respect)-300.1(these)-302.1(requests.)]TJ
1.1128 -1.2203 TD
[(A)-298.6(rst)-296.3(challenge)-301.4(of)-300.4(entering)-300.2(information)-302.6(into)-301(an)-300.1(EHR)-298.1(will)]TJ
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[(other)-443.5(men;)-440(lesbians)-446.9(are)-436.4(women)-441.5(attracted)-445.9(to)-439.5(other)-443.5(women.)]TJ
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[(Half)-300.7(a)-296.7(dozen)-305.8(national)-300.6(and)-296.8(state)-298.8(surveys)-300.6(that)-301(measure)-303.7(sexual)]TJ
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[(than)-329.2(men)-323.3(to)-325.7(self-identify)-334.2(as)-323.3(bisexual.)]TJ
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(31)Tj
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[(Technically)-326.3(men)-323.3(and)]TJ
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[(women)-251.8(attracted)-249.9(to)-249.8(the)-250.3(same)-244.9(sex)-250(are)-246.7(homosexuals.)-252.5(However,)]TJ
T*
[(many)-251.5(prefer)-255.9(other)-253.8(labels.)-255.4(Same-sex)-252.2(behavior)-255.2(does)-247.3(not)-253.2(always)]TJ
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[(match)-360.6(an)-350.7(individuals)-363.4(sexual)-355.5(identity.)-356.7(For)-355.7(example,)-354.6(9.4%)-357.7(of)]TJ
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[(men)-418.2(in)-411.6(a)-410.5(2006)-415.4(New)-412.5(York)-416.8(City)-413.3(study)-408.9(identied)-418.1(themselves)]TJ
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[(Attraction,)-406.9(behavior,)-403.6(and)-404.2(identity)-404.4(are)-398.5(three)-409(as-)]TJ
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[(pects)-432.3(of)-426.9(sexual)-431.4(orientation)-431.4(that)-433.8(do)-429.4(not)-430.3(always)-427.2(correspond.)]TJ
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[(We)-378.3(believe)-378.6(that)-383.2(questions)-378.9(about)-381.6(behavior)-375.4(\(with)-382.5(whom)-378.4(you)]TJ
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[(or)-319.6(heterosexual\),)-321.8(and)-322(attraction)-319.9(\(to)-319.9(whom)-315.2(you)-318.4(are)-322.6(attracted\))]TJ
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T*
[(tance)-609.5(of)-603.9(these)-612(three)-605(aspects)-610.1(of)-603.9(sexual)-608.4(orientation)-608.5(varies)]TJ
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[(depending)-394.9(on)-385.5(context.)-390.7(For)-387.3(example,)-386.2(in)-386.3(the)-389.5(case)-385.7(of)-388.9(sexually)]TJ
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[(transmitted)-250.6(infections,)-242.3(sexual)-241.7(behavior)-242.6(is)-245.1(usually)-242.6(paramount.)]TJ
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[(Many)-689(transgender)-693.2(people)-691.7(identify)-695.3(as)-690(heterosexual,)-694.4(and)]TJ
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[(LGBT)-513.6(patients)-515.8(may)-513.7(be)-516.5(hesitant)-517.8(to)-515.4(disclose)-514.2(information)]TJ
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[(about)-583.9(their)-583.4(sexual)-583.2(orientation)-589.5(or)-585.2(gender)-580.4(identity)-587.8(due)-579.6(to)]TJ
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[(exacerbated)-255.3(by)-242.8(both)-251.3(the)-244(increasing)-252.9(computerization)-250.1(of)-249.8(health)]TJ
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(36)Tj
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(37)Tj
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[(A)-393.9(201)-13.1(2)]TJ
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[(HH)19(S)-352.6(r)0(e)24.7(g)0(u)19.5(l)0(a)22.3(t)12.2(io)19(n)-351.1()0(n)18.9(a)13.1(li)24.5(ze)19.6(d)-350.8(i)0(n)-342(J)12.2(a)13.1(n)0(u)20.6(a)0(r)18.8(y)14.6(,)-350.7(2)0(0)19.9(1)13.1(3)-353.6(m)15.1(an)16.1(d)16(a)0(t)19(e)12.8(s)-355.4()67.7(a)23.9(pp)16.3(ro)21.8(-)]TJ
28.0042 74.5535 TD
[(pr)23.2(ia)22.3(t)12.2(e)-410.9(se)17.8(c)13.4(u)0(r)16.9(i)15.4(ty)-403.2(a)13.1(n)0(d)-398.4(p)0(r)23.2(i)0(v)21(a)0(c)20.2(y)-409.1(pr)23.2(ot)22.1(ec)19.8(ti)21.3(on)19.1(s)79()-412.9(f)12.2(or)-401.8(a)13.1(n)0(y)-399.8()67.7(p)15.7(e)12.7(r)0(s)23.3(o)0(n)19.1(a)13.1(ll)18.2(y)]TJ
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[(i)15.4(d)0(e)16.1(n)15.6(ti)21.3(a)16.5(b)14.5(l)0(e)-363.8(i)0(n)18.4(f)12.2(or)21.8(ma)21.9(t)12.2(i)0(o)19(n)0(,)19()67.7()-374.9(i)0(n)18.4(c)13.4(lu)20.4(di)18.8(n)15.6(g)-377.5(se)24.1(ns)20.6(it)21.3(iv)21(e)-379.3(h)0(e)22(a)13.1(lt)21.3(h)-376.4(i)0(n)18.4(f)12.2(or)21.8(ma)21.9(-)]TJ
T*
[(t)12.2(i)0(o)19(n)-237.3(th)21.4(at)-233.9(i)15.4(s)-241.6(co)23.2(ll)18.2(e)12.7(c)0(t)19.2(e)12.7(d)-243.3(a)13.1(nd)-227.7(us)16.3(e)12.7(d)-236.9(in)-234.5(t)12.2(h)0(e)-230.9(p)0(r)23.2(o)0(v)21.8(i)0(s)20.5(i)0(o)19(n)-237.3(of)-230.9(he)22(al)22.2(th)-231.5(ca)20.2(re)24.7(.)]TJ
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(38)Tj
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[(Another)-264.9(concern)-267.9(that)-263.1(some)-267.1(LGBT)-260.7(advocates)-265.8(have)-262.8(raised)-267.2(is)]TJ
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[(whether)-376.1(self-disclosure)-376.5(may)-374.5(open)-374.1(LGBT)-368.2(patients)-376.7(up)-375.8(to)-370(dis-)]TJ
T*
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T*
[(tients)-470.6(and)-467.5(providers)-469.3(that)-465.4(prejudicial)-469.6(treatment)-470.3(occurs)-472.6(and)]TJ
T*
[(anti-LGBT)-457.7(attitudes)-459(are)-461.7(widespread.)]TJ
6.7246 0 0 5.9768 459.0991 631.5022 Tm
(39,40)Tj
8.9663 0 0 8.9663 478.318 627.5337 Tm
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[(insensitive)-375.1(treatment)-381.7(by)-369.2(clinical)-376(staff)-375.3(may)-374.5(also)-373.9(occur.)-379.4(As)-369.4(of)]TJ
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[(early)-355.8(2013,)-348.7(21)-353.1(states)-357.1(and)-353.7(the)-357.8(District)-358.5(of)-351(Columbia)-354.3(outlawed)]TJ
T*
[(discrimination)-284.8(on)-284.4(the)-282(basis)-282(of)-281.4(sexual)-279.7(orientation,)-288.9(as)-279(did)-281.4(hun-)]TJ
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[(dreds)-418.9(of)-426.9(municipalities.)-423.1(Sixteen)-425.1(of)-420.6(these)-428.6(states)-420.3(also)-424.4(outlaw)]TJ
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[(discrimination)-385.9(on)-379.2(the)-383.1(basis)-383.1(of)-382.6(gender)-378(identity.)]TJ
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(41)Tj
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[(More)-381.5(than)]TJ
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[(a)-397.9(sexual)-399.8(orientation)-399.8(nondiscrimination)-408.1(law,)-399.6(and)-397.9(more)-399.3(than)]TJ
0 -1.2203 TD
[(a)-208.2(third)-219.7(lives)-211.3(in)-215.6(a)-214.5(state)-210.3(or)-218.5(municipality)-211.2(with)-217.7(a)-214.5(transgender)-212.7(non-)]TJ
T*
[(discrimination)-240.5(law.)-241.5(While)-243.3(most)-236.1(of)-243.5(these)-238.9(laws)-239.9(cover)-243.7(public)-241.1(ac-)]TJ
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[(commodations,)-371(including)-379.5(health-care)-376.8(access,)-370.3(not)-373.4(all)-373.3(do.)-369.1(For)]TJ
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T*
[(law)-396.7(protects)-398.3(against)-397.8(discrimination)-398.6(in)-398.9(access)-392.6(to)-401.6(health)-395.9(care)]TJ
T*
[(and)-385.3(homeless)-389.1(shelters.)-386.5(Massachusetts)-389.2(gender)-390.7(identity)-385.4(non-)]TJ
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[(discrimination)-468.1(law)-466.2(does)-468.6(not.)-471.1(In)-467.1(much)-463.2(of)-471.1(the)-465.3(country)-474(it)-465.6(is)]TJ
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[(still)-322.2(legal)-320.7(to)-319.4(deny)-320.5(a)-315.7(person)-325.6(a)-322(job,)-318.6(promotion,)-321.7(housing,)-326.6(or)-319.6(ac-)]TJ
T*
[(cess)-229.4(to)-224.5(a)-233.5(public)-228.5(accommodation,)-229.3(such)-226.6(as)-228.5(a)-227.1(health-care)-237.7(facility,)]TJ
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[(due)-307.8(to)-313.1(real)-307.1(or)-307(perceived)-311.8(SOGI.)-315.1(The)-309.8(Joint)-307.8(Commissions)-314.3(2010)]TJ
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[(requirement)-264.7(that)-269.4(hospitals)-263.8(adopt)-266.4(an)-262.1(SOGI)-268(nondiscrimination)]TJ
T*
[(policy)-343.7(is)-340(an)-344.3(important)-344.9(step)-344.5(toward)-343.2(reducing)-344.4(anti-LGBT)-343.9(dis-)]TJ
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[(crimination)-232.7(in)-228.2(healthcare.)]TJ
6.7246 0 0 5.9768 410.5133 412.3275 Tm
[(11\()-10.1(p61\))]TJ
8.9663 0 0 8.9663 434.381 408.3022 Tm
[(This)-232.5(will)-227.2(have)-231.2(to)-224.5(be)-231.9(accompa-)]TJ
-13.7776 -1.2203 TD
[(nied)-300.7(by)-299.7(processes)-305(to)-300.4(adjudicate)-305.4(patient)-299.5(concerns.)]TJ
1.1128 -1.2203 TD
[(The)-233.9(ACA)-230.6(and)-233.5(regulations)-235.9(adopted)-237.6(as)-234.8(part)-229.7(of)-237.2(its)-232.9(implemen-)]TJ
-1.1128 -1.2266 TD
[(tation)-528.6(include)-526.1(some)-526.3(new)-529.7(protections)-528.1(for)-528.7(LGBT)-526.2(people)-527.3(in)]TJ
0 -1.2203 TD
[(health)-446.5(care.)-444.9(ACA)-439.2(Section)-450.4(1557)-440.7(prohibits)-445.1(discrimination)-449.2(on)]TJ
T*
[(the)-484.3(basis)-484.3(of)-490.1(existing)-486.6(civil)-484.8(rights)-488(law)-485.2(by)-483.1(any)-487.9(entity)-486.4(taking)]TJ
T*
[(money)-400.1(from)-406.2(the)-402.1(U.S.)-404.1(government.)-408.2(This)-403.3(would)-398(include)-406(any)]TJ
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[(hospital)-338.3(receiving)-337.9(Medicaid)-339.3(or)-332.3(Medicare)-339.7(funding,)-338.6(for)-339.1(exam-)]TJ
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[(ple.)-298.6(Section)-298.7(1557)-295.2(explicitly)-299.9(refers)-300.2(to)-300.4(Title)-295(IX)-297.2(of)-300.4(the)-294.6(Education)]TJ
T*
[(Amendments)-260.8(of)-256.2(1972.)-253.9(Title)-257(IX,)-255.9(often)-259.9(used)-258.5(to)-256.2(protect)-264.2(girls)-253.8(and)]TJ
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[(women)-422.6(from)-425.1(sex)-420.7(discrimination)-430.2(in)-424.2(school)-424.1(sports,)-428.2(has)-421.5(been)]TJ
0 -1.2203 TD
[(interpreted)-304.2(by)-293.4(the)-300.9(courts)-303.1(and)-296.8(the)-300.9(U.S.)-302.9(Department)-301.8(of)-300.4(Health)]TJ
T*
[(and)-239.8(Human)-242.1(Services)-244.1(to)-243.5(also)-241.1(cover)-243.7(gender)-238.9(identity)-246.3(and,)-236.5(there-)]TJ
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[(fore,)-247(transgender)-250.6(people.)]TJ
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(42)Tj
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[(A)-241.7(2012)-244.6(federal)-247.3(regulation)-247.2(outlaws)]TJ
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[(SOGI)-299.6(discrimination)-303.7(by)-299.7(insurers)-303.1(whose)-306.2(products)-301.1(are)-303.6(offered)]TJ
T*
[(on)-290.7(state)-286.2(health)-294.7(insurance)-290.6(marketplaces.)-294.9(This)-289.4(protects)-290.8(against)]TJ
T*
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[(health)-465.4(care.)-457.6(Most)-464.9(Americansabout)-469.4(55%have)-458.5(insurance)]TJ
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[(that)-326.3(is)-327.3(large)-330.5(group)-326.7(coverage)-329.7(offered)-329.7(by)-331.3(their)-324.1(employer.)-329.2(This)]TJ
T*
[(insurance)-379.1(is)-384.2(regulated)-379.5(by)-375.6(the)-383.1(Employee)-379.2(Retirement)-383.1(Income)]TJ
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[(Security)-381.2(Act,)-377.1(which)-377.9(does)-373.7(not)-379.7(prohibit)-380.6(SOGI)-375.5(discrimination.)]TJ
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[(However,)-229.8(many)-232.5(of)-230.9(these)-232.6(employers)-232.8(do)-233.4(prohibit)-228.8(such)-233(discrim-)]TJ
T*
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(x)Tj
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[(A)-304.9(federal)-310.5(regulation)-310.4(published)-306.3(in)-310.4(late)-306.9(2012)-307.9(calls)-310.7(for)]TJ
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(43)Tj
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T*
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T*
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T*
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[(ha)22.4(s)-380.7(b)14.6(ee)19.2(n)-382.8(n)15.6(eg)21(le)21.9(c)13.4(t)12.2(e)12.8(d)-382.4(in)-373.6(m)15.1(e)12.8(di)25.1(ca)20.2(l)-382.9(e)12.8(d)16(u)0(c)18.3(a)13.1(t)12.2(i)0(o)25.3(n)0(,)-373(a)-378.9(f)12.2(a)13.1(ct)-372.8(t)12.2(h)0(a)22.4(t)-379.8(wa)24.2(s)-380.7(r)0(e)18.4(-)]TJ
0 -1.2203 TD
[(c)13.4(e)0(n)22(t)12.2(ly)-311.4(c)13.4(o)0(n)25.5()0(r)21.6(m)0(e)21.5(d)-319.1(b)14.6(y)-320.6(a)-315.7(s)0(t)17.2(u)0(d)27.3(y)-320.6(of)-306.7(me)21.5(d)16(i)0(c)22.5(a)0(l)-306.5(s)0(c)18.4(h)15.6(oo)19.7(l)-319.7(c)13.4(ur)23.2(ri)21.1(c)13.4(u)0(l)20.4(a)-315.7(pu)22.6(b)14.6(-)]TJ
T*
[(li)24.6(sh)20.6(e)12.7(d)-293.9(in)]TJ
/F9 1 Tf
3.9961 0 TD
[(Th)22.8(e)-297.9(J)12.2(o)13.4(u)0(r)20.2(n)14.6(a)13.4(l)-299.1(o)13.4(f)-299.1(t)12.2(h)13.1(e)-297.9(A)16.2(me)23.2(ri)22.7(ca)21(n)-295.3(M)13.9(ed)18.8(ic)24.7(a)13.4(l)-299.1(A)16.2(s)0(s)17.6(o)13.4(c)14(i)0(a)24.1(t)0(i)16.6(o)13.4(n)]TJ
/F4 1 Tf
19.4746 0 TD
.2938 Tc
[(,w)293.8(h)314.1(i)293.8(c)316.3(h)]TJ
-23.4706 -1.2266 TD
0 Tc
[(sh)20.6(ow)27.2(ed)-293.8(th)21.4(a)13.1(t)-310.3(si)26.8(gn)23.8(i)18.8(c)13.4(a)13.1(nt)-294.7(nu)20.5(m)15.1(b)14.6(er)18.4(s)-304.8(o)0(f)-294.1(a)13.1(c)13.4(a)13.1(de)22.4(mi)24.2(c)-309.1(m)15.1(e)12.7(d)0(i)18.8(c)13.4(a)13.1(l)-307(c)13.4(e)12.7(nt)21.4(e)12.7(r)0(s)]TJ
0 -1.2203 TD
[(ha)22.4(ve)-354.7(no)-360.2(t)12.2(e)12.8(a)13.1(c)0(h)22.6(i)0(n)18.4(g)-364.8(on)-360.2(L)16(G)0(B)23.5(T)-369.7(i)15.4(s)0(s)22.7(u)0(e)17.7(s)0(,)-352(p)0(a)24.4(r)0(t)17.8(i)15.4(cu)18.3(l)15.4(a)13.1(rl)21.1(y)-364.8(i)0(n)-361(t)12.2(he)-357.4(c)13.4(l)0(i)24.6(n)0(i)18.4(c)13.4(a)13.1(l)]TJ
T*
-.0171 Tc
[(ye)-17.1(ar)-17.1(s)6.2(.)]TJ
6.7246 0 0 5.9768 84.4724 642.4439 Tm
-.0195 Tc
(44)Tj
8.9663 0 0 8.9663 95.9811 638.4754 Tm
0 Tc
[(Pe)24(rh)21.2(a)13.1(p)0(s)-540.1(r)0(e)24.7(l)15.4(at)19(e)12.8(d)-546.8(t)12.2(o)-546.5(ga)21.4(ps)-533.8(in)-538(t)12.2(h)0(e)22(i)0(r)-535.4(e)12.8(du)20.9(c)13.4(a)0(t)19(i)15.4(on)19.1(,)-546.7(m)15.1(a)13.1(n)0(y)]TJ
-3.7874 -1.2203 TD
[(he)22(a)13.1(l)0(t)21.3(h)0(-)21.4(c)13.4(a)13.1(r)0(e)-550.7(p)0(r)23.2(o)16.2(vi)21(de)22.4(rs)-545.8(a)13.1(r)0(e)-544.4(u)0(n)20.6(c)13.4(om)18.6(f)12.2(o)0(r)21.8(t)12.2(a)13.1(b)14.6(le)-547.2(pr)23.2(ov)21.8(id)25.1(in)18.4(g)-554.5(c)13.4(a)13.1(r)0(e)-550.7(t)12.2(o)]TJ
0 -1.2266 TD
[(LG)23.5(BT)-404.3(pe)24(op)21.2(l)15.4(e)0(.)-407.5(A)0(l)26.7(t)12.2(ho)19.1(ug)25.8(h)-414.4(a)0(n)22.4(t)12.2(i-)21.3(ga)21.4(y)-415.4(a)13.1(t)12.2(t)12.2(i)0(t)21.3(u)0(d)20.9(e)12.8(s)-412.3(a)13.1(mo)18.6(n)15.6(g)-415.4(pr)23.2(ov)21.8(id)25.1(e)12.7(r)0(s)]TJ
0 -1.2203 TD
[(a)13.1(p)0(p)22.6(e)12.8(ar)-411.2(t)12.2(o)-420.1(ha)22.4(ve)-411.6(de)22.4(c)13.4(l)0(i)24.5(n)0(e)22(d)-420.3(si)20.4(g)14.6(n)0(i)24.7()0(c)23(a)13.1(nt)21.4(ly)-412.6(o)16.2(v)0(e)18.3(r)-418(t)12.2(h)0(e)-414.3(p)0(a)24.4(s)0(t)-406.4(t)12.2(wo)-409.1(de)22.4(-)]TJ
T*
[(c)13.4(a)0(d)22.8(e)12.7(s,)-383.6(a)-391.5(2)13.1(00)19.9(7)-391.5(s)0(t)23.5(u)0(d)20.9(y)-390.1(f)12.2(o)0(u)21.2(n)0(d)-379.4(t)12.2(ha)22.4(t)-398.8(1)13.1(8)13.1(%)-393.6(o)16.2(f)-398.8(d)16(o)0(c)23.2(t)12.2(or)21.8(s)-393.3(i)0(n)-386.3(C)12.5(a)13.1(l)15.4(if)21.3(or)21.8(ni)24.7(a)]TJ
0 -1.2267 TD
[(a)13.1(r)0(e)-329.4()67.7(s)22.1(om)25(e)12.7(t)0(i)21.3(m)0(e)21.5(s)0()79()-337(or)-325.9()61.3()17.1(of)22.1(te)18.6(n)15.6()61.3()-337(u)0(n)20.6(c)13.4(om)25(f)12.2(o)0(r)21.8(t)12.2(a)13.1(b)0(l)23.7(e)-341.3(c)13.4(a)13.1(ri)21.1(ng)-324(fo)22.1(r)-342.1(g)14.6(a)13.1(y)-339.5(pa)24.4(-)]TJ
0 -1.2203 TD
-.0122 Tc
[(ti)-12.2(e)9.7(n)-12.2(t)9.2(s)-12.2(.)]TJ
6.7246 0 0 5.9768 84.9259 576.6802 Tm
-.0195 Tc
(40)Tj
8.9663 0 0 8.9663 95.074 572.7117 Tm
0 Tc
[(If)-382(cl)22.5(in)18.4(i)15.4(c)13.4(ia)22.2(ns)-384.1(ar)18.8(e)-391.9(t)12.2(o)-401.1(m)15.1(a)13.1(k)0(e)-383.7(a)-397.9(di)25.1(f)12.2(f)0(e)18.6(r)0(e)24.7(n)0(c)22.6(e)12.7(,)-394.9(i)0(n)-386.3(a)13.1(dd)19.3(i)15.4(t)12.2(io)19(n)-395.4(t)12.2(o)]TJ
-3.6863 -1.2203 TD
[(mo)25(re)-367.3(da)22.8(t)12.2(a)-378.9(o)16.2(n)-376.4(th)21.4(e)-379.3(n)0(e)22(e)12.8(ds)-364.7(of)-370(L)16(G)0(B)23.5(T)-376.1(pa)24.4(ti)21.3(e)12.8(n)0(t)21.4(s)0(,)-364.6(t)12.2(he)22(y)-377.5(w)0(i)20.1(l)15.4(l)-376.6(n)0(e)22(e)12.8(d)-382.4(t)12.2(o)]TJ
0 -1.2266 TD
[(ov)21.8(e)12.8(r)0(c)25.3(o)0(m)18.6(e)-372.9(t)12.2(h)0(e)22(i)0(r)-364.6(p)0(r)23.2(e)12.8(j)14(u)0(d)20.9(i)0(c)22.5(e)12.8(s)-374.4(a)13.1(s)-380.7(w)17.3(el)21.9(l)-376.6(a)13.1(s)-374.4(o)0(b)24.4(t)12.2(ai)22.3(n)-376.4(a)-372.6(gr)20.2(e)12.8(a)13.1(t)12.2(e)0(r)-367.3(u)0(n)26.9(d)0(e)22.4(r)0(-)]TJ
0 -1.2203 TD
[(st)23.5(a)13.1(n)0(d)18.9(i)15.4(ng)-450.4(of)-452.2(d)16(i)0(s)20.4(p)0(a)24.4(r)0(i)21.1(t)12.2(i)15.4(e)0(s)-450.1(f)0(a)19(c)13.4(e)12.8(d)-464.6(b)14.6(y)-459.7(LG)23.5(BT)-448.6(pa)24.4(t)12.2(i)0(e)21.9(n)0(t)21.4(s)-462.9(a)13.1(n)0(d)-449(r)0(e)24.7(c)13.4(ei)21.9(ve)]TJ
T*
[(mo)25(re)-323.1(e)12.7(d)0(u)20.9(c)13.4(a)13.1(t)0(i)21.3(o)0(n)-322.3(a)13.1(bo)24.4(ut)-324.3(ho)25.5(w)-336.7(t)12.2(o)-331.6(h)0(e)22(l)0(p)-321(t)12.2(he)22(m)-332.7(r)0(e)24.7(d)0(u)20.9(c)13.4(e)-335(r)0(i)21.1(s)0(k)25.9(,)-331.7(di)25.1(sp)22.6(la)22.3(y)]TJ
0 -1.2266 TD
[(re)24.7(si)20.4(li)24.6(e)12.8(n)0(c)22.6(e)-240.2(in)-228.2(t)12.2(h)0(e)-230.9(f)12.2(a)13.1(c)13.4(e)-240.2(o)0(f)-230.9(o)0(n)25.5(g)0(o)18.1(i)15.4(ng)-229.1(d)16(i)0(s)20.4(c)13.4(ri)21.1(m)15.1(i)0(n)18.4(a)13.1(t)12.2(i)0(o)25.3(n)-243.7(a)13.1(n)0(d)-227.7(s)0(o)21.2(c)13.4(i)15.4(a)0(l)-230.7(m)15.1(ar)18.8(-)]TJ
0 -1.2203 TD
[(g)14.6(i)0(n)18.4(a)13.1(li)24.6(z)13.1(a)13.1(t)0(i)21.3(o)0(n)19.1(,)-211.6(a)13.1(n)0(d)-202.4(l)0(i)24.5(v)0(e)-203(h)0(e)22(a)13.1(lt)21.3(hi)24.7(e)12.8(r)-215.7(li)24.5(ve)24.7(s.)-206.6(Pr)23.2(o)16.2(v)0(i)21(d)0(e)22.4(r)-215.7(t)12.2(r)0(a)25.1(i)0(n)24.7(i)0(n)18.4(g)-213.1(i)15.4(n)-212(LG)23.5(BT)]TJ
T*
[(he)22(a)13.1(l)0(t)21.3(h)-287.9(is)-276.7(e)12.7(s)0(s)22.7(e)0(n)22(t)12.2(ia)22.2(l.)]TJ
/F1 1 Tf
0 -3.054 TD
[(The)-300.2(Way)-301.1(Forward)]TJ
/F4 1 Tf
1.1128 -1.8336 TD
[(In)-473.4(summary,)-473.2(striking)-477(LGBT)-475.7(health)-478.1(disparities)-479.7(exist)-475.3(and)]TJ
-1.1128 -1.2266 TD
[(overlap)-286.7(with)-287.2(racial)-290.6(and)-284.1(other)-291.8(disparities.)-286.6(LGBT)-286(people)-293.3(expe-)]TJ
0 -1.2203 TD
[(rience)-303.9(a)-303(shortage)-303.3(of)-300.4(primary)-298.6(medical)-303.5(care)-302.9(and)-296.8(mental)-307.9(health)]TJ
T*
[(providers)-273.3(culturally)-270.6(competent)-277(to)-268.8(serve)-274.4(them.)-269.8(Given)-271.9(the)-269.3(out-)]TJ
0 -1.2266 TD
[(ward)-200.9(invisibility)-206.7(of)-205.6(LGBT)-203.8(people)-204.8(and)-201.9(their)-204(history)-206.3(of)-199.3(invisibil-)]TJ
0 -1.2203 TD
[(ity)-476.3(in)-474.8(the)-478(health-care)-484.3(system,)-475.8(it)-478.2(is)-472.7(critical)-477.7(for)-478.2(clinicians)-481.9(to)]TJ
T*
[(address)-356.5(and)-353.7(screen)-358.6(for)-351.7(health)-357.9(conditions)-358.6(disproportionately)]TJ
0 -1.2266 TD
[(affecting)-359.2(LGBT)-355.5(people)-362.9(and)-353.7(have)-357.6(frank)-362.6(discussions)-357.2(with)-356.8(pa-)]TJ
0 -1.2203 TD
[(tients)-211.4(about)-210.9(sexual)-216.4(identity)-208.4(and)-208.2(behavior)-217.3(and)-208.2(gender)-207.3(identity.)]TJ
T*
[(However,)-210.9(most)-204.5(clinicians)-203.7(dont)-207.5(ask)-207.6(questions)-208.2(about)-204.5(these)-207.3(top-)]TJ
T*
[(ics;)-474.9(many)-479.1(are)-474.3(uncomfortable)-484(discussing)-477.7(sex)-477.6(with)-476.9(patients.)]TJ
0 -1.2266 TD
[(Gathering)-222.7(data)-223.8(on)-221.1(sexual)-222.7(and)-220.9(gender)-220(identity)-227.4(in)-221.9(EHR)-222.2(will)-220.9(im-)]TJ
0 -1.2203 TD
[(prove)-391.2(our)-384.2(understanding)-394.1(of)-382.6(LGBT)-387.1(disparities)-391.2(and)-385.3(help)-387.5(im-)]TJ
T*
[(prove)-536.6(clinicians)-534.3(conversations)-537.6(with)-533.8(patients)-534.7(about)-539.7(LGBT)]TJ
0 -1.2266 TD
[(issues.)-688.2(Improved)-684.7(patientprovider)-691.1(communication)-691(about)]TJ
0 -1.2203 TD
[(LGBT)-456.7(issues)-464(could)-458.9(be)-459.6(an)-464.5(important)-458.7(step)-464.6(toward)-457(reducing)]TJ
T*
[(health)-301(disparities)-309(affecting)-302.3(this)-299.6(population.)]TJ
1.1128 -1.2266 TD
[(As)-312.5(many)-308.4(speakers)-311.9(at)-309.8(the)-313.6(October)-314.1(2012)-307.9(IOM)-313.8(workshop)-309.2(on)]TJ
-1.1128 -1.2203 TD
[(LGBT)-380.8(data)-388.2(collection)-385.2(in)-380(EHR)-386.6(systems)-385.7(noted,)-385.5(health)-383.2(profes-)]TJ
T*
[(sionals)-388.4(and)-385.3(administrative)-390.2(staff)-387.9(need)-385.6(training)-385.7(in)-386.3(LGBT)-387.1(cul-)]TJ
T*
[(tural)-492.4(competence)-497(to)-490.1(appropriately)-493.3(gather)-495.2(this)-495.6(information)]TJ
0 -1.2266 TD
[(from)-210.2(patients.)-208.9(Such)-204.8(training)-208.6(should)-211.4(occur)-205.7(in)-209.2(a)-201.8(broader)-207(context)]TJ
0 -1.2203 TD
[(of)-445.8(training)-442.6(health)-440.1(professionals)-451.8(and)-442.2(administrative)-440.8(staff)-444.8(in)]TJ
T*
[(fully)-348.4(incorporating)-354.6(the)-351.5(requirements)-348.3(of)-351(meaningful)-352.2(use)-350.3(into)]TJ
0 -1.2266 TD
[(their)-437.9(daily)-431.3(work.)-429.7(Beginning)-433.6(the)-433.7(process)-436.6(of)-433.2(gathering)-437(these)]TJ
0 -1.2203 TD
[(data)-293.4(as)-298(part)-292.9(of)-300.4(the)-294.6(implementation)-301.4(of)-294.1(meaningful)-301.6(use)-293.4(guide-)]TJ
T*
[(lines)-372.1(is)-365.3(crucial)-367.6(to)-363.6(the)-370.5(ability)-367.2(of)-370(researchers)-367(and)-366.3(clinicians)-374.4(to)]TJ
0 -1.2266 TD
[(learn)-323.2(more)-323.4(about)-318.4(LGBT)-323.9(health)-320(needs)-323.6(and)-322(inform)-318.2(training)-322.4(in)]TJ
0 -1.2203 TD
[(the)-383.1(future.)-380.2(It)-382(is)-377.9(important)-382.8(to)-376.3(study)-383.6(the)-383.1(most)-375.2(effective)-384(ways)]TJ
T*
[(to)-256.2(gather)-261.3(SOGI)-261.6(information)-258.4(in)-259.8(order)-260(to)-256.2(optimize)-261.6(the)-256.7(data)-255.4(col-)]TJ
0 -1.2266 TD
[(lection)-303.7(using)-304.9(ways)-297.7(that)-301(are)-303.6(most)-299.3(acceptable)-304.3(to)-300.4(consumers.)]TJ
1.1128 -1.2203 TD
[(As)-350.5(t)12.2(h)0(i)18.4(s)-336.4(ar)18.8(t)12.2(i)0(c)22.5(l)0(e)-332.2(w)0(e)23.8(n)0(t)-332.6(t)12.2(o)-344.2(p)0(r)23.2(e)12.8(ss)-331.4(in)-329.4(sp)22.6(ri)21.1(ng)-330.3(2)13.1(0)0(1)19.9(3)13.1(,)-338(O)0(N)15.9(C)12.5(H)12.7(I)0(T)-327.6(w)0(a)17.8(s)]TJ
-1.1128 -1.2203 TD
[(co)23.2(ns)20.6(id)18.8(e)12.7(r)0(i)21.1(n)0(g)-241.7(w)0(h)20.3(e)0(t)18.6(h)0(e)22(r)-253.6(to)-243.5(in)18.4(c)13.4(l)0(u)20.4(d)0(e)-243.2(S)0(O)17.4(G)13.9(I)-255(q)14.6(ue)17.7(st)23.5(io)19(ns)-245(in)-240.9(th)21.4(e)-259.1(c)13.4(or)21.8(e)-252.8(d)0(e)16.1(-)]TJ
T*
[(mo)18.6(g)14.6(r)0(a)18.8(p)0(h)20.5(i)15.4(c)-207.9(s)0(e)17.8(c)13.4(ti)21.3(on)-202.2(o)16.2(f)-209.1(me)21.5(an)22.4(in)18.4(gf)20.4(ul)-194.6(us)16.3(e)-202.2(g)0(u)19.5(i)0(d)18.8(e)12.8(li)24.6(ne)15.7(s.)-193.9(At)-197.9(a)-208.2(F)0(e)21(b)0(r)20.2(u)0(a)24.4(r)0(y)]TJ
0 -1.2266 TD
[(6)13.1(,)-293.8(20)19.9(1)13.1(3)0(,)-280.6(m)0(e)21.5(e)0(t)18.6(i)0(n)18.4(g)-288.9(of)-287.8(t)12.2(h)0(e)-281.5(H)0(e)19.1(a)13.1(lt)21.3(h)-294.2(I)0(n)19.8(f)0(o)22.1(r)0(m)20.7(a)0(t)19(i)0(o)25.3(n)-294.2(Te)16.1(c)13.4(h)0(n)18.5(o)0(l)25.3(o)0(g)18.1(y)-288.9(Po)21.2(li)18.2(c)13.4(y)]TJ
0 -1.2203 TD
[(C)12.5(o)0(m)18.6(m)15.1(it)21.3(te)18.6(e,)-458.1(an)-464.5(O)15.9(N)0(C)18.8(H)12.7(IT)-460.4(st)17.2(a)13.1(f)12.2(f)-474.7(p)0(e)24(r)0(s)23.3(o)0(n)-461.4(n)0(o)19.1(t)12.2(ed)-458.1(th)15.1(a)13.1(t)-468.4(th)21.4(er)18.4(e)-467.8(w)0(a)17.8(s)]TJ
T*
[()67.7()0(o)20.6(v)0(e)18.3(r)0(w)23(h)0(e)22(l)0(m)17.9(i)15.4(ng)-248.1(su)22.6(pp)16.3(or)21.8(t)12.2()67.7()-261.1(i)0(n)-247.2(p)0(u)22.6(b)0(l)17.3(i)15.4(c)-258.5(c)0(o)16.9(m)15.1(me)21.5(nt)-250.4(su)22.6(bm)23.3(it)21.3(t)12.2(e)0(d)-249.5(f)12.2(or)-250.1(re)18.4(-)]TJ
27.9978 74.5535 TD
[(qu)19.5(ir)21.1(in)18.4(g)-200.4(t)12.2(ha)22.4(t)-202.8(p)0(r)23.2(o)0(v)21.8(i)0(d)18.8(e)12.7(rs)-191.7(ga)21.4(t)12.2(h)0(e)15.7(r)-196.7(SO)17.4(G)13.9(I)-204.4(d)16(a)0(t)19(a)13.1(.)-205.2(T)0(h)25.2(e)-202.2(Fe)21(nw)20.3(a)13.1(y)-200.4(In)19.8(st)17.2(i)15.4(t)0(u)17.1(t)12.2(e)12.8(,)]TJ
0 -1.2203 TD
[(th)15.1(e)-240.2(C)12.5(e)12.7(n)0(t)21.4(e)0(r)-234.5(f)12.2(or)-231.1(Am)20(e)12.7(r)0(i)21.1(c)13.4(an)-230.5(Pr)16.9(o)16.2(g)0(r)20.2(e)0(s)17.8(s)0(,)-225.5(t)0(h)15.1(e)-240.2(Am)26.3(er)18.4(ic)22.5(a)13.1(n)-243.7(Ps)22.6(yc)21.6(ho)19.1(lo)19(g)14.6(i)0(c)22.5(a)0(l)]TJ
T*
[(As)16.3(so)21.2(c)13.4(i)0(a)22.2(t)0(i)21.3(o)0(n)19.1(,)-496.1(a)13.1(n)0(d)-486.9(1)0(4)20(2)-492.7(ot)15.7(h)15.6(e)0(r)-487.5(c)0(o)16.9(m)15.1(mu)20(ni)18.4(t)12.2(y)14.6(-b)20.4(as)18.1(e)12.8(d)-496.2(or)21.8(ga)21.4(ni)18.4(z)13.1(a)13.1(t)0(i)21.3(o)0(n)19.1(s)]TJ
0 -1.2267 TD
[(su)16.3(b)14.6(m)0(i)17.9(t)12.2(t)12.2(e)0(d)-338(a)-347.3(co)16.9(m)15.1(m)0(u)20(n)0(i)24.7(t)0(y)-340(p)0(u)22.6(b)0(l)17.3(i)15.4(c)-353.4(c)13.4(om)18.6(m)15.1(e)12.7(nt)-339(to)-338.4(ON)15.9(C)12.5(H)12.7(IT)-340.2(c)13.4(a)13.1(ll)18.2(in)24.7(g)]TJ
0 -1.2203 TD
[(fo)15.7(r)-544.5(t)0(h)21.4(e)-550(in)18.4(c)13.4(l)0(u)20.4(s)0(i)20.4(o)0(n)-537.3(o)0(f)-540.7(S)14.2(OG)17.2(I)-545.9(i)0(n)-538(m)0(e)21.5(a)13.1(ni)18.4(ng)23.8(f)12.2(u)0(l)-542.3(u)0(s)22.6(e)-550(g)14.5(u)0(i)20.4(d)0(e)22.4(l)0(i)18.2(n)0(e)22(s)0(.)]TJ
6.7246 0 0 5.9768 545.5558 686.2676 Tm
(45)Tj
8.9663 0 0 8.9663 313.0582 671.3573 Tm
[(Mo)17.4(st)-488.6(of)-496.4(t)12.2(h)0(e)22(s)0(e)-494.4(g)0(r)20.2(o)0(u)21.2(p)0(s)-489.5(w)0(e)17.4(r)0(e)-487.5(L)0(G)17.2(B)16(T)-502.5(a)0(n)22.4(d)-502.5(HI)16.9(V/)25.8(AI)21.8(DS)-493.1(gr)20.2(ou)21.2(ps)22.6(.)]TJ
0 -1.2266 TD
[(Th)18.9(e)-486.8(H)0(e)19.1(a)13.1(lt)21.3(h)-490.2(I)0(n)19.8(f)12.2(or)21.8(ma)21.9(t)12.2(i)0(o)19(n)-483.9(Te)22.4(ch)16.3(n)15.6(o)0(l)19(o)0(g)18.1(y)-485(Po)21.2(li)24.5(cy)-477.9(C)12.5(o)0(m)18.6(m)15.1(it)21.3(te)18.6(e)-486.8(w)0(i)20.1(l)15.4(l)]TJ
0 -1.2203 TD
[(ma)21.9(ke)-655.6(a)-669.7(r)0(e)24.7(c)0(o)16.9(m)15.1(me)21.5(nd)18.9(a)13.1(t)12.2(io)19(n)-667.3(t)12.2(o)-666.7(O)0(N)22.3(C)0(H)18.8(I)0(T)-656.4(i)0(n)-658.2(t)12.2(he)-654.5(f)12.2(a)0(l)22.2(l)0(.)-657.7(M)0(a)20.7(n)0(y)]TJ
T*
[(he)15.7(a)13.1(l)0(t)21.3(h)0(-)21.4(c)0(a)20.2(r)0(e)-228.2(o)16.2(rg)20.2(a)13.1(n)0(i)18.4(z)13.1(at)19(io)19(n)15.6(s)-241.6(a)13.1(r)0(e)-221.9(a)0(l)15.9(r)0(e)24.7(a)13.1(dy)-228.7(m)15.1(o)0(v)21.8(i)0(n)18.4(g)-238.4(f)12.2(o)0(r)21.8(w)0(a)24.2(r)0(d)-225(w)0(i)20.1(t)12.2(h)-237.3(e)0(f)18.6(-)]TJ
T*
[(fo)15.7(rt)24.1(s)-260.6(t)12.2(o)-255.7(g)14.5(at)19(he)22(r)-259.9(s)0(u)22.6(c)13.4(h)-256.3(d)0(a)22.8(t)0(a)-246.6(i)0(n)-247.2(E)0(H)22.3(R)0(,)-247.4(i)0(n)24.7(c)0(l)22.5(u)0(d)20.9(i)0(n)18.4(g)-257.3(t)12.2(h)0(e)-243.5(M)0(a)20.7(y)0(o)-247.5(C)12.5(li)18.2(n)15.6(i)0(c)-249.4(i)15.4(n)]TJ
0 -1.2266 TD
[(Mi)16.6(nn)24.8(es)17.8(ot)22(a)13.1(,)-198.9(t)12.2(h)0(e)-193(U)0(n)20.5(i)15.4(ve)18.3(rs)23.3(it)21.3(y)-200.4(o)0(f)-186.6(C)12.5(a)13.1(l)0(i)18.2(f)12.2(or)21.8(ni)18.4(a)-195.5(a)13.1(t)-202.8(D)0(a)24.4(v)0(i)21(s)0(,)-187.6(K)0(a)23(i)0(s)20.4(e)12.8(r)-196.7(P)0(e)17.7(r)0(m)20.7(a)13.1(-)]TJ
0 -1.2203 TD
[(ne)15.7(nt)21.4(e)12.7(,)-287.4(an)16.1(d)-287.5(B)0(e)22.4(t)12.2(h)-294.2(I)16.9(sr)17(a)13.1(e)12.8(l)-294.4(H)12.7(os)21.2(pi)20.4(t)12.2(a)13.1(l)-294.4(i)15.4(n)-294.2(N)12.7(e)12.7(w)-292.5(Yo)24.6(rk)-283.3(C)12.5(i)0(t)21.3(y)14.5(.)]TJ
1.1128 -1.2203 TD
[(Primary)-222.8(care)-220.7(providers)-229(are)-221.4(key)-223.7(to)-218.2(better)-227.2(understanding,)-226.3(re-)]TJ
-1.1128 -1.2267 TD
[(ducing)-312.2(and,)-312.3(one)-315.9(day,)-307(eliminating)-313.6(health)-313.7(disparities)-315.3(affecting)]TJ
0 -1.2203 TD
[(LGBT)-380.8(patients.)-379.6(Structural)-378.9(factors)-377.6(exacerbating)-383.9(LGBT)-374.5(health)]TJ
T*
[(disparities)-315.3(include)-311.2(nondisclosure)-310.8(of)-306.7(sexual)-311.3(and)-309.4(gender)-308.5(iden-)]TJ
0 -1.2266 TD
[(tity)-344(to)-344.7(health-care)-345.2(providers)-342.8(and)-341(a)-341(lack)-341.9(of)-344.7(providers)-342.8(trained)]TJ
0 -1.2203 TD
[(to)-388.9(address)-381.8(the)-383.1(specic)-387(health-care)-383.1(needs)-386.9(of)-382.6(LGBT)-380.8(people.)]TJ
6.7246 0 0 5.9768 545.4424 543.7983 Tm
(19)Tj
8.9663 0 0 8.9663 313.0582 528.8881 Tm
[(A)-418.7(providers)-414.2(knowledge)-415(of)-414.2(a)-410.5(patients)-422.8(SOGI)-413.4(is)-409.5(essential)-417.5(to)]TJ
0 -1.2266 TD
[(providing)-257.4(appropriate)-257.8(prevention)-256.4(screening)-262.4(and)-252.5(care.)-255.2(Health)]TJ
0 -1.2203 TD
[(disparities)-271.1(are)-265.7(driven)-264.2(in)-259.8(part)-267.6(by)-261.8(poor)-266.8(quality)-263.8(of)-262.5(care)-265(and)-265.1(bar-)]TJ
T*
[(riers)-252.7(to)-256.2(access.)-250.1(Providers)-256.2(lack)-253.3(of)-249.8(training)-252.9(in)-253.5(LGBT)-248(health)-256.8(and)]TJ
T*
[(widespread)-235.1(inability)-235(to)-230.9(provide)-233.3(culturally)-232.7(competent)-232.7(care)-233.3(are)]TJ
0 -1.2266 TD
[(important)-357.5(factors)-352.3(in)-348.4(poor)-349(quality)-352.4(of)-351(care)-347.2(for)-351.7(LGBT)-349.2(patients.)]TJ
0 -1.2203 TD
[(Barriers)-363.4(to)-357.3(access)-354.7(include)-361.8(lower)-356.3(rates)-356(of)-357.3(insurance)-366.5(coverage)]TJ
T*
[(for)-509.8(LGBT)-500.9(people)-508.3(and)-499.1(lower)-508(rates)-501.4(of)-509.1(access)-500.1(to)-509.1(preventive)]TJ
0 -1.2266 TD
[(care)-461(for)-452.9(lesbians)-459.5(and)-454.8(transgender)-459.3(people.)]TJ
6.7246 0 0 5.9768 482.74 445.2093 Tm
(12,46)Tj
8.9663 0 0 8.9663 501.9589 441.1841 Tm
[(A)-456.6(California)]TJ
-21.0679 -1.2203 TD
[(study)-358.3(found)-358.7(partnered)-356.7(gay)-349.8(men)-354.9(were)-356.2(only)-355.5(42%)-354.7(as)-354.9(likely)-354.4(as)]TJ
T*
[(married)-245.2(heterosexual)-248.8(men)-247.4(to)-243.5(get)-238.7(employer-sponsored)-254.8(depen-)]TJ
0 -1.2266 TD
[(dent)-291.3(coverage;)-288.4(partnered)-287.1(lesbians)-282.5(were)-286.7(only)-286(28%)-285.2(as)-285.4(likely)-284.9(as)]TJ
0 -1.2203 TD
[(married)-340(heterosexual)-343.7(women)-340.4(to)-338.4(have)-345(partner)-341.1(or)-338.6(spousal)-340(in-)]TJ
T*
(surance.)Tj
6.7246 0 0 5.9768 345.5999 390.3873 Tm
(47)Tj
8.9663 0 0 8.9663 355.0676 386.4188 Tm
[(The)-309.8(expansion)-308.2(of)-306.7(health)-313.7(coverage)-304.4(under)-311.8(the)-307.3(ACA)]TJ
-4.6853 -1.2266 TD
[(is)-352.6(especially)-357.7(important)-357.5(for)-351.7(LGBT)-349.2(people)-356.6(given)-353.4(the)-351.5(repeal)-352.7(of)]TJ
0 -1.2203 TD
[(public)-253.7(sector)-257.4(domestic)-254.4(partner)-252.6(health)-256.8(coverage)-253.8(for)-250.5(thousands)]TJ
T*
[(of)-376.3(same-sex)-375.2(partners)-374.1(through)-376.9(anti-gay)-369.8(ballot)-374.6(measures,)-371.2(pri-)]TJ
T*
[(vate)-487.5(insurer)-491.4(discrimination)-493.4(against)-486.4(LGBT)-488.3(people,)-486(and)-486.4(the)]TJ
0 -1.2266 TD
[(high)-400.4(rate)-398.9(of)-395.3(HIV)-396.9(among)-393.4(gay)-394(men)-399.2(\(a)-392(pre-existing)-406.8(condition)]TJ
0 -1.2203 TD
[(that)-598.2(has)-585.9(precluded)-593.7(many)-592.9(from)-589.5(getting)-592(health)-598.2(insurance;)]TJ
T*
[(such)-308.8(denial)-303.7(will)-303.1(no)-309.7(longer)-305.6(be)-301.5(legal)-301.7(starting)-311(in)-304.1(2014\).)-304.9(The)-303.5(im-)]TJ
0 -1.2266 TD
[(portance)-310.9(of)-306.7(assessing)-306.9(SOGI)-305.9(in)-310.4(clinical)-306.4(settings)-305.7(should)-312.5(be)-301.5(un-)]TJ
0 -1.2203 TD
[(derstood)-304.8(in)-304.1(this)-299.6(broader)-301.9(context.)]TJ
1.1128 -1.2203 TD
[(The)-259.2(ad)22.8(va)18.7(nc)22.6(es)-241.5(we)-235.5(ha)22.4(ve)-240.9(se)24.1(e)12.7(n)-250(in)-240.9(LG)23.5(BT)-239.9(h)15.6(e)0(a)19.6(l)0(t)21.3(h)-250(po)21.2(li)24.6(cy)-237.7(a)13.1(n)0(d)-240.3(H)12.7(IV)]TJ
-1.1128 -1.2266 TD
[(po)14.8(l)15.4(i)0(c)22.5(y)-263.7(un)20.5(de)22.4(r)-266.3(t)12.2(he)-249.9(Ob)17.8(a)13.1(m)0(a)21.9()13.1(Bi)18.8(de)22.4(n)-262.6(A)0(d)20.9(m)0(i)24.2(n)0(i)18.4(s)0(t)23.5(r)0(a)18.8(t)12.2(io)19(n)-262.6(h)0(a)22.4(v)0(e)-253.6(b)14.6(ee)19.2(n)-262.6(u)0(n)20.5(-)]TJ
0 -1.2203 TD
[(pr)16.9(e)12.7(c)0(e)19.8(d)0(e)22.4(n)0(t)21.4(e)0(d)22.4(.)-546.7(Ho)22.5(we)17.4(ve)24.7(r,)-534.7(if)-535.1(ou)21.2(r)-550.8(g)14.6(ov)21.8(er)18.4(nm)24.3(en)22(t)-550.6(d)16(oe)16.3(sn)20.6(t)-533.5(in)18.4(c)13.4(l)0(u)20.4(d)0(e)]TJ
T*
[(SO)17.4(G)13.9(I)-444.7(da)22.8(t)12.2(a)-442.1(co)23.2(ll)18.2(e)12.8(c)0(t)19.2(i)0(o)19(n)-439.7(in)-430.5(me)21.5(a)13.1(n)0(i)18.4(n)0(g)23.8(f)0(u)17.1(l)-439.8(us)22.6(e)-442.5(g)0(u)19.5(i)0(d)25.1(e)0(l)21.9(i)0(n)18.4(e)12.7(s,)-434.2(we)-431.5(wi)20.1(l)15.4(l)]TJ
T*
[(mi)17.9(ss)-382(a)-391.5(g)0(o)18.1(l)15.4(de)16.1(n)-389.1(o)0(p)21.2(p)0(o)21.2(r)0(t)17.8(u)0(n)20.5(i)0(t)21.3(y)-390.1(to)-388.9(sy)25.9(st)17.2(e)12.8(m)0(a)21.9(t)12.2(ic)22.5(al)22.2(ly)-387.3(g)14.6(a)0(t)19(h)0(e)22(r)-392.7(es)17.8(se)24.1(nt)21.4(ia)22.3(l)]TJ
0 -1.2266 TD
[(da)16.5(t)12.2(a)-195.5(on)-183.2(LG)17.2(BT)-183(he)22(al)22.2(th)21.4(.)-198.9(I)0(t)-186(w)0(i)20.1(l)0(l)-184.1(a)13.1(ls)20.5(o)-198.8(b)14.6(e)-202.2(v)0(e)24.7(r)0(y)-188.5(d)16(if)21.3(c)16.7(ul)20.4(t)-196.5(t)12.2(o)-198.8(m)15.1(a)13.1(k)0(e)-187.7(p)0(r)16.9(o)16.2(g-)]TJ
0 -1.2203 TD
[(re)18.4(ss)-223.9(to)22.1(wa)17.8(rd)-225(t)12.2(h)0(e)-224.6(H)0(e)19.1(a)13.1(lt)21.3(hy)-229.1(Pe)24(op)21.2(le)-224.7(2)13.1(0)0(2)19.9(0)-233.5(go)18.1(a)13.1(l)-237.5(of)-224.5(e)12.8(l)0(i)18.2(m)15.1(in)18.4(a)13.1(t)12.2(in)18.4(g)-232(L)0(G)17.2(B)16(T)]TJ
T*
[(he)15.7(a)13.1(l)0(t)21.3(h)-294.2(di)18.8(sp)22.6(a)13.1(r)0(i)21.1(t)12.2(ie)15.5(s.)-282.4(W)13.6(h)0(i)18.4(l)15.4(e)-297.1(a)13.1(ss)16.3(e)12.8(s)0(s)22.7(i)0(n)18.4(g)-295.3(a)13.1(n)0(d)-284.6(t)12.2(ra)18.8(c)13.4(k)0(i)17.3(n)15.6(g)-295.3(S)0(O)17.4(G)13.9(I)-293(i)0(n)-285.1(E)0(H)22.3(R)]TJ
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[(is)-409.5(a)-410.5(c)0(o)16.9(m)15.1(pl)20.4(ic)22.5(a)13.1(t)0(e)18.6(d)-414(un)20.6(de)22.4(rt)17.8(a)13.1(k)0(i)23.7(n)0(g)17.5(,)-413.9(we)-399.9(sh)20.6(ou)21.2(ld)-404.9(no)19.1(t)-417.8(l)15.4(et)-405(th)21.4(e)-417.2(p)0(e)17.7(r)0(f)24.1(e)12.7(ct)]TJ
0 -1.2203 TD
[(be)-225.6(th)15.1(e)-233.8(e)12.7(ne)15.7(m)15.1(y)-238.4(of)-224.5(t)12.2(h)0(e)-230.9(g)14.5(oo)19.7(d.)-227.2(T)16(h)0(e)-230.9(b)14.6(e)12.7(n)0(e)15.7()16(ts)-229.4(t)12.2(o)-236.7(pa)18.1(t)12.2(i)0(e)21.9(n)0(t)-225.2(c)0(a)20.2(r)0(e)18.4(,)-230.5(me)21.5(di)18.8(c)13.4(a)0(l)]TJ
T*
[(kn)17.5(ow)20.9(l)15.4(e)0(d)16.1(g)14.6(e,)-243.1(sc)18.4(ie)21.9(nc)22.6(e,)-243.1(an)22.4(d)-255.9(p)0(u)22.6(b)0(l)17.3(i)15.4(c)-258.5(h)0(e)22(a)13.1(lt)21.3(h)-256.3(t)0(h)21.4(a)0(t)-246.6(w)0(o)20.9(u)0(l)20.4(d)-249.6(ac)20.2(cr)19(ue)-241.5(fr)17.8(om)]TJ
0 -1.2266 TD
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[(Author)-307.1(Disclosure)-298.8(Statement)]TJ
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1.1128 -1.8336 TD
[(No)-299.9(competing)-303.5(nancial)-306(interests)-308.2(exist.)]TJ
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-1.1128 -2.4849 TD
(References)Tj
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[(1.)-501.9(Boehmer)-231.1(U,)-231.9(Bowen)-229(DJ,)-231.3(Bauer)-228.4(GR:)-232(Overweight)-232.3(and)-232(obesity)-228.8(in)]TJ
1.2519 -1.2318 TD
[(sexual)-539.2(minority)-535.9(women:)-544.8(evidence)-538.5(from)-534.8(population-based)]TJ
0 -1.2385 TD
[(data.)-301.1(Am)-303.2(J)-300.6(Pub)-297.2(Health)-308.8(2007;97:11341140.)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 62.022 749.5368 Tm
(6)Tj
43.0401 0 TD
[(CAHILL)-301.5(AND)-299.3(MAKADON)]TJ
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