Homelessness and health care disparities among lesbian, gay, bisexual, and transgender youth

Understanding harms associated with gender identity conversion efforts among transgender and nonbinary individuals: The role of preexisting mental well-being

Background: Affirmation of gender identity is critical for the mental health and overall well-being of transgender and nonbinary (TNB) persons. Gender identity conversion efforts (GICE), an outlawed practice for licensed professionals in numerous U.S. jurisdictions, have been associated with negative mental health and substance use outcomes. Limited previous literature examining GICE exposure has been criticized for failing to distinguish mental well-being for TNB persons before or after GICE. Our study builds on current literature by examining differences in TNB persons' psychosocial risk indicators based on their GICE exposure, accounting for pre-GICE mental well-being. Methods: We conducted a secondary data analysis using the 2015 U.S. Transgender Survey (N = 25,810), the largest available national survey aimed at understanding TNB persons' experiences. Using logistic regression models, we examined how GICE exposure (disaggregated by temporal precedence of initial suicide attempts) is related to health (psychological distress, extra-medical prescription use, healthcare avoidance), socio-structural (public restroom avoidance, housing instability), and interpersonal outcomes (sexual assault, emotional and physical intimate partner violence (IPV)). Results and conclusions: Initiating a suicide attempt post-GICE or in the absence of GICE were the only consistently significant predictors of poor outcomes across all domains compared to participants who never experienced GICE or attempted suicide. Findings suggest, however, that a combination of GICE with a history of suicide attempts (pre- or post-GICE) was indicative of the highest risk across outcomes, highlighting the particularly hazardous nature of combining poor mental well-being and GICE exposures. Our study adds much-needed complexity to our understanding of how GICE exposure's role in the well-being of TNB persons may differ related to their pre-GICE mental health. Our findings add further credence to previous studies identifying harms associated with GICE exposure, regardless of pre-GICE mental well-being.

Housing insecurity and intersecting social determinants of health among transgender people in the USA: A targeted ethnography

Background: Housing is an important social determinant of health (SDOH). Transgender people face a unique blend of discrimination and compromised social services, putting them at risk for housing insecurity and associated public health concerns. Aims: This targeted ethnography explores housing insecurity as a SDOH among transgender people in the U.S. Methods: In-depth interviews were conducted with transgender people (n = 41) throughout the U.S.A., identified through purposive sampling. A semi-structured guide was used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes. Results: Responses revealed pervasive housing insecurity and inter-related challenges. Respondents discussed how intersecting identities create unique constellations of vulnerability, which "intersect like a star." Financial insecurity and interpersonal rejection were lead housing insecurity causes, often resulting in psychological strain, which was sometimes addressed with substances and sexual risk-taking. These factors were cyclically accompanied by financial and employment insecurity and a cascade of unmet social needs. Social support facilitated coping. Discussion: Findings support increasing transgender housing security intervention resources that address intersecting and cyclical discrimination, trauma, housing, employment, and health issues.

Interviewing Adolescents About Sexual Matters

To optimally address sex and sexuality, normalize gender and sexual diversities, and attend to adolescents' needs, clinicians will best serve their patients and their families by becoming comfortable initiating confidential, developmentally appropriate discussions with all adolescent patients. The goal is to create a safe, affirming, nonjudgmental space wherein adolescents may learn about sexual matters, discuss concerns, ask questions, and find support to assist them to achieve healthy, positive development. This article provides useful, practical suggestions to begin these conversations, offers specific examples and tips to encourage dialogue, and discusses ways to be a resource to adolescent patients.

"I feel like I am surviving the health care system": understanding LGBTQ health in Nova Scotia, Canada

Background

Currently, there is a dearth of baseline data on the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations in the province of Nova Scotia, Canada. Historically, LGBTQ health research has tended to focus on individual-level health risks associated with poor health outcomes among these populations, which has served to obscure the ways in which they maintain their own health and wellness across the life course. As such, there is an urgent need to shift the focus of LGBTQ health research towards strengths-based perspectives that explore the complex and resilient ways in which LGBTQ populations promote their health.

Methods

This paper discusses the findings of our recent scoping review as well as the qualitative data to emerge from community consultations aimed at developing strengths-based approaches to understanding and advancing LGBTQ pathways to health across Nova Scotia.

Results

Our scoping review findings demonstrated the lack of strengths-based research on LGBTQ health in Nova Scotia. Specifically, the studies examined in our scoping review identified a number of health-promoting factors and a wide variety of measurement tools, some of which may prove useful for future strengths-based health research with LGBTQ populations. In addition, our community consultations revealed that many participants had negative experiences with health care systems and services in Nova Scotia. However, participants also shared a number of factors that contribute to LGBTQ health and suggestions for how LGBTQ pathways to health in Nova Scotia can be improved.

Conclusions

There is an urgent need to conduct research on the health needs, lived experiences, and outcomes of LGBTQ populations in Nova Scotia to address gaps in our knowledge of their unique health needs. In moving forward, it is important that future health research take an intersectional, strengths-based perspective in an effort to highlight the factors that promote LGBTQ health and wellness across the life course, while taking into account the social determinants of health.

A scoping study: children, policy and cultural shifts in homelessness services in South Australia: are children still falling through the gaps?

Homeless families are the fastest growing segment of the homelessness population. Homelessness services are often the first to know when children are at risk of disengagement with health, welfare and education services. Changes to Australian policy to explicitly attend to the needs of children are attempts to address the complexity of, and provide better outcomes for, homeless children. There are mounting levels of evidence describing some of the needs of children who are homeless. Using the scoping study methodological framework, this review of academic and grey literature identified the extent to which service providers provide for the needs of homeless children. The literature search was conducted from September 2012 to April 2013 using ProQuest, Science Direct, Sage and OVID databases. Therefore, the objectives of this scoping study were to: (i) identify the specific needs of children in homelessness; (ii) describe recent changes in policy relating to care for children in homelessness services; (iii) explore the evidence on how service providers can enact care for children in homelessness services; (iv) identify the types of practice changes that are needed to optimise outcomes for children; and (v) identify the gaps in service delivery. This article describes the Australian policy changes and explores the potential impact of subsequent sector reforms on the internal practices in front-line homelessness services, in order to overcome structural and systemic barriers, and promote opportunities for children in homeless families. This scoping study literature review contributes to the understanding of the impact of policy change on front-line staff and suggests possible practice changes and future research options.

Gaps in Transgender Medicine Content Identified Among Canadian Medical School Curricula

Purpose: The transgender community is a diverse group that requires unique consideration in the healthcare setting. However, several studies have suggested that their needs are not currently being met by our medical system. Although the reason for this discrepancy is likely multifactorial, inadequate training of healthcare professionals to manage this population has been cited as a contributing factor.

Methods: To evaluate the role that Canadian medical schools play in addressing these proposed deficits, program administrators were invited to provide curricular information detailing their delivery of transgender health, and medical students were surveyed to assess the impact of current curricula on their knowledge, attitudes, and experiences with regard to transgender health.

Results: Six of fourteen schools provided curricular information about their instruction in transgender health and wide variation was found; 255/1152 University of British Columbia (UBC) students and 155/2358 students from eight other Canadian medical schools responded to the survey. Greater than 95% of responders agreed that transgender issues are important and should be addressed by physicians. However, fewer than 10% of students felt that they were sufficiently knowledgeable to do so. At UBC, there was no significant improvement in the self-reported knowledge levels after receiving the transgender-related curricula, and only 24% of students felt the topic was proficiently taught.

Conclusion: This study showed that the majority of students who responded do not feel comfortable addressing the needs of transgender individuals in a healthcare setting and suggests that a reevaluation of related curricula may be warranted.

The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health

BACKGROUND

Historically, lesbian, gay, bisexual, transgender and queer (LGBTQ) health research has focused heavily on the risks for poor health outcomes, obscuring the ways in which LGBTQ populations maintain and improve their health across the life course. In this paper we argue that informing culturally competent health policy and systems requires shifting the LGBTQ health research evidence base away from deficit-focused approaches toward strengths-based approaches to understanding and measuring LGBTQ health.

METHODS

We recently conducted a scoping review with the aim of exploring strengths-based approaches to LGBTQ health research. Our team found that the concept of resilience emerged as a key conceptual framework. This paper discusses a subset of our scoping review findings on the utility of resilience as a conceptual framework in understanding and measuring LGBTQ health.

RESULTS

The findings of our scoping review suggest that the ways in which resilience is defined and measured in relation to LGBTQ populations remains contested. Given that LGBTQ populations have unique lived experiences of adversity and discrimination, and may also have unique factors that contribute to their resilience, the utility of heteronormative and cis-normative models of resilience is questionable. Our findings suggest that there is a need to consider further exploration and development of LGBTQ-specific models and measures of resilience that take into account structural, social, and individual determinants of health and incorporate an intersectional lens.

CONCLUSIONS

While we fully acknowledge that the resilience of LGBTQ populations is central to advancing LGBTQ health, there remains much work to be done before the concept of resilience can be truly useful in measuring LGBTQ health.