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Klöbl M, Reed MB, Handschuh P, Kaufmann U, Konadu ME, Ritter V, Spurny-Dworak B, Kranz GS, Lanzenberger R, Spies M. Gender Dysphoria and Sexual Euphoria: A Bayesian Perspective on the Influence of Gender-Affirming Hormone Therapy on Sexual Arousal. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1859-1871. [PMID: 38216784 PMCID: PMC11106106 DOI: 10.1007/s10508-023-02778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
Self-reported sexual orientation of transgender individuals occasionally changes over transition. Using functional magnetic resonance imaging, we tested the hypothesis that neural and behavioral patterns of sexual arousal in transgender individuals would shift from the assigned to the experienced gender (e.g., trans women's responses becoming more dissimilar to those of cis men and more similar to those of cis women). To this aim, trans women (N = 12) and trans men (N = 20) as well as cisgender women (N = 24) and cisgender men (N = 14) rated visual stimuli showing male-female, female-female or male-male intercourse for sexual arousal before and after four months of gender-affirming hormone therapy. A Bayesian framework allowed us to incorporate previous behavioral findings. The hypothesized changes could indeed be observed in the behavioral responses with the strongest results for trans men and female-female scenes. Activation of the ventral striatum supported our hypothesis only for female-female scenes in trans women. The respective application or depletion of androgens in trans men and trans women might partly explain this observation. The prominent role of female-female stimuli might be based on the differential responses they elicit in cis women and men or, in theory, the controversial concept of autogynephilia. We show that correlates of sexual arousal in transgender individuals might change in the direction of the experienced gender. Future investigations should elucidate the mechanistic role of sex hormones and the cause of the differential neural and behavioral findings.The study was registered at ClinicalTrials.gov (NCT02715232), March 22, 2016.
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Affiliation(s)
- Manfred Klöbl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Murray Bruce Reed
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Patricia Handschuh
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Melisande Elisabeth Konadu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Vera Ritter
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Benjamin Spurny-Dworak
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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2
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Jayne PE, Szucs LE, Lesesne CA, Grose RG, Johns MM. "I wouldn't have felt so alone": The sexual health education experiences of transgender and gender diverse youth living in the southeastern United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024. [PMID: 38623631 DOI: 10.1111/psrh.12258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce. METHODS We conducted a multi-stage thematic analysis of 33 in-depth interviews among transgender and gender diverse youth (ages 15-24) living in the southeastern United States on their sexual health education experiences. RESULTS Our study participants described school-based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white-centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment-free information while holding positive framing around sexuality and gender. CONCLUSION There is much work needed to improve the breadth, quality, and relevance of school-based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community-based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer-friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways.
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Affiliation(s)
- Paula E Jayne
- U.S. Centers for Disease Control and Prevention's Division of Adolescent and School Health, Atlanta, Georgia, USA
| | - Leigh E Szucs
- U.S. Centers for Disease Control and Prevention's Division of Adolescent and School Health, Chamblee, Georgia, USA
| | | | - Rose Grace Grose
- Colorado School of Public Health, Community Health Education, University of Northern Colorado, Greeley, Colorado, USA
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3
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Fischbach AL, Hindenach A, van der Miesen AIR, Yang JS, Buckley OJ, Song M, Campos L, Strang JF. Autistic and non-autistic transgender youth are similar in gender development and sexuality phenotypes. BRITISH JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2024. [PMID: 38613223 DOI: 10.1111/bjdp.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
Increasing rhetoric regarding the common intersection of autism and gender diversity has resulted in legislation banning autistic transgender youth from accessing standard of care supports, as well as legislative efforts banning all youth gender care in part justified by the proportional over-occurrence of autism. Yet, no study has investigated whether autistic and non-autistic transgender youth present fundamentally different gender-related phenotypes. To address this gap, we extensively characterized autism, gender diversity, and sexuality among autistic and non-autistic transgender binary youth (N = 66, Mage = 17.17, SDage = 2.12) in order to investigate similarities and/or differences in gender and sexuality phenotypes. Neither autism diagnostic status nor continuous autistic traits were significantly related to any gender or sexuality phenotypes. These findings suggest that the developmental and experiential features of gender diversity are very similar between autistic and non-autistic transgender adolescents. Future research is needed to determine whether the similarity in profiles is maintained over time into adulthood.
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Affiliation(s)
- Abigail L Fischbach
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Andy Hindenach
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Ji Seung Yang
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Olivia J Buckley
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Minneh Song
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Laura Campos
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - John F Strang
- Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
- Department of Psychiatry, and Behavioral Sciences, George Washington University School of Medicine, Washington, DC, USA
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4
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Bosse JD, Clark KD, Dion KA, Chiodo LM. Transgender and nonbinary young adults' depression and suicidality is associated with sibling and parental acceptance-rejection. J Nurs Scholarsh 2024; 56:87-102. [PMID: 37235487 DOI: 10.1111/jnu.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/15/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Transgender and nonbinary young adults (TNB YA) report high rates of depression and more suicidality than their cisgender counterparts. Parental rejection is a known predictor of worse mental health among TNB YA; however, less is known about TNB YA experiences of sibling acceptance-rejection. The purpose of this study was to determine how TNB YA perception of sibling and parental acceptance-rejection are related to TNB YA depression and suicidality. DESIGN Cross-sectional. METHODS TNB YA (ages 18-25) who had disclosed their gender identity to an adult sibling were recruited to take part in an online study and completed measures of sibling and parent acceptance-rejection, depression, as well as lifetime and past year suicidality. Stepwise regressions were conducted to evaluate associations between acceptance-rejection and TNB YA depression and suicidality. RESULTS The sample consisted of 286 TNB YA (Mage = 21.5, SD = 2.2) who were predominantly White (80.6%) and assigned female sex at birth (92.7%). Each family member's acceptance-rejection was associated with increased TNB YA depression scores when considered independently and combined. Independently, high rejection from each family member was associated with greater odds of reporting most suicidality outcomes. When all family members were considered together, only high rejection from a male parent was associated with four times greater odds of reporting lifetime suicidality. High rejection from both parents was associated with greater odds of reporting past year suicide attempt (OR: 3.26 female parent; 2.75 male parent). CONCLUSION Rejection from family members is associated with worse depression and suicidality, and rejection from male parents may be particularly damaging. Sibling acceptance uniquely contributes to TNB YA's depression symptoms alone and in the context of parental support.
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Affiliation(s)
- Jordon D Bosse
- Elaine Marieb College of Nursing, University of Massachusetts, Massachusetts, Amherst, USA
| | - Kristen D Clark
- Department of Nursing, University of New Hampshire, Durham, New Hampshire, USA
| | - Kimberly A Dion
- Elaine Marieb College of Nursing, University of Massachusetts, Massachusetts, Amherst, USA
| | - Lisa M Chiodo
- Elaine Marieb College of Nursing, University of Massachusetts, Massachusetts, Amherst, USA
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5
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Reisner SL, Choi SK, Herman JL, Bockting W, Krueger EA, Meyer IH. Sexual orientation in transgender adults in the United States. BMC Public Health 2023; 23:1799. [PMID: 37715161 PMCID: PMC10503109 DOI: 10.1186/s12889-023-16654-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: 07/14/2022] [Accepted: 08/30/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Sexual orientation refers to a person's enduring emotional, romantic, or sexual attractions to other people. Sexual orientation measures do not typically consider desires for, or sexual behavior with, transgender people. We describe measures inclusive of transgender people and characterize sexual orientation identity, behavior, and attraction in a representative sample of the U.S. transgender population. METHODS Between April 2016-December 2018, a U.S. national probability sample of transgender (n = 274) and cisgender (n = 1,162) adults were invited to complete a self-administered web or mailed paper survey. We assessed sexual identity with updated response options inclusive of recent identity terms (e.g., queer), and revised sexual behavior and attraction measures that included transgender people. Multiple response options were allowed for sexual behavior and attraction. Weighted descriptive statistics and sexual orientation differences by gender identity groups were estimated using age-adjusted comparisons. RESULTS Compared to the cisgender population, the transgender population was more likely to identify as a sexual minority and have heterogeneity in sexual orientation, behavior, and attraction. In the transgender population, the most frequently endorsed sexual orientation identities were "bisexual" (18.9%), "queer" (18.1%), and "straight" (17.6%). Sexually active transgender respondents reported diverse partners in the prior 5 years: 52.6% cisgender women (CW), 42.7% cisgender men (CM), 16.9% transgender women (TW), and 19.5% transgender men (TM); 27.7% did not have sex in the past 5 years. Overall, 73.6% were "somewhat"/ "very" attracted to CW, 58.3% CM, 56.8% TW, 52.4% TM, 59.9% genderqueer/nonbinary-females-at-birth, 51.9% genderqueer/nonbinary-males-at-birth. Sexual orientation identity, behavior, and attraction significantly differed by gender identity for TW, TM, and nonbinary participants (all p < 0.05). CONCLUSIONS Inclusive measures of sexual orientation captured diverse sexual identities, partner genders, and desires. Future research is needed to cognitively test and validate these measures, especially with cisgender respondents, and to assess the relation of sexual orientation and health for transgender people.
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Affiliation(s)
- Sari L Reisner
- Department of Medicine, Harvard Medical School, 221 Longwood Ave, 5th Floor, Boston, MA, 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Soon Kyu Choi
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jody L Herman
- The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA, USA
| | - Walter Bockting
- Program for the Study of LGBTQ+ Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Evan A Krueger
- School of Social Work, Tulane University, New Orleans, LA, USA
| | - Ilan H Meyer
- The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA, USA
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6
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Katz-Wise SL, Ranker LR, Kraus AD, Wang YC, Xuan Z, Green JG, Holt M. Fluidity in Gender Identity and Sexual Orientation Identity in Transgender and Nonbinary Youth. JOURNAL OF SEX RESEARCH 2023:1-10. [PMID: 37585555 DOI: 10.1080/00224499.2023.2244926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Changes in sexual orientation identity (SOI) and gender identity (GI) have rarely been studied in transgender and/or nonbinary youth (TNBY), but documenting such changes is important for understanding identity development and gender transition and supporting the needs of TNBY. This study examined the frequency and patterning of changes in GI and SOI across 3 months (T1-T2) and 1.5 years (T1-T4) among 183 TNBY (baseline age 14-17 years; 83.6% White, 16.9% Hispanic/Latinx) who participated in a longitudinal US study. Participants completed online surveys including measures of GI and SOI. The most common gender identity selected at T1 (with or without another gender identity) was nonbinary (56.3%), and more than half (57.4%) of youth identified with a plurisexual identity (e.g., bisexual, pansexual). GI fluidity from T1-T2 was 13.2% and from T1-T4 was 28.9%. It was equally common to move toward a nonbinary gender identity as toward a binary gender identity. SOI fluidity was more common (30.6% from T1-T2; 55.8% from T1-T4) than GI fluidity. Shifts toward plurisexual identities were more common than shifts toward monosexual identities (e.g., straight, gay). Findings highlight the need to assess changes in GI and SOI in research and clinical practice to address the unique needs of TNBY accurately and effectively.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health
| | - Lynsie R Ranker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Community Health Sciences, Boston University School of Public Health
| | - Aidan D Kraus
- Wheelock College of Education and Human Development, Boston University
| | - Yu-Chi Wang
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health
| | | | - Melissa Holt
- Wheelock College of Education and Human Development, Boston University
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7
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Mittleman J. Sexual Fluidity: Implications for Population Research. Demography 2023; 60:1257-1282. [PMID: 37489833 DOI: 10.1215/00703370-10898916] [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: 07/26/2023]
Abstract
For the first time ever, national censuses have begun asking adults to report their sexual orientations. However, because such surveys provide only cross-sectional snapshots of populations, these data obscure one key complexity: that sexuality can be fluid, with sexual self-identification evolving over time. Drawing on unique, restricted-use data from the Population Assessment of Tobacco and Health, the current study documents the prevalence, correlates, and empirical consequences of sexual fluidity in the contemporary United States. Overall, about 1 in 11 American adults changed sexual identities over five annual surveys, including 6% of cisgender men, 11% of cisgender women, and 35% of gender minorities. Fluidity was particularly pronounced among young adults and among those who had ever identified as bisexual or "something else." Despite the frequency and patterning of sexual fluidity, accounting for fluidity did little to change observed patterns of disadvantage on three measures of sexual minority well-being: mental health, financial insecurity, and substance use. Given these facts, I argue that demographic research should foreground the complexities inherent in quantifying sexuality, focusing less on how many people "are" a given sexual orientation and more on the social dynamics that continue to produce sexual minority disadvantage.
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Affiliation(s)
- Joel Mittleman
- Department of Sociology, University of Notre Dame, Notre Dame, IN, USA
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8
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Layland EK, Bränström R, Murchison GR, Pachankis JE. Kept in the Closet: Structural Stigma and the Timing of Sexual Minority Developmental Milestones Across 28 European Countries. J Youth Adolesc 2023:10.1007/s10964-023-01818-2. [PMID: 37410349 DOI: 10.1007/s10964-023-01818-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
Structural stigma's role in lesbian, gay, and bisexual (LGB) people's attainment of identity development milestones remains unknown. In a sample of 111,498 LGB people (ages 15 to 65+) living across 28 European countries, associations were investigated between structural stigma measured using an objective index of discriminatory country-level laws and policies affecting LGB people and the timing and pacing of LGB self-awareness, coming out, and closet duration, and subgroup differences in these associations. On average, self-awareness occurred at age 14.8 years old (SD = 5.1), coming out occurred at 18.5 years old (SD = 5.7), and the closet was 3.9 years long (SD = 4.9); thereby highlighting adolescence as a key period for sexual identity development and disclosure. Greater structural stigma was associated with higher odds of never coming out, later age of coming out, and longer closet duration. Gender identity, transgender identity, and sexual identity moderated associations between structural stigma and these developmental milestones. Reducing structural stigma can plausibly promote sexual identity development among LGB populations, especially during adolescence when identity related milestones are often attained.
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Affiliation(s)
- E K Layland
- Department of Human Development and Family Sciences, University of Delaware, 111 Alison Hall West, Newark, DE, 19716, USA.
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA.
| | - R Bränström
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden
| | - G R Murchison
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
| | - J E Pachankis
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
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9
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Blayney JA, Jaffe AE, Hequembourg AL, Parrott DJ. Sexual Victimization Among Sexual and Gender Minoritized Groups: Recent Research and Future Directions. Curr Psychiatry Rep 2023; 25:183-191. [PMID: 37014545 PMCID: PMC10947481 DOI: 10.1007/s11920-023-01420-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE OF THE REVIEW Sexual victimization is a significant public health concern. Compared to heterosexual and cisgender peers, sexual and gender minoritized (SGM) individuals are at elevated risk for sexual victimization. Prominent theories suggest that this risk is due in part to the stigma SGM individuals face when navigating heteronormative cultures. The goal of this article is to review the prevalence, risk factors, and consequences of sexual victimization in SGM individuals. RECENT FINDINGS Studies continue to show that SGM individuals-bisexual and/or gender minoritized in particular-are at higher risk for sexual victimization. Little work has focused on risk factors, though recent research continues to highlight post-victimization disparities among SGM individuals. Emerging studies also point to theoretically informed factors that may influence victimization risk and recovery, including sexual and gender-related stigma. To inform prevention and intervention efforts, future research would benefit from streamlining assessment, methodology, and dissemination practices.
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Affiliation(s)
- Jessica A Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Amy L Hequembourg
- School of Nursing, State University of New York at Buffalo, Buffalo, NY, USA
| | - Dominic J Parrott
- Department of Psychology, Georgia State University, Atlanta, GA, USA
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10
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Katz-Wise SL, Todd KP. The current state of sexual fluidity research. Curr Opin Psychol 2022; 48:101497. [PMID: 36401908 PMCID: PMC10289116 DOI: 10.1016/j.copsyc.2022.101497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/14/2022] [Accepted: 10/18/2022] [Indexed: 01/28/2023]
Abstract
Sexual fluidity research (i.e., change over time in one or more sexual orientation dimensions) has grown exponentially, with advancements in conceptual models, measurement, and understanding of sexual orientation as a construct and developmental process that accommodates potential for change. Sexual fluidity research has also moved beyond samples of white cisgender women to consider the experiences of individuals with other sociodemographic characteristics and has examined change across multiple dimensions of sexual orientation, mechanisms of change, and associations with health outcomes. This review provides a brief narrative of historical conceptualizations of sexual orientation and fluidity and the current state of research on sexual fluidity. Finally, we identify opportunities for future research, policy, and clinical practice.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Kieran P Todd
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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11
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Dolsen EA, Byers AL, Flentje A, Goulet JL, Jasuja GK, Lynch KE, Maguen S, Neylan TC. Sleep disturbance and suicide risk among sexual and gender minority people. Neurobiol Stress 2022; 21:100488. [PMID: 36164391 PMCID: PMC9508603 DOI: 10.1016/j.ynstr.2022.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/01/2022] Open
Abstract
Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender and/or heterosexual individuals. The present narrative review evaluates nascent research related to sleep disturbance and suicide-related thoughts and behaviors (STBs) among SGM populations, and discusses how experiences of minority stress may explain heightened risk among SGM people. Although there is a growing understanding of the link between sleep disturbance and STBs, most research has not been conducted in SGM populations or has not examined suicide as an outcome. Research is needed to examine whether and how aspects of sleep disturbances relate to STBs among SGM people in order to better tailor sleep treatments for SGM populations.
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Affiliation(s)
- Emily A Dolsen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Amy L Byers
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, USA
| | - Joseph L Goulet
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA
| | - Shira Maguen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Thomas C Neylan
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
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Sheffield A, Tung I, Berona J, Northrup JB, Nannini S, Hipwell AE, Keenan K. Factor structure of the Outness Inventory in a sample of Black and White lesbian and bisexual young adult women. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022; 28:132-145. [PMID: 38560510 PMCID: PMC10977668 DOI: 10.1080/19359705.2022.2046973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction The Outness Inventory (OI; Mohr & Fassinger, 2000) is the most commonly used measure for assessing an individual's level of outness, or openness about sexual identity. However, data on the validity of the OI factor structure across diverse populations is limited. The present study aimed to test the factor structure of the OI in a population-based sample of Black and White young adult women. Method Participants included 319 lesbian and bisexual women drawn from the Pittsburgh Girls Study (PGS), a large longitudinal study of 5- to 8-year-old girls (53% Black) oversampled from low-income neighborhoods and followed through adulthood. Participants completed the 11-item OI at ages 20-23 years. Confirmatory factor analyses evaluated measurement invariance of the OI across race and suggested significant differences in factor structure between Black and White sexual minority women. Exploratory factor analyses were conducted separately by race. Results An EFA revealed three factors for the Black subsample: Family, Straight Friends, and Work/Strangers. Three factors also emerged for the White subsample, representing Familiar Acquaintances, Less Familiar Acquaintances, and Work. Conclusion Additional research is needed to investigate potential culturally-based differences in domains of disclosure, which may help to better understand how specific contexts of outness relate to mental health.
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Affiliation(s)
- Alexis Sheffield
- Department of Psychology, University of New Mexico, Albuquerque, NM
| | - Irene Tung
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Johnny Berona
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
| | - Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sierra Nannini
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
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13
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Boskey ER, Ganor O. Sexual Orientation and Attraction in a Cohort of Transmasculine Adolescents and Young Adults. Transgend Health 2022; 7:270-275. [PMID: 36643063 PMCID: PMC9829161 DOI: 10.1089/trgh.2020.0190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
As part of an ongoing longitudinal study of transmasculine adolescents and young adults seeking gender-affirming surgery, this analysis examined sexual orientation and attraction in a cohort of 167 binary and nonbinary participants 15-35 years of age. Correlations were analyzed using Pearson's chi square. Binary and nonbinary transmasculine individuals had different patterns of orientation and attraction, with binary males more likely to be heterosexual and less likely to be queer (p<0.003). Nonbinary individuals were more likely to be attracted to and have history with other nonbinary people (p<0.01). Transmasculine sexual identities are variable, complex, and not well described by standard sexual orientation categories.
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Affiliation(s)
- Elizabeth R. Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Address correspondence to: Elizabeth R. Boskey, PhD, MPH, LICSW, Center for Gender Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Zubizarreta D, Beccia AL, Trinh MH, Reynolds CA, Reisner SL, Charlton BM. Human papillomavirus vaccination disparities among U.S. college students: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA). Soc Sci Med 2022; 301:114871. [PMID: 35344774 DOI: 10.1016/j.socscimed.2022.114871] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/24/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
We investigated how gender identity, sexual orientation, and race/ethnicity intersect to shape the social epidemiology of HPV vaccination initiation among U.S. college students. Cross-sectional survey data were from the National College Health Assessment (Fall, 2019-Spring, 2020; N = 65,047). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy by nesting participants within 36 social strata defined using gender identity, sexual orientation, and race/ethnicity. Bayesian multilevel logistic regression models with random intercepts for social strata were fit for HPV vaccination initiation. Intersectional models adjusted for the additive main effects to isolate intersectional interactions, controlling for age and geographic region. Social strata that included cisgender men, transgender women, and non-binary assigned-male-at-birth individuals and strata that included racial/ethnic minorities had a significantly lower likelihood of HPV vaccination initiation relative to strata including cisgender women and non-Hispanic White individuals, respectively, while strata including lesbian/gay and bisexual/pansexual/queer individuals had a significantly higher likelihood of HPV vaccination initiation relative to strata including heterosexual individuals. We also observed substantial between-stratum inequities in the predicted prevalence of HPV vaccination initiation, with estimates ranging from 59.2% for heterosexual, racial/ethnic minority, cisgender men to 87.1% for bisexual/pansexual/queer, racial/ethnic minority, non-binary assigned-female-at-birth individuals. That being said, the majority of the observed between-stratum variance was driven by additive rather than intersectional interaction effects and the discriminatory accuracy of intersectional stratification with respect to predicting HPV vaccination initiation was low. Collectively, our findings point to a need for more universal guidelines and clinician recommendations that promote HPV vaccine uptake for all adolescents, regardless of race/ethnicity, gender identity, sex-assigned-at-birth, or sexual orientation; however, utilizing an intersectional lens will ensure that resulting public health interventions address inequities and center the needs and experiences of multiply marginalized adolescents.
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Affiliation(s)
- Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ariel L Beccia
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Mai-Han Trinh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Colleen A Reynolds
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sari L Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Brittany M Charlton
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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15
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Warwick RM, Araya AC, Shumer DE, Selkie EM. Transgender Youths' Sexual Health and Education: A Qualitative Analysis. J Pediatr Adolesc Gynecol 2022; 35:138-146. [PMID: 34619356 DOI: 10.1016/j.jpag.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVE To characterize transgender adolescents' sexual behaviors, identities, and their perceived experiences with sex education. DESIGN Semi-structured interviews were conducted and addressed sexual experiences and perceptions of sex education received from family, school educators, and healthcare providers. Interviews were audio recorded, transcribed, and analyzed utilizing NVivo 12 software for thematic analysis. SETTING Child and adolescent gender services clinic at a Midwestern university-based medical center in the United States. PARTICIPANTS 30 transgender adolescents between the ages of 15 to 20. INTERVENTIONS AND MAIN OUTCOME MEASURES Themes generated during semi-structured interviews. RESULTS Sexual orientations were inclusive of attractions to a spectrum of gender identities. Libido was perceived to be impacted by gender-affirming hormone therapy, which was unanticipated for some adolescents. Family and school-based sex education was perceived to be relevant only for heterosexual and cisgender adolescents. Inclusive education for transgender adolescents was desired. Counseling provided by gender-affirming providers on sexual health was trusted and other healthcare providers were perceived to lack training on gender-inclusive care. CONCLUSION This study demonstrated that families and school educators did not provide sex education perceived to be applicable to transgender adolescents. Similarly, healthcare providers of transgender adolescents were perceived to not provide inclusive or comprehensive medical care in comparison to physicians who routinely provide gender-affirming care. Gaps in education and healthcare could be improved with sex education outreach or training for families and school educators as well as the development and implementation of professional competencies for pediatricians on transgender adolescent healthcare.
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Affiliation(s)
| | - Adrian C Araya
- Division of Pediatric Endocrinology, Michigan Medicine, Ann Arbor, MI
| | - Daniel E Shumer
- Division of Pediatric Endocrinology, Michigan Medicine, Ann Arbor, MI
| | - Ellen M Selkie
- Division of Adolescent Medicine, Michigan Medicine, Ann Arbor, MI
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Grov C, Westmoreland DA, D’Angelo AB, Pantalone DW. How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention. JOURNAL OF SEX RESEARCH 2021; 58:891-913. [PMID: 34180743 PMCID: PMC9729849 DOI: 10.1080/00224499.2021.1936440] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP's approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | | | - Alexa B. D’Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY
- CUNY Institute for Implementation Science in Population Health, New York, NY
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts Boston
- The Fenway Institute, Fenway Health, Boston, MA
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17
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Poteat VP, Rosenbach SB, Smith RL, Santo JB. A guide for innovation in LGBQ+ youth peer relationships research. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2021. [DOI: 10.1016/j.appdev.2021.101298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Do same-sex unions dissolve more often than different-sex unions? Methodological insights from Colombian data on sexual behavior. DEMOGRAPHIC RESEARCH 2021. [DOI: 10.4054/demres.2021.44.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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19
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Wirtz AL, Iyer JR, Brooks D, Hailey‐Fair K, Galai N, Beyrer C, Celentano D, Arrington‐Sanders R. An evaluation of assumptions underlying respondent-driven sampling and the social contexts of sexual and gender minority youth participating in HIV clinical trials in the United States. J Int AIDS Soc 2021; 24:e25694. [PMID: 33978326 PMCID: PMC8114466 DOI: 10.1002/jia2.25694] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/09/2021] [Accepted: 02/25/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Respondent-driven sampling (RDS) has been an effective sampling strategy for HIV research in many settings, but has had limited success among some youth in the United States. We evaluated a modified RDS approach for sampling Black and Latinx sexual and gender minority youth (BLSGMY) and explored how lived experiences and social contexts of BLSGMY youth may impact traditional RDS assumptions. METHODS RDS was implemented in three US cities, Baltimore, Philadelphia and Washington DC, to engage BLSGMY aged 15 to 24 years in HIV prevention or care intervention trials. RDS was modified to include targeted seed recruitment from venues, Internet and health clinics, and provided options for electronic or paper coupons. Qualitative interviews were conducted among a sub-sample of RDS participants to explore their experiences with RDS. Interviews were coded using RDS assumptions as an analytic framework. RESULTS Between August 2017 and October 2019, 405 participants were enrolled, 1670 coupons were distributed, with 133 returned, yielding a 0.079 return rate. The maximum recruitment depth was four waves among seeds that propagated. Self-reported median network size was 5 (IQR 2 to 10) and reduced to 3 (IQR 1 to 5) when asked how many peers were seen in the past 30 days. Qualitative interviews (n = 27) revealed that small social networks, peer trust and targeted referral of peers with certain characteristics challenged network, random recruitment, and reciprocity assumptions of RDS. HIV stigma and research hesitancy were barriers to participation and peer referral. Other situational factors, such as phone ownership and access to reliable transportation, reportedly created challenges for referred peers to participate in research. CONCLUSIONS Small social networks and varying relationships with peers among BLSGMY challenge assumptions that underlie traditional RDS. Modified RDS approaches, including those that incorporate social media, may support recruitment for community-based research but may challenge assumptions of reciprocal relationships. Research hesitancy and situational barriers are relevant and must be addressed across any sampling method and study design that includes BLSGMY in the United States.
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Affiliation(s)
- Andrea L. Wirtz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Jessica R. Iyer
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Durryle Brooks
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Kimberly Hailey‐Fair
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Division of Adolescent and Young Adult MedicineJohns Hopkins School of MedicineBaltimoreMDUSA
| | - Noya Galai
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Chris Beyrer
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - David Celentano
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Renata Arrington‐Sanders
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Division of Adolescent and Young Adult MedicineJohns Hopkins School of MedicineBaltimoreMDUSA
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20
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Dubin S, Cook TE, Radix A, Greene RE. Sexual Orientation Demographic Data in a Clinical Cohort of Transgender Patients. Appl Clin Inform 2021; 12:222-228. [PMID: 33730758 DOI: 10.1055/s-0041-1725184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND There are specific issues regarding sexual orientation (SO) collection and analysis among transgender and nonbinary patients. A limitation to meaningful SO and gender identity (GI) data collection is their consideration as a fixed trait or demographic data point. METHODS A de-identified patient database from a single electronic health record (EHR) that allows for searching any discrete data point in the EHR was used to query demographic data (sex assigned at birth and current GI) for transgender individuals from January 2011 to March 2020 at a large urban tertiary care academic health center. RESULTS A cohort of transgender individuals were identified by using EHR data from a two-step demographic question. Almost half of male identified (46.70%, n = 85) and female identified (47.51%, n = 86) individuals had "heterosexual/straight" input for SO. Overall, male and female identified (i.e., binary) GI aggregate categories had similar SO responses. Assigned male at birth (AMAB) nonbinary individuals (n = 6) had "homosexual/gay" SO data input. Assigned female at birth (AFAB) nonbinary individuals (n = 56) had almost half "something else" SO data input (41.67%, n = 15). Individuals with "choose not to disclose" for GI (n = 249) almost all had "choose not to disclose" SO data (96.27%, n = 232). CONCLUSION Current SO categories do not fully capture transgender individuals' identities and experiences, and limit the clinical and epidemiological utility of collecting this data in the current form. Anatomical assumptions based on SO should be seen as a potential shortcoming in over-reliance on SO as an indicator of screening needs and risk factors.
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Affiliation(s)
- Samuel Dubin
- NYU Langone Health, New York University School of Medicine, New York, New York, United States
| | - Tiffany E Cook
- NYU Langone Health, New York University School of Medicine, New York, New York, United States
| | - Asa Radix
- Callen Lorde Community Health Center, NYU Grossman School of Medicine, New York City, New York, United States
| | - Richard E Greene
- NYU Langone Health, New York University School of Medicine, New York, New York, United States
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21
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Sexual orientation in transgender individuals: results from the longitudinal ENIGI study. Int J Impot Res 2021; 33:694-702. [PMID: 33483604 DOI: 10.1038/s41443-020-00402-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/05/2020] [Accepted: 12/16/2020] [Indexed: 11/09/2022]
Abstract
Transgender people and their next-of-kin may request information on sexual orientation and preferred partners during hormonal affirming process. Although previous research on sexual orientation in transgender people is extensive, this literature may already be outdated and/or the methodology of studies assessing sexual orientation may fall short. This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Gender role and preferred partner in sexual fantasies, sexual orientation and gender of current sexual partner were assessed at baseline (initiation of HT) and every follow-up visit. Data from 469 transgender women (TW) and 433 transgender men (TM) were analyzed cross-sectionally and prospectively. At baseline, more than half reported having no partner (35% of TW, 47% of TM). After 12 months, more than half reported having a partner (59% of TW, 56% of TM), with no changes between one and three years of HT. The majority of TM preferred a female partner, TW preferred male and female partners. The sexual identity of their partner matched their sexual orientation in >80%. Sexual orientation did not change over time. We did not observe associations with serum levels of sex steroids or gender-affirming surgery (chest or genital surgery). Sexual orientation did not change during hormonal transition and was not associated with sex steroids or surgery. Also, preferences matched the partner's sexual identity. We do not assume that changing serum levels of sex steroids is directly associated with changes in partner choice. The number of people with a current partner increased, possibly due to the indirect effects of gender-affirming care.
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22
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Suen LW, Lunn MR, Katuzny K, Finn S, Duncan L, Sevelius J, Flentje A, Capriotti MR, Lubensky ME, Hunt C, Weber S, Bibbins-Domingo K, Obedin-Maliver J. What Sexual and Gender Minority People Want Researchers to Know About Sexual Orientation and Gender Identity Questions: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2301-2318. [PMID: 32875381 PMCID: PMC7497435 DOI: 10.1007/s10508-020-01810-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 05/19/2023]
Abstract
Sexual and gender minority (SGM) people-including members of the lesbian, gay, bisexual, transgender, and queer communities-are understudied and underrepresented in research. Current sexual orientation and gender identity (SOGI) questions do not sufficiently engage SGM people, and there is a critical gap in understanding how SOGI questions reduce inclusion and accurate empirical representation. We conducted a qualitative study to answer the question, "For SGM people, what are the major limitations with current SOGI questions?" Focus groups probed reactions to SOGI questions adapted from prior national surveys and clinical best practice guidelines. Questions were refined and presented in semi-structured cognitive interviews. Template analysis using a priori themes guided analysis. There were 74 participants: 55 in nine focus groups and 19 in cognitive interviews. Participants were diverse: 51.3% identified as gender minorities, 87.8% as sexual minorities, 8.1% as Hispanic/Latinx, 13.5% as Black or African-American, and 43.2% as Non-white. Two major themes emerged: (1) SOGI questions did not allow for identity fluidity and complexity, reducing inclusion and representation, and (2) SOGI question stems and answer choices were often not clear as to which SOGI dimension was being assessed. To our knowledge, this represents the largest body of qualitative data studying SGM perspectives when responding to SOGI questions. We present recommendations for future development and use of SOGI measures. Attention to these topics may improve meaningful participation of SGM people in research and implementation of such research within and for SGM communities.
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Affiliation(s)
- Leslie W Suen
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Katie Katuzny
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Alliance Health Project, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Sacha Finn
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Laura Duncan
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Jae Sevelius
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Division of Prevention Science, Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- School of Nursing-Community Health Systems, University of California, San Francisco School of Nursing, San Francisco, CA, USA
| | | | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- School of Nursing-Community Health Systems, University of California, San Francisco School of Nursing, San Francisco, CA, USA
| | - Carolyn Hunt
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Shannon Weber
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA.
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
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Barsigian LL, Hammack PL, Morrow QJ, Wilson BDM, Russell ST. Narratives of Gender, Sexuality, and Community in Three Generations of Genderqueer Sexual Minorities. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2020; 7:276-292. [PMID: 32984432 PMCID: PMC7511091 DOI: 10.1037/sgd0000384] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Genderqueer identities-those that challenge a strict binary between woman and man-are increasingly visible within mainstream culture and psychological research. However, little is known about generational differences in the lived experience of genderqueer people. Inductive thematic analysis of interviews with 30 genderqueer sexual minorities of 3 distinct generations living the United States revealed 3 major themes: (a) unintelligibility: genderqueer people face challenges in identifying, naming, and expressing their gender due to the constraints of everyday language and material culture; (b) managing stigma through challenging oppression: genderqueer people manage stigma by naming and challenging the gender binary, often in relation to other forms of oppression; and (c) connection beyond mainstream LGBTQ communities: genderqueer people often find connection outside of mainstream LGBTQ spaces, such as through ethnicity-based or sexual subcommunities (e.g., kink/BDSM, polyamorous). Within these themes, key generational patterns included (a) greater challenges among the middle and older generations in naming and expressing a genderqueer identity, especially in relation to their sexual identity; (b) intensified critique of mainstream LGBTQ politics among the younger generation; and (c) greater challenges in finding and maintaining community among the middle and older generations. Across generations, participants emphasized the need to create more inclusive environments by changing language and social structures to deemphasize the gender binary.
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Goldberg SK, Rothblum ED, Russell ST, Meyer IH. Exploring the Q in LGBTQ: Demographic characteristic and sexuality of Queer people in a U.S. representative sample of sexual minorities. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2020; 7:101-112. [PMID: 34017899 PMCID: PMC8132578 DOI: 10.1037/sgd0000359] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although queer identity has been used among sexual minorities for decades, little is known about the population of queer-identified people in the U.S. We compared people who identify as queer (unweighted n = 88; weighted % = 5.8%) with those who identify as lesbian/gay (n = 833; 46.9%), bisexual (n = 493; 40.6%) or other sexual minority identities (n = 93; 6.7%), in order to describe queer-identified people as a distinct sexual minority group. The study is the first to estimate demographic characteristics and sexuality of queer-identified people using a U.S. nationally representative sample. We found that queer people are overwhelmingly cisgender women and genderqueer/ nonbinary (GQNB), younger, and more highly educated than other groups. After stratifying by gender identity (cisgender women; cisgender men; GQNB), survey-weighted descriptive differences in attraction, sexual partnering, and relationship patterns show that queer individuals are more likely to report attraction to, and sexual relationships with, transgender and GQNB people, though differences by respondent gender identity were noted: The majority of queer women are attracted to and partnered with both women and men, and were more likely than other groups to be attracted to and partnered with cisgender and transgender people. In contrast, queer men are split in their attractions-about half were attracted exclusively to men, and half to men and women-but the majority partnered with men only. Of all groups, queer men are the most likely to partner with transgender men, but none had partnered with transgender women. GQNB people are more likely than cisgender people to identify as queer (25.9%) and are attracted to both cisgender and transgender women and men, yet predominantly partnered with cisgender people. The results provide support for queer as a distinct sexual identity.
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Affiliation(s)
- Shoshana K Goldberg
- Dept. of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina
| | | | - Stephen T Russell
- Chair, Dept. of Human Development and Family Science, University of Texas at Austin
| | - Ilan H Meyer
- The Williams Institute, University of California Los Angeles School of Law
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Lindley LM, Nagoshi JL, Nagoshi CT, Hess R, Boscia A. An eco-developmental framework on the intersectionality of gender and sexual identities in transgender individuals. PSYCHOLOGY & SEXUALITY 2020. [DOI: 10.1080/19419899.2020.1713873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Julie L. Nagoshi
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Craig T. Nagoshi
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
| | - Robert Hess
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
| | - Aedan Boscia
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
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26
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Bosse JD. Sexual and Gender Identity Development in Young Adults and Implications for Healthcare. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00215-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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The Medical Management of Gender Dysphoric, Gender Fluid, Gender Nonconforming, Gender Queer, Nonbinary, and Transgender Patients: One Clinic’s Approach. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Jadwin-Cakmak L, Reisner SL, Hughto JMW, Salomon L, Martinez M, Popoff E, Rivera BA, Harper GW. HIV prevention and HIV care among transgender and gender diverse youth: design and implementation of a multisite mixed-methods study protocol in the U.S. BMC Public Health 2019; 19:1531. [PMID: 31730450 PMCID: PMC6858737 DOI: 10.1186/s12889-019-7605-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the U.S., transgender and gender diverse (TGD) populations face structural, interpersonal, and individual barriers to healthcare. Less is known, however, about the HIV prevention and treatment experiences of TGD youth in the U.S. The current study was developed to fill this research gap. METHODS This article describes the research protocol for a multi-site, U.S.-based mixed-methods study that sought to identify the multi-level facilitators and barriers that influence participation of TGD youth in various stages of the HIV prevention (e.g., pre-exposure prophylaxis uptake) and care continua. A sample of diverse TGD youth ages 16-24 was recruited from 14 U.S. sites. TGD youth participants completed a one-time, in-person visit that included an informed consent process, computer-based quantitative survey, and in-depth qualitative interview assessing experiences accessing HIV prevention and/or care services. Providers serving TGD youth were recruited from the same 14 sites and completed a one-time visit via phone that included informed consent, demographic questionnaire, and in-depth qualitative interview assessing their experiences providing HIV prevention or treatment services to TGD youth. RESULTS Overall, 186 TGD youth ages 16-24 and 59 providers serving TGD youth were recruited and enrolled from across the 14 U.S. sites. TGD youth participants had a mean age of 20.69; 77.3% youth of color; 59.7% trans-feminine; 15.5% trans-masculine; 24.9% non-binary; 53.6% family income under poverty level. Providers included medical and mental health providers as well as case manager/care coordinators, HIV test counselors, and health educators/outreach workers. Providers were 81.3% cisgender and 30.5% people of color. Successes with community-engagement strategies and gender-affirming research methods are reported. CONCLUSIONS This study addresses critical gaps in current knowledge about the HIV prevention and care experiences of TGD youth. Findings have implications for the development of HIV interventions across levels to support the health and well-being of TGD youth. Future research is warranted to replicate and expand on lessons learned regarding recruitment and engagement of communities of TGD youth, including longitudinal designs to assess engagement across their developmental stages. Lessons learned working with TGD youth through developing and implementing the study protocol are shared. TRIAL REGISTRATION Registered on ClinicalTrials.gov on 05/20/2015 (NCT02449629).
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Affiliation(s)
- Laura Jadwin-Cakmak
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Sari L Reisner
- Pediatrics, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.,The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Jaclyn M W Hughto
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.,Departments of Epidemiology and Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.,Center for Health Equity Research, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Liz Salomon
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Miguel Martinez
- Children's Hospital Los Angeles, Center for Transyouth Health and Development, 4650 Sunset Blvd, MS#2, Los Angeles, CA, 90027, USA
| | - Elliot Popoff
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Bré Anne Rivera
- Trans Sistas of Color Project, 77 Victor Street, Highland Park, MI, 48203, USA
| | - Gary W Harper
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
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29
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Greaves LM, Sibley CG, Fraser G, Barlow FK. Comparing Pansexual- and Bisexual-Identified Participants on Demographics, Psychological Well-Being, and Political Ideology in a New Zealand National Sample. JOURNAL OF SEX RESEARCH 2019; 56:1083-1090. [PMID: 30724611 DOI: 10.1080/00224499.2019.1568376] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Pansexuality, characterized by attraction to people regardless of their gender, is an emerging sexual identity. Research has started to explore the differences between those who identify as pansexual and those who identify as bisexual, typically defined as being attracted to both men and women. This article extends past research by testing for differences between those who identify as pansexual (n = 52) and bisexual (n = 497) in a nationally representative sample. We used the New Zealand Attitudes and Values Study (NZAVS) to test for differences in demographic variables, psychological well-being, and political ideology. We found that pansexual participants were younger, more likely to be gender diverse (transgender or nonbinary), and more likely to be from the indigenous Māori ethnic group than bisexual participants. Pansexual participants also reported higher psychological distress and were more politically liberal than bisexual participants. These results suggest that people who identify as pansexual are, on average, quantifiably different from those who identify as bisexual; this study adds to a new but growing body of research on emerging plurisexual identities.
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Affiliation(s)
| | | | - Gloria Fraser
- School of Psychology, Victoria University of Wellington
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30
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Patterson JG, Jabson Tree JM, Kamen C. Cultural competency and microaggressions in the provision of care to LGBT patients in rural and appalachian Tennessee. PATIENT EDUCATION AND COUNSELING 2019; 102:2081-2090. [PMID: 31208771 DOI: 10.1016/j.pec.2019.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE Lack of provider training in lesbian, gay, bisexual, and transgender (LGBT) cultural competence may diminish healthcare access. Culturally competent providers may enact microaggressions when providing LGBT patient care, especially in sociopolitically conservative areas. Our study examined LGBT cultural competence and microaggressions among healthcare providers in rural Tennessee. METHODS Providers (n = 85) completed a self-report survey on LGBT cultural competence. Post-survey, we invited respondents to provide an interview to contextualize quantitative findings and identify barriers to LGBT patient care (n = 6). RESULTS Most quantitative respondents disagreed that they preferred not to care for LGBT patients (85.9%) or that they would refuse care to LGBT patients (92.9%). Only half felt competent to provide LGBT patient care (54.1%). Fewer oncology than primary care providers felt competent treating LGBT patients, and more physicians than nurses reported their training did not adequately address LGBT issues. Qualitatively, interviewees reported serving patients "equally", yet described discomfort with LGBT patients and LGBT microaggressions in clinical practice. PRINCIPAL CONCLUSIONS While many providers felt competent to provide LGBT patient care, they described behaviors and attitudes that may contribute to LGBT healthcare inequities. PRACTICE IMPLICATIONS Provider training must address how microaggressions negatively influence patient-provider interactions and LGBT patient care.
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Affiliation(s)
- Joanne G Patterson
- Department of Public Health, University of Tennessee, Knoxville, TN, United States.
| | | | - Charles Kamen
- Cancer Control Unit, Department of Surgery, University of Rochester, Rochester, NY, United States.
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31
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Keuroghlian AS, Ard KL, Makadon HJ. Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments. Sex Health 2019; 14:119-122. [PMID: 28160786 DOI: 10.1071/sh16145] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/09/2017] [Indexed: 11/23/2022]
Abstract
Lesbian, gay, bisexual and transgender (LGBT) people face pervasive health disparities and barriers to high-quality care. Adequate LGBT sexual health education for emerging health professionals is currently lacking. Clinical training programs and healthcare organisations are well poised to start addressing these disparities and affirming LGBT patients through curricula designed to cultivate core competencies in LBGT health as well as health care environments that welcome, include and protect LGBT patients, students and staff. Health education programs can emphasise mastery of basic LGBT concepts and terminology, as well as openness towards and acceptance of LGBT people. Core concepts, language and positive attitudes can be instilled alongside clinical skill in delivering inclusive sexual health care, through novel educational strategies and paradigms for clinical implementation. Caring for the health needs of LGBT patients also involves the creation of health care settings that affirm LGBT communities in a manner that is responsive to culturally specific needs, sensitivities and challenges that vary across the globe.
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Affiliation(s)
- Alex S Keuroghlian
- The National LGBT Health Education Center at The Fenway Institute, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Kevin L Ard
- The National LGBT Health Education Center at The Fenway Institute, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Harvey J Makadon
- The National LGBT Health Education Center at The Fenway Institute, 1340 Boylston Street, Boston, MA, 02215, USA
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32
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Scheffey KL, Ogden SN, Dichter ME. "The Idea of Categorizing Makes Me Feel Uncomfortable": University Student Perspectives on Sexual Orientation and Gender Identity Labeling in the Healthcare Setting. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1555-1562. [PMID: 30850917 DOI: 10.1007/s10508-019-1401-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 06/09/2023]
Abstract
As healthcare settings are increasingly adding sexual orientation and gender identity (SO/GI) to routinely collected patient demographic information, it is important to understand how patients conceptualize and label these identities. This study explored university students' perspectives on and experiences with choosing SO/GI labels in the healthcare setting. We employed a mixed-method approach, collecting survey data on self-identified SO/GI labels across various contexts and conducting focus groups centered around experiences of SO/GI data collection and labeling in healthcare. Thirty-four graduate and undergraduate university students completed the survey and participated in six one-time focus groups. While many participants indicated that their self-identified SO/GI labels were consistent across contexts/relationships, 47% indicated that they used different labels to describe their SO or GI depending on the context. The focus group discussions revealed ways in which participants struggled to label their SO/GI on forms: They reported that (1) their authentic SO/GI labels were not among the commonly listed labels or (2) they felt that labeling their SO/GI identities was problematic. Participants reported that choosing a label that did not fit their lived experience was not only inaccurate, but could also feel painful and alienating. These findings hold implications for the collection and interpretation of patient SO/GI information, both for epidemiological purposes and for patient-centered care.
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Affiliation(s)
- Kathryn L Scheffey
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, PPMC Andrew Mutch Building, Floor 7, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Shannon N Ogden
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, PPMC Andrew Mutch Building, Floor 7, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Melissa E Dichter
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, PPMC Andrew Mutch Building, Floor 7, 51 N. 39th Street, Philadelphia, PA, 19104, USA.
- U.S. Department of Veterans Affairs, Center for Health Equity Research and Promotion, Philadelphia, PA, USA.
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33
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Hammack PL, Frost DM, Hughes SD. Queer Intimacies: A New Paradigm for the Study of Relationship Diversity. JOURNAL OF SEX RESEARCH 2019; 56:556-592. [PMID: 30362833 DOI: 10.1080/00224499.2018.1531281] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Recognition of sexual and gender diversity in the 21st century challenges normative assumptions of intimacy that privilege heterosexual monogamy and the biological family unit, presume binary cisgender identities, essentialize binary sexual identities, and view sexual or romantic desire as necessary. We propose a queer paradigm to study relationship diversity grounded in seven axioms: intimacy may occur (1) within relationships featuring any combination of cisgender, transgender, or nonbinary identities; (2) with people of multiple gender identities across the life course; (3) in multiple relationships simultaneously with consent; (4) within relationships characterized by consensual asymmetry, power exchange, or role-play; (5) in the absence or limited experience of sexual or romantic desire; (6) in the context of a chosen rather than biological family; and (7) in other possible forms yet unknown. We review research on queer relational forms, including same-sex relationships; relationships in which one or more partners identify as transgender, gender nonbinary, bisexual, pansexual, sexually fluid, "mostly" straight, asexual, or aromantic; polyamory and other forms of consensual nonmonogamy; kink/fetish relationships; and chosen families. We argue that a queer paradigm shifts the dominant scientific conception of relationships away from the confines of normativity toward an embrace of diversity, fluidity, and possibility.
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Affiliation(s)
| | - David M Frost
- b Department of Social Science, University College London
| | - Sam D Hughes
- a Department of Psychology , University of California, Santa Cruz
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34
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Berona J, Stepp SD, Hipwell AE, Keenan KE. Trajectories of Sexual Orientation from Adolescence to Young Adulthood: Results from a Community-Based Urban Sample of Girls. J Adolesc Health 2018; 63:57-61. [PMID: 30060858 PMCID: PMC6534354 DOI: 10.1016/j.jadohealth.2018.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 12/22/2017] [Accepted: 01/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To examine the longitudinal cohesion and stability of sexual minority status indicators. METHODS The sample comprised 2,450 girls recruited from the city of Pittsburgh at ages 5-8 years. Sexual attraction, sexual partnering, romantic partnering, and sexual orientation identity were assessed between 14 and 22 years. RESULTS Repeated measures latent class analysis identified three sexual minority trajectories: primarily other-sex oriented (n = 716), primarily same-sex oriented (n = 90), and bisexually oriented (n = 235). Sexual minority status indicators displayed fluidity over time but cohered within latent classes. CONCLUSIONS Within this large sample of girls, several distinct sexuality trajectories emerged. Trajectories are relatively stable from adolescence to young adulthood.
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Affiliation(s)
- Johnny Berona
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medical Center, Chicago, Illinois.
| | - Stephanie D. Stepp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kate E. Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medical Center, Chicago, Illinois
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35
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Tree-McGrath CAF, Puckett JA, Reisner SL, Pantalone DW. Sexuality and gender affirmation in transgender men who have sex with cisgender men. Int J Transgend 2018. [DOI: 10.1080/15532739.2018.1463584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
| | - Jae A. Puckett
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Sari L. Reisner
- Boston Children's Hospital/Harvard Medical School; Harvard T.H. Chan School of Public Health; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts Boston; The Fenway Institute, Fenway Health, Boston, MA, USA
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36
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Abstract
Many models of queer sexuality continue to depict a linear narrative of sexual development, beginning in repression/concealment and eventuating in coming out. The present study sought to challenge this by engaging in a hermeneutically informed thematic analysis of interviews with eight queer people living in Western Australia. Four themes were identified: "searching for identity," "society, stigma, and self," "sexual self-discovery," and "coming in." Interviewees discussed internalized homophobia and its impact on their life; experiences and implications of finding a community and achieving a sense of belonging; the concept of sexual self-discovery being a lifelong process; and sexuality as fluid, dynamic, and situational rather than static. The article concludes by suggesting that the idea of "coming in"-arriving at a place of acceptance of one's sexuality, regardless of its fluidity or how it is viewed by society-offers considerable analytic leverage for understanding the journeys of sexual self-discovery of queer-identified people.
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Affiliation(s)
- Shoshana Rosenberg
- a Department of Sexology, School of Public Health , Curtin University , Perth , Western Australia , Australia
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37
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Katz-Wise SL, Williams DN, Keo-Meier CL, Budge SL, Pardo S, Sharp C. Longitudinal Associations of Sexual Fluidity and Health in Transgender Men and Cisgender Women and Men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2017; 4:460-471. [PMID: 29276717 DOI: 10.1037/sgd0000246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research has just begun to study associations between sexual fluidity and health among cisgender individuals; only one cross-sectional study examined these links among transgender individuals. The goals of the current study were to prospectively examine fluidity in sexual attractions and fluidity in sexual orientation identity, and associations with health-related outcomes. Participants were a community-based sample of 45 transgender men, ages 16-51 years, who had recently begun testosterone, and 95 cisgender individuals (53 women, 42 men), ages 18-55 years, who completed surveys either in-person or via mail. Analyses tested for group differences in sexual fluidity, sociodemographic predictors of sexual fluidity among transgender men, and associations between sexual fluidity and health across the three groups. As hypothesized, transgender men reported more fluidity in sexual attractions and sexual orientation identity than did cisgender individuals. Contrary to our hypotheses, testosterone use was not significantly associated with sexual fluidity, although less education was. As hypothesized, fluidity in sexual orientation identity was associated with more adverse mental health outcomes among transgender men (depression and anxiety) and cisgender women (anxiety and stress), as well as decreased vitality among transgender men and cisgender women, and decreased social functioning among cisgender women. In contrast, fluidity in sexual attractions was only associated with less depression among cisgender women, but was not significantly associated with any other health-related outcomes. This study increases knowledge about sexual fluidity among transgender men and implications for health and can inform clinical work with this population.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - David N Williams
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Colton L Keo-Meier
- Department of Psychology, University of Houston, Houston, TX, School of Medicine, University of Texas Medical Branch, Galveston, TX, and Menninger Department of Psychiatry and Behavioral Services, Baylor College of Medicine, Houston, TX
| | - Stephanie L Budge
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI
| | - Seth Pardo
- San Francisco Department of Public Health, San Francisco, CA
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX
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38
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Morandini JS, Blaszczynski A, Dar-Nimrod I. Who Adopts Queer and Pansexual Sexual Identities? JOURNAL OF SEX RESEARCH 2017; 54:911-922. [PMID: 27911091 DOI: 10.1080/00224499.2016.1249332] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Some nonheterosexual individuals are eschewing lesbian/gay and bisexual identities for queer and pansexual identities. The present study aimed to examine the sexual and demographic characteristics of nonheterosexual individuals who adopt these labels. A convenience sample of 2,220 nonheterosexual (1,459 lesbian/gay, 413 bisexual, 168 queer, 146 pansexual, and 34 other "write-in") individuals were recruited for a cross-sectional online survey. In support of our hypotheses, those adopting pansexual identities were younger than those adopting lesbian, gay, and bisexual identities, and those adopting queer and pansexual identities were more likely to be noncisgender than cisgender, and more likely to be cisgender women than men. The majority of pansexual individuals demonstrated sexual orientation indices within the bisexual range, and showed equivalent patterns of sexual attraction, romantic attraction, sexual behavior, and partner gender as bisexual-identified men and women. In contrast, three-quarters of queer men, and more than half of queer women, reported sexual attraction in the homosexual range. This study found that rather than a general movement toward nontraditional sexual identities, queer and pansexual identities appear most appealing to nonheterosexual women and noncisgender individuals. These findings contribute important information regarding who adopts queer and pansexual identities in contemporary sexual minority populations.
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39
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Katz-Wise SL, Mereish EH, Woulfe J. Associations of Bisexual-Specific Minority Stress and Health Among Cisgender and Transgender Adults with Bisexual Orientation. JOURNAL OF SEX RESEARCH 2017; 54:899-910. [PMID: 27834488 PMCID: PMC6296471 DOI: 10.1080/00224499.2016.1236181] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), age 18 to 66 years, with bisexual orientation based on identity and/or attractions to multiple genders. Participants completed an online survey. Hierarchical linear regression analyses were conducted with sexual minority stress and bisexual-specific minority stress as the predictors and physical health, measured by the 36-Item Short Form Survey (SF-36), as the outcome. Models controlled for demographic variables. Moderation analyses were conducted to test for gender differences. Greater bisexual-specific minority stress significantly predicted poorer overall physical health (β = -0.16), greater pain (β = -0.16), and poorer general health (β = -0.25) above and beyond the effects of sexual minority stress. Gender moderated the association between bisexual-specific minority stress and health, such that bisexual-specific minority stress predicted overall physical health and role limitations for transgender individuals but not for cisgender women. Addressing bisexual-specific minority stress is necessary to improve the health and well-being of bisexual individuals.
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Affiliation(s)
- Sabra L Katz-Wise
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- b Department of Pediatrics , Harvard Medical School
- c Department of Social and Behavioral Sciences , Harvard T. H. Chan School of Public Health
| | | | - Julie Woulfe
- e Department of Counseling, Developmental, and Educational Psychology , Boston College
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40
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Katz-Wise SL, Reisner SL, White Hughto JM, Budge SL. Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1425-1439. [PMID: 27542082 PMCID: PMC5316507 DOI: 10.1007/s10508-016-0812-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 02/05/2016] [Accepted: 07/11/2016] [Indexed: 05/12/2023]
Abstract
This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated adjusted risk ratios and 95 % confidence intervals to examine associations between changes in attractions and mental health outcomes (lifetime self-harm, suicide attempts, depression diagnosis; past-week clinically significant depressive distress assessed via CES-D 10) among the entire sample (N = 452; 285 female-to-male spectrum, 167 male-to-female spectrum) and after gender transition among those who had socially transitioned (n = 205; 156 female-to-male spectrum, 49 male-to-female spectrum). Models were adjusted for known population social determinants (age, race/ethnicity, gender identity, socioeconomic status, sexual orientation identity), transgender-specific determinants (age of transgender realization, social transition, medical transition, visual gender nonconformity, non-binary gender identification), and survey mode (online vs. in-person sampling). Lifetime changes in attractions were significantly associated with increased probability of all mental health outcomes; individuals reporting any change in attractions were more likely than individuals not reporting changes to indicate lifetime self-harm, suicide attempts, depression diagnosis, and current depressive distress (all ps < .05). Changes in attractions post-social transition were not significantly associated with mental health outcomes. Many, but not all, population and transgender-specific social determinants were significantly associated with mental health in the full sample and among those who had socially transitioned. Clinical implications of findings about changes in attractions and mental health are discussed for transgender individuals.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sari L Reisner
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA.
| | - Jaclyn M White Hughto
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Stephanie L Budge
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
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41
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Dharma C, Bauer GR. Understanding sexual orientation and health in Canada: Who are we capturing and who are we missing using the Statistics Canada sexual orientation question? Canadian Journal of Public Health 2017; 108:e21-e26. [PMID: 28425895 DOI: 10.17269/cjph.108.5848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Public health research on inequalities in Canada depends heavily on population data sets such as the Canadian Community Health Survey. While sexual orientation has three dimensions - identity, behaviour and attraction - Statistics Canada and public health agencies assess sexual orientation with a single questionnaire item on identity, defined behaviourally. This study aims to evaluate this item, to allow for clearer interpretation of sexual orientation frequencies and inequalities. METHODS Through an online convenience sampling of Canadians ≥14 years of age, participants (n = 311) completed the Statistics Canada question and a second set of sexual orientation questions. RESULTS The single-item question had an 85.8% sensitivity in capturing sexual minorities, broadly defined by their sexual identity, lifetime behaviour and attraction. Kappa statistic for agreement between the single item and sexual identity was 0.89; with past year, lifetime behaviour and attraction were 0.39, 0.48 and 0.57 respectively. The item captured 99.3% of those with a sexual minority identity, 84.2% of those with any lifetime same-sex partners, 98.4% with a past-year same-sex partner, and 97.8% who indicated at least equal attraction to same-sex persons. CONCLUSION Findings from Statistics Canada surveys can be best interpreted as applying to those who identify as sexual minorities. Analyses using this measure will underidentify those with same-sex partners or attractions who do not identify as a sexual minority, and should be interpreted accordingly. To understand patterns of sexual minority health in Canada, there is a need to incorporate other dimensions of sexual orientation.
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Affiliation(s)
- Christoffer Dharma
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON.
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Patterson JG, Jabson JM, Bowen DJ. Measuring Sexual and Gender Minority Populations in Health Surveillance. LGBT Health 2017; 4:82-105. [PMID: 28287877 DOI: 10.1089/lgbt.2016.0026] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Sexual and gender minorities (SGMs) are underrepresented and information about SGMs is difficult to locate in national health surveillance data, and this limits identification and resolution of SGM health disparities. It is also not known how measures of sexual orientation and transgender-inclusive gender identity in health surveillance compare with best practice recommendations. This article reviews and summarizes the publicly available, English language, large-scale, rigorously sampled, national, international, and regional data sources that include sexual orientation or transgender-inclusive gender identity and compares measures with best practice guidelines. METHODS A systematic review was undertaken of national, international, state, and regional health surveillance data sources. Data sources that measured sexual orientation or transgender-inclusive gender identity and met seven inclusion criteria were included. RESULTS Forty-three publicly accessible national, international, and regional data sources included measures of sexual orientation and transgender-inclusive gender identity and health. For each data source, sampling design, sample characteristics, study years, survey questions, contact persons, and data access links are provided. Few data sources met best practice recommendations for SGM measurement: 14% measured all three dimensions of sexual orientation (identity, behavior, attraction) as recommended by the Sexual Minority Assessment Research Team. No data sources measured transgender-inclusive gender identity according to the Gender Identity in U.S. Surveillance-recommended two-step method of measuring sex assigned at birth and current gender identity. CONCLUSIONS This article provides a much needed detailed summary of extant health surveillance data sources that can be used to inform research about health risks and disparities among SGM populations. Future recommendations are for more rigorous measurement and oversampling to advance what is known about SGM health disparities and guide development of interventions to reduce disparities.
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Affiliation(s)
- Joanne G Patterson
- 1 Department of Public Health, University of Tennessee , Knoxville, Tennessee
| | - Jennifer M Jabson
- 1 Department of Public Health, University of Tennessee , Knoxville, Tennessee
| | - Deborah J Bowen
- 2 Department of Health Services, University of Washington , Seattle, Washington
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Mereish EH, Katz-Wise SL, Woulfe J. We're Here and We're Queer: Sexual Orientation and Sexual Fluidity Differences Between Bisexual and Queer Women. JOURNAL OF BISEXUALITY 2016; 17:125-139. [PMID: 29249909 PMCID: PMC5730064 DOI: 10.1080/15299716.2016.1217448] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Theorists and researchers have noted an overlap between bisexually-identified and queer-identified individuals. Whereas early definitions of bisexuality may have been predominantly binary (i.e., attracted to women and men), in recent years there has been a move toward a more "queer" understanding of bisexuality (e.g., attraction to more than one gender beyond female and male). The purpose of this study was to examine similarities and differences between bisexually-identified and queer-identified adult women, ages 18-66 years, on sociodemographic characteristic, two dimensions of sexual orientation (sexual behaviors and attractions), fluidity in attractions and sexual orientation identity, and identity centrality and affirmation in an online sample (N = 489), which was mostly from the United States (73.5%). Our results indicated that bisexual and queer women were similar in terms of sociodemographic characteristics, with the exception of education; queer women were more educated than bisexual women. Queer women were also more likely than bisexual women to report variability in their sexual behaviors and attractions and more fluidity in their sexual orientation identity. Additionally, queer women reported higher levels of identity centrality and affirmation than bisexual women. Considerations for sexual minority women's health research are discussed.
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Affiliation(s)
- Ethan H Mereish
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Julie Woulfe
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Boston, MA
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Martin-Storey A. Gender, Sexuality, and Gender Nonconformity: Understanding Variation in Functioning. CHILD DEVELOPMENT PERSPECTIVES 2016. [DOI: 10.1111/cdep.12194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blair KL, Hoskin RA. Contemporary understandings of femme identities and related experiences of discrimination. PSYCHOLOGY & SEXUALITY 2015. [DOI: 10.1080/19419899.2015.1053824] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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