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Kidd JD, Levin FR, Dolezal C, Hughes TL, Bockting WO. Understanding predictors of improvement in risky drinking in a U.S. multi-site, longitudinal cohort study of transgender individuals: Implications for culturally-tailored prevention and treatment efforts. Addict Behav 2019; 96:68-75. [PMID: 31039507 PMCID: PMC6571154 DOI: 10.1016/j.addbeh.2019.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE While transgender people report higher rates of risky drinking than the general population, no studies have examined transgender alcohol use longitudinally. This study investigated minority stress and identity development predictors of improvement in risky drinking among transgender individuals. METHODS Data come from a multi-site, longitudinal cohort study of U.S. transgender individuals (N = 330) and include measures of enacted stigma, felt stigma, identity development, and risky alcohol use. Theory-driven, hierarchical multivariable logistic regression was used to investigate the hypothesis that minority stress and identity development factors are related to improvement in risky drinking between baseline and 1-year follow-up. RESULTS Baseline risky drinkers (n = 106; 37.1%) were younger and more likely to have female sex assigned at birth. At 1-year follow-up, 68 baseline risky drinkers (64.2%) reported persistent risky drinking, while 38 (35.8%) reported improved drinking. Controlling for demographics and study site, female sex assigned at birth and enacted stigma were associated with lower odds of improved drinking. Non-white/Hispanic race/ethnicity, felt stigma, change in gender role/expression for 1-5 years, and diffuse-avoidant identity style were associated with higher odds of improvement. CONCLUSIONS/IMPORTANCE This is the first study to identity predictors of improvement in risky drinking among transgender individuals. Compared to trans-feminine individuals (assigned male at birth), trans-masculine individuals (assigned female at birth) were more likely to report risky drinking at baseline and had lower odds of improvement at 1-year follow-up. Improved drinking may be facilitated by preventing anti-transgender discrimination. Felt stigma and diffuse-avoidant identity style may lower alcohol risk via avoidance of drinking venues. Further research is needed to explicate these relationships and to inform culturally-tailored alcohol interventions for this at-risk population.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Frances R Levin
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Curtis Dolezal
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, United States of America.
| | - Walter O Bockting
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, United States of America.
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52
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Progovac AM, Mullin BO, Creedon TB, McDowell A, Sanchez-Roman MJ, Hatfield LA, Schuster MA, Cook BL. Trends in Mental Health Care Use in Medicare from 2009 to 2014 by Gender Minority and Disability Status. LGBT Health 2019; 6:297-305. [PMID: 31436481 DOI: 10.1089/lgbt.2018.0221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study examines trends in Medicare beneficiaries' mental health care use from 2009 to 2014 by gender minority and disability status. Methods: Using 2009 to 2014 Medicare claims, we modeled mental health care use (outpatient mental health care, inpatient mental health care, and psychotropic drugs) over time, adjusting for age and behavioral health diagnoses. We compared trends for gender minority beneficiaries (identified using diagnosis codes) to trends for a 5% random sample of other beneficiaries, stratified by original entitlement reason (age vs. disability). Results: Adjusted outpatient and inpatient mental health care use decreased and differences generally narrowed between gender minority and other beneficiaries over the study period. Among beneficiaries qualifying through disability, the gap in the number of outpatient and inpatient visits (among those with at least one visit in a given year) widened. Psychotropic drug use rose for all beneficiaries, but the proportion of gender minority beneficiaries in the aged cohort who had a psychotropic medication prescription rose faster than for other aged beneficiaries. Conclusions: Mental health care needs for Medicare beneficiaries may be met increasingly by using psychotropic medications rather than outpatient visits, and this pattern is more pronounced for identified gender minority (especially aged) beneficiaries. These trends may indicate a growing need for research and provider training in safe and effective psychotropic medication prescribing alongside gender-affirming treatments such as hormone therapy, especially for aged gender minority individuals who likely already experience polypharmacy.
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Affiliation(s)
- Ana M Progovac
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Brian O Mullin
- Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Timothy B Creedon
- Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Alex McDowell
- PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts.,Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Maria Jose Sanchez-Roman
- Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts.,Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Benjamin Lê Cook
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
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53
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McDowell A, Progovac AM, Cook BL, Rose S. Estimating the Health Status of Privately Insured Gender Minority Children and Adults. LGBT Health 2019; 6:289-296. [PMID: 31314674 DOI: 10.1089/lgbt.2018.0238] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose: The purpose of this study was to characterize the health status of privately insured gender minority individuals. Methods: We created a diagnosis-based algorithm to identify gender minority children and adults in the 2009-2015 IBM® MarketScan® Commercial Database. We compared the age-adjusted health status among individuals with and without gender minority-related diagnosis codes. Results: The percentage of the privately insured population with gender minority-related diagnosis codes increased from 0.004% in 2009 to 0.026% in 2015. Age-adjusted analyses demonstrated that individuals with gender minority-related diagnosis codes were more likely to have diagnoses for mental health disorders (odds ratio [OR] = 8.5; 95% confidence interval [CI] = 8.1-9.0), substance use disorders (OR = 3.4; 95% CI = 2.9-3.9), and diabetes (OR = 1.4; 95% CI = 1.2-1.6), driven by high prevalence of these conditions among individuals younger than 18 years. Conclusions: Our findings highlight a markedly greater prevalence of mental health and substance use disorder diagnoses among privately insured gender minority individuals. These results establish a reference point for evaluating the impact of federal- and state-level policies that ban health insurance discrimination based on gender identity on the health and health care use of gender minority individuals.
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Affiliation(s)
- Alex McDowell
- PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts.,Department of Health Care Policy and Harvard Medical School, Boston, Massachusetts
| | - Ana M Progovac
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Benjamin Lê Cook
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Sherri Rose
- Department of Health Care Policy and Harvard Medical School, Boston, Massachusetts
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Downing J, Conron K, Herman JL, Blosnich JR. Transgender And Cisgender US Veterans Have Few Health Differences. Health Aff (Millwood) 2019; 37:1160-1168. [PMID: 29985698 DOI: 10.1377/hlthaff.2018.0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transgender people have been able to serve openly in the military since June 2016. However, the administration of President Donald Trump has signaled its interest in reinstating a ban on transgender military service. In March 2018 President Trump issued a revised memorandum that stated, in part, that people with a "history or diagnosis of gender dysphoria" who "may require substantial medical treatment, including medications and surgery-are disqualified from military service except under certain limited circumstances." Whether and how the health of transgender service members differs from that of cisgender service members (that is, those who identify with their sex assigned at birth) is largely unknown. This study used population-level data for 2014-16 from the Behavioral Risk Factor Surveillance System to compare the health of transgender and cisgender veterans and civilians. An estimated 0.5 percent of veterans in the sample identified themselves as transgender. While transgender civilians had worse health than cisgender civilians across most indicators, very few differences existed among veterans. However, transgender veterans had higher odds of having at least one disability compared to cisgender veterans, despite similar levels of access to health care. These findings largely suggest that transgender veterans do not have worse health than cisgender veterans.
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Affiliation(s)
- Janelle Downing
- Janelle Downing ( ) is an assistant professor of health services policy and management, University of South Carolina, in Columbia
| | - Kerith Conron
- Kerith Conron is the Blachford-Cooper Distinguished Scholar and research director of the Williams Institute, University of California Los Angeles School of Law
| | - Jody L Herman
- Jody L. Herman is a Williams Institute Scholar of Public Policy at the Williams Institute, University of California Los Angeles School of Law
| | - John R Blosnich
- John R. Blosnich is a research health scientist at the Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, in Pennsylvania
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55
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Lewis NJW, Batra P, Misiolek BA, Rockafellow S, Tupper C. Transgender/gender nonconforming adults’ worries and coping actions related to discrimination: Relevance to pharmacist care. Am J Health Syst Pharm 2019; 76:512-520. [DOI: 10.1093/ajhp/zxz023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nancy J W Lewis
- Department of Pharmacy Practice,University of Michigan College of Pharmacy, Ann Arbor, MI
- Transcend the Binary, Ferndale, MI
| | - Peter Batra
- Institute of Social Research, University of Michigan, Ann Arbor, MI
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Becasen JS, Denard CL, Mullins MM, Higa DH, Sipe TA. Estimating the Prevalence of HIV and Sexual Behaviors Among the US Transgender Population: A Systematic Review and Meta-Analysis, 2006-2017. Am J Public Health 2019; 109:e1-e8. [PMID: 30496000 PMCID: PMC6301428 DOI: 10.2105/ajph.2018.304727] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2018] [Indexed: 11/04/2022]
Abstract
Background. Transgender women (transwomen) in the United States have been shown to have high HIV risk with Black and Hispanic transwomen being particularly vulnerable. Growing research on transgender men (transmen) also shows increased HIV risk and burden, although not as much is known for this transgender population.Objectives. This systematic review estimates the prevalence of self-reported and laboratory-confirmed HIV infection, reported sexual and injection behaviors, and contextual factors associated with HIV risk of transgender persons living in the United States.Search Methods. We searched the HIV Prevention Research Synthesis database and MEDLINE, EMBASE, PsycINFO, CINAHL, and Sociological Abstracts databases from January 2006 to March 2017 and January 2006 to May 2017, respectively. Additional hand searches were conducted in December 2017 to obtain studies not found in the literature searches.Selection Criteria. Eligible reports were published US-based studies that included transgender persons and reported HIV status.Data collection and analysis. Data were double-coded and quality assessed. We used random-effects models employing the DerSimonian-Laird method to calculate overall prevalence of HIV infection, risk behaviors, and contextual factors for transwomen, transmen, and race/ethnicity subgroups.Main Results. We reviewed 88 studies, the majority of which were cross-sectional surveys. Overall laboratory-confirmed estimated prevalence of HIV infection was 9.2% (95% confidence interval [CI] = 6.0%, 13.7%; κ = 24). Among transwomen and transmen, HIV infection prevalence estimates were 14.1% (95% CI = 8.7%, 22.2%; κ = 13) and 3.2% (95% CI = 1.4%, 7.1%; κ = 8), respectively. Self-reported HIV infection was 16.1% (95% CI = 12.0%, 21.2%; κ = 44), 21.0% (95% CI = 15.9%, 27.2%; κ = 30), and 1.2% (95% CI = 0.4%, 3.1%; κ = 7) for overall, transwomen, and transmen, respectively. HIV infection estimates were highest among Blacks (44.2%; 95% CI = 23.2%, 67.5%; κ = 4). Overall, participation in sex work was 31.0% (95% CI = 23.9%, 39.0%; κ = 39). Transwomen (37.9%; 95% CI = 29.0%, 47.7%; κ = 29) reported higher participation in sex work than transmen (13.1%; 95% CI = 6.6%, 24.3%; κ = 10; P = .001). Most outcomes indicated high heterogeneity in the overall and subgroup analyses.Conclusions. The availability of more data allowed us to calculate estimates separately for transwomen and transmen. HIV prevalence estimates for US transwomen were lower than previous estimates, but estimates for HIV prevalence and participation in sex work were higher when compared with transmen. Evidence gaps remain for transmen and the syndemic relationship of HIV, risky behaviors, and contextual factors specific to the transgender experience.Public Health Implications. This study highlights gender disparities for HIV and risky sexual behavior, as well as evidence gaps that exist for transmen. Tailored programs and services for the transgender population need to be developed to encourage use of and access to HIV prevention services.
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Affiliation(s)
- Jeffrey S Becasen
- Jeffrey S. Becasen, Mary M. Mullins, Darrel H. Higa, and Theresa Ann Sipe are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Christa L. Denard is with ICF International, Atlanta
| | - Christa L Denard
- Jeffrey S. Becasen, Mary M. Mullins, Darrel H. Higa, and Theresa Ann Sipe are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Christa L. Denard is with ICF International, Atlanta
| | - Mary M Mullins
- Jeffrey S. Becasen, Mary M. Mullins, Darrel H. Higa, and Theresa Ann Sipe are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Christa L. Denard is with ICF International, Atlanta
| | - Darrel H Higa
- Jeffrey S. Becasen, Mary M. Mullins, Darrel H. Higa, and Theresa Ann Sipe are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Christa L. Denard is with ICF International, Atlanta
| | - Theresa Ann Sipe
- Jeffrey S. Becasen, Mary M. Mullins, Darrel H. Higa, and Theresa Ann Sipe are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Christa L. Denard is with ICF International, Atlanta
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57
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Wilson EC, Turner C, Arayasirikul S, Woods T, Nguyen T, Lin R, Franza K, Tryon J, Nemoto T, Iwamoto M. Housing and income effects on HIV-related health outcomes in the San Francisco Bay Area - findings from the SPNS transwomen of color initiative. AIDS Care 2018; 30:1356-1359. [PMID: 29920118 DOI: 10.1080/09540121.2018.1489102] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Transwomen of color are disproportionately impacted by HIV and may have worse health outcomes than other populations. This analysis was conducted to examine structural factors associated with poor health outcomes among transwomen of color living with HIV in the San Francisco Bay Area (N = 159). Univariate and multivariable analyses were conducted to determine if structural factors were associated with poor HIV-related health outcomes. A majority of participants were Black or African American (110/159, 69.2%), 32 (20.1%) identified their primary race/ethnicity as Hispanic or Latino/a or Spanish, and 17 (10.7%) identified as another race/ethnicity. Transwomen of color in our sample faced extreme structural barriers, including residential transience, extreme low income, high prevalence of running out of money in the last six months, high rates of food insecurity, high prevalence of income via entitlement programs, engagement in sex work and other illicit activities for income. Unstable housing was the structural factor most consistently associated with poor health outcomes along the HIV care continuum and may explain engagement in other sources of income generation. Interventions are needed that go beyond the individual and health care-level to address needs for housing and economic opportunities to improve HIV care outcomes among transwomen of color living with HIV in the San Francisco Bay Area.
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Affiliation(s)
- E C Wilson
- a Center for Public Health Research, San Francisco Department of Public Health , San Francisco , California , USA
| | - C Turner
- a Center for Public Health Research, San Francisco Department of Public Health , San Francisco , California , USA
| | - S Arayasirikul
- a Center for Public Health Research, San Francisco Department of Public Health , San Francisco , California , USA
| | - T Woods
- b Brandy Martell Project, TransVision program, Tri City Health Center
| | - T Nguyen
- b Brandy Martell Project, TransVision program, Tri City Health Center
| | - R Lin
- a Center for Public Health Research, San Francisco Department of Public Health , San Francisco , California , USA
| | - K Franza
- c TransAccess Program, Asian and Pacific Islander Wellness Center and San Francisco Department of Public Health
| | - J Tryon
- c TransAccess Program, Asian and Pacific Islander Wellness Center and San Francisco Department of Public Health
| | - T Nemoto
- d Butterfly Nest, Public Health International
| | - M Iwamoto
- d Butterfly Nest, Public Health International
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58
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Gilbert PA, Pass LE, Keuroghlian AS, Greenfield TK, Reisner SL. Alcohol research with transgender populations: A systematic review and recommendations to strengthen future studies. Drug Alcohol Depend 2018; 186:138-146. [PMID: 29571076 PMCID: PMC5911250 DOI: 10.1016/j.drugalcdep.2018.01.016] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is a recent and growing research literature on alcohol use and related harms among transgender and other gender minority populations; however, current definitions and measures of hazardous drinking do not consider the complexity of physiological sex characteristics and socially constructed gender, raising doubts regarding their validity, applicability, and use with these populations. To address this, we reviewed current research on alcohol-related outcomes in transgender populations and critically summarized key issues for consideration in future research. METHODS We conducted a systematic review of transgender alcohol research in English language, peer-reviewed journals, published 1990-2017, and extracted key details (e.g., sample composition, alcohol measures, results). RESULTS Forty-four studies met all inclusion criteria for the review, the majority of which were conducted in the United States. The prevalence of hazardous drinking was high; however, estimates varied widely across studies. We noted frequent methodological weaknesses, including few attempts to differentiate sex and gender, poor attention to appropriate definitions of hazardous drinking, and reliance on cross-sectional study designs and non-probability sampling methods. CONCLUSION Given findings that suggest high need for ongoing public health attention, we offer recommendations to improve future alcohol studies with transgender and other gender minority populations, such as being explicit as to whether and how sex and/or gender are operationalized and relevant for the research question, expanding the repertoire of alcohol measures to include those not contingent on sex or gender, testing the psychometric performance of established screening instruments with transgender populations, and shifting from descriptive to analytic study designs.
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Affiliation(s)
- Paul A. Gilbert
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren E. Pass
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Alex S. Keuroghlian
- Harvard Medical School, Boston, MA, USA,The Fenway Institute, Fenway Health, Boston, MA, USA,Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Tom K. Greenfield
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sari L. Reisner
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
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59
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Valentine SE, Shipherd JC. A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev 2018; 66:24-38. [PMID: 29627104 DOI: 10.1016/j.cpr.2018.03.003] [Citation(s) in RCA: 305] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 03/13/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
Transgender and gender non-conforming (TGNC) populations, including those who do not identify with gender binary constructs (man or woman) are increasingly recognized in health care settings. Research on the health of TGNC people is growing, and disparities are often noted. In this review, we examine 77 studies published between January 1, 1997 and March 22, 2017 which reported mental health outcomes in TGNC populations to (a) characterize what is known about mental health outcomes and (b) describe what gaps persist in this literature. In general, depressive symptoms, suicidality, interpersonal trauma exposure, substance use disorders, anxiety, and general distress have been consistently elevated among TGNC adults. We also used the minority stress model as a framework for summarizing existing literature. While no studies included all elements of the Minority Stress Model, this summary gives an overview of which studies have looked at each element. Findings suggest that TGNC people are exposed to a variety of social stressors, including stigma, discrimination, and bias events that contribute to mental health problems. Social support, community connectedness, and effective coping strategies appear beneficial. We argue that routine collection of gender identity data could advance our understanding mental health risk and resilience factors among TGNC populations.
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Affiliation(s)
- Sarah E Valentine
- Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
| | - Jillian C Shipherd
- Boston University School of Medicine, Boston, MA, USA; Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Program, Veterans Health Administration, Washington, DC, USA; National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
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60
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Saludes V, Folch C, Morales-Carmona A, Ferrer L, Fernàndez-López L, Muñoz R, Jiménez M, Loureiro E, Fernández-Dávila P, Bascuñana E, Casabona J, Martró E. Community-based screening of hepatitis C with a one-step RNA detection algorithm from dried-blood spots: Analysis of key populations in Barcelona, Spain. J Viral Hepat 2018; 25:236-244. [PMID: 29053912 DOI: 10.1111/jvh.12809] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/15/2017] [Indexed: 12/30/2022]
Abstract
Alternative strategies are required to enhance the diagnosis of silent hepatitis C virus (HCV) infections in key populations at risk. Among them, HCV prevalence and bio-behavioural data are scarce for HIV-negative men who have sex with men (MSM) and men and trans-women sex workers. We sought to describe and assess the potential benefits of a community-based one-step HCV screening and confirmatory strategy for these populations in Barcelona. The screening strategy based on a real-time RT-PCR assay for HCV-RNA detection in dried-blood spots (DBS) was validated and implemented in addition to an antibody point-of-care test in a community centre. HCV prevalence was assessed, and bio-behavioural data were collected. The molecular assay was precise, reproducible, sensitive and specific. Four HIV-negative MSM reported being currently infected (0.75% HCV self-reported prevalence). Implementation of DBS testing was easy, and acceptability was >95%, but no silent HCV case was diagnosed (N = 580). High-risk sexual practices and drug use for sex were reported frequently. HIV prevalence was 4.7% in MSM and 10% in sex workers. Self-reported prevalence of other STIs ranged from 11.3% to 36.2%. In conclusion, HCV-RNA testing in DBS showed a good performance, but the assessed one-step strategy does not seem beneficial in this setting. Although no silent HCV infections were detected, the observed high-risk behaviours and prevalence of other STIs suggest that HCV spread should be periodically monitored among these populations in Barcelona by means of behavioural surveillance, rapid antibody testing and molecular confirmation in DBS.
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Affiliation(s)
- V Saludes
- Microbiology Service, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - C Folch
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | | | - L Ferrer
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - L Fernàndez-López
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - R Muñoz
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - M Jiménez
- Microbiology Service, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Badalona, Spain
| | - E Loureiro
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - P Fernández-Dávila
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain.,Research Department, Stop Sida, Barcelona, Spain
| | - E Bascuñana
- Microbiology Service, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Badalona, Spain
| | - J Casabona
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain
| | - E Martró
- Microbiology Service, Germans Trias i Pujol University Hospital, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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61
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Transgender Health Care in the U.S. Military and Veterans Health Administration Facilities. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0120-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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