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Chang CJ, Livingston NA, Rashkovsky KT, Harper KL, Kuehn KS, Khalifian C, Harned MS, Tucker RP, Depp CA. A Scoping Review of Suicide Prevention Interventions for Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Individuals. LGBT Health 2024. [PMID: 38722250 DOI: 10.1089/lgbt.2023.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Purpose: This scoping review summarizes the literature on suicide-specific psychological interventions among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people to synthesize existing findings and support future intervention research and dissemination. Methods: Electronic databases PsycInfo and PubMed were searched for reports of psychological intervention studies with suicide-related outcome data among LGBTQ+ people. A total of 1269 articles were screened, and 19 studies met inclusion criteria (k = 3 examined suicide-specific interventions tailored to LGBTQ+ people, k = 4 examined nontailored suicide-specific interventions, k = 11 examined minority stress- or LGBTQ+ interventions that were not suicide-specific, and k = 1 examined other types of interventions). Results: Synthesis of this literature was made challenging by varied study designs, and features limit confidence in the degree of internal and external validity of the interventions evaluated. The only established suicide-specific intervention examined was Dialectical Behavior Therapy, and minority stress- and LGBTQ-specific interventions rarely targeted suicidal thoughts and behaviors (STBs). Nevertheless, most interventions reviewed demonstrated support for feasibility and/or acceptability. Only five studies tested suicide-related outcome differences between an LGBTQ+ group and a cisgender/heterosexual group. These studies did not find significant differences in STBs, but certain subgroups such as bisexual individuals may exhibit specific treatment disparities. Conclusion: Given the dearth of research, more research examining interventions that may reduce STBs among LGBTQ+ people is critically needed to address this public health issue.
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Affiliation(s)
- Cindy J Chang
- Veterans Affairs San Diego Healthcare System, U.S. Department of Veterans Affairs, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Nicholas A Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Katerine T Rashkovsky
- Veterans Affairs San Diego Healthcare System, U.S. Department of Veterans Affairs, San Diego, California, USA
| | - Kelly L Harper
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Kevin S Kuehn
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Chandra Khalifian
- Veterans Affairs San Diego Healthcare System, U.S. Department of Veterans Affairs, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Melanie S Harned
- VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Colin A Depp
- Veterans Affairs San Diego Healthcare System, U.S. Department of Veterans Affairs, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
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Facente SN, Davila X, Kowell N, Calma N, Kwan MM, Gupta S. Let's Connect: Impact Evaluation of an Intervention to Reduce Mental Health Disparities Among People Who are LGBTQ+ . Community Ment Health J 2024; 60:754-763. [PMID: 38337136 PMCID: PMC11001695 DOI: 10.1007/s10597-024-01231-4] [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: 06/16/2023] [Accepted: 01/02/2024] [Indexed: 02/12/2024]
Abstract
Lesbian, gay, bisexual, transgender, queer, or similarly identified (LGBTQ+) people experience substantial mental health disparities compared to heterosexuals. The "Let's Connect" intervention was designed to improve mental health outcomes for LGBTQ+ people. This impact evaluation aimed to assess effectiveness of this intervention during its pilot phase, using a single arm pilot trial. Respondents completed baseline surveys at intervention start, a post survey on the last day of the intervention (at 6 weeks), then a follow-up survey 6 weeks after the intervention ended (at 12 weeks). Pre-post differences in outcomes were analyzed using paired t-tests, chi-square tests, and generalized estimating equations to evaluate impact on mental health outcomes at 6 and 12 weeks, and identify characteristics associated with loss to follow-up. The average value of all three outcome measures decreased substantially between the baseline and post surveys; all of these differences were highly statistically significant, and further decreased between the end of the intervention at 6 weeks and the 12 week follow-up survey. Let's Connect participants did experience substantial improvements in mental health outcomes, on average, between the start and end of this intervention. Further study of this intervention using a randomized design and control group is warranted.
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Affiliation(s)
- Shelley N Facente
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA.
- Facente Consulting, Richmond, CA, USA.
| | | | - Niko Kowell
- San Francisco Community Health Center, San Francisco, CA, USA
| | - Nicky Calma
- San Francisco Community Health Center, San Francisco, CA, USA
| | - Ming Ming Kwan
- San Francisco Community Health Center, San Francisco, CA, USA
| | - Shalika Gupta
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA
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Kiger ME, Fowler L, Eviston M, Cook A, Forbush J, Nelson S, Clark W, Hammond C, Knickerbocker K, Gawrys-Strand E, Schulteis D, Duby J. A Case-Based, Longitudinal Curriculum in Pediatric Behavioral and Mental Health. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11400. [PMID: 38686119 PMCID: PMC11056487 DOI: 10.15766/mep_2374-8265.11400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 02/08/2024] [Indexed: 05/02/2024]
Abstract
Introduction Pediatric behavioral and mental health (BMH) disorders are increasingly common, but most pediatricians feel inadequately trained to manage them. We implemented a case-based, longitudinal curriculum in BMH within a pediatric residency program to prepare trainees to diagnose and manage these conditions. Methods The pediatric residency program at Wright State University/Wright-Patterson Medical Center implemented a new BMH curriculum in 2020-2021. The curriculum consisted of five simulated cases involving depression, anxiety, attention deficit disorder with hyperactivity (ADHD), developmental delays, behavioral concerns, and autism. To reflect follow-up within a continuity clinic, cases included initial encounters and multiple follow-up visits. Faculty facilitators led residents in monthly small-group meetings over the academic year, with each session consisting of two to three simulated patient encounters. Residents completed pre-post surveys regarding their confidence in diagnosing and managing BMH conditions and pre- and posttests to evaluate the impact of the curriculum on knowledge gains. Results All 47 pediatric residents participated in the curriculum; 38 (81%) completed pre-post surveys. Upon completion of the curriculum, residents reported significantly increased confidence in managing ADHD, treating depression, creating safety plans for suicidality, recognizing autism, and counseling patients and families on special education services. Knowledge-based pre- and posttests completed by 25 residents (53%) also demonstrated significant improvement (M = 92.4, SD = 10.9, pre vs. M = 99.3, SD = 6.6, post, p = .009). Discussion This case-based, longitudinal curriculum in pediatric BMH simulating patient continuity improved residents' confidence and knowledge in diagnosing and managing common BMH conditions.
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Affiliation(s)
- Michelle E. Kiger
- Associate Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine; Military Pediatric Residency Program Director, Wright-Patterson Medical Center
| | - Lauryn Fowler
- Assistant Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
| | - Maggie Eviston
- Third-Year Pediatric Resident, Dayton Children's Hospital/Wright-Patterson Medical Center
| | - Amanda Cook
- Third-Year Pediatric Resident, Dayton Children's Hospital/Wright-Patterson Medical Center
| | - Jason Forbush
- Assistant Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
| | - Suzie Nelson
- Assistant Professor, Department of Psychiatry, Wright State University Boonshoft School of Medicine
| | - William Clark
- Assistant Professor, Department of Psychiatry, Wright State University Boonshoft School of Medicine
| | - Caitlin Hammond
- Assistant Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
| | - Kara Knickerbocker
- Assistant Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
| | | | - Daniel Schulteis
- Assistant Professor, Department of Pediatrics, Medical College of Wisconsin
| | - John Duby
- Professor and Chair, Department of Pediatrics, Wright State University Boonshoft School of Medicine
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Yan X, Ni Y, Lu Y, Wang Q, Tang W, Tan RKJ, Tucker JD, Hall BJ, Baral S, Song H, Zhou Y, Wu D. Homoprejudiced Violence Experiences and High-Risk Sexual Behaviors among Chinese Men Who Have Sex with Men: Depression Severity and Recreational Drug Usage as Potential Mediators. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1265-1276. [PMID: 38172350 DOI: 10.1007/s10508-023-02775-4] [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: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
Homoprejudiced violence is a type of aggression against an individual or a community based on their actual or perceived sexual orientation. It may be linked to risks of acquiring HIV/STI via psychosocial variables. This study explored the association between homoprejudiced violence experiences and high-risk sexual behaviors, and potential psychosocial mediators. Using cross-sectional survey data collected in China through Blued among men who have sex with men (MSM) in January 2021, this study conducted multiple mediation analyses. Standard instruments were used to collect data on depressive symptoms in the last two weeks (PHQ-9), recreational drug usage in the last three months, and ever experiencing homoprejudiced violence (12-item survey instrument). Dependent variables were having condomless anal sex and having three or more sexual partners in the last three months. Among 1828 MSM, nearly half (847, 46%) had experienced homoprejudiced violence. Twenty-three percent (427) reached a score that suggested moderate or severe depression and 35% (644) had used recreational drugs. In the last three months, 40% (731) had condomless anal sex and 34% (626) had three or more sexual partners. The indirect mediational coefficients through depression on condomless anal sex and multiple sexual partners were 0.04 (95% CI: [0.02, 0.07]) and 0.02 (95% CI: [0.001, 0.05]), respectively. The indirect mediational coefficient of homoprejudiced violence experience on multiple sexual partners through recreational drug use was 0.05 (95% CI: [0.03, 0.08]). These findings suggest that more comprehensive interventions are needed to address the syndemic of homoprejudiced violence, mental health issues, and HIV/STI-related risks.
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Affiliation(s)
- Xumeng Yan
- Department of Social Medicine and Health Education, School of Public Health of Nanjing Medical University, No. 101 Longmian Avenue Nanjing, Nanjing, 211166, Jiangsu, China
- University of North Carolina Project-China, Guangzhou, China
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Yuxin Ni
- University of North Carolina Project-China, Guangzhou, China
- Department of Health Law Policy and Management, Boston University, Boston, MA, USA
| | - Ying Lu
- University of North Carolina Project-China, Guangzhou, China
| | - Qianyun Wang
- University of North Carolina Project-China, Guangzhou, China
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rayner Kay Jin Tan
- University of North Carolina Project-China, Guangzhou, China
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- International Diagnostics Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian J Hall
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yi Zhou
- Department of HIV/AIDS Prevention and Control, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Dan Wu
- Department of Social Medicine and Health Education, School of Public Health of Nanjing Medical University, No. 101 Longmian Avenue Nanjing, Nanjing, 211166, Jiangsu, China.
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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.
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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
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Veldhuis CB, Kreski NT, Usseglio J, Keyes KM. Are Cisgender Women and Transgender and Nonbinary People Drinking More During the COVID-19 Pandemic? It Depends. Alcohol Res 2023; 43:05. [PMID: 38170029 PMCID: PMC10760999 DOI: 10.35946/arcr.v43.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
PURPOSE This narrative review of research conducted during the first 2 years of the COVID-19 pandemic examines whether alcohol use among cisgender women and transgender and nonbinary people increased during the pandemic. The overarching goal of the review is to inform intervention and prevention efforts to halt the narrowing of gender-related differences in alcohol use. SEARCH METHODS Eight databases (PubMed, APA PsycInfo, CINAHL, Embase, Scopus, Gender Studies Database, GenderWatch, and Web of Science) were searched for peer-reviewed literature, published between March 2020 and July 2022, that reported gender differences or findings specific to women, transgender or nonbinary people, and alcohol use during the pandemic. The search focused on studies conducted in the United States and excluded qualitative research. SEARCH RESULTS A total 4,132 records were identified, including 400 duplicates. Of the remaining 3,732 unique records for consideration in the review, 51 were ultimately included. Overall, most studies found increases in alcohol use as well as gender differences in alcohol use, with cisgender women experiencing the most serious consequences. The findings for transgender and nonbinary people were equivocal due to the dearth of research and because many studies aggregated across gender. DISCUSSION AND CONCLUSIONS Alcohol use by cisgender women seems to have increased during the pandemic; however, sizable limitations need to be considered, particularly the low number of studies on alcohol use during the pandemic that analyzed gender differences. This is of concern as gender differences in alcohol use had been narrowing before the pandemic; and this review suggests the gap has narrowed even further. Cisgender women and transgender and nonbinary people have experienced sizable stressors during the pandemic; thus, understanding the health and health behavior impacts of these stressors is critical to preventing the worsening of problematic alcohol use.
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Affiliation(s)
- Cindy B Veldhuis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Noah T Kreski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia Irving Medical Center, Columbia University, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Buckley PR, Murry VM, Gust CJ, Ladika A, Pampel FC. Racial and Ethnic Representation in Preventive Intervention Research: a Methodological Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1261-1274. [PMID: 37386352 DOI: 10.1007/s11121-023-01564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
Individuals who are Asian or Asian American, Black or African American, Native American or American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and Hispanic or Latino (i.e., presently considered racial ethnic minoritized groups in the USA) lacked equal access to resources for mitigating risk during COVID-19, which highlighted public health disparities and exacerbated inequities rooted in structural racism that have contributed to many injustices, such as failing public school systems and unsafe neighborhoods. Minoritized groups are also vulnerable to climate change wherein the most severe harms disproportionately fall upon underserved communities. While systemic changes are needed to address these pervasive syndemic conditions, immediate efforts involve examining strategies to promote equitable health and well-being-which served as the impetus for this study. We conducted a descriptive analysis on the prevalence of culturally tailored interventions and reporting of sample characteristics among 885 programs with evaluations published from 2010 to 2021 and recorded in the Blueprints for Healthy Youth Development registry. Inferential analyses also examined (1) reporting time trends and (2) the relationship between study quality (i.e., strong methods, beneficial effects) and culturally tailored programs and racial ethnic enrollment. Two percent of programs were developed for Black or African American youth, and 4% targeted Hispanic or Latino populations. For the 77% of studies that reported race, most enrollees were White (35%) followed by Black or African American (28%), and 31% collapsed across race or categorized race with ethnicity. In the 64% of studies that reported ethnicity, 32% of enrollees were Hispanic or Latino. Reporting has not improved, and there was no relationship between high-quality studies and programs developed for racial ethnic youth, or samples with high proportions of racial ethnic enrollees. Research gaps on racial ethnic groups call for clear reporting and better representation to reduce disparities and improve the utility of interventions.
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Affiliation(s)
- Pamela R Buckley
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA.
| | - Velma McBride Murry
- Departments of Health Policy & Human and Organizational Development, Vanderbilt University Medical Center and Vanderbilt University, Nashville, USA
| | - Charleen J Gust
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
| | - Amanda Ladika
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
| | - Fred C Pampel
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, USA
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Delmonaco D, Li S, Paneda C, Popoff E, Hughson L, Jadwin-Cakmak L, Alferio J, Stephenson C, Henry A, Powdhar K, Gierlinger I, Harper GW, Haimson OL. Community-Engaged Participatory Methods to Address Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Young People's Health Information Needs With a Resource Website: Participatory Design and Development Study. JMIR Form Res 2023; 7:e41682. [PMID: 37676709 PMCID: PMC10514765 DOI: 10.2196/41682] [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: 08/04/2022] [Revised: 12/14/2022] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) young people (aged 15 to 25 years) face unique health challenges and often lack resources to adequately address their health information needs related to gender and sexuality. Beyond information access issues, LGBTQ+ young people may need information resources to be designed and organized differently compared with their cisgender and heterosexual peers and, because of identity exploration, may have different information needs related to gender and sexuality than older people. OBJECTIVE The objective of our study was to work with a community partner to develop an inclusive and comprehensive new website to address LGBTQ+ young people's health information needs. To design this resource website using a community-engaged approach, our objective required working with and incorporating content and design recommendations from young LGBTQ+ participants. METHODS We conducted interviews (n=17) and participatory design sessions (n=11; total individual participants: n=25) with LGBTQ+ young people to understand their health information needs and elicit design recommendations for the new website. We involved our community partner in all aspects of the research and design process. RESULTS We present participants' desired resources, health topics, and technical website features that can facilitate information seeking for LGBTQ+ young people exploring their sexuality and gender and looking for health resources. We describe how filters can allow people to find information related to intersecting marginalized identities and how dark mode can be a privacy measure to avoid unwanted identity disclosure. We reflect on our design process and situate the website development in previous critical reflections on participatory research with marginalized communities. We suggest recommendations for future LGBTQ+ health websites based on our research and design experiences and final website design, which can enable LGBTQ+ young people to access information, find the right information, and navigate identity disclosure concerns. These design recommendations include filters, a reduced number of links, conscientious choice of graphics, dark mode, and resources tailored to intersecting identities. CONCLUSIONS Meaningful collaboration with community partners throughout the design process is vital for developing technological resources that meet community needs. We argue for community partner leadership rather than just involvement in community-based research endeavors at the intersection of human-computer interaction and health.
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Affiliation(s)
| | - Shannon Li
- University of Michigan, Ann Arbor, MI, United States
| | | | - Elliot Popoff
- University of Michigan, Ann Arbor, MI, United States
| | - Luna Hughson
- University of Michigan, Ann Arbor, MI, United States
| | | | - Jack Alferio
- University of Michigan, Ann Arbor, MI, United States
| | | | | | | | | | - Gary W Harper
- University of Michigan, Ann Arbor, MI, United States
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9
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Siconolfi D, Davis JP, Pedersen ER, Tucker JS, Dunbar MS, Rodriguez A, D'Amico EJ. Trajectories of Emerging Adults' Binge Drinking and Depressive Symptoms and Associations With Sexual Violence Victimization: Examining Differences by Sexual and Gender Minority Status. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6085-6112. [PMID: 36214487 PMCID: PMC10012535 DOI: 10.1177/08862605221128052] [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] [Indexed: 06/16/2023]
Abstract
We examined longitudinal associations between binge drinking (BD), depressive symptoms, and sexual violence (sexual harassment and sexual assault) among sexual and gender minority (SGM) and non-SGM emerging adults. Data were drawn from four annual web-based surveys of a diverse cohort of 2,553 emerging adults, spanning from approximately age 19 (2016) to age 22 (2020). About 18% were SGM individuals. We tested a multigroup parallel process latent growth curve model (recent depression symptoms; past-year BD) with time-varying covariates (past-year sexual harassment; sexual assault) to determine associations of sexual violence with BD and depression outcomes over time, and whether growth curves and associations differed by SGM status. For both SGM and non-SGM emerging adults, past-year sexual harassment was associated with depressive symptoms at each time point, but harassment was not associated with BD. For both groups, sexual assault was associated with both depressive symptoms and BD. To our knowledge, this is the first study to examine longitudinal, contemporaneous associations of sexual violence (including both harassment and assault as distinct constructs), with BD and depressive symptoms among racially and ethnically diverse emerging adults, comparing SGM and non-SGM groups. Although our models do not disentangle directionality or causality, the findings suggest the need to address sexual violence victimization (assault and harassment) in the context of depression screening and treatment, and vice versa. We discuss a number of intervention strategies currently in use for an implicitly non-SGM general population that could be adapted for greater inclusion of and relevance to SGM populations.
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Affiliation(s)
| | - Jordan P Davis
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Eric R Pedersen
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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10
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Srikummoon P, Oonarom A, Manojai N, Maneeton B, Maneeton N, Wiriyacosol P, Chiawkhun P, Kawilapat S, Homkham N, Traisathit P. Experiences of Being Bullied and the Quality of Life of Transgender Women in Chiang Mai Province, Thailand. Transgend Health 2023; 8:175-187. [PMID: 37013090 PMCID: PMC10066783 DOI: 10.1089/trgh.2021.0068] [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: 11/12/2022] Open
Abstract
Purpose The objective of this study is to identify factors associated with depression and the quality of life of Thai transgender women (TGW) from Chiang Mai province, Thailand, who have experienced being bullied. Methods We conducted the study on TGW ≥18 years of age in Chiang Mai province, Thailand, from May to November 2020. Data were collected using self-reporting questionnaires at the MPlus Chiang Mai foundation. Binary logistic regression analysis was used to examine the association between potential factors associated with depression and quality of life. Results Of the 205 TGW individuals who participated in this study with a median age of 24 years, most were students (43.3%), and the most common type of bullying was verbal (30.9%). The prevalence of depression among the TGW participants was 30.1%, although most of the participants had a good overall quality of life (53.4%). The impacts of being physically bullied at primary or secondary school and experiencing cyberbullying at primary school were associated with a higher risk of depression. The impacts of being cyberbullied within the previous 6 months and physically bullied at primary or secondary school were associated with a fair quality of life. Conclusion Our results show that many TGW had experienced bullying in their childhood and within the previous 6 months. Screening for experiences of having been bullied and psychological problems might be advantageous for the wellbeing of TGW, while counseling programs or psychotherapy should be provided for those who have experienced bullying to mitigate depression and improve their quality of life.
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Affiliation(s)
- Pimwarat Srikummoon
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Awirut Oonarom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Punjaree Wiriyacosol
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phisanu Chiawkhun
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Suttipong Kawilapat
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nontiya Homkham
- Faculty of Public Health, Thammasat University, Pathumthani, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Research Center in Bioresources for Agriculture, Industry and Medicine, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
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11
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Coulter RWS, Gartner RE. LGBTQ+ Youth-Generated Intervention Concepts for Reducing Teen Dating Violence Inequities. Health Promot Pract 2023; 24:252-257. [PMID: 36419324 PMCID: PMC10467361 DOI: 10.1177/15248399221137276] [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: 11/26/2022]
Abstract
Lesbian, gay, bisexual, transgender, queer, nonbinary, and other sexual and gender minority (LGBTQ+) youth are at substantially greater risk than cisgender heterosexual youth for experiencing teen dating violence (TDV) victimization, including emotional, physical, and sexual abuse within dating/romantic relationships. Despite these inequities, there are no evidence-based interventions designed specifically to address TDV among LGBTQ+ youth. To redress this dearth of interventions, we utilized a youth-centric approach, wherein 46 LGBTQ+ youth co-developed intervention concepts for reducing TDV. Participants engaged in a process of generating, prioritizing, and refining intervention concepts for reducing TDV inequities using human-centered design activities. LGBTQ+ youth generated eight intervention concepts, including the name, description, audience, problem focus, goals, and process for each. Their interventions focused on strategies for enhancing education, support systems, and advocacy. The intervention concepts had a wide variety of intended audiences, including LGBTQ+ and non-LGBTQ+ youth, teachers, school administrators, and policymakers. Overall, LGBTQ+ youth sought to improve education and skills pertaining to violence, sexual health, and healthy relationships; enhance support systems and resources for students' basic, mental health, and safety needs; and build advocacy channels related to "outing" and LGBTQ+ students' needs. These LGBTQ+ youth-generated programmatic and policy intervention concepts, in addition to our human-centered design approach, can be directly leveraged by health promotion practitioners and prevention experts into future intervention development, implementation, and evaluation efforts to improve LGBTQ+ youth health, well-being, resilience, and advocacy.
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12
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Herrmann L, Reiss F, Becker-Hebly I, Baldus C, Gilbert M, Stadler G, Kaman A, Graumann L, Ravens-Sieberer U. Systematic Review of Gender-Specific Child and Adolescent Mental Health Care. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01506-z. [PMID: 36849848 DOI: 10.1007/s10578-023-01506-z] [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] [Accepted: 01/29/2023] [Indexed: 03/01/2023]
Abstract
Gender differences in mental health emerge as early as in childhood and adolescence, highlighting the potential need for gender-specific child and adolescent mental health care. However, it is unclear how gender-specific child and adolescent mental health care is implemented and whether its' approaches are useful. Therefore, this study reviews gender-specific interventions and their effectiveness for child and adolescent mental health. Five databases were searched for articles published between 2000 and 2021. In total, 43 studies were included. Most interventions were conducted in school (n = 15) or community settings (n = 8). Substance-related disorders (n = 13) and eating disorders (n = 12) were addressed most frequently. Most interventions targeted girls (n = 31). Various gender-specific aspects were considered, including gender-specific risk and protective factors (n = 35) and needs (n = 35). Although most interventions yielded significant improvements in mental health outcomes (n = 32), only few studies reported medium or large effect sizes (n = 13). Additionally, there was a lack of strong causal evidence derived from randomized controlled trials, calling for more rigorous trials in the research field. Nevertheless, our findings indicate that gender-specific mental health care can be a promising approach to meet gender-specific mental health needs.
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Affiliation(s)
- Lena Herrmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Franziska Reiss
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Christiane Baldus
- German Center for Addiction Research in Childhood and Adolescence, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martha Gilbert
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Gertraud Stadler
- Institute of Gender in Medicine, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Kaman
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Lina Graumann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany.
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13
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Murphy M, Rogers BG, Streed C, Hughto JM, Radix A, Galipeau D, Napoleon S, Scott T, Noh M, Sutten Coats C, Hubbard L, Chan PA, Nunn A, Berk J. Implementing Gender-Affirming Care in Correctional Settings: A Review of Key Barriers and Action Steps for Change. JOURNAL OF CORRECTIONAL HEALTH CARE 2023; 29:3-11. [PMID: 36378847 PMCID: PMC10081719 DOI: 10.1089/jchc.21.09.0094] [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: 11/16/2022]
Abstract
Transgender and gender-diverse (TGD) people are disproportionately impacted by incarceration, interpersonal violence, HIV and other sexually transmitted infections, substance use disorders, and suicidality. Little is known about successful approaches to improve health outcomes for TGD individuals impacted by incarceration. We review the barriers to providing gender-affirming clinical care in correctional systems in the United States, identify key knowledge gaps regarding the provision of gender-affirming care to incarcerated TGD populations, and highlight necessary steps to improve the health and safety of this highly vulnerable population. We also describe the components of a gender-affirming care model implemented in a state correctional facility, including support from correctional administrators, identifying a gender-affirming care provider, standardizing clinical care protocols, and adapting clinical services to TGD population needs. Similar models should be employed elsewhere to improve health outcomes for TGD populations during incarceration and on release.
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Affiliation(s)
- Matthew Murphy
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Department of Corrections, Cranston, Rhode Island, USA
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
| | - Brooke G. Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Carl Streed
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Jaclyn M.W. Hughto
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Asa Radix
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Drew Galipeau
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Siena Napoleon
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ty Scott
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Madeline Noh
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Cassie Sutten Coats
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Leigh Hubbard
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
| | - Philip A. Chan
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Amy Nunn
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Justin Berk
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Department of Corrections, Cranston, Rhode Island, USA
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14
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Clark KA, Salway T, McConocha EM, Pachankis JE. How do sexual and gender minority people acquire the capability for suicide? Voices from survivors of near-fatal suicide attempts. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100044. [PMID: 35845718 PMCID: PMC9282160 DOI: 10.1016/j.ssmqr.2022.100044] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite well-documented disparities by sexual and gender minority (SGM) status in suicide attempt and mortality rates, few studies have investigated the lived experiences that contribute to SGM people's disproportionate risk of suicide. Having a history of at least one near-fatal (or medically serious) suicide attempt serves as a proxy for suicide mortality, but no known study has involved SGM people who have made such an attempt. Ideation-to-action theories of suicide posit that individuals acquire the capability for suicide through repeated exposure to painful and provocative events - namely, traumatic, threatening, and risky experiences - that can diminish the pain and fear of death. Yet whether identity-specific features of acquired capability for suicide contribute to SGM people's disproportionate risk of suicide remains unknown. Drawing upon interviews with 22 SGM people who experienced a recent near-fatal suicide attempt, the current study sought to identify specific determinants of how SGM individuals acquire the capability to kill themselves, a potentially powerful, and modifiable, pathway to suicide. Results identified three SGM-specific contributors to the acquired capability for suicide: (1) identity invalidation during developmentally sensitive periods of childhood and adolescence that left participants feeling erased, invisible, and, in some cases, non-existent; (2) normalization of suicide within SGM social networks that increased acceptability and reduced the fear of suicide; and (3) structural stigma and SGM community trauma as habituating sources of pain that engendered feelings of exhaustion and positioned suicide as a reprieve from pervasive anti-SGM norms. This study demonstrates that dominant suicidology theories might need to be refined to account for the stigma-related determinants of SGM suicide. Further, this study reinforces the importance of qualitative methods for understanding the lived experience of suicide and calls for SGM-specific suicide prevention efforts to respond to stigma to support those SGM people who contemplate suicide.
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Affiliation(s)
- Kirsty A. Clark
- Department of Medicine, Health, and Society, Vanderbilt University, United States
- Corresponding. Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, 37235, United States. (K.A. Clark)
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Canada
| | | | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, United States
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15
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Platt L, Bowen R, Grenfell P, Stuart R, Sarker MD, Hill K, Walker J, Javarez X, Henham C, Mtetwa S, Hargreaves J, Boily MC, Vickerman P, Hernandez P, Elmes J. The Effect of Systemic Racism and Homophobia on Police Enforcement and Sexual and Emotional Violence among Sex Workers in East London: Findings from a Cohort Study. J Urban Health 2022; 99:1127-1140. [PMID: 36222972 PMCID: PMC9727011 DOI: 10.1007/s11524-022-00673-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/31/2022]
Abstract
There is extensive qualitative evidence of violence and enforcement impacting sex workers who are ethnically or racially minoritized, and gender or sexual minority sex workers, but there is little quantitative evidence. Baseline and follow-up data were collected among 288 sex workers of diverse genders (cis/transgender women and men and non-binary people) in London (2018-2019). Interviewer-administered and self-completed questionnaires included reports of rape, emotional violence, and (un)lawful police encounters. We used generalized estimating equation models (Stata vs 16.1) to measure associations between (i) ethnic/racial identity (Black, Asian, mixed or multiple vs White) and recent (6 months) or past police enforcement and (ii) ethnic/racial and sexual identity (lesbian, gay or bisexual (LGB) vs. heterosexual) with recent rape and emotional violence (there was insufficient data to examine the association with transgender/non-binary identities). Ethnically/racially minoritized sex workers (26.4%) reported more police encounters partly due to increased representation in street settings (51.4% vs 30.7% off-street, p = 0.002). After accounting for street setting, ethnically/racially minoritized sex workers had higher odds of recent arrest (adjusted odds ratio 2.8, 95% CI 1.3-5.8), past imprisonment (aOR 2.3, 95% CI 1.1-5.0), police extortion (aOR 3.3, 95% CI 1.4-7.8), and rape (aOR 3.6, 95% CI 1.1-11.5). LGB-identifying sex workers (55.4%) were more vulnerable to rape (aOR 2.4, 95% CI 1.1-5.2) and emotional violence. Sex workers identifying as ethnically/racially minoritized (aOR 2.1, 95% CI 1.0-4.5), LGB (aOR 2.0, 95% CI 1.0-4.0), or who use drugs (aOR 2.0, 95% CI 1.1-3.8) were more likely to have experienced emotional violence than white-identifying, heterosexual or those who did not use drugs. Experience of any recent police enforcement was associated with increased odds of rape (aOR 3.6, 95% CI 1.3-8.4) and emotional violence (aOR 4.9, 95% CI 1.8-13.0). Findings show how police enforcement disproportionately targets ethnically/racially minoritized sex workers and contributes to increased risk of rape and emotional violence, which is elevated among sexual and ethnically/racially minoritized workers.
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Affiliation(s)
- Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Pippa Grenfell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Stuart
- College of Business, Arts and Social Sciences, Brunel University, London, UK
| | - M D Sarker
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathleen Hill
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Josephine Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Xavier Javarez
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Carolyn Henham
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - James Hargreaves
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - M-C Boily
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paz Hernandez
- Open Doors, Homerton University Foundation Trust, London, UK
| | - Jocelyn Elmes
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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16
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Hsiang E, Gyamerah A, Baguso G, Jain J, McFarland W, Wilson EC, Santos GM. Prevalence and correlates of substance use and associations with HIV-related outcomes among trans women in the San Francisco Bay Area. BMC Infect Dis 2022; 22:886. [PMID: 36435761 PMCID: PMC9701418 DOI: 10.1186/s12879-022-07868-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 11/10/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Trans women face tremendous social inequities as well as disproportionate rates of HIV and substance use, yet disaggregated substance use data specific to trans women remain limited. METHODS We conducted a secondary analysis of baseline data from the Trans*National Study (2016-2017) surveying trans women in the San Francisco Bay Area (n = 629). Multivariable logistic regression was used to analyze socio-demographic and environmental correlates of substance use, and bivariate associations between substance use and HIV-associated outcomes are presented alongside prevalence data. RESULTS Over half (52.9%) reported using substances in the prior year, most frequently marijuana, methamphetamine, and crack/cocaine. Those with unmet gender-affirming health care needs, lack of insurance, or a history of experiencing racial violence, transphobic violence, adult housing instability, or extreme poverty had higher odds of substance use. Sex work and condomless anal sex were also independently associated with substance use. CONCLUSIONS Among this sample of trans women, substance use and substance use concurrent with sex were highly prevalent, and associated with a number of socioeconomic and health care needs. These findings corroborate the need for holistic and intersectional efforts to reduce substance use and HIV risk.
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Affiliation(s)
- Elaine Hsiang
- Department of Emergency Medicine, University of California, San Francisco, 505 Parnassus Avenue, M24, Box 203, San Francisco, CA, 94143, USA.
| | - Akua Gyamerah
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, University of California, San Francisco, San Francisco, CA USA
| | - Glenda Baguso
- grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA
| | - Jennifer Jain
- grid.266102.10000 0001 2297 6811Department of Psychiatry, University of California, San Francisco, San Francisco, CA USA
| | - Willi McFarland
- grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA
| | - Erin C. Wilson
- grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA USA
| | - Glenn-Milo Santos
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA
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17
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Blosnich JR. Interpersonal and self-directed violence among sexual and gender minority populations: Moving research from prevalence to prevention. CURR EPIDEMIOL REP 2022; 9:142-160. [PMID: 36845319 PMCID: PMC9957556 DOI: 10.1007/s40471-022-00299-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
Purpose of review This scoping review of reviews aimed to detail the breadth of violence research about sexual and gender minorities (SGM) in terms of the three generations of health disparities research (i.e., documenting, understanding, and reducing disparities). Recent findings Seventy-three reviews met inclusion criteria. Nearly 70% of the reviews for interpersonal violence and for self-directed violence were classified as first-generation studies. Critical third-generation studies were considerably scant (7% for interpersonal violence and 6% for self-directed violence). Summary Third-generation research to reduce or prevent violence against SGM populations must account for larger scale social environmental dynamics. Sexual orientation and gender identity (SOGI) data collection has increased in population-based health surveys, but administrative datasets (e.g., health care, social services, coroner and medical examiner offices, law enforcement) must begin including SOGI to meet the needs of scaled public health interventions to curb violence among SGM communities.
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Affiliation(s)
- John R. Blosnich
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W 34 St., Los Angeles, CA 90089, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, USA
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18
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Peng C, Wang Z, Yu Y, Cheng J, Qiu X, Liu X. Co-occurrence of sibling and peer bullying victimization and depression and anxiety among Chinese adolescents: The role of sexual orientation. CHILD ABUSE & NEGLECT 2022; 131:105684. [PMID: 35691132 DOI: 10.1016/j.chiabu.2022.105684] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/22/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Bullying victimization is a robust predictor of mental distress among lesbian/gay, bisexual, and questioning (LGBQ) adolescents. However, few research accounted bullying victimization within the context of both sibling and peer relationships. OBJECTIVE To examine the effect of sibling and peer bullying victimization on depression and anxiety between heterosexual adolescents and LGBQ adolescents. METHOD This was a cross-sectional study with a random sample of 3062 Chinese senior high school students (56.0% female) aged 14 to 18. Related information was collected through a self-reported questionnaire. The associations were examined via a set of logistic regression analysis. RESULTS Of the participants, 12.5% were victims of sibling bullying only, 10.1% reported peer victimization only, and 4.7% were involved in both sibling and peer victimization. Compared to heterosexuals, LGBQ adolescents had increased risks of sibling victimization only, peer victimization only, and both sibling and peer victimization. The prevalence of major depression and generalized anxiety disorder were 24.9% and 18.7% respectively. Bullying victimization and sexual orientation were independently associated with depression and anxiety. Furthermore, the stratified analysis indicated that sibling victimization only was significantly associated with depression and anxiety for heterosexual adolescents, while the associations were not significant for LGBQ adolescents. CONCLUSIONS Sexual orientation and bullying victimization are predictive factors of depression and anxiety. In particular, bullying victimization shows the different effects on depression and anxiety between heterosexual and LGBQ adolescents. Anti-bullying intervention could take distinct strategies based on different sexual orientation to reduce risks of adolescents' mental health problems.
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Affiliation(s)
- Chang Peng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Wang
- College of Teacher Education, Qilu Normal University, Jinan, China
| | - Yizhen Yu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junhan Cheng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyan Qiu
- Institute of Higher Education, Hunan University of Science and Engineering, Yongzhou, China
| | - Xiaoqun Liu
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China.
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19
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Silveri G, Schimmenti S, Prina E, Gios L, Mirandola M, Converti M, Fiorillo A, Pinna F, Ventriglio A, Galeazzi GM, Sherriff N, Zeeman L, Amaddeo F, Paribello P, Pinna F, Giallanella D, Gaggiano C, Ventriglio A, Converti M, Fiorillo A, Galeazzi GM, Marchi M, Arcolin E, Fiore G, Mirandola M, Schimmenti S, Silveri G, Prina E, Amaddeo F, Bragazzi NL. Barriers in care pathways and unmet mental health needs in LGBTIQ + communities. Int Rev Psychiatry 2022; 34:215-229. [PMID: 36151825 DOI: 10.1080/09540261.2022.2075256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.
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Affiliation(s)
- Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of integrated activity of Mental Health and Pathological Dependencies, USL-IRCSS company of Reggio Emilia, Reggio Emilia, Italy
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Laetitia Zeeman
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Pasquale Paribello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Giallanella
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Costanza Gaggiano
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Arcolin
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Fiore
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
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Relationships of Homophobic Bullying Victimization during Childhood with Borderline Personality Disorder Symptoms in Early Adulthood among Gay and Bisexual Men: Mediating Effect of Depressive Symptoms and Moderating Effect of Family Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084789. [PMID: 35457655 PMCID: PMC9027503 DOI: 10.3390/ijerph19084789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023]
Abstract
This study investigated (1) the associations of homophobic bullying victimization in childhood with borderline personality disorder (BPD) symptoms in early adulthood among gay and bisexual men; (2) the mediating effect of depressive symptoms on the association between homophobic bullying victimization and BPD symptoms, and (3) the moderating effects of perceived family support on the association between homophobic bullying victimization and BPD symptoms. A total of 500 gay or bisexual men aged between 20 and 25 years were recruited into this study. The experiences of physical, verbal and social relationship bullying victimization during childhood were evaluated using the Mandarin Chinese version of the School Bullying Experience Questionnaire. The experiences of cyberbullying victimization during childhood were evaluated using the Cyberbullying Experiences Questionnaire. BPD symptoms were assessed using the Borderline Symptom List. Depressive symptoms were examined using the Center for Epidemiologic Studies Depression Scale. Perceived family support was evaluated using the Family Adaptation, Partnership, Growth, Affection, and Resolve index. The results of mediation analyses demonstrated that all the types of homophobic bullying victimization in childhood were directly associated with BDP symptoms in young adulthood as well as indirectly associated with BPD symptoms through the mediation of depressive symptoms. The results of moderation analyses demonstrated that the association between homophobic bullying victimization and BPD symptoms decreased when the individuals had more family support. Intervention programs to reduce homophobic bullying victimization and enhance family support for gay and bisexual men and their families are necessary. Interventions to improve depressive and BPD symptoms among gay and bisexual men are also necessary, especially for those who experienced homophobic bullying victimization during childhood.
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21
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Bhatt N, Cannella J, Gentile JP. Gender-affirming Care for Transgender Patients. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:23-32. [PMID: 35958971 PMCID: PMC9341318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, plus (LGBTQIA+ or LGBTQ+) individuals face a wide array of health disparities both within and separate from the healthcare system. Transgender patients are subject to microaggressions, misgendering, and harassment from providers, medical staff, and fellow patients. These patients experience drastic disparities in suicidality, depression, anxiety, substance use, malignancy, sexually transmitted disease (STD), and victimization of violence. Providers have the opportunity to intervene and positively impact patient experiences through gender-affirming care, but they first require an adequate knowledge base and understanding of the importance of sensitive and inclusive care. Seemingly small interventions, such as listing one's own pronouns, using gender-neutral language, validating and affirming patients, and utilizing appropriate mental and physical health screenings, can lead to significant impacts on the patient experience, health outcomes, and quality of life. This article will discuss some of the most common disparities and obstacles faced by transgender patients and will argue the paramount role of the provider in establishing gender-affirming care and some high-impact avenues which the provider, regardless of specialty, may pursue when caring for these patients.
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Affiliation(s)
- Nita Bhatt
- Dr. Bhatt is Associate Director of Medical Student Education and Associate Professor in the Department of Psychiatry at Wright State University in Dayton, Ohio
| | - Jesse Cannella
- Mr. Cannella is a medical student at Wright State University Boonshoft School of Medicine in Dayton, Ohio
| | - Julie P Gentile
- Dr. Gentile is Professor and Chair of the Department of Psychiatry at Wright State University in Dayton, Ohio
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22
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Kidd JD, Paschen-Wolff MM, Mericle AA, Caceres BA, Drabble LA, Hughes TL. A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations. J Subst Abuse Treat 2022; 133:108539. [PMID: 34175174 PMCID: PMC8674383 DOI: 10.1016/j.jsat.2021.108539] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/28/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Alcohol, tobacco, and other drug use are among the most prevalent and important health disparities affecting sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) populations. Although numerous government agencies and health experts have called for substance use intervention studies to address these disparities, such studies continue to be relatively rare. METHOD We conducted a scoping review of prevention and drug treatment intervention studies for alcohol, tobacco, and other drug use that were conducted with SGM adults. We searched three databases to identify pertinent English-language, peer-reviewed articles published between 1985 and 2019. RESULTS Our search yielded 71 articles. The majority focused on sexual minority men and studied individual or group psychotherapies for alcohol, tobacco, or methamphetamine use. CONCLUSION Our findings highlight the need for intervention research focused on sexual minority women and gender minority individuals and on cannabis and opioid use. There is also a need for more research that evaluates dyadic, population-level, and medication interventions.
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Affiliation(s)
- Jeremy D Kidd
- Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Margaret M Paschen-Wolff
- Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Amy A Mericle
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound Street, Suite 450, Emeryville, CA 94608, USA.
| | - Billy A Caceres
- Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA.
| | - Laurie A Drabble
- San Jose State University, College of Health and Human Sciences, One Washington Square, San Jose, CA 95191, USA.
| | - Tonda L Hughes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Columbia University School of Nursing, 560 W. 168th Street, New York, NY 10032, USA.
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23
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O'Brien RT, Gagnon KW, Egan JE, Coulter RWS. Gaming Preferences and Motivations Among Bullied Sexual and Gender Minority Youth: An Interview Study. Games Health J 2022; 11:79-84. [PMID: 35049380 PMCID: PMC9057884 DOI: 10.1089/g4h.2021.0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Game-based interventions can easily disseminate health information to hard-to-reach populations, such as sexual and gender minority youth (SGMY; e.g., gay/lesbian, bisexual, and transgender youth). SGMY disproportionately experience health problems, which have been attributed to greater violence victimization, such as bullying. Nevertheless, few interventions exist to improve health outcomes for bullied SGMY. Since game-based interventions offer economically viable and easily scalable solutions, we explored why bullied SGMY play games, the gaming characteristics they enjoy, and their preferences for future game-based interventions. Materials and Methods: We conducted semistructured qualitative interviews with 20 14- to 18-year-old U.S.-residing bullied SGMY recruited from social media. We asked participants about their current gaming experiences, preferences, and suggestions for future games and then conducted thematic analysis. Results: The majority of SGMY reported playing games to experience positive feelings associated with higher degrees of agency. Through controlling in-game storyline and character customization settings, SGMY described feeling safe and engaged in game play. In addition, SGMY reported playing games as a distraction from the real world. Coping with stress and other negative emotions was a commonly reported motivation for playing games, as was gleaning happiness independent from stress management. Furthermore, SGMY mentioned using games to connect with people, both in-person and virtually, to develop and maintain friendships. Conclusion: This study highlights specific methods of tailoring games to the interests of bullied SGMY. In addition, our findings are preliminary indicators that SGMY may use games to achieve healthy psychosocial developmental milestones. This study may be integral in informing the development of future game-based interventions for SGMY.
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Affiliation(s)
- Robert T O'Brien
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kelly W Gagnon
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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24
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Sevelius JM, Glidden DV, Deutsch M, Welborn L, Contreras A, Salinas A, Venegas L, Grant RM. Uptake, Retention, and Adherence to Pre-exposure Prophylaxis (PrEP) in TRIUMPH: A Peer-Led PrEP Demonstration Project for Transgender Communities in Oakland and Sacramento, California. J Acquir Immune Defic Syndr 2021; 88:S27-S38. [PMID: 34757990 PMCID: PMC8579996 DOI: 10.1097/qai.0000000000002808] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND TRIUMPH (Trans Research-Informed communities United in Mobilization for the Prevention of HIV) was a community-led, transgender-specific pre-exposure prophylaxis (PrEP) demonstration project at 2 community-based clinical sites in California. TRIUMPH used peer health education, community mobilization, and clinical integration of PrEP with hormone therapy to promote PrEP knowledge and acceptability. The goal of this study was to evaluate PrEP uptake, retention, and adherence among TRIUMPH participants and examine site-based differences. METHODS Eligible participants were adult transgender and gender diverse people interested in PrEP. Participants were seen at baseline and at 1, 3, 6, 9, and 12 months for PrEP provision, clinical visits, and HIV testing. PrEP uptake was defined as dispensation of PrEP, PrEP retention was defined as proportion of expected visits completed among those who initiated PrEP, and PrEP adherence was assessed by measuring tenofovir diphosphate concentrations in dried blood spots. Logistic regression models quantified the association of variables with PrEP outcomes. RESULTS TRIUMPH enrolled 185 participants; the median age was 28 years (interquartile range: 23-35), 7% was Black, and 58% was Latinx. PrEP uptake was as follows: 78% in Oakland and 98% in Sacramento; 91% among trans women, 96% among trans men, and 70% among nonbinary participants. Almost half (47%) rarely/never believed about HIV, and 42% reported condomless sex act in the past 3 months. Participants who reported higher numbers of sex partners were more likely to be retained and adherent; other predictors of adherence included not having a primary partner and not experiencing violence in the past 3 months. CONCLUSIONS This community-led, trans-specific PrEP demonstration project documents high levels of PrEP initiation in a young transgender and gender diverse cohort at risk of HIV acquisition.
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25
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Warwick RM, Shumer DE. Gender-affirming multidisciplinary care for transgender and non-binary children and adolescents. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.2004146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Daniel E. Shumer
- Department of Pediatrics, Division of Pediatric Endocrinology, Michigan Medicine, Ann Arbor, MI, USA
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26
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Marmet S, Wicki M, Gmel G, Gachoud C, Bertholet N, Studer J. Sexual Minority Orientation Is Associated With Greater Psychological Impact Due to the COVID-19 Crisis-Evidence From a Longitudinal Cohort Study of Young Swiss Men. Front Public Health 2021; 9:692884. [PMID: 34746075 PMCID: PMC8570433 DOI: 10.3389/fpubh.2021.692884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/24/2021] [Indexed: 01/26/2023] Open
Abstract
Background: The COVID-19 pandemic and its countermeasures may have had a significant impact on the psychological well-being of specific population subgroups. The present study investigated whether sexual minority men (defined here as attracted partly or exclusively to men) from an ongoing cohort study of young Swiss men experienced different psychological impacts, levels of substance use and addictive behaviors, and to which degree pre-existing vulnerabilities and participants experiences during the crisis might explain these differences. Methods: An ongoing cohort sample based on the general population of young Swiss men (mean age = 29.07 years; SD = 1.27) was assessed before and during the COVID-19 crisis for depression, stress, sleep quality, substance use and addictive behaviors. Additionally, during the crisis, we assessed its impact in form of fear, isolation and traumatic experiences. Potential associations between these outcomes and sexual orientation (sexual minority vs. heterosexual) were tested using linear regression models. It was additionally estimated to which degree these associations were attenuated if adjusted for differences in mental health, personality and socioeconomic status before the crisis, as well as the experience of the COVID-19 crisis (infection with the virus and changes to work situation). Results: Compared to heterosexual men, sexual minority men showed higher levels of psychological trauma (b = 0.37 [0.25, 0.49]), fear (b = 0.18 [0.06, 0.30]) and isolation (b = 0.32 [0.20, 0.44]) due to the COVID-19 pandemic as well as higher levels of depression (b = 0.31 [0.20, 0.41]) and lower sleep quality (b = −0.13 [−0.24, −0.02]) during the crisis. These differences were to a large degree explained by higher pre-crisis levels of mental health problems and the personality dimension of neuroticism-anxiety. Sexual minority men showed higher overall levels of substance use and addictive behaviors, but these differences were already present before the crisis. Conclusion: The COVID-19 crisis may have worsened pre-existing vulnerabilities in sexual minority men, leading to its greater psychological impact on them than on heterosexual men. Reducing minority stress due to sexual orientation may help not only to improve mental health among important proportions of the population but also to reduce their vulnerability to crises. Services offering psychological support to sexual minorities may need to be reinforced during crises.
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Affiliation(s)
- Simon Marmet
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Wicki
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Faculty of Health and Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Céline Gachoud
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Bertholet
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joseph Studer
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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27
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Berona J, Whitton S, Newcomb ME, Mustanski B, Gibbons R. Predicting the Transition From Suicidal Ideation to Suicide Attempt Among Sexual and Gender Minority Youths. Psychiatr Serv 2021; 72:1261-1267. [PMID: 34346732 PMCID: PMC8570968 DOI: 10.1176/appi.ps.202000497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sexual and gender minority youths are more likely to consider, attempt, and die by suicide than are heterosexual and cisgender youths, yet little is known about how to predict future attempts or transitions from suicidal thoughts to behaviors. Additionally, adaptive measurement of psychopathology is a promising approach that may help characterize risk in this population. This study examined the validity of the Computerized Adaptive Test for Suicide Scale (CAT-SS) in predicting suicide attempts and the transition from suicidal ideation to attempt. METHODS The CAT-SS was administered to participants of two ongoing cohort studies of sexual and gender minority adolescents and young adults (N=1,006). Survival analyses examined longitudinal associations between CAT-SS scores and time to suicide attempt. Analyses were conducted for the full sample and stratified by those with and without a history of suicidal ideation, with comparisons between adaptive and static measures of depressive symptoms. RESULTS The CAT-SS predicted future suicide attempts in the overall sample (hazard ratio [HR]=1.34, 95% confidence interval [CI]=1.03-1.74). Among youths without a history of suicidal ideation, social support reduced the risk for attempts (HR=0.66, 95% CI=0.45-0.96). Among youths with a history of ideation, predictors of the transition from suicidal thoughts to attempts included baseline CAT-SS score (HR=1.51, 95% CI=1.06-2.15) and victimization (HR=2.48, 95% CI=1.10-5.59). CONCLUSIONS Risk and protective factors for suicide attempts differed between youths with and without a history of suicidal thoughts. The CAT-SS had validity in predicting future risk of the sample overall and of youths with suicidal ideation.
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Affiliation(s)
- Johnny Berona
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Sarah Whitton
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Michael E Newcomb
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Robert Gibbons
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
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28
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Sallabank G, Chavanduka TMD, Walsh AR, Sullivan P, Wolfe J, Filipowicz R, Bonar EE, Horvath KJ, Hailu B, Bauermeister J, Stephenson R. Mapping LGBTQ+ Youth Resource Density Across Four High HIV Prevalence Corridors in the US. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2021; 20:300-314. [PMID: 34703505 PMCID: PMC8532447 DOI: 10.1007/s13178-021-00660-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Studies using geospatial data to understand LGBTQ+-friendly sexual health and wellness resource availability have often focused on services catered to adults. While HIV rates have increased in adolescents in recent years, few studies have explored disparities in resource access for adolescent gay and bisexual men (AGBMSM). METHODS We used geospatial data of resources (collected and verified 2017-2018) from the iReach app to understand disparities in resource access for AGBMSM within and between 4 high HIV prevalence corridors in the US. RESULTS AGBMSM in non-metro areas had access to fewer resources and some rural counties had no LGBTQ+ -friendly resources. Corridors comprising states with legacies of punitive laws targeting sexual and gender minorities demonstrate stark geographic disparities across the US. CONCLUSIONS Policy-makers must understand the granularity of disparities within regions. Online resources may be able to surmount LGBTQ+ resource deserts. However, physical access to LGBTQ+ -friendly services must be improved as a fundamental strategy for reducing HIV among AGBMSM. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13178-021-00660-0.
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Affiliation(s)
- Gregory Sallabank
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI USA
| | - Tanaka M. D. Chavanduka
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI USA
| | - Alison R. Walsh
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI USA
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - James Wolfe
- School of Nursing, University of Pennsylvania, Philadelphia, PA USA
| | | | - Erin E. Bonar
- Dept of Psychiatry and Addiction Center, Injury Prevention Center, Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI USA
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, CA USA
| | - Benyam Hailu
- Division of Clinical & Health Services Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD USA
| | | | - Rob Stephenson
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI USA
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29
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Egan JE, Corey SL, Henderson ER, Abebe KZ, Louth-Marquez W, Espelage D, Hunter SC, DeLucas M, Miller E, Morrill BA, Hieftje K, Sang JM, Friedman MS, Coulter RWS. Feasibility of a Web-Accessible Game-Based Intervention Aimed at Improving Help Seeking and Coping Among Sexual and Gender Minority Youth: Results From a Randomized Controlled Trial. J Adolesc Health 2021; 69:604-614. [PMID: 34140199 PMCID: PMC8494066 DOI: 10.1016/j.jadohealth.2021.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/15/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To address the gap in interventions for improving sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, and transgender youth) health, we tested the feasibility of a game-based intervention for increasing help-seeking, productive coping skills, resource knowledge/use, and well-being. METHODS We conducted a 2-arm randomized controlled trial testing a theory-based, community-informed, Web-accessible computer role-playing game intervention. Control condition received a list of resources. Primary hypotheses were high levels of implementation success, game demand, and game acceptability. RESULTS We randomized 240 SGMYs aged 14-18 years into the intervention (n = 120) or control (n = 120) conditions. Participants completed baseline (100%), 1-month follow-up (T2; 73.3%), and 2-month follow-up (T3; 64.4%) surveys. Among intervention participants, 55.8% downloaded and played the game. Of those who played, 46.2% reported a desire to play it again, and 50.8% would recommend it. Game acceptability exceeded hypothesized benchmarks, wherein participants reported high positive affect (M = 2.36; 95% confidence interval [CI]: 2.13, 2.58), low negative affect (M = 2.75; 95% CI: 2.55, 2.95), low tension/annoyance (M = 3.18; 95% CI: 2.98, 3.39), and high competence (M = 2.23; 95% CI: 2.04, 2.43) while playing the game. In multivariable intent-to-treat analyses of 38 secondary/tertiary outcomes, intervention participants reported significantly larger reductions than control participants in cyberbullying victimization (T2 b = -.28; 95% CI: -.56, -.01), binge drinking frequency (T2 b = -.39; 95% CI: -.71, -.06), and marijuana use frequency (T3 b = -2.78; 95% CI: -4.49, -1.08). CONCLUSIONS We successfully implemented a Web-accessible game trial with SGMY. The game-based intervention was feasible and acceptable to SGMY, and preliminary results show it improved several health-related behaviors. A larger scale trial is needed to test whether the game-based intervention can reduce health inequities for SGMY.
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Affiliation(s)
- James E Egan
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Stephanie L Corey
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emmett R Henderson
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaleab Z Abebe
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William Louth-Marquez
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dorothy Espelage
- School of Education, University of North Carolina, Chapel Hill, North Carolina
| | - Simon C Hunter
- Department of Psychology, Glasgow Caledonian University, Glasgow, United Kingdom
| | | | - Elizabeth Miller
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Jordan M Sang
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark S Friedman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert W S Coulter
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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30
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Q Chat Space: Assessing the Feasibility and Acceptability of an Internet-Based Support Program for LGBTQ Youth. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 23:130-141. [PMID: 34490582 PMCID: PMC8420963 DOI: 10.1007/s11121-021-01291-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 11/04/2022]
Abstract
There are few psychosocial support programs specifically designed to meet the unique developmental and health needs of LGBTQ youth. Even when available, many youth face significant barriers to accessing LGBTQ-specific services for fear of being “outed” to parents, peers, and community members. The current study assessed the utility, feasibility, and acceptability of a synchronous, adult-facilitated, chat-based Internet community support program for LGBTQ youth aged 13–19. Chat transcripts were analyzed to examine how LGBTQ youth used the chat-based platform to connect with peers and trusted adults. A separate user satisfaction survey was collected to assess the personal (e.g., sexual orientation, gender identity, age) and contextual (e.g., geography, family environment) characteristics of youth engaging in the platform, their preferred topics of discussion, and their satisfaction with the program focus and facilitators. Qualitative data analysis demonstrated the degree to which LGBTQ youth were comfortable disclosing difficult and challenging situations with family, friends, and in their community and in seeking support from peers and facilitators online. Youth also used the platform to explore facets of sexual and gender identity/expression and self-acceptance. Overall, users were very satisfied with the platform, and participants accurately reflect the program’s desired populations for engagement (e.g., LGBTQ youth of color, LGBTQ youth in the South). Together, findings support the feasibility and acceptability of synchronous, adult-facilitated, chat-based Internet programs to connect and support LGBTQ youth, which encourage future research and innovation in service delivery.
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Lucassen MFG, Stasiak K, Fleming T, Frampton C, Perry Y, Shepherd M, Merry SN. Computerized cognitive behavioural therapy for gender minority adolescents: Analysis of the real-world implementation of SPARX in New Zealand. Aust N Z J Psychiatry 2021; 55:874-882. [PMID: 33287554 PMCID: PMC8404718 DOI: 10.1177/0004867420976846] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE SPARX is a form of computerized cognitive behavioural therapy in serious game format funded via the Ministry of Health to be freely available in New Zealand. At registration users identify themselves as male, female, transgender or intersex. We aimed to establish whether adolescent transgender users of SPARX, compared to adolescent male and female users, were more likely to have high mental health needs at baseline and were more likely to complete SPARX. We also sought to determine changes in transgender adolescents' depressive symptoms after using SPARX. METHODS Quantitative analysis of 5 years of usage data from the nation-wide delivery of SPARX in New Zealand. RESULTS There were 9079 adolescents who completed the registration process and used SPARX, 2.3% (n = 207) identified as transgender. The majority of transgender registrants (69.0%) completing a baseline Patient Health Questionnaire - modified for Adolescents were categorized as having high mental health needs, significantly more so than male and female registrants (p < 0.001). Over half of all SPARX registrants completed the first module of the program, with subsequently lower proportions of transgender registrants completing Module 4 (p = 0.005) and Module 7 (i.e. the last module, p = 0.048). Of those registrants completing a baseline and subsequent Patient Health Questionnaire - modified for Adolescents, both male (n = 247) and female (n = 630) registrants, on average, had improvements in their scores (2.68 and 3.15, respectively), whereas transgender registrants (n = 14) did not (-0.43) (p = 0.048). CONCLUSION This is the first study describing the impact of an e-therapy on transgender young people. The analysis of data from this free self-help intervention suggests that transgender adolescents seeking treatment for depression have particularly high mental health needs, and an existing well tested tool may be less effective for them than it is for others. Taken together the results appear to suggest targeted efforts may be required for transgender adolescents.
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Affiliation(s)
- Mathijs FG Lucassen
- Department of Health and Social Care, Faculty of Wellbeing, Education, and Language Studies, The Open University, Milton Keynes, UK,Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand,Mathijs FG Lucassen, Department of Health and Social Care, Faculty of Wellbeing, Education, and Language Studies, The Open University, Milton Keynes, MK7 6AA, UK. ;
| | - Karolina Stasiak
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Theresa Fleming
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand,School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Christopher Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Yael Perry
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | - Sally N Merry
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Diamond LM, Dehlin AJ, Alley J. Systemic inflammation as a driver of health disparities among sexually-diverse and gender-diverse individuals. Psychoneuroendocrinology 2021; 129:105215. [PMID: 34090051 DOI: 10.1016/j.psyneuen.2021.105215] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 01/28/2023]
Abstract
Sexually-diverse individuals (those who seek sexual or romantic relationships with the same and/or multiple genders) and gender-diverse individuals (those whose gender identity and/or expression differs from their birth-assigned sex/gender) have disproportionately high physical health problems, but the underlying biological causes for these health disparities remain unclear. Building on the minority stress model linking social stigmatization to health outcomes, we argue that systemic inflammation (the body's primary response to both physical and psychological threats, indicated by inflammatory markers such as C-reactive protein and proinflammatory cytokines) is a primary biobehavioral pathway linking sexual and gender stigma to physical health outcomes. Expectations and experiences of social threat (i.e., rejection, shame, and isolation) are widespread and chronic among sexually-diverse and gender-diverse individuals, and social threats are particularly potent drivers of inflammation. We review research suggesting that framing "minority stress" in terms of social safety versus threat, and attending specifically to the inflammatory consequences of these experiences, can advance our understanding of the biobehavioral consequences of sexual and gender stigma and can promote the development of health promoting interventions for this population.
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Zhao M, Xiao D, Wang W, Wu R, Zhang W, Guo L, Lu C. Association Among Maltreatment, Bullying and Mental Health, Risk Behavior and Sexual Attraction in Chinese Students. Acad Pediatr 2021; 21:849-857. [PMID: 33279736 DOI: 10.1016/j.acap.2020.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify the association between sexual attraction, childhood maltreatment and bullying victimization, and mental and behavioral health problems among Chinese adolescents. METHODS A cross-sectional study among Chinese high school students by multistage stratified cluster sampling was conducted using a self-reported questionnaire. Participants who were same- or both-sex attracted were identified as sexual minorities, and those who were opposite-sex attracted were identified as heterosexuals. Childhood maltreatment was assessed as physical, emotional, and sexual abuse, and bullying was assessed as traditional and cyberbullying. Psychological distress was assessed as depressive and anxiety symptoms, and self-destructive behavior was assessed as suicidal behavior and nonsuicidal self-injury. Logistic regression and path analysis were conducted to analyze the data. RESULTS There were 1360 sexual minority and 15,020 heterosexual respondents. Sexual minority status was associated with increased risk of maltreatment (adjusted odds ratio [AOR] range: 1.25-2.46) and bullying (AOR range: 1.38-1.77) victimization, and a series of health problems (AOR range: 1.85-3.69). Furthermore, childhood maltreatment could partially explain the association of sexual minority status with psychological distress (indirect effect: β = 0.026 for boys; β = 0.086 for girls) and self-destructive behavior (β = 0.056 for boys; β = 0.125 for girls), and bullying could partially explain the association between sexual minority status and psychological distress (β = 0.040 for boys; β = 0.031 for girls). CONCLUSIONS Sexual minority adolescents were more likely than heterosexuals to experience different forms of childhood victimization, which may put them at higher risk for mental and behavioral health problems. Interventions based on both family and school are essential.
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Affiliation(s)
- Meijun Zhao
- Department of Medical Statistics and Epidemiology (M Zhao, W Wang, R Wu, L Guo, C Lu), School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Di Xiao
- Department of Medical Statistics and Epidemiology (M Zhao, W Wang, R Wu, L Guo, C Lu), School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology (M Zhao, W Wang, R Wu, L Guo, C Lu), School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ruipeng Wu
- Department of Medical Statistics and Epidemiology (M Zhao, W Wang, R Wu, L Guo, C Lu), School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Weihong Zhang
- Faculty of Psychology and Educational Sciences, Department of Experimental Clinical and Health Psychology (W Zhang), Ghent University, Ghent, Belgium
| | - Lan Guo
- Department of Medical Statistics and Epidemiology (M Zhao, W Wang, R Wu, L Guo, C Lu), School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology (M Zhao, W Wang, R Wu, L Guo, C Lu), School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
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Moore TR, Foster EN, Mair C, Burke JG, Coulter RWS. Leveraging Complex Systems Science to Advance Sexual and Gender Minority Youth Health Research and Equity. LGBT Health 2021; 8:379-385. [PMID: 34182823 DOI: 10.1089/lgbt.2020.0297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Over the past two decades, sexual and gender minority (SGM) youth health inequities have remained the same or widened, highlighting the need for new approaches to foster health equity. Complex systems science (CSS) techniques must be added to our armamentarium because of the following: CSS techniques can model cyclical feedback loops inherent in the relationships between SGM youth health outcomes and their multilevel causes, thereby enhancing the integration of real-world complexity in scientific models; and CSS can simulate multiple hypothetical interventions, thereby identifying future interventions with great potential impact. We describe four promising CSS techniques for advancing SGM youth health equity.
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Affiliation(s)
- Travis R Moore
- ChildObesity180, Division of Nutrition Interventions, Communication, and Behavior Change, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Elizabeth N Foster
- Department of Library and Information Science, School of Computing and Information, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Social Dynamics and Community Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christina Mair
- Center for Social Dynamics and Community Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessica G Burke
- Center for Social Dynamics and Community Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert W S Coulter
- Center for Social Dynamics and Community Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Enhanced H3K4 Trimethylation in TNF- α Promoter Gene Locus with Cell Apoptosis in the Ventral-Medial Striatum following Opioid Withdrawal of Neonatal Rat Offspring from Morphine-Addicted Mothers. Mediators Inflamm 2021; 2021:9828995. [PMID: 34220336 PMCID: PMC8221879 DOI: 10.1155/2021/9828995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/12/2021] [Accepted: 05/31/2021] [Indexed: 12/03/2022] Open
Abstract
Prenatal opioid exposure might disturb epigenetic programming in the brain of neonatal offspring with various consequences for gene expressions and behaviors. This study determined whether altered trimethylation of histone 3 at lysine 4 (H3K4me3) in the promoter of the tumor necrosis factor-α (tnf-α) gene with neural cell apoptosis was involved in the ventral-medial striatum, an important brain region for withdrawal symptoms, of neonatal rat offspring from morphine-addicted mothers. Female adult rats were injected with morphine before gestation and until 14 days after giving birth. On postnatal day 14 (P14), rat offspring from morphine-addicted mothers were subjected to an opioid-withdrawal protocol and were analyzed 2 or 8 h after administration of that protocol. Expressions of the TNF-α protein, H3K4me3 in the tnf-α promoter gene, and neural cell apoptosis within the ventral-medial striatum of neonatal rat offspring were evaluated. In the absence of significant opioid withdrawal (2 h after initiation of the opioid-withdrawal protocol on P14), prenatal morphine exposure led to increased levels of H3K4me3 in the tnf-α promoter gene, of the TNF-α protein, and of neural cell apoptosis within the ventral-medial striatum of neonatal rat offspring. Following opioid withdrawal (8 h after initiation of the opioid-withdrawal protocol on P14), differential expression of H3K4me3 in the tnf-α promoter gene locus and upregulation of the level of TNF-α protein expression were further enhanced in these offspring. In addition, increased levels of caspase-3 and neural cell apoptosis were also observed. Taken together, this study revealed that prenatal opioid exposure can activate an epigenetic histone mechanism which regulates proinflammatory factor generation, which hence, led to cell apoptotic damage within the ventral-medial striatum of neonatal rat offspring from morphine-addicted mothers. More importantly, the opioid-withdrawal episode may provide augmented effects for the abovementioned alterations and could lead to deleterious effects in the neonatal brain of such offspring.
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Fish JN, Bishop MD, Russell ST. Developmental Differences in Sexual Orientation and Gender Identity-Related Substance Use Disparities: Findings From Population-Based Data. J Adolesc Health 2021; 68:1162-1169. [PMID: 33478920 PMCID: PMC8154626 DOI: 10.1016/j.jadohealth.2020.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Despite well-established substance use disparities between sexual and gender minority adolescents and their heterosexual, cisgender peers, there remain questions about whether there are developmental differences in the onset and progression of these disparities across adolescence. These perspectives are critical for prevention efforts. We therefore estimate age-based patterns of five substance use behaviors across groups of adolescents defined by sexual orientation and gender identity (SOGI). METHODS Data are from the 2013-2015 cycles of the California Healthy Kids Survey (N = 634,454). Substance use was assessed with past 30-day e-cigarette use, combustible cigarette use, alcohol use, heavy episodic drinking, and marijuana use. Two- and three-way interactions were used to assess differences in age-specific prevalence rates of each substance by (1) sex and sexual identity; and (2) gender identity. RESULTS Across all substances, SOGI differences in past 30-day use were present by age 12 years. Most disparities persisted to age 18 years and older. SOGI disparities in combustible and e-cigarette use were wider in late adolescence. Analyses by sexual identity show that sexual minority girls reported the highest rates of substance use across age, followed by sexual minority boys. CONCLUSIONS SOGI differences in substance use emerged in early adolescence and appeared to persist and accelerate by late adolescence. Sexual minority girls had the highest rates of substance use across all ages. The findings underscore the urgent need for screening and prevention strategies to reduce substance use for sexual and gender minority youth.
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Affiliation(s)
- Jessica N Fish
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland; School of Public Health, University of Maryland, University of Maryland Prevention Research Center, College Park, Maryland.
| | - Meg D Bishop
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas
| | - Stephen T Russell
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas
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Coulter RWS, Mitchell S, Prangley K, Smallwood S, Bonanno L, Foster EN, Wilson A, Miller E, Chugani CD. Generating Intervention Concepts for Reducing Adolescent Relationship Abuse Inequities Among Sexual and Gender Minority Youth: Protocol for a Web-Based, Longitudinal, Human-Centered Design Study. JMIR Res Protoc 2021; 10:e26554. [PMID: 33843601 PMCID: PMC8076986 DOI: 10.2196/26554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/31/2021] [Accepted: 02/25/2021] [Indexed: 01/23/2023] Open
Abstract
Background Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) are at greater risk than their cisgender heterosexual peers for adolescent relationship abuse (ARA; physical, sexual, or psychological abuse in a romantic relationship). However, there is a dearth of efficacious interventions for reducing ARA among SGMY. To address this intervention gap, we designed a novel web-based methodology leveraging the field of human-centered design to generate multiple ARA intervention concepts with SGMY. Objective This paper aims to describe study procedures for a pilot study to rigorously test the feasibility, acceptability, and appropriateness of using web-based human-centered design methods with SGMY to create novel, stakeholder-driven ARA intervention concepts. Methods We are conducting a longitudinal, web-based human-centered design study with 45-60 SGMY (aged between 14 and 18 years) recruited via social media from across the United States. Using MURAL (a collaborative, visual web-based workspace) and Zoom (a videoconferencing platform), the SGMY will participate in four group-based sessions (1.5 hours each). In session 1, the SGMY will use rose-thorn-bud to individually document their ideas about healthy and unhealthy relationship characteristics and then use affinity clustering as a group to categorize their self-reported ideas based on similarities and differences. In session 2, the SGMY will use rose-thorn-bud to individually critique a universal evidence-based intervention to reduce ARA and affinity clustering to aggregate their ideas as a group. In session 3, the SGMY will use a creative matrix to generate intervention ideas for reducing ARA among them and force-rank the intervention ideas based on their potential ease of implementation and potential impact using an importance-difficulty matrix. In session 4, the SGMY will generate and refine intervention concepts (from session 3 ideations) to reduce ARA using round robin (for rapid iteration) and concept poster (for fleshing out ideas more fully). We will use content analyses to document the intervention concepts. In a follow-up survey, the SGMY will complete validated measures about the feasibility, acceptability, and appropriateness of the web-based human-centered design methods (a priori benchmarks for success: means >3.75 on each 5-point scale). Results This study was funded in February 2020. Data collection began in August 2020 and will be completed by April 2021. Conclusions Through rigorous testing of the feasibility of our web-based human-centered design methodology, our study may help demonstrate the use of human-centered design methods to engage harder-to-reach stakeholders and actively involve them in the co-creation of relevant interventions. Successful completion of this project also has the potential to catalyze intervention research to address ARA inequities for SGMY. Finally, our approach may be transferable to other populations and health topics, thereby advancing prevention science and health equity. International Registered Report Identifier (IRRID) DERR1-10.2196/26554
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Affiliation(s)
- Robert W S Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Shannon Mitchell
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kelly Prangley
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Seth Smallwood
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Leyna Bonanno
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth N Foster
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Abby Wilson
- LUMA Institute, Pittsburgh, PA, United States
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Carla D Chugani
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
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Finlay-Jones A, Strauss P, Perry Y, Waters Z, Gilbey D, Windred MA, Murdoch A, Pugh C, Ohan JL, Lin A. Group mindful self-compassion training to improve mental health outcomes for LGBTQIA+ young adults: Rationale and protocol for a randomised controlled trial. Contemp Clin Trials 2021; 102:106268. [PMID: 33421648 DOI: 10.1016/j.cct.2021.106268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/10/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Young adults who are lesbian, gay, bisexual, trans, queer or questioning, intersex, asexual and other diverse genders and sexualities (LGBTQIA+) are more likely to experience mental health difficulties and are at significantly elevated risk of substance abuse, self-harm and suicide, relative to their heterosexual, endosex and cisgender peers. There is a need for effective mental health interventions for LGBTQIA+ young adults. Mindful Self-Compassion training is a promising approach; among LGBTQIA+ individuals, self-compassion accounts for more variation in mental health outcomes than bullying, victimization, and adverse childhood experiences combined. Furthermore, LGBTQIA+ individuals with high self-compassion report more positive identity and happiness, less self-stigma, and lower suicidality than those with low self-compassion. METHOD This paper outlines the rationale and protocol for a single-blind CONSORT-compliant randomised controlled trial, comparing group Mindful Self-Compassion to a delayed-treatment waitlist control group, for improving mental health, decreasing self-criticism and increasing self-compassion in LGBTQIA+ young adults (age 18-25 years). Mindful Self-Compassion training is an 8-week group program that focuses on cultivating self-compassion and mindfulness. While typically delivered as a face-to-face program, the proposed trial will investigate efficacy of the program when provided via videoconferencing. DISCUSSION Videoconference Mindful Self-Compassion training has the potential to improve the mental health of Australian LGBTQIA+ young adults and provide a possible cost-effective, scalable intervention for this population. The proposed trial will be the first to determine its efficacy for LGBTQIA+ young adults and will provide the first data on the delivery of the program via videoconferencing.
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Affiliation(s)
- Amy Finlay-Jones
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Penelope Strauss
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Yael Perry
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia.
| | - Zoe Waters
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Dylan Gilbey
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Meg-An Windred
- Minus18, 81 Rupert St, Collingwood, VIC 3066, Australia.
| | - Adrian Murdoch
- Minus18, 81 Rupert St, Collingwood, VIC 3066, Australia.
| | - Charlotte Pugh
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia.
| | - Jeneva L Ohan
- School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Ashleigh Lin
- Telethon Kids Institute, PO Box 855, Perth 6872, Australia; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
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Zhao M, Xiao D, Wang W, Wu R, Dewaele A, Zhang W, Buysse A, Song C, Guo L, Lu C. Association of sexual minority status, gender nonconformity with childhood victimization and adulthood depressive symptoms: A path analysis. CHILD ABUSE & NEGLECT 2021; 111:104822. [PMID: 33291012 DOI: 10.1016/j.chiabu.2020.104822] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/04/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sexual minority status and childhood gender nonconformity have been associated with elevated risks of childhood adversities and poorer mental health. OBJECTIVE To explore how abuse and bullying explain the disparities in the associations of sexual minority status and childhood gender nonconformity with adulthood depressive symptoms in men. PARTICIPANTS AND SETTING We conducted a cross-sectional study using a self-report questionnaire among Chinese adult men (18-35 years) who were identified as heterosexual (n = 873) and sexual minority (n = 858) in Guangzhou from 2017 to 2019. METHODS Structural equation modeling (SEM) were conducted for path analysis. RESULTS The levels of exposure to childhood maltreatment were higher in sexual minorities than in straight men, and sexual minority status predicted an increased risk of depressive symptoms via childhood maltreatment (indirect effect: β = 0.026, p = 0.004). Meanwhile, childhood gender nonconformity predicted higher depressive symptoms via both family (indirect effect: β = 0.042, p < 0.001) and school (indirect effect: β = 0.028, p < 0.001) victimization, and there was a direct effect (β = 0.154, p < 0.001) of gender nonconformity on depressive symptoms. CONCLUSION Sexual minority status and gender nonconformity are indicators of men's increased risk of childhood victimization and adulthood depressive symptoms. As a result, intervention based on both family and school dimensions needs to be developed.
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Affiliation(s)
- Meijun Zhao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Di Xiao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ruipeng Wu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Alexis Dewaele
- Faculty of Psychology and Educational Sciences, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Weihong Zhang
- Faculty of Psychology and Educational Sciences, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Ann Buysse
- Faculty of Psychology and Educational Sciences, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Chao Song
- Faculty of Psychology and Educational Sciences, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
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Gilbey D, Morgan H, Lin A, Perry Y. Effectiveness, Acceptability, and Feasibility of Digital Health Interventions for LGBTIQ+ Young People: Systematic Review. J Med Internet Res 2020; 22:e20158. [PMID: 33270039 PMCID: PMC7746499 DOI: 10.2196/20158] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/30/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Young people (aged 12-25 years) with diverse sexuality, gender, or bodily characteristics, such as those who identify as lesbian, gay, bisexual, transgender, intersex, or queer (LGBTIQ+), are at substantially greater risk of a range of mental, physical, and sexual health difficulties compared with their peers. Digital health interventions have been identified as a potential way to reduce these health disparities. OBJECTIVE This review aims to summarize the characteristics of existing evidence-based digital health interventions for LGBTIQ+ young people and to describe the evidence for their effectiveness, acceptability, and feasibility. METHODS A systematic literature search was conducted using internet databases and gray literature sources, and the results were screened for inclusion. The included studies were synthesized qualitatively. RESULTS The search identified 38 studies of 24 unique interventions seeking to address mental, physical, or sexual health-related concerns in LGBTIQ+ young people. Substantially more evidence-based interventions existed for gay and bisexual men than for any other population group, and there were more interventions related to risk reduction of sexually transmitted infections than to any other health concern. There was some evidence for the effectiveness, feasibility, and acceptability of these interventions overall; however, the quality of evidence is often lacking. CONCLUSIONS There is sufficient evidence to suggest that targeted digital health interventions are an important focus for future research aimed at addressing health difficulties in LGBTIQ+ young people. Additional digital health interventions are needed for a wider range of health difficulties, particularly in terms of mental and physical health concerns, as well as more targeted interventions for same gender-attracted women, trans and gender-diverse people, and people with intersex variations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020128164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=128164.
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Affiliation(s)
- Dylan Gilbey
- Telethon Kids Institute, Perth, Australia.,School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Helen Morgan
- Telethon Kids Institute, Perth, Australia.,Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth, Australia.,Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Yael Perry
- Telethon Kids Institute, Perth, Australia.,Centre for Child Health Research, The University of Western Australia, Perth, Australia
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Associations Between LGBTQ-Affirming School Climate and Intimate Partner Violence Victimization Among Adolescents. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:227-236. [PMID: 33219902 DOI: 10.1007/s11121-020-01192-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
Intimate partner violence (IPV) impacts sexual minority adolescents at rates equal to or greater than the rate it impacts heterosexual adolescents. We investigated whether reports of physical and sexual IPV were less frequent in school jurisdictions with more affirming climates for lesbian, gay, bisexual, transgender, and queer (LGBTQ) students; and whether these associations varied for sexual orientation subgroups. We combined student-level data from the 2015 Youth Risk Behavior Surveys on demographics and experiences with physical and sexual IPV with jurisdiction-level data from the 2014 School Health Profiles on LGBTQ-affirming school climate. Multilevel logistic regression models examined associations between LGBTQ-affirming school climates and IPV. We stratified our data by sex and examined whether these associations differed by sexual orientation subgroups using cross-level interaction terms between school climate and sexual orientation (assessed via sexual identity and behavior). Sexual minority youth were more likely to report experiencing past-year physical and sexual IPV than their heterosexual counterparts. Attending schools with more LGBTQ-affirming climates reduced the likelihood of reporting physical IPV, but not sexual IPV, for female students. More LGBTQ-affirming school climates increased risk for sexual IPV among gay male students. Establishing LGBTQ-affirming school climates may reduce physical IPV for female students, but may have unintended consequences on sexual IPV prevalence for gay male students. More work is necessary to ensure that these climates are affirming for all sexual minority students and to address sexual violence prevention.
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Fish JN. Future Directions in Understanding and Addressing Mental Health among LGBTQ Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:943-956. [PMID: 33074740 PMCID: PMC7736182 DOI: 10.1080/15374416.2020.1815207] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Today's LGBTQ youth come of age at a time of dynamic social and political change with regard to LGBTQ rights and visibility, yet remain vulnerable to compromised mental health. Despite advances in individual-level treatment strategies, school-based programs, and state-level policies that address LGBTQ mental health, there remains a critical gap in large-scale evidence-based prevention and intervention programs designed to support the positive development and mental health of LGBTQ youth. To spur advances in research and translation, I pose six considerations for future scholarship and practice. I begin by framing LGBTQ (mental) health disparities in a life course perspective and discuss how research focused on the timing of events could offer insight into the optimum targets and timing of prevention and intervention strategies. Next, I argue the importance of expanding notions of "mental health" to include perspectives of wellbeing, positive youth development, and resilience. I then consider how research might attend to the complexity of LGBTQ youths' lived experience within and across the various contexts they traverse in their day-to-day lives. Similarly, I discuss the importance of exploring heterogeneity in LGBTQ youth experiences and mental health. I also offer suggestions for how community partnerships may be a key resource for developing and evaluating evidence-informed programs and tools designed to foster the positive development and mental health of LGBTQ youth. Finally, I acknowledge the potentials of team science for advancing research and practice for LGBTQ youth health and wellbeing. Throughout, these future directions center the urgent needs of LGBTQ youth.
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Affiliation(s)
- Jessica N. Fish
- Department of Family Science, School of Public Health, University of Maryland, College Park, 4200 Valley Drive, Suite 1142, College Park, MD, 20742
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43
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Fish JN, Exten C. Sexual Orientation Differences in Alcohol Use Disorder Across the Adult Life Course. Am J Prev Med 2020; 59:428-436. [PMID: 32713615 PMCID: PMC7483372 DOI: 10.1016/j.amepre.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/14/2020] [Accepted: 04/14/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Sexual orientation‒related disparities in alcohol use disorder are well-established. Yet, the degree to which sexual orientation differences in alcohol use disorder vary across the life course is poorly understood. There is also a limited understanding of how exposure to minority stressors and their relationship with alcohol use disorder vary as a function of age. METHODS Using nationally representative data collected in 2012-2013, authors used sex-stratified time-varying effect models to estimate age-specific prevalence rates of alcohol use disorder among heterosexual and sexual minority adults aged 18-60 years (N=28,090). Among sexual minority adults (n=1,050), authors also assessed age-specific associations between exposure to lesbian, gay, and bisexual‒related discrimination and alcohol use disorder. Analyses were conducted in 2019. RESULTS Gay and bisexual male participants aged 18-45 years demonstrated the highest prevalence rates of alcohol use disorder (e.g., >45% at age 25 years), whereas lesbian, gay, and bisexual female participants were most likely to meet the criteria for alcohol use disorder between ages 45 and 55 years. Sexual minority adults who experienced discrimination in the past year had greater odds of alcohol use disorder between ages 23 and 34 years and again from ages 42 to 53 years; the association between discrimination and alcohol use disorder was strongest among sexual minority men. CONCLUSIONS Sexual orientation-related disparities in alcohol use disorder are dynamic across the life course and point to critical times for screening and intervention. Developmental perspectives of sexual minority health inequities demand focused research attention as findings will help to identify strategies for promoting sexual minority health at distinct points in the life course.
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Affiliation(s)
- Jessica N Fish
- Department of Family Science, University of Maryland Prevention Research Center, School of Public Health, University of Maryland, College Park, Maryland.
| | - Cara Exten
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania
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Hequembourg AL, Livingston JA, Wang W. Prospective associations among relationship abuse, sexual harassment and bullying in a community sample of sexual minority and exclusively heterosexual youth. J Adolesc 2020; 83:52-61. [PMID: 32736276 PMCID: PMC7484239 DOI: 10.1016/j.adolescence.2020.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sexual minority youth (SMY) are at significantly greater risk for experiencing adolescent relationship abuse (ARA) than exclusively heterosexual youth, yet little is known about the factors that elevate their risks for such abuse. Peer victimization (i.e., bullying, sexual harassment) has been associated with ARA among heterosexual youth. SMY experience higher rates of peer victimization than heterosexual youth, suggesting that it may be a risk factor for ARA among these youth. Using longitudinal data from a community sample of adolescents recruited from the northeastern US, we examined whether sexual identity was associated prospectively with ARA, and whether that relationship would be indirect, and mediated via bullying and sexual harassment at a 12-month follow-up. We expected to find higher rates of peer victimization and ARA among SMY than heterosexual youth, and we expected that sexual harassment and bullying would predict subsequent relationship abuse. METHODS Adolescents (N = 800; 58% female; 81% European-American; 19% SMY) between 13 and 15 years (M = 14.45, SD = 0.85) completed a web survey at baseline, 6-months and 12-months. RESULTS Consistent with prior studies, SMY reported higher rates of bullying, sexual harassment, and relationship abuse than heterosexual youth. SMY who reported sexual harassment at baseline were more likely to report relationship abuse over time. Contrary to our expectations, however, bully victimization did not predict subsequent relationship abuse. CONCLUSIONS Sexual harassment can be particularly harmful for SMY because it targets gender and sexual identity at a formative developmental period and puts youth at risk for relationship abuse.
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Affiliation(s)
- Amy L Hequembourg
- School of Nursing, State University of New York at Buffalo, 3435 Main Street, Wende Hall, Buffalo, NY, 14214, USA.
| | - Jennifer A Livingston
- School of Nursing, State University of New York at Buffalo, 3435 Main Street, Wende Hall, Buffalo, NY, 14214, USA.
| | - Weijun Wang
- Clinical and Research Institute on Addictions, State University of New York at Buffalo, 1021 Main Street, Buffalo, NY, 14203, USA.
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Baiden P, LaBrenz CA, Asiedua-Baiden G, Muehlenkamp JJ. Examining the intersection of race/ethnicity and sexual orientation on suicidal ideation and suicide attempt among adolescents: Findings from the 2017 Youth Risk Behavior Survey. J Psychiatr Res 2020; 125:13-20. [PMID: 32179279 DOI: 10.1016/j.jpsychires.2020.02.029] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/02/2020] [Accepted: 02/26/2020] [Indexed: 12/28/2022]
Abstract
Although some studies have examined factors associated with suicidal behaviors, few studies have examined the intersection of sexual orientation and race/ethnicity on suicidal behaviors among adolescents. The objective of this study is to examine the intersection of sexual orientation and race/ethnicity on suicidal ideation and suicide attempt. We hypothesized that controlling for the effects of known risk factors for suicidal behaviors, there will be an interaction effect between sexual orientation and race/ethnicity on suicidal behaviors. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 13,697 adolescents aged 14-18 years (51.8% female) was analyzed using binary logistic regression. Of the 13,697 adolescents, 17.7% reported suicidal ideation and 7.7% made at least one suicide attempt during the past 12 months. In the multivariate logistic regression models, non-White sexual minority adolescents are less likely to report suicidal ideation. However, Hispanic lesbian/gay adolescents had 1.71 times higher odds of making a suicide attempt. Odds of suicide attempt are 1.2 times higher for Black or African American bisexual adolescents and American Indian/Native Hawaiian/Pacific Islander bisexual adolescents had 2.44 times higher odds of making a suicide attempt. Other significant predictors of suicidal behaviors include a history of sexual assault, a victim of bullying, depression, cigarette smoking, misuse of prescription pain medication, and illicit drug use. The findings of the present study extend past research on the intersection of sexual orientation and race/ethnicity on mental health problems among adolescents including suicidal behaviors.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019, USA.
| | - Catherine A LaBrenz
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019, USA
| | | | - Jennifer J Muehlenkamp
- University of Wisconsin-Eau Claire, Department of Psychology, 105 Garfield Avenue, Eau Claire, WI, 54702, USA
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46
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Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of a new National Academy of Medicine report on planned place of birth and implications during the SARS-CoV-2 pandemic and commentaries on reviews focused on anorectal sexually transmitted infections and feeding methods following cleft lip repair in infants.
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Fish JN. Sexual minority youth are at a disadvantage: what now? THE LANCET. CHILD & ADOLESCENT HEALTH 2020; 4:3-4. [PMID: 31753805 PMCID: PMC8072516 DOI: 10.1016/s2352-4642(19)30383-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jessica N Fish
- Department of Family Science, School of Public Health, University of Maryland at College Park, College Park, MD 20742, USA.
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48
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Coulter RWS, Jun HJ, Truong N, Mair C, Markovic N, Friedman MR, Silvestre AJ, Stall R, Corliss HL. Effects of familial and non-familial warmth during childhood and adolescence on sexual-orientation disparities in alcohol use trajectories and disorder during emerging adulthood. Drug Alcohol Depend 2019; 205:107643. [PMID: 31689643 PMCID: PMC6952075 DOI: 10.1016/j.drugalcdep.2019.107643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND We investigated sexual-orientation differences in typologies of self-reported familial and non-familial warmth in childhood (before age 11) and adolescence (ages 11-17); and tested whether warmth explained sexual minority emerging adults' (ages 18-25) heightened odds of having heavier alcohol use trajectories (AUTs) and heightened risk for past-year alcohol use disorder (AUD) compared to completely heterosexuals. METHODS Using self-reported data from the U.S.-based Growing Up Today Study cohort, latent class analyses identified typologies of familial and non-familial warmth during childhood and adolescence. Multivariable regression models tested our objectives. RESULTS Six warmth classes emerged, including: High-High (i.e., high familial and high non-familial warmth, respectively); High-Moderate; Moderate-Moderate; Moderate-Occasional; Occasional-Occasional; and Low-Low. Among women, sexual minorities had higher odds than completely heterosexuals of being in the Moderate-Moderate, Moderate-Occasional, and Occasional-Occasional versus the High-High warmth class. There were not significant associations between sexual orientation and warmth classes for men. Lower warmth classes were generally associated with greater past-year AUD, and mediated heightened disparities in AUD for sexual minority women versus completely heterosexual women (4.3% mediated), but not among men. Warmth classes were generally unassociated with AUTs, and did not mediate sexual-orientation differences in AUTs. CONCLUSIONS Lower warmth was associated with greater alcohol-related problems, but not alcohol use itself. Warmth explained a small proportion of AUD disparities for sexual minority women-but not for men.
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Affiliation(s)
- Robert W S Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA; Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261 USA; Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, 3414 Fifth Ave, Pittsburgh, PA, 15213 USA; Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261 USA.
| | - Hee-Jin Jun
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 100, San Diego, CA, 92123 USA
| | - Nhan Truong
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 100, San Diego, CA, 92123 USA
| | - Christina Mair
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Nina Markovic
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261 USA; Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA, 15261 USA
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261 USA; Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 3520 Fifth Avenue, Pittsburgh, PA, 15261 USA
| | - Anthony J Silvestre
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261 USA; Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 3520 Fifth Avenue, Pittsburgh, PA, 15261 USA
| | - Ron Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA; Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261 USA
| | - Heather L Corliss
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 100, San Diego, CA, 92123 USA; Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02115, USA
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Dowshen N, Ford CA. Urgent Need for Research to Achieve Health Equity for Sexual and Gender Minority Youth. Pediatrics 2019; 144:e20192133. [PMID: 31427461 PMCID: PMC6855821 DOI: 10.1542/peds.2019-2133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nadia Dowshen
- Craig-Dalsimer Division of Adolescent Medicine and
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carol A Ford
- Craig-Dalsimer Division of Adolescent Medicine and
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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