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Srithumsuk W, Thummapol O, Bhatarasakoon P. Social Determinants of Health Inequities for Older LGBT Adults: A Scoping Review. J Transcult Nurs 2024; 35:368-380. [PMID: 38767232 DOI: 10.1177/10436596241253866] [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: 05/22/2024] Open
Abstract
INTRODUCTION Despite the research on a health-disparate population, less is known about the social determinants of health (SDOH) inequities among older lesbian, gay, bisexual, and transgender (LGBT) adults. This scoping review aimed to explore and summarize what is known in the literature regarding the SDOH among older LGBT adults. METHODS The Joanna Briggs Institute's (JBI) approach guided this scoping review, which examined 31 articles that included quantitative, qualitative, and mixed-method studies. Data were analyzed by three independent reviewers through a predesigned process of data charting, descriptive summary, and thematic analysis. RESULTS Older participants were primarily LGBT and LGB. The findings identified four intersecting dimensions of individuals, social, economic, and health care system, contributing to health inequities and poor health outcomes. CONCLUSION Given the importance of SDOH for older LGBT adults, stakeholders including health care providers need to better understand the multiple intersecting influences, provide culturally congruent health care, and integrate sources of support into the care of these sexual- and gender-minority older adults.
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2
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Nelson CL. Exploring Resilience Among Midlife and Older Sexual Minority and Heterosexual Adults: A Multidimensional Analysis. J Appl Gerontol 2024:7334648241255496. [PMID: 38767117 DOI: 10.1177/07334648241255496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Research on resilience in sexual minority midlife and older adults is limited. Using a multidimensional approach, this study examined trait resilience (optimism), resilience as a dynamic process (perceived control), and relational resilience (social support), analyzing their roles in physical and mental health among sexual minority adults. Analyzing data from MIDUS 2 and MIDUS Refresher, we examined a sample of 492 participants, comprising 164 sexual minority and 328 propensity-matched heterosexual individuals. Among sexual minority participants, perceived control was associated with fewer chronic conditions and optimism with lower depressed affect. Among heterosexual participants, perceived control was associated with both outcomes. Subgroup analyses found variations, particularly among lesbian and bisexual women. Resilience measures were not associated with the health outcomes for gay or bisexual men. This study highlighted the complex roles of trait resilience and dynamic resilience processes in association with health outcomes among sexual minority midlife and older adults across diverse subgroups.
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Affiliation(s)
- Christi L Nelson
- University of Washington, Seattle, WA, USA
- University of South Florida, Tampa, FL, USA
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3
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Cheung CK, Tsang EYH. Distress as a Function of Social Exclusion and Assertiveness among Homosexual/Bisexual People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:633. [PMID: 38791847 PMCID: PMC11120836 DOI: 10.3390/ijerph21050633] [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: 04/16/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Homosexual (lesbian or gay) and bisexual (i.e., LGB) people tend to suffer from social exclusion and thus distress. To prevent or relieve distress, the people's assertiveness about justice and rights is an advocated means, but its effectiveness is uncertain, considering possible conflict with social exclusion. To clarify the effectiveness, this study analyzed data collected from 189 Chinese LGB adults in Hong Kong, which is a special administrative region of China generally Westernized and liberal to sexual orientation. Controlling for prior distress reported, the analysis showed that distress was lower when assertiveness was higher or social exclusion experienced was lower. However, distress was higher when both assertiveness and social exclusion experienced were higher. The higher distress implies a conflict between assertiveness and social exclusion to raise distress. It also implies the need to avoid conflict when promoting assertiveness and eliminating social exclusion to prevent distress in LGB people.
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Affiliation(s)
- Chau-kiu Cheung
- Department of Social and Behavioural Sciences, College of Liberal Arts and Social Sciences, City University of Hong Kong, Hong Kong, China;
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Yang W, Craig SL, Anderson JAE, Ross LE, Muntaner C. Sexual orientation and cognition in aging populations: Results from the Canadian Longitudinal Study on Aging. Acta Psychol (Amst) 2024; 242:104117. [PMID: 38134682 DOI: 10.1016/j.actpsy.2023.104117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
The current study utilized the Canadian Longitudinal Study on Aging (CLSA) data to investigate the relationship between sexual orientation and cognitive health of the aging population. Cognitive flexibility and verbal fluency were examined as outcome variables in the study. A total of 45,993 respondents were included in the analyses. Each model had social support or social participation as a mediator. A series of mediation analysis, stratified by gender, revealed that aging gay men performed better in cognitive tasks related to cognitive flexibility when compared to their heterosexual counterparts. The results also indicated that social support is a protective factor for cognitive health in aging lesbian women. This study provides an opportunity to consider how clinical and social services can strategize to build inclusive environments for the aging sexual minority population.
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Affiliation(s)
- Wook Yang
- Rongxiang Xu College of Health and Human Services, California State University Los Angeles, 5151 State University Drive, Los Angeles, CA 90032, USA
| | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada
| | - John A E Anderson
- Department of Cognitive Science, Carleton University, 2202A Dunton Tower, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
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Brown MJ, Amoatika D, Addo PNO, Kaur A, Haider MR, Merrell MA, Crouch E. Childhood Sexual Trauma and Subjective Cognitive Decline: An Assessment of Racial/Ethnic and Sexual Orientation Disparities. J Appl Gerontol 2023; 42:2129-2138. [PMID: 37218145 PMCID: PMC10523896 DOI: 10.1177/07334648231175299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Prior studies examining the association between childhood sexual abuse (CSA) and subjective cognitive decline (SCD) are limited. The aim of this study was to examine the racial/ethnic and sexual orientation disparities in the association between CSA and SCD. Using data from the 2019 Behavioral Risk Factor Surveillance System Survey, crude and multivariable logistic regression models were used to determine the association between CSA and SCD adjusting for sociodemographic characteristics, diabetes, hypertension, and depression. There were statistically significant differences in CSA status by age, gender, income, education, employment, and health status (depression). Black and Hispanic/Latine respondents had a stronger relationship between CSA and SCD compared to White populations. Also, sexual minority populations had a stronger relationship between CSA and SCD compared to heterosexual populations. Health disparities exist in the association between CSA and SCD. Trauma-informed interventions should be implemented among affected populations.
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Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Daniel Amoatika
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Prince Nii Ossah Addo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Melinda A. Merrell
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Elizabeth Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Okafor CN, Ware D, Meanley S, Brennan-Ing M, Haberlen S, Teplin L, Mimiaga MJ, Reuel Friedman M, Plankey M. Individual-Level Psychosocial Resiliencies as Mediators of the Relationship Between Internalized Homophobia and Depressive Symptoms Among Middle-Aged and Older Men Living With and Without HIV. AIDS Behav 2023; 27:3171-3182. [PMID: 36943601 DOI: 10.1007/s10461-023-04037-9] [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] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
Among sexual minority men (SMM), internalized homophobia (IH) has been consistently associated with increased depression symptoms. However, some SMM experiencing IH demonstrate resilience to buffer against depression symptoms. In this analysis, we used the Stress Process Model (SPM) as a conceptual framework to explore individual-level psychosocial resilience (ILPR) factors serving as a buffer of the IH-depression relationship. To utilize the SPM to explore whether four ILPR factors, including volunteerism, optimism, religiosity/spirituality, and global resiliency measure mediate the relationship between IH and depression symptoms among middle-aged and older SMM living with and without HIV. We used exploratory and confirmatory factor analysis to construct measurement models for the four ILPR factors. We examined whether the four ILPR factors mediated the IH-depression relationship. IH was significantly and positively associated with depression symptoms. There was a partial mediation of the IH-depression association by the four ILPR. Specifically, we found statistically significant indirect effects of optimism and the global resilience measure and supporting buffering effects of the IH-depression association. Although, the indirect effects religiosity/spirituality on the IH-depression relationship was significant, it did not support a buffering of effect. The indirect effects of volunteerism were not statistically significant. Our findings highlight the potential role of ILPR factors in the development of resilience against the negative effects of IH. Implications of these results for future research and practice are discussed.
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Affiliation(s)
- Chukwuemeka N Okafor
- Division of Infectious Diseases, Department of Medicine, Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Deanna Ware
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging at Hunter College, City University of New York, New York City, USA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Linda Teplin
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Matthew J Mimiaga
- School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers School of Public Health, Piscataway, USA
| | - Michael Plankey
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, USA
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Cheung CK, Tsang EYH. Conditions for Social Exclusion Leading to Distress Change in Chinese Lesbian, Gay, and Bisexual (LGB) People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105911. [PMID: 37239639 DOI: 10.3390/ijerph20105911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023]
Abstract
Lesbian, gay, and bisexual (LGB) people are likely to be at risk of distress because of social exclusion, including the feelings of resentment, resistance, and rejection they might experience from society. Nevertheless, the conditions for social exclusion leading to changes in distress are empirically unclear, especially in Chinese LGB people. To examine these conditions, this study surveyed 303 Chinese LGB people in Taiwan, Hong Kong, and various places in Mainland China. For comparability with other LGB studies, the study did not explicitly identify asexual, demisexual, or pansexual people in the LGB group. Results show that the retrospective reporting of social exclusion in 2016 did not significantly and unconditionally predict levels of distress in 2017. However, the reporting of exclusion significantly predicted current distress when the retrospective report of distress in 2016 was high. These results from the stress-vulnerability model indicate that prior distress is a vulnerability condition that allows social exclusion to exert its stressful effect. This study implies the need to prevent the social exclusion of highly distressed LGB people.
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Affiliation(s)
- Chau-Kiu Cheung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong 518000, China
| | - Eileen Yuk-Ha Tsang
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong 518000, China
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Berman M, Eaton LA, Watson RJ, Earnshaw VA, Wiginton JM, Layland E. Factors Associated with Disclosure of Sexual Orientation Among Black Sexual Minority Men. LGBT Health 2023; 10:51-61. [PMID: 36099207 PMCID: PMC10039276 DOI: 10.1089/lgbt.2021.0446] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose: This study evaluated the characteristics associated with sexual orientation disclosure among HIV-negative Black sexual minority men (BSMM) in the greater Atlanta, Georgia area. Survey data were collected from 475 HIV-negative BSMM from 2017 to 2019 as part of a larger behavioral intervention study focused on stigma, prejudice, and HIV-testing uptake. Methods: Participants reported their levels of sexual orientation disclosure globally, to their community, and to their family. Data were analyzed using one-way analysis of variance and multinomial logistic regression to determine whether demographic, minority stress, substance use, and mental health were associated with sexual orientation disclosure globally, to community members, and to family members. Results: Findings revealed that participants with older age, bisexual identity, and higher levels of internalized homophobia had higher odds of global, community, and family sexual orientation nondisclosure. Furthermore, participants with higher levels of resilience had lower odds of partial sexual orientation disclosure compared with their fully disclosed counterparts. Conclusions: These findings reveal variations associated with sexual orientation disclosure across varying contexts among HIV-negative BSMM, particularly among family member disclosure.
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Affiliation(s)
- Marcie Berman
- Department of Psychological Science, Central Connecticut State University, New Britain, Connecticut, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
| | - John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric Layland
- Department of Public Health, Yale University, New Haven, Connecticut, USA
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Jurček A, Keogh B, Sheaf G, Hafford-Letchfield T, Higgins A. Defining and researching the concept of resilience in LGBT+ later life: Findings from a mixed study systematic review. PLoS One 2022; 17:e0277384. [PMID: 36367883 PMCID: PMC9651550 DOI: 10.1371/journal.pone.0277384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Within the literature, resilience is described as either a trait, an outcome or a process and no universal definition exists. A growing body of research shows that older LGBT+ adults show signs of resilience despite facing multiple inequalities that negatively impact their health and social wellbeing. The aim of this review was to examine how resilience is defined in LGBT+ ageing research and how it is studied. A mixed-study systematic search of peer-reviewed research papers published before June 2022 was conducted using the electronic databases CINAHL, Embase, Medline, PsycInfo, Social Science Database and Web of Science. This resulted in the screening of 7101 papers 27 of which matched the inclusion criteria. A quality appraisal was conducted using the Mixed Methods Appraisal Tool. Findings show that papers often lack a clear definition of resilience and application of resilience theory within the studies, although many of the papers conceptualised resilience as either a trait, process or an outcome. However, resilience was rarely the primary focus of the studies and was researched using a variety of measurement instruments and conceptual frameworks. Given the socioeconomic disparities, diverse social relations, histories of discrimination and stigma, and acts of resistance that have shaped the lives of older LGBT+ populations, resilience is a topic of growing interest for researchers and practitioners. Clear definitions of resilience and application of resilience theory could help improve methods used to study the concept and lead to more robust findings and the development of effective interventions. Greater clarity on the concept of resilience could also broaden the focus of research that informs policies and practice, and support practitioner training in resilience and the particular experiences of older LGBT+ adults.
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Affiliation(s)
- Anže Jurček
- Faculty of Social Work, University of Ljubljana, Topniška ulica, Ljubljana, Slovenia
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin, Ireland
| | | | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Górska S, Singh Roy A, Whitehall L, Irvine Fitzpatrick L, Duffy N, Forsyth K. A systematic review and correlational meta-analysis of factors associated with resilience of normally aging, community-living older adults. THE GERONTOLOGIST 2021; 62:e520-e533. [PMID: 34346489 PMCID: PMC9579466 DOI: 10.1093/geront/gnab110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Global policy emphasizes the need to promote healthy aging through supporting inclusivity, safety, and functional independence. Research indicates that efforts to enhance resilience can contribute to meeting these objectives. We employed a meta-analytical approach to examine evidence on resilience in community-living older adults. Research Design and Methods We searched electronic databases until January 13, 2020 for observational studies investigating factors associated with resilience in this population. Articles had to provide quantitative data based on standardized assessment and include samples where mean participants’ age and lower 95% confidence interval were more than 55 years. We included 49 studies reported in 43 articles and completed 38 independent meta-analyses, 27 for personal and 11 for contextual factors associated with resilience. Results A range of personal and contextual factors were significantly associated with resilience, with effects sizes predominantly small to moderate (0.1 < r < 0.49). Factors reflecting psychological and physical well-being and access to/quality of social support were associated with higher resilience. Factors indicative of poorer psychological well-being and social challenges were associated with lower resilience. Longitudinal evidence was limited. The level of between-study heterogeneity was substantial to considerable. Where relevant analysis was possible, the identified publication bias was also considerable. Discussion and Implications The quality of the available evidence, as well as issues related to measurement of resilience, indicates the need for further work relative to its conceptualization and assessment. The presented findings have important clinical implications, particularly within the context of the coronavirus disease 2019 impact on resilience in older adults.
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Affiliation(s)
- Sylwia Górska
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - Anusua Singh Roy
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - Lucy Whitehall
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | | | - Nichola Duffy
- Edinburgh Health and Social Care Partnership, NHS Lothian, Edinburgh, Scotland
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
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Handlovsky I, Bungay V, Johnson J, Oliffe J. Overcoming adversity: a grounded theory of health management among middle-aged and older gay men. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1566-1580. [PMID: 32579289 DOI: 10.1111/1467-9566.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article presents findings from a grounded theory study in which we explored how self-identifying gay men between 40 and 76 years of age manage their health in the context of homophobia, heteronormativity and discrimination. Data were collected with 25 men over a 6-month period in a large urban setting in Western Canada. A preliminary theory of health management is discussed, consisting of the central phenomenon of overcoming adversity. Three thematic processes are considered that illustrate how adversity and health management are situated within the interrelationships of historical and ongoing discrimination inclusive of and external to the healthcare encounter, the complexity of men's illnesses, and the temporal aspects of HIV epidemics and treatments that occurred throughout their lives. These themes include: advocating for health needs, knowing about health issues and treatments, and engaging in health promoting practices. These findings help to address a gap in knowledge concerning health management among older gay men and support that initiatives aimed at health care with gay men must appreciate the systemic role of discrimination, while supporting men's individual efforts in actively managing their health.
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Affiliation(s)
| | | | - Joy Johnson
- Simon Fraser Faculty of Health Sciences, Burnaby, BC, Canada
| | - John Oliffe
- UBC School of Nursing, Vancouver, BC, Canada
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Goodyear T, Mniszak C, Jenkins E, Fast D, Knight R. "Am I gonna get in trouble for acknowledging my will to be safe?": Identifying the experiences of young sexual minority men and substance use in the context of an opioid overdose crisis. Harm Reduct J 2020; 17:23. [PMID: 32228646 PMCID: PMC7106659 DOI: 10.1186/s12954-020-00365-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/13/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND North America and other parts of the globe are in the midst of a public health emergency related to opioid overdoses and a highly contaminated illicit drug supply. Unfortunately, there is a substantial gap in our understandings about how this crisis affects key populations not conventionally identified within overdose-related surveillance data. This gap is particularly pronounced for gay, bisexual, and other men who have sex with men (sexual minority men)-a population that experiences substance use-related inequities across adolescence and young adulthood. METHODS We draw on in-depth semi-structured interviews conducted in 2018 with a diverse sample (N = 50) of sexual minority men ages 15-30 who use substances and live in Vancouver, Canada, to identify how patterns and contexts of substance use are occurring in the context of the opioid overdose crisis. RESULTS Our analysis revealed three themes: awareness, perceptions, and experiences of risk; strategies to mitigate risk; and barriers to safer substance use. First, participants described how they are deeply impacted by the contaminated illicit drug supply, and how there is growing apprehension that fatal and non-fatal overdose risk is high and rising. Second, participants described how procuring substances from "trustworthy" drug suppliers and other harm reduction strategies (e.g., drug checking technologies, Naloxone kits, not using alone) could reduce overdose risk. Third, participants described how interpersonal, service-related, and socio-structural barriers (e.g., drug criminalization and the lack of a regulated drug supply) limit opportunities for safer substance use. CONCLUSIONS Equity-oriented policies and programming that can facilitate opportunities for safer substance use among young sexual minority men are critically needed, including community- and peer-led initiatives, access to low-barrier harm reduction services within commonly frequented social spaces (e.g., Pride, night clubs, bathhouses), nonjudgmental and inclusive substance use-related health services, the decriminalization of drug use, and the provision of a safe drug supply.
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Affiliation(s)
- Trevor Goodyear
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Caroline Mniszak
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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Correro AN, Nielson KA. A Review of Minority Stress as a Risk Factor for Cognitive Decline in Lesbian, Gay, Bisexual, and Transgender (LGBT) Elders. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2019; 24:2-19. [PMID: 33014237 DOI: 10.1080/19359705.2019.1644570] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) older adults comprise a unique and growing subset of the aging population. The historical context in which they came of age was imbued with victimization and discrimination. These experiences are subjectively stressful and collectively known as minority stress. Older LGBT adults continue to face stressors related to their gender and sexual identities in their daily lives. Importantly, chronic minority stress (CMS), like other forms of chronic stress, is harmful to health and well-being. CMS contributes to LGBT health disparities, including cardiovascular disease and depression, conditions that in turn increase risk for premature cognitive decline. Furthermore, long-term exposure to stress hormones is associated with accelerated brain aging. Yet, the cognitive functioning of LGBT elders and the influence of CMS on their cognition is all but unexplored. In this review, we examine the influences of CMS in LGBT elders and connect those influences to existing research on stress and cognitive aging. We propose a testable model describing how CMS in LGBT elders heightens risk for premature cognitive aging and how ameliorating factors may help protect from CMS risk. Research is desperately needed to calibrate this model toward improving LGBT quality of life and mental health practices.
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Affiliation(s)
| | - Kristy A Nielson
- Department of Psychology, Marquette University.,Department of Neurology and the Center for Imaging Research, Medical College of Wisconsin
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14
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Handlovsky I, Bungay V, Oliffe J, Johnson J. Developing Resilience: Gay Men's Response to Systemic Discrimination. Am J Mens Health 2018; 12:1473-1485. [PMID: 29683025 PMCID: PMC6142121 DOI: 10.1177/1557988318768607] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 11/16/2022] Open
Abstract
Gay men experience marked health disparities compared to heterosexual men, associated with profound discrimination. Resilience as a concept has received growing attention to increase understanding about how gay men promote and protect their health in the presence of adversity. Missing in this literature are the perspectives and experiences of gay men over 40 years. This investigation, drawing on grounded theory methods, examined how gay men over 40 years of age develop resilience over the course of their lives to promote and protect their health. In-depth interviews were undertaken with 25 men ranging between 40 and 76 years of age who experienced an array of health concerns including depression, anxiety, suicidality, and HIV. Men actively resist discrimination via three interrelated protective processes that dynamically influence the development of resilience over their life course: (a) building and sustaining networks, (b) addressing mental health, and (c) advocating for respectful care encounters. Initiatives to promote and protect the health of gay men must be rooted in the recognition of the systemic role of discrimination, while supporting men's resilience in actively resisting discrimination.
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Affiliation(s)
| | | | - John Oliffe
- UBC School of Nursing, Vancouver, BC, Canada
| | - Joy Johnson
- Vice President Research, Simon Fraser Faculty of Health Sciences, Burnaby, BC, Canada
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