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Wagner S, Panagiotakopoulos L, Nash R, Bradlyn A, Getahun D, Lash TL, Roblin D, Silverberg MJ, Tangpricha V, Vupputuri S, Goodman M. Progression of Gender Dysphoria in Children and Adolescents: A Longitudinal Study. Pediatrics 2021; 148:peds.2020-027722. [PMID: 34099504 PMCID: PMC8276590 DOI: 10.1542/peds.2020-027722] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The progression of gender-expansive behavior to gender dysphoria and to gender-affirming hormonal treatment (GAHT) in children and adolescents is poorly understood. METHODS A cohort of 958 gender-diverse (GD) children and adolescents who did not have a gender dysphoria-related diagnosis (GDRD) or GAHT at index were identified. Rates of first GDRD and first GAHT prescription were compared across demographic groups. RESULTS Overall, 29% of participants received a GDRD and 25% were prescribed GAHT during the average follow-up of 3.5 years (maximum 9 years). Compared with youth assigned male sex at birth, those assigned female sex at birth were more likely to receive a diagnosis and initiate GAHT with hazard ratio (95% confidence interval) estimates of 1.3 (1.0-1.7), and 2.5 (1.8-3.3), respectively. A progression to diagnosis was more common among those aged ≥15 years at initial presentation compared with those aged 10 to 14 years and those aged 3 to 9 years (37% vs 28% vs 16%, respectively). By using the youngest group as a reference, the adjusted hazard ratios (95% confidence interval) for a GDRD were 2.0 (1.3-3.0) for age 10 to 14 years and 2.7 (1.8-3.9) for age ≥15 years. Racial and ethnic minorities were less likely to receive a diagnosis or be prescribed GAHT. CONCLUSIONS This study characterized the progression of GD behavior in children and adolescents. Less than one-third of GD youth receive an eventual GDRD, and approximately one-quarter receive GAHT. Female sex at birth, older age of initial GD presentation to medical care, and non-Hispanic white race and ethnicity increased the likelihood of receiving diagnosis and treatment.
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Affiliation(s)
- Stephanie Wagner
- School of Medicine,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Rebecca Nash
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Andrew Bradlyn
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Timothy L. Lash
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | | | - Vin Tangpricha
- School of Medicine,Atlanta US Department of Veterans Affairs Medical Center, Atlanta, Georgia
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, Georgia
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Zhang Q, Rechler W, Bradlyn A, Flanders WD, Getahun D, Lash TL, McCracken C, Nash R, Panagiotakopoulos L, Roblin D, Sandberg DE, Silverberg MJ, Tangpricha V, Vupputuri S, Goodman M. Changes in Size and Demographic Composition of Transgender and Gender Non-Binary Population Receiving Care at Integrated Health Systems. Endocr Pract 2021; 27:390-395. [PMID: 33678315 DOI: 10.1016/j.eprac.2020.11.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine temporal changes in the number and demographic composition of transgender/gender non-binary (TGNB) population using data from integrated health care systems. METHODS Electronic health records from Kaiser Permanente health plans in Georgia and Northern and Southern California were used to identify TGNB individuals, who sought care from January 2006 to December 2014, and the data were analyzed by year, site, age, and sex assigned at birth. RESULTS In 2006, the number of TGNB people (and corresponding 95% CI) per 100 000 population were 3.5 (1.9, 6.3) in Georgia, 5.5 (4.8, 6.4) in Southern California, and 17 (16, 19) in Northern California. In 2014, these frequencies increased to 38 (32, 45), 44 (42, 46), and 75 (72, 78) per 100 000 population, respectively. When analyzed by age, the most rapid increase was observed among persons 18 to 25 years old, and this increase accelerated after 2010. The ratio of transmasculine to transfeminine persons also changed from 1:1.7 in 2006 to 1:1 in 2014 overall and from 1:1 in 2006 to 1.8:1 in 2014 among persons <18 years of age. CONCLUSION This analysis confirms previous observations that the proportion of TGNB people is growing, especially among young adults. The composition of the TGNB population is also changing from predominantly transfeminine to roughly 1:1 overall and to predominantly transmasculine in children and adolescents.
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Affiliation(s)
- Qi Zhang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Willi Rechler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Emory University, School of Medicine, Atlanta, Georgia
| | - Andrew Bradlyn
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Courtney McCracken
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - David E Sandberg
- Susan B. Meister Child Health and Evaluation Research Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Vin Tangpricha
- Emory University, School of Medicine, Atlanta, Georgia; The Atlanta VA Medical Center, Atlanta, Georgia
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
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Antun A, Zhang Q, Bhasin S, Bradlyn A, Flanders WD, Getahun D, Lash TL, Nash R, Roblin D, Silverberg MJ, Tangpricha V, Vupputuri S, Goodman M. Longitudinal Changes in Hematologic Parameters Among Transgender People Receiving Hormone Therapy. J Endocr Soc 2020; 4:bvaa119. [PMID: 33834151 PMCID: PMC8011434 DOI: 10.1210/jendso/bvaa119] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/13/2020] [Indexed: 12/23/2022] Open
Abstract
CONTEXT The effect of gender-affirming hormone therapy (HT) on erythropoiesis is an area of priority in transgender health research. OBJECTIVE To compare changes in hematologic parameters and rates of erythrocytosis and anemia among transgender people to those of cisgender controls. DESIGN Longitudinal observational study. PARTICIPANTS AND SETTING We compared 559 transfeminine (TF) and 424 transmasculine (TM) people enrolled in 3 integrated health care systems to matched cisgender referents. INTERVENTIONS AND OUTCOME Hormone therapy receipt was ascertained from filled prescriptions. Hemoglobin (Hb) and hematocrit (Hct) levels were examined from the first blood test to HT initiation, and from the start of HT to the most recent blood test. Rates of erythrocytosis and anemia in transgender participants and referents were compared by calculating adjusted hazard ratios and 95% confidence intervals (CI). RESULTS In the TF group, there was a downward trend for both Hb and Hct. The corresponding changes in the TM cohort were in the opposite direction. TM study participants experienced a 7-fold higher rate (95% CI: 4.1-13.4) of erythrocytosis relative to matched cisgender males, and an 83-fold higher rate (95% CI: 36.1-191.2) compared to cisgender females. The corresponding rates for anemia were elevated in TF subjects but primarily relative to cisgender males (hazard ratio 5.9; 95% CI: 4.6-7.5). CONCLUSIONS Our results support previous recommendations that hematological parameters of transgender people receiving HT should be interpreted based on their affirmed gender, rather than their sex documented at birth. The clinical significance of erythrocytosis following testosterone therapy, as well as anemia following feminizing HT, requires further investigation.
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Affiliation(s)
- Ana Antun
- Emory University, School of Medicine, Atlanta, Georgia
- The Atlanta VA Medical Center, Atlanta, Georgia
| | - Qi Zhang
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Shalender Bhasin
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard School of Medicine, Boston, Massachusetts
| | - Andrew Bradlyn
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - W Dana Flanders
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Timothy L Lash
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rebecca Nash
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, Maryland
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Vin Tangpricha
- Emory University, School of Medicine, Atlanta, Georgia
- The Atlanta VA Medical Center, Atlanta, Georgia
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, Maryland
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, Georgia
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Mak J, Shires DA, Zhang Q, Prieto LR, Ahmedani BK, Kattari L, Becerra-Culqui TA, Bradlyn A, Flanders WD, Getahun D, Giammattei SV, Hunkeler EM, Lash TL, Nash R, Quinn VP, Robinson B, Roblin D, Silverberg MJ, Slovis J, Tangpricha V, Vupputuri S, Goodman M. Suicide Attempts Among a Cohort of Transgender and Gender Diverse People. Am J Prev Med 2020; 59:570-577. [PMID: 32798005 PMCID: PMC7508867 DOI: 10.1016/j.amepre.2020.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. METHODS Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. RESULTS During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged <18 years than among those aged >45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2-5 times higher among those with 1-2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. CONCLUSIONS Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings.
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Affiliation(s)
- Josephine Mak
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
| | - Qi Zhang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lucas R Prieto
- School of Social Work, Michigan State University, East Lansing, Michigan
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, Michigan
| | - Tracy A Becerra-Culqui
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Andrew Bradlyn
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Shawn V Giammattei
- The Rockway Institute, Alliant International University, San Francisco, California
| | - Enid M Hunkeler
- Division of Research, Kaiser Permanente, Northern California (emerita), Oakland, California
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California (emerita), Pasadena, California
| | - Brandi Robinson
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, Maryland
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Jennifer Slovis
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Vin Tangpricha
- School of Medicine, Emory University, Atlanta, Georgia; The Atlanta VA Medical Center, Atlanta, Georgia
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, Maryland
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Parker M, Fang X, Bradlyn A. Costs and effectiveness of a culturally tailored communication training program to increase cultural competence among multi-disciplinary care management teams. BMC Health Serv Res 2020; 20:784. [PMID: 32831063 PMCID: PMC7446111 DOI: 10.1186/s12913-020-05662-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have demonstrated that cultural competence improves patient-provider communication, which promotes adherence to established care plans and improves patient satisfaction and health outcomes. However, there is very little data available regarding the costs associated with the development and implementation of cultural competence training, or the cost-effectiveness of these programs. To that end, this evaluation aims to describe costs, program effectiveness, and cost-effectiveness of a culturally tailored communication training program to improve cultural competence among multi-disciplinary care management teams. METHODS As part of a region-wide quality improvement initiative to reduce healthcare disparities among African American patients with uncontrolled hypertension, three multi-disciplinary care management teams were invited to participate in a two-part communication training program. A paired samples t-test was used to assess program effectiveness based on participant responses to a validated cultural competence self-assessment survey 2 weeks before and after the training program. A micro-costing approach was used to estimate programmatic costs for content development and delivery. Cost-effectiveness was then determined using the average cost-effectiveness ratio, and sensitivity analyses were conducted to assess the impact of participant mix on this result. RESULTS All scores (n = 17) improved after training; however, only the culturally competent behaviors (CCB) subscale change was statistically significant (p = 0.02). Overall program costs were $5754.19. The average program cost per participant was $138.51, with an ACER of $337.83 per 1-unit increase in CCB score. Sensitivity analyses yielded a range of ACERs between $122.59 and $457.07, where all participants are support staff or nurses, respectively. CONCLUSIONS Culturally tailored communication training increases how frequently participants demonstrate culturally competent behaviors and may be a cost-effective intervention for care management teams to address individual cultural competence. Detailed costs associated with cultural competence training are largely unavailable in the literature; as such, these data may serve as a financial framework for organizations considering the implementation of similar programs.
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Affiliation(s)
- Marie Parker
- Kaiser Foundation Health Plan of Georgia, 3495 Piedmont Road, NE, Atlanta, GA, 30305, USA.
- Georgia State University School of Public Health, Urban Life Building, 140 Decatur Street, Suite 439, Atlanta, GA, 30303, USA.
- Center for Research and Evaluation, Kaiser Permanente, 1375 Peachtree Street, NE, Atlanta, GA, 30309, USA.
| | - Xiangming Fang
- Georgia State University School of Public Health, Urban Life Building, 140 Decatur Street, Suite 439, Atlanta, GA, 30303, USA
- China Agricultural University, 17 Qinghua E Rd, Haidian District, Beijing, China
| | - Andrew Bradlyn
- Center for Research and Evaluation, Kaiser Permanente, 1375 Peachtree Street, NE, Atlanta, GA, 30309, USA
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To M, Zhang Q, Bradlyn A, Getahun D, Giammattei S, Nash R, Owen-Smith AA, Roblin D, Silverberg MJ, Tangpricha V, Vupputuri S, Goodman M. Visual Conformity With Affirmed Gender or "Passing": Its Distribution and Association With Depression and Anxiety in a Cohort of Transgender People. J Sex Med 2020; 17:2084-2092. [PMID: 32807706 DOI: 10.1016/j.jsxm.2020.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/12/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Visual conformity with affirmed gender (VCAG) or "passing" is thought to be an important, but poorly understood, determinant of well-being in transgender people. VCAG is a subjective measure that is different from having an inner sense of being congruent with one's gender identity. AIM We examined the frequency and determinants of VCAG and explored its association with mental health outcomes in a cohort of transgender adults. METHODS The "Study of Transition, Outcomes & Gender (STRONG)" is a cohort of transgender individuals recruited from 3 Kaiser Permanente health plans located in Georgia, Northern California and Southern California. A subset of cohort members completed a survey between 2015 and 2017. VCAG was assessed as the difference between 2 scales: scale 1 reflecting the person's sense of how they are perceived by others, and scale 2 reflecting the person's desire to be perceived. Participants were considered to have achieved VCAG when their scale 1 scores were equal to or exceeded their scale 2 scores. The frequency of VCAG and their independent associations with anxiety and depression symptoms were explored using data from 620 survey respondents including 309 transwomen and 311 transmen. Based on self-described gender identity, none of the participants identified as nonbinary or gender fluid. OUTCOMES VCAG, depression, and anxiety. RESULTS VCAG was achieved in 28% of transwomen and 62% of transmen and was more common in persons who reported greater sense of acceptance and pride in their gender identity as measured on the Transgender Congruence Scale. Another factor associated with greater likelihood of VCAG was receipt of gender-affirming surgery, but the association was only evident among transmen. Participants who achieved VCAG had a lower likelihood of depression and anxiety with prevalence ratios (95% confidence intervals) of 0.79 (0.65, 0.96) and 0.67 (0.46, 0.98), respectively. CLINICAL IMPLICATIONS VCAG may serve as an important outcome measure after gender-affirming therapy. STRENGTHS AND LIMITATIONS Strengths of this study include a well-defined sampling frame and use of a novel patient-centered outcome of interest. Cross-sectional design and uncertain generalizability of results are the limitations. CONCLUSION These results, once confirmed by prospective studies, may help better characterize the determinants of well-being in the transgender community, facilitating the design of interventions to improve the well-being and quality of life of this vulnerable population. To M, Zhang Q, Bradlyn A, et al. Visual Conformity With Affirmed Gender or "Passing": Its Distribution and Association With Depression and Anxiety in a Cohort of Transgender People. J Sex Med 2020;17:2084-2092.
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Affiliation(s)
- Margaret To
- Emory University, School of Medicine, Atlanta, GA, USA
| | - Qi Zhang
- Emory University, Rollins School of Public Health, Atlanta GA, USA
| | - Andrew Bradlyn
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Shawn Giammattei
- The Rockway Institute, Alliant International University, San Francisco, CA, USA
| | - Rebecca Nash
- Emory University, Rollins School of Public Health, Atlanta GA, USA
| | - Ashli A Owen-Smith
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA; Georgia State University, School of Public Health, Department of Health Policy and Behavioral Sciences, Atlanta GA, USA
| | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | | | - Vin Tangpricha
- Emory University, School of Medicine, Atlanta, GA, USA; The Atlanta Veteran Affairs Medical Center, Atlanta GA, USA
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Michael Goodman
- Emory University, Rollins School of Public Health, Atlanta GA, USA.
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Gerth J, Becerra-Culqui T, Bradlyn A, Getahun D, Hunkeler EM, Lash TL, Millman A, Nash R, Quinn VP, Robinson B, Roblin D, Silverberg MJ, Tangpricha V, Vupputuri S, Goodman M. Agreement between medical records and self-reports: Implications for transgender health research. Rev Endocr Metab Disord 2018; 19:263-269. [PMID: 30219985 PMCID: PMC6438197 DOI: 10.1007/s11154-018-9461-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A key priority of transgender health research is the evaluation of long-term effects of gender affirmation treatment. Thus, accurate assessment of treatment receipt is critical. The data for this analysis came from an electronic medical records (EMR) based cohort of transgender individuals. A subset of cohort members were also asked to complete a self-administered survey. Information from the EMR was compared with survey responses to assess the extent of agreement regarding transmasculine (TM)/transfeminine (TF) status, hormone therapy receipt, and type of surgery performed. Logistic regression models were used to assess whether participant characteristics were associated with disagreement between data sources. Agreement between EMR and survey-derived information was high regarding TM/TF status (99%) and hormone therapy receipt (97%). Lower agreement was observed for chest reconstruction surgery (72%) and genital reconstruction surgery (84%). Using survey responses as the "gold standard", both chest and genital reconstruction surgeries had high specificity (95 and 93%, respectively), but the corresponding sensitivities were low (49 and 68%, respectively). A lower proportion of TM had concordant results for chest reconstruction surgery (64% versus 79% for TF) while genital reconstruction surgery concordance was lower among TF (79% versus 89% for TM). For both surgery types, agreement was highest among the youngest participants. Our findings offer assurance that EMR-based data appropriately classify cohort participants with respect to their TM/TF status or hormone therapy receipt. However, current EMR data may not capture the complete history of gender affirmation surgeries. This information is useful in future studies of outcomes related to gender affirming therapy.
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Affiliation(s)
- Joseph Gerth
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, CNR 3021, Atlanta, GA, 30322, USA
| | - Tracy Becerra-Culqui
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Andrew Bradlyn
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Enid M Hunkeler
- Emerita, Division of Research, Kaiser Permanente, Northern California, Oakland, CA, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, CNR 3021, Atlanta, GA, 30322, USA
| | - Andrea Millman
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, CNR 3021, Atlanta, GA, 30322, USA
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Brandi Robinson
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | | | - Vin Tangpricha
- School of Medicine, Emory University, Atlanta, GA, USA
- The Atlanta VA Medical Center, Atlanta, GA, USA
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, CNR 3021, Atlanta, GA, 30322, USA.
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Cottrell L, Harris CV, Bradlyn A, Gunel E, Neal WA, Abildso L, Coffman JW. Identifying the People and Factors That Influence Children’s Intentions to Make Lifestyle Changes. Health Promot Pract 2011; 13:183-9. [PMID: 21343422 DOI: 10.1177/1524839910384053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Childhood obesity and health behavior programs are increasingly a focus within literature and individual provider practices. This study was designed to inform “best practices” for establishing effective programs in the medical setting by identifying persons and factors that influence children’s willingness to be active, eat healthy, and lose weight when medically appropriate. A total of 342 child and parent dyads living in a rural setting participated in this study. Child and parent report of theory of planned behavior constructs and child intentions to lose weight, eat healthier, and increase own exercise was established as the study outcomes. Parent and child perceptions and child characteristics (e.g., weight status) were associated with children’s intentions to lose weight and obtain more exercise whereas only child perceptions were associated with children’s intentions to eat healthier. Incorporating children as young as 10 years of age in conversations and planning for diet and physical activity lifestyle changes is essential for the success of the treatment option.
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Gainor SJ, Bradlyn A, Harris CV, Remick SC, Shumway J. Health professions students' understanding and attitudes about cancer clinical trials: Implications for including cancer clinical trial competencies in curricula. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cottrell L, Harris CV, Deskins S, Bradlyn A, Wrye Coffman J. Developing culturally tailored health belief-based intervention materials to improve child and parent participation in a cardiovascular screening program. Health Promot Pract 2009; 11:418-27. [PMID: 19325184 DOI: 10.1177/1524839908321561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Coronary Artery Risk Detection in Appalachian Communities Project was developed to reduce children's future cardiovascular risk by implementing a school-based screening program statewide. Despite the elimination of environmental barriers related to screening cost and accessibility, only half of eligible children participate in the program each year. The authors used the theory of planned behavior to identify health beliefs associated with screening participation. This article describes the process used to identify community health beliefs and the development of theoretically based materials to increase participation. Focus groups and individual interviews were conducted to identify core health beliefs held by parents, community leaders, and children (Phase I). Data obtained were used to expand and revise a Health Beliefs Questionnaire, which was distributed to larger samples (Phase II). This information was used to design recruitment materials that emphasized the benefits of screening while directly addressing potential belief-based barriers to screening participation (Phase III).
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Affiliation(s)
- Lesley Cottrell
- Department of Pediatrics at the West Virginia University School of Medicine in Morgantown, West Virginia, USA
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