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Michael GM, Morrison SD, Nolan IT, Shoham M, Gomez DA, Akhavan A, Hubbs BS, Satterwhite T. Role of allogeneic placental tissues in penile inversion vaginoplasty. Transl Androl Urol 2024; 13:736-747. [PMID: 38855581 PMCID: PMC11157404 DOI: 10.21037/tau-23-420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/17/2024] [Indexed: 06/11/2024] Open
Abstract
Background The role of allogeneic placental tissue (APT) in genital gender-affirming surgery (GAS) is not well understood. Penile inversion vaginoplasty (PIV), the most common genital GAS, often results in tissue healing- or wound-related complications, including scarring and neovaginal stenosis. Surgical reoperation and revision vaginoplasty are common. The aim of this study was to evaluate the contribution of APT to postoperative outcomes in PIV. Methods The authors performed a retrospective analysis of consecutive adult patients undergoing primary PIV during a 6-year period (September 1, 2014 to September 1, 2020). Subjects receiving intraoperative application of an APT biomaterial were compared to those undergoing primary PIV without APT. Postoperative outcomes-including wound healing morbidity and reoperation-were compared between groups. Short- and long-term complications were classified using Clavien-Dindo. Results A total of 182 primary PIV cases were reviewed (115 conventional PIV; 67 PIV-APT). The postoperative follow-up time for the population averaged 12.7 months. All-cause and wound related complications were significantly lower amongst PIV-APT patients when compared to conventional PIV (P=0.002 and P=0.004, respectively). The rate of long-term complications was significantly lower in PIV-APT subjects: prolonged pain (P=0.001), prolonged swelling (P=0.047), and neovaginal stenosis (P<0.001). The PIV-APT group required significantly less reoperation for vaginal depth enhancement (P=0.007). Conclusions Though its use in urogenital reconstruction has been limited, this study indicates that the placement of APT during PIV significantly lowered the risk of complications associated with poor wound healing. This supports a novel use for placental tissues in reducing complications in genital GAS.
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Affiliation(s)
| | - Shane D. Morrison
- Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Ian T. Nolan
- Division of Plastic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Maia Shoham
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Arya Akhavan
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Brandon S. Hubbs
- Department of Clinical Research, MiMedx Group, Inc., Marietta, GA, USA
| | - Thomas Satterwhite
- Align Surgical Associates, Inc., San Francisco, CA, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
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Waterman EA, McLain M, Zulfiqar H, Ahmar Qadeer T, Ciavoi SM. The Link Between Intimate Partner Violence and Food Insecurity: A Review of Quantitative and Qualitative Studies. TRAUMA, VIOLENCE & ABUSE 2024; 25:1511-1530. [PMID: 37485673 DOI: 10.1177/15248380231186152] [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: 07/25/2023]
Abstract
Intimate partner violence (IPV) and food insecurity are global health issues that affect millions of people worldwide. Numerous studies show that IPV and food insecurity are linked; however, there is a lack of synthesis of this research. Using a systematic search and review, we examined the international quantitative and qualitative research published on the link between IPV and food insecurity. We searched for peer-reviewed, English-language articles with participants above the age of 16 in 4 large online databases. Fifty-six studies were included from around the world that discussed the link between food insecurity and IPV perpetration and/or victimization. We found evidence in both qualitative and quantitative studies for a meaningful connection between these two global health isues. We also reviewed the literature on moderators and mediators (e.g., mental health). Our findings indicate the importance of implementing IPV prevention strategies which also address household food insecurity, and the potential for food insecurity resources to provide IPV resources. Future research should focus more frequently on IPV perpetration as opposed to victimization, and further examine the moderating and mediating mechanisms that inform the link between IPV and food insecurity.
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Gold E, Perez de Bronner S, Goday PS. Nutrition considerations in the transgender and gender-diverse patient. Nutr Clin Pract 2024; 39:366-372. [PMID: 37528505 DOI: 10.1002/ncp.11049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/12/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023] Open
Abstract
The nutrition professional is increasingly providing care to individuals who identify as transgender. However, there are few definitive guidelines on providing medical nutrition care to this population. It is becoming better understood that this population is at elevated nutrition risk secondary to significant health disparities. More recently, the increasing prevalence of gender-affirming medical intervention has resulted in uncertainty when providing medical nutrition assessments and therapies, as many standardized guidelines and assessment tools are sex-specific. This review aims to provide clarity in exploring various gender-affirming methods to providing nutrition care to the transgender and gender-diverse population.
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Affiliation(s)
- Evelyn Gold
- Complex Healthcare Division, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Susana Perez de Bronner
- Clinical Nutrition & Lactation, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Praveen S Goday
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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Gibb JK, Williams S, Mikelsteins K, Charles J, McKinnon L, Beach L, McKerracher L, Fields J. Queering food security research: A critical analysis of 2SLGBTQ+ People's experiences of food insecurity in Toronto during the COVID-19 pandemic. Soc Sci Med 2024; 345:116709. [PMID: 38422687 DOI: 10.1016/j.socscimed.2024.116709] [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: 05/29/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Household food insecurity (HFI), stress, isolation, and discrimination are major determinants of health that disproportionately affect 2SLGBTQ + people. The COVID-19 pandemic potentially exacerbated these inequities. This study investigates HFI rates among 2SLGBTQ + adults living in diverse household conditions during the pandemic and explores the idea that heteronormative conceptions of the "household" may affect measurement of HFI. METHODS Cross-sectional survey responses were collected from 437 self-identified 2SLGBTQ + people from Toronto, Canada between March and July 2021. The survey measured HFI, sexual/gender identities, socio-demographic factors, household composition, and psycho-social stress/distress. Multinomial logistic regression was used to assess variation in odds of marginal, moderate, and severe HFI in relation to sexual/gender identities, household composition, psycho-social distress, and socio-demographic covariates. RESULTS Forty-two percent of respondents reported some level of HFI, with severe HFI higher among respondents who were bisexual, transgender/gender diverse, and/or assigned-female-at-birth. Living alone was associated with decreased odds of reporting marginal HFI but increased odds of moderate or severe HFI compared to living with a partner, family, or roommates; living with children was associated with decreased odds of both marginal and severe HFI. One indicator of psycho-social distress (perceived discrimination) was associated with higher odds of all levels of HFI, while the other (isolation) was associated with decreased odds of marginal HFI. CONCLUSION These findings highlight the high prevalence of HFI linked with discrimination among 2SLGBTQ + individuals during the pandemic. The complicated results regarding household composition and social isolation may suggest a need to revise definitions of the household when measuring, monitoring, and seeking to mitigate HFI in 2SLGBTQ + communities.
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Affiliation(s)
- James K Gibb
- Department of Anthropology, Northwestern University, Evanston, USA; Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.
| | - Sarah Williams
- Department of Anthropology, University of Connecticut, Storrs, USA
| | - Kaspars Mikelsteins
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada
| | - Jada Charles
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada; Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Leela McKinnon
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Laura Beach
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Luseadra McKerracher
- Aarhus Institute for Advanced Studies and Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jessica Fields
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada; Department of Sociology, University of Toronto, Toronto, Canada
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Zubizarreta D, Wirtz AL, Humes E, Cooney EE, Stevenson M, Althoff KN, Radix AE, Poteat T, Beyrer C, Wawrzyniak AJ, Mayer KH, Reisner SL. Food Insecurity Is High in a Multi-Site Cohort of Transgender Women Vulnerable to or Living with HIV in the Eastern and Southern United States: Baseline Findings from the LITE Cohort. Nutrients 2024; 16:707. [PMID: 38474837 DOI: 10.3390/nu16050707] [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: 01/20/2024] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalence and correlates of food insecurity-the unavailability of food and limited access to it-have not been adequately considered among transgender women (TW), particularly alongside other health-related conditions burdening this population, such as HIV infection. This study examined the prevalence and correlates of food insecurity among TW. Between 2018 and 2020, 1590 TW in the Eastern and Southern U.S. completed a multi-site baseline assessment (socio-behavioral survey and HIV testing). Descriptive statistics were calculated and multivariable Poisson models with robust error variance were used to estimate prevalence ratios and 95% confidence intervals for correlates of food insecurity (dichotomized as sometimes-to-always vs. seldom-to-never running out of food). Eighteen percent of TW were living with HIV and nearly half of participants (44%) reported food insecurity. Correlates of food insecurity included being Black, multiracial, or another race/ethnicity; having < college education, low income, unstable housing, and high anticipated discrimination; and a history of sex work and sexual violence (all p < 0.05). Food insecurity was highly prevalent among TW. Current programs to provide food support do not adequately meet the needs of TW. HIV pr evention and care programs may benefit from addressing food insecurity.
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Affiliation(s)
- Dougie Zubizarreta
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Erin E Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Meg Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY 10011, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Tonia Poteat
- Division of Healthcare in Adult Populations, School of Nursing, Duke University, Durham, NC 27710, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | | | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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Espinosa CC, Crim SM, Carree T, Dasgupta S. Unmet Needs for Ancillary Services and Associations with Clinical Outcomes Among Transgender Women with Diagnosed HIV: Medical Monitoring Project, United States, 2015-2020. LGBT Health 2024; 11:143-155. [PMID: 37851999 DOI: 10.1089/lgbt.2023.0040] [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: 10/20/2023] Open
Abstract
Purpose: Access to ancillary services-including HIV support services, non-HIV clinical services, and subsistence services-can support care engagement and viral suppression and reduce disparities among people with HIV (PWH). We used representative U.S. data to assess differences in unmet needs for ancillary services between transgender women with HIV and other PWH. In addition, we examined associations between unmet needs and clinical outcomes among transgender women. Methods: We analyzed 2015-2020 Medical Monitoring Project data among transgender women (N = 362), cisgender men (N = 17,319), and cisgender women (N = 6016) with HIV. We reported weighted percentages for characteristics, and reported adjusted prevalence ratios (aPRs) controlling for race/ethnicity and age, and 95% confidence intervals (CI) using logistic regression with predicted marginal means to assess differences between groups. Results: Among transgender women, unmet needs were highest for dental care (24.9%), shelter or housing (13.9%), and transportation assistance (12.6%). Transgender women were more likely than cisgender men to have unmet subsistence needs. Among transgender women, unmet needs for ancillary services were negatively associated with many clinical outcomes after adjusting for age and race/ethnicity. Unmet needs for subsistence services were associated with higher levels of antiretroviral therapy nonadherence (aPR: 1.39; 95% CI: 1.13-1.70) and detectable viral loads (aPR: 1.47; 1.09-1.98), emergency room visits (aPR: 1.42; 1.06-1.90), and depression (aPR: 2.74; 1.83-4.10) or anxiety (aPR: 3.20; 2.05-5.00) symptoms. Conclusions: Transgender women with HIV were more likely than cisgender men with HIV to experience unmet needs for subsistence services-likely a reflection of substantial socioeconomic disadvantage. Addressing unmet needs is an essential step for improving care outcomes among transgender women with HIV.
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Affiliation(s)
- Catherine C Espinosa
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stacy M Crim
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tamara Carree
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- DLH Corp, Atlanta, Georgia, USA
| | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ferrero EM, Yunker AG, Cuffe S, Gautam S, Mendoza K, Bhupathiraju SN, Mattei J. Nutrition and Health in the Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Community: A Narrative Review. Adv Nutr 2023; 14:1297-1306. [PMID: 37536566 PMCID: PMC10721458 DOI: 10.1016/j.advnut.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/16/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
Sexual and gender minorities have a higher risk for health and nutrition-related disparities across the life course compared to the heterosexual or cisgender population. Experiences of stigmatization and discrimination are associated with diminished mental health quality and psychological distress, which are risk factors for developing various eating disorders. Other nutrition disparities include increased risk for food insecurity, body dissatisfaction, and weight complications, such as those experienced by the transgender population in association with gender-affirming hormone therapies. Despite the need for tailored nutrition recommendations that address the unique needs of the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) community, there are currently no such guidelines in North America. The purpose of this review is to summarize major LGBTQ+ nutrition disparities and highlight the need for tailored recommendations. We examine the evidence on mental health and social disparities in this group, including vulnerabilities to disordered eating, food insecurity, and healthcare provider discrimination. Importantly, we identify a scarcity of literature on dietary concerns and nutrition care guidelines for LGBTQ+ groups, including studies that address intersectionality and differences among specific gender and sexual orientations. These gaps underline the urgency of prioritizing nutrition for LGBTQ+ health needs and for developing tailored public health nutrition recommendations for this underserved population. Our review suggests that future LGBTQ+ health and nutrition research agendas should include personalized and precision nutrition, social determinants of health, diet quality, body image, and healthcare provider cultural competency and responsiveness. Moreover, the current evidence on LGBTQ+ nutrition and health will be strengthened when research studies (including clinical trials) with robust methodologies amplify inclusion and representation of this community to elucidate health and nutrition disparities in sexual and gender minorities.
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Affiliation(s)
- Elisabetta M Ferrero
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Alexandra G Yunker
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sherri Cuffe
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Saloni Gautam
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kenny Mendoza
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Shilpa N Bhupathiraju
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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Arteaga I, Wilde PE. Measuring Food Security in the United States for More Than 25 years: History, Methods, Findings, and Opportunities. J Acad Nutr Diet 2023; 123:S5-S19. [PMID: 36669754 DOI: 10.1016/j.jand.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/29/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
This article sets the stage for the "25 Years of Food Security Measurement: Answered Questions and Further Research" conference, with support from the Economic Research Service of the US Department of Agriculture, by providing some history of federal food security measurement, summarizing notable findings, and reviewing selected special topics in analysis methods. The federal government uses food security surveys to monitor national progress toward reducing food insecurity and to evaluate federal nutrition assistance programs. For the monitoring purpose, there is a tension between focus (on a single authoritative measurement approach) and breadth (encompassing multiple tools or instruments suitable for diverse populations, contexts, and applications). For the program evaluation purpose, challenges include coordination with study designs capable of real causal estimation in the face of strong self-selection effects and tailored reference periods in survey questions that match the timing of program participation. Some analysis methods treat the food security survey items as distinct experiences of hardship, whereas others treat the food security survey items as windows on an underlying latent variable, a food insecurity score. The severity of food-related hardship may be assessed quantitatively by the number of distinct hardships reported, by the estimated value of a latent food insecurity score, or by the frequency of occurrence for sentinel hardships. Ongoing work investigates statistical approaches that are sufficiently simple for policy application and yet sufficiently flexible to accurately match the empirical survey evidence.
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Affiliation(s)
- Irma Arteaga
- Truman School of Government and Public Affairs, University of Missouri, Columbia, Missouri.
| | - Parke E Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
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Rhodes EC, Nyhan K, Okoli N, O’Connor Duffany K, Rodriguez ME, Perkins B, Ross D, Pérez-Escamilla R. Client experience of food assistance programs among adults in the United States: a qualitative evidence synthesis protocol. Front Public Health 2023; 11:1193451. [PMID: 37719734 PMCID: PMC10501444 DOI: 10.3389/fpubh.2023.1193451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Policymakers, health practitioners, and other key partners are increasingly focused on ensuring that clients of food assistance programs have positive experiences, a key aspect of high-quality programming. The objectives of this review are to describe the experiences of clients participating in food assistance programs in the United States (US) and to identify ways that these programs promote or hinder positive experiences. Methods and analysis We will conduct a qualitative evidence synthesis with partners from food security organizations and community members. Peer-reviewed literature will be systematically searched in Scopus, CINAHL, and AGRICOLA. To identify grey literature, we will use Google's programmable search engine. This review will consider sources that present results of primary qualitative studies that focus on at least one food assistance program in the US and explore the perspectives of adult clients. Only sources published in English or Spanish from 2007 onward will be included. Multiple reviewers will screen articles for inclusion and extract data from articles that meet the inclusion criteria, using a structured data extraction tool. Thematic synthesis or meta-ethnography may be appropriate approaches for synthesizing the extracted data. The final selection of synthesis method will be determined once the set of primary qualitative studies to be included in the review is complete and the type of data presented in these studies is known. We will assess the methodological quality of the included studies using the CASP (Critical Appraisal Skills Programme) tool for qualitative studies and assess the confidence in the review findings using the GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach. Discussion The findings of this review will inform the development of measures to assess client experience and quality improvement efforts.
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Affiliation(s)
- Elizabeth C. Rhodes
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, United States
- Department of Environmental Health Sciences, Yale University School of Public Health, New Haven, CT, United States
| | - Ngozi Okoli
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, United States
| | - Kathleen O’Connor Duffany
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, United States
| | | | | | - Daniel Ross
- DAISA Enterprises, LLC, South Hadley, MA, United States
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, United States
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Gunaydin D, Burchell D, Hickens N, Joy P. Not Just Checklists and Rainbows: Exploring Canadian Dietitians' Beliefs, Values, and Knowledge of Transgender Nutritional Care. Transgend Health 2023; 8:381-388. [PMID: 37525835 PMCID: PMC10387146 DOI: 10.1089/trgh.2021.0107] [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: 01/06/2023] Open
Abstract
Purpose Many transgender (short form: trans) people are experiencing disparities within Canadian health care systems, including nutritional and dietetic health care systems. This research explores the views, beliefs, and experiences of Canadian dietitians about trans nutritional care and seeks to understand how dietitians can better address the nutritional needs of trans individuals. Methods Semistructured online interviews were conducted with 16 Canadian dietitians. Interviews were transcribed and the data were analyzed thematically. Results Three main themes were created; (1) There's an Unjust System, (2) We've Come a Long Way, and (3) Not Just Checklists and Rainbows. The participants explored the historic nature of the Canadian dietetic profession and noted the connection between cis-normativity and the erasure of trans identities. They also explored how dietitians could better address the health needs of trans people, including moving beyond the acknowledgement of trans identities to changing the way gender is viewed in the profession. Conclusion The dietetic profession must move beyond surface-level activities and rethink gender. Recommendations include adding trans-focused care training into the profession, creating safer spaces for trans individuals, advocacy and allyship, and recruiting trans people to the profession.
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Affiliation(s)
- Duygu Gunaydin
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Drew Burchell
- Department of Biology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Nicholas Hickens
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Phillip Joy
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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Hamill MM, Hu F, Adebajo S, Kokogho A, Tiamiyu AB, Parker ZF, Charurat ME, Ake JA, Baral SD, Nowak RG, Crowell TA. Food and Water Insecurity in Sexual and Gender Minority Groups Living With HIV in Lagos, Nigeria. J Acquir Immune Defic Syndr 2023; 93:171-180. [PMID: 36881816 PMCID: PMC10293107 DOI: 10.1097/qai.0000000000003183] [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: 09/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Food and water insecurity are associated with poor health outcomes that may be exacerbated by social marginalization and barriers to health care experienced by sexual and gender minorities (SGM) in resource-limited settings. We explored factors associated with food and water insecurity in SGM with HIV. SETTING A longitudinal study of 357 men who have sex with men, transgender women, and other gender-identifying people in Lagos, Nigeria. METHODS Laboratory testing, interviews, food and water assessments, and anthropometry were performed quarterly. Robust Poisson regression with generalized estimating equations was used to evaluate factors potentially associated with food and water insecurity. RESULTS From 2014 to 2018, 357 SGM with HIV completed either the food or water assessments. At baseline, participants identified as cisgender men who have sex with men 265 (74.2%), transgender women 63 (17.7%), or as nonbinary/other gender 29 (8.1%). Food insecurity and water insecurity were reported by 63/344(18.3%) and 113/357(31.7%), respectively, at any visit. Food and water insecurity each decreased with ongoing study participation. Food insecurity was associated with nonpartnered relationship status, CD4 count <500 cells/mm 3 , and lack of access to piped water. Water insecurity was associated with age 25 years or older, living with a man, transactional sex, and food insecurity. CONCLUSIONS Food and water insecurity were common among SGM in Nigeria and decreased with continued study participation, suggesting amenability to intervention when SGM are successfully engaged in care. Targeted interventions to support food and water security may improve HIV-related outcomes, such as CD4 count.
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Affiliation(s)
- Matthew M. Hamill
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
| | - Fengming Hu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation, University of Maryland Baltimore, Baltimore, USA
| | - Afoke Kokogho
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Abdulwasiu B. Tiamiyu
- HJF Medical Research International, Abuja, Nigeria
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Zahra F. Parker
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Manhattan E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Trevor A. Crowell
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
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King WM, Jadwin-Cakmak L, Trammell R, Gamarel KE. Structural vulnerability as a conceptual framework for transgender health research: findings from a community needs assessment of transgender women of colour in Detroit. CULTURE, HEALTH & SEXUALITY 2023; 25:681-697. [PMID: 35736653 PMCID: PMC9780405 DOI: 10.1080/13691058.2022.2086709] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/02/2022] [Indexed: 06/02/2023]
Abstract
The concept of structural vulnerability explains how systems of oppression drive health inequities by reducing access to survival resources (e.g. food, housing) for marginalised populations. Indicators of structural vulnerability such as housing instability, violent victimisation and poverty are often interconnected and result from intersectional oppression. We sought to demonstrate the utility of the structural vulnerability framework for transgender health research by examining patterns of structural vulnerability indicators among transgender women of colour in Detroit. We conducted latent class analysis and tested associations between classes and mental health and substance use outcomes. Membership to the Lowest Vulnerability class was negatively associated with post-traumatic stress disorder (PTSD) (aOR = 0.10, 95% CI: 0.02-0.59). High Economic Vulnerability membership was associated with daily marijuana use (aOR = 4.61, 95% CI: 1.31-16.16). Complex Multi-Vulnerability membership was associated with PTSD (aOR = 9.75, 95% CI: 2.55-37.29), anxiety (aOR = 4.12, 95% CI: 1.22-13.97), suicidality (aOR = 6.20, 95% CI: 1.39-27.70), and club drug use (aOR = 4.75, 95% CI: 1.31-17.29). Substantively different findings emerged when testing relationships between each indicator and each outcome, highlighting the value of theoretically grounded quantitative approaches to understanding health inequities. Community-driven interventions and policy changes that reduce structural vulnerability may improve mental health and substance use outcomes among structurally vulnerable trans women of colour.
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Affiliation(s)
- Wesley M King
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Racquelle Trammell
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Trans Sistas of Colour Project, Detroit, MI, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
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13
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Fledderjohann J, Patterson S, Owino M. Food Insecurity: A Barrier to Reproductive Justice Globally. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:296-311. [PMID: 38595861 PMCID: PMC10903663 DOI: 10.1080/19317611.2023.2201841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/11/2024]
Abstract
Objective: Reproductive Justice identifies three core reproductive rights for all people: (1) the right to not have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments. We aim to illustrate that food insecurity infringes upon on all three of these rights and so is a pressing issue for reproductive justice and for sexual and reproductive health more broadly. Methods: Using a phenomenological approach, we outline potential pathways between food insecurity and reproductive justice. Results: There are numerous potential pathways between food insecurity and reproductive justice, including entry into sexual relationships for material support, links to sexually transmitted infections and infertility, structural violence, prioritization and spending tradeoffs between food and other basic necessities, biological impacts of malnutrition, restricted reproductive choices, population control measures, and social stigma and exclusion. Marginalized people are disproportionately impacted by food insecurity and its consequences, with implications for sexual health and pleasure and for reproductive justice. Conclusions:Meaningful and equitable collaboration between people with lived experience of food insecurity, human rights and reproductive justice activists, and academics is critical to sensitively contextualize this work and mobilize broader social change.
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Affiliation(s)
| | - Sophie Patterson
- Faculty of Health and Medicine, Lancaster University, Bailrigg Campus, Lancaster, UK
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Maureen Owino
- Faculty of Environmental Studies and Urban Health, York University, Toronto, Canada
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14
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Ancheta AJ, Hughes TL, Liu J, Russell ST, Bruzzese JM. Interpersonal- and Community-Level Risk Factors for Adolescent Obesity: An Examination of Sexual Identity, School Violence, and School Climate in a Large Sample of Urban Adolescents. J Youth Adolesc 2023:10.1007/s10964-023-01774-x. [PMID: 37067642 DOI: 10.1007/s10964-023-01774-x] [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: 01/04/2023] [Accepted: 03/26/2023] [Indexed: 04/18/2023]
Abstract
Sexual minority adolescents are more likely to have obesity compared to their heterosexual peers, but little is known about potential contributors to this disparity that lie outside of individual-level health behaviors, such as diet and exercise. One possible contributor is school violence victimization, a factor associated with overweight/obesity in adolescence. Another possible contributor is school climate, which is associated with feelings of safety and connectedness that can lower the likelihood of school violence victimization. Moreover, even less is known about relationships among all these factors among sexual minority adolescents. This gap in the literature was addressed by analyzing CDC's district-level data from the Youth Risk Behavior Survey and School Health Profiles (N = 60,625; 50.9% female, Mage = 16 years, 84.7% heterosexual, 15.3% sexual minority). Using multilevel mixed effects logistic regression models and controlling for covariates, it was found that among females and males, those with 2+ counts of last 12-month school violence victimization had higher odds of obesity than those with no school violence victimization (AOR = 1.33; AOR = 1.24). Furthermore, females and males in more positive LGBTQ school climates had lower odds of obesity than those in less positive school climates (AOR = 0.84; AOR = 0.85). There were no sexual identity differences in these models. Findings support the careful consideration of school violence victimization and LGBTQ school climate in future obesity prevention initiatives.
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Affiliation(s)
- April J Ancheta
- Perelman School of Medicine, University of Pennsylvania, 13th Floor, 423 Guardian Dr, Philadelphia, PA, 19146, USA.
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, 19146, USA.
| | - Tonda L Hughes
- Columbia University School of Nursing, New York, NY, 10032, USA
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, 10032, USA
| | - Stephen T Russell
- Department of Human Development and Family Studies, University of Texas, 108 Dean Keeton St, Austin, TX, 78712, USA
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15
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Richson BN, Hazzard VM, Christensen KA, Hagan KE. Do the SCOFF items function differently by food-security status in U.S. college students?: Statistically, but not practically, significant differences. Eat Behav 2023; 49:101743. [PMID: 37209568 PMCID: PMC10681748 DOI: 10.1016/j.eatbeh.2023.101743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/05/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Abstract
Despite food insecurity (FI) being associated with eating disorders (EDs), little research has examined if ED screening measures perform differently in individuals with FI. This study tested whether items on the SCOFF performed differently as a function of FI. As many people with FI hold multiple marginalized identities, this study also tested if the SCOFF performs differently as a function of food-security status in individuals with different gender identities and different perceived weight statuses. Data were from the 2020/2021 Healthy Minds Study (N = 122,269). Past-year FI was established using the two-item Hunger Vital Sign. Differential item functioning (DIF) assessed whether SCOFF items performed differently (i.e., had different probabilities of endorsement) in groups of individuals with FI versus those without. Both uniform DIF (constant between-group difference in item-endorsement probability across ED pathology) and non-uniform DIF (variable between-group difference in item-endorsement probability across ED pathology) were examined. Several SCOFF items demonstrated both statistically significant uniform and non-uniform DIF (ps < .001), but no instances of DIF reached practical significance (as indicated by effect sizes pseudo ΔR2 ≥ 0.035; all pseudo ΔR2's ≤ 0.006). When stratifying by gender identity and weight status, although most items demonstrated statistically significant DIF, only the SCOFF item measuring body-size perception showed practically significant non-uniform DIF for perceived weight status. Findings suggest the SCOFF is an appropriate screening measure for ED pathology among college students with FI and provide preliminary support for using the SCOFF in individuals with FI and certain marginalized identities.
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Affiliation(s)
- Brianne N Richson
- Department of Psychology, University of Kansas, Lawrence, KS, USA; Department of Psychiatry, University of California San Diego Eating Disorders Center for Treatment and Research, San Diego, CA, USA.
| | - Vivienne M Hazzard
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kara A Christensen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Kelsey E Hagan
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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16
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Gomes SM, Jacob MCM, Chaves VM, Pereira de Sousa LM, Signorelli MC, Canavese de Oliveira D, de Oliveira Lyra C, Roberto Augusto Noro L. Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic. PLoS One 2023; 18:e0284257. [PMID: 37163501 PMCID: PMC10171619 DOI: 10.1371/journal.pone.0284257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/27/2023] [Indexed: 05/12/2023] Open
Abstract
Transgender people often live with social vulnerability, largely promoted by gender-based prejudice. Our aim in this article was to raise preliminary data on how the COVID-19 pandemic and perceived prejudice have contributed to the problem of food and food insecurity in the transgender communities in Brazil. We conducted a web-based cross-sectional study, in which 109 transgender people from all regions of Brazil participated. We used the Chi-Square test and Poisson regression modeling with robust variance to estimate the association between food insecurity and the investigated factors. In our sample, 68.8% of transgender people experienced food insecurity, of these, 20.2% experienced severe food insecurity. Our results showed that the difficulties in purchasing food in the transgender community predate the COVID-19 pandemic, yet that the restrictive measures adopted have also impacted overall access to quality food. However, the main explanations for food insecurity were income and employment. In predicting food insecurity, the experiences of prejudice must be considered, and give rise to the hypothesis that specific conditions to which transgender people are exposed explain, to some degree, their vulnerability to food insecurity.
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Affiliation(s)
- Sávio Marcelino Gomes
- Department of Nutrition, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Michelle Cristine Medeiros Jacob
- Department of Nutrition, Laboratório Horta Comunitária Nutrir, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Viviany Moura Chaves
- Department of Nutrition, Laboratório Horta Comunitária Nutrir, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Luciana Maria Pereira de Sousa
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Daniel Canavese de Oliveira
- Department of Public Health, Universidade federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Clélia de Oliveira Lyra
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Luiz Roberto Augusto Noro
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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17
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Leslie IS, Carson J, Bruce A. LGBTQ+ food insufficiency in New England. AGRICULTURE AND HUMAN VALUES 2022; 40:1-16. [PMID: 36530207 PMCID: PMC9735207 DOI: 10.1007/s10460-022-10403-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
As a group, LGBTQ+ people experience food insecurity at a disproportionately high rate, yet food security scholars and practitioners are only beginning to uncover patterns in how food insecurity varies by subgroups of this diverse community. In this paper, we use data from the U.S. Census Bureau's Household Pulse Survey-which added measures of gender identity and sexuality for the first time in 2021-to analyze New Englanders' food insufficiency rates by gender, sexuality, race, and ethnicity. We find that (1) in the past seven days, 13.0 percent of LGB + (lesbian, gay, bisexual, and other non-heterosexual) New Englanders experience food insufficiency-which is nearly twice the rate of heterosexual people-and 19.8 percent of transgender+ (transgender, genderqueer, gender non-binary, and other non-cisgender people) New Englanders experience food insufficiency-which is two to three times the rate of cisgender men and women. (2) Whereas cisgender New Englanders experience food insufficiency at a lower rate than their counterparts in the rest of the nation (about two percentage points lower for both cisgender men and women), transgender+ New Englanders experience no such New England advantage compared to transgender+ people in the country as a whole. (3) LGBTQ+ New Englanders of color experience devastatingly high rates of food insufficiency, with, for example, one in three Black transgender+ New Englanders not having enough food to eat in the past seven days. These findings suggest that addressing food insecurity in New England demands approaching the problem with an intersectional queer lens, with attention to the ways in which racism, cissexism, and heterosexism are creating a systemic, ongoing food crisis for LGBTQ+ New Englanders, especially those who are transgender+ and/or people of color.
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Affiliation(s)
- Isaac Sohn Leslie
- University of Vermont Extension, 130 Austine Dr. #300, Brattleboro, VT 05301 USA
| | - Jessica Carson
- Carsey School of Public Policy, University of New Hampshire, 73 Main Street, Durham, NH 03824 USA
| | - Analena Bruce
- Department of Agriculture, Nutrition, and Food Systems, University of New Hampshire, 129 Main Street, Durham, NH 03824 USA
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18
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Kent K, Visentin D, Peterson C, Ayre I, Elliott C, Primo C, Murray S. Severity of Food Insecurity among Australian University Students, Professional and Academic Staff. Nutrients 2022; 14:nu14193956. [PMID: 36235608 PMCID: PMC9571391 DOI: 10.3390/nu14193956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022] Open
Abstract
Assessments of the severity of food insecurity within Australian university students are lacking, and the experience of food insecurity in Australian university staff is unknown. A cross-sectional online survey in March 2022 aimed to characterize the severity of food insecurity in students, professional and academic staff at the University of Tasmania (UTAS). The Household Food Security Survey Module six-item short form assessed food security status in addition to seven demographic and education characteristics for students and six demographic and employment characteristics for staff. Participants were categorized as having high, marginal, low, or very low food security. Multivariate binary logistic regression identified students and staff at higher risk of food insecurity. Among student respondents (n = 1257), the prevalence of food insecurity was 41.9% comprising 8.2% marginal, 16.5% low, and 17.3% very low food security. Younger, non-binary, first-year enrolled, on campus, and international students were at significantly higher risk of food insecurity. Among staff (n = 560), 16.3% were food insecure comprising 3.8% marginal, 5.5% low, and 7.0% very low food security. Professional staff, staff on casual contracts, and staff recently employed, were at significantly higher risk of food insecurity. Our findings suggest a high occurrence of food insecurity in UTAS students and staff, with a large proportion of food insecure staff and students experiencing very low food security. Our findings have implications for efforts towards reducing food insecurity at university campuses through a holistic and integrated approach, advocating for food systems that support healthy, sustainable, and equitable food procurement and provision for both university students and staff.
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Affiliation(s)
- Katherine Kent
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
- School of Health Sciences, University of Tasmania, Launceston, TAS 7250, Australia
- Correspondence: (K.K.); (S.M.)
| | - Denis Visentin
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
| | - Corey Peterson
- Sustainability Unit, University of Tasmania, Launceston, TAS 7250, Australia
| | - Ian Ayre
- Sustainability Unit, University of Tasmania, Launceston, TAS 7250, Australia
| | - Catherine Elliott
- Sustainability Unit, University of Tasmania, Launceston, TAS 7250, Australia
| | - Carmen Primo
- Sustainability Unit, University of Tasmania, Launceston, TAS 7250, Australia
| | - Sandra Murray
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
- Correspondence: (K.K.); (S.M.)
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19
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Linsenmeyer W, Garwood S, Waters J. An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients. J Acad Nutr Diet 2022; 122:1081-1086. [DOI: 10.1016/j.jand.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
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20
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Gomes SM, Jacob MC, Rocha C, Medeiros MF, Lyra CO, Noro LR. Expanding the limits of sex: a systematic review concerning food and nutrition in transgender populations. Public Health Nutr 2021; 24:6436-6449. [PMID: 33866993 PMCID: PMC11148592 DOI: 10.1017/s1368980021001671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the literature and identify main themes, methods and results of studies concerning food and nutrition addressed in research on transgender populations. DESIGN A systematic review conducted through July 2020 in the MedLine/PubMed, Scopus and Web of Science databases. RESULTS Of the 778 studies identified in the databases, we selected thirty-seven. The studies were recent, most of them published after 2015, being produced in Global North countries. The most often used study design was cross-sectional; the least frequently used study design was ethnographic. Body image and weight control were predominant themes (n 25), followed by food and nutrition security (n 5), nutritional status (n 5), nutritional health assistance (n 1) and emic visions of healthy eating (n 1). CONCLUSIONS The transgender community presents body, food and nutritional relationships traversed by its unique gender experience, which challenges dietary and nutritional recommendations based on the traditional division by sex (male and female). We need to complete the lacking research and understand contexts in the Global South, strategically investing in exploratory-ethnographic research, to develop categories of analysis and recommendations that consider the transgender experience.
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Affiliation(s)
- Sávio Marcelino Gomes
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, 59056-000 Natal, Natal, Rio Grande do Norte, Brazil
- Laboratório Horta Comunitária Nutrir, Nutrition Department, Universidade Federal do Rio Grande do Norte, 59078-970 Natal, Natal, Rio Grande do Norte, Brazil
| | - Michelle Cm Jacob
- Laboratório Horta Comunitária Nutrir, Nutrition Department, Universidade Federal do Rio Grande do Norte, 59078-970 Natal, Natal, Rio Grande do Norte, Brazil
| | - Cecília Rocha
- Centre for Studies in Food Security, School of Nutrition, Ryerson University, Toronto, ONM5B 2K3, Canada
| | - Maria Fa Medeiros
- Laboratório Horta Comunitária Nutrir, Nutrition Department, Universidade Federal do Rio Grande do Norte, 59078-970 Natal, Natal, Rio Grande do Norte, Brazil
| | - Clélia O Lyra
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, 59056-000 Natal, Natal, Rio Grande do Norte, Brazil
| | - Luiz Ra Noro
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, 59056-000 Natal, Natal, Rio Grande do Norte, Brazil
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21
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Gibb JK, Shokoohi M, Salway T, Ross LE. Sexual orientation-based disparities in food security among adults in the United States: results from the 2003-2016 NHANES. Am J Clin Nutr 2021; 114:2006-2016. [PMID: 34551071 DOI: 10.1093/ajcn/nqab290] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/11/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Access to sufficient, safe, culturally appropriate, and nutritious food is essential for maintaining both physical and mental health. Despite a growing body of evidence suggesting that sexual minority (SM) people experience significant disparities in socioeconomic and material resource security, there remains a paucity of empirical studies examining the prevalence of food insecurity among SM people relative to their heterosexual peers. OBJECTIVES To determine the prevalence of adult and household food insecurity across sexual orientation groups in the United States after adjusting for multiple covariates. METHODS We combined 7 cycles of US NHANES, 2003-2016 (N = 21,300) to examine sexual orientation-based disparities in adult food security among lesbian/gay (n = 373), bisexual (n = 606), same-sex experienced (SSE, n = 693), other sexual minorities (OSMs, n = 88), and heterosexual (n = 19,540) people. Food (in)security was measured using the US Food Security Survey Module and categorized as secure, marginally insecure, moderately insecure, and severely insecure. RESULTS Severe adult food insecurity was higher among bisexuals (17.16%; 95% CI: 14.36, 20.38), SSE (13.71%; 95% CI: 11.34, 16.48), OSMs (12.50%; 95% CI: 7.04, 21.24), and lesbians/gays (13.14%; 95% CI: 10.07, 16.97) compared with heterosexuals (8.23%; 95% CI: 7.85, 8.62). Multivariable multinomial logistic regression analysis adjusting for gender, race/ethnicity, age, citizenship, education, household size, income, cycle year, emergency food use, and Supplemental Nutrition Assistance Program participation showed that bisexuals, OSMs, SSE, and lesbians/gays were more likely to experience moderate to severe food insecurity compared with heterosexuals. CONCLUSIONS SM people are significantly more likely to experience increased likelihood of food insecurity relative to their heterosexual peers.
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Affiliation(s)
- James K Gibb
- Department of Health & Society, University of Toronto, Scarborough, Ontario, Canada.,Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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22
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Quathamer NN, Joy P. Being in a queer time: Exploring the influence of the COVID-19 pandemic on LGBTQ+ body image. Nutr Diet 2021; 79:400-410. [PMID: 34337841 PMCID: PMC8441880 DOI: 10.1111/1747-0080.12699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/21/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022]
Abstract
Aim The isolating public health measures mandated during the COVID‐19 pandemic had complex influences on the lives and body image of lesbian, gay, bisexual, trans, and queer individuals (LGBTQ+) in Canada. The aim of this study was to explore the impact the COVID‐19 pandemic had on body image for LGBTQ+ Canadians. Methods The qualitative research process was guided by queer theory and poststructuralism and consisted of an online survey with open‐ended questions and semi‐structured virtual interviews. A total of 70 self‐identifying LGBTQ+ individuals completed the survey, and eight individuals partook in the interviews. Responses were analysed using Foucauldian discourse analysis. Results Four major discursive considerations were found to shape participants' experiences, including, (a) time for reflection, (b) time away from social surveillance, (c) time to work on oneself, and (d) time to (dis)connect. Woven through these considerations were social discourses of hetero‐cis‐normativity, healthism, and resistance. Discussion The COVID‐19 pandemic was a ‘queer time’ for LGBTQ+ people. Competing social discourses created complex and often contradictory meanings of bodies and body image. COVID‐19‐related self‐isolation was for some participants a reprieve from constant body monitoring while for others it was a time of continued pressure to embody body ideals. Participants suggested that nutritional messages during such times be ones of compassion and non‐judgement of bodies.
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Affiliation(s)
- Natalie Nat Quathamer
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Phillip Joy
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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23
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Joy P. Exploring the Experiences and the Nutritional Supports of LGBTQ+ Canadians during the COVID-19 Pandemic. CAN J DIET PRACT RES 2021; 82:183-191. [PMID: 34286620 DOI: 10.3148/cjdpr-2021-015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: The COVID-19 pandemic has impacted the lives of lesbian, gay, bi, trans, queer, and other groups (LGBTQ+) within Canada. This research aimed to explore the experiences of LGBTQ+ Canadians in relation to their nutritional needs, practices, and supports during the COVID-19 pandemic.Methods: The qualitative study was framed within a poststructuralism and queer theory paradigm and consisted of an online questionnaire. Participants were recruited and asked to complete open-ended questions. Responses were coded using thematic analysis.Results: Seventy participants completed the questionnaire. Data analysis resulted in 3 major themes, including (i) (dis)comforts of food and eating, (ii) shifting views of food and food practices, and (iii) what supports? The themes revealed that many LGBTQ+ individuals experienced stress and anxiety during the COVID-19 pandemic. It was a time in which their views and practices of food, cooking, and eating were changed. Nutritional supports were discussed in terms of family, friends, and partners.Conclusion: The findings highlight the complexity to the meanings people give to food, cooking, and eating during stressful times. It is recommended that dietitians familiarize themselves with the experiences of LGBTQ+ people, especially during times of global health emergencies to ensure equitable health care for LGBTQ+ communities.
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Affiliation(s)
- Phillip Joy
- Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS
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24
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Linsenmeyer WR, Katz IM, Reed JL, Giedinghagen AM, Lewis CB, Garwood SK. Disordered Eating, Food Insecurity, and Weight Status Among Transgender and Gender Nonbinary Youth and Young Adults: A Cross-Sectional Study Using a Nutrition Screening Protocol. LGBT Health 2021; 8:359-366. [PMID: 34097472 DOI: 10.1089/lgbt.2020.0308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose: The purpose of this study was to describe the prevalence of and relationships among disordered eating, food insecurity, and weight status among transgender and gender nonbinary youth and young adults. Methods: This cross-sectional study involved a screening protocol to assess disordered eating and food insecurity risk from September to December of 2019 at a gender clinic using five validated measures: (1) previous eating disorder diagnosis (yes/no); (2) Sick, Control, One Stone, Fat, Food Questionnaire (SCOFF); (3) Adolescent Binge Eating Disorder Questionnaire (ADO-BED); (4) Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS); and (5) Hunger Vital Sign. Age, assigned sex at birth, gender identity, stage of medical transition, and body mass index were collected. Pearson's r correlation coefficients, between-groups t-tests, one-way analysis of variance tests, and Tukey's honest significant difference test were used to characterize the relationships between variables. Results: A total of 164 participants ages 12-23 years completed the screener. Using assigned sex at birth, 1.8% were underweight, 53% were a healthy weight, 17.1% were overweight, and 28.0% were obese. An estimated 8.7% reported a previous eating disorder diagnosis, 28.0% screened positive on the SCOFF, 9.1% on the ADO-BED, 75.0% on the NIAS, and 21.2% on the Hunger Vital Sign. Transgender males scored higher on the NIAS than transgender females (p = 0.03). Those with a previous eating disorder diagnosis scored significantly higher on the Hunger Vital Sign (p < 0.05). Conclusion: Gender clinics should routinely screen for disordered eating, food insecurity, overweight, and obesity to identify patients in need of further evaluation and referral.
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Affiliation(s)
- Whitney R Linsenmeyer
- Department of Nutrition and Dietetics, Saint Louis University, St. Louis, Missouri, USA
| | - Ian M Katz
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Jamie L Reed
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrea M Giedinghagen
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher B Lewis
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sarah K Garwood
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
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Tomar A, Spadine MN, Graves-Boswell T, Wigfall LT. COVID-19 among LGBTQ+ individuals living with HIV/AIDS: psycho-social challenges and care options. AIMS Public Health 2021; 8:303-308. [PMID: 34017893 PMCID: PMC8116188 DOI: 10.3934/publichealth.2021023] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022] Open
Abstract
Prolonged social isolation during the COVID-19 lockdown has adversely impacted the mental, social, and physical wellbeing of the global populace. Coping with mental and physical stressors amidst the global lockdown is especially strenuous for the Lesbian, Gay, Bisexual, Transgender, and more (LGBT+) community, who are frequently subjected to social stigma and minority stress. Systematic stigma and discrimination place LGBT+ individuals at higher risk for deleterious behaviors, such as substance abuse (e.g., injection drug use, smoking, alcohol) and risky sexual practices (e.g., anal/vaginal/oral sex). Maladaptive coping behaviors consequently increase the chances of HIV/AIDS risk among LGBT+ individuals, compared to heterosexual individuals. LGBT+ individuals Living with HIV/AIDS perpetually face higher rates of unemployment, income disparity, and intimate partner violence. Prolonged home confinement, and impaired accessibility to healthcare, legal, and criminal justice services during lockdown may deplete the quality of life of LGBT+ individuals Living with HIV/AIDS. Therefore, it is critical that multidisciplinary service providers, including health professionals, employers, social services providers, educational institutions and community organizations, move toward online service delivery, so that homebound HIV-positive LGBT+ individuals are secured with a wide range of care options. Non-judgemental, tele-counseling may bridge the gap to mental health services. Community clinics catering to HIV-positive and/or LGBT+ clients may consider precociously supplying essential amenities, such as Preexposure (PrEP)/postexposure prophylaxis (PEP), condoms, emergency contraception, and sterile needles. Lastly, efforts directed at the sustenance of at-risk/HIV-positive LGBT+ health should persevere, even after the pandemic.
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Affiliation(s)
- Aditi Tomar
- Department of Health Education and Kinesiology, College of Education and Human Development, Texas A&M University, USA
| | - Mandy N Spadine
- Department of Health Education and Kinesiology, College of Education and Human Development, Texas A&M University, USA
| | - Taylor Graves-Boswell
- Department of Health Education and Kinesiology, College of Education and Human Development, Texas A&M University, USA
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Engelman A, Paludneviciene R, Wagner K, Jacobs K, Kushalnagar P. Food Worry in the Deaf and Hard-of-Hearing Population During the COVID-19 Pandemic. Public Health Rep 2021; 136:239-244. [PMID: 33296264 PMCID: PMC8093837 DOI: 10.1177/0033354920974666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID) pandemic has highlighted preexisting health disparities, including food insecurity, in the deaf and hard-of-hearing (DHH) population. We examined factors associated with food worry during the COVID-19 pandemic. METHODS We collected survey data on worry about food shortages, worry about contracting COVID-19, and concerns about DHH people staying home and being lonely from April 17 through May 1, 2020, via a bilingual American Sign Language/English online survey platform. The sample consisted of 537 DHH adults living in the United States. We examined the relationship between demographic characteristics and food worry. We used logistic regression and model fitting to predict the likelihood of experiencing food worry. RESULTS The mean (SD) age of survey respondents was 47 (16), and 25% of the sample identified as people of color. Forty-two percent of survey respondents had a high level of food worry. Increased worry about contracting COVID-19 and concerns about DHH people staying home and being lonely among DHH younger adults or those without a college degree predicted food worry. Gender and race/ethnicity did not contribute to the model for food worry. CONCLUSIONS Food worry was explained by multiple, intersecting factors, including demographic variables, worry about contracting COVID-19, and concerns about loneliness. Interventions or programs implemented by DHH-serving organizations as well as government programs, social service providers, and food banks should be fully accessible to subgroups of DHH young adults without a college degree who are at risk for food insecurity.
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Affiliation(s)
- Alina Engelman
- Department of Health Sciences, California State University, East
Bay, Hayward, CA, USA
| | - Raylene Paludneviciene
- Department of Psychology, Gallaudet University, Washington, DC,
USA
- Center for Deaf Health Equity, Gallaudet University, Washington,
DC, USA
| | - Kathryn Wagner
- Department of Psychology, Gallaudet University, Washington, DC,
USA
| | - Katja Jacobs
- Department of Psychology, Gallaudet University, Washington, DC,
USA
| | - Poorna Kushalnagar
- Department of Psychology, Gallaudet University, Washington, DC,
USA
- Center for Deaf Health Equity, Gallaudet University, Washington,
DC, USA
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DuBois LZ, Gibb JK, Juster RP, Powers SI. Biocultural approaches to transgender and gender diverse experience and health: Integrating biomarkers and advancing gender/sex research. Am J Hum Biol 2020; 33:e23555. [PMID: 33340194 DOI: 10.1002/ajhb.23555] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/06/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022] Open
Abstract
Transgender and gender diverse (TGD) people are increasingly visible in U.S. communities and in national media. With this increased visibility, access to gender affirming healthcare is also on the rise, particularly for urban youth. Political backlash and entrenchment in a gender binary, however, continue to marginalize TGD people, increasing risk for health disparities. The 2016 National Institute of Health recognition of sexual and gender minority people as a health disparities population increases available funding for much-needed research. In this article, we speak to the need for a biocultural human biology of gender/sex diversity by delineating factors that influence physiological functioning, mental health, and physical health of TGD people. We propose that many of these factors can best be investigated with minimally invasively collected biomarker samples (MICBS) and discuss how to integrate MICBS into research inclusive of TGD people. Research use of MICBS among TGD people remains limited, and wider use could enable essential biological and health data to be collected from a population often excluded from research. We provide a broad overview of terminology and current literature, point to key research questions, and address potential challenges researchers might face when aiming to integrate MCIBS in research inclusive of transgender and gender diverse people. We argue that, when used effectively, MICBS can enhance human biologists' ability to empirically measure physiology and health-related outcomes and enable more accurate identification of pathways linking human experience, embodiment, and health.
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Affiliation(s)
- L Zachary DuBois
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - James K Gibb
- Department of Anthropology, University of Toronto, Ontario, Canada
| | | | - Sally I Powers
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Sexual orientation and food insecurity: findings from the New York City Community Health Survey. Public Health Nutr 2020; 24:5657-5662. [PMID: 33331259 DOI: 10.1017/s1368980020005157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Food insecurity is a serious public health concern that disproportionately impacts minority groups. However, limited research has assessed food insecurity among sexual minorities. The current study investigates whether individuals identifying as lesbian/gay or bisexual (LGB) sexual orientation were more likely to experience food insecurity relative to heterosexual persons. DESIGN Data are from the 2017 and 2018 New York City Community Health Survey. Multinomial logistic regression is used to assess the association between sexual orientation and food insecurity. SETTING A sample of adults (18 years and older) who identify as heterosexual, gay/lesbian or bisexual living in New York City in 2017 and 2018. PARTICIPANTS 18 610 non-institutionalised adults. RESULTS Bisexual individuals have significantly higher rates of both mild (relative risk ratio (RRR) = 1·719, 95 % CI 1·148, 2·573) and moderate-to-severe food insecurity (RRR = 1·851, 95 % CI 1·097, 3·122) relative to heterosexual individuals, net of covariates from demographic, household and socio-economic characteristics. Study findings showed no difference in the likelihood of food insecurity between gay/lesbian individuals and heterosexual individuals. CONCLUSION Results illustrate a complex interplay between sexual orientation and food insecurity among adults living in New York City. Findings suggest that efforts to connect LGB individuals to public assistance programmes such as Supplemental Nutritional Assistance Program, as well as providing information and connections to food assistance through local LGBTQ+ centres, government agencies (i.e., NYC Human Resources Administration) and non-profit organisations (i.e., Food Bank for New York City) may be beneficial approaches to alleviate food insecurity among this population.
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Patterson JG, Russomanno J, Teferra AA, Jabson Tree JM. Disparities in food insecurity at the intersection of race and sexual orientation: A population-based study of adult women in the United States. SSM Popul Health 2020; 12:100655. [PMID: 32864410 PMCID: PMC7442904 DOI: 10.1016/j.ssmph.2020.100655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023] Open
Abstract
Food insecurity affects 1 in 8 American adults annually, and is more prevalent in Black and sexual minority women. We applied an intersectional approach to investigate food insecurity prevalence in women with intersecting minority race and sexual orientation. We used two United States surveillance systems-National Health Interview Survey (NHIS) 2013-2018 and National Health and Nutrition Examination Survey (NHANES) 2005-2014, to estimate how race and sexual orientation jointly influence food insecurity prevalence in women aged 18-59 years (NHIS: N = 47596; NHANES: N = 5106). All analyses were stratified for Supplemental Nutrition Assistance Program (SNAP) use. Relative measures estimated weighted prevalence ratios (PR) comparing Black and White sexual minority women (SMW) to heterosexual White women. Absolute prevalence measures estimated the excess prevalence of food insecurity due to multiple marginalization. Patterns of food insecurity prevalence were similar across NHIS and NHANES, and differed only for non-SNAP users. Relative prevalence of food insecurity was greater in Black SMW than heterosexual White women in NHIS (PR: 2.16; 95% confidence interval [CI], 1.41-3.30) and NHANES (PR: 2.79; 95% CI, 1.73-4.51). The strength of the association between multiple marginalization and food insecurity was stronger for Black SMW than White SMW. Absolute measures were significant only for NHIS and did not support our a priori hypothesis: For non-SNAP users, being Black and sexual minority reduced the joint disparity in food insecurity by approximately 50% (Synergy Index: 0.52; 95% CI, 0.11-0.93). Overall, our study illuminated population-level differences in food insecurity among women of diverse minority races and sexual orientations. Black SMW experienced high rates of food insecurity, which may contribute to chronic disease disparities. Yet, intersecting minority social positions (race and sexual orientation) reduced food insecurity; these findings are unexpected and must be further investigated. Increasing SNAP use among multiply marginalized women may attenuate food insecurity disparities.
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Affiliation(s)
- Joanne G. Patterson
- The Ohio State University Comprehensive Cancer Center, 1841 Neil Avenue, 400A Cunz Hall, Columbus, OH, 43210, United States
| | - Jennifer Russomanno
- University of Tennessee Graduate School of Medicine, Office of Continuing Education & Professional Development, 1924 Alcoa Highway, Box U94, Knoxville, TN, 37920, United States
| | - Andreas A. Teferra
- The Ohio State University College of Public Health, 1841 Neil Avenue, Cunz Hall, Columbus, OH, 43210, United States
| | - Jennifer M. Jabson Tree
- University of Tennessee Department of Public Health, 1814 Andy Holt Avenue, 360 HPER, Knoxville, TN, 37996, United States
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Sanchez C, Grzenda A, Varias A, Widge AS, Carpenter LL, McDonald WM, Nemeroff CB, Kalin NH, Martin G, Tohen M, Filippou-Frye M, Ramsey D, Linos E, Mangurian C, Rodriguez CI. Social media recruitment for mental health research: A systematic review. Compr Psychiatry 2020; 103:152197. [PMID: 32992073 PMCID: PMC7704547 DOI: 10.1016/j.comppsych.2020.152197] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/14/2020] [Accepted: 08/06/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Social media holds exciting promise for advancing mental health research recruitment, however, the extent and efficacy to which these platforms are currently in use are underexplored. OBJECTIVE A systematic review was conducted to characterize the current use and efficacy of social media in recruiting participants for mental health research. METHOD A literature review was performed using MEDLINE, EMBASE, and PsychINFO. Only non-duplicative manuscripts written in the English language and published between 1/1/2004-3/31/2019 were selected for further screening. Data extracted included study type and design, participant inclusion criteria, social media platform, advertising strategy, final recruited sample size, recruitment location, year, monetary incentives, comparison to other recruitment methods if performed, and final cost per participant. RESULTS A total of 176 unique studies that used social media for mental health research recruitment were reviewed. The majority of studies were cross-sectional (62.5%) in design and recruited adults. Facebook was overwhelmingly the recruitment platform of choice (92.6%), with the use of paid advertisements being the predominant strategy (60.8%). Of the reviewed studies, substance abuse (43.8%) and mood disorders (15.3%) were the primary subjects of investigation. In 68.3% of studies, social media recruitment performed as well as or better than traditional recruitment methods in the number and cost of final enrolled participants. The majority of studies used Facebook for recruitment at a median cost per final recruited study participant of $19.47. In 55.6% of the studies, social media recruitment was the more cost-effective recruitment method when compared to traditional methods (e.g., referrals, mailing). CONCLUSION Social media appears to be an effective and economical recruitment tool for mental health research. The platform raises methodological and privacy concerns not covered in current research regulations that warrant additional consideration.
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Affiliation(s)
- Catherine Sanchez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Adrienne Grzenda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Andrea Varias
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Alik S Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
| | - Linda L Carpenter
- Department of Psychiatry and Human Behavior, Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - William M McDonald
- Department of Psychiatry and Human Behavior, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles B Nemeroff
- Department of Psychiatry, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Glenn Martin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Maria Filippou-Frye
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Drew Ramsey
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University, Stanford, CA, USA
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA; UCSF Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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Patterson JG, Russomanno J, Jabson Tree JM. Sexual orientation disparities in food insecurity and food assistance use in U.S. adult women: National Health and Nutrition Examination Survey, 2005-2014. BMC Public Health 2020; 20:1155. [PMID: 32787863 PMCID: PMC7425068 DOI: 10.1186/s12889-020-09261-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 07/14/2020] [Indexed: 01/13/2023] Open
Abstract
Background Nearly 40 million American adults report past year food insecurity. This is concerning, as food insecurity is associated with chronic disease morbidity and premature mortality. Women disproportionately experience food insecurity, and sexual minority women (i.e., lesbian, bisexual, and heterosexual women reporting same-sex behavior; SMW) may be at greater risk for experiencing food insecurity disparities. The purpose of this study was to investigate patterns and prevalence of food insecurity and food assistance use in sexual minority and exclusively heterosexual women using population-level health surveillance data. Methods Using pooled 2004–2014 National Health and Nutrition Examination Survey data (N = 7379), we estimated weighted point prevalence of past 12-month food insecurity, severe food insecurity, Supplemental Nutrition Assistance Program (SNAP) use, and emergency food assistance use. We then used Poisson regression with robust variance to estimate prevalence ratios comparing SMW to exclusively heterosexual women on all outcomes. Women were classified by sexual identity and lifetime same-sex behavior as lesbian (n = 88), bisexual (n = 251), heterosexual and reporting same-sex behavior (heterosexual WSW; n = 366), or exclusively heterosexual women (referent; n = 6674). Results Between 20.6–27.3% of lesbian, bisexual, and heterosexual WSW reported past 12-month food insecurity (versus 13.1% of exclusively heterosexual women). All SMW reported greater prevalence of past 12-month food insecurity and severe food insecurity than exclusively heterosexual women: prevalence ratios (PR) ranged from 1.34 (95% confidence interval [CI], 1.05–1.70) to 1.84 (95% CI, 1.13–3.01). No differences were found in SNAP participation by sexual orientation, but more lesbians and heterosexual WSW reported using emergency food assistance in the past 12-months (PR = 1.89; 95% CI, 1.29–2.79 and PR = 1.43; 95% CI, 1.03–2.00 respectively). Conclusions All SMW reported higher prevalence of food insecurity than exclusively heterosexual women. Lesbians and heterosexual WSW were also more likely to rely on emergency food assistance. This is problematic as SNAP use may reduce food insecurity over time, but emergency food resources (e.g., food pantries) do not. More evidence is needed to understand the multilevel factors driving food insecurity in this population to develop policy and community-based efforts to increase SNAP participation and decrease food insecurity.
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Affiliation(s)
- Joanne G Patterson
- The Ohio State University Comprehensive Cancer Center, c/o College of Public Health, 1841 Neil Avenue, 400A Cunz Hall, Columbus, OH, 43110, USA.
| | - Jennifer Russomanno
- University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Box U94, Knoxville, TN, 37920, USA
| | - Jennifer M Jabson Tree
- University of Tennessee Department of Public Health, 367 HPER, Knoxville, TN, 37996, USA
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Russomanno J, Jabson Tree JM. Food insecurity and food pantry use among transgender and gender non-conforming people in the Southeast United States. BMC Public Health 2020; 20:590. [PMID: 32349699 PMCID: PMC7191729 DOI: 10.1186/s12889-020-08684-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transgender and gender non-conforming (TGNC) people face high rates of poverty, joblessness, and homelessness, rendering this population vulnerable to experiencing food insecurity. Yet, there is almost no empirical evidence concerning food insecurity and the use of local and federal food assistance resources in the TGNC community. Food insecurity, the use of local and Federal food assistance resources, and associations with gender-related minority stressors and resilience using the Gender Minority Stress and Resilience (GMSR) scale among TGNC individuals living in the Southeast United States (U.S.) were documented in this study. METHODS A cross-sectional online survey was conducted with TGNC people living in the Southeast U.S. Participants were recruited via targeted Facebook advertisements. RESULTS In total, 105 TGNC people completed the survey; 79% of survey participants experienced food insecurity, 19% utilized Federal, and 22% utilized local food assistance resources. High levels of minority stress and community resilience were reported. The GMSR resilience scale Pride (aOR = 1.09, 95% CI 1.00-1.19, p = .04) was significantly associated with the use of local food pantries, but minority stressors were not. No significant associations were found between GMSR and food security. CONCLUSION TGNC people living in the Southeast U.S. experienced food insecurity, unstable housing, low wages, and social stigma that were a barrier to using emergency food resources. Multi-level public health solutions that address discriminatory legislative policies and create linkages between TGNC people and local and federal food assistance are required to address issues of food insecurity in the TGNC population.
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Affiliation(s)
- Jennifer Russomanno
- The University of Tennessee Department of Public Health, 1924 Alcoa Highway, Knoxville, TN, 37920, USA.
| | - Jennifer M Jabson Tree
- The University of Tennessee Department of Public Health, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
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Bishop A, Overcash F, McGuire J, Reicks M. Diet and Physical Activity Behaviors Among Adolescent Transgender Students: School Survey Results. J Adolesc Health 2020; 66:484-490. [PMID: 31959401 DOI: 10.1016/j.jadohealth.2019.10.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/10/2019] [Accepted: 10/13/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Diet and physical activity behaviors are determinants of health for adolescents; however, few studies have assessed these behaviors among transgender youth. This study examined dietary behaviors, physical activity, weight-based bullying, and weight status among four groups based on transgender and gender nonconforming (TGNC) status and birth-assigned sex. METHODS Data were from a large cross-sectional, population-based, statewide survey of high school students (n = 80,794, Minnesota Student Survey, 2016). Comparisons were made for dietary and physical activity behaviors among TGNC and cisgender youth and among TGNC birth-assigned males and females and cisgender males and females. RESULTS About 2.7% of the total survey respondents identified as TGNC. TGNC students were more likely to be ethnically diverse, not living with a biological parent, participating in free or reduced-price school meals, and skipping meals compared with cisgender students. TGNC youth reported less frequent intake of fruit and milk and more frequent intake of fast food and soft drinks than cisgender students. TGNC students were also more likely to be overweight or obese, bullied for weight or size, and less likely to be physically active compared with cisgender youth. TGNC birth-assigned males reported more frequent intake of fast food and soft drinks and less physical activity compared with TGNC birth-assigned females and cisgender boys and girls. CONCLUSIONS TGNC students reported more negative health behaviors than cisgender students. Programs to address disparities in diet and physical activity behaviors may need to be tailored by gender identity and gender identity subgroups.
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Affiliation(s)
- Anna Bishop
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota
| | - Francine Overcash
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota
| | - Jenifer McGuire
- Department of Family Social Sciences, University of Minnesota, St. Paul, Minnesota
| | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota.
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Russomanno J, Patterson JG, Jabson Tree JM. Social Media Recruitment of Marginalized, Hard-to-Reach Populations: Development of Recruitment and Monitoring Guidelines. JMIR Public Health Surveill 2019; 5:e14886. [PMID: 31789598 PMCID: PMC6915454 DOI: 10.2196/14886] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/27/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Social media can be a useful strategy for recruiting hard-to-reach, stigmatized populations into research studies; however, it may also introduce risks for participant and research team exposure to negative comments. Currently, there is no published formal social media recruitment and monitoring guidelines that specifically address harm reduction for social media recruitment of marginalized populations. OBJECTIVE The purpose of this research study was to investigate the utility, successes, challenges, and positive and negative consequences of using targeted Facebook advertisements as a strategy to recruit transgender and gender nonconforming (TGNC) people into a research study. METHODS TGNC adults living in the Southeast Unites States were recruited via targeted Facebook advertisements over two cycles in April and June 2017. During cycle 1, researchers only used inclusion terms to recruit the target population. During cycle 2, the social media recruitment and monitoring protocol and inclusion and exclusion terms were used. RESULTS The cycle 1 advertisement reached 8518 people and had 188 reactions, comments, and shares but produced cyberbullying, including discriminatory comments from Facebook members. Cycle 2 reached fewer people (6976) and received 166 reactions, comments, and shares but produced mostly positive comments. CONCLUSIONS Researchers must consider potential harms of using targeted Facebook advertisements to recruit hard-to-reach and stigmatized populations. To minimize harm to participants and research staff, researchers must preemptively implement detailed social media recruitment and monitoring guidelines for monitoring and responding to negative feedback on targeted Facebook advertisements.
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Affiliation(s)
- Jennifer Russomanno
- Department of Public Health, University of Tennessee, Knoxville, TN, United States
| | - Joanne G Patterson
- Arthur G James Cancer Hospital and Richard J Solove Research Institute/College of Public Health, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
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Glick JL, Lopez A, Pollock M, Theall KP. "Housing Insecurity Seems to Almost Go Hand in Hand with Being Trans": Housing Stress among Transgender and Gender Non-conforming Individuals in New Orleans. J Urban Health 2019; 96:751-759. [PMID: 31529193 PMCID: PMC6814659 DOI: 10.1007/s11524-019-00384-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Housing is an important social determinant of physical and mental health. Transgender and gender non-conforming individuals (T/GNCI) face a unique constellation of discrimination and compromised social services, putting them at risk for housing insecurity, homelessness, and its associated public health concerns. This study explores housing insecurity among T/GNCI in New Orleans, LA, where the infrastructural landscape is marked by an underinvestment in housing stock and disaster capitalism. In-depth interviews were conducted with T/GNCI (n = 17) living in New Orleans, identified through purposive sampling. Semi-structured guides were used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes using NVIVO 11. Respondents discussed an array of circumstances that contribute to housing insecurity, including intersectional stigma and discrimination coupled with gentrification and a changing housing landscape in the city. Housing was intricately intertwined with employment and other structural issues; vulnerability in one realm was closely tied to insecurity in the others. Social support and queer family structures emerged as a key source of resilience, coping, and survival. The study supports an increase of resources for T/GNC housing access and interventions that address the cyclical discrimination, housing, and employment issues this population faces with a consideration of the historical and current structural barriers impeding their access to safe, stable, long-term housing.
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Affiliation(s)
- Jennifer L Glick
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Alex Lopez
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Miranda Pollock
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center - New Orleans, New Orleans, LA, 70112, USA
| | - Katherine P Theall
- Global Community Health and Behavioral Sciences and LSUHSC Comprehensive Alcohol and HIV Research Center (CARC), Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
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