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Liang Z, Chen Y. An Intersectional Exploration of Outness, Encountered Discrimination and Violence, and Non-Suicidal Self-Injury among Asexual Youth across Gender Identities. J Youth Adolesc 2024; 53:2045-2059. [PMID: 38739331 DOI: 10.1007/s10964-024-01999-4] [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: 01/03/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
Current research on asexual youth is limited, especially in understanding the impact of their outness and the intersection of sexual orientation with gender minority identities. This study investigates the influence of outness on experiences of harassment, discrimination, violence, and the risk of non-suicidal self-injury (NSSI) among asexual youth, with a focus on those with transgender and non-binary identities. Data for this study were obtained from the 2021 Ace Community Survey, an international online survey designed to assess the needs and health status of the Ace community, targeting respondents aged 13 and older. The analysis involved a subsample of 5574 respondents aged 13 to 24 (mean age = 19.28), including 2361 cisgender (mean age = 19.65), 1,195 transgender (mean age = 18.80), and 2,018 non-binary individuals (mean age = 19.13). The results revealed that experienceds of sexual violence, verbal aggression, and physical harassment and bullying not only correlated with but also completely mediated the relationship between outness and NSSI. Asexual transgender youth experienced heightened levels of discrimination and NSSI but demonstrated notable resilience against the negative effects of identity disclosure, highlighting complex dynamics of vulnerability and protection within these communities.
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Affiliation(s)
- Zurong Liang
- Department of Sociology, Zhejiang University, Hangzhou, China.
| | - Yutian Chen
- Department of Sociology, Zhejiang University, Hangzhou, China
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2
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Dorri AA, Loza O, Bond MA, Ciszek E, Elias-Curry Y, Aguilar S, Fliedner P, Norwood A, Stone AL, Cooper MB, Schick V, Wilkerson JM, Wermuth PP, Yockey RA, Schnarrs P. Understanding the Experiences of Latinx LGBTQ Texans at the Beginning of the COVID-19 Pandemic. JOURNAL OF HOMOSEXUALITY 2024; 71:2424-2448. [PMID: 37552613 DOI: 10.1080/00918369.2023.2241597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Marginalized communities have been disproportionately affected by COVID-19, including both racial/ethnic minority and sexual minority populations. To date, there has been little research examining the impact of the COVID-19 pandemic at the intersections of marginalized identities. Furthermore, available national data on COVID-19 outcomes may obscure our understanding of region-specific outcomes, particularly in the U.S. South. Using an intersectional approach, we explore differences in worries over COVID-19, preventative behaviors, and COVID-19 outcomes in the early months of the pandemic in a diverse sample of LGBTQ people (N = 1076) living in Texas. Our findings indicated that LGBTQ Latinx people in Texas reported more COVID-19 related worries and adverse outcomes than non-Latinx LGBTQ people. These findings are in line with previous research that found that the increased risk to Latinx and LGBTQ populations in public health crises is often overlooked and can be attributed to many factors such as socioeconomic status, occupational propensity, disparities in physical health, and barriers to healthcare access. Furthermore, our findings suggest the necessity of utilizing an intersectional approach when examining the disproportionate burden marginalized communities face in public health crises.
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Affiliation(s)
- Armin A Dorri
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Oralia Loza
- Department of Public Health Sciences, University of Texas at El Paso, El Paso, Texas, USA
| | - Mark A Bond
- New Meridian Corporation, Austin, Texas, USA
| | - Erica Ciszek
- Stan Richards School of Advertising & Public Relations, University of Texas at Austin, Texas, USA
| | - Yona Elias-Curry
- Department of Population Health, University of Texas at Austin, Austin, Texas, USA
| | - Sheridan Aguilar
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Paul Fliedner
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Aliza Norwood
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Amy L Stone
- Department of Sociology & Anthropology, Trinity University, San Antonio, Texas, USA
| | - M Brett Cooper
- Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA
| | - Vanessa Schick
- School of Public Health, University of Texas Health at Houston, Houston, Texas, USA
| | - J Michael Wilkerson
- School of Public Health, University of Texas Health at Houston, Houston, Texas, USA
| | - Paige P Wermuth
- School of Public Health, University of Texas Health at Houston, Houston, Texas, USA
| | - Robert A Yockey
- School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas, USA
| | - Phillip Schnarrs
- Department of Population Health, University of Texas at Austin, Austin, Texas, USA
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Coulaud PJ, Salway T, Adams N, Ball W, Larmarange J, Kelly-Irving M, Knight R. Knowledge gaps in existing research exploring sexual fluidity and mental health among young adults. J Epidemiol Community Health 2024; 78:556-560. [PMID: 38944417 DOI: 10.1136/jech-2023-221844] [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: 04/10/2024] [Accepted: 06/18/2024] [Indexed: 07/01/2024]
Abstract
While there is a large body of evidence indicating that sexual minority youth experience inequitably high rates of mental health problems (eg, depression, suicidality), we know little about how temporal changes in sexual attractions, identities and behaviour may impact mental health (and other) outcomes. In this essay, we review existing research regarding sexual fluidity and mental health among young adults in order to identify critical knowledge gaps with respect to an epidemiological understanding of the relationship between these factors. We describe three gaps that in turn inform a larger public health research agenda on this topic. First, there are a number of methodological challenges given that fluidity can occur over short or long periods of time and across multiple dimensions of sexual orientation (eg, attractions, identities and behaviour) with various patterns (eg, directionality of change). Tailored measures that accurately and inclusively reflect diversities of sexual fluidity trajectories are needed. Second, causal relationships between sexual fluidity and mental health remain uncertain and unquantified. Third, little is known about how features of context (eg, gender norms and political climate) influence youth experiences with sexual fluidity and mental health. Finally, we propose a set of recommendations to address these knowledge gaps to improve the quality of epidemiological research involving young people.
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Affiliation(s)
- Pierre-Julien Coulaud
- École de Santé Publique, Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Québec, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Nick Adams
- School of Nursing Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, Scotland
| | - William Ball
- School of Nursing Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, Scotland
| | - Joseph Larmarange
- Centre Population et Développement (UMR 196 Université Paris Cité, IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France
| | - Michelle Kelly-Irving
- Centre for Epidemiology and Research in Population Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Rod Knight
- École de Santé Publique, Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Québec, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Québec, Canada
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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Understanding and tackling cancer inequities: What opportunities does intersectionality offer researchers, policymakers, and providers? A scoping review. J Psychosoc Oncol 2024:1-28. [PMID: 39120128 DOI: 10.1080/07347332.2024.2361642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PROBLEM IDENTIFICATION We summarised the international evidence relating to the role of intersectionality in patients' lived experience of inequities along the cancer care pathway. We produced guidance to use intersectionality in future research. LITERATURE SEARCH We included 42 articles published between 1989 to 2023 that used intersectionality to guide the study and interpretation of inequities in cancer care. DATA EVALUATION/SYNTHESIS Articles predominantly comprised North American (n = 37), followed by European (n = 4) and Asian (n = 1) studies. Similar compounding effects of racism, homophobia, and discrimination across countries exacerbated inequities in cancer care experience and cancer outcomes particularly for women of color and sexual/gender minority groups. Professionals' knowledge, attitudes, and behaviors toward minoritised groups affected patient-provider relationships and influenced cancer patients' psychosocial responses. CONCLUSION Intersectionality provides a framework to assess the personal, interpersonal, and structural processes through which cancer inequities manifest within and across countries.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
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D'souza S, Ghatole B, Raghuram H, Sukhija S, Singh S, Shaikh A, Bandewar SS, Bhan A. Understanding structural inequities in Covid-19 vaccine access and uptake among disability, transgender and gender-diverse communities in India. Vaccine 2024:126174. [PMID: 39117525 DOI: 10.1016/j.vaccine.2024.126174] [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: 02/29/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Undervaccination and vaccination-related anxieties among marginalised communities like the transgender and gender-diverse (TGD) and disability communities are underexplored in the Indian context. Our study seeks to understand the role of structural and historical inequities in shaping COVID-19 vaccine access for the two communities in India. METHODS Using a participatory qualitative research approach, TGD and disabled individuals were involved in and consulted throughout the research process. We interviewed 45 individuals for our study, hailing from the two communities and other key stakeholders and health system representatives involved in vaccination roll-out in India. We conducted an inductive thematic analysis guided by the socio-ecological model and intersectionality approach. RESULTS Despite intent to get vaccinated among most participants, several structural barriers shaped COVID-19 vaccine access for people from the TGD and disability community. This included information and communication gaps with respect to the specific health needs of the two communities, barriers related to vaccine registration, data collection, transport, infrastructure and actual or anticipated mistreatment at vaccine centres. Each emergent structural gap in vaccination had parallels in past health systems experiences, pointing to the longstanding and pervasive inequities within health and allied systems which impact how communities perceive and respond to new health system interventions. CONCLUSION This study uncovers the structural inequities within health systems that have permeated the planning, design and outreach of COVID-19 vaccination programs in India. Moving beyond notions of vaccine hesitancy among the TGD and disability community, we underscore the importance of socio-historical contexts of marginalisation and advocate for systems to recognise these contexts and respond equitably to the vaccination and health needs of the two communities. While some challenges among the two communities were distinct, the study explores how a shared experience of exclusion from public systems can provide avenues for cross-movement advocacy and solidarity, and help inform health system reforms.
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Affiliation(s)
- Sharin D'souza
- Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India.
| | - Bhakti Ghatole
- Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Harikeerthan Raghuram
- Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Shreyus Sukhija
- Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
| | - Satendra Singh
- Department of Physiology, University College of Medical Sciences, Delhi, India
| | - Aqsa Shaikh
- Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | | | - Anant Bhan
- Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India
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Weststrate NM, McLean KC, Fivush R. Intergenerational Storytelling and Positive Psychosocial Development: Stories as Developmental Resources for Marginalized Groups. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2024:10888683241259902. [PMID: 39068536 DOI: 10.1177/10888683241259902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
ACADEMIC ABSTRACT We articulate an intergenerational model of positive psychosocial development that centers storytelling in an ecological framework and is motivated by an orientation toward social justice. We bring together diverse literature (e.g., racial-ethnic socialization, family storytelling, narrative psychology) to argue that the intergenerational transmission of stories about one's group is equally important for elders and youth, and especially important for groups who are marginalized, because stories provide a developmental resource for resistance and resilience in the face of injustice. We describe how storytelling activities can support positive psychosocial development in culturally dynamic contexts and illustrate our model with a case study involving LGBTQ+ communities, arguing that intergenerational storytelling is uniquely important for this group given issues of access to stories. We argue that harnessing the power of intergenerational storytelling could provide a culturally safe and sustaining practice for fostering psychosocial development among LGBTQ+ people and other equity-seeking populations. PUBLIC ABSTRACT Understanding one's identity as part of a group with shared history and culture that has existed through time is important for positive psychological functioning. This is especially true for marginalized communities for whom identity-relevant knowledge is often erased, silenced, or distorted in mainstream public discourses (e.g., school curricula, news media, television, and film). To compensate for these limitations around access, one channel for the transmission of this knowledge is through oral storytelling between generations of elders and youth. Contemporary psychological science has often assumed that such storytelling occurs within families, but when families cannot or would not share such knowledge, youth suffer. We present a model of intergenerational storytelling that expands our ideas around who counts as "family" and how knowledge can be transmitted through alternative channels, using LGBTQ+ communities as a case example.
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Mereish EH, Abramson JR, Lee H, Watson RJ. Intersectional Oppression-Based Stress, Drinking to Cope Motives, and Alcohol Use and Hazardous Drinking Among Sexual and Gender Minority Adolescents Who Are Black, Indigenous, and People of Color. LGBT Health 2024. [PMID: 38973422 DOI: 10.1089/lgbt.2024.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Purpose: This study examined the associations between intersectional oppression-based stress and recent alcohol use and hazardous drinking among sexual and gender minority (SGM; e.g., queer or transgender) adolescents who were Black, Indigenous, and People of Color (BIPOC), also known as queer and transgender BIPOC (QTBIPOC) adolescents, and the mediating role of coping motives (i.e., drinking to cope) on these associations. Methods: Data were from a subsample of QTBIPOC adolescents who used alcohol in the past year (n = 1365) from a national U.S. sample of SGM adolescents aged 13-18 years. Results: Intersectional oppression-based stressors were associated with greater odds of recent alcohol use and hazardous drinking, as well as greater coping motives. Coping motives mediated the associations between intersectional-based stressors and both recent alcohol use and hazardous drinking among the aggregate sample of QTBIPOC adolescents, as well as among some subgroups of BIPOC adolescents. Conclusions: The results of this study highlight that intersectional oppression-based stressors are prevalent among QTBIPOC adolescents and serve as a risk factor for alcohol use and hazardous drinking. Multilevel interventions are needed to target and dismantle intersectional oppressions to address alcohol inequities impacting QTBIPOC adolescents. Drinking to cope motives mediated the associations between intersectional oppression-based stress and drinking outcomes, underscoring another important mechanism to target within a context of oppression in drinking interventions.
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Affiliation(s)
- Ethan H Mereish
- Lavender Lab, Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Jessica R Abramson
- Lavender Lab, Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Hyemin Lee
- Lavender Lab, Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Ryan J Watson
- Department of Human Development And Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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Axelsson Fisk S, Cassel J, Rostila M, Liu C, Juárez SP. Intersectional socioeconomic disparities in continuous smoking through pregnancy among pre-pregnant smokers in Sweden between 2006 and 2016. BMC Pregnancy Childbirth 2024; 24:465. [PMID: 38971755 PMCID: PMC11227709 DOI: 10.1186/s12884-024-06647-0] [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: 03/02/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND While well-established associations exist between socioeconomic conditions and smoking during pregnancy (SDP), less is known about social disparities in the risk of continuous SDP. Intersectional analyses that consider multiple social factors simultaneously can offer valuable insight for planning smoking cessation interventions. METHODS We include all 146,222 pregnancies in Sweden between 2006 and 2016 where the mother smoked at three months before pregnancy. The outcome was continuous SDP defined as self-reported smoking in the third trimester. Exposures were age, education, migration status and civil status. We examined all exposures in a mutually adjusted unidimensional analysis and in an intersectional model including 36 possible combinations. We present ORs with 95% Confidence Intervals, and the Area Under the Curve (AUC) as a measure of discriminatory accuracy (DA). RESULTS In our study, education status was the factor most strongly associated to continuous SDP among women who smoked at three months before pregnancy. In the unidimensional analysis women with low and middle education had ORs for continuous SDP of 6.92 (95%CI 6.63-7.22) and 3.06 (95%CI 2.94-3.18) respectively compared to women with high education. In the intersectional analysis, odds of continuous SDP were 17.50 (95%CI 14.56-21.03) for married women born in Sweden aged ≥ 35 years with low education, compared to the reference group of married women born in Sweden aged 25-34 with high education. AUC-values were 0.658 and 0.660 for the unidimensional and intersectional models, respectively. CONCLUSION The unidimensional and intersectional analyses showed that low education status increases odds of continuous SDP but that in isolation education status is insufficient to identify the women at highest odds of continuous SDP. Interventions targeted to social groups should be preceded by intersectional analyses but further research is needed before recommending intensified smoking cessation to specific social groups.
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Affiliation(s)
- Sten Axelsson Fisk
- Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund University, BMC C14. Lund, Lund, 22185, Sweden.
- Department of Obstetrics and Gynaecology, Ystad Hospital, Ystad, Sweden.
| | - Jannike Cassel
- Department of Obstetrics and Gynaecology, Ystad Hospital, Ystad, Sweden
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS), Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Stockholm, Sweden
| | - Can Liu
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Sol Pia Juárez
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
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Gitelman J, Smith B, Warren CM, Andreacchi AT, Pabayo R, Hobin E. Sexual Identity and Heavy Drinking Among Adults in Canada by Racially Minoritized Status and Income, 2015-2020. LGBT Health 2024. [PMID: 38968343 DOI: 10.1089/lgbt.2023.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024] Open
Abstract
Purpose: Our objective was to estimate inequities in heavy drinking between heterosexual, gay or lesbian, and bisexual or pansexual individuals, by sex/gender, and to determine whether this association is heterogeneous across racially minoritized status and income groups in Canadians aged 15 and older. Methods: We pooled three Canadian Community Health Survey cycles (2015-2020) and used separate modified Poisson regressions to explore the sex/gender-specific association between sexual identity and heavy drinking prevalence by racially minoritized status, and income, adjusted for survey cycle, age, marital status, and region. Results: With racially minoritized status, and income categories collapsed, heavy drinking was 1.3 times higher (95% confidence interval [CI] = 1.0-1.7) among bisexual or pansexual women compared with heterosexual women, with no differences among men. Among racially minoritized women, heavy drinking was 2.9 (95% CI = 1.3-6.4) times higher among bisexual or pansexual women and 1.9 (95% CI = 0.7-5.2) times higher among gay or lesbian women compared with heterosexual women. Among racially minoritized men, heavy drinking was 1.9 (95% CI = 0.9-4.0) times higher among gay men compared with heterosexual men. No differences were observed across sexual identity in White men or women. Bisexual or pansexual women reported increased heavy drinking relative to heterosexual women across income quintiles. Conclusion: Heavy drinking is distributed heterogeneously across sexual identity, sex/gender, racially minoritized status, and income. These results encourage equity-focused interventions to reduce heavy drinking among intersecting sociodemographic groups experiencing a greater burden of heavy drinking.
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Affiliation(s)
- Julian Gitelman
- Public Health and Preventive Medicine Residency Program, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Brendan Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada
| | - Christine M Warren
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada
| | | | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Canada
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Adhikary P, Mburu G, Kabra R, Habib NA, Kiarie J, Dhabhai N, Chowdhury R, Mazumder S. Intersectional analysis of the experiences of women who fail to conceive in low and middle income neighbourhoods of Delhi, India: Findings from a qualitative study. PLoS One 2024; 19:e0304029. [PMID: 38959201 PMCID: PMC11221677 DOI: 10.1371/journal.pone.0304029] [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: 11/03/2023] [Accepted: 05/05/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Experiences of delayed conception and infertility have been reported among women. However, the concept of intersectionality is rarely utilised in studies of infertility, and it is particularly uncommon in research from low- and middle- income countries. RESEARCH QUESTION What are the lived experiences of women with delayed conception in low to -middle income neighbourhoods of Delhi, India? METHODS This was a qualitative study (n = 35) that recruited women who had failed to conceive after 18 months of regular unprotected sexual intercourse. Data were collected between February and July 2021. Data were collected through focus group discussions in low income to middle income neighbourhoods of Delhi, India. Analysis identified themes related to intersecting axes of inequality. RESULTS The results showed that gender intersected with economics, masculinity, patriarchal norms and class to influence the experiences of women. The intersection of gender, economics and patriarchal norms compromised women's agency to be active generators of family income, and this dynamic was exacerbated by patrilocal residence. In addition, masculinity contributed to stigmatisation and blaming of women, due to the inaccurate perception that men did not contribute to a couple's infertility. The intersection of gender and social class in medical settings created barriers to women's access to medical information. CONCLUSION Findings from this study provide representative examples of the variety of axes of inequality that shape women's experiences in the study setting. Although these findings may not be generalisable to all women who are experiencing delayed conception, they highlight a need for improved awareness and education on infertility, as well as a need to ensure the availability and accessibility of fertility care for couples in need.
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Affiliation(s)
| | - Gitau Mburu
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rita Kabra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ndema Abu Habib
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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11
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Saia T, Yaghmaian R, Cuesta R, Mueller C, Pebdani RN. A call to action for disability and rehabilitation research using a DisCrit and Disability Justice framework. Disabil Rehabil 2024; 46:3189-3195. [PMID: 37605564 DOI: 10.1080/09638288.2023.2242780] [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: 02/27/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Disability and ableism exist within a societal context that does not ignore the many facets of a person's identity, however often our disability research does not recognize how experiences vary based on the intersecting identities individuals hold. This article utilizes Intersectionality, Dis/ability Critical Race Studies (DisCrit), and Disability Justice to identify ways for rehabilitation researchers to adapt their research practices for maximum inclusivity and representation. MATERIALS AND METHODS Using these three frameworks, we have developed a call to action including recommendations for rehabilitation researchers to consider as they design and implement research projects. RESULTS Incorporating these frameworks provides an opportunity to reimagine current research practices. CONCLUSIONS An accessible approach can help researchers better understand and report on the nuances of intersecting identities on the lives of disabled people.
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Affiliation(s)
- Toni Saia
- San Diego State University, San Diego, CA, USA
| | | | | | | | - Roxanna N Pebdani
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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12
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Hall P, Wallace BC, Adams MA. Exploring pathways to successful aging among older black lesbians and sexual minority women: A focus on life satisfaction and intersectional factors. J Women Aging 2024; 36:328-342. [PMID: 38588608 DOI: 10.1080/08952841.2024.2336652] [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: 11/07/2023] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Satisfaction with life is a core aspect of successful aging, which is influenced by a broad range of factors, including health, socioeconomic status, and social relationships. Black lesbians experience various social challenges, including racism, sexism, ageism, and heterosexualism, that may present as deterrents to aging successfully. To develop better policies and programs in support of successful aging among all adults, an understanding of the unique components associated with their intersecting identities must be explored. This study was carried out to gain a better understanding of how Black lesbians and other Black sexual minority women (BSMW) view successful aging within the context of life satisfaction. METHODS Inferential statistics were used to determine relationships between satisfaction with life (SWLS-3) and selected independent variables. Backward stepwise regression was conducted to ascertain significant relationships of the study outcome variable. RESULTS The respondents were 118 Black lesbians and other BSMW aged 50 and above. Independent t-tests showed that those living with a partner had a significantly higher SWLS-3. Backwards stepwise regression indicated the predictor variables for higher rates of SWLS-3 to be harmony in life, annual household income, and provider sensitivity/cultural competence to their patient being Black. CONCLUSION This study provides insight on factors increasing and diminishing satisfaction with life for aging Black lesbians and other BSMW. Future research should replicate this study with a more diverse and nationally representative sample, especially given the study limitations of having recruited a highly educated sample during a global pandemic.
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Affiliation(s)
- Porsha Hall
- Department of Health & Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Barbara C Wallace
- Department of Health & Behavior Studies, Teachers College, Columbia University, New York, NY, USA
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization of Black Lesbians on Aging, Atlanta, GA, USA
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Chakraborty P, Everett BG, Reynolds CA, Hoatson T, Stuart JJ, McKetta SC, Soled KRS, Huang AK, Chavarro JE, Eliassen AH, Obedin-Maliver J, Austin SB, Rich-Edwards JW, Haneuse S, Charlton BM. Sexual orientation disparities in gestational diabetes and hypertensive disorders of pregnancy. Paediatr Perinat Epidemiol 2024. [PMID: 38949425 DOI: 10.1111/ppe.13101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/05/2024] [Accepted: 06/09/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Sexual minority (SM) individuals (e.g., those with same-sex attractions/partners or who identify as lesbian/gay/bisexual) experience a host of physical and mental health disparities. However, little is known about sexual orientation-related disparities in gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP; gestational hypertension [gHTN] and preeclampsia). OBJECTIVE To estimate disparities in GDM, gHTN and preeclampsia by sexual orientation. METHODS We used data from the Nurses' Health Study II-a cohort of nurses across the US enrolled in 1989 at 25-42 years of age-restricted to those with pregnancies ≥20 weeks gestation and non-missing sexual orientation data (63,518 participants; 146,079 pregnancies). Our primary outcomes were GDM, gHTN and preeclampsia, which participants reported for each of their pregnancies. Participants also reported their sexual orientation identity and same-sex attractions/partners. We compared the risk of each outcome in pregnancies among heterosexual participants with no same-sex experience (reference) to those among SM participants overall and within subgroups: (1) heterosexual with same-sex experience, (2) mostly heterosexual, (3) bisexual and (4) lesbian/gay participants. We used modified Poisson models to estimate risk ratios (RR) and 95% confidence intervals (CI), fit via weighted generalised estimating equations, to account for multiple pregnancies per person over time and informative cluster sizes. RESULTS The overall prevalence of each outcome was ≤5%. Mostly heterosexual participants had a 31% higher risk of gHTN (RR 1.31, 95% CI 1.03, 1.66), and heterosexual participants with same-sex experience had a 31% higher risk of GDM (RR 1.31, 95% CI 1.13, 1.50), compared to heterosexual participants with no same-sex experience. The magnitudes of the risk ratios were high among bisexual participants for gHTN and preeclampsia and among lesbian/gay participants for gHTN. CONCLUSIONS Some SM groups may be disparately burdened by GDM and HDP. Elucidating modifiable mechanisms (e.g., structural barriers, discrimination) for reducing adverse pregnancy outcomes among SM populations is critical.
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Affiliation(s)
- Payal Chakraborty
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Bethany G Everett
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
| | - Colleen A Reynolds
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tabor Hoatson
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Jennifer J Stuart
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah C McKetta
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kodiak R S Soled
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Aimee K Huang
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford School of Medicine, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Tran JT, Rigg KK, Galea JT, Kosyluk KA. Examining the Effects of Digital Stories to Address Mental Illness and Sexual and Gender Minority-Related Stigma. JOURNAL OF HOMOSEXUALITY 2024:1-18. [PMID: 38923913 DOI: 10.1080/00918369.2024.2368204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Sexual and gender minority (SGM) individuals living with mental illness often experience stigma associated with marginalized identities of sexual orientation, gender identity, and mental illness (MI). Sharing stories of lived experiences is an effective approach to reducing various forms of stigma; however, it is unclear whether stories shared by SGM living with mental illness (SGM MI) can reduce MI- and SGM-related stigma. METHODS Using a randomized controlled trial design, participants watched digital stories of self-identified SGM individuals living with a mental illness, non-SGM individuals living with mental illness, or a control condition (TedTalks on environmental issues and growing up in China) to examine the use of representative digital stories in addressing SGM- and MI-related stigma. RESULTS In a sample of 218 participants, digital stories of SGM MI effectively reduced MI-related stigma (personal stigma (from 33.19 to 31.90) and discrimination (from 8.33 to 7.57)), but were ineffective at reducing SGM-related personal stigma (negative attitudes toward lesbians and gay men, transphobia, or genderism; p > .05). CONCLUSION Our study highlights the need to develop culturally adapted anti-stigma programs in collaboration with individuals with lived intersectional SGM and MI experiences.
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Affiliation(s)
- Jennifer T Tran
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida, USA
| | - Khary K Rigg
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida, USA
| | - Jerome T Galea
- School of Social Work, University of South Florida, Tampa, Florida, USA
| | - Kristin A Kosyluk
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida, USA
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Soares GH, Haag D, Bastos JL, Mejia G, Jamieson L. Triple Jeopardy in Oral Health: Additive Effects of Immigrant Status, Education, and Neighborhood. JDR Clin Trans Res 2024:23800844241253518. [PMID: 38877725 DOI: 10.1177/23800844241253518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
PURPOSE To estimate the additive effects of parent's nativity status/language spoken at country of birth, education, and area-level socioeconomic status (SES) on untreated dental caries among children aged 5 to 9 y in Australia. METHODS Cross-sectional population-based data were obtained from the 2014 National Child Oral Health Study (N = 12,140). Indicators of social position used to explore additive effects on dental caries included nativity status, language, university degree, and neighborhood socioeconomic level. Multiple-way interactions were examined, and departure from additivity resulting from 2- and 3-way interactions were estimated as relative excess risk due to interaction (RERI). RESULTS Children marginalized across multiple layers of disadvantage had substantially higher frequencies of dental caries compared with children in the most advantaged category. RERI for the 3-way interaction between immigrant status, education, and neighborhood SES was negative (RERI3: -0.14; 95% confidence interval [CI]: -1.68, 1.40). When operationalizing language, education, and neighborhood SES, the joint effect of the 3 marginalized positions was additive (RERI3: 0.43; 95% CI: -2.08, 2.95). CONCLUSION Children marginalized across multiple intersecting axes of disadvantage bear the greatest burden of dental caries, with frequencies surpassing the cumulative effect of each social position alone. Findings emphasize the need to account for intersecting inequities and their oral health effects among children with immigrant backgrounds. KNOWLEDGE TRANSFER STATEMENT Our analysis underscores the necessity for policies and public health strategies targeting dental caries-related inequities to comprehensively account for various indicators of social disadvantage, particularly encompassing language proficiency, educational attainment, and neighborhood socioeconomic status. Within the intricate interplay of these factors, we identify a vulnerable subgroup comprising children with the highest prevalence of dental decay. Therefore, prioritizing this specific demographic should be the focal point of policies and public health initiatives aimed at fostering equitable oral health outcomes.
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Affiliation(s)
- G H Soares
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - D Haag
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - J L Bastos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - G Mejia
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
| | - L Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia
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16
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Takenaka BP, Kirklewski SJ, Griffith FJ, Gibbs JJ, Lauckner CK, Nicholson E, Tengatenga C, Hansen NB, Kershaw T. "It's another gay disease": an intersectional qualitative approach contextualizing the lived experiences of young gay, bisexual, and other sexual minoritized men in the United States during the mpox outbreak. BMC Public Health 2024; 24:1574. [PMID: 38862933 PMCID: PMC11167942 DOI: 10.1186/s12889-024-19062-z] [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: 04/07/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The U.S. mpox outbreak in 2022 introduced new and exacerbated existing challenges that disproportionately stigmatize gay, bisexual, and other sexual minoritized men (GBSMM). This study contextualizes the perceptions, susceptibility, and lived experiences of the mpox outbreak among GBSMM in the U.S. using an intersectional framework. METHODS Between September 2022 to February 2023, we conducted 33 semi-structured qualitative interviews with purposively sampled GBSMM in the Northeast and the South region of the United States on various aspects related to their experience during the mpox outbreak. RESULTS We identified four themes: (1) understanding and conceptualizations of mpox, (2) mpox vaccine availability and accessibility, (3) mpox vaccine hesitancy and mistrust, and (4) call to action and recommendations. GBSMM collectively discussed the elevated mpox stigmatization and homophobic discourse from mainstream social media and news outlets. GBSMM also discussed the lack of availability of mpox vaccines, unclear procedures to receive the vaccine, and continued mistrust in government, non-government, and other institutions of health that were complicit in anti-LGBTQ + narratives related to mpox. However, they expressed that these challenges may be addressed through more LGTBQ + representation and leveraging ways to empower these communities. CONCLUSION GBSMM have mpox experiences that are distinct and multifaceted. Effectively addressing mpox and mitigating public health emergencies for GBSMM requires prioritizing destigmatizing communication channels and vaccine distribution strategies by centering their stories and lived experiences to advance health equity.
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Affiliation(s)
- Bryce Puesta Takenaka
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA.
| | - Sally J Kirklewski
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA
| | - Frances J Griffith
- Yale School of Medicine, Division of Prevention and Community Research, 389 Whitney Avenue, New Haven, CT, 06516, USA
| | - Jeremy J Gibbs
- School of Social Work, University of Georgia, 279 Williams St, Athens, GA, 30602, USA
| | - Carolyn K Lauckner
- College of Medicine, Department of Behavioral Sciences, University of Kentucky, 800 Rose Street MN 150, Lexington, KY, 40506, USA
| | - Erin Nicholson
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA
| | - Cecil Tengatenga
- School of Medicine, University of Connecticut, 200 Academic Wy, Farmington, CT, 06032, USA
| | - Nathan B Hansen
- Department of Health Promotion & Behavior, University of Georgia College of Public Health, 100 Foster Road, Athens, GA, 30606, USA
| | - Trace Kershaw
- Yale School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT, 06510, USA
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Bear Don't Walk OJ, Paullada A, Everhart A, Casanova-Perez R, Cohen T, Veinot T. Opportunities for incorporating intersectionality into biomedical informatics. J Biomed Inform 2024; 154:104653. [PMID: 38734158 PMCID: PMC11146624 DOI: 10.1016/j.jbi.2024.104653] [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: 11/18/2023] [Revised: 04/06/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
Many approaches in biomedical informatics (BMI) rely on the ability to define, gather, and manipulate biomedical data to support health through a cyclical research-practice lifecycle. Researchers within this field are often fortunate to work closely with healthcare and public health systems to influence data generation and capture and have access to a vast amount of biomedical data. Many informaticists also have the expertise to engage with stakeholders, develop new methods and applications, and influence policy. However, research and policy that explicitly seeks to address the systemic drivers of health would more effectively support health. Intersectionality is a theoretical framework that can facilitate such research. It holds that individual human experiences reflect larger socio-structural level systems of privilege and oppression, and cannot be truly understood if these systems are examined in isolation. Intersectionality explicitly accounts for the interrelated nature of systems of privilege and oppression, providing a lens through which to examine and challenge inequities. In this paper, we propose intersectionality as an intervention into how we conduct BMI research. We begin by discussing intersectionality's history and core principles as they apply to BMI. We then elaborate on the potential for intersectionality to stimulate BMI research. Specifically, we posit that our efforts in BMI to improve health should address intersectionality's five key considerations: (1) systems of privilege and oppression that shape health; (2) the interrelated nature of upstream health drivers; (3) the nuances of health outcomes within groups; (4) the problematic and power-laden nature of categories that we assign to people in research and in society; and (5) research to inform and support social change.
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Affiliation(s)
- Oliver J Bear Don't Walk
- Department of Biomedical Informatics and Medical Education, University of Washington, United States.
| | - Amandalynne Paullada
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Avery Everhart
- Department of Geography, Faculty of Arts, University of British Columbia, Canada
| | - Reggie Casanova-Perez
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Tiffany Veinot
- School of Information and School of Public Health, University of Michigan, United States
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18
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Jenkins WD, Walters S, Phillips G, Green K, Fenner E, Bolinski R, Spenner A, Luckey G. Stigma, Mental Health, and Health care Use Among Rural Sexual and Gender Minority Individuals. HEALTH EDUCATION & BEHAVIOR 2024; 51:477-489. [PMID: 36036544 PMCID: PMC10064479 DOI: 10.1177/10901981221120393] [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: 11/16/2022]
Abstract
Sexual and gender minorities (SGM) frequently experience depression and health care-related stigma. Health care satisfaction is important for seeking care, but little is known about SGM health care satisfaction, and especially as it relates to depression among rural SGM. From May 25 to July 2, 2021, we surveyed rural Illinois (IL) individuals aged ≥18 years on the topics of demographics, depression, health care satisfaction, past health care experiences, internalized stigma, and victimization. Among the 398 respondents, the gender identity distribution included cisgender males and females (171 and 203, respectively) and transgender males and females (8 and 7, respectively), while sexual orientation included heterosexuals (114), gay/lesbians (143), and other orientations (141). Analyses were conducted with respect to both identity and orientation (and their interaction). In univariate analysis, transgender individuals were more likely than cisgender to screen positive for depression and less likely to report feeling accepted by their medical provider. Compared to heterosexual respondents, gay/lesbians and other orientations were more likely to screen positive for depression. In logistic regression, factors associated with increased risk of depression included nonheterosexual orientation and past poor health care experiences. In linear regression, factors most commonly associated with the seven satisfaction subscales include: sexual orientation, past poor experiences, and employment. There were significant differences in depression across both sexual orientation and gender identity, and in health care satisfaction by sexual orientation. Rural SGMs are more vulnerable to depression and less likely to report satisfactory care. As health care engagement is critical for screening and care adherence, engaging rural SGM in a routine and satisfactory fashion is needed.
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Affiliation(s)
- Wiley D. Jenkins
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | | | - Kanicia Green
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Emma Fenner
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | - Allison Spenner
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Georgia Luckey
- Southern Illinois University School of Medicine, Springfield, IL, USA
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19
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Fivian E, Harris-Fry H, Offner C, Zaman M, Shankar B, Allen E, Kadiyala S. The Extent, Range, and Nature of Quantitative Nutrition Research Engaging with Intersectional Inequalities: A Systematic Scoping Review. Adv Nutr 2024; 15:100237. [PMID: 38710327 PMCID: PMC11180316 DOI: 10.1016/j.advnut.2024.100237] [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: 12/08/2023] [Revised: 03/10/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024] Open
Abstract
Addressing malnutrition for all requires understanding inequalities in nutrition outcomes and how they intersect. Intersectionality is increasingly used as a theoretical tool for understanding how social characteristics intersect to shape inequalities in health outcomes. However, little is known about the extent, range, and nature of quantitative nutrition research engaging with intersectional inequalities. This systematic scoping review aimed to address this gap. Between 15 May 2021 and 15 May 2022, we searched 8 databases. Studies eligible for inclusion used any quantitative research methodology and aimed to investigate how social characteristics intersect to influence nutrition outcomes. In total, 55 studies were included, with 85% published since 2015. Studies spanned populations in 14 countries but were concentrated in the United States (n = 35) and India (n = 7), with just 1 in a low-income country (Mozambique). Race or ethnicity and gender were most commonly intersected (n = 20), and body mass index and overweight and/or obesity were the most common outcomes. No studies investigated indicators of infant and young child feeding or micronutrient status. Study designs were mostly cross-sectional (80%); no mixed-method or interventional research was identified. Regression with interaction terms was the most prevalent method (n = 26); 2 of 15 studies using nonlinear models took extra steps to assess interaction on the additive scale, as recommended for understanding intersectionality and assessing public health impacts. Nine studies investigated mechanisms that may explain why intersectional inequalities in nutrition outcomes exist, but intervention-relevant interpretations were mostly limited. We conclude that quantitative nutrition research engaging with intersectionality is gaining traction but is mostly limited to the United States and India. Future research must consider the intersectionality of a wider spectrum of public health nutrition challenges across diverse settings and use more robust and mixed-method research to identify specific interventions for addressing intersectional inequalities in nutrition outcomes. Data systems in nutrition must improve to facilitate this. This review was registered in PROSPERO as CRD42021253339.
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Affiliation(s)
- Emily Fivian
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Helen Harris-Fry
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Offner
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michele Zaman
- Department of Medicine, Queen's University, Ontario, Canada
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, United Kingdom
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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20
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Billman Miller MG, Denning DM, Alvarez JC, Castro Lebron J, Bakoyema S, Brown TA. Examining eating disorder pathology and self-stigma of help-seeking behaviors in a community sample of sexual minority adults: an intersectional investigation of race and gender. Eat Disord 2024:1-22. [PMID: 38814278 DOI: 10.1080/10640266.2024.2355699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Self-stigma of seeking psychological help is a critical factor prohibiting individuals from seeking eating disorder (ED) treatment, but has been widely unexplored in racial/ethnic and sexual minority (SM) samples. The current study examined differences in ED pathology and self-stigma of help-seeking at the intersection of race and gender within a cisgender SM sample. METHODS Cisgender SM participants (n = 354) identifying as Black, Indigenous, or People of Color (BIPOC; 52%), Asian American and Pacific Islander (AAPI; 24%), or White (24%) were recruited through Prolific Academic. One-way analyses of variance were used to examine differences in the Self-Stigma of Seeking Help Scale (SSOSH) and Eating Pathology Symptom Inventory (EPSI) subscales among men and women in each group. Pearson's correlations explored associations between SSOSH and EPSI subscales within each subgroup. RESULTS Findings indicated significant between-group differences on the SSOSH and the EPSI subscales of Body Dissatisfaction, Purging, and Excessive Exercise. SSOSH was significantly positively correlated with Body Dissatisfaction in the White SM cis-women group and Binge Eating in the BIPOC SM cis-men group. CONCLUSIONS Results demonstrate unique, intersectional between-group differences in ED pathology and self-stigma among SM individuals. Further research on the impact of intersectionality on these constructs within larger samples is warranted.
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Affiliation(s)
| | - Dominic M Denning
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Jordan C Alvarez
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Jorge Castro Lebron
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Seba Bakoyema
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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21
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Jones R, Robinson AT, Beach LB, Lindsey ML, Kirabo A, Hinton A, Erlandson KM, Jenkins ND. Exercise to Prevent Accelerated Vascular Aging in People Living With HIV. Circ Res 2024; 134:1607-1635. [PMID: 38781293 PMCID: PMC11126195 DOI: 10.1161/circresaha.124.323975] [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: 05/25/2024]
Abstract
Given advances in antiretroviral therapy, the mortality rate for HIV infection has dropped considerably over recent decades. However, people living with HIV (PLWH) experience longer life spans coupled with persistent immune activation despite viral suppression and potential toxicity from long-term antiretroviral therapy use. Consequently, PLWH face a cardiovascular disease (CVD) risk more than twice that of the general population, making it the leading cause of death among this group. Here, we briefly review the epidemiology of CVD in PLWH highlighting disparities at the intersections of sex and gender, age, race/ethnicity, and the contributions of social determinants of health and psychosocial stress to increased CVD risk among individuals with marginalized identities. We then overview the pathophysiology of HIV and discuss the primary factors implicated as contributors to CVD risk among PLWH on antiretroviral therapy. Subsequently, we highlight the functional evidence of premature vascular dysfunction as an early pathophysiological determinant of CVD risk among PLWH, discuss several mechanisms underlying premature vascular dysfunction in PLWH, and synthesize current research on the pathophysiological mechanisms underlying accelerated vascular aging in PLWH, focusing on immune activation, chronic inflammation, and oxidative stress. We consider understudied aspects such as HIV-related changes to the gut microbiome and psychosocial stress, which may serve as mechanisms through which exercise can abrogate accelerated vascular aging. Emphasizing the significance of exercise, we review various modalities and their impacts on vascular health, proposing a holistic approach to managing CVD risks in PLWH. The discussion extends to critical future study areas related to vascular aging, CVD, and the efficacy of exercise interventions, with a call for more inclusive research that considers the diversity of the PLWH population.
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Affiliation(s)
- Raymond Jones
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Lauren B. Beach
- Department of Medical Social Sciences, Northwestern, Chicago, IL
- Department of Preventive Medicine, Northwestern, Chicago, IL
| | - Merry L. Lindsey
- School of Graduate Studies, Meharry Medical College, Nashville, TN
- Research Service, Nashville VA Medical Center, Nashville, TN
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Immunobiology, Nashville, TN
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN
- Vanderbilt Institute for Global Health, Nashville, TN
| | - Antentor Hinton
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN
| | | | - Nathaniel D.M. Jenkins
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA
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22
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AuBuchon KE, Stock ML, Mathur VA, Attey B, Bowleg L. Bystander Acknowledgment Mitigates the Psychological and Physiological Pain of Racial Discrimination for Black Young Adults: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2024:104560. [PMID: 38735424 DOI: 10.1016/j.jpain.2024.104560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/14/2024]
Abstract
Racism increases pain sensitization and contributes to racialized pain inequities; however, research has not tested interventions targeting racism to reduce pain. In this study, we examined whether White bystanders can act to mitigate racism's pain-sensitizing effects. To simulate racial exclusion in the laboratory, Black young adults (age 18-30; N = 92) were randomly assigned to be included or excluded by White players in a ball-tossing game (Cyberball). For half of the excluded participants, White bystanders acknowledged and apologized for the racial exclusion. Participants completed a cold pressor task to assess pain threshold, tolerance, and unpleasantness, and completed a survey assessing psychological needs (ie, belongingness, self-esteem, meaningful existence, and self-control). Participants who experienced racial exclusion reported significantly more threatened psychological needs and increased laboratory pain sensitization (ie, lower pain threshold and tolerance) than those who were included. However, when a White bystander acknowledged the racism, excluded participants reported higher levels of self-control, self-esteem, and decreased pain sensitization (pain threshold and tolerance) relative to excluded participants whose experience was not acknowledged. Our findings support that racism increased Black people's pain sensitivity and provide initial evidence for White bystander acknowledgment as a health intervention. PERSPECTIVE: Continual exposure to racism likely contributes to inequities in pain sensitization. We demonstrate that acute exposure to mild racism increases acute pain sensitization. Results suggest that a bystander acknowledging witnessed racism can buffer the acute sensitizing effects of racism on pain, pointing to the potential of interpersonal interventions targeting racism. TRIAL REGISTRATION: Clinicaltrials.gov NCT06113926.
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Affiliation(s)
- Katarina E AuBuchon
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia.
| | - Michelle L Stock
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Brianna Attey
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia
| | - Lisa Bowleg
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia
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Merz S, Aksakal T, Hibtay A, Yücesoy H, Fieselmann J, Annaç K, Yılmaz-Aslan Y, Brzoska P, Tezcan-Güntekin H. Racism against healthcare users in inpatient care: a scoping review. Int J Equity Health 2024; 23:89. [PMID: 38698455 PMCID: PMC11067303 DOI: 10.1186/s12939-024-02156-w] [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: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Racism in the healthcare system has become a burgeoning focus in health policy-making and research. Existing research has shown both interpersonal and structural forms of racism limiting access to quality healthcare for racialised healthcare users. Nevertheless, little is known about the specifics of racism in the inpatient sector, specifically hospitals and rehabilitation facilities. The aim of this scoping review is therefore to map the evidence on racial discrimination experienced by people receiving treatment in inpatient settings (hospitals and rehabilitation facilities) or their caregivers in high-income countries, focusing specifically on whether intersectional axes of discrimination have been taken into account when describing these experiences. METHODS Based on the conceptual framework developed by Arksey and O'Malley, this scoping review surveyed existing research on racism and racial discrimination in inpatient care in high-income countries published between 2013 and 2023. The software Rayyan was used to support the screening process while MAXQDA was used for thematic coding. RESULTS Forty-seven articles were included in this review. Specifics of the inpatient sector included different hospitalisation, admission and referral rates within and across hospitals; the threat of racial discrimination from other healthcare users; and the spatial segregation of healthcare users according to ethnic, religious or racialised criteria. While most articles described some interactions between race and other social categories in the sample composition, the framework of intersectionality was rarely considered explicitly during analysis. DISCUSSION While the USA continue to predominate in discussions, other high-income countries including Canada, Australia and the UK also examine racism in their own healthcare systems. Absent from the literature are studies from a wider range of European countries as well as of racialised and disadvantaged groups other than refugees or recent immigrants. Research in this area would also benefit from an engagement with approaches to intersectionality in public health to produce a more nuanced understanding of the interactions of racism with other axes of discrimination. As inpatient care exhibits a range of specific structures, future research and policy-making ought to consider these specifics to develop targeted interventions, including training for non-clinical staff and robust, transparent and accessible complaint procedures.
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Affiliation(s)
- Sibille Merz
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Tuğba Aksakal
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Ariam Hibtay
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Hilâl Yücesoy
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Jana Fieselmann
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Kübra Annaç
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Yüce Yılmaz-Aslan
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Patrick Brzoska
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - Hürrem Tezcan-Güntekin
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
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Griffith DM, Efird CR, Baskin ML, Webb Hooper M, Davis RE, Resnicow K. Cultural Sensitivity and Cultural Tailoring: Lessons Learned and Refinements After Two Decades of Incorporating Culture in Health Communication Research. Annu Rev Public Health 2024; 45:195-212. [PMID: 37931182 DOI: 10.1146/annurev-publhealth-060722-031158] [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: 11/08/2023]
Abstract
In this article, we examine progress and challenges in designing, implementing, and evaluating culturally sensitive behavioral interventions by tailoring health communication to groups or individuals. After defining common tailoring constructs (i.e., culture, race, and ethnicity), cultural sensitivity, and cultural tailoring, we examine when it is useful to culturally tailor and address cultural sensitivity in health communication by group tailoring or individual tailoring and when tailoring health communication may not be necessary or appropriate for achieving behavior change. After reviewing selected approaches to cultural tailoring, we critique the quality of research in this domain with a focus on the internal validity of empirical findings. Then we explore the ways in which cultural sensitivity, group targeting, and individual tailoring have incorporated culture in health promotion and health communication. We conclude by articulating yet unanswered questions and suggesting future directions to move the field forward.
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Affiliation(s)
- Derek M Griffith
- Center for Men's Health Equity, Racial Justice Institute, Georgetown University, Washington, DC, USA;
- Racial Justice Institute, Georgetown University, Washington, DC, USA
- Department of Health Management and Policy, School of Health, Georgetown University, Washington, DC, USA
| | - Caroline R Efird
- Racial Justice Institute, Georgetown University, Washington, DC, USA
| | - Monica L Baskin
- Division of Hematology/Oncology, School of Medicine; and Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Monica Webb Hooper
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Rachel E Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health; and Community Outreach and Health Disparities Research, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
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25
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Lim S, Mantsios A, Braithwaite RS, Pitts R. A secondary gendered analysis of interviews with Latina cisgender women indicated for HIV pre-exposure prophylaxis. AIDS Care 2024; 36:692-702. [PMID: 38466205 DOI: 10.1080/09540121.2024.2325070] [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: 03/08/2023] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
HIV infections disproportionately impact Latinx populations in the United States, yet oral pre-exposure prophylaxis (PrEP) uptake is low. This study was a secondary gendered analysis of interviews with Latina cisgender women (n = 20) recruited from an urban safety net hospital inNew York City between August 2019 and October 2022. All women were indicated for PrEP by the provider. In-depth interviews were conducted with participants in English and Spanish and asked about social determinants of health, sexual partnerships and behaviors, and PrEP-specific enablers and barriers. Secondary thematic content analysis was conducted to identify gender-related factors influencing PrEP uptake. The following themes emerged from the data:structural factors (e.g., employment), partner-related factors, low sexual health knowledge, and resilience and empowerment. Partner-related factors were the most salient; partner infidelity served as reasons for initiating PrEP. Despite being constrained by low power in relationships, women made empowered choices to initiate PrEP and protect themselves. Findings indicated that the impact of gender inequity was an important factor in Latina women's PrEP decision making, pointing to a need to address partner-driven HIV risk, imbalance of power in relationships, and gender norms.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Ronald S Braithwaite
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert Pitts
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Division of Infectious Diseases, NYC Health + Hospitals/Bellevue, New York, NY, USA
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26
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Friedman MR, Badri S, Bowleg L, Haberlen SA, Jones DL, Kempf MC, Konkle-Parker D, Kwait J, Martinson J, Mimiaga MJ, Plankey MW, Stosor V, Tsai AC, Turan JM, Ware D, Wu K. Intersectional stigma and the non-communicable disease syndemic in the context of HIV: protocol for a multisite, observational study in the USA. BMJ Open 2024; 14:e075368. [PMID: 38670612 PMCID: PMC11057270 DOI: 10.1136/bmjopen-2023-075368] [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: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic. METHODS AND ANALYSIS Collecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design. ETHICS AND DISSEMINATION This protocol is approved as a single-IRB study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.
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Grants
- U01 HL146245 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- UL1 TR001409 NCATS NIH HHS
- KL2 TR001432 NCATS NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- TL1 TR001431 NCATS NIH HHS
- U01 HL146193 NHLBI NIH HHS
- R01 HL160326 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- U01 HL146205 NHLBI NIH HHS
- P30 MH116867 NIMH NIH HHS
- P30 AI073961 NIAID NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR001881 NCATS NIH HHS
- UL1 TR000004 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- UL1 TR003098 NCATS NIH HHS
- P30 AI050410 NIAID NIH HHS
- Data Analysis and Coordination Center
- National Heart, Lung, and Blood Institute (NHLBI)
- National Institutes of Health, National Heart, Lung, and Blood Institute
- National Institutes of Health (NIH)
- UCLA
- CTSA
- ICTR
- National Institutes of Health, Office of AIDS Research (OAR)
- UCSF
- the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD)
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Affiliation(s)
- M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers University, Newark, New Jersey, USA
| | - Sheila Badri
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Lisa Bowleg
- Department of Psychology, The George Washington University, Washington, District of Columbia, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jenn Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew J Mimiaga
- Center for LGBTQ+ Advocacy, Research & Health and Department of Epidemiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine and Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Janet M Turan
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Katherine Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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27
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Kieu TKT, Galper EF, Sorin CR, Bloom BE. Using an intersectional life course perspective to understand familial environment and its impact on sexuality development among Asian American sexual minority college students. CULTURE, HEALTH & SEXUALITY 2024:1-19. [PMID: 38639035 DOI: 10.1080/13691058.2024.2341832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
There is a dearth of research understanding the sexual health of Asian American adolescents, and even more so for those who identify as sexual minorities (lesbian, gay, bisexual, queer, asexual, and other sexual orientations). This study is a secondary qualitative analysis focused on young adults' recollections of their formal and informal sex education experiences in childhood and adolescence using a sub-sample of in-depth interviews from students who self-identified as both Asian and sexual minorities living in the USA (n = 9). Results were organised into three sections: (1) latent cultural factors (e.g. stigma surrounding sex, self-sufficiency, filial piety); (2) the downstream effects of latent cultural factors (e.g. sex-related discussions, rules disallowing dating, role of lateral family members); and (3) the impact of deficient familial sex-related discussions (e.g. Internet, resentment). Study findings underscore the links between identity concealment and relationship concealment that are unique to Asian sexual minority individuals. We suggest that interventions involving Asian American US youth and their families should be culturally informed and promote cross-generational sex-related discussion. Future research should further explore the role of chosen family and non-parental family members as a point of intervention as they can be helpful sources of informal sex education.
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Affiliation(s)
- Talia Kim-Thanh Kieu
- Department of Health Behavior, Gillings School of Global Public Health, University of NC, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Emily F Galper
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, USA
| | - Cierra Raine Sorin
- Department of Sociology, University of CA Santa Barbara, Santa Barbara, CA, USA
| | - Brittnie E Bloom
- University of California Global Health Institute Women's Health, Gender, and Empowerment Center of Expertise, Los Angeles, CA, USA
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
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Chu W, Tam CC, Harrison S. Associations between perceived discrimination experiences, treatment adherence self-efficacy, and depressive symptoms among people living with HIV in the Southern United States. AIDS Care 2024:1-10. [PMID: 38623601 DOI: 10.1080/09540121.2024.2341231] [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: 07/25/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Abstract
This study examined associations between perceived discrimination, treatment adherence self-efficacy, and depressive symptoms among people living with HIV (PLHIV) in the Southern United States. Cross-sectional survey data were collected from 402 PLHIV who self-reported on interpersonal discrimination experiences based on HIV status, sexuality, gender, income, and living condition. Participants also reported on adherence self-efficacy and depressive symptoms. We employed K-means clustering to identify groups based on discrimination experiences, and logistic regressions to examine group differences on adherence self-efficacy and depressive symptoms. Results suggested three groups: a cluster with high perceived discrimination across all identities/conditions (n = 41; 11%; Cluster 1); a cluster with high perceived discrimination based on HIV status, income, and living condition (n = 49; 13%; Cluster 2); and a cluster with low perceived discrimination across all identities/conditions (n = 288; 76%; Cluster 3). Compared to Cluster 3, Cluster 1 and 2 had 2.22 times (p = .037) and 3.98 times (p<.001) greater odds of reporting depressive symptoms. Compared to Cluster 3, Cluster 2 had 3.40 times (p = .003) greater odds of reporting lower adherence self-efficacy. Findings demonstrate the need for individual-level support for PLHIV with discrimination histories, and broader efforts to end the stigma, discrimination, and marginalization of PLHIV based on HIV status and other characteristics.
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Affiliation(s)
- Wendy Chu
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
| | - Cheuk Chi Tam
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Sayward Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
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29
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Bailey AH, Williams A, Poddar A, Cimpian A. Intersectional Male-Centric and White-Centric Biases in Collective Concepts. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2024:1461672241232114. [PMID: 38613360 DOI: 10.1177/01461672241232114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In principle, the fundamental concepts person, woman, and man should apply equally to people of different genders and races/ethnicities. In reality, these concepts might prioritize certain groups over others. Based on interdisciplinary theories of androcentrism, we hypothesized that (a) person is more associated with men than women (person = man) and (b) woman is more associated with women than man is with men (i.e., women are more gendered: gender = woman). We applied natural language processing tools (specifically, word embeddings) to the linguistic output of millions of individuals (specifically, the Common Crawl corpus). We found the hypothesized person = man / gender = woman bias. This bias was stronger about Hispanic and White (vs. Asian) women and men. We also uncovered parallel biases favoring White individuals in the concepts person, woman, and man. Western society prioritizes men and White individuals as people and "others" women as people with gender, with implications for equity across policy- and decision-making contexts.
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Poteat T, Hall P, Adams MA, Gautam DS, Ashenden R, Horn J. Caregiving Among Older Black Same-Gender-Loving Women During the COVID-19 Pandemic: Findings From Qualitative Research. THE GERONTOLOGIST 2024; 64:gnad103. [PMID: 37480588 PMCID: PMC10943494 DOI: 10.1093/geront/gnad103] [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: 02/09/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Few data on caregiving during the coronavirus disease 2019 pandemic use an intersectional lens to attend to how multiple social categories, such as gender, age, race, and sexual orientation, shape caregiving experiences. This analysis sought to explore caregiving experiences of aging Black same-gender-loving women. RESEARCH DESIGN AND METHODS Sixteen focus groups were conducted with 4-8 participants each (N = 102) from across the United States. Audio-recorded discussions lasted for approximately 90 min and were transcribed verbatim. Two analysts coded transcripts for discussions related to caregiving and used content analysis to identify themes. RESULTS Participants engaged in caregiving for children, parents, family, friends, and neighbors. They provided physical, economical, instrumental, and/or secondary caregiving; and sometimes received care themselves. The pandemic heavily affected their stress level and mental health as well as their intimate partner relationships. Discussions mostly offered descriptions of increased caregiving difficulty caused by the pandemic. However, a few participants identified ways the pandemic made caregiving easier; changed caregiving without making it easier or harder; or thwarted their ability to provide care. DISCUSSION AND IMPLICATIONS Older Black same-gender-loving women described some pandemic caregiving experiences that diverged from the existing literature, demonstrating the importance of considering how gender, race, age, and sexual orientation affect caregiving experiences during a pandemic fraught with health inequities. Ensuring the multiply marginalized caregivers have access to the practical and emotional support they need is critical for advancing health equity and preparing for future pandemics.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, North Carolina, USA
| | - Porsha Hall
- ZAMI NOBLA: National Organization on Black Lesbians on Aging, Atlanta, Georgia, USA
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization on Black Lesbians on Aging, Atlanta, Georgia, USA
| | - Dipa Sharma Gautam
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Robynn Ashenden
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Horn
- Family Caregiver Support Center, Pikes Peak Area Agency on Aging, Colorado Springs, Colorado, USA
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Picó-Pérez M, Marco EA, Thurston LT, Ambrosi V, Genon S, Bryant KL, Martínez AB, Ciccia L, Kaiser Trujillo A. Researchers' sex/gender identity influences how sex/gender question is investigated in neuroscience: an example from an OHBM meeting. Brain Struct Funct 2024; 229:741-758. [PMID: 38366123 PMCID: PMC10978731 DOI: 10.1007/s00429-023-02750-8] [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: 09/13/2023] [Accepted: 12/04/2023] [Indexed: 02/18/2024]
Abstract
Gender inequality and diversity in STEM is a challenging field of research. Although the relation between the sex/gender of the researcher and the scientific research practices has been previously examined, less interest has been demonstrated towards the relation between sex/gender of the researcher and the way sex/gender as a variable is explored. Here, we examine, from a neurofeminist perspective, both questions: whether sex/gender identity is related to the examination of sex/gender as a variable and whether different approaches towards examining sex/gender are being used in different topics of study within neuroscience. Using the database of submitted posters to the Organization of Human Brain Mapping 2022 annual conference, we identified abstracts examining a sex/gender-related research question. Among these target abstracts, we identified four analytical categories, varying in their degree of content-related complexity: (1) sex/gender as a covariate, (2) sex/gender as a binary variable for the study of sex/gender differences, (3) sex/gender with additional biological information, and (4) sex/gender with additional social information. Statistical comparisons between sex/gender of researcher and the target abstract showed that the proportion of abstracts from Non-binary or Other first authors compared to both Women and Men was lower for all submitted abstracts than for the target abstracts; that more researchers with sex/gender-identity other than man implemented analytical category of sex/gender with additional social information; and, for instance, that research involving cognitive, affective, and behavioural neuroscience more frequently fit into the sex/gender with additional social information-category. Word cloud analysis confirmed the validity of the four exploratorily identified analytical categories. We conclude by discussing how raising awareness about contemporary neurofeminist approaches, including perspectives from the global south, is critical to neuroscientific and societal progress.
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Affiliation(s)
- Maria Picó-Pérez
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Departamento de Psicología Básica, Clínica y Psicobiología, Universitat Jaume I, Castelló de la Plana, Spain
| | | | | | - Valerie Ambrosi
- Institute Technology and Education, University of Bremen, Bremen, Germany
| | - Sarah Genon
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich, Germany
| | - Katherine L Bryant
- Laboratoire de Psychologie Cognitive, Université Aix-Marseille, Marseille, France
| | - Ana Belén Martínez
- Filosofía de la Biología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Lu Ciccia
- Centro de Investigaciones y Estudios de Género, Universidad Nacional Autónoma de México, Ciudad de México, México
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Poteat TC, Hall P, Brooks M, Horn J, Yang C, Pereira N, Adams MA. Caregiving During the COVID-19 Pandemic: A Cross-Sectional Study with Older Cisgender Sexual Minority Women in the United States. LGBT Health 2024; 11:219-228. [PMID: 37971831 PMCID: PMC11001953 DOI: 10.1089/lgbt.2023.0226] [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: 11/19/2023] Open
Abstract
Purpose: This study describes prevalence of caregiving before and after the onset of the COVID-19 pandemic among racially diverse older cisgender sexual minority women, examines factors associated with caregiving, and assesses relationships between caregiving and health. Methods: A convenience sample of participants aged ≥50 years completed self-administered online surveys assessing sociodemographic characteristics, caregiver status, self-rated health, and depressive symptoms. Bivariate statistics compared response variables by race, caregiver status, and timing of caregiving relative to the pandemic. Results: Of 365 participants, 82.7% identified as lesbian or gay and 41.1% as Black/African American; 40% were caregivers before (n = 32), during (n = 34), or both before and during (n = 80) the pandemic. A greater proportion of caregivers lived with a partner (45.9% vs. 35.6%, p = 0.06), were unemployed (37.7% vs. 29.7%, p = 0.07), and had high school or lower education (11.6% vs. 5%, p = 0.09). No differences were found in self-rated health by caregiver status; however, a higher proportion of Black (vs. White) caregivers reported good to excellent physical health (77.9% vs. 62.9%, p = 0.05). Caregivers more frequently reported depressive symptoms (28.1% vs. 17.8%, p = 0.03). Caregivers both before and during the pandemic had lower educational attainment than those who provided care only before or only during the pandemic (p = 0.04). Conclusion: Caregiving was common among older sexual minority women during the pandemic and experiences varied by race and other social factors. Consideration of these intersecting experiences is important for fully understanding caregiver experiences during COVID-19. Overall, caregiving was associated with depressive symptoms, underscoring the importance of psychosocial support for all caregivers.
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Affiliation(s)
- Tonia C. Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Porsha Hall
- ZAMI NOBLA: National Organization of Black Lesbians on Aging, Atlanta, Georgia, USA
| | - Madeline Brooks
- Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer Horn
- Family Caregiver Support Center, Pikes Peak Area Agency on Aging, Colorado Springs, Colorado, USA
| | - Chloe Yang
- Department of Health Behavior, Gillings School of Public Health, Chapel Hill, North Carolina, USA
| | - Nastacia Pereira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization of Black Lesbians on Aging, Atlanta, Georgia, USA
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James D. Initial Development and Validation of the Brief Internalized Heterosexist Racism Scale for Gay and Bisexual Black Men: A Measure of Internalized Heterosexist Racism. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1307-1325. [PMID: 38388762 PMCID: PMC10955034 DOI: 10.1007/s10508-023-02805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 02/24/2024]
Abstract
We introduce internalized heterosexist racism (IHR), or the internalization of damaging stereotypes, harmful beliefs, and negative attitudes about being a sexual minority person of color. We also present the initial development and validation of the Brief Internalized Heterosexist Racism Scale for gay and bisexual Black men (IHR-GBBM), a unidimensional, 10-item measure of IHR. Exploratory factor analyses on an internet-obtained sample of gay and bisexual Black men (N = 312; Mean age = 30.36 years) show that the IHR-GBBM had evidence of good internal consistency, and good convergent, discriminant, concurrent, and incremental validity. The IHR-GBBM was positively correlated with internalized racism, internalized heterosexism, and discrimination (racist, heterosexist). IHR was also negatively correlated with race stigma consciousness, weakly positively correlated with sexual identity stigma consciousness, but not correlated with either race identity, sexual identity, or social desirability. Hierarchical regressions showed that the IHR-GBBM explained an additional variance of 2.8% and 3.1% in anxiety symptoms and substance use coping, respectively, after accounting for (1) sociodemographics, (2) internalized racism and internalized heterosexism, and (3) an interaction of internalized racism and internalized heterosexism. Older participants and those who were "out" about their sexual identity reported lower IHR. Those who did not know/want to report their HIV status reported greater IHR. Results revealed no sexual identity, sexual position, relationship status, income, education, or employment status differences in IHR. We hope the development of the IHR-GBBM spurs future research on predictors and consequences of IHR. We discuss limitations and implications for the future study of internalized heterosexist racism.
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Affiliation(s)
- Drexler James
- Department of Psychology, University of Minnesota, Twin Cities, 75 E River Rd, Minneapolis, MN, 55455-0366, USA.
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Mahar EA, Irving LH, Derovanesian A, Masterson A, Webster GD. Stigma Toward Consensual Non-Monogamy: Thematic Analysis and Minority Stress. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2024; 50:571-586. [PMID: 36461779 DOI: 10.1177/01461672221139086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Consensually non-monogamous (CNM) romantic and sexual relationships tend to be stigmatized. The present research examined this stigma across two studies. First, we qualitatively explored the specific ways that people in CNM relationships report experiencing stigma using thematic analysis and identified the following four themes: Expressions of discomfort/disapproval of CNM, Loss of resources/threatening behaviors, Character devaluation, and Relationship devaluation (Study 1; N = 372). Second, we examined the relationship between experienced stigma and psychological well-being for people in CNM relationships, using the framework of minority stress theory. We found that experienced stigma was positively associated with psychological distress and that this association was partially statistically mediated by anticipated stigma and internalized stigma (Study 2; N = 383). Overall, this research strives to achieve a better understanding of the processes and potential consequences of stigma toward CNM relationships and individuals.
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Eschliman EL, Patel EU, Murray SM, German D, Kirk GD, Mehta SH, Kaufman MR, Genberg BL. Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use. Subst Use Misuse 2024; 59:1210-1220. [PMID: 38519443 PMCID: PMC11194036 DOI: 10.1080/10826084.2024.2330906] [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: 03/25/2024]
Abstract
BACKGROUND People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population. METHODS This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland. Logistic regressions with generalized estimating equations were used to estimate associations between drug use-related discrimination in healthcare settings and subsequent ED utilization for the sample overall and six subgroups based on race, sex, and HIV status. RESULTS 1,342 participants contributed data from 7,289 semiannual study visits. Participants were predominately Black (82%), mostly male (66%), and 33% were living with HIV. Drug use-related discrimination in healthcare settings (reported at 6% of study visits) was positively associated with any subsequent ED use (OR = 1.40, 95% CI: 1.15-1.72). Positive associations persisted after adjusting for covariates, including past sixth-month ED use and drug use, among the overall sample (aOR = 1.28, 95% CI: 1.04-1.59) and among some subgroups. CONCLUSIONS Drug use-related discrimination in healthcare settings was associated with greater subsequent ED utilization in this sample. Further exploration of mechanisms driving this relationship may help improve care and optimize healthcare engagement for people with a history of injection drug use.
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Affiliation(s)
- Evan L. Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Michelle R. Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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Vincent W. Willingness to Use Digital Health Screening and Tracking Tools for Public Health in Sexual Minority Populations in a National Probability Sample: Quantitative Intersectional Analysis. J Med Internet Res 2024; 26:e47448. [PMID: 38457790 PMCID: PMC10960216 DOI: 10.2196/47448] [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: 03/20/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Little is known about sexual minority adults' willingness to use digital health tools, such as pandemic-related tools for screening and tracking, outside of HIV prevention and intervention efforts for sexual minority men, specifically. Additionally, given the current cultural climate in the United States, heterosexual and sexual minority adults may differ in their willingness to use digital health tools, and there may be within-group differences among sexual minority adults. OBJECTIVE This study compared sexual minority and heterosexual adults' willingness to use COVID-19-related digital health tools for public health screening and tracking and tested whether sexual minority adults differed from each other by age group, gender, and race or ethnicity. METHODS We analyzed data from a cross-sectional, national probability survey (n=2047) implemented from May 30 to June 8, 2020, in the United States during the height of the public health response to the COVID-19 pandemic. Using latent-variable modeling, heterosexual and sexual minority adults were tested for differences in their willingness to use digital health tools for public health screening and tracking. Among sexual minority adults, specifically, associations with age, gender, and race or ethnicity were assessed. RESULTS On average, sexual minority adults showed greater willingness to use digital health tools for screening and tracking than heterosexual adults (latent factor mean difference 0.46, 95% CI 0.15-0.77). Among sexual minority adults, there were no differences by age group, gender, or race or ethnicity. However, African American (b=0.41, 95% CI 0.19-0.62), Hispanic or Latino (b=0.36, 95% CI 0.18-0.55), and other racial or ethnic minority (b=0.54, 95% CI 0.31-0.77) heterosexual adults showed greater willingness to use digital health tools for screening and tracking than White heterosexual adults. CONCLUSIONS In the United States, sexual minority adults were more willing to use digital health tools for screening and tracking than heterosexual adults. Sexual minority adults did not differ from each other by age, gender, or race or ethnicity in terms of their willingness to use these digital health tools, so no sexual orientation-based or intersectional disparities were identified. Furthermore, White heterosexual adults were less willing to use these tools than racial or ethnic minority heterosexual adults. Findings support the use of digital health tools with sexual minority adults, which could be important for other public health-related concerns (eg, the recent example of mpox). Additional studies are needed regarding the decision-making process of White heterosexual adults regarding the use of digital health tools to address public health crises, including pandemics or outbreaks that disproportionately affect minoritized populations.
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Affiliation(s)
- Wilson Vincent
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
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Marbaniang I, Moodie EEM, Latimer E, Skakoon-Sparling S, Hart TA, Grace D, Moore DM, Lachowsky NJ, Jollimore J, Lambert G, Zhang T, Dvorakova M, Cox J. Using an intersectionality-based approach to evaluate mental health services use among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver. Epidemiol Psychiatr Sci 2024; 33:e10. [PMID: 38438301 PMCID: PMC10940056 DOI: 10.1017/s2045796024000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 03/06/2024] Open
Abstract
AIMS To cope with homonegativity-generated stress, gay, bisexual and other men who have sex with men (GBM) use more mental health services (MHS) compared with heterosexual men. Most previous research on MHS among GBM uses data from largely white HIV-negative samples. Using an intersectionality-based approach, we evaluated the concomitant impact of racialization and HIV stigma on MHS use among GBM, through the mediating role of perceived discrimination (PD). METHODS We used baseline data from 2371 GBM enrolled in the Engage cohort study, collected between 2017 and 2019, in Montreal, Toronto and Vancouver, using respondent-driven sampling. The exposure was GBM groups: Group 1 (n = 1376): white HIV-negative; Group 2 (n = 327): white living with HIV; Group 3 (n = 577): racialized as non-white HIV-negative; Group 4 (n = 91): racialized as non-white living with HIV. The mediator was interpersonal PD scores measured using the Everyday Discrimination Scale (5-item version). The outcome was MHS use (yes/no) in the prior 6 months. We fit a three-way decomposition of causal mediation effects utilizing the imputation method for natural effect models. We obtained odds ratios (ORs) for pure direct effect (PDE, unmediated effect), pure indirect effect (PIE, mediated effect), mediated interaction effect (MIE, effect due to interaction between the exposure and mediator) and total effect (TE, overall effect). Analyses controlled for age, chronic mental health condition, Canadian citizenship, being cisgender and city of enrolment. RESULTS Mean PD scores were highest for racialized HIV-negative GBM (10.3, SD: 5.0) and lowest for white HIV-negative GBM (8.4, SD: 3.9). MHS use was highest in white GBM living with HIV (GBMHIV) (40.4%) and lowest in racialized HIV-negative GBM (26.9%). Compared with white HIV-negative GBM, white GBMHIV had higher TE (OR: 1.71; 95% CI: 1.27, 2.29) and PDE (OR: 1.68; 95% CI: 1.27, 2.24), and racialized HIV-negative GBM had higher PIE (OR: 1.09; 95% CI: 1.02, 1.17). Effects for racialized GBMHIV did not significantly differ from those of white HIV-negative GBM. MIEs across all groups were comparable. CONCLUSIONS Higher MHS use was observed among white GBMHIV compared with white HIV-negative GBM. PD positively mediated MHS use only among racialized HIV-negative GBM. MHS may need to take into account the intersecting impact of homonegativity, racism and HIV stigma on the mental health of GBM.
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Affiliation(s)
- Ivan Marbaniang
- Department of Epidemiology, McGill University, Montreal, QC, Canada
| | - Erica E. M. Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Eric Latimer
- Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Trevor A. Hart
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Disease, University of British Columbia, Vancouver, BC, Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | | | - Gilles Lambert
- Institut National de Santé Publique du Québec, Montreal, QC, Canada
| | - Terri Zhang
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Milada Dvorakova
- Clinical Outcomes Research and Evaluation, Research Institute–McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Clinical Outcomes Research and Evaluation, Research Institute–McGill University Health Centre, Montreal, QC, Canada
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Moreno-Agostino D, Woodhead C, Ploubidis GB, Das-Munshi J. A quantitative approach to the intersectional study of mental health inequalities during the COVID-19 pandemic in UK young adults. Soc Psychiatry Psychiatr Epidemiol 2024; 59:417-429. [PMID: 36692519 PMCID: PMC9872068 DOI: 10.1007/s00127-023-02424-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE Mental health inequalities across social identities/positions during the COVID-19 pandemic have been mostly reported independently from each other or in a limited way (e.g., at the intersection between age and sex or gender). We aim to provide an inclusive socio-demographic mapping of different mental health measures in the population using quantitative methods that are consistent with an intersectional perspective. METHODS Data included 8,588 participants from two British cohorts (born in 1990 and 2000-2002, respectively), collected in February/March 2021 (during the third UK nationwide lockdown). Measures of anxiety and depressive symptomatology, loneliness, and life satisfaction were analysed using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) models. RESULTS We found evidence of large mental health inequalities across intersectional strata. Large proportions of those inequalities were accounted for by the additive effects of the variables used to define the intersections, with some of the largest gaps associated with sexual orientation (with sexual minority groups showing substantially worse outcomes). Additional inequalities were found by cohort/generation, birth sex, racial/ethnic groups, and socioeconomic position. Intersectional effects were observed mostly in intersections defined by combinations of privileged and marginalised social identities/positions (e.g., lower-than-expected life satisfaction in South Asian men in their thirties from a sexual minority and a disadvantaged childhood social class). CONCLUSION We found substantial inequalities largely cutting across intersectional strata defined by multiple co-constituting social identities/positions. The large gaps found by sexual orientation extend the existing evidence that sexual minority groups were disproportionately affected by the pandemic. Study implications and limitations are discussed.
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Affiliation(s)
- Darío Moreno-Agostino
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK.
- ESRC Centre for Society and Mental Health, King's College London, Melbourne House, 44-46 Aldwych, London, WC2B 4LL, UK.
| | - Charlotte Woodhead
- ESRC Centre for Society and Mental Health, King's College London, Melbourne House, 44-46 Aldwych, London, WC2B 4LL, UK
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK
- ESRC Centre for Society and Mental Health, King's College London, Melbourne House, 44-46 Aldwych, London, WC2B 4LL, UK
| | - Jayati Das-Munshi
- ESRC Centre for Society and Mental Health, King's College London, Melbourne House, 44-46 Aldwych, London, WC2B 4LL, UK
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Trust, London, UK
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Rose RE, Singh S, Berezin MN, Javdani S. "Roses have thorns for a reason": The promises and perils of critical youth participatory research with system-impacted girls of Color. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:144-158. [PMID: 37016921 PMCID: PMC10551042 DOI: 10.1002/ajcp.12651] [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: 11/01/2021] [Revised: 06/01/2022] [Accepted: 11/28/2022] [Indexed: 06/19/2023]
Abstract
Scholarship on girlhood-especially for girls of Color-is often relegated to studying risk and emphasizing individual deficits over humanizing girls and centering their voices. This approach to generating scholarship renders oppressive systems and processes invisible from inquiry and unaddressed by practice, with particularly insidious consequences for youth in the legal system. Critical youth participatory action research (YPAR) is acknowledged as an antidote to these conceptualizations because it resists deficit-oriented narratives circling systems-impacted youth by inviting them to the knowledge-generating table. In this paper, we present an empirical analysis of the promises and perils that emerged as we conducted a year-long critical YPAR project alongside five system-impacted girls of Color. Our thematic analysis of process notes (30 meetings, 120 h) documents the stories posited by girls, in a democratized space, about the injustices of interconnected institutions, and unearths a complicated tension for both youth and adult coresearchers around the promises and perils of engaging in YPAR within the academy. These findings underscore the importance of using intersectional, collaborative research to challenge perceptions around how we legitimize knowledge. We describe lessons learned in conducting YPAR in academic settings and highlight recommendations to grow youth-adult partnerships within oppressive systems to share power.
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Affiliation(s)
- Raquel E. Rose
- Department of Applied Psychology, New York University, New York, New York, USA
| | | | - McKenzie N. Berezin
- Department of Applied Psychology, New York University, New York, New York, USA
| | - Shabnam Javdani
- Department of Applied Psychology, New York University, New York, New York, USA
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Reynolds A, Greenfield EA, Williams-Butler A. Early life adversity, race, and childhood socioeconomic status: intersecting drivers of later life cognition. Aging Ment Health 2024; 28:511-519. [PMID: 37572032 PMCID: PMC10859546 DOI: 10.1080/13607863.2023.2242296] [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: 12/15/2022] [Accepted: 07/06/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES Research on associations between early life adversity (ELA) and later life cognition has yielded mixed results and generally have not considered how broader societal systems of stratification potentially influence associations. The current study addresses this gap by exploring if racialized identity and childhood socioeconomic status (cSES) moderate associations between ELA exposure and later life cognition. METHODS Using data from the Health and Retirement Study (Waves 2010-2018), we used growth curve modeling to examine if the confluence of ELA, cSES, and racialized identity is associated with cognition. RESULTS Among White participants, greater exposure to ELA was associated with poorer baseline cognitive functioning, and higher cSES buffered against this association. Among Black participants, exposure to ELA was not associated with baseline cognitive functioning, regardless of cSES. We did not find evidence of any associations between main predictors nor their interactions with change in cognition over time. CONCLUSIONS This study provides evidence that associations between ELA and later life cognition is contingent upon multiple social positions in the United States. These findings support the importance of integrating insights on intersecting social positions within life-course-oriented efforts to reduce racialized cognitive disparities.
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Affiliation(s)
- Addam Reynolds
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
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Hsieh N. Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:38-59. [PMID: 37776198 PMCID: PMC10922600 DOI: 10.1177/00221465231199276] [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: 10/02/2023]
Abstract
Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.
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Affiliation(s)
- Ning Hsieh
- Michigan State University, East Lansing, MI, USA
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Belisle LA, Pinchevsky GM, Ortega G. Examining the prevalence of adverse childhood experiences (ACEs) among justice-involved youth in the U.S.: The importance of accounting for race/ethnicity, gender, and gendered racial/ethnic groups. CHILD ABUSE & NEGLECT 2024; 149:106514. [PMID: 38359774 DOI: 10.1016/j.chiabu.2023.106514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Youth in the U.S. juvenile justice system are exposed to adverse childhood experiences (ACEs) at higher rates than youth in the general public. Additionally, research has demonstrated ACEs can vary by race/ethnicity and gender. However, little is known about how ACEs are experienced across gendered racial/ethnic groups of justice-involved youth. OBJECTIVE To address this gap, this exploratory study is the first to apply an intersectional lens to examine the prevalence of ACEs among a group of justice-involved youth in the U.S. PARTICIPANTS & SETTING Using secondary data, this study examines ACEs by gender, race/ethnicity, and six gendered racial/ethnic groups of justice-involved youth referred to the Division of Youth and Family Services (DYFS) in Milwaukee, Wisconsin. METHODS Descriptive analyses are presented by gender and race/ethnicity separately, followed by gendered racial/ethnic groups to understand differential rates of exposure to ACEs. RESULTS The study's findings align with previous research and reinforce that justice-involved youth experience higher rates of adversity than the general public. The results also support the feminist pathway's perspective within an intersectional context, emphasizing the importance of accounting for race/ethnicity and gender simultaneously to identify the unique experiences of ACEs among justice-involved youth. CONCLUSION Recommendations related to these findings and considerations surrounding ACE measures are discussed. Specifically, findings from this study stress the importance of accounting for gender and race/ethnicity simultaneously when measuring experiences of adversity. This is a critical step to providing equitable treatment and services to address trauma-related needs across gendered racial/ethnic groups of system-involved youth.
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Desmarais A, Christophe NK, Robins RW. Mexican-Origin Children's Trajectories of Ethnic-Racial Pride from Childhood through Emerging Adulthood: Associations with Mothers and Fathers' Trajectories. J Youth Adolesc 2024; 53:685-700. [PMID: 38015356 DOI: 10.1007/s10964-023-01902-7] [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: 08/25/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
Ethnic-racial pride (positive feelings about one's ethnic-racial group) is critical to healthy identity development across the lifespan. Research on ethnic-racial pride development among Latinx populations has focused exclusively on youth, without regard to pride development amongst parents and relations between pride within family units. Using multivariate Latent Growth Curve Modelling among 674 Mexican-origin youth and their parents (673 mothers; 437 fathers), the trajectory of youth's pride from 5th grade through emerging adulthood (14 years/12 waves of data) as well as relations with parental pride trajectories were examined. Respondents' pride generally decreased from waves 1 to 7 (~age 11-17 in youth) and increased after wave 7. Youth's and mothers' trajectories were unrelated, but complex associations emerged between youth's and fathers' trajectories. This study supports the dynamic nature of ethnic-racial pride across distinct life stages and underscores the complex interplay of youth and parental pride trajectories, emphasizing the pivotal role parents may play in co-shaping identity development alongside their children.
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Kibuchi E, Chumo I, Kabaria C, Elsey H, Phillips-Howard P, de Siqueira-Filha NT, Whittaker L, Leyland AH, Mberu B, Gray L. Health inequalities at the intersection of multiple social determinants among under five children residing Nairobi urban slums: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002931. [PMID: 38422055 PMCID: PMC10903897 DOI: 10.1371/journal.pgph.0002931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
In this analysis we examine through an intersectionality lens how key social determinants of health (SDOH) are associated with health conditions among under-five children (<5y) residing in Nairobi slums, Kenya. We used cross-sectional data collected from Nairobi slums between June and November 2012 to explore how multiple interactions of SDoH shape health inequalities in slums. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. We constructed intersectional strata for each health condition from combinations of significant SDoH obtained using univariate analyses. We then estimated the intersectional effects of health condition in a series of MAIHDA logistic regression models distinguishing between additive and interaction effects. We quantified discriminatory accuracy (DA) of the intersectional strata by means of the variance partitioning coefficient (VPC) and the area under the receiver operating characteristic curve (AUC-ROC). The total participants were 2,199 <5y, with 120 records (5.5%) dropped because health conditions were recorded as "not applicable". The main outcome variables were three health conditions: 1) whether a child had diarrhea or not, 2) whether a child had fever or not, and 3) whether a child had cough or not in the previous two weeks. We found non-significant intersectional effects for each health condition. The head of household ethnic group was significantly associated with each health condition. We found good DA for diarrhea (VPC = 9.0%, AUC-ROC = 76.6%) an indication of large intersectional effects. However, fever (VPC = 1.9%, AUC-ROC = 66.3%) and cough (VPC = 0.5%, AUC-ROC = 61.8%) had weak DA indicating existence of small intersectional effects. Our study shows pathways for SDoH that affect diarrhea, cough, and fever for <5y living in slums are multiplicative and shared. The findings show that <5y from Luo and Luhya ethnic groups, recent migrants (less than 2 years), and households experiencing CHE are more likely to face worse health outcomes. We recommend relevant stakeholders to develop strategies aimed at identifying these groups for targeted proportionate universalism based on the level of their need.
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Affiliation(s)
- Eliud Kibuchi
- School of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Helen Elsey
- Department of Health Sciences, University of York, York, United Kingdom
| | | | | | - Lana Whittaker
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Alastair H. Leyland
- School of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - Linsay Gray
- School of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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Castle SD, Byrd WC, Koester BP, Pearson MI, Bonem E, Caporale N, Cwik S, Denaro K, Fiorini S, Li Y, Mead C, Rypkema H, Sweeder RD, Valdivia Medinaceli MB, Whitcomb KM, Brownell SE, Levesque-Bristol C, Molinaro M, Singh C, McKay TA, Matz RL. Systemic advantage has a meaningful relationship with grade outcomes in students' early STEM courses at six research universities. INTERNATIONAL JOURNAL OF STEM EDUCATION 2024; 11:14. [PMID: 38404757 PMCID: PMC10891193 DOI: 10.1186/s40594-024-00474-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Abstract
Background Large introductory lecture courses are frequently post-secondary students' first formal interaction with science, technology, engineering, and mathematics (STEM) disciplines. Grade outcomes in these courses are often disparate across student populations, which, in turn, has implications for student retention. This study positions such disparities as a manifestation of systemic inequities along the dimensions of sex, race/ethnicity, income, and first-generation status and investigates the extent to which they are similar across peer institutions. Results We examined grade outcomes in a selected set of early STEM courses across six large, public, research-intensive universities in the United States over ten years. In this sample of more than 200,000 STEM course enrollments, we find that course grade benefits increase significantly with the number of systemic advantages students possess at all six institutions. The observed trends in academic outcomes versus advantage are strikingly similar across universities despite the fact that we did not control for differences in grading practices, contexts, and instructor and student populations. The findings are concerning given that these courses are often students' first post-secondary STEM experiences. Conclusions STEM course grades are typically lower than those in other disciplines; students taking them often pay grade penalties. The systemic advantages some student groups experience are correlated with significant reductions in these grade penalties at all six institutions. The consistency of these findings across institutions and courses supports the claim that inequities in STEM education are a systemic problem, driven by factors that go beyond specific courses or individual institutions. Our work provides a basis for the exploration of contexts where inequities are exacerbated or reduced and can be used to advocate for structural change within STEM education. To cultivate more equitable learning environments, we must reckon with how pervasive structural barriers in STEM courses negatively shape the experiences of marginalized students. Supplementary Information The online version contains supplementary material available at 10.1186/s40594-024-00474-7.
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Affiliation(s)
- Sarah D. Castle
- Department of Mathematics and Statistical Science, University of Idaho, MS 1103, 875 Perimeter Dr, Moscow, ID 83844 USA
| | - W. Carson Byrd
- Center for the Study of Higher & Postsecondary Education, University of Michigan, 2117 School of Education Building, 610 E University Ave, Ann Arbor, MI 48109 USA
| | - Benjamin P. Koester
- LSA Dean: Undergraduate Education, University of Michigan, 450 Church St, Ann Arbor, MI 48109 USA
| | - Meaghan I. Pearson
- Combined Program in Education and Psychology, University of Michigan, 610 East University Ave, Suite 1400 D, Ann Arbor, MI 48109 USA
| | - Emily Bonem
- Center for Instructional Excellence, Purdue University, 155 South Grant St, West Lafayette, IN 47907 USA
| | - Natalia Caporale
- Department of Neurobiology, Physiology and Behavior, University of California Davis, 188 Briggs Hall, Davis, CA 95616 USA
| | - Sonja Cwik
- Department of Physics and Astronomy, University of Pittsburgh, 3941 O’Hara St, Pittsburgh, PA 15260 USA
| | - Kameryn Denaro
- Division of Teaching Excellence and Innovation, University of California Irvine, 3000 Anteater Instruction Research Building, 653 E Peltason Dr, Irvine, CA 92697 USA
| | - Stefano Fiorini
- Institutional Analytics—Research and Analytics, UITS and Department of Anthropology, Indiana University Bloomington, Cyberinfrastructure Building, 2709 E 10th St, Bloomington, IN 47401 USA
| | - Yangqiuting Li
- Department of Physics, Oregon State University, 103 SW Memorial Place, Corvallis, OR 97331 USA
| | - Chris Mead
- School of Earth and Space Exploration, Arizona State University, PO Box 871404, Tempe, AZ 85287 USA
| | - Heather Rypkema
- Foundational Course Initiative, Center for Research On Learning and Teaching, University of Michigan, 100 Washtenaw Ave, Ann Arbor, MI 48109 USA
| | - Ryan D. Sweeder
- Lyman Briggs College and the Office of Undergraduate Education, Michigan State University, 919 E Shaw Ln, East Lansing, MI 48103 USA
| | - Montserrat B. Valdivia Medinaceli
- Program in Qualitative and Quantitative Research Methodology, Indiana University Bloomington, 201 N Rose Ave, Bloomington, IN 47405 USA
| | - Kyle M. Whitcomb
- Department of Physics and Astronomy, University of Pittsburgh, 3941 O’Hara St, Pittsburgh, PA 15260 USA
| | - Sara E. Brownell
- Research for Inclusive STEM Education Center, Arizona State University, 427 E Tyler Mall, Tempe, AZ 85281 USA
| | - Chantal Levesque-Bristol
- Center for Instructional Excellence, Purdue University, 155 South Grant St, West Lafayette, IN 47907 USA
| | - Marco Molinaro
- Academic Innovation and Technology/Teaching and Learning Transformation Center, University of Maryland, College Park, 4131 Campus Drive, College Park, MD 20742 USA
| | - Chandralekha Singh
- Department of Physics and Astronomy, University of Pittsburgh, 3941 O’Hara St, Pittsburgh, PA 15260 USA
| | - Timothy A. McKay
- Department of Physics, University of Michigan, 450 Church St, Ann Arbor, MI 48109 USA
| | - Rebecca L. Matz
- Center for Academic Innovation, University of Michigan, 317 Maynard St, Ann Arbor, MI 48104 USA
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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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