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Harris MTH, Laks J, Hurstak E, Jain JP, Lambert AM, Maschke AD, Bagley SM, Farley J, Coffin PO, McMahan VM, Barrett C, Walley AY, Gunn CM. "If you're strung out and female, they will take advantage of you": A qualitative study exploring drug use and substance use service experiences among women in Boston and San Francisco. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209190. [PMID: 37866442 PMCID: PMC11040599 DOI: 10.1016/j.josat.2023.209190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/12/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Significant disparities in substance use severity and treatment persist among women who use drugs compared to men. Thus, we explored how identifying as a woman was related to drug use and treatment experiences. METHODS The study recruited participants for a qualitative interview study in Boston and San Francisco from January-November 2020. Self-identified women, age ≥ 18 years, with nonprescribed opioid use in the past 14 days were eligible for inclusion. The study team developed deductive codes based on intersectionality theory and inductive codes generated from transcript review, and identified themes using grounded content analysis. RESULTS The study enrolled thirty-six participants. The median age was 46; 58 % were White, 16 % were Black, 14 % were Hispanic, and 39 % were unstably housed. Other drug use was common with 81 % reporting benzodiazepine, 50 % cocaine, and 31 % meth/amphetamine use respectively. We found that gender (i.e., identifying as a woman) intersected with drug use and sex work practices and exacerbated experiences of marginalization. Violence was ubiquitous in drug use environments. Some women reported experiences of gender-based violence in substance use service settings that perpetuated cycles of trauma and reinforced barriers to care. Substance use services that were women-led, safe, and responsive to women's needs were valued and sought after. CONCLUSION Women reported a cycle of trauma and drug use exacerbated by oppression in substance use services settings. In addition to increasing access to gender-responsive care, our study highlights the need for greater research and examination of practices within substance use service settings that may be contributing to gender-based violence.
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Affiliation(s)
- Miriam T H Harris
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jordana Laks
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Emily Hurstak
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jennifer P Jain
- School of Nursing and Department of Community Health Systems at the University of California, San Francisco, CA 94143, USA.
| | - Audrey M Lambert
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Ariel D Maschke
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA.
| | - John Farley
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Phillip O Coffin
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Vanessa M McMahan
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Cynthia Barrett
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA 02118, USA.
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Dailey A, Gant Z, Hu X, Lyons SJ, Okello A, Johnson AS. A Census Tract-Level Examination of Diagnosed HIV Infection and Social Vulnerability Themes Among Black/African American, Hispanic/Latino, and White Adults, 2019-USA. J Racial Ethn Health Disparities 2024; 11:468-491. [PMID: 36808571 PMCID: PMC9937524 DOI: 10.1007/s40615-023-01533-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Assessing HIV diagnosis and the social vulnerability index (SVI) by themes (socioeconomic status, household composition and disability, minority status and English proficiency, and housing type and transportation) might help to identify specific social factors contributing to disparities across census tracts with high rates of diagnosed HIV infection in the USA. METHODS We examined HIV rate ratios in 2019 using data from CDC's National HIV Surveillance System (NHSS) for Black/African American, Hispanic/Latino, and White persons aged ≥ 18 years. NHSS data were linked to CDC/ATSDR SVI data to compare census tracts with the lowest SVI (Q1) and highest SVI (Q4) scores. Rates and rate ratios were calculated for 4 SVI themes by sex assigned at birth for age group, transmission category, and region of residence. RESULTS In the socioeconomic theme analysis, we observed wide within-group disparity among White females with diagnosed HIV infection. In the household composition and disability theme, we observed high HIV diagnosis rates among Hispanic/Latino and White males who lived in the least socially vulnerable census tracts. In the minority status and English proficiency theme, we observed a high percentage of Hispanic/Latino adults with diagnosed HIV infection in the most socially vulnerable census tracts. In the housing type and transportation theme, we observed a high percentage of HIV diagnoses attributed to injection drug use in the most socially vulnerable census tracts. CONCLUSION The development and prioritization of interventions that address specific social factors contributing to disparities in HIV across census tracts with high diagnosis rates are critical to reducing new HIV infections in the USA.
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Affiliation(s)
- André Dailey
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, HIV Surveillance Branch, 1600 Clifton Rd NE, MS US8-2, Atlanta, GA, 30329-4027, USA.
| | - Zanetta Gant
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, HIV Surveillance Branch, 1600 Clifton Rd NE, MS US8-2, Atlanta, GA, 30329-4027, USA
| | - Xiaohong Hu
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, HIV Surveillance Branch, 1600 Clifton Rd NE, MS US8-2, Atlanta, GA, 30329-4027, USA
| | - Shacara Johnson Lyons
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, HIV Surveillance Branch, 1600 Clifton Rd NE, MS US8-2, Atlanta, GA, 30329-4027, USA
| | - Amanda Okello
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, HIV Surveillance Branch, 1600 Clifton Rd NE, MS US8-2, Atlanta, GA, 30329-4027, USA
| | - Anna Satcher Johnson
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, HIV Surveillance Branch, 1600 Clifton Rd NE, MS US8-2, Atlanta, GA, 30329-4027, USA
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Lawrence SE, Watson RJ, Eadeh HM, Brown C, Puhl RM, Eisenberg ME. Bias-based bullying, self-esteem, queer identity pride, and disordered eating behaviors among sexually and gender diverse adolescents. Int J Eat Disord 2024; 57:303-315. [PMID: 37990394 PMCID: PMC10922269 DOI: 10.1002/eat.24092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Limited research incorporates an intersectional approach when evaluating disordered eating behaviors among those holding minoritized social positions, such as lesbian, gay, bisexual, queer, questioning, and/or transgender/gender diverse (LGBTQ) adolescents. The current study assessed stigma experiences from peers at school, self-esteem, LGBTQ pride, and overlapping social positions as they relate to disordered eating behaviors among LGBTQ adolescents. METHOD Participants included 11,083 adolescents (Mage = 15.6, SD = 1.3; 34.8% transgender/gender diverse) from a large national survey study of LGBTQ adolescents from 2017. Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify bias-based bullying experiences (i.e., weight-based, identity-based), self-esteem, LGBTQ pride, and overlapping social positions (i.e., gender identity, sexual identity, race/ethnicity, body mass index (BMI) percentile) associated with the highest prevalence of unhealthy weight control behaviors, extreme unhealthy weight control behaviors, and past year binge eating. RESULTS Adolescents in the 28 identified groups with a high prevalence of disordered eating behavior held at least one structurally marginalized social position (e.g., high BMI), bias-based bullying experience, low self-esteem, or low LGBTQ pride in addition to being LGBTQ. Weight-based bullying was a salient risk-factor for disordered eating across social positions. Among adolescents with the same social positions, levels of self-esteem, LGBTQ pride, but no bias-based bullying experience, prevalence estimates of disordered eating were, on average, 23% lower. DISCUSSION LGBTQ adolescents with multiple marginalized social positions and related factors engage in disproportionately high prevalence disordered eating. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents. PUBLIC SIGNIFICANCE Multiply marginalized LGBTQ adolescents, most of whom also reported experiencing bias-based bullying from peers at school, reported disproportionately high prevalence disordered eating. In comparison groups of adolescents with no bias-based bullying experience, prevalence of disordered eating was, on average, 24% lower. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents.
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Affiliation(s)
- Samantha E. Lawrence
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- School of Social Work, University of Connecticut, Hartford, CT, USA
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Hana-May Eadeh
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Camille Brown
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Rebecca M. Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT, USA
| | - Marla E. Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Adkins-Jackson PB, Taikeff N, Akingbulu J, Avila-Rieger JF, Corona-Long CA. Parkinson's Disease Inequities in Daily Cognitive Activities: An Intersectional Approach. Ethn Dis 2024; 34:113-122. [PMID: 38973807 PMCID: PMC11223038 DOI: 10.18865/ed.34.2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Objective Intersectionality approaches to examining differences in Parkinson's disease (PD) based on racialized group, gender identity, and socioeconomic status (SES) are not well covered in the literature. Additionally, the differences in daily cognitive activities for persons diagnosed with PD by racialized group, gender, and SES are undetermined. This study was conducted to explore the differences in PD daily cognitive activities for diverse racialized groups by gender and SES. Methods This study was a secondary analysis of the Michael J. Fox Foundation's Fox Insight online clinical dataset. Persons with PD were partitioned into 16 racialized by gender groups (Black women, Indigenous men, Latina/x women, Asian men, etc.) that were used in within-group comparisons of low-, middle-, and high-SES-a new variable comprising education and income. Results Intersectional analyses revealed most items differed between low-SES and high-SES except for items associated with Black and Indigenous men, for whom significant differential item functioning was found between mid-SES and high-SES. Conclusions These findings revealed that within-group differences exist and may be missed in research in which social factors are adjusted for instead of included in the model.
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Affiliation(s)
- Paris B. Adkins-Jackson
- Departments of Epidemiology and Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Josephine Akingbulu
- School of Community and Global Health, Claremont Graduate University, Claremont, CA
| | - Justina F. Avila-Rieger
- Gertrude H. Sergievsky Center and Institute for Research in Aging and Alzheimer’s Disease, Columbia University, New York, NY
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Levandowski BA, Pro GC, Rietberg-Miller SB, Camplain R. We are complex beings: comparison of statistical methods to capture and account for intersectionality. BMJ Open 2024; 14:e077194. [PMID: 38296287 PMCID: PMC10828873 DOI: 10.1136/bmjopen-2023-077194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Intersectionality conceptualises how different parts of our identity compound, creating unique and multifaceted experiences of oppression. Our objective was to explore and compare several quantitative analytical approaches to measure interactions among four sociodemographic variables and interpret the relative impact of axes of marginalisation on self-reported health, to visualise the potential elevated impact of intersectionality on health outcomes. DESIGN Secondary analysis of National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative cross-sectional study of 36 309 non-institutionalised US citizens aged 18 years or older. PRIMARY OUTCOME MEASURES We assessed the effect of interactions among race/ethnicity, disability status, sexual orientation and income level on a self-reported health outcome with three approaches: non-intersectional multivariate regression, intersectional multivariate regression with a single multicategorical predictor variable and intersectional multivariate regression with two-way interactions. RESULTS Multivariate regression with a single multicategorical predictor variable allows for more flexibility in a logistic regression problem. In the fully fitted model, compared with individuals who were white, above the poverty level, had no disability and were heterosexual (referent), only those who were white, above the poverty level, had no disability and were gay/lesbian/bisexual/not sure (LGBQ+) demonstrated no significant difference in the odds of reporting excellent/very good health (aOR=0.90, 95% CI=0.71 to 1.13, p=0.36). Multivariate regression with two-way interactions modelled the extent that the relationship between each predictor and outcome depended on the value of a third predictor variable, allowing social position variation at several intersections. For example, compared with heterosexual individuals, LGBQ+ individuals had lower odds of reporting better health among whites (aOR=0.94, 95% CI=0.93 to 0.95) but higher odds of reporting better health among Black Indigenous People of Color (BIPOC) individuals (aOR=1.13, 95% CI=1.11 to 1.15). CONCLUSION These quantitative approaches help us to understand compounding intersectional experiences within healthcare, to plan interventions and policies that address multiple needs simultaneously.
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Affiliation(s)
- Brooke A Levandowski
- Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - George C Pro
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Ricky Camplain
- Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana, USA
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Richburg A, Stewart AJ. Body Image Among Sexual and Gender Minorities: An Intersectional Analysis. JOURNAL OF HOMOSEXUALITY 2024; 71:319-343. [PMID: 36043896 DOI: 10.1080/00918369.2022.2114399] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Body image is consequential for overall well-being and has a complex relation to gender. Sexual and gender minority (SGM) individuals develop body image amid intersecting systems of oppression, such as sexism, cisnormativity, heteronormativity, and gender binary pressures. This study used an intersectionality framework to examine how various aspects of gender identification (cis/trans, binary/nonbinary, woman/man identification) related to body image differences among SGM individuals. We also assessed whether identification with conventionally masculine and feminine personality traits predicted body image. We used one-way and two-way ANOVAs and linear regressions to analyze two indicators of body image (body appreciation and drive for muscularity) in a sample of 643 SGM individuals (148 sexual minority (SM) cis women, 171 trans women, 121 SM cis men, 43 trans men, 160 nonbinary individuals). Results implicated cisnormativity as an influential and hierarchical force for body image, although woman/man and binary/nonbinary identification also played roles in group differences. With a few exceptions, masculine but not feminine trait identification significantly predicted body appreciation and drive for muscularity, indicating a complicated association with overall body image. These findings underscore the value of an intersectional lens for analyzing how broad social forces may manifest in individual-level body image for SGM individuals.
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Affiliation(s)
- Abigail Richburg
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Abigail J Stewart
- Departments of Psychology and Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
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He JW, Terry AL, Lizotte D, Bauer G, Ryan BL. Understanding intersectional inequality in access to primary care providers using multilevel analysis of individual heterogeneity and discriminatory accuracy. PLoS One 2024; 19:e0296657. [PMID: 38241267 PMCID: PMC10798491 DOI: 10.1371/journal.pone.0296657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Despite the Canadian healthcare system's commitment to equity, evidence for disparate access to primary care (PC) providers exists across individual social identities/positions. Intersectionality allows us to reflect the realities of how social power shapes healthcare experiences at an individual's interdependent and intersecting social identities/positions. The objectives of this study were to determine: (1) the extent to which intersections can be used classify those who had/did not have a PC provider; (2) the degree to which each social identity/position contributes to the ability to classify individuals as having a PC provider; and (3) predicted probabilities of having a PC provider for each intersection. METHODS AND FINDINGS Using national cross-sectional data from 241,445 individuals in Canada aged ≥18, we constructed 320 intersections along the dimensions of gender, age, immigration status, race, and income to examine the outcome of whether one had a PC provider. Multilevel analysis of individual heterogeneity and discriminatory accuracy, a multi-level model using individual-level data, was employed to address intersectional objectives. An intra-class correlation coefficient (ICC) of 23% (95%CI: 21-26%) suggests that these intersections could, to a very good extent, explain individual variation in the outcome, with age playing the largest role. Not all between-intersection variance in this outcome could be explained by additive effects of dimensions (remaining ICC: 6%; 95%CI: 2-16%). The highest intersectional predicted probability existed for established immigrant, older South Asian women with high income. The lowest intersectional predicted probability existed for recently immigrated, young, Black men with low income. CONCLUSIONS Despite a "universal" healthcare system, our analysis demonstrated a substantial amount of inequity in primary care across intersections of gender, age, immigration status, race, and income.
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Affiliation(s)
- Jennifer W. He
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Amanda L. Terry
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Dan Lizotte
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Computer Science, Western University, London, Ontario, Canada
| | - Greta Bauer
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Bridget L. Ryan
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
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Garcia M. Intersectional Microaggressions and Implications for Health Inequities and HIV Among Latino/x Sexual Minority Males in Puerto Rico. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01900-2. [PMID: 38198018 DOI: 10.1007/s40615-023-01900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/21/2023] [Accepted: 12/16/2023] [Indexed: 01/11/2024]
Abstract
Latino/x sexual minority males (SMM) continue to be disproportionately impacted by health inequities. This study aims to understand the lived experience of Puerto Rican (PR) SMM related to how intersectional microaggressions influence health-related risk and protective factors. Young adult (ages 21-30) PR SMM from San Juan, Puerto Rico, completed a bilingual in-depth individual interview (14 in Spanish and 1 in English). A thematic analysis based on the original language of the interviews was conducted using NVivo. Six prominent themes were identified through the data analysis: (1) religious microaggressions, being gay is bad because God doesn't like it; (2) gender microaggressions, gay is not good because it's not for men; (3) sexuality microaggressions, this one is a homosexual, coming out as a sexual minority; (4) trans microaggressions, drag queens create an illusion; (5) internalized microaggressions, battling with internalized homophobia; and (6) mitigating microaggressions, establishing a supportive community. Findings suggest that multiple forms of microaggressions based on the intersectionality of sexuality and gender manifest from straight as well as gay communities. PR SMM demonstrated their resiliency by assessing interactions with others to mitigate risks and enhance supportive networks.
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Affiliation(s)
- Moctezuma Garcia
- School of Social Work, San José State University, San Jose, CA, 95112, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
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Dejene A, Carter Z, Woo E, Sun S, Loucks EB, Proulx J. The Evolution of Mindfulness-Based Stress Reduction Teacher Training Programs for People Who Serve Historically Underrepresented Racial and Ethnic Groups. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241244744. [PMID: 38623412 PMCID: PMC11017240 DOI: 10.1177/27536130241244744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024]
Abstract
Background There is a lack of mindfulness instructors from underserved/underrepresented communities who have completed systematic mindfulness teacher-training programs to meet the growing demand for culturally responsive mindfulness training in those communities. Objectives To investigate strategies for increasing the representation of Mindfulness-Based Stress Reduction (MBSR) teachers who serve historically underrepresented racial and ethnic groups. Methods Conducted through 4 one-hour Zoom focus groups (n = 54; women = 74%), this study queried individuals with experience serving underrepresented racial and ethnic communities, and had mindfulness experience, on how to increase participation from underrepresented communities in mindfulness. Thematic analysis of transcripts of participant responses involved double-coding by three team members, supporting rigorous evaluation of the data. All respondents who expressed interest in participating enrolled (no dropout from study enrollment to participation in focus groups). Results The study identified four key themes that illuminate challenges and essential adaptations for MBSR teacher training aimed at individuals serving historically underrepresented racial and ethnic groups. These themes include: (1) Cost and time commitment; (2) Trauma sensitivity; (3) Cultural Awareness; and (4) Diversity in teachers. Conclusion Participants provided actionable recommendations poised to facilitate the expansion of MBSR into more diverse communities, emphasizing optimal benefits and effective communication of inherent healing strengths within these communities. The findings underscore the compelling interest among leaders in marginalized communities to extend the reach of MBSR through culturally responsive approaches. This involves guiding pertinent adjustments and encouraging greater involvement of underserved communities in MBSR teacher training programs.
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Affiliation(s)
- Abraham Dejene
- Department of Behavioral and Social Science, Brown University, Providence, RI, USA
| | - Zoie Carter
- Department of Behavioral and Social Science, Brown University, Providence, RI, USA
| | - Erin Woo
- Department of Behavioral and Social Science, Brown University, Providence, RI, USA
| | - Shufang Sun
- Department of Behavioral and Social Science, Brown University, Providence, RI, USA
| | - Eric B. Loucks
- Department of Behavioral and Social Science, Brown University, Providence, RI, USA
| | - Jeffrey Proulx
- Department of Behavioral and Social Science, Brown University, Providence, RI, USA
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Avieli H, Band-Winterstein T. The Multiple Punishment of Being an Older Adult Coping With Health Problems in Prison. THE GERONTOLOGIST 2024; 64:gnad030. [PMID: 36943327 DOI: 10.1093/geront/gnad030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies have examined the vulnerabilities and the extent of health problems experienced by the older adult population in prison. However, reports about the subjective experiences of incarcerated older adults who are coping with health problems are scarce. This is alarming since older adults comprise the fastest-growing demographic in the prison systems of the United States and Europe. The aim of the current study was to bring forth the voices of older adults who are living with diseases in prison and to outline the landscape of struggling with everyday health care management. RESEARCH DESIGN AND METHODS An interpretive phenomenological analysis was used to analyze the narratives of 23 individuals aged 60-88 who were coping with health problems in prison. RESULTS The narratives revealed 3 major themes: (1) living day to day with illness in prison: fighting prison bureaucracy and public humiliation; (2) coping with complex medical issues: lack of professional medical care and cumulative problems, and (3) what does the future hold? Fear of living with illness out of prison. DISCUSSION AND IMPLICATIONS Intersectionality was used as a conceptual framework for understanding the participants' narratives. The cumulative effect of belonging to systematically oppressed and marginalized groups is discussed. The research findings point to issues and experiences that are unique to older adults coping with health problems in prison and can serve as a framework for developing tailored interventions for these individuals.
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Affiliation(s)
- Hila Avieli
- Department of Criminology, Ariel University, Ariel, Israel
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Evans CR. Overcoming combination fatigue: Addressing high-dimensional effect measure modification and interaction in clinical, biomedical, and epidemiologic research using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Soc Sci Med 2024; 340:116493. [PMID: 38128257 DOI: 10.1016/j.socscimed.2023.116493] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/21/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Growing interest in precision medicine, gene-environment interactions, health equity, expanding diversity in research, and the generalizability results, requires researchers to evaluate how the effects of treatments or exposures differ across numerous subgroups. Evaluating combination complexity, in the form of effect measure modification and interaction, is therefore a common study aim in the biomedical, clinical, and epidemiologic sciences. There is also substantial interest in expanding the combinations of factors analyzed to include complex treatment protocols (e.g., multiple study arms or factorial randomization), comorbid medical conditions or risk factors, and sociodemographic and other subgroup identifiers. However, expanding the number of subgroup category combinations creates combination fatigue problems, including concerns over small sample size, reduced power, multiple testing, spurious results, and design and analytic complexity. Creative new approaches for managing combination fatigue and evaluating high-dimensional effect measure modification and interaction are needed. Intersectional MAIHDA (multilevel analysis of individual heterogeneity and discriminatory accuracy) has already attracted substantial interest in social epidemiology, and has been hailed as the new gold standard for investigating health inequities across complex intersections of social identity. Leveraging the inherent advantages of multilevel models, a more general multicategorical MAIHDA can be used to study statistical interactions and predict effects across high-dimensional combinations of conditions, with important advantages over alternative approaches. Though it has primarily been used thus far as an analytic approach, MAIHDA should also be used as a framework for study design. In this article, I introduce MAIHDA to the broader health sciences research community, discuss its advantages over conventional approaches, and provide an overview of potential applications in clinical, biomedical, and epidemiologic research.
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Affiliation(s)
- Clare R Evans
- Department of Sociology, 1291 University of Oregon, Eugene, OR, 97403, USA.
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Porsch LM, Xu M, Veldhuis CB, Bochicchio LA, Zollweg SS, Hughes TL. Intimate Partner Violence Among Sexual Minority Women: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3014-3036. [PMID: 36154756 PMCID: PMC10039964 DOI: 10.1177/15248380221122815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Intimate partner violence (IPV) is prevalent among sexual minority women (SMW). However, compared to IPV research with heterosexual women and other LGBTQ+ population groups, SMW are understudied. We conducted a scoping review to examine the current state of knowledge about IPV among SMW, and to identify gaps and directions for future research. A search of Medline, Embase, CINAHL, and PsycINFO databases returned 1,807 papers published between January 2000 and December 2021. After independent reviewers screened these papers for relevance, 99 were included in the final review. Papers were included if they used quantitative methods and reported IPV data on adult SMW separately from other groups. Findings confirmed high rates of IPV among SMW and highlighted groups with particular vulnerabilities, including non-monosexual women and SMW of color. Risk factors for IPV in this population include prior trauma and victimization, psychological and emotional concerns, substance use, and minority stressors. Outcomes include poor mental and physical health. Findings related to the effects of minority stressors on IPV and comparisons across sexual minority groups were inconsistent. Future research should focus on IPV perpetration; mechanisms underlying risk for IPV, including structural-level risk factors; and understanding differences among SMW subgroups.
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Affiliation(s)
| | - Mariah Xu
- Columbia University, New York, NY, USA
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Sherman AD, Febres-Cordero S, Bonds Johnson K, Clark KD, Klepper M, Duroseau B, Lin Y, Zhang W, Coleman M, Prakash D, Daniel GA, Chand AT, Kalu U, Tarter R, Allgood S, Cohen S, Kelly U, Balthazar M. Intersectionality in nursing research: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023; 5:100155. [PMID: 37982092 PMCID: PMC10655863 DOI: 10.1016/j.ijnsa.2023.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 11/21/2023] Open
Abstract
Background An intersectional approach to health research provides an analytical foundation to explain the multidimensionality of health status, resource accessibility, privilege, oppression, and current and historical context. The use of intersectionality in health research has known limitations. Its use in health-related fields too often focuses on outcomes, such as health disparities, rather than processes, such as power structures and social determinants. Objective This scoping review serves to examine how intersectionality has been implemented by nurses in the peer-reviewed literature. We offer insight into how it may be incorporated to inform future nursing research and healthcare provision. Design & Methods Systematic searches of PubMed (n = 257), SCOPUS (n = 807), EMBASE (n = 396), CINAHL (n = 224), and Health Source: Nursing and Academics (n = 491), published since the seminal publication on intersectionality (1989 - 2023), identified 131 research articles that met inclusion and exclusion criteria. Data extraction and synthesis were used to describe the breadth and depth of the literature specific to the application of intersectionality in nursing research. Results The included studies used intersectionality to examine the intersections of numerous identities, such as race, gender, and immigration status. However, most studies were descriptive/observational in nature, underreported their methods, and conducted deficit-based research instead of strength-based inquiries. Of note, the vast majority of included articles were published within the last five years. Conclusions Future researchers using intersectionality as a framework can improve their approach by reporting clear definitions and operationalization of intersectionality. Observational science dominated the included studies; future research should focus on intervention development and evaluation using an intersectional lens. Lastly, caution should be placed on research that focuses solely on deficits among marginalized communities, which places scientists at risk of perpetuating stereotypes or enhancing already-existing stigmas.
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Affiliation(s)
- Athena D. F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH, USA
| | | | | | - Yufen Lin
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Wenhui Zhang
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Mercy Coleman
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Diane Prakash
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Gaea A. Daniel
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Arzina Tabassum Chand
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Ugo Kalu
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Robin Tarter
- Oregon Health and Science University, Portland, OR, USA
| | | | - Sydney Cohen
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Monique Balthazar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
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Lin E, Sleboda P, Rimel BJ, Datta GD. Inequities in colorectal and breast cancer screening: At the intersection of race/ethnicity, sexuality, and gender. SSM Popul Health 2023; 24:101540. [PMID: 37920304 PMCID: PMC10618777 DOI: 10.1016/j.ssmph.2023.101540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
Objective To investigate the joint impact of sexual orientation, gender identity, and race/ethnicity on colorectal and breast cancer screening disparities in the United States. Methods Utilizing sampling weighted data from the 2016 and 2018 Behavioral Risk Factor Surveillance System, we assessed differences in two metrics via chi-square statistics: 1) lifetime uptake, and 2) up-to-date colorectal and breast cancer screening by sexual orientation and gender identity, within and across racial/ethnic classifications. Results Within specific races/ethnicities, lifetime CRC screening was higher among gay/lesbian (within NH-White, Hispanic, and Asian/Pacific Islander) and bisexual individuals (Hispanic) compared to straight individuals, and lowest overall among transgender women and transgender nonconforming populations (p < 0.05). Asian transgender women had the lowest lifetime CRC screening (13.0%; w.n. = 1,428). Lifetime breast cancer screening was lowest among the Hispanic bisexual population (86.6%; w.n. = 26,940) and Hispanic transgender nonconforming population (71.8%; w.n. = 739); within all races, SGM individuals (except NH-White, Hispanic, and Black bisexual populations, and NH-White transgender men) had greater breast cancer screening adherence compared to straight individuals. Conclusions Due to small, unweighted sample sizes, results should be interpreted with caution. Heterogeneity in screening participation by SGM status within and across racial/ethnic groups were observed, revealing the need to disaggregate data to account for intersecting identities and for studies with larger sample sizes to increase estimate reliability.
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Affiliation(s)
- Emmeline Lin
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
| | - Patrycja Sleboda
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
| | - Bobbie J. Rimel
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Geetanjali D. Datta
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
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Rodrigues IB, Fahim C, Garad Y, Presseau J, Hoens AM, Braimoh J, Duncan D, Bruyn-Martin L, Straus SE. Developing the intersectionality supplemented Consolidated Framework for Implementation Research (CFIR) and tools for intersectionality considerations. BMC Med Res Methodol 2023; 23:262. [PMID: 37946142 PMCID: PMC10636989 DOI: 10.1186/s12874-023-02083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The concept of intersectionality proposes that demographic and social constructs intersect with larger social structures of oppression and privilege to shape experiences. While intersectionality is a widely accepted concept in feminist and gender studies, there has been little attempt to use this lens in implementation science. We aimed to supplement the Consolidated Framework for Implementation Research (CFIR), a commonly used framework in implementation science, to support the incorporation of intersectionality in implementation science projects by (1) integrating an intersectional lens to the CFIR; and (2) developing a tool for researchers to be used alongside the updated framework. METHODS Using a nominal group technique, an interdisciplinary framework committee (n = 17) prioritized the CFIR as one of three implementation science models, theories, and frameworks to supplement with intersectionality considerations; the modification of the other two frameworks are described in other papers. The CFIR subgroup (n = 7) reviewed the five domains and 26 constructs in the CFIR and prioritized domains and constructs for supplementation with intersectional considerations. The subgroup then iteratively developed recommendations and prompts for incorporating an intersectional approach within the prioritized domains and constructs. We developed recommendations and prompts to help researchers consider how personal identities and power structures may affect the facilitators and inhibitors of behavior change and the implementation of subsequent interventions. RESULTS We achieved consensus on how to apply an intersectional lens to CFIR after six rounds of meetings. The final intersectionality supplemented CFIR includes the five original domains, and 28 constructs; the outer systems and structures and the outer cultures constructs were added to the outer setting domain. Intersectionality prompts were added to 13 of the 28 constructs. CONCLUSION Through an expert-consensus approach, we modified the CFIR to include intersectionality considerations and developed a tool with prompts to help implementation users apply an intersectional lens using the updated framework.
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Affiliation(s)
- Isabel B Rodrigues
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Christine Fahim
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
| | - Yasmin Garad
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Braimoh
- Department of Social Science, York University, Toronto, ON, Canada
| | - Diane Duncan
- Physician Learning Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lora Bruyn-Martin
- Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Sharon E Straus
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Mayo D, Lozano A, Williams RS, Safren SA, Harkness A. The Relationship Between Intersectional Oppression and Affirmation and Latino Sexual Minority Men's Mental Health. LGBT Health 2023; 10:629-638. [PMID: 37466482 PMCID: PMC10712364 DOI: 10.1089/lgbt.2022.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Purpose: Latino sexual minority men (LSMM) may experience oppression based on their ethnicity, sexual orientation, and migratory status, yet scientific literature is only beginning to explore the intersection of these experiences. This study examined mental health (MH) in relation to LSMM's experiences of intersectional oppression and affirmation. Methods: We conducted a secondary analysis of baseline data from a cohort study examining LSMM's (n = 290) health care engagement in Miami, FL, from February to September 2020. Latent class analysis (LCA) identified classes based on self-reported multiple identity discrimination (e.g., race, ethnicity, and skin color), sexual orientation stigma/affirmation, and migration-related stress. Logistic and linear regressions examined associations between class membership and anxious, depressive, post-traumatic stress, somatic symptoms, and overall MH burden. Results: The LCA revealed a three-class solution: (1) affirmed LSMM (73.8%), (2) LSMM with intersectional oppression (21.7%), and (3) LSMM with immigration stress (4.5%). The three classes varied in terms of multiple identity discrimination, sexual orientation stigma/affirmation, and migration-related stress. Compared with Class 1, Class 2 had greater conditional probabilities of reporting clinically significant depressive (p = 0.033) and post-traumatic stress symptoms (p = 0.031), and at least one MH concern (p = 0.018). Greater depressive symptoms (p = 0.007), post-traumatic stress symptoms (p = 0.049), somatic symptoms (p = 0.024), and clinically significant MH concerns (p = 0.018) were found among Class 2 than among Class 1. Conclusion: Findings identified three groups of LSMM based on their experiences of intersectional oppression and affirmation. Discrimination at the intersection of multiple identities, sexual orientation stigma/affirmation, and migration-related stress were associated with LSMM's MH outcomes, particularly among immigrants.
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Affiliation(s)
- Daniel Mayo
- College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Alyssa Lozano
- Department of Public Health Sciences and University of Miami, Miami, Florida, USA
| | | | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
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Jones C, Jadva V, Zadeh S, Golombok S. Single fathers' experiences of using egg donation and surrogacy to start a family. Hum Reprod 2023; 38:1981-1990. [PMID: 37528054 PMCID: PMC10546079 DOI: 10.1093/humrep/dead152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/05/2023] [Indexed: 08/03/2023] Open
Abstract
STUDY QUESTION What are the experiences of single men using egg donation and surrogacy as a route to parenthood? SUMMARY ANSWER The fathers mainly had a positive relationship with the surrogate and simultaneously exercised agency, and experienced challenges, during the process of surrogacy. WHAT IS KNOWN ALREADY Little is known about single men's experiences of egg donation and surrogacy arrangements. Studies have focused on single men's decision-making processes about the use of surrogacy and family functioning once these families are formed. Questions remain about how fathers experience and navigate the process of surrogacy as a single man. STUDY DESIGN, SIZE, DURATION The study is an international, in-depth qualitative study of fathers who chose to begin a family and parent alone. Data were collected between 2018 and 2021 as part of a larger study of solo fathers with different routes to parenthood. The present study reports on 21 fathers who used surrogacy and egg donation to begin their family. The average age of the fathers was 44 years, the fathers had young children aged 6 years or younger, and lived in countries across Australia, Europe, and North America. PARTICIPANTS/MATERIALS, SETTING, METHODS Purposive sampling was used to recruit participants. In-depth semi-structured interviews were conducted. Interview topics included fathers' experiences of the process of using egg donation and surrogacy, and navigating the relationship with the surrogate. The audio-recorded interviews lasted around 2 hours and were subsequently transcribed verbatim. MAIN RESULTS AND THE ROLE OF CHANCE Data were analysed using reflexive thematic analysis and qualitative content analysis. Most of the fathers chose an identifiable egg donor. Regarding the relationship with the surrogate, many fathers had remained in contact with her, but to differing degrees, and they generally reported positive relationships. Thematic analysis led to the identification of three themes relating to the fathers' experiences of choosing surrogacy as a single man: the ability to make choices; challenges and constraints; and special relationship. LIMITATIONS, REASONS FOR CAUTION Due to the variation between different countries regarding laws on surrogacy, contextual factors may have impacted on the experiences of single fathers, and the sample size was small. However, the research provides new insights into an area with little academic literature. WIDER IMPLICATIONS OF THE FINDINGS Given the growing trend of single men having children through surrogacy, the findings suggest that this new path to parenthood can be both rewarding and challenging. Single men may benefit from tailored support and counselling to help them navigate the surrogacy journey. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Wellcome Trust (grant number 208013/Z/17/Z). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER n/a.
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Affiliation(s)
- C Jones
- Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, UK
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - V Jadva
- UCL Institute for Women’s Health, University College London, London, UK
| | - S Zadeh
- Thomas Coram Research Unit, University College London, London, UK
| | - S Golombok
- Centre for Family Research, University of Cambridge, Cambridge, UK
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Nillni YI, Horenstein A, McClendon J, Duke CC, Sawdy M, Galovski TE. The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans. PLoS One 2023; 18:e0291965. [PMID: 37751447 PMCID: PMC10521990 DOI: 10.1371/journal.pone.0291965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES Black and Hispanic/Latinx individuals experience a greater burden of mental health symptoms as compared to White individuals in the general population. Examination of ethnoracial disparities and mechanisms explaining these disparities among veterans is still in its nascence. The current study examined perceived everyday discrimination and income as parallel mediators of the association between race/ethnicity and PTSD, depression, and general anxiety symptoms in a sample of White, Black, and Hispanic/Latinx veterans stratified by gender. METHODS A random sample of 3,060 veterans living across the U.S. (oversampled for veterans living in high crime communities) completed a mail-based survey. Veterans completed self-report measures of perceived discrimination via the Everyday Discrimination Scale, PTSD symptoms via the Posttraumatic Stress Disorder Checklist-5, depressive symptoms via the Patient Health Questionnaire, and anxiety symptoms via the Generalized Anxiety Disorder Questionnaire. RESULTS Models comparing Black vs. White veterans found that the significant effect of race on PTSD, depression, and anxiety symptoms was mediated by both perceived discrimination and income for both male and female veterans. Results were less consistent in models comparing Hispanic/Latinx vs. White veterans. Income, but not perceived discrimination, mediated the relationship between ethnicity/race and depression and anxiety symptoms, but only among women. CONCLUSIONS Results suggest that discrimination and socioeconomic status are important mechanisms through which marginalized social status negatively impacts mental health.
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Affiliation(s)
- Yael I. Nillni
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | | | - Juliette McClendon
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | | | - Molly Sawdy
- Suffolk University, Boston, MA, United States of America
| | - Tara E. Galovski
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
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Campbell CK, Hammack PL, Gordon AR, Lightfoot MA. "I Was Always Trying to Figure It Out… on My Own Terms": Structural Barriers, the Internet, and Sexual Identity Development among Lesbian, Gay, Bisexual, and Queer People of Different Generations. JOURNAL OF HOMOSEXUALITY 2023; 70:2560-2582. [PMID: 35605228 PMCID: PMC9681935 DOI: 10.1080/00918369.2022.2071136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Recognizing the historical grounding of sexual identity development, we examined the spontaneous narration of the internet's significance among a diverse sample of three distinct birth cohorts of sexual minority adults (n = 36, ages 18-59) in the United States. Thematic analysis revealed two structural barriers and four roles of the internet in sexual identity development. Structural barriers were being in a heterosexual marriage (exclusive to members of the older cohort), and (2) growing up in a conservative family, religion, or community (which cut across cohorts). Roles of the internet included: learning about LGBQ+ identities and sex; watching pornography (which appeared only in narratives of the younger cohort); finding affirming community; and facilitating initial LGBQ+ romantic and sexual experiences (which appeared mostly in narratives of the younger cohort). Most participants who described the internet as playing a role in sexual identity development were members of the younger (ages 18-25) and middle (ages 34-41) cohorts. We discuss how the internet has assumed a unique role in history in the development of sexual minority people. Further, our findings highlight that sexual identity development occurs across the lifespan, and how that process and the roles of the internet vary by generation and structural realities.
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Affiliation(s)
- Chadwick K. Campbell
- Division of Prevention Sciences, University of California San Francisco, San Francisco, CA
- Department of Psychology, University of California, Santa Cruz, Santa Cruz, CA
| | - Phillip L. Hammack
- Department of Psychology, University of California, Santa Cruz, Santa Cruz, CA
| | - Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Marguerita A. Lightfoot
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR
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Calvet X, Cantera LM. Prevalence and Characteristics of Sexual Victimization among Gay and Bisexual Men: A Preliminary Study in Spain. Healthcare (Basel) 2023; 11:2496. [PMID: 37761693 PMCID: PMC10530702 DOI: 10.3390/healthcare11182496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Sexual violence is an understudied issue in the population of gay and bisexual men, although the existing articles to date demonstrate that it is a problem that merits public attention. This study aims to approach the problem of invisibility around the matter, as well as presenting a number of variables that have been usually overlooked in Spanish research or have not been assessed at all. Lifetime sexual victimization, sociodemographic characteristics, situational characteristics and social support were examined among 550 gay and bisexual males living in Spain using a self-administrated questionnaire. Results analysis show that 90.00% (87.18-92.38%) of participants reported at least one experience of unwanted insinuation, 87.27% (84.19-89.94%) reported at least one experience of sexual coercion, 64.00% (59.83-68.02%) reported at least one experience of sexual assault, and specifically 19.82% (16.57-23.40%) reported being raped during their lifetime. Significant differences have been found between some categories regarding gender identity, sexual orientation, age, race/ethnicity and educational level. Overall, these results showcase sexual violence as a pervasive problem in the Spanish gay and bisexual community.
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Affiliation(s)
- Xavier Calvet
- Social Psychology Area, Department of Social Psychology, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Barcelona, Spain;
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Taggart T, Sawyer S, Andreou A, Kershaw T, Milburn NG. "But I Live Here Too": Social-structural stressors, racial discrimination, and resiliency among urban dwelling black emerging adult men. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 72:48-59. [PMID: 37042933 PMCID: PMC10523859 DOI: 10.1002/ajcp.12667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 01/14/2023] [Accepted: 02/12/2023] [Indexed: 06/19/2023]
Abstract
For many Black emerging adult men in the United States, social-structural stressors rooted in racial discrimination are daily experiences that place them at greater risk for poor health. Emerging adulthood is a critical life course period marked by greater experimentation with health risk behaviors. Although Black men's health vulnerabilities during this period are connected to their social-structural environments, investigations of these factors among noncollege sampled Black men remain limited. We conduced thirty semi-structured in-depth interviews to examine associations between social-structural challenges and social-structural resources for resiliency. Interviews were audio-recorded, transcribed verbatim, and coded using Dedoose web-based qualitative software. Through open coding, emergent concepts were connected across interviews and major themes were identified. We found three core social-structural stressors: (1) Racial profiling, (2) neighborhood violence, and (3) lack of economic opportunities, and three resilience factors: (1) Positive social networks, (2) community-based resources, and (3) safe environments that foster a sense of community. Collectively, these findings provide insight into developing structural- and community-level interventions tailored to bolster resiliency across multiple levels and counteract the social-structural challenges that young Black men face.
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Affiliation(s)
- Tamara Taggart
- Department of Prevention and Community Health, George Washington University
- Department of Social and Behavioral Sciences, Yale School of Public Health
| | - Simone Sawyer
- Department of Prevention and Community Health, George Washington University
| | | | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health
| | - Norweeta G. Milburn
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles
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Zollweg SS, Belloir JA, Drabble LA, Everett B, Taylor JY, Hughes TL. Structural stigma and alcohol use among sexual and gender minority adults: A systematic review. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100185. [PMID: 37663525 PMCID: PMC10474584 DOI: 10.1016/j.dadr.2023.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
Background Sexual and gender minority (SGM) people are more likely than their cisgender, heterosexual counterparts to report negative alcohol-related outcomes. Although the association between individual- and interpersonal-level minority stressors and negative alcohol-related outcomes among SGM people is well-established, structural-level minority stressors are understudied. This systematic review examined structural-level stigma and alcohol-related outcomes among SGM people to inform future research, interventions, and policy. Methods We used five electronic databases to search for studies published between January 2010 and May 2022 that examined associations between structural stigma and alcohol use among SGM adults in the United States. Peer-reviewed, quantitative studies available in English were included. We conducted quality appraisal using the Joanna Briggs Institute checklist. Results The final sample included 11 studies. Overall, there was moderate to strong support for a positive association between structural stigma and negative alcohol-related outcomes among SGM people, with differences by gender, sexual identity, race, and ethnicity. All studies used cross-sectional designs, and nearly half utilized non-probability samples. Transgender and nonbinary people, SGM people of color, and sexual identity subgroups beyond gay, lesbian, and heterosexual were underrepresented. Structural stigma was most commonly measured as a state-level index. Alcohol measures were heterogeneous. Multilevel stigma and resiliency factors were understudied. Conclusions Addressing structural stigma is critical in reducing negative alcohol-related outcomes and inequities among SGM people. Research is needed that includes probability samples, longitudinal designs, and samples that reflect the diversity of SGM people. Future studies should examine the influence of multilevel stigma and resiliency factors on alcohol-related outcomes.
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Affiliation(s)
- Sarah S. Zollweg
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
- National Clinician Scholars Program, David Geffen School of Medicine, University of California, Los Angeles, CA, 1100 Glendon Ave, Suite 900, Los Angeles, CA 90024
| | - Joseph A. Belloir
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
| | - Laurie A. Drabble
- San Jose State University College of Health and Human Sciences, One Washington Square, San Jose, CA, 95192, USA
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., #450, Emeryville, CA, 94608, USA
| | - Bethany Everett
- University of Utah, Department of Sociology, 380 S. 1530 E, Salt Lake City, UT, 84112, USA
| | - Jacquelyn Y. Taylor
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
| | - Tonda L. Hughes
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
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Shah SH, Harris LM, Menghwani V, Stoler J, Brewis A, Miller JD, Workman CL, Adams EA, Pearson AL, Hagaman A, Wutich A, Young SL. Variations in household water affordability and water insecurity: An intersectional perspective from 18 low- and middle-income countries. ENVIRONMENT AND PLANNING. F, PHILOSOPHY, THEORY, MODELS, METHODS AND PRACTICE 2023; 2:369-398. [PMID: 38707600 PMCID: PMC11065962 DOI: 10.1177/26349825231156900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Compounding systems of marginalization differentiate and shape water-related risks. Yet, quantitative water security scholarship rarely assesses such risks through intersectionality, a paradigm that conceptualizes and examines racial, gendered, class, and other oppressions as interdependent. Using an intersectionality approach, we analyze the relationships between household head gender and self-reported socio-economic status, and water affordability (proportion of monthly income spent on water) and water insecurity (a composite measure of 11 self-reported experiences) for over 4000 households across 18 low- and middle-income countries in Central and South America, Africa, and Asia. Interaction terms and composite categorical variables were included in regression models, adjusting for putative confounders. Among households with a high socio-economic status, the proportion of monthly income spent on water differed by household head gender. In contrast, greater household water insecurity was associated with lower socio-economic status and did not meaningfully vary by the gender of the household head. We contextualize and interpret these experiences through larger systems of power and privilege. Overall, our results provide evidence of broad intersectional patterns from diverse sites, while indicating that their nature and magnitude depend on local contexts. Through a critical reflection on the study's value and limitations, including the operationalization of social contexts across different sites, we propose methodological approaches to advance multi-sited and quantitative intersectional research on water affordability and water insecurity. These approaches include developing scale-appropriate models, analyzing complementarities and differences between site-specific and multi-sited data, collecting data on gendered power relations, and measuring the impacts of household water insecurity.
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Affiliation(s)
- Sameer H Shah
- University of Washington, USA; The University of British Columbia, Canada
| | | | - Vikas Menghwani
- The University of British Columbia, Canada; University of Saskatchewan, Canada
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Valdez LA, Jaeger EC, Garcia DO, Griffith DM. Breaking Down Machismo: Shifting Definitions and Embodiments of Latino Manhood in Middle-Aged Latino Men. Am J Mens Health 2023; 17:15579883231195118. [PMID: 37694827 PMCID: PMC10496479 DOI: 10.1177/15579883231195118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
There is a notable gap in empirical research regarding how Latino men define and demonstrate machismo, masculinity, and manhood as well as the behavioral consequences associated with these concepts. In our study, we employed a phenomenological thematic approach to analyze 20 semi-structured individual interviews conducted with Latino men residing in South Florida. Our primary objectives were twofold: to examine (1) how do Latino men ages 35 to 60 years describe what it means to be a man and (2) what are the attributes that these men seek to show others that demonstrate their character, cultural values, and gender identity. Findings suggest that Latino men understood expectations associated with machismo and explained that fulfillment of their role as provider, protector, and head of the family was important to their perception of self. While some participants reported a desire to embody characteristics associated with traditional machismo, others strived to demonstrate character, familism, and respect and to provide financial and other instrumental support to their families. Participants reported that their transition into middle age was accompanied by a shift in their perspectives on gender roles, moving away from rigid patriarchal views. Exposure to a more fluid and flexible approach to manhood offered relief from the pressures associated with inflexible manifestations of machismo, which can have negative social, behavioral, and physical health implications. The implications of our research extend to the conceptualization of gender ideals, highlighting the need to incorporate intersectionality, role strain, precarious manhood, and culturally specific notions of manhood as foundational elements in this discourse.
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Affiliation(s)
- Luis A. Valdez
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Emily C. Jaeger
- Center for Men’s Health Equity, Georgetown University, Washington, DC, USA
| | - David O. Garcia
- Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Derek M. Griffith
- Center for Men’s Health Equity, Georgetown University, Washington, DC, USA
- Department of Health Management and Policy, School of Health, Georgetown University, Washington, DC, USA
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Metheny N, Scott D, Buch J, Fallon S, Chavez J. Trusted Sources of Information and COVID-19 Vaccine Uptake in a Sample of Latinx Sexual and Gender Minorities in South Florida. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:729-734. [PMID: 37104063 PMCID: PMC10524457 DOI: 10.1097/phh.0000000000001757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To examine factors associated with COVID-19 vaccine uptake in a sample of Latino/a/x sexual and/or gender minority (SGM) individuals in South Florida. DESIGN Data were collected via an online survey from March 2021 to August 2022, as part of the Community Engagement Alliance Against COVID-19 Disparities. A multivariate regression analysis was fit using completion of a COVID-19 vaccine regimen as the outcome. Key covariates included trusted sources of information (eg, doctor, media), COVID-19-related challenges (eg, accessing medication, transportation), and dominant wave of SARS-CoV-2 at the time of data collection. SETTING Miami-Dade and Broward counties, Florida. RESULTS White Latino/a/x, bachelor's educated respondents, and those with high levels of trust in community organizations had significantly greater odds of vaccination. CONCLUSION Community organizations may be key to improving vaccine uptake among marginalized Latino/a/x SGM for COVID-19 and other emerging communicable diseases, such as meningitis and Mpox (monkeypox). The results of this study suggest that tailored public health messaging and additional funding for vaccine distribution are needed to better equip community organizations with the resources they need to serve this population.
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Affiliation(s)
- Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida (Dr Metheny and Mr Scott); Latinos Salud, Miami, Florida (Mr Buch and Dr Fallon); and Miller School of Medicine, University of Miami, Miami, Florida (Ms Chavez)
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76
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Celeste-Villalvir A, Payan DD, Armenta G, Palar K, Then-Paulino A, Acevedo R, Fulcar MA, Derose KP. Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic. PLoS One 2023; 18:e0290228. [PMID: 37616218 PMCID: PMC10449144 DOI: 10.1371/journal.pone.0290228] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men's experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women's experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to "move on" and "look ahead." Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.
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Affiliation(s)
- Alane Celeste-Villalvir
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Denise D. Payan
- Department of Health, Society and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, United States of America
| | - Gabriela Armenta
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, United States of America
| | - Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Amarilis Then-Paulino
- Facultad de Ciencia de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Maria Altagracia Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Kathryn P. Derose
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, California, United States of America
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77
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Belus JM, Tralka H, Satinsky EN, Seitz-Brown C, Daughters SB, Magidson JF. Substance Use Outcomes Among Sexual and Gender Minority Individuals Living with HIV Following Residential Substance Use Treatment in Washington, DC. ALCOHOLISM TREATMENT QUARTERLY 2023; 41:373-385. [PMID: 37886040 PMCID: PMC10601688 DOI: 10.1080/07347324.2023.2241419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
This study explored how sexual or gender minority (SGM) status influenced substance use (SU) treatment outcomes in a predominantly African American and unemployed sample of people with HIV. N = 60 participants were enrolled in an abstinence-focused inpatient SU treatment center, followed by outpatient treatment sessions. At 12-months follow-up, the survival rate (i.e. those who did not reuse substances) was 37.6% (non-SGM group) vs. 4.8% (SGM group). The impact of SGM status on reuse was .54 log odds, p = .11, which translates to a 71.8% increase in the hazard of reusing substances for SGM vs. non-SGM individuals. For both groups, frequency of reuse remained stable and problems associated with SU decreased over time. Results suggest a potentially clinically relevant finding that SGM individuals have possible heigh-tened risk of SU after a mixed inpatient-outpatient program. ClinicalTrials.gov trial registration number: NCT01351454.
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Affiliation(s)
- Jennifer M. Belus
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Hannah Tralka
- Department of Behavioural and Community Health, University of Maryland, College Park, MD, USA
| | - Emily N. Satinsky
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - C.J. Seitz-Brown
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Stacey B. Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica F. Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA
- Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, MD, USA
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78
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Xavier Hall CD, Harris R, Burns P, Girod C, Yount KM, Wong FY. Utilizing Latent Class Analysis to Assess the Association of Intersectional Stigma on Mental Health Outcomes Among Young Adult Black, Indigenous, and Sexual Minority Women of Color. LGBT Health 2023; 10:463-470. [PMID: 36951670 PMCID: PMC10468552 DOI: 10.1089/lgbt.2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Purpose: Discrimination has detrimental effects on mental health, particularly among Black, Indigenous, and people of color who are also sexual minority women (BIPOC SMW); however, measurement of multiple intersecting forms of discrimination (e.g., race, gender, and sexual identity discrimination among BIPOC SMW) poses methodological challenges. This analysis uses latent class analysis (LCA) to examine the influences of discrimination on mental health in a convenience sample of BIPOC SMW. Methods: Online survey data from BIPOC SMW aged 18-29 years (n = 324) were used to estimate latent classes for discrimination type (race, gender, and sexual identity). Data for this study were collected from July to October 2018. Adjusted linear regressions examined the influences of discrimination profiles on perceived stress and depressive symptoms. Results: Utilizing LCA, the following four classes emerged: (1) low discrimination; (2) mid-level discrimination; (3) high racial, medium gender, and low sexual identity discrimination; (4) high discrimination. Classes 3 and 4 were positively associated with perceived stress and depressive symptoms relative to Class 1 in adjusted models. Conclusion: This analysis highlights the importance of intersectionality and the adverse impact of multiple forms of discrimination on mental health outcomes for BIPOC SMW. Respondents reporting higher levels of racial or multiple forms of discrimination had poorer mental health outcomes. LCA is a promising analytical tool for investigating intersectional stigma and discrimination. There is an urgent need to develop tailored, culturally appropriate intersectional mental health interventions to address the multiple identities and oppressions faced by BIPOC SMW.
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Affiliation(s)
- Casey D. Xavier Hall
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, Florida, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rachel Harris
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Paul Burns
- John D. Bower School of Population Health, Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Kathryn M. Yount
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Sociology, Emory University, Atlanta, Georgia, USA
| | - Frankie Y. Wong
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, Florida, USA
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
- Department of Epidemiology, Fudan University, Shanghai, China
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79
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Johns MM, Gordon AR, Andrzejewski J, Harper CR, Michaels S, Hansen C, Fordyce E, Dunville R. Differences in Health Care Experiences among Transgender and Gender Diverse Youth by Gender Identity and Race/Ethnicity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1128-1141. [PMID: 37086334 DOI: 10.1007/s11121-023-01521-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/23/2023]
Abstract
Transgender and gender diverse (TGD) youth experience significant risk for negative health outcomes, yet few studies exist that address TGD youth's experiences of health care. This paper explores the equitable access and utilization of health care in a sample of TGD youth of diverse gender and racial/ethnic identities. Data for this analysis are from the TGD subsample (n = 1415) of the 2018 Survey of Today's Adolescent Relationships and Transitions (START) Project. We assessed five health care experiences: being insured, having a current health care provider, being out to one's provider, believing your provider was knowledgeable about transgender issues, and barriers to accessing care due to gender identity/expression. We examined the proportion of TGD youth who reported each of these outcomes and within-group differences by gender identity and race/ethnicity using descriptive statistics, logistic regression, and predicted probabilities. When differences were examined by gender identity, barriers to equitable care were consistently more present among transgender females than youth of other gender identities. There were few significant differences by race/ethnicity; however, dual referent models demonstrated barriers to equitable care were particularly evident among Black and Hispanic transgender women. We discuss these findings through the lens of intersectionality and highlight the importance of research and intervention work focused on reducing barriers to equitable care for TGD youth.
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Affiliation(s)
- Michelle M Johns
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- NORC at the University of Chicago, 1447 Peachtree Street NE, Suite 700, Atlanta, GA, 30309, USA.
| | - Allegra R Gordon
- Boston University School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jack Andrzejewski
- San Diego Joint Doctoral Program in Public Health, San Diego State University, University of California, San Diego, CA, USA
| | - Christopher R Harper
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stuart Michaels
- NORC at the University of Chicago, 1447 Peachtree Street NE, Suite 700, Atlanta, GA, 30309, USA
| | - Christopher Hansen
- NORC at the University of Chicago, 1447 Peachtree Street NE, Suite 700, Atlanta, GA, 30309, USA
| | - Erin Fordyce
- NORC at the University of Chicago, 1447 Peachtree Street NE, Suite 700, Atlanta, GA, 30309, USA
| | - Richard Dunville
- NORC at the University of Chicago, 1447 Peachtree Street NE, Suite 700, Atlanta, GA, 30309, USA
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80
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Shrader CH, Duncan DT, Chen YT, Driver R, Russell J, Moody RL, Knox J, Skaathun B, Durrell M, Hanson H, Eavou R, Goedel WC, Schneider JA. Latent Profile Patterns of Network-Level Norms and Associations with Individual-Level Sexual Behaviors: The N2 Cohort Study in Chicago. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2355-2372. [PMID: 36877319 PMCID: PMC10480356 DOI: 10.1007/s10508-023-02555-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Individual-level behavior can be influenced by injunctive and descriptive social network norms surrounding that behavior. There is a need to understand how the influence of social norms within an individual's social networks may influence individual-level sexual behavior. We aimed to typologize the network-level norms of sexual behaviors within the social networks of Black sexual and gender minoritized groups (SGM) assigned male at birth. Survey data were collected in Chicago, Illinois, USA, between 2018 and 2019 from Black SGM. A total of 371 participants provided individual-level information about sociodemographic characteristics and HIV vulnerability from sex (i.e., condomless sex, group sex, use of alcohol/drugs to enhance sex) and completed an egocentric network inventory assessing perceptions of their social network members' (alters') injunctive and descriptive norms surrounding sexual behaviors with increased HIV vulnerability. We used Latent Profile Analysis (LPA) to identify network-level norms based on the proportion of alters' approval of the participant engaging in condomless sex, group sex, and use of drugs to enhance sex (i.e., injunctive norms) and alters' engagement in these behaviors (i.e., descriptive norms). We then used binomial regression analyses to examine associations between network-level norm profiles and individual-level HIV vulnerability from sex. The results of our LPA indicated that our sample experienced five distinct latent profiles of network-level norms: (1) low HIV vulnerability network norm, (2) moderately high HIV vulnerability network norm, (3) high HIV vulnerability network norm, (4) condomless sex dominant network norm, and (5) approval of drug use during sex dominant network norm. Condomless anal sex, group sex, and using drugs to enhance sex were positively and significantly associated with higher HIV vulnerability social network norm profiles, relative to low HIV vulnerability norm profiles. To mitigate Black SGM's HIV vulnerability, future HIV risk reduction strategies can consider using network-level intervention approaches such as opinion leaders, segmentation, induction, or alteration, through an intersectionality framework.
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Affiliation(s)
- Cho-Hee Shrader
- Department of Epidemiology, ICAP at Columbia University, Columbia University, 211 W 117th St APT 3A, New York, NY, 10026, USA.
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Yen-Tyng Chen
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA
| | - Redd Driver
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
| | - Jonathan Russell
- Department of Epidemiology, ICAP at Columbia University, Columbia University, 211 W 117th St APT 3A, New York, NY, 10026, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Raymond L Moody
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Mainza Durrell
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Hillary Hanson
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Rebecca Eavou
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - William C Goedel
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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81
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Bell D, Rahman S, Rochon R. (Trans)forming fitness: Intersectionality as a framework for resistance and collective action. Front Sports Act Living 2023; 5:944782. [PMID: 37564917 PMCID: PMC10410259 DOI: 10.3389/fspor.2023.944782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 02/24/2023] [Indexed: 08/12/2023] Open
Abstract
Fitness is a lifelong pursuit, yet many LGBTQ2S+ individuals are averse to group fitness or experiences in big box gyms. Due to the COVID-19 pandemic, virtual fitness programs offered the potential to facilitate opportunities for the greater inclusion of such individuals and the chance to connect, collaborate and advocate for a change in who and what defines fitness. Justice Roe, owner of Fit4AllBodies, utilizes the term fitness industrial complex to provide a framework to discuss the problems of exclusion. His explanation supports research documenting that bodies that are not "the norm", defined by ableism, classism, (hetero)patriarchy and racism, fueled by white supremacy, are oftentimes viewed as "less than" in the fitness and recreation world ( 1- 3). Applying an intersectional framework, this article explores the possibilities for transformative collective action in fitness communities that removes barriers and challenges the injustices that contribute to racialized LGBTQ2S+ individuals feeling unwelcome. With the need to shift to virtual training spaces as a result of a global pandemic, and the rise in the public discourse surrounding racial injustices both on and offline, a sense of belonging and community is important, especially among groups that often face exclusionary practices, such as racialized LGBTQ2S+ community members. These individuals are at greater risk of losing opportunities to access fitness programs that can provide immense health and psychological benefits. What could an intersectional perspective on resistance in sport look like? Using the example of LGBTQ2S+ access to online fitness spaces during the prolonged global COVID-19 pandemic starting in 2020, we suggest that explicit coaching education and intentional communities, centered around social justice, are needed to address the historical roots of systemic oppression, accessibility, and social constructs tied to fitness.
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Affiliation(s)
- Deniece Bell
- Indigeneity Diaspora Equity and Anti-Racism in Sport (IDEAS) Research Lab, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Saidur Rahman
- Indigeneity Diaspora Equity and Anti-Racism in Sport (IDEAS) Research Lab, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - R. Rochon
- Department of Sport Management, Florida State University, Tallahassee, FL, United States
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Tinner L, Holman D, Ejegi-Memeh S, Laverty AA. Use of Intersectionality Theory in Interventional Health Research in High-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6370. [PMID: 37510601 PMCID: PMC10379482 DOI: 10.3390/ijerph20146370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/12/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Intersectionality theory posits that considering a single axis of inequality is limited and that considering (dis)advantage on multiple axes simultaneously is needed. The extent to which intersectionality has been used within interventional health research has not been systematically examined. This scoping review aimed to map out the use of intersectionality. It explores the use of intersectionality when designing and implementing public health interventions, or when analysing the impact of these interventions. METHODS We undertook systematic searches of Medline and Scopus from inception through June 2021, with key search terms including "intersectionality", "interventions" and "public health". References were screened and those using intersectionality and primary data from high-income countries were included and relevant data synthesised. RESULTS After screening 2108 studies, we included 12 studies. Six studies were qualitative and focused on alcohol and substance abuse (two studies), mental health (two studies), general health promotion (one study) and housing interventions (one study). The three quantitative studies examined mental health (two studies) and smoking cessation (one study), while the three mixed-method studies examined mental health (two studies) and sexual exploitation (one study). Intersectionality was used primarily to analyse intervention effects (eight studies), but also for intervention design (three studies), and one study used it for both design and analysis. Ethnicity and gender were the most commonly included axes of inequality (11 studies), followed by socio-economic position (10 studies). Four studies included consideration of LGBTQ+ and only one considered physical disability. Intersectional frameworks were used by studies to formulate specific questions and assess differences in outcomes by intersectional markers of identity. Analytical studies also recommended intersectionality approaches to improve future treatments and to structure interventions to focus on power and structural dynamics. CONCLUSIONS Intersectionality theory is not yet commonly used in interventional health research, in either design or analysis. Conditions such as mental health have more studies using intersectionality, while studies considering LGBTQ+ and physical disability as axes of inequality are particularly sparse. The lack of studies in our review suggests that theoretical and methodological advancements need to be made in order to increase engagement with intersectionality in interventional health.
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Affiliation(s)
- Laura Tinner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Daniel Holman
- Department of Sociological Studies, The University of Sheffield, The Wave, 2 Whitham Road, Sheffield S10 2AH, UK
| | - Stephanie Ejegi-Memeh
- Department of Sociological Studies, The University of Sheffield, The Wave, 2 Whitham Road, Sheffield S10 2AH, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation, School of Public Health, Imperial College London, London SW7 2BX, UK
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Murchison GR, Eiduson R, Agénor M, Gordon AR. Tradeoffs, Constraints, and Strategies in Transgender and Nonbinary Young Adults' Romantic Relationships: The Identity Needs in Relationships Framework. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2023; 40:2149-2180. [PMID: 38736630 PMCID: PMC11086993 DOI: 10.1177/02654075221142183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Prior research suggests that prejudice and structural disadvantage (e.g., cissexism, racism, sexism) put transgender and nonbinary (TNB) young adults at risk for adverse romantic relationship experiences, yet supportive romantic relationships may help TNB young adults cope with these stressors and promote their psychological wellbeing. Accordingly, there is a need to better understand how TNB young adults navigate romantic relationships in the context of prejudice and structural disadvantage. To address this topic, we analyzed in-depth interviews with TNB young adults (18-30 years; N=30) using template-style thematic analysis, guided by intersectionality as an analytical framework. Our analysis resulted in three themes. Theme 1 describes how prejudice and structural disadvantage constrained the strategies that TNB young adults used to pursue fulfilling romantic relationships (e.g., leaving adverse relationships). Theme 2 addresses the tradeoffs that some participants faced in their romantic relationships, including tradeoffs between psychological needs related to their social identities (e.g., gender identity affirmation) and general psychological needs (e.g., intimacy). Theme 3 highlights individual and contextual factors (e.g., lessons from prior romantic relationships) that helped participants build fulfilling romantic relationship. These themes form the basis for the Identity Needs in Relationships Framework, a new conceptual framework addressing how TNB young adults navigate romantic relationships in the context of prejudice and structural disadvantage. The framework offers an explanation for why some TNB young adults maintain romantic relationships that seem to undermine their wellbeing, and it draws attention to strategies and resources that may help TNB young adults form fulfilling romantic relationships despite the prejudice and structural disadvantage they face.
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Affiliation(s)
- Gabriel R. Murchison
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Rose Eiduson
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA
| | - Madina Agénor
- Department of Behavioral & Social Sciences and Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
| | - Allegra R. Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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84
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Quinn KG, Edwards T, Takahashi L, Johnson A, Spector A, Dakin A, Bouacha N, Valadez-Tapia S, Voisin D. "The Fight is Two Times as Hard": A Qualitative Examination of a Violence Syndemic Among Young Black Sexual Minority Men. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:8162-8186. [PMID: 36803199 PMCID: PMC10714286 DOI: 10.1177/08862605231153891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Young Black men who have sex with men (YBMSM) are disproportionately impacted by violence, including violence rooted in anti-Black racism, sexual identity bullying, and neighborhood violence rooted in structural racism and inequities. These multiple forms of violence are frequently co-occurring and interactive creating syndemic conditions that can negatively impact HIV care. This qualitative study is based on in-depth interviews with 31 YBMSM, aged 16-30 years, living with HIV in Chicago, IL, to examine how violence has impacted their lives. Using thematic analysis, we identified five themes that reflect how YBMSM experience violence at the intersection of racism, homonegativity, socioeconomic status, and HIV status: (a) the experience of intersectional violence; (b) long histories of violence contributed to hypervigilance, lack of safety, and lack of trust; (c) making meaning of violence and the importance of strength; (d) normalizing violence for survival; and (e) the cyclical nature of violence. Our study highlights how multiple forms of violence can accumulate across an individual's life and contribute to social and contextual situations that further contribute to violence and negatively impact mental health and HIV care.
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Affiliation(s)
- Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Travonne Edwards
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Lois Takahashi
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - Anthony Johnson
- School of Social Work, Loyola University Chicago, Chicago, IL
| | - Antoinette Spector
- Department of Physical Therapy, Rehabilitation Sciences & Technology, University of Wisconsin, Milwaukee, Milwaukee, WI
| | | | | | | | - Dexter Voisin
- School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH
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85
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RIVERA AS, RUSIE LK, FEINSTEIN MJ, SIDDIQUE J, LLOYD-JONES DM, BEACH LB. Intersectionality-informed analysis of durable viral suppression disparities in people with HIV. AIDS 2023; 37:1285-1296. [PMID: 37070543 PMCID: PMC10556196 DOI: 10.1097/qad.0000000000003565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The aim of this study was to examine drivers of durable viral suppression (DVS) disparities among people with HIV (PWH) using quantitative intersectional approaches. DESIGN A retrospective cohort analysis from electronic health records informed by intersectionality to better capture the concept of interlocking and interacting systems of oppression. METHODS We analyzed data of PWH seen at a LGBTQ federally qualified health center in Chicago (2012-2019) with at least three viral loads. We identified PWH who achieved DVS using latent trajectory analysis and examined disparities using three intersectional approaches: Adding interactions, latent class analysis (LCA), and qualitative comparative analysis (QCA). Findings were compared with main effects only regression. RESULTS Among 5967 PWH, 90% showed viral trajectories consistent with DVS. Main effects regression showed that substance use [odds ratio (OR) 0.56, 0.46-0.68] and socioeconomic status like being unhoused (OR: 0.39, 0.29-0.53), but not sexual orientation or gender identity (SOGI) were associated with DVS. Adding interactions, we found that race and ethnicity modified the association between insurance and DVS ( P for interaction <0.05). With LCA, we uncovered four social position categories influenced by SOGI with varying rates of DVS. For example, the transgender women-majority class had worse DVS rates versus the class of mostly nonpoor white cisgender gay men (82 vs. 95%). QCA showed that combinations, rather than single factors alone, were important for achieving DVS. Combinations vary with marginalized populations (e.g. black gay/lesbian transgender women) having distinct sufficient combinations compared with historically privileged groups (e.g. white cisgender gay men). CONCLUSION Social factors likely interact to produce DVS disparities. Intersectionality-informed analysis uncover nuance that can inform solutions.
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Affiliation(s)
- Adovich S. RIVERA
- Institute for Public Health and Management, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Kaiser Permanente South California Department of Research and Evaluation, Pasadena, CA, USA
| | | | - Matthew J. FEINSTEIN
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Juned SIDDIQUE
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Donald M. LLOYD-JONES
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren B. BEACH
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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86
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Muñoz EA, Shorey RC, Temple JR. Reproductive Coercion Victimization and Associated Mental Health Outcomes Among Female-Identifying Young Adults. J Trauma Dissociation 2023; 24:538-554. [PMID: 37198921 PMCID: PMC10373799 DOI: 10.1080/15299732.2023.2212407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
Reproductive coercion is a serious public health problem. Victimization has been associated with poor mental health outcomes, including symptoms of posttraumatic stress disorder (PTSD) and depression in clinical and college samples. We build on these findings by examining the association between reproductive coercion victimization and mental and behavioral health outcomes, including depression, PTSD symptoms, anxiety, and drinking behaviors in a diverse community-derived sample of female-identifying young adults (mean age = 20; SD=.72). Participants (n = 368) were originally recruited as part of a study on dating violence in seven Texas public high schools. Participants completed an online study that included demographic questions and measures that assessed the variables of interest. Results of regression analyses showed that reproductive coercion victimization predicted depression, anxiety, and PTSD symptoms, after controlling for race, sexual orientation, and age. The findings also revealed that victims of reproductive coercion were more likely consume more drinks per drinking occasion compared to their non-victimized counterparts. These results add to the growing literature that experiencing reproductive coercion is a risk marker for poor mental and behavioral health. To develop targeted prevention and intervention programs, future research should examine potential mechanisms underlying this relationship.
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Affiliation(s)
- Emily A Muñoz
- Department of Psychology, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | - Ryan C Shorey
- Department of Psychology, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | - Jeff R Temple
- Center for Violence Prevention, UTMB Health, Galveston, TX, USA
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87
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Burke NL, Hazzard VM, Schaefer LM, Simone M, O’Flynn JL, Rodgers RF. Socioeconomic status and eating disorder prevalence: at the intersections of gender identity, sexual orientation, and race/ethnicity. Psychol Med 2023; 53:4255-4265. [PMID: 35574702 PMCID: PMC9666565 DOI: 10.1017/s0033291722001015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Longstanding biases have fostered the erroneous notion that only those of higher socioeconomic status (SES) experience eating disorders (EDs); however, EDs present across all SES strata. Considering the dearth of ED research among those of lower SES, this study examined (1) the overall association between SES and ED prevalence, and (2) ED prevalence in the context of four relevant social identities (i.e. SES, gender identity, sexual orientation, and race/ethnicity) from an intersectional perspective, as unique combinations of multiple social identities may differentially influence risk. METHODS A sample of 120 891 undergraduate/graduate students from the Healthy Minds Study self-reported family SES with a single-item question, gender identity, sexual orientation, and race/ethnicity, and were screened for ED risk. RESULTS Participants of lower SES had 1.27 (95% CI 1.25-1.30) times greater prevalence of a positive ED screen than those of higher SES. Substantial heterogeneity was observed across the four social identities beyond the association with SES. For example, positive ED screens were particularly common among lower SES, Latinx, sexual minority cisgender men and women, with 52% of bisexual men and 52% of lesbian women of Latinx ethnicity and lower SES screening positive. CONCLUSIONS Although positive ED screens were more common among undergraduate/graduate students of lower SES, the particularly high ED risk reported by certain groups of lower SES with multiple minority identities reinforces the importance of investigating multi-layered constructs of identity when identifying groups at disproportionate risk.
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Affiliation(s)
- Natasha L. Burke
- Department of Psychology, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458, USA
| | - Vivienne M. Hazzard
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, USA, 55454
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, 55454
| | - Lauren M. Schaefer
- Sanford Center for Bio-behavioral Research, 120 Eighth Street South, Fargo, ND 58103, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, 1919 Elm Street N, Fargo, ND, 58102, USA
| | - Melissa Simone
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, USA, 55454
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, 55454
| | - Jennifer L. O’Flynn
- Department of Applied Psychology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, MA, 02139, USA
| | - Rachel F. Rodgers
- Department of Applied Psychology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
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88
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Weßel M, Gerhards SM. "Discrimination is always intersectional" - understanding structural racism and teaching intersectionality in medical education in Germany. BMC MEDICAL EDUCATION 2023; 23:399. [PMID: 37268929 PMCID: PMC10236740 DOI: 10.1186/s12909-023-04386-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Racism in medicine represents a global problem. It takes place on the individual, institutional and structural level. Especially structural racism can have serious effects on the health of individual people. Furthermore, racist discrimination is not always based on race solemnly but frequently intersects with other social categories such as gender, class or religion. To describe this multidimensional form of discrimination the term intersectionality has been coined. However, the understanding of structural intersectional racism in medicine is still fragmented, especially in the German context. Yet, medical students need to be trained in understanding structural and intersectional racism to see the impact of racist structures on the patient's health. METHOD We conducted a qualitative study to explore the knowledge, awareness and perception of racism in medicine and health care of medical students in Germany. Our research questions are how do medical student understand structural racism and its effects on health in Germany? Do students see interrelations with other forms of discrimination and in this context to what extent are they familiar with the concept of intersectionality? Which categories intersect from their point of views with race in context of medicine and health care? We conducted focus groups with medical students (n = 32) in Germany. RESULTS Our results demonstrate that students have a wide spectrum of knowledge, awareness and perceptions about racism from being rather elaborate to very little knowledge about it. The students have particular problems to understand and situate structural racism in Germany. Some raised doubts about the relevance. Yet, other students are aware of the concept of intersectionality and are convinced that racism must be looked at from an intersectional perspective. CONCLUSIONS The diverse knowledge, awareness and perceptions of medical students about structural racism and intersectionality hints to a lack of systematic education of medical students about these issues in Germany. Yet, in context of diversifying societies an understanding about racism and its impact on health is imminent for future medical doctors to provide good care for their patients. Therefore, this knowledge gap must be systematically filled by the medical education.
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Affiliation(s)
- Merle Weßel
- Ethics in Medicine, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26111, Oldenburg, Germany.
| | - Simon Matteo Gerhards
- Ethics in Medicine, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26111, Oldenburg, Germany
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89
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King WM, Jadwin-Cakmak L, Trammell R, Gamarel KE. Structural vulnerability as a conceptual framework for transgender health research: findings from a community needs assessment of transgender women of colour in Detroit. CULTURE, HEALTH & SEXUALITY 2023; 25:681-697. [PMID: 35736653 PMCID: PMC9780405 DOI: 10.1080/13691058.2022.2086709] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/02/2022] [Indexed: 06/02/2023]
Abstract
The concept of structural vulnerability explains how systems of oppression drive health inequities by reducing access to survival resources (e.g. food, housing) for marginalised populations. Indicators of structural vulnerability such as housing instability, violent victimisation and poverty are often interconnected and result from intersectional oppression. We sought to demonstrate the utility of the structural vulnerability framework for transgender health research by examining patterns of structural vulnerability indicators among transgender women of colour in Detroit. We conducted latent class analysis and tested associations between classes and mental health and substance use outcomes. Membership to the Lowest Vulnerability class was negatively associated with post-traumatic stress disorder (PTSD) (aOR = 0.10, 95% CI: 0.02-0.59). High Economic Vulnerability membership was associated with daily marijuana use (aOR = 4.61, 95% CI: 1.31-16.16). Complex Multi-Vulnerability membership was associated with PTSD (aOR = 9.75, 95% CI: 2.55-37.29), anxiety (aOR = 4.12, 95% CI: 1.22-13.97), suicidality (aOR = 6.20, 95% CI: 1.39-27.70), and club drug use (aOR = 4.75, 95% CI: 1.31-17.29). Substantively different findings emerged when testing relationships between each indicator and each outcome, highlighting the value of theoretically grounded quantitative approaches to understanding health inequities. Community-driven interventions and policy changes that reduce structural vulnerability may improve mental health and substance use outcomes among structurally vulnerable trans women of colour.
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Affiliation(s)
- Wesley M King
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Racquelle Trammell
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Trans Sistas of Colour Project, Detroit, MI, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
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90
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Behler AC, George N, Collibee C, Hamilton L, Oleson EB, Thamotharan S. A conceptual framework for queer, black womxn sexual assault survivors: an adaptation of the minoritised stress model. CULTURE, HEALTH & SEXUALITY 2023; 25:791-802. [PMID: 35900895 DOI: 10.1080/13691058.2022.2089734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 06/10/2022] [Indexed: 06/02/2023]
Abstract
Queer, Black womxn experience sexual assault at an alarming rate in the USA leading to adverse mental and physical health outcomes in survivors. A synthesis of the literature was conducted to understand their unique lived experiences and needs. This article proposes an adapted Meyer's Minoritised Stress framework to understand salient clinical factors impacting Queer, Black womxn sexual assault survivors, including those associated with multiple minoritised identities: Queer-based trauma, race-based trauma, cultural betrayal trauma, and misogynoir. Given the high rates of victimisation, marginalisation and discrimination, psychologists and others working with members of this population should engage with and address these factors to provide culturally responsive, sexually affirming and effective mental health treatment and care.
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Affiliation(s)
| | - Nevita George
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Charlene Collibee
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Lindsey Hamilton
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Erik B Oleson
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Sneha Thamotharan
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
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91
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Cicero EC, Lett E, Flatt JD, Benson GP, Epps F. Transgender Adults From Minoritized Ethnoracial Groups in the U.S. Report Greater Subjective Cognitive Decline. J Gerontol B Psychol Sci Soc Sci 2023; 78:1051-1059. [PMID: 36688593 PMCID: PMC10214655 DOI: 10.1093/geronb/gbad012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Investigate subjective cognitive decline (SCD) among 4 study groups consisting of cisgender and transgender adults who are from minoritized ethnoracial groups (i.e., minoritized ethnoracial transgender, minoritized ethnoracial cisgender) and White cisgender and transgender adults aged 45+ (i.e., White transgender, White cisgender) to determine the odds of SCD by group and to test for group differences. METHODS Data from the 2015-2020 Behavioral Risk Factor Surveillance System were used in a modified case-control approach to perform an intercategorical intersectional study. Each transgender participant was matched to 2 cisgender men and 2 cisgender women, on state, ethnoracial identity, and age. Multivariable logistic regressions modeled SCD odds by group and post hoc contrasts estimated pairwise odds ratios comparing the SCD odds for each combination of groups. RESULTS SCD prevalence was highest among minoritized ethnoracial transgender (21.6%), followed by White transgender (15.0%), minoritized ethnoracial cisgender (12.0%), and White cisgender (9.0%). After accounting for age, education, and survey year, the odds of SCD were higher in minoritized ethnoracial transgender when compared to White cisgender (adjusted odds ratio [aOR] = 2.51, 95% confidence interval [CI]: 1.59-3.96) and minoritized ethnoracial cisgender (aOR = 1.89, 95% CI: 1.16-3.09). The odds of SCD were higher in White transgender compared to White cisgender (aOR = 1.66, 95% CI: 1.20-2.30). DISCUSSION When considering the intersection of transgender and ethnoracial identities, we found that transgender adults from minoritized ethnoracial groups reported higher odds of SCD when compared to cisgender adults from minoritized ethnoracial groups. Additional studies are needed to understand the relationship between racialized and gendered inequities in cognitive impairment and how specific mechanisms of systemic transphobia and racism may contribute to this inequity.
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Affiliation(s)
- Ethan C Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Applied Transgender Studies, Chicago, Illinois, USA
| | - Jason D Flatt
- School of Public Health, Department of Social and Behavioral Health Program, University of Nevada, Las Vegas, Nevada, USA
| | - G Perusi Benson
- Department of Psychology, North Carolina State University, Raleigh, North Carolina, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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92
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Janssen T, Gamarel KE, Mereish EH, Colby SM, Haikalis M, Jackson KM. Associations Among Enacted Stigma, Perceived Chances for Success, Life Satisfaction, and Substance Use Among Sexual Minority and Heterosexual Youth. Subst Use Misuse 2023; 58:1121-1131. [PMID: 37216278 PMCID: PMC10388366 DOI: 10.1080/10826084.2023.2212282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background: Sexual minority youth report high rates of substance use compared to heterosexual youth. Stigma can diminish perceptions of future success and life satisfaction and contribute to elevated substance use. This study examined whether experiences of enacted stigma (i.e., discrimination) and substance use among sexual minority and heterosexual youth were indirectly associated through perceived chances for success and life satisfaction. Method: In a sample of 487 adolescents who indicated their sexual identity (58% female, M age = 16.0, 20% sexual minority), we assessed substance use status and factors that might explain sexual minority disparities in substance use. Using structural equation modeling, we examined indirect associations between sexual minority status and substance use status through these factors. Results: Compared to heterosexual youth, sexual minority youth reported greater stigma, which was associated with both lower perceived chances for success and life satisfaction, which were in turn associated with greater likelihood of substance use. Conclusions: Findings highlight the importance of attending to stigma, perceived chances for success, and general life satisfaction to understand and intervene to prevent substance use among sexual minority youth.
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Affiliation(s)
- Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health
| | - Ethan H. Mereish
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
- Department of Health Studies, American University
| | - Suzanne M. Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - Michelle Haikalis
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
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93
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Cha E, Vyas V, King KD, Reifferscheid L, MacDonald SE. Inclusion of intersectionality in studies of immunization uptake in Canada: A scoping review. Vaccine 2023:S0264-410X(23)00510-8. [PMID: 37202274 DOI: 10.1016/j.vaccine.2023.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Intersectionality refers to the interconnectedness of various social locations creating unique experiences for individuals and groups, in the context of systems of privilege and oppression. As part of immunization coverage research, intersectionality allows healthcare professionals and policymakers to become aware of the constellation of characteristics contributing to low vaccine uptake. The objective of this study was to examine the application of intersectionality theory or concepts, and the appropriate use of sex and gender terminology, in Canadian immunization coverage research. MATERIALS AND METHODS The eligibility criteria for this scoping review included English or French language studies on immunization coverage among Canadians of all ages. Six research databases were searched without date restrictions. We searched provincial and federal websites, as well as the Proquest Dissertations and Theses Global database for grey literature. RESULTS Of 4725 studies identified in the search, 78 were included in the review. Of these, 20 studies included intersectionality concepts, specifically intersections of individual-level characteristics influencing vaccine uptake. However, no studies explicitly used an intersectionality framework to guide their research. Of the 19 studies that mentioned "gender", 18 had misused this term, conflating it with "sex". CONCLUSIONS Based on our findings, there is an evident lack of intersectionality framework utilization in immunization coverage research in Canada, as well as misuse of the terms "gender" and "sex". Rather than only focusing on discrete characteristics, research should explore the interaction between numerous characteristics to better understand the barriers to immunization uptake in Canada.
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Affiliation(s)
- Eunah Cha
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Vidhi Vyas
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Keith D King
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Laura Reifferscheid
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Shannon E MacDonald
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
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94
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Kim MJ, Wilkins K, Gorman B. Healthcare satisfaction at the intersections of sexual orientation and race/ethnicity. ETHNICITY & HEALTH 2023; 28:601-618. [PMID: 35803900 DOI: 10.1080/13557858.2022.2096207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/26/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Existing scholarship has consistently demonstrated disparities in healthcare experience based on sexual identity. However, relatively little research has considered intersections with race/ethnicity, despite that intersection with other characteristics may complicate healthcare experiences and satisfaction among sexual minorities. This study aims to address such a gap by examining healthcare satisfaction across the intersections of sexual and racial/ethnic identity. DESIGN Utilizing data on U.S. adults included in the 2013-2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 372,766), we investigate levels of satisfaction with care among a range of groups simultaneously embodying two identities. RESULTS Findings from ordered logistic regression models show that among adults who identify as heterosexual, the odds of reporting high satisfaction with care are lower among Blacks, Asians, and Native Americans. Among sexual minority adults, the likelihood of reporting high satisfaction with care is consistently lower among Native American gay and lesbian adults compared to gays and lesbians of other race/ethnicity or Native American and White heterosexuals, indicating heightened vulnerability to poorer healthcare experience among this multiple minority group. CONCLUSION While levels of satisfaction with care tend to be generally high across groups, future research should endeavor to investigate the driving factors that lower the odds of high healthcare satisfaction among those with intersecting minority identities.
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Affiliation(s)
- Min Ju Kim
- Department of Sociology, Rice University, Houston, TX, USA
| | - Kiana Wilkins
- Department of Sociology, Rice University, Houston, TX, USA
| | - Bridget Gorman
- Department of Sociology, Rice University, Houston, TX, USA
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95
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Kuhlemeier A. Measurement Invariance of Psychological Distress, Substance Use, and Adult Social Support across Race/Ethnicity and Sex among Sexual Minority Youth. JOURNAL OF SEX RESEARCH 2023; 60:674-688. [PMID: 35200066 PMCID: PMC9399311 DOI: 10.1080/00224499.2022.2038059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Research on intersectional differences among sexual minority youth (SMY) relies on population-level datasets to ensure sufficiently large samples to explore between-group differences and assess the influence of axes of oppression/privilege. I argue that a structural equation modeling framework for investigating intersectional differences among SMY increases the nuance with which we understand heterogeneity and provides tools for ensuring that variables measure comparable constructs across diverse populations - an assumption of traditional univariate methods that is rarely empirically verified. Using a subset of SMY that identified as either White or Hispanic/Latino and male or female from the New Mexico Youth Risk and Resiliency Survey (N = 3,654), this study tested invariance of three latent constructs: psychological distress, substance use, and adult support across sexual orientation, race/ethnicity, sex, and three-way intersections of those identities. Analyses established invariance across race/ethnicity and sex of all constructs among gay/lesbian youth. Partial invariance models were required to account for intersectional differences in substance use among bisexual youth and in psychological distress among questioning youth. This study models a novel strategy for examining how social location at the intersection of multiple axes of oppression/privilege shape behavioral health and social support and paves the way for significant advances in research on SMY.
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Affiliation(s)
- Alena Kuhlemeier
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM 87131
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96
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McGuire FH, Beccia AL, Peoples J, Williams MR, Schuler MS, Duncan AE. Depression at the intersection of race/ethnicity, sex/gender, and sexual orientation in a nationally representative sample of US adults: A design-weighted MAIHDA. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.13.23288529. [PMID: 37131598 PMCID: PMC10153310 DOI: 10.1101/2023.04.13.23288529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study examined how race/ethnicity, sex/gender, and sexual orientation intersect to socially pattern depression among US adults. We used repeated, cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (NSDUH; n=234,772) to conduct design-weighted multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) for two outcomes: past-year and lifetime major depressive episode (MDE). With 42 intersectional groups constructed from seven race/ethnicity, two sex/gender, and three sexual orientation categories, we estimated group-specific prevalence and excess/reduced prevalence attributable to intersectional effects (i.e., two-way or higher interactions between identity variables). Models revealed heterogeneity between intersectional groups, with prevalence estimates ranging from 3.4-31.4% (past-year) and 6.7-47.4% (lifetime). Model main effects indicated that people who were Multiracial, White, women, gay/lesbian, or bisexual had greater odds of MDE. Additive effects of race/ethnicity, sex/gender, and sexual orientation explained most between-group variance; however, approximately 3% (past-year) and 12% (lifetime) were attributable to intersectional effects, with some groups experiencing excess/reduced prevalence. For both outcomes, sexual orientation main effects (42.9-54.0%) explained a greater proportion of between-group variance relative to race/ethnicity (10.0-17.1%) and sex/gender (7.5-7.9%). Notably, we extend MAIHDA to calculate nationally representative estimates to open future opportunities to quantify intersectionality with complex sample survey data.
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Affiliation(s)
- F. Hunter McGuire
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Ariel L. Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - JaNiene Peoples
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | | | | | - Alexis E. Duncan
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA
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97
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Sternberg B, Badea C, Rubin M. Intersectional Person Perception: A Scoping Review of Studies Investigating the Roles of Category Relationships and Cognitive Processes. SOCIAL COGNITION 2023. [DOI: 10.1521/soco.2023.41.2.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
This review considered experimental studies that used an intersectional framework in order to examine (1) how perceived relationship between the categories in a given intersection impacts the perception of its members and (2) how intersectional person perception has been studied through different cognitive processes. A systematic search in databases identified 5,393 records, and a screening processes resulted in 43 articles reporting 110 studies. The way intersectional targets were cognitively processed depended on contextual factors as well as on the perceived relationship between intersected identities (e.g., perceived [in-]congruence between identities). Less prototypical intersectional targets (e.g., Black gay men) sometimes experienced intersectional invisibility, facing both relative advantages (e.g., being less associated with certain negative stereotypes), and disadvantages (e.g., being overlooked, less recognized) compared to more prototypical members of their constituent ingroups (e.g., Black people, gay men). Future work should incorporate observed exceptions to these patterns and expand the cultural context of analysis.
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98
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Scott SB, Knopp K, Yang JP, Do QA, Gaska KA. Sexual Minority Women, Health Care Discrimination, and Poor Health Outcomes: A Mediation Model Through Delayed Care. LGBT Health 2023; 10:202-210. [PMID: 36521166 DOI: 10.1089/lgbt.2021.0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Sexual minority (SM) women are a heterogeneous group who commonly report negative health care experiences at the intersection of their diverse sexual orientations and racial/ethnic identities. However, scarce research has evaluated how negative health care experiences may affect health outcomes among this population. Informed by the Health Equity Promotion Model for SM health, this study evaluated mediation models in which delayed care mediated the association between provider discrimination and poor health outcomes in SM women. Sexual orientation (plurisexual or monosexual) and race/ethnicity (women of color or White) were evaluated as moderators of the direct and indirect pathways. Methods: The sample included SM women (N = 1530) from the nationally representative Association of American Medical Colleges biannual Consumer Survey of Healthcare Access (2010-2020). Mediation models were conducted with lavaan structural equation modeling software. Results: Reported discrimination from a health care provider was associated with higher physical and emotional impairment, and these associations were partially mediated through delayed care. Sexual orientation and race/ethnicity also moderated several indirect and direct pathways. Conclusion: Results provide evidence of delayed care as a possible mediation pathway between provider discrimination and worse health in SM women and that the strength of these associations may vary by sexual orientation and race/ethnicity. Results indicate a need for policy change and clinical trainings to reduce the harm of provider discrimination on SM women.
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Affiliation(s)
- Shelby B Scott
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Kayla Knopp
- Advanced Fellowship for Women's Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Joyce P Yang
- Department of Psychology, University of San Francisco, San Francisco, California, USA
| | - Quyen A Do
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Karie A Gaska
- Department of Clinical Foundations, Ross University School of Medicine, St. Michael, Barbados
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99
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Ünsal BC, Demetrovics Z, Reinhardt M. Stronger together: community participation, structural stigma, and depression among sexual and gender minority adults in 28 European countries. Soc Psychiatry Psychiatr Epidemiol 2023; 58:657-669. [PMID: 36434298 PMCID: PMC10066166 DOI: 10.1007/s00127-022-02385-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Although discriminatory laws, policies, and public attitudes (i.e., structural stigma) are linked to adverse mental health outcomes among sexual and gender minority (SGM) populations, little attention has been paid to protective factors, such as community participation, about which inconsistencies exist whether it ameliorates or exacerbates mental health burdens. Thus, we examined the mediator roles of identity disclosure and victimization and the moderator role of structural stigma in the association of community participation with depression. METHODS Data from the EU-LGBTI-II survey assessing community participation, identity disclosure, victimization, and depression among sexual minority men (n = 62,939), women (n = 38,976), and gender minority adults (n = 15,845) in 28 European countries were used. Structural stigma was measured as discriminatory legislation, policies, and societal attitudes using publicly available data. RESULTS Findings showed that community participation predicted lower and higher levels of depression through identity disclosure and victimization, respectively. For sexual minority men and women, structural stigma moderated the indirect effect through identity disclosure, with a larger effect in higher structural stigma countries. Only for sexual minority men, the indirect effect through victimization was also moderated, with a larger effect in high-stigma countries. For gender minorities, no moderation effect was found. CONCLUSIONS Community participation is differentially linked to depression through identity disclosure and victimization, and as a function of structural stigma. It can be a double-edged sword, especially for sexual minority men in high-stigma countries, who are expected to pay the price while enjoying its benefits, highlighting the targets and considerations for interventions.
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Affiliation(s)
- Berk C Ünsal
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Melinda Reinhardt
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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100
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Pacheco M, Warfield SK, Hatzistavrakis P, Mochida-Meek S, Moskowitz D, Matson M, Mustanski B. "I don't see myself represented:" Strategies and considerations for engaging gay male Native Hawaiian and Other Pacific Islander teens in research and HIV prevention services. AIDS Behav 2023; 27:1055-1067. [PMID: 36097088 PMCID: PMC9466349 DOI: 10.1007/s10461-022-03843-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 12/02/2022]
Abstract
Significant efforts have been applied to the development of sexual health programs for minority young gay males. Given the absence of research with Native Hawaiian and other Pacific Islander (NHOPI) gay teen males, this study was done to assess how to reach them. Interviews were conducted with 20 NHOPI gay males ages 19-24 as near peers that can inform reaching teens. Data was analyzed using the Reflexive Thematic Analysis method. Three themes were identified: (1) Culture is a crucial factor for recruitment and engagement-whether participants realized it or not; (2) Confidentiality is key in recruitment to provide a safe space for NHOPI gay teen male research participation; and (3) NHOPI gay teen males experience multiple identity conflicts that must be considered for recruitment and engagement initiatives. Online recruitment efforts are optimal and should reflect distinct NHOPI cultures. More research is needed when it comes to understanding the cultural acceptance and understanding of homosexuality in NHOPI communities and how to integrate cultural education into recruitment methods and interventions.
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Affiliation(s)
- Misty Pacheco
- Department of Kinesiology and Exercise Sciences, University of Hawai'i at Hilo, 200 W Kawili Street, 96720, Hilo, HI, USA.
| | | | - Patti Hatzistavrakis
- Department of Kinesiology and Exercise Sciences, University of Hawai'i at Hilo, 200 W Kawili Street, 96720, Hilo, HI, USA
| | - Summer Mochida-Meek
- Department of Kinesiology and Exercise Sciences, University of Hawai'i at Hilo, 200 W Kawili Street, 96720, Hilo, HI, USA
| | - David Moskowitz
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Margaret Matson
- Department of Medical Social Sciences, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
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