Experiences of stress and social safety among sexual and gender minority youth by disability status

BACKGROUND

Though separate bodies of research have shown sexual and gender minority (SGM) youth, and youth with disabilities, separately, face distinct social and health disparities, little is known about youth who both identify as SGM and have disabilities.

OBJECTIVE

The current study examined differences in wellbeing among SGM youth by disability category (i.e., physical, developmental, psychiatric) across victimization, bullying, dating violence, school safety, and experienced stress.

METHODS

Using self-reported data from 9418 SGM youth aged 13-17 in the United States, multivariate linear regressions were conducted to examine how stress and social safety experiences varied across disability status.

RESULTS

Compared to SGM youth without a disability, SGM youth across all disability categories (physical, developmental, psychiatric) had greater odds of LGBT- and disability-based victimization, greater average stress, as well as lower levels of school safety. SGM youth with any disability, physical disability, or psychiatric disability also had greater odds of dating violence compared to SGM youth without a disability.

CONCLUSION

SGM youth with disabilities may be in particular need of targeted programs that address both disability and sexual/gender identities, and may benefit from increased supports across developmental contexts (e.g., against bullying in school). Stakeholders should consider how such support can be improved, tailored, and implemented, for SGM youth and the diversity of disabilities they have.

Human immunodeficiency virus diagnosis and care among adults with intellectual and developmental disabilities who are publicly insured

BACKGROUND

This study aimed to assess the prevalence of human immunodeficiency virus (HIV) testing, HIV diagnosis and receipt of HIV care among adults with intellectual and developmental disabilities (IDDs) who are publicly insured in the USA.

DESIGN

This study is a cross-sectional analysis of Medicare-Medicaid linked data of adults with IDD who were publicly insured in 2012 (n = 878 186).

METHODS

We estimated adjusted prevalence ratios of HIV testing, diagnosis and receipt of antiretroviral therapy (ART). We also identified the relationship between predisposing (age, gender, race and ethnicity), enabling (Medicare, Medicaid or both; rural status; geographical location; and county income) and need-related characteristics (IDD diagnosis and other co-occurring conditions) associated with these outcomes.

RESULTS

Only 0.12% of adults with IDD who had no known HIV diagnosis had received an HIV test in the past year. The prevalence of HIV diagnosis among adults with IDD was 0.38%, although differences by type of IDD diagnosis were observed. Prevalence of HIV diagnosis differed by type of IDD. Among adults with IDD who were living with HIV, approximately 71% had received ART during 2012. The adjusted analyses indicate significant racial disparities, with Black adults with IDD making up the majority (59.11%) of the HIV-positive IDD adult population.

CONCLUSIONS

Adults with IDD are a unique priority population at risk for HIV-related disparities, and the level of risk is differential among subtypes of IDD. People with IDD, like other people with disabilities, should be considered in prevention programming and treatment guidelines to address disparities across the HIV care continuum.

Comfort Levels of Outpatient Health Care Professionals When Asking About Substance Use-Related Sexual Activity: A Pilot Survey

BACKGROUND

Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based intervention for substance use. Health care professionals may not receive SBIRT training or know of substance use's intersection with sexual activity. This pilot survey inquired about SBIRT training history, attitudes, and comfort among outpatient health care professionals, including assessing sexual activity-related use.

METHODS

We conducted a snowball cross-sectional survey of outpatient health care professionals at a large southeastern academic medical center in June 2021 with 4-point Likert questions covering demographics, substance use attitudes, SBIRT training history, and comfort implementing SBIRT. Analysis used descriptive statistics and stratification by demographic and practice characteristics.

RESULTS

Seventy-three professionals responded, of whom 82% were White and 66% were female. Forty-seven percent were 30 to 39 years old, 33% were internal medicine professionals, and 59% reported previous SBIRT training. All participants reported believing substance use is a significant health issue. Most reported that they were comfortable or somewhat comfortable assessing patients for substance use (85%), dropping to 60% discussing sexual activity. Advanced practice providers and physicians identified more comfort with rapport building around substance use than other health care respondents. Professionals in infectious diseases and psychiatry reported the greatest comfort assessing substance use with concurrent sexual activity.

CONCLUSIONS

There are gaps in SBIRT training and beliefs among health care professionals. Although health care workers report that assessing substance use is important, some professionals endorsed more comfort discussing substance use with patients than others, especially when inquiring about sexual activity. Future work could replicate the pilot to inform increasing comfort through training in the intersection of substance use and sexuality.

The Opioid Overdose Resuscitation Education for Addiction Counselors and Trainees (Opioid Overdose REACT) naloxone response education pilot project improved confidence and knowledge among addiction counselors and trainees

INTRODUCTION

Community programs to teach nonmedical laypeople how to recognize an opioid overdose and effectively resuscitate the victim using naloxone have proliferated recently as a significant component of harm-reduction efforts. Although many such programs target laypeople like first responders or friends and family members of people who use drugs, there are currently no programs that specifically target addiction counselors, despite their work with a client population at high risk of an opioid overdose.

METHODS

The four-hour curriculum designed by the authors covered opioid agonist and antagonist pharmacology; opioid toxidrome signs; legal implications and indications for using the naloxone kits; and hands-on training. Participants were two cohorts of addiction counselors and addiction counseling trainees at our institution and an affiliated Opioid Treatment Program methadone clinic. Surveys testing participant knowledge and confidence were conducted at baseline, immediately post-training, six months post-training, and 12 months post-training.

RESULTS

Overall, opioid and naloxone pharmacology knowledge, as well as the confidence to intervene in an overdose emergency, improved among participants in both cohorts. Knowledge scores at baseline (n = 36, median 5/10) improved significantly immediately post-training (n = 31, median 7/10, P < 0.0001, Wilcoxon signed-rank test) and were sustained six (n = 19) and 12 months (n = 11) later. Two participants reported using their naloxone kits to successfully reverse a client overdose in the 12 months after taking the course.

DISCUSSION

These results from our knowledge translation pilot project suggest that our educational program to train addiction counselors in opioid pharmacology and toxicology, allowing them to recognize and respond to an opioid overdose, is feasible and could be effective. Specific barriers to implementing such educational programs include cost, stigma, and unclear best practice for designing and conducting these programs.

CONCLUSIONS

Further study of providing opioid pharmacology education and overdose and naloxone training to addiction counselors and counseling trainees appears to be warranted.

Mental and Physical Health Disparities Among Sexual and Gender Minority Adolescents Based on Disability Status

Purpose: Sexual and gender minority (SGM) youth and youth with disabilities both experience health disparities. Little data exist on whether SGM youth with disabilities have worse health outcomes compared with SGM youth without disabilities. This study aimed to examine differences in health behaviors and outcomes among a sample of SGM youth by different types of disabilities. Methods: Secondary analyses were conducted with a subset (N = 9418) of the LGBTQ National Teen Survey, a comprehensive survey of risk and protective factors and health outcomes of SGM youth across the United States collected in 2017. Multiple types of disabilities (physical, cognitive, or psychiatric) and mental, behavioral, and physical health outcomes were self-reported. Results: Of the sample, 18.3% reported a disability. Significant findings included higher odds of exercise avoidance, greater depressive symptoms and sleep concerns, and lower self-esteem and overall health ratings among SGM youth who reported any form of disability compared with SGM youth who reported no disability. Youth with cognitive disabilities had lower odds of alcohol use than youth with no disability. Youth with psychiatric disabilities had higher odds of cannabis and cigarette use, and lower physical activity than youth with no disability. Youth with either psychiatric or physical disabilities reported higher body mass index than youth with no disability. Conclusion: SGM youth with disabilities experience greater health disparities than SGM youth with no reported disabilities. Results provide groundwork evidence about the impact of disability status on SGM adolescents. Disability-inclusive or -specific frameworks are needed for future interventions and studies of SGM youth.

Sexual Risk Behavior and Sexually Transmitted Infections Among College Students With Disabilities

BACKGROUND

In the past 20 years, there has been an increase in the number of college students with disabilities (SWDs) in the United States. Students with disabilities may have not received relevant, or accessible, sexual health education from medical providers, parents, or school health educators. Because of the lack of this education, the college social environment, and developmental timing of traditional college aged students, SWDs are at risk of engaging in health compromising sexual behavior.

METHODS

We conducted a secondary data analysis of traditionally aged (18- to 24-year-olds) college students who completed the National College Health Assessment administered in Fall 2017 and Spring 2018 (N = 95,119). We use prevalence and generalized linear models to describe self-reported sexual health behavior and outcomes among college students without disabilities and SWDs, by disability category.

RESULTS

Findings indicate that college students with disabilities-particularly students with attention-deficient hyperactivity disorder, psychiatric conditions, and multiple disabilities-are at higher risk than students without disabilities to engage in health compromising sexual health behavior and that students with multiple disabilities have higher adjusted prevalence ratios of being diagnosed and/or treated for a sexually transmitted infection.

CONCLUSIONS

Students with disabilities are not a monolithic population and there is cross-disability variability of engaging in health compromising and health promoting behavior. These findings highlight the need for college health promotion specialists and clinicians to advocate for accessible, sex positive, disability inclusive sexual health education.