Physical and Mental Disabilities among the Gender-Diverse Population Using the Behavioral Risk Factor Surveillance System, BRFSS (2017-2019): A Propensity-Matched Analysis

Recognizing and Addressing Health Care Barriers for Transgender and Nonbinary People Living With a Chronic Illness or Disability

This paper explores the health care experiences of individuals who are transgender and/or nonbinary (TGNB) and live with a chronic illness and/or disability (CI/D). Using an interpretivist epistemological worldview and an intersectional lens, the research team explored the compounded barriers faced by this patient population and propose solutions for improving their care. The study conducted in-depth interviews with TGNB individuals who self-identified as having a CI/D to understand their health and health care experiences. The interdisciplinary research team, which includes individuals with diverse backgrounds and experiences related to gender identity and CI/D, analyzed the data thematically using an iterative interpretive approach. Participants described barriers such as diagnostic overshadowing and provider skepticism that were exacerbated by their dual TGNB-CI/D identities. Participants interacted with health care systems frequently due to ongoing medical needs, which increased the likelihood of negative encounters like misdiagnosis, inappropriate questioning related to their gender identity, and skepticism of their CI/D. Gaslighting experiences further eroded trust in health care providers and contributed to health care inequities. The lack of LGBTQ+ competent care, coupled with discriminatory attitudes, led some participants to forgo seeking essential health care services altogether. Participants identified several strategies to mitigate barriers, including advocating for LGBTQ+ competent care through provider education and training; structural changes to address financial barriers and insurance issues; leveraging telehealth services; and increasing community support networks. By enacting the suggested actionable solutions, which were grounded in participants' voices and experiences, the health care system can reduce disparities and provide better, more affirming health care to this group.

Gender identity and activity limitations: A national study on transgender and non-binary Canadians

INTRODUCTION

Activity limitations among transgender and non-binary individuals remain largely unexplored using population-based samples. This study examines the risk of activity limitations across different gender identities in Canada.

METHOD

Using data from the 2021 Canadian long-form Census, logistic regressions estimated the adjusted odds of reporting activity limitations (seeing, hearing, mobility/dexterity, mental, cognitive, and other) across gender identities.

RESULTS

Non-binary individuals assigned female at birth (AFAB) had the highest predicted probability of reporting any activity limitations (76.13 %), followed by non-binary individuals assigned male at birth (AMAB) at 61.56 %, transgender men (44.71 %), and transgender women (34.41 %). Cisgender men (19.31 %) and cisgender women (21.98 %) had the lowest probabilities. Mental limitations showed the largest disparity, with 39.4 % of non-binary AFAB individuals affected, compared to 4.9 % of cisgender men. These findings highlight significant disparities in activity limitations across gender identities.

CONCLUSION

Non-binary and transgender individuals are most at risk for activity limitations. These findings underscore the need for targeted policies to address challenges faced by gender-diverse populations. Future research should investigate the mechanisms behind these disparities. Healthcare policies must prioritize culturally competent, transgender-inclusive care to reduce disparities in activity limitations.

Exploring the Intersection of Gender Diversity and Intellectual Disability: A Scoping Review With a Focus on Clinical Care

BACKGROUND

Little research has been conducted solely exploring gender diversity in people with intellectual disabilities. This review explores the literature, discusses the prevalence, and identifies clinical best practices for people at the intersection of gender diversity and intellectual disability.

METHOD

A scoping review was conducted utilising PRISMA methodology of the following databases: PubMed, CINAHL Complete (EBSCO), Cochrane Library (Wiley), Dissertations & Theses Global (ProQuest), PsycInfo (EBSCO), Scopus and Web of Science.

RESULTS

Five hundred seventy five titles and abstracts were screened, 61 full-text articles were reviewed and 17 met inclusion criteria. Four major themes were identified: prevalence, trauma and co-occurring mental health disorders, barriers to care and best practices.

CONCLUSION

This review highlights the lack of research and provides valuable insight into the experiences of people with gender diversity and intellectual disability. Further research is needed to understand the prevalence and explore the intersection and experience of gender-diverse people with intellectual disabilities.

Social-Ecological Determinants of Suicidal Ideation Among Sexual and Gender Minority Adults: A Cross-Sectional Study in the United States

Background/Objectives: Sexual and gender minority (SGM) adults are at an increased risk for suicide and suicidal ideation compared with cisgender/heterosexual adults. Due to the complexity of suicidal ideation, individual, social, and systemic factors must be considered. The purpose of this study was to identify determinants of suicidal ideation among SGM adults using constructs from the Social-Ecological Model (SEM). Methods: This was a cross-sectional study of data collected from 1034 SGM adults between 27 January and 7 February 2022, and variables reflected the four constructs of the SEM, including individual, family, community, and societal levels. Hierarchical multiple linear regression was used to enter the variables in blocks. Results: The final model explained 55% of the variance in suicidal ideation, and determinants of suicidal ideation were identified at all four levels. At the individual level, factors were depression (p < 0.001, β = 0.231), anxiety (p < 0.001, β = 0.279), vigilance distress (p = 0.036, β = 0.157), not being out/open (p = 0.046, β = 1.136), having some college education (p = 0.002, β = -1.875), and personal strength (p = 0.012, β = -0.131). Family of origin discrimination distress was significant at the family level (p = 0.016, β = 0.174). Social resources (p < 0.001, β = -0.113), victimization distress (p < 0.001, β = 0.795), and harassment/discrimination distress (p = 0.035, β = 0.179) were significant at the community level. At the social level, SGM protective state law score (p = 0.43, β = -0.35) and having a proposed or enacted transgender sports ban (p = 0.027, β = 1.480) were significant. Conclusions: Understanding the factors across the various levels of the SEM that influence suicidal ideation allows for the development of multi-level, social-ecological suicide prevention programs. Such programs can address the unique needs of SGM individuals and help mitigate suicidal ideation.

Moderated Mediation Analysis of Structural Stigma and Suicidal Ideation and Behaviors Among Sexual and Gender Minority Adults

Purpose: This study aimed to conduct a moderated mediation analysis to understand further the complex pathways through which structural stigma in the form of transgender sports bans was associated with suicidal ideation and behaviors among sexual and gender minority (SGM) adults. Methods: A cross-sectional survey of 1033 adults who identified as SGM from across the 50 U.S. states and Washington, DC was conducted between January 28 and February 7, 2022. Distal discrimination distress was the mediation variable; individual resilience and social resources were the moderation variables. Familiarity with transgender sports bans represented structural stigma. The conditional process analysis was applied to build a moderated mediation model. Both conditional direct and indirect effects were computed by estimated coefficients. All models were based on linear regression. Results: Our final model explained nearly half (46%) of the variation in suicidal ideation and behaviors between those SGM adults familiar and those not familiar with transgender sports bans. Social resources significantly moderated the conditional indirect effect of distal discrimination distress (adjusted estimate = -0.23; 95% confidence interval = -0.37 to -0.08). Conclusion: Both discrimination distress and social resources influenced the association between structural stigma as measured by familiarity with transgender sports bans and suicidal ideation and behaviors among SGM adults. Findings support the need for future research examining the pathway between structural stigma and suicidal ideation and behaviors among SGM adults and how minority stress, social safety, and other constructs shape this pathway.

Identifying facilitators and barriers to culturally responsive communication for racial, ethnic, sexual, and gender minoritized patients when screened for COVID-19 vaccinations: A scoping review protocol

INTRODUCTION

Racial, ethnic, sexual, and gender minoritized groups are considered historically excluded groups and have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. The influence of social determinants of health (SDOH), including access to screening and treatment, and other systemic and structural factors are largely responsible for these disparities. Primary care practitioner (PCP) competence in culturally responsive screening practices will be critical to reducing the impact of systemic and structural factors serving as barriers to screening and treatment. Correspondingly, improving the capacity of PCPs to communicate with patients in a culturally responsive manner may influence improved screening and treatment outcomes for minoritized groups related to COVID-19. This scoping literature review aims to determine the current breadth of literature on culturally responsive communication (CRC) in regard to COVID-19 vaccination screening for historically excluded, or minoritized groups. Results from this review will inform the development of a training series and social marketing campaign to improve PCPs capacity in CRC. This manuscript provides details on our study protocol.

OBJECTIVES

This scoping literature review aims to analyze existing literature on culturally responsive COVID-19 vaccinations between PCPs and patients in the U.S., specifically for racial, ethnic, sexual, and gender minoritized groups. Results of this scoping review will inform the development of a training series and social marketing campaign to improve capacity of PCPs in this area. Additionally, the review will inform recommendations for future research.

MATERIALS AND METHODS

This scoping review will be performed following the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Relevant studies between the years 2019-2022 were identified using a rigorous search strategy across four databases: MEDLINE (via PubMed), Scopus, Cochrane (CENTRAL; via Wiley), and CINAHL (via EBSCO), using Boolean and Medical Subject Headings (MeSH) search terms. Studies will be uploaded to the data extraction tool, Covidence, to remove duplicates and perform a title/abstract screening, followed by a full-text screening.

RESULTS

The data extraction and analysis phases of the scoping review are in progress. Data will be analyzed for themes related to culturally responsive COVID-19 screening practices in clinical encounters with the identified study populations. Results will be reported by theme and align to PRISMA-ScR guidelines.

DISCUSSION

To our knowledge, this is the first study to use scoping methods to investigate the barriers and facilitators to CRC of COVID-19 vaccine screening for historically excluded communities in the U.S. The work and results from this research will be directly utilized for the development of nationally-accessible, continuing medical education materials to teach PCPs about CRC, as well as other materials to influence relevant policy changes within the healthcare landscape.

Impact of COVID-19 on Sexual and Gender Minority Communities: Focus Group Discussions

BACKGROUND

People who identify as sexual and gender minorities (SGM) experienced disproportionate economic and mental health issues related to COVID-19 when compared to the general population. The purpose of this study was to better understand how COVID-19 has impacted the SGM community and ways to address vaccine hesitancy.

METHODS

Three focus groups were conducted with 21 members of the SGM community between 5 November and 10 December 2020. A thematic analysis using the reflexive approach was applied to the transcripts of the focus groups.

RESULTS

Four themes emerged: (1) Impact of COVID-19 on the Community, (2) Perceptions of Contact Tracing and Testing, (3) Perceptions of a Potential COVID-19 Vaccine, and (4) Decreasing Vaccine Hesitancy. The most relevant subthemes were that social isolation led to anxiety, stress, and fear in the SGM community during COVID-19; resilience and adaptation were positive outcomes of the pandemic; histories of medical racism contributed to hesitancy to get tested; and specific messaging from trusted messengers may be needed to encourage SGM communities to get vaccinated. These findings support other COVID-19 research on the SGM community during the start of the pandemic.

CONCLUSIONS

This study provides insight into the impact of the early stages of COVID-19 on the SGM community, highlighting the unique hurdles faced by SGM individuals with regard to contact tracing and vaccine hesitancy.

COVID-19 impact on the psychological health of Latinx transgender and non-binary individuals in mainland United States and Puerto Rico: a mixed-methods study

BACKGROUND

The COVID-19 pandemic continues to generate an unprecedented impact on all aspects of everyday life across the world. However, those with historically and currently marginalized identities (i.e., gender or ethnicity) who already experience a wide range of structural inequities have been disproportionally impacted. LTNB are a particularly at-risk population as they lie at the intersection of race/ethnicity, gender identity, language, migration status, geographical location, among others, which could further increase their COVID-19 and other health-related risks and disparities. The objective of this study was to examine the impact of key social determinants of health (i.e., gender identity, country, health insurance, employment) among a sample of LTNB individuals.

METHODS

The team implemented a cross-sectional exploratory design with an online survey technique using the secure web platforms REDcap and SurveyMonkey. A total of 133 participants completed the online survey. Most of the sample self-identified as transwomen (38.8%), transmen (26.3%), and non-binary (21.8%) between the ages of 21 to 72. All participants were Latinx living in either Puerto Rico (47.7%) or mainland United States (52.3%). Descriptive statistics, reliability tests, Mann-Whitney and rapid thematic analysis test were conducted.

RESULTS

Findings show that most participants were always (38.1%) or almost always (33.3%) worried about contracting COVID-19. Individuals living in Puerto Rico reported more difficulties than those residing in the mainland US regarding COVID-19 impact on psychosocial, emotional, and COVID-related thinking. Most participants' answers for the COVID-19 open-ended questions focused on three main domains: income, access to trans-affirmative health care, and coping strategies.

DISCUSSION

Findings evidence that although most of LTNB participants were negatively impacted by the COVID-19 pandemic in multiple aspects of their lives, those living in Puerto Rico experienced these differently when compared to those in mainland US. More research is needed to understand better the mechanisms and pathways through which this context specifically impacts LTNB health and wellbeing, particularly in Puerto Rico. This study could help shape the public health response taking into account the geographical location and other intersectional identities that play critical roles in the production and reproduction of inequities.