1
|
Jewell TI, Petty EM. LGBTQ+ health education for medical students in the United States: a narrative literature review. Med Educ Online 2024; 29:2312716. [PMID: 38359164 PMCID: PMC10877666 DOI: 10.1080/10872981.2024.2312716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other sexual/gender minorities (LGBTQ+) may experience discrimination when seeking healthcare. Medical students should be trained in inclusive and affirming care for LGBTQ+ patients. This narrative literature review explores the landscape of interventions and evaluations related to LGBTQ+ health content taught in medical schools in the USA and suggests strategies for further curriculum development. METHODS PubMed, ERIC, and Education Research Complete databases were systematically searched for peer-reviewed articles on LGBTQ+ health in medical student education in the USA published between 1 January 2011-6 February 2023. Articles were screened for eligibility and data was abstracted from all eligible articles. Data abstraction included the type of intervention or evaluation, sample population and size, and key outcomes. RESULTS One hundred thirty-four articles met inclusion criteria and were reviewed. This includes 6 (4.5%) that evaluate existing curriculum, 77 (57.5%) study the impact of curriculum components and interventions, 36 (26.9%) evaluate student knowledge and learning experiences, and 15 (11.2%) describe the development of broad learning objectives and curriculum. Eight studies identified student knowledge gaps related to gender identity and affirming care and these topics were covered in 34 curriculum interventions. CONCLUSION Medical student education is important to address health disparities faced by the LGBTQ+ community, and has been an increasingly studied topic in the USA. A variety of curriculum interventions at single institutions show promise in enhancing student knowledge and training in LGBTQ+ health. Despite this, multiple studies indicate that students report inadequate education on certain topics with limitations in their knowledge and preparedness to care for LGBTQ+ patients, particularly transgender and gender diverse patients. Additional integration of LGBTQ+ curriculum content in areas of perceived deficits could help better prepare future physicians to care for LGBTQ+ patients and populations.
Collapse
Affiliation(s)
- Tess I. Jewell
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Elizabeth M. Petty
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
2
|
Amundsen E, Muller AE, Reierth E, Skogen V, Berg RC. Chemsex Among Men Who Have Sex With Men: A Systematic Scoping Review of Research Methods. J Homosex 2024; 71:1392-1418. [PMID: 36939142 DOI: 10.1080/00918369.2023.2170757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Chemsex refers to the use of psychoactive substances with sex. We carried out a systematic scoping review of methodological characteristics of chemsex research among men who have sex with men (MSM), published between 2010 and 2020. For inclusion, chemsex had to be the main focus, and studies had to specify GHB/GBL, stimulant (amphetamine, crystal meth, ecstasy/MDMA, cathinones, cocaine) and/or ketamine use with sex as a variable. From 7055 titles/abstracts, 108 studies were included, mostly cross-sectional, and from Western countries. About one-third of studies recruited exclusively from clinical settings. A majority of these recruited from sexually transmitted infection (STI) clinics. The included quantitative studies analyzed possible associations between chemsex and STI health (40%), mental health (15%), drug health (12%), sexological health (10%), and post-diagnostic HIV health (7%). Most studies included GHB/GBL and crystal meth in their operationalization of chemsex. Definitions and operationalizations of chemsex vary greatly in the literature, and researchers of chemsex among MSM should consider ways in which this variation impacts the validity of their results. More studies are needed among MSM in non-high income and non-Western countries, and examination of possible links between chemsex and post-diagnostic HIV health, sexological health, and mental health.
Collapse
Affiliation(s)
- Eirik Amundsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Eirik Reierth
- Science and Health Library, UiT The Arctic University of Norway, Tromsø, Norway
| | - Vegard Skogen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Infectious Diseases, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Rigmor C Berg
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
3
|
Moreno A, Belhouari S, Dussault A. A Systematic Literature Review of the Impact of COVID-19 on the Health of LGBTQIA+ Older Adults: Identification of Risk and Protective Health Factors and Development of a Model of Health and Disease. J Homosex 2024; 71:1297-1331. [PMID: 36853995 DOI: 10.1080/00918369.2023.2169851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/18/2023]
Abstract
It is important to understand the differential impact of COVID-19 on the health of older lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and people with other sexual orientations and forms of gender expression (LGBTQIA+). The objective of this study is to systematically review the impact of COVID-19 on LGBTQIA+ older adults' health including risk and protective factors. We reviewed a total of 167 records including LGBTQIA+ older adults published since 2019. Two independent reviewers screened titles and abstracts and extracted information of 21 full-text records meeting inclusion criteria using COVIDENCE software. The results show that the negative health consequences are exacerbated by personal risk (e.g., perceived homo/transphobia and ageism in LGBTQIA+ communities) and environmental factors (e.g., heterosexism within health services). The negative impact seems to be reduced by personal protective (e.g., resilience, spirituality, and hobbies) and environmental factors (e.g., technology use to increase social participation and social rituals). In conclusion, the health of LGBTQIA+ older adults has been disproportionately affected during the pandemic associated to the latest coronavirus (COVID-19). The experiences of LGBTQIA+ older adults during the pandemic are integrated in a Model of Health and Disease for LGBTQIA+ older adults. Specific strategies to promote health and well-being in this community are provided.
Collapse
Affiliation(s)
- Alexander Moreno
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Notre-Dame Hospital, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (CCSMTL), Montreal, Quebec, Canada
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Salima Belhouari
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Alexane Dussault
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
4
|
Asadi S, Cunningham TJ, Morgan TA, Zimmerman M, Rodriguez-Seijas C. Examining Measurement Invariance in the Personality Inventory for DSM-5 Brief Form Across Sexual and Gender Minority Status. Assessment 2024; 31:678-697. [PMID: 37248665 DOI: 10.1177/10731911231176449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Brief Form (PID-5-BF) was developed with an assumption of invariance across sexual and gender minority (SGM) individuals. This assumption has yet to be tested empirically. Using multigroup confirmatory factor analysis, we examined measurement invariance in the PID-5-BF across the SGM status in clinical (N = 1,174; n = 254 SGM) and nonclinical (N = 1,456; n = 151 SGM) samples. Measurement invariance was supported for the PID-5-BF structure, item thresholds, and factor loadings, but not at the item intercept level. SGM individuals endorsed higher negative affectivity, antagonism, disinhibition, and psychoticism domains in both samples. In the clinical sample, adjusting for partial invariance decreased detachment and antagonism levels for SGM persons. In the nonclinical sample, adjusting for partial invariance reduced antagonism disparities in the SGM group, even rendering original group differences null. Our results support the use of the PID-5-BF in SGM populations but indicate that some measurement bias may drive observed disparities in maladaptive trait domains and, in turn, personality disorder diagnosis.
Collapse
|
5
|
Ganz O, Schulz JA, Ehlke SJ, King Jensen JL, Villanti AC. Cigarette smoking behaviors and nicotine dependence at the intersection of sexual identity and sex in the United States: Findings from the National Survey on Drug Use and Health. Prev Med Rep 2024; 38:102593. [PMID: 38283968 PMCID: PMC10820633 DOI: 10.1016/j.pmedr.2024.102593] [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: 08/16/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Cigarette smoking is disproportionately high among lesbian, gay, and bisexual (LGB) adults. Yet, collapsing these identities into a monolith can disguise important within group disparities (e.g., lesbian/gay versus bisexual female). The purpose of this study is to report recent national prevalence estimates and trends of cigarette smoking behaviors and nicotine dependence by sexual identity and sex. METHODS Data were from the 2015-2019 National Survey on Drug Use and Health (n = 210,392; adults 18+), a nationally representative, repeated cross-sectional study of substance use and mental health in the U.S. We examined bivariate and multivariable associations between sexual identity and cigarette smoking measures (i.e., former smoking, lifetime smoking, current smoking, current daily smoking, nicotine dependence) by sex. We also examined linear time trends in current and former smoking. Covariates included age, race/ethnicity, education, annual household income, and survey year. RESULTS Bisexual women had the highest unadjusted prevalence of current smoking (31 %) and lowest of former smoking (25 %). LGB females and males had higher adjusted prevalence of current smoking, daily smoking, and nicotine dependence than heterosexual adults. Bisexual females and gay and bisexual males had lower adjusted prevalence of former smoking (adjusted prevalence ratio range: 0.78-0.85) than heterosexual counterparts. DISCUSSION This is the first study to identify disproportionately low prevalence of former smoking among bisexual females. Paired with findings of high prevalence of current cigarette smoking and nicotine dependence, these data suggest that tobacco control interventions targeted toward bisexual females are urgently needed to reduce the burden of cigarette smoking among these individuals.
Collapse
Affiliation(s)
- Ollie Ganz
- Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 693 Hoes Lane West, Piscataway, NJ 08854, USA
| | - Jonathan A. Schulz
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401, USA
| | - Sarah J. Ehlke
- Department of Psychology, Old Dominion University, 5115 Hampton Blvd., Norfolk, VA 23529, USA
| | - Jessica L. King Jensen
- Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ 08901, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, 317 George Street, New Brunswick, NJ 08901, USA
| | - Andrea C. Villanti
- Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 693 Hoes Lane West, Piscataway, NJ 08854, USA
| |
Collapse
|
6
|
Chan ASW, Ku HB, Yan E. Exploring discrimination, social acceptance, and its impact on the psychological well-being of older men who have sex with men: A cross-sectional study. BMC Public Health 2024; 24:49. [PMID: 38166786 PMCID: PMC10763053 DOI: 10.1186/s12889-023-17574-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The exploration of discrimination, social acceptance, and their impact on the psychological well-being of older men who have sex with men (MSM) is a critical area of study within the broader field of LGBTQ+ research. This demographic, comprising individuals who identify as both male and homosexual and are aged in the older spectrum of the population, faces unique challenges that intersect age, sexual orientation, and societal attitudes. Objectives This study aimed to explore the relationship between social acceptance and isolation with discrimination and the impact on the psychological well-being of older MSM. METHODS A cross-sectional survey was administered among older MSM residing in three distinct regions: the People's Republic of China (PRC), Hong Kong, and Taiwan, with a total sample size of N = 453 participants, evenly distributed with N = 151 individuals from each region. The survey included the General Health Questionnaire-12 (GHQ-12), the Discrimination and Self-Stigma Evaluation Scale (DSSES), and the Perceived Acceptance Scale (PAS) which measures the perceived social acceptance from friends, mother, father, and family. The data were analyzed using descriptive statistics, ANOVA, and regression analysis. RESULTS The mean scores of the GHQ-12 indicated that the participants had a moderate level of psychological distress, with a mean score of 6.38 (SD = 2.55). The DSSES mean score was 27.78 (SD = 8.73), indicating that participants experienced discrimination in their everyday lives. The PAS mean score was 3.08 (SD = 0.48), indicating that participants had a moderate level of perceived social acceptance. These results suggest that discrimination and social acceptance differ among older MSM in different areas in PRC, Hong Kong, and Taiwan. CONCLUSIONS The study highlights the impact of discrimination and social acceptance on the psychological well-being of older MSM. The findings suggest that interventions aimed at reducing discrimination and promoting social acceptance may improve the psychological well-being of older MSM. These results have important implications for healthcare providers and policymakers in developing strategies to promote social acceptance and reduce discrimination towards older MSM.
Collapse
Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
| | - Hok Bun Ku
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Elsie Yan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
| |
Collapse
|
7
|
Bleasdale J, Wilson K, Aidoo-Frimpong G, Gabriel SJ, Przybyla SM. Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Education in Healthcare Professional Graduate Programs: A Comparison of Medical, Nursing, and Pharmacy Students. J Homosex 2024; 71:193-206. [PMID: 35984396 PMCID: PMC10804216 DOI: 10.1080/00918369.2022.2111535] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Relative to cisgender heterosexual persons, lesbian, gay, bisexual, and transgender (LGBT) people experience greater health inequities, thereby affecting their engagement in care. One strategy to address these disparities is to educate future healthcare professionals to provide nondiscriminatory care to LGBT people. The goal of this study was to explore the perceived coverage of LGBT health education topics in graduate-level medical (MD), pharmacy (PharmD) and nursing (DNP) curricula. Cross-sectional data were collected from web-based surveys (N = 733) completed by healthcare professional students enrolled at two universities in New York State. Of those who responded, 50.5% were MD, 38.9% were PharmD, and 10.6% were DNP students. Overall, mean scores indicated a dearth of perceived LGBT health coverage. Results demonstrated variations in coverage by degree program. Findings highlight the need to develop educational curricula inclusive of topics concerning LGBT patient health. Adequately educating the next generation of healthcare professionals can further promote healthcare engagement among LGBT persons and improve pedagogical practices in healthcare professional education programs.
Collapse
Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Kennethea Wilson
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Steven J Gabriel
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Sarahmona M Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| |
Collapse
|
8
|
Dangerfield DT, Anderson JN, Tinnell T. Cultural acceptability of STI screening guidelines and sexual positioning assessments among black sexual minority men. J Adv Nurs 2023. [PMID: 38151805 DOI: 10.1111/jan.16017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 12/29/2023]
Abstract
AIM To identify attitudes towards HIV/STI screening guidelines and explore the acceptability of assessing sexual positioning practices among Black sexual minority men (SMM). BACKGROUND Risks for HIV/STIs vary by sexual positioning practices. However, clinicians and Black SMM do not always discuss sexuality with each other. Therefore, HIV/STI screening and testing remain suboptimal. DESIGN Qualitative study using focus groups. METHODS Data were obtained from 12 focus groups and one in-depth interview conducted in Baltimore, MD among HIV-negative Black SMM between October 2019 and May 2020 (N = 39). Groups were stratified into three age categories: 18-24, 25-34 and 35+. Participants were given the "5 P's" from the CDC's 2015 Sexual History Screening Guidelines and asked to discuss attitudes towards existing questions regarding sexual positioning practices. Themes were identified using an electronic pile sorting approach. RESULTS Most identified as homosexual/gay/same gender-loving (68%), were employed (69%) and single (66%). Additionally, 34% had ever been diagnosed with an STI, of whom 38% had a history of repeated STI acquisition in their lifetime. Participants across age groups said clinicians should use the words "top" and "bottom" to demonstrate cultural familiarity and build trust. Some said that screening for sexual positioning was unnecessary and intrusive; others said that questions should be justified. Younger men wanted clinicians to ask questions in ways that make them feel cared for. DISCUSSION Guidelines should include language for clinicians to use culturally specific language and better ways to prepare Black SMM patients for screening. IMPACT TO NURSING PRACTICE Some Black SMM will not discuss sexual positioning practices without clinicians' demonstration of cultural understanding and respect. Screening should incorporate culturally responsive language, justification and convey care. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ). NO PATIENT OR PUBLIC CONTRIBUTION There was no patient or public involvement in the design or drafting of this discursive paper.
Collapse
Affiliation(s)
- Derek T Dangerfield
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Janeane N Anderson
- College of Nursing, University of Tennessee Health Science Center, Memphis, USA
| | | |
Collapse
|
9
|
Ginaldi L, De Martinis M. Modernizing Gender, Sex, and Sexual Orientation Data Through Engagement and Education. J Med Internet Res 2023; 25:e51632. [PMID: 37966895 PMCID: PMC10687674 DOI: 10.2196/51632] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
10
|
Queen R, Courtney KL, Lau F, Davison K, Devor A, Antonio MG. Authors' Reply: Modernizing Gender, Sex, and Sexual Orientation Data Through Engagement and Education. J Med Internet Res 2023; 25:e52286. [PMID: 37966876 PMCID: PMC10687682 DOI: 10.2196/52286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Roz Queen
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Karen L Courtney
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Kelly Davison
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Aaron Devor
- Chair in Transgender Studies, University of Victoria, Victoria, BC, Canada
| | - Marcy G Antonio
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
- School of Information, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
11
|
Cannon CEB. Improving Policy and Treatment Interventions for Sexual and Gender Minority Perpetrators of Intimate Partner Violence to Reduce Adverse Health Outcomes. LGBT Health 2023; 10:S6-S9. [PMID: 37754918 DOI: 10.1089/lgbt.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Intimate partner violence (IPV), understood as physical, sexual, and psychological aggression, is a pernicious health problem that is as or more prevalent in sexual and gender minority (SGM) relationships as in heterosexual and cisgender ones. IPV has many impacts, including physical and psychological health consequences. Effective treatment of abusers is needed to reduce IPV in SGM communities. Yet IPV in SGM relationships is understudied, making it difficult to determine whether current treatment, designed for people who identify as cisgender and heterosexual, is effective for SGM IPV abusers. This perspective identifies policy barriers to and recommendations for improving IPV perpetrator treatment for SGM individuals.
Collapse
Affiliation(s)
- Clare E B Cannon
- Department of Human Ecology, University of California, Davis, Davis, California, USA
- Department of Social Work, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
12
|
Dorri AA, Loza O, Bond MA, Ciszek E, Elias-Curry Y, Aguilar S, Fliedner P, Norwood A, Stone AL, Cooper MB, Schick V, Wilkerson JM, Wermuth PP, Yockey RA, Schnarrs P. Understanding the Experiences of Latinx LGBTQ Texans at the Beginning of the COVID-19 Pandemic. J Homosex 2023:1-25. [PMID: 37552613 DOI: 10.1080/00918369.2023.2241597] [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] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Marginalized communities have been disproportionately affected by COVID-19, including both racial/ethnic minority and sexual minority populations. To date, there has been little research examining the impact of the COVID-19 pandemic at the intersections of marginalized identities. Furthermore, available national data on COVID-19 outcomes may obscure our understanding of region-specific outcomes, particularly in the U.S. South. Using an intersectional approach, we explore differences in worries over COVID-19, preventative behaviors, and COVID-19 outcomes in the early months of the pandemic in a diverse sample of LGBTQ people (N = 1076) living in Texas. Our findings indicated that LGBTQ Latinx people in Texas reported more COVID-19 related worries and adverse outcomes than non-Latinx LGBTQ people. These findings are in line with previous research that found that the increased risk to Latinx and LGBTQ populations in public health crises is often overlooked and can be attributed to many factors such as socioeconomic status, occupational propensity, disparities in physical health, and barriers to healthcare access. Furthermore, our findings suggest the necessity of utilizing an intersectional approach when examining the disproportionate burden marginalized communities face in public health crises.
Collapse
Affiliation(s)
- Armin A Dorri
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas, USA
| | - Oralia Loza
- Department of Public Health Sciences, University of Texas at El Paso, El Paso, Texas, USA
| | - Mark A Bond
- New Meridian Corporation, Austin, Texas, USA
| | - Erica Ciszek
- Stan Richards School of Advertising & Public Relations, University of Texas at Austin, Texas, USA
| | - Yona Elias-Curry
- Department of Population Health, University of Texas at Austin, Austin, Texas, USA
| | - Sheridan Aguilar
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Paul Fliedner
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Aliza Norwood
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Amy L Stone
- Department of Sociology & Anthropology, Trinity University, San Antonio, Texas, USA
| | - M Brett Cooper
- Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA
| | - Vanessa Schick
- School of Public Health, University of Texas Health at Houston, Houston, Texas, USA
| | - J Michael Wilkerson
- School of Public Health, University of Texas Health at Houston, Houston, Texas, USA
| | - Paige P Wermuth
- School of Public Health, University of Texas Health at Houston, Houston, Texas, USA
| | - Robert A Yockey
- School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas, USA
| | - Phillip Schnarrs
- Department of Population Health, University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
13
|
Pierce G. How Older White Gay Men and Lesbians Leverage Advantages to Navigate Healthcare. J Homosex 2023; 70:1743-1762. [PMID: 35235496 DOI: 10.1080/00918369.2022.2042661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A lifetime of disadvantages shapes how lesbians and gay men navigate healthcare as they age and their fears about end-of-life care. This paper investigates how a localized group of older white, college educated, and economically privileged gay men and lesbians conceptualize their approach to healthcare. Analyzing 23 in-depth interviews with gay men and lesbians over the age of 60 I consider how they utilize their advantages when aging and facing declining health. I pay particular attention to how discriminatory social and legal contexts shaped elders' current situations and ability to be "out" and engage with healthcare professionals. I utilize the theory of cumulative advantages and disadvantages as another way to understand literature on health inequalities and LGBTQ health work, finding that despite systemic inequalities some gay men and lesbian elders use their resources to find gay-friendly primary care physicians, age at home, and build social supports for caregiving as their health declines.
Collapse
Affiliation(s)
- Grey Pierce
- Master of Science, Historic Preservation, Master of the Arts, Sociology, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
14
|
Queen R, Courtney KL, Lau F, Davison K, Devor A, Antonio MG. What's Next for Modernizing Gender, Sex, and Sexual Orientation Terminology in Digital Health Systems? Viewpoint on Research and Implementation Priorities. J Med Internet Res 2023; 25:e46773. [PMID: 37490327 PMCID: PMC10410371 DOI: 10.2196/46773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/30/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023] Open
Abstract
In 2021, Canada Health Infoway and the University of Victoria's Gender, Sex, and Sexual Orientation Research Team hosted a series of discussions to successfully and safely modernize gender, sex, and sexual orientation information practices within digital health systems. Five main topic areas were covered: (1) terminology standards; (2) digital health and electronic health record functions; (3) policy and practice implications; (4) primary care settings; and (5) acute and tertiary care settings. In this viewpoint paper, we provide priorities for future research and implementation projects and recommendations that emerged from these discussions.
Collapse
Affiliation(s)
- Roz Queen
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Karen L Courtney
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Kelly Davison
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Aaron Devor
- Chair in Transgender Studies, Unveristy of Victoria, Victoria, BC, Canada
| | - Marcy G Antonio
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
- School of Information, University of Michigan, Anna Arbor, MI, United States
| |
Collapse
|
15
|
Linsenmeyer W, Heiden-Rootes K, Drallmeier T, Rahman R, Buxbaum E, Rosen W, Gombos B, Otte A. Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators. Health Promot Pract 2023:15248399231183643. [PMID: 37403757 DOI: 10.1177/15248399231183643] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Clinical education programs are positioned to train future health care professionals to provide excellent health care for transgender and gender-diverse patients. The purpose of this resource, Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators, is to facilitate critical inquiry among clinical educators regarding their approach to teaching about sex, gender, the historical and sociopolitical context of transgender health, and how to prepare their students to apply standards of care and clinical care guidelines set forth by national and international professional organizations.
Collapse
|
16
|
Gonzales G, Lavey F. The Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults in Nashville, Tennessee. J Urban Health 2023:10.1007/s11524-023-00745-8. [PMID: 37351727 DOI: 10.1007/s11524-023-00745-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) populations experience widespread disparities in health outcomes, health behaviors, and access to care compared to their non-LGBT counterparts. Moreover, very few studies have either studied the social determinants of health (SDoH) of LGBT populations or LGBT health in large cities located in the US South. This study uses novel, community-informed, and representative data to study the SDoH of LGBT adults in Nashville and Davidson County, Tennessee. Compared to non-LGBT adults (n = 1583), LGBT adults (n = 128) in Nashville, Tennessee, were more likely to report being dissatisfied with life and feeling emotionally upset or physical symptoms as a result of how they were treated based on their race/ethnicity compared to non-LGBT adults. LGBT adults in Nashville were also less likely to keep a firearm in the home than their non-LGBT peers. This study documents new disparities in the SDoH for LGBT adults living in one of the largest and fastest growing cities in the southeastern US. More research on LGBT populations in urban centers located in the US South is critically needed. Meanwhile, locally based community organizations and public health leaders may consider developing and testing innovative solutions to enhance social networks and social supports among LGBT populations. Addressing the SDoH among LGBT adults in southern cities will be essential for achieving health equity for all LGBT populations in the USA.
Collapse
Affiliation(s)
- Gilbert Gonzales
- Department of Medicine, Health & Society, Department of Health Policy, Program for Public Policy Studies, LGBTQ+ Policy Lab, Vanderbilt University, 2301 Vanderbilt Place PMB #351665, Nashville, TN, 37235-1665, USA.
| | | |
Collapse
|
17
|
Kcomt L, Boyd CJ, Evans-Polce RJ, Veliz P, Engstrom C, West BT, McCabe SE. Ethnic Discrimination, Sexual Orientation Discrimination, and DSM-5 Alcohol Use Disorder Among U.S. Latino or Hispanic Adults. J Homosex 2023:1-21. [PMID: 37272895 PMCID: PMC10696128 DOI: 10.1080/00918369.2023.2217516] [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: 06/06/2023]
Abstract
We aimed to assess the probability of past-year DSM-5 alcohol use disorder (AUD) and past-year moderate-to-severe DSM-5 AUD as a function of past-year ethnic discrimination among U.S. Latino/Hispanic adults and as a function of past-year discrimination types among Latino/Hispanic sexual minorities (SM). We used data from the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions-III (n = 36,309 U.S. adults aged ≥18 years). Our sample consisted of 6,954 Latino/Hispanic adults. Multivariable logistic regression analyses estimated the association of past-year ethnic discrimination with past-year AUD and past-year moderate-to-severe AUD among the overall Latino/Hispanic population. We tested the association between discrimination types (i.e. none, ethnic or sexual orientation discrimination, both) with AUD and moderate-to-severe AUD among Latino/Hispanic SM adults. Among Latino/Hispanic adults, 13.4% met criteria for past-year AUD and 6.4% met criteria for past-year moderate-to-severe AUD. Ethnic discrimination was significantly associated with AUD (AOR = 1.09, 95% CI = 1.07-1.12) and moderate-to-severe AUD (AOR = 1.10, 95% CI = 1.06-1.13). Latino/Hispanic SMs who experienced both ethnic and sexual orientation discrimination were more likely to meet criteria for AUD (AOR = 3.44, 95% CI = 1.97-6.03) and moderate-to-severe AUD (AOR = 2.69, 95% CI = 1.25-5.82) compared to those who did not experience discrimination. Discrimination is a risk factor for AUD and moderate-to-severe AUD among Latino/Hispanic overall and SM populations.
Collapse
Affiliation(s)
- Luisa Kcomt
- School of Social Work, Wayne State University, Detroit, MI
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI
| | - Carol J. Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI
- Addiction Center, Department of Psychiatry, Rachel Upjohn Building, University of Michigan, Ann Arbor, MI
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI
| | - Rebecca J. Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI
| | - Phil Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Curtiss Engstrom
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Brady T. West
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI
- Institute for Social Research, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI
- Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI
- Institute for Social Research, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI
| |
Collapse
|
18
|
Eden TM, Smallwood SW, Matthews DD. Using a Measurement Model to Reconceptualize the Church Experiences of Black Men who have Sex with Men. J Relig Health 2023; 62:2213-2225. [PMID: 36260262 PMCID: PMC10113399 DOI: 10.1007/s10943-022-01671-w] [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] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Religious spaces have proven to be effective sites of health intervention among Black Americans. Less is known about how religious environments impact the health of subgroups of Black Americans, specifically Black men who have sex with men (MSM). Using data from the Promoting Our Worth, Equality, and Resilience study, we explored the factor structure of a 10-item religious environment scale among Black MSM (N = 2,482). Exploratory factor analysis revealed three distinct factors: (1) visibility of MSM, (2) structural support, and (3) structural homonegativity. The relationship between Black MSM and their religious environments is complex and should be investigated using measures that accurately reflect their lived experiences.
Collapse
Affiliation(s)
- Tiffany M Eden
- Department of Health Behavior, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC, 27599-7440, USA.
| | - Stacy W Smallwood
- Department of Health Policy & Community Health, Georgia Southern University, Statesboro, GA, USA
| | - Derrick D Matthews
- Department of Health Behavior, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC, 27599-7440, USA
| |
Collapse
|
19
|
Cantor T, Domogauer J, Stasenko M. SGM health curricula should be mandatory in training programs. Curr Probl Cancer 2023; 47:100882. [PMID: 35768317 DOI: 10.1016/j.currproblcancer.2022.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 01/18/2023]
|
20
|
Abstract
Transgender and gender diverse (TGD) youth, particularly transgender youth of color, experience barriers to most, if not all, types of care across the United States. Consequently, clinicians are concerned about the increase of anti-transgender policies in the United States, with many states now restricting gender-affirming care. In this manuscript, we suggest several empirically based techniques to provide quality clinical care. We also share resources to support TGD youth and their families, while accommodating for some of these newer restrictions on the care that clinicians are able to provide. Ongoing training and awareness in these techniques will allow clinicians and their health care institutions to more effectively and immediately respond to anti-transgender policies and be able to provide care. By continuing to advocate for some of these strategies, there is potential to reduce the health inequities that many TGD youth experience. Prioritizing screening for gender discrimination, creating a safe space for TGD youth, and providing immediate clinical strategies to reduce distress can reduce symptoms of depression and suicide. These changes, albeit small, will allow clinicians to feel more comfortable providing gender affirming care through holistic changes in clinical practices and care.
Collapse
Affiliation(s)
- Juan Pablo Zapata
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
21
|
Maragh-Bass AC, Hucks-Ortiz C, Beyrer C, Remien RH, Mayer K, Del Rio C, Batey DS, Farley JE, Gamble T, Tolley EE. Multilevel Stigma and Its Associations with Medical Care Ratings Among Men Who Have Sex With Men in HPTN 078. J Prim Care Community Health 2023; 14:21501319231175362. [PMID: 37243342 DOI: 10.1177/21501319231175362] [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: 05/28/2023] Open
Abstract
INTRODUCTION Our research assessed associations between stigma-related variables and medical care ratings among clients with HIV in HIV Prevention Trials Network (HPTN) 078 who were men who have sex with men (MSM). METHODS Logistic regression explored care ratings, stigma, socio-demographics (N = 637). Qualitative thematic coding and themes explored stigmatizing experiences in different settings (N = 111). RESULTS Whites were twice as likely as African-Americans to report high care ratings (P < .05). Clients who reported familial exclusion due to having sex with men were 40% less likely to report high medical care ratings (P < .05). Clients who agreed healthcare providers think people with HIV "sleep around" were half as likely to report high care ratings (P < .08). Stigmatization included "treating me like they'll catch HIV from my hand," and care avoidance so others didn't "know I was having sex with men". CONCLUSIONS Providers can promote African American MSM client retention with more affirming healthcare provision, namely minimizing assumptions and addressing identities and client needs beyond just HIV care.
Collapse
Affiliation(s)
| | - Christopher Hucks-Ortiz
- Black AIDS Institute, Los Angeles, CA, USA
- HIV Prevention Trials Network Black Caucus, Los Angeles, CA, USA
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kenneth Mayer
- The Fenway Institute and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | |
Collapse
|
22
|
Gonzales G, Tran NM, Bennett MA. State Policies and Health Disparities between Transgender and Cisgender Adults: Considerations and Challenges Using Population-Based Survey Data. J Health Polit Policy Law 2022; 47:555-581. [PMID: 35576319 DOI: 10.1215/03616878-9978117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT The authors examined the association between state-level policy protections and self-rated health disparities between transgender and cisgender adults. METHODS They used data on transgender (n = 4,982) and cisgender (n = 1,168,859) adults from the 2014-2019 Behavioral Risk Factor Surveillance System. The authors estimated state-specific health disparities between transgender and cisgender adults, and they used multivariable logistic regression models to compare adjusted odds ratios between transgender and cisgender adults by state-level policy environments. FINDINGS Transgender adults were significantly more likely to report poor/fair health, frequent mental distress, and frequent poor physical health days compared to cisgender adults. Disparities between transgender and cisgender adults were found in states with strengthened protections and in states with limited protections. Compared to transgender adults in states with limited protections, transgender adults in states with strengthened protections were marginally less likely to report frequent mental distress. CONCLUSIONS Transgender adults in most states reported worse self-rated health than their cisgender peers. Much more research and robust data collection on gender identity are needed to study the associations between state policies and transgender health and to identify best practices for achieving health equity for transgender Americans.
Collapse
|
23
|
Pinto P, Macleod CI, Nhamo-Murire M. The Binary Order of Things: A Discursive Study of Nursing Students' Talk on Providing, and Learning About, LGBT Patient Care. J Homosex 2022:1-32. [PMID: 35452360 DOI: 10.1080/00918369.2022.2048163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers' prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and "scientifically" supported through binary, deterministic views of sexuality and gender. Such "expert" views accord with Foucault's notion of "grotesque discourse." We conclude with a discussion of the findings' implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives.
Collapse
Affiliation(s)
- Pedro Pinto
- Critical Studies in Sexualities and Reproduction (Cssr), Department of Psychology, Rhodes University, Makhanda, South Africa
| | - Catriona Ida Macleod
- Critical Studies in Sexualities and Reproduction (Cssr), Department of Psychology, Rhodes University, Makhanda, South Africa
| | - Mercy Nhamo-Murire
- Critical Studies in Sexualities and Reproduction (Cssr), Department of Psychology, Rhodes University, Makhanda, South Africa
| |
Collapse
|
24
|
Baskaran AB, Hauser J. Maya Ta Maya Ho (Love is Love): A Qualitative Study on LGBTQI+ Experiences in Hospice & Palliative Care in Nepal. J Palliat Care 2022:8258597221092896. [PMID: 35404145 DOI: 10.1177/08258597221092896] [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: 02/21/2024]
Abstract
OBJECTIVE(S) LGBTQI+ disparities in hospice and palliative care have been vastly underrecognized in medical practice and research. This may result in LGBTQI+ community members distrusting health care professionals, avoiding encounters due to fears of discrimination or mistreatment, and seldom disclosing their identities to health care professionals. LGBTQI+ patients often lack familial emotional and caregiver support, a central theme of hospice and palliative care - for example, older LGBTQI+ people are twice as likely as cisgender heterosexual people to live alone and four times as likely to not have children. LGBTQI+ populations are also highly intersectional; therefore, members may be further stigmatized. Blue Diamond Society is a non-governmental organization in Nepal that specializes in LGBTQI+ advocacy and patient care. Our main objective in this study was to explore Nepali LGBTQI+ patients' experiences in hospice and palliative care. METHODS 29 interviews were conducted with patients, health care professionals, family members, and administrators involved with Blue Diamond Society (BDS), a Nepali NGO that serves Nepal's LGBTQI+ community. Questions were developed based on open-ended questioning to abstract relevant life and health history information pertaining to experiences with BDS and palliative care. These interviews were translated and transcribed verbatim. Qualitative Content analysis was conducted to identify prevalent themes. RESULTS Four themes were identified: Fear of Dying without Family; Understanding Oneself and Sense of Community; Patient as Advocate; and Intersectionality and Eliminating Reductionism. CONCLUSIONS This study elucidated themes inherent to the experiences of LGBTQI+ Nepali people receiving palliative and hospice care, ultimately describing the unique needs of LGBTQI+ Nepali patients in palliative and hospice care settings. In doing so, this study presents an intersectional focus on palliative and hospice care, elaborating on challenges specific to a deeply marginalized community that remains underrepresented in academia. Findings from this study describe an expanded notion of "palliation" to embody "whole-person care," that is, the palliation of social and structural pain, in addition to the more traditional conceptions of palliation as purely physical, emotional, and/or spiritual. This study also identified the importance of acknowledging and affirming the intersectional marginalization at which LGBTQI+ Nepalis live, ranging from experiences with socioeconomic status, family and communal conflict, ethnicity, race, sex, gender, sexual orientation, age, and environmental resource scarcity. In further understanding and improving upon intersectional LGBTQI+ cultural humility, this study provides opportunities for further research on cross-cultural LGBTQI+ patient needs in hospice and palliative care in a variety of resource settings.
Collapse
Affiliation(s)
- Archit B Baskaran
- Northwestern University Feinberg School of Medicine, 233 East Erie Street, Apt 1108, Chicago, IL 60611, USA
| | - Joshua Hauser
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| |
Collapse
|
25
|
Friedman Burley J, Du Mont J, Reid A, Macdonald S. Promoting Awareness to Counter Damaging Attitudes, Beliefs, and Reactions Related to Sexual Assault Against Trans People: A Social Media Campaign for Health and Social Service Providers. Health Promot Pract 2022:15248399221074981. [PMID: 35301901 DOI: 10.1177/15248399221074981] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transgender (trans) people face high rates of sexual assault and often encounter systemic barriers in accessing appropriate care and supports, including, among others, stigma, discrimination, and a lack of provider knowledge. Trans communities and allies in research and the service sector have emphasized the potential of advocacy as a tool to dismantle barriers for trans people; however, to date, few advocacy efforts have been undertaken in the sexual assault context. To address this gap, we developed and implemented #TRANSformativeKnowledge, a social media campaign to promote awareness among providers about the damaging attitudes, beliefs, and reactions that often impede trans survivors' access to appropriate services. Based on insights from a recorded consultation with trans community members and health and social service professionals, we designed seven posters for circulation on Twitter, each containing a representative quote, key message, and associated call to action. The campaign was launched May 17, 2021, with posters Tweeted twice weekly, including one final summary post on June 30, 2021. The campaign reached approximately 100,000 Twitter users, with almost 2,000 engagements. As demonstrated by these findings, our social media advocacy campaign represents a viable method for disseminating knowledge about sexual assault against trans people, which could be replicated by others aspiring to advance health equity through advocacy.
Collapse
Affiliation(s)
- Joseph Friedman Burley
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Ontario, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Reid
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
26
|
Schmid AT, Payam S. "I Don't Want to Have Sex as a Woman": A Qualitative Study Exploring Sexuality and Sexual Practices of Drag Queens in Germany. J Homosex 2022:1-21. [PMID: 35285775 DOI: 10.1080/00918369.2022.2051117] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Drag queens are typically gay men who perform as caricature-like women. They thereby publicly challenge "naturally" binary gender role categories, though it remains unclear how that interplays with their private (e.g., sexual) lives. This study seeks to answer this question by exploring the sexuality and sexual practices of drag queens. Employing a critical realist approach, ten semi-structured interviews were conducted in Germany, with questions focusing on the drag queens' views on sexuality and sexual positioning. By adopting a thematic analysis, three main themes were identified: natural versus artificial identity; advocacy for sexuality; and rejection of heteronormativity. Results suggest that the primary intention of drag queens is to challenge heteronorms, while they regularly adhered to these privately. This illustrates the distinction made by the participants between their "public" persona, an artificial character that lacks sexuality, and their "private" life (e.g., sexual practices), shaped by an "inborn" sexuality.
Collapse
Affiliation(s)
- Anna Theresa Schmid
- Chair of Sociology of Diversity, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Shahin Payam
- Chair of Sociology of Diversity, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| |
Collapse
|
27
|
Newsom KD, Carter GA, Hille JJ. Assessing Whether Medical Students Consistently Ask Patients About Sexual Orientation and Gender Identity as a Function of Year in Training. LGBT Health 2022; 9:142-147. [PMID: 35104423 DOI: 10.1089/lgbt.2021.0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The Institute of Medicine has suggested that teaching health care providers to inquire about and document the sexual orientation and gender identity (SOGI) of their patients will provide more accurate epidemiological data and allow for more patient-centered care, thus improving sexual and gender minority health. The purpose of this study was to determine whether medical students are asking about SOGI and to identify reasons why students were opting not to ask. Methods: In July 2020, an online survey was made available to second-, third-, and fourth-year medical students at a Midwestern medical school. Respondents were asked whether they consistently inquired about the SOGI of their patients, and the reasons they do not ask. The number of students asking about SOGI and reasons for not asking were analyzed using chi-square analyses as a function of year in training. Results: Of 1089 eligible participants, 364 completed the survey (33.4%). The number of students asking about sexual orientation significantly decreased with every year of training (92.8%, 82.2%, and 52.7%). The number of students asking about gender identity significantly decreased after the second year of training (69.9%, 40.6%, and 26.4%). Reasons that significantly increased across training included believing SOGI is irrelevant to encounters, limiting inquiries to patients with sexual health complaints only, and negative influence from their attendings. Conclusion: As medical students progressed into the clinical years of their training, they were less likely to ask their patients about SOGI and more likely to cite negative influence from their attendings and question the relevance of obtaining SOGI.
Collapse
Affiliation(s)
- Keeley D Newsom
- Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Gregory A Carter
- Department of Community and Health Systems, Indiana University School of Nursing, Indiana University, Bloomington, Indiana, USA
| | - Jessica J Hille
- Kinsey Institute, Indiana University, Bloomington, Indiana, USA
| |
Collapse
|
28
|
March C, Gonzales G. Frequent users of emergency departments in the United States by sexual orientation. Acad Emerg Med 2022; 29:112-114. [PMID: 34331783 DOI: 10.1111/acem.14363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/22/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Cooper March
- Vanderbilt University School of Medicine Nashville Tennessee USA
| | - Gilbert Gonzales
- Department of Medicine, Health & Society Department of Health Policy Vanderbilt University Nashville Tennessee USA
| |
Collapse
|
29
|
Panza E, Fehling KB, Pantalone DW, Dodson S, Selby EA. Multiply marginalized: Linking minority stress due to sexual orientation, gender, and weight to dysregulated eating among sexual minority women of higher body weight. Psychol Sex Orientat Gend Divers 2021; 8:420-428. [PMID: 34926715 PMCID: PMC8675908 DOI: 10.1037/sgd0000431] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE This study assessed whether baseline levels of distal and proximal minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating in daily life among sexual minority women with overweight/obesity. METHODS Fifty-five sexual minority women ages 18-60 (M = 25 ± 9) with BMI > 25kg/m2 (M = 32 ± 5) completed baseline assessments of distal and proximal minority stressors due to sexual orientation, gender, and weight. Participants then completed an Ecological Momentary Assessment (EMA) protocol. For five days, participants responded to five random prompts assessing engagement in dysregulated eating (i.e., overeating, binge eating). The cumulative number of EMA-measured overeating and binge eating episodes was summed per participant. RESULTS Several minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating behaviors during EMA. Women with higher (vs. lower) baseline levels of internalized homophobia reported more cumulative episodes of binge eating during the EMA period. Women reporting greater (vs. less) baseline sexual orientation concealment reported more episodes of overeating during the EMA period. Women with greater (vs. less) baseline weight bias experiences and internalization reported more overeating and binge eating episodes during the EMA period. CONCLUSIONS Findings from this pilot study identify internalized homophobia, sexual orientation concealment, and experienced and internalized weight bias as potential risk factors for dysregulated eating behaviors among sexual minority women of higher body weight.
Collapse
Affiliation(s)
- Emily Panza
- Rutgers, the State University of New Jersey, New Brunswick, NJ
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert School of Medicine, Brown University
| | - Kara B. Fehling
- Rutgers, the State University of New Jersey, New Brunswick, NJ
| | - David W. Pantalone
- University of Massachusetts Boston, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Samira Dodson
- Rutgers, the State University of New Jersey, New Brunswick, NJ
- Binghamton University, Binghamton, NY
| | - Edward A. Selby
- Rutgers, the State University of New Jersey, New Brunswick, NJ
| |
Collapse
|
30
|
Murphy S, Morrell JS. Eating Competence and Dietary Intake of Sexual and Gender Minority College Students. Nutrients 2021; 13:2388. [PMID: 34371896 DOI: 10.3390/nu13072388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Sexual and gender minority college students are underrepresented in nutrition research and may face unique challenges related to eating which impact their overall diet quality. We assessed the differences in eating competence and dietary intake between sexual and gender minority (SGM) and cisgender heterosexual (CH) college students. Participants (n = 2645) reported sexual orientation, gender identity and completed the Eating Competence Satter Inventory (ecSI 2.0™ through an online questionnaire. Three-day food records examined dietary intake. Intake was compared to recommendations for nutrients of public health concern. Chi-square and ANCOVA examined differences between eating competence and dietary intake. There were no differences in total ecSI 2.0™ scores. Subscale scores for Eating Attitudes and Contextual Skills were significantly higher in CH vs. SGM students (13.4 ± 0.1 vs. 12.4 ± 0.4 p = 0.01 and 10.7 ± 0.1 vs. 9.9 ± 0.3, p = 0.01, respectively). Most students (40.8%) met one nutrient recommendation. The proportion of students meeting nutrient recommendations were similar for SGM and CH. SGM populations may struggle with attitudes and eating behaviors. Dietary intake of SGM and CH students were similarly inadequate when compared to recommendations.
Collapse
|
31
|
Nadler LE, Ogden SN, Scheffey KL, Cronholm PF, Dichter ME. Provider Practices and Perspectives regarding Collection and Documentation of Gender Identity. J Homosex 2021; 68:901-913. [PMID: 31526306 PMCID: PMC7676221 DOI: 10.1080/00918369.2019.1667162] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Recent recommendations to include patient sexual orientation (SO) and gender identity (GI) in the electronic health record (EHR) aim to improve clinical care and address health disparities among sexual and gender minority patients. Collection and documentation of GI may be complex due to multiple clinically relevant components. This study explored provider practices in collecting and documenting GI across multiple specialties. Qualitative interviews with 25 healthcare providers were transcribed verbatim, and thematic analysis and principles of grounded theory were used to analyze the data. Without a protocol and absent dedicated locations in the EHR for collecting and documenting patient GI, provider practices were inconsistent and highlighted challenges for communication across clinical staff. Providers noted that patients' disclosure of GI was typically unprompted, or was presumed through disclosure of gender affirming treatments. Findings indicate the need for provider training and appropriate EHR fields to support GI collection and documentation.
Collapse
Affiliation(s)
- Lauren E. Nadler
- Department of Family Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shannon N. Ogden
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn L. Scheffey
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa E. Dichter
- School of Social Work, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA
| |
Collapse
|
32
|
Anzani A, Sacchi S, Prunas A. Microaggressions towards lesbian and transgender women: Biased information gathering when working alongside gender and sexual minorities. J Clin Psychol 2021; 77:2027-2040. [PMID: 33942305 PMCID: PMC8453726 DOI: 10.1002/jclp.23140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 11/14/2022]
Abstract
Objective Microaggressions, a concept originally introduced for ethnic minorities, represent subtle day‐to‐day discrimination, damaging the psychological health and well‐being of lesbian, gay, bisexual, and transgender individuals as well. This study aimed to assess whether microaggressions occur in psychotherapists’ assessments of clients who identify as either lesbian or transgender woman when compared with those identifying as heterosexual woman. Methods The study included a sample of 135 licensed psychotherapists (110 cisgender women and 25 cisgender men). Participants were presented with an audio file of a woman introducing herself during her first therapy session. Three versions were presented: a transgender, a lesbian, and a heterosexual client. Participants were asked to assess the clinical relevance of 10 questions defined as neutral (N = 5) and microaggressive (N = 5), used to determine a clinical impression of the client. A repeated measure analysis of variance was conducted to understand the likelihood of clients of different gender identity and sexual orientation receiving microaggressions. Results Participants were more prone to consider microaggressive questions relevant where the client identified as either lesbian or transgender. Conclusions The findings highlighted a bias against lesbian and trans women in evaluating the relevance and usefulness of clinical information while making a psychological assessment of a case.
Collapse
Affiliation(s)
- Annalisa Anzani
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Simona Sacchi
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Antonio Prunas
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| |
Collapse
|
33
|
Du Mont J, Friedman Burley J, Hodgson R, Macdonald S. Advancing Trans-Affirming Practice to Recognize, Account for, and Address the Unique Experiences and Needs of Transgender Sexual Assault Survivors. Health Promot Pract 2021; 23:749-752. [PMID: 33899524 PMCID: PMC9561803 DOI: 10.1177/15248399211009183] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transgender (trans) persons are sexually assaulted at high rates and often encounter barriers to equitable services and supports. The receipt of timely and appropriate postassault care, provided increasingly by specialized forensic nurses around the world, is critical in ameliorating the harms that accompany sexual assault. In order to adequately respond to the acute health care needs of trans clients and attend to longer term psychosocial difficulties that some experience, forensic nurses not only require specialized training but must also cultivate collaborative relationships with trans-positive health and social services in their communities. To meet this need, we describe our strategy to advance trans-affirming practice in the sexual assault context. We outline the design and evaluation of a trans-affirming care curriculum for forensic nurses. We also discuss the planning, formation, and maturation of an intersectoral network through which to disseminate our curriculum, foster collaboration, and promote trans-affirming practice across health care and social services in Ontario, Canada. Our approach to advancing trans-affirming practice holds the potential to address systemic barriers experienced by trans survivors and transform the response to sexual assault across other sectors and jurisdictions.
Collapse
Affiliation(s)
- Janice Du Mont
- Women’s College Hospital, Toronto, Ontario,
Canada
- University of Toronto, Toronto, Ontario,
Canada
- Janice Du Mont, Women’s College Research Institute,
Women’s College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada; e-mail:
| | - Joseph Friedman Burley
- Women’s College Hospital, Toronto, Ontario,
Canada
- Ontario Network of Sexual Assault/Domestic
Violence Treatment Centres, Toronto, Ontario, Canada
| | - Robyn Hodgson
- London InterCommunity Health Centre, London,
Ontario, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic
Violence Treatment Centres, Toronto, Ontario, Canada
| |
Collapse
|
34
|
Gavulic KA, Gonzales G. Health Care Expenditures and Financial Burden: A Comparison of Adults in Same-Sex Couples and Different-Sex Couples. Med Care Res Rev 2021; 79:281-289. [PMID: 33783242 DOI: 10.1177/10775587211004308] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We used data from the 2014-2017 Medical Expenditure Panel Survey to compare health care expenditures and financial burden between adults in same-sex couples (n = 514) and adults in different-sex couples (n = 41,043). Compared with men in different-sex couples ($3,994), men in same-sex couples ($6,896) were more likely to spend more on health care, especially on prescription medications ($2,745 vs. $1,050), which was primarily driven by antiviral medications ($1,061 vs. $35). Women in same-sex couples ($5,886) reported similar health care expenditures compared with women in different-sex couples ($5,619). However, women in same-sex couples were significantly more likely to experience financial burden compared with women in different-sex couples (25.7% vs. 11.3%). We speculate that the disparities reported here are due to a variety of issues, including elevated health needs requiring prescriptions for lesbian, gay, bisexual, and transgender (LGBT) men and lower incomes for LGBT women. More research is needed to understand health services utilization and expenditure patterns among LGBT populations.
Collapse
Affiliation(s)
- Kyle A Gavulic
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | |
Collapse
|
35
|
Wilkerson JM, Di Paola A, Nieto D, Schick V, Latini DM, Braun-Harvey D, Zoschke IN, McCurdy S. Sexual Violence and Chemsex among Substance-Using Sexual and Gender Minorities in Texas. Subst Use Misuse 2021; 56:2141-2150. [PMID: 34550052 DOI: 10.1080/10826084.2021.1975743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 12/31/2022]
Abstract
UNLABELLED Chemsex is the use of methamphetamine or other substances to enhance sexual experiences, and is most often associated with sexual minority men. Within the chemsex literature, questions of sexual violence emerge due, in part, to ambiguity about what constitutes consent within sexualized environments with co-occurring substance use. To understand the context in which sexual violence occurs, data from an online survey of sexual and gender minority Texans were analyzed using bivariate and logistic regression (N = 1273), and qualitative interviews with substance-using sexual minority men from a separate sample were thematically analyzed (N = 22). Among survey participants, 12.8% experienced a form of sexual violence (10.1% experienced intimate partner violence and 7.6% experienced sexual assault). When participants were categorized based on past year substance use and sex party attendance, 48.0% of participants who used drugs and attended sex parties (a proxy for chemsex) experienced sexual violence (41.6% experienced intimate partner violence and 41.0% experienced sexual assault). When variables statistically significant at the bivariate-level were entered into logistic regression models, participants in the chemsex category were 12.5 [95% CI: 6.9, 22.8] times more likely to experience sexual violence. Substance-using sexual minority men experiencing sexual violence describe situations in which consent is difficult to revoke and sexual exploitation is likely to occur. Studies which more deeply explore the relationship between sexual and relationship violence and chemsex among sexual and gender minorities are needed. Particularly, the notion of consent needs further conceptualization in the context of drug use and sex parties. HIGHLIGHTS Measures of recent substance use and sex party attendance were combined to create a proxy measure for chemsex, which is the use of substances to enhance sexual experiences.Substance-using sexual and gender minorities engaging in chemsex were at increased risk of sexual violence.In addition to engaging in chemsex, variables associated with an increased odds of sexual violence among sexual and gender minorities were younger age, having a non-monosexual sexual identity, and receiving a mental health diagnoses.Studies on sexual and gender minorities engaging in chemsex should be developed to further explore sexual exploitation.
Collapse
Affiliation(s)
- J Michael Wilkerson
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Angela Di Paola
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Dominica Nieto
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - David M Latini
- Scott Department of Urology, the Montrose Center, and the Montrose Research Institute, Baylor College of Medicine, Houston, Texas, USA
| | | | - I Niles Zoschke
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Sheryl McCurdy
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| |
Collapse
|
36
|
Abstract
The present cross-sectional descriptive study examined the attitudes and behaviors of health-care providers toward LGBT patients in Lebanon. Participants (N = 141) generally showed positive attitudes and behaviors toward LGBT patients. Mental health providers were significantly less likely to believe that homosexuality is a mental health disorder or that it is unnatural to identify with a gender identity other than one's biological sex when compared to non-mental health providers. Mental health providers were also more likely to be willing to address transgender people by their gender pronouns, and to believe that homosexuality is a natural variation on the sexual orientation spectrum when compared to non-mental health providers. Findings show favorable attitudes and behaviors of health-care providers toward LGBT individuals when compared to previous investigations in Lebanon. Implications on the educational, research, and policy levels are discussed.
Collapse
Affiliation(s)
- Hady Naal
- Department of Psychology, Haigazian University , Beirut, Lebanon
- Lebanese Medical Association for Sexual Health , Beirut, Lebanon
| | - Sarah Abboud
- Lebanese Medical Association for Sexual Health , Beirut, Lebanon
- College of Nursing, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Omar Harfoush
- Lebanese Medical Association for Sexual Health , Beirut, Lebanon
- Department of Internal Medicine, Medstar Health Internal Medicine Residency Program , Baltimore, Maryland, USA
| | - Hossam Mahmoud
- Department of Psychiatry, Tufts University School of Medicine , Boston, Massachusetts, USA
- Regroup Therapy , Chicago, Illinois, USA
| |
Collapse
|
37
|
Hunter DJ, Boyle K. A healthier way to meet people: the experiences of LGBT people exercising with a peer group. ACTA ACUST UNITED AC 2020; 29:1068-1073. [PMID: 33035100 DOI: 10.12968/bjon.2020.29.18.1068] [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: 11/11/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual and trans (LGBT) individuals have been shown to have poorer health when compared to those who identified as heterosexual. Additionally, they encounter barriers that deter participation in sports. AIM To understand the experiences of LGBT individuals who participate in physical activity with peers. METHOD An exploratory-descriptive qualitative (EDQ) study with data collected via face-to-face interviews from 12 participants. Data were thematically analysed to identify findings. FINDINGS exercising with peers represents a healthier way to meet people. Participants experienced improved physical, mental and social health. CONCLUSION Engaging with a peer group for physical activity can have a transformational effect on members of the LGBT community, impacting on all aspects of their wellbeing. Nurses, and other health professionals, should be aware of the multifaceted benefits that exercising with a peer group can have, using their regular interactions with this patient group to recommend peer-supported exercise.
Collapse
Affiliation(s)
- David J Hunter
- Lecturer in Nursing and Health Care, University of Glasgow
| | - Kevin Boyle
- Community Staff Nurse, NHS Greater Glasgow & Clyde, Glasgow. At time of writing, he was a Student Nurse at the University of the West of Scotland, Paisley
| |
Collapse
|
38
|
Gonzales G, Henning-Smith C, Ehrenfeld JM. Changes in health insurance coverage, access to care, and health services utilization by sexual minority status in the United States, 2013-2018. Health Serv Res 2020; 56:235-246. [PMID: 33000467 DOI: 10.1111/1475-6773.13567] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine the changes in health insurance coverage, access to care, and health services utilization among nonelderly sexual minority and heterosexual adults between pooled years 2013-2014 and 2017-2018. DATA SOURCES Data on 3223 sexual minorities (lesbians, gay men, bisexual individuals, and other nonheterosexual populations) and 86 181 heterosexuals aged 18-64 years were obtained from the 2013, 2014, 2017, and 2018 National Health Interview Surveys. STUDY DESIGN Unadjusted and regression-adjusted estimates compared changes in health insurance status, access to care, and health services utilization for nonelderly adults by sexual minority status. Regression-adjusted changes were obtained from logistic regression models controlling for demographic and socioeconomic characteristics. PRINCIPAL FINDINGS Uninsurance declined for both sexual minority adults (5 percentage points, P < .05) and heterosexual adults (2.5 percentage points, P < .001) between 2013-2014 and 2017-2018. Reductions in uninsurance for sexual minority and heterosexual adults were associated with increases in Medicaid coverage. Sexual minority and heterosexual adults were also less likely to report unmet medical care in 2017-2018 compared with 2013-2014. Low-income adults (regardless of sexual minority status) experienced relatively large increases in Medicaid coverage and substantial improvements in access to care over the study period. The gains in coverage and access to care across the study period were generally similar for heterosexual and sexual minority adults. CONCLUSIONS Sexual minority and heterosexual adults have experienced improvements in health insurance coverage and access to care in recent years. Ongoing health equity research and public health initiatives should continue to monitor health care access and the potential benefits of recent health insurance expansions by sexual orientation and sexual minority status when possible.
Collapse
Affiliation(s)
- Gilbert Gonzales
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, Tennessee, USA.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carrie Henning-Smith
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jesse M Ehrenfeld
- Department of Advancing a Healthier Wisconsin Endowment, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Division of AHW-Research and Education, Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
39
|
Solazzo AL, Austin SB, Rosario M, Corliss HL, Charlton BM. Maternal Comfort with Lesbian, Gay, and Bisexual People and Their Children's Drinking, Smoking, and Disordered Weight Control Behaviors as Adults. LGBT Health 2020; 7:375-384. [PMID: 32877268 DOI: 10.1089/lgbt.2019.0315] [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: 11/12/2022] Open
Abstract
Purpose: We investigated associations between maternal comfort with lesbian, gay, and bisexual (LGB) people during the participant's adolescence and their health indicators in adulthood. Methods: Data came from a prospective cohort, Growing Up Today Study (N = 7476), limited to men and women who provided information during their adulthood about recent binge drinking, cigarette smoking, or disordered weight control behaviors (DWCB) and whose mothers provided information during the participant's adolescence about her comfort with LGB people. Results: Increased maternal comfort with LGB people was associated with increased engagement in health indicators for heterosexual but not sexual minority adults (binge drinking, cigarette smoking, and DWCB for women; binge drinking for men). No association existed between maternal comfort with LGB people and binge drinking or cigarette smoking for sexual minority women, and binge drinking for sexual minority men. This resulted in statistically smaller differences across sexual orientation in cigarette smoking for women when their mothers were highly comfortable with LGB people compared with those whose mothers were uncomfortable with LGB people. There were no differences in binge drinking (women and men) and DWCB (women only) across sexual orientation when mothers were highly comfortable with LGB people. Conclusion: Maternal comfort with LGB people is associated with certain sexual orientation-related disparities in health indicators through adulthood, due to increased engagement in health indicators by heterosexual adults. Exposure to sexual orientation stigma in adolescence, measured as maternal comfort with LGB people, possibly drives well-known differences in drinking, smoking, and DWCB during adulthood between heterosexual and sexual minority adults.
Collapse
Affiliation(s)
- Alexa L Solazzo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret Rosario
- Department of Psychology, City College and The Graduate Center, City University of New York, New York, New York, USA
| | - Heather L Corliss
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, California, USA
| | - Brittany M Charlton
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
40
|
Singer S, Tkachenko E, Yeung H, Mostaghimi A. Skin cancer and skin cancer risk behaviors among sexual and gender minority populations: A systematic review. J Am Acad Dermatol 2020; 83:511-522. [PMID: 32068044 PMCID: PMC7369213 DOI: 10.1016/j.jaad.2020.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 02/01/2020] [Accepted: 02/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Individuals of sexual and gender minorities may have different lifetime risk of skin cancer and ultraviolet radiation exposure than heterosexual persons. OBJECTIVE To systematically review the prevalence of skin cancer and behaviors that increase risk of skin cancer among sexual and gender minority populations. METHODS We performed a systematic literature review in PubMed/MEDLINE, Embase, Cochrane, and Web of Science, searching for articles through October 18, 2019, that investigated risk of skin cancer and behaviors among sexual and gender minority populations. RESULTS Sexual minority men have a higher lifetime risk of any skin cancer (odds ratio range: 1.3-2.1) and indoor tanning bed use (odds ratio range: 2.8-5.9) compared with heterosexual men, whereas sexual minority women may use indoor tanning beds less frequently than heterosexual women and do not have an elevated risk of lifetime history of skin cancer. Gender-nonconforming individuals have higher lifetime prevalence of any skin cancer compared with cisgender men. LIMITATIONS Most variables rely on self-reporting in their original studies. CONCLUSIONS Sexual minority men disproportionately engage in use of indoor tanning beds, which may result in increased lifetime risk of skin cancer. Recognition of this risk is important for providing appropriate screening for patients in this population.
Collapse
Affiliation(s)
- Sean Singer
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth Tkachenko
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
41
|
Wilkerson JM, Di Paola A, McCurdy S, Schick V. Covariates of hazardous alcohol use among sexual and gender minorities in Texas: Identifying the most vulnerable. Addict Behav 2020; 105:106327. [PMID: 32044679 DOI: 10.1016/j.addbeh.2020.106327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Information is limited on the prevalence of hazardous drinking and associated covariates among sexual and gender minority (SGM) persons. These analyses estimated the prevalence of hazardous drinking and identified associated covariates. METHODS A total of 1273 SGM adolescents and adults living in Texas completed an online survey between March 2016 and January 2017. Variables associated with hazardous drinking at the bivariate-level (p < 0.10) were entered into multiple logistic regression models to estimate the strength of their association. RESULTS More than a third (39.1%) of participants meet criteria for hazardous drinking. Compared to non-hazardous drinkers, hazardous drinkers were younger (x- = 20.7 [SD = 8.9] vs. x- = 26.5 [SD = 13.8]) and more likely to be Hispanic (41.5% vs. 26.2%). Hazardous drinkers were more likely to report using substances in past 12 months, including opioids (15.3% vs. 6.7%), stimulants (26.3% vs. 12.7%), and marijuana (37.6% vs. 21.2%). More hazardous drinkers reported injecting drugs (12.3% vs. 5.8%) and having a history of incarceration (14.1% vs. 7.3%). They were less likely to be diagnosed with depression (50.2% vs. 56.5%). When entered into a multivariate logistic regression model, hazardous drinkers were more likely to be younger (aOR = 0.97 [0.95, 0.98]), Hispanic (aOR = 1.5 [1.2, 2.0]), have a history of incarceration (aOR = 2.4 [1.5, 3.6]), and use a substance, not including marijuana (aOR = 1.7 [1.3, 2.3]). They were less likely to be diagnosed with depression (aOR = 0.73 [0.6, 0.9]). CONCLUSIONS Our findings highlight the intersection of race and ethnicity, mental health, criminal justice involvement, and substance use and the need for tailored interventions that address underlying determinants.
Collapse
|
42
|
Caceres BA, Travers J, Primiano JE, Luscombe RE, Dorsen C. Provider and LGBT Individuals' Perspectives on LGBT Issues in Long-Term Care: A Systematic Review. Gerontologist 2020; 60:e169-e183. [PMID: 30726910 PMCID: PMC7117618 DOI: 10.1093/geront/gnz012] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Discrimination toward the lesbian, gay, bisexual and transgender (LGBT) population has raised concerns about the type of long-term services and supports (LTSS) that will be available to them as they age. To understand the unique needs of aging LGBT populations, we sought to synthesize and critique the evidence related to LTSS providers and LGBT individuals' perspectives of LGBT issues in LTSS in the United States. RESEARCH DESIGN AND METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of the literature was conducted. The Crowe Critical Appraisal Tool was used to appraise the quality of the included studies. RESULTS Nineteen studies met inclusion criteria. Seven studies that examined the perspectives of LTSS providers identified two themes, including that they lack knowledge and training on LGBT health issues and generally report negative attitudes toward same-sex relations among older adults. In addition, 12 studies that examined the perspectives of LGBT individuals found that they (i) are concerned about LTSS planning, (ii) fear discrimination from providers in LTSS, and (iii) identify several strategies for improving care of LGBT older adults receiving LTSS. DISCUSSION AND IMPLICATIONS This systematic review highlights the importance for LTSS providers to receive training in LGBT health and be reflective of potential biases toward the LGBT population. LGBT individuals identified concerns related to LTSS planning and fear of discrimination from LTSS providers. LGBT individuals also identified a need for increased training of providers to improve the care of LGBT older adults in LTSS.
Collapse
Affiliation(s)
- Billy A Caceres
- Program for the Study of LGBT Health, Columbia University School of Nursing, New York, New York
- Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing, New York
| | - Jasmine Travers
- National Clinician Scholars Program, Yale University, New Haven, Connecticut
| | | | | | - Caroline Dorsen
- New York University Rory Meyers, College of Nursing, New York
| |
Collapse
|
43
|
Gonzales G, McKay T, Carpenter CS. Disparities in Health Insurance Coverage and Access to Care for Children By Mother's Sexual Orientation. Matern Child Health J 2019; 24:630-639. [PMID: 31873831 DOI: 10.1007/s10995-019-02857-7] [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: 10/25/2022]
Abstract
OBJECTIVE Few population-based studies have examined the health care experiences of children with sexual minority parents. The purpose of this study was to compare health insurance status, access to care, and health services utilization for children by mother's sexual orientation. METHODS We used data on children with lesbian mothers (n = 195), bisexual mothers (n = 299), and heterosexual mothers (n = 23,772) in the 2013-2017 National Health Interview Survey. Logistic regression models were used to compare health insurance status, access to care, and health services utilization while adjusting for demographic and socioeconomic characteristics of the child, mother, and household. RESULTS After controlling for sociodemographic factors, there were no statistically significant differences in health insurance coverage, access to care, or health services utilization between children of lesbian mothers and children of heterosexual mothers. Compared to children with heterosexual mothers, children with bisexual mothers were more likely to have public health insurance (OR 2.33; 95% CI 1.07-7.68), delayed medical care due to cost (OR 2.33; 95% CI 1.12-4.86), unmet medical care due to cost (OR 2.86; 95% CI 1.07-7.68), and a visit to the emergency room (OR 1.74; 95% CI 1.27-2.39) in the prior year after controlling for child-level characteristics. Some of these differences were attenuated after controlling for maternal demographics and household characteristics. CONCLUSIONS FOR PRACTICE Children with bisexual mothers experience barriers to routine medical care. Addressing socioeconomic dimensions of health care access and targeted outreach to bisexual parents will help promote health equity for children growing up in sexual minority households.
Collapse
Affiliation(s)
- Gilbert Gonzales
- Center for Medicine, Health & Society, Vanderbilt University, 2301 Vanderbilt Place PMB #351665, Nashville, TN, 37235-1665, USA.
| | - Tara McKay
- Center for Medicine, Health & Society, Vanderbilt University, 2301 Vanderbilt Place PMB #351665, Nashville, TN, 37235-1665, USA
| | | |
Collapse
|
44
|
Gonzales G, Dedania R, Driscoll R. Health Insurance Coverage and Access to Care Among US-Born and Foreign-Born Sexual Minorities. J Immigr Minor Health 2019; 21:540-8. [PMID: 29946865 DOI: 10.1007/s10903-018-0774-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sexual minorities and immigrants face unique challenges to accessing health care in the United States. This study used data on nonelderly adults (n = 100,667) from the 2013-2016 National Health Interview Survey. Unadjusted prevalence estimates and multivariable logistic regression models (with and without interactions between immigration and sexual minority status) were used to compare health insurance coverage and access to care by immigration and sexual minority status. We did not find any differences in uninsurance, having a usual source of care, and a recent office visit by sexual orientation for US-born and foreign-born adults. However, compared to their heterosexual counterparts, US-born and foreign-born sexual minorities were more likely to have an emergency room visit in the prior year and report financial-related barriers to medical care, dental care, prescription medications, and mental health care. Foreign-born sexual minorities were more likely to have an emergency room visit and unmet mental health care needs due to cost compared to other subpopulations after controlling for sociodemographic characteristics. Broadening the knowledge and scope of research on sexual minority immigrants can inform targeted health policy approaches with the goal of achieving health equity for sexual minority immigrants.
Collapse
|
45
|
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) patients experience vast health care disparities. Numerous government and professional organizations have attempted to address these disparities by calling for improvement in LGBT health and increased research endeavors. Despite these initiatives, residents still receive inadequate education and training in LGBT health. Here, the authors review these shortcomings and provide a framework for how to improve resident education and training in LGBT health. They describe methods of curricular enhancements and departmental/institutional climate optimization to improve resident competency. Finally, they discuss how LGBT-competent physicians can publicize their expertise and improve overall LGBT health care delivery.
Collapse
Affiliation(s)
- Joseph W Fakhoury
- Department of Dermatology, Wayne State University School of Medicine, 18100 Oakwood Boulevard, Suite 300, Dearborn, MI 48214, USA
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, 18100 Oakwood Boulevard, Suite 300, Dearborn, MI 48214, USA.
| |
Collapse
|
46
|
Boris JR, McClain ZBR, Bernadzikowski T. Clinical Course of Transgender Adolescents with Complicated Postural Orthostatic Tachycardia Syndrome Undergoing Hormonal Therapy in Gender Transition: A Case Series. Transgend Health 2019; 4:331-334. [PMID: 31754630 PMCID: PMC6868651 DOI: 10.1089/trgh.2019.0041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/13/2022] Open
Abstract
Purpose: Postural orthostatic tachycardia syndrome (POTS), an increasingly recognized dysautonomia, may affect as many as 3,000,000 Americans. Concurrently, prevalence estimates suggest 10% of individuals identify as lesbian, gay, bisexual, transgender, or questioning/queer. The preponderance of female POTS patients implies hormonal differences between natal sexes and their role in POTS. Transgender POTS patients using hormone therapies may offer further insight into the mechanism of POTS. There have been no previously published studies of transgender patients with POTS undergoing gender-affirming hormone therapy. Methods: We reviewed our electronic health record for clinical histories of transgender patients in our POTS Database. Results: Three patients who transitioned from female to male demonstrated clinical improvement of their POTS symptoms with the addition of testosterone therapy. Conclusion: We present our clinical experience of three transgender POTS patients who transitioned from female to male with hormone therapy, all of whom demonstrated clinical improvement with testosterone. This may give further insight into the pathophysiology of POTS. However, the authors do not endorse the use of hormone therapy as primary therapy for the symptoms of POTS.
Collapse
Affiliation(s)
| | - Zachary B R McClain
- Division of Adolescent Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas Bernadzikowski
- Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
47
|
Demant D, Saliba B. Queer binge: harmful alcohol use among sexual minority young people in Australia. Public Health 2019; 179:18-26. [PMID: 31715550 DOI: 10.1016/j.puhe.2019.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/14/2019] [Accepted: 09/30/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The literature suggests that sexual minority young people (SMYP) use alcohol at disproportionate levels when compared with their heterosexual counterparts. Little is known about alcohol dependency symptoms and correlations between high-risk alcohol use/dependency symptoms and minority stress in this population in general and between subgroups. STUDY DESIGN Cross-sectional study. METHODS Descriptive statistics, adjusted odds ratios, and analysis of covariance were used to determine high-risk alcohol use, dependency symptoms, differences between subgroups, and correlations between alcohol use, dependency symptoms, and minority stress. RESULTS A total of 1556 Australian SMYPs aged 18 to 35 years completed the survey. Fifty percent of the participants reported high-risk alcohol consumption with significant differences between subgroups. Typical dependency symptoms such as 'health, social, legal or financial problems due to alcohol consumption' (16.8%, n = 247) were identified in large parts of the sample. High-risk consumption and dependency symptoms were significantly correlated with minority stress. CONCLUSION High levels of high-risk alcohol use and dependency symptoms were found, largely consistent with existing literature. However, disparities are not distributed equally in this population, suggesting that future health promotion interventions should focus on SMYP subgroups. Significant correlations between minority stress and dependency symptoms/high-risk use suggest a potential route for future interventions in these populations.
Collapse
Affiliation(s)
- Daniel Demant
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, Australia; School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
| | - Bernard Saliba
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| |
Collapse
|
48
|
Abstract
Sexual health is shaped by cultural, economic, and social norms in society. In the Arab region, cultural sensitivities and taboos surrounding sexuality are prominent and may prevent individuals from accessing and utilising sexual health services. It is important to map out available sexual health services to identify the challenges in availability, access, and treatment, and determine opportunities for improvement. We collected data on sexual health services through (1) relevant published and unpublished literature, (2) Arab media which included forums, websites, blogs and posts, and online surveys conducted in the Arab region, (3) a questionnaire emailed to sexual and reproductive health experts, organisations, clinics, and non-governmental organisations (NGOs), (4) phone and in-person formal and informal interviews with sexual health experts in the field, and (5) advice and recommendations from sexual health experts attending a World Health Organization (WHO) consultation meeting in Dubai related to sexual health in the Arab region. Although there is significant progress when it comes to the availability and provision of sexual health services in Arab countries, there is still a lot to be done to ensure that appropriate needs are met. This study discusses the implication of findings to inform programme and policy implementation in the region.
Collapse
Affiliation(s)
- Leona Zahlan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Nicole Khauli
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
49
|
Caceres BA, Hickey KT, Heitkemper EM, Hughes TL. An intersectional approach to examine sleep duration in sexual minority adults in the United States: findings from the Behavioral Risk Factor Surveillance System. Sleep Health 2019; 5:621-629. [PMID: 31377249 DOI: 10.1016/j.sleh.2019.06.006] [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] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 05/20/2019] [Accepted: 06/18/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Investigate sexual identity differences in sleep duration and the multiplicative effect of sexual identity and race/ethnicity among US adults. DESIGN Cross-sectional. PARTICIPANTS The sample consisted of 267,906 participants from the Behavioral Risk Factor Surveillance System. MEASUREMENTS Sleep duration was categorized as very short (≤4 hours), short (5-6 hours), adequate (7-8 hours), or long (≥9 hours). Sex-stratified multinomial logistic regressions were used to examine sexual identity differences in sleep duration. We then examined sleep duration by comparing sexual minorities to (1) same-race/-ethnicity heterosexuals and (2) White participants with the same sexual identity. RESULTS Sexual minority women had higher odds of very short sleep compared to heterosexual women, regardless of race/ethnicity. Black gay men had higher rates of very short sleep but lower rates of long sleep relative to Black heterosexual men. Latino and Asian/Pacific Islander bisexual men reported higher rates of short sleep than their heterosexual counterparts. Black lesbian and other-race bisexual women were more likely to have very short sleep than their heterosexual peers. Black lesbian women also had higher rates of long sleep. Analyses examining racial/ethnic differences by sexual identity found that Black and Latino gay men reported higher rates of very short sleep compared to White gay men. Black bisexual women had higher rates of short sleep duration than White bisexual women. CONCLUSIONS More research is needed to understand how to promote sleep health among sexual minorities, particularly racial/ethnic minorities, and the impact of inadequate sleep duration on health outcomes in this population.
Collapse
Affiliation(s)
- Billy A Caceres
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032.
| | - Kathleen T Hickey
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
| | - Elizabeth M Heitkemper
- Department of Biomedical Informatics, Columbia University, 622 W 168th St, PH20, New York, NY 10032
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
| |
Collapse
|
50
|
Jennings L, Barcelos C, McWilliams C, Malecki K. Inequalities in lesbian, gay, bisexual, and transgender (LGBT) health and health care access and utilization in Wisconsin. Prev Med Rep 2019; 14:100864. [PMID: 31011518 PMCID: PMC6465572 DOI: 10.1016/j.pmedr.2019.100864] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 01/05/2019] [Revised: 03/06/2019] [Accepted: 03/31/2019] [Indexed: 12/25/2022] Open
Abstract
There are known health disparities between lesbian, gay, bisexual and transgender (LGBT) people and non-LGBT people, but only in the past couple of decades have population-based health surveys in the United States included questions on sexual and gender identity. We aimed to better understand LGBT disparities in health, health care access and utilization, and quality of care. Data are from the Survey of the Health of Wisconsin (SHOW) from 2014 to 2016 (n = 1957). The analyses focused on comparing health care access and utilization, and quality of care between LGB and non-LGB people and transgender and cisgender people. 3.8% (n = 73) identified as lesbian, gay or bisexual, and 1.3% (n = 25) were transgender. LGB adults were 2.17 (95th CI: 1.07-4.4) times more likely to delay obtaining health care. Transgender adults were 2.76 (95th CI: 1.64-4.65) times more likely to report poor quality of care and 2.78 (95th CI: 1.10-7.10) unfair treatment when receiving medical care. The results show differences in health care access and utilization and quality of care, and they add to the growing body of literature that suggest that improved health care services for LGBT patients are needed to promote health equity for LGBT populations.
Collapse
Affiliation(s)
- Linn Jennings
- Department of Population Health Sciences, University of Wisconsin-Madison, Wisconsin Alumni Research Foundation, Madison, WI, USA
| | - Chris Barcelos
- Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Christine McWilliams
- Department of Population Health Sciences, University of Wisconsin-Madison, Wisconsin Alumni Research Foundation, Madison, WI, USA
| | - Kristen Malecki
- Department of Population Health Sciences, University of Wisconsin-Madison, Wisconsin Alumni Research Foundation, Madison, WI, USA
| |
Collapse
|