Parent Awareness of and Attitudes Toward Gender-Affirming Pediatric Health Care: A Cross-Sectional Survey

PURPOSE

We aimed to characterize parent attitudes toward gender-affirming healthcare for transgender youth, from a general parent sample in a diverse urban setting.

METHODS

We surveyed Chicago parents through the Voices of Child Health in Chicago Parent Panel Survey via web and phone in English and Spanish from May-July 2022. We used both probability-based and nonprobability-based sampling, with calibration weights for the nonprobability sample. Parents responded about their awareness of a debate about and support for autonomy in gender-affirming healthcare for transgender youth and provided demographic information. We used descriptive analyses and logistic regression to examine predictors of awareness and support. Data were weighted to be representative of Chicago's parent population.

RESULTS

Surveys were completed by 1,059 parents. The survey completion rate for the probability sample was 43.1% (a completion rate was not available for the nonprobability sample from online, opt-in surveys). Most parents were unaware of the debate about gender-affirming healthcare (56.0%). More than two-thirds of parents (68.9%) support decisions about gender-affirming healthcare being left to children, their parents, and their doctor. Parents who were aware of the debate were more likely to support gender-affirming healthcare (83.7%) than parents who were not aware (57.2%, p < .0001). Parents who were aware of the debate had higher odds of supporting gender-affirming care for youth (adjusted odds ratio = 3.00, 95% confidence interval: 1.93-4.66) in a multivariable logistic regression model.

DISCUSSION

Broad parent support for gender-affirming healthcare for transgender youth is an important perspective to consider in policy discussions at state and federal levels.

Multidisciplinary Care for Gender-Diverse Youth: A Narrative Review and Unique Model of Gender-Affirming Care

Heightened public awareness about gender diversity in childhood and adolescence has resulted in more youth and families seeking medical and mental health services. In response to these needs, there has been nationwide growth in specialized multidisciplinary clinics treating gender-diverse and transgender youth. Despite general agreement that comprehensive treatment is best delivered through a multidisciplinary team by both medical and mental health clinicians with gender-related expertise and familiarity with child and adolescent development, there is currently no consensus regarding the best approach to clinical care with gender-diverse and transgender youth. In this article, we provide a narrative review of the gender affirmative model guiding our clinical practice and describe the development of our unique model of affirming care within the Gender and Sex Development Program at the Ann & Robert H. Lurie Children's Hospital of Chicago.

Diagnostic and prognostic biomarkers in melanoma

Melanoma is a lethal melanocytic neoplasm. Unfortunately, the histological diagnosis can be difficult at times. Distinguishing ambiguous melanocytic neoplasms that are benign nevi from those that represent true melanoma is important both for treatment and prognosis. Diagnostic biomarkers currently used to assist in the diagnosis of melanoma are usually specific only for melanocytic neoplasms and not necessarily for their ability to metastasize. Traditional prognostic biomarkers include depth of invasion and mitotic count. Newer diagnostic and prognostic biomarkers utilize immunohistochemical staining as well as ribonucleic acid, micro-ribonucleic acid, and deoxyribonucleic acid assays and fluorescence in situ hybridization. Improved diagnostic and prognostic biomarkers are of increasing importance in the treatment of melanoma with the development of newer and more targeted therapies. Herein, the authors review many of the common as well as newer diagnostic and prognostic biomarkers used in melanoma.

Resource list: Clinical care programs for gender-nonconforming children and adolescents

Locating specialized services for gender-nonconforming children and adolescents can be challenging. The following resource list--organized by U.S. and Canada geographical region--serves to help clinicians access the most up-to-date information on this special population and pass it along to their patients and families.

Toxicity and carcinogenicity of nitrofurazone in F344/N rats and B6C3F1 mice

Toxicology and carcinogenesis studies were conducted by feeding diets containing nitrofurazone (99% pure) to groups of F344/N rats and B6C3F1 mice for 14 days, 13 wk or 2 yr. In the 14-day studies, in which doses ranged from 630 to 10,000 ppm, nitrofurazone was more toxic to mice than to rats. Accordingly, in the 13-wk studies, doses for rats ranged from 150 to 2500 ppm and for mice from 70 to 1250 ppm. At the higher doses, convulsive seizures and gonadal hypoplasia were observed in both species. Evidence of toxicity in rats also included degenerative arthropathy. For the 2-yr studies, rats were exposed to 0, 310 or 620 ppm nitrofurazone and the survival of male rats given 620 ppm was lower than that of controls (33/50, 30/50 and 20/50 in the control, 310- and 620-ppm groups, respectively). Nitrofurazone administration increased the incidences of mammary gland fibroadenomas in female rats (8/49, 36/50 and 36/50 in the control, 310- and 620-ppm groups, respectively). In male rats it was associated with a marginal increase in sebaceous gland adenomas and trichoepitheliomas of the skin, mesotheliomas of the tunica vaginalis, and tumours of the perputial gland. Nitrofurazone caused testicular degeneration (atrophy of germinal epithelium and aspermatogenesis) in rats, and degeneration of vertebral and knee articular cartilage in rats of both sexes. In mice, dietary concentrations of nitrofurazone for the 2-yr studies were 0, 150 or 310 ppm. In mice of each sex, nitrofurazone administration induced stimulus-sensitive convulsive seizures, primarily during the first year of study. In male mice, there was no evidence of any chemically-related carcinogenic effects, but there was a treatment-related decrease in survival (39/50, 31/50 and 27/50 in the control, 150- and 310-ppm groups, respectively). In female mice nitrofurazone induced ovarian lesions with increased incidences of benign mixed tumours (0/47, 17/50 and 20/50 in control, low- and high-dose groups, respectively) and granulosa cell tumours (1/47, 4/50 and 9/50 in control, low- and high-dose groups, respectively).

Physical and psychosocial function in rheumatoid arthritis. Clinical use of a self-administered health status instrument

The treatment of chronic disease is often directed at preservation of function, but most functional measures are crude, and rarely include indicators of psychosocial status. The Sickness Impact Profile (SIP) is a newer "health status" measure designed to comprehensively assess such outcomes. The functional and psychosocial impacts of rheumatoid arthritis and their relation to disease duration were measured by having 79 patients self-administer the SIP. Disease impacts were pervasive, including effects on leisure, social, and sexual activities, as well as physical function. While physical and psychosocial disease impacts were positively correlated, the association diminished with longer duration of disease. The self-administered SIP appears to be practical and useful in clinical settings. Specific results may help to target patient education, increase physician awareness of the distress patients experience, suggest that the need for social rehabilitative services, and help monitor responses to therapy.