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Rakshit S, Roy T, Jana PC, Gupta K. A Comprehensive Review on the Importance of Sustainable Synthesized Coinage Metal Nanomaterials and Their Diverse Biomedical Applications. Biol Trace Elem Res 2024:10.1007/s12011-024-04361-8. [PMID: 39222235 DOI: 10.1007/s12011-024-04361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
From a historical perspective, coinage metals (CMNMs) are most renowned for their monetary, ornamental, and metallurgical merits; nevertheless, as nanotechnology's potential has only just come to light, their metal nanostructures and uses may be viewed as products of modern science. Notable characteristics of CMNMs include visual, electrical, chemical, and catalytic qualities that depend on shape and size. Due diligence on the creation and synthesis of CMNMs and their possible uses has been greatly promoted by these characteristics. This review focuses on solution-based methods and provides an overview of the latest developments in CMNMs and their bimetallic nanostructures. It discusses a range of synthetic techniques, including conventional procedures and more modern approaches used to enhance functionality by successfully manipulating the CMNMs nanostructure's size, shape, and composition. To help with the design of new nanostructures with improved capabilities in the future, this study offers a brief assessment of the difficulties and potential future directions of these intriguing metal nanostructures. This review focuses on mechanisms and factors influencing the synthesis process, green synthesis, and sustainable synthesis methods. It also discusses the wide range of biological domains in which CMNMs are applied, including antibacterial, antifungal, and anticancer. Researchers will therefore find the appropriateness of both synthesizing and using CMNMS keeping in mind the different levels of environmental effects.
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Affiliation(s)
- Soumen Rakshit
- Department of Physics, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
| | - Tamanna Roy
- Department of Microbiology, Bankura Sammilani Medical College and Hospital, Bankura, 722102, West Bengal, India
| | - Paresh Chandra Jana
- Department of Physics, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
| | - Kajal Gupta
- Department of Chemistry, Nistarini College, Purulia, 723101, West Bengal, India.
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Chaudhry A, Hebert-Beirne J, Alessi EJ, Khuzam MZ, Mitchell U, Molina Y, Wasfie D, Fox S, Abboud S. Exploring the Health Impact of Intersectional Minority Identity Stressors on Arab Sexual Minority Women Migrants to the United States. QUALITATIVE HEALTH RESEARCH 2024:10497323241265288. [PMID: 39172019 DOI: 10.1177/10497323241265288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Using an intersectionality lens and the minority stress theory as our theoretical grounding, this qualitative study is the first to examine the mental health of Arab sexual minority women (SMW) migrants to the United States. The study aimed to (1) explore the perceptions and experiences of intersectional minority identity-related life stressors and (2) discern their impact on the mental health of first-generation Arab SMW migrants. From December 2022 to March 2023, we conducted 20 semi-structured interviews with Arab SMW migrants. Guided by principles of community engagement in research, four community advisors, including three Arab SMW migrants and a mental health service provider, assisted in mock interviews, recruitment, and data analysis. This enriched our thematic analysis providing a nuanced understanding of Arab SMW migrant experiences. Participants reflected diverse nationalities, socioeconomic statuses, and religions and identified as lesbian, bisexual, or queer. Our sample included asylum seekers, documented migrants, and non-binary individuals (assigned female at birth). Findings revealed three major themes: (1) Community- and Interpersonal-Level Stressors, (2) Strategies for Coping with Stressors, and (3) Impact of Intersectional Life Stressors on Mental Health. Community- and interpersonal-level stressors included challenges navigating migration-related stressors, rejection and discrimination from the Arab, queer, and dominant-group (i.e., non-Arab, non-White) communities, and experiences of invalidation of their intersectional identities. Coping mechanisms included avoidance, identity concealment, and seeking social support. Participants reported various mental health impacts, from anxiety, depression to suicidal thoughts, emphasizing the urgency for tailored interventions. Participants called for the development of support groups specifically for Arab SMW migrants.
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Affiliation(s)
- Aeysha Chaudhry
- School of Public Health, Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Jennifer Hebert-Beirne
- School of Public Health, Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Edward J Alessi
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Maya Z Khuzam
- Department of Political Science Ann Arbor, University of Michigan, MI, USA
| | - Uchechi Mitchell
- School of Public Health, Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Yamile Molina
- School of Public Health, Division of Community Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Dhuha Wasfie
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Samara Fox
- Baystate Medical Center, Springfield, MA, USA
| | - Sarah Abboud
- College of Nursing, Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL, USA
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Metheny N, Tran NK, Scott D, Dastur Z, Lubensky ME, Lunn MR, Obedin-Maliver J, Flentje A. Intimate partner violence is related to future alcohol use among a nationwide sample of LGBTQIA+ people: Results from The PRIDE Study. Drug Alcohol Depend 2024; 260:111342. [PMID: 38820909 DOI: 10.1016/j.drugalcdep.2024.111342] [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: 11/15/2023] [Revised: 04/09/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, intersex, aromantic and asexual (LGBTQIA+) communities in the United States experience higher rates of alcohol use than the general population. While experiencing intimate partner violence (IPV) is thought to lead to increased alcohol use in LGBTQIA+ people, little research has investigated the temporal relationship between IPV and alcohol use in this population. METHODS Data from two annual questionnaires of The Population Research in Identity and Disparities for Equality Study (The PRIDE Study) longitudinal cohort (n=3,783) were included. Overall IPV and three sub-types (physical, sexual, and emotional) - measured in 2021 using the extended Hurt, Insult, Threaten, Scream (E-HITS) screening tool - was examined as a predictor of Alcohol Use Disorders Identification Test (AUDIT) score in 2022 using multivariable linear regression to assess linear and quadratic associations. Models were adjusted for sociodemographic characteristics and history of alcohol use. RESULTS One-quarter (24.7%) of respondents reported experiencing past-year IPV in 2021. The mean AUDIT score in 2022 was 3.52 (SD = 4.13). In adjusted models, both linear (B: 0.26, 95% CI: 0.14, 0.38) and quadratic (B: -0.03, 95% CI: -0.04, -0.01) terms for overall IPV were significantly associated with next-year AUDIT score. These patterns were mirrored in each IPV sub-type, were not attenuated when accounting for relationship characteristics, and were heterogeneous across gender identity groups. CONCLUSIONS These results provide evidence of a temporal relationship between IPV and alcohol use in LGBTQIA+ communities, suggesting that efforts to prevent and mitigate IPV may help reduce alcohol use disparities in this population.
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Affiliation(s)
- Nicholas Metheny
- Nell Hodgson Woodruff School of Nursing Emory University, Atlanta, GA, USA.
| | - Nguyen Khai Tran
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Dalton Scott
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Public Health, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Public Health, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA; Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA; Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA
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Vogel EA, Flentje A, Lunn MR, Obedin-Maliver J, Capriotti MR, Ramo DE, Prochaska JJ. Active Social Media Use and Health Indicators Among Sexual and Gender Minority Adults. LGBT Health 2024; 11:292-300. [PMID: 38153392 DOI: 10.1089/lgbt.2023.0170] [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: 12/29/2023] Open
Abstract
Purpose: Sexual and gender minority (SGM) individuals may receive social support through active use of social media (i.e., posting and interacting). This study examined associations between active social media use, social support, and health indicators in a large sample of SGM adults in the United States. Methods: Data were derived from the 2017 wave of The PRIDE Study, a national cohort study of SGM health. SGM-identified adults reporting social media use (N = 5995) completed measures of active social media use, social support, depressive symptoms, cigarette smoking, hazardous drinking, sleep, and physical activity. Regression models examined main and interactive effects of active social media use and social support on health indicators. Results: The sample reported a moderate level of active social media use (mean [M] = 3.2 [1.0], scale = 1-5) and relatively high social support (M = 16.7 [3.3], scale = 4-20); 31.8% reported moderate-to-severe depressive symptoms. Participants with greater active social media use were more likely to experience depressive symptoms (adjusted odds ratio [AOR] = 1.18, 95% confidence interval [CI] = 1.10-1.26), cigarette smoking (AOR = 1.11, 95% CI = 1.01-1.22), insufficient sleep (AOR = 1.13, 95% CI = 1.06-1.21), and physical inactivity (AOR = 1.09, 95% CI = 1.02-1.15) than those with less active social media use. Active social media use did not significantly interact with social support to predict any health indicators (p values >0.159). Conclusions: Among SGM adults, active social media use was associated with several negative health indicators. Active social media use may increase health risks, or SGM adults with poor health may actively use social media to maintain social connections. Moderate active social media use may be compatible with health.
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Affiliation(s)
- Erin A Vogel
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew R Capriotti
- Department of Psychology, San Jose State University, San Jose, California, USA
| | | | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, USA
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Obedin-Maliver J, Hunt C, Flentje A, Armea-Warren C, Bahati M, Lubensky ME, Dastur Z, Eastburn C, Hundertmark E, Moretti DJ, Pho A, Rescate A, Greene RE, Williams JT, Hursey D, Cook-Daniels L, Lunn MR. Engaging Sexual and Gender Minority (SGM) Communities for Health Research: Building and Sustaining PRIDEnet. JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP 2024; 16:9. [PMID: 39149568 PMCID: PMC11326444 DOI: 10.54656/jces.v16i2.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Lesbian, gay, bisexual, transgender, queer, intersex, asexual, aromantic, and other sexual and/or gender minority (LGBTQIA+) communities are underrepresented in health research and subject to documented health disparities. In addition, LGBTQIA+ communities have experienced mistreatment, discrimination, and stigma in health care and health research settings. Effectively engaging LGBTQIA+ communities and individuals in health research is critical to developing representative data sets, improving health care provision and policy, and reducing disparities. However, little is known about what engagement approaches work well with LGBTQIA+ people. This paper describes the development of PRIDEnet (pridenet.org), a national network dedicated to catalyzing LGBTQIA+ community involvement in health research and built upon well-established community-engaged research (CEnR) principles. PRIDEnet's relationship building and digital communications activities engage thousands of LGBTQIA+-identified people across the country and offer multiple low-threshold ways to participate in specific studies and shape research. These activities comprise a CEnR infrastructure that engages LGBTQIA+ people on behalf of other projects, primarily The PRIDE Study (pridestudy.org) and the National Institutes of Health's All of Us Research Program (joinallofus.org/lgbtqia). Our impact, results, and lessons learned apply to those engaging communities underserved in biomedical research and include: the importance of building adaptable infrastructure that sustains transformational relationships long-term; implementing high-touch activities to establish trust and broad-reach activities to build large data sets; nurturing a team of diverse professionals with lived experiences that reflect those of the communities to be engaged; and maintaining CEnR mechanisms that exceed advice-giving and result in substantive research contributions from beginning to end.
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Tran NK, Lett E, Flentje A, Ingram S, Lubensky ME, Dastur Z, Obedin-Maliver J, Lunn MR. Inequities in Conversion Practice Exposure at the Intersection of Ethnoracial and Gender Identities. Am J Public Health 2024; 114:424-434. [PMID: 38478865 PMCID: PMC10937597 DOI: 10.2105/ajph.2024.307580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 03/17/2024]
Abstract
Objectives. To examine inequities in conversion practice exposure across intersections of ethnoracial groups and gender identity in the United States. Methods. Data were obtained from The Population Research in Identity and Disparities for Equality Study of sexual and gender minority people from 2019 to 2021 (n = 9274). We considered 3 outcomes: lifetime exposure, age of first exposure, and period between first and last exposure among those exposed to conversion practices. We used log-binomial, Cox proportional hazards, and negative binomial models to examine inequities by ethnoracial groups and gender identity adjusting for confounders. We considered additive interaction. Results. Conversion practice prevalence was highest among minoritized ethnoracial transgender and nonbinary participants (TNB; 8.6%). Compared with White cisgender participants, minoritized ethnoracial TNB participants had twice the prevalence (prevalence ratio = 2.16; 95% confidence interval [CI] = 1.62, 2.86) and risk (hazard ratio = 2.04; 95% CI = 1.51, 2.69) of conversion practice exposure. Furthermore, there was evidence of a positive additive interaction for age of first exposure. Conclusions. Minoritized ethnoracial TNB participants were most likely to recall experiencing conversion practices. Public Health Implications. Policies banning conversion practices may reduce the disproportionate burden experienced by minoritized ethnoracial TNB participants. (Am J Public Health. 2024;114(4):424-434. https://doi.org/10.2105/AJPH.2024.307580).
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Affiliation(s)
- Nguyen K Tran
- Nguyen K. Tran, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, Juno Obedin-Maliver, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA. Elle Lett is with the Health Systems and Population Health and the Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle. Shalonda Ingram is with the Born Brown Institute, Washington, DC
| | - Elle Lett
- Nguyen K. Tran, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, Juno Obedin-Maliver, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA. Elle Lett is with the Health Systems and Population Health and the Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle. Shalonda Ingram is with the Born Brown Institute, Washington, DC
| | - Annesa Flentje
- Nguyen K. Tran, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, Juno Obedin-Maliver, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA. Elle Lett is with the Health Systems and Population Health and the Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle. Shalonda Ingram is with the Born Brown Institute, Washington, DC
| | - Shalonda Ingram
- Nguyen K. Tran, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, Juno Obedin-Maliver, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA. Elle Lett is with the Health Systems and Population Health and the Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle. Shalonda Ingram is with the Born Brown Institute, Washington, DC
| | - Micah E Lubensky
- Nguyen K. Tran, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, Juno Obedin-Maliver, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA. Elle Lett is with the Health Systems and Population Health and the Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle. Shalonda Ingram is with the Born Brown Institute, Washington, DC
| | - Zubin Dastur
- Nguyen K. Tran, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, Juno Obedin-Maliver, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA. Elle Lett is with the Health Systems and Population Health and the Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle. Shalonda Ingram is with the Born Brown Institute, Washington, DC
| | - Juno Obedin-Maliver
- Nguyen K. Tran, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, Juno Obedin-Maliver, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA. Elle Lett is with the Health Systems and Population Health and the Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle. Shalonda Ingram is with the Born Brown Institute, Washington, DC
| | - Mitchell R Lunn
- Nguyen K. Tran, Annesa Flentje, Micah E. Lubensky, Zubin Dastur, Juno Obedin-Maliver, and Mitchell R. Lunn are with The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA. Elle Lett is with the Health Systems and Population Health and the Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle. Shalonda Ingram is with the Born Brown Institute, Washington, DC
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Tordoff DM, Moseson H, Ragosta S, Hastings J, Flentje A, Capriotti MR, Lubensky ME, Lunn MR, Obedin-Maliver J. Family building and pregnancy experiences of cisgender sexual minority women. AJOG GLOBAL REPORTS 2024; 4:100298. [PMID: 38269079 PMCID: PMC10806344 DOI: 10.1016/j.xagr.2023.100298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Although 10% to 20% of cisgender women aged 18 to 40 years have a sexual minority identity (eg, bisexual, lesbian, and queer), there is limited research on the family building and pregnancy experiences of sexual minority cisgender women. Improving our understanding of the family building and pregnancy experiences of cisgender sexual minority women is critical for improving the perinatal health of this population. OBJECTIVE This study aimed to compare the mode of family building, past pregnancy experiences, and future pregnancy intentions among cisgender sexual minority women by sexual orientation. STUDY DESIGN This is an observational study which was conducted using cross-sectional data collected in 2019 from a national sample of 1369 cisgender sexual minority women aged 18 to 45 years. RESULTS Most participants (n=794, 58%) endorsed multiple sexual orientations, most commonly queer (n=641, 47%), lesbian (n=640, 47%), and/or bisexual (n=583, 43%). There were 243 (18%) cisgender sexual minority women who were parents. Pregnancy was used by 74% (181/243) of women to build their families. Among participants who used pregnancy, 60% (108/181) became pregnant through sexual activity with another parent of the child, whereas 27% (64/243) of women used donor sperm. An additional 10% (n=24) became parents through second-parent adoption, 10% (n=25) through adoption, and 14% (n=35) through step-parenting. Bisexual women more often used sexual activity to become parents (61/100, 61%) compared with queer (40/89, 45%) and lesbian women (40/130, 31%). In contrast, lesbian (50/130, 39%) and queer (25/89, 27%) women more often used donor sperm to become parents compared with bisexual women (11/100, 11%). Among the 266 (19%) cisgender sexual minority women who had ever been pregnant, there were 545 pregnancies (mean, 2.05 pregnancies per woman). Among those pregnancies, 59% (n=327) resulted in live birth, 23% (n=126) resulted in miscarriage, 15% (n=83) resulted in abortion, and 2% (n=9) resulted in ectopic pregnancy. A quarter of women had future pregnancy intentions, with no differences by sexual orientation. Overall, few participants (16%) reported that all of their healthcare providers were aware of their sexual orientation. CONCLUSION Cisgender sexual minority women primarily built their families through pregnancy and a quarter have future pregnancy desires. In addition, there were important differences in family building methods used by sexual orientation. Providers should be aware of the pregnancy and family-building patterns, plans, and needs of cisgender sexual minority women.
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Affiliation(s)
- Diana M. Tordoff
- Stanford University School of Medicine, Palo Alto, CA (Drs Tordoff, Lunn, and Obedin-Maliver)
| | - Heidi Moseson
- Ibis Reproductive Health, Oakland, CA (Dr Moseson and Mx. Ragosta)
| | - Sachiko Ragosta
- Ibis Reproductive Health, Oakland, CA (Dr Moseson and Mx. Ragosta)
| | - Jen Hastings
- University of California, San Francisco, San Francisco, CA (Drs Hastings, Flentje, and Lubensky)
| | - Annesa Flentje
- University of California, San Francisco, San Francisco, CA (Drs Hastings, Flentje, and Lubensky)
| | - Matthew R. Capriotti
- Department of Psychology, San Jose State University, San Jose, CA (Dr Capriotti)
| | - Micah E. Lubensky
- University of California, San Francisco, San Francisco, CA (Drs Hastings, Flentje, and Lubensky)
| | - Mitchell R. Lunn
- Stanford University School of Medicine, Palo Alto, CA (Drs Tordoff, Lunn, and Obedin-Maliver)
| | - Juno Obedin-Maliver
- Stanford University School of Medicine, Palo Alto, CA (Drs Tordoff, Lunn, and Obedin-Maliver)
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Igwe J, Wangdak Yuthok TY, Cruz E, Mueller A, Lan RH, Brown‐Johnson C, Idris M, Rodriguez F, Clark K, Palaniappan L, Echols M, Wang P, Onwuanyi A, Pemu P, Lewis EF. Opportunities to Increase Science of Diversity and Inclusion in Clinical Trials: Equity and a Lack of a Control. J Am Heart Assoc 2023; 12:e030042. [PMID: 38108253 PMCID: PMC10863780 DOI: 10.1161/jaha.123.030042] [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] [Indexed: 12/19/2023]
Abstract
The United States witnessed a nearly 4-fold increase in personal health care expenditures between 1980 and 2010. Despite innovations and obvious benefits to health, participants enrolled in clinical trials still do not accurately represent the racial and ethnic composition of patients nationally or globally. This lack of diversity in cohorts limits the generalizability and significance of results among all populations and has deep repercussions for patient equity. To advance diversity in clinical trials, robust evidence for the most effective strategies for recruitment of diverse participants is needed. A major limitation of previous literature on clinical trial diversity is the lack of control or comparator groups for different strategies. To date, interventions have focused primarily on (1) community-based interventions, (2) institutional practices, and (3) digital health systems. This review article outlines prior intervention strategies across these 3 categories and considers health policy and ethical incentives for substantiation before US Food and Drug Administration approval. There are no current studies that comprehensively compare these interventions against one another. The American Heart Association Strategically Focused Research Network on the Science of Diversity in Clinical Trials represents a multicenter, collaborative network between Stanford School of Medicine and Morehouse School of Medicine created to understand the barriers to diversity in clinical trials by contemporaneous head-to-head interventional strategies accessing digital, institutional, and community-based recruitment strategies to produce informed recruitment strategies targeted to improve underrepresented patient representation in clinical trials.
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Affiliation(s)
- Joseph‐Kevin Igwe
- Department of MedicineStanford University, School of MedicineStanfordCA
- Department of MedicineMorehouse School of MedicineAtlantaGA
- American Heart Association Strategically Focused Research Network on the Science of Diversity in Clinical Trials Research FellowDurhamNC
| | | | - Erin Cruz
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Adrienne Mueller
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Roy Hao Lan
- Department of MedicineStanford University, School of MedicineStanfordCA
| | | | - Muhammed Idris
- Department of MedicineMorehouse School of MedicineAtlantaGA
| | - Fatima Rodriguez
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Kira Clark
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Latha Palaniappan
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Melvin Echols
- Department of MedicineMorehouse School of MedicineAtlantaGA
| | - Paul Wang
- Department of MedicineStanford University, School of MedicineStanfordCA
| | | | - Priscilla Pemu
- Department of MedicineMorehouse School of MedicineAtlantaGA
| | - Eldrin F. Lewis
- Department of MedicineStanford University, School of MedicineStanfordCA
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9
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Coe D, Bigirumurame T, Burgess M, Rouse J, Wroe C. Enablers and barriers to engaging under-served groups in research: Survey of the United Kingdom research professional's views. NIHR OPEN RESEARCH 2023; 3:37. [PMID: 39139271 PMCID: PMC11319909 DOI: 10.3310/nihropenres.13434.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 08/15/2024]
Abstract
Background There is a known lack of diversity in research participant populations. This impacts on the generalisability of findings and affects clinician prescribing. In the United Kingdom the research community defines those who are underrepresented as under-served. They are commonly those affected by health inequality and disparity. The notion of under-served is complex, with numerous papers identifying multiple factors that contribute to being under-served and in turn suggesting many strategies to improve engagement. Methods Research professionals in the UK were invited to complete an online survey. The broad aim was to explore their views on under-served groups. The findings were analysed using statistical and qualitative methods to identify enablers and barriers to engaging the under-served. Descriptive statistics were utilised with associations compared univariately by chi-square test and logistic regression for multivariable analysis. Results A total of 945 completed responses were received. Those identified as under-served in this study reflected the previous body of works with a broader descriptor of ethnic and cultural minorities and the addition of adolescents and young adults. Language and literacy skills had the most impact on being under-served. Only 13% of respondents said they felt equipped to meet the needs of the under-served. The main strategy to increase diversity was community engagement and movement of research delivery into the community. The barriers were funding and time. Training needs identified were linked to community engagement, cultural competence and consent processes. Conclusions The UK findings from research professionals reflected the previous literature. Adolescents and young people were added to those identified as under-served. Enablers included community outreach and improvement to communication. Barriers were time, funding, organisational processes and lack of focus. Issues were identified with translation and interpretation services. Training requirements focus on methodologies and methods to engage and the consent processes of those from under-served groups.
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Affiliation(s)
- Dorothy Coe
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, England, UK
| | - Theophile Bigirumurame
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, England, UK
| | - Meera Burgess
- Clinical Research Network Coordinating Centre, National Institute for Health and Care Research, NIHR, UK
| | - John Rouse
- Clinical Research Network North East and North Cumbria, National Institute for Health and Care Research, Regent Point, Newcastle, UK
| | - Caroline Wroe
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, England, UK
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10
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Cicero EC, Lunn MR, Obedin-Maliver J, Sunder G, Lubensky ME, Capriotti MR, Flentje A. Acceptability of Biospecimen Collection Among Sexual and/or Gender Minority Adults in the United States. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2023; 4:311-344. [PMID: 39234441 PMCID: PMC11374103 DOI: 10.1891/lgbtq-2022-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Health studies using biospecimens have an underrepresentation of sexual and/or gender minority (SGM) participants, making it difficult to use data to advance SGM health knowledge. This study examined: 1) the willingness of SGM adults to provide research biospecimens, 2) if SGM groups differ in their willingness, 3) the relationship of demographic characteristics with willingness, and 4) the ideas/concerns of SGM adults toward providing research biospecimens. Data collected in 2018-2019 from The Population Research in Identity and Disparities for Equality Study were analyzed. Regressions examined willingness to provide biospecimens (blood, buccal swab, hair, saliva, and urine) across SGM groups (cisgender sexual minority [SM] men, cisgender SM women, gender-expansive, transfeminine, and transmasculine adults; N = 4,982) and the relationship of demographics with a willingness to provide each biospecimen type. A thematic analysis of an open-ended item elucidated SGM adults' (N = 776) perspective toward providing biospecimens. Most SGM adults were willing to provide biospecimens. Cisgender SM women were less willing to provide some types (blood 54% and urine 63%) than the other groups. Cisgender SM men were most willing to provide all types. Older age, identifying as pansexual, and income >$50,000/year were associated with increased odds of providing biospecimen(s). Gender identity was a significant predictor for all biospecimen types. A gender identity other than cisgender man was associated with 1.6-2.4× lower odds of providing biospecimen(s). Participants expressed concerns about data confidentiality and privacy, data access and misuse, research purposes, and inadvertent disclosure of SGM status. SGM adults' concerns about donating biospecimens can be used to create an affirming and inclusive methodology.
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Affiliation(s)
- Ethan C Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Gowri Sunder
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, USA
| | - Matthew R Capriotti
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
- Department of Psychology, San Jose State University, San Jose, California, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, USA
- Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, California, USA
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11
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Compte EJ, McGuire FH, Brown TA, Lavender JM, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Lunn MR, Obedin-Maliver J, Nagata JM. Investigating the factor structure and measurement invariance of the eating disorder examination questionnaire (EDE-Q) among cisgender gay men and lesbian women from the United States. J Eat Disord 2023; 11:164. [PMID: 37736682 PMCID: PMC10515023 DOI: 10.1186/s40337-023-00880-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Although the Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms, evidence indicates potential limitations with its original factor structure and associated psychometric properties in a variety of populations, including sexual minority populations. The aims of the current investigation were to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of cisgender gay men and cisgender lesbian women. METHODS Data were drawn from 1624 adults (1060 cisgender gay men, 564 cisgender lesbian women) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach's alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated. RESULTS A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q from Grilo et al. (Obes Surg. 23:657-662, 2013), consistently evidenced the best fit across cisgender gay men and lesbian women. The internal consistencies of the three subscales were adequate in both groups, and measurement invariance across the groups was supported. CONCLUSIONS Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in cisgender gay men and lesbian women. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse sexual minority samples across race, ethnicity, socioeconomic status, and age ranges.
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Affiliation(s)
- Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, 2640 Diagonal Las Torres Avenue, Peñalolén, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Av. Humberto Lobo 1001, Del Valle, 66220, San Pedro Garza García, N.L., Mexico
| | - F Hunter McGuire
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, 101 Cary Hall, Auburn, AL, 36849-5234, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
- The Metis Foundation, 84 NE Interstate 410 Loop # 325, San Antonio, TX, 78216, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA
| | - Matthew R Capriotti
- Department of Psychology, San José State University, 1 Washington Sq, San Jose, CA, 95192, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 291 Campus Drive Li Ka Shing Building, Stanford, CA, 94305-5101, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 291 Campus Drive Li Ka Shing Building, Stanford, CA, 94305-5101, USA
- Department of Community Health Systems, University of California, San Francisco, 675 18th St. UCSF Pritzker Psychiatry Building, San Francisco, CA, 94107, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 291 Campus Drive Li Ka Shing Building, Stanford, CA, 94305-5101, USA
- Department of Community Health Systems, University of California, San Francisco, 675 18th St. UCSF Pritzker Psychiatry Building, San Francisco, CA, 94107, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 291 Campus Drive Li Ka Shing Building, Stanford, CA, 94305-5101, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94304, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 291 Campus Drive Li Ka Shing Building, Stanford, CA, 94305-5101, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 770 Welch Road, #201, Palo Alto, CA, 94304, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA.
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12
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Nagata JM, Compte EJ, McGuire FH, Brown TA, Lavender JM, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Lunn MR, Obedin-Maliver J. Investigating the factor structure and measurement invariance of the Eating Disorder Examination-Questionnaire (EDE-Q) in a community sample of gender minority adults from the United States. Int J Eat Disord 2023; 56:1570-1580. [PMID: 37163420 PMCID: PMC10524485 DOI: 10.1002/eat.23978] [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: 11/19/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms. However, evidence indicates potential problems with its original factor structure and associated psychometric properties in a variety of populations, including gender minority populations. The aim of the current investigation was to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of gender minority adults. METHODS Data were drawn from 1567 adults (337 transgender men, 180 transgender women, and 1050 gender-expansive individuals) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach's alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated. RESULTS A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q consistently evidenced the best fit across gender minority groups (transgender men, transgender women, gender-expansive individuals). The internal consistencies of the three subscales were adequate in all groups, and measurement invariance across the groups was supported. DISCUSSION Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in gender minority populations. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse gender minority samples across race, ethnicity, socioeconomic status, and age ranges. PUBLIC SIGNIFICANCE STATEMENT Although transgender individuals have greater risk of developing an eating disorder, the factor structure of the Eating Disorder Examination-Questionnaire, one of the most widely used eating disorder assessment measures, has not been explored in transgender adults. We found that a seven-item model including three factors of dietary restraint, shape and weight overvaluation, and body dissatisfaction had the best fit among transgender and nonbinary adults.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Emilio J. Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Monterrey, México
| | - F. Hunter McGuire
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Tiffany A. Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
| | - Stuart B. Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA
| | - Matthew R. Capriotti
- Department of Psychology, San José State University, San Jose, CA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
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13
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Tran NK, Lunn MR, Schulkey CE, Tesfaye S, Nambiar S, Chatterjee S, Kozlowski D, Lozano P, Randal FT, Mo Y, Qi S, Hundertmark E, Eastburn C, Pho AT, Dastur Z, Lubensky ME, Flentje A, Obedin-Maliver J. Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program. JAMA Netw Open 2023; 6:e2324969. [PMID: 37523187 PMCID: PMC10391317 DOI: 10.1001/jamanetworkopen.2023.24969] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Importance Limited data describe the health status of sexual or gender minority (SGM) people due to inaccurate and inconsistent ascertainment of gender identity, sex assigned at birth, and sexual orientation. Objective To evaluate whether the prevalence of 12 health conditions is higher among SGM adults in the All of Us Research Program data compared with cisgender heterosexual (non-SGM) people. Design, Setting, and Participants This cross-sectional study used data from a multidisciplinary research consortium, the All of Us Research Program, that links participant-reported survey information to electronic health records (EHR) and physical measurements. In total, 372 082 US adults recruited and enrolled at an All of Us health care provider organization or by directly visiting the enrollment website from May 31, 2017, to January 1, 2022, and were assessed for study eligibility. Exposures Self-identified gender identity and sexual orientation group. Main Outcomes and Measures Twelve health conditions were evaluated: 11 using EHR data and 1, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), using participants' physical measurements. Logistic regression (adjusting for age, income, and employment, enrollment year, and US Census division) was used to obtain adjusted odds ratios (AORs) for the associations between each SGM group and health condition compared with a non-SGM reference group. Results The analytic sample included 346 868 participants (median [IQR] age, 55 [39-68] years; 30 763 [8.9%] self-identified as SGM). Among participants with available BMI (80.2%) and EHR data (69.4%), SGM groups had higher odds of anxiety, depression, HIV diagnosis, and tobacco use disorder but lower odds of cardiovascular disease, kidney disease, diabetes, and hypertension. Estimated associations for asthma (AOR, 0.39 [95% CI, 0.24-0.63] for gender diverse people assigned male at birth; AOR, 0.51 [95% CI, 0.38-0.69] for transgender women), a BMI of 25 or higher (AOR, 1.65 [95% CI, 1.38-1.96] for transgender men), cancer (AOR, 1.15 [95% CI, 1.07-1.23] for cisgender sexual minority men; AOR, 0.88 [95% CI, 0.81-0.95] for cisgender sexual minority women), and substance use disorder (AOR, 0.35 [95% CI, 0.24-0.52] for gender diverse people assigned female at birth; AOR, 0.65 [95% CI, 0.49-0.87] for transgender men) varied substantially across SGM groups compared with non-SGM groups. Conclusions and Relevance In this cross-sectional analysis of data from the All of Us Research Program, SGM participants experienced health inequities that varied by group and condition. The All of Us Research Program can be a valuable resource for conducting health research focused on SGM people.
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Affiliation(s)
- Nguyen K Tran
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Claire E Schulkey
- All of Us Research Program, Office of the Director, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | - Paula Lozano
- Center for Asian Health Equity, The University of Chicago Medicine, Chicago, Illinois
- Asian Health Coalition, Chicago, Illinois
| | - Fornessa T Randal
- Center for Asian Health Equity, The University of Chicago Medicine, Chicago, Illinois
- Asian Health Coalition, Chicago, Illinois
| | - Yicklun Mo
- Center for Asian Health Equity, The University of Chicago Medicine, Chicago, Illinois
- Asian Health Coalition, Chicago, Illinois
| | - Siya Qi
- Center for Asian Health Equity, The University of Chicago Medicine, Chicago, Illinois
- Asian Health Coalition, Chicago, Illinois
| | - Ell Hundertmark
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Division of Gynecology and Gynecologic Specialties, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Chloe Eastburn
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Los Angeles LGBT Center, Los Angeles, California
| | - Anthony T Pho
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Division of Gynecology and Gynecologic Specialties, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Department of Community Health Systems, University of California, San Francisco
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Department of Community Health Systems, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- Division of Gynecology and Gynecologic Specialties, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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Scheer JR, Cascalheira CJ, Helminen EC, Shaw TJ, Schwarz AA, Jaipuriar V, Brisbin CD, Batchelder AW, Sullivan TP, Jackson SD. "I Know Myself Again, Which Makes Me Motivated for Life": Feasibility and Acceptability of Using Experience Sampling Methods With Trauma-Exposed Sexual Minority Women. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:8692-8720. [PMID: 36789733 PMCID: PMC10238639 DOI: 10.1177/08862605231153888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intensive longitudinal designs (e.g., experience sampling methods [ESMs]) hold promise for examining the dynamic interplay between daily adversity, coping strategies, and behavioral and mental health issues among marginalized populations. However, few studies have used intensive longitudinal designs with sexual minority women (SMW), an understudied and at-risk population. We assessed feasibility and acceptability of using once-daily, interval-contingent ESM with 161 trauma-exposed SMW (Mage = 29.1, SD = 7.57); 20.5% nonbinary; 32.3% queer; 52.2% people of color; 14.3% with annual incomes ≤$9,999; and 30.4% in Southern United States (U.S.). SMW completed one comprehensive online baseline assessment and once-daily brief online assessments for 14 days. Daily surveys assessed past-24-hour stressors, stress responses, and behavioral and mental health symptoms. At the end of the 14-day ESM period, SMW answered three open-ended questions about participating in this study and about research with SMW. Regarding feasibility, 151 participants (94.0%) initiated the post-baseline ESM study portion and 72 (45.0%) completed all 14 daily surveys. An average of 11.70 (median = 13, SD = 3.31) daily surveys (83.5%) were completed by those who initiated the ESM. ESM completion level varied by race/ethnicity and U.S. region. Qualitative acceptability data revealed several themes, namely that SMW (1) enjoyed participating and felt positively about the ESM experience, (2) felt supported to reflect on impacts of early and ongoing stressors, (3) appreciated the chance to self-reflect and challenge existing thought patterns and coping behaviors, (4) recognized their capacity to tolerate trauma-related distress, (5) recommended that researchers focus on SMW's diverse stressors and daily experiences, (6) wanted a rationale for providing sensitive information and more space to narrate their experiences, and (7) recognized the need for affirmative treatment and policies. Findings could inform modifications to ESM protocols to improve their feasibility and acceptability among trauma-exposed SMW and promote ongoing utility of this valuable method.
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Affiliation(s)
| | - Cory J Cascalheira
- Department of Psychology, Syracuse University, NY, USA
- New Mexico State University, Las Cruces, NM,USA
| | - Emily C Helminen
- Department of Psychology, Syracuse University, NY, USA
- Rochester Institute of Technology, Rochester, NY, USA
| | - Thomas J Shaw
- Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | | | | | - Cal D Brisbin
- Luskin School of Public Affairs, The University of California, Los Angeles, CA, USA
| | - Abigail W Batchelder
- Harvard Medical School, Harvard University, Boston, MA, USA
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Tami P Sullivan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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15
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Nair US, Kue J, Athilingam P, Rodríguez CS, Menon U. Application of the ConNECT Framework to achieve digital health equity. Nurs Outlook 2023; 71:101991. [PMID: 37302261 DOI: 10.1016/j.outlook.2023.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The emphasis on digital technology and informatics in health care (digital health) has introduced innovative ways to deliver health care and engage populations in health research. However, inadequate attention to the development and implementation of digital health interventions can exacerbate health disparities. PURPOSE We applied the transdisciplinary ConNECT Framework principles within the context of digital health, with an aim to describe strategies to achieve digital health equity. METHODS We described the five ConNECT principles of (a) integrating context, (b) fostering a norm of inclusion, (c) ensuring equitable diffusion of innovations, (d) harnessing communication technology, and (e) prioritizing specialized training within the framework of achieving digital health equity. FINDINGS AND DISCUSSION We describe proactive, actionable strategies for the systematic application of the ConNECT Framework principles to address digital health equity. Recommendations to reduce the digital health divide in nursing research and practice are also described.
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Affiliation(s)
- Uma S Nair
- College of Nursing, University of South Florida, Tampa, FL.
| | - Jennifer Kue
- College of Nursing, University of South Florida, Tampa, FL
| | | | | | - Usha Menon
- College of Nursing, University of South Florida, Tampa, FL
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16
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Pasin C, Consiglio CR, Huisman J, de Lange AMG, Peckham H, Vallejo-Yagüe E, Abela IA, Islander U, Neuner-Jehle N, Pujantell M, Roth O, Schirmer M, Tepekule B, Zeeb M, Hachfeld A, Aebi-Popp K, Kouyos RD, Bonhoeffer S. Sex and gender in infection and immunity: addressing the bottlenecks from basic science to public health and clinical applications. ROYAL SOCIETY OPEN SCIENCE 2023; 10:221628. [PMID: 37416827 PMCID: PMC10320357 DOI: 10.1098/rsos.221628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/14/2023] [Indexed: 07/08/2023]
Abstract
Although sex and gender are recognized as major determinants of health and immunity, their role is rarely considered in clinical practice and public health. We identified six bottlenecks preventing the inclusion of sex and gender considerations from basic science to clinical practice, precision medicine and public health policies. (i) A terminology-related bottleneck, linked to the definitions of sex and gender themselves, and the lack of consensus on how to evaluate gender. (ii) A data-related bottleneck, due to gaps in sex-disaggregated data, data on trans/non-binary people and gender identity. (iii) A translational bottleneck, limited by animal models and the underrepresentation of gender minorities in biomedical studies. (iv) A statistical bottleneck, with inappropriate statistical analyses and results interpretation. (v) An ethical bottleneck posed by the underrepresentation of pregnant people and gender minorities in clinical studies. (vi) A structural bottleneck, as systemic bias and discriminations affect not only academic research but also decision makers. We specify guidelines for researchers, scientific journals, funding agencies and academic institutions to address these bottlenecks. Following such guidelines will support the development of more efficient and equitable care strategies for all.
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Affiliation(s)
- Chloé Pasin
- Collegium Helveticum, 8092 Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Camila R. Consiglio
- Department of Women's and Children's Health, Karolinska Institutet, 17165 Stockholm, Sweden
| | - Jana S. Huisman
- Institute of Integrative Biology, ETH Zurich, 8092 Zurich, Switzerland
- Physics of Living Systems, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ann-Marie G. de Lange
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, 1011 Lausanne, Switzerland
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Hannah Peckham
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London WC1E 6JF, UK
| | | | - Irene A. Abela
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Ulrika Islander
- Department of Rheumatology and Inflammation Research, University of Gothenburg, 40530 Gothenburg, Sweden
- SciLifeLab, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Nadia Neuner-Jehle
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Maria Pujantell
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Leibniz Institute of Virology, 20251 Hamburg, Germany
| | - Olivia Roth
- Marine Evolutionary Biology, Zoological Institute, Christian-Albrechts-University Kiel, 24118 Kiel, Germany
| | - Melanie Schirmer
- Emmy Noether Group for Computational Microbiome Research, ZIEL – Institute for Food and Health, Technical University of Munich, 85354 Freising, Germany
| | - Burcu Tepekule
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Marius Zeeb
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Anna Hachfeld
- Department of Infectious Diseases, University Hospital and University of Bern, 3012 Bern, Switzerland
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, University Hospital and University of Bern, 3012 Bern, Switzerland
- Department of Obstetrics and Gynecology, Lindenhofspital, 3012 Bern, Switzerland
| | - Roger D. Kouyos
- Institute of Medical Virology, University of Zurich, 8057 Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Sebastian Bonhoeffer
- Collegium Helveticum, 8092 Zurich, Switzerland
- Institute of Integrative Biology, ETH Zurich, 8092 Zurich, Switzerland
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Inman EM, Obedin-Maliver J, Ragosta S, Hastings J, Berry J, Lunn MR, Flentje A, Capriotti MR, Lubensky ME, Stoeffler A, Dastur Z, Moseson H. Reports of Negative Interactions with Healthcare Providers among Transgender, Nonbinary, and Gender-Expansive People assigned Female at Birth in the United States: Results from an Online, Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6007. [PMID: 37297611 PMCID: PMC10252942 DOI: 10.3390/ijerph20116007] [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: 04/01/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
Over one million people in the United States are transgender, nonbinary, or gender expansive (TGE). TGE individuals, particularly those who have pursued gender-affirming care, often need to disclose their identities in the process of seeking healthcare. Unfortunately, TGE individuals often report negative experiences with healthcare providers (HCPs). We conducted a cross-sectional online survey of 1684 TGE people assigned female or intersex at birth in the United States to evaluate the quality of their healthcare experiences. Most respondents (70.1%, n = 1180) reported at least one negative interaction with an HCP in the past year, ranging from an unsolicited harmful opinion about gender identity to physical attacks and abuse. In an adjusted logistic regression model, those who had pursued gender-affirming medical care (51.9% of the sample, n = 874) had 8.1 times the odds (95% CI: 4.1-17.1) of reporting any negative interaction with an HCP in the past year, compared to those who had not pursued gender-affirming care, and tended to report a higher number of such negative interactions. These findings suggest that HCPs are failing to create safe, high-quality care interactions for TGE populations. Improving care quality and reducing bias is crucial for improving the health and well-being of TGE people.
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Affiliation(s)
- Elizabeth M. Inman
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sachiko Ragosta
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
| | - Jen Hastings
- Department of Family and Community Medicine, University of California, 995 Portrero Ave, San Francisco, CA 94410, USA
| | - Jasmine Berry
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Community Health Systems, University of California, 2 Koret Way, San Francisco, CA 94143, USA
- Alliance Health Project, Department of Psychiatry, University of California, 1930 Market Street, San Francisco, CA 94102, USA
| | - Matthew R. Capriotti
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Psychology, San José State University, 1 Washington Square, San Jose, CA 94192, USA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Alliance Health Project, Department of Psychiatry, University of California, 1930 Market Street, San Francisco, CA 94102, USA
| | - Ari Stoeffler
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Heidi Moseson
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
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18
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Yang MJ, Martínez Ú, Simmons VN, Schabath MB, Vinci C. Considerations and recommendations for mHealth interventions for substance use among Sexual and Gender Minority (SGM) individuals: A narrative review of the past 5 years. CURRENT ADDICTION REPORTS 2023; 10:1-13. [PMID: 37359146 PMCID: PMC10214315 DOI: 10.1007/s40429-023-00497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/28/2023]
Abstract
Purposeof Review The prevalence of problematic substance use is disproportionately higher among sexual and gender minority (SGM) adults compared to adults in the general population. mHealth as a treatment modality could reduce barriers to accessing substance use treatments among SGM populations. Through a qualitative literature search, the current narrative review aimed to understand the lived experiences of SGM individuals who use substances and to synthesize recommendations made in the literature to inform future mHealth interventions. Recent Findings Positive and negative reinforcement motives were prominent reasons for substance use, which included SGM identity expression and conformity motives. Individual- and system-level treatment barriers included a lack of safe and nonjudgmental environment, shame and stigma, and limited knowledge about treatment options. Barriers were directly linked to the reported substance use treatment needs in this population. Summary On-demand app features, real-time intervention and assessment, and anonymity should be considered in future mHealth trials. Supplementary Information The online version contains supplementary material available at 10.1007/s40429-023-00497-0.
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Affiliation(s)
- Min-Jeong Yang
- Department of Health Outcomes and Behavior, Tobacco Research and Intervention Program, H. Lee Moffitt Cancer Center & Research Institute, MRC-TRIP, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - Úrsula Martínez
- Department of Health Outcomes and Behavior, Tobacco Research and Intervention Program, H. Lee Moffitt Cancer Center & Research Institute, MRC-TRIP, 12902 Magnolia Drive, Tampa, FL 33612 USA
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL USA
| | - Vani N. Simmons
- Department of Health Outcomes and Behavior, Tobacco Research and Intervention Program, H. Lee Moffitt Cancer Center & Research Institute, MRC-TRIP, 12902 Magnolia Drive, Tampa, FL 33612 USA
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL USA
- Department of Psychology, University of South Florida, Tampa, FL USA
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL USA
| | - Matthew B. Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL USA
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL USA
| | - Christine Vinci
- Department of Health Outcomes and Behavior, Tobacco Research and Intervention Program, H. Lee Moffitt Cancer Center & Research Institute, MRC-TRIP, 12902 Magnolia Drive, Tampa, FL 33612 USA
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL USA
- Department of Psychology, University of South Florida, Tampa, FL USA
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19
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Keegan G, Crown A, Joseph KA. Diversity, Equity, and Inclusion in Clinical Trials. Surg Oncol Clin N Am 2023; 32:221-232. [PMID: 36410919 DOI: 10.1016/j.soc.2022.08.005] [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: 11/05/2022]
Abstract
Minority groups are vastly underrepresented in clinical trial participants and leadership. Because these studies provide innovative and revolutionary treatment options to patients with cancer and have the potential to extend survival, it is imperative that public and private stakeholders, as well as hospital and clinical trial leadership, prioritize equity and inclusion of diverse populations in clinical trial development and recruitment strategies. Achieving equity in clinical trials could be an important step in reducing the overall cancer burden and mortality disparities in vulnerable populations.
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Affiliation(s)
- Grace Keegan
- Keegan-University of Chicago, Pritzker School of Medicine, 924 E. 57th Street, Chicago, IL 60637, USA
| | - Angelena Crown
- Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
| | - Kathie-Ann Joseph
- Department of Surgery, New York University Grossman School of Medicine, NYC Health and Hospitals/Bellevue, New York, NY, USA; NYU Langone Health's Institute for Excellence in Health Equity, 180 Madison Avenue, New York, NY, USA.
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20
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John SE, Evans SA, Kim B, Ozgul P, Loring DW, Parker M, Lah JJ, Levey AI, Goldstein FC. Examination of the reliability and feasibility of two smartphone applications to assess executive functioning in racially diverse older adults. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 29:1068-1086. [PMID: 34382482 PMCID: PMC8837703 DOI: 10.1080/13825585.2021.1962790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
Inclusion of Black participants in clinical research is a national priority. Mobile applications and remote data collection may increase study access for diverse populations. This study examined the reliability and feasibility of two mobile smartphone application-based cognitive measures in a diverse middle aged and older adult sample. Black (n = 44; Mage = 59.93) and non-Hispanic white (NHW; n = 50; Mage = 61.06) participants completed traditional paper-based neuropsychological testing and two app-based measures, Arrows and Number Match. Intraclass correlations demonstrated poor to moderate reliability (range: .417-.569) between performance on the app-based versions and performance on the traditional versions. Performance score differences by racial group were not statistically significant. Both Black and NHW participants rated the app-based measures as feasible and acceptable, though Black participants endorsed a stronger likelihood of future use. These findings add to the growing literature on remote cognitive testing .
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Affiliation(s)
- Samantha E. John
- Department of Brain Health, School of Integrated Health Sciences, UNLV, Las Vegas, NV, USA
| | - Sarah A. Evans
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Bona Kim
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Petek Ozgul
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Monica Parker
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - James J. Lah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA
| | - Allan I. Levey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA
| | - Felicia C. Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA
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21
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Nagata JM, Compte EJ, McGuire FH, Lavender JM, Murray SB, Brown TA, Capriotti MR, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR. Psychometric validation of the Muscle Dysmorphic Disorder Inventory (MDDI) among U.S. transgender men. Body Image 2022; 42:43-49. [PMID: 35653965 PMCID: PMC10069164 DOI: 10.1016/j.bodyim.2022.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/27/2022] [Accepted: 05/09/2022] [Indexed: 02/06/2023]
Abstract
Muscle dysmorphia (MD) is characterized by a pervasive belief or fear of insufficient muscularity and an elevated drive for muscularity, representing the pathological and extreme pursuit of muscularity. Psychometric properties of one of the most widely used measures of MD symptoms-the Muscle Dysmorphic Disorder Inventory (MDDI)-have yet to be evaluated in transgender men despite emerging evidence suggesting differential risk for MD symptoms in this population. In this study, we assessed the psychometric properties of the MDDI in a sample of 330 transgender men ages 18-67 years who participated in a large-scale national longitudinal cohort study of sexual and gender minority adults in the U.S. Using a two-step, split-sample approach, an initial exploratory factor analysis supported a three-factor structure and a subsequent confirmatory factor analysis of a re-specified three-factor model demonstrated good overall fit (χ2/df = 1.84, CFI =0.94, TLI =0.92, RMSEA =0.07 [90% CI =0.05,.09], SRMR =0.08). Moreover, results supported the internal consistency and convergent validity of the MDDI subscales in transgender men. Findings inform the use of the MDDI among transgender men and provide a foundation to support further work on the MDDI and MD symptoms among gender minority populations.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile; Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - F Hunter McGuire
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Metis Foundation, San Antonio, TX, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Matthew R Capriotti
- Department of Psychology, San José State University, San Jose, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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22
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Clark KD, Lunn MR, Lev EM, Trujillo MA, Lubensky ME, Capriotti MR, Hoffmann TJ, Obedin-Maliver J, Flentje A. State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9916. [PMID: 36011548 PMCID: PMC9407724 DOI: 10.3390/ijerph19169916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Legislation has been passed in some states to reduce discrimination and victimization toward sexual and gender minority people (SGM; people who are not solely heterosexual and/or whose gender identity is not equal to what is socially associated with sex assigned at birth). The purpose of these analyses is to test whether state-level policy environments are associated with past-year discrimination and victimization among SGM people. Cross-sectional data from The Population Research in Identity and Disparities for Equality (PRIDE) Study annual questionnaire (collected 2018−2019), a national study of the health of SGM adults in the USA, were used for these analyses. Measures included related to discrimination, victimization, and demographic characteristics. State-level policy environments were measured using data from the Movement Advancement Project. Logistic regression analyses evaluated state-level policy environment scores and past-year discrimination and victimization among gender identity categories. In this sample, 7044 people (gender minority n = 2530) were included. Cisgender sexual minority (odds ratio [OR] = 1.007, p = 0.041) and the gender expansive subgroup of gender minority people (OR = 1.010, p = 0.047) in states with more protective policy environments had greater odds of discrimination. The gender expansive subgroup was found to have greater odds of victimization in states with more protective policy environments (OR = 1.003, p < 0.05). There was no relationship between state-level policy environments and victimization among any other study groups. SGM people may experience increased risk for discrimination and victimization despite legislative protections, posing continued risks for poor health outcomes and marginalization. Evaluation of factors (e.g., implementation strategies, systems of accountability) that influence the effectiveness of state-level polices on the reported experiences of discrimination and victimization among SGM people is needed.
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Affiliation(s)
- Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH 03824, USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Eliot M. Lev
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA 94143, USA
| | - Michael A. Trujillo
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA 94143, USA
| | | | - Thomas J. Hoffmann
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine San Francisco, San Francisco, CA 94143, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA 94304, USA
- Department of Community Health Systems, University of California San Francisco School of Nursing, San Francisco, CA 94143, USA
- Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, CA 94143, USA
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23
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Flentje A, Clark KD, Cicero E, Capriotti MR, Lubensky ME, Sauceda J, Neilands TB, Lunn MR, Obedin-Maliver J. Minority Stress, Structural Stigma, and Physical Health Among Sexual and Gender Minority Individuals: Examining the Relative Strength of the Relationships. Ann Behav Med 2022; 56:573-591. [PMID: 34228052 PMCID: PMC9242547 DOI: 10.1093/abm/kaab051] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sexual and gender minority (SGM; i.e., non-heterosexual and transgender or gender-expansive, respectively) people experience physical health disparities attributed to greater exposure to minority stress (experiences of discrimination or victimization, anticipation of discrimination or victimization, concealment of SGM status, and internalization of stigma) and structural stigma. PURPOSE To examine which components of minority stress and structural stigma have the strongest relationships with physical health among SGM people. METHODS Participants (5,299 SGM people, 1,902 gender minority individuals) were from The Population Research in Identity and Disparities for Equality (PRIDE) Study. Dominance analyses estimated effect sizes showing how important each component of minority stress and structural stigma was to physical health outcomes. RESULTS Among cisgender sexual minority women, transmasculine individuals, American Indian or Alaskan Native SGM individuals, Asian SGM individuals, and White SGM individuals a safe current environment for SGM people had the strongest relationship with physical health. For gender-expansive individuals and Black, African American, or African SGM individuals, the safety of the environment for SGM people in which they were raised had the strongest relationship with physical health. Among transfeminine individuals, victimization experiences had the strongest relationship with physical health. Among Hispanic, Latino, or Spanish individuals, accepting current environments had the strongest relationship with physical health. Among cisgender sexual minority men prejudice/discrimination experiences had the strongest relationship with physical health. CONCLUSION Safe community environments had the strongest relationships with physical health among most groups of SGM people. Increasing safety and buffering the effects of unsafe communities are important for SGM health.
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Affiliation(s)
- Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
- Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kristen D Clark
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Ethan Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Micah E Lubensky
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John Sauceda
- Division of Prevention Science, University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), UCSF Prevention Research Center, San Francisco, CA, USA
| | - Torsten B Neilands
- Division of Prevention Science, University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), UCSF Prevention Research Center, San Francisco, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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Nagata JM, DeBenedetto AM, Brown TA, Lavender JM, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Cattle CJ, Obedin-Maliver J, Lunn MR. Associations among romantic and sexual partner history and muscle dysmorphia symptoms, disordered eating, and appearance- and performance-enhancing drugs and supplement use among cisgender gay men. Body Image 2022; 41:67-73. [PMID: 35228105 PMCID: PMC9997419 DOI: 10.1016/j.bodyim.2022.02.004] [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: 07/29/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 01/12/2023]
Abstract
This study examined relationship status (e.g., single versus not single) and number of sexual partners in relation to muscularity- and disordered eating-related attitudes and behaviors among 1090 cisgender gay men enrolled in The PRIDE Study in 2018. Participants completed measures assessing muscle dysmorphia (MD) symptoms, disordered eating attitudes and behaviors, and appearance- and performance-enhancing drug or supplement (APEDS) use. In linear regression models adjusting for theoretically relevant covariates, neither relationship status nor number of past-month sexual partners was associated with disordered eating attitudes. In terms of MD symptoms, single (versus not single) relationship status was associated with greater appearance intolerance, and a greater number of sexual partners was associated with greater drive for size and functional impairment. In adjusted logistic regression models, a greater number of past-month sexual partners was associated with use of anabolic-androgenic steroids, synthetic performance-enhancing substances, protein supplements, and creatine supplements, as well as greater likelihood of engaging in compelled/driven exercise. Across all associations, effect sizes were generally small. Overall, results support that inquiring about sexual partners may have utility in evaluating risk for muscularity-oriented attitudes and behaviors among cisgender gay men. Future work will need to replicate these findings, particularly in more diverse samples.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | | | - Tiffany A Brown
- Department of Psychology, Auburn University, Auburn, AL, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason M Lavender
- San Diego State University Research Foundation, San Diego, CA, USA; Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Matthew R Capriotti
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA; Department of Psychology, San José State University, San Jose, CA, USA
| | - Annesa Flentje
- Department of Psychology, San José State University, San Jose, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Community Health Systems, University of California, San Francisco, CA, USA
| | - Micah E Lubensky
- Department of Psychology, San José State University, San Jose, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- Department of Psychology, San José State University, San Jose, CA, USA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- Department of Psychology, San José State University, San Jose, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Cascalheira CJ, Hamdi SM, Scheer JR, Saha K, Boubrahimi SF, De Choudhury M. Classifying Minority Stress Disclosure on Social Media with Bidirectional Long Short-Term Memory. PROCEEDINGS OF THE ... INTERNATIONAL AAAI CONFERENCE ON WEBLOGS AND SOCIAL MEDIA. INTERNATIONAL AAAI CONFERENCE ON WEBLOGS AND SOCIAL MEDIA 2022; 16:1373-1377. [PMID: 35765687 PMCID: PMC9235017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Because of their stigmatized social status, sexual and gender minority (SGM; e.g., gay, transgender) people experience minority stress (i.e., identity-based stress arising from adverse social conditions). Given that minority stress is the leading framework for understanding health inequity among SGM people, researchers and clinicians need accurate methods to detect minority stress. Since social media fulfills important developmental, affiliative, and coping functions for SGM people, social media may be an ecologically valid channel for detecting minority stress. In this paper, we propose a bidirectional long short-term memory (BI-LSTM) network for classifying minority stress disclosed on Reddit. Our experiments on a dataset of 12,645 Reddit posts resulted in an average accuracy of 65%.
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Nagata JM, McGuire FH, Lavender JM, Brown TA, Murray SB, Greene RE, Compte EJ, Flentje A, Lubensky ME, Obedin‐Maliver J, Lunn MR. Appearance and performance-enhancing drugs and supplements, eating disorders, and muscle dysmorphia among gender minority people. Int J Eat Disord 2022; 55:678-687. [PMID: 35352378 PMCID: PMC9106876 DOI: 10.1002/eat.23708] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Appearance and performance-enhancing drugs and supplements (APEDS) can be used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among gender minority people. METHOD Participants were 1653 gender minority individuals (1120 gender-expansive [defined as a broad range of gender identities that are generally situated outside of the woman-man gender binary, e.g., genderqueer, nonbinary] people, 352 transgender men, and 181 transgender women) recruited from The Population Research in Identity and Disparities for Equality Study in 2018. Regression analyses stratified by gender identity examined associations of any APEDS use with eating disorder and muscle dysmorphia symptom scores. RESULTS Lifetime APEDS use was common across groups (30.7% of gender-expansive people, 45.2% of transgender men, and 14.9% of transgender women). Protein supplements and creatine supplements were the most commonly used APEDS. Among gender-expansive people and transgender men, lifetime use of any APEDS was significantly associated with higher eating disorder scores, dietary restraint, binge eating, compelled/driven exercise, and muscle dysmorphia symptoms. Any APEDS use was additionally associated with laxative use among gender-expansive people. Among transgender women, use of any APEDS was not significantly associated with eating disorder or muscle dysmorphia symptoms. DISCUSSION APEDS use is common and associated with eating disorder and muscle dysmorphia symptoms in gender-expansive people and transgender men, thus highlighting the importance of assessing for these behaviors and symptoms among these populations, particularly in clinical settings. PUBLIC SIGNIFICANCE This study aimed to examine APEDS use among gender minority people. We found that 30.7% of gender-expansive (e.g., nonbinary) people, 45.2% of transgender men, and 14.9% of transgender women reported lifetime APEDS use, which was associated with eating disorder and muscle dysmorphia symptoms in transgender men and gender-expansive people. Clinicians should assess for these behaviors in gender minority populations.
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Affiliation(s)
- Jason M. Nagata
- Department of PediatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - F. Hunter McGuire
- The Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
- The Metis FoundationSan AntonioTexasUSA
| | - Tiffany A. Brown
- Department of Psychological SciencesAuburn UniversityAuburnAlabamaUSA
| | - Stuart B. Murray
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Emilio J. Compte
- Eating Behavior Research Center, School of PsychologyUniversidad Adolfo IbáñezSantiagoChile
- Research DepartmentComenzar de Nuevo Treatment CenterMonterreyMexico
| | - Annesa Flentje
- Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Alliance Health Project, Department of Psychiatry and Behavioral SciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
| | - Micah E. Lubensky
- Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
| | - Juno Obedin‐Maliver
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
- Department of Obstetrics and GynecologyStanford University School of MedicineStanfordCaliforniaUSA
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
- Division of Nephrology, Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
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Clark KD, Lunn MR, Sherman ADF, Bosley HG, Lubensky ME, Obedin-Maliver J, Dastur Z, Flentje A. COVID-19 News and Its Association with the Mental Health of Sexual and Gender Minority Adults: A Cross-Sectional Study. JMIR Public Health Surveill 2022; 8:e34710. [PMID: 35486805 PMCID: PMC9153913 DOI: 10.2196/34710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/14/2022] [Accepted: 04/27/2022] [Indexed: 11/14/2022] Open
Abstract
Background Sexual and gender minority (SGM; people whose sexual orientation is not heterosexual or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and substantial disparities in anxiety and posttraumatic stress disorder (PTSD). Exposure to traumatic stressors such as news related to COVID-19 may be associated with symptoms of anxiety and PTSD. Objective This study aims to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States. Methods Data were collected between March 23 and August 2, 2020, from The PRIDE Study, a national longitudinal cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and symptoms of anxiety using the Generalized Anxiety Disorder-7 and symptoms of COVID-19–related PTSD using the Impact of Events Scale-Revised. Results Our sample included a total of 3079 SGM participants. Each unit increase in COVID-19–related news exposure was associated with greater anxiety symptoms (odds ratio 1.77, 95% CI 1.63-1.93; P<.001) and 1.93 greater odds of PTSD (95% CI 1.74-2.14; P<.001). Conclusions Our study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities.
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Affiliation(s)
- Kristen D Clark
- Department of Nursing, University of New Hampshire, 4 Library Way, Durham, US
| | - Mitchel R Lunn
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, US.,The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, US.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, US
| | | | - Hannah G Bosley
- Department of Psychiatry, University of California San Francisco, San Francisco, US
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, US.,Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, US
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, US.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, US.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, US
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, US.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, US
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, US.,Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, US
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Kelsey MD, Patrick-Lake B, Abdulai R, Broedl UC, Brown A, Cohn E, Curtis LH, Komelasky C, Mbagwu M, Mensah GA, Mentz RJ, Nyaku A, Omokaro SO, Sewards J, Whitlock K, Zhang X, Bloomfield GS. Inclusion and diversity in clinical trials: Actionable steps to drive lasting change. Contemp Clin Trials 2022; 116:106740. [PMID: 35364292 PMCID: PMC9133187 DOI: 10.1016/j.cct.2022.106740] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Improving diversity in clinical trials is essential in order to produce generalizable results. Although the importance of representation has become increasingly recognized, identifying strategies to approach this work remains elusive. This article reviews the proceedings of a multi-stakeholder conference about the current state of diversity in clinical trials and outlines actionable steps for improvement. METHODS Conference attendees included representatives from the United States Food and Drug Administration (FDA), National Institutes of Health (NIH), practicing clinical investigators, pharmaceutical and device companies, community-based organizations, data analytics companies, and patient advocacy groups. At this virtual event, attendees were asked to consider key questions around best practices for engagement of underrepresented populations. RESULTS Community engagement is an integral part of recruitment and retention of underrepresented groups. Decentralization of sites and use of digital tools can enhance the accessibility of clinical research. Finally, improving representation among investigators and clinical research staff may translate to diverse clinical trial participants. CONCLUSION Improving diversity in clinical trials is an ethical and scientific imperative, which requires a multifaceted approach.
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Affiliation(s)
- Michelle D Kelsey
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | | | | | | | | | | | - Lesley H Curtis
- Duke Clinical Research Institute, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | - George A Mensah
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - Amesika Nyaku
- Division of Infectious Diseases, Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | | | | | | | - Xinzhi Zhang
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Gerald S Bloomfield
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
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Nagata JM, McGuire FH, Lavender JM, Brown TA, Murray SB, Compte EJ, Cattle CJ, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR. Appearance and performance-enhancing drugs and supplements (APEDS): Lifetime use and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people. Eat Behav 2022; 44:101595. [PMID: 35066385 PMCID: PMC9359347 DOI: 10.1016/j.eatbeh.2022.101595] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Appearance and performance-enhancing drugs and supplements (APEDS) are used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people. METHODS Participants were cisgender sexual minority people (1090 gay men, 100 bisexual plus men, 564 lesbian women, and 507 bisexual plus women) recruited from The PRIDE Study in 2018 who reported lifetime APEDS use and completed the Eating Disorder Examination-Questionnaire (EDE-Q) and the Muscle Dysmorphic Disorder Inventory (MDDI). Regression analyses stratified by gender and sexual orientation examined associations of any APEDS use with EDE-Q and MDDI scores. RESULTS Lifetime APEDS use was common across the four groups of cisgender sexual minority people (44% of gay men, 42% of bisexual plus men, 29% of lesbian women, and 30% of bisexual plus women). Protein supplements and creatine supplements were the most commonly used APEDS. Any APEDS use was associated with higher EDE-Q scores on one or more subscales in all sexual minority groups. Further, any APEDS use was associated with higher MDDI Total Scores in all groups; any APEDS use was associated with all MDDI subscale scores in cisgender gay men only. DISCUSSION APEDS use is common and associated with eating disorder and muscle dysmorphia symptoms in sexual minority men and women, thus highlighting the importance of assessing for these behaviors and symptoms among these populations in clinical settings.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0110, San Francisco, CA 94143, USA.
| | - F Hunter McGuire
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130, USA.
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA; The Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA.
| | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; San Diego State University Research Foundation, 5250 Campanile Dr, San Diego, CA 92182, USA.
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar St #2200, Los Angeles, CA 90033, USA.
| | - Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Diagonal Las Torres 2640, Santiago, Peñalolén, Región Metropolitana, Chile; Research Department, Comenzar de Nuevo Treatment Center, Avenida Humberto Lobo 1001, Del Valle, 66220 San Pedro Garza García, N.L., Mexico.
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0110, San Francisco, CA 94143, USA.
| | - Annesa Flentje
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way San Francisco, CA 94143, USA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1930 Market Street, San Francisco, CA 94102, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA.
| | - Micah E Lubensky
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way San Francisco, CA 94143, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA.
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, 150 Governor's Lane, HRP Redwood Building, Stanford, CA 94305-5405, USA.
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, 150 Governor's Lane, HRP Redwood Building, Stanford, CA 94305-5405, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA.
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Clark KD, Luong S, Lunn MR, Flowers E, Bahalkeh E, Lubensky ME, Capriotti MR, Obedin-Maliver J, Flentje A. Healthcare Mistreatment, State-Level Policy Protections, and Healthcare Avoidance Among Gender Minority People. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1717-1730. [PMID: 36458212 PMCID: PMC9701649 DOI: 10.1007/s13178-022-00748-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 05/07/2023]
Abstract
INTRODUCTION This study examined whether past experiences of mistreatment in healthcare were associated with greater healthcare avoidance due to anticipated mistreatment among gender minority (GM) people. We evaluated whether state-level healthcare policy protections moderated this relationship. METHODS Data from the 2018 Annual Questionnaire of The PRIDE Study, a national longitudinal study on sexual and gender minority people's health, were used in these analyses. Logistic regression modeling tested relationships between lifetime healthcare mistreatment due to gender identity or expression and past-year healthcare avoidance due to anticipated mistreatment among GM participants. Interactions between lifetime healthcare mistreatment and state-level healthcare policy protections and their relationship with past-year healthcare avoidance were tested. RESULTS Participants reporting any lifetime healthcare mistreatment had greater odds of past-year healthcare avoidance due to anticipated mistreatment among gender expansive people (n = 1290, OR = 4.71 [CI]: 3.57-6.20), transfeminine people (n = 263, OR = 10.32 [CI]: 4.72-22.59), and transmasculine people (n = 471, OR = 3.90 [CI]: 2.50-6.13). Presence of state-level healthcare policy protections did not moderate this relationship in any study groups. CONCLUSIONS For GM people, reporting lifetime healthcare mistreatment was associated with healthcare avoidance due to anticipated mistreatment. State-level healthcare policy protections were not a moderating factor in this relationship. Efforts to evaluate the implementation and enforcement of state-level policies are needed. Continued efforts to understand instances of and to diminish healthcare mistreatment of GM people are recommended. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13178-022-00748-1.
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Affiliation(s)
- Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH USA
| | - Sean Luong
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA
| | - Elena Flowers
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, CA USA
| | - Esmaeil Bahalkeh
- Department of Health Management & Policy, University of New Hampshire, Durham, NH USA
| | - Micah E. Lubensky
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
| | | | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
- Department of Psychiatry, School of Medicine, Alliance Health Project, University of California San Francisco, San Francisco, CA USA
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Moseson H, Fix L, Gerdts C, Ragosta S, Hastings J, Stoeffler A, Goldberg EA, Lunn MR, Flentje A, Capriotti MR, Lubensky ME, Obedin-Maliver J. Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:e22-e30. [PMID: 33674348 PMCID: PMC8685648 DOI: 10.1136/bmjsrh-2020-200966] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Transgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision. METHODS In 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings. RESULTS Of 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost. CONCLUSIONS These data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.
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Affiliation(s)
| | - Laura Fix
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | | | | | - Jen Hastings
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ari Stoeffler
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | - Eli A Goldberg
- Department of Family Medicine, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Mitchell R Lunn
- Department of Nephrology, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- The PRIDE Study, Stanford University, Stanford, California, USA
| | - Annesa Flentje
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA
- Alliance Health Project, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew R Capriotti
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Psychology, San Jose State University, San Jose, California, USA
| | - Micah E Lubensky
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA
| | - Juno Obedin-Maliver
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- The PRIDE Study, Stanford University, Stanford, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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Rajamani G, Rodriguez Espinosa P, Rosas LG. Intersection of Health Informatics Tools and Community Engagement in Health-Related Research to Reduce Health Inequities: Scoping Review. J Particip Med 2021; 13:e30062. [PMID: 34797214 PMCID: PMC8663666 DOI: 10.2196/30062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/29/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The exponential growth of health information technology has the potential to facilitate community engagement in research. However, little is known about the use of health information technology in community-engaged research, such as which types of health information technology are used, which populations are engaged, and what are the research outcomes. OBJECTIVE The objectives of this scoping review were to examine studies that used health information technology for community engagement and to assess (1) the types of populations, (2) community engagement strategies, (3) types of health information technology tools, and (4) outcomes of interest. METHODS We searched PubMed and PCORI Literature Explorer using terms related to health information technology, health informatics, community engagement, and stakeholder involvement. This search process yielded 967 papers for screening. After inclusion and exclusion criteria were applied, a total of 37 papers were analyzed for key themes and for approaches relevant to health information technology and community engagement research. RESULTS This analysis revealed that the communities engaged were generally underrepresented populations in health-related research, including racial or ethnic minority communities such as Black/African American, American Indian/Alaska Native, Latino ethnicity, and communities from low socioeconomic backgrounds. The studies focused on various age groups, ranging from preschoolers to older adults. The studies were also geographically spread across the United States and the world. Community engagement strategies included collaborative development of health information technology tools and partnerships to promote use (encompassing collaborative development, use of community advisory boards, and focus groups for eliciting information needs) and use of health information technology to engage communities in research (eg, through citizen science). The types of technology varied across studies, with mobile or tablet-based apps being the most common platform. Outcomes measured included eliciting user needs and requirements, assessing health information technology tools and prototypes with participants, measuring knowledge, and advocating for community change. CONCLUSIONS This study illustrates the current landscape at the intersection of health information technology tools and community-engaged research approaches. It highlights studies in which various community-engaged research approaches were used to design culturally centered health information technology tools, to promote health information technology uptake, or for engagement in health research and advocacy. Our findings can serve as a platform for generating future research upon which to expand the scope of health information technology tools and their use for meaningful stakeholder engagement. Studies that incorporate community context and needs have a greater chance of cocreating culturally centered health information technology tools and better knowledge to promote action and improve health outcomes.
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Affiliation(s)
- Geetanjali Rajamani
- Department of Human Biology, Stanford University, Stanford, CA, United States
| | - Patricia Rodriguez Espinosa
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, United States
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Community norms for the eating disorder examination questionnaire (EDE-Q) among cisgender bisexual plus women and men. Eat Weight Disord 2021; 26:2227-2239. [PMID: 33270173 PMCID: PMC8437880 DOI: 10.1007/s40519-020-01070-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Cisgender bisexual plus (including bisexual, pansexual, and polysexual) women and men experience unique health concerns including eating disorders. The purpose of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in cisgender bisexual plus women and men using the Eating Disorders Examination Questionnaire (EDE-Q). METHODS Participants were cisgender bisexual plus women (n = 462) and men (n = 93) participants in The PRIDE Study, an existing study of sexual and gender minority people. RESULTS Mean and standard deviation of EDE-Q scores among cisgender bisexual plus women and men, respectively, were: Global (1.75 ± 1.26, 1.56 ± 1.18), Restraint (1.34 ± 1.44, 1.42 ± 1.53), Eating Concern (0.96 ± 1.13, 0.63 ± 0.96), Weight Concern 2.27 ± 1.55, 1.89 ± 1.46), and Shape Concern 42 ± 1.62, 2.30 ± 1.57). Among cisgender bisexual plus women and men, respectively, 27.5% and 22.6% scored in the clinically significant range on the Global score. Bisexual plus women and men reported any occurrence (≥ 1/28 days) of dietary restraint (19.3%, 23.7%), objective binge episodes (11.1%, 10.8%), excessive exercise (4.5%, 5.4%), self-induced vomiting (1.7%, 0.0%), and laxative misuse (0.4%, 1.1%), respectively. A lower percentage of age-matched cisgender bisexual plus women (18-25 years) reported any occurrence of objective binge episodes, self-induced vomiting, laxative misuse, and excessive exercise than previously published in young women. Age-matched cisgender bisexual plus men (18-26 years) reported higher weight concern subscale scores than previously published in young men. CONCLUSIONS These norms should aid clinicians in applying and interpreting the EDE-Q scores of cisgender bisexual plus women and men. LEVEL OF EVIDENCE Level V: cross-sectional descriptive study.
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Compte EJ, Cattle CJ, Lavender JM, Murray SB, Brown TA, Capriotti MR, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR, Nagata JM. Psychometric evaluation of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender gay men and cisgender lesbian women. Body Image 2021; 38:241-250. [PMID: 33962223 PMCID: PMC8635416 DOI: 10.1016/j.bodyim.2021.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 12/19/2022]
Abstract
Despite increasing empirical interest in muscle dysmorphia (MD), a dearth of research has assessed this construct in sexual minority populations. In particular, the psychometric properties of one of the most widely used measures of MD symptoms-the Muscle Dysmorphic Disorder Inventory (MDDI)-have not been evaluated in sexual minority populations despite emerging evidence suggesting differential risk for MD symptoms across sexual orientation groups. In this study, we assessed the psychometric properties of the MDDI in a sample of 715 cisgender gay men and 404 cisgender lesbian women ages 18-50 years who participated in a large-scale national longitudinal cohort study of sexual and gender minority adults. The factor structure of the MDDI was examined in each sample using a two-step, split-sample exploratory and confirmatory factor analytic approach. Exploratory factor analysis supported a three-factor structure in both samples, which were confirmed by confirmatory factor analysis. Moreover, results supported the internal consistency reliability and convergent validity of the MDDI subscales in both samples. Cumulatively, these findings suggest that the MDDI is an appropriate measure of MD symptoms among cisgender gay men and cisgender lesbian women.
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Affiliation(s)
- Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile; Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Metis Foundation, San Antonio, TX, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, CA, USA; San Diego State University Research Foundation, San Diego, CA, USA
| | - Matthew R Capriotti
- Department of Psychology, San José State University, San Jose, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Annesa Flentje
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
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Pho AT, Bakken S, Lunn MR, Lubensky ME, Flentje A, Dastur Z, Obedin-Maliver J. Online health information seeking, health literacy, and human papillomavirus vaccination among transgender and gender-diverse people. J Am Med Inform Assoc 2021; 29:285-295. [PMID: 34383916 PMCID: PMC8757308 DOI: 10.1093/jamia/ocab150] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/17/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Objective The purpose of this study is to describe online health information seeking among a sample of transgender and gender diverse (TGD) people compared with cisgender sexual minority people to explore associations with human papillomavirus (HPV) vaccination, and whether general health literacy and eHealth literacy moderate this relationship. Materials and Methods We performed a cross-sectional online survey of TGD and cisgender sexual minority participants from The PRIDE Study, a longitudinal, U.S.-based, national health study of sexual and gender minority people. We employed multivariable logistic regression to model the association of online health information seeking and HPV vaccination. Results The online survey yielded 3258 responses. Compared with cisgender sexual minority participants, TGD had increased odds of reporting HPV vaccination (aOR, 1.5; 95% CI, 1.1-2.2) but decreased odds when they had looked for information about vaccines online (aOR, 0.7; 95% CI, 0.5-0.9). TGD participants had over twice the odds of reporting HPV vaccination if they visited a social networking site like Facebook (aOR, 2.4; 95% CI, 1.1-5.6). No moderating effects from general or eHealth literacy were observed. Discussion Decreased reporting of HPV vaccination among TGD people after searching for vaccine information online suggests vaccine hesitancy, which may potentially be related to the quality of online content. Increased reporting of vaccination after using social media may be related to peer validation. Conclusions Future studies should investigate potential deterrents to HPV vaccination in online health information to enhance its effectiveness and further explore which aspects of social media might increase vaccine uptake among TGD people.
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Affiliation(s)
- Anthony T Pho
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, School of Nursing, Columbia University, New York, New York, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA.,Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Division of Gynecology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Division of Gynecology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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Nagata JM, Compte EJ, McGuire FH, Lavender JM, Brown TA, Murray SB, Flentje A, Capriotti MR, Lubensky ME, Obedin-Maliver J, Lunn MR. Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among gender minority populations. J Eat Disord 2021; 9:87. [PMID: 34261536 PMCID: PMC8278632 DOI: 10.1186/s40337-021-00442-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/02/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of heightened body image-related concerns among gender minority populations, little is known about the degree of MD symptoms among gender minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to assess community norms of the MDDI in gender-expansive people, transgender men, and transgender women. METHOD Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people, were examined. We calculated means, standard deviations, and percentiles for the MDDI total and subscale scores among gender-expansive people (i.e., those who identify outside of the binary system of man or woman; n = 1023), transgender men (n = 326), and transgender women (n = 177). The Kruskal-Wallis test was used to assess group differences and post hoc Dunn's tests were used to examine pairwise differences. RESULTS Transgender men reported the highest mean MDDI total score (30.5 ± 7.5), followed by gender-expansive people (27.2 ± 6.7), then transgender women (24.6 ± 5.7). The differences in total MDDI score were driven largely by the Drive for Size subscale and, to a lesser extent, the Functional Impairment subscale. There were no significant differences in the Appearance Intolerance subscale among the three groups. CONCLUSIONS Transgender men reported higher Drive for Size, Functional Impairment, and Total MDDI scores compared to gender-expansive people and transgender women. These norms provide insights into the experience of MD symptoms among gender minorities and can aid researchers and clinicians in the interpretation of MDDI scores among gender minority populations.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
| | - Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - F Hunter McGuire
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
| | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, CA, USA
- San Diego State University Research Foundation, San Diego, CA, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Annesa Flentje
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew R Capriotti
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Psychology, San José State University, San Jose, CA, USA
| | - Micah E Lubensky
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Streed CG, Beach LB, Caceres BA, Dowshen NL, Moreau KL, Mukherjee M, Poteat T, Radix A, Reisner SL, Singh V. Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e136-e148. [PMID: 34235936 DOI: 10.1161/cir.0000000000001003] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is growing evidence that people who are transgender and gender diverse (TGD) are impacted by disparities across a variety of cardiovascular risk factors compared with their peers who are cisgender. Prior literature has characterized disparities in cardiovascular morbidity and mortality as a result of a higher prevalence of health risk behaviors. Mounting research has revealed that cardiovascular risk factors at the individual level likely do not fully account for increased risk in cardiovascular health disparities among people who are TGD. Excess cardiovascular morbidity and mortality is hypothesized to be driven in part by psychosocial stressors across the lifespan at multiple levels, including structural violence (eg, discrimination, affordable housing, access to health care). This American Heart Association scientific statement reviews the existing literature on the cardiovascular health of people who are TGD. When applicable, the effects of gender-affirming hormone use on individual cardiovascular risk factors are also reviewed. Informed by a conceptual model building on minority stress theory, this statement identifies research gaps and provides suggestions for improving cardiovascular research and clinical care for people who are TGD, including the role of resilience-promoting factors. Advancing the cardiovascular health of people who are TGD requires a multifaceted approach that integrates best practices into research, health promotion, and cardiovascular care for this understudied population.
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Nagata JM, Compte EJ, Cattle CJ, Lavender JM, Brown TA, Murray SB, Flentje A, Capriotti MR, Lubensky ME, Obedin-Maliver J, Lunn MR. Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender sexual minority men and women. BMC Psychiatry 2021; 21:297. [PMID: 34103034 PMCID: PMC8186088 DOI: 10.1186/s12888-021-03302-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/24/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of elevated body image-related concerns among sexual minority populations, little is known about the degree of muscle dysmorphia (MD) symptoms among sexual minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to examine the nature and severity of MD symptoms in cisgender sexual minority men and women and provide community norms of the MDDI for these populations. METHODS Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people from the United States, were examined. Participants included cisgender gay men (N = 1090), cisgender bisexual plus (bisexual, pansexual, and/or polysexual) men (N = 100), cisgender lesbian women (N = 563), and cisgender bisexual plus women (N = 507). We calculated means, standard deviations (SD), and percentiles for the MDDI total and subscale scores for cisgender sexual minority men and women. We compared MDDI scores by sexual orientation using linear regression models, both unadjusted and adjusted for sociodemographics. RESULTS Overall, the sample was 85.2% White, 3.0% Asian or Pacific Islander, 2.0% Black, 0.5% Native American, 3.9% multiracial, and 6.6% Hispanic/Latino/a. The mean age was 38.6 (SD = 14.3) and 69.4% had a college degree or higher. Means (SD) for the MDDI total score were 27.4 (7.7) for cisgender gay men, 26.4 (6.4) for cisgender bisexual plus men, 24.3 (6.1) for cisgender lesbian women, and 24.6 (5.5) for cisgender bisexual plus women. There were no significant differences in MDDI scores between cisgender gay and bisexual plus men, or between cisgender lesbian women and bisexual plus women in unadjusted or adjusted models. CONCLUSIONS These normative data provide insights into the experience of MD symptoms among cisgender sexual minority men and women and can aid researchers and clinicians in the evaluation of MD symptoms and interpretation of MDDI scores in sexual minority populations.
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Affiliation(s)
- Jason M. Nagata
- grid.266102.10000 0001 2297 6811Department of Pediatrics, University of California, San Francisco, Box 0110, 550 16th Street, 4th Floor, San Francisco, CA 94158 USA
| | - Emilio J. Compte
- grid.440617.00000 0001 2162 5606Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile ,Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Chloe J. Cattle
- grid.266102.10000 0001 2297 6811Department of Pediatrics, University of California, San Francisco, Box 0110, 550 16th Street, 4th Floor, San Francisco, CA 94158 USA
| | - Jason M. Lavender
- grid.265436.00000 0001 0421 5525Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD USA ,The Metis Foundation, San Antonio, TX USA
| | - Tiffany A. Brown
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, San Diego, CA USA ,grid.263081.e0000 0001 0790 1491San Diego State University Research Foundation, San Diego, CA USA
| | - Stuart B. Murray
- grid.42505.360000 0001 2156 6853Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA USA
| | - Annesa Flentje
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA USA ,grid.168010.e0000000419368956The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
| | - Matthew R. Capriotti
- grid.168010.e0000000419368956The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA ,grid.186587.50000 0001 0722 3678Department of Psychology, San José State University, San Jose, CA USA
| | - Micah E. Lubensky
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, University of California, San Francisco, San Francisco, CA USA ,grid.168010.e0000000419368956The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
| | - Juno Obedin-Maliver
- grid.168010.e0000000419368956The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA
| | - Mitchell R. Lunn
- grid.168010.e0000000419368956The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA USA
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Abortion experiences and preferences of transgender, nonbinary, and gender-expansive people in the United States. Am J Obstet Gynecol 2021; 224:376.e1-376.e11. [PMID: 32986990 PMCID: PMC7518170 DOI: 10.1016/j.ajog.2020.09.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/18/2020] [Accepted: 09/22/2020] [Indexed: 01/28/2023]
Abstract
Background Transgender, nonbinary, and gender-expansive people who were assigned female or intersex at birth experience pregnancy and have abortions. Scarce data have been published on individual abortion experiences or preferences of this understudied population. Objective This study aimed to fill existing evidence gaps on the abortion experiences and preferences of transgender, nonbinary, and gender-expansive people in the United States to inform policies and practices to improve access to and quality of abortion care for this population. Study Design In 2019, we recruited transgender, nonbinary, and gender-expansive people who were assigned female or intersex at birth at the age of ≥18 years from across the United States to participate in an online survey about sexual and reproductive health recruited through The Population Research in Identities and Disparities for Equality Study and online postings. We descriptively analyzed closed- and open-ended survey responses related to pregnancy history, abortion experiences, preferences for abortion method, recommendations to improve abortion care for transgender, nonbinary, and gender-expansive people, and respondent sociodemographic characteristics. Results Most of the 1694 respondents were <30 years of age. Respondents represented multiple gender identities and sexual orientations and resided across all 4 United States Census Regions. Overall, 210 respondents (12%) had ever been pregnant; these 210 reported 433 total pregnancies, of which 92 (21%) ended in abortion. For respondents’ most recent abortion, 41 (61%) were surgical, 23 (34%) were medication, and 3 (5%) were another method (primarily herbal). Most recent abortions took place at ≤9 weeks’ gestation (n=41, 61%). If they were to need an abortion today, respondents preferred medication abortion over surgical abortion in a 3:1 ratio (n=703 vs n=217), but 514 respondents (30%) did not know which method they would prefer. The reasons for medication abortion preference among the 703 respondents included a belief that it is the least invasive method (n=553, 79%) and the most private method (n=388, 55%). To improve accessibility and quality of abortion care for transgender, nonbinary, and gender-expansive patients, respondents most frequently recommended that abortion clinics adopt gender-neutral or gender-affirming intake forms, that providers use gender-neutral language, and that greater privacy be incorporated into the clinic. Conclusion These data contribute substantially to the evidence base on individual experiences of and preferences for abortion care for transgender, nonbinary, and gender-expansive people. Findings can be used to adapt abortion care to better include and affirm the experiences of this underserved population.
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Lunn MR, Lubensky M, Hunt C, Flentje A, Capriotti MR, Sooksaman C, Harnett T, Currie D, Neal C, Obedin-Maliver J. A digital health research platform for community engagement, recruitment, and retention of sexual and gender minority adults in a national longitudinal cohort study--The PRIDE Study. J Am Med Inform Assoc 2021; 26:737-748. [PMID: 31162545 DOI: 10.1093/jamia/ocz082] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/02/2019] [Accepted: 05/10/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Sexual and gender minority (SGM) people are underrepresented in research. We sought to create a digital research platform to engage, recruit, and retain SGM people in a national, longitudinal, dynamic, cohort study (The PRIDE Study) of SGM health. MATERIALS AND METHODS We partnered with design and development firms and engaged SGM community members to build a secure, cloud-based, containerized, microservices-based, feature-rich, research platform. We created PRIDEnet, a national network of individuals and organizations that actively engaged SGM communities in all stages of health research. The PRIDE Study participants were recruited via in-person outreach, communications to PRIDEnet constituents, social media advertising, and word-of-mouth. Participants completed surveys to report demographic as well as physical, mental, and social health data. RESULTS We built a secure digital research platform with engaging functionality that engaged SGM people and recruited and retained 13 731 diverse individuals in 2 years. A sizeable sample of 3813 gender minority people (32.8% of cohort) were recruited despite representing only approximately 0.6% of the population. Participants engaged with the platform and completed comprehensive annual surveys- including questions about sensitive and stigmatizing topics- to create a data resource and join a cohort for ongoing SGM health research. DISCUSSION With an appealing digital platform, recruitment and engagement in online-only longitudinal cohort studies are possible. Participant engagement with meaningful, bidirectional relationships creates stakeholders and enables study cocreation. Research about effective tactics to engage, recruit, and maintain active participation from all communities is needed. CONCLUSION This digital research platform successfully recruited and engaged diverse SGM participants in The PRIDE Study. A similar approach may be successful in partnership with other underrepresented and vulnerable populations.
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Affiliation(s)
- Mitchell R Lunn
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA
| | - Micah Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Carolyn Hunt
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Matthew R Capriotti
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Psychology, San Jose State University, San Jose, California, USA
| | | | | | | | | | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
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Suen LW, Lunn MR, Katuzny K, Finn S, Duncan L, Sevelius J, Flentje A, Capriotti MR, Lubensky ME, Hunt C, Weber S, Bibbins-Domingo K, Obedin-Maliver J. What Sexual and Gender Minority People Want Researchers to Know About Sexual Orientation and Gender Identity Questions: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2301-2318. [PMID: 32875381 PMCID: PMC7497435 DOI: 10.1007/s10508-020-01810-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 05/19/2023]
Abstract
Sexual and gender minority (SGM) people-including members of the lesbian, gay, bisexual, transgender, and queer communities-are understudied and underrepresented in research. Current sexual orientation and gender identity (SOGI) questions do not sufficiently engage SGM people, and there is a critical gap in understanding how SOGI questions reduce inclusion and accurate empirical representation. We conducted a qualitative study to answer the question, "For SGM people, what are the major limitations with current SOGI questions?" Focus groups probed reactions to SOGI questions adapted from prior national surveys and clinical best practice guidelines. Questions were refined and presented in semi-structured cognitive interviews. Template analysis using a priori themes guided analysis. There were 74 participants: 55 in nine focus groups and 19 in cognitive interviews. Participants were diverse: 51.3% identified as gender minorities, 87.8% as sexual minorities, 8.1% as Hispanic/Latinx, 13.5% as Black or African-American, and 43.2% as Non-white. Two major themes emerged: (1) SOGI questions did not allow for identity fluidity and complexity, reducing inclusion and representation, and (2) SOGI question stems and answer choices were often not clear as to which SOGI dimension was being assessed. To our knowledge, this represents the largest body of qualitative data studying SGM perspectives when responding to SOGI questions. We present recommendations for future development and use of SOGI measures. Attention to these topics may improve meaningful participation of SGM people in research and implementation of such research within and for SGM communities.
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Affiliation(s)
- Leslie W Suen
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Katie Katuzny
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Alliance Health Project, Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Sacha Finn
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Laura Duncan
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Jae Sevelius
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Division of Prevention Science, Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- School of Nursing-Community Health Systems, University of California, San Francisco School of Nursing, San Francisco, CA, USA
| | | | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- School of Nursing-Community Health Systems, University of California, San Francisco School of Nursing, San Francisco, CA, USA
| | - Carolyn Hunt
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Shannon Weber
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA.
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
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Nagata JM, Murray SB, Flentje A, Compte EJ, Schauer R, Pak E, Capriotti MR, Lubensky ME, Lunn MR, Obedin-Maliver J. Eating disorder attitudes and disordered eating behaviors as measured by the Eating Disorder Examination Questionnaire (EDE-Q) among cisgender lesbian women. Body Image 2020; 34:215-220. [PMID: 32652490 PMCID: PMC7494647 DOI: 10.1016/j.bodyim.2020.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 06/02/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022]
Abstract
The Eating Disorder Examination Questionnaire (EDE-Q) is a measure of eating disorder attitudes and disordered eating behaviors. Prior descriptive studies of the EDE-Q for women either did not assess or omitted reporting sexual orientation. This study's objective was to assess eating disorder attitudes and disordered eating behaviors as measured by the EDE-Q among cisgender lesbian women. We present mean scores and standard deviations for the EDE-Q among 563 self-identified cisgender lesbian women ages 18-77 who were recruited from The PRIDE Study in 2018. Among cisgender lesbian women, 3.4 % scored in the clinically significant range on the Restraint, 1.6 % on the Eating Concern, 9.1 % on the Weight Concern, 13.9 % on the Shape Concern, and 3.9 % on the Global Score scales of the EDE-Q. We found that 13.5 % of participants reported any occurrence (≥1/28 days) of dietary restriction, 8.7 % for objective binge episodes, 5.3 % for excessive exercise, .4% for self-induced vomiting, and .4% for laxative misuse. Participants reported a current (1.8 %) or lifetime (7.1 %) diagnosis of an eating disorder by a clinician. These EDE-Q descriptive data capture eating disorder attitudes and disordered eating behaviors among cisgender lesbian women and may aid clinicians and researchers in interpreting the EDE-Q in this specific population.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Stuart B. Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Annesa Flentje
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA,The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA,Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
| | - Emilio J. Compte
- School of Psychology, Adolfo Ibáñez University, Santiago Chile,Research Department, Comenzar de Nuevo Treatment Center, Monterrey, México
| | - Rebecca Schauer
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Erica Pak
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Matthew R. Capriotti
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA,Department of Psychology, San José State University, San Jose, CA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
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Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among transgender men and women. Eat Behav 2020; 37:101381. [PMID: 32416588 PMCID: PMC7447532 DOI: 10.1016/j.eatbeh.2020.101381] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 11/21/2022]
Abstract
Transgender men and women may be at risk for eating disorders, but prior community norms of the Eating Disorders Examination Questionnaire (EDE-Q) are based on presumed cisgender men and woman and have not intentionally included transgender people. The objective of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in transgender men and women using the EDE-Q. Participants were 312 transgender men and 172 transgender women participants in The PRIDE Study, an existing cohort study of sexual and gender minority people. We present mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in transgender men and women. Transgender men and women reported any occurrence (≥1/week) of dietary restraint (25.0% and 27.9%), objective binge episodes (11.2% and 12.8%), excessive exercise (8.0% and 8.1%), self-induced vomiting (1.6% and 1.7%), and laxative misuse (.3% and .6%), respectively. Compared to a prior study of presumed cisgender men 18-26 years (Lavender, De Young, & Anderson, 2010), our age-matched subsample of transgender men reported lower rates of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18-42 years (Mond, Hay, Rodgers, & Owen, 2006), we found that an age-matched sample of transgender women reported higher rates of dietary restraint but lower rates of excessive exercise. These norms should aid clinicians in applying and researchers in investigating and interpreting the EDE-Q scores of transgender men and women.
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Callier S, Fullerton SM. Diversity and Inclusion in Unregulated mHealth Research: Addressing the Risks. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:115-121. [PMID: 32342751 DOI: 10.1177/1073110520917036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
mHealth devices and applications, with their wide accessibility and ease of use, have the potential to address persistent inequities in biomedical research participation. Yet, while mHealth technologies may facilitate more inclusive research participation, negative features of some unregulated use in research - misleading enrollment practices, the promotion of secondary mHealth applications, discriminatory profiling, and poorer quality feedback due to dependencies on biased data and algorithms - may threaten the trust and engagement of underrepresented individuals and communities. To maximize the participation of currently disenfranchised groups, those involved in unregulated mHealth research must become aware of potential risks, adopt targeted education policies, audit algorithms for hidden biases, and engage citizen scientists and other community members to identify and forestall possible harms.
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Affiliation(s)
- Shawneequa Callier
- Shawneequa Callier, M.A., J.D., is an Associate Professor of Clinical Research and Leadership in the Department of Clinical Research and Leadership at the School of Medicine and Health Sciences at The George Washington University in Washington, D.C. She is also a Special Volunteer at the Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health. Stephanie M. Fullerton, D.Phil., is a Professor in the Department of Bioethics and Humanities at the University of Washington School of Medicine in Seattle, WA
| | - Stephanie M Fullerton
- Shawneequa Callier, M.A., J.D., is an Associate Professor of Clinical Research and Leadership in the Department of Clinical Research and Leadership at the School of Medicine and Health Sciences at The George Washington University in Washington, D.C. She is also a Special Volunteer at the Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health. Stephanie M. Fullerton, D.Phil., is a Professor in the Department of Bioethics and Humanities at the University of Washington School of Medicine in Seattle, WA
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Barger BT, Obedin-Maliver J, Capriotti MR, Lunn MR, Flentje A. Characterization of substance use among underrepresented sexual and gender minority participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Subst Abus 2020; 42:104-115. [PMID: 32032500 DOI: 10.1080/08897077.2019.1702610] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Profiles of substance use among less commonly described subgroups of sexual and gender minority (SGM) people (e.g., queer, genderqueer) remain largely unknown. Objective(s): To identify substance use differences among less commonly described SGM identity-based subgroups. Methods: The PRIDE Study is a national, online, longitudinal cohort study of self-identified SGM adults living in the U.S. Between 2015-2017, an iPhone application was used to administer three cross-sectional health questionnaires to participants, one of which included questions about binge alcohol, marijuana, and other drug use (substance use). This study was a secondary data analysis of participant responses to substance use survey items. Logistic regression and generalized linear modeling assessed relationships between sexual orientation or gender and use of or reported problems with substances within the past year. Results: Among the 1790 participants included in this study, 51.0% reported binge alcohol use, 39.8% reported marijuana use, and 19.7% reported other drug use (65.9% endorsed use of one or more of these) within the past year. Over 30% indicated substance use had been a problem in their life. Asexual individuals had lower odds of reporting past year binge alcohol and marijuana use (aOR: 0.27, 95% CI: 0.12-0.61; aOR: 0.38, 95% CI: 0.15-0.96, respectively), and queer participants had higher odds of reporting past year marijuana use (aOR: 2.52, 95% CI: 1.58-4.03) compared to lesbian participants. Gender nonbinary participants had lower odds of reporting past year binge alcohol use (aOR: 0.48, 95% CI: 0.32-0.71) and transmasculine participants had higher odds of reporting past year marijuana use (aOR: 2.18, 95% CI: 1.10-4.31) compared to cisgender women. Conclusions: Substance use heterogeneity exists between SGM groups. Comprehensive assessment of sexual orientation and gender may improve understanding of substance use and increase equity within support and treatment services for SGM populations. Highlights We examined substance use among less represented sexual and gender minority groups. Alcohol and other drug use were examined by both sexual orientation and gender identity. Analyses included identities such as queer, pansexual, genderqueer and nonbinary. Alcohol use differed across asexual, genderqueer and gender nonbinary groups. Marijuana use differed across queer, asexual and transmasculine groups.
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Affiliation(s)
- Branden T Barger
- Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, California, USA.,The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew R Capriotti
- Department of Psychology, San Jose State University, San Jose, California, USA.,Division of Nephrology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, USA.,Department of Community Health Systems, University of California, San Francisco, School of Nursing, San Francisco, California, USA.,Alliance Health Project, Department of Psychiatry, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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Special issues raised by evolving areas of clinical research. ETHICAL CONSIDERATIONS WHEN PREPARING A CLINICAL RESEARCH PROTOCOL 2020. [PMCID: PMC7329119 DOI: 10.1016/b978-0-12-386935-7.00014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Each study presents its own set of ethical considerations. Certain kinds of ethical issues are inherent in particular areas of clinical research, regardless of specific ethical questions associated with a specific study. In this chapter, some of the most common special areas of clinical research are presented, highlighting the ethical issues most frequently associated with each.
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Nagata JM, Capriotti MR, Murray SB, Compte EJ, Griffiths S, Bibbins-Domingo K, Obedin-Maliver J, Flentje A, Lubensky M, Lunn MR. Community norms for the Eating Disorder Examination Questionnaire among cisgender gay men. EUROPEAN EATING DISORDERS REVIEW 2020; 28:92-101. [PMID: 31793119 PMCID: PMC7275693 DOI: 10.1002/erv.2708] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/07/2019] [Accepted: 09/15/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Prior norms of the Eating Disorders Examination Questionnaire (EDE-Q) among men have not considered sexual orientation. This study's objective was to assess EDE-Q community norms among cisgender gay men. METHOD Participants were 978 self-identified cisgender gay men from The PRIDE Study recruited in 2018. RESULTS We present mean scores and standard deviations for the EDE-Q among cisgender gay men ages 18-82. Among cisgender gay men, 4.0% scored in the clinically significant range on the global score, 5.7% on the restraint, 2.1% on the eating concern, 10.5% on the weight concern, and 21.4% on the shape concern subscales of the EDE-Q. The global score as well as weight and shape concerns in a young adult subsample (18-26 years) from The PRIDE Study were higher than previously reported norms in young men (Lavender, 2010). Participants reported any occurrence (≥1/28 days) of dietary restraint (19.8%), objective binge episodes (10.9%), excessive exercise (10.1%), laxative misuse (1.1%), and self-induced vomiting (0.6%). Binge eating, excessive exercise, and self-induced vomiting in The PRIDE Study subsample were lower than previously reported in young men. DISCUSSION We provide EDE-Q norms among cisgender gay men, which should aid clinicians and researchers to interpret the EDE-Q scores of cisgender gay men.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Matthew R. Capriotti
- Department of Psychology, San José State University, San Jose, CA
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
| | - Stuart B. Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Emilio J Compte
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
- DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
| | - Micah Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
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