1
|
Hinds JT, Zahra AG, Ruiz RA, Johnston CA, Sewell KB, Lee JGL. A Scoping Review of Trends in the Size of Lesbian, Gay, and Bisexual Tobacco Use Disparities, 1996-2020, United States and Canada. LGBT Health 2024. [PMID: 38800875 DOI: 10.1089/lgbt.2023.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Purpose: Tobacco use is a major health disparity for lesbian, gay, bisexual, and transgender (LGBT) populations compared with heterosexual/cisgender populations. In this scoping review, we aimed to determine if LGBT tobacco use disparities are improving or worsening over time and if trends in disparities differed across subgroups. Methods: We included articles that longitudinally explored youth and adult LGB tobacco use in the United States and Canada after searching four databases and capturing records through July 2022. Two reviewers independently screened the title/abstract and full text of 2326 and 45 articles, respectively. Eleven articles from 18 larger assessments met inclusion criteria, spanning data collection from 1996 to 2020. Results: All studies consistently demonstrated tobacco disparities for LGB populations. No articles examined longitudinal transgender tobacco disparities. Most studies focused on smoking combustible cigarettes. Disparities in heavy or daily use for all LGB youth subgroups compared with heterosexual samples appear to be shrinking longitudinally. Results for early-onset, current, and lifetime smoking were less consistent. Adult evidence was relatively sparse; however, after 2010, studies show diminishing disparities over time, except for current smoking by bisexual women. Conclusions: Large tobacco use disparities persist for LGB populations, although the size of disparities may be decreasing for some groups. Initiatives for lesbian and bisexual women and girls should be prioritized, in addition to interventions addressing LGB smoking broadly. Surveillance instruments should uniformly and consistently assess LGBT identities and tobacco use behaviors.
Collapse
Affiliation(s)
- Josephine T Hinds
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
| | - Abdul G Zahra
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
| | - Raymond A Ruiz
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Carol A Johnston
- Department of Applied Human Sciences, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Kerry B Sewell
- Laupus Health Sciences Library, East Carolina University, Greenville, North Carolina, USA
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
| |
Collapse
|
2
|
Nghiem J, Liu M, Fruitman K, Zhou C, Zonana J, Outram T, Ceccolini CJ, Spellun J, Hankins D. Exploring Preclinical Medical Students' Experience Facilitating Group Dialectical Behavior Therapy (DBT) for a Student-Run Mental Health Clinic: A Qualitative Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-01975-x. [PMID: 38782840 DOI: 10.1007/s40596-024-01975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This report explores the experiences of preclinical medical students who led group dialectical behavior therapy (DBT) for a student-run LGBTQ + mental health clinic. METHODS In the clinic, experienced clinicians trained and supervised preclinical medical students to facilitate DBT groups. The authors conducted a qualitative study to understand the impact of the DBT groups on the student facilitators via semi-structured interviews, which were evaluated using thematic analysis. RESULTS The clinic hosted nine iterations of group DBT facilitated by preclinical medical students, involving 18 student leaders and 30 patients. Twelve student facilitators were interviewed. Participants had a diverse array of specialty interests and were primarily motivated by the opportunity for early clinical experience. They reported improved clinical skills, increased appreciation of psychotherapy as a treatment modality, and increased interest in incorporating psychotherapy in their future practice. Furthermore, participants reported using DBT skills to cultivate wellbeing during clerkship year and in their personal lives. CONCLUSIONS Offering preclinical medical students the opportunity to lead group DBT therapy is a novel educational model providing early training in psychotherapy techniques. This opportunity for early direct patient experience in a supervised group setting attracted medical students with a diverse range of specialty interests. This model provided medical students specific DBT skills to implement in future patient care interactions and to maintain their personal wellbeing throughout medical training. The broad appeal and lasting effects of this program may prove beneficial at other institutions.
Collapse
Affiliation(s)
| | | | | | - Constance Zhou
- Weill-Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | | | | | | | | | | |
Collapse
|
3
|
Fisher AD, Ristori J, Romani A, Cassioli E, Mazzoli F, Cocchetti C, Pierdominici M, Marconi M, Ricca V, Maggi M, Vignozzi L, Castellini G. Back to the Future: Is GnRHa Treatment in Transgender and Gender Diverse Adolescents Only an Extended Evaluation Phase? J Clin Endocrinol Metab 2024; 109:1565-1579. [PMID: 38099569 DOI: 10.1210/clinem/dgad729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Indexed: 05/18/2024]
Abstract
CONTEXT The role of body modifications induced by gonadal suppression in transgender and gender diverse adolescents on psychological functioning has not yet been evaluated. OBJECTIVE The main aim of the present study was to explore several hormone, physical and psychological functioning changes during gonadotropin-releasing hormone analog (GnRHa) treatment in transgender and gender diverse adolescents (TGDAs). The potential relationship between the physical and hormone effects of GnRHa and psychological well-being, along with its magnitude, was assessed for the first time. METHODS This prospective multidisciplinary study included 36 TGDA (22 assigned female at birth, and 14 assigned male at birth) who received psychological assessment followed by triptorelin prescription after referring to the Florence Gender Clinic. This study consisted of 3 time points: first referral (T0), psychological assessment (T1); and treatment with intramuscular injections of triptorelin for 3 up to 12 months (T2). Psychometric questionnaires were administered at each time point, and clinical and biochemical evaluations were performed at T1 and T2. RESULTS The following results were found: (1) GnRHa showed efficacy in inhibiting puberty progression in TGDAs; (2) an increase in psychopathology was observed before starting GnRHa (T1) compared with baseline levels; (3) during GnRHa treatment (T2), a significant improvement in psychological functioning, as well as decrease in suicidality, body uneasiness, depression, and anxiety levels were observed; (4) hormone and physical changes (in terms of gonadotropin and sex steroid levels, height and body mass index percentiles, waist-hip ratio, and acne severity) observed during triptorelin treatment significantly correlated with a reduction in suicidal ideation, anxiety, and body image concerns. CONCLUSION Psychological improvement in TGDA on GnRHa seems to be related to the objective body changes induced by a GnRHa. Therefore, the rationale for treatment with a GnRHa may not only be considered an extension of the evaluation phase, but also the start of a medical (even if reversible) gender-affirming path, especially in TGDAs whose puberty has already progressed.
Collapse
Affiliation(s)
- Alessandra D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence 50139, Italy
| | - Jiska Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence 50139, Italy
- Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence 50139, Italy
| | - Alessia Romani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence 50139, Italy
- Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence 50139, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence 50100, Italy
| | - Francesca Mazzoli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence 50139, Italy
- Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence 50139, Italy
| | - Carlotta Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence 50139, Italy
- Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence 50139, Italy
| | - Marina Pierdominici
- Reference Center for Gender Medicine, Italian National Institute of Health, Rome 00161, Italy
| | - Matteo Marconi
- Reference Center for Gender Medicine, Italian National Institute of Health, Rome 00161, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence 50100, Italy
| | - Mario Maggi
- Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence 50139, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence 50139, Italy
- Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence 50139, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence 50100, Italy
| |
Collapse
|
4
|
Amos N, Bourne A, Macioti PG, Hill AO, Melendez-Torres GJ. COVID-19, lockdowns, and the mental wellbeing of LGBTQ people in Australia. CULTURE, HEALTH & SEXUALITY 2024:1-16. [PMID: 38753968 DOI: 10.1080/13691058.2024.2352586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
LGBTQ communities around the world entered the COVID-19 pandemic with generally high rates of poor mental health and faced additional challenges including stigma, discrimination, and barriers to care. This study sample was drawn from a survey of 3135 LGBTQ adults residing in Australia during the pandemic. Regression analysis was used to explore individual differences in psychological distress and perceived change in mental wellbeing since the onset of the pandemic as well as the impact of lockdowns, by taking advantage of a natural experiment comparing the states that experienced more extensive lockdowns (Victoria and New South Wales) to the rest of Australia. The burden of mental health was found to vary across gender, sexual orientation, age, and area of residence. While no impact of lockdowns on psychological distress was observed, participants living in the states of Victoria (β = -0.15; 95% CI = -0.23, -0.07) and New South Wales (β = -0.13; 95% CI = -0.21, -0.05) self-reported a more negative impact of the pandemic on their mental wellbeing compared to the rest of the country. The findings suggest that the COVID-19 pandemic had a negative impact on the mental wellbeing of LGBTQ populations, particularly among those who experienced extensive lockdowns and highlight the need for increased efforts to enable access to mental health supports during times of crisis.
Collapse
Affiliation(s)
- Natalie Amos
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Paola Gioia Macioti
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | | |
Collapse
|
5
|
Depolli GT, Quinalha R, Azevedo RR. Self-Esteem, Self-Satisfaction with Voice, and Self-Assessment with Descriptive Terms of One's Own Voice for Voice Among Brazilian LGBTQIAPN+ People. J Voice 2024:S0892-1997(24)00116-4. [PMID: 38760252 DOI: 10.1016/j.jvoice.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES To analyze self-esteem, self-satisfaction with voice, and self-assessment with descriptive terms of one's own voice among Brazilian LGBTQIAPN+ people. STUDY DESIGN Cross-sectional, observational, qualitative-quantitative study. METHODS The study included any person who identified as Brazilian LGBTQIAPN+ and excluded those under 18 years old. Participants answered a sociodemographic questionnaire, the Rosenberg Self-Esteem Scale, and the Descriptive terms of one's own voice (which were analyzed with text processing techniques). The 10 terms most listed as positive or negative were selected for simple logistic regression associated with the Rosenberg Self-Esteem Scale. The alpha level of significance used in all analyses was 5%. RESULTS The study considered the responses from 411 participants. It is noteworthy that 92.45% (n = 380) of the studied population identified as cisgender. Among the participants, 28 were classified as having unsatisfactory self-esteem, 208 as having average self-esteem, and 178 as having satisfactory self-esteem. Individuals with unsatisfactory scores described themselves using terms such as "high," "boring," "ugly," "unfriendly," and "masculine," while those with average scores used terms like "insecure," "nasal," "out of tune," and "high." Those with satisfactory scores associated themselves with terms such as "expressive," "sympathetic," "kind," "pleasant," and "stable." The terms "cheerful," "adequate," and "boring" significantly associated with the Rosenberg Self-Esteem Scale.score. CONCLUSION LGBTQIAPN+ people with unsatisfactory self-esteem referred to their voices with negative descriptive terms, similar to people with average self-esteem, who often did not select any positive term. On the other hand, people with satisfactory self-esteem assessed their voices with positive descriptive terms and few negative adjectives. People with satisfactory scores are more likely to think that their voice is "cheerful" and less likely to consider it "adequate" or "boring" than people with unsatisfactory scores on the Rosenberg Self-Esteem Scale. The majority of participants were cisgender homosexual males, thus caution should be exercised in generalizing the data to the entire community.
Collapse
Affiliation(s)
- Gabriel Trevizani Depolli
- Speech-Language Pathology Department, Universidade Federal de São Paulo - UNIFESP, São Paulo, São Paulo, Brazil.
| | - Renan Quinalha
- Paulista School of Politics, Economics, and Business, Universidade Federal de São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Renata Rangel Azevedo
- Speech-Language Pathology Department, Universidade Federal de São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| |
Collapse
|
6
|
Yates S, Gladstone B, Foster K, Silvén Hagström A, Reupert A, O'Dea L, Cuff R, McGaw V, Hine R. Epistemic injustice in experiences of young people with parents with mental health challenges. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:702-721. [PMID: 37994180 DOI: 10.1111/1467-9566.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023]
Abstract
Amongst the impacts of growing up with a parent with mental health challenges is the experience of stigma-by-association, in which children and young people experience impacts of stigmatisation due to their parent's devalued identity. This article seeks to expand our understanding of this issue through an abductive analysis of qualitative data collected through a codesign process with young people. Results indicate that young people's experiences of stigmatisation can be effectively understood as experiences of epistemic injustice. Participants expressed that their experiences comprised 'more than' stigma, and their responses suggest the centrality to their experiences of being diminished and dismissed in respect of their capacity to provide accurate accounts of their experiences of marginalisation and distress. Importantly, this diminishment stems not only from their status as children, and as children of parents with mental health challenges but operates through a range of stigmatised identities and devalued statuses, including their own mental health status, sexual minoritisation, disability and social class. Forms of epistemic injustice thus play out across the social and institutional settings they engage with. The psychological and social impacts of this injustice are explored, and the implications for our understanding of stigma around family mental health discussed.
Collapse
Affiliation(s)
- Scott Yates
- School of Applied Social Sciences, De Montfort University, Leicester, UK
| | - Brenda Gladstone
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kim Foster
- National School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia
| | | | - Andrea Reupert
- School of Educational Psychology and Counselling, Monash University, Clayton, Victoria, Australia
| | - Lotti O'Dea
- Satellite Foundation, Melbourne, Victoria, Australia
| | - Rose Cuff
- Satellite Foundation, Melbourne, Victoria, Australia
| | - Violette McGaw
- Trauma Recovery Program, Toowong Private Hospital, Brisbane, Queensland, Australia
| | - Rochelle Hine
- Monash Rural Health, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
7
|
Jayne PE, Szucs LE, Lesesne CA, Grose RG, Johns MM. "I wouldn't have felt so alone": The sexual health education experiences of transgender and gender diverse youth living in the southeastern United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024. [PMID: 38623631 DOI: 10.1111/psrh.12258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce. METHODS We conducted a multi-stage thematic analysis of 33 in-depth interviews among transgender and gender diverse youth (ages 15-24) living in the southeastern United States on their sexual health education experiences. RESULTS Our study participants described school-based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white-centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment-free information while holding positive framing around sexuality and gender. CONCLUSION There is much work needed to improve the breadth, quality, and relevance of school-based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community-based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer-friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways.
Collapse
Affiliation(s)
- Paula E Jayne
- U.S. Centers for Disease Control and Prevention's Division of Adolescent and School Health, Atlanta, Georgia, USA
| | - Leigh E Szucs
- U.S. Centers for Disease Control and Prevention's Division of Adolescent and School Health, Chamblee, Georgia, USA
| | | | - Rose Grace Grose
- Colorado School of Public Health, Community Health Education, University of Northern Colorado, Greeley, Colorado, USA
| | | |
Collapse
|
8
|
Zytner ZJE, Stanley JR, Grewal P, Dettmer E, Toulany A, Palmert MR, Sorbara JC. Gender diversity among adolescents with obesity in a weight management programme. Clin Obes 2024:e12664. [PMID: 38622908 DOI: 10.1111/cob.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/11/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
Gender dysphoria (GD) and obesity share commonalities, including associations with mental health comorbidities, disordered eating, body dissatisfaction and may intensify with physical and developmental changes during adolescence. While associations of obesity and gender diversity have been identified, rates of gender diversity among adolescents with obesity remain unclear. The aim was to examine gender diversity among adolescents with obesity in a weight management programme. A single-centre cross-sectional questionnaire study was conducted. Eligible adolescents received the Gender Identity/GD Questionnaire for Adolescents and Adults (GIDYQ-AA), a validated instrument measuring gender diversity and GD. Gender identities, sexual orientations, questionnaire scores, and frequency of GD (GIDYQ-AA score <3) were determined. The relationship of GIDYQ-AA scores and BMI Z-score (BMIz) was assessed. Of 72 consenting youth, 29 assigned females (AF) and 17 assigned males (AM) completed GIDYQ-AA and demographic questions. Seventeen (59%) AF reported non-heterosexual orientations, and 6 (21%) reported non-cisgender identities. One (6%) AM reported non-cisgender identity. Two (4%) AF individuals had GD based on GIDYQ-AA scores. GIDYQ-AA scores did not correlate with BMIz. In conclusion, adolescents with obesity, particularly AF with non-heterosexual orientation, reported high rates of non-cisgender identity and GD. Routine screening for gender-related concerns in weight management settings may be warranted.
Collapse
Affiliation(s)
- Zachary J E Zytner
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joshua R Stanley
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Preeti Grewal
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Dettmer
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alene Toulany
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark R Palmert
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julia C Sorbara
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Shuler SL, Klimczak K, Pollitt AM. Queer in the Latter Days: An Integrated Model of Sexual and Religious Identity Development Among Former Mormon Sexual Minority Adults. JOURNAL OF HOMOSEXUALITY 2024; 71:1201-1230. [PMID: 36715727 DOI: 10.1080/00918369.2023.2169087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Sexual minority individuals often have complicated relationships with conservative religion, including conflicts between their sexual and religious identities. Sexual minority members of the Church of Jesus Christ of Latter-Day Saints (CJCLDS) experience unique struggles, given the policies and doctrine of the CJCLDS and its commitment to heteronormative family structures and gender roles. A better understanding of the identity development trajectory for sexual minority individuals formerly involved in the church can deepens our understanding of sexual identity development in constrained contexts and help promote successful identity integration within this subpopulation. Transcripts from semi-structured interviews with thirty-four sexual minority individuals who identified as former members of the CJCLDS were analyzed using an inductive thematic approach, followed by a deductive theory-building process in which Cass's Homosexual Identity Formation Model and Genia's Religious Identity Development Model were overlaid on themes. We present a model that captures the trajectory of sexual and religious identity development that captures the experiences of sexual minority adults within the constraints of the CJCLDS, a non-affirming religious denomination.
Collapse
Affiliation(s)
- Shay L Shuler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Connecticut, USA
| | - Korena Klimczak
- Department of Clinical and Counseling Psychology, Utah State University, Logan, Utah, USA
| | - Amanda M Pollitt
- Department of Health Sciences, Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| |
Collapse
|
10
|
Ventres WB, Stone LA, Abou-Arab ER, Meza J, Buck DS, Crowder JW, Edgoose JYC, Brown A, Plumb EJ, Norris AK, Allen JJ, Giammar LE, Wood JE, Dickson SM, Brown GA. Storylines of family medicine IX: people and places-diverse populations and locations of care. Fam Med Community Health 2024; 12:e002826. [PMID: 38609086 PMCID: PMC11029404 DOI: 10.1136/fmch-2024-002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IX: people and places-diverse populations and locations of care', authors address the following themes: 'LGBTQIA+health in family medicine', 'A family medicine approach to substance use disorders', 'Shameless medicine for people experiencing homelessness', '''Difficult" encounters-finding the person behind the patient', 'Attending to patients with medically unexplained symptoms', 'Making house calls and home visits', 'Family physicians in the procedure room', 'Robust rural family medicine' and 'Full-spectrum family medicine'. May readers appreciate the breadth of family medicine in these essays.
Collapse
Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Emad R Abou-Arab
- Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Julio Meza
- Family Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - David S Buck
- Community Medicine, University of Houston, Tilman J Fertitta Family College of Medicine, Houston, Texas, USA
| | - Jerome W Crowder
- Social and Behavioral Sciences, University of Houston, Tilman J Fertitta Family College of Medicine, Houston, Texas, USA
| | - Jennifer Y C Edgoose
- Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alexander Brown
- NH Dartmouth Family Medicine Residency, Concord, New Hampshire, USA
| | - Ellen J Plumb
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Amber K Norris
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Jay J Allen
- Duluth Family Medicine Residency Program, University of Minnesota Medical School Duluth Campus, Duluth, Minnesota, USA
| | - Lauren E Giammar
- Duluth Family Medicine Residency Program, University of Minnesota Medical School Duluth Campus, Duluth, Minnesota, USA
| | - John E Wood
- Duluth Family Medicine Residency Program, University of Minnesota Medical School Duluth Campus, Duluth, Minnesota, USA
| | - Scott M Dickson
- UAMS Northeast Regional Campus Family Medicine Residency Program, Jonesboro, Arkansas, USA
| | - G Austin Brown
- Cascades East Family Medicine Residency Program, Oregon Health & Science University School of Medicine, Klamath Falls, Oregon, USA
| |
Collapse
|
11
|
Shamrock OW, Abu-Ba'are GR, Zigah EY, Dakpui HD, Adjaka G, LeBlanc NM, Alio AP, Nelson L. Community stigma, victimization, and coping strategies among gay, bisexual, and other cis-gender men who have sex with men in slum communities in Ghana. BSGH-003. BMC Public Health 2024; 24:966. [PMID: 38580970 PMCID: PMC10998418 DOI: 10.1186/s12889-024-18242-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Gay, bisexual, and cis-gender men who have sex with men (GBMSM) face severe consequences, especially within stigmatized environments. However, very little is known about the experiences of GBMSM living in slums in SSA and Ghana. This study investigates the experiences of stigma, victimization, and coping strategies and proposes some interventional approaches for combating stigma facing GBMSM in slum communities. METHODS We engaged GBMSM living in slums in two major Ghanaian cities. We used a time-location sampling and collected data through in-depth individual interviews. Two major themes emerged from the study: (1) insecurities and criminalization of GBMSM activity, and (2) GBMSM coping strategies. RESULTS Findings show GBMSM experienced negative attitudes from the community due to their sexual behavior/orientation. GBMSM also developed coping strategies to avert negative experiences, such as hiding their identities/behavior, avoiding gender non-conforming men, and having relationships with persons outside their communities. CONCLUSION We propose interventions such as HIV Education, Empathy, Empowerment, Acceptance, and Commitment Therapy as possible measures to improve the experiences of GBMSM living in Ghanaian slum communities.
Collapse
Affiliation(s)
- Osman Wumpini Shamrock
- School of Nursing, University of Rochester, Rochester, USA
- Behavioral, Sexual and Gender Health Lab, Accra, Ghana
- Behavioral, Sexual and Gender Health Lab, University of Rochester, New Haven, Connecticut, USA
| | - Gamji Rabiu Abu-Ba'are
- School of Nursing, University of Rochester, Rochester, USA
- Behavioral, Sexual and Gender Health Lab, Accra, Ghana
- School of Public Health, University of Rochester, Rochester, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
- Behavioral, Sexual and Gender Health Lab, University of Rochester, New Haven, Connecticut, USA
| | | | | | - Gideon Adjaka
- Hope Alliance Foundation, Non-profit Organization, Accra, Ghana
| | - Natalie M LeBlanc
- School of Nursing, University of Rochester, Rochester, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Amina P Alio
- School of Public Health, University of Rochester, Rochester, USA
| | - LaRon Nelson
- School of Nursing, Yale University, West Haven, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
12
|
Ragavan MI, Coulter RWS, Sickler L, Shaw DS, De Genna NM. Associations Among Plurisexual Identity, Intimate Partner Violence, Reproductive Coercion, and Parental Monitoring in a Sample of Adolescent and Young Adult Pregnant People. LGBT Health 2024. [PMID: 38574316 DOI: 10.1089/lgbt.2023.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Purpose: The goal of this study was to examine plurisexual identity, intimate partner violence (IPV), reproductive coercion, and parental monitoring among pregnant 13-21-year-olds. Methods: We conducted a cross-sectional analysis of data collected from a cohort of pregnant adolescents and young adults between October 2019 and May 2023 (n = 398). Logistic regression was completed to assess IPV and reproductive coercion as a function of plurisexual identity. Next, we assessed potential interactions between parental monitoring and plurisexual identity and examined IPV and reproductive coercion as a function of parental monitoring for the full sample and stratified by plurisexuality. Results: Plurisexual identity was associated with IPV (adjusted odds ratio [aOR] = 2.3; confidence interval [CI]: 1.4-4.0). IPV was inversely related to parental monitoring among plurisexual participants (aOR: 0.51; CI: 0.32-0.82), but this association was not significant for heterosexual participants (aOR: 1.1; CI: 0.75-1.6). Conclusions: This work demonstrates the importance of parental monitoring in supporting young plurisexual pregnant people.
Collapse
Affiliation(s)
- Maya I Ragavan
- Division of General Academic Pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Natacha M De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
13
|
Coleman TA, Chee K, Chin-See R, Salama R, Sajan M, Narbonne M, Travers R, Coulombe S. Minority Stressors, Social Provisions, and Past-Year Suicidal Ideation and Suicide Attempts in a Sample of Sexual Orientation and Gender Identity/Expression Minority People in Canada. LGBT Health 2024. [PMID: 38557210 DOI: 10.1089/lgbt.2022.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Purpose: Mental health disparities in sexual orientation and/or gender identity and/or expression (SOGIE) minority groups are well-documented, with research consistently showing higher levels of suicidality, even in Canada, considered one of the world's most accepting countries of SOGIE minority groups. Adverse outcomes in these groups are often framed using minority stress theory, with social support frequently studied as an integral buffer to these outcomes. This analysis explores facets of minority stress and social support associated with past-year suicidal ideation and suicide attempts. Methods: A cross-sectional internet survey of SOGIE diverse people in Canada (n = 1542) was conducted. Binary logistic regression calculated bivariate and multivariate factors associated with past-year suicidal ideation and suicide attempts. Backward elimination (retaining sociodemographic factors and self-rated mental health) identified salient minority stress and social support (provisions) factors. Results: Over half (56.72%) of participants had ever thought of dying by suicide, with 24.84% having attempted suicide. During the past year, 26.80% had thought of dying by suicide, with 5.32% having attempted suicide. Victimization events, and guidance (e.g., someone to talk to about important decisions) and attachment (e.g., close relationships providing emotional security) social provision subscales remained salient after backward elimination procedures. Conclusion: Our findings emphasize that a fulsome, multilevel approach considering structural, community, and individual strategies to address overt discrimination, integrating social connections and guidance, is necessary to prevent dying by suicide.
Collapse
Affiliation(s)
- Todd A Coleman
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Kenny Chee
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Robert Chin-See
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Ramez Salama
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Maria Sajan
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Macie Narbonne
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Robb Travers
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Simon Coulombe
- Département des relations industrielles, Université Laval, Québec, Québec, Canada
| |
Collapse
|
14
|
McGregor K, McKenna JL, Williams CR, Barrera EP, Boskey ER. Association of Pubertal Blockade at Tanner 2/3 With Psychosocial Benefits in Transgender and Gender Diverse Youth at Hormone Readiness Assessment. J Adolesc Health 2024; 74:801-807. [PMID: 38099903 DOI: 10.1016/j.jadohealth.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 08/04/2023] [Accepted: 10/23/2023] [Indexed: 03/24/2024]
Abstract
PURPOSE Compare psychosocial function at the time of hormone readiness assessment for transgender and gender diverse (TGD) youth who received pubertal blockade to prevent a nonaffirming puberty with those who did not. METHODS Retrospective cohort study of psychological assessment data from hormone readiness evaluations conducted at a multispecialty gender clinic. Participants include all TGD youth between the ages of 13 and 17 assessed for hormone readiness between 2017 and 2021. RESULTS Our cohort consisted of 438 TGD youth, 40 who were prescribed pubertal blockade at Tanner stage 2 or 3, and 398 who had not. The blocker population was younger, more likely to be assigned male and affirming a female identity, and had a different racial/ethnic identity distribution. Having puberty blocked was associated with significantly lower T-scores on the Youth Self Report for internalizing problems (β = -7.4, p < .001), anxiety problems (β = -4.6, p = .003), depressive problems (β = -6.5, p < .001), stress problems (β = -4.0, p = .01), and total problems (β = -4.9, p = .003). The blocker population was also significantly less likely to report any suicidal thoughts (odds ratio = 0.38, p = .05). With the exception of increased risk of suicidal thoughts, these associations remained significant when adjusted for gender. DISCUSSION At the time of hormone readiness evaluation, TGD youth who received pubertal blockade at Tanner 2 or 3 were found to have less anxiety, depression, stress, total problems, internalizing difficulties, and suicidal ideation than TGD peers who had been through more of a nonaffirming puberty.
Collapse
Affiliation(s)
- Kerry McGregor
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; Department of Psychology, Harvard Medical School, Boston, Massachusetts; Gender Multispecialty Service, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - John L McKenna
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; Department of Psychology, Harvard Medical School, Boston, Massachusetts; Gender Multispecialty Service, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Coleen R Williams
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; Department of Psychology, Harvard Medical School, Boston, Massachusetts; Gender Multispecialty Service, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Ellis P Barrera
- Gender Multispecialty Service, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth R Boskey
- Gender Multispecialty Service, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Gynecology, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|
15
|
Ching THW, Finkelstein-Fox L, Lee SY, Watson RJ. Effects of sexual and gender minority stress on depressive symptoms among adolescents of color in the United States. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2024; 30:309-318. [PMID: 36048116 PMCID: PMC9975117 DOI: 10.1037/cdp0000562] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE There is a need for more research on minority stress theory (MST) with sexual and gender minority (SGM) adolescents of color, because of their disproportionate risk for depression. METHOD We recruited 1,627 SGM adolescents of color in the United States to complete measures assessing lesbian, gay, bisexual, transgender, and queer (LGBTQ) climate, LGBTQ microaggressions within one's ethnoracial community, internalized LGBTQ stigma, stress management ability, and depressive symptoms. Using structural equation modeling, a hybrid measurement-structural model was tested, indicating good model fit. RESULTS Multiple significant indirect pathways linking LGBTQ climate and depressive symptoms emerged. A less positive LGBTQ climate was associated with more microaggression-related stress, more internalized LGBTQ stigma, and worse stress management ability, all of which were associated with greater depressive symptoms. A serial mediation with more microaggression-related stress being associated with greater internalized LGBTQ stigma approached significance. CONCLUSIONS Our findings generally support MST processes in terms of depressive symptoms in SGM adolescents of color, suggesting that psychosocial interventions targeting these processes may have meaningful implications for the mental health of this vulnerable group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Sharon Y. Lee
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT
| |
Collapse
|
16
|
Juster RP, Rutherford C, Keyes K, Hatzenbuehler ML. Associations Between Structural Stigma and Allostatic Load Among Sexual Minorities: Results From a Population-Based Study. Psychosom Med 2024; 86:157-168. [PMID: 38345315 DOI: 10.1097/psy.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Structural forms of stigma and discrimination are associated with adverse health outcomes across numerous stigmatized groups, including lesbian, gay, and bisexual (LGB) individuals. However, the biological consequences of structural stigma among LGB populations are understudied. To begin to address this gap, we assessed associations between indicators of structural stigma (i.e., state-level policies) targeting LGB individuals and allostatic load (AL) indices representing physiological dysregulations. METHODS Pooled data from the continuous 2001-2014 National Health and Nutritional Examination Survey were analyzed (LGB: n = 864; heterosexual: n = 20,310). Ten state-level LGB-related policies (e.g., employment nondiscrimination protections, same-sex marriage) were used to operationalize structural stigma. A sex-specific AL index representing 11 immune, metabolic, and cardiovascular biomarkers was estimated. Multilevel models were used to examine associations between structural stigma and AL, net of nine individual-level characteristics (e.g., education, race/ethnicity, age, and health behaviors). RESULTS Sexual minority men living in states with low levels of structural stigma experienced significantly lower AL ( β = -0.45, p = .02) compared with sexual minority men living in states with high structural stigma (i.e., fewer protective policies). There was no significant association between structural stigma and AL among sexual minority women. CONCLUSIONS By demonstrating direct associations between structural stigma and indices of physiological dysregulation, our findings provide a mechanistic understanding of how the social environment can "get under the skin and skull" for sexual minority men in the United States. Future research should explore whether these mechanisms generalize to other marginalized groups exposed to structural stigma.
Collapse
Affiliation(s)
- Robert-Paul Juster
- From the Department of Psychiatry and Addiction (Juster), University of Montreal; Research Center of the Montreal Mental Health University Institute (Juster), Montreal, Quebec, Canada; Department of Epidemiology, Mailman School of Public Health, Columbia University (Rutherford, Keyes), New York, New York; and Department of Psychology, Harvard University (Hatzenbuehler), Cambridge, Massachusetts
| | | | | | | |
Collapse
|
17
|
Gautam K, Aguilar C, Paudel K, Dhakal M, Wickersham JA, Acharya B, Sapkota S, Deuba K, Shrestha R. Preferences for mHealth Intervention to Address Mental Health Challenges Among Men Who Have Sex With Men in Nepal: Qualitative Study. JMIR Hum Factors 2024; 11:e56002. [PMID: 38551632 PMCID: PMC11015371 DOI: 10.2196/56002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/01/2024] [Accepted: 02/18/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately burdened by poor mental health. Despite the increasing burden, evidence-based interventions for MSM are largely nonexistent in Nepal. OBJECTIVE This study explored mental health concerns, contributing factors, barriers to mental health care and support, and preferred interventions to improve access to and use of mental health support services among MSM in Nepal. METHODS We conducted focus groups with MSM in Kathmandu, Nepal, in January 2023. In total, 28 participants took part in 5 focus group sessions. Participants discussed several topics related to the mental health issues they experienced, factors contributing to these issues, and their suggestions for potential interventions to address existing barriers. The discussions were recorded, transcribed, and analyzed using Dedoose (version 9.0.54; SocioCultural Research Consultants, LLC) software for thematic analysis. RESULTS Participants reported substantial mental health problems, including anxiety, depression, suicidal ideation, and behaviors. Contributing factors included family rejection, isolation, bullying, stigma, discrimination, and fear of HIV and other sexually transmitted infections. Barriers to accessing services included cost, lack of lesbian, gay, bisexual, transgender, intersex, queer, and asexual (LGBTIQA+)-friendly providers, and the stigma associated with mental health and sexuality. Participants suggested a smartphone app with features such as a mental health screening tool, digital consultation, helpline number, directory of LGBTIQA+-friendly providers, mental health resources, and a discussion forum for peer support as potential solutions. Participants emphasized the importance of privacy and confidentiality to ensure mobile apps are safe and accessible. CONCLUSIONS The findings of this study have potential transferability to other low-resource settings facing similar challenges. Intervention developers can use these findings to design tailored mobile apps to facilitate mental health care delivery and support for MSM and other marginalized groups.
Collapse
Affiliation(s)
- Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Camille Aguilar
- School of Nursing and Health Studies, University of Miami, Miami, FL, United States
| | - Kiran Paudel
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- Nepal Health Frontiers, Tokha-5, Kathmandu, Nepal
| | - Manisha Dhakal
- Blue Diamond Society, Dhumbarahi Height, Kathmandu, Nepal
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States
| | - Bibhav Acharya
- Department of Psychiatry and Behavioral Sciences, School of Medicine, UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
- Possible, Kathmandu, Nepal
| | | | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
18
|
Bränström R, Hatzenbuehler ML, Lattanner MR, Hollinsaid NL, McDade TW, Pachankis JE. Threats to social safety and neuro-inflammatory mechanisms underlying sexual orientation disparities in depression symptom severity: A prospective cohort study of young adults. Brain Behav Immun 2024; 119:211-219. [PMID: 38548185 DOI: 10.1016/j.bbi.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/25/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024] Open
Abstract
Sexual minority individuals have a markedly elevated risk of depression compared to heterosexuals. We examined early threats to social safety and chronically elevated inflammation as mechanisms contributing to this disparity in depression symptoms, and compared the relative strength of the co-occurrence between chronic inflammation and depression symptoms for sexual minorities versus heterosexuals. To do so, we analyzed data from a prospective cohort of sexual minority and heterosexual young adults (n = 595), recruited from a nationally representative sample, that included assessments of early threats to social safety in the form of adverse childhood interpersonal events, three biomarkers of inflammation (i.e., CRP, IL-6, TNF-α) measured at two time points, and depression symptoms over four years. In pre-registered analyses, we found that sexual minorities experienced more adverse childhood interpersonal events, were more likely to display chronically elevated inflammation, and reported more severe depression symptoms than heterosexuals. Adverse childhood interpersonal events and chronically elevated inflammation explained approximately 23 % of the total effect of the association between sexual orientation and depression symptom severity. Further, there was an increased coupling of chronically elevated inflammation and depression symptoms among sexual minorities compared to heterosexuals. These results provide novel longitudinal, population-based evidence for the role of chronically elevated inflammation in linking threats to social safety during childhood with depression symptom severity in young adulthood, consistent with the primary tenets of the social signal transduction theory of depression. Our study extends this theory to the population level by finding that members of a stigmatized population (i.e., sexual minorities) experience a greater risk of depression because of their greater exposure to adverse childhood interpersonal events and the subsequent link to chronic inflammation, highlighting potential biopsychosocial intervention targets.
Collapse
Affiliation(s)
- Richard Bränström
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | | | - Micah R Lattanner
- Department of Public Health, Santa Clara University, Santa Clara, CA USA
| | | | - Thomas W McDade
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
19
|
O'Leary KB, Rufino KA, Patriquin MA, Kapoor S. Gender Identity and Mental Health Symptom Severity Among Adolescents Admitted to an Inpatient Psychiatric Hospital. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01674-6. [PMID: 38446365 DOI: 10.1007/s10578-024-01674-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 03/07/2024]
Abstract
Transgender youth are at an increased risk of suicide, substance use, experiencing violent assaults, and reporting major depressive episodes and greater psychological distress compared to their cisgender counterparts. This study examined mental health symptom severity in adolescents admitted to an inpatient psychiatric hospital who wished they were of a different gender compared to those who did not. A group of 180 adolescents admitted to an inpatient psychiatric hospital completed assessments to measure mental health symptom severity at admission. Gender diverse (n = 90) and cisgender (n = 90) groups were established. Analyses of variance (ANOVA) were used to examine between group (gender diverse vs. cisgender) difference on depression, anxiety, suicide risk, nighttime sleep quality, and emotion regulation problems. Results revealed significant differences in emotion regulation difficulties at admission, specifically in nonacceptance and awareness. There were no significant differences on measures of depression, anxiety, suicide risk, and nighttime sleep quality at admission. This study is one of the first to measure mental health symptom severity in gender diverse adolescents while admitted to an inpatient psychiatric setting. Adolescents in the gender diverse group had significantly higher level of difficulty with emotion regulation, which may indicate an increased risk of developing psychiatric symptoms such as depression and anxiety. This paper demonstrates the importance of using targeted interventions to address difficulties with emotion regulation in at-risk adolescents.
Collapse
Affiliation(s)
- Kerry B O'Leary
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. Kerry.O'
| | - Katrina A Rufino
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
- The Menninger Clinic, Houston, TX, USA
- University of Houston-Downtown, Houston, TX, USA
| | - Michelle A Patriquin
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
- The Menninger Clinic, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Shweta Kapoor
- Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
20
|
Bonomo JA, Luo K, Ramallo JA. LGBTQ+ cardiovascular health equity: a brief review. Front Cardiovasc Med 2024; 11:1350603. [PMID: 38510198 PMCID: PMC10951381 DOI: 10.3389/fcvm.2024.1350603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Data shows that social drivers of health (SDOH), including economic stability, racial/cultural identity, and community, have a significant impact on cardiovascular morbidity and mortality. LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other gender and sexual minority) patients face a variety of unique health risk factors and bear a disproportionate burden of CVD compared to cis-gender, heterosexual peers. There is a paucity of research assessing the etiologies of CVD health disparities within the LGBTQ+ community. Herein, we seek to explore existing literature on LGBTQ+ health disparities with a focus on cardiovascular disease, examine trends impacting LGBTQ+ health equity, and identify strategies and interventions that aim to promote LGBTQ+ cardiovascular health equity on a regional and national level.
Collapse
Affiliation(s)
- Jason A. Bonomo
- Inova Scar Heart and Vascular, Inova Health System, Falls Church, VA, United States
| | - Kate Luo
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Jorge A. Ramallo
- Inova Pride Clinic, Inova Health System, Falls Church, VA, United States
| |
Collapse
|
21
|
Cornelisse VJ, Murphy D, Lee SJ, Stoove M, Traeger MW, Wright EJ. Physical and mental health of long-term users of HIV preexposure prophylaxis in Australia. AIDS 2024; 38:363-372. [PMID: 37877295 DOI: 10.1097/qad.0000000000003768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
INTRODUCTION HIV preexposure prophylaxis (PrEP) is highly effective at preventing HIV. We aimed to assess mental and physical health among long-term PrEP users in Australia's X-PLORE cohort. METHODS In early 2021, 1485 X-PLORE participants were emailed a survey covering demographics, sexual practices, ongoing PrEP use, physical and psychological diagnoses received since commencing PrEP, substance use, and impacts of the COVID-19 pandemic. Current anxiety and depression were assessed using GAD-7 and PHQ-9 questionnaires. RESULTS Of 476 participants (completion rate 32.1%), 99.8% were cis-gender men. Median PrEP use duration was 48 months (2002 person-years), with 81.7% currently using PrEP. PrEP-related toxicity was uncommon: 2.9% reported bone fractures, 1.3% low bone density, and 4.0% reported kidney problems, largely not necessitating PrEP cessation. Most (92.0%) rated their health as 'good' to 'excellent', and 22.6% reported improved health since starting PrEP, often because of improved mental health. Only 6.2% reported deterioration in health since starting PrEP, largely unrelated to PrEP. The most common diagnoses were hypertension (9.9%), depression (13.2%) and anxiety (14.9%); 17% had PHQ-9 scores indicating current moderate-to-severe depression, which was associated with unemployment [adjusted odds ratio (aOR) 3.90], regular cannabis use (aOR 2.49), and having ceased PrEP (aOR 2.13). CONCLUSION Among long-term PrEP users, of which over 80% were currently using PrEP, self-reported PrEP toxicity was uncommon. With almost one in five PrEP users categorized as having depression, and with higher risk among those having ceased PrEP, we recommend routine screening for depression and anxiety in PrEP users and corresponding follow-up of patients no longer attending for PrEP.
Collapse
Affiliation(s)
- Vincent J Cornelisse
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- The Kirby Institute, UNSW Sydney, Sydney
| | - Dean Murphy
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- The Kirby Institute, UNSW Sydney, Sydney
| | - Sue J Lee
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
| | - Mark Stoove
- Burnet Institute
- Australian Research Centre in Sex, Health and Society, LaTrobe University
- School of Public Health and Preventive Medicine, Monash University
| | - Michael W Traeger
- Burnet Institute
- School of Public Health and Preventive Medicine, Monash University
| | - Edwina J Wright
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- Burnet Institute
- Doherty Institute, Melbourne, Australia
| |
Collapse
|
22
|
Dickson CA, Ergun-Longmire B, Greydanus DE, Eke R, Giedeman B, Nickson NM, Hoang LN, Adabanya U, Payares DVP, Chahin S, McCrary J, White K, Moon JH, Haitova N, Deleon J, Apple RW. Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon). Dis Mon 2024; 70:101631. [PMID: 37739834 DOI: 10.1016/j.disamonth.2023.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.
Collapse
Affiliation(s)
- Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Berrin Ergun-Longmire
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ransome Eke
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Bethany Giedeman
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nikoli M Nickson
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Uzochukwu Adabanya
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Daniela V Pinto Payares
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Summer Chahin
- Department of Psychology, C.S. Mott Children's Hospital/Michigan Medicine, Ann Arbor, MI, United States
| | - Jerica McCrary
- Center for Rural Health and Health Disparities, Mercer University School of Medicine, Columbus, GA, United States
| | - Katie White
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Jin Hyung Moon
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Nizoramo Haitova
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI, United States
| | - Jocelyn Deleon
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| |
Collapse
|
23
|
Zelin NS, Scott C, Avila-Quintero VJ, Curlin K, Flores JM, Bloch MH. Sexual Orientation and Racial Bias in Relation to Medical Specialty. JOURNAL OF HOMOSEXUALITY 2024; 71:574-599. [PMID: 36269161 DOI: 10.1080/00918369.2022.2132441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Physician explicit and implicit biases involving race and sexual orientation (SO) affect patient and provider experiences in healthcare settings. An anonymous survey was disseminated nationally to graduating medical students, residents, and practicing physicians to evaluate SO and racial biases across medical specialties. SO explicit and implicit bias were measured with the Attitudes toward Lesbians and Gay Men Scale, short form (ATLG-S) and Gay-Straight Implicit Association Test (IAT). Racial explicit and implicit bias were measured with the Quick Discrimination Index (QDI) and the Black-White IAT. Medical specialty was associated with racial explicit bias and specialty prestige with Black-White IAT score. Medical specialty and specialty prestige were not associated with SO bias. Female sex, sexual and gender minority (SGM) identity, and decreased religiosity were associated with reduced SO and racial bias. Provider race was associated with racial implicit and explicit bias.
Collapse
Affiliation(s)
| | - Carter Scott
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kaveri Curlin
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Jose M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael H Bloch
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
24
|
Terry E, Pharr JR, Batra R, Batra K. Protective and Risk Factors for Suicidal Ideation and Behavior Among Sexual Minority Women in the United States: A Cross-Sectional Study. LGBT Health 2024. [PMID: 38324060 DOI: 10.1089/lgbt.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Purpose: The purpose of this study was to understand the factors associated with suicidal ideation and behavior and serious suicidal ideation and behavior among sexual minority women (SMW), including resilience, discrimination, mental health, and sociodemographic characteristics. Methods: Web-based surveys were conducted with SMW from across the United States during January-February, 2022 using psychometric valid tools. Bivariate, hierarchical regression, and logistic regression analyses were used to analyze the data. Results: Of 497 participants, 70% were identified as bisexual and 30% as lesbian. The mean scores for anxiety, depression, and stress were significantly higher among bisexual women compared to their lesbian counterparts (p < 0.05). The proportion of serious suicidal ideation and behavior was higher among bisexual women compared to lesbian women (53.9% vs. 41.2%, p = 0.012). Conversely, the mean scores of resilience were lower among bisexual women compared to lesbian women (139.7 ± 33.4 vs. 147.5 ± 33.6, p = 0.024). Lesbian women had nearly 57.4% lower odds of having serious suicidal ideation and behavior as compared to bisexual women (adjusted odds ratio = 0.426; p = 0.023). Experiencing anxiety, depression, victimization distress, and family discrimination distress were positively associated with serious suicidal ideation and behavior, whereas personal resilience and family cohesion were negatively associated with serious suicidal ideation and behavior. Conclusions: Tackling structural inequities such as racism and homophobia remains vital to improving the mental health of SMW. Interventions to strengthen social and familial supports may be particularly impactful, especially at the family level.
Collapse
Affiliation(s)
- Emylia Terry
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Ravi Batra
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
- Office of Research, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| |
Collapse
|
25
|
Harris MTH, Laks J, Hurstak E, Jain JP, Lambert AM, Maschke AD, Bagley SM, Farley J, Coffin PO, McMahan VM, Barrett C, Walley AY, Gunn CM. "If you're strung out and female, they will take advantage of you": A qualitative study exploring drug use and substance use service experiences among women in Boston and San Francisco. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209190. [PMID: 37866442 PMCID: PMC11040599 DOI: 10.1016/j.josat.2023.209190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/12/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Significant disparities in substance use severity and treatment persist among women who use drugs compared to men. Thus, we explored how identifying as a woman was related to drug use and treatment experiences. METHODS The study recruited participants for a qualitative interview study in Boston and San Francisco from January-November 2020. Self-identified women, age ≥ 18 years, with nonprescribed opioid use in the past 14 days were eligible for inclusion. The study team developed deductive codes based on intersectionality theory and inductive codes generated from transcript review, and identified themes using grounded content analysis. RESULTS The study enrolled thirty-six participants. The median age was 46; 58 % were White, 16 % were Black, 14 % were Hispanic, and 39 % were unstably housed. Other drug use was common with 81 % reporting benzodiazepine, 50 % cocaine, and 31 % meth/amphetamine use respectively. We found that gender (i.e., identifying as a woman) intersected with drug use and sex work practices and exacerbated experiences of marginalization. Violence was ubiquitous in drug use environments. Some women reported experiences of gender-based violence in substance use service settings that perpetuated cycles of trauma and reinforced barriers to care. Substance use services that were women-led, safe, and responsive to women's needs were valued and sought after. CONCLUSION Women reported a cycle of trauma and drug use exacerbated by oppression in substance use services settings. In addition to increasing access to gender-responsive care, our study highlights the need for greater research and examination of practices within substance use service settings that may be contributing to gender-based violence.
Collapse
Affiliation(s)
- Miriam T H Harris
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jordana Laks
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Emily Hurstak
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jennifer P Jain
- School of Nursing and Department of Community Health Systems at the University of California, San Francisco, CA 94143, USA.
| | - Audrey M Lambert
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Ariel D Maschke
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA.
| | - John Farley
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Phillip O Coffin
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Vanessa M McMahan
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Cynthia Barrett
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA 02118, USA.
| |
Collapse
|
26
|
Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry 2024; 23:58-90. [PMID: 38214615 PMCID: PMC10786006 DOI: 10.1002/wps.21160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.
Collapse
Affiliation(s)
| | - Deidre M Anglin
- City College, City University of New York, New York, NY, USA
- Graduate Center, City University of New York, New York, NY, USA
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Praveetha Patalay
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Thomas Steare
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Talen Wright
- Division of Psychiatry, University College London, London, UK
| | | |
Collapse
|
27
|
Jauregui JC, Hong C, Assaf RD, Cunningham NJ, Krueger EA, Flynn R, Holloway IW. Examining Factors Associated with Cannabis Use Among Sexual and Gender Minority and Cisgender Heterosexual Emerging Adults in California. LGBT Health 2024. [PMID: 38301143 DOI: 10.1089/lgbt.2023.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Purpose: We explored correlates of cannabis risk and examined differences between sexual and gender minority (SGM) and cisgender heterosexual emerging adults (ages 18-29) in California. Methods: We recruited 1491 participants aged 18-29 years for a cross-sectional online survey. Ordinal logistic regressions assessed associations between minority stress (discrimination and internalized homophobia [IH]), social support (perceived social support and lesbian, gay, bisexual, transgender, and queer+ [LGBTQ+] community connectedness), and cannabis risk scores (low, medium, and high risk of developing problems related to their cannabis use). We also explored differences in cannabis risk scores by sexual orientation and gender identity (SOGI). Results: Higher everyday discrimination scores were associated with increased odds of self-scoring in a higher cannabis risk range (adjusted odds ratio = 1.53, 95% confidence interval [CI] = 1.31-1.79). We found no significant associations for IH, LGBTQ+ community connectedness, or social support on cannabis risk scores. There were also no statistically significant differences by SOGI groups; however, SOGI did moderate the relationship between IH and cannabis risk score such that the slope for IH was 0.43 units higher for cisgender sexual minority women compared to cisgender sexual minority men (95% CI = 0.05-0.81). Conclusion: Our findings suggest that experiences of everyday discrimination are important contributors to developing cannabis-related problems and IH may have more pronounced effects for sexual minority women compared to sexual minority men. More research is needed to better understand risk and protective factors of cannabis risk to inform the development of culturally tailored interventions for SGM emerging adults.
Collapse
Affiliation(s)
- Juan C Jauregui
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, USA
| | - Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, USA
| | - Ryan D Assaf
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Benioff Homelessness and Housing Initiative, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Evan A Krueger
- School of Social Work, Tulane University, New Orleans, Louisiana, USA
| | - Risa Flynn
- Los Angeles LGBT Center, Los Angeles, California, USA
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, USA
| |
Collapse
|
28
|
Veltman A, Rose TL, Chaimowitz G. Mental Health Care for People Who Identify as Two Spirit, Lesbian, Gay, Bisexual, Transgender, and (or) Queer (2SLGBTQ+). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:140-155. [PMID: 38219049 PMCID: PMC10789226 DOI: 10.1177/07067437231195727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Affiliation(s)
- Albina Veltman
- Associate Chair, Equity Diversity Inclusion & Indigenous Reconciliation & Associate Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Tara La Rose
- Associate Professor, School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Gary Chaimowitz
- Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
29
|
Keum BT, Maurin-Waters E, Chong ESK. The Mental Health Costs of Online Heterosexism Among LGBTQ+ Individuals: Development and Initial Validation of the Perceived Online Heterosexism Scale. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:525-541. [PMID: 37943472 DOI: 10.1007/s10508-023-02733-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
Experiences of heterosexism are rampant online, where bias and harassment against LGBTQ+ individuals spread conveniently and widely. Yet, research has been limited in understanding the exposure to online heterosexism among LGBTQ+ individuals partly due to the lack of a quantitative measure to advance this research. Thus, the current study developed and examined the psychometric properties of the Perceived Online Heterosexism Scale (POHS). Items were developed via a literature review, a survey of social media platforms, and an expert review. Exploratory (N = 288) and confirmatory (N = 653) factor analyses yielded a 4-factor structure and produced a 20-item scale with the following subscales: (1) Heterosexist Cyberaggression (4 items), (2) Online Heterosexist Stereotyping (4 items), (3) Online Exposure to Systemic Heterosexism (8 items), and (4) Heterosexist Online Media (four items). Internal consistency estimates ranged from .91 to .96, and the POHS accounted for 65.9% of the variance. Examination of a second-order model suggested that a total scale score can also be used. Initial construct validity was evidenced as POHS scores were associated with an existing heterosexism measure, anxiety and depressive symptoms, internalized heterosexism, and LGBTQ+ community connectedness in line with theory and empirical evidence. Implications for research practice are discussed.
Collapse
Affiliation(s)
- Brian TaeHyuk Keum
- Department of Counseling, Developmental & Educational Psychology, Lynch School of Education and Human Development, Boston College, 140 Commonwealth Ave., Chestnut Hill, MA, 02467, USA.
| | - Emily Maurin-Waters
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
| | - Eddie S K Chong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
30
|
Wong ML, Nagata JM, Barreto M. Sleep and Socioemotional Outcomes Among Sexual and Gender Minority Adolescents: A Longitudinal Study. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:543-553. [PMID: 37993697 PMCID: PMC11078824 DOI: 10.1007/s10508-023-02732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/24/2023]
Abstract
Sexual and gender minority adolescents face specific stressors associated with their minority status, leading to compromised socioemotional outcomes and sleep. Sleep patterns have, in turn, been found to predict socioemotional outcomes. As such, we aimed to investigate whether healthy sleep patterns prospectively predicted socioemotional outcomes, and whether associations varied as a function of sexual and gender minority status. We conducted a secondary data analysis among adolescents at age 14 to 17, from a nationally representative prospective cohort in the United Kingdom (N = 8923, mean age = 13.8), with 7021 cisgender heterosexual, 1801 sexual minority, and 101 gender minority adolescents. Indicators of socioemotional outcomes included self-esteem, emotional well-being, peer relationships, and relationship with parents. The results showed that gender minority adolescents reported the worst sleep patterns and socioemotional outcomes, followed by sexual minority and cisgender heterosexual adolescents. Results from multi-group path analyses showed that emotional well-being, self-esteem, and peer relationships at age 17 were prospectively predicted by sleep patterns and the associations were moderated by sexual and gender minority status. Influence of sleep patterns, particularly sleep initiation problems and frequent awakening, on socioemotional outcomes was greater among gender minority adolescents, when compared to cisgender heterosexual adolescents. In conclusion, positive socioemotional outcomes were predicted by healthy sleep patterns. The potential role of sleep health in optimizing socioemotional outcomes among sexual and gender minority adolescents might warrant further investigation in prevention or intervention studies.
Collapse
Affiliation(s)
- Mark Lawrence Wong
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong.
| | - Jason M Nagata
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA
| | | |
Collapse
|
31
|
Gordon JH, Tran KT, Visoki E, Argabright ST, DiDomenico GE, Saiegh E, Hoffman KW, Erez G, Barzilay R. The Role of Individual Discrimination and Structural Stigma in the Mental Health of Sexual Minority Youth. J Am Acad Child Adolesc Psychiatry 2024; 63:231-244. [PMID: 37422106 PMCID: PMC10770287 DOI: 10.1016/j.jaac.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Sexual minority (SM) youth experience a greater mental health burden compared with their heterosexual peers. This study aimed to characterize mental health disparities among SM compared with non-SM youth, test main and interactive associations of SM identity and stressors targeting SM youth at the individual level (interpersonal SM discrimination) and structural level (state-level structural SM stigma) with youth mental health, and explore the contribution of interpersonal SM discrimination to the mental health burden of SM youth. METHOD Participants included 11,622 youth (ages 9-13; 47.6% assigned female at birth) from the Adolescent Brain Cognitive Development (ABCD) Study. Linear mixed-effects models tested main and interactive associations of SM identity, interpersonal SM discrimination, and structural SM stigma with mental health measures (self-reported overall psychopathology, suicidal ideation, and suicide attempts), adjusting for demographics and other interpersonal stressors not specific to SM (other discrimination types, peer victimization, and cyberbullying). Longitudinal mediation models tested whether interpersonal SM discrimination mediated the associations between SM identity and mental health measures. RESULTS SM youth (n = 1,051) experienced more interpersonal SM discrimination and overall psychopathology compared with their non-SM peers (n = 10,571). Adjusting for demographics, there were significant associations (main effects) of interpersonal SM discrimination and structural SM stigma with overall psychopathology. When further adjusting for other non-SM-related stressors, the main effect of structural SM stigma was no longer significant. Interpersonal SM discrimination was also significantly associated with suicidal ideation and attempt, accounting for demographics, while structural SM stigma was not. Accounting for both demographics and other non-SM stressors, there was a significant interaction between SM identity and structural SM stigma in association with psychopathology (p = .02), such that, compared with their peers, SM youth showed a greater association between structural SM stigma and psychopathology. Longitudinal mediation revealed that interpersonal SM discrimination was a significant mediator explaining approximately 10% to 15% of the variance of the pathways between SM identity and all mental health outcomes. CONCLUSION Results delineate contributions of interpersonal discrimination and structural stigma targeting SM youth to their heightened mental health burden in early adolescence. These findings underscore the need to address microlevel and macrolevel SM discrimination and structural stigma when caring for this population. DIVERSITY & INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.
Collapse
Affiliation(s)
- Joshua H Gordon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kate T Tran
- Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania; Lifespan Brain Institute of CHOP, and Penn Medicine, Philadelphia, Pennsylvania
| | - Elina Visoki
- Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania; Lifespan Brain Institute of CHOP, and Penn Medicine, Philadelphia, Pennsylvania
| | - Stirling T Argabright
- Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania; Lifespan Brain Institute of CHOP, and Penn Medicine, Philadelphia, Pennsylvania
| | - Grace E DiDomenico
- Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania; Lifespan Brain Institute of CHOP, and Penn Medicine, Philadelphia, Pennsylvania
| | - Eugenia Saiegh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin W Hoffman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania
| | - Galit Erez
- Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Ran Barzilay
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania; Lifespan Brain Institute of CHOP, and Penn Medicine, Philadelphia, Pennsylvania.
| |
Collapse
|
32
|
Mammadli T, Hong C. Substance Use and Misuse among Sexual and Gender Minority Communities Living in Former Soviet Union Countries: A Scoping Review. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:59-76. [PMID: 38600900 PMCID: PMC10903640 DOI: 10.1080/19317611.2024.2303517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/04/2024] [Indexed: 04/12/2024]
Abstract
Objectives We reviewed literature examining substance use among sexual and gender minorities (SGM) living in the former Soviet Union (USSR) nations. Methods Searches were conducted across five databases (PubMed, SocINDEX, CINAHL, PscyInfo, LGBTQ + Source) to identify peer-reviewed literature. Results Across 19 studies, high hazardous substance use prevalence was documented. Substance use was correlated with (a) sexual health and behaviors and (b) mental wellbeing and the use of other substances. Conclusion We discuss minority stress implications and challenges presented by the paucity of evidence in the literature examining substance use among SGM women and SGM living in countries unrepresented in reviewed studies.
Collapse
Affiliation(s)
- Tural Mammadli
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Chenglin Hong
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
33
|
Schnabel D, Keuroghlian AS. Clinical Considerations for Children of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and All Sexually and Gender Diverse Families. LGBT Health 2024. [PMID: 38190484 DOI: 10.1089/lgbt.2023.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
The visibility of lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexually and gender diverse (LGBTQIA+) families is growing. Anti-LGBTQIA+ rhetoric and actions continue to shape the public discourse, legislation, and health care. This article highlights unique challenges and strengths of children raised by LGBTQIA+ parents. Health care professionals should be cognizant of challenges and resiliencies these children experience in a normative society regarding gender identity, sexual orientation, and sex development. Clinicians can conduct inclusive and nonjudgmental family and social histories in welcoming practices, with careful consideration of unique familial dynamics these children may experience at home.
Collapse
Affiliation(s)
- Dominic Schnabel
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- The National LGBTQIA+ Health Education Center at The Fenway Institute, Boston, Massachusetts, USA
| |
Collapse
|
34
|
Huang MF, Chang YP, Chou WJ, Yen CF. A 4-year prospective investigation of predictive effects of prepandemic sexual stigma, affective symptoms, and family support on fear of COVID-19 among lesbian, gay, and bisexual individuals. Front Public Health 2024; 11:1297042. [PMID: 38259737 PMCID: PMC10800656 DOI: 10.3389/fpubh.2023.1297042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Aim This prospective study examined whether prepandemic sexual stigma, affective symptoms, and family support can predict fear of coronavirus disease 2019 (COVID-19) among lesbian, gay, and bisexual (LGB) individuals. Methods Data of 1,000 LGB individual on prepandemic sociodemographic characteristics, sexual stigma (familial sexual stigma [FSS] measured by the Homosexuality-Related Stigma Scale, internalized sexual stigma [ISS] measured by the Measure of Internalized Sexual Stigma for Lesbians and Gay Men, and sexual orientation microaggression [SOM] measured by the Sexual Orientation Microaggression Inventory), affective symptoms (i.e., depression measured by the Center for Epidemiologic Studies-Depression Scale and anxiety measured by the State-Trait Anxiety Inventory-State version), and family support measured by the Adaptability, Partnership, Growth, Affection, and Resolve Index were collected. Four years later, the fear of COVID-19 was assessed using the Fear of COVID-19 Scale and the associations of prepandemic sexual stigma, affective symptoms, and perceived family support on fear of COVID-19 4 years later were analyzed using multiple linear regression analysis. Results In total, 670 (67.3%) participants agreed and completed the follow-up assessment. Greater prepandemic FSS, ISS, SOM, affective symptoms, and perceived family support were significantly associated with a greater fear of COVID-19 at follow-up. Conclusion The identified predictors should be considered when designing interventions aimed at preventing and reducing the fear of COVID-19 in LGB individuals.
Collapse
Affiliation(s)
- Mei-Feng Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, New York, NY, United States
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, Taiwan
| |
Collapse
|
35
|
Luz PM, Spaeth H, Scott JA, Grinsztejn B, Veloso VG, Freedberg KA, Losina E. Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation. Braz J Infect Dis 2024; 28:103722. [PMID: 38369294 PMCID: PMC10897846 DOI: 10.1016/j.bjid.2024.103722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/24/2023] [Accepted: 01/24/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. METHODS Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. RESULTS With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. CONCLUSIONS In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities.
Collapse
Affiliation(s)
- Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
| | - Hailey Spaeth
- Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United States
| | - Justine A Scott
- Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United States
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Valdilea G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Kenneth A Freedberg
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Division of General Internal Medicine, Boston, MA, United States; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Elena Losina
- Harvard Medical School, Boston, MA, United States; Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, United States; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States; Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| |
Collapse
|
36
|
Kiekens WJ, Baams L, Stevens GWJM. Sexual Attraction Disparities in Adolescent Mental Health: The Role of School Norms. LGBT Health 2024; 11:28-37. [PMID: 37590484 DOI: 10.1089/lgbt.2022.0314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Purpose: Few studies examine whether and how heterosexist norms in schools might influence disparities in mental health between sexual minority and heterosexual adolescents. Addressing this gap, we study disparities in life satisfaction, psychosomatic complaints, and emotional problems between same/both-sex attracted and other-sex attracted adolescents and examine the moderating role of heterosexist norms on the classroom- and school-level. Methods: We used data from the 2013 and 2017 Dutch Health and Behavior in School-Aged Children study (N = 12,756; mean age = 14.02; standard deviation = 1.54). Separate multi-level analyses for life satisfaction, psychosomatic complaints, and emotional problems were conducted in which cross-level interaction effects between sexual attraction and school and classroom-level heterosexist norms were estimated. Results: Same-sex attracted, both-sex attracted, and adolescents unsure about their sexual attraction reported lower life satisfaction, more psychosomatic complaints, and more emotional problems than their other-sex attracted peers. On average, stronger school-level heterosexist norms were associated with higher life satisfaction, fewer psychosomatic complaints, and fewer emotional problems. Stronger classroom-level heterosexist norms were associated with fewer emotional problems. One moderating effect of sexual attraction and school-level heterosexist norms was found. Contrary to expectations, disparities in life satisfaction between same-sex attracted and other-sex attracted adolescents were smaller when classroom-level heterosexist norms were stronger. Standardized regression coefficients showed that the associations were small. Conclusion: Although our findings suggest pressing health disparities between heterosexual and sexual minority adolescents, heterosexist norms at the school and classroom level were weakly associated with these health disparities.
Collapse
Affiliation(s)
- Wouter J Kiekens
- Department of Sociology, Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, The Netherlands
| | - Laura Baams
- Department of Pedagogy and Educational Sciences, University of Groningen, Groningen, The Netherlands
| | - Gonneke W J M Stevens
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
37
|
Pu Y, Xu W. Parenting Desire Among Sexual Minority Women in China: From the Stigma Perspective. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:293-306. [PMID: 37620669 DOI: 10.1007/s10508-023-02682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
In China, women who are childless or have children outside of heterosexual marriage are generally stigmatized. Consequently, Chinese sexual minority women are challenged for their willingness to have children. This study explored how multiple (structural-interpersonal-individual) levels of sexual minority stigma are related to parenting desire among Chinese sexual minority women. Furthermore, it examined the mediation mechanism of individual stigma and the moderation effect of outness to one's family in the link between structural/interpersonal stigma and parenting desire. Participants (265 lesbian and 193 bisexual women) completed online measures of structural stigma (adherence to Confucianism), interpersonal stigma (discrimination events), individual stigma (internalized homophobia and rejection sensitivity), outness to one's family, and parenting desire. Lesbian women reported lower structural and individual stigma and parenting desire levels than bisexual women. Sexual minority women's high adherence to Confucianism, internalized homophobia, and rejection sensitivity were positively associated with their increased parenting desires. Notably, adherence to Confucianism and discrimination events were associated with parenting desire through internalized homophobia, but not rejection sensitivity; moreover, outness to one's family buffered the direct link between adherence to Confucianism and parenting desire and strengthened the direct link between discrimination events and internalized homophobia and the indirect link between discrimination events and parenting desire. This study contributes to a robust understanding of how sexual minority stigma is connected to parenting desire among sexual minority women in Chinese sociocultural contexts, providing cultural-specific evidence to support theories of stigma and minority stress.
Collapse
Affiliation(s)
- Yaxin Pu
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, 610065, China
- Institute of Psychology, Sichuan University, Chengdu, China
| | - Wenjian Xu
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, 610065, China.
- Institute of Psychology, Sichuan University, Chengdu, China.
| |
Collapse
|
38
|
McClellan LS, van der Miesen AIR, Tishelman AC, Fischbach AL, Song M, Campos LA, Strang JF. Cognitive and Developmental Profiles Associated with Self-Reported Sexual and Gender Minority Stigmatization Among Binary Transgender Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-17. [PMID: 38118056 DOI: 10.1080/15374416.2023.2292045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
OBJECTIVE Sexual and gender minority (SGM) stigmatization is a key factor related to transgender adolescent mental health. While previous research has focused on direct associations between stigmatization and mental health, the present study of transgender youth, equitably recruited across the autism spectrum, examines cognitive and developmental factors in relation to the self-report of experienced and perceived SGM stigmatization. METHOD 65 binary transgender adolescents (43% transfeminine; ages 13-21 years) were intentionally recruited across the spectrum of autism traits from no traits to full criteria autism. Participants completed measures of autism-related social differences, cognitive abilities, and self-reported directly experienced and perceived SGM stigma. Autism-related social differences, cognitive abilities, and age were studied in relation to both SGM stigma factors. RESULTS Autism-related social differences were negatively associated with level of directly experienced SGM stigma but unassociated with perceived stigma. Greater cognitive ability was positively associated with level of perceived SGM stigma, but unassociated with report of directly experienced stigma. Older age was positively associated with level of perceived SGM stigma. There was a statistical trend toward older age positively associated with level of directly experienced stigma. CONCLUSIONS The present study identifies candidate cognitive and developmental influences on self-reported SGM stigmatization among transgender adolescents, evenly recruited across the autism spectrum. The factors which may impact the perception and experience of stigmatization have been notably under-explored in the mental health field. The examination of these individual characteristics may allow for more precise predictive models for research with transgender youth, and ultimately, in clinical care.
Collapse
Affiliation(s)
- Lucy S McClellan
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit
| | | | - Abigail L Fischbach
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - Minneh Song
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - Laura A Campos
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - John F Strang
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
- Departments of Pediatrics, Neurology, and Behavioral Science, George Washington University School of Medicine
| |
Collapse
|
39
|
Yadav S, Hong YR, Westen S, Marlow NM, Haller MJ, Walker AF. Sociodemographic factors associated with major depressive episodes and suicidal ideation among emerging adults with diabetes in the U.S. Front Endocrinol (Lausanne) 2023; 14:1276336. [PMID: 38144571 PMCID: PMC10740161 DOI: 10.3389/fendo.2023.1276336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/15/2023] [Indexed: 12/26/2023] Open
Abstract
Background Research focused on disparities related to mental health comorbidities, especially among emerging adults with diabetes, is limited. Identifying associated factors of disparities could inform policy decisions to make diabetes-related interdisciplinary care more accessible for vulnerable groups. Method Using data from the National Survey on Drug Use and Health (2015-2019), we examined disparities in presence of major depressive episode (MDE) and suicidal ideation among emerging adults with diabetes. Survey design-adjusted bivariate and multivariable logistic regression models were used for statistical analyses. Results The study included 1,125 emerging adults (18-25 years old), with a history of type 1 diabetes (T1D) or type 2 diabetes (T2D). After controlling for sociodemographic and health-related characteristics, we found lower odds of having past-year major MDE for non-Hispanic Black (AOR, 0.42, p=0.032) compared to their non-Hispanic White counterparts. Females were 3.02 times more likely to have past-year MDE than males (AOR, 3.02, p=0.004). The odds of having past-year MDE were 1.96 times higher among individuals who identified as LGB (lesbian, gay, bisexual) (AOR, 1.96, P=0.038). There were no statistically significant disparities in suicidal ideation related to race/ethnicity, sex, education, and family income. However, individuals who identified as LGB had significantly higher likelihood of suicidal ideation than their heterosexual counterparts (AOR, 2.47, P=0.004). Conclusion Significant disparities related to MDE and suicidal ideation exist based on race/ethnicity, gender, and sexual orientation. Integration of a mental health professional into the multidisciplinary diabetes care team is critical for effective management of comorbid mental health conditions in younger patients with diabetes.
Collapse
Affiliation(s)
- Sandhya Yadav
- Department of Health Services Research Management, and Policy, University of Florida, Gainesville, FL, United States
| | - Young-Rock Hong
- Department of Health Services Research Management, and Policy, University of Florida, Gainesville, FL, United States
| | - Sarah Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Nicole M. Marlow
- Department of Health Services Research Management, and Policy, University of Florida, Gainesville, FL, United States
| | - Michael J. Haller
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Ashby F. Walker
- Department of Health Services Research Management, and Policy, University of Florida, Gainesville, FL, United States
| |
Collapse
|
40
|
Biernesser C, Win E, Escobar-Viera C, Farzan R, Rose M, Goldstein T. Development and codesign of flourish: A digital suicide prevention intervention for LGBTQ+ youth who have experienced online victimization. Internet Interv 2023; 34:100663. [PMID: 37693013 PMCID: PMC10491770 DOI: 10.1016/j.invent.2023.100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023] Open
Abstract
Background LGBTQ+ youth experience disproportionately high rates of online victimization (OV), referring to harmful remarks, images, or behaviors in online settings, which is associated with suicidal risk. Current services have gaps in supporting LGBTQ+ youth facing OV events. To address these gaps, this study aims to develop Flourish, a digital suicide prevention intervention for LGBTQ+ youth who have experienced OV. Methods Qualitative interviews were conducted with 20 LGBTQ+ youth with past-year history of OV and lifetime history of suicidality, 11 of their parents, and 10 LGBTQ+-serving professionals. Subsequently, an iterative codesign process was conducted with 22 youth through individual and group design sessions, followed by usability testing. Data were recorded and transcribed. Qualitative interviews were analyzed using a qualitative description approach, and data from design sessions and usability testing were analyzed using rapid qualitative techniques. Results Interviews with youth, parents, and professionals suggested preferences for Flourish to be a partially automated, text message intervention leveraging web-based content that is a safe space for LGBTQ+ youth to seek support for OV through education, coping skills, and help-seeking resources. School and mental health services professionals considered the potential for implementing Flourish within youth services settings. Usability testing, assessed through the System Usability Scale, yielded an average rating of 91, indicating excellent perceived usability. Conclusions Flourish has potential to be an acceptable intervention to support LGBTQ+ youth following OV. Future steps will include testing the feasibility and efficacy of Flourish and further examining Flourish's potential for implementation within services for LGBTQ+ youth.
Collapse
Affiliation(s)
- Candice Biernesser
- University of Pittsburgh School of Medicine, Department of Psychiatry, United States of America
| | - Emma Win
- University of Pittsburgh School of Medicine, Department of Psychiatry, United States of America
- University of Pittsburgh School of Social Work, United States of America
| | - César Escobar-Viera
- University of Pittsburgh School of Medicine, Department of Psychiatry, United States of America
| | - Rosta Farzan
- University of Pittsburgh, School of Computing and Information, United States of America
| | - Morgan Rose
- University of Pittsburgh School of Medicine, Department of Psychiatry, United States of America
- University of Pittsburgh Dietrich School of Arts and Science, Department of Psychology, United States of America
| | - Tina Goldstein
- University of Pittsburgh School of Medicine, Department of Psychiatry, United States of America
- University of Pittsburgh Dietrich School of Arts and Science, Department of Psychology, United States of America
| |
Collapse
|
41
|
Deal C, Gonzales G. Homelessness Among Sexual Minority Youth. Pediatrics 2023; 152:e2023062227. [PMID: 37981876 DOI: 10.1542/peds.2023-062227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVES This study examines the prevalence and types of homelessness experienced by sexual minority and heterosexual youth. Then, we examine whether state-level nondiscrimination policies and/or public attitudes on sexual diversity are associated with reduced homelessness among sexual minority youth. Finally, we investigate the differences in health risk behaviors at the intersections of sexual minority and homelessness status. METHODS We conducted a secondary data analysis using a large population-based sample from 21 states collected in the 2017 and 2019 Youth Risk Behavior Surveys. Self-reported data were obtained from sexual minority (n = 28 405) and heterosexual (n = 136 232) youth through a survey administered in high schools. We assessed the prevalence of homelessness and the types of homelessness. Sexual minority-stratified bivariate and multivariable analyses assessed associations between homelessness, state-level policy and cultural environments, and health-risk behaviors. RESULTS Sexual minority youth were significantly more likely (12%) to be homeless compared with heterosexual youth (4.1%). Greater acceptance of sexual diversity at the state-level was associated with reduced homelessness among both sexual minority and heterosexual youth. Finally, homeless sexual minority youth experienced a broad array of health risk behaviors in excess of both nonhomeless sexual minority youth and homeless heterosexual youth. CONCLUSIONS Sexual minority high school students were more likely to experience homelessness than their heterosexual peers. Public attitudes and greater acceptance of sexual diversity were associated with lower levels of sexual minority homelessness. More research and public health programs are needed to prevent and address homelessness among sexual minority youth.
Collapse
Affiliation(s)
| | - Gilbert Gonzales
- Vanderbilt LGBTQ+ Policy Lab, and
- Department of Medicine, Health, and Society, Program for Public Policy Studies, Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
42
|
Staton M, Tillson M, Levi MM, Dickson M, Webster M, Leukefeld C. Identifying and Treating Incarcerated Women Experiencing Substance Use Disorders: A Review. Subst Abuse Rehabil 2023; 14:131-145. [PMID: 38026785 PMCID: PMC10655602 DOI: 10.2147/sar.s409944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
While research on substance use disorder (SUD) treatment among justice-involved populations has grown in recent years, the majority of corrections-based SUD studies have predominantly included incarcerated men or men on community supervision. This review 1) highlights special considerations for incarcerated women that may serve as facilitating factors or barriers to SUD treatment; 2) describes selected evidence-based practices for women along the cascade of care for SUD including screening and assessment, treatment and intervention strategies, and referral to services during community re-entry; and 3) discusses conclusions and implications for SUD treatment for incarcerated women.
Collapse
Affiliation(s)
- Michele Staton
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Mary M Levi
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Megan Dickson
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Matt Webster
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Carl Leukefeld
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
43
|
Qiao S, Garrett CM, Addo PNO, Adeagbo O, Moore DM, Muttau N, Sharma A, Lwatula C, Ngosa L, Kabwe M, Manasyan A, Menon JA, Weissman S, Li X, Harper GW. The Impacts of Stigma Against Sexual Minority Men Within and Between Various Socioecological Levels: Breaking the Vicious Cycle in Zambia. Am J Mens Health 2023; 17:15579883231209190. [PMID: 37909703 PMCID: PMC10621297 DOI: 10.1177/15579883231209190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
Sexual minority men (SMM) face persistent stigma in Zambia. From a holistic perspective, we aim to explore its impacts within and between multiple socioecological levels, demonstrating how their interactions create a vicious cycle of barriers to the well-being of SMM. In-depth interviews were conducted with 20 purposively recruited SMM from Lusaka, Zambia. All interviews were audio-recorded, after written consent, transcribed verbatim, and iteratively coded employing inductive (i.e., data-driven) approaches for thematic analysis using NVivo. Results suggest three key themes: (1) interpersonal socially perpetuated sexual minority stigma (SMS); (2) multidirectional interactions between psychosocial well-being and risk-taking behaviors; and (3) institutionally perpetuated SMS as a barrier to seeking and receiving health care. SMS permeates across all levels of the socioecological model to negatively impact the psychosocial well-being of SMM while acting also as a barrier to accessing HIV prevention and care. Our study necessitates structural public health intervention to decrease stigma and discrimination against SMM in Zambia, in efforts to increase their psychosocial well-being as well as their access to and utilization of HIV care by breaking the vicious cycle of SMS that pervades through the intrapersonal, interpersonal, and institutional levels of the socioecological model.
Collapse
Affiliation(s)
- Shan Qiao
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Camryn M. Garrett
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Prince N. O. Addo
- Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Oluwafemi Adeagbo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Darius M. Moore
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Nobutu Muttau
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Levy Ngosa
- Dignitate Zambia Limited (DZL), Lusaka, Zambia
| | | | - Albert Manasyan
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Sharon Weissman
- Department of Internal Medicine, School of Medicine Columbia, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Gary W. Harper
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
44
|
Cassidy B, Fischl A, Fasone A, Braxter B. Stakeholders Inform an LGBTQIA+ Health Best Practices Learning Module for Nursing Students. J Transcult Nurs 2023; 34:453-463. [PMID: 37642391 DOI: 10.1177/10436596231191250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION The American Association of Colleges of Nursing (AACN) summons nurse educators to address health care inequities by preparing leaders who advocate for vulnerable groups. A lack of academic guidelines promoting cultural competence in nursing with lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, and asexual and/or aromantic (LGBTQIA+) individuals exist. The purpose of this study was to develop a learning module for health care providers about best practices in LGBTQIA+ health informed by key stakeholders. METHODS Exploratory qualitative design utilized focus group methodology obtaining stakeholder's views on LGBTQIA+ health, with a convenience sample recruited from a large public university. Focus group thematic analysis informed development of the learning module. RESULTS Three overarching themes emerged from focus group discussions (n = 31): appropriate terminology, health disparities, and respectful communication. DISCUSSION This project addresses an educational gap in nursing curriculum using an interactive online module, introducing key concepts about LGBTQIA+ health. Future research focused on the development of standards of care for LGBTQIA+ individuals can support inclusion and reduce discrimination in health care settings.
Collapse
|
45
|
Canavera KE, Bjornard KL, Cost NG, Grady A, Irving H, Kaye EC, Ketterl T, Levine J, Reinecke J, Rios J, Roth M, Sawyer K, Thomas SM, Unguru Y, Johnson LM. Disparate Access to Fertility Preservation in Youth: A Call for Advocacy to Close the Gap. J Pediatr 2023; 261:113496. [PMID: 37211206 DOI: 10.1016/j.jpeds.2023.113496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 04/07/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Affiliation(s)
| | - Kari L Bjornard
- Department of Pediatrics, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN; Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Nicholas G Cost
- Department of Pediatric Urology and the Surgical Oncology Program, Children's Hospital Colorado, Aurora, CO
| | - Allison Grady
- Department of Pediatrics, Oncology Section, Medical College of Wisconsin, Milwaukee, WI; University of Wisconsin-Milwaukee College of Nursing, Milwaukee, WI
| | - Helen Irving
- Department of Oncology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Erica C Kaye
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Tyler Ketterl
- Department of Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, WA
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, New York, NY
| | | | - Julie Rios
- Department of Obstetrics, Gynecology, and Reproductive Science, The University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kimberly Sawyer
- Department of Pediatrics, Section of Palliative Care, Baylor College of Medicine, Houston, TX
| | - Stefanie M Thomas
- Department of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Cleveland Clinic Children's, Cleveland, OH
| | - Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD
| | - Liza-Marie Johnson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.
| |
Collapse
|
46
|
Mellen EJ, Hatzenbuehler ML. Sexual Violence-Related Stigma, Mental Health, and Treatment-Seeking: A Multimodal Assessment in a Population-Based Study of Young Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11243-11271. [PMID: 37491905 DOI: 10.1177/08862605231179715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Sexual violence (SV) is a stigmatized form of trauma, yet the stigma experiences of those reporting SV are often assumed rather than explicitly measured. We adapted a measure that quantified three key features of SV stigma across three levels: negative self-image (individual), disclosure concerns (interpersonal), and concerns about public attitudes (structural). We administered this measure to a population-based sample of Swedish young adults (N = 453) who reported a history of either sexual assault (SA) or intimate partner sexual violence (IPSV). Among both groups, 89% endorsed at least one item on the stigma scale. Experiences of SV-related stigma were associated with significantly higher symptoms of generalized anxiety, depression, and posttraumatic stress disorder, with greater perceived need for mental health treatment, and with more shame (measured implicitly via a reaction-time task). Experiences of stigma were negatively associated with symptoms of alcohol misuse. Results suggest that exposure to SV stigma may be a critical, but often overlooked, correlate of post-assault recovery.
Collapse
|
47
|
Roulston C, McKetta S, Price M, Fox KR, Schleider JL. Structural Correlates of Mental Health Support Access among Sexual Minority Youth of Color during COVID-19. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:649-658. [PMID: 35259041 PMCID: PMC9452605 DOI: 10.1080/15374416.2022.2034633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many youth with mental health needs cannot access treatment, with multiply-marginalized youth, such as sexual minority youth of Color (SMYoC), experiencing both structural and identity-related barriers to care. The COVID-19 pandemic threatens to exacerbate multi-level treatment access barriers facing SMYoC youth nationwide. However, little large-scale research has examined access to mental health care among SMYoC across the United States, either during or prior to the pandemic. Such work is critical to understanding and ameliorating barriers in this domain. Using data from adolescents who self-identified as SMYoC and who endorsed a desire for mental health support during the COVID-19 pandemic (N = 470, ages 13-16, from 43 U.S. states), we examined associations between state-level, structural factors (income inequality; mental health-care provider shortage; anti-Black racism; homophobia; and the interaction between anti-Black racism and homophobia) and SMYoC mental health treatment access. Multinomial logistic regressions revealed state-level mental health-care provider shortage as the only significant predictor of SMYoC reporting they never (versus always) accessed mental health support during the COVID-19 pandemic. SMYoC living in areas with both lower homophobia and lower anti-Black racism were more likely to report always (versus sometimes) accessing mental health treatment. Results highlight the critical importance of considering diverse structural factors and applying an intersectional lens when exploring barriers to mental health treatment among multiply-marginalized youth. In locations where provider shortages are less severe, cultural stigma - including anti-Black racism and homophobia - may still pose challenges for SMYoC in need of mental health care.
Collapse
Affiliation(s)
| | - Sarah McKetta
- Department of Epidemiology, Columbia University Mailman School of Health
| | | | | | | |
Collapse
|
48
|
Moody RL, Carter JA, Talan A, Sizemore KM, Russell ST, Rendina HJ. Associations of adverse and protective childhood experiences with thwarted belongingness, perceived burdensomeness, and suicide risk among sexual minority men. Psychol Med 2023; 53:5615-5624. [PMID: 36117279 PMCID: PMC10024646 DOI: 10.1017/s0033291722002823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sexual minority men (SMM) experience higher suicidal ideation and suicide attempts than the general population. We examined the associations of adverse childhood experiences (ACES) and protective and compensatory childhood experiences (PACES) with suicidal ideation and suicide attempts in adulthood via thwarted belongingness and perceived burdensomeness among SMM. METHODS Data are from the UNITE study, a national longitudinal cohort study of HIV-negative SMM from the 50 U.S. states and Puerto Rico. Between 2017 and 2019, participants (N = 6303) completed web-based assessments at baseline and 12-month follow-up. ACES and PACES occurring before the age of 18, and current symptoms of thwarted belongingness and perceived burdensomeness were assessed at baseline. Past-week suicidal ideation and past-year suicide attempt were assessed at follow-up. RESULTS 424 (6.7%) participants reported past-week suicidal ideation and 123 (2.0%) reported a past-year suicide attempt. The results of our multivariate model suggest that each additional adverse childhood experience was prospectively associated with 14% higher odds of past-week suicidal ideation (AOR = 1.14, 95% CI 1.09-1.19) and 19% higher odds of past-year suicide attempt (AOR = 1.19, 95% CI 1.11-1.29). Each additional protective childhood experience was prospectively associated with 15% lower odds of past-week suicidal ideation (AOR = 0.85, 95% CI 0.81-0.90) and 11% lower odds of past-year suicide attempt (AOR = 0.89, 95% CI 0.82-0.98). Perceived burdensomeness partially mediated these prospective associations. CONCLUSION To reduce suicide, screening and treating perceived burdensomeness among SMM with high ACES may be warranted. PACES may decrease perceived burdensomeness and associated suicide risk.
Collapse
Affiliation(s)
- Raymond L. Moody
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 181st Street, New York, NY 10032, USA
| | - Joseph A. Carter
- Department of Psychology, City University of New York Graduate Center, Health Psychology and Clinical Sciences Program, New York, NY, USA
| | - Ali Talan
- Whitman-Walker Institute, Washington, DC, USA
| | - K. Marie Sizemore
- Department of Psychiatry, Rutgers University Institute for Health, Health Care Policy, and Aging, New Brunswick, NJ, USA
| | - Stephen T. Russell
- Department of Human Development and Family Sciences, University of Texas at Austin School of Human Ecology, Austin, TX, USA
| | - H. Jonathon Rendina
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, and Whitman-Walker Institute, Washington, DC, USA
| |
Collapse
|
49
|
Zollweg SS, Belloir JA, Drabble LA, Everett B, Taylor JY, Hughes TL. Structural stigma and alcohol use among sexual and gender minority adults: A systematic review. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100185. [PMID: 37663525 PMCID: PMC10474584 DOI: 10.1016/j.dadr.2023.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
Background Sexual and gender minority (SGM) people are more likely than their cisgender, heterosexual counterparts to report negative alcohol-related outcomes. Although the association between individual- and interpersonal-level minority stressors and negative alcohol-related outcomes among SGM people is well-established, structural-level minority stressors are understudied. This systematic review examined structural-level stigma and alcohol-related outcomes among SGM people to inform future research, interventions, and policy. Methods We used five electronic databases to search for studies published between January 2010 and May 2022 that examined associations between structural stigma and alcohol use among SGM adults in the United States. Peer-reviewed, quantitative studies available in English were included. We conducted quality appraisal using the Joanna Briggs Institute checklist. Results The final sample included 11 studies. Overall, there was moderate to strong support for a positive association between structural stigma and negative alcohol-related outcomes among SGM people, with differences by gender, sexual identity, race, and ethnicity. All studies used cross-sectional designs, and nearly half utilized non-probability samples. Transgender and nonbinary people, SGM people of color, and sexual identity subgroups beyond gay, lesbian, and heterosexual were underrepresented. Structural stigma was most commonly measured as a state-level index. Alcohol measures were heterogeneous. Multilevel stigma and resiliency factors were understudied. Conclusions Addressing structural stigma is critical in reducing negative alcohol-related outcomes and inequities among SGM people. Research is needed that includes probability samples, longitudinal designs, and samples that reflect the diversity of SGM people. Future studies should examine the influence of multilevel stigma and resiliency factors on alcohol-related outcomes.
Collapse
Affiliation(s)
- Sarah S. Zollweg
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
- National Clinician Scholars Program, David Geffen School of Medicine, University of California, Los Angeles, CA, 1100 Glendon Ave, Suite 900, Los Angeles, CA 90024
| | - Joseph A. Belloir
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
| | - Laurie A. Drabble
- San Jose State University College of Health and Human Sciences, One Washington Square, San Jose, CA, 95192, USA
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., #450, Emeryville, CA, 94608, USA
| | - Bethany Everett
- University of Utah, Department of Sociology, 380 S. 1530 E, Salt Lake City, UT, 84112, USA
| | - Jacquelyn Y. Taylor
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
| | - Tonda L. Hughes
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
| |
Collapse
|
50
|
Storholm ED, Reynolds HE, Muthuramalingam S, Nacht CL, Felner JK, Wagner GJ, Stephenson R, Siconolfi DE. Intimate Partner Violence and the Sexual Health of Sexual Minority Men. LGBT Health 2023; 10:S39-S48. [PMID: 37754928 PMCID: PMC10623463 DOI: 10.1089/lgbt.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Purpose: This qualitative study explores the pathways by which various forms of intimate partner violence (IPV) impact the sexual health behaviors of cisgender identified sexual minority men (SMM). Methods: Semi-structured interviews were conducted with 23 racially and ethnically diverse SMM who recently experienced IPV and 10 clinical and social service providers focused on how experiences of IPV directly or indirectly influences sexual risk as well as engagement in HIV prevention behaviors (e.g., pre-exposure prophylaxis [PrEP] use). Applied thematic analysis, including cycles of analytic memo writing and coding, aided the identification of patterns across the data. Results: Analyses yielded three overarching themes: use of condoms, use of PrEP, and HIV and sexually transmitted infections (STIs). Participants described different ways condom use or nonuse was a mechanism by which power and/or control might be asserted by one partner over the other partner. A range of responses to questions about PrEP were identified, including partners encouraging PrEP use, as well as avoidance of conversations about PrEP or actual PrEP use, to prevent experiencing aggression or IPV from partners. Responses regarding HIV/STIs included those ranging from a new diagnosis being a potential trigger for violence to the exploitation of status to control partners. Conclusion: These findings suggest that in relationships with IPV, HIV prevention strategies can be sources of relationship control and trigger abuse. Addressing IPV may help to prevent HIV/STI transmission and promote the health of SMM. In addition, long-acting formulations of PrEP may be a promising strategy for SMM experiencing IPV when oral PrEP medications may be a risk factor for violence.
Collapse
Affiliation(s)
- Erik D. Storholm
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Hannah E. Reynolds
- School of Public Health, San Diego State University, San Diego, California, USA
| | | | - Carrie L. Nacht
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Jennifer K. Felner
- School of Public Health, San Diego State University, San Diego, California, USA
| | | | - Rob Stephenson
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|