1
|
Fakhrjahani I, Tiwari T, Jessani A. A Scoping Review of Oral Health Outcomes and Oral Health Service Utilization of 2SLGBTQ+ People. JDR Clin Trans Res 2024; 9:199-211. [PMID: 37968914 PMCID: PMC11184910 DOI: 10.1177/23800844231206359] [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: 11/17/2023] Open
Abstract
BACKGROUND Oral health is an integral aspect of overall well-being and quality of life. Population groups such as two-spirit, lesbian, gay, bisexual, transgender, and queer, including other sexual and gender minorities (2SLGBTQ+), have reported poor oral health outcomes. Therefore, the aim of this review was to investigate the extent and scope of the literature describing 2SLGBTQ+ oral health outcomes, including unmet oral health needs and patterns of oral health care service utilization, as well as the risk factors affecting both. METHODS A comprehensive search strategy was developed to review the scope of the literature pertinent to unmet oral health needs and factors affecting access to oral health care among 2SLGBTQ+ members, globally. In total, 6 databases were searched with a combination of keywords relevant to 2SLGBTQ+ oral health status and oral health care utilization. RESULTS Our review identified 10 studies that met the eligibility criteria. Five out of 10 studies were based in India, 4 in the United States, and 1 in Brazil. Two studies reported poorer oral health outcomes among transgender people as compared with cisgender people, while 2 studies reported similar patterns of dental service utilization between their transgender and cisgender participants. Five studies explored the personal and structural risk factors associated with poor oral health outcomes, including financial affordability and income level and perceived discrimination, including instances of misgendering in health care settings. However, further comprehensive studies must be conducted to validate the trends and findings reported by the studies in the review and to generate data from diverse regional contexts. CONCLUSIONS Our review identified that the extent of the literature in this research area is sparse and scarce. The evidence indicates poorer oral health status among 2SLGBTQ+ communities. Wider studies with diverse, representative samples are required to gain a comprehensive understanding of 2SLGBTQ+ oral health outcomes. KNOWLEDGE TRANSFER STATEMENT The results of this review will undoubtedly be important for many years to come as 2SLGBTQ+ oral health equity is prioritized by experts in public health dentistry. This review will allow other researchers to understand and fill literature gaps regarding 2SLGBTQ+ oral health outcomes, furthering this area of research.
Collapse
Affiliation(s)
- I. Fakhrjahani
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - T. Tiwari
- Department of Community Dentistry and Population Health, School of Dental Medicine, University of Colorado, Aurora, CO, USA
| | - A. Jessani
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| |
Collapse
|
2
|
Mehta V, Negi S, Mathur A, Tripathy S, Oberoi S, Shamim MA, Karobari I. Oral health status among the transgender population of India: A systematic review and meta-analysis. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38807264 DOI: 10.1111/scd.13027] [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: 04/09/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The invisibility of the transgender population within official records, combined with other socio-economic factors, impacts oral health status among transgender people. Hence, our systematic review and meta-analysis aim to generate a pooled estimate of the oral health status of the transgender community in India. MATERIAL AND METHODS A systematic search was performed across four databases. The studies included a quantitative research design conducted in India and involved self-identified transgender individuals. The pooled prevalence was determined at a 95% confidence interval (CI). Q-statistics and the I2 test were utilized to evaluate the source of heterogeneity. Leave-one-out analysis and Baujat plots were used to detect outliers within the studies. A Doi plot and LFK index were employed to assess the publication bias. RESULTS A total of 12 studies comprising 1566 transgender participants were included. The pooled prevalence of toothbrush use among transgenders in India was found at 83% (95% CI: 0.73-0.91), smoking = 12% (CI: 0.03-0.26), smokeless tobacco = 53% (CI = 0.38-0.68), dental caries = 78% (CI: 67%-88%), calculus = 65% (CI: 0.4-0.86), and bleeding 18% (CI:0.08-0.32). CONCLUSION Oral health disparities among Indian transgender individuals are evident in the low toothbrush usage, an elevated prevalence of tobacco use, and dental disorders such as calculus, cavities, and bleeding. Tailored dental health programs that include inclusive healthcare services and awareness are essential. PROSPERO REGISTRATION CRD42023468872.
Collapse
Affiliation(s)
- Vini Mehta
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri Pune, India
| | - Sapna Negi
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri Pune, India
| | - Ankita Mathur
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri Pune, India
| | - Snehasish Tripathy
- Department of Dental Research Cell, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri Pune, India
| | - Simmi Oberoi
- Department of Community Medicine, Government Medical College, Patiala, Punjab, India
| | | | - Isaqali Karobari
- Dental Research Unit, Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospital, Saveetha University, Chennai, Tamil Nadu, India
| |
Collapse
|
3
|
Dasson Bajaj P, Shenoy R, Davda LS, Mala K, Bajaj G, Rao A, K S A, Pai M, Jodalli P, B R A. A scoping review exploring oral health inequalities in India: a call for action to reform policy, practice and research. Int J Equity Health 2023; 22:242. [PMID: 37990194 PMCID: PMC10664303 DOI: 10.1186/s12939-023-02056-5] [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: 09/11/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Reduction in health inequalities and providing universal access to health care have been identified as two important global milestones by the World Health Organization for countries to achieve by 2030. Therefore, recognizing the magnitude of oral health inequalities in India has become a pressing priority to improve access to dental care within the country. This scoping review was conducted with the aim of reviewing, collating and analysing the current knowledge base on oral health inequalities in India. METHODOLOGY The scoping review followed Arksey and O'Malley's approach, and reporting was performed in accordance with the PRISMA-ScR guidelines. A systematic search was conducted on Scopus, PubMed, Web of Science, and EMBASE to identify literature addressing one or more dimensions of oral health inequalities in India, published in English between January 2002 and April 2022. The data were charted, and qualitative analysis was performed to derive themes, highlighting the key concepts emerging from this review. RESULTS In accordance with the eligibility criteria, a total of 71 articles retrieved through database search and backward citation search were included in this scoping review. The major themes ranged from individual to diverse sociodemographic factors acting as barriers to and facilitators of access to dental care. Deficiencies in human resources for oral health, along with a wide diversity in dental service provision and dental education were other major themes contributing to inequality. Subsequently, this has resulted in recommendations on restructuring the dental workforce and their development and modifications in oral health care policies and practices. The qualitative synthesis demonstrates the intertwined nature of the multiple factors that influence the goal of achieving an affordable, accessible, extensive and inclusive oral healthcare system in India. CONCLUSIONS This comprehensive review provides a broad perspective on oral health inequalities in India, providing valuable insights for both researchers and policymakers in this area and guiding their efforts towards achieving universal oral health coverage in the Indian context.
Collapse
Affiliation(s)
- Parul Dasson Bajaj
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ramya Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Latha Sanjay Davda
- Civilian Dental Surgeon, UK and Adjunct Faculty, Manipal College of Dental Sciences Mangalore, Ministry of Defense, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kundabala Mala
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Gagan Bajaj
- Department of Audiology and Speech Language Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ashwini Rao
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Aparna K S
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Mithun Pai
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Praveen Jodalli
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Avinash B R
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| |
Collapse
|
4
|
Gadhiraju T, Jalihal S, Ankola AV, Pai Khot AJ, Tom A, K RSK. Prevalence of dental caries and periodontal disease among transgenders in Belagavi district, Karnataka, India: A cross-sectional study. SPECIAL CARE IN DENTISTRY 2023; 43:546-553. [PMID: 36435634 DOI: 10.1111/scd.12806] [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: 06/23/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/28/2022]
Abstract
AIM To assess the oral health practices and the prevalence of dental caries, and periodontal disease among transgenders. METHODS AND RESULTS The study was conducted on a sample of 180 participants from the transgender community in Belagavi district over a course of two months. A trained and calibrated examiners recorded oral health status according to WHO dentition status and treatment needs (1997) and Community Periodontal Index (CPI) under the supervision of the subject expert. Chi-square test, spearman's rank correlation coefficient test, multiple linear regression and logistic regression were applied. The statistical significance was set at p ≤ .05 for all the tests. The prevalence of dental caries and periodontal disease among transgenders was 72.2% and 92.2%, respectively. A positive linear correlation and a significant relationship was found between the oral hygiene practices/deleterious habits and dental caries among the transgenders. Multiple linear regression model revealed that the prevalence of dental caries and periodontal disease was significantly associated with age and oral hygiene practices. CONCLUSION The prevalence of dental caries and periodontal diseases among transgenders was high. These results may be of use to promote oral health promotion and establishing a paradigm for dentists to work toward improving oral health.
Collapse
Affiliation(s)
- Tejaswi Gadhiraju
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Sagar Jalihal
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Anil V Ankola
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Atrey J Pai Khot
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Aleena Tom
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Ram Surath Kumar K
- Department of Public Health Dentistry, KAHER's KLE Vishwanath Katti Institute of Dental Sciences, Belagavi, Karnataka, India
| |
Collapse
|
5
|
Chakrapani V, Newman PA, Shunmugam M, Rawat S, Mohan BR, Baruah D, Tepjan S. A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people's health in India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001362. [PMID: 37079524 PMCID: PMC10118178 DOI: 10.1371/journal.pgph.0001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/18/2023] [Indexed: 04/21/2023]
Abstract
Amid incremental progress in establishing an enabling legal and policy environment for lesbian, gay, bisexual, transgender and queer-identified people, and people with intersex variations (LGBTQI+) in India, evidence gaps on LGBTQI+ health are of increasing concern. To that end, we conducted a scoping review to map and synthesize the current evidence base, identify research gaps, and provide recommendations for future research. We conducted a scoping review using the Joanna Briggs Institute methodology. We systematically searched 14 databases to identify peer-reviewed journal articles published in English language between January 1, 2010 and November 20, 2021, that reported empirical qualitative, quantitative or mixed methods data on LGBTQI+ people's health in India. Out of 3,003 results in total, we identified 177 eligible articles; 62% used quantitative, 31% qualitative, and 7% mixed methods. The majority (55%) focused on gay and other men who have sex with men (MSM), 16% transgender women, and 14% both of these populations; 4% focused on lesbian and bisexual women, and 2% on transmasculine people. Overall, studies reported high prevalence of HIV and sexually transmitted infections; multilevel risk factors for HIV; high levels of mental health burden linked to stigma, discrimination, and violence victimization; and non-availability of gender-affirmative medical care in government hospitals. Few longitudinal studies and intervention studies were identified. Findings suggest that LGBTQI+ health research in India needs to move beyond the predominant focus on HIV, and gay men/MSM and transgender women, to include mental health and non-communicable diseases, and individuals across the LGBTQI+ spectrum. Future research should build on largely descriptive studies to include explanatory and intervention studies, beyond urban to rural sites, and examine healthcare and service needs among LGBTQI+ people across the life course. Increased Indian government funding for LGBTQI+ health research, including dedicated support and training for early career researchers, is crucial to building a comprehensive and sustainable evidence base to inform targeted health policies and programs moving forward.
Collapse
Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
- The Humsafar Trust, Mumbai, India
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- VOICES-Thailand Foundation, Chiang Mai, Thailand
| | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | | | | | | | | |
Collapse
|
6
|
Tamrat J. "Trans-forming" dental practice norms: Exploring transgender identity and oral health implications. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2022; 56:131-139. [PMID: 36451990 PMCID: PMC9674002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This narrative review explores current research to broaden understanding and awareness of the transgender experience while identifying oral health needs and proposing strategies of inclusivity to optimize oral health outcomes. METHODS A comprehensive electronic literature search was conducted in the following online databases: PubMed, Google Scholar, CINAHL, and Education Source. The search yielded 35 articles with a wide range of study designs and methodologies. RESULTS & DISCUSSION Several themes emerged from the literature, including psychosocial oral health implications, barriers to oral health care, inclusive dental practice strategies, and cultural competence of oral health providers. CONCLUSION The transgender population experiences many social and health disparities that stem from discrimination. Systemic inequalities, coupled with other barriers to care, have significant oral health implications for this population. Implementing inclusivity strategies and gaining awareness of the transgender experience will contribute to better oral health outcomes in this community.
Collapse
Affiliation(s)
- Jessica Tamrat
- Alumna, Dental Hygiene Degree Program, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada. This literature review was written in partial fulfillment of the requirements for the BDSc(DH) program at the University of British Columbia.
| |
Collapse
|
7
|
'I'm not interested in research; i'm interested in services': How to better health and social services for transgender women living with and affected by HIV. Soc Sci Med 2021; 292:114610. [PMID: 34923191 DOI: 10.1016/j.socscimed.2021.114610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/15/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022]
Abstract
This paper presents results of a research priority setting process focused on trans women living with and affected by HIV across Canada. It features data from semi-structured interviews and focus groups conducted with a diverse group of 76 trans women in five urban centers across the country on how they have navigated health and social service programming within their geographic context. The results focus on the structure and types of services. Respondents offered simple, yet creative ways to address barriers to vital services based on their individual and collective experiences. Notably, participants stressed the need for 1) trans-friendly and trans-specific services, 2) integrated health services, and aid in navigating complex, overlapping systems, and 3) comprehensive community-based services. They also suggest employing trans women as care coordinators or case managers in order to foster more trans-friendly environments and empower community members. We identify concrete ways to improve health and social services at the level of service delivery and program design, as well as recommendations for future participatory research. We close with an interrogation of trans people, and trans women living with and affected by HIV in particular, as 'hard to reach' populations.
Collapse
|
8
|
Kumar V, Atre S, Jain R, Bhanushali N, Singh S, Chaudhari S. Include-integrate-involve: Deciphering oral healthcare providers' professional demeanor towards sexual and gender minority cohorts in a metropolitan city of western India. J Oral Biol Craniofac Res 2021; 11:149-157. [PMID: 33537187 DOI: 10.1016/j.jobcr.2021.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives The Sexual and Gender Minorities (SGM) have been subject to disparities in healthcare. This study gauges and compares the demeanor of oral health task force in privately-funded and government-funded dental schools of India towards SGM cohorts. Study design A descriptive, cross-sectional, point prevalent study was conducted following standard statements of the STROBE guidelines and using the Medical Condition Regard Scale (MCRS). It was conducted among the clinical oral health taskforce hailing from private-funded and government-funded institutes. Methods One-way ANOVA test computed differences in mean MCRS scores among the undergraduates, postgraduates and faculty. Independent t-test compared responses of participants from private institutions and government institutions using SPSS version 17 statistical software. Results All the respondents were mostly but not completely satisfied to work with SGM patients (MCRS score = 4.55 ± 1.114) indicative of some underlying hesitance. Though everyone had a positive regard, undergraduates and those from private institutions felt more compassionate and showed greater willingness to put in extra efforts to help them feel at ease (P-value <0.05). This is interpretive of more receptiveness towards specialized training and policy reforms of these individuals. Conclusion The significant differences between institutes and designations highlight disparities in knowledge and training resulting in the underlying hesitation. Health education urgently needs a targeted and focused SGM-related training program to deconstruct these disparities and provide equitable oral and general health for all individuals irrespective of their sexual orientation.
Collapse
Affiliation(s)
- Vaibhav Kumar
- T.P.C.T's Terna Dental College & Hospital, Navi Mumbai, India
| | - Swarali Atre
- T.P.C.T's Terna Dental College & Hospital, Navi Mumbai, India
| | - Romi Jain
- T.P.C.T's Terna Dental College & Hospital, Navi Mumbai, India
| | | | - Shishir Singh
- T.P.C.T's Terna Dental College & Hospital, Navi Mumbai, India
| | | |
Collapse
|
9
|
Pandya AK, Redcay A. Access to health services: Barriers faced by the transgender population in India. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2020. [DOI: 10.1080/19359705.2020.1850592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Apurva kumar Pandya
- Department of Public Health, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Alex Redcay
- Department of Social Work, Millersville University of Pennsylvania, Millersville, Pennsylvania, USA
| |
Collapse
|
10
|
Slums, Space, and State of Health-A Link between Settlement Morphology and Health Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062022. [PMID: 32204347 PMCID: PMC7143924 DOI: 10.3390/ijerph17062022] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/31/2022]
Abstract
Approximately 1 billion slum dwellers worldwide are exposed to increased health risks due to their spatial environment. Recent studies have therefore called for the spatial environment to be introduced as a separate dimension in medical studies. Hence, this study investigates how and on which spatial scale relationships between the settlement morphology and the health status of the inhabitants can be identified. To this end, we summarize the current literature on the identification of slums from a geographical perspective and review the current literature on slums and health of the last five years (376 studies) focusing on the considered scales in the studies. We show that the majority of medical studies are restricted to certain geographical regions. It is desirable that the number of studies be adapted to the number of the respective population. On the basis of these studies, we develop a framework to investigate the relationship between space and health. Finally, we apply our methodology to investigate the relationship between the prevalence of slums and different health metrics using data of the global burden of diseases for different prefectures in Brazil on a subnational level.
Collapse
|