Intimate Partner Violence in Transgender and Nonbinary Relationships: Actor-Partner Associations with Relationship Satisfaction, Dyadic Coping, and Partner Support

Purpose: Transgender and nonbinary (TNB) adults experience disproportionate levels of intimate partner violence (IPV) compared with cisgender populations. Most research with TNB samples has focused on individual and demographic risk factors associated with IPV. Scarce research with TNB samples has evaluated how relational factors correlate with IPV victimization, which would be more consistent with dyadic models of IPV. The current study assessed associations between relational factors and psychological and physical victimization among TNB adults and their significant others. Methods: The sample included 112 dyads (total N = 224; mean [M] relationship length = 8.2 years; M age = 35) comprising a TNB adult and their significant other. Given our dyadic sample, we used actor-partner interdependence models to assess actor (i.e., intrapersonal) and partner (i.e., cross-partner) associations between relational factors (e.g., relationship satisfaction, dyadic coping, and partner social support) and IPV victimization among TNB individuals and their partners. Results: We identified numerous actor-partner effects across dyadic coping subscales and measures of partner support on TNB adult reports of IPV victimization. Actor effects were also significant for relationship satisfaction on both TNB and their partner's reports of IPV victimization. Conclusion: Results provide some of the first evidence of relational factors in association with IPV victimization among TNB adults and their intimate partners. These findings have clinical implications for identifying TNB individuals at risk for IPV in their relationships.

Centering Asian American Women's Health: Prevalence of Health Care Discrimination and Associated Health Outcomes

Asian American women routinely face multiple and intersectional forms of discrimination based on their marginalized social identities, including during their interactions within the US health care system. However, most research on discrimination against Asian American women is limited by its exclusive focus on race-, gender-, or language-based forms of discrimination; and research has yet to assess if their discriminatory health care experiences are associated with poor health outcomes. To address this gap, we centered the experiences of Asian American women (N = 905) from the Association of American Medical Colleges Biannual Consumer Survey of Health Care Access, a national survey of health care consumers conducted from 2011 to 2020. Prevalence rates were established for unfair treatment due to race, gender, culture, language, age, health insurance, and sexual orientation. Multiple regression models were used to assess how these discriminatory experiences were associated with health and functioning outcomes. Findings demonstrate a high prevalence (32.0%) and wide range of discriminatory experiences in health care settings among Asian American women. The majority of these discriminatory experiences were significantly associated with poorer health and functioning outcomes, even after controlling for demographic influences. Results highlight the need for further development of culturally sensitive medical practices and policies to improve the delivery of health care for Asian American women.

Sexual Minority Women and Discriminatory Health Care Experiences: An Intersectional Evaluation Across Race and Ethnicity

OBJECTIVE

Health care discrimination contributes to medical mistrust among marginalized communities. Sexual minority women of color (SM-WOC) are marginalized because of the intersection of their sexual orientation, gender, and race/ethnicity and regularly report poor health care experiences at the intersection of these identities. However, research has yet to quantify differences in the prevalence of reported health care discrimination across SM women of various racial/ethnic backgrounds. As such, this study compared the rates of discriminatory treatment during the most recent medical appointment between SM-WOC (Black, Hispanic, Asian American, Native American) and White SM women.

METHODS

We used nationally representative data from the Association of American Medical Colleges survey of health care services. Data were collected from 2010 to 2019 from N = 1,499 SM women (n = 458 SM-WOC). Binary logistic regressions compared frequencies of reported identity-based discrimination between each minoritized racial/ethnic group to White SM women.

RESULTS

Across the sample, 33% of SM-WOC reported discrimination during their last medical appointment compared with 19% of White SM women. Discriminatory treatment was more common among every minoritized racial/ethnic group of SM women compared with White SM women, with variability in frequency of specific forms of identity-based discrimination across minoritized racial/ethnic groups.

CONCLUSIONS

Although discriminatory treatment during the last medical appointment was common for all SM women, prevalence was higher for SM-WOC compared with White SM women. Findings have important implications for policy and practice to reduce health disparities, such as targeted interventions for SM-WOC and provider trainings in cultural humility, implicit bias, and common microaggressions.

Sexual Minority Women, Health Care Discrimination, and Poor Health Outcomes: A Mediation Model Through Delayed Care

Purpose: Sexual minority (SM) women are a heterogeneous group who commonly report negative health care experiences at the intersection of their diverse sexual orientations and racial/ethnic identities. However, scarce research has evaluated how negative health care experiences may affect health outcomes among this population. Informed by the Health Equity Promotion Model for SM health, this study evaluated mediation models in which delayed care mediated the association between provider discrimination and poor health outcomes in SM women. Sexual orientation (plurisexual or monosexual) and race/ethnicity (women of color or White) were evaluated as moderators of the direct and indirect pathways. Methods: The sample included SM women (N = 1530) from the nationally representative Association of American Medical Colleges biannual Consumer Survey of Healthcare Access (2010-2020). Mediation models were conducted with lavaan structural equation modeling software. Results: Reported discrimination from a health care provider was associated with higher physical and emotional impairment, and these associations were partially mediated through delayed care. Sexual orientation and race/ethnicity also moderated several indirect and direct pathways. Conclusion: Results provide evidence of delayed care as a possible mediation pathway between provider discrimination and worse health in SM women and that the strength of these associations may vary by sexual orientation and race/ethnicity. Results indicate a need for policy change and clinical trainings to reduce the harm of provider discrimination on SM women.

We are not all the same: The importance of perceived difference in racial ideology and Afrocentricity for African American relationships

A large body of existing research on African American relationships perpetuates a deficit model that assumes Eurocentric norms and emphasizes between-group differences (e.g., cross-racial comparisons with the majority group-European Americans). The current study examined within-group variability and the influence of culturally unique factors, Afrocentricity, racial ideology, and perceived discrepancy between self and partner on African American relationship processes. Data were collected from 137 self-identified African American adults in same-race, cross-gender relationships. Consistent with the literature on protective values of Afrocentricity, there was an association between reported relationship quality and high levels of one's own and perceived partner's Afrocentricity. Discrepancies between self and partner Afrocentricity were not associated with relationship processes, but higher perceived discrepancies across all four subscales of racial ideology were associated with lower relationship dedication. Higher perceived discrepancies on the humanist and assimilationist subscales were also related to higher levels of conflict. These findings have important clinical implications and demonstrate a need for further research into the nuances of individual factors and dyadic processes that are unique to African American couples.

Having a Baby: Impact on Married and Cohabiting Parents' Relationships

The current study evaluates the effects of having a baby on relationship quality and stability, contrasting married and unmarried cohabiting parents (N = 179; 38% unmarried cohabiting). Participants provided several waves of data, including time points before, during, and after pregnancy. Results indicated that cohabiting parents broke up at a significantly higher rate after having a baby compared to married parents. In terms of relationship quality, interrupted time-series analyses indicated that negative communication significantly increased after baby regardless of marital status. In addition, married parents had significantly higher levels of relationship satisfaction and commitment before baby compared to cohabiting parents but experienced modest declines in relationship satisfaction after baby. Cohabiting parents did not show such declines but remained lower in satisfaction throughout the study. Gender moderated commitment trajectories, such that married and cohabiting women demonstrated decreased commitment after baby, but married and cohabiting men demonstrated no significant changes in commitment. This study adds to the literature by examining both relationship stability and relationship quality trajectories from before pregnancy to after the birth of a baby among married and cohabiting parents in the same sample. Implications of these findings for practice and future research are discussed.

Intimate partner violence in female same-gender couples: An investigation of actor-partner correlates within the past year

Objective: Female same-gender couples experience higher rates of intimate partner violence (IPV) as compared to other couples, yet research on IPV in this population is limited and almost exclusively focused on individual-level correlates. Given the interdependent nature of IPV, the current study examined actor and partner associations of recent IPV use in female same-gender couples. Method: Data were collected from 103 adult female same-gender couples (N = 206) and analyzed using actor-partner interdependence models. Results: The odds of engaging in physical assault in the last year were positively associated with partner (but not actor) discrimination, alcohol use, and anxiety symptoms and negatively associated with both actor and partner relationship adjustment, emotional intimacy, and partner (but not actor) dedication and social support. The odds of engaging in high levels of psychological aggression in the last year were positively associated with actor and partner depressive and anxiety symptoms, actor (but not partner) negative communication, and partner (but not actor) discrimination and negatively associated with both actor and partner emotional intimacy, actor (but not partner) relationship adjustment, dedication, and social support. Conclusion: These findings demonstrate the interdependent nature of IPV-associated factors in female same-gender couples. Clinical implications include evaluating factors associated with recent IPV use that take into account dyadic associations between partners. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Unequally into "Us": Characteristics of Individuals in Asymmetrically Committed Relationships

This study examined characteristics of individuals that are associated with being in asymmetrically committed relationships (ACRs), defined as romantic relationships in which there was a substantial difference in the commitment levels of the partners. These ACRs were studied in a national sample of unmarried, opposite-sex romantic relationships (N = 315 couples). Perceiving oneself as having more potential alternative partners was associated with increased odds of being the less committed partner in an ACR compared to not being in an ACR, as was being more attachment avoidant, having more prior relationship partners, and having a history of extradyadic sex during the present relationship. Additionally, having parents who never married was associated with being the less committed partner in an ACR but parental divorce was not. Although fewer characteristics were associated with being the more committed partner within an ACR, more attachment anxiety was associated with increased odds of being in such a position compared to not being in an ACR. We also address how some findings change when controlling for commitment levels. Overall, the findings advance understanding of commitment in romantic relationships, particularly when there are substantial asymmetries involved. Implications for both research on asymmetrical commitment as well as practice (e.g., therapy or relationship education) are discussed.

Sexuality Within Female Same-Gender Couples: Definitions of Sex, Sexual Frequency Norms, and Factors Associated with Sexual Satisfaction

Despite a growing number of female same-gender (FSG) relationships, couples-based research and interventions have focused primarily on mixed-gender couples. Consequently, research has applied a heteronormative lens to understanding some relationship factors, including sexuality. The current study sought to provide descriptive data regarding frequency and conceptualizations of sex across partners in FSG relationships, as well as to analyze how relationship factors are associated with sexual satisfaction in this population. Participants (N = 206) were 103 adult FSG couples who had been together for at least 2 months. Individuals provided self-report data on how they conceptualized sex, and actor-partner models were utilized to assess relationship factors associated with sexual satisfaction. Findings indicated that women in FSG relationships hold broad definitions of sex, with the majority of behaviors conceptualized as sex, including acts that involved partnered genital touching. In dyadic actor-partner models, sexual satisfaction was predicted by several factors including sexual frequency, emotional intimacy, and sexual intimacy. Unexpectedly, higher desired sexual frequency was associated with lower sexual satisfaction; however, this finding only emerged after controlling for actual sexual frequency, suggesting that discrepancies between desired and actual sex frequency may be important for FSG couples. Implications for clinical practice with FSG couples are explored, including a strength-based focus on broad conceptualizations of sex within this population and targeting relationship factors associated with sexual satisfaction.

Piloting relationship education for female same-sex couples: Results of a small randomized waitlist-control trial

Relationship education represents a promising, nonstigmatizing approach to promoting the health and stability of same-sex couples. A new culturally sensitive adaptation of relationship education was developed specifically for female same-sex couples (The Strengthening Same-Sex Relationships Program, Female version; SSSR-F). SSSR-F includes adaptations of evidence-based strategies to build core relationship skills (e.g., communication skills training) as well as new content to address unique challenges faced by this population (e.g., discrimination; low social support). A small randomized waitlist-control trial (N = 37 couples) was conducted to evaluate program feasibility, acceptability, and efficacy. Three proximal outcomes targeted by SSSR-F (communication, perceived stress, social support) and 3 distal outcomes (global relationship satisfaction, instability, and confidence) were assessed at pre- and posttreatment and 3-month follow-up. Results of multilevel models accounting for nonindependence in dyadic data indicated statistically significant program effects on positive and negative couple communication, relationship satisfaction, and relationship confidence and small, nonsignificant program effects on stress, social support, and relationship instability. Analyses of follow-up data suggest maintenance of effects on the proximal but not the distal outcomes. Ratings of program satisfaction were high. Overall, findings support the feasibility, acceptability, and initial efficacy of SSSR-F, highlighting the potential value of culturally sensitive relationship education for same-sex couples. Continued efforts are needed to increase sustainability of program effects on global relationship quality over time. (PsycINFO Database Record

Changes in the Sexual Relationship and Relationship Adjustment Precede Extradyadic Sexual Involvement

Extradyadic sexual involvement (ESI) is associated with negative consequences for individuals and threatens couple stability. Research on ESI in unmarried samples has been marked by methodological limitations, such as examining only mean levels of sexual satisfaction or frequency to predict later ESI as opposed to changes in various aspects of the sexual relationship over time. The current study compared linear trajectories of four aspects of the sexual relationship-sexual satisfaction, frequency of sex, comfort communicating about sex, and sexual closeness-between individuals in opposite-sex, unmarried relationships who subsequently engaged in ESI (ESI group; n = 183) compared to individuals who did not engage in ESI (non-ESI group; n = 603). Trajectories of relationship adjustment were also evaluated leading up to ESI as well as controlled for in models evaluating the sexual relationship. Results indicated that relationship adjustment declined for individuals preceding ESI, but did not change for the non-ESI group. When controlling for relationship adjustment, comfort communicating about sex decreased for ESI women but increased for ESI men. Some results became nonsignificant after controlling for relationship adjustment, including that sexual satisfaction declined more steeply in the ESI group compared to the non-ESI group, and ESI women significantly decreased in sexual closeness while ESI men demonstrated no significant change. Some mean level differences were also discovered directly before ESI. Conclusions include that changes in a couple's sexual relationship and relationship adjustment are associated with ESI behaviors, providing novel information regarding normative and risk trajectories.

Reasons for Divorce and Recollections of Premarital Intervention: Implications for Improving Relationship Education

The study presents findings from interviews of 52 divorced individuals who received the Prevention and Relationship Enhancement Program (PREP) while engaged to be married. Using both quantitative and qualitative methods, the study sought to understand participant reasons for divorce (including identification of the "final straw") in order to understand if the program covered these topics effectively. Participants also provided suggestions based on their premarital education experiences so as to improve future relationship education efforts. The most commonly reported major contributors to divorce were lack of commitment, infidelity, and conflict/arguing. The most common "final straw" reasons were infidelity, domestic violence, and substance use. More participants blamed their partners than blamed themselves for the divorce. Recommendations from participants for the improvement of premarital education included receiving relationship education before making a commitment to marry (when it would be easier to break-up), having support for implementing skills outside of the educational setting, and increasing content about the stages of typical marital development. These results provide new insights into the timing and content of premarital and relationship education.

What factors affect lymph node yield in surgery for rectal cancer?

OBJECTIVE

The detection of lymph node metastases is of vital importance in patients undergoing excisional surgery for rectal cancer as it provides important prognostic information and facilitates decision-making with regards to adjuvant therapy. It has been suggested that patients in whom only a small number of nodes are present in the excised specimen have a worse prognosis, presumably due to inadequate lymphadenectomy and consequent understaging of the disease. The aim of this study was to determine which factors affect the yield of lymph nodes.

METHODS

This was a retrospective study of patients who had undergone a resection for histologically proven adenocarcinoma of the rectum. The total number of lymph nodes identified in the excised specimen was recorded in each case. A multivariate analysis was performed to ascertain whether this number was significantly influenced by any of several variables.

RESULTS

A total of 167 patients were studied (M:F ratio 107 : 60, median age 70 years). The median number of lymph nodes contained within the resected specimen was 16 (interquartile range 10-21). On univariate analysis a significantly higher yield of lymph nodes was obtained with tumours in the middle third of the rectum (P=0.007), larger tumours (P < 0.001), more locally advanced tumours according to both pT staging (P=0.001) and Dukes' staging (P=0.020), an increased number of involved nodes (P=0.003) and examination by a specialist histopathologist (P=0.003). On multivariate analysis the only significant variables were tumour size (P=0.021), number of positive nodes (P=0.007) and histopathologist (P=0.021).

CONCLUSIONS

The number of lymph nodes identified within the excised specimen in patients undergoing resection of a rectal cancer positively correlates with the size of the tumour and is also dependent on the examining histopathologist. In addition, in node-positive patients the number of involved nodes increases with increasing lymph node yield.

The two week referral for colorectal cancer: a retrospective analysis

OBJECTIVE

The two-week referral (TWR) system was introduced in July 2000 to address the delays in referral, diagnosis and treatment of colorectal cancer (CRC) and lessen the associated psychological morbidity of prolonged waiting. General practitioners complete a proforma outlining 'high-risk' criteria for CRC to ensure an urgent referral within 14 days. The aim of the study was to analyse the TWR process and the proforma criteria.

PATIENTS AND METHODS

One hundred and forty-nine two-week referral proforma were retrospectively reviewed between January and August 2001. The waiting times and proforma data, together with investigations performed and diagnoses made were gathered for 144 patients. Three did not attend clinic and two sets of notes were missing.

RESULTS

Ninety-six percent of patients (n = 144) were two week compliant and 14 CRC (10%) were diagnosed. The most common referral symptom was a recent change in bowel habit (36.6%) but specificity for all criteria was low. The highest diagnostic yield was a palpable abdominal or rectal mass where 16.7% had CRC and iron deficiency anaemia had high sensitivity (90%) for surgical pathology. Per rectum examination and haemoglobin analysis by general practitioners was infrequently performed.

DISCUSSION

Our study has shown that CRC is difficult to diagnose by history and examination alone with a 10% detection rate. CRC incidence in TWR may be improved by primary care through routine rectal examinations, increased detection of iron deficiency anaemia and public education to reduce presentation via other referral routes. Further studies are needed to address these issues.

Comparison of service delivery models influencing teachers' use of assistive technology for students with severe disabilities

Since the 70s and 80s the use of assistive technology in the classroom setting for individuals with severe disabilities has emerged. Assistive technology has provided a new set of tools which allow students to achieve a greater level of independence. Literature review has indicated the need for additional training of related service and classroom personnel in the use of this technology. Training would promote confidence levels in assistive technology application, which may result in increased daily use within the educational domains. The purpose of this research study was to investigate the perceived effectiveness of consultation versus direct service delivery models that influence special educators' and paraprofessionals' use Of assistive technology with students who have severe disabilities. Thirty special educators and sixteen paraprofessionals completed a questionnaire regarding their use of assistive technology with their students and the service delivery model they perceived to be most effective. The results indicated no significant difference between teachers' and paraprofessionals' perceived effectiveness of service delivery models. However, descriptive data did suggest that teachers were utilizing and benefiting from collaborative consultation services when training students with severe disabilities. Limitations to the study and recommendation for further research are also discussed.