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Welsh EF, Andrus EC, Sandler CB, Moravek MB, Stroumsa D, Kattari SK, Walline HM, Goudsmit CM, Brouwer AF. Cervicovaginal and Anal Self-Sampling for Human Papillomavirus Testing in a Transgender and Gender Diverse Population Assigned Female at Birth: Comfort, Difficulty, and Willingness to Use. LGBT Health 2024. [PMID: 38574315 DOI: 10.1089/lgbt.2023.0336] [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] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Purpose: Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for cervical cancer screening. At-home human papillomavirus (HPV) testing may expand access to cervical cancer screening for TGD people AFAB. This study assessed the perceptions of TGD individuals AFAB who self-collected cervicovaginal and anal samples. Methods: We recruited TGD individuals AFAB to collect cervicovaginal and anal specimens at home using self-sampling for HPV testing, and individuals reported their perceptions of self-sampling. Associations between demographic and health characteristics and each of comfort of use, ease of use, and willingness to use self-sampling were estimated using robust Poisson regression. Results: Of 137 consenting participants, 101 completed the sample collection and the surveys. The majority of participants reported that the cervicovaginal self-swab was not uncomfortable (68.3%) and not difficult to use (86.1%), and nearly all (96.0%) were willing to use the swab in the future. Fewer participants found the anal swab to not be uncomfortable (47.5%), but most participants still found the anal swab to not be difficult to use (70.2%) and were willing to use the swab in the future (89.1%). Participants were more willing to use either swab if they had not seen a medical professional in the past year. Conclusions: TGD individuals AFAB were willing to use and preferred self-sampling methods for cervicovaginal and anal HPV testing. Developing clinically approved self-sampling options for HPV testing could expand access to cancer screening for TGD populations.
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Affiliation(s)
- Erin F Welsh
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Claire B Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly B Moravek
- Department of Obstetrics and Gynecology, Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Daphna Stroumsa
- Department of Obstetrics and Gynecology, Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Department of Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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2
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McIntosh RD, Andrus EC, Walline HM, Sandler CB, Goudsmit CM, Moravek MB, Stroumsa D, Kattari SK, Brouwer AF. Prevalence and Determinants of Cervicovaginal, Oral, and Anal Human Papillomavirus Infection in a Population of Transgender and Gender Diverse People Assigned Female at Birth. LGBT Health 2024. [PMID: 38530059 DOI: 10.1089/lgbt.2023.0335] [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] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Purpose: The human papillomavirus (HPV) causes cervicovaginal, oral, and anogenital cancer, and cervical cancer screening options include HPV testing of a clinician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face many barriers to preventive care, including cancer screening. Self-sampling options may increase access and participation in HPV testing and cancer screening. This study estimated the prevalence of HPV in self-collected cervicovaginal, oral, and anal samples from Midwestern TGD individuals AFAB. Methods: We recruited TGD individuals AFAB for an observational study, mailing them materials to self-collect cervicovaginal, oral, and anal samples at home. We tested samples for high-risk (HR; 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and other HPV genotypes (6, 11, 66, 68, 73, 90) using a polymerase chain reaction mass array test. Prevalence ratios for HPV infection at each site as a function of participant characteristics were estimated in log-binomial models. Results: Out of 137 consenting participants, 102 completed sample collection. Among those with valid tests, 8.8% (HR = 6.6%; HPV 16/18 = 3.3%) were positive for oral HPV, 30.5% (HR = 26.8%; HPV 16/18 = 9.7%) for cervicovaginal HPV, and 39.6% (HR = 33.3%; HPV 16/18 = 8.3%) for anal HPV. A larger fraction of oral (71.4%) than anal infections (50.0%) were concordant with a cervicovaginal infection of the same type. Conclusions: We detected HR cervicovaginal, oral, and anal HPV in TGD people AFAB. It is essential that we reduce barriers to cancer screening for TGD populations, such as through the development of a clinically approved self-screening HPV test.
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Affiliation(s)
- Ryan D McIntosh
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily C Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather M Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Claire B Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Molly B Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Department of Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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Kattari L, Hill H, Shires DA, Prieto LR, Modi IK, Misiolek BA, Kattari SK. Prescription Pain Reliever Misuse Among Transgender and Gender Diverse Adults. Transgend Health 2024; 9:68-75. [PMID: 38312452 PMCID: PMC10835153 DOI: 10.1089/trgh.2022.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Purpose Little is known about the prevalence and risks associated with transgender and gender diverse (TGD) persons' misuse of prescription pain relievers (PPRs). This study explores the relationship between PPR misuse and various sociodemographic identities and experiences of discrimination in health care among TGD adults. Methods TGD participants (n=595) were recruited in 2018 to participate in a cross-sectional statewide trans health survey through convenience sampling. Chi-square tests of independence and logistic regressions were conducted to explore associations between sociodemographics and experiences of discrimination among persons who had ever misused PPRs, or who had misused PPRs in the past year. Results Sociodemographics such as gender identity (odds ratio [OR]=0.44, p=0.01), race/ethnicity (OR=0.14, p<0.001), and sexual orientation influence TGD individuals likeliness of misusing PPRs (OR=0.40, p<0.001). Notably, those who were ever diagnosed with anxiety had a higher likeliness of having lifetime PPR misuse compared with those who were never diagnosed (OR=2.05, p=0.05), and those reporting past-year discrimination within the mental health care setting because of their gender identity were more than twice as likely to report past-year misuse than those who reported not experiencing it (OR=2.43, p=0.004). Conclusion Certain subpopulations of TGD individuals may be at elevated risk of PPR misuse. It is imperative to acknowledge the impact of multimarginalized identities as well as differences across various identities and experiences within the TGD community while working to address non-PPR misuse.
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Affiliation(s)
- Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Haley Hill
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Lucas R Prieto
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Ishaan K Modi
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | | | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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4
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McIntosh RD, Andrus EC, Walline HM, Sandler CB, Goudsmit CM, Moravek MB, Stroumsa D, Kattari SK, Brouwer AF. Prevalence and determinants of cervicovaginal, oral, and anal HPV infection in a population of transgender and gender diverse people assigned female at birth. medRxiv 2023:2023.08.15.23294129. [PMID: 37645745 PMCID: PMC10462201 DOI: 10.1101/2023.08.15.23294129] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Introduction HPV causes oral, cervicovaginal, and anogenital cancer, and cervical cancer screening options include HPV testing of a physician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face discrimination and stigma in many healthcare settings; are believed to be a lower risk for cervical cancer by many physicians; are less likely to be up to date on preventive health care services such as pelvic health exams; and are more likely to have inadequate results from screening tests. Self-sampling options may increase access and participation in HPV testing and cancer screening. Methods We recruited 137 TGD individuals AFAB for an observational study, mailing them a kit to self-collect cervicovaginal, oral, and anal samples at home. We tested samples for HPV genotypes 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73 and 90 using a PCR mass array test. Results 102 participants completed the study. Among those with valid tests, 8.8% were positive for oral HPV, 30.5% were positive for cervicovaginal HPV, and 39.6% were positive for anal HPV. A large fraction of anal (50.0%) and oral (71.4%) infections were concordant with a cervicovaginal infection of the same type. Conclusions HPV infection in TGD people AFAB may be just as high, if not higher, than in cisgender women. It is essential that we reduce barriers to cancer screening for TGD populations, such as through the development of a clinically approved self-screening HPV test.
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Affiliation(s)
- Ryan D. McIntosh
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Emily C. Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Heather M. Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Claire B. Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Molly B. Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, United States
| | - Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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5
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Welsh EF, Andrus EC, Sandler CB, Moravek MB, Stroumsa D, Kattari SK, Walline HM, Goudsmit CM, Brouwer AF. Cervicovaginal and anal self-sampling for HPV testing in a transgender and gender diverse population assigned female at birth: comfort, difficulty, and willingness to use. medRxiv 2023:2023.08.15.23294132. [PMID: 37645965 PMCID: PMC10462238 DOI: 10.1101/2023.08.15.23294132] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for HPV and cervical cancer screening. Self-sampling options may expand access to HPV testing for TGD people AFAB. Methods We recruited TGD individuals AFAB to collect cervicovaginal and anal specimens at-home using self-sampling for HPV testing, and individuals reported their perceptions of self-sampling. Associations between demographic and health characteristics and each of comfort of use, ease of use, and willingness to use self-sampling were estimated using robust Poisson regression. Results The majority of the 101 participants who completed the study reported that the cervicovaginal self-swab was not uncomfortable (68.3%) and not difficult to use (86.1%), and nearly all (96.0%) were willing to use the swab in the future. Fewer participants found the anal swab to not be uncomfortable (47.5%), but most participants still found the anal swab to not be difficult to use (70.2%) and were willing to use the swab in the future (89.1%). Participants were more willing to use either swab if they had not seen a medical professional in the past year. About 70% of participants who reported negative experiences with either self-swab were still willing to use that swab in the future. Conclusions TGD AFAB individuals were willing to use and preferred self-sampling methods for cervicovaginal and anal HPV testing. Developing clinically approved self-sampling options for cancer screening could expand access to HPV screening for TGD AFAB populations.
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Affiliation(s)
- Erin F Welsh
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Emily C. Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Claire B. Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Molly B. Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, United States
| | - Heather M. Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | | | - Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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Smith MJ, Sherwood K, Sung C, Williams ED, Ross B, Sharma S, Sharma A, Harrington M, Brown C, Telfer D, Bond J, Toda S, Kearon D, Morrow S, Lovelace T, Dababnah S, Kattari SK, Magaña S, Watkins T, Liggett C, Riddle E, Smith JD, Hume K, Dawkins T, Baker-Ericzén M, Eack SM, Sinco B, Burke-Miller JK, Olsen D, Elkins J, Humm L, Steacy C. Enhancing pre-employment transition services: A type 1 hybrid randomized controlled trial protocol for evaluating WorkChat: A Virtual Workday among autistic transition-age youth. Contemp Clin Trials Commun 2023; 34:101153. [PMID: 37456506 PMCID: PMC10338963 DOI: 10.1016/j.conctc.2023.101153] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 07/18/2023] Open
Abstract
Autistic transition-age youth experience high rates of unemployment and underemployment, in part due to the social challenges they may face when having conversations in the workplace. In an effort to help enhance conversational abilities in the workplace, our collaborative team partnered to develop WorkChat: A Virtual Workday. Specifically, our team of scientists, community partners, and diversity and inclusion experts participated in a community-engaged process to develop WorkChat using iterative feedback from autistic transition-age youth and their teachers. With initial development complete, this study reports on the protocol that our collaborative team developed, reviewed, and approved to conduct a randomized controlled trial (RCT) to evaluate the real-world effectiveness and initial implementation process outcomes of WorkChat when integrated into post-secondary pre-employment transition services (Pre-ETS). Our aims are to: 1) evaluate whether services-as-usual in combination with WorkChat, compared to services-as-usual with an attention control, enhances social cognition and work-based social ability (between pre- and post-test); reduces anxiety about work-based social encounters (between pre- and post-test), and increases sustained employment by 9-month follow-up; 2) evaluate whether social cognitive ability and work-based social ability mediate the effect of WorkChat on sustained employment; and 3) conduct a multilevel, mixed-method process evaluation of WorkChat implementation.
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Affiliation(s)
- Matthew J. Smith
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Kari Sherwood
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
- University of Michigan, Department of Psychology, Ann Arbor, MI, USA
| | - Connie Sung
- Michigan State University, East Lansing, MI, USA
| | - Ed-Dee Williams
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Brittany Ross
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Sagun Sharma
- Michigan State University, East Lansing, MI, USA
| | - Apara Sharma
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | | | | | | | - Justine Bond
- Michigan Rehabilitation Services, Lansing, MI, USA
| | - Sen Toda
- Michigan Career and Technical Institute, Plainwell, MI, USA
| | | | | | - Temple Lovelace
- Advanced Education Research & Development Fund, Oakland, CA, USA
| | - Sarah Dababnah
- University of Maryland, School of Social Work, Baltimore, MD, USA
| | - Shanna K. Kattari
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
- University of Michigan, Department of Women's and Gender Studies, Ann Arbor, MI, USA
| | - Sandra Magaña
- University of Texas, School of Social Work, Austin, TX, USA
| | - Tikia Watkins
- Walled Lake Consolidated Schools, Walled Lake, MI, USA
| | | | | | - Justin D. Smith
- University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Kara Hume
- University of North Carolina, School of Education, Chapel Hill, NC, USA
| | - Tamara Dawkins
- University of North Carolina, Department of Psychiatry, Chapel Hill, NC, USA
| | - Mary Baker-Ericzén
- San Diego State University, Interwork Institute and Department of Administration, Rehabiliation, and Post-Secondary Education, San Diego, CA, USA
| | - Shaun M. Eack
- University of Pittsburgh, School of Social Work and Department of Psychiatry, Pittsburgh, PA, USA
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7
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Lacombe-Duncan A, Kattari SK, Kattari L, Scheim AI, Misiolek BA. Sexually transmitted infection testing among transgender and non-binary persons: results of a community-based cross-sectional survey. Sex Health 2023; 20:87-91. [PMID: 36347262 DOI: 10.1071/sh22128] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Studies show higher rates of sexually transmitted infections (STIs) among transgender (trans) and non-binary (TNB) persons compared with the general population. Scant studies have examined non-HIV STI testing (henceforth referred to as STI testing); fewer inclusive of trans men and non-binary persons. We characterised the prevalence of STI testing and time since last STI test and gender-based differences in these outcomes among TNB persons. METHODS Data were analysed from a 2018 community-based participatory cross-sectional survey (n =528). Prevalence of lifetime STI testing history and time since last STI test were reported overall and compared across genders (trans men, trans women, non-binary assigned female at-birth, non-binary assigned male at-birth) using Chi-squared, then bivariable and multivariable logistic regression analyses to compare lifetime STI testing history (ever vs never) across sociodemographic and health care characteristics. RESULTS Most (n =425; 80.5%) participants reported having ever had an STI test; over half (59.8%) ever tested had tested within the past year. Bivariate analyses showed no significant gender differences in lifetime STI testing history (P =0.298) or time since last STI test (P =0.118). In a multivariable model, higher age, reporting multiple committed partners (vs single/divorced), known HIV status, and ever receiving information about pre-exposure prophylaxis (PrEP) were positively associated with ever having had an STI test, whereas Latinx race/ethnicity (vs white) was negatively associated. CONCLUSIONS Findings showed high rates of lifetime STI testing and recent testing, with no gender-based differences. Never testing rates were concerning considering screening recommendations. Broad based (non-gender specific) TNB-focused interventions may be warranted to increase uptake.
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Affiliation(s)
| | - Shanna K Kattari
- University of Michigan, School of Social Work, Ann Arbor, MI, USA; and University of Michigan, Department of Women's and Gender Studies, Ann Arbor, MI, USA
| | - Leonardo Kattari
- Michigan State University, School of Social Work, East Lansing, MI, USA
| | - Ayden I Scheim
- Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA
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8
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Slayter EM, Kattari SK, Yakas L, Singh RCB, Goulden A, Taylor S, Wernick LJ, Simmons LD, Prince D. Beyond Ramps, Curb Cuts, and Captions: A Call for Disability Justice in Social Work. Soc Work 2022; 68:89-92. [PMID: 36409996 DOI: 10.1093/sw/swac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 06/16/2023]
Affiliation(s)
- Elspeth M Slayter
- PhD, MSW, MA is professor, School of Social Work, Salem State University, 352 Lafayette Street, Salem, MA 01970, USA
| | - Shanna K Kattari
- PhD, MEd, is associate professor, School of Social Work and Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Laura Yakas
- PhD, MSW, MA, is lecturer, School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Rose C B Singh
- MSW, is a PhD candidate Memorial University of Newfoundland and Labrador, St. John's, Newfoundland, Canada
| | - Ami Goulden
- PhD, MA, MSW, is assistant professor, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland, Canada
| | - Sarah Taylor
- PhD, MSW, is professor and department chair, Department of Social Work, California State University, East Bay, Hayward, CA, USA
| | - Laura J Wernick
- PhD, MSW, MPA, MA, is associate professor, School of Social Service, Fordham University, New York, NY, USA
| | - Lamont D Simmons
- PhD, MA, MSW, is assistant professor, School of Social Work, Salem State University, Salem, MA, USA
| | - Dana Prince
- PhD, MPH, is assistant professor, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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9
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Kattari SK, Kattari L, Lacombe-Duncan A, Shelton J, Misiolek BA. Differential Experiences of Sexual, Physical, and Emotional Intimate Partner Violence Among Transgender and Gender Diverse Adults. J Interpers Violence 2022; 37:NP23281-NP23305. [PMID: 35271412 DOI: 10.1177/08862605221078805] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Various forms of intimate partner violence (IPV) are unfortunately common amongst adults in the United States, and these rates are devastatingly higher for transgender and gender diverse (TGD) individuals than for the general population. However, the TGD population is not monolithic, and is diverse regarding gender, sexual orientation, age, race/ethnicity, urbanicity, and other sociodemographic categories. This study uses data from the 2018 Michigan Trans Health Survey to explore these within group differences regarding sexual, physical, and emotional forms of IPV using chi-square tests of independence and logistic regressions. Chi square tests of independence found homelessness had significant associations across all outcome variables: "ever experienced physical violence from a partner," "ever experienced forced sex from a partner," "ever been threatened to be outed by a partner," and "ever had gender belittled by a partner." Gender identity and sexual orientation had significant associations with "ever experienced forced sex from a partner," "ever been threatened to be outed by a partner," and "ever had gender belittled by a partner." Urbanicity showed a significant association with "ever being threatened to be outed by a partner." In the logistic regressions, age indicated significantly higher likelihood of IPV physical IPV with each year of age; experiences of homelessness were significantly related to likelihood for all outcomes variables. Gender and sexual orientation were also significant across the models, with differing levels of likeliness depending on identities. Findings demonstrate a need for TGD inclusive programming, and specifically programs that target TGD persons who are older, report additional genders (meaning, multiple identities and/or identities besides transfeminine, transmasculine, or nonbinary), queer sexual orientations, and who are/have experienced homelessness. Programs are needed both in the realms of intimate partner violence prevention work and social services that support survivors of violence, such as mental health clinics, rape crisis centers, and shelters.
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Affiliation(s)
| | | | | | - Jama Shelton
- Hunter College, City University of New York, 366436New York, NY, USA
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10
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Lacombe‐Duncan A, Kattari L, Kattari SK, Scheim AI, Alexander F, Yonce S, Misiolek BA. HIV testing among transgender and nonbinary persons in Michigan, United States: results of a community-based survey. J Int AIDS Soc 2022; 25 Suppl 5:e25972. [PMID: 36225152 PMCID: PMC9557000 DOI: 10.1002/jia2.25972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Transgender (trans) and nonbinary people (TNB) are disproportionately impacted by HIV. HIV testing is critical to engage TNB people in HIV prevention and care. Yet, scant literature has examined social and structural factors associated with HIV testing among TNB people of diverse genders and in geographies with potentially lower trans acceptance. We: (1) characterized the prevalence of never having been tested for HIV; and (2) identified associated factors, among TNB people in Michigan, United States. METHODS Data were from a community-based participatory cross-sectional survey (n = 539 sexually experienced TNB people). The prevalence of never having had an HIV test was reported overall and compared across socio-demographic, clinical, social and structural factors using bivariable and multivariable logistic regression analyses. RESULTS AND DISCUSSION Approximately one-quarter (26.2%) of participants had never had an HIV test (20.8% transfeminine; 30.0% transmasculine; 17.8% nonbinary assigned male at-birth; and 32.0% nonbinary assigned female at-birth). In a multivariable socio-demographic model, older age (adjusted odds ratio [aOR] for 1-year increase: 0.93, 95% CI: 0.90, 0.96, p<0.001) and Black/African American race (vs. White) (aOR: 0.28, 95% CI: 0.09, 0.86, p<0.05) were associated with increased odds of HIV testing (aORs for never testing). In separate multivariable models controlling for socio-demographics, ever experiencing sexual violence (aOR: 0.38, 95% CI: 0.21, 0.67, p<0.001), not accessed sexual/reproductive healthcare in the past 12 months (aOR: 4.46, 95% CI: 2.68, 7.43, p<0.001) and reporting a very/somewhat inclusive primary care provider (PCP) (aOR: 0.29, 95% CI: 0.17, 0.49, p<0.001) were associated with HIV testing (aORs for never testing). CONCLUSIONS Findings contribute to scant literature about gender-based differences in HIV testing inclusive of transmasculine and nonbinary people. Lack of statistically significant gender differences suggests that broad TNB interventions may be warranted. These could include training healthcare providers in trans-inclusive practices with sexual violence survivors and PCPs in trans-inclusive HIV prevention and care. Findings showing Black participants were less likely to have never had an HIV test suggest the promise of culturally tailored services, though further investigation is needed. Findings identify social and structural factors associated with HIV testing and can inform multi-level interventions to increase TNB person's HIV testing.
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Affiliation(s)
| | - Leonardo Kattari
- School of Social Work, Michigan State UniversityEast LansingMichiganUSA
| | - Shanna K. Kattari
- School of Social Work, University of MichiganAnn ArborMichiganUSA
- Department of Women's and Gender Studies, University of MichiganAnn ArborMichiganUSA
| | - Ayden I. Scheim
- Dornsife School of Public Health, Drexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Flyn Alexander
- School of Social Work, University of MichiganAnn ArborMichiganUSA
| | - Sophie Yonce
- Lyman Briggs College, Michigan State UniversityEast LansingMichiganUSA
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11
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Kattari SK, Gross EB, Harner V, Andrus E, Stroumsa D, Moravek MB, Brouwer A. "Doing it on my own terms": Transgender and nonbinary adults' experiences with HPV self-swabbing home testing kits. Womens Reprod Health (Phila) 2022; 10:496-512. [PMID: 38105788 PMCID: PMC10720596 DOI: 10.1080/23293691.2022.2094737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/19/2022] [Indexed: 12/19/2023]
Abstract
The human papillomavirus (HPV) carries a significant health risk for people with a cervix. Among transgender and nonbinary people, however, testing and treatment for HPV can pose difficulties, and even be traumatic at times. This current study is part of a larger mixed methods study conducted in Michigan in 2020, and it explores the experiences of transmasculine and nonbinary people with at-home self-swabbing HPV test kits and knowledge of HPV transmission/screenings. Phenomenological methods were used by conducting virtual qualitative interviews with ten transmasculine and nonbinary individuals with cervixes, ages 23-59. Interviews were independently coded by members of the research team and a tabletop theming method was used. Four themes were generated from the data: 1) Multilevel barriers; 2) "Get it done, so I know that I am safe"; 3) Contrasting preferences for care; and 4) Community calls for change. The discussion focuses on the implications of these findings for improving sexual health care for the transgender and nonbinary community, along with directions for further research.
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Affiliation(s)
- Shanna K. Kattari
- School of Social Work & Department of Women’s
and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Emma B. Gross
- School of Social Work, Department of Psychology,
University of Michigan, Ann Arbor, MI, USA
| | - Vern Harner
- School of Social Work, University of Washington, Seattle,
WA, USA
| | - Emily Andrus
- School of Public Health, Department of Epidemiology,
University of Michigan, Ann Arbor, MI, USA
| | - Daphna Stroumsa
- Medical School, Department of Obstetrics and Gynecology
& Institute for Healthcare Policy and Innovation, University of Michigan, Ann
Arbor, MI, USA
| | - Molly B. Moravek
- Medical School, Department of Obstetrics and Gynecology,
University of Michigan, Ann Arbor, MI, USA
| | - Andrew Brouwer
- School of Public Health, Department of Epidemiology,
University of Michigan, Ann Arbor, MI, USA
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12
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Paceley MS, Kattari SK, Levin NJ, Banks A, Ramseyer Winter V, Bauerband L, Harper DM. Interdisciplinary, Inclusive, and Innovative: Promoting a Paradigmatic Shift in Cancer Research Among Transgender and Gender Diverse Adolescents and Young Adults. Ann LGBTQ Public Popul Health 2022; 3:129-134. [PMID: 37885620 PMCID: PMC10601924 DOI: 10.1891/lgbtq-2021-0005] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Transgender and gender diverse (TGD) adolescents and young adults (AYA) face heightened risks of cancer due to cissexism and transphobia in healthcare, low cancer screening rates, limited knowledge and awareness of cancer risk and screenings, poor healthcare experiences, and exposure to sexually transmitted infections (STIs). Despite this, TGD AYA cancer risk is relatively unexamined in oncology research. To intervene early and mitigate risk, we require holistic understandings of cancer risk among TGD AYA. This research brief engages with an interdisciplinary knowledge base to identify gaps and limitations warranting critical attention by TGD AYA and cancer scholars. The current literature on TGD AYA risks for cancer are explored with specific attention to the social environment and its impact on cancer risk. The brief ends with a call to action for a paradigmatic shift to promote inclusive, innovative, and interdisciplinary cancer research with TGD AYA.
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13
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Guz S, Hecht HK, Kattari SK, Gross EB, Ross E. A Scoping Review of Empirical Asexuality Research in Social Science Literature. Arch Sex Behav 2022; 51:2135-2145. [PMID: 35604513 DOI: 10.1007/s10508-022-02307-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/03/2019] [Revised: 01/06/2022] [Accepted: 02/07/2022] [Indexed: 06/15/2023]
Abstract
Research on asexuality as a part of the experience of human sexuality has increased over the last two decades. However, there has not yet been a systematic review of the extant literature on asexuality. This paper aims to provide a systematic scoping review of literature on asexuality with articles published in 2004 through August 2021. After a systematic search procedure, 48 studies were included. A codebook was developed to extract broad information about the literature on asexuality, including sampling techniques, research participant sociodemographics, and conceptualization of asexuality. Results of the review indicate that the research is currently split between qualitative and quantitative methods. The literature primarily relied on convenience sampling within asexual online communities. The primary online community was Asexual Visibility and Education Network (AVEN), which may have contributed to the majority of participants being White, presumptively cisgender, women between the ages of 20-30. Analysis of the overall literature scope demonstrates no support for asexuality as a medical condition (i.e., a disorder requiring treatment) and instead supports the need to recognize asexuality as a complex identity and sexual orientation. Implications for research are discussed, such as the need for additional research on the topic of human sexuality that includes asexuality as a sexual orientation as well as the need for more intersectional research within the literature.
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Affiliation(s)
- Samantha Guz
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60th St., Chicago, IL, 60637, USA.
| | - Hillary K Hecht
- UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Shanna K Kattari
- School of Social Work & Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - E B Gross
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Emily Ross
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
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14
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Kattari SK, Bakko M, Langenderfer-Magruder L, Holloway BT. Transgender and Nonbinary Experiences of Victimization in Health care. J Interpers Violence 2021; 36:NP13054-NP13076. [PMID: 32046594 DOI: 10.1177/0886260520905091] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 06/10/2023]
Abstract
Transgender and nonbinary (TNB) individuals experience high rates of myriad types of victimization, including in health care settings. Many TNB people avoid medical visits for fear of mistreatment and, when they do visit a provider, report negative experiences (e.g., denial of services, misgendering, verbal abuse). These negative experiences are heightened for TNB individuals who have an intersecting marginalized identity (e.g., low socioeconomic status, disability). Using data from the 2015 United States Transgender Survey, the largest survey of TNB individuals in the United States to date, the present study examines differential experiences of victimization in health care settings by TNB identity and other demographics (i.e., race, age, class, educational level, disability). A series of multivariate logistic regressions were run to determine adjusted odds ratios (AORs) for TNB individuals recently (i.e., in the past year) experiencing four forms of victimization: (a) doctor/health care provider used harsh or abusive language; (b) doctor/health care provider was physically rough or abusive; (c) patient was verbally harassed in health care setting; and (d) patient experienced unwanted sexual contact in health care setting. Frequency of victimization varied by gender identity and type of victimization; the most prevalent form was verbal harassment by a doctor/provider (5.84%) and the least prevalent was unwanted sexual contact in a health care setting (1.20%). Although findings varied by form of violence, generally, regression models demonstrated elevated odds of experiencing some form of health care victimization for those who were transgender compared with genderqueer, biracial/multiracial compared with White, low income compared with higher income, and disabled compared to non-disabled. In addition, odds ratios for victimization increased with age and, for some forms, increased with low educational attainment. We discuss the need for increased mandatory trainings for providers to reduce discriminatory and violent behavior toward TNB patients, as well as intersectional research to better ascertain the extent and nuance of victimization within TNB health care.
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15
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Ruppert R, Kattari SK, Sussman S. Review: Prevalence of Addictions among Transgender and Gender Diverse Subgroups. Int J Environ Res Public Health 2021; 18:ijerph18168843. [PMID: 34444595 PMCID: PMC8393320 DOI: 10.3390/ijerph18168843] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022]
Abstract
We conducted an analysis of the prevalence of substance and behavioral addictions across different transgender and gender diverse (TGD) subgroups. We performed a scoping review using MEDLINE and Google Scholar databases and examined 12 addictions, including alcohol, nicotine, cannabis, illicit drugs, gambling, eating/food, internet, sex, love, exercise, work, and shopping. We presented prevalence rates for each addiction as a function of an individual’s gender identity (stratified into transgender females, transgender males, and gender nonconforming), and used cisgender women and men as reference groups. We included 55 studies in our final analysis, the majority of which investigated substance use disorders among TGD subgroups. Overall findings indicated that substantial differences in substance use exist among US TGD subgroups. There were far fewer publications that examined the prevalence of behavioral addictions across TGD subgroups. However, despite limited research in this area, findings still suggest that notable differences in behavioral addictions may exist between individual TGD subgroups. The conclusions of our review may provide clinicians with a better ability to screen for and treat at-risk individuals within the TGD community.
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Affiliation(s)
- Ryan Ruppert
- Keck School of Medicine of USC, Los Angeles, CA 90033, USA;
- Correspondence: or ; Tel.: +1-302-358-6852
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Steve Sussman
- Keck School of Medicine of USC, Los Angeles, CA 90033, USA;
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16
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Klemmer CL, Rusow J, Goldbach J, Kattari SK, Rice E. Socially Assigned Gender Nonconformity and School Violence Experience Among Transgender and Cisgender Adolescents. J Interpers Violence 2021; 36:NP8567-NP8589. [PMID: 31023178 DOI: 10.1177/0886260519844781] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 06/09/2023]
Abstract
Although literature documents the experiences of socially assigned gender nonconformity (SAGNC) by minority sexual orientation (i.e., lesbian, gay, and bisexual [LGB]), examination of the role of gender expression on school violence outcomes in the presence of sexual orientation and gender identity is not well understood. This study describes SAGNC among a representative sample of adolescents, accounting for sexual orientation and gender identity (e.g., transgender). A secondary data analysis was conducted using Youth Risk Behavior Survey data from Los Angeles Unified School District high schools in 2013 (N = 1,496). The prevalence of school violence by self-reported SAGNC and gender identity was obtained. Associations between SAGNC and school violence were examined using multivariate logistic regression adjusted for mischievous response bias. Two hundred ninety-one (19.5%) adolescents reported SAGNC. Having missed school due to a safety concern and being bullied in the past year were more common among socially assigned gender nonconforming adolescents than those who conformed to gender expression expectations. Socially assigned gender nonconforming adolescents, regardless of sexual orientation or gender identity, are at greater risk of missed school due to safety concerns, and bullying, as compared with those who conform to norms of gender expression. Future research should measure SAGNC, sexual orientation, gender identity, and expression with larger representative samples of school populations across contexts (urban and rural), and inclusive of structural factors (e.g., school climate) to guide the development of prevention efforts.
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Affiliation(s)
| | - Joshua Rusow
- University of Southern California, Los Angeles, USA
| | | | | | - Eric Rice
- University of Southern California, Los Angeles, USA
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17
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Atteberry-Ash B, Kattari SK, Harner V, Prince DM, Verdino AP, Kattari L, Park IY. Differential Experiences of Mental Health among Transgender and Gender-Diverse Youth in Colorado. Behav Sci (Basel) 2021; 11:48. [PMID: 33918631 PMCID: PMC8069714 DOI: 10.3390/bs11040048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022] Open
Abstract
Young people experience a variety of mental health concerns, including depression, non-suicidal self-injury, and suicidal ideation. These issues are at even higher rates among transgender and gender-diverse (TGD) young people, due to the additional burden of having to navigate a world in which transphobia impacts them at the individual, organizational, and policy levels. However, much of the extant research focuses only on comparing TGD youth to cisgender counterparts. This study explores the nuance within the TDG youth population regarding mental health, examining how gender, race/ethnicity, and sexual orientation change the likelihood of experiencing each of these mental health concerns. Among a sample of over 400 young people, findings indicate that those TGD young people who do not identify themselves within the masculine/feminine binary and those with marginalized sexual orientations were two to three times more likely to experience adverse mental health outcomes, as compared to their peers who are questioning their gender, and who are heterosexual. The implications for mental health professionals and others who work with young people are to recognize that mental health is not a one-size-fits all model for young TGD people, and that the intersection of multiple marginalized identities, must be addressed in order to improve the mental health of this group of young people. Findings can also be used to better understand issues of stigma, discrimination, and victimization in education, health care, and beyond.
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Affiliation(s)
- Brittanie Atteberry-Ash
- School of Social Work, University of Texas Arlington, 211 S Cooper St., Arlington, TX 76019, USA
| | - Shanna K. Kattari
- School of Social Work and College of Literature, Science, and the Arts Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Vern Harner
- School of Social Work, University of Washington, Seattle, WA 98105, USA;
| | - Dana M. Prince
- The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Anthony P. Verdino
- School of Social Service Administration, University of Chicago, Chicago, IL 60637, USA;
| | - Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, MI 48824, USA;
| | - In Young Park
- Graduate School of Social Work, University of Denver, Denver, CO 80208, USA;
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18
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Seelman KL, Vasi A, Kattari SK, Alvarez-Hernandez LR. Predictors of healthcare mistreatment among transgender and gender diverse individuals: Are there different patterns by patient race and ethnicity? Soc Work Health Care 2021; 60:411-429. [PMID: 33834953 DOI: 10.1080/00981389.2021.1909201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/08/2020] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 05/28/2023]
Abstract
Using data from the 2015 United States Transgender Survey, this study investigates which patient sociodemographic characteristics and psychosocial risks are associated with likelihood of transgender mistreatment in healthcare and how patterns vary for patients of color. Numerous predictors, including alignment of identity documents, were associated with healthcare mistreatment. Among subgroups of transgender patients of color, psychosocial risks were more consistently significant than sociodemographic characteristics in predicting mistreatment. National and international health organizations are called to enact clear policies that affirm transgender patients and patients of color and establish a commitment to effectively serving these populations within their ethical codes.
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Affiliation(s)
| | - Andre Vasi
- School of Public Health, Georgia State University, Atlanta, USA
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19
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Seelman KL, Kattari SK, Harvey P, Bakko M. Trans Men's Access to Knowledgeable Providers and Their Experiences in Health Care Settings: Differences by Demographics, Mental Health, and Degree of Being "Out" to Providers. Health Soc Work 2021; 45:229-239. [PMID: 33347583 DOI: 10.1093/hsw/hlaa030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/29/2019] [Revised: 06/12/2019] [Accepted: 07/08/2019] [Indexed: 06/12/2023]
Abstract
Transgender adults face a health care system rife with stigma, including a lack of culturally responsive providers and high likelihood of discrimination and mistreatment. However, there is a gap in knowledge about trans men-those assigned a female sex at birth who identify as men or as transmasculine-including subgroups, such as trans men of color. Using data from the U.S. Transgender Survey, the largest transgender survey conducted in the United States, this study analyzes whether trans men's access to knowledgeable providers and their experiences of mistreatment in health care were related to demographic and mental health characteristics and degree of being "out" to providers. Among 7,950 trans men, respondent race and ethnicity, education level, disability status, psychological distress, suicidality, and being less "out" were associated with assessing one's health care provider as not knowledgeable about trans-related care. Mistreatment in health care was more common among Alaska Native/American Indian trans men; those who lived in or near poverty; those who were queer, pansexual, bisexual, or an orientation not listed; those with a disability; those experiencing distress or suicidality; and those who were more "out." This article discusses how findings can inform culturally responsive health care interventions with trans men.
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Affiliation(s)
- Kristie L Seelman
- associate professor, School of Social Work, Georgia State University, PO Box 3992, Atlanta, GA 30302-3992
| | - Shanna K Kattari
- assistant professor, School of Social Work and Department of Women's and Gender Studies, University of Michigan, Ann Arbor
| | - Penny Harvey
- assistant professor, Department of Human Sexuality Studies, California Institute of Integral Studies, San Francisco
| | - Matthew Bakko
- doctoral student, School of Social Work and Department of Sociology, University of Michigan, Ann Arbor
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20
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Kattari SK. Review of Trauma and Disability in Mad Max: Beyond the Road Warrior's Fury by Mick Broderick and Katie Ellis. DSQ 2021. [DOI: 10.18061/dsq.v41i1.7835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
No abstract available.
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21
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Guz S, Kattari SK, Atteberry-Ash B, Klemmer CL, Call J, Kattari L. Depression and Suicide Risk at the Cross-Section of Sexual Orientation and Gender Identity for Youth. J Adolesc Health 2021; 68:317-323. [PMID: 32680801 DOI: 10.1016/j.jadohealth.2020.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 02/01/2020] [Revised: 05/23/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Adolescence is a developmental phase in which young people begin to explore their identity and seek to understand how their identity fits into the larger society. Although this is a developmental task for all adolescents, it is especially salient for sexual and gender minority youth. Owing to oppressive social structures and stigmatized identities, adolescents who identify as nonheterosexual or noncisgender are vulnerable to experiencing disproportionate adverse health outcomes. METHODS To further the literature on adolescent mental health among sexual and gender minority youth, this study analyzed a representative statewide sample of high school students (ages 14-18) to analyze how sexual orientation and gender identity are associated with depression and suicidality. RESULTS Results aligned with previous research demonstrating that sexual and gender minority youth were all at a heightened risk for depression. However, transgender youth and youth questioning their sexuality or gender were at especially heightened risk for experiencing depression and suicidality. CONCLUSION The findings of this study indicate a need to target or adapt direct services and programming for sexual and gender minority adolescents.
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Affiliation(s)
- Samantha Guz
- University of Chicago School of Social Service Administration, Chicago, Illinois.
| | - Shanna K Kattari
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | | | - Cary L Klemmer
- University of Southern California Dworak-Peck School of Social Work, Los Angeles, California
| | - Jarrod Call
- University of Denver Graduate School of Social Work, Denver, Colorado
| | - Leonardo Kattari
- University of Michigan School of Social Work, Ann Arbor, Michigan
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Abstract
Microaggressions perpetuate inequalities and stereotypes against people from marginalized communities. Research demonstrates that ongoing experiences of identity-related microaggressions can negatively impact mental health outcomes, increase somatic symptoms, and increase negative affect. This study explores the relationship between experiences of ableist microaggressions and mental health outcomes among disabled adults by using a quantitative cross-sectional survey of 311 U.S. adults who identify as disabled/having a disability, to examine the correlation between ableist microaggressions (using the AMS-65) and mental health (assessed by the MHI-18). Findings indicate that increased experiences ableist microaggressions are negatively correlated with positive mental health outcomes, and that the visibility of disabilities/impairments are correlated with experiencing ableist microaggressions. These findings can inform the work of counselors, therapists, social workers, and other human service professionals when supporting disabled individuals, recognizing that their mental health may be related to these common and often unintentional oppressive interactions.
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Peitzmeier SM, Malik M, Kattari SK, Marrow E, Stephenson R, Agénor M, Reisner SL. Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates. Am J Public Health 2020; 110:e1-e14. [PMID: 32673114 DOI: 10.2105/ajph.2020.305774] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals.Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations.Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population.Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location.Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups.Main Results: We identified 85 articles from 74 unique data sets (ntotal = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations.Authors' Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed.Public Health Implications: Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population.
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Affiliation(s)
- Sarah M Peitzmeier
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Mannat Malik
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Shanna K Kattari
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Elliot Marrow
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Rob Stephenson
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Madina Agénor
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
| | - Sari L Reisner
- Sarah M. Peitzmeier is with the Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities, Ann Arbor. Mannat Malik is with the Department of Epidemiology and Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Shanna K. Kattari is with the University of Michigan School of Social Work and University of Michigan Department of Women's Studies, Ann Arbor. Elliot Marrow is with The Fenway Institute, Fenway Health, Boston, MA. Rob Stephenson is with the Department of Systems, Population, and Leadership, University of Michigan School of Nursing, and The Center for Sexuality and Health Disparities. Madina Agénor is with the Department of Community Health, Tufts University School of Arts and Sciences, Medford, MA. Sari L. Reisner is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston
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Kattari SK, Curley KM, Bakko M, Misiolek BA. Response to "Opportunities Missed: Commentary on 'Development and Validation of the Trans-Inclusive Provider Scale'". Am J Prev Med 2020; 59:e28-e30. [PMID: 32389531 DOI: 10.1016/j.amepre.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Shanna K Kattari
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | | | - Matthew Bakko
- University of Michigan School of Social Work, Ann Arbor, Michigan
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Bakko M, Kattari SK. Transgender-Related Insurance Denials as Barriers to Transgender Healthcare: Differences in Experience by Insurance Type. J Gen Intern Med 2020; 35:1693-1700. [PMID: 32128693 PMCID: PMC7280420 DOI: 10.1007/s11606-020-05724-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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: 07/23/2019] [Revised: 12/25/2019] [Accepted: 02/05/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Insurance-based denials are common barriers for transgender and non-binary individuals in accessing medically necessary gender-affirming care. Little is known about how experiences of transgender-related insurance denials may vary by insurance type. OBJECTIVE This study investigates the association between transgender and non-binary individuals' experiences of different forms of transgender-related insurance denials and insurance type. DESIGN AND PARTICIPANTS The 2015 United States Transgender Survey was conducted by the National Center for Transgender Equality to ascertain US transgender and non-binary experiences across multiple life experiences, including individual health status, health services access and utilization, and experiences with denials. MAIN MEASURES Multivariate logistic regressions were conducted, and adjusted risk ratios were calculated, to analyze the likelihood of experiencing eight different forms of denials by insurance type, including private, Medicare, Medicaid, and military-related, and having multiple types of insurance coverage. KEY RESULTS Models revealed significant relationships between transgender-related insurance denials and insurance type for 11,320 transgender and non-binary adults. Compared with those with private insurance, Medicaid coverage was associated with an increased likelihood of experiencing denials for hormone therapy (adjusted risk ratio (ARR) = 1.22; CI = 1.05-1.42; p = 0.02); having no in-network surgery providers was associated with Medicare (ARR = 1.84; CI = 1.29-2.62; p = 0.009) or Medicaid (ARR = 1.54; CI = 1.20-1.98; p = 0.003); and military-based insurance was associated with transition-related surgery denials (ARR = 1.53; CI = 1.36-1.72; p < 0.001). CONCLUSIONS Researchers and practitioners must consider the link between type of insurance coverage and experiences with different forms of transgender-related insurance denial. These results provide continuing support for broad non-discrimination policy efforts, but also direct our attention to targeted insurance policy interventions by form of denial, which can promote equitable access for transgender and non-binary people across all healthcare needs.
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Affiliation(s)
- Matthew Bakko
- School of Social Work, Department of Sociology, University of Michigan, Ann Arbor, MI, USA.
| | - Shanna K Kattari
- School of Social Work, Department of Women's Studies, University of Michigan, Ann Arbor, MI, USA
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Kattari SK, Curley KM, Bakko M, Misiolek BA. Development and Validation of the Trans-Inclusive Provider Scale. Am J Prev Med 2020; 58:707-714. [PMID: 32044143 DOI: 10.1016/j.amepre.2019.12.005] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Transgender and gender diverse individuals experience a variety of barriers to accessing culturally responsive care across different types of health services. This study develops and validates a scale to assess for trans-inclusive healthcare practices, which may be used in a variety of ways. METHODS The authors and community partners developed 34 initial practices indicating provider inclusivity of transgender and gender diverse patients. Data were collected in 2018, using an online survey of transgender and gender diverse adults in Michigan (n=626), analyzed in 2019. RESULTS An exploratory factor analysis was conducted. The following 6 components were retained with 27 items: trans-inclusive messaging, name/pronoun usage, outreach, gender-affirming practice, referral comfort, and inclusive intake forms. Full sample analysis showed Cronbach's α to be 0.91. The sample was split in half to run 2 sets of cases in a principal components analysis, Sample A (n=323) and Sample B (n=303). Percentage of variance explained and Cronbach's α were consistent across samples, giving evidence to reliability and validity. CONCLUSIONS Findings suggest that the Trans-Inclusive Provider Scale may be useful in identifying providers' behaviors regarding inclusivity of transgender and gender diverse patients and provide growth opportunities at both individual and practice levels. It could also guide improvements after trainings or be used as a micro-intervention, allowing providers to assess behaviors and identify opportunities to improve.
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Affiliation(s)
- Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan.
| | | | - Matthew Bakko
- School of Social Work, University of Michigan, Ann Arbor, Michigan
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Kattari SK, Bakko M, Hecht HK, Kattari L. Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults. SSM Popul Health 2020; 10:100525. [PMID: 31872041 PMCID: PMC6909214 DOI: 10.1016/j.ssmph.2019.100525] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [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: 09/30/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 01/26/2023] Open
Abstract
Transgender and nonbinary patients have a wide array of experiences when attempting to access healthcare, including discrimination and having to educate providers about trans people. This study examines the mental health factors connected to transgender and nonbinary patients' experience with providers to determine the likelihood of transgender or nonbinary patients receiving respectful care after a provider knows about the patient's gender identity, and patients' experience of having to educate providers about trans people, controlling for sociodemographic factor. Using data from the 2015 United States Trans Survey (N = 27,715), chi-square tests of independence and multivariate logistic regressions were used to explore the odds of transgender or nonbinary individuals having a positive experience with a doctor or healthcare provider. Of the respondents, 24.31% experienced having to educate a provider about trans people when seeking care, and 62.90% experienced a provider knowing they were transgender or nonbinary and treating them with respect. Those experiencing depression and suicidal thoughts were significantly less likely to have had a provider treat them with respect, and significantly more likely to need to educate their providers. Gender, age, disability status, and educational level were significant across both variables; income was significant regarding having to educate a provider. Healthcare providers need ongoing training and education to improve their care of transgender and nonbinary patients, specifically around acknowledging the multiple backgrounds and experiences of such patients, including those related to mental health, gender, race, age, income, educational level, and disability.
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Affiliation(s)
- Shanna K. Kattari
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Matthew Bakko
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Hillary K. Hecht
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Leonardo Kattari
- Michigan State University School of Social Work, 655 Auditorium Road, East Lansing, MI, 48824, USA
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Abstract
Stalking is often considered to be a form of interpersonal violence; yet, despite an increase in lesbian, gay, bisexual, transgender, and queer (LGBTQ)-specific research on other forms of interpersonal violence, such as intimate partner violence and sexual assault, there is a relative lack of literature on stalking victimization of LGBTQ individuals, particularly as it relates to gender identity. This is problematic given the results of numerous studies indicating LGBTQ individuals, and transgender individuals in particular, experience victimization in various forms and contexts at alarming rates. In the current study, we examined secondary data to determine the prevalence of lifetime stalking victimization and subsequent police reporting in a large community-based sample of LGBTQ individuals living in Colorado (N = 1,116). In addition, using chi-square analyses, we examined independence of stalking experiences and police reporting by both gender identity (transgender, cisgender male, cisgender female) and sexual orientation (gay, lesbian, bisexual, heterosexual, queer, other). Approximately 15% of the total sample reported ever experiencing stalking; yet, only about one quarter of those who were stalked reported it to police. Although no statistically significant differences emerged by gender identity or sexual orientation, transgender, bisexual, and queer participants had the highest prevalence of lifetime stalking victimization. Moreover, these groups reported the lowest prevalence of reporting their victimization to the police. We provide suggestions to improve the development of research on this topic including a need for an inclusive definition of stalking and studies using larger, representative samples to better discern potential significant differences in stalking experiences of LGBTQ persons.
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Kattari SK, Brittain DR, Markus AR, Hall KC. Expanding Women's Health Practitioners and Researchers' Understanding of Transgender/Nonbinary Health Issues. Womens Health Issues 2020; 30:3-6. [DOI: 10.1016/j.whi.2019.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/24/2022]
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Todd K, Peitzmeier SM, Kattari SK, Miller-Perusse M, Sharma A, Stephenson R. Demographic and Behavioral Profiles of Nonbinary and Binary Transgender Youth. Transgend Health 2019; 4:254-261. [PMID: 31641692 PMCID: PMC6802728 DOI: 10.1089/trgh.2018.0068] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: Emerging literature suggests there may be important differences in the demographic characteristics and health profiles of nonbinary transgender youth compared to binary transgender youth. Methods: Between June 2017 and June 2018, 202 transgender youth aged 15-24 years were recruited into a randomized trial of home HIV testing, Project Moxie. This analysis compares demographic and health risk behavior characteristics between youth reporting nonbinary and binary transgender identities in baseline surveys. Results: Nonbinary youth were significantly less likely to have accessed medical interventions to affirm their gender than binary youth (8.4% vs. 46.2%), and less likely to be living currently as the gender that most affirms them (80.7% vs. 91.6%). While there were no significant differences in the low levels of resilience reported across the sample, nonbinary youth reported significantly higher levels of stress. Health risk behaviors were generally high across nonbinary and binary participants, with no significant differences in sexual partner count, condomless sex, alcohol use, tobacco, marijuana, or other drug use. Conclusion: Findings affirmed many similarities, and key disparities, between nonbinary and binary transgender youth. Research and interventions dedicated to the unique needs and experiences of nonbinary transgender youth to address high levels of health risk behaviors and stress are critical.
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Affiliation(s)
- Kieran Todd
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Sarah M. Peitzmeier
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Shanna K. Kattari
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Michael Miller-Perusse
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- Department of Systems, Population and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
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Sussman S, Kattari SK, Baezconde-Garbanati L, Glackin SN. Commentary: The Problems of Grouping All Adversity Into a Special Populations Label. Eval Health Prof 2019; 43:66-70. [PMID: 31623449 DOI: 10.1177/0163278719882738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/27/2023]
Abstract
"Special populations" refer to groups of people whose needs are not fully addressed by traditional health services delivery. Greater access to these services, or tailored services, must be provided to reduce inequities in physical and mental health-care systems. Many different groups have been identified as special populations. We comment on controversies regarding the use of the term special populations in health practice and policy. Applicable conceptual issues include intersectionality, unitization, definitional drawbacks, and looping effects. There is a need to make clear the challenges posed by use of this term (e.g., discrimination, workability). An approach that acknowledges the diversity of groups and accommodates them where necessary without discrimination and unequal treatment is needed.
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Affiliation(s)
- Steve Sussman
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA.,School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Sociology, University of Southern California, Los Angeles, CA, USA
| | - Shane N Glackin
- Department of Sociology, Philosophy, and Anthropology, University of Exeter, UK
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Kattari SK, Atteberry-Ash B, Kinney MK, Walls NE, Kattari L. One size does not fit all: differential transgender health experiences. Soc Work Health Care 2019; 58:899-917. [PMID: 31618117 DOI: 10.1080/00981389.2019.1677279] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/05/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
Transgender and nonbinary (TNB) adults face a multitude of challenges when attempting to access general health care. Issues include fear of discrimination and encounters with providers who are not familiar with treating the needs of this population. These challenges may result in the delay or denial of medically necessary care. This study explores nuanced experiences of gender identity and sexual orientation around accessing health care. Using a statewide sample of TNB individuals (N = 417), analyses include descriptive statistics and logistic regressions predicting delayed care due to fear of discrimination and having any medical intervention to understand the importance of transgender-inclusive care and other experiences across identities. Findings indicate differential experiences across gender identity, sexual orientation, and age. Access to a trans-inclusive primary care provider was one of the strongest indicators both for not delaying care due to fear of discrimination and having had a medical intervention. Providers should be provided with more nuanced training about being culturally responsive and aware of differences across sexual orientation within the TNB community. This will move toward ensuring not only increased access to needed care and medical interventions, but toward potentially lowering the rate of those who delay access to care due to fear of discrimination.
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Affiliation(s)
- Shanna K Kattari
- University of Michigan School of Social Work , Ann Arbor , Michigan , USA
| | | | - M Killian Kinney
- University of Indiana School of Social Work , Indianapolis , Indiana , USA
| | - N Eugene Walls
- University of Denver Graduate School of Social Work , Denver , Colorado , USA
| | - Leonardo Kattari
- University of Michigan School of Social Work , Ann Arbor , Michigan , USA
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Bakko M, Kattari SK. Differential Access to Transgender Inclusive Insurance and Healthcare in the United States: Challenges to Health across the Life Course. J Aging Soc Policy 2019; 33:67-81. [PMID: 31230581 DOI: 10.1080/08959420.2019.1632681] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This commentary explores how different types of insurance (Medicare, Medicaid, state government, and private insurance) address issues of transgender-related care, and how access to transgender affirming insurance coverage and healthcare across life stages depends both on type of insurance and geographical location. We argue that the current state of transgender health insurance policy and practices are inadequate for achieving goals of continuity of care and positive health outcomes across the life course. Transgender individuals are uninsured at a higher rate than their cisgender (non-transgender) counterparts, face discrimination or refusal of care from their providers, and, if insured, experience denials of coverage from insurance companies. These ruptures in coverage can be addressed through extending insurance coverage for all treatments necessary to affirm a transgender person's gender identity, training to support transgender affirming healthcare, and research on the health needs of the transgender community across the life course.
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Affiliation(s)
- Matthew Bakko
- University of Michigan School of Social Work and Department of Sociology , Ann Arbor, Michigan, USA
| | - Shanna K Kattari
- University of Michigan School of Social Work , Ann Arbor, Michigan, USA
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Walls NE, Atteberry-Ash B, Kattari SK, Peitzmeier S, Kattari L, Langenderfer-Magruder L. Gender Identity, Sexual Orientation, Mental Health, and Bullying as Predictors of Partner Violence in a Representative Sample of Youth. J Adolesc Health 2019; 64:86-92. [PMID: 30392863 DOI: 10.1016/j.jadohealth.2018.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 05/15/2018] [Revised: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Partner violence (PV) is prevalent among US adolescents, though little is known about its prevalence and correlates across gender identities and sexual orientations. Existing research has frequently placed lesbian, gay, bisexual (LGB), questioning, and transgender adolescents in the same category, obscuring potential differences in risk of PV. METHODS This study (N = 9,352) uses the 2015 Healthy Kids Colorado Study, a statewide representative survey, to explore how sexual orientation and gender identity are associated with PV victimization among high-school youth, and whether there is a relationship between mental health and bullying victimization and PV. RESULTS Out of all youth who dated in the past year, 9.4% reported experiencing past-year PV. Compared to their cisgender heterosexual peers, cisgender LGB youth (AOR = 1.48 [1.17, 1.86]) and cisgender questioning youth (AOR = 1.68 [1.13, 2.48]) had elevated risk of experiencing PV. Transgender youth, particularly those who are both transgender and LGB (AOR = 3.25 [2.02, 5.22]) or transgender and questioning their sexual orientation (AOR = 8.57 [4.28, 17.16]), had the highest risk of PV. Depressive symptoms (AOR = 1.99 [1.67, 2.37]), suicidality (AOR = 1.83 [1.62, 2.06]), bullying victimization (AOR = 1.58 [1.31, 1.91]), and online bullying victimization (AOR = 1.98 [1.62, 2.06]) were associated with PV. CONCLUSIONS LGB, questioning and transgender high school students are at elevated risk of PV, with the highest risk among those who are both LGB and transgender. Adolescents who report PV are also more likely to be struggling with bullying, depression, and suicidality. PV prevention and response interventions should use intersectional approaches responsive to the unique needs of LGBT youth.
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Affiliation(s)
- N Eugene Walls
- Graduate School of Social Work, University of Denver, Denver, Colorado.
| | | | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | | | - Leo Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan
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Kattari SK, Walls NE, Speer SR. Differences in Experiences of Discrimination in Accessing Social Services Among Transgender/Gender Nonconforming Individuals by (Dis)Ability. ACTA ACUST UNITED AC 2018; 16:116-140. [PMID: 28447917 DOI: 10.1080/1536710x.2017.1299661] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 01/06/2023]
Abstract
Transgender and gender nonconforming (GNC) individuals frequently experience discrimination and potentially a lack of respect from service providers, suggesting they have decreased access to professionals with cultural competency. Similarly, people with disabilities experience higher levels of discrimination in social services than their nondisabled counterparts. From an intersectional perspective, this study examines rates of discrimination in accessing social services faced by transgender and GNC people, comparing across ability. Data indicate that although transgender and GNC individuals of all abilities experience gender-based discrimination when accessing social services, those with disabilities experience higher levels of antitransgender discrimination in mental health centers, rape crisis centers, and domestic violence shelters.
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Affiliation(s)
- Shanna K Kattari
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - N Eugene Walls
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
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Begun S, Kattari SK, McKay K, Ramseyer Winter V, O'Neill E. Exploring U.S. Social Work Students' Sexual Attitudes and Abortion Viewpoints. J Sex Res 2017; 54:752-763. [PMID: 27253491 DOI: 10.1080/00224499.2016.1186586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Social workers frequently engage with sexual and reproductive health topics, yet a notable paucity of social work research exists regarding abortion. Informed by overlapping theoretical frameworks of human rights and reproductive justice, this study examined a large, nationwide survey of social work students in the United States (N = 504). Linear regressions indicated that students' endorsements of permissive sexual attitudes and support for birth control are inversely associated with holding anti-choice abortion views. Moreover, distinct relationships were found among sociodemographic characteristics and abortion attitudes and knowledge, suggesting that social work education efforts regarding contentious reproductive and sexual health topics should also focus on nuances of cultural competence and diversity, as well as general human rights principles and professional ethics.
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Whitfield DL, Kattari SK, Walls NE, Al-Tayyib A. Grindr, Scruff, and on the Hunt: Predictors of Condomless Anal Sex, Internet Use, and Mobile Application Use Among Men Who Have Sex With Men. Am J Mens Health 2017; 11:775-784. [PMID: 28134002 PMCID: PMC5675229 DOI: 10.1177/1557988316687843] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/30/2016] [Accepted: 12/12/2016] [Indexed: 11/16/2022] Open
Abstract
In 2016, gay, bisexual, and other men who have sex with men (MSM) comprise more than half of all new HIV diagnoses in the United States, with the primary mode of infection being condomless anal sex (CAS). While studies report an association between use of Internet-based social networking sites and increased CAS, the research on the relationship between cell phone mobile applications (e.g., Grindr, Scruff, Jack'd) and CAS is much less developed. The present study examines whether the manner in which gay, bisexual, and other MSM find sexual partners predicts an increase in likelihood of engaging in CAS in an urban, noncoastal U.S. city. Conducting a secondary data analysis of the 2011 National HIV Behavioral Surveillance survey for Denver ( N = 546), the authors performed binary logistic regression analyses to assess the models that predict how MSM find sexual partners, and the odds of engaging in CAS. While the results suggest that age and race are associated with the mode of finding sexual partners, using the Internet or a mobile app to find sexual partners was not predictive of CAS ( ZWald = .41, p = .52; ZWald = .80, p = .37). In terms of HIV prevention, these findings suggest a need for intervention to address HIV prevention on multiple levels (e.g., individual, group, community).
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Abstract
Transgender-inclusive behaviors are actions and communication supporting transgender individuals. Examples include using language not reinforcing the gender binary, asking for and using correct pronouns, creation of spaces that welcome members of the transgender community, and acknowledging cisgender (non-transgender) privilege. A survey was developed measuring this behavior in individuals to examine the impact of transgender-inclusive behavior and the potential effect of interventions on promoting inclusive behavior. Data were collected utilizing an online survey (N = 1,051). The sample was split in half to run two sets of cases in a principal components analysis. Analysis of the full sample showed Cronbach's alpha to be .93 (n = 918). Findings suggest that the Transgender Inclusive Behavior Scale (TIBS) may be a useful instrument for identifying behaviors related to being inclusive of transgender individuals, groups, and communities. It may also be used to measure behavior change before and after transgender-specific educational and behavioral interventions.
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Affiliation(s)
- Shanna K Kattari
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - Ashley A O'Connor
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - Leonardo Kattari
- b Colorado Department of Public Health and Environment , Denver , Colorado , USA
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Abstract
People with disabilities often experience the idea that those with disabilities are not, or should not be, sexual beings. This article examines how people with physical disabilities define sexual activity, their levels of sexual satisfaction, group differences in how people define different acts as sexual activities, and the differences in levels of sexual satisfaction. Additionally, this study (N = 450) looks at the correlations between levels of independence in multiple contexts. Levels of independence are also assessed in relationship to severity of disability and sexual satisfaction. Implications for social work and social service practice, education, and policy are discussed.
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Affiliation(s)
- Shanna K Kattari
- a Graduate School of Social Work , University of Denver , Denver , CO , USA
| | - George Turner
- b Turner Professional Group , Kansas City , MS , USA
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Kattari SK, Walls NE, Speer SR, Kattari L. Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people. Soc Work Health Care 2016; 55:635-650. [PMID: 27351890 DOI: 10.1080/00981389.00982016.01193099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Using a statewide survey of transgender and gender variant individuals (N = 417), this study examines the association between having a transgender-inclusive provider and three mental health concerns: current experience of depression, lifetime experience of anxiety disorder, and suicidality within the last year. Findings suggest that having a transgender-inclusive provider is associated with decreased rates of depression and suicidality, but not with lifetime experience of having anxiety. Implications for future research and education of providers are discussed.
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Affiliation(s)
- Shanna K Kattari
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - N Eugene Walls
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | | | - Leonardo Kattari
- b Colorado Department of Public Health and Environment , University of Denver , Denver , Colorado , USA
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Kattari SK, Walls NE, Speer SR, Kattari L. Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people. Soc Work Health Care 2016; 55:635-50. [PMID: 27351890 DOI: 10.1080/00981389.2016.1193099] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 03/17/2016] [Accepted: 05/19/2016] [Indexed: 05/28/2023]
Abstract
Using a statewide survey of transgender and gender variant individuals (N = 417), this study examines the association between having a transgender-inclusive provider and three mental health concerns: current experience of depression, lifetime experience of anxiety disorder, and suicidality within the last year. Findings suggest that having a transgender-inclusive provider is associated with decreased rates of depression and suicidality, but not with lifetime experience of having anxiety. Implications for future research and education of providers are discussed.
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Affiliation(s)
- Shanna K Kattari
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - N Eugene Walls
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | | | - Leonardo Kattari
- b Colorado Department of Public Health and Environment , University of Denver , Denver , Colorado , USA
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Winter VR, O'Neill E, Begun S, Kattari SK, McKay K. MSW student perceptions of sexual health as relevant to the profession: Do social work educational experiences matter? Soc Work Health Care 2016; 55:614-634. [PMID: 27332145 DOI: 10.1080/00981389.2016.1189476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/15/2015] [Accepted: 05/10/2016] [Indexed: 06/06/2023]
Abstract
Many social work clients are at an increased risk for negative outcomes related to sexual behavior, including unwanted pregnancies and sexually transmitted infections (STIs). However, there is a dearth of literature on social work student experiences with these topics in social work classrooms and their perceptions about the topic's relevance to their practice. The purpose of this study is to explore relationships between experiences with STIs and contraception as topics in social work education and practica experiences on student perceptions toward sexual health as a relevant topic for social work. Among a national sample of MSW students (N = 443), experiences with STIs and contraception as topics in practica was significantly related to perceptions toward sexual health's relevance to social work. Findings and implications are discussed.
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Affiliation(s)
| | - Elizabeth O'Neill
- b School of Social Welfare , University of Kansas , Lawrence , Kansas , USA
| | - Stephanie Begun
- c Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - Shanna K Kattari
- c Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - Kimberly McKay
- d School of Social Work , Temple University , Philadelphia , Pennsylvania , USA
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Langenderfer-Magruder L, Whitfield DL, Walls NE, Kattari SK, Ramos D. Experiences of Intimate Partner Violence and Subsequent Police Reporting Among Lesbian, Gay, Bisexual, Transgender, and Queer Adults in Colorado: Comparing Rates of Cisgender and Transgender Victimization. J Interpers Violence 2016; 31:855-71. [PMID: 25392392 DOI: 10.1177/0886260514556767] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Research indicates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at high risk of victimization by others and that transgender individuals may be at even higher risk than their cisgender LGBQ peers. In examining partner violence in particular, extant literature suggests that LGBTQ individuals are at equal or higher risk of partner violence victimization compared with their heterosexual peers. As opposed to sexual orientation, there is little research on gender identity and partner violence within the LGBTQ literature. In the current study, the authors investigated intimate partner violence (IPV) in a large sample of LGBTQ adults (N = 1,139) to determine lifetime prevalence and police reporting in both cisgender and transgender individuals. Results show that more than one fifth of all participants ever experienced partner violence, with transgender participants demonstrating significantly higher rates than their cisgender peers. Implications focus on the use of inclusive language as well as future research and practice with LGBTQ IPV victims.
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Langenderfer-Magruder L, Walls NE, Kattari SK, Whitfield DL, Ramos D. Sexual Victimization and Subsequent Police Reporting by Gender Identity Among Lesbian, Gay, Bisexual, Transgender, and Queer Adults. Violence Vict 2016; 31:320-331. [PMID: 26831853 DOI: 10.1891/0886-6708.vv-d-14-00082] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Prevalence of sexual victimization among lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons is frequently found to be higher than the prevalence reported by their heterosexual peers. Transgender individuals are often included solely as part of larger LGBTQ research samples, potentially obfuscating differences between sexual orientation and gender identity. In this study, the authors examined sexual assault/rape in a large convenience sample of LGBTQ adults (N = 1,124) by respondents' gender identity (cisgender, transgender) to determine whether differences exist in lifetime prevalence of sexual assault/rape and subsequent police reporting. Findings indicate transgender individuals report having experienced sexual assault/rape more than twice as frequently as cisgender LGBQ individuals. Authors found no statistically significant difference in reporting sexual violence to police. Implications for research and practice are discussed.
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Langenderfer-Magruder L, Walls NE, Kattari SK, Whitfield DL, Ramos D. Sexual Victimization and Subsequent Police Reporting by Gender Identity Among Lesbian, Gay, Bisexual, Transgender, and Queer Adults. Violence Vict 2016; 31:320-331. [PMID: 26831853 DOI: 10.1891/0886-6708.vv-d-1814-00082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Prevalence of sexual victimization among lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons is frequently found to be higher than the prevalence reported by their heterosexual peers. Transgender individuals are often included solely as part of larger LGBTQ research samples, potentially obfuscating differences between sexual orientation and gender identity. In this study, the authors examined sexual assault/rape in a large convenience sample of LGBTQ adults (N = 1,124) by respondents' gender identity (cisgender, transgender) to determine whether differences exist in lifetime prevalence of sexual assault/rape and subsequent police reporting. Findings indicate transgender individuals report having experienced sexual assault/rape more than twice as frequently as cisgender LGBQ individuals. Authors found no statistically significant difference in reporting sexual violence to police. Implications for research and practice are discussed.
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Kattari SK, Walls NE, Whitfield DL, Langenderfer-Magruder L. Racial and Ethnic Differences in Experiences of Discrimination in Accessing Health Services Among Transgender People in the United States. Int J Transgend 2015. [DOI: 10.1080/15532739.2015.1064336] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kattari SK, Hasche L. Differences Across Age Groups in Transgender and Gender Non-Conforming People’s Experiences of Health Care Discrimination, Harassment, and Victimization. J Aging Health 2015; 28:285-306. [DOI: 10.1177/0898264315590228] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Given the increasing diversity among older adults and changes in health policy, knowledge is needed on potential barriers to health care for transgender and gender non-conforming (GNC) individuals. Method: Using the 2010 National Transgender Discrimination Survey (NTDS), logistic regression models test differences between age groups (below 35, 35-49, 50-64, and 65 and above) in lifetime experience of anti-transgender discrimination, harassment, and victimization within health care settings while considering the influences of insurance status, level of passing, time of transition, and other socio-demographic factors. Results: Although more than one fifth of transgender and GNC individuals of all ages reported health discrimination, harassment, or victimization, significant age differences were found. Insurance status and level of passing were also influential. Discussion: Medicare policy changes and this study’s findings prompt further consideration for revising other health insurance policies. In addition, expanded cultural competency trainings that are specific to transgender and GNC individuals are crucial.
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