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Agénor M, Lett E, Ramanayake N, Zubizarreta D, Murchison GR, Eiduson R, Gordon AR. Racial/Ethnic Differences in Sexually Transmitted Infection Testing Among Transgender Men and Nonbinary Assigned Female at Birth Young Adults in the United States: a National Study. J Racial Ethn Health Disparities 2023; 10:2900-2910. [PMID: 36469284 DOI: 10.1007/s40615-022-01467-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) cause a major burden of disease in the United States (US)-especially among structurally marginalized populations, including transgender and nonbinary people, individuals assigned female at birth (AFAB), Black and Latinx/e individuals, and young adults. Although screening can help detect and prevent STIs, research on STI testing among populations at diverse intersections of multiple forms of structural marginalization, including Black, Latinx/e, and other racially/ethnically minoritized transgender men and nonbinary AFAB US young adults, is extremely scarce. METHODS We conducted a national cross-sectional online survey of transgender and nonbinary US young adults from February to July 2019. Using Poisson regression, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the associations between race/ethnicity-which we conceptualized as a system of structural inequality that shapes individuals' and groups' exposure to racism-and lifetime and past-year STI testing among transgender men and nonbinary AFAB US young adults aged 18-30 years with at least one-lifetime sexual partner (N = 378). RESULTS Approximately 74% of participants had received an STI test in their lifetime, and, among those, 72% with a past-year sexual partner had been tested for an STI in the last 12 months. We observed no statistically significant association between race/ethnicity and lifetime STI testing among transgender and nonbinary AFAB young adults with a lifetime sexual partner. In contrast, Black (PR = 1.32; 95%: 1.03, 1.68) and Latinx/e (PR = 1.39; 95% CI: 1.11, 1.75) transgender men and nonbinary AFAB young adults who ever received an STI test and had a past-year sexual partner were significantly more likely to have received an STI test in the last 12 months relative to their White counterparts, adjusting for demographic factors. Further adjustment for lifetime STI diagnosis and health insurance status did not appreciably attenuate these observed adjusted differences; however, the adjusted difference in the prevalence of past-year STI testing between Black (but not Latinx/e) and White transgender men and nonbinary AFAB young adults was no longer statistically significant upon further adjustment for educational attainment and employment status, possibly due to small sample sizes. CONCLUSION The higher adjusted prevalence of past-year STI testing among Black and Latinx/e compared to White transgender men and nonbinary AFAB US young adults may reflect racist and xenophobic sexual stereotypes about Black and Latinx/e people among health care providers and institutions, the history of hyper-surveillance of Black and Latinx/e people by public health institutions in the context of infectious disease containment, and/or agency and resistance among Black and Latinx/e transgender men and nonbinary AFAB young adults with regard to sexual health promotion in the face of multiple compounding systems of oppression.
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Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Applied Transgender Studies, Chicago, IL, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | | | - Dougie Zubizarreta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gabriel R Murchison
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Rose Eiduson
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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Eisenstadt BE, Murchison GR, Soulliard ZA, Gordon AR. Body Image and High-Risk Weight and Shape Control Behaviors Among Transgender and Nonbinary Young Adults: The Role of Sexual Assault. LGBT Health 2023; 10:586-594. [PMID: 37410994 PMCID: PMC10712357 DOI: 10.1089/lgbt.2022.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Purpose: Transgender and nonbinary (TNB) populations experience disproportionate rates of sexual assault. Despite evidence from cisgender samples linking sexual assault exposure to body image concerns and disordered eating behaviors, such as weight and shape control behaviors (WSCBs), little is known about these relationships in TNB people. The purpose of this study was to assess associations among past-year sexual assault exposure, body areas satisfaction, body weight esteem, and high-risk WSCBs in a sample of TNB young adults. Methods: A sample of 714 participants completed a cross-sectional online survey. Multivariable linear and logistic models were fit to determine associations between constructs of interest. Natural effects mediation analyses assessed for potential mediation of the relationship between sexual assault and WSCBs by body areas satisfaction and body weight esteem. Analyses were stratified by three gender identity categories. Results: Past-year sexual assault exposure was associated with significantly decreased body areas satisfaction, but only for nonbinary participants. No significant association was found between sexual assault and body weight esteem. Sexual assault was associated with significantly increased risk for WSCBs across gender identity categories. No mediation of these relationships by body areas satisfaction and body weight esteem was observed. Conclusion: Findings support clinical consideration of WSCBs in TNB survivors of sexual assault. Results suggest that multiple factors, including body image and sexual assault, may contribute separately to disordered eating behaviors in TNB young adults.
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Affiliation(s)
- Benjamin E. Eisenstadt
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Gabriel R. Murchison
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Layland EK, Bränström R, Murchison GR, Pachankis JE. Kept in the Closet: Structural Stigma and the Timing of Sexual Minority Developmental Milestones Across 28 European Countries. J Youth Adolesc 2023:10.1007/s10964-023-01818-2. [PMID: 37410349 DOI: 10.1007/s10964-023-01818-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
Structural stigma's role in lesbian, gay, and bisexual (LGB) people's attainment of identity development milestones remains unknown. In a sample of 111,498 LGB people (ages 15 to 65+) living across 28 European countries, associations were investigated between structural stigma measured using an objective index of discriminatory country-level laws and policies affecting LGB people and the timing and pacing of LGB self-awareness, coming out, and closet duration, and subgroup differences in these associations. On average, self-awareness occurred at age 14.8 years old (SD = 5.1), coming out occurred at 18.5 years old (SD = 5.7), and the closet was 3.9 years long (SD = 4.9); thereby highlighting adolescence as a key period for sexual identity development and disclosure. Greater structural stigma was associated with higher odds of never coming out, later age of coming out, and longer closet duration. Gender identity, transgender identity, and sexual identity moderated associations between structural stigma and these developmental milestones. Reducing structural stigma can plausibly promote sexual identity development among LGB populations, especially during adolescence when identity related milestones are often attained.
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Affiliation(s)
- E K Layland
- Department of Human Development and Family Sciences, University of Delaware, 111 Alison Hall West, Newark, DE, 19716, USA.
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA.
| | - R Bränström
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden
| | - G R Murchison
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
| | - J E Pachankis
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
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Murchison GR, Chen JT, Austin SB, Reisner SL. Interventional Effects Analysis of Dating Violence and Sexual Assault Victimization in LGBTQ + Adolescents: Quantifying the Roles of Inequities in School and Family Factors. Prev Sci 2023; 24:1023-1034. [PMID: 37349640 PMCID: PMC10645412 DOI: 10.1007/s11121-023-01562-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
Lesbian, gay, bisexual, transgender/nonbinary, and queer (LGBTQ +) adolescents experience considerable disparities in dating violence and sexual assault victimization relative to heterosexual and cisgender peers. These disparities may be driven in part by the disruptive effects of heterosexism and cissexism on school-based and family relationships. To quantify the potential roles of these processes and identify priorities for prevention efforts, we estimated the extent to which dating violence and sexual assault victimization in LGBTQ + adolescents could be reduced by eliminating sexual orientation and gender modality inequities in school adult support, bullying victimization, and family adversity. We analyzed data from a cross-sectional, population-based survey of high school students in Dane County, Wisconsin (N = 15,467; 13% sexual minority; 4% transgender/nonbinary; 72% White) using interventional effects analysis, adjusting for grade, race/ethnicity, and family financial status. We found that eliminating inequities in bullying victimization and family adversity could significantly reduce dating violence and sexual assault victimization in LGBTQ + adolescents, particularly sexual minority cisgender girls and transgender/nonbinary adolescents. For instance, eliminating gender modality inequities in family adversity could reduce sexual assault victimization in transgender/nonbinary adolescents by 2.4 percentage points, representing 27% of the existing sexual assault victimization disparity between transgender/nonbinary and cisgender adolescents (P < 0.001). Results suggest that dating violence and sexual assault victimization in LGBTQ + adolescents could be meaningfully reduced by policies and practices addressing anti-LGBTQ + bullying as well as heterosexism- and cissexism-related stress in LGBTQ + adolescents' families.
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Affiliation(s)
- Gabriel R Murchison
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
| | - Jarvis T Chen
- Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - S Bryn Austin
- Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Murchison GR, Aguayo-Romero RA, Lett E, Katz-Wise SL, Agénor M, Gordon AR. Transgender/nonbinary young adults' exposure to cissexism-related social stressors: Variation across gender groups. Soc Sci Med 2023; 329:116013. [PMID: 37315357 PMCID: PMC10710666 DOI: 10.1016/j.socscimed.2023.116013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Young adults who are transgender and/or nonbinary (TNB) experience discrimination, violence, and other social stressors as a result of cissexism, the system of power relations that marginalizes people whose genders diverge from sociocultural expectations for the sex they were assigned at birth. However, variation in TNB young adults' exposure to social stressors across gender groups, particularly specific nonbinary gender groups (e.g., agender, genderqueer), has not been well characterized. METHODS We analyzed data from an online cross-sectional survey of U.S. TNB young adults (N = 667; ages 18-30 years; 44% White, 24% multiracial, 14% Black, 10% Latinx, 7% Asian, 1% another race/ethnicity), assessing gender non-affirmation; cissexist discrimination, rejection, and victimization; general discrimination; sexual assault victimization; and psychological, physical, and sexual abuse in childhood/adolescence. We used generalized linear models to test for variation in stressors across six gender groups (transgender woman [n = 259], transgender man [n = 141], agender [n = 36], gender fluid [n = 30], genderqueer [n = 51], nonbinary [n = 150]) and compare each group to the full sample. We performed similar analyses among nonbinary gender groups. RESULTS Exposure to stressors was considerable in all groups. Several stressors (e.g., past-year cissexist discrimination) did not vary significantly by gender group. Compared to the full sample, transgender women reported greater lifetime cissexist rejection and lifetime and past-year cissexist victimization. Compared to the full sample, transgender men and women reported greater lifetime cissexist discrimination and lower past-year gender non-affirmation. No stressors varied significantly across nonbinary gender groups. CONCLUSION Among TNB young adults, women, men, and nonbinary people experience distinct patterns of some (though not all) stigma-related stressors. Decisions about (dis)aggregating research participants by gender group, or providing gender-tailored services for TNB people, should account for patterning of pertinent stressors. Efforts to eliminate structural cissexism should address intersections with other systems of power relations, including sexism and binary normativity.
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Affiliation(s)
- Gabriel R Murchison
- Yale School of Public Health, Department of Social & Behavioral Sciences, New Haven, CT, USA
| | - Rodrigo A Aguayo-Romero
- Harvard Medical School, Department of Medicine, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA; Fenway Health, The Fenway Institute, Boston, MA, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, IL, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sabra L Katz-Wise
- Boston Children's Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA, USA; Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA; Harvard Medical School, Department of Pediatrics, Boston, MA, USA
| | - Madina Agénor
- Fenway Health, The Fenway Institute, Boston, MA, USA; Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, USA; Brown University School of Public Health, Center for Health Promotion and Health Equity, Providence, RI, USA
| | - Allegra R Gordon
- Boston Children's Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA, USA; Harvard Medical School, Department of Pediatrics, Boston, MA, USA; Boston University School of Public Health, Department of Community Health Sciences, Boston, MA, USA.
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Murchison GR, Austin SB, Reisner SL, Chen JT. Middle School Psychological Distress and Sexual Harassment Victimization as Predictors of Dating Violence Involvement. J Interpers Violence 2023; 38:6576-6600. [PMID: 36367156 PMCID: PMC10692829 DOI: 10.1177/08862605221135166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Adolescent sexual harassment victimization is increasingly recognized as a strong risk factor for dating violence victimization and perpetration. Research on this association has focused on older adolescents and on sexual harassment at a single time point rather than chronic exposure. Furthermore, potential mechanisms, such as psychological distress, are not well understood. The goals of this study were to identify whether sexual harassment victimization and psychological distress were reciprocally related, whether chronic psychological distress and sexual harassment victimization in early adolescence were associated with higher levels of dating violence involvement measured in mid-adolescence, and whether these relationships differed between boys and girls. We used longitudinal data from 4,718 US middle school students to fit regression models for the associations between sexual harassment victimization and psychological distress. We then used data from a subset of 1,279 students followed up in high school to fit marginal structural models for sixth- to eighth-grade psychological distress and sexual harassment victimization as predictors of dating violence involvement measured in ninth grade. We found that (1) sexual harassment victimization was positively, concurrently associated with psychological distress, with a stronger association among girls than boys; (2) psychological distress was positively, prospectively associated with sexual harassment victimization among girls but not boys; (3) chronic sixth- to eighth-grade psychological distress was not significantly associated with dating violence victimization or perpetration measured in ninth grade; and (4) chronic sixth- to eighth-grade sexual harassment victimization was associated with significantly higher levels of dating violence victimization and perpetration measured in ninth grade. The results support a reciprocal relationship between distress and sexual harassment victimization for early adolescent girls, and they call for further attention to gender differences in the content and impact of sexual harassment. Furthermore, the findings indicate that preventing sexual harassment in early adolescence may be critical in reducing dating violence.
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Affiliation(s)
- Gabriel R. Murchison
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - S. Bryn Austin
- Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jarvis T. Chen
- Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Eiduson R, Murchison GR, Agénor M, Suarez L, Gordon AR. Sexual healthcare experiences of nonbinary young adults. Cult Health Sex 2022; 24:1319-1335. [PMID: 34657546 DOI: 10.1080/13691058.2021.1946595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
Nonbinary young adults (who do not identify with a binary male or female identity and may hold diverse gender identities, including genderqueer, nonbinary and agender) may have unique and unmet sexual healthcare needs compared to binary transgender and cisgender people. However, there is limited knowledge about the sexual health and healthcare needs of nonbinary young adults. We conducted 19 semi-structured, in-depth interviews between August and November 2018 with nonbinary people aged 18-30 years in New England. Interview topics included experiences accessing sexual healthcare and engaging in sexual activity. Interviews were transcribed and transcripts were analysed using inductive and deductive thematic analysis. Three main themes were identified. First, participants described barriers to accessing high-quality sexual healthcare at both the interpersonal and institutional level. Second, participants employed strategies to meet their sexual healthcare needs despite encountering barriers. Third, participants articulated the ways nonbinary gender identities affect sexual relationships, with implications for sexual health. These findings underscore the need for research and advocacy - in collaboration with nonbinary persons themselves - to develop best practices to meet the sexual healthcare needs and advance the sexual health of nonbinary young people.
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Affiliation(s)
| | | | - Madina Agénor
- Department of Community Health, Tufts University, Medford, MA, USA
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Allegra R Gordon
- Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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Agénor M, Lett E, Murchison GR, Tabaac AR, Dowshen N, Gordon AR. Gender-Related Health Care Discrimination and Human Papillomavirus Vaccination Among Transgender and Nonbinary Young Adults in the United States. Transgend Health 2022. [PMID: 37525839 PMCID: PMC10387145 DOI: 10.1089/trgh.2021.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Although transgender and nonbinary (TNB) people can acquire human papillomavirus (HPV), research examining HPV vaccination in these populations is scarce. TNB individuals experience high levels of gender-related health care discrimination, which may undermine HPV vaccine uptake. Using data from a national online survey (N=716), we found a negative association between gender-related health care discrimination and HPV vaccination among transgender women and nonbinary individuals who were assigned male at birth (AMAB; odds ratio [OR]=0.52; 95% confidence interval [CI]: 0.29-0.93). Addressing gender-related health care discrimination may facilitate HPV vaccination and help prevent HPV-related cancers among transgender women and nonbinary AMAB individuals.
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Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Elle Lett
- Center for Health Equity Advancement, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Applied Transgender Studies, Chicago, Illinois, USA
| | - Gabriel R. Murchison
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ariella R. Tabaac
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Nadia Dowshen
- Department of Pediatrics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Allegra R. Gordon
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
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Agénor M, Murchison GR, Najarro J, Grimshaw A, Cottrill AA, Janiak E, Gordon AR, Charlton BM. Mapping the scientific literature on reproductive health among transgender and gender diverse people: a scoping review. Sex Reprod Health Matters 2021; 29:1886395. [PMID: 33625311 PMCID: PMC8011687 DOI: 10.1080/26410397.2021.1886395] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 01/21/2023] Open
Abstract
We conducted a scoping review to map the extent, range and nature of the scientific research literature on the reproductive health (RH) of transgender and gender diverse assigned female at birth and assigned male at birth persons. A research librarian conducted literature searches in Ovid MEDLINE®, Ovid Embase, the Cochrane Library, PubMed, Google Scholar, Gender Studies Database, Gender Watch, and Web of Science Core Collection. The results were limited to peer-reviewed journal articles published between 2000 and 2018 involving human participants, written in English, pertaining to RH, and including disaggregated data for transgender and gender diverse people. A total of 2197 unique citations with abstracts were identified and entered into Covidence. Two independent screeners performed a title and abstract review and selected 75 records for full-text review. The two screeners independently extracted data from 37 eligible articles, which were reviewed, collated, summarised, and analysed using a numerical summary and thematic analysis approach. The existing scientific research literature was limited in terms of RH topics, geographic locations, study designs, sampling and analytical strategies, and populations studied. Research is needed that: focuses on the full range of RH issues; includes transgender and gender diverse people from the Global South and understudied and multiply marginalised subpopulations; is guided by intersectionality; and uses intervention, implementation science, and community-based participatory research approaches. Further, programmes, practices, and policies that address the multilevel barriers to RH among transgender and gender diverse people addressed in the existing scientific literature are warranted.
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Affiliation(s)
- Madina Agénor
- Gerald R. Gill Assistant Professor, Department of Community Health, Tufts University, Medford, MA, USA; Adjunct Faculty, Department of Obstetrics and Gynecology, Tufts University School of Medicine, and The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Gabriel R. Murchison
- PhD Student, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jesse Najarro
- Undergraduate Student, Department of Community Health, Tufts University, Medford, MA, USA
| | - Alyssa Grimshaw
- Clinical Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Alischer A. Cottrill
- Research Coordinator, Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Elizabeth Janiak
- Director of Social Science Research, Planned Parenthood League of Massachusetts, Boston, MA, USA; Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, USA and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Instructor, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Allegra R. Gordon
- Assistant Professor, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Instructor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Brittany M. Charlton
- Assistant Professor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA, Department of Pediatrics, Harvard Medical School, Boston, MA, USA and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Murchison GR, Rosenbach SB, Poteat VP, Yoshikawa H, Calzo JP. Gender-sexuality alliance membership and activities: associations with students' comfort, confidence and awareness regarding substance use resources. Health Educ Res 2021; 36:295-308. [PMID: 33544834 PMCID: PMC8487662 DOI: 10.1093/her/cyab007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
Belonging to a school Gender and Sexuality Alliance (GSA) is associated with lower substance use among LGBTQ+ youth. However, it is unknown whether GSA participation facilitates access to resources for substance use concerns. Using longitudinal data from 38 Massachusetts high schools, we compared sources of support for substance use concerns listed by GSA members (n = 361) and nonmembers (n = 1539). Subsequently, we tested whether GSA membership was associated with comfort, confidence and awareness regarding substance use resources in school and the community. Finally, we assessed whether specific GSA activities and discussions (e.g. social support) were associated with these outcomes. Among students with recent substance use, GSA membership was associated with greater comfort, confidence and awareness regarding school-based substance use resources in the spring semester, adjusted for fall semester levels and non-GSA club involvement. Furthermore, students in GSAs where members reported more advocacy and social support activities reported higher levels of comfort, confidence and awareness regarding community-based substance use resources. These results indicate that among students using alcohol or nicotine products, GSA members may be more receptive to school-based substance use prevention efforts. Furthermore, GSA-based social support and activism experiences may promote access to community-based substance use resources.
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Affiliation(s)
- Gabriel R Murchison
- Department of Social & Behavioral Sciences, Harvard University, Boston, MA, USA
| | - Sarah B Rosenbach
- Department of Applied Psychology, New York University, New York, NY, USA
| | - V Paul Poteat
- Department of Counseling, Developmental & Educational Psychology, Boston College, Chestnut Hill, MA, USA
| | - Hirokazu Yoshikawa
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Jerel P Calzo
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA, USA
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Poteat VP, Calzo JP, Yoshikawa H, Lipkin A, Ceccolini CJ, Rosenbach SB, O'Brien MD, Marx RA, Murchison GR, Burson E. Greater Engagement in Gender-Sexuality Alliances (GSAs) and GSA Characteristics Predict Youth Empowerment and Reduced Mental Health Concerns. Child Dev 2019; 91:1509-1528. [PMID: 31762010 DOI: 10.1111/cdev.13345] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Extracurricular groups can promote healthy development, yet the literature has given limited attention to indirect associations between extracurricular involvement and mental health or to sexual and gender minority youth. Among 580 youth (Mage = 15.59, range = 10-20 years) and adult advisors in 38 Gender-Sexuality Alliances (GSAs), multilevel structural equation models showed that greater engagement in GSAs over the school year predicted increased perceived peer validation, self-efficacy to promote social justice, and hope (baseline adjusted). Through increased hope, greater engagement indirectly predicted reduced depressive and anxiety symptoms at the year's end (baseline adjusted). GSAs whose members had more mental health discussions and more meetings reported reduced mental health concerns. Findings suggest how groups addressing issues of equity and justice improve members' health.
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Agénor M, Murchison GR, Chen JT, Bowen DJ, Rosenthal MB, Haneuse S, Austin SB. Impact of the Affordable Care Act on human papillomavirus vaccination initiation among lesbian, bisexual, and heterosexual U.S. women. Health Serv Res 2019; 55:18-25. [PMID: 31709542 DOI: 10.1111/1475-6773.13231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the effect of the 2010 Affordable Care Act (ACA) extended dependent coverage and no cost-sharing provisions on human papillomavirus (HPV) vaccination in relation to sexual orientation identity among U.S. women. DATA SOURCES 2006-2010 and 2011-2015 National Survey of Family Growth. STUDY DESIGN We used an interrupted time series design and multivariable Poisson regression to assess differences in HPV vaccination initiation before (2007-2010) and after (2011-2015) the 2010 ACA provisions among heterosexual, bisexual, and lesbian U.S. women aged 15-25 years (N = 7033), adjusting for temporal trends and demographic factors. DATA COLLECTION Computer-assisted personal interview and audio computer-assisted self-interview questionnaires. PRINCIPAL FINDINGS The adjusted prevalence of HPV vaccination initiation was significantly higher among lesbian and bisexual women after compared to before the 2010 ACA-at 19.1 (95% confidence interval [CI]: 5.4, 32.9) and 15.7 (95% CI: 4.4, 27.1) percentage points in 2015 compared to 2007-2010, respectively. We observed no association between the 2010 ACA provisions and HPV vaccination initiation among heterosexual women after adjusting for temporal trends and demographic factors. CONCLUSIONS The 2010 ACA provisions may have improved HPV vaccination initiation among lesbian and bisexual women. Policies and programs that increase access to health insurance and provide HPV vaccines at no cost to patients may facilitate HPV vaccine uptake in these marginalized populations.
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Affiliation(s)
- Madina Agénor
- Department of Community Health, Tufts University, Medford, Massachusetts.,The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Gabriel R Murchison
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sydney Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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13
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Murchison GR, Agénor M, Reisner SL, Watson RJ. School Restroom and Locker Room Restrictions and Sexual Assault Risk Among Transgender Youth. Pediatrics 2019; 143:peds.2018-2902. [PMID: 31061223 PMCID: PMC8849575 DOI: 10.1542/peds.2018-2902] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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] [Accepted: 03/05/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Transgender and gender nonbinary adolescents experience high rates of peer victimization, but the prevalence of sexual assault in this population has not been established. Some schools restrict transgender and nonbinary students from using restrooms and locker rooms that match their gender identity, with unknown effects on sexual assault risk. We tested whether these restrictions were associated with the 12-month prevalence of sexual assault victimization. METHODS Survey responses were analyzed from 3673 transgender and nonbinary US adolescents in grades 7 through 12 who participated in the cross-sectional 2017 LGBTQ Teen Study. We estimated the association between school restroom and locker room restrictions and sexual assault, adjusting for potential social and behavioral confounders, using logistic regression. We also tested potential mediators. RESULTS The 12-month prevalence of sexual assault was 26.5% among transgender boys, 27.0% among nonbinary youth assigned female at birth, 18.5% among transgender girls, and 17.6% among nonbinary youth assigned male at birth. Youth whose restroom and locker room use was restricted were more likely to experience sexual assault compared with those without restrictions, with risk ratios of 1.26 (95% confidence interval [CI]: 1.02-1.52) in transgender boys, 1.42 (95% CI: 1.10-1.78) in nonbinary youth assigned female at birth, and 2.49 (95% CI: 1.11-4.28) in transgender girls. Restrictions were not associated with sexual assault among nonbinary youth assigned male at birth. CONCLUSIONS Pediatricians should be aware that sexual assault is highly prevalent in transgender and nonbinary youth and that restrictive school restroom and locker room policies may be associated with risk.
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Affiliation(s)
- Gabriel R. Murchison
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA 02115
| | - Madina Agénor
- Department of Community Health, Tufts University, 574 Boston Ave Suite 208, Medford, MA 02155.,The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, USA, 02215
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, USA, 02215,Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, USA 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA 02115,Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA 02115
| | - Ryan J. Watson
- Department of Human Development and Family Studies, University of Connecticut, 348 Mansfield Road U1058, Storrs, CT, USA, 06269
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14
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White Hughto JM, Murchison GR, Clark K, Pachankis JE, Reisner SL. Geographic and Individual Differences in Healthcare Access for U.S. Transgender Adults: A Multilevel Analysis. LGBT Health 2016; 3:424-433. [PMID: 27636030 DOI: 10.1089/lgbt.2016.0044] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To identify geographic and individual-level factors associated with healthcare access among transgender people in the United States. METHODS Multilevel analyses were conducted to investigate lifetime healthcare refusal using national data from 5831 U.S. transgender adults. Hierarchical generalized linear models examined associations between individual (age, gender, race, income, insurance, and healthcare avoidance) and state-level factors (percent voting Republican, percent same-sex couple households, income inequality, and transgender protective laws) and lifetime refusal of care. RESULTS Results show that individual-level factors (being older; trans feminine; Native American, multiracial, or other racial/ethnic minority; having low income; and avoiding care due to discrimination) are positively associated with care refusal (all P-values <0.05). Adjusting for individual-level factors, variation was observed across U.S. states, with a greater proportion of states in the Southern and Western United States with transgender residents at increased odds of experiencing care refusal, relative to other regions of the United States. When adjusting for state-level factors, the percentage of the state population voting Republican was positively associated with care refusal among the transgender adults sampled (P < 0.01). CONCLUSION Transgender adults surveyed reported differential access to healthcare by geographic region. Identifying geographic and individual-level factors associated with healthcare barriers allows for the development of targeted educational and policy interventions to improve healthcare access for transgender people most in need of services.
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Affiliation(s)
- Jaclyn M White Hughto
- 1 Chronic Disease Epidemiology, Yale School of Public Health , New Haven, Connecticut.,2 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Gabriel R Murchison
- 1 Chronic Disease Epidemiology, Yale School of Public Health , New Haven, Connecticut
| | - Kirsty Clark
- 1 Chronic Disease Epidemiology, Yale School of Public Health , New Haven, Connecticut
| | - John E Pachankis
- 1 Chronic Disease Epidemiology, Yale School of Public Health , New Haven, Connecticut
| | - Sari L Reisner
- 2 The Fenway Institute , Fenway Health, Boston, Massachusetts.,3 Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School , Boston, Massachusetts.,4 Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
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Abstract
There is a growing interest in HIV infection and sexually transmitted infection (STI) disease burden and risk among transgender people globally; however, the majority of work has been conducted with male-to-female transgender populations. This research synthesis comprehensively reviews HIV and STI research in female-to-male (FTM) transgender adults. A paucity of research exists about HIV and STIs in FTMs. Only 25 peer-reviewed papers (18 quantitative, 7 qualitative) and 11 'grey literature' reports were identified, most in the US or Canada, that include data identifying HIV and STI risks in FTMs (five with fully laboratory-confirmed HIV and/or STIs, and five with partial laboratory confirmation). Little is known about the sexual and drug use risk behaviours contributing to HIV and STIs in FTMs. Future directions are suggested, including the need for routine surveillance and monitoring of HIV and STIs globally by transgender identity, more standardised sexual risk assessment measures, targeted data collection in lower- and middle-income countries, and explicit consideration of the rationale for inclusion/exclusion of FTMs in category-based prevention approaches with MSM and transgender people. Implications for research, policy, programming, and interventions are discussed, including the need to address diverse sexual identities, attractions, and behaviours and engage local FTM communities.
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Affiliation(s)
- Sari L Reisner
- a Division of General Pediatrics , Boston Children's Hospital/Harvard Medical School , Boston , MA , USA.,b Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,c Fenway Health , The Fenway Institute , Boston , MA , USA
| | - Gabriel R Murchison
- d Department of Chronic Disease Epidemiology , Yale School of Public Health , New Haven , CT , USA
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