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Lim G, Bourne A, Hill A, McNair R, Lyons A, Amos N. Community connection is associated with lower psychological distress for sexual minority women who view community connection positively. Cult Health Sex 2024; 26:513-530. [PMID: 37452686 DOI: 10.1080/13691058.2023.2231043] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
We examined factors associated with sexual minority women's evaluations of belonging to the lesbian, gay, bisexual, transgender and queer (LGBTQ) community in Australia, and assessed whether a positive view of community participation impacted levels of psychological distress. 2424 cisgender sexual minority women participated in a national, online, cross-sectional survey of LGBTIQ adult Australians' health and well-being. Multivariable regression analyses were conducted to investigate sociodemographic factors associated with sexual minority women's belonging to the LGBTQ community, feelings towards community connection, and associations between community connection and recent psychological distress. Most sexual minority women (58.9%) reported feeling that they are part of the LGBTQ community, and a majority of the participants felt positive about being connected to this community (68.5%). Participants who were bisexual, non-university educated, and who resided in an outer-suburban location were least likely to evaluate participation in the LGBTQ community positively. Feeling positive about community connection was associated with lower levels of psychological distress. Feeling a part of LGBTQ community was associated with lower psychological distress, but this link appears contingent upon positive feelings about community participation. Sexual minority women's' relationships to the LGBTQ community are often complex, and community connection and participation in and of itself is not a panacea for the negative outcomes associated with sexual minority stressors.
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Affiliation(s)
- Gene Lim
- Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Adam Bourne
- Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Adam Hill
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Ruth McNair
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony Lyons
- Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Natalie Amos
- Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
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Bush R, Staiger PK, McNeill IM, Brown R, Orellana L, Lubman D, McNair R. Evaluation of an SMS Based Alcohol Intervention for Same Sex Attracted Women: A Randomized Controlled Trial to Examine Feasibility, Acceptability, and Efficacy. Subst Use Misuse 2024; 59:1157-1166. [PMID: 38407160 DOI: 10.1080/10826084.2024.2321257] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
PURPOSE The purpose of this randomized controlled trial (Trial registration ID: redacted) was to examine the feasibility, acceptability, and efficacy of the Step One program, an SMS-based alcohol intervention for same-sex attracted women (SSAW). METHODS Ninety-seven SSAW who scored ≥8 on the Alcohol Use Disorders Identification Test (AUDIT) were randomly allocated to receive the Step One program (n = 47; mean age = 36.79) or a weekly message containing a link to a website with health information and support services for LGBT individuals (n = 50; mean age = 34.08). Participants completed questionnaires on alcohol use, wellbeing, and help-seeking at baseline (T1), intervention completion (T2; 4 wk after baseline) and 12 wk post-intervention (T3). In addition, participants in the intervention condition completed feasibility and accessibility measures at T2, and a subsample (n = 10) was interviewed about acceptability at T3. RESULTS Across conditions, participants significantly reduced their alcohol intake and improved their wellbeing and help-seeking over time. However, there were no significant differences between the intervention and control condition. Furthermore, frequency of help-seeking was low; only four intervention group participants and three control group participants began accessing support between T1 and T3. Overall, our findings indicate the intervention would benefit from revision prior to implementation. CONCLUSIONS Our approach was consistent with best practice in the development of an ecologically valid intervention; however, this intervention, in its current form, lacks the complexity desired by its users to optimally facilitate alcohol reduction among SSAW. Keywords: Alcohol intervention; Intervention mapping framework; Randomized controlled trial (RCT); Same-sex attracted women; Short-message service (SMS).
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Affiliation(s)
- Rachel Bush
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Ilona M McNeill
- School of Psychology, Deakin University, Geelong, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | | | - Dan Lubman
- Turning Point, Monash University, Eastern Health, Richmond, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Carlton, Australia
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Buckingham P, Bourne A, McNair R, Hill AO, Lyons A, Carman M, Amos N. The influence of care continuity and disclosure of sexual orientation in general practice on lesbian, bi+ and queer cisgender women's engagement with mental health services. Aust J Prim Health 2024; 30:NULL. [PMID: 37574262 DOI: 10.1071/py23001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Lesbian, bisexual+ and queer (LBQ+) cisgender women have considerable unmet mental health needs. The aims of this study were to examine LBQ+ cisgender women's prior engagement with general practitioners (GPs), and how this relationship shaped their mental health service use. METHOD Data from 2707 cisgender LBQ+ women were drawn from a national survey of adults who are lesbian, gay, bisexual, trans, intersex, queer or questioning, asexual and other diverse sexuality and gender identities (LGBTIQA+) in Australia. Multivariable logistic regression analyses examined demographic predictors of continuity of care with GPs and GPs' awareness of LBQ+ women's sexual orientation. The relationship between these variables and recent mental health service use was then analysed, comparing LBQ+ women's engagement with services known to be LGBTIQA+ inclusive and those without an inclusive reputation. RESULTS LBQ+ cisgender women with a regular GP had greater odds of having accessed mental health services in the last 12months. Two-thirds had a regular GP, with the lowest odds among women aged 18-35years and highest odds among women with a disability. LBQ+ women who did not believe their regular GP knew of their sexuality had lower odds of having accessed LGBTIQA+ inclusive mental health services. These individuals were typically aged below 25years, bisexual+ or queer identified, had below undergraduate-level education, earned <$2000 AUD per week, or lived in an outer-suburban or regional area. CONCLUSION GPs may be missing opportunities to promote continuity of care through developing trusting relationships with specific sub-populations of LBQ+ women, which in turn appears to sustain inequitable access to mental health care. To offer appropriate care and referrals for this population, GPs should provide safe and inclusive environments to enable comfortable and supportive discussions about sexual orientation when this is relevant to a person's health care.
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Affiliation(s)
- Pip Buckingham
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia; and Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia; and Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Vic., Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia; and Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
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Kerr L, Bourne A, Hill AO, McNair R, Wyatt K, Lyons A, Carman M, Amos N. Cervical screening among LGBTQ people: how affirming services may aid in achieving cervical cancer elimination targets. Women Health 2023; 63:736-746. [PMID: 37779316 DOI: 10.1080/03630242.2023.2263594] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
To reach cervical cancer elimination targets it is necessary to increase screening rates among underserved populations such as LGBTQ communities. This paper examines rates of attendance and associated factors of cervical screening in LGBTQ communities. Data from 2,424 people aged 25 to 74 years and assigned female at birth were drawn from an online national Australian survey of LGBTQ adults. Over half of the sample had accessed cervical screening in the past 2 years. Using a multivariable logistic regression analysis, significant associations were found between screening, sociodemographic traits and health-care access. Trans men were least likely to access cervical screening, while bisexual, pansexual and queer identified participants were most likely to access screening. People who lived outside inner-suburban areas and those who had a disability were less likely to have had screening. Evidence of trusting relationships with a general practitioner (having a regular GP and GP's knowledge of the individual's LGBTQ identity) increased the likelihood that participants had screened, as did recent access to a medical service that was LGBTQ-inclusive or catered specifically to LGBTQ communities. The findings suggest the importance of training health providers, as well as targeted public health messaging for increasing uptake of cervical screening among LGBTQ people.
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Affiliation(s)
- Lucille Kerr
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
- Department of Nursing Research, Cabrini Research, Malvern, Victoria, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Kerryann Wyatt
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
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Hill AO, Cook T, McNair R, Amos N, Carman M, Hartland E, Lyons A, Bourne A. Demographic and psychosocial factors associated with recent suicidal ideation and suicide attempts among trans and gender diverse people in Australia. Suicide Life Threat Behav 2023; 53:320-333. [PMID: 36786221 DOI: 10.1111/sltb.12946] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/15/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Correlates of suicidal ideation and suicide attempts among a large cross-section of trans and gender diverse populations in Australia were examined. METHODS A national survey was conducted that included 1466 trans and gender diverse participants aged 18+ years. Multivariable regressions identified factors associated with recent suicidal ideation and suicide attempts. RESULTS Overall, 62.4% reported suicidal ideation and 9.5% suicide attempt in the past 12 months. The likelihood of suicidal ideation was higher for younger participants or those who felt treated unfairly or socially excluded due to their gender identity in the past 12 months. It was lower for those with a postgraduate degree, who felt accepted by family or work, or who felt their gender identity was respected when accessing a mainstream medical clinic in the past 12 months. The likelihood of suicide attempts was greater for those aged younger or who had recently experienced sexual harassment based on their sexual orientation or gender identity, and lower for those who were non-binary. CONCLUSION Urgent attention for suicide prevention is necessary for trans and gender diverse communities. These findings point to a range of risk and protective factors, which may help inform the targeting and design of suicide prevention strategies.
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Affiliation(s)
- Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Teddy Cook
- ACON Health, Surry Hills, New South Wales, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | | | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,Kirby Institute, UNSW, Sydney, New South Wales, Australia
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Amos N, Hart B, Hill AO, Melendez-Torres GJ, McNair R, Carman M, Lyons A, Bourne A. Health intervention experiences and associated mental health outcomes in a sample of LGBTQ people with intersex variations in Australia. Cult Health Sex 2022:1-14. [PMID: 35921389 DOI: 10.1080/13691058.2022.2102677] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
People with intersex variation/s have sex characteristics determined by reproductive anatomy or chromosomal, gonadal, or hormonal expressions that are not typical of medical and societal norms for male or female bodies and are widely subjected to irreversible medical interventions at an early age to reinforce sex assignment. These interventions may be accompanied by experiences of lack of autonomy for the individual and, at times, lack of fully informed consent on the part of the individual or their parents/carers. People with intersex variations additionally experience high rates of mental health concerns relating to stigma, discrimination and poor healthcare experiences. The intersections between LGBTQ identities and intersex variations are poorly understood but are important given a high proportion of people with intersex variations identify as LGBTQ. This study explored associations between healthcare experiences and mental health outcomes among 46 LGBTQ people aged between 18 and 67 years old with intersex variations in Australia. Findings provide evidence of associations between suicidal thinking, suicidal attempts, depression or anxiety and negative healthcare experiences, including limited autonomy and consent, and challenges accessing psychological support. These highlight the need for further research and proactive intervention to advance human rights and improve health outcomes for this population.
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Affiliation(s)
- Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Bonnie Hart
- Independent Researcher and Consultant, Brisbane, Queensland, Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | | | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
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7
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Amos N, Bourne A, Hill AO, Power J, McNair R, Mooney-Somers J, Pennay A, Carman M, Lyons A. Alcohol and tobacco consumption among Australian sexual minority women: Patterns of use and service engagement. Int J Drug Policy 2022; 100:103516. [PMID: 34753044 DOI: 10.1016/j.drugpo.2021.103516] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sexual minority women consume both alcohol and tobacco at higher rates than heterosexual women. However, various sociodemographic and cultural factors associated with these practices among sexual minority women in Australia are not well understood, nor are the factors associated with seeking alcohol-related support. METHODS This study utilised data from cisgender sexual minority women respondents of Private Lives 3: a national, online, cross-sectional survey of the health and wellbeing of LGBTIQ adults in Australia aged 18+ conducted in 2019. Multivariable analyses were performed to identify co-existing smoking and alcohol use, sociodemographic factors associated with smoking, alcohol consumption and seeking alcohol-related support. RESULTS Of 2,647 sexual minority women respondents, 16.90% were currently smoking tobacco, 7.67% smoking tobacco daily and 60.50% reported potentially risky patterns of alcohol consumption. Tobacco and potentially risky alcohol consumption were found to frequently co-occur. Women who identified as queer were more likely than lesbian identifying women to currently smoke tobacco and to smoke tobacco daily. Tobacco consumption was associated with increased age, unemployment, low-mid range income and secondary-school education, while potential risky drinking was associated with living in outer urban or rural areas and being Australian born . Self-reporting having struggled with alcohol in the past twelve months was associated with residential location. Less than 3% of the sample has sought help for alcohol use. Seeking support was more likely as women aged, and with potentially risky drinking, and much more likely with self-perceived struggles with alcohol. CONCLUSIONS The findings highlight the need for future alcohol and tobacco use health promotion strategies focussing on sexual minority women to attend to within group differences that relate to risk of higher consumption. They also highlight the need for approaches that empower sexual minority women to self-identify when they are struggling with alcohol use and encourage seeking support with organisations that are affirming of sexual minority women.
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Affiliation(s)
- Natalie Amos
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Level 3, 780 Elizabeth St, Melbourne, Victoria, 3004, Australia
| | - Julie Mooney-Somers
- University of Sydney, Faculty of Medicine and Health, Sydney Health Ethics, Level 1 Medical Foundation Building, 91-97 Parramatta Road, Camperdown, NSW, 2050, Australia
| | - Amy Pennay
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Building NR1, Bundoora, Victoria, 3086, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Building NR6, Bundoora, Victoria, 3086, Australia
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Lyons A, Hill AO, McNair R, Carman M, Morris S, Bourne A. Demographic and psychosocial factors associated with recent suicidal ideation and suicide attempts among lesbian, gay, bisexual, pansexual, queer, and asexual (LGBQ) people in Australia: Correlates of suicidality among LGBQ Australians. J Affect Disord 2022; 296:522-531. [PMID: 34606809 DOI: 10.1016/j.jad.2021.09.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/16/2021] [Revised: 08/31/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To examine demographic and psychosocial correlates of suicidal ideation and suicide attempts among a large cross-section of sexual orientation populations in Australia, including lesbian, gay, bisexual, pansexual, queer, and asexual (LGBQ) people. METHODS A national survey was conducted involving 5,174 cisgender LGBQ participants aged 18+ years. Multivariable regressions identified factors associated with recent suicidal ideation and suicide attempts. RESULTS In all, 37.2% reported suicidal ideation and 3.9% a suicide attempt in the past 12 months. The likelihood of suicidal ideation was greater for those who identified as queer or felt treated unfairly or socially excluded due to their sexual orientation, and lower for those in a committed relationship, who felt part of LGBTIQ communities, or felt accepted in family, work, and health services. The likelihood of suicide attempts was greater for those aged younger or had recently experienced verbal abuse or social exclusion, and lower for those in a committed relationship or who felt part of LGBTIQ communities. LIMITATIONS Participants were recruited largely through paid Facebook advertising and the sample may therefore not be representative of all LGBQ adults in Australia. However, a representative population-level study would require the collection of population demographic data to provide the necessary and sexual identity is not included in the Australian Census. CONCLUSION These findings highlight an urgent need for supporting LGBQ people and may help inform tailored support services, including culturally-safe suicide prevention programs. These could involve peer support, trauma-informed counselling, supporting committed relationships, and addressing marginalization in the wider community.
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Affiliation(s)
- Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Sally Morris
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia; Kirby Institute, UNSW, Sydney, Australia
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Perales F, Campbell AK, Everett BG, McNair R, Hughes TL. Prevalence and Sociodemographic Correlates of Identifying as Mainly Heterosexual: Stability and Change across Three Cohorts of Australian Women. Arch Sex Behav 2021; 50:3459-3477. [PMID: 34008060 DOI: 10.1007/s10508-021-02000-0] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 06/12/2023]
Abstract
In recent decades, the ways in which sexual minorities identify have changed dramatically. In response, social and health surveys have begun offering a greater range of response options within sexual orientation questions-for example, intermediate categories for "mainly heterosexual" and "mainly lesbian/gay" alongside the more common response options of "heterosexual," "bisexual," and "lesbian/gay." Recent studies indicate that women who identify as "mainly heterosexual" report poorer health, greater health-risk behaviors, and higher rates of victimization than women identifying as "exclusively heterosexual." However, we know very little about the demographic profile of women who choose the "mainly heterosexual" identity label compared to the adjacent "exclusively heterosexual" or "bisexual" labels or about changes over time in the prevalence and correlates of "mainly heterosexual" identification. This study addressed these knowledge gaps by modeling unique, high-quality survey data from three national cohorts of Australian women (Australian Longitudinal Study on Women's Health, 2000-2017, n = 76,930 observations). Consistent with the facilitative environments model, we document stark cross-cohort increases in the percentage of Australian women identifying as "mainly heterosexual"-from ∼1% of those born in 1946-1951 to ∼26% of those born in 1989-1995, coinciding with comparable declines in the percentage of women identifying as "exclusively heterosexual." We also found evidence of cohort differences in the associations between key sociodemographic factors-such as age, education, and socioeconomic status-and the likelihood of women identifying as "mainly heterosexual." Finally, our results indicate that same-sex sexual attractions were more strongly associated with "mainly heterosexual" identification than was same-sex sexual behavior.
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Affiliation(s)
- Francisco Perales
- School of Social Science, University of Queensland, Michie Building (#9), St Lucia Campus, St Lucia, Brisbane, QLD, 4072, Australia.
| | - Alice K Campbell
- Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia
| | | | - Ruth McNair
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York City, NY, USA
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Bush R, Brown R, McNair R, Orellana L, Lubman DI, Staiger PK. Effectiveness of a culturally tailored SMS alcohol intervention for same-sex attracted women: protocol for an RCT. BMC Womens Health 2019; 19:29. [PMID: 30728002 PMCID: PMC6364437 DOI: 10.1186/s12905-019-0729-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022]
Abstract
Background There is a large disparity between alcohol treatment access and prevalence of hazardous drinking among same-sex attracted women (SSAW). Yet, this population typically report low satisfaction with care and a reluctance to attend mainstream health services. Currently, there are few culturally tailored services for SSAW available despite evidence indicating that many feel uncomfortable in mainstream services. This paper describes the protocol of a randomised controlled trial aimed at examining the impact of a culturally sensitive four-week short message service (SMS) alcohol intervention on SSAW’s alcohol intake, wellbeing, and engagement with alcohol treatment. Methods A randomised controlled trial comparing a culturally tailored SMS intervention (The Step One Program) with a generic ‘thank you’ message, and a nested qualitative study to further explore the intervention’s feasibility and acceptability. The Step One Program was co-designed using an Intervention Mapping framework and engaging potential consumers in the developmental process. Participants are block randomised (1:1 ratio) and followed up at the completion of the intervention and at 12 weeks post-intervention. The primary outcomes are alcohol reduction (as measured by the Alcohol Use Disorders Identification Test and self-reported alcohol intake), wellbeing (as measured by the Personal Wellbeing Index – Adult), and help-seeking (as measured by the number of alcohol services accessed and frequency of access). Upon completion of the 12-week post-intervention survey, participants in the intervention group were contacted via email regarding a phone interview on intervention acceptability. Discussion This study may have important implications for clinical practice, improve healthcare access and equity for SSAW, and provide direction for future research in this field. The outcomes of the current study may stimulate the development of other culturally tailored health programs for SSAW. The results will inform whether individually tailoring the messages according to content and delivery frequency may be warranted to increase its acceptability. Trial registration This trial was registered with the Australian New Zealand Clinical Trials Registry (trial ID: ACTRN12617000768392).
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Affiliation(s)
- Rachel Bush
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, 221 Burwood Highway, Burwood, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health and Eastern Health Clinical School, Monash University, 110 Church St, Fitzroy, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Australia. .,Centre for Drug Use, Addiction and Anti-Social Behaviour Research (CEDAAR), Deakin University, Geelong, Australia.
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Pennay A, McNair R, Hughes TL, Leonard W, Brown R, Lubman DI. Improving alcohol and mental health treatment for lesbian, bisexual and queer women: Identity matters. Aust N Z J Public Health 2017; 42:35-42. [PMID: 29235690 DOI: 10.1111/1753-6405.12739] [Citation(s) in RCA: 11] [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] [Received: 04/01/2017] [Revised: 07/01/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Lesbian, bisexual and queer (LBQ) women experience substantial unmet alcohol and mental health treatment needs. This paper explores the way in which sexual identity shapes experience, and needs, in relation to alcohol and mental health treatment, and presents key messages for improving treatment. METHODS Twenty-five in-depth interviews were undertaken with same-sex attracted Australian women, aged 19-71. Interview transcripts were analysed thematically. RESULTS Key messages offered by participants focused on language, disclosure and practitioner training. Variation in sexual identity did not alter treatment expectations or needs; however, we noted an important difference with respect to identity salience, with high LBQ identity salience linked with preference for disclosure and acknowledgement of sexual identity in treatment interactions, and low identity salience linked with a preference not to disclose and for sexual identity not to require acknowledgement in treatment. CONCLUSIONS Treatment providers may find it useful to gather information about the centrality of sexual identity to LBQ women as a means of overcoming treatment barriers related to heteronormative conventions and discrimination, language and disclosure. Implications for public health: Treatment providers should adopt more inclusive language, seek information about identity salience and the importance of sexual identity to the current treatment, and regularly pursue LBQ-related professional development upskilling.
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Affiliation(s)
- Amy Pennay
- Centre for Alcohol Policy Research, La Trobe University, Victoria
| | - Ruth McNair
- Department of General Practice, University of Melbourne, Victoria
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York City, NY, US
| | | | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Victoria
| | - Dan I Lubman
- Turning Point, Eastern Health, Victoria.,Eastern Health Clinical School, Monash University, Victoria
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12
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Szalacha LA, Hughes TL, McNair R, Loxton D. Mental health, sexual identity, and interpersonal violence: Findings from the Australian longitudinal Women's health study. BMC Womens Health 2017; 17:94. [PMID: 28964264 PMCID: PMC5622594 DOI: 10.1186/s12905-017-0452-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We examined the relationships among experiences of interpersonal violence, mental health, and sexual identity in a national sample of young adult women in Australia. METHODS We used existing data from the third (2003) wave of young adult women (aged 25-30) in the Australian Longitudinal Study on Women's Health (ALSWH). We conducted bivariate analyses and fit multiple and logistic regression models to test experiences of six types of interpersonal violence (physical abuse, severe physical abuse, emotional abuse, sexual abuse, harassment, and being in a violent relationship), and the number of types of violence experienced, as predictors of mental health. We compared types and number of types of violence across sexual identity subgroups. RESULTS Experiences of interpersonal violence varied significantly by sexual identity. Controlling for demographic characteristics, compared to exclusively heterosexual women, mainly heterosexual and bisexual women were significantly more likely to report physical, sexual, and emotional abuse. Mainly heterosexual and lesbian women were more likely to report severe physical abuse. Mainly heterosexual women were more than three times as likely to have been in a violent relationship in the past three years, and all three sexual minority subgroups were two to three times as likely to have experienced harassment. Bisexual women reported significantly higher levels of depression than any of the other sexual identity groups and scored lower on mental health than did exclusively heterosexual women. In linear regression models, interpersonal violence strongly predicted poorer mental health for lesbian and bisexual women. Notably, mental health indicators were similar for exclusively heterosexual and sexual minority women who did not report interpersonal violence. Experiencing multiple types of interpersonal violence was the strongest predictor of stress, anxiety and depression. CONCLUSIONS Interpersonal violence is a key contributor to mental health disparities, especially among women who identify as mainly heterosexual or bisexual. More research is needed that examines within-group differences to determine which subgroups are at greatest risk for various types of interpersonal violence. Such information is critical to the development of effective prevention and intervention strategies.
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Affiliation(s)
- Laura A. Szalacha
- Office of Nursing Research, College of Nursing, University of Arizona, Tucson, USA
| | - Tonda L. Hughes
- Nursing and Psychiatry, School of Nursing, Columbia University, New York City, USA
- Global Health Research, School of Nursing, Columbia University, New York City, USA
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Deborah Loxton
- Australian Longitudinal Study on Women’s Health, University of Newcastle, Melbourne, Australia
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
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13
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14
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Pepping CA, Lyons A, McNair R, Kirby JN, Petrocchi N, Gilbert P. A tailored compassion-focused therapy program for sexual minority young adults with depressive symotomatology: study protocol for a randomized controlled trial. BMC Psychol 2017; 5:5. [PMID: 28249624 PMCID: PMC5333442 DOI: 10.1186/s40359-017-0175-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 02/22/2017] [Indexed: 12/13/2022] Open
Abstract
Background Lesbian, gay, and bisexual (LGB) men and women represent one of the highest-risk populations for depressive symptomatology and disorders, with young LGB adults being at greatest risk. To date, there have been no randomized controlled trials (RCT) to specifically target depressive symptoms in young LGB adults. This is despite research highlighting unique predictors of depressive symptomatology in this population. Here we outline a protocol for an RCT that will test the preliminary efficacy of a tailored compassion-focused therapy (CFT) intervention for young LGB adults compared with a self-directed cognitive behavioral therapy (CBT) program with no specific tailoring for LGB individuals. Methods The CFT intervention consists of 8 units with self-directed reading and activities tailored to LGB young adults, and 8 x weekly 1-hour consultations with a therapist. The CBT intervention consists of 8 units with self-guided reading and activities, with 1 x 1-hour session with a therapist at the mid-point of therapy. Fifty LGB individuals with scores of 13 or above on the Beck Depression Inventory-II will be randomized to either the CFT or CBT condition. The primary outcome measure is depressive symptomatology. Secondary outcome measures are symptoms of anxiety, suicidal ideation, internalized homophobia, self-compassion, and shame and guilt proneness. Assessments will occur at pre-intervention, post-intervention, and at 3-month post-intervention. Discussion This study is an RCT to test the preliminary efficacy of an LGB-tailored compassion-focused intervention for young LGB adults with depressive symptomatology. If this intervention is efficacious, this could begin to address the substantial mental health disparities amongst sexual minorities. Trial registration ACTRN12616001018404. Prospective registration, registered 02/08/2016.
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Affiliation(s)
| | - Anthony Lyons
- Australian Research Centre in Sex, Health, and Society, La Trobe University, Melbourne, Australia
| | - Ruth McNair
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - James N Kirby
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Nicola Petrocchi
- Department of Economics and Social Sciences, John Cabot University, Rome, Italy
| | - Paul Gilbert
- Department of Psychology, University of Derby, Derby, UK
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15
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McNair R, Griffiths L, Reid K, Sloan H. Medical students developing confidence and patient centredness in diverse clinical settings: a longitudinal survey study. BMC Med Educ 2016; 16:176. [PMID: 27421655 PMCID: PMC4946086 DOI: 10.1186/s12909-016-0689-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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] [Received: 11/11/2015] [Accepted: 06/11/2016] [Indexed: 05/09/2023]
Abstract
BACKGROUND Medical student clinical confidence and positive attitudes to patient centredness are important outcomes of medical education. The clinical placement setting is regarded as a critical support to these outcomes, so understanding how the setting is influential is important. The aim of this study was to compare students' attitudes towards patient-centredness and clinical confidence as they progressed through their medical course, and understand the influence of diverse clinical placement zones. METHODS Students at one Australian medical school completed a questionnaire at the beginning of second year and at the end of their third year of medical training. The questionnaire measured attitudes to patient centred care, clinical confidence, role modelling experiences and clinical learning experiences. Descriptive analyses investigated change in these attitudes over time. Repeated measures analysis of variance was used to assess the influence of placement location on each variable of interest. Responses to two open-ended questions were also coded by two researchers and themes were identified. RESULTS Student confidence increased over the course of two years of clinical training (p < 0.001), but attitudes to patient centredness (p = 0.933) did not change. The location of clinical placements (urban, outer urban and rural) was unrelated to levels of confidence or patient centredness. Students had positive attitudes towards patient-centredness throughout, and noted its importance in contributing to quality care. Patient-centred care was encouraged within the clinical placements, and was influenced by positive and negative role modelling, direct teaching, and opportunities to practise patient-centred care. CONCLUSIONS A new generation of doctors with a strong patient-centred focus is emerging. Medical schools have a responsibility to facilitate clinical placements that will support the acquisition and maintenance of skills in patient centred care through positive role modelling.
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Affiliation(s)
- Ruth McNair
- />The Department of General Practice, The University of Melbourne, 200 Berkeley St, Carlton, 3053 VIC Australia
| | - Leonie Griffiths
- />Northern Clinical School, Melbourne Medical School, the University of Melbourne, 185 Cooper St, Epping, 3076 Australia
| | - Katharine Reid
- />Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010 Australia
| | - Hannah Sloan
- />Melbourne Medical School, The University of Melbourne, Parkville, VIC 3010 Australia
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Bilardi J, Walker S, Mooney-Somers J, McNair R, Temple-Smith M, Bellhouse C, Fairley C, Chen M, Bradshaw C. P088 Sexual contact is the trigger! Women’s views and experiences of the triggers for the onset of bacterial vaginosis and exacerbating factors associated with recurrence. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.142] [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: 11/04/2022]
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17
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Crouch SR, McNair R, Waters E. Impact of family structure and socio-demographic characteristics on child health and wellbeing in same-sex parent families: A cross-sectional survey. J Paediatr Child Health 2016; 52:499-505. [PMID: 27144884 DOI: 10.1111/jpc.13171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED Children with same-sex attracted parents develop well in terms of their health and wellbeing. There are many recognised factors that have an impact on child health, in general, including individual, family and wider social mediators. The aim of this study is to determine the impact of family structure and socio-demographic characteristics on child health and wellbeing in Australian same-sex parent families. METHODS A cross-sectional survey of self-identified same-sex attracted parents from across Australia was used to collect information on child health and wellbeing between May and December 2012. Mixed-effects multiple linear regression models were used to identify associations between family structure/socio-demographic characteristics and child wellbeing. Child health outcomes were measured using the Child Health Questionnaire and the Strengths and Difficulties Questionnaire. RESULTS In same-sex parent families, biological relationships, parental gender and parental education were not significantly associated with health and wellbeing. Parental income, rurality and stable parental relationships were associated with health and wellbeing, and living in a single-parent household was associated with poorer wellbeing. CONCLUSIONS Stable dual parent families offer good outcomes for children with same-sex attracted parents. Family processes are most important. This study does not support the assertion that children require both male and female parents, nor that biological relationships are essential to health and wellbeing. This study provides scientific data from a cross-sectional Australian-based study to describe and understand health determinants for children in family contexts that comprise same-sex parent and all family contexts. It recommends equitable, stigma-free family support.
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Affiliation(s)
- Simon Robert Crouch
- The Jack Brockhoff Child Health and Wellbeing Program, The Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Waters
- The Jack Brockhoff Child Health and Wellbeing Program, The Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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18
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Bilardi J, Walker S, McNair R, Mooney-Somers J, Temple-Smith M, Bellhouse C, Fairley C, Chen M, Bradshaw C. Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study. PLoS One 2016; 11:e0151794. [PMID: 27010725 PMCID: PMC4807032 DOI: 10.1371/journal.pone.0151794] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/17/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women's recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV. METHODS A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews. RESULTS The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women's frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching. CONCLUSION In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.
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Affiliation(s)
- Jade Bilardi
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sandra Walker
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Bellhouse
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Christopher Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Marcus Chen
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Catriona Bradshaw
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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19
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Bilardi J, Walker S, Mooney-Somers J, Temple-Smith M, McNair R, Bellhouse C, Fairley C, Chen M, Bradshaw C. Women's Views and Experiences of the Triggers for Onset of Bacterial Vaginosis and Exacerbating Factors Associated with Recurrence. PLoS One 2016; 11:e0150272. [PMID: 26930414 PMCID: PMC4773144 DOI: 10.1371/journal.pone.0150272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/11/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is the most common vaginal infection affecting women of childbearing age. While the aetiology and transmissibility of BV remain unclear, there is strong evidence to suggest an association between BV and sexual activity. This study explored women's views and experiences of the triggers for BV onset and factors associated with recurrence. METHODS A descriptive, social constructionist approach was chosen as the framework for the study. Thirty five women of varying sexual orientation who had experienced recurrent BV in the past five years took part in semi-structured interviews. RESULTS The majority of women predominantly reported sexual contact triggered the onset of BV and sexual and non-sexual factors precipitated recurrence. Recurrence was most commonly referred to in terms of a 'flare-up' of symptoms. The majority of women did not think BV was a sexually transmitted infection however many reported being informed this by their clinician. Single women who attributed BV onset to sex with casual partners were most likely to display self-blame tendencies and to consider changing their future sexual behaviour. Women who have sex with women (WSW) were more inclined to believe their partner was responsible for the transmission of or reinfection with BV and seek partner treatment or change their sexual practices. CONCLUSION Findings from this study strongly suggest women believe that BV onset is associated with sexual activity, concurring with epidemiological data which increasingly suggest BV may be sexually transmitted. Exacerbating factors associated with recurrence were largely heterogeneous and may reflect the fact it is difficult to determine whether recurrence is due to persistent BV or a new infection in women. There was however evidence to suggest possible transmission and reinfection among WSW, reinforcing the need for new approaches to treatment and management strategies including male and female partner treatment trials.
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Affiliation(s)
- Jade Bilardi
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Sandra Walker
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Bellhouse
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Marcus Chen
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Catriona Bradshaw
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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McNair R, Pennay A, Hughes T, Brown R, Leonard W, Lubman DI. A model for lesbian, bisexual and queer-related influences on alcohol consumption and implications for policy and practice. Cult Health Sex 2015; 18:405-421. [PMID: 26466746 DOI: 10.1080/13691058.2015.1089602] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Research consistently reports higher rates of problematic drinking among lesbian, bisexual and queer women than among heterosexual women, but relatively little research has identified underlying factors. Within this context, the aim of the present study was to qualitatively explore the sociocultural influences on alcohol consumption among lesbian, bisexual and queer women in Australia. An ethnographic study including in-depth interviews and 10 sessions of participant observation was conducted with 25 Australian lesbian, bisexual and queer women. Analysis of transcripts and fieldnotes focused on lesbian, bisexual and queer-related influences on alcohol consumption. Three lesbian, bisexual and queer-related factors were identified that influenced alcohol use: (1) coping, (2) connection and (3) intersections with lesbian, bisexual and queer identity. Most participants reported consuming alcohol to cope with discrimination or to connect with like-minded others. Alcohol use had positive influences for some women through facilitating social connection and wellbeing. Women with a high lesbian, bisexual and queer identity salience were more likely to seek lesbian, bisexual and queer community connection involving alcohol, to publicly identify as lesbian, bisexual and queer and to experience discrimination. National policies need to address underlying causes of discrimination against lesbian, bisexual and queer women. Alcohol policies and clinical interventions should acknowledge the impact of discrimination on higher alcohol consumption amongst lesbian, bisexual and queer women compared with heterosexual women, and should utilise health promotion messages regarding safe drinking that facilitate lesbian, bisexual and queer social connection.
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Affiliation(s)
- Ruth McNair
- a Department of General Practice , University of Melbourne , Melbourne , Australia
| | - Amy Pennay
- b Centre for Health Equity , University of Melbourne
- c Centre for Alcohol Policy Research, and Turning Point , Fitzroy , Australia
| | - Tonda Hughes
- d School of Nursing , The University of Illinois at Chicago , Chicago , USA
| | - Rhonda Brown
- e School of Nursing and Midwifery, Faculty of Health , Deakin University , Burwood , Australia
| | - William Leonard
- f Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - Dan I Lubman
- g Turning Point and Eastern Health Clinical School , Monash University , Fitzroy , Australia
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21
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O'Doherty LJ, Taft A, McNair R, Hegarty K. Fractured Identity in the Context of Intimate Partner Violence: Barriers to and Opportunities for Seeking Help in Health Settings. Violence Against Women 2015; 22:225-48. [PMID: 26337674 DOI: 10.1177/1077801215601248] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 11/15/2022]
Abstract
Intimate partner violence has profound effects on women's identities. However, detailed examination of how abuse affects identity is lacking. We interviewed 14 diverse women (Australia), applying social identity theory to analyze their experiences of identity and help-seeking in health settings. The destabilizing effect of violence on social identities was strongly supported. Women concealed abuse to preserve a public identity. However, when the violence threatened the most integrated identities, women unveiled an abuse identity, receiving mixed responses from health providers. A healing context where a woman can display an abuse identity safely is crucial to enable her to rebuild an integrated self-concept.
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Affiliation(s)
| | - Angela Taft
- La Trobe University, Melbourne, Victoria, Australia
| | - Ruth McNair
- The University of Melbourne, Victoria, Australia
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22
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Bilardi J, Walker S, Temple-Smith M, McNair R, Mooney-Somers J, Bellhouse C, Fairley C, Chen M, Bradshaw C. P14.05 Sexual contact is the trigger! women’s views and experience of the causes and triggers of bacterial vaginosis. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.517] [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: 11/04/2022]
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23
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McNair R, Hegarty K, Taft A. Disclosure for same-sex attracted women enhancing the quality of the patient-doctor relationship in general practice. Aust Fam Physician 2015; 44:573-578. [PMID: 26510146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Same-sex-attracted women describe lower satisfaction with their general practice care, compared with heterosexual women. Yet, they have greater health inequalities, which requires effective care. A lack of disclosure of sexual orientation to general practitioners (GPs) may be one factor influencing these issues. METHODS This study on the disclosure of sexual orientation by same-sex attracted women to their usual GP explored the impact of disclosure on the quality of the patient-doctor relationship. In-depth interviews with 33 same-sex-attracted women and 27 GPs in Australia were conducted during 2005-06. These interviews were analysed to understand the perspectives of the women and their GPs. RESULTS Disclosure in the context of provider sensitivity and normalisation enhanced the perceived quality of the patient-doctor relation-ship. Conversely, silencing of disclosure and pathologising of sexual orientation diminished the relationship. DISCUSSION Facilitating disclosure should be a shared responsibility between same-sex attracted women and their usual GP. This must be accompanied by improved GP knowledge and affirming attitudes regarding specific health needs of same-sex attracted women.
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Affiliation(s)
- Ruth McNair
- MBBS, DRANZCOG, DA(UK), FRACGP, Senior Lecturer, Department of General Practice, University of Melbourne, Carlton, VIC
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Crouch SR, Waters E, McNair R, Power J. The health perspectives of Australian adolescents from same-sex parent families: a mixed methods study. Child Care Health Dev 2015; 41:356-64. [PMID: 25131803 DOI: 10.1111/cch.12180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Accepted: 06/20/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research involving adolescents from same-sex parent families provides an important contribution to the evidence base on their health, well-being and the impact of stigma. To date reports on the perspectives of adolescents with same-sex attracted parents have been limited. This study aimed to describe the multidimensional experiences of physical, mental and social well-being of adolescents living in this context. METHODS A mixed methods study of adolescents with same-sex attracted parents comprising of an adolescent-report survey of 10- to 17-year-olds and family interviews with adolescents and their parents. Data were collected in 2012 and 2013 as part of the Australian Study of Child Health in Same-Sex Families. RESULTS The findings from qualitative interviews with seven adolescents and responses to an open-ended survey question (n = 16) suggest four themes: perceptions of normality, positive concepts of health, spheres of life (including family, friends and community) and avoiding negativity. The quantitative sample of adolescents with same-sex attracted parents (n = 35) reported higher scores than population normative data on the dimensions general health and family activities within the Child Health Questionnaire (CHQ) as well as higher on the peer problems scale on the Strengths and Difficulties Questionnaire (SDQ). Perceived stigma correlates with lower health and well-being overall. CONCLUSIONS Positive health outcomes are informed by the ways adolescents conceptualize health and how they construct their spheres of life. Peer relationships, and community perspectives of same-sex families, inform perceived stigma and its correlation with poorer health and well-being. Although adolescents see their families as essentially normal they are negatively affected by external societal stigma.
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Affiliation(s)
- S R Crouch
- The Jack Brockhoff Child Health and Wellbeing Program, The Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia
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25
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von Doussa H, Power J, McNair R, Brown R, Schofield M, Perlesz A, Pitts M, Bickerdike A. Building healthcare workers' confidence to work with same-sex parented families. Health Promot Int 2015; 31:459-69. [PMID: 25736035 DOI: 10.1093/heapro/dav010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 11/12/2022] Open
Abstract
This article reports on a qualitative study of barriers and access to healthcare for same-sex attracted parents and their children. Focus groups were held with same-sex attracted parents to explore their experiences with healthcare providers and identify barriers and facilitators to access. Parents reported experiencing uncomfortable or anxiety-provoking encounters with healthcare workers who struggled to adopt inclusive or appropriate language to engage their family. Parents valued healthcare workers who were able to be open and honest and comfortably ask questions about their relationships and family. A separate set of focus groups were held with mainstream healthcare workers to identity their experiences and concerns about delivering equitable and quality care for same-sex parented families. Healthcare workers reported lacking confidence to actively engage with same-sex attracted parents and their children. This lack of confidence related to workers' unfamiliarity with same-sex parents, or lesbian, gay and bisexual culture, and limited opportunities to gain information or training in this area. Workers were seeking training and resources that offered information about appropriate language and terminology as well as concrete strategies for engaging with same-sex parented families. For instance, workers suggested they would find it useful to have a set of 'door opening' questions they could utilize to ask clients about their sexuality, relationship status or family make-up. This article outlines a set of guidelines for healthcare providers for working with same-sex parented families which was a key outcome of this study.
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Affiliation(s)
- Henry von Doussa
- The Bouverie Centre, La Trobe University, Melbourne, VIC, Australia
| | - Jennifer Power
- The Bouverie Centre, La Trobe University, Melbourne, VIC, Australia
| | - Ruth McNair
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia
| | - Margot Schofield
- Counselling and Psychological Health, School of Public Health and Human Biosciences, La Trobe University, Melbourne, VIC, Australia
| | - Amaryll Perlesz
- The Bouverie Centre, La Trobe University, Melbourne, VIC, Australia
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Crouch SR, Waters E, McNair R, Power J, Davis E. Parent-reported measures of child health and wellbeing in same-sex parent families: a cross-sectional survey. BMC Public Health 2014; 14:635. [PMID: 24952766 PMCID: PMC4082299 DOI: 10.1186/1471-2458-14-635] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/19/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It has been suggested that children with same-sex attracted parents score well in psychosocial aspects of their health, however questions remain about the impact of stigma on these children. Research to date has focused on lesbian parents and has been limited by small sample sizes. This study aims to describe the physical, mental and social wellbeing of Australian children with same-sex attracted parents, and the impact that stigma has on them. METHODS A cross-sectional survey, the Australian Study of Child Health in Same-Sex Families, was distributed in 2012 to a convenience sample of 390 parents from Australia who self-identified as same-sex attracted and had children aged 0-17 years. Parent-reported, multidimensional measures of child health and wellbeing and the relationship to perceived stigma were measured. RESULTS 315 parents completed the survey (completion rate = 81%) representing 500 children. 80% of children had a female index parent while 18% had a male index parent. Children in same-sex parent families had higher scores on measures of general behavior, general health and family cohesion compared to population normative data (β = 2.93, 95% CI = 0.35 to 5.52, P = .03; β = 5.60, 95% CI = 2.69 to 8.52, P = <.001; and β = 6.01, 95% CI = 2.84 to 9.17, P = <.001 respectively). There were no significant differences between the two groups for all other scale scores. Physical activity, mental health, and family cohesion were all negatively associated with increased stigma (β = -3.03, 95% CI = -5.86 to -0.21, P = .04; β = -10.45, 95% CI = -18.48 to -2.42, P = .01; and β = -9.82, 95% CI = -17.86 to -1.78, P = .02 respectively) and the presence of emotional symptoms was positively associated with increased stigma (β =0.94, 95% CI = 0.08 to 1.81, P = .03). CONCLUSIONS Australian children with same-sex attracted parents score higher than population samples on a number of parent-reported measures of child health. Perceived stigma is negatively associated with mental health. Through improved awareness of stigma these findings play an important role in health policy, improving child health outcomes.
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Affiliation(s)
- Simon R Crouch
- The Jack Brockhoff Child Health and Wellbeing Program, The Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Elizabeth Waters
- The Jack Brockhoff Child Health and Wellbeing Program, The Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Ruth McNair
- The Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Jennifer Power
- The Bouverie Centre, La Trobe University, Brunswick, Victoria, Australia
| | - Elise Davis
- The Jack Brockhoff Child Health and Wellbeing Program, The Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Crouch S, Waters E, McNair R, Power J, Davis E, van Mourik L. Triumphs and challenges in recruiting same-sex parent families. Aust N Z J Public Health 2014; 38:87-8. [PMID: 24494954 DOI: 10.1111/1753-6405.12141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Simon Crouch
- The McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Victoria
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Abstract
A 64-year-old man presented with intermittent but progressive lateral-sided knee pain. Symptoms mimicked those of a lateral meniscal tear. Magnetic resonance imaging revealed a cyamella associated with popliteal tendonitis and an intact lateral meniscus.
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Affiliation(s)
- N Rehmatullah
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK.
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Bilardi JE, Walker S, Temple-Smith M, McNair R, Mooney-Somers J, Bellhouse C, Fairley CK, Chen MY, Bradshaw C. The burden of bacterial vaginosis: women's experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis. PLoS One 2013; 8:e74378. [PMID: 24040236 PMCID: PMC3770676 DOI: 10.1371/journal.pone.0074378] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bacterial vaginosis is a common vaginal infection, causing an abnormal vaginal discharge and/or odour in up to 50% of sufferers. Recurrence is common following recommended treatment. There are limited data on women's experience of bacterial vaginosis, and the impact on their self-esteem, sexual relationships and quality of life. The aim of this study was to explore the experiences and impact of recurrent bacterial vaginosis on women. METHODS A social constructionist approach was chosen as the framework for the study. Thirty five women with male and/or female partners participated in semi-structured interviews face-to-face or by telephone about their experience of recurrent bacterial vaginosis. RESULTS Recurrent bacterial vaginosis impacted on women to varying degrees, with some women reporting it had little impact on their lives but most reporting it had a moderate to severe impact. The degree to which it impacted on women physically, emotionally, sexually and socially often depended on the frequency of episodes and severity of symptoms. Women commonly reported that symptoms of bacterial vaginosis made them feel embarrassed, ashamed, 'dirty' and very concerned others may detect their malodour and abnormal discharge. The biggest impact of recurrent bacterial vaginosis was on women's self-esteem and sex lives, with women regularly avoiding sexual activity, in particular oral sex, as they were too embarrassed and self-conscious of their symptoms to engage in these activities. Women often felt confused about why they were experiencing recurrent bacterial vaginosis and frustrated at their lack of control over recurrence. CONCLUSION Women's experience of recurrent bacterial vaginosis varied broadly and significantly in this study. Some women reported little impact on their lives but most reported a moderate to severe impact, mainly on their self-esteem and sex life. Further support and acknowledgement of these impacts are required when managing women with recurrent bacterial vaginosis.
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Affiliation(s)
- Jade E. Bilardi
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- * E-mail:
| | - Sandra Walker
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Meredith Temple-Smith
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia
| | - Ruth McNair
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and the Law in Medicine and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Clare Bellhouse
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Christopher K. Fairley
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Marcus Y. Chen
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Catriona Bradshaw
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
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McNair R, Brown R. Clinical translation of the research article titled "the influence of early drinking contexts on current drinking among adult lesbian and bisexual women". J Am Psychiatr Nurses Assoc 2013; 19:255-8. [PMID: 24071821 DOI: 10.1177/1078390313505642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ruth McNair
- Ruth McNair, PhD, MBBS, DRANZCOG, DA(UK), FRACGP, The University of Melbourne, Melbourne, Victoria, Australia; Northside Clinic, Melbourne, Victoria, Australia
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Bilardi JE, Walker S, Temple-Smith M, McNair R, Mooney-Somers J, Bellhouse C, Peterson S, Fairley CK, Chen MY, Bradshaw C. P3.005 The Burden of Bacterial Vaginosis: Women’s Experience of Living with Recurrent Bacterial Vaginsosis. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0465] [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: 11/04/2022]
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Crouch SR, Waters E, McNair R, Power J, Davis E. ACHESS--The Australian study of child health in same-sex families: background research, design and methodology. BMC Public Health 2012; 12:646. [PMID: 22888859 PMCID: PMC3487744 DOI: 10.1186/1471-2458-12-646] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 08/09/2012] [Indexed: 11/23/2022] Open
Abstract
Background There are an increasing number of children in Australia growing up with same-sex attracted parents. Although children from same-sex parent families do in general perform well on many psychosocial measures recent research is beginning to consider some small but significant differences when these children are compared with children from other family backgrounds. In particular studies suggest that there is an association between the stigma that same-sex parent families experience and child wellbeing. Research to date lacks a holistic view with the complete physical, mental and social wellbeing of children not yet addressed. In addition, most studies have focused only on families with lesbian parents and have studied only small numbers of children. Methods/design The Australian Study of Child Health in Same-Sex Families (ACHESS) is a national study that aims to determine the complete physical, mental and social wellbeing of Australian children under the age 18 years with at least one parent who self identifies as being same-sex attracted. There will be a particular focus on the impact that stigma and discrimination has on these families. Parent and child surveys will be used to collect data and will be available both online and in paper form. Measures have been chosen whenever possible that have sound conceptual underpinnings, robust psychometric properties and Australian normative data, and include the Child Health Questionnaire (CHQ), the Strengths and Difficulties Questionnaire (SDQ) and the Kessler Psychological Distress Scale (K10). Discussion ACHESS aims to be the largest study of its kind and will for the first time produce a detailed quantitative analysis of Australian children with same-sex attracted parents. By inviting participants to take part in further research it will also establish a valuable cohort of children, and their families, to launch future waves of research that will help us better understand the health and wellbeing of children with same-sex attracted parents.
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Affiliation(s)
- Simon Robert Crouch
- The McCaughey Centre, Melbourne School of Population Health, The University of Melbourne, Carlton, VIC 3053, Australia.
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Hughes T, Szalacha LA, McNair R. Substance abuse and mental health disparities: comparisons across sexual identity groups in a national sample of young Australian women. Soc Sci Med 2010; 71:824-31. [PMID: 20579794 DOI: 10.1016/j.socscimed.2010.05.009] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 03/08/2010] [Accepted: 05/10/2010] [Indexed: 11/19/2022]
Abstract
A growing body of research amply documents health disparities related to substance abuse among sexual minority women. However, relatively little research has examined risk factors or predictors of substance use in this population and even less has explored differences among sexual minority subgroups. Using data from 8850 women aged 25-30 years in the 2003 survey of the Australian Longitudinal Study on Women's Health Survey (ALSWH) we compared rates of substance use (alcohol, marijuana and other illicit drugs) and potential predictors (e.g., depression, anxiety, perceived stress, lower levels of social support) across four sexual identity groups-exclusively heterosexual, mainly heterosexual, bisexual and lesbian. Using statistical weighting of the sample and controlling for demographic characteristics we fitted logistic regression models to estimate adjusted odds ratios for substance use. Compared with exclusively heterosexual women sexual minority women reported significantly higher levels of substance use-but there was notable variation among the three sexual minority subgroups. Women who identified as mainly heterosexual were significantly more likely than exclusively heterosexual women to report at-risk drinking and those who identified as bisexual were more likely to report marijuana use. Mainly heterosexual and bisexual women were also more likely to report binge drinking. Findings implicate stress as an important predictor of substance use and emphasize the need for research that more systematically examines the relationships between minority stress and substance use in sexual minority women. Findings of variations in risk across sexual minority subgroups suggest prevention and intervention strategies aimed at reducing health disparities should be targeted toward specific sexual minority subgroups.
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Affiliation(s)
- Tonda Hughes
- University of Illinois at Chicago, Health Systems Sciences, College of Nursing, M/C 802, 845 S. Damen Avenue, Chicago, Illinois 60304, USA.
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Power JJ, Perlesz A, Schofield MJ, Pitts MK, Brown R, McNair R, Barrett A, Bickerdike A. Understanding resilience in same-sex parented families: the work, love, play study. BMC Public Health 2010; 10:115. [PMID: 20211027 PMCID: PMC2841103 DOI: 10.1186/1471-2458-10-115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 03/09/2010] [Indexed: 11/18/2022] Open
Abstract
Background While families headed by same-sex couples have achieved greater public visibility in recent years, there are still many challenges for these families in dealing with legal and community contexts that are not supportive of same-sex relationships. The Work, Love, Play study is a large longitudinal study of same-sex parents. It aims to investigate many facets of family life among this sample and examine how they change over time. The study focuses specifically on two key areas missing from the current literature: factors supporting resilience in same-sex parented families; and health and wellbeing outcomes for same-sex couples who undergo separation, including the negotiation of shared parenting arrangements post-separation. The current paper aims to provide a comprehensive overview of the design and methods of this longitudinal study and discuss its significance. Methods/Design The Work, Love, Play study is a mixed design, three wave, longitudinal cohort study of same-sex attracted parents. The sample includes lesbian, gay, bisexual and transgender parents in Australia and New Zealand (including single parents within these categories) caring for any children under the age of 18 years. The study will be conducted over six years from 2008 to 2014. Quantitative data are to be collected via three on-line surveys in 2008, 2010 and 2012 from the cohort of parents recruited in Wave1. Qualitative data will be collected via interviews with purposively selected subsamples in 2012 and 2013. Data collection began in 2008 and 355 respondents to Wave One of the study have agreed to participate in future surveys. Work is currently underway to increase this sample size. The methods and survey instruments are described. Discussion This study will make an important contribution to the existing research on same-sex parented families. Strengths of the study design include the longitudinal method, which will allow understanding of changes over time within internal family relationships and social supports. Further, the mixed method design enables triangulation of qualitative and quantitative data. A broad recruitment strategy has already enabled a large sample size with the inclusion of both gay men and lesbians.
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Affiliation(s)
- Jennifer J Power
- The Bouverie Centre, La Trobe University, 8 Gardiner Street, Brunswick, Victoria 3056, Australia.
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McNair R, Stone N, Sims J, Curtis C. Australian evidence for interprofessional education contributing to effective teamwork preparation and interest in rural practice. J Interprof Care 2009; 19:579-94. [PMID: 16373214 DOI: 10.1080/13561820500412452] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A pilot interprofessional education (IPE) placement for undergraduate health care professional students was undertaken in rural Victoria, Australia from 2001 to 2003. Medical, nursing, physiotherapy and pharmacy students were involved, and the project is ongoing. This paper briefly outlines the educational model, then focuses on the evaluation methods and results obtained from student evaluations. The placement experience improved self-reported teamwork skills and knowledge, and supported participating students' belief in the value of interprofessional practice. Placements strengthened nursing and allied health students' intention to work in rural health settings after graduation. The rural interprofessional educational experience improved interprofessional abilities in a group of students who have the potential to influence change towards collaborative practices in their future workplaces. The results obtained provide sufficiently strong evidence to justify the continuation and expansion of this educational model in the Australian setting. Pedagogical and evaluation modifications are discussed that may benefit future IPE programs.
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Affiliation(s)
- Ruth McNair
- The Department of General Practice, University of Melbourne, Carlton, Victoria, Australia.
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Cox P, McNair R. Risk reduction as an accepted framework for safer-sex promotion among women who have sex with women. Sex Health 2009; 6:15-8. [PMID: 19254487 DOI: 10.1071/sh08022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Accepted: 08/12/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Safer-sex information for women who have sex with women (WSW) is often very difficult to locate. Girl2girl.info is one of the only websites focussed on safer sex for WSW. The present article describes the predevelopment consultation and evaluation of girl2girl.info. A risk-reduction framework was used to develop the website. METHODS Girl2girl.info was developed in 2004 using questionnaires and focus groups with 36 consumers who were WSW, largely based in Canberra, Australia. In 2006-2007 the site was evaluated using mixed methods of questionnaires with 74 WSW and interviews with 17 health professionals around Australia. RESULTS This research has identified some key attitudes toward safer sex of WSW participants, in particular a misperception that the majority of WSW are at low risk for sexually transmissible infections and a consistent aversion to using latex for safer sex. CONCLUSIONS The article concludes that the promotion of a risk-reduction approach - including non-latex-based safer-sex practices - for WSW is both a theoretically appropriate and engaging form of health promotion for WSW.
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Affiliation(s)
- Peta Cox
- 106 Lennox Street, Newtown, Sydney, NSW 2042, Australia.
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McNair R. Lesbian and bisexual women's sexual health. Aust Fam Physician 2009; 38:388-393. [PMID: 19521580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Lesbian and bisexual women have specific sexual health needs, including the need for information about transmission and prevention of sexually transmissible infections (STIs) between women, contraceptive and conception advice, and support regarding any abuse experiences. These needs can be easily accommodated in general practice. However, there are a number of barriers to general practitioners meeting these needs, including lack of experience in facilitating disclosure of sexual orientation, fears of being intrusive, and lack of specific knowledge and skills in the area of minority sexual orientation. OBJECTIVE This article presents the current evidence related to lesbian and bisexual women's sexual health, describes practical skills to conduct a sensitive sexual history, and discusses sexual health advice that GPs could provide to this group of women. DISCUSSION Improved GP knowledge in this area will increase GPs' perceived need to inquire about sexual orientation. Sensitive inquiry can be facilitated by creating a welcoming practice environment, using appropriate terminology, assuring confidentiality, establishing relevance, and by using focused and normalising questions.
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Affiliation(s)
- Ruth McNair
- Department of General Practice, University of Melbourne, Victoria
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McNair R, Power J, Carr S. Comparing knowledge and perceived risk related to the human papilloma virus among Australian women of diverse sexual orientations. Aust N Z J Public Health 2009; 33:87-93. [PMID: 19236366 DOI: 10.1111/j.1753-6405.2009.00345.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The study compared levels of awareness of human papilloma virus (HPV) as a sexually transmissible infection (STI) between women of different sexual orientations. It also examined self-reported risk factors for HPV infection, perceived level of personal risk, and willingness to have the HPV vaccine. METHODS Recruitment occurred through community sampling and data was collected using a self-completion questionnaire. RESULTS A convenience sample of 349 women completed the questionnaire in early 2007, 309 were sexually active; 47.6% had lifetime sexual partners of both genders, 26.9% had only male partners, and 25.5% had only female partners. Women with partners of both genders were more likely to have ever had a pap test but were also more likely to report an abnormal result (OR 3.19) than women with only male partners. Only 68% of the sample had heard of HPV and women with partners of both genders were significantly more likely to be aware than women with only male partners (OR 2.56). Forty-four per cent did not know how HPV was transmitted and less than half correctly identified HPV-associated clinical problems, with no differences according to gender of partners. The majority of women had risk factors for HPV, however, few felt personally at risk. CONCLUSIONS The very low personal risk perception for HPV, particularly among women who have female and male sexual partners, suggests the need for targeted education for this group regarding HPV transmission and prevention. IMPLICATIONS Health promotion regarding HPV should be broadened to specifically include information about HPV as an STI between women.
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Affiliation(s)
- Ruth McNair
- The Department of General Practice, University of Melbourne, Victoria, Australia.
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McNair R, Simmonds M, Collier J, Knight A. Effects of an exercise program on symptoms and function in individuals with severe osteoarthritis of the knee joint. J Sci Med Sport 2009. [DOI: 10.1016/j.jsams.2008.12.010] [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: 11/26/2022]
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Power J, McNair R, Carr S. Absent sexual scripts: lesbian and bisexual women's knowledge, attitudes and action regarding safer sex and sexual health information. Cult Health Sex 2009; 11:67-81. [PMID: 19234951 DOI: 10.1080/13691050802541674] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Despite recent evidence demonstrating that lesbian and bisexual women are at risk of sexually transmitted infections (STIs), there is a common perception that STIs cannot be transmitted between women. This paper reports on a study in which a self-report questionnaire, completed by over 300 lesbian and bisexual women and a comparison group of heterosexual women, was undertaken to determine lesbian and bisexual women's levels of knowledge about the human papillomavirus (HPV) and their attitudes toward the HPV vaccine and cervical smear testing. Alongside this, a series of in-depth interviews with lesbian and bisexual women explored how they perceive their level of HPV risk, the reasons why they do or do not feel at risk and how they manage their sexual health in relation to their lesbian or bisexual identity. The study concludes that lesbians generally feel at low risk for STIs because they are excluded from dominant sexual scripts that inform the negotiation of safer sex practice. Lesbians are unlikely to engage with sexual health promotion targeted toward gay men or heterosexual women, yet lesbian-specific sexual health promotion does not adequately construct an alternate discourse on safer sex that lesbians can relate to their own sexual practice.
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Affiliation(s)
- Jennifer Power
- Department of General Practice, University of Melbourne, Australia.
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McNair R, Taft A, Hegarty K. Using reflexivity to enhance in-depth interviewing skills for the clinician researcher. BMC Med Res Methodol 2008; 8:73. [PMID: 18992167 PMCID: PMC2644878 DOI: 10.1186/1471-2288-8-73] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 11/09/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary health care clinicians are being encouraged to undertake qualitative research, however the in-depth interviewing skills required are not as straightforward as might be first supposed. While there are benefits and certain skills that clinicians can bring to interview-based research, there are important new skills to develop. To date there has been neither discussion about these new skills, nor any preparatory guidelines for clinicians entering into interview-based research in the qualitative research literature. In the absence of formal guidelines, we suggest the use of reflexivity throughout the interview process as a means to become more accomplished in this area. We present our own experiences as a novice general practitioner (GP) researcher undertaking a PhD study and her experienced supervisors. The PhD study used critical phenomenology through in-depth interviews to understand the experience of the patient-doctor relationship between same-sex attracted women and their usual GP in Australia. RESULTS We used reflexivity to improve the rigour of the data collection. This enabled improved probing, fewer assumptions, avoidance of premature interpretation, and an accentuated sense of curiosity during interviews. We also enlisted reciprocity between interviewer and interviewee as a tool to improve engagement and trust, share interview control, and ultimately improve the depth of the interview content. CONCLUSION Preparatory recommendations for novice clinician research interviewers include the importance of recognising the multiple identities that they bring to the interview. In this setting in particular this involves acknowledging the clinician interviewer as a potential insider in relation to interviewees and negotiating shared understanding to avoid insider assumptions. Other essential requirements are having an experienced research supervisor, arranging pilot interviews that include active feedback on interviewing style from interviewees, and being reflexive during interviews. More formal guidelines for in-depth interviewing skills development are needed.
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Affiliation(s)
- Ruth McNair
- The Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, 3053, Victoria, Australia.
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Abstract
OBJECTIVES To compare the mental health status of early adult and mid-life Australian women according to sexual orientation. METHODS AND SAMPLE Cross-sectional analyses of the Australian Longitudinal Study on Women's Health (ALSWH) surveys for the younger (22-27 years) and mid-age (50-55 years) cohorts. Women were classified into one of four groups: exclusively heterosexual, mainly heterosexual, bisexual and lesbian. Regression analyses were used to examine the effects of sexual orientation on mental health after adjusting for age, region of residence and education and to assess the potential mediating roles of stress, abuse and social support. RESULTS Younger, mainly heterosexual, bisexual and lesbian women had poorer mental health outcomes than exclusively heterosexual women on all outcome measures except anxiety in lesbian women, even after adjustment for age, region and education. Mid-age mainly heterosexual women had poorer mental health on all outcomes except for medically diagnosed anxiety and bisexual women had significantly higher odds of self-harm than exclusively heterosexual women. All non-heterosexual women in both cohorts reported higher levels of stress and lifetime abuse. Controlling for stress, abuse and social support attenuated the mental health findings. CONCLUSIONS The poorer mental health in young non-heterosexual women and mid-life mainly heterosexual women highlights the need for health care providers to be particularly sensitive to mental health issues in these women. Stress, social support and lifetime abuse may play a role in explaining the poorer mental health and discrimination may also be important.
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Affiliation(s)
- Ruth McNair
- Department of General Practice, University of Melbourne, Carlton, Victoria.
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43
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Abstract
Health care providers working with women who have sex with women (WSW) have been ill-informed about a range of sexual health issues for these women. Pertinent issues include sexual behaviours that carry risks of sexually transmissible infection (STI), prevention strategies for safer sex and understanding experiences of abuse. A relative silence continues in all of these areas within the mainstream medical literature, textbooks, research and policy documents, which perpetuates medical ignorance. There is evidence that the prevalence of STIs among WSW is at least as high as among heterosexual women, if not higher among some sub-groups. Risk factors include the sex and number of sexual partners, minimal use of protected sexual behaviours and low levels of knowledge of STI prevention among WSW. Importantly, marginalisation leading to poorer mental health and experiences of abuse can combine to influence risk taking including substance abuse and risky sexual behaviours. Safe-sex guidelines and the need to recognise the impact of sexual abuse are presented.
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Affiliation(s)
- Ruth McNair
- The Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, VIC 3053, Australia.
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Reynolds J, Proudfoot D, Skepper J, McNair R, Johannides A, Weissberg P, Shanahan C. MINERAL ION-INDUCED RELEASE OF MINERALIZATION-COMPETENT MATRIX VESICLES FROM HUMAN VASCULAR SMOOTH MUSCLE CELLS. Cardiovasc Pathol 2004. [DOI: 10.1016/j.carpath.2004.03.550] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Reynolds J, Proudfoot D, Skepper J, McNair R, Johannides A, Weissberg P, Shanahan C. MINERAL ION-INDUCED RELEASE OF MINERALIZATION-COMPETENT MATRIX VESICLES FROM HUMAN VASCULAR SMOOTH MUSCLE CELLS. Cardiovasc Pathol 2004. [DOI: 10.1016/j.carpath.2004.03.560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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46
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Abstract
Lesbian health is emerging as a distinct discipline in practice and research. Evidence is increasingly available that lesbians are a unique and underserved population in the health care system. They display reduced health seeking behaviors and have specific risk factors which potentially affect their health and well being. They also have specific health issues in fields as diverse as fertility, sexual health and mental health, which require specific knowledge from health care practitioners. Above all, lesbian health care consumers repeatedly decry the lack of sensitivity and knowledge that they experience in their interactions with providers, and call for improved training. However, medical education generally ignores lesbian health at all levels. In this paper, the inclusion of lesbian health in medical education programs is reviewed, and recent political initiatives involving gay and lesbian health in Australia are discussed. The paper concludes with suggestions to integrate lesbian health in medical training.
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Affiliation(s)
- Ruth McNair
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia.
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47
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McNair R, Brown R, Stone N, Sims J. Rural interprofessional education: promoting teamwork in primary health care education and practice. Aust J Rural Health 2001; 9 Suppl 1:S19-26. [PMID: 11998271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
In a climate of increasing incentives to work effectively within a primary health care team, the ability of various health care professionals to collaborate comes into focus. The principles of effective teamwork can be learned and this learning is most effectively achieved in the field under the supervision of experienced preceptors. It is also enhanced if learners have the opportunity to participate actively in the team and do so from undergraduate level. A 3 year project is underway in Victoria involving rural primary care placements for mixed groups of nursing and medical students. The students are educated in the field by medical and nursing tutors and preceptors who are currently working closely together. The learning objectives include understanding the principles of collaboration, teamwork and various roles in the health care team within a primary health care framework. The present paper describes the context for an evolving interprofessional education project in rural primary care, designed to promote collaboration. It outlines the policy underpinning the project's development. It provides a brief review of the associated evidence base, highlighting barriers to and enablers of interprofessional education. Lessons learnt during the implementation and evaluation of this project will guide efforts to extend the reach of interprofessional education across the primary health care sector.
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Affiliation(s)
- R McNair
- Department of General Practice, University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia.
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48
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Abstract
OBJECTIVES To map the provision of shared obstetric care in Victoria, and investigate the views of care providers about the ways in which current practice could be improved. METHOD All Victorian public hospitals with > or = 300 births per annum and a purposive sample of hospitals with < 300 births per annum were mailed a questionnaire seeking information about current practice. Interviews with key informants (n = 32) were conducted at four case study sites. RESULTS The response rate to the hospital survey was 98% (42/43). Fourteen different models of shared care were identified. Two-thirds of hospitals with > or = 300 births per annum (16/28) had three or more different models of shared care. Six hospitals (15%) had written guidelines for all models of shared care offered; 13 (32%) had written guidelines covering some models. Practice varied considerably in relation to: exclusion criteria, recommended schedule of visits and use of patient-held records. There was little consensus about the content of visits and responsibility for covering particular aspects of care. Few hospitals (6/42) had written information for women about shared care. Care providers expressed divergent views regarding the question of where ultimate responsibility lies for individual patient care and for the overall management of shared care. CONCLUSIONS Current funding arrangements provide strong incentives to expand enrollment in shared obstetric care. Expansion of shared care has occurred without the development of formal, consultative and agreed arrangements between providers, or adequate provision for monitoring, evaluation and review. The variety, complexity and fluidity of models of shared care and lack of agreed procedures contribute to difficulties experienced by both providers and women participating in shared care. IMPLICATIONS Detailed evidence-based agreed guidelines developed in consultation with hospital and community providers, and provision of improved information to women about what to expect in shared care arrangements are urgently required.
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Affiliation(s)
- W Dawson
- Centre for the Study of Mothers' and Children's Health, School of Public Health, La Trobe University, Victoria
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49
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McNair R. Lesbian sexuality. Do GPs contribute to lesbian invisibility and ill health? Aust Fam Physician 2000; 29:514-6. [PMID: 10863801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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50
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McNair R, Brown R. Innovative perspectives in youth health care. Aust Fam Physician 1996; 25:347-51. [PMID: 8867185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A dedicated youth health service in an 'adolescent friendly' environment can provide a needed alternative to mainstream general practice for the large sub group of adolescents who require confidential management of their sexual health and psychological needs. Such a service has been operating in Melton, Victoria, since November 1993 under the name of the Backdoor Youth-Health Service.
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Affiliation(s)
- R McNair
- Melton Community Health Centre, VIC
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