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Ginaldi L, De Martinis M. Who needs education on LGBTQIA+ healthcare inclusion? Med Educ Online 2024; 29:2329403. [PMID: 38484289 PMCID: PMC10946259 DOI: 10.1080/10872981.2024.2329403] [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: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
The topic of education on healthcare needs and equity of care for LGBTQIA+ populations is an extremely current issue. There is a demand for education on these topics not only from medical and other health sciences students but also from established healthcare professionals. Given this widespread educational deficiency, it is natural to ask whether the teaching class is prepared to satisfy these requests or in turn needs training on these issues and above all whether it is capable of transmitting attention and sensitivity on the issues of inclusion and equality in needs of healthcare.
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Affiliation(s)
- Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, Teramo, Italy
- Technical Group for the Coordination of Gender Medicine, Regione Abruzzo, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, Teramo, Italy
- Technical Group for the Coordination of Gender Medicine, Regione Abruzzo, Italy
- Long-Term Care Unit, “Maria SS. dello Splendore” Hospital, Giulianova, Italy
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
- President bachelor’s degree in Nursing, “Teramo hub” University of L’Aquila, Teramo, Italy
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2
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Aggarwal RA, Fields CD, van Zuilen MH. Mental Health for LGBTQIA+ Older Adults. Clin Geriatr Med 2024; 40:299-308. [PMID: 38521600 DOI: 10.1016/j.cger.2023.10.003] [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: 03/25/2024]
Abstract
LGBTQIA+ older adults share a unique set of risk factors that impact mental health. This article provides an overview of the minority stress and allostatic load models and how they can lead to worse physical and mental health outcomes. The article also describes unique epidemiologic and psychosocial context for various aspects of mental health among LGBTQIA+ older adults. Within each section are suggestions for health care providers when addressing these mental health issues and caring for LGBTQIA+ older adults in all settings.
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Affiliation(s)
- Rohin A Aggarwal
- Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Cynthia D Fields
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 235, Baltimore, MD 21287, USA
| | - Maria H van Zuilen
- Department of Medical Education, University of Miami Miller School of Medicine (R53), 1600 NW 19th Avenue, Miami, FL 33136, USA
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3
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Danielewicz M. Medical Issues Affecting Older Gay and Bisexual Men. Clin Geriatr Med 2024; 40:239-250. [PMID: 38521595 DOI: 10.1016/j.cger.2023.11.003] [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: 03/25/2024]
Abstract
Older gay and bisexual men constitute diverse, sizable, and potentially vulnerable populations. They have and continue to face discrimination and stigma in multiple settings, including health care. Older gay and bisexual men report worse health, higher rates of alcohol and tobacco use, and higher HIV rates compared with their heterosexual counterparts. They have unique needs and experiences in multiple realms of health care including mental health, sexual health, and cancer screenings. Geriatric medicine physicians and providers can educate themselves on these unique needs and risks and take steps to provide inclusive, affirming care.
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Affiliation(s)
- Michael Danielewicz
- Pride at the Jefferson Center for Healthy Aging, Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA 19147, USA.
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4
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Primbas AD, Ogawa A. Medical Issues Affecting Older Lesbian and Bisexual Women. Clin Geriatr Med 2024; 40:251-260. [PMID: 38521596 DOI: 10.1016/j.cger.2023.12.001] [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: 03/25/2024]
Abstract
Lesbian and bisexual (LB) women are a growing and understudied population in the United States. LB women have unique histories and health experiences and encounter numerous resource and health care disparities that impact healthy aging. Despite LB population growth, little research has investigated the experiences of LB women separately from the broader lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity (LGBTQ+) community. The research that does exist largely focuses on the experiences of younger LB women. Nonetheless, there are unique care considerations providers can enact to improve clinical care and address lifetimes of disparities and discrimination.
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Affiliation(s)
- Angela D Primbas
- Division of Geriatrics, Department of Medicine, UCLA David Geffen School of Medicine, University of California, 200 Medical Plaza, Suite 365A, Los Angeles, CA 90024, USA.
| | - Al Ogawa
- Swedish Cherry Hill Family Medicine Residency
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Shastri VG, Erney EJ. Psychosocial and Financial Issues Affecting LGBTQ+ Older Adults. Clin Geriatr Med 2024; 40:309-320. [PMID: 38521601 DOI: 10.1016/j.cger.2023.10.004] [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: 03/25/2024]
Abstract
Isolation, financial insecurity, incomplete advance care planning, and lack of safe/affordable/inclusive long-term care are challenges magnified in gender and sexual minorities. LGBTQIA+ older adults are disproportionately more likely to live alone and experience financial poverty and social isolation. LGBTQIA+ adults suffering from cognitive impairment are an especially defenseless population due to their lack of social connection and potential lack of financial resources and advance care planning.
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Affiliation(s)
- Vinita Gidvani Shastri
- GRECC, VA Palo Alto Health Care System, Stanford School of Medicine, 3801 Miranda Avenue (182b), Palo Alto, CA 94304, USA.
| | - Erica Joy Erney
- The Permanente Medical Group, Kaiser Permanente Santa Clara Medical Center, 710 Lawrence Expressway, Dept 440 (MOB), Santa Clara, CA 95051, USA
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Fowler JA, Buckley L, Viskovich S, Muir M, Dean JA. Healthcare providers perspectives on digital, self-guided mental health programs for LGBTQIA+ individuals: A cross-sectional online survey. Psychiatry Res 2024; 335:115873. [PMID: 38555827 DOI: 10.1016/j.psychres.2024.115873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 03/07/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Digital, self-guided mental health programs are a promising avenue for mental health support for LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual plus additional sexuality, gender, and romantic identities) people - however, healthcare providers (HCPs) perspectives on programs are largely unknown. The aim of this study was to explore these perspectives. A cross-sectional online survey was distributed across Australia, with a final sample of 540 HCPs from a range of disciplines. Most respondents (419, 81.2 %), reported that digital, self-guided mental health programs would be useful, but 74.5 % (n = 380) also reported that they had concerns. Thematic analysis of open-text responses showed that HCPs believe programs may help overcome access barriers and could be useful as part of a wider care journey. Others were concerned about patient safety, and whether programs could be appropriately tailored to LGBTQIA+ experiences. Content analysis of open-text responses showed affirming language and imagery, content on LGBTQIA+ people's unique challenges, wider health information, and connections to community were important to include in programs. HCPs advocated for programs that offered broad and sub-population specific information. These findings show that HCPs are enthusiastic about digital, self-guided mental health programs, but care should be taken to address key concerns to facilitate future implementation.
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Affiliation(s)
- James A Fowler
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, Brisbane, QLD 4006, Australia.
| | - Lisa Buckley
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, Brisbane, QLD 4006, Australia
| | - Shelley Viskovich
- The University of Queensland, Faculty of Health and Behavioral Sciences, School of Psychology, St Lucia, Brisbane, QLD 4027, Australia
| | - Miranda Muir
- The University of Queensland, Faculty of Health and Behavioral Sciences, School of Psychology, St Lucia, Brisbane, QLD 4027, Australia
| | - Judith A Dean
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, Brisbane, QLD 4006, Australia
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Draper-Rodi J, Abbey H, Hammond J, Thomson OT, Brownhill K, MacMillan A, Fabusuyi Y, Vogel S. Overcoming barriers to equality, diversity, inclusivity, and sense of belonging in healthcare education: the Underrepresented Groups' Experiences in Osteopathic Training (UrGEnT) mixed methods study. BMC Med Educ 2024; 24:468. [PMID: 38671395 PMCID: PMC11055260 DOI: 10.1186/s12909-024-05404-3] [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] [Received: 02/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Individuals from minority groups have historically faced social injustices. Those from underrepresented groups have been less likely to access both healthcare services and higher education. Little is known about the experiences of underrepresented students during their undergraduate studies in osteopathy in the UK. The aim of this project was to explore awareness of cultural diversity and beliefs about patients from underrepresented groups in current osteopathic educational environments and evaluate students' preparedness to manage patients from diverse groups. The project also aimed to investigate the educational experiences of students from underrepresented backgrounds during their training and their opinions on changes that could support better levels of recruitment and achievement. The findings were discussed with stakeholders in interactive workshops with the aim to develop recommendations for action and change. METHODS A transformative action research paradigm informed this mixed methods project. It included: 1/ a survey of students from all seven osteopathic educational providers in the UK using the Multidimensional Cultural Humility Scale (MCHS); 2/ a series of focus groups with students from underrepresented groups (women, students with disabilities, students from minority ethnic backgrounds, and students identifying as LGBTQIA+); and 3/ a workshop forum to discuss findings. RESULTS A total of 202 participants completed the MCHS and demographic questionnaire and seven focus groups were conducted. A model was developed to describe participants' training experiences comprising two main themes: institutional contextual obstacles (with four sub-themes) and underrepresented students' conceptual understanding of Equity, Diversity and Inclusion (EDI). Recommendations for change identified in the workshops were based on three topics: institutions, staff, and students. CONCLUSION Our findings confirm conclusions from other institutions that staff education is urgently needed to create and maintain equitable, inclusive environments in osteopathic educational institutions in the UK to support all students, particularly those from underrepresented groups. Institutional EDI processes and policies also need to be clarified or modified to ensure their usefulness, accessibility, and implementation.
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Affiliation(s)
- Jerry Draper-Rodi
- University College of Osteopathy, 275 Borough High Street, SE1 1JE, London, UK.
- National Council for Osteopathic Research, 275 Borough High Street, SE1 1JE, London, UK.
| | - Hilary Abbey
- University College of Osteopathy, 275 Borough High Street, SE1 1JE, London, UK
| | - John Hammond
- School of Allied and Public Health Professions, North Holmes Road, CT1 1QU, Canterbury, Kent, UK
| | - Oliver T Thomson
- University College of Osteopathy, 275 Borough High Street, SE1 1JE, London, UK
| | - Kevin Brownhill
- University College of Osteopathy, 275 Borough High Street, SE1 1JE, London, UK
| | - Andrew MacMillan
- University College of Osteopathy, 275 Borough High Street, SE1 1JE, London, UK
- University of Portsmouth, University House, Winston Churchill Ave, PO1 2UP, Hampshire, Portsmouth, England
| | - Yinka Fabusuyi
- University College of Osteopathy, 275 Borough High Street, SE1 1JE, London, UK
| | - Steven Vogel
- University College of Osteopathy, 275 Borough High Street, SE1 1JE, London, UK
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8
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Perone AK. An Historical Case Study of Trans Exclusion and Empowerment: Implications for Transgender Older Adults and Aging. J Gerontol Soc Work 2024:1-27. [PMID: 38652754 DOI: 10.1080/01634372.2024.2339987] [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] [Received: 08/03/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
Transgender older adults have a long history of exclusion that shapes current experiences with social services. However, scant gerontological research uses archival data, which can provide critical context for service providers. Moreover, sparse research examines how exclusion can be a catalyst for change that social workers could leverage. Empowerment theory provides a theoretical tool to explain how this is possible. This multidisciplinary case study blends community member interviews and archival data to answer this question: How did exclusion shape empowerment and social change for transgender Americans? This study focuses on the events before and after the Compton's Cafeteria Riot, one of the first acts of LGBTQIA+ collective resistance that led to new services for and by transgender Americans. Data reveal how exclusion facilitated the emergence of collective empowerment among transgender women and queer youth in San Francisco. Archival data shows how exclusion preceded self-efficacy, critical consciousness, involvement with similar others, acquisition of new skills, and ultimately action to eliminate social, economic, and political barriers and power imbalances. This study provides both empirical and theoretical tools to contribute new data and perspectives on trans exclusion and empowerment and its implications for social workers serving transgender older adults.
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Affiliation(s)
- Angela K Perone
- Berkeley School of Social Welfare, Center for the Advanced Study of Aging Services, University of California, Haviland Hall, Berkeley, California, USA
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9
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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.
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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
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Feher M, Forjan J. "The Slovenian Word For These People is 'Degenerates'!": Examining Negative Attitudes Toward Non-Normative Sexual and Gender Identities in Slovenian Online Comments. J Homosex 2024; 71:1332-1355. [PMID: 36689307 DOI: 10.1080/00918369.2023.2170304] [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: 06/17/2023]
Abstract
Numerous reports have documented the discrimination, physical, and verbal attacks on LGBTQIA+ people throughout the world and the situation in Slovenia, a Central European country, is similar, albeit with its own national and historic specifics. Therefore, we see it as crucial to identify the prevailing negative discourses about the LGBTQIA+ community within this country. In this paper, we identify different negative discourses about non-normative sexual and gender identities in Slovenia by analyzing hateful online comments posted under different LGBTQIA-related articles on the most frequented Slovenian news websites. We identified seven different themes within anti-LGBTQIA+ discourses with the current article focusing on themes of the Hegemonic binary and Non-normative identities. The anti-LGBTQIA+ discourses identified in this article often denigrate the non-normative LGBTQIA+ identity and discursively construct it as inferior to the prevailing cis-heterosexual identity. We argue that identified discourses are linked with the resurgence of the anti-gender movement and the retraditionalization of society and also constitute a form of violence, which is especially true for violence directed at subjects constituted as dispensable, whose life is seen as not worth valuing and not worth living, which are often members of the LGBTQIA+ community.
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Affiliation(s)
- Miha Feher
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Jan Forjan
- Faculty of Social Work, University of Ljubljana, Ljubljana, Slovenia
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Kim RW, McKenzie NC, Leslie KS. Retrospective review of Mpox: Morphology and presentation in skin of color and sexual minorities. J Am Acad Dermatol 2024:S0190-9622(24)00625-X. [PMID: 38608867 DOI: 10.1016/j.jaad.2024.01.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Richard W Kim
- University of California San Francisco School of Medicine, San Francisco, California.
| | | | - Kieron S Leslie
- Department of Dermatology, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California
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12
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Hunt GR, Higgins DJ, Willis ML, Mathews B, Lawrence D, Meinck F, Pacella R, Thomas HJ, Scott JG, Erskine HE, Malacova E, Haslam DM. The Prevalence of Peer Sexual Harassment During Childhood in Australia. J Interpers Violence 2024:8862605241245368. [PMID: 38591149 DOI: 10.1177/08862605241245368] [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: 04/10/2024]
Abstract
Sexual harassment inflicted by adolescents on their peers is a major public health issue, but its prevalence across childhood is not known. We provide the first nationally representative data on the prevalence of peer sexual harassment across childhood, using cross-sectional data from the Australian Child Maltreatment Study (ACMS). The ACMS surveyed 8,503 people aged 16 and over about their experiences of child maltreatment and associated health outcomes. The prevalence of peer sexual harassment was assessed using the Juvenile Victimization Questionnaire (JVQ)-R2 Adapted Version (ACMS), with survey data weighted to reflect characteristics of the Australian population. Overall, 1 in 10 (10.4% (95% Confidence Intervals (CI) [9.7, 11.3])) Australians experienced peer sexual harassment during childhood. Peer sexual harassment is an issue disproportionately affecting gender-diverse individuals (24.0%, 95% CI [15.5, 35.2]) and women (15.3%, 95% CI [14.0, 16.7%]), compared to men (5.0%, 95% CI [4.3, 5.9]). Rates of peer sexual harassment were also very high among sexuality diverse participants (prevalence estimates ranging between 14.2% and 29.8%). Peer sexual harassment was predominately inflicted by male peers (9.6%, 95% CI [8.9, 10.4]), compared to 1.8% (95% CI [1.5, 2.2]) reporting harassment from female peers. These findings have implications for understanding and reducing attitudes supporting peer sexual harassment in childhood, particularly against girls and gender and sexuality diverse youth, and associations with other gendered violence both in childhood and later life.
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Affiliation(s)
| | | | | | - Ben Mathews
- Queensland University of Technology, Brisbane, Australia
- Johns Hopkins University, Bloomberg School of Public Health, MD, USA
| | | | - Franziska Meinck
- University of Edinburgh, UK
- North-West University, Vanderbijlpark, South Africa
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hannah J Thomas
- Queensland Centre for Mental Health Research, Wacol, Australia
- The University of Queensland, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - James G Scott
- The University of Queensland, Brisbane, Australia
- Children's Health QLD, South Brisbane, Australia
| | - Holly E Erskine
- Queensland Centre for Mental Health Research, Wacol, Australia
| | - Eva Malacova
- QIMR Berghofer, Medical Research Institute, Brisbane, QLD, Australia
| | - Divna M Haslam
- Queensland University of Technology, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
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13
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Ginaldi L, Lelii S, Pinto ME, Trovato G, De Martinis M. Sexual orientation and gender identity (SOGI) and electronic health record data collection by national health systems to overcome disparities in healthcare. Intensive Crit Care Nurs 2024:103699. [PMID: 38584050 DOI: 10.1016/j.iccn.2024.103699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy; Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, Italy; Technical Group for the Coordination of Gender Medicine, Regione Abruzzo, Italy
| | - Sara Lelii
- Long-Term Care Unit, "Maria SS. dello Splendore" Hospital, Giulianova AUSL 04, Teramo, Italy
| | - Maria Elena Pinto
- Long-Term Care Unit, "Maria SS. dello Splendore" Hospital, Giulianova AUSL 04, Teramo, Italy
| | - Giacomo Trovato
- Long-Term Care Unit, "Maria SS. dello Splendore" Hospital, Giulianova AUSL 04, Teramo, Italy
| | - Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy; Technical Group for the Coordination of Gender Medicine, Regione Abruzzo, Italy; Long-Term Care Unit, "Maria SS. dello Splendore" Hospital, Giulianova AUSL 04, Teramo, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy; President Bachelor's Degree in Nursing, "Teramo Hub" University of L'Aquila, Italy.
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14
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Villemure SE, Wilby KJ. The burden of an identity: Coping strategies for sexual and gender minority individuals in pharmacy practice. Am J Health Syst Pharm 2024; 81:291-296. [PMID: 38141247 DOI: 10.1093/ajhp/zxad318] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Indexed: 12/25/2023] Open
Abstract
PURPOSE Sexual or gender minority (SGM) individuals are known to experience stigma and discrimination in pharmacy settings. It is also known that SGM individuals may delay or avoid care in pharmacies due to the stress associated with these experiences. Aside from avoidance, however, little is known about how SGM individuals cope with stigma and discrimination and how their coping strategies may influence their healthcare behaviors. Therefore, this study aimed to characterize how SGM individuals cope with stigma and discrimination associated with their SGM identity in pharmacy settings. METHODS This was a qualitative study conducted using semistructured interviews. A total of 31 SGM individuals were recruited across 2 Canadian provinces. Interviews followed a topic guide designed according to the minority stress model to elicit participants' lived experiences in community pharmacies. Thematic analysis was used to identify and interpret themes. RESULTS Five themes were identified that described coping strategies used by SGM individuals when encountering minority stress processes in pharmacy settings: avoidance (avoiding or withdrawing from care), seeking support (from people or settings), perseverance (when faced with no other option), concealment (of SGM identity), and lowering expectations (of pharmacist knowledge and competence). CONCLUSION Our findings support the notion that individuals cope in different ways and across a wide spectrum of behaviors. Those who avoid care, conceal their SGM identity, or are forced to persevere through interactions may be at increased risk for both physical and mental health disparities. Those who seek support or lower expectations may also be at risk for reduced access to quality care.
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Affiliation(s)
- Samuel E Villemure
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Kyle John Wilby
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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15
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A Nardolillo J, DiLucia A, Kerwin T, Ramirez SR, Vazquez MC, Murry LT, Medlin CG. An exploratory mixed-methods evaluation of continuing education opportunities related to the care of sexual and gender minority patients from ACPE-accredited providers. Am J Health Syst Pharm 2024; 81:306-315. [PMID: 38150575 DOI: 10.1093/ajhp/zxad331] [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: 12/20/2023] [Indexed: 12/29/2023] Open
Abstract
PURPOSE The objective of this analysis was to describe trends in continuing education opportunities for pharmacy professionals across the US related to the care of sexual and gender minority (SGM) patients. METHODS Continuing education programs offered by Accreditation Council for Pharmacy Education (ACPE)-accredited providers from 2012 through 2022 were identified by searching the ACPE database for titles containing SGM terminology. Data including ACPE provider classification, activity type, format, audience, ACPE topic designator, interprofessional accreditation, contact hours, and learning objectives were collected. Content analysis was used to categorize activities. RESULTS Following removal of duplicates and non-SGM-focused programming, 726 programs were identified. The most commonly observed program characteristics included a live format (67.6%, n = 491), a pharmacist audience (77.1%, n = 560), knowledge-based activities (90.8%, n = 656), a college or school of pharmacy provider (21.6%, n = 157), an ACPE topic of pharmacy administration (50.6%, n = 367), and a focus on pharmacy rather than interprofessional audiences (87.1%, n = 632). The median program length was 1 hour (interquartile range, 1-1.25 hours). The qualitative analysis identified programs focused on topics of gender-affirming care (pharmacotherapy) (32.1%, n = 233), general SGM (26.7%, n = 194), gender-affirming care (nonpharmacotherapy), sexually transmitted infections (7.2%, n = 52), and health disparities (3.9%, n = 28). CONCLUSION Advancement has occurred in the number of available continuing pharmacy education programs focused on the care of SGM patients. Further information regarding specific content and effectiveness of continuing education is necessary to determine strategies to better prepare pharmacy professionals to care for this growing patient population.
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Affiliation(s)
- Joseph A Nardolillo
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island College of Pharmacy, Kingston, RI, and Rhode Island Primary Care Physicians Corporation, Cranston, RI, USA
| | - Alex DiLucia
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Taya Kerwin
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Samantha R Ramirez
- Department of Pharmacy Practice and Clinical Sciences, The University of Texas at El Paso School of Pharmacy, El Paso, TX, USA
| | - Maria C Vazquez
- Department of Pharmacy Practice and Clinical Sciences, The University of Texas at El Paso School of Pharmacy, El Paso, TX, USA
| | - Logan T Murry
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | - Christopher G Medlin
- Department of Pharmacy Practice and Clinical Sciences, The University of Texas at El Paso School of Pharmacy, El Paso, TX, USA
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Morrison T, Wright W, Astle K, Abdul-Mutakabbir JC. Exploring the intersectionality of racism and sexual/gender minority health: A call to action for health-system pharmacists. Am J Health Syst Pharm 2024; 81:326-333. [PMID: 38146922 DOI: 10.1093/ajhp/zxad327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
- Takira Morrison
- Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
| | - Wesley Wright
- Department of Pharmacy Practice, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Kevin Astle
- Department of Pharmacotherapeutics and Clinical Research, Taneja College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Jacinda C Abdul-Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA
- Division of the Black Diaspora and African American Studies, University of California San Diego, La Jolla, CA, USA
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Rogers SM, Lopez RM, Crossway AK, Moffit DM, Sturtevant J, Hansen A. The Role of the Athletic Trainer in Providing Care to Transgender and Gender-Diverse Patients: Foundational Knowledge and Disparities-Part I. J Athl Train 2024; 59:338-344. [PMID: 36735644 DOI: 10.4085/1062-6050-0311.22] [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: 02/04/2023]
Abstract
Transgender and gender-diverse (TGD) patients experience discrimination, harassment, marginalization, and minority stress at greater rates than their cisgender counterparts, leading to numerous health and health care disparities that negatively affect well-being and access to quality health care.1 Despite being in an opportune position to improve health equity for TGD patients under their care, many athletic trainers (ATs) report having little to no formal education on TGD patient care, leading to a reduction in self-reported competence. As such, to fill this knowledge gap, the purposes of the first part of this 2-part narrative literature review are to (1) provide readers with foundational information and terminology, (2) explore relevant health and health care disparities, and (3) identify the role of the AT within an interprofessional care team treating TGD patients.
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Affiliation(s)
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa
| | | | - Dani M Moffit
- Physical Therapy & Athletic Training Department, Idaho State University, Pocatello
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Maestre G, Hill C, Griffin P, Hall S, Hu W, Flatt J, Babulal G, Thorpe R, Henderson JN, Buchwald D, Manson S, Cicero E, Gilmore‐Bykovskyi A, Gamaldo A, Glover C, Barnes L, Kind A, James B, Zeki Al Hazzouri A, Wharton W, Caramelli P, Szanton S, Whitmer R, Benn Torres J, Deters K, Okonkwo O, Das R, Martinez‐Gonzalez K, Carrillo M. Promoting diverse perspectives: Addressing health disparities related to Alzheimer's and all dementias. Alzheimers Dement 2024; 20:3099-3107. [PMID: 38460119 PMCID: PMC11032522 DOI: 10.1002/alz.13752] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 03/11/2024]
Abstract
Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participants are primarily well-resourced, non-Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowledge gap about Alzheimer's-related risk factors in those other groups. The Alzheimer's Association hosted a virtual conference on June 14-16, 2021, supported in part by the National Institute on Aging (R13 AG072859-01), focused on health disparities. The conference was held entirely online and consisted of 2 days of core programming and a day of focused meetings centered on American Indian and Alaska Natives and on LGBTQIA+ populations. Over 1300 registrants attended discussions focused on the structural and systemic inequities experienced across diverse groups, as well as ways to investigate and address these inequities.
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Affiliation(s)
- Gladys Maestre
- School of MedicineAlzheimer's Disease Resource Center for Minority Aging ResearchUniversity of Texas Rio Grande ValleyBrownsvilleTexasUSA
| | - Carl Hill
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Percy Griffin
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Stephen Hall
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - William Hu
- Rutgers Robert Wood Johnson Medical School and Rutgers Institute for HealthHealth Care Policy, and Aging ResearchNew BrunswickNew JerseyUSA
| | - Jason Flatt
- Department of Social and Behavioral HealthSchool of Public HealthUniversity of Nevada Las VegasLas VegasNevadaUSA
| | - Ganesh Babulal
- Department of NeurologySchool of MedicineWashington University in St. LouisSt. LouisMissouriUSA
| | - Roland Thorpe
- Center on AgingCenter on Health Disparities SolutionsHopkins Population CenterAlzheimer's Disease Resource Center for Minority Aging ResearchJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health Elson S Floyd College of Medicine Washington State UniversitySeattleWashingtonUSA
| | - Spero Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Ethan Cicero
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Andrea Gilmore‐Bykovskyi
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Alyssa Gamaldo
- Pennsylvania State UniversityState CollegePennsylvaniaUSA
| | | | - Lisa Barnes
- Rush University Medical CenterChicagoIllinoisUSA
| | - Amy Kind
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWisconsinUSA
| | - Bryan James
- Rush University Medical CenterChicagoIllinoisUSA
| | - Adina Zeki Al Hazzouri
- Mailman School of Public HealthDepartment of EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Sarah Szanton
- Johns Hopkins University School of NursingBaltimoreMarylandUSA
| | - Rachel Whitmer
- Department of Public Health SciencesDepartment of NeurologyUniversity of California DavisDavisCaliforniaUSA
| | | | - Kacie Deters
- Department of NeurosciencesUniversity of California San Diego School of MedicineLa JollaCaliforniaUSA
| | - Ozioma Okonkwo
- Department of Medicine and the Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Rina Das
- National Institute on Minority Health and Health DisparitiesBethesdaMarylandUSA
| | | | - Maria Carrillo
- Medical & Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
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Crossway AK, Rogers SM, Hansen A, Sturtevant J, Moffit DM, Lopez RM. The Role of the Athletic Trainer in Providing Care to Transgender and Gender-Diverse Patients: Considerations for Medical Affirmation-Part II. J Athl Train 2024; 59:345-353. [PMID: 36735628 DOI: 10.4085/1062-6050-0313.22] [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: 02/04/2023]
Abstract
Recently, with discriminatory legislation efforts and changing participation policies in organized sports, media attention surrounding transgender and gender-diverse (TGD) individuals has increased. These changes and the historical lack of competence and education regarding the transgender patient population have resulted in subpar patient care and a misunderstanding of the athletic trainer's (AT's) role within the health care and compliance systems. This literature review is the second part of a 2-paper series, and our objective was to educate ATs on the processes relevant to medical affirmation, including compliance considerations regarding medical eligibility, and to establish the AT's role. The gender affirmation framework includes social and legal components, which are discussed in part 1 of this literature, and the medical component is thoroughly discussed in part 2. All health care providers involved in the care of TGD individuals should work collaboratively on an interprofessional care team and have a general knowledge of the gender-affirmation process, including gender-affirming hormone therapy, surgical options, known risks and complications, and the general health needs of TGD patients. With this knowledge, ATs, as point-of-care providers and members of the interprofessional care team, are uniquely positioned to help reduce health and health care disparities. Furthermore, ATs can use their knowledge to facilitate medical compliance and eligibility in the evolving policies of sporting organizations.
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Affiliation(s)
| | | | | | | | - Dani M Moffit
- Physical Therapy & Athletic Training Department, Idaho State University, Pocatello
| | - Rebecca M Lopez
- Department of Orthopaedics & Sports Medicine, School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa
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20
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Tatta J, Phillips RS, Ryder LR, Haberman A, Kakimi M, Miller OG. A Call to Action: Develop Physical Therapist Practice Guidelines to Affirm People Who Identify as LGBTQIA. Phys Ther 2024:pzae049. [PMID: 38531777 DOI: 10.1093/ptj/pzae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/22/2023] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Joe Tatta
- Integrative Pain Science Institute, New York, New York, USA
- Arcadia University, Department of Physical Therapy, Glenside, Pennsylvania, USA
- PT Proud Special Interest Group, Academy of Leadership and Innovation, A Component of the American Physical Therapy Association, Alexandria, Virginia, USA
| | - Robert S Phillips
- PT Proud Special Interest Group, Academy of Leadership and Innovation, A Component of the American Physical Therapy Association, Alexandria, Virginia, USA
- Franklin Pierce University, Department of Physical Therapy, Goodyear, Arizona, USA
- Cleveland Clinic Rehabilitation Hospitals - Edwin Shaw, Akron, Ohio, USA
| | - Lee R Ryder
- PT Proud Special Interest Group, Academy of Leadership and Innovation, A Component of the American Physical Therapy Association, Alexandria, Virginia, USA
| | - Aviel Haberman
- PT Proud Special Interest Group, Academy of Leadership and Innovation, A Component of the American Physical Therapy Association, Alexandria, Virginia, USA
- California State University, Sacramento, Department of Physical Therapy, Sacramento, California, USA
| | - Mel Kakimi
- PT Proud Special Interest Group, Academy of Leadership and Innovation, A Component of the American Physical Therapy Association, Alexandria, Virginia, USA
- Pacific University, School of Physical Therapy & Athletic Training, Forest Grove, Oregon, USA
| | - Olivia G Miller
- PT Proud Special Interest Group, Academy of Leadership and Innovation, A Component of the American Physical Therapy Association, Alexandria, Virginia, USA
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21
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Yee S, Mamone AA, Fatima M, Sharon-Weiner M, Librach CL. Parenthood desire, perceived parenthood stigma, and barriers to achieving parenthood in childless sexual minority men. J Assist Reprod Genet 2024:10.1007/s10815-024-03098-6. [PMID: 38520619 DOI: 10.1007/s10815-024-03098-6] [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] [Received: 01/08/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
PURPOSE To examine the parenthood desire, perceived parenthood stigma, and barriers to achieving parenthood among sexual minority men (SMM) in Canada, and to investigate factors influencing their fertility and assisted reproductive knowledge. METHODS Data were collected from March to mid-June 2023 using a 78-item anonymous online survey. Childless cisgender SMM (age 18+) living in Canada were recruited from the LGBTQIA+ community outside the fertility care networks. Chi-square, t-tests, ANOVA, reliability tests, Spearman's correlation, and hierarchical regression model were used for analysis. RESULTS Over 160 people clicked the survey hyperlink during the study period and 112 completed surveys were analyzed. The mean age of participants was 33.2±8.5 (range: 19.7-60.0). Having a child by any means was "quite"/"very" important to 35.7% (n=40), yet 56.0% (n=61) thought it was "unlikely" to achieve parenthood. Financial readiness (n=90, 85.7%) and relationship stability (n=86, 81.9%) were the two most "important" parenthood considerations. Participants who were non-white (p=0.017), under age 30 (p=0.008), and had no siblings (p=0.024) had significantly higher means of parenthood desire compared to others. The final hierarchical regression model explained 43% of the variance in the knowledge scores (R2adj =0.353), predicted by the levels of (i) education (β=0.37, p<0.001), (ii) family acceptance of sexual orientation (β=0.39, p=0.004), and (iii) parenthood desire (β=0.27, p=0.002). CONCLUSIONS With an increasing number of SMM desiring children, it is pivotal to advance family-building equality through improving their fertility and assisted reproductive knowledge, removing disparities in accessing adoption and assisted reproductive services, and decreasing social stigma against SMM having children.
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Affiliation(s)
- Samantha Yee
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, Canada.
| | - Amar A Mamone
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, Canada
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Maryam Fatima
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, Canada
| | - Maya Sharon-Weiner
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Clifford L Librach
- CReATe Fertility Centre, 790 Bay Street, Suite 1100, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Reproductive Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada
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22
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Rahman E, Rao P, Webb WR, Philipp-Dormston WG, Sayed K, Almeida ART, Mosahebi A, Carruthers JDA, Carruthers A. Embracing Spectrum: Celebrating LGBTQIA+ Journeys in Aesthetic Medicine: A Kaleidoscope of Identity. Aesthetic Plast Surg 2024:10.1007/s00266-024-03923-4. [PMID: 38499877 DOI: 10.1007/s00266-024-03923-4] [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] [Received: 12/04/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE This synaptic systemised review critically examines the provision of aesthetic medical care to LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more) individuals, assessing both the clinical practices and the educational frameworks that guide interactions with LGBTQIA+ patients in aesthetic settings. METHODS Following PRISMA-S guidelines, a comprehensive review was conducted, initially identifying 159 potentially relevant articles. Upon stringent full-text review, 33 studies met the inclusion criteria and were subject to an in-depth thematic analysis. The scope encompassed qualitative studies, quantitative analyses, and a cross section of interdisciplinary research, predominantly from Western settings. RESULTS The analysis distilled four principal themes: the imperative of identity affirmation in aesthetic interventions, substantial barriers to inclusive and empathetic care, the critical need for patient empowerment, and the existing deficiencies within medical education regarding LGBTQIA+ care. These themes highlight a complex interplay between the clinical aspirations of LGBTQIA+ individuals and the current capacity of aesthetic medicine to cater to this diversity. CONCLUSIONS There is a pressing need for a paradigmatic shift towards more inclusive, competent, and sensitive aesthetic medical care for LGBTQIA+ patients. It underscores the necessity of reform in medical education and advocates for policy changes that promote a more equitable healthcare environment. This research serves as a call to action, emphasizing the ethical imperative to integrate comprehensive LGBTQIA+ care competencies into aesthetic medicine curricula and practice. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Eqram Rahman
- Research and Innovation Hub, Innovation Aesthetics, London, WC2H 9JQ, UK.
| | - Parinitha Rao
- Aesthetic Dermatology Practice, The Skin Address, Bangalore, India
| | | | | | - Karim Sayed
- Nomi Clinic, Oslo, Norway
- University of South East Norway, Notodden, Norway
| | - Ada R T Almeida
- Dermatologic Clinic, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | | | - Jean D A Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - Alastair Carruthers
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
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23
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Bernier LB, Foley JD, Salomaa AC, Scheer JR, Kelly J, Hoeppner B, Batchelder AW. Examining sexual minority engagement in recovery community centers. J Subst Use Addict Treat 2024; 161:209340. [PMID: 38494052 DOI: 10.1016/j.josat.2024.209340] [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] [Received: 09/04/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Research indicates that sexual minority (SM) individuals with alcohol and other drug use disorders may underutilize recovery resources generally but be more likely to use recovery community centers (RCCs). To inform recovery supports, this study characterized SM and heterosexual RCC members by demographics and clinical and recovery support service utilization. METHODS Cross-sectional secondary analyses compared SM and heterosexual RCC members in the northeastern U.S. (n = 337). Qualitative analyses coded the top three recovery facilitators. RESULTS Of the 337 participants (Meanage[SD] = 40.98[12.38], 51.8 % female), SM RCC members were more likely than heterosexuals to endorse lifetime psychiatric diagnoses and emergency department mental health treatment (p < .01). RCC service utilization and qualitatively derived recovery facilitators were mostly consistent across groups. CONCLUSIONS RCCs engaged SM individuals in recovery in ways consistent with heterosexuals. Despite otherwise vastly similar demographic characteristics across sexual identity, findings suggest a need for additional mental health resources for SM individuals in recovery.
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Affiliation(s)
- Lauren B Bernier
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jacklyn D Foley
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Anna C Salomaa
- Boston University School of Medicine, Boston, MA, USA; VA Boston Healthcare System, Boston, MA, USA
| | | | - John Kelly
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Bettina Hoeppner
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Abigail W Batchelder
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
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24
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Goodall KR, Morse E, Howard CM. Culturally sensitive emergency care for sexual and gender minority youth: A quality improvement initiative. Int Emerg Nurs 2024; 73:101425. [PMID: 38437776 DOI: 10.1016/j.ienj.2024.101425] [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] [Revised: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Despite evidence of the impact of provider implicit bias and overt discrimination experienced by sexual and gender minority youth (SGMY), evidence surrounding sexual and gender minority cultural sensitivity training for pediatric emergency health professionals is limited. No targeted training existed to improve the clinical preparedness of healthcare professionals serving SGMY by increasing providers' knowledge and attitudinal awareness in a pediatric emergency department at a large, urban pediatric hospital in the Southeastern United States. METHODS The Institute for Healthcare Improvement's [15] Model for Improvement informed the project and was completed in four Plan-Do-Study-Act cycles. A cross-sectional, pre-test post-test design was used to gather demographic data, administer the LGBT-DOCSS questionnaire, and collect participant feedback on the training session. The LGBT-DOCSS results were analyzed using an independent samples t-test. INTERVENTIONS Evidence-based pedagogical strategies were utilized for a 60-minute staff training session. Staff (n = 25) had six opportunities to attend one of the training sessions over a period of 4 months. RESULTS Self-selection and voluntary participation contributed to recruiting participants who demonstrated high baseline LGBT-DOCSS scores, particularly on the subscales that measure knowledge and attitudinal awareness. After the sessions, participants showed an increase in LGBT-DOCSS scores with a statistically significant increase in the clinical preparedness subscale. CONCLUSIONS This project was the first at the institution to focus on culturally sensitive emergency care for sexual and gender minority youth. The content was well received by staff, who demonstrated increased clinical preparedness after the training. Implementing the training as a required component of new nurse orientation and onboarding is the next step in creating a safety culture for SGMY in the PED setting.
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Affiliation(s)
- Kaysi R Goodall
- College of Nursing, Belmont University, 1900 Belmont Blvd., Nashville, TN 37212, United States.
| | - Elizabeth Morse
- College of Nursing, Belmont University, 1900 Belmont Blvd., Nashville, TN 37212, United States.
| | - Carolyn M Howard
- College of Nursing, Belmont University, 1900 Belmont Blvd., Nashville, TN 37212, United States.
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Practice Committee of the American Society for Reproductive Medicine, American Society for Reproductive Medicine, Washington, D.C.. Electronic address: asrm@asrm.org. Inclusive language and environment to welcome lesbian, gay, bisexual, transgender, queer, questioning, intersex, and asexual+ patients. Fertil Steril 2024:S0015-0282(24)00034-7. [PMID: 38430081 DOI: 10.1016/j.fertnstert.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/03/2024]
Abstract
Using inclusive language and creating an inclusive clinical environment to serve lesbian, gay, bisexual, transgender, queer, questioning, intersex, and asexual+ patients is vital to optimizing access to care and patient outcomes. Practical recommendations are made for increasing inclusivity in the clinic, and a glossary of current terms is included.
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26
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Chaudhary S, Lindsay D, Ray R, Glass BD. Do the attitudes and practices of Australian pharmacists reflect a need for education and training to provide care for people who are transgender? Int J Pharm Pract 2024; 32:61-68. [PMID: 37963473 DOI: 10.1093/ijpp/riad077] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/28/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Many transgender and gender diverse (TGD) people access care through community pharmacy in Australia. However, there is limited information available about the role of Australian pharmacists in providing care for TGD people. OBJECTIVE To explore the attitudes, practices, and training needs of pharmacists in the provision of care for TGD people in Australia. METHOD Pharmacists Australia-wide were invited to participate in an online survey through Facebook, e-newsletters of pharmacy organizations and a professional pharmacy journal. Quantitative data were analysed for descriptive and inferential statistics. A Fisher exact test was used to investigate associations between two variables. Results with P value <0.05 were considered statistically significant. Content analysis was used to analyse data from free-text responses. RESULT Of the 169 respondents, the majority were female (75.1%), aged below 40 years (74%) and with less than 10 years of working experience as a pharmacist (58%). Although 95% of the sample agreed that they had an important role in the provision of care for TGD people, only 29.6% were confident about their knowledge of pharmacotherapeutic treatments for gender affirmation. Only 2.4% had received education about TGD care at university, and only 5.3% received any TGD healthcare training over the past 5 years. CONCLUSION Although pharmacists had a positive attitude and recognized their role in TGD care, they expressed a lack of confidence in their knowledge to be a barrier to providing quality care. Most recommended the need for more education about TGD healthcare in pharmacy curricula and continuous professional education activities.
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Affiliation(s)
- Swapna Chaudhary
- College of Medicine and Dentistry, James Cook University, 1, James Cook Drive, Douglas, Qld 4811, Australia
| | - Daniel Lindsay
- Health Economics, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston Qld 4006, Locked Bag 2000 Royal Brisbane Hospital, Qld 4029, Australia
- School of Public Health, The University of Queensland, 11 Wyndham Street, Herston, Qld 4006, Australia
| | - Robin Ray
- College of Medicine and Dentistry, James Cook University, 1, James Cook Drive, Douglas, Qld 4811, Australia
| | - Beverley D Glass
- College of Medicine and Dentistry, James Cook University, 1, James Cook Drive, Douglas, Qld 4811, Australia
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Macedo A, Aurindo M, Febra C. Effectiveness of undergraduate medical students training on LGBTQIA + people health: a systematic review and meta-analysis. BMC Med Educ 2024; 24:63. [PMID: 38229060 DOI: 10.1186/s12909-024-05041-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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 01/06/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND Adequacy of learning models and their ability to engage students and match session's objectives are critical factors in achieving the desired outcome. In this systematic review and meta-analysis, we assess the methodological approach, content, and effectiveness of training initiatives addressing medical students' knowledge, attitudes, confidence and discrimination perception towards LGBTQIA + people. METHOD PubMed, Web of Science, Medline and Scopus were searched to identify published studies, from 2013 to 2023, on effectiveness of training initiatives addressing medical students' knowledge, attitudes, confidence and discrimination perception towards LGBTQIA + people. The risk of bias of the selected studies was assessed by the Medical Education Research Study Quality Instrument. Overall effect sizes were calculated using a Mantel-Haenszel method, fixed effect meta-analyses. RESULTS A total of 22 studies were included, representing 2,164 medical students. The interventions were highly diverse and included seminars, lectures, videos, real-case discussions, roleplay, and group discussions with people from the LGBTQIA + community. After the interventions, there was a significant improvement in self-confidence and comfort interacting with patients and in the understanding of the unique and specific health concerns experienced by LGBTQIA + patients. CONCLUSION Our findings indicated that the outcomes of interventions training actions for medical students that promote knowledge and equity regarding LGBTQIA + people, regardless of their scope, methodology and duration, result in a considerable increase in students' self-confidence and comfort interacting with LGBTQIA + patients, highlight the need for more actions and programs in this area promoting a more inclusive society and greater equity.
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Affiliation(s)
- Ana Macedo
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Edifício 2 - Ala Norte Campus de Gambelas, Faro, 8005-139, Portugal.
- ABC Clinical Reseach Center, Algarve Biomedical Center (ABC), Edifício 2 - Ala Norte Campus de Gambelas, Faro, 8005-139, Portugal.
| | - Maria Aurindo
- National Statistical institute of Portugal, Lisboa, Portugal
| | - Cláudia Febra
- Faculty of Medicine, University of Porto, Porto, Portugal
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Murdock M. Providing Inclusive Midwifery Care for 2SLGBTQQIA+ People: Supporting Inclusion in Ontario's Midwifery Education Program. J Midwifery Womens Health 2024; 69:91-100. [PMID: 37708221 DOI: 10.1111/jmwh.13557] [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: 09/16/2023]
Abstract
INTRODUCTION Research on how midwives in North America are trained to provide inclusive care to Two Spirited, Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, or Asexual (2SLGBTQQIA+) clients is limited. The objective of this study was to define 2SLGBTQQIA+ inclusive midwifery care in the Canadian context and to explore the experiences of graduates of Ontario's Midwifery Education Program (MEP) to determine how midwives are trained to provide inclusive care. METHODS Ethics approval was obtained for this qualitative study to perform semistructured interviews with graduates from the MEP hosted by McMaster, Toronto Metropolitan, and Laurentian University. Eleven midwives were recruited and were required to be (1) graduates of Ontario's MEP, (2) registered midwives under the College of Midwives of Ontario or elsewhere, (3) currently practicing or on leave, and (4) self-identified advocates for 2SLGBTQQIA+ individuals. RESULTS When defining 2SLGBTQQIA+ inclusive care, midwives described the following principles: using inclusive language, changing the clinical environment, amending documents and websites, and tailoring care for each client. Participants recognized recent efforts by Ontario's MEP to provide 2SLGBTQQIA+ inclusive education while highlighting the need to expand 2SLGBTQQIA+ content across all courses, practicing inclusive care during placement, and ensuring an inclusive environment in the program. DISCUSSION Midwives in this study helped conceptualize inclusive midwifery care for 2SLGBTQQIA+ clients and underlined remaining gaps in Ontario's MEP toward providing student midwives with this competency by graduation. This study helped to fill a gap in the literature on how Canadian midwives are trained to provide 2SLGBTQQIA+ inclusive care and generated recommendations for Ontario's MEP to support prelicensure education that trains inclusive midwives. Having demonstrated gaps in how birth workers are trained to provide 2SLGBTQQIA+ inclusive care, this study points to the need for other prelicensure health professional programs to evaluate their training and to support 2SLGBTQQIA+ inclusive practice.
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Affiliation(s)
- Melanie Murdock
- Department of Gender Studies, Queen's University, Kingston, Ontario, Canada
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29
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Astle KN, Hart LA, Holloway J, Medlin CG, Mills AR, Nardolillo JA, Phan T, Wilby KJ. Born This Way: Integrating LGBTQIA+ Identities as Pharmacy Practitioners. Am J Pharm Educ 2023; 87:100122. [PMID: 38097310 DOI: 10.1016/j.ajpe.2023.100122] [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: 07/13/2022] [Revised: 02/20/2023] [Accepted: 04/11/2023] [Indexed: 12/18/2023]
Abstract
Progression through the profession of pharmacy is filled with many milestones that can contribute to feelings of stress, rejection, and isolation. For Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual+(LGBTQIA+) students and practitioners, these feelings can be compounded by similar issues experienced by their sexual orientation or gender identity. Historically, LGBTQIA+ students, new practitioners, and seasoned professionals alike have lacked visible role models for how to intersect personal and professional identity in the pharmacy profession. In this paper, the authors describe experiences of intersecting personal queer identities with professional pharmacy identities; exploring barriers to integration and developing solutions to overcome these barriers. The authors also share how the formation of a collective of LGBTQIA+ practitioners and educators has led to a unified voice to advocate for the advancement of LGBTQIA+ healthcare in pharmacy education and practice. This manuscript will provide readers with a guide to navigate and address issues with the integration of personal and professional identity to lead to practice that validates personal identity as important, valuable, and affirmed.
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Affiliation(s)
| | - Laura A Hart
- University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA
| | | | | | - Alex R Mills
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, University Ave, MS, USA
| | | | - Tam Phan
- University of Southern Calfornia, Los Angeles, CA, USA
| | - Kyle John Wilby
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada; Editorial Board, American Journal of Pharmaceutical Education, USA
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30
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O'Sullivan L, Zayhowski K, Hoffman E, Carmichael N. A qualitative study of LGBTQIA+ genetic counselors' experiences while applying to graduate school. J Genet Couns 2023; 32:1200-1212. [PMID: 37574455 DOI: 10.1002/jgc4.1760] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
Research has shown that lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexual and gender minority (LGBTQIA+) healthcare students experience discrimination during admissions and training. While several studies have examined the experiences of racial and ethnic minorities within the genetic counseling field, the admissions experiences of LGBTQIA+ individuals have not been explored. Through semi-structured interviews, this qualitative study investigated the experiences of ten LGBTQIA+ genetic counselors and genetic counseling students during graduate school admissions. Interview questions focused on participants' perceptions of the genetic counseling field prior to applying, important factors in choosing and ranking programs, decisions surrounding disclosure of LGBTQIA+ identities, interview experiences related to their identities, and the impacts, if any, of their identities on their overall admissions journey. Transcripts were coded and analyzed utilizing a constructivist grounded theory approach, resulting in the emergence of themes regarding factors that influenced participants' decisions to disclose their identity and how their LGBTQIA+ identity factored into their selection of a training program. This study adds new perspectives to the conversations around diversity, equity, and inclusion within the genetic counseling field. Further, it provides genetic counselors and genetic counseling programs insight into inclusive admissions processes and suggests ways to improve inclusivity in graduate admissions.
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Affiliation(s)
- Lauren O'Sullivan
- Graduate School of Arts and Sciences, Brandeis University, Waltham, Massachusetts, USA
| | - Kimberly Zayhowski
- Department of Obstetrics and Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Eileen Hoffman
- Division of Genetics, UMass Memorial Health, Worcester, Massachusetts, USA
| | - Nikkola Carmichael
- Graduate School of Arts and Sciences, Brandeis University, Waltham, Massachusetts, USA
- Department of Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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31
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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
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32
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Jacobson AR, Blaszczak J, Ahn J, Viglianti BL. DEXA Screening for Transgender and Gender Diverse Patients: An Overview of Current Guidance and Call for Improved Protocols. Acad Radiol 2023:S1076-6332(23)00590-1. [PMID: 37977892 DOI: 10.1016/j.acra.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Affiliation(s)
| | - Julie Blaszczak
- Department of Family Medicine, University of Michigan, Ann Arbor, MI (J.B.).
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor MI (J.A.).
| | - Benjamin L Viglianti
- Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI (B.L.V.).
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Szabó BA, Sümeghy D. Travel Patterns and Motivations of the Hungarian Gay and Lesbian Community. J Homosex 2023:1-24. [PMID: 37934474 DOI: 10.1080/00918369.2023.2275296] [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: 11/08/2023]
Abstract
Tourism plays a key role for gay people, as it is not only a way to escape from work, but also a source of liberation and self-embracement. This role can be particularly valued in societies and political environments that are perceived as hostile toward this group. The present study examines the travel motivations and habits of gay and lesbian people, based on a questionnaire sample of 1473 respondents. The results show that for this group, but especially for women, acceptance and an open culture are of paramount importance when choosing a destination. In contrast, services and events specifically targeted at this sector, which are popular in the Western world, do not typically influence decision-making (they tend to be more attractive to women). Sex per se is not a travel motivator for this group, but is an important feature of travel for men. In addition to gender, the services and activities that an individual engages in while traveling are influenced by the degree of their sexual embracement, the place of residence and the company with which the individual travels.
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Affiliation(s)
- Balázs Attila Szabó
- Department of Tourism, Doctoral School of Earth Sciences, University of Pécs, Pécs, Hungary
| | - Dávid Sümeghy
- Department of Political Science, Lund University, Lund, Sweden
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Abstract
René Sève recalls that Contemporary Law in the Western World is based on autonomy of equal subjects, mutually recognizing the right to each carry out their own life project. The LGBTQIA+ person therefore exercises their ability to be their own species, according to Kirkegaard's word. It remains that "life project" also implies a constraint of stability and rationality. The author then shows, using Canadian and French statistical data, the difficulties of achieving this ideal for minors and, for adults, the other medical, paramedical and social conditions required. The rights of LGBT people cannot be considered independently of the physical and financial limits of the health system and therefore of the public debate on its priorities.
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Affiliation(s)
- René Sève
- Archives de philosophie du droit, Paris, France.
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35
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Wong CN, Wilczek MP, Smith LH, Bosse JD, Richard EL, Cavanaugh R, Manjourides J, Orkaby AR, Olivieri-Mui B. Frailty Among Sexual and Gender Minority Older Adults: The All of Us Database. J Gerontol A Biol Sci Med Sci 2023; 78:2111-2118. [PMID: 37485864 PMCID: PMC10613018 DOI: 10.1093/gerona/glad149] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Despite known disparities in health status among older sexual and gender minority adults (OSGM), the prevalence of frailty is unknown. The aim of this study was to develop and validate a deficit-accumulation frailty index (AoU-FI) for the All of Us database to describe and compare frailty between OSGM and non-OSGM participants. METHODS Developed using a standardized approach, the AoU-FI consists of 33 deficits from baseline survey responses of adults aged 50+. OSGM were self-reported as "not straight" or as having discordant gender and sex assigned at birth. Descriptive statistics characterized the AoU-FI. Regression was used to assess the association between frailty, age, and gender. Validation of the AoU-FI used Cox proportional hazard models to test the association between frailty categories (robust <0.15, 0.15 ≤ pre-frail ≤ 0.25, frail >0.25) and mortality. RESULTS There were 9 110 OSGM and 67 420 non-OSGM with sufficient data to calculate AoU-FI; 41% OSGM versus 50% non-OSGM were robust, whereas 34% versus 32% were pre-frail, and 26% versus 19% were frail. Mean AoU-FI was 0.19 (95% confidence interval [CI]: 0.187, 0.191) for OSGM and 0.168 (95% CI: 0.167, 0.169) for non-OSGM. Compared to robust, odds of mortality were higher among frail OSGM (odds ratio [OR] 6.40; 95% CI: 1.84, 22.23) and non-OSGM (OR 3.96; 95% CI: 2.96, 5.29). CONCLUSIONS The AoU-FI identified a higher burden of frailty, increased risk of mortality, and an attenuated impact of age on frailty among OSGM compared to non-OSGM. Future work is needed to understand how frailty affects the OSGM population.
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Affiliation(s)
- Chelsea N Wong
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Louisa H Smith
- Roux Institute, Northeastern University, Portland, Maine, USA
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Jordon D Bosse
- School of Nursing, Northeastern University, Boston, Massachusetts, USA
| | - Erin L Richard
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California, USA
| | | | - Justin Manjourides
- Roux Institute, Northeastern University, Portland, Maine, USA
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Ariela R Orkaby
- New England Geriatric Research, Education, and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Division of Aging, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brianne Olivieri-Mui
- Roux Institute, Northeastern University, Portland, Maine, USA
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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Berro T, Zayhowski K. Toward depathologizing queerness: An analysis of queer oppression in clinical genetics. J Genet Couns 2023. [PMID: 37876321 DOI: 10.1002/jgc4.1819] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
Critically examining the way that the field of clinical genetics has impacted queer communities offers the field an opportunity to strengthen our commitment to inclusive high-quality care to all patients, families, and communities. This article reviews the origins of clinical genetics and genetic counseling in the eugenics movement and how this ontology promoted harmful medical practices grounded in assumptions of what is "normal." We critically examine existing clinical genetics practices and how commonly used binary frameworks for gender, sex, and sexuality perpetuate heteronormative, cisnormative, and bioessentialist assumptions. In order to move toward queer inclusivity, the genetic counseling field must first take accountability for past injustices. Restorative justice and trauma-informed approaches offer a way to engage with the queer community and to begin to rectify the history of medical harm. Through our analysis, we advocate for expanding efforts to depathologize queerness, promote bodily autonomy, and provide equitable healthcare for the queer community.
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Affiliation(s)
- Tala Berro
- Department of Genetics, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Kimberly Zayhowski
- Department of Obstetrics and Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Courtney J, Aragon KG, Douglas M, Malhotra A. A Resource Compendium for Embedding LGBTQIA+ Patient Care in the Professional Identity of Community Pharmacists. Am J Pharm Educ 2023; 87:100127. [PMID: 37852690 DOI: 10.1016/j.ajpe.2023.100127] [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: 08/18/2022] [Revised: 03/08/2023] [Accepted: 04/18/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Cultural, clinical, social, and legally competent patient care for lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) patients is currently scarcely incorporated in pharmacy curricula. Furthermore, clinical, legal, and socio-cultural training that prepares pharmacists on the job to provide LGBTQIA+ competent patient care is scant. Here, our objectives were to (1) systematically review the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify trends in community pharmacists' professional identity development related to the provision of competent LGBTQIA+ patient care, and (2) create a reference guide for community pharmacists for self-directed learning. The literature search focused on 4 professional identity domains common to most pharmacists: academic and clinical competence, cultural sensitivity, knowledge of state and federal laws, and continuing professional development. FINDINGS A total of 207 articles were identified, with 93 retrieved, of which 26 articles were included in the final analysis based on title and abstract and other inclusion criteria. SUMMARY Overall, our search identified that the LGBTQIA+ health professions literature focused on the following themes: guidance for appropriate drug selection and therapy, creation of cultural sensitivity training curricula, community pharmacists' perceptions of their ability to provide LGBTQIA+ care, health system interventions, and Allyship education for advancing LGBTQIA+ care, the need for enhanced training of pharmacists for understanding the federal and state laws and requirements while providing care, and the need for a resource compendium to help community pharmacists access self-directed learning information, for which we have created a self-help resource guide for pharmacists in these 4 professional pharmacist identity domains.
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Affiliation(s)
- Jennifer Courtney
- California Northstate University College of Pharmacy, Elk Gove, CA, USA
| | | | - Monica Douglas
- University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Ashim Malhotra
- California Northstate University College of Pharmacy, Elk Gove, CA, USA.
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Llorin H, Zayhowski K. The erasure of transgender and intersex identities through fetal sex prediction and genetic essentialism. J Genet Couns 2023; 32:942-944. [PMID: 37306043 DOI: 10.1002/jgc4.1736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/22/2023] [Accepted: 05/27/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Hannah Llorin
- 23andMe, Inc., Sunnyvale, California, USA
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Kimberly Zayhowski
- Department of Obstetrics and Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Paciente R, Pranoto EP, Woolard A, Munro E, Lombardi K. The queers are all right: a content analysis of LGBTQIA + mental health on TikTok. Cult Health Sex 2023:1-12. [PMID: 37729467 DOI: 10.1080/13691058.2023.2253882] [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] [Received: 02/24/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023]
Abstract
The formation of online communities instils a sense of connectedness which can ameliorate the mental health concerns that result from minority stressors for lesbian, gay, queer, intersex, asexual, and other diverse genders/sexualities (LGBTQIA+). The aim of this study was to explore how LGBTQIA + people communicate social and mental health concerns on TikTok. It was anticipated that factors affecting mental health, such as minority stressors and community connectedness, would be addressed by the videos collected. Engagement statistics, demographics and content analysis were used to describe the 50 most-viewed videos across the top five related hashtags: #genderidentity, #lgbtqawareness, #sexualidentity, #lgbtmentalhealth, and #transmentalhealth. The content analysis indicates that TikTok is used as a way for members of the LGBTQIA + community to connect with each other and enhance feelings of community connectedness, which research shows may buffer the effects of minority stressors. Engagement with social media can be especially beneficial for those who may not be able to connect in the real-world. Further interactions, such as analysis of the comment section, should be investigated to develop a fuller understanding of how LGBTQIA + TikTok users respond to these contents.
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Affiliation(s)
- Rigel Paciente
- Youth Mental Health, Telethon Kids Institute, Nedlands, Australia
- School of Psychology, The University of Western Australia, Perth, Australia
| | | | - Alix Woolard
- Youth Mental Health, Telethon Kids Institute, Nedlands, Australia
- School of Psychology, The University of Western Australia, Perth, Australia
| | - Emily Munro
- Youth Mental Health, Telethon Kids Institute, Nedlands, Australia
| | - Karen Lombardi
- Youth Mental Health, Telethon Kids Institute, Nedlands, Australia
- School of Medical and Health Sciences, Edith Cowan University, Edith Cowan University, Australia
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40
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Mawdsley A, Willis SC. Evaluating Heteronormative Attitudes and Beliefs of United Kingdom Pharmacy Educators. J Homosex 2023:1-13. [PMID: 37417739 DOI: 10.1080/00918369.2023.2231118] [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] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
United Kingdom (UK) pharmacy curricula have previously been shown to be hetero- and cis-normative. A possible reason may be that educators hold binary beliefs and attitudes toward sexuality and gender norms, and that these are manifest in teaching practice and discourse. The purpose of this study is to investigate these attitudes and beliefs. A cross-sectional survey using the 16-item heteronormative attitudes and beliefs scale (HABS) was distributed to educators at UK universities teaching on undergraduate Master of Pharmacy degree programs, with 123 surveys returned. Total HABS scores and subscales measuring normative beliefs (NB) and essential sex and gender (ESG) were calculated with non-parametric statistics comparing scores based on demographic and contextual characteristics of the sample. The mean total HABS score was 40.06, for NB it was 16.46 and ESG it was 23.60 indicating moderate-low normative beliefs and attitudes. Two demographic categories reached statistical significance: gender (p = .049 total HABS score) and sexuality (p = < .001 total HABS score, p = .008NB subscore and p = < .001 ESG subscore) (p < .05) indicating that female and queer identifying educators have significantly lower heteronormative attitudes and beliefs. Findings indicate that UK pharmacy educators do not hold normative values and beliefs; curricula are influenced by the normative structures within higher education.
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Affiliation(s)
- Andrew Mawdsley
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Sarah C Willis
- Management and Policy Division Alliance Manchester Business School, University of Manchester, Manchester, UK
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41
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Tubertini E, Carbone A, Santinello M. Staff Members' Experience of Italian Shelters for LGBTQIA+ Homeless and Runaway People: An Exploratory Study. Int J Environ Res Public Health 2023; 20:6214. [PMID: 37444062 PMCID: PMC10341461 DOI: 10.3390/ijerph20136214] [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: 03/22/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Some LGBTQIA+ people, after coming out, experience marginalization and homelessness due to rejection and discrimination from their family and community. The increase in support requests led to the creation of LGBTQIA+ temporary shelter homes worldwide. This study aims to explore the functioning and effectiveness of shelters, analyzing the experiences of staff members in Italy. METHODS Focus groups were held with a total of 15 staff members (age range: 32-53) working in three shelters for LGBTQIA+ people. Data were analyzed qualitatively through the grounded theory methodology. RESULTS Data coding showed five final core categories: (1) user characteristics; (2) staff characteristics; (3) community relations; (4) activities carried out by services; (5) criteria for intervention assessment and staff satisfaction. Results revealed some criticalities in the effectiveness of these services, particularly the difficulty in achieving autonomy for users, a weakness attributable to the non-exhaustive training of staff members and the funding discontinuity. CONCLUSION To improve the efficacy of shelters, this study emphasizes the necessity to (a) carry out an analysis of the vulnerability of the local LGBTQIA+ community, (b) establish a stable network with local services (NHS system), and (c) implement staff members' psychological training.
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Affiliation(s)
- Elena Tubertini
- Department of Developmental Psychology and Socialisation, University of Padua, 35131 Padova, Italy; (E.T.); (M.S.)
| | - Agostino Carbone
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
- Department of Health Policy–The London School of Economics and Political Sciences, CPEC–Care Policy and Evaluation Center, St Clement’s Ln, London WC2A 2HD, UK
| | - Massimo Santinello
- Department of Developmental Psychology and Socialisation, University of Padua, 35131 Padova, Italy; (E.T.); (M.S.)
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Simpson MD, Klibert JJ, Pritulsky CL, Weiss BJ. The Conditional Effects of Savoring on the Relationship between Minority Stress and Alcohol Misuse in an LGBTQIA + Sample. Subst Use Misuse 2023; 58:1367-1376. [PMID: 37313581 DOI: 10.1080/10826084.2023.2223268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Alcohol-related difficulties are a significant public health concern in lesbian, gay, bisexual, transgender, questioning, intersex, asexual, and people with other sexual orientations and forms of gender identity (LGBTQIA+) communities. Considering these concerns, there is a strong push to develop affirming and strength-based prevention efforts. Unfortunately, such efforts are undermined by the lack of protective LGBTQIA + models for alcohol misuse. To this end, the purpose of the current study was to evaluate whether savoring, the ability to create, maintain, and prolong positive emotions, meets basic criteria for a protective factor for alcohol misuse in a sample of LGBTQIA + adults. Methods: The sample was comprised of 226 LGBTQIA + adults who completed an online survey. Results: Results indicated that savoring was inversely related to alcohol misuse. In addition, the relationship between minority stress and alcohol misuse varied as a function of savoring; at high levels of savoring (a score of 136.63 on the Savoring Beliefs Inventory), the relationship between minority stress and alcohol misuse was non-significant. Conclusions: In combination, these findings offer preliminary support for savoring as a protective factor for alcohol misuse among different LGBTQIA + communities. However, longitudinal and experimental research is needed to solidify the role of savoring in minimizing alcohol-related problems in this population.
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Filimonov AK, Gates AR, Allos AN, Billings HJ, Goldina A, Wisco JJ. A Call to Action for Improving LGBTQIA2S+ Inclusive Policies and Practices in Educating Science and Medical Professionals. Med Sci Educ 2023; 33:767-772. [PMID: 37501802 PMCID: PMC10368593 DOI: 10.1007/s40670-023-01797-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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 07/29/2023]
Abstract
Based on Nature's novel sex and gender guidelines, we share a call to action to enact policy changes in medical and scientific education. We conducted a literature search of current policies and practices affecting sex and gender minorities. Our work indicated a scarcity of guidelines and curricula dedicated to standardizing LGBTQIA2S+ topics. Educational policies must be enacted to ensure that sex and gender guidelines are implemented across all institutions as it impacts the future of healthcare and science. It is essential that sex and gender considerations be mandated topics in both medical and scientific education.
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Affiliation(s)
- Anastasia K. Filimonov
- Laboratory for Translational Anatomy of Degenerative Diseases and Developmental Disorders (TAD4), Department of Anatomy and Neurobiology, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, 72 E Concord St., L-1004, Boston, MA 02118 USA
| | - Alexandra R. Gates
- Department of Biological and Environmental Sciences, Elizabethtown College, Elizabethtown, PA 17022 USA
| | - Annmarie N. Allos
- Department of Cognitive Science, Dartmouth College, Hanover, NH 03755 USA
| | - Heather J. Billings
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, Morgantown, WV 26506 USA
| | - Anya Goldina
- Department of Biological and Environmental Sciences, Elizabethtown College, Elizabethtown, PA 17022 USA
| | - Jonathan J. Wisco
- Laboratory for Translational Anatomy of Degenerative Diseases and Developmental Disorders (TAD4), Department of Anatomy and Neurobiology, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, 72 E Concord St., L-1004, Boston, MA 02118 USA
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Violette CJ, Nguyen BT. Expectations for family building, assisted reproduction, and adoption among lesbians in the National Survey of Family Growth, 2017-2019. F S Rep 2023; 4:190-195. [PMID: 37398611 PMCID: PMC10310959 DOI: 10.1016/j.xfre.2023.04.003] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To characterize the family-building goals and experiences of lesbians compared with those of heterosexual females in the United States. Design Secondary analysis of nationally representative, cross-sectional survey data. Setting National Survey of Family Growth 2017-2019. Patients 159 reproductive-age lesbian respondents and 5,127 reproductive-age heterosexual respondents. Interventions We characterized family-building goals and the use of assisted reproduction and adoption among lesbians using nationally representative female respondent data from the 2017-2019 National Survey of Family Growth. We performed bivariate analyses examining variations in these outcomes between lesbian and heterosexual individuals. Main Outcome Measures Wantedness of children, use of assisted reproductive technology, and pursuit of adoption among reproductive-age lesbian and heterosexual participants. Results We identified 159 reproductive-age lesbian respondents of the National Survey of Family Growth, representing 2.3% or approximately 1.75 million US individuals of reproductive age. The lesbian respondents were younger, less religious, and less likely to have children than heterosexual respondents. These groups did not differ significantly by race/ethnicity, education, or income. More than half of the individuals reported wanting a child in the future, with proportions similar between the lesbian and heterosexual individuals (48% vs. 51%, respectively; P = .52). Accordingly, 18% of both the lesbian and heterosexual individuals reported that they would be greatly bothered if they were unable to have children. Nevertheless, health care providers reportedly asked the lesbians about their desire to get pregnant less frequently than they asked the heterosexual individuals (21% vs. 32%, respectively; P = .04). Only 26% of the lesbians had ever been pregnant compared with 64% of the heterosexual individuals (P<.01). Approximately one third (31%) of lesbians with medical insurance were seeking reproductive services compared with 10% of heterosexual individuals (P = .05). Lesbians were significantly more likely to be seeking adoption than heterosexual individuals (7.0% vs. 1.3%, respectively; P = .01), although they were more likely to report being turned down (17% vs. 10%, respectively; P = .03), not knowing why they were unable to adopt (19% vs. 1%, respectively; P = .02), and quitting because of the adoption process (100% vs. 45%, respectively; P = .04). Conclusions Approximately half of US females of reproductive age desire to have a child, a proportion that is not different between lesbian and heterosexual individuals. However, fewer lesbians are asked about their desires to get pregnant, and fewer ever become pregnant. Lesbians are significantly more likely to pursue assisted reproductive services when covered by insurance and more likely to seek adoption. Unfortunately, lesbians are more likely to face challenges with adoption.
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Affiliation(s)
- Caroline J. Violette
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Brian T. Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Mitchell LA, Jacobs C, McEwen A. (In)visibility of LGBTQIA+ people and relationships in healthcare: A scoping review. Patient Educ Couns 2023; 114:107828. [PMID: 37301011 DOI: 10.1016/j.pec.2023.107828] [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] [Received: 10/30/2022] [Revised: 05/16/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To identify and map research into the visibility of LGBTQIA+ people and their relationships in healthcare, with the view to inform future research and practice. METHOD Five databases were systematically searched for published and grey literature. Primary research reporting on visibility of LGBTQIA+ people in healthcare was included. Two reviewers independently screened the studies until an acceptable level of agreement was reached. A narrative synthesis was conducted and findings mapped to a taxonomy of microaggressions involving three sub-categories: microinsults, microassaults and microinvalidations. RESULTS The microaggressions identified included Microinsults: 'Perception of health professionals' knowledge and comfort' and 'Disclosure'; Microassaults: 'Discrimination and stigma'; Microvalidations: 'Accessing and navigating through services', 'Encounters of assumptions and stereotypes', 'Validating identities and including relationships', and 'Reading the environment'. CONCLUSION Despite growing societal acceptance, microaggressions still exist within healthcare. Groups within LGBTQIA+ communities have varying levels of visibility in research and healthcare based on the studies included. PRACTICE IMPLICATIONS The limited visibility of LGBT and lack of visibility of QIA+ people and their relationships in healthcare highlight the need to include the views of all LGBTQIA+ communities in research, and to ensure health professionals and clinical services are equipped to address this (in)visibility gap.
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Affiliation(s)
- Lucas A Mitchell
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia; Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Australia.
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Alison McEwen
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Howat A, Masterson C, Darwin Z. Non-birthing mothers' experiences of perinatal anxiety and depression: Understanding the perspectives of the non-birthing mothers in female same-sex parented families. Midwifery 2023; 120:103650. [PMID: 36893549 DOI: 10.1016/j.midw.2023.103650] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Partners of birthing mothers can themselves experience perinatal mental health (PMH) difficulties. Despite birth rates increasing amongst LGBTQIA+ communities and the significant impact of PMH difficulties, this area is under-researched. This study aimed to examine the experiences of perinatal depression and anxiety of non-birthing mothers in female same-sex parented families. DESIGN Interpretative Phenomenological Analysis (IPA) was used to explore the experiences of non-birthing mothers who self-identified as having experienced perinatal anxiety and/or depression. SETTING AND PARTICIPANTS Sevenparticipants were recruited from online and local voluntary and support networks for LGBTQIA+ communities and for PMH. Interviews were in-person, online or via telephone. MEASUREMENTS AND FINDINGS Six themes were generated. Distress was characterised by feelings of "Failure and Inadequacy in Role" (i.e., parent, partner and individual) and "Powerlessness and Intolerable Uncertainty" in their parenting journey. These feelings were reciprocally influenced by perceptions of the "Legitimacy of (Di)stress as a Non-birthing Parent", which impacted help-seeking. Stressors that contributed to these experiences were: "Parenting Without" a parental role template, social recognition and safety, and parental connectedness; and "Changed Relationship Dynamics" with their partner. Finally,participants spoke about "Moving Forward" in their lives. KEY CONCLUSIONS Some findings are consistent with the literature on paternal mental health, including parents' emphasis on protecting their family and experiencing services as focusing on the birthing parent. Others appeared distinct or amplified for LGBTQIA+ parents, including the lack of a defined and socially recognised role; stigma concerning both mental health and homophobia; exclusion from heteronormative healthcare systems; and the importance placed on biological connectedness. IMPLICATIONS FOR PRACTICE Culturally competent care is needed to tackle minority stress and recognise diverse family forms.
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Affiliation(s)
- Alexandra Howat
- Leeds Institute of Health Sciences, School of Medicine, Worsley Building, Clarendon Way, University of Leeds, Leeds, LS2 9NL United Kingdom.
| | - Ciara Masterson
- Leeds Institute of Health Sciences, School of Medicine, Worsley Building, Clarendon Way, University of Leeds, Leeds, LS2 9NL United Kingdom
| | - Zoe Darwin
- School of Human and Health Sciences, Department of Allied Health Professions, Sport and Exercise, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH United Kingdom
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Pereira CCDA, Torres TS, Luz PM, Hoagland B, Farias A, Brito JDU, Lacerda MVG, Silva DAR, Benedetti M, Pimenta MC, Grinsztejn B, Veloso VG. Preferences for pre-exposure prophylaxis (PrEP) among sexual and gender minorities: a discrete choice experiment in Brazil. Lancet Reg Health Am 2023; 19:100432. [PMID: 36950036 PMCID: PMC10025414 DOI: 10.1016/j.lana.2023.100432] [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] [Received: 04/18/2022] [Revised: 10/27/2022] [Accepted: 01/10/2023] [Indexed: 02/09/2023]
Abstract
Background Men who have sex with men (MSM) and transgender women (TGW) are disproportionally affected by HIV infection in Latin America. This study aims to assess pre-exposure prophylaxis (PrEP) preferences among sexual and gender minorities (SGM) and identify attributes and levels that are related to PrEP uptake and adherence, both crucial for PrEP success. Methods We conducted a discrete choice experiment (DCE) among SGM from all Brazilian regions (September-December/2020). The survey was administered face-to-face (five Brazilian capitals) and online (entire country). We used a D-efficient zero-prior blocked experimental design to select 60 paired-profile DCE choice tasks. Findings The total sample size was 3924 (90.5% MSM; 7.2% TGW and 2.3% non-binary or gender diverse persons). In random-effects logit models, highest levels of protection and "no side effects" were the most important attribute levels. For "presentation", injectable and implant were preferred over oral. Participants were willing to accept a 4.1% protection reduction to receive injectable PrEP or a 4.2% reduction if PrEP were taken monthly. The largest class in the latent class models was defined predominantly by the preference for the highest HIV protection level (p < 0.005). Respondents in this class also preferred no side effects, injectable and implant presentations. Interpretation Higher HIV protection, no side effects, and presentation, whether injectable or implant, were the most important attributes in PrEP preferences. Protection against HIV was the most important attribute. PrEP programs should make available technologies such as long-acting presentations that could reunite the most desired attributes, thus maximizing acceptability and user-appropriateness. Funding Unitaid.
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Affiliation(s)
| | - Thiago Silva Torres
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Paula Mendes Luz
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Brenda Hoagland
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Alessandro Farias
- Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | | | | | - Daila Alena Raenck Silva
- Centro de Testagem e Aconselhamento (CTA) Santa Marta, Secretaria Municipal de Saúde de Porto Alegre, RS, Brazil
| | - Marcos Benedetti
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | - Beatriz Grinsztejn
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Valdilea Gonçalves Veloso
- Laboratório de Pesquisa Clínica em HIV/AIDS (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas – INI, FIOCRUZ, Rio de Janeiro, RJ, Brazil
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Prediger C, Heinrichs K, Tezcan-Güntekin H, Stadler G, Pilz González L, Lyk P, Majgaard G, Stock C. LGBTQIA+ Adolescents' Perceptions of Gender Tailoring and Portrayal in a Virtual-Reality-Based Alcohol-Prevention Tool: A Qualitative Interview Study and Thematic Analysis. Int J Environ Res Public Health 2023; 20:2784. [PMID: 36833482 PMCID: PMC9957229 DOI: 10.3390/ijerph20042784] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Gender-sensitive interventions in alcohol-prevention that target adolescents often lead to binary tailoring for girls and boys. However, increased societal and legal recognition of sexual and gender minorities as well as research with this age group demand a broader understanding of gender. Therefore, the present study addresses the question of how interventions should be further developed to include sexual and gender diversity by exploring LGBTQIA+ adolescents' perceptions of gender portrayal and gender-tailoring using Virtual LimitLab-a virtual-reality simulation for training refusal skills under peer pressure to consume alcohol. Qualitative interviews with 16 LGBTQIA+ adolescents were conducted after individual simulation testing. Using a thematic analysis with reflexive orientation, four themes were identified: Statements on relevance of gender, opinions on tailoring- and flirting options, and opinions on characters. Participants called for greater diversity representation among the characters, regarding gender identity and sexual orientation, as well as for representing, e.g., racialised peers. Moreover, participants suggested expanding the simulation's flirting options by adding bisexual and aromantic/asexual options. Divergent views on the relevance of gender and wishes for tailoring options reflected the participant group's heterogeneity. Based on these findings, future gender-sensitive interventions should conceptualise gender in a complex and multidimensional manner that intersects with further diversity categories.
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Affiliation(s)
- Christina Prediger
- Institute of Health and Nursing Science, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Katherina Heinrichs
- Institute of Health and Nursing Science, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hürrem Tezcan-Güntekin
- Department of Health and Education, Alice Salomon University of Applied Science, Alice-Salomon-Platz 5, 12627 Berlin, Germany
| | - Gertraud Stadler
- Institute of Gender in Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Laura Pilz González
- Institute of Health and Nursing Science, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Patricia Lyk
- SDU Game Development and Learning Technology, Mærsk Mc-Kinney Møller Institute, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Gunver Majgaard
- SDU Game Development and Learning Technology, Mærsk Mc-Kinney Møller Institute, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Christiane Stock
- Institute of Health and Nursing Science, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Unit for Health Promotion Research, University of Southern Denmark, Degnevej 14, 6705 Esbjerg, Denmark
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Balaji JN, Prakash S, Joshi A, Surapaneni KM. A Scoping Review on COVID-19 Vaccine Hesitancy among the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual ( LGBTQIA+) Community and Factors Fostering Its Refusal. Healthcare (Basel) 2023; 11. [PMID: 36673613 DOI: 10.3390/healthcare11020245] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The ramifications of the existing crisis caused by the coronavirus pandemic are sensed in all walks of life. Among the various efforts made to curb the spread of this novel infection, the development of COVID-19 vaccines had a profound role in flattening the pandemic curve. Even though the rapid vaccine drive received a highly welcoming response among people, the reluctance and ignorance of a part of the population towards available safe vaccines stand as impediments to achieving the desired outcome. The LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual) communities are the least studied groups in this regard. OBJECTIVE The purpose of this study is to extensively review and report on COVID-19 vaccine uptake and refusal among the LGBTQIA+ population and enumerate the factors contributing to vaccine hesitancy. The study extends further to outline a conceptual framework for interventions to enhance COVID-19 vaccine acceptance among the LGBTQIA+ population. METHODS We performed a systematic search using key terms on Google Scholar and PubMed. The obtained results were filtered using the eligibility criteria framed for this study. The initial search provided an extensive result of 4510 articles which were later screened at various levels to arrive at the final inclusive collection of manuscripts adding to 17. The studies were analyzed by the authors individually, and the data were categorized using variables. The results are interpreted using charts and graphs. The whole manuscript has been structured in accordance with the PRISMA extension for scoping reviews. RESULT The comprehensive search yielded 17 eligible articles for this review. Most of the studies were conducted in the United States (n = 17), and predominantly cross-sectional studies have been conducted. The major comparative factor was the HIV status of the LGBTQIA+ population. HIV-affected patients were more willing to take up COVID-19 vaccination. However, social stigma, discrimination, lack of access and non-prioritization in vaccine drives were found to be the major factors contributing to vaccine hesitancy among this population. CONCLUSION The invention of the COVID-19 vaccination revolutionized the healthcare systems burdened with COVID-19. Although this is a breakthrough scientific contribution, many factors are associated with the rate of vaccine acceptance, especially among sexual and gender minorities. The reviewed studies have revealed numerous factors that influence vaccine uptake and refusal with the commonest being concerns on discrimination, social stigma, inequitable access to healthcare, vaccine safety, efficacy, potency, side effects and lack of trust in medical workers. These impediments in vaccine coverage should be meticulously addressed to ensure optimum LGBTQIA+ physical and mental health as well as for providing non-discriminative, equitable and quality healthcare service regardless of the gender or sexual orientation of individuals.
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Mukhtar S. COVID-19 feminist framework and biopsychosocial-spiritual perspective for social workers and mental health practitioners to manage violence, abuse, and trauma against children, women, BIPOC, and LGBTQIA+ during and post-COVID-19. Int Soc Work 2023; 66:93-106. [PMID: 36687135 PMCID: PMC9843293 DOI: 10.1177/00208728211067158] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This article explains the integrated implementation of a COVID-19 Feminist Framework (CFF) and biopsychosocial-spiritual perspective (BPSS-P) on the inclusive equitability of social service providers, practitioners, and policy-developers on global platforms. Mechanisms of CFF and BPSS-P entail the process to address/mitigate institutional inequities, mental health issues, violation of human rights, race/sex/gender-based violence, abuse, and trauma amid COVID-19. This discourse is about raising consciousness, collective liberation, wellbeing, and equality for women, children, BIPOC, LGBTQIA+, and gender-diverse people. This article further discusses social workers and mental health practitioners' uniqueness for short-term and long-term support for emotional, cognitive-behavioral, and psychosocial repercussions on the individual and community levels.
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Affiliation(s)
- Sonia Mukhtar
- Sonia Mukhtar, University of Management and
Technology, C-II Block C 2 Phase 1 Johar Town, Lahore 54770, Punjab, Pakistan.
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