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Kahn NF, Kidd KM, Hodax JK, Goldenberg ME, Asante PG, Kyweluk MA, Christakis DA, Pratt W, Richardson LP, Sequeira GM. Telemedicine-Based Provision of Adolescent Gender-Affirming Medical Care to Promote Equitable Access. Telemed J E Health 2024. [PMID: 38597959 DOI: 10.1089/tmj.2023.0575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Purpose: To explore transgender and nonbinary (TNB) young adults' (1) interest in receiving gender-affirming medications through telemedicine before age 18 years and (2) willingness to initiate this care with primary care providers (PCPs). Methods: Data were from a survey of TNB young adults who had not received gender-affirming medications before age 18 years. Chi-square and Wald tests identified demographic differences in telemedicine interest and willingness to initiate medications with their PCP as minors. Results: Among 280 respondents, 82.5% indicated interest in telemedicine and 42.0% were willing to initiate medications with their PCP. Black/African American respondents were more likely to indicate interest in telemedicine than White and multiracial respondents. Respondents from rural areas were more likely to indicate willingness to initiate medications with their PCP than those from urban areas. Conclusions: Telemedicine expansion and further support for PCPs may represent critical opportunities to promote equitable access to adolescent gender-affirming care.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Kacie M Kidd
- West Virginia University School of Medicine, Department of Pediatrics, Morgantown, West Virginia, USA
| | - Juanita K Hodax
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | | | - Peter G Asante
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | | | - Dimitri A Christakis
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Wanda Pratt
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Laura P Richardson
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Gina M Sequeira
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
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Sequeira GM, Kidd KM, Slekar A, Kahn NF, Costello LM, Negrin I, Huzurbazar S, Narumanchi J. Comfort Providing Gender-Affirming Care and Preferences for Consultative Support Among Rural Pediatric Primary Care Providers. Telemed J E Health 2024. [PMID: 38512469 DOI: 10.1089/tmj.2023.0537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Objective: To examine how specialist-to-pediatric primary care provider (PPCP) consultative support may impact PPCP comfort in providing gender-affirming care. Methods: PPCPs in West Virginia completed an electronic survey. T-tests compared comfort providing gender-affirming care and rank-sum tests compared the practicality of four consultative support modalities by time in practice and specialty. Results: Of 51 participants, 47.1% had been in practice for <10 years and 59.6% were trained in pediatrics. PPCPs with <10 years in practice and those trained in pediatrics were more comfortable providing gender-affirming care than those in practice >10 years and those trained in family medicine. PPCPs felt that telemedicine was more practical than tele-education, although they reported all consultative support modalities would increase comfort providing this care. Conclusions: Access to consultative support can increase PPCP comfort providing gender-affirming care, although certain modalities may be more effective for PPCPs with varying levels of experience and specialty training.
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Affiliation(s)
- Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Alana Slekar
- West Virginia University, Morgantown, West Virginia, USA
| | - Nicole F Kahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa M Costello
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Isabela Negrin
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Snehalata Huzurbazar
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Janani Narumanchi
- Department of Pediatrics, University of Tennessee School of Medicine, Memphis, Tennessee, USA
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Kidd KM, Slekar A, Sequeira GM, Kahn NF, Costello LM, Negrin I, Farjo S, Lusk S, Huzurbazar S, Narumanchi J. Pediatric Gender Care in Primary Care Settings in West Virginia: Provider Knowledge, Attitudes, and Educational Experiences. J Adolesc Health 2024:S1054-139X(23)01010-8. [PMID: 38323962 DOI: 10.1016/j.jadohealth.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE Pediatric primary care providers (PPCPs) often care for gender diverse youth (GDY), particularly in rural areas, but little is known about their relevant knowledge, attitudes, or educational experiences regarding caring for this population. METHODS This study surveyed PPCPs throughout the rural state of West Virginia using an online survey assessing 1) demographics, 2) knowledge, 3) attitudes, and 4) educational experiences. Knowledge and attitude scores were calculated and proportion-tests and t-tests were used to compare these scores by PPCP characteristics including age, time in practice, and training background. RESULTS In total, 51 PPCPs from throughout the state completed the survey and 82% had cared for GDY in the prior year. Younger providers ( DISCUSSION PPCPs in a rural state reported caring for GDY, but knowledge and attitudes related to this care varied by age, time in practice, and relevant educational experiences. More research is needed to determine best strategies for providing education to PPCPs, particularly those who are older and have been in practice longer, and to better understand the impacts of legislation limiting evidence-based gender-affirming care on PPCP knowledge, attitudes, and access to educational experiences.
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Affiliation(s)
- Kacie M Kidd
- Division of Adolescent Medicine, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia.
| | - Alana Slekar
- West Virginia University, Morgantown, West Virginia
| | - Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
| | - Nicole F Kahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
| | - Lisa M Costello
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Isabela Negrin
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Sara Farjo
- WVU Urgent Care, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Savannah Lusk
- Department of Family Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Snehalata Huzurbazar
- Department of Mathematics and Data Science, West Virginia University, Morgantown, West Virginia
| | - Janani Narumanchi
- Department of Pediatrics, University of Tennessee School of Medicine, Memphis, Tennessee
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Burnett O, Sequeira GM, Rodanthe RS, Kidd KM. Nine Ways Parents Can Support Their Gender Diverse Children. Transgend Health 2024; 9:98-103. [PMID: 38312457 PMCID: PMC10835157 DOI: 10.1089/trgh.2022.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Parental support is associated with improved mental health outcomes for gender diverse youth (GDY). Parents often seek guidance from pediatric providers, but few studies explore what actions make GDY feel supported. Using a qualitative analysis of open-ended survey responses, we aimed to identify ways in which GDY want to be supported by their parents or caregivers. Nine key themes were identified, including using affirming language at home and other settings as desired by GDY, seeking education, and aiding in accessing affirming items and care. Findings from this study can help pediatric medical and mental health providers help parents to support their GDY.
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Affiliation(s)
- Oliver Burnett
- Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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5
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Sequeira GM, Asante PG, Bocek K, Kahn NF, Sethness JL, Hodax JK, Kidd KM, Pratt W, Christakis DA, Richardson LP. Evaluating an Electronic Consultation Platform to Support Pediatric Primary Care Providers in Caring for Transgender and Nonbinary Adolescents. Telemed J E Health 2024; 30:595-600. [PMID: 37624647 PMCID: PMC10877380 DOI: 10.1089/tmj.2023.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/27/2023] Open
Abstract
Background: An electronic consultation (e-consult) platform was implemented to support pediatric primary care providers (PCPs) in providing gender-affirming care to transgender and nonbinary (TNB) adolescents. Following implementation, a study was conducted to (1) explore how access to this e-consult platform impacts PCP confidence and referral patterns, (2) describe the content of questions, and (3) evaluate PCP's perspectives regarding platform usability. Methods: Following each submission, providers completed a 17-item survey. A total of 20 providers submitted 38 e-consults and 26 follow-up surveys between October 2021 and December 2022. Results: All PCPs reported a high overall value and increased confidence caring for TNB adolescents. Nearly one in five (19%) felt it allowed them to avoid submitting a specialty referral. Mean System Usability Scale score was 78.2 indicating good usability. Conclusion: This e-consult platform shows great promise in increasing PCP confidence providing gender-affirming care adolescents. More widespread utilization could help improve access to care and decrease specialty care referrals.
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Affiliation(s)
- Gina M. Sequeira
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter G. Asante
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kevin Bocek
- Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Janis L. Sethness
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Juanita K. Hodax
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kacie M. Kidd
- West Virginia University, Morgantown, West Virginia, USA
| | - Wanda Pratt
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dimitri A. Christakis
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Laura P. Richardson
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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6
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Kahn NF, Asante PG, Coker TR, Kidd KM, Christakis DA, Richardson LP, Sequeira GM. Demographic Differences in Gender Dysphoria Diagnosis and Access to Gender-Affirming Care Among Adolescents. LGBT Health 2024. [PMID: 38190267 DOI: 10.1089/lgbt.2023.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Purpose: The goal of this article was to identify demographic differences in receipt of gender dysphoria (GD) diagnosis and access to gender-affirming care (GAC) among adolescents whose gender identity and/or pronouns differed from their sex assigned at birth. Methods: Data were from 2444 patients who were 13-17 years old and had a documented gender identity and/or pronouns that differed from their sex assigned at birth in the electronic health record. Adjusted logistic regression models explored associations between demographic characteristics (sex assigned at birth, gender identity, race and ethnicity, language, insurance type, rural status) and presence of GD diagnosis and having accessed GAC. Results: The average predicted probability (Pr) of having received a GD diagnosis was 0.62 (95% confidence interval [CI] = 0.60-0.63) and of having accessed GAC was 0.48 (95% CI = 0.46-0.50). Various significant demographic differences emerged. Notably, Black/African American youth were the least likely to have received a GD diagnosis (Pr = 0.43, 95% CI = 0.33-0.54) and accessed GAC (Pr = 0.32, 95% CI = 0.22-0.43). Although there were no significant differences in GD diagnosis by insurance type, youth using Medicaid, other government insurance, or self-pay/charity care were less likely to have accessed GAC compared with youth using commercial/private insurance. Conclusion: Results indicate significant differences in both receipt of GD diagnosis and accessing GAC by various demographic characteristics, particularly among Black/African American youth. Identification of these differences provides an opportunity to further understand potential barriers and promote more equitable access to GAC among adolescents who desire this care.
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Affiliation(s)
- Nicole F Kahn
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Peter G Asante
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Tumaini R Coker
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Dimitri A Christakis
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Laura P Richardson
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Gina M Sequeira
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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7
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Hodax JK, Crouch JM, Sethness JL, Loren D, Kahn NF, Asante PG, Sequeira GM. Strategies for Providing Gender-Affirming Care for Adolescents in the Primary Care Setting. Pediatr Ann 2023; 52:e442-e449. [PMID: 38049184 DOI: 10.3928/19382359-20231016-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Transgender and gender diverse (TGD) youth have high rates of health disparities and face significant barriers to accessing medical care. Primary care providers (PCPs) are often the first health care providers that TGD youth seek out to discuss gender identity and find support. Thus, it is crucial for PCPs to have an understanding of gender diversity and knowledge to support TGD youth with gender-affirming care. The purpose of this article is to offer strategies PCPs can implement to increase their comfort and capacity in providing care for TGD people. Key steps to support TGD youth in the primary care setting include creating affirming clinical environments, discussing gender identity at routine visits, supporting parents and families, supporting social transition, and providing menstrual suppression for those who desire it. Multidisciplinary gender clinics can partner with PCPs to support adolescents in accessing gender-affirming medical care and to provide additional education and support. [Pediatr Ann. 2023;52(12):e442-e449.].
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8
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Kahn NF, Sequeira GM, Reyes V, Garrison MM, Orlich F, Christakis DA, Aye T, Conard LAE, Dowshen N, Kazak AE, Nahata L, Nokoff NJ, Voss RV, Richardson LP. Mental Health of Youth With Autism Spectrum Disorder and Gender Dysphoria. Pediatrics 2023; 152:e2023063289. [PMID: 37909059 DOI: 10.1542/peds.2023-063289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Youth with either autism spectrum disorder (ASD) or gender dysphoria (GD) alone have also been shown to be at greater risk for mental health (MH) concerns; however, very little research has considered how cooccurring ASD and GD may exacerbate MH concerns. The purpose of this study was to examine associations between ASD, GD, and MH diagnoses (anxiety, depression, eating disorder, suicidality, and self-harm) among US adolescent populations. METHODS This is a secondary analysis of a large administrative dataset formed by 8 pediatric health system members of the PEDSnet learning health system network. Analyses included descriptive statistics and adjusted mixed logistic regression models testing for associations between combinations of ASD and GD diagnoses and MH diagnoses as recorded in the patient's electronic medical record. RESULTS Based on data from 919 898 patients aged 9 to 18 years, adjusted mixed logistic regression indicated significantly greater odds of each MH diagnosis among those with ASD alone, GD alone, and cooccurring ASD/GD diagnoses compared with those with neither diagnosis. Youth with cooccurring ASD/GD were at significantly greater risk of also having anxiety (average predicted probability, 0.75; 95% confidence interval, 0.68-0.81) or depression diagnoses (average predicted probability, 0.33; 95% confidence interval, 0.24-0.43) compared with youth with ASD alone, GD alone, or neither diagnosis. CONCLUSIONS Youth with cooccurring ASD/GD are more likely to also be diagnosed with MH concerns, particularly anxiety and depression. This study highlights the need to implement developmentally appropriate, gender-affirming MH services and interventions for youth with cooccurring ASD/GD.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Gina M Sequeira
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | | | - Michelle M Garrison
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Felice Orlich
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Tandy Aye
- Stanford School of Medicine, Stanford, California
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
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Kidd KM, Sequeira GM, Katz-Wise SL, Fechter-Leggett M, Gandy M, Herring N, Miller E, Dowshen NL. "Difficult to Find, Stressful to Navigate": Parents' Experiences Accessing Affirming Care for Gender-Diverse Youth. LGBT Health 2023; 10:496-504. [PMID: 37184531 PMCID: PMC10552142 DOI: 10.1089/lgbt.2021.0468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Purpose: Gender-diverse youth (GDY) face significant health disparities, which can be mitigated by gender-affirming medical care. Understanding parents' experiences seeking care for their GDY can identify barriers to care and improve access. This study sought to understand parents' experiences accessing gender-affirming medical care with their GDY. Methods: We asked parents of GDY in the United States to describe their experiences with gender-affirming medical care through a single open-ended item on an online survey disseminated through social media in February of 2020. Open-ended survey responses were analyzed through inductive thematic analysis by two authors using an iteratively developed codebook adjudicated by consensus. This codebook was used to identify key themes. Results: We analyzed 277 responses from majority White (93.9%) parents from 41 U.S. states. Themes included (1) Experiences accessing care: finding a provider, financial and insurance-related considerations, the impact of geography on care access; (2) Experiences receiving care: factors in successful or unsuccessful patient-provider interactions, differing approaches to initiating care, sense of community with other families; and (3) Outcomes related to receiving care: how care for their child was perceived to be lifesaving or helped their child thrive. Conclusions: Parents highlighted how access to gender-affirming medical care improved their GDY's health and wellbeing, and described numerous barriers they experienced with finding and receiving this care. Given the evidence that gender-affirming medical care mitigates health disparities, providers, policymakers, insurance companies, and health systems leaders should urgently address these challenges to ensure equitable receipt of care for all GDY.
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Affiliation(s)
- Kacie M. Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Gina M. Sequeira
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Sabra L. Katz-Wise
- Boston Children's Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Molly Fechter-Leggett
- West Virginia University Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Megan Gandy
- School of Social Work, West Virginia University, Morgantown, West Virginia, USA
| | - Nadeen Herring
- blaq noyz, LLC, Rowan University, Glassboro, New Jersey, USA
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nadia L. Dowshen
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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10
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Hughes LD, Gamarel KE, Restar AJ, Sequeira GM, Dowshen N, Regan K, Kidd KM. Adolescent Providers' Experiences of Harassment Related to Delivering Gender-Affirming Care. J Adolesc Health 2023; 73:672-678. [PMID: 37589604 PMCID: PMC10568537 DOI: 10.1016/j.jadohealth.2023.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE The politicization of adolescent gender-affirming care has occurred alongside targeted harassment (e.g., threats of violence, doxing, bomb threats) of adolescent gender-affirming care providers across the United States. This study sought to explore their experiences of targeted harassment. METHODS From October to December 2022, mental and physical health gender-affirming care providers from across the United States completed a survey including open-ended questions about the kinds of harassment they experienced (i.e., method and messages of harassment) and its impact on their lives and practices. Thematic analyses were used to analyze their responses. RESULTS In total, 117 providers completed the survey and 70% shared that either they, their practice, or their institution had received threats specific to delivering gender-affirming care. The most common experiences were threats via social media or mailed letters. Several received death threats. Providers described how targeted harassment impacted their psychological well-being and required them to reassess clinic safety. Additionally, providers expressed the need for a more accurate representation of gender-affirming care in media and stronger advocacy from institutions and organizations emphasizing the importance of this care. DISCUSSION Adolescent gender-affirming care providers are experiencing targeted harassment, significantly affecting their ability to deliver care to transgender and gender-diverse adolescents and their families. Providers stressed the importance of receiving support from their institutions to ensure their safety. The ongoing sociopolitical climate related to gender-affirming care coupled with targeted harassment of those providing it will further limit access to this care.
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Affiliation(s)
- Landon D Hughes
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Arjee J Restar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington; Department of Behavioral and Social Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Gina M Sequeira
- Department of Pediatrics, University of Washington, Seattle, Washington; Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nadia Dowshen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Gender & Sexual Development Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katelyn Regan
- Gender & Sexual Development Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
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11
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Tordoff DM, Sequeira GM, Shook AG, Williams F, Hayden L, Kasenic A, Inwards-Breland D, Ahrens K. Factors Associated with Time to Receiving Gender-Affirming Hormones and Puberty Blockers at a Pediatric Clinic Serving Transgender and Nonbinary Youth. Transgend Health 2023; 8:420-428. [PMID: 37810940 PMCID: PMC10551760 DOI: 10.1089/trgh.2021.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose To describe barriers to care for a cohort of transgender and nonbinary (TNB) youth and examine factors associated with delays in receiving puberty blockers (PBs) or gender-affirming hormones (GAHs). Methods We used longitudinal data from a prospective cohort of TNB youth seeking care at a multidisciplinary pediatric gender clinic between August 2017 and June 2018. We calculated the time between (i) initial clinic contact, (ii) phone intake, (iii) first medical appointment, and (iv) initiating PBs/GAHs. We estimated Kaplan-Meier curves for each time-to-care interval and used Cox regression models to estimate hazard ratios (HRs) for factors hypothesized to be barriers and facilitators of care. Results Our cohort included 104 youth aged 13-20 years. The median time from contacting the clinic to initiating PBs/GAHs was 307 days (range, 54-807). Lower income level, Medicaid insurance, and lack of family support were associated with longer times from contacting the clinic to completing the first medical appointment. In addition, older youth experienced longer times to first medical appointment relative to youth aged 13-14 years. Youth younger than 18 years of age who did not complete a mental health assessment before their first medical appointment experienced delays from first medical appointment to initiating PBs/GAHs (HR=0.44, 95% confidence interval, 0.22-0.88). Conclusion Certain subsets of youth disproportionately experienced delays in receiving gender-affirming medications, and these factors varied by stage of care engagement. Given the association between gender-affirming care and improved mental health, identifying sociostructural and clinic-level barriers to care is critically important to facilitating more equitable access.
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Affiliation(s)
- Diana M. Tordoff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Gina M. Sequeira
- Seattle Children's Research Institute, Seattle, Washington, USA
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Alic G. Shook
- Seattle University, College of Nursing, Seattle, Washington, USA
- Seattle Children's Center for Pediatric Nursing Research, Seattle, Washington, USA
| | | | - Lara Hayden
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ash Kasenic
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - David Inwards-Breland
- Rady Children's Hospital, San Diego, California, USA
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UC San Diego, San Diego, California, USA
| | - Kym Ahrens
- Seattle Children's Research Institute, Seattle, Washington, USA
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
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12
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Kidd KM, Didden E, Harman H, Sequeira GM, Faeder M, Inwards-Breland DJ, Voss RV, Katz-Wise SL. Parents of Gender Diverse Youth: Support Sought, Received, and Still Needed. J Adolesc Health 2023:S1054-139X(23)00380-4. [PMID: 37715763 PMCID: PMC10947309 DOI: 10.1016/j.jadohealth.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/14/2023] [Accepted: 08/01/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Gender diverse youth (GDY) have improved mental health when affirmed by parents, but little is known about the support parents of GDY seek, receive, and still need. This qualitative study explored experiences of parents of GDY to better understand their support needs. METHODS Parents of GDY submitted videos and were interviewed about their journey supporting their GDY. Data collection continued until thematic saturation was reached. Audio recordings from videos and interviews were transcribed and analyzed via an inductive thematic analysis using the rigorous and accelerated data reduction technique. RESULTS In total, 25 parents of GDY (mean age 15 years, range 6-21 years) from 12 states provided video recordings and interviews; 36% were People of Color and 28% were fathers. We identified four themes and 12 subthemes. Theme 1: support through education included acknowledging ignorance about gender diversity and remedying ignorance. Theme 2: engaging community noted that support was multilayered and based around the family unit and pre-existing community. Theme 3: expanding community included acknowledgement that seeking new community was important for many to reduce feelings of isolation. It also highlighted that "safe spaces" for parents of GDY were not always safe for those of other marginalized groups, particularly People of Color. Theme 4: support in healthcare spaces centered experiences navigating medical and mental healthcare for GDY and feeling supported and unsupported in those spaces. DISCUSSION Parents identified numerous ways they sought, received, and needed support to understand and affirm their GDY. These findings will aid development of targeted support interventions for parents of GDY. Further research is needed to evaluate the impact of these interventions on GDY health.
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Affiliation(s)
- Kacie M Kidd
- Department of Pediatrics, Division of Adolescent Medicine, West Virginia University School of Medicine, WVU Medicine Children's Hospital, Morgantown, West Virginia.
| | - El Didden
- West Virginia University School of Medicine, WVU Medicine Children's Hospital, Morgantown, West Virginia
| | - Hayley Harman
- West Virginia University School of Medicine, WVU Medicine Children's Hospital, Morgantown, West Virginia
| | - Gina M Sequeira
- Department of Pediatrics, Division of Adolescent Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Morgan Faeder
- Department of Psychiatry, University of Pittsburgh School of Medicine, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | | | - Raina V Voss
- Department of Pediatrics, Divison of Adolescent and Young Adult Medicine, Northwestern University Feinburg School of Medicine, Lurie Children's Hospital, Chicago, Illinois
| | - Sabra L Katz-Wise
- Harvard TH Chan School of Public Health, Boston Children's Hospital, Boston, Massachusetts
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13
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McNamara M, Sequeira GM, Hughes L, Goepferd AK, Kidd K. Bans on Gender-Affirming Healthcare: The Adolescent Medicine Provider's Dilemma. J Adolesc Health 2023; 73:406-409. [PMID: 37410003 DOI: 10.1016/j.jadohealth.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Meredithe McNamara
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
| | - Gina M Sequeira
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Landon Hughes
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Kacie Kidd
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia
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14
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Kahn NF, Sequeira GM, Garrison MM, Orlich F, Christakis DA, Aye T, Conard LAE, Dowshen N, Kazak AE, Nahata L, Nokoff NJ, Voss RV, Richardson LP. Co-occurring Autism Spectrum Disorder and Gender Dysphoria in Adolescents. Pediatrics 2023; 152:e2023061363. [PMID: 37395084 DOI: 10.1542/peds.2023-061363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses. METHODS This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis. RESULTS Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth. CONCLUSIONS Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Gina M Sequeira
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Michelle M Garrison
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Felice Orlich
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Tandy Aye
- Stanford School of Medicine, Stanford, California
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
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15
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Rankine J, Kidd KM, Sequeira GM, Miller E, Ray KN. Adolescent Perspectives on the Use of Telemedicine for Confidential Health Care: An Exploratory Mixed-Methods Study. J Adolesc Health 2023; 73:360-366. [PMID: 37227338 PMCID: PMC10524174 DOI: 10.1016/j.jadohealth.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Telemedicine can improve access to adolescent health care, but adolescents may experience barriers to accessing this care confidentially. Gender-diverse youth (GDY) may especially benefit from telemedicine through increased access to geographically limited adolescent medicine subspecialty care but may have unique confidentiality needs. In an exploratory analysis, we examined adolescents' perceived acceptability, preferences, and self-efficacy related to using telemedicine for confidential care. METHODS We surveyed 12- to 17-year-olds following a telemedicine visit with an adolescent medicine subspecialist. Open-ended questions assessing acceptability of telemedicine for confidential care and opportunities to enhance confidentiality were qualitatively analyzed. Likert-type questions assessing preference for future use of telemedicine for confidential care and self-efficacy to complete components of telemedicine visits confidentially were summarized and compared across cisgender versus GDY. RESULTS Participants (n = 88) included 57 GDY and 28 cisgender females. Factors affecting the acceptability of telemedicine for confidential care related to patient location, telehealth technology, adolescent-clinician relationships, and quality or experience of care. Perceived opportunities to protect confidentiality included using headphones, secure messaging, and prompting from clinicians. Most participants (53/88) were likely or very likely to use telemedicine for future confidential care, but self-efficacy for completing components of telemedicine visits confidentially varied by component. DISCUSSION Adolescents in our sample were interested in using telemedicine for confidential care, but cisgender and GDY recognized threats to confidentiality that may reduce acceptability of telemedicine for these services. Clinicians and health systems should carefully consider youth's preferences and unique confidentiality needs to ensure equitable access, uptake, and outcomes of telemedicine.
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Affiliation(s)
- Jacquelin Rankine
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Kacie M Kidd
- WVU Medicine Children's, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Gina M Sequeira
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kristin N Ray
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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16
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Sequeira GM, Kahn NF, Ricklefs C, Collin A, Asante PG, Pratt W, Christakis D, Richardson LP. Barriers Pediatric PCP's Identify To Providing Gender-Affirming Care For Adolescents. J Adolesc Health 2023; 73:367-374. [PMID: 37294258 PMCID: PMC10802986 DOI: 10.1016/j.jadohealth.2023.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Both affirming environments and access to gender-affirming medical care have a positive impact on the mental health of transgender and gender diverse (TGD) youth, however, many TGD youth experience barriers in accessing this care. Pediatric primary care providers (PCPs) can play an important role in expanding access to gender-affirming care for TGD youth; however, few currently provide this care. The purpose of this study was to explore pediatric PCPs' perspectives regarding barriers they experience to providing gender-affirming care in the primary care setting. METHODS Pediatric PCPs who had sought out support from the Seattle Children's Gender Clinic were recruited via email to participate in semistructured, one-hour Zoom interviews. All interviews were transcribed and then subsequently analyzed in Dedoose qualitative analysis software using a reflexive thematic analysis framework. RESULTS Provider participants (n = 15) represented a wide range of experiences with respect to years in practice, number of TGD youth seen, and practice location (urban, rural, suburban). PCPs identified both health system and community-level barriers to providing gender-affirming care to TGD youth. Health system-level barriers included: (1) lack of foundational knowledge and skills, (2) limited clinical decision-making support, and (3) health system design limitations. Community-level barriers included (1) community and institutional biases, (2) provider attitudes regarding gender-affirming care provision, and (3) challenges identifying community resources to support TGD youth. DISCUSSION A multitude of health system and community-level barriers must be overcome in the pediatric primary care setting to ensure that TGD youth receive timely, effective, and more equitable gender-affirming care.
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Affiliation(s)
- Gina M Sequeira
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
| | - Nicole F Kahn
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Colbey Ricklefs
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Arin Collin
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Peter G Asante
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Wanda Pratt
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Dimitri Christakis
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Laura P Richardson
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
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17
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Lucas R, Kahn N, Bocek K, Tordoff DM, Karrington B, Richardson LP, Sequeira GM. Telemedicine Utilization Among Transgender and Gender-Diverse Adolescents Before and After the COVID-19 Pandemic. Telemed J E Health 2023; 29:1304-1311. [PMID: 36791325 DOI: 10.1089/tmj.2022.0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Introduction: Little is known about how expansion of telemedicine services during the COVID-19 pandemic has affected access to gender-affirming care for transgender and gender-diverse (TGD) youth. The purpose of this study was to explore differences in demographic characteristics and visit completion rates at a multidisciplinary gender clinic before and after telemedicine implementation in March 2020 and among telemedicine users and nonusers. Methods: Data were from electronic health records of Seattle Children's Gender Clinic (SCGC) patients seen between April 2019 and February 2021. We assessed differences in demographic characteristics and care utilization (i.e., encounter type and status) between April 2019 and February 2020 (pre-telemedicine) and April 2020 and February 2021 (post-telemedicine). Results: Of the 1,051 unique patients seen at SCGC during this time period, majority groups were as follows: 62% identified as transmasculine/male, 68% were non-Hispanic White, and 76% resided within 50 miles of the clinic. Statistically significant differences were observed in patient pronouns and insurance type when comparing the pre- and post-telemedicine periods (p < 0.01). Half (52%) of post-telemedicine period encounters were conducted through telemedicine, and telemedicine encounters were significantly more likely to be completed (72% vs. 50%) and less likely to be canceled (21% vs. 46%) compared with in-person encounters. Conclusions: Telemedicine services facilitated continued access to gender-affirming care services for TGD youth during the COVID-19 pandemic. Although the introduction of telemedicine did not exacerbate demographic disparities in access to this care, further research and interventions are warranted to address the ongoing disparities in access to gender-affirming care for youth of color and rural youth.
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Affiliation(s)
- Ruby Lucas
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Nicole Kahn
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kevin Bocek
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Diana M Tordoff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Baer Karrington
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Laura P Richardson
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Gina M Sequeira
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
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18
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Kahn NF, Anan YH, Bocek KM, Christakis DA, Richardson LP, Pratt W, Sequeira GM. Understanding Transgender and Gender-Diverse Youth's Experiences Receiving Care via Telemedicine: Qualitative Interview Study. JMIR Pediatr Parent 2023; 6:e42378. [PMID: 36745775 PMCID: PMC10055384 DOI: 10.2196/42378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender-diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine. OBJECTIVE The purpose of this study was to explore these experiences to (1) inform necessary changes to the provision of pediatric gender-affirming care and (2) help providers and health systems determine if and how telemedicine should be made available post pandemic. METHODS Youth (aged 14-17 years) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semistructured interview exploring perceived advantages or disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by 2 research team members using an inductive thematic analysis framework. RESULTS A total of 15 TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (ie, initial vs return and complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care. CONCLUSIONS Given the variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care.
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Affiliation(s)
- Nicole F Kahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Yomna H Anan
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Kevin M Bocek
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Dimitri A Christakis
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Laura P Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, WA, United States
| | - Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
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19
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Eitel KB, Hodax JK, DiVall S, Kidd KM, Salehi P, Sequeira GM. Leuprolide Acetate for Puberty Suppression in Transgender and Gender Diverse Youth: A Comparison of Subcutaneous Eligard Versus Intramuscular Lupron. J Adolesc Health 2023; 72:307-311. [PMID: 36404242 DOI: 10.1016/j.jadohealth.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/24/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the efficacy of intramuscular Lupron and subcutaneous Eligard, two formulations of leuprolide, for puberty suppression in transgender and gender diverse (TGD) youth. METHODS A retrospective chart review of TGD youth receiving Lupron or Eligard 22.5 mg every 3 months was conducted to determine hormone levels obtained 1 hour after an injection (1hrPost) and patient-reported clinical puberty suppression. RESULTS Forty eight patients were analyzed: 33% assigned female at birth of which 25% were premenarchal, mean age at first injection 13.7 years, and 50% received concurrent gender affirming hormones. Of these, 13% received Lupron, 52% Eligard, and 35% initially received Lupron then transitioned to Eligard due to drug shortages. There were 55 incidents of 1hrPost levels, 42 after Eligard and 13 after Lupron. Clinical puberty suppression occurred in all patients; however, biochemical suppression occurred in 90% of Eligard and 69% of Lupron (p = .06). DISCUSSION Eligard and Lupron were both effective in suppressing clinical puberty progression in our population of TGD youth, of which 50% were receiving concurrent gender affirming hormones.
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Affiliation(s)
- Kelsey B Eitel
- Division of Endocrinology, Department of Pediatrics, University of Washington, Seattle Children's, Seattle, Washington.
| | - Juanita K Hodax
- Division of Endocrinology, Department of Pediatrics, University of Washington, Seattle Children's, Seattle, Washington
| | - Sara DiVall
- Division of Endocrinology, Department of Pediatrics, University of Washington, Seattle Children's, Seattle, Washington
| | - Kacie M Kidd
- Division of Adolescent Medicine, Department of Pediatrics, West Virginia University, Morgantown, West Virginia
| | - Parisa Salehi
- Division of Endocrinology, Department of Pediatrics, University of Washington, Seattle Children's, Seattle, Washington
| | - Gina M Sequeira
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle Children's, Seattle, Washington
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20
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Sequeira GM, Kahn NF, Bocek KM, Shafii T, Asante PG, Christakis DA, Pratt W, Richardson LP. Pediatric Primary Care Providers' Perspectives on Telehealth Platforms to Support Care for Transgender and Gender-Diverse Youths: Exploratory Qualitative Study. JMIR Hum Factors 2023; 10:e39118. [PMID: 36719714 PMCID: PMC9929719 DOI: 10.2196/39118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Access to gender-affirming care services for transgender and gender-diverse youths is limited, in part because this care is currently provided primarily by specialists. Telehealth platforms that enable primary care providers (PCPs) to receive education from and consult specialists may help improve the access to such services. However, little is known about PCPs' preferences regarding receiving this support. OBJECTIVE This study aimed to explore pediatric PCPs' perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting. METHODS PCPs who had previously requested support from the Seattle Children's Gender Clinic were recruited to participate in semistructured, 1-hour web-based interviews. Overall, 3 specialist-to-PCP telehealth modalities (tele-education, electronic consultation, and telephonic consultation) were described, and the participants were invited to share their perspectives on the benefits and drawbacks of each modality, which modality would be the most effective, and the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using a reflexive thematic analysis framework. RESULTS The interviews were completed with 15 pediatric PCPs. The benefits of the tele-education platform were developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, having scheduled education sessions, and increasing provider confidence. The drawbacks were requiring a substantial time commitment and not allowing for real-time, patient-specific consultation. The benefits of the electronic consultation platform were convenient and efficient communication, documentation in the electronic health record, the ability to bill for provider time, and sufficient time to synthesize information. The drawbacks of this platform were electronic health record-related difficulties, text-based communication challenges, inability to receive an answer in real time, forced conversations with patients about billing, and limitations for providers who lack baseline knowledge. With respect to telephonic consultation, the benefits were having a dialogue with a specialist, receiving compensation for PCP's time, and helping with high acuity or complex cases. The drawbacks were challenges associated with using the phone for communication, the limited expertise of the responding providers, and the lack of utility for nonemergent issues. Regarding the most effective platform, the responses were mixed, with 27% (4/15) preferring the electronic consultation, 27% (4/15) preferring tele-education, 20% (3/15) preferring telephonic consultation, and the remaining 27% (4/15) suggesting a hybrid of the 3 models. CONCLUSIONS A diverse suite of telehealth-based training and consultation services must be developed to meet the needs of PCPs with different levels of experience and training in gender-affirming care. Beyond the widely used telephonic consultation model, electronic consultation and tele-education may provide important alternative training and consultation opportunities to facilitate greater PCP independence and promote wider access to gender-affirming care.
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Affiliation(s)
- Gina M Sequeira
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Nicole F Kahn
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Kevin M Bocek
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Taraneh Shafii
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Peter G Asante
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Wanda Pratt
- Information School, University of Washington, Seattle, WA, United States
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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21
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Szoko N, Sequeira GM, Coulter RWS, Kobey J, Ridenour E, Burnett O, Kidd KM. Sexual Orientation Among Gender Diverse Youth. J Adolesc Health 2023; 72:153-155. [PMID: 36216680 PMCID: PMC10748722 DOI: 10.1016/j.jadohealth.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/09/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Many youth are gender diverse, but our understanding of sexual orientation among gender diverse youth (GDY) is limited. We sought to compare sexual identity, attraction, and contact between cisgender youth and GDY and to describe these characteristics across GDY subgroups. METHODS We analyzed cross-sectional data from school-based surveys of 4,207 adolescents. Two-sample t-tests or chi-squared tests compared characteristics between GDY and cisgender youth. Sexual attraction/contact was summarized with frequencies/proportions and stratified by transmasculine, transfeminine, and nonbinary identities. RESULTS Two hundred eighty-one (9.1%) youth were GDY. Compared to cisgender peers, GDY were more likely to identify as sexual minority youth. In total, 29.9% of GDY were transmasculine, 36.7% transfeminine, and 33.5% nonbinary. Many transmasculine (45%) and transfeminine (58%) youth identified as heterosexual; most nonbinary youth (91%) identified as sexual minority youth. For transgender youth identifying as heterosexual, sexual attraction/contact varied. DISCUSSION Aspects of sexuality among GDY remain complex, warranting individualized approaches to sexual/reproductive healthcare.
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Affiliation(s)
- Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Gina M Sequeira
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Robert W S Coulter
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jaxon Kobey
- Centered Within Counseling, LLC, Columbia, Missouri
| | - Elissa Ridenour
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Kacie M Kidd
- Division of Adolescent Medicine, WVU Medicine Children's, Morgantown, West Virginia
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22
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Boyer TL, Coulter RWS, Miller E, Kidd KM, Sequeira GM. State of Transgender Health Education and Provision of Gender-Affirming Care to Transgender and Gender Diverse Adolescents. J Adolesc Health 2022; 71:769-770. [PMID: 36403992 DOI: 10.1016/j.jadohealth.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Taylor L Boyer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Gina M Sequeira
- School of Medicine, University of Washington, Seattle, Washington; Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
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23
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Kidd KM, Sequeira GM, Mann MJ, Smith ML, Benton BR, Kristjansson AL. The Prevalence of Gender-Diverse Youth in a Rural Appalachian Region. JAMA Pediatr 2022; 176:1149-1150. [PMID: 35939289 PMCID: PMC9361181 DOI: 10.1001/jamapediatrics.2022.2768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022]
Abstract
This study discusses a survey that explores youth gender identity in the Appalachian region.
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Affiliation(s)
- Kacie M. Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown
| | - Gina M. Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle
| | - Michael J. Mann
- Department of Public Health and Population Science, Boise State University, Idaho
| | - Megan L. Smith
- Department of Public Health and Population Science, Boise State University, Idaho
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24
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Sequeira GM, Kidd KM, Thornburgh C, Ley A, Sciulli D, Clapp M, Pitetti R, Matheo L, Womeldorff H, Christakis DA, Zuckerbraun NS. Increasing Frequency of Affirmed Name and Pronoun Documentation in a Pediatric Emergency Department. Hosp Pediatr 2022; 12:995-1001. [PMID: 36226552 PMCID: PMC9647634 DOI: 10.1542/hpeds.2022-006818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES In a previous study of 204 transgender and gender diverse youth in our region, 44% reported being made to feel uncomfortable in the emergency department (ED) because of their gender identity. The objective of our study was to conduct a 2 year quality improvement project to increase affirmed name and pronoun documentation in the pediatric ED. METHODS Using process mapping, we identified 5 key drivers and change ideas. The key driver diagram was updated as interventions were implemented over 3 Plan-Do-Study-Act cycles. Our primary outcome, the percentage of ED visits per month with pronouns documented, was plotted on a run chart with the goal of seeing a 50% increase in form completion from a baseline median of ∼14% over the 2 year study period. RESULTS The frequency of pronoun documentation increased from a baseline median of 13.8% to a median of 47.8%. The most significant increase in pronoun documentation occurred in Plan-Do-Study-Act cycle 3, immediately after ED-wide dissemination of a near-miss case and subsequent call for improvement by ED leadership. Roughly 1.7% of all encounters during the study period involved patients whose pronouns were discordant from the sex listed in their electronic health record. CONCLUSIONS This quality-improvement project increased the frequency of pronoun documentation in the ED. This has the potential to improve the quality of care provided to transgender and gender diverse youth in the ED setting and identify patients who may benefit from receiving a referral to a pediatric gender clinic for additional support.
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Affiliation(s)
- Gina M. Sequeira
- Seattle Children’s Research Institute, Seattle Washington
- Seattle Children’s Hospital, Seattle, Washington
| | - Kacie M. Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | | | - Alexandra Ley
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Darci Sciulli
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Megan Clapp
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raymond Pitetti
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Loreta Matheo
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Dimitri A. Christakis
- Seattle Children’s Research Institute, Seattle Washington
- Seattle Children’s Hospital, Seattle, Washington
| | - Noel S. Zuckerbraun
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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25
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Boyer TL, Sequeira GM, Egan JE, Ray KN, Miller E, Coulter RWS. Binary and Nonbinary Transgender Adolescents' Healthcare Experiences, Avoidance, and Well Visits. J Adolesc Health 2022; 71:438-445. [PMID: 35725539 PMCID: PMC9827712 DOI: 10.1016/j.jadohealth.2022.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/30/2022] [Accepted: 04/23/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To explore differences in healthcare experiences, healthcare avoidance, and well visit attendance between binary and nonbinary transgender adolescents; also, to explore the association between distinct healthcare experiences and healthcare avoidance and well visits. METHODS We surveyed transgender adolescents ages 12-26 (n = 156) recruited from a multidisciplinary gender clinic from July through November 2018. Differences in distinct healthcare experiences by demographics were assessed using multivariable linear regression. Multivariable logistic regression was used to examine independent associations between demographics and lifetime healthcare avoidance and past-year well visit and also, associations between distinct healthcare experiences and lifetime healthcare avoidance and past-year well visit. RESULTS Compared to transfeminine adolescents, more non-affirming healthcare experiences were reported by nonbinary (β = 1.41, 95% confidence interval [CI]: 0.49, 2.33) and transmasculine adolescents (β = 0.78, 95% CI: 0.02, 1.53). Gender-affirming healthcare experiences did not differ by demographics. Transmasculine adolescents had over three times the odds of lifetime healthcare avoidance (adjusted odds ratio [aOR] = 3.58, 95% CI: 1.41, 9.08) than transfeminine peers. Only younger age was associated with past-year well visit (aOR = 3.83, 95% CI: 1.44, 10.17). Non-affirming healthcare experiences were positively associated with healthcare avoidance (aOR = 1.85, 95% CI: 1.47, 2.34). Gender-affirming healthcare experiences were not associated with healthcare avoidance or past-year well visit. DISCUSSION Nonbinary and transmasculine adolescents experienced more non-affirming healthcare experiences than transfeminine adolescents. Non-affirming healthcare experiences were associated with healthcare avoidance, which was disproportionately more prevalent among transmasculine adolescents. Providers must be better equipped to provide inclusive, gender-affirming care to increase receipt of care for transgender adolescents beyond specialized gender clinics.
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Affiliation(s)
- Taylor L Boyer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Gina M Sequeira
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington; Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - James E Egan
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristin N Ray
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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26
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Valentine A, Davis S, Furniss A, Dowshen N, Kazak AE, Lewis C, Loeb DF, Nahata L, Pyle L, Schilling LM, Sequeira GM, Nokoff N. Multicenter Analysis of Cardiometabolic-related Diagnoses in Transgender and Gender-Diverse Youth: A PEDSnet Study. J Clin Endocrinol Metab 2022; 107:e4004-e4014. [PMID: 35945152 PMCID: PMC9516032 DOI: 10.1210/clinem/dgac469] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Indexed: 12/30/2022]
Abstract
CONTEXT Studies on cardiometabolic health in transgender and gender-diverse youth (TGDY) are limited to small cohorts. OBJECTIVE This work aimed to determine the odds of cardiometabolic-related diagnoses in TGDY compared to matched controls in a cross-sectional analysis, using a large, multisite database (PEDSnet). METHODS Electronic health record data (2009-2019) were used to determine odds of cardiometabolic-related outcomes based on diagnosis, anthropometric, and laboratory data using logistic regression among TGDY youth vs controls. The association of gender-affirming hormone therapy (GAHT) with these outcomes was examined separately among TGDY. TGDY (n = 4172) were extracted from 6 PEDSnet sites and propensity-score matched on 8 variables to controls (n = 16 648). Main outcomes measures included odds of having cardiometabolic-related diagnoses among TGDY compared to matched controls, and among TGDY prescribed GAHT compared to those not prescribed GAHT. RESULTS In adjusted analyses, TGDY had higher odds of overweight/obesity (1.2; 95% CI, 1.1-1.3) than controls. TGDY with a testosterone prescription alone or in combination with a gonadotropin-releasing hormone agonist (GnRHa) had higher odds of dyslipidemia (1.7; 95% CI, 1.3-2.3 and 3.7; 95% CI, 2.1-6.7, respectively) and liver dysfunction (1.5; 95% CI, 1.1-1.9 and 2.5; 95% CI, 1.4-4.3) than TGDY not prescribed GAHT. TGDY with a testosterone prescription alone had higher odds of overweight/obesity (1.8; 95% CI, 1.5-2.1) and hypertension (1.6 95% CI, 1.2-2.2) than those not prescribed testosterone. Estradiol and GnRHa alone were not associated with greater odds of cardiometabolic-related diagnoses. CONCLUSION TGDY have increased odds of overweight/obesity compared to matched controls. Screening and tailored weight management, sensitive to the needs of TGDY, are needed.
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Affiliation(s)
- Anna Valentine
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, Colorado 80045, USA
- Children’s Hospital Colorado, Division of Endocrinology, Aurora, Colorado 80045USA
| | - Shanlee Davis
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, Colorado 80045, USA
- Children’s Hospital Colorado, Division of Endocrinology, Aurora, Colorado 80045USA
| | - Anna Furniss
- University of Colorado Adult & Child Consortium for Health Outcomes Research and Delivery Sciences (ACCORDS), Aurora, Colorado 80045, USA
| | - Nadia Dowshen
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA
| | - Anne E Kazak
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania 19107, USA
| | - Christopher Lewis
- Washington University School of Medicine, St Louis, Missouri 63110, USA
| | - Danielle F Loeb
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, Colorado 80045, USA
| | - Leena Nahata
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, Ohio 43215, USA
- Division of Endocrinology, Nationwide Children’s Hospital, Columbus, Ohio 43205, USA
| | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, Colorado 80045, USA
- University of Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, Colorado 80045, USA
| | - Lisa M Schilling
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, Colorado 80045, USA
- University of Colorado Data Science to Patient Value Initiative, Aurora, CO 80045, USA
| | - Gina M Sequeira
- Seattle Children’s Research Institute, Seattle, Washington 98121, USA
| | - Natalie Nokoff
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, Colorado 80045, USA
- Children’s Hospital Colorado, Division of Endocrinology, Aurora, Colorado 80045USA
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27
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Nunes-Moreno M, Buchanan C, Cole FS, Davis S, Dempsey A, Dowshen N, Furniss A, Kazak AE, Kerlek AJ, Margolis P, Pyle L, Razzaghi H, Reirden DH, Schwartz B, Sequeira GM, Nokoff NJ. Behavioral Health Diagnoses in Youth with Gender Dysphoria Compared with Controls: A PEDSnet Study. J Pediatr 2022; 241:147-153.e1. [PMID: 34571022 PMCID: PMC8828680 DOI: 10.1016/j.jpeds.2021.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the odds of a psychiatric or neurodevelopmental diagnosis among youth with a diagnosis of gender dysphoria compared with matched controls in a large electronic health record dataset from 6 pediatric health systems, PEDSnet. We hypothesized that youth with gender dysphoria would have higher odds of having psychiatric and neurodevelopmental diagnoses than controls. STUDY DESIGN All youth with a diagnosis of gender dysphoria (n = 4173 age at last visit 16.2 ± 3.4) and at least 1 outpatient encounter were extracted from the PEDSnet database and propensity-score matched on 8 variables to controls without gender dysphoria (n = 16 648, age at last visit 16.2 ± 4.8) using multivariable logistic regression. The odds of having psychiatric and neurodevelopmental diagnoses were examined using generalized estimating equations. RESULTS Youth with gender dysphoria had higher odds of psychiatric (OR 4.0 [95% CI 3.8, 4.3] P < .0001) and neurodevelopmental diagnoses (1.9 [1.7, 2.0], P < .0001). Youth with gender dysphoria were more likely to have a diagnosis across all psychiatric disorder subcategories, with particularly high odds of mood disorder (7.3 [6.8, 7.9], P < .0001) and anxiety (5.5 [5.1, 5.9], P < .0001). Youth with gender dysphoria had a greater odds of autism spectrum disorder (2.6, [2.2, 3.0], P < .0001). CONCLUSIONS Youth with gender dysphoria at large pediatric health systems have greater odds of psychiatric and several neurodevelopmental diagnoses compared with youth without gender dysphoria. Further studies are needed to evaluate changes in mental health over time with access to gender affirming care.
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Affiliation(s)
| | - Cindy Buchanan
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Shanlee Davis
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amanda Dempsey
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nadia Dowshen
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Anna Furniss
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Anne E Kazak
- Nemours Children's Health System, Center for Healthcare Delivery Science Wilmington, DE
| | | | | | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Hanieh Razzaghi
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Beth Schwartz
- Nemours Children's Health System, Center for Healthcare Delivery Science Wilmington, DE
| | - Gina M Sequeira
- University of Washington, Department of Pediatrics, Seattle, WA
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28
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Kidd KM, Sequeira GM, Rothenberger SD, Paglisotti T, Kristjansson A, Schweiberger K, Miller E, Coulter RWS. Operationalizing and analyzing 2-step gender identity questions: Methodological and ethical considerations. J Am Med Inform Assoc 2022; 29:249-256. [PMID: 34472616 PMCID: PMC8757306 DOI: 10.1093/jamia/ocab137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Two-step questions to assess gender identity are recommended for optimizing care delivery for gender-diverse individuals. As gender identity fields are increasingly integrated into electronic health records, guidance is needed on how to analyze these data. The goal of this study was to assess potential approaches for analyzing 2-step gender identity questions and the impact of each on suicidal ideation. MATERIALS AND METHODS A regional Youth Risk Behavior Survey in one Northeastern school district used a 2-step question to assess gender identity. Three gender measurement strategies (GMSs) were used to operationalize gender identity, (1) combining all gender-diverse youth (GDY) into one category, (2) grouping GDY based on sex assigned at birth, and (3) categorizing GDY based on binary and nonbinary identities. Mixed-effects logistic regression was used to compare odds of suicidal ideation between gender identity categories for each GMS. RESULTS Of the 3010 participants, 8.3% were GDY. Subcategories of GDY had significantly higher odds (odds ratio range, 1.6-2.9) of suicidal ideation than cisgender girls regardless of GMS, while every category of GDY had significantly higher odds (odds ratio range, 2.1-5.0) of suicidal ideation than cisgender boys. CONCLUSIONS The field of clinical informatics has an opportunity to incorporate inclusive items like the 2-step gender identity question into electronic health records to optimize care and strengthen clinical research. Analysis of the 2-step gender identity question impacts study results and interpretation. Attention to how data about GDY are captured will support for more nuanced, tailored analyses that better reflect unique experiences within this population.
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Affiliation(s)
- Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Gina M Sequeira
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, Washington, USA
| | - Scott D Rothenberger
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Taylor Paglisotti
- Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Alfgeir Kristjansson
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Kelsey Schweiberger
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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29
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Sequeira GM, Boyer T, Coulter RWS, Miller E, Kahn NF, Ray KN. Healthcare Experiences of Gender Diverse Youth Across Clinical Settings. J Pediatr 2022; 240:251-255. [PMID: 34536494 PMCID: PMC8712353 DOI: 10.1016/j.jpeds.2021.08.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 01/03/2023]
Abstract
We explored gender diverse youth's experiences seeking and receiving gender-affirming care in various health system locations. Results provide evidence for system-, clinic-, and provider-level improvements to promote the development of affirming environments and to improve health outcomes for gender diverse youth.
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Affiliation(s)
- Gina M. Sequeira
- University of Washington, Seattle, Washington,Seattle Children’s Hospital, Seattle, Washington
| | - Taylor Boyer
- VA Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Robert W. S. Coulter
- University of Pittsburgh, Pittsburgh, Pennsylvania,UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- University of Pittsburgh, Pittsburgh, Pennsylvania,UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Kristin N. Ray
- University of Pittsburgh, Pittsburgh, Pennsylvania,UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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30
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Affiliation(s)
| | | | - Gina M Sequeira
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle
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31
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Rankine J, Yeramosu D, Matheo L, Sequeira GM, Miller E, Ray KN. Optimizing e-Consultations to Adolescent Medicine Specialists: Qualitative Synthesis of Feedback From User-Centered Design. JMIR Hum Factors 2021; 8:e25568. [PMID: 34383665 PMCID: PMC8380586 DOI: 10.2196/25568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/21/2021] [Accepted: 05/24/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND e-Consultations between primary care physicians and specialists are a valuable means of improving access to specialty care. Adolescents and young adults (AYAs) face unique challenges in accessing limited adolescent medicine specialty care resources, which contributes to delayed or forgone care. e-Consultations between general pediatricians and adolescent medicine specialists may alleviate these barriers to care. However, the optimal application of this model in adolescent medicine requires careful attention to the nuances of AYA care. OBJECTIVE This study aims to qualitatively analyze feedback obtained during the iterative development of an e-consultation system for communication between general pediatricians and adolescent medicine specialists tailored to the specific health care needs of AYAs. METHODS We conducted an iterative user-centered design and evaluation process in two phases. In the first phase, we created a static e-consultation prototype and storyboards and evaluated them with target users (general pediatricians and adolescent medicine specialists). In the second phase, we incorporated feedback to develop a functional prototype within the electronic health record and again evaluated this with general pediatricians and adolescent medicine specialists. In each phase, general pediatricians and adolescent medicine specialists provided think-aloud feedback during the use of the prototypes and semistructured exit interviews, which was qualitatively analyzed to identify perspectives related to the usefulness and usability of the e-consultation system. RESULTS Both general pediatricians (n=12) and adolescent medicine specialists (n=12) perceived the usefulness of e-consultations for AYA patients, with more varied perceptions of potential usefulness for generalist and adolescent medicine clinicians. General pediatricians and adolescent medicine specialists discussed ways to maximize the usability of e-consultations for AYAs, primarily by improving efficiency (eg, reducing documentation, emphasizing critical information, using autopopulated data fields, and balancing specificity and efficiency through text prompts) and reducing the potential for errors (eg, prompting a review of autopopulated data fields, requiring physician contact information, and prompting explicit discussion of patient communication and confidentiality expectations). Through iterative design, patient history documentation was streamlined, whereas documentation of communication and confidentiality expectations were enhanced. CONCLUSIONS Through an iterative user-centered design process, we identified user perspectives to guide the refinement of an e-consultation system based on general pediatrician and adolescent medicine specialist feedback on usefulness and usability related to the care of AYAs. Qualitative analysis of this feedback revealed both opportunities and risks related to confidentiality, communication, and the use of tailored documentation prompts that should be considered in the development and use of e-consultations with AYAs.
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Affiliation(s)
- Jacquelin Rankine
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Deepika Yeramosu
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Loreta Matheo
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Gina M Sequeira
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
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32
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Abstract
Gender identity is a person’s internal sense of being a boy, a girl, some of both, or neither and typically develops early in childhood.
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Affiliation(s)
- Gina M. Sequeira
- Seattle Children’s Hospital, Division of Adolescent Medicine, Seattle, Washington
| | - Kristin Dayton
- Department of Pediatrics, University of Florida, Gainesville
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33
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Kidd KM, Hill A, Sequeira GM, McMillan C, Switzer G, Rofey D, Miller E, Montano GT. Development and Psychometric Analysis of the Transgender Family Acceptance To Empowerment (TransFATE) Scale. J Adolesc Health 2021; 68:1096-1103. [PMID: 33268218 PMCID: PMC8053728 DOI: 10.1016/j.jadohealth.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Parent and caregiver support can reduce health disparities experienced by gender diverse youth (GDY). Parent and caregiver empowerment improves health outcomes for children with medical and mental health diagnoses, but no existing scale measures this construct in families of GDY. We aimed to develop a scale measuring empowerment in parents and caregivers of GDY. METHODS We adapted two existing scales and added investigator-derived items to create a survey instrument. We revised using input from focus groups and experts assessing face and content validity. Using the revised scale, we surveyed parents and caregivers of GDY from across the U.S. to assess the construct validity through exploratory and confirmatory factor analyses, internal consistency, and convergent validity. RESULTS The initial 67 items were reduced to 42 items after face and content validity analyses. Parents and caregivers (n = 309) from 31 states completed the revised measure. Most participants were white (81.4%), mothers (69.3%), and parenting a gender diverse child who identifies on the binary (transmasculine, male, transfeminine, or female; 91.3%). Exploratory factor analyses showed a two-factor solution: Factor 1 having 10 items (Cronbach's alpha = .86) and Factor 2 having six items (Cronbach's alpha = .86). Our confirmatory factor analysis demonstrated good fit (Comparative Factor Index = .972, Tucker-Lewis Index = .968, Root Mean Square Error of Approximation = .060 [90% confidence interval = .410-.078], and Standardized Root Mean Square Residual = .062). CONCLUSIONS The Transgender Family Acceptance To Empowerment (TransFATE) scale demonstrates face, content, and construct validity among a geographically diverse sample of GDY's parents and caregivers. This scale has the potential to aid in developing and evaluating programs focused on building stronger social supports for GDY through increased family empowerment.
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Affiliation(s)
- Kacie M Kidd
- Center for Adolescent & Young Adult Health, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Amber Hill
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gina M Sequeira
- Center for Adolescent & Young Adult Health, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Calvin McMillan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Galen Switzer
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dana Rofey
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Center for Adolescent & Young Adult Health, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gerald T Montano
- Center for Adolescent & Young Adult Health, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Kidd KM, Sequeira GM, Paglisotti T, Katz-Wise SL, Kazmerski TM, Hillier A, Miller E, Dowshen N. "This Could Mean Death for My Child": Parent Perspectives on Laws Banning Gender-Affirming Care for Transgender Adolescents. J Adolesc Health 2021; 68:1082-1088. [PMID: 33067153 PMCID: PMC8041924 DOI: 10.1016/j.jadohealth.2020.09.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Numerous U.S. state legislatures have proposed bills to ban gender-affirming medical interventions for minors. Parents and caregivers play a critical role in advocating for and supporting their transgender and gender-diverse youth (TGDY). We aimed to understand parent and caregiver perspectives about this potential legislation and perceived effects on their TGDY's mental health. METHODS We developed and launched a social-media based, anonymous online survey in February 2020 to assess parent and caregiver perspectives on proposed laws to ban gender-affirming medical interventions for minors. Participants were asked to respond to two open-ended questions about these laws; responses were coded to identify key themes. RESULTS We analyzed responses from 273 participants from 43 states. Most identified as white (86.4%) female (90.0%) mothers (93.8%), and 83.6% of their TGDY had received gender-affirming medical interventions before age 18 years. The most salient theme, which appeared in the majority of responses, described parent and caregiver fears that these laws would lead to worsening mental health and suicide for their TGDY. Additional themes included a fear that their TGDY would face increased discrimination, lose access to gender-affirming medical interventions, and lose autonomy over medical decision-making due to government overreach. CONCLUSIONS In this convenience sample, parents and caregivers overwhelmingly expressed fear that the proposed legislation will lead to worsening mental health and increased suicidal ideation for their TGDY. They implored lawmakers to hear their stories and to leave critical decisions about gender-affirming medical interventions to families and their medical providers.
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Affiliation(s)
- Kacie M. Kidd
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave
| | - Gina M. Sequeira
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave
| | - Taylor Paglisotti
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave
| | - Sabra L. Katz-Wise
- Boston Children’s Hospital, Division of Adolescent/Young Adult Medicine, 300 Longwood Ave, Boston MA 02115
| | - Traci M. Kazmerski
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave
| | - Amy Hillier
- University of Pennsylvania, School of Social Policy & Practice, Colonial Penn Center, 3641 Locust Walk, Philadelphia PA 19104
| | - Elizabeth Miller
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave
| | - Nadia Dowshen
- University of Pennsylvania, School of Medicine, Colonial Penn Center, 3641 Locust Walk, Philadelphia PA 19104
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35
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Kidd KM, Sequeira GM, Douglas C, Paglisotti T, Inwards-Breland DJ, Miller E, Coulter RWS. Prevalence of Gender-Diverse Youth in an Urban School District. Pediatrics 2021; 147:peds.2020-049823. [PMID: 34006616 PMCID: PMC8168604 DOI: 10.1542/peds.2020-049823] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kacie M. Kidd
- University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania;,School of Medicine and
| | - Gina M. Sequeira
- Seattle Children’s Hospital, Seattle, Washington;,University of Washington, Seattle, Washington
| | - Claudia Douglas
- Seattle Children’s Hospital, Seattle, Washington;,University of Washington, Seattle, Washington
| | - Taylor Paglisotti
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - David J. Inwards-Breland
- Rady Children’s Hospital, San Diego, California; and,School of Medicine, University of California, San Diego, San Diego, California
| | - Elizabeth Miller
- University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania;,School of Medicine and
| | - Robert W. S. Coulter
- School of Medicine and,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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36
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Sequeira GM, Kidd KM, Rankine J, Miller E, Ray KN, Fortenberry JD, Richardson LP. Gender-Diverse Youth's Experiences and Satisfaction with Telemedicine for Gender-Affirming Care During the COVID-19 Pandemic. Transgend Health 2021; 7:127-134. [PMID: 35586577 PMCID: PMC9051870 DOI: 10.1089/trgh.2020.0148] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose Telemedicine holds potential to improve access to gender-affirming care for gender-diverse youth (GDY), but little is known about youth's perspectives regarding its use. The purpose of this study was to explore GDY's experiences and satisfaction with telemedicine for gender-affirming care during the COVID-19 pandemic. Methods An online, cross-sectional survey was completed by 12-17-year-old GDY after a telemedicine gender clinic visit. Demographic characteristics, responses to a 12-item telemedicine satisfaction scale, and items assessing interest in future telemedicine use were analyzed using descriptive statistics. Open-ended items exploring GDY's experiences were coded qualitatively to identify key themes. Results Participants' (n=57) mean age was 15.6 years. A majority were satisfied with telemedicine (85%) and willing to use it in the future (88%). Most GDY preferred in-person visits for their first gender care visit (79%), with fewer preferring in-person for follow-up visits (47%). Three key themes emerged from the open-ended comments: (1) benefits of telemedicine including saving time and feeling safe; (2) usability of telemedicine such as privacy concerns and technological difficulties; and (3) telemedicine acceptability, which included comfort, impact on anxiety, camera use, and patient preference. Conclusions Despite their preference for in-person visits, a majority of GDY were satisfied and comfortable with telemedicine, and expressed their interest in continuing to have telemedicine as an option for care. Pediatric gender care providers should continue services through telemedicine while implementing protocols related to privacy and hesitation regarding camera use. While adolescents may find telemedicine acceptable, it remains unclear whether telemedicine can improve access to gender-affirming care.
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Affiliation(s)
- Gina M. Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kacie M. Kidd
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacquelin Rankine
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristin N. Ray
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - J. Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
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37
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Thornburgh C, Kidd KM, Burnett JD, Sequeira GM. Community-Informed Peer Support for Parents of Gender-Diverse Youth. Pediatrics 2020; 146:peds.2020-0571. [PMID: 32973119 PMCID: PMC7546091 DOI: 10.1542/peds.2020-0571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Caitlin Thornburgh
- University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kacie M. Kidd
- University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania;,Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Johanna D. Burnett
- Department of Chemistry and Biochemistry, Duquesne University, Pittsburgh, Pennsylvania
| | - Gina M. Sequeira
- University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania;,Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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38
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Evans YN, Golub S, Sequeira GM, Eisenstein E, North S. Using Telemedicine to Reach Adolescents During the COVID-19 Pandemic. J Adolesc Health 2020; 67:469-471. [PMID: 32768330 PMCID: PMC7403159 DOI: 10.1016/j.jadohealth.2020.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Yolanda N Evans
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Sarah Golub
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | | | | | - Steve North
- Center for Rural Health Innovation, Spruce Pine, North Carolina
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39
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Sequeira GM, Ray KN, Miller E, Coulter RWS. Transgender Youth's Disclosure of Gender Identity to Providers Outside of Specialized Gender Centers. J Adolesc Health 2020; 66:691-698. [PMID: 32089449 PMCID: PMC8496159 DOI: 10.1016/j.jadohealth.2019.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE Transgender youth face significant health disparities and multiple barriers to receiving quality health care. Gender identity disclosure to health care providers (HCPs) is an important step in creating affirming relationships for transgender youth. The objectives of this study were to (1) determine the prevalence of voluntary disclosure and intentional avoidance to HCPs outside of gender clinics, (2) identify factors associated with voluntary disclosure and intentional avoidance, and (3) elucidate strategies to increase comfort with disclosure. METHODS A cross-sectional survey was administered to transgender youth aged 12-26 years. Bivariate analyses were conducted using χ2 or Fisher's exact tests. Two logistic regression models for each outcome variable were used to examine factors associated with voluntary disclosure and intentional avoidance. RESULTS Two thirds (65%) of youth (N = 153) identified as transmasculine, and 57% were under 18 years. Three-quarters (78%) had voluntarily disclosed their gender identity to an HCP outside of gender clinic, whereas 46% had intentionally avoided disclosure. Odds ratios (ORs) of ever having disclosed were lower for participants ≥18 years (OR = .33; 95% confidence interval [CI]: .11-.98), those out to fewer people (OR = .12; 95% CI: .02-.81) and out for <1 year (OR = .03; 95% CI: .004-.31). Odds of intentional avoidance were lower among youth with higher perceived parental support (OR = .83; 95% CI: .70-.98). CONCLUSION A majority of transgender youth reported having voluntarily disclosed their gender identity to an HCP outside of gender clinic, but almost half reported having intentionally avoided disclosure when they felt it was important. Parental support may play a protective role in mitigating avoidance.
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Affiliation(s)
- Gina M. Sequeira
- UPMC Children’s Hospital of Pittsburgh Pittsburgh,
PA, USA 15213,Department of Pediatrics University of Pittsburgh
School of Medicine Pittsburgh, PA 15224
| | - Kristin N. Ray
- Department of Pediatrics University of Pittsburgh
School of Medicine Pittsburgh, PA 15224
| | - Elizabeth Miller
- UPMC Children’s Hospital of Pittsburgh Pittsburgh,
PA, USA 15213,Department of Pediatrics University of Pittsburgh
School of Medicine Pittsburgh, PA 15224
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40
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Abstract
This survey study assesses preferences concerning name and pronoun documentation in the electronic medical record and investigates how these preferences differ by demographic and gender-related characteristics among transgender youths seeking care at a specialty gender clinic.
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Affiliation(s)
- Gina M. Sequeira
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kacie Kidd
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Kristin N. Ray
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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41
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Kidd KM, Sequeira GM, Voss RV, Weiner DJ, Ramsey BW, Jain R, Kazmerski TM. Caring for gender diverse youth with cystic fibrosis. J Cyst Fibros 2020; 19:1018-1020. [PMID: 32268993 DOI: 10.1016/j.jcf.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/27/2020] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
Abstract
Gender diverse youth with cystic fibrosis have unique health needs. Providers should be aware of existing health disparities in this population as well as aspects of gender-affirming care including hormone therapy, chest binding, and use of affirming language. This communication provides an introduction to these concerns.
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Affiliation(s)
- Kacie M Kidd
- University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA.
| | | | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Daniel J Weiner
- University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Bonnie W Ramsey
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, USA
| | - Raksha Jain
- University of Texas Southwestern Medical Center, Dallas, USA
| | - Traci M Kazmerski
- University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
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Sequeira GM, Kidd K, El Nokali NE, Rothenberger SD, Levine MD, Montano GT, Rofey D. Early Effects of Testosterone Initiation on Body Mass Index in Transmasculine Adolescents. J Adolesc Health 2019; 65:818-820. [PMID: 31543405 PMCID: PMC8496160 DOI: 10.1016/j.jadohealth.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/22/2019] [Accepted: 06/28/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Increasing numbers of transgender youth are receiving hormone therapy in accordance with national and international guidelines. This study sought to determine the effect of testosterone on body mass index (BMI) z-score in transmasculine adolescents at 6 and 12 months after initiation. METHODS A retrospective chart review collected anthropomorphic data on transmasculine adolescents, aged 13 to 19 years, before and during testosterone use. These measurements were used to create a linear mixed model to explore the change in BMI z-score after initiating testosterone. RESULTS The increase in BMI z-score in transmasculine adolescents was significantly higher after six months of testosterone use, but there was no significant change between baseline and 12 months. CONCLUSIONS Additional study is needed to understand the full short- and long-term impact of testosterone use on BMI z-score in transmasculine adolescents to provide appropriate informed consent and develop interventions to improve health outcomes.
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Affiliation(s)
- Gina M. Sequeira
- Division of Adolescent and Young Adult Medicine, UPMC
Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania,Address correspondence to: Gina M. Sequeira, M.D.,
120 Lytton Ave, Suite M60, Pittsburgh, PA 15213.
(G.M. Sequeira)
| | - Kacie Kidd
- Division of Adolescent and Young Adult Medicine, UPMC
Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Michele D. Levine
- Department of Psychiatry, University of Pittsburgh,
Pittsburgh, Pennsylvania
| | - Gerald T. Montano
- Division of Adolescent and Young Adult Medicine, UPMC
Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dana Rofey
- Department of Psychiatry, University of Pittsburgh,
Pittsburgh, Pennsylvania
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Kidd KM, Sequeira GM, Dhar CP, Montano GT, Witchel SF, Rofey D. Gendered Body Mass Index Percentile Charts and Transgender Youth: Making the Case to Change Charts. Transgend Health 2019; 4:297-299. [PMID: 31663036 PMCID: PMC6818482 DOI: 10.1089/trgh.2019.0016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Body mass index (BMI) is defined as weight (kg)/height2 (m2). Differences in BMI percentiles between sexes confound the diagnosis of weight-related disorders in transgender youth because choosing the appropriate chart is challenging. Data on BMI measures are needed for transgender youth, but there are no guidelines on how to collect or report this data. We use two theoretical cases to assert that health care providers and researchers should consider use of both male and female growth charts for transgender youth, particularly for individuals at the extremes of weight.
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Affiliation(s)
- Kacie M. Kidd
- Center for Adolescent and Young Adult Health, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gina M. Sequeira
- Center for Adolescent and Young Adult Health, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cherie Priya Dhar
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gerald T. Montano
- Center for Adolescent and Young Adult Health, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Selma Feldman Witchel
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dana Rofey
- Department of Psychiatry, Pediatrics, Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract
The number of gender diverse and transgender youth presenting for treatment are increasing. This is a vulnerable population with unique medical needs; it is essential that all pediatricians attain an adequate level of knowledge and comfort caring for these youth so that their health outcomes may be improved. There are several organizations which provide clinical practice guidelines for the treatment of transgender youth including the WPATH and the Endocrine Society and they recommend that certain eligibility criteria should be met prior to initiation of gender affirming hormones. Medical intervention for transgender youth can be broken down into stages based on pubertal development: pre-pubertal, pubertal and post-pubertal. Pre-pubertally no medical intervention is recommended. Once puberty has commenced, youth are eligible for puberty blockers; and post-pubertally, youth are eligible for feminizing and masculinizing hormone regimens. Treatment with gonadotropin releasing hormone agonists are used to block puberty. Their function is many-fold: to pause puberty so that the youth may explore their gender identity, to delay the development of (irreversible) secondary sex characteristics, and to obviate the need for future gender affirmation surgeries. Masculinizing hormone regimens consists of testosterone and feminizing hormone regimens consist of both estradiol as well as spironolactone. In short term studies gender affirming hormone treatment with both estradiol and testosterone has been found to be safe and improve mental health and quality of life outcomes; additional long term studies are needed to further elucidate the implications of gender affirming hormones on physical and mental health in transgender patients. There are a variety of surgeries that transgender individuals may desire in order to affirm their gender identity; it is important for providers to understand that desire for medical interventions is variable among persons and that a discussion about individual desires for surgical options is recommended.
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Affiliation(s)
- Caroline Salas-Humara
- NYU School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, New York, NY, United States.
| | - Gina M Sequeira
- UPMC Children's Hospital of Pittsburgh, Center for Adolescent and Young Adult Health, United States
| | - Wilma Rossi
- Children's Hospital of Philadelphia, United States
| | - Cherie Priya Dhar
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, United States
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Close AG, Sequeira GM, Montano GT, Alessi LJ, McCormick MC, Cooper JD, Epperly RA, Zuckerbraun NS. Improving the Evaluation and Management of Abnormal Uterine Bleeding in Female Adolescents Presenting for Emergency Care. J Pediatr Adolesc Gynecol 2019; 32:128-134. [PMID: 30453029 PMCID: PMC8091628 DOI: 10.1016/j.jpag.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/04/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE We sought to improve emergency care for adolescents with abnormal uterine bleeding (AUB) by developing a clinical effectiveness guideline (CEG) and assessing its effect on quality of care. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS A stakeholder engagement group designed a CEG algorithm for emergency AUB management. Pediatric residents received CEG training and their knowledge and attitudes were assessed using pre- and post intervention surveys. International Classification of Diseases ninth and 10th revision codes identified electronic health record data for patients who presented to the pediatric emergency department for AUB 6 months before and after CEG implementation. A weighted, 20-point scoring system consisting of prioritized aspects of history, laboratory studies, and management was developed to quantify the quality of care provided. MAIN OUTCOME MEASURES Descriptive statistics, χ2 test, Wilcoxon rank sum test, and a run chart were used for analysis. RESULTS Pediatric residents reported higher confidence and knowledge scores post CEG implementation. Of the 91 patients identified, 62 met inclusion criteria. Median score was 14 ± 7 before CEG implementation and 15.5 ± 6 after. The Wilcoxon rank sum test showed a difference in AUB evaluation and management scores (P = .09) after implementation of the CEG. Run chart data showed no shifts or trends (overall median score, 14 points). Pre- and post implementation, points were deducted most frequently for not assessing personal/family clotting disorder history. The largest improvements in care were with appropriate medication dosing and disposition. CONCLUSION We designed a CEG and educational intervention for AUB management in a pediatric emergency department. These findings suggest our CEG might be an effective tool to improve emergency AUB care for adolescents and could increase trainees' confidence in managing this condition, although additional cycles are needed.
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Affiliation(s)
- Allison G Close
- Hematology/Oncology Division, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Institute of Clinical Research, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Gina M Sequeira
- Institute of Clinical Research, University of Pittsburgh, Pittsburgh, Pennsylvania; Adolescent Medicine Division, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gerald T Montano
- Adolescent Medicine Division, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lauren J Alessi
- General Academic Medicine Division, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Meghan C McCormick
- Hematology/Oncology Division, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - James D Cooper
- Hematology/Oncology Division, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca A Epperly
- Department of Oncology, Saint Jude Children's Research Hospital, Memphis, Tennessee
| | - Noel S Zuckerbraun
- Emergency Medicine Division, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Sequeira GM, Chakraborti C, Panunti BA. Integrating Lesbian, Gay, Bisexual, and Transgender (LGBT) Content Into Undergraduate Medical School Curricula: A Qualitative Study. Ochsner J 2012. [PMID: 23267268 DOI: 10.1043/1524-5012-12.4.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The lesbian, gay, bisexual, and transgender (LGBT) community is a diverse, underserved, and often stigmatized group that faces many barriers to accessing quality healthcare. Not only are few practicing physicians knowledgeable about and sensitive to the needs of LGBT patients, but medical school curricula include limited LGBT-related content. Our goals were to use LGBT-related educational sessions to gauge undergraduate medical students' interest and their perceptions of relevance and to eventually incorporate this topic into the curriculum. METHODS We provided 4 educational sessions to preclinical medical students at the Tulane University School of Medicine: 3 optional, 1-hour didactic sessions and 1 standardized patient encounter. Following sessions 1-3, students completed electronic feedback forms; we then analyzed their responses thematically. RESULTS THE THEMATIC ANALYSIS OF STUDENT RESPONSES IDENTIFIED KEY THEMES: a current lack of exposure to LGBT content, agreement that LGBT material is applicable to students' work as future physicians, and the relevance of including such information in the medical school curriculum. CONCLUSION The study validated the underlying assumption that LGBT educational sessions are meaningful to and valued by medical students.
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