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von der Warth R, Körner M, Farin-Glattacker E. Health literacy of trans and gender diverse individuals -a cross sectional survey in Germany. BMC Public Health 2024; 24:324. [PMID: 38287341 PMCID: PMC10826089 DOI: 10.1186/s12889-024-17823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION To date, there has been little research on the general health literacy of trans and gender diverse individuals, even though previous research undermines the importance of good health literacy in this sample. The aim of the article is therefore to describe the general health literacy of trans and gender diverse individuals based on a German survey. METHODS In September 2022, a survey study was conducted in which health literacy was recorded using HLS-EU-16. Data will be presented descriptively; gender differences will be explored using a Χ2- test and a univariate analysis of variance (ANOVA). RESULTS Out of N = 223 participants, n = 129 individuals (57.8%) identified as non-binary; n = 49 (22.0%) identified themselves as male, while n = 45 (20.2%) identified as female. Mean age was 28.03 years. Overall, 26.4% of all the participants showed an inadequate health literacy, as proposed by the HLS-EU-16. In trend, health-related task related to media use were more often perceived as easy compared to the German general population. CONCLUSION Individuals, who identify as trans and gender diverse may have a general health literacy below average compared to the German general population. However, tasks related to media use were perceived as easy, which might be a good starting point for health literacy related interventions. TRIAL REGISTRATION DRKS00026249, Date of registration: 15/03/2022.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
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2
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Morse B, Soares A, Kwan BM, Allen M, Lee RS, Desanto K, Holliman BD, Ytell K, Schilling LM. A Transgender Health Information Resource: Participatory Design Study. JMIR Hum Factors 2023; 10:e42382. [PMID: 37318836 DOI: 10.2196/42382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/07/2023] [Accepted: 04/15/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Despite the abundance of health information on the internet for people who identify as transgender and gender diverse (TGD), much of the content used is found on social media channels, requiring individuals to vet the information for relevance and quality. OBJECTIVE We developed a prototype transgender health information resource (TGHIR) delivered via a mobile app to provide credible health and wellness information for people who are TGD. METHODS We partnered with the TGD community and used a participatory design approach that included focus groups and co-design sessions to identify users' needs and priorities. We used the Agile software development methodology to build the prototype. A medical librarian and physicians with expertise in transgender health curated a set of 97 information resources that constituted the foundational content of the prototype. To evaluate the prototype TGHIR app, we assessed the app with test users, using a single item from the System Usability Scale to assess feature usability, cognitive walk-throughs, and the user version of the Mobile Application Rating Scale to evaluate the app's objective and subjective quality. RESULTS A total of 13 people who identified as TGD or TGD allies rated their satisfaction with 9 of 10 (90%) app features as good to excellent, and 1 (10%) of the features-the ability to filter to narrow TGHIR resources-was rated as okay. The overall quality score on the user version of the Mobile Application Rating Scale was 4.25 out of 5 after 4 weeks of use, indicating a good-quality mobile app. The information subscore received the highest rating, at 4.75 out of 5. CONCLUSIONS Community partnership and participatory design were effective in the development of the TGHIR app, resulting in an information resource app with satisfactory features and overall high-quality ratings. Test users felt that the TGHIR app would be helpful for people who are TGD and their care partners.
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Affiliation(s)
- Brad Morse
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Andrey Soares
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Bethany M Kwan
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Rita S Lee
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kristen Desanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kate Ytell
- Elevance Health, Denver, CO, United States
| | - Lisa M Schilling
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Stoehr JR, Hamidian Jahromi A, Hunter EL, Schechter LS. Telemedicine for Gender-Affirming Medical and Surgical Care: A Systematic Review and Call-to-Action. Transgend Health 2022; 7:117-126. [PMID: 36644513 PMCID: PMC9829135 DOI: 10.1089/trgh.2020.0136] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Telemedicine has facilitated the delivery of affordable and accessible health care. However, little has been discussed about its use in gender-affirming care (GAC). Telemedicine has the potential to overcome many barriers encountered by transgender individuals such as limited geographic access to care and financial constraints, which have both been exacerbated by the COVID-19 pandemic. Telemedicine may also enhance opportunities for training in gender-affirming surgery. A systematic review of the literature on telehealth and GAC was performed. Identified uses of telehealth included: an electronic teleconsultation service, a virtual peer health consultation service, and an open online course on LGBT+ rights and health care for health care providers and laypeople. As the medical and health care communities adjust to the new reality of health care, efforts should be made to effectively incorporate telemedicine into GAC.
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Affiliation(s)
- Jenna Rose Stoehr
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alireza Hamidian Jahromi
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois, USA.,The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, The University of Illinois at Chicago, Illinois, USA
| | - Ezra Leigh Hunter
- The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, The University of Illinois at Chicago, Illinois, USA
| | - Loren S. Schechter
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois, USA.,The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, The University of Illinois at Chicago, Illinois, USA.,Address correspondence to: Loren S. Schechter, MD, The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, The University of Illinois at Chicago, 4646 N Marine Dr, Chicago, IL 60640, USA,
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4
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Harner V. Trans intracommunity support & knowledge sharing in the United States & Canada: A scoping literature review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1715-1728. [PMID: 33438797 DOI: 10.1111/hsc.13276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/24/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
Intracommunity support and knowledge sharing is used in transgender ("trans") communities as they navigate systems of oppression. Even for individuals with access to accepting families and service providers, connecting with other trans individuals can provide useful insight and resources. Conducted between December 2018 and April 2019, this scoping literature review examines the extent, range and nature of research activity regarding intracommunity knowledge and support sharing within trans communities. Drawing from Weeks' framework regarding sexual communities and the concepts of positive in-group identity and group-level coping, this review specifically addresses the guiding questions of what, how and why knowledge and support are shared within trans communities. Empirical studies conducted between 2004 and 2019 in the United States and Canada that were published in English and had a discernible trans sample or subsample were included. Thirty-one studies met the criteria. Key themes from this literature are (a) sharing information related to advocacy & education, identity/expression and personal stories/experience while (b) utilising an array of both online and/or in-person methods in order to (c) build community/support and navigate identity development and transition. Implications from the review, including impacts on both clients and students in social work and care programs, are discussed.
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5
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Pho AT, Bakken S, Lunn MR, Lubensky ME, Flentje A, Dastur Z, Obedin-Maliver J. Online health information seeking, health literacy, and human papillomavirus vaccination among transgender and gender-diverse people. J Am Med Inform Assoc 2021; 29:285-295. [PMID: 34383916 PMCID: PMC8757308 DOI: 10.1093/jamia/ocab150] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/17/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Objective The purpose of this study is to describe online health information seeking among a sample of transgender and gender diverse (TGD) people compared with cisgender sexual minority people to explore associations with human papillomavirus (HPV) vaccination, and whether general health literacy and eHealth literacy moderate this relationship. Materials and Methods We performed a cross-sectional online survey of TGD and cisgender sexual minority participants from The PRIDE Study, a longitudinal, U.S.-based, national health study of sexual and gender minority people. We employed multivariable logistic regression to model the association of online health information seeking and HPV vaccination. Results The online survey yielded 3258 responses. Compared with cisgender sexual minority participants, TGD had increased odds of reporting HPV vaccination (aOR, 1.5; 95% CI, 1.1-2.2) but decreased odds when they had looked for information about vaccines online (aOR, 0.7; 95% CI, 0.5-0.9). TGD participants had over twice the odds of reporting HPV vaccination if they visited a social networking site like Facebook (aOR, 2.4; 95% CI, 1.1-5.6). No moderating effects from general or eHealth literacy were observed. Discussion Decreased reporting of HPV vaccination among TGD people after searching for vaccine information online suggests vaccine hesitancy, which may potentially be related to the quality of online content. Increased reporting of vaccination after using social media may be related to peer validation. Conclusions Future studies should investigate potential deterrents to HPV vaccination in online health information to enhance its effectiveness and further explore which aspects of social media might increase vaccine uptake among TGD people.
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Affiliation(s)
- Anthony T Pho
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, School of Nursing, Columbia University, New York, New York, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA.,Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Division of Gynecology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Division of Gynecology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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6
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Pho AT, Mangal S, Bakken S. Human Papillomavirus Vaccination Among Transgender and Gender Diverse People in the United States: An Integrative Review. Transgend Health 2021; 7:303-313. [PMID: 36033213 PMCID: PMC9398477 DOI: 10.1089/trgh.2020.0174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective This integrative review explores the barriers to and facilitators for human papillomavirus (HPV) vaccination among adult transgender and gender diverse (TGD) people in the United States. Data Source A systematic search of electronic databases included PubMed/MEDLINE, CINAHL, and EMBASE from 1985 to 2020. Inclusion and Exclusion Criteria Inclusion criteria included studies from the United States that described HPV vaccination barriers or facilitators and included adult TGD participants, both quantitative and qualitative studies. Exclusion criteria were studies that reported only HPV vaccine prevalence, non-English/non-U.S. studies, and studies limited to pediatric populations. Data Extraction Two investigators used Covidence software to screen studies and manage data extraction. Quality of the quantitative studies was appraised using a checklist proposed by the Joanna Briggs Institute (JBI); qualitative studies were appraised using quality criteria informed by the literature. Data Synthesis The Social Ecological Model guided the review to organize barriers to and facilitators for HPV vaccination at the patient-, provider-, and system-levels. Results Database searches and hand-searching yielded 843 citations. After screening, eight articles were retained in the review. Seven were cross-sectional studies and one was a qualitative focus-group. All retained quantitative studies met six of the eight JBI quality checklist items. Conclusion The low proportion of TGD participants in the retained studies highlights a gap in knowledge about HPV vaccination among this population. Future studies of HPV vaccination should recruit TGD people to better represent their perspectives.
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Affiliation(s)
- Anthony T. Pho
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sabrina Mangal
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, School of Nursing, Columbia University, New York, New York, USA
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7
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Uhrig JD, Stryker JE, Bresee S, Gard Read J, Parvanta S, Ruiz F, DeLuca N. HIV information needs of transgender people and their healthcare providers. AIDS Care 2018; 31:357-363. [PMID: 30021453 DOI: 10.1080/09540121.2018.1499862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Despite the disproportionate burden of HIV among transgender people in the United States, few HIV-related communication materials exist for transgender people or their healthcare providers. Our goal was to understand the barriers and facilitators transgender people face in accessing HIV prevention, testing, and care services and the potential implications for message development and dissemination. We reviewed the literature and interviewed nine key informants representing healthcare and service providers, researchers, and transgender advocates. Healthcare providers who care for transgender patients often demonstrate a lack of transgender competent care strategies. In addition, transgender people face many barriers to accessing HIV services. Although communication materials cannot address many of these barriers, materials specifically developed for transgender people and their healthcare providers would fill a gap and may increase uptake of HIV services. Materials for transgender people should include gender-affirming messaging and imagery, be framed in terms of resiliency, and present HIV information tailored to the needs of transgender people. Materials for healthcare providers should provide basic information to increase transgender competency and provision of comprehensive healthcare for transgender patients, inclusive of gender-affirming and HIV prevention, testing and care services. Channels for disseminating materials to transgender people and healthcare providers are described.
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Affiliation(s)
- Jennifer D Uhrig
- a Center for Communication Science, RTI International , Research Triangle Park , NC , USA
| | - Jo Ellen Stryker
- b National Center for HIV, Viral Hepatitis, STD and TB Prevention, Division for HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Sara Bresee
- b National Center for HIV, Viral Hepatitis, STD and TB Prevention, Division for HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Jennifer Gard Read
- a Center for Communication Science, RTI International , Research Triangle Park , NC , USA
| | - Sarah Parvanta
- a Center for Communication Science, RTI International , Research Triangle Park , NC , USA
| | - Francisco Ruiz
- b National Center for HIV, Viral Hepatitis, STD and TB Prevention, Division for HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Nickolas DeLuca
- c Center for Global Health, Centers for Disease Control and Prevention , Atlanta , GA , USA
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8
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Adams N, Pearce R, Veale J, Radix A, Castro D, Sarkar A, Thom KC. Guidance and Ethical Considerations for Undertaking Transgender Health Research and Institutional Review Boards Adjudicating this Research. Transgend Health 2017; 2:165-175. [PMID: 29098202 PMCID: PMC5665092 DOI: 10.1089/trgh.2017.0012] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The purpose of this review is to create a set of provisional criteria for Institutional Review Boards (IRBs) to refer to when assessing the ethical orientation of transgender health research proposals. We began by searching for literature on this topic using databases and the reference lists of key articles, resulting in a preliminary set of criteria. We then collaborated to develop the following nine guidelines: (1) Whenever possible, research should be grounded, from inception to dissemination, in a meaningful collaboration with community stakeholders; (2) language and framing of transgender health research should be non-stigmatizing; (3) research should be disseminated back to the community; (4) the diversity of the transgender and gender diverse (TGGD) community should be accurately reflected and sensitively reflected; (5) informed consent must be meaningful, without coercion or undue influence; (6) the protection of participant confidentiality should be paramount; (7) alternative consent procedures should be considered for TGGD minors; (8) research should align with current professional standards that refute conversion, reorientation, or reparative therapy; and (9) IRBs should guard against the temptation to avoid, limit, or delay research on this subject.
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Affiliation(s)
- Noah Adams
- Faculty of Health Professions, School of Social Work, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ruth Pearce
- Department of Sociology, University of Warwick, Coventry, United Kingdom
| | - Jaimie Veale
- Department of Psychology, University of Waikato, Hamilton, New Zealand
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York.,New York University School of Medicine, New York, New York
| | - Danielle Castro
- Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, California
| | - Amrita Sarkar
- IRGT, A Global Network of Trans Women and HIV, Oakland, California.,Solidarity and Action Against HIV Infection in India, New Delhi, India
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9
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Evans YN, Gridley SJ, Crouch J, Wang A, Moreno MA, Ahrens K, Breland DJ. Understanding Online Resource Use by Transgender Youth and Caregivers: A Qualitative Study. Transgend Health 2017; 2:129-139. [PMID: 29082333 DOI: 10.1089/trgh.2017.0011] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study assessed what online resources transgender youth and their caregivers use to acquire information about transgender health. Methods: Through a variety of settings, including subspecialty clinics, support groups, and online solicitation, we recruited caregivers of transgender youth aged 22 years or younger and self-identified transgender youth aged 14-22 years. We used a mixed methods approach of conducting in-person focus groups, interviews in person or through phone, and an online survey that allowed for increased flexibility for participants and to triangulate key themes from multiple data sources. Scripts were semistructured, and prompts were focused on resources accessed by transgender youth and their caregivers. Results: We had a total of 65 participants, including 50 caregivers and 15 youth. Five main themes emerged from participants on why they sought out information on the Internet and what they found in their online searches. These themes include (1) exploring gender identity, (2) filling knowledge gaps, (3) seeking support networks, (4) finding transgender-friendly providers, and (5) encountering misinformation. Conclusion: Our findings demonstrate the need for reliable trustworthy content online, the importance of the virtual community to support both youth and caregivers, and the challenge of navigating misinformation that is often faced by transgender youth as they navigate online resources. We propose partnering with professional organizations, such as the American Academy of Pediatrics or World Professional Association of Transgender Health, to promote evidence-based guidelines, position statements, and online information on healthcare for transgender youth.
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Affiliation(s)
- Yolanda N Evans
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | | | - Julia Crouch
- Seattle Children's Research Institute, Seattle, Washington
| | - Alicia Wang
- University of Washington School of Medicine, Seattle, Washington
| | - Megan A Moreno
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | - Kym Ahrens
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
| | - David J Breland
- Department of Pediatrics, University of Washington, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington
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10
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Rood BA, Reisner SL, Puckett JA, Surace FI, Berman AK, Pantalone DW. Internalized transphobia: Exploring perceptions of social messages in transgender and gender-nonconforming adults. Int J Transgend 2017. [DOI: 10.1080/15532739.2017.1329048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Brian A. Rood
- Department of Psychology, Augsburg College, Minneapolis, MN, USA
| | - Sari L. Reisner
- Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jae A. Puckett
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | | | - Ariel K. Berman
- Department of Psychology, Western Michigan University, Kalamazoo, MI, USA
| | - David W. Pantalone
- Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychology, University of Massachusetts, Boston, MA, USA
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11
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Ross KA, Castle Bell G. A Culture-Centered Approach to Improving Healthy Trans-Patient-Practitioner Communication: Recommendations for Practitioners Communicating withTrans Individuals. HEALTH COMMUNICATION 2017; 32:730-740. [PMID: 27399644 DOI: 10.1080/10410236.2016.1172286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The following manuscript explores trans individuals' lived experiences with practitioners and the types of advice they suggested be provided to practitioners treating trans patients to improve the trans-patient-practitioner relationship. Thirteen semi-structured qualitative interviews were conducted with individuals who self-identified as trans. Interviews were analyzed using thematic analysis (Braun & Clarke, 2006; Owen, 1984). Data analysis revealed that changes in practitioner's communication behavior during office visits as well as modifications to office logistics and e-health particulars would contribute to a healthy communication environment. Interviewees explained that these variations may potentially improve trans-patient-practitioner communication. We conclude by offering practical and theoretical implications as well as areas of future research for trans health communication.
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Affiliation(s)
- Katy A Ross
- a Scripps College of Communication, School of Communication Studies , Ohio University
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12
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Vargas CR, Ricci JA, Lee M, Tobias AM, Medalie DA, Lee BT. The accessibility, readability, and quality of online resources for gender affirming surgery. J Surg Res 2017; 217:198-206. [PMID: 28587891 DOI: 10.1016/j.jss.2017.05.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/15/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The transgender population is disproportionally affected by health disparities related to access to care. In many communities, transgender specialists are geographically distant and locally available medical professionals may be unfamiliar with unique needs of transgender patients. As a result, use of Internet resources for information about gender affirming surgery is particularly important. This study simulates a patient search for online educational material about gender affirming surgery and evaluates the accessibility, readability, and quality of the information. METHODS An Internet search for the term "transgender surgery" was performed, and the first 10 relevant hits were identified. Readability was assessed using 10 established tests: Coleman-Liau, Flesch-Kincaid, FORCAST, Fry, Gunning Fog, New Dale-Chall, New Fog Count, Raygor Estimate, Simple Measure of Gobbledygook, and Flesch Reading Ease. Quality was assessed using Journal of the American Medical Association criteria and the DISCERN instrument. RESULTS Review of 69 results was required to identify 10 sites with relevant patient information. There were 97 articles collected; overall mean reading level was 14.7. Individual Web site reading levels ranged from 12.0 to 17.5. All articles and Web sites exceeded the recommended sixth grade level. Quality ranged from 0 to 4 (Journal of the American Medical Association) and 35 to 79 (DISCERN) across Web sites. CONCLUSIONS Web sites with relevant patient information about gender affirming surgery were difficult to identify from search results. The content of these sites universally exceeded the recommended reading level. A wide range of Web site quality was noted, and this may further complicate successful navigation. Barriers in access to appropriately written patient information on the Internet may contribute to disparities in referral, involvement, satisfaction, and outcomes.
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Affiliation(s)
- Christina R Vargas
- Department of Plastic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Joseph A Ricci
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michelle Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adam M Tobias
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel A Medalie
- Division of Plastic and Reconstructive Surgery, Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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13
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Austin A, Craig SL, Alessi EJ. Affirmative Cognitive Behavior Therapy with Transgender and Gender Nonconforming Adults. Psychiatr Clin North Am 2017; 40:141-156. [PMID: 28159140 DOI: 10.1016/j.psc.2016.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Although there is growing awareness in contemporary society regarding transgender and gender nonconforming (TGNC) identities, transgender people continue to be highly marginalized and subject to transphobic discrimination and victimization. As a result, authentically expressing and navigating a TGNC identity can be difficult. Psychiatrists and other mental health professionals can play a key role in supporting TGNC client health and well-being through the use of trans-affirmative approaches. Trans-affirmative practice recognizes all experiences of gender as equally healthy and valuable This article focuses on transgender affirmative cognitive behavior therapy.
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Affiliation(s)
- Ashley Austin
- School of Social Work, Barry University, 11300 Northeast 2nd Avenue, Miami Shores, FL 33161, USA.
| | - Shelley L Craig
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1A1, Canada
| | - Edward J Alessi
- School of Social Work, Rutgers, The State University of New Jersey, 360 Martin Luther King Jr. Boulevard, Hill Hall, Room 401, Newark, NJ 07102, USA
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14
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Hussain Z, Kuzian E, Hussain N. A 15-Year Review of Trends in Representation of Female Subjects in Islamic Bioethics Research. JOURNAL OF RELIGION AND HEALTH 2017; 56:284-293. [PMID: 27393703 DOI: 10.1007/s10943-016-0283-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Gender representation in Islamic bioethics research in the twenty-first century has not been studied. To study temporal trends in representation of female subjects in Islamic bioethics research, PubMed-listed publications on Islamic bioethics from years 2000 to 2014 were reviewed for gender participation in human subjects' research. There were temporal trends of increasing publications of Islamic bioethics-related human subjects' research (64 papers over 15 years; R 2 = 0.72; p < 0.0004). Female subjects were well represented with a trend toward increasing participation. This was true for women from Muslim-majority countries even in non-gender-focused studies over the past 15 years.
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Affiliation(s)
- Zeenat Hussain
- Department of Liberal Studies, New York University, 726 Broadway, New York, NY, 10003, USA
| | - Edyta Kuzian
- Department of Liberal Studies, New York University, 726 Broadway, New York, NY, 10003, USA
- Department of Philosophy, Fordham University, 441 E. Fordham Road, Collins Hall 101, Bronx, NY, 10458, USA
| | - Naveed Hussain
- Department of Pediatrics, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA.
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15
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Abstract
In this article, we aim to provide readers with tools to critically consider decisions related to conducting research with trans populations. We first present the historical and contemporary contexts that shaped our approach to writing this article, and drawing from various social justice frameworks, we set forward our own critical framework to guide the discussion of research considerations with trans populations. We then move into discussing considerations for participant recruitment and sampling strategies, such as effective use of language in recruitment and study materials, consideration of research venues, and recruitment of diverse samples. We also provide a number of considerations related to research methods, study design, and dissemination of study results. Therefore, this article seeks to not only raise a number of important considerations for research with trans populations but also to provide readers with critical tools for adapting decision making when planning and conducting research with trans populations.
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16
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Moradi B, Tebbe EA, Brewster ME, Budge SL, Lenzen A, Ege E, Schuch E, Arango S, Angelone N, Mender E, Hiner DL, Huscher K, Painter J, Flores MJ. A Content Analysis of Literature on Trans People and Issues. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000015609044] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study provides a content analysis of more than a decade (2002–2012) of academic scholarship about trans people and issues. A total of 960 trans-focused publications were coded; there was a close balance of nonempirical (54%) and empirical (46%) publications. The analyses revealed that the literature on trans people and issues is growing, although many publications include trans people and issues nominally without substantive attention. The analyses also pointed to underutilized research designs and methodologies, the need for more clear assessment and more consistent reporting of demographic characteristics, and topics that warrant further attention. Specifically, literature on trans people and issues continues to be needed on the topics of focus thus far, such as psychological and identity-related distress. Scholarship is also needed to address important topics that have been understudied, including self-harm and suicide, positive functioning and mental health promoting factors, developmental issues across the life span, school and workplace experiences, and the training and competencies of health care providers to ensure affirmative and effective services for trans people.
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Affiliation(s)
| | | | | | | | | | - Engin Ege
- University of Florida, Gainesville, FL, USA
| | | | | | | | - Eli Mender
- University of Florida, Gainesville, FL, USA
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17
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Rood BA, Reisner SL, Surace FI, Puckett JA, Maroney MR, Pantalone DW. Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals. Transgend Health 2016; 1:151-164. [PMID: 29159306 PMCID: PMC5685272 DOI: 10.1089/trgh.2016.0012] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Transgender and gender-nonconforming (TGNC) individuals often are the target of enacted or external (i.e., distal) experiences of stigma, discrimination, and violence, which are linked to adverse health, particularly psychological distress. There is limited research, however, examining felt or internal (i.e., proximal) stressors faced by TGNC individuals. This study sought to examine one type of internal stressor, expecting rejection, and aimed to (1) identify how and to what extent rejection expectations operate day-to-day for TGNC individuals and (2) explore how TGNC individuals respond to expectations of rejection. Methods: In-depth interviews were conducted with 30 participants from 2014 to 2015 who identified as TGNC (mean age=30.4; 60% people of color); data were analyzed using a consensual qualitative research method. Results: Four thematic categories emerged about expecting rejection: (1) where to expect rejection; (2) thoughts and feelings associated with expectations of rejection; (3) coping strategies used to manage the expectation of rejection; and (4) the intersection of race and ethnicity with rejection expectations. Conclusion: Findings from this study suggest that expecting rejection is a frequent and salient internal stressor for TGNC individuals. We discuss the psychological and cumulative potential health impact of minority stress, and the applicability of Meyer's Minority Stress Model. Therapeutic interventions are needed to address the specific cognitive, emotional, and behavioral responses TGNC individuals experience as a result of the stress associated with expecting rejection, including fear, anxiety, and situational avoidance.
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Affiliation(s)
- Brian A Rood
- Department of Psychology, Augsburg College, Minneapolis, Minnesota
| | - Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts.,The Fenway Institute, Fenway Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Francisco I Surace
- Department of Psychology, University of Massachusetts, Boston, Massachusetts
| | - Jae A Puckett
- Department of Psychology, University of South Dakota, Vermillion, South Dakota
| | - Meredith R Maroney
- Department of Counseling and School Psychology, University of Massachusetts, Boston, Massachusetts
| | - David W Pantalone
- The Fenway Institute, Fenway Health, Boston, Massachusetts.,Department of Psychology, University of Massachusetts, Boston, Massachusetts
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18
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Deutsch MB. Evaluation of Patient-Oriented, Internet-Based Information on Gender-Affirming Hormone Treatments. LGBT Health 2016; 3:200-7. [DOI: 10.1089/lgbt.2015.0116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Madeline B. Deutsch
- Department of Family and Community Medicine, University of California–San Francisco, San Francisco, California
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19
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Benotsch EG, Zimmerman RS, Cathers L, Heck T, McNulty S, Pierce J, Perrin PB, Snipes DJ. Use of the Internet to Meet Sexual Partners, Sexual Risk Behavior, and Mental Health in Transgender Adults. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:597-605. [PMID: 25428577 DOI: 10.1007/s10508-014-0432-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 10/25/2014] [Accepted: 10/31/2014] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to examine the use of the internet to meet sexual partners among transgender individuals and examine correlates of this use, including sexual risk behavior, discrimination experiences, and mental health. A sample of 166 transgender adults (112 male-to-female transgender women and 54 female-to-male transgender men) were recruited in community venues and anonymously completed measures assessing these variables. Most participants (64.5 %) were HIV-negative, 25.2 % were HIV-positive, and 10.3 % did not know their HIV status. Overall, 33.7 % of participants reported having met a sexual partner over the internet, which did not differ significantly between transgender women and men. Among these individuals, transgender women reported significantly more lifetime internet sexual partners (median = 3) than transgender men (median = 1). Use of the internet to meet sexual partners was associated with lower self-esteem but not with depression, anxiety, somatic distress or discrimination experiences. Among transgender women, use of the internet to meet sexual partners was associated with each of the 11 sexual risk behaviors examined, including having multiple partners, sex under the influence of drugs, number of unprotected anal or vaginal sex acts, and history of commercial sex work. The use of the internet to meet partners was not associated with sexual risk behavior among transgender men (0/11 variables assessed). Although the internet is a common mode of meeting sexual partners among some transgender adults, it may also be a potential venue for prevention interventions targeting transgender individuals at particularly high risk for HIV acquisition.
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Affiliation(s)
- Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, PO Box 842018, Richmond, VA, 23284, USA.
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA.
- Institute for Women's Health, Virginia Commonwealth University, Richmond, VA, USA.
| | - Rick S Zimmerman
- College of Nursing, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Laurie Cathers
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Women's Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Ted Heck
- Virginia Department of Health, Richmond, VA, USA
| | | | - Juan Pierce
- Minority Health Consortium, Richmond, VA, USA
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, PO Box 842018, Richmond, VA, 23284, USA
| | - Daniel J Snipes
- Department of Psychology, Virginia Commonwealth University, PO Box 842018, Richmond, VA, 23284, USA
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Abstract
PURPOSE OF REVIEW Recent data on the high burden of HIV among transgender women have stimulated interest in addressing HIV in this vulnerable population. This review situates the epidemiologic data on HIV among transgender women in the context of the social determinants of health and describes opportunities for effective interventions. RECENT FINDINGS Transgender women experience unique vulnerability to HIV that can be attributed to multilevel, intersecting factors that also influence the HIV treatment and care continuum. Stigma and discrimination, lack of social and legal recognition of their affirmed gender, and exclusion from employment and educational opportunities represent fundamental drivers of HIV risk in transgender women worldwide. SUMMARY Interventions to improve engagement in HIV prevention, testing, care, and treatment among transgender women should build on community strengths and address structural factors as well as psychosocial and biologic factors that increase HIV vulnerability and prevent access to HIV services.
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Affiliation(s)
- Tonia Poteat
- aDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland bThe Fenway Institute, Fenway Health cDepartment of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA dCallen-Lorde Community Health Center, New York, New York, USA
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21
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Feldman J, Romine RS, Bockting WO. HIV risk behaviors in the U.S. transgender population: prevalence and predictors in a large internet sample. JOURNAL OF HOMOSEXUALITY 2014; 61:1558-88. [PMID: 25022491 PMCID: PMC4162812 DOI: 10.1080/00918369.2014.944048] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
To study the influence of gender on HIV risk, a sample of the U.S. transgender population (N = 1,229) was recruited via the Internet. HIV risk and prevalence were lower than reported in prior studies of localized, urban samples but higher than the overall U.S. population. Findings suggest that gender nonconformity alone does not itself result in markedly higher HIV risk. Sex with nontransgender men emerged as the strongest independent predictor of unsafe sex for both male-to-female (MtF) and female-to-male (FtM) participants. These sexual relationships constitute a process that may either affirm or problematize gender identity and sexual orientation, with different emphases for MtFs and FtMs, respectively.
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Affiliation(s)
- Jamie Feldman
- a Program in Human Sexuality, Department of Family Medicine and Community Health, Medical School , University of Minnesota , Minneapolis , Minnesota , USA
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22
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Horvath KJ, Iantaffi A, Swinburne-Romine R, Bockting W. A comparison of mental health, substance use, and sexual risk behaviors between rural and non-rural transgender persons. JOURNAL OF HOMOSEXUALITY 2014; 61:1117-30. [PMID: 24380580 PMCID: PMC4301267 DOI: 10.1080/00918369.2014.872502] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed.
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Affiliation(s)
- Keith J Horvath
- a Division of Epidemiology & Community Health , University of Minnesota , Minneapolis , Minnesota , USA
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