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Fredriksen-Goldsen KI, Romanelli M, Jung HH, Kim HJ. Health, Economic, and Social Disparities among Lesbian, Gay, Bisexual, and Sexually Diverse Adults: Results from a Population-Based Study. Behav Med 2024; 50:141-152. [PMID: 36729025 PMCID: PMC10394107 DOI: 10.1080/08964289.2022.2153787] [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: 12/27/2021] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 02/03/2023]
Abstract
We investigated health, economic, and social disparities among lesbian, gay, bisexual, and sexually diverse adults, 18 years and older. Analyzing 2011-2019 Washington State Behavioral Risk Factor Surveillance System (N = 109,527), we estimated and compared the prevalence rates of background characteristics, economic and social indicators, health outcomes, chronic conditions, health care access, health behaviors, and preventive care by gender and sexual identity. Sexual minority adults reported heightened risks of poor general health, physical and mental health, disability, subjective cognitive decline, and financial barriers to health care, compared with their straight counterparts. Economic disparities and disability were evident for lesbians and both bisexual adult women and men. We found higher rates of smoking and excessive drinking among lesbians and bisexual women, and higher rates of smoking and living alone among gay men. Sexually diverse adults experience disparities in health care access. This study is one of the first to identify disparities among sexually diverse populations, in addition to lesbian, gay, and bisexual adults. More research is required to understand the mechanisms of disparities within these groups to address their distinct intervention needs.
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Hoy-Ellis CP, Kim HJ, Oswald AG, Nelson C, Fredriksen-Goldsen KI. Transgender older adults' prior military service: Mental health differences by gender identification. Am J Orthopsychiatry 2024:2024-68654-001. [PMID: 38546561 DOI: 10.1037/ort0000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Despite a proportionally higher likelihood of serving, the role of prior military service in the mental health of transgender individuals is understudied. Research on the impact of military service on mental health tends to be proximal. We examined the distal relationship between prior military service, identity stigma, and mental health among transgender older adults, drawing comparisons between transgender men and women. We conducted a series of weighted multivariate linear models to predict the relationships between prior military service, identity stigma, perceived stress, and depression among 183 transgender women and men aged 51-87 (M = 60.11, SD = 0.668) using 2014 data from the National Health, Aging, and Sexuality/Gender Study. Prior military service was negatively associated with depression and perceived stress; identity stigma was positively associated with both. Prior military service and lower depression and perceived stress were significant for transgender men, but not women. Identity stigma was significant with depression and perceived stress among transgender women, but not transgender men. Our preliminary findings suggest that prior military service may serve as a protective factor for mental health among transgender men, but not transgender women. We need to better understand how military experience interacts with other characteristics, such as differing gender identities influences the mental health of transgender service members. Further research is needed to inform underlying mechanisms whereby military service differentially impacts mental health by gender identity so all active-duty personnel can share in the many benefits that accrue from military service, including protective effects on mental health in later life. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Hyun-Jun Kim
- Goldsen Institute, School of Social Work, University of Washington
| | - Austin G Oswald
- Goldsen Institute, School of Social Work, University of Washington
| | - Christi Nelson
- Goldsen Institute, School of Social Work, University of Washington
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3
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Fredriksen-Goldsen KI, Jones BR, Hoy-Ellis C, Kim HJ, Emlet CA, La Fazia D, McKenzie G, Petros R, Teri L. Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA). Contemp Clin Trials Commun 2023; 35:101169. [PMID: 37638227 PMCID: PMC10448412 DOI: 10.1016/j.conctc.2023.101169] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background Sexual and gender minority (SGM) older adults and their care partners, compared to the general population, face unique vulnerabilities that exacerbate living with dementia, including elevated disparities in comorbidities, social isolation, and structural inequities, such as discrimination and lack of access to supports. Methods This paper describes the virtual adaptation process of the first-ever randomized controlled clinical trial intervention, Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA), that was designed for SGM older adults living with dementia and their care partners and built upon the foundation of RDAD and NHAS. Results The virtual adaptation of IDEA was guided by the goals of accessibility, quality, ease of delivery, sustainability, and cultural relevance. The implementation required the development of a HIPPA-compliant online virtual platform, coach and participant virtual training, and modification of necessary intervention elements and materials, as needed. Based on the preliminary findings, the participants and intervention coaches responded well to the virtual adaptation of IDEA. When comparing to in-person delivery, the virtual delivery decreased attrition among both intervention participants and coaches. Discussion The virtual adaptation of the IDEA intervention resulted in preliminary, unexpected, yet potentially important benefits, including the ability to expand the reach of the intervention and decreased attrition. Virtual interventions are an emerging field for people living with dementia and their care partners and additional systematic research is needed to fully assess the benefits and limitations as well as to evaluate if specific subgroups are better served by differing delivery modalities.
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Affiliation(s)
| | - Brittany R. Jones
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Charles Hoy-Ellis
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Hyun-Jun Kim
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Charles A. Emlet
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - David La Fazia
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Glenise McKenzie
- Oregon Health & Sciences University, School of Nursing, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Ryan Petros
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Linda Teri
- University of Washington, School of Nursing, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
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Berridge C, Turner NR, Liu L, Fredriksen-Goldsen KI, Lyons KS, Demiris G, Kaye J, Lober WB. Preliminary Efficacy of Let's Talk Tech: Technology Use Planning for Dementia Care Dyads. Innov Aging 2023; 7:igad018. [PMID: 37123031 PMCID: PMC10132307 DOI: 10.1093/geroni/igad018] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Indexed: 03/06/2023] Open
Abstract
Background and Objective Care partners of people living with dementia require support to knowledgeably navigate decision making about how and when to use monitoring technologies for care purposes. We conducted a pilot study of a novel self-administered intervention, "Let's Talk Tech," for people living with mild dementia and their care partners. This paper presents preliminary efficacy findings of this intervention designed to educate and facilitate dyadic communication about a range of technologies used in dementia care and to document the preferences of the person living with dementia. It is the first-of-its-kind decision-making and planning tool with a specific focus on technology use. Research Design and Methods We used a 1-group pretest-post-test design and paired t tests to assess change over 2 time periods in measures of technology comprehension, care partner knowledge of the participant living with mild Alzheimer's disease's (AD) preferences, care partner preparedness to make decisions about technology use, and mutual understanding. Thematic analysis was conducted on postintervention interview transcripts to elucidate mechanisms and experiences with Let's Talk Tech. Results Twenty-nine mild AD dementia care dyads who live together completed the study. There was statistically significant improvement with medium and large effect sizes on outcome measures of care partners' understanding of each technology, care partners' perceptions of the person living with dementia's understanding of each technology, knowledge of the person living with dementia's preferences, decision-making preparedness, and care partners' feelings of mutual understanding. Participants reported that it helped them have important and meaningful conversations about using technology. Discussion and Implications Let's Talk Tech demonstrated promising preliminary efficacy on targeted measures that can lead to informed, shared decision making about technologies used in dementia care. Future studies should assess efficacy with larger samples and more diverse sample populations in terms of race, ethnicity, and dementia type.
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Affiliation(s)
- Clara Berridge
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Natalie R Turner
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Liu Liu
- College of Education, University of Washington, Seattle, Washington, USA
| | | | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts, USA
| | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey Kaye
- Layton Aging and Alzheimer’s Disease Center and Oregon Center for Aging and Technology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - William B Lober
- Clinical Informatics Research Group, School of Nursing, University of Washington, Seattle, Washington, USA
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Hoy-Ellis CP, Fredriksen-Goldsen KI, Kim HJ. Utilization of Recommended Preventive Health Screenings Between Transgender and Cisgender Older Adults in Sexual and Gender Minority Communities. J Aging Health 2022; 34:844-857. [PMID: 35112914 PMCID: PMC9706779 DOI: 10.1177/08982643211068557] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ObjectivesTransgender older adults are among the most health disparate populations in the United States; they also face some of the most significant barriers in accessing high quality, affordable, preventive healthcare services. We compare utilization rates of eight recommended preventive health screenings for adults aged 50 and older, by gender identity. Methods: We analyzed data from 2514 lesbian, gay, bisexual, and transgender adults aged 50 and older, testing associations between gender identities and screening service utilizations by applying a series of multivariate logistic regression analyses, controlling for sociodemographics. Results: Compared to cisgender LGB participants, transgender participants had significantly lower odds to have met four of the recommended screenings. Transgender men had significantly lower odds than transgender women to have met two of the recommended screenings. Discussion: Increasing transgender older adults' access to preventative health screening tests is critical to reduce the health burden in this aging population.
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Di Lorito C, Bosco A, Peel E, Hinchliff S, Dening T, Calasanti T, de Vries B, Cutler N, Fredriksen-Goldsen KI, Harwood RH. Are dementia services and support organisations meeting the needs of Lesbian, Gay, Bisexual and Transgender (LGBT) caregivers of LGBT people living with dementia? A scoping review of the literature. Aging Ment Health 2022; 26:1912-1921. [PMID: 34842010 DOI: 10.1080/13607863.2021.2008870] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES More than 60% of people with dementia live at home, where assistance is usually provided by informal caregivers. Research on the experiences of the Lesbian, Gay, Bisexual and Transgender (LGBT) caregivers is limited. This scoping review of the literature synthesizes international evidence on support provision for the population of LGBT caregivers. METHODS Eight electronic databases and Google Scholar were searched using terms including 'Dementia', 'LGBT' and 'Caregiver' for all types of articles, including empirical studies, grey literature and sources from charity/third sector/lobbying organisations. Article selection was performed by two raters. Data were analysed through deductive thematic analysis, and three themes were established a priori: Distinct experiences of LGBT caregivers; current barriers to support; strategies to overcome the current challenges. RESULTS Twenty articles were included. Distinct experiences of LGBT caregivers included a loss of LGBT identity, the impact of historical events, families of choice, and disclosing LGBT identities. Current barriers to support included poor representation of LGBT caregivers in support services, negative attitudes of staff and reluctance of caregivers to seek support. Strategies to overcome the current challenges included staff awareness training and kite-marking inclusion. CONCLUSION Limited cultural competency of staff and a subsequent reluctance to seek help have an impact on use of support services among LGBT caregivers. Implications for practice include the development of cost-effective, feasible, and acceptable inclusiveness training for services. Implications for policy include implementation in organisations of top-down agendas supporting staff to understand sexuality and non-heteronormative relationships in older age.
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Affiliation(s)
| | - Alessandro Bosco
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Elizabeth Peel
- School of Social Sciences and Humanities, Loughborough University, Loughborough, UK
| | | | - Tom Dening
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Toni Calasanti
- Department of Sociology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Brian de Vries
- School of Social Work, Center for Research and Education on Gender and Sexuality, School of Social Work, San Francisco State University, San Francisco, CA, USA
| | | | | | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Fredriksen-Goldsen KI, Jung H, Kim HJ, Petros R, Emlet C. Disparities in Subjective Cognitive Impairment by Sexual Orientation and Gender in a National Population Based Study of U.S. Adults, 2013-2018. J Aging Health 2022; 34:519-528. [PMID: 34645296 PMCID: PMC10484229 DOI: 10.1177/08982643211046466] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: This is the first national population-based study to examine cognitive impairment disparities among sexual minority mid-life and older adults. Methods: Using the National Health Interview Survey (2013-2018), we compared weighted prevalence of subjective cognitive impairment by sexual orientation and gender, among those aged 45 plus, applying logistic regressions adjusting for age, income, education, race/ethnicity, and survey years. Results: Sexual minorities (24.5%) were more likely to have subjective cognitive impairment than heterosexuals (19.1%). Sexual minority women had higher odds of greater severity, frequency, and extent of subjective cognitive impairment. Sexual minorities were also more likely to report activity limitations resulting from cognitive impairment and were no more likely to attribute limitations to dementia or senility. Discussion: Cognitive health disparities are of particular concern in this historically and socially marginalized population. The investigation of explanatory factors is needed, and targeted interventions and policies are warranted to address cognitive challenges faced by sexual minorities.
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Affiliation(s)
| | - Hailey Jung
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Ryan Petros
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Charles Emlet
- School of Social Work, University of Washington, Seattle, WA, USA
- University of Washington, Tacoma, WA, USA
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8
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Kittle KR, Boerner K, Kim K, Fredriksen-Goldsen KI. Social Resource Variations Among LGBT Middle-Aged and Older Adults: The Intersections of Sociodemographic Characteristics. Gerontologist 2022; 62:1324-1335. [PMID: 35106592 PMCID: PMC9579464 DOI: 10.1093/geront/gnac021] [Citation(s) in RCA: 2] [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] [Received: 09/02/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Understanding the influence of social resources on health is crucial in gerontological research. However, access to social resources may differ by one's particular lesbian, gay, bisexual, and transgender (LGBT) identity and the intersection of LGBT identity with other sociodemographic characteristics, including age. RESEARCH DESIGN AND METHODS Using 2010 data from Caring and Aging With Pride (N = 2,536), this study examined how access to social resources varied by LGBT identity and whether the effect of LGBT identity was modified by additional sociodemographic characteristics among LGBT adults aged 50-95 years. RESULTS Lesbian respondents had larger social networks than gay male respondents, and gay male respondents had smaller networks than transgender respondents. Lesbian respondents reported more social support and community belonging than other identity groups. Bisexual male respondents and transgender respondents had less support than gay male respondents, and bisexual male respondents reported less community belonging than gay male respondents. Age and education moderated the association between LGBT identity and social support. DISCUSSION AND IMPLICATIONS This study demonstrated differences in access to social resources according to environmental circumstances that can intersect and govern access to social resources. Findings highlight the importance of considering social support separately from social network size; thus, large social networks do not necessarily provide ample social support. LGBT older adults had different perceptions of social support than their middle-aged counterparts. Health and human service professionals should not only consider the sexual and gender identity of their LGBT clients, but also education and age when assessing access to social resources.
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Affiliation(s)
- Krystal R Kittle
- Address correspondence to: Krystal R. Kittle, PhD, Department of Environmental and Occupational Health, Social & Behavioral Health Program, School of Public Health, University of Nevada, Las Vegas, 4700 S. Maryland Parkway, Suite #335, Las Vegas, NV 89119, USA. E-mail:
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Kyungmin Kim
- Department of Child Development and Family Studies, Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
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9
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Lyons A, Alba B, Waling A, Minichiello V, Hughes M, Fredriksen-Goldsen KI, Edmonds S, Blanchard M, Irlam C. Volunteering among Older Lesbian and Gay Adults: Associations with Mental, Physical and Social Well-Being. J Aging Health 2020; 33:3-13. [PMID: 32857633 DOI: 10.1177/0898264320952910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/12/2022]
Abstract
Objectives: Volunteering is associated with positive well-being among older people, providing opportunities to stay active and socially connected. This may be especially relevant for older lesbian and gay people, who are less likely than heterosexual people to have a partner, children or support from their family of origin. Methods: Patterns of volunteering and mental, physical and social well-being were examined in a sample of 754 lesbian and gay adults in Australia aged 60 years and older who completed a nationwide survey. Results: Volunteers reported greater positive mental health than non-volunteers. Among the gay men, volunteers additionally reported higher self-rated health and social support and lower psychological distress. Both the lesbian women and gay men who volunteered for lesbian, gay, bisexual, transgender or intersex (LGBTI) organisations also reported greater LGBTI community connectedness than volunteers for non-LGBTI organisations. Discussion: These findings provide further insight into potential factors associated with the well-being of older lesbian and gay adults.
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Affiliation(s)
- Anthony Lyons
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, 2080La Trobe University, Australia
| | - Beatrice Alba
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, 2080La Trobe University, Australia.,School of Psychology, 2104Deakin University, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, 2080La Trobe University, Australia
| | - Victor Minichiello
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, 2080La Trobe University, Australia.,School of Justice, Faculty of Law, 1969Queensland University of Technology, Australia
| | - Mark Hughes
- School of Arts and Social Sciences, 4571Southern Cross University, Australia
| | | | | | - Michelle Blanchard
- 104504SANE Australia, Australia.,Anne Deveson Research Centre, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Australia
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10
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Abstract
Objective: This study examines whether disparities exist in poor health and depressive symptomatology among older gay/bisexual men (50+) with (n = 371) and without (n = 973) HIV. If so, what risk/promoting factors account for those disparities? Method: These cross-sectional analyses used 2014 data from the Aging With Pride: National Health, Aging, and Sexuality/Gender Study. Results: Those with HIV reported poorer health and more depressive symptomatology accounted for by lower income, resilience and social support, and more lifetime victimization. Poorer health among those with HIV was associated with more chronic conditions. Higher depressive symptomatology was associated with diagnosed anxiety and drug addiction. Community engagement reduced disparities in poor health and depression. Implications: Older gay/bisexual men living with HIV infection are at greater risk for physical and mental health issues. Assessments should be conducted with attention to these risk factors. Interventions for improving social support, resilience, and community engagement are warranted.
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Troisi R, Palmer JR, Hatch EE, Strohsnitter WC, Huo D, Hyer M, Fredriksen-Goldsen KI, Hoover R, Titus L. Gender Identity and Sexual Orientation Identity in Women and Men Prenatally Exposed to Diethylstilbestrol. Arch Sex Behav 2020; 49:447-454. [PMID: 31975033 PMCID: PMC7031187 DOI: 10.1007/s10508-020-01637-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 05/09/2023]
Abstract
We assessed the associations of prenatal diethylstilbestrol (DES) exposure, a potent estrogen, with sexual orientation and gender identity in 3306 women and 1848 men who participated in a study of prenatal DES exposure. Odds ratios (OR) and 95% confidence intervals (CI) were derived from logistic regression models adjusted for birth year, study cohort, and education. Among women, the OR for DES in relation to reporting sexual orientation identity as nonheterosexual was 0.61 (95% CI 0.40-0.92) primarily due to a strong inverse association with a lesbian identity (OR 0.44, 95% CI 0.25-0.76). Among men, the OR for DES in relation to reporting a nonheterosexual sexual orientation identity was 1.4 (95% CI 0.82-2.4), and ORs were similar for having a gay identity (1.4, 95% CI 0.72-2.85) and bisexual identity (1.4, 95% CI 0.57-3.5). Only five individuals reported a gender identity not conforming to that assigned at birth, preventing meaningful analysis. Women who were prenatally exposed to DES were less likely to have a lesbian or bisexual orientation, while DES-exposed men were somewhat more likely to report being gay or bisexual, but estimates were imprecise.
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Affiliation(s)
- Rebecca Troisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, USA.
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - William C Strohsnitter
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | | | | | - Robert Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Linda Titus
- Departments of Epidemiology and Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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12
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Fredriksen-Goldsen KI, Kim HJ. The Science of Conducting Research With LGBT Older Adults- An Introduction to Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). Gerontologist 2018; 57:S1-S14. [PMID: 28087791 DOI: 10.1093/geront/gnw212] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
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13
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Affiliation(s)
- V Fabbre
- Washington University in St. Louis, St. Louis, Missouri, United States
| | - S Jen
- University of Washington, Seattle, Washington, USA
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14
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Foglia MB, Fredriksen-Goldsen KI. Health Disparities among LGBT Older Adults and the Role of Nonconscious Bias. Hastings Cent Rep 2018; 44 Suppl 4:S40-4. [PMID: 25231786 DOI: 10.1002/hast.369] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper describes the significance of key empirical findings from the recent and landmark study Caring and Aging with Pride: The National Health, Aging and Sexuality Study (with Karen I. Fredriksen-Goldsen as the principal investigator), on lesbian, gay, bisexual, and transgender aging and health disparities. We will illustrate these findings with select quotations from study participants and show how nonconscious bias (i.e., activation of negative stereotypes outside conscious awareness) in the clinical encounter and health care setting can threaten shared decision-making and perpetuate health disparities among LGBT older adults. We recognize that clinical ethicists are not immune from nonconscious bias but maintain that they are well situated to recognize bias and resulting injustice by virtue of their training. Further, we discuss how clinical ethicists can influence the organization's ethical culture and environment to improve the quality and acceptability of health care for LGBT older adults.
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Lee S, Fredriksen-Goldsen KI, McClain C, Kim HJ, Suzer-Gurtekin ZT. Are Sexual Minorities Less Likely to Participate in Surveys? An Examination of Proxy Nonresponse Measures and Associated Biases with Sexual Orientation in a Population-Based Health Survey. Field methods 2018; 30:208-224. [PMID: 31105471 PMCID: PMC6519959 DOI: 10.1177/1525822x18777736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
One of the implicit assumptions in survey research is lower response rates by sexual minorities than non-minorities. With rapidly changing public attitudes towards same-sex marriage, we reconsider this assumption. We used data from the 2013 and 2014 National Health Interview Survey (NHIS) that include contact history data for all sample families (n=117,589) as well as sexual orientation information about adults sampled from responding families (n=71,110). We created proxy nonresponse indicators based on contact efforts and reluctance from contact history data and linked them to sexual orientation of the sample adult and simulated nonresponse. The data did not support the assumption: straight adults were more difficult to get cooperation from than non-straights. With female sexual minorities showing higher nonresponse than the male counterpart, special considerations are required. Replication analyses may provide insights into what factors influence study participation decisions, which will inform how nonresponse may impact the accuracy of research findings.
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Affiliation(s)
- Sunghee Lee
- Institute for Social Research, University of Michigan, Ann
Arbor, MI, USA
| | | | - Colleen McClain
- Institute for Social Research, University of Michigan, Ann
Arbor, MI, USA
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle,
WA, USA
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16
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Fredriksen-Goldsen KI, Jen S, Bryan AEB, Goldsen J. Cognitive Impairment, Alzheimer's Disease, and Other Dementias in the Lives of Lesbian, Gay, Bisexual and Transgender (LGBT) Older Adults and Their Caregivers: Needs and Competencies. J Appl Gerontol 2018; 37:545-569. [PMID: 27729400 PMCID: PMC5383534 DOI: 10.1177/0733464816672047] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [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] [Indexed: 12/29/2022] Open
Abstract
Cognitive impairment, Alzheimer's disease, and other dementias are important health concerns for older adults. As a marginalized and growing segment of the older adult population, lesbian, gay, bisexual, and transgender (LGBT) older adults face distinct risk factors related to cognitive impairment and dementias, including social isolation, discrimination, barriers to health care access, limited availability of and support for caregivers, and higher rates of certain chronic illnesses. We examine cognitive impairment and dementias among LGBT older adults, describe their unique risk factors, and outline key competencies for health care and human service providers to ensure culturally relevant care for LGBT older adults experiencing cognitive impairment, Alzheimer's disease, or other dementias, as well as their caregivers, families, and communities. Implications include developing an awareness of the context of LGBT older adults' lives and relationships, the importance of early detection and support, and the development of policies and practices that promote community-level advocacy and education.
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Affiliation(s)
| | - Sarah Jen
- University of Washington, Seattle, USA
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Muraco A, Putney J, Shiu C, Fredriksen-Goldsen KI. Lifesaving in Every Way: The Role of Companion Animals in the Lives of Older Lesbian, Gay, Bisexual, and Transgender Adults Age 50 and Over. Res Aging 2018; 40:859-882. [PMID: 29357737 DOI: 10.1177/0164027517752149] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 12/29/2022]
Abstract
This study uses mixed-methods data and a life-course perspective to explore the role of pets in the lives of lesbian, gay, bisexual, and transgender (LGBT) adults age 50 and over and addresses the following research questions: (1) How does having a pet relate to perceived social support and social network size? and (2) how do LGBT older adults describe the meaning of pets in their lives? The qualitative data ( N = 59) were collected from face-to-face interviews, and the quantitative data ( N = 2,560) were collected via surveys from a sample across the United States. Qualitative findings show that pets are characterized as kin and companions and provide support; we also explore why participants do not have pets. The quantitative findings show that LGBT older adults with a pet had higher perceived social support; those with a disability and limited social network size, who had a pet had significantly higher perceived social support than those without a pet.
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Affiliation(s)
- Anna Muraco
- 1 Department of Sociology, Loyola Marymount University, Los Angeles, CA, USA
| | | | - Chengshi Shiu
- 3 School of Social Work, University of Washington, Seattle, WA, USA
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Kim HJ, Fredriksen-Goldsen KI, Bryan AEB, Muraco A. Social Network Types and Mental Health Among LGBT Older Adults. Gerontologist 2017; 57:S84-S94. [PMID: 28087798 DOI: 10.1093/geront/gnw169] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 03/08/2016] [Accepted: 10/24/2016] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY This study was designed to identify social network types among lesbian, gay, bisexual, and transgender (LGBT) older adults and examine the relationship between social network type and mental health. DESIGN AND METHODS We analyzed the 2014 survey data of LGBT adults aged 50 and older (N = 2,450) from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. Latent profile analyses were conducted to identify clusters of social network ties based on 11 indicators. Multiple regression analysis was performed to examine the association between social network types and mental health. RESULTS We found five social network types. Ordered from greatest to least access to family, friend, and other non-family network ties, they were diverse, diverse/no children, immediate family-focused, friend-centered/restricted, and fully restricted. The friend-centered/restricted (33%) and diverse/no children network types (31%) were the most prevalent. Among individuals with the friend-centered/restricted type, access to social networks was limited to friends, and across both types children were not present. The least prevalent type was the fully restricted network type (6%). Social network type was significantly associated with mental health, after controlling for background characteristics and total social network size; those with the fully restricted type showed the poorest mental health. IMPLICATIONS Unique social network types (diverse/no children and friend-centered/restricted) emerge among LGBT older adults. Moreover, individuals with fully restricted social networks are at particular risk due to heightened health needs and limited social resources. This study highlights the importance of understanding heterogeneous social relations and developing tailored interventions to promote social connectedness and mental health in LGBT older adults.
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Affiliation(s)
- Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle.
| | | | | | - Anna Muraco
- Department of Sociology, Loyola Marymount University, Los Angeles, California
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Hoy-Ellis CP, Shiu C, Sullivan KM, Kim HJ, Sturges AM, Fredriksen-Goldsen KI. Prior Military Service, Identity Stigma, and Mental Health Among Transgender Older Adults. Gerontologist 2017; 57:S63-S71. [PMID: 28087796 DOI: 10.1093/geront/gnw173] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 06/08/2016] [Accepted: 10/21/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Converging evidence from large community-based samples, Internet studies, and Veterans Health Administration data suggest that transgender adults have high rates of U.S. military service. However, little is known about the role of prior military service in their mental health later in life, particularly in relation to identity stigma. In this article, we examine relationships between prior military service, identity stigma, and mental health among transgender older adults. DESIGN AND METHODS We used a subsample of transgender older adults (n = 183) from the 2014 survey of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). We employed weighted multivariate linear models to evaluate the relationships between psychological health-related quality of life (HRQOL), depressive symptomatology (Center for Epidemiological Studies Depression Scale [CES-D] scores), identity stigma, and prior military service, controlling for background characteristics. RESULTS Identity stigma was significantly related with higher depressive symptomatology and lower psychological HRQOL. Having a history of prior military service significantly predicted lower depressive symptomatology and higher psychological HRQOL. The relationships between psychological HRQOL, identity stigma, and prior military service were largely explained by depressive symptomatology. Prior military service significantly attenuated the relationship between identity stigma and depressive symptomatology. IMPLICATIONS By identifying the role of military service in the mental health of transgender older adults, this study provides insights into how prior military service may contribute to resilience and positive mental health outcomes. Directions for future research are discussed.
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Affiliation(s)
| | - Chengshi Shiu
- School of Social Work, University of Washington, Seattle
| | | | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
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Fredriksen-Goldsen KI, Bryan AEB, Jen S, Goldsen J, Kim HJ, Muraco A. The Unfolding of LGBT Lives: Key Events Associated With Health and Well-being in Later Life. Gerontologist 2017; 57:S15-S29. [PMID: 28087792 DOI: 10.1093/geront/gnw185] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 06/17/2016] [Accepted: 12/22/2016] [Indexed: 01/06/2023] Open
Abstract
PURPOSE OF THE STUDY Life events are associated with the health and well-being of older adults. Using the Health Equity Promotion Model, this article explores historical and environmental context as it frames life experiences and adaptation of lesbian, gay, bisexual, and transgender (LGBT) older adults. DESIGN AND METHODS This was the largest study to date of LGBT older adults to identify life events related to identity development, work, and kin relationships and their associations with health and quality of life (QOL). Using latent profile analysis (LPA), clusters of life events were identified and associations between life event clusters were tested. RESULTS On average, LGBT older adults first disclosed their identities in their 20s; many experienced job-related discrimination. More had been in opposite-sex marriage than in same-sex marriage. Four clusters emerged: "Retired Survivors" were the oldest and one of the most prevalent groups; "Midlife Bloomers" first disclosed their LGBT identities in mid-40s, on average; "Beleaguered At-Risk" had high rates of job-related discrimination and few social resources; and "Visibly Resourced" had a high degree of identity visibility and were socially and economically advantaged. Clusters differed significantly in mental and physical health and QOL, with the Visibly Resourced faring best and Beleaguered At-Risk faring worst on most indicators; Retired Survivors and Midlife Bloomers showed similar health and QOL. IMPLICATIONS Historical and environmental contexts frame normative and non-normative life events. Future research will benefit from the use of longitudinal data and an assessment of timing and sequencing of key life events in the lives of LGBT older adults.
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Affiliation(s)
| | | | - Sarah Jen
- School of Social Work, University of Washington, Seattle
| | - Jayn Goldsen
- School of Social Work, University of Washington, Seattle
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
| | - Anna Muraco
- Department of Sociology, Loyola Marymount University, Los Angeles, California
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Bryan AEB, Kim HJ, Fredriksen-Goldsen KI. Factors Associated With High-Risk Alcohol Consumption Among LGB Older Adults: The Roles of Gender, Social Support, Perceived Stress, Discrimination, and Stigma. Gerontologist 2017; 57:S95-S104. [PMID: 28087799 DOI: 10.1093/geront/gnw100] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 03/08/2016] [Accepted: 10/31/2016] [Indexed: 01/09/2023] Open
Abstract
PURPOSE OF THE STUDY Lesbian, gay, and bisexual (LGB) adults have elevated rates of high-risk alcohol consumption compared with heterosexual adults. Although drinking tends to decline with age in the general population, we know little about LGB older adults' drinking. Using 2014 data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), we aimed to identify factors associated with high-risk drinking in LGB older adults. DESIGN AND METHODS A U.S. sample of 2,351 LGB adults aged 50-98 years completed a survey about personal and social experiences, substance use, and health. Multinomial logistic regression was conducted to identify predictors of past-month high-risk alcohol consumption. RESULTS Approximately one fifth (20.6%) of LGB older adults reported high-risk drinking, with nonsignificantly different rates between men (22.4%) and women (18.4%). For women, current smoking and greater social support were associated with greater likelihood of high-risk drinking; older age, higher income, recovery from addiction, and greater perceived stress were associated with lower likelihood. For men, higher income, current smoking, and greater day-to-day discrimination were associated with greater likelihood of high-risk drinking; transgender identity and recovery from addiction were associated with lower likelihood. IMPLICATIONS Social contexts and perceived drinking norms may encourage higher levels of alcohol consumption in LGB older women, whereas men's drinking may be linked with discrimination-related stress. Prevention and intervention with this population should take into account gender differences and sexual minority-specific risk factors. With future waves of data, we will be able to examine LGB older adults' drinking trajectories over time.
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Affiliation(s)
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
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Kim HJ, Jen S, Fredriksen-Goldsen KI. Race/Ethnicity and Health-Related Quality of Life Among LGBT Older Adults. Gerontologist 2017; 57:S30-S39. [PMID: 28087793 DOI: 10.1093/geront/gnw172] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [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: 04/08/2016] [Accepted: 10/24/2016] [Indexed: 01/09/2023] Open
Abstract
PURPOSE OF THE STUDY Few existing studies have addressed racial/ethnic differences in the health and quality of life of lesbian, gay, bisexual, and transgender (LGBT) older adults. Guided by the Health Equity Promotion Model, this study examines health-promoting and health risk factors that contribute to racial/ethnic health disparities among LGBT adults aged 50 and older. DESIGN AND METHODS We utilized weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. By applying multiple mediator models, we analyzed the indirect effects of race/ethnicity on health-related quality of life (HRQOL) via demographics, lifetime LGBT-related discrimination, and victimization, and socioeconomic, identity-related, spiritual, and social resources. RESULTS Although African Americans and Hispanics, compared with non-Hispanic Whites, reported lower physical HRQOL and comparable psychological HRQOL, indirect pathways between race/ethnicity and HRQOL were observed. African Americans and Hispanics had lower income, educational attainment, identity affirmation, and social support, which were associated with a decrease in physical and psychological HRQOL. African Americans had higher lifetime LGBT-related discrimination, which was linked to a decrease in their physical and psychological HRQOL. African Americans and Hispanics had higher spirituality, which was associated with an increase in psychological HRQOL. IMPLICATIONS Findings illustrate the importance of identifying both health-promoting and health risk factors to understand ways to maximize the health potential of racially and ethnically diverse LGBT older adults. Interventions aimed at health equity should be tailored to bolster identity affirmation and social networks of LGBT older adults of color and to support strengths, including spiritual resources.
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Affiliation(s)
- Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle.
| | - Sarah Jen
- School of Social Work, University of Washington, Seattle
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Goldsen J, Bryan AEB, Kim HJ, Muraco A, Jen S, Fredriksen-Goldsen KI. Who Says I Do: The Changing Context of Marriage and Health and Quality of Life for LGBT Older Adults. Gerontologist 2017; 57:S50-S62. [PMID: 28087795 DOI: 10.1093/geront/gnw174] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 06/08/2016] [Accepted: 11/04/2016] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY Until recently, lesbian, gay, bisexual, and transgender (LGBT) adults were excluded from full participation in civil marriage. The purpose of this study is to examine how legal marriage and relationship status are associated with health-promoting and at-risk factors, health, and quality of life of LGBT adults aged 50 and older. DESIGN AND METHODS We utilized weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) participants who resided in states with legalized same-sex marriage in 2014 (N = 1,821). Multinomial logistic regression was conducted to examine differences by relationship status (legally married, unmarried partnered, single) in economic and social resources; LGBT contextual and identity factors; health; and quality of life. RESULTS We found 24% were legally married, and 26% unmarried partnered; one-half were single. Those legally married reported better quality of life and more economic and social resources than unmarried partnered; physical health indicators were similar between legally married and unmarried partnered. Those single reported poorer health and fewer resources than legally married and unmarried partnered. Among women, being legally married was associated with more LGBT microaggressions. IMPLICATIONS LGBT older adults, and practitioners serving them, should become educated about how legal same-sex marriage interfaces with the context of LGBT older adults' lives, and policies and protections related to age and sexual and gender identity. Longitudinal research is needed to understand factors contributing to decisions to marry, including short- and long-term economic, social, and health outcomes associated with legal marriage among LGBT older adults.
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Affiliation(s)
- Jayn Goldsen
- School of Social Work, University of Washington, Seattle.
| | | | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
| | - Anna Muraco
- Department of Sociology, Loyola Marymount University, Los Angeles, CA
| | - Sarah Jen
- School of Social Work, University of Washington, Seattle
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Fredriksen-Goldsen KI, Kim HJ, McKenzie GL, Krinsky L, Emlet CA. Plan of Action for Real-World Translation of LGBTQ Health and Aging Research. LGBT Health 2017; 4:384-388. [PMID: 29099666 DOI: 10.1089/lgbt.2017.0185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 01/01/2023] Open
Abstract
Despite accumulating evidence of health disparities, there exists limited translational research to enhance optimal health and aging of lesbian, gay, bisexual, transgender, and queer-identified * (LGBTQ) older adults. Based on the Health Equity Promotion Model that addresses the distinct needs and strengths of LGBTQ older adults, we underscore the important role of collaborations among researchers, practitioners, and communities to build community capacity. Given the rapidly shifting context, we advance principles to guide future work that will enhance translational research and the development of evidence-based practice so that LGBTQ older adults can reach their full health potential.
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Affiliation(s)
| | - Hyun-Jun Kim
- 1 School of Social Work, University of Washington , Seattle, Washington
| | - Glenise L McKenzie
- 2 School of Nursing Portland Campus, Oregon Health & Science University , Portland, Oregon
| | - Lisa Krinsky
- 3 LGBT Aging Project, The Fenway Institute , Boston, Massachusetts
| | - Charles A Emlet
- 4 School of Social Work, University of Washington , Tacoma, Washington
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Emlet CA, Fredriksen-Goldsen KI, Kim HJ, Hoy-Ellis C. The Relationship Between Sexual Minority Stigma and Sexual Health Risk Behaviors Among HIV-Positive Older Gay and Bisexual Men. J Appl Gerontol 2017; 36:931-952. [PMID: 26100507 PMCID: PMC4704987 DOI: 10.1177/0733464815591210] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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] [Indexed: 11/15/2022] Open
Abstract
This study investigates how internalized sexual minority stigma and enacted sexual minority stigma in health care settings are associated with sexual health risk behaviors (SRBs) and the mediating role of infrequent routine health care and perceived stress among older gay and bisexual (G/B) men living with HIV disease. Survey responses from 135 sexually active older G/B men living with HIV were analyzed using hierarchical linear regression models. Results indicate that one fifth of G/B older adult men living with HIV are engaged in multiple SRBs. Internalized sexual minority stigma and enacted sexual minority stigma in health care settings are significantly associated with SRBs. The relationship between internalized sexual minority stigma and SRBs are mediated by infrequent routine health care and elevated levels of perceived stress. Improved primary and secondary prevention strategies are needed for the growing number of sexually active older G/B men.
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Emlet CA, Fredriksen-Goldsen KI, Kim HJ, Hoy-Ellis C. The Relationship Between Sexual Minority Stigma and Sexual Health Risk Behaviors Among HIV-Positive Older Gay and Bisexual Men. J Appl Gerontol 2017. [PMID: 26100507 DOI: 10.1177/073346481559120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
This study investigates how internalized sexual minority stigma and enacted sexual minority stigma in health care settings are associated with sexual health risk behaviors (SRBs) and the mediating role of infrequent routine health care and perceived stress among older gay and bisexual (G/B) men living with HIV disease. Survey responses from 135 sexually active older G/B men living with HIV were analyzed using hierarchical linear regression models. Results indicate that one fifth of G/B older adult men living with HIV are engaged in multiple SRBs. Internalized sexual minority stigma and enacted sexual minority stigma in health care settings are significantly associated with SRBs. The relationship between internalized sexual minority stigma and SRBs are mediated by infrequent routine health care and elevated levels of perceived stress. Improved primary and secondary prevention strategies are needed for the growing number of sexually active older G/B men.
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Affiliation(s)
| | | | - Hun-Jun Kim
- 2 University of Washington, Seattle, WA, USA
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Fredriksen-Goldsen KI, Kim HJ, Shui C, Bryan AEB. Chronic Health Conditions and Key Health Indicators Among Lesbian, Gay, and Bisexual Older US Adults, 2013-2014. Am J Public Health 2017; 107:1332-1338. [PMID: 28700299 DOI: 10.2105/ajph.2017.303922] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To examine disparities in chronic conditions and health indicators among lesbian, gay, and bisexual (LGB) adults aged 50 years or older in the United States. METHODS We used data from the 2013 and 2014 National Health Interview Survey to compare disparities in chronic conditions, health outcomes and behaviors, health care access, and preventive health care by sexual orientation and gender. RESULTS LGB older adults were significantly more likely than heterosexual older adults to have a weakened immune system and low back or neck pain. In addition, sexual minority older women were more likely than their heterosexual counterparts to report having arthritis, asthma, a heart attack, a stroke, a higher number of chronic conditions, and poor general health. Sexual minority older men were more likely to report having angina pectoris or cancer. Rates of disability and mental distress were higher among LGB older adults. CONCLUSIONS At substantial cost to society, many disparities in chronic conditions, disability, and mental distress observed in younger LGB adults persist, whereas others, such as cardiovascular disease risks, present in later life. Interventions are needed to maximize LGB health.
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Affiliation(s)
| | - Hyun-Jun Kim
- All of the authors are with the School of Social Work, University of Washington, Seattle
| | - Chengshi Shui
- All of the authors are with the School of Social Work, University of Washington, Seattle
| | - Amanda E B Bryan
- All of the authors are with the School of Social Work, University of Washington, Seattle
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Abstract
This study aims to (a) examine the direct and indirect effects internalized heterosexism, disclosure of gender identity, and perceived general stress in association with depression among transgender older adults; and (b) to assess the relative contribution of each relationship. Secondary analyses of data from a large community-based study of older sexual and gender minorities were conducted utilizing structural equation modeling with a subsample (n = 174) of transgender adults aged 50 to 86-years old. Disclosure of gender identity had no significant direct or indirect effects on either perceived general stress or depression. Internalized heterosexism did not have a direct effect on depression, but did have a significant indirect effect through perceived general stress. Finally, perceived general stress had an additional significant direct effect on depression, over and above internalized heterosexism. Total effect sizes appear to be considerable with standardized betas greater than 5.0. Perceived general stress and internalized heterosexism independently and cumulatively have significant direct and indirect effects on depression among transgender older adults. Implications for depression among transgender older adults and the role of community psychology are discussed.
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Fredriksen-Goldsen KI, Shiu C, Bryan AEB, Goldsen J, Kim HJ. Health Equity and Aging of Bisexual Older Adults: Pathways of Risk and Resilience. J Gerontol B Psychol Sci Soc Sci 2017; 72:468-478. [PMID: 27815302 PMCID: PMC5927101 DOI: 10.1093/geronb/gbw120] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 01/25/2016] [Accepted: 08/29/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Bisexual older adults are a growing yet largely invisible, underserved, and understudied population. Utilizing the Health Equity Promotion Model, we examined hypothesized mechanisms accounting for health disparities between bisexual older adults and lesbian and gay older adults. METHOD Based on data from Caring and Aging with Pride, the largest national survey of LGBT older adults, this study (N = 2,463) utilized structural equation modeling to investigate direct and indirect associations between sexual identity (bisexual vs. lesbian and gay) and health via sexual identity factors (identity disclosure and internalized stigma), social resources, and socioeconomic status (SES). RESULTS Bisexual older adults reported significantly poorer health compared with lesbian and gay older adults. Indirect effects involving sexual identity factors, social resources, and SES explained the association between bisexual identity and poorer health. A potentially protective pathway was also identified wherein bisexuals had larger social networks after adjusting for other factors. DISCUSSION Bisexual older adults face distinct challenges and health risks relative to other older adults, likely because of the accumulation of socioeconomic and psychosocial disadvantages across the life course. Interventions taking into account older bisexuals' unique risk and protective factors may be helpful in reducing health inequities.
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Affiliation(s)
| | - Chengshi Shiu
- School of Social Work, University of Washington, Seattle
| | | | - Jayn Goldsen
- School of Social Work, University of Washington, Seattle
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
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Kim HJ, Acey K, Guess A, Jen S, Fredriksen-Goldsen KI. A Collaboration for Health and Wellness: GRIOT Circle and Caring and Aging with Pride. Generations 2017; 40:49-55. [PMID: 28435182 PMCID: PMC5396960] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite growing racial and ethnic diversity among lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults in the United States, LGBTQ older adults of color largely are invisible in aging services, research, and public policy. GRIOT Circle and Caring and Aging with Pride are pioneering efforts in community-based services and research. This article describes innovative and effective ways to reach and serve LGBTQ older adults of color, how research can be designed collaboratively to address strengths and disparities in social, health, and economic well-being, and barriers to accessing aging services in these populations.
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Affiliation(s)
- Hyun-Jun Kim
- Aging with Pride: National Health, Aging, Sexuality and Gender Study at the School of Social Work, University of Washington in Seattle
| | - Katherine Acey
- Barnard College Center for Research on Women. She is the former executive director of GRIOT Circle in Brooklyn, New York, and serves an advisor to the organization
| | | | - Sarah Jen
- Aging with Pride, and a doctoral student in the School of Social Work at the University of Washington
| | - Karen I Fredriksen-Goldsen
- Hartford Center of Excellence at the School of Social Work, University of Washington. She also is a principal investigator of Aging with Pride: National Health, Aging, Sexuality and Gender Study
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Fredriksen-Goldsen KI. The Future of LGBT+ Aging: A Blueprint for Action in Services, Policies, and Research. Generations 2017; 40:6-15. [PMID: 28366980 PMCID: PMC5375167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Karen I Fredriksen-Goldsen
- Hartford Center of Excellence at the University of Washington in Seattle, Washington. She leads the landmark study, Aging with Pride: National Health, Aging, Sexuality and Gender Study, the first federally funded longitudinal study of LGBT aging, health, and well-being
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Fredriksen-Goldsen KI, Kim HJ, Bryan AEB, Shiu C, Emlet CA. The Cascading Effects of Marginalization and Pathways of Resilience in Attaining Good Health Among LGBT Older Adults. Gerontologist 2017; 57:S72-S83. [PMID: 28087797 PMCID: PMC5241752 DOI: 10.1093/geront/gnw170] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [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: 03/08/2016] [Accepted: 08/08/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE OF THE STUDY Lesbian, gay, bisexual, and transgender (LGBT) older adults comprise a diverse and growing health disparate population. In the present study, using the Health Equity Promotion Model, we investigated pathways by which LGBT older adults experience resilience, risk, and marginalization and their relationship to attaining positive health outcomes. DESIGN AND METHODS Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) is the first longitudinal research project designed to examine the health, aging, and well-being of LGBT adults aged 50 and older. Using data from 2014 (N = 2,415), we tested a structural equation model linking lifetime marginalization, identity affirmation and management, social and psychological resources, and health behaviors to positive health outcomes. RESULTS Identity affirmation positively predicted social resources and mental health, and social resources positively predicted mental health. Marginalization was associated with fewer social resources for LGBT older adults with an open identity management style, lower identity affirmation for LGBT older adults who strategically concealed their sexual identity, and poorer mental health. Mental health was associated with better health behaviors, which in turn predicted positive physical health outcomes. IMPLICATIONS Although a health disparate population, good health among LGBT older adults appears to be attained via multiple resilience and risk pathways. Providers must remain aware of the historical contexts in which LGBT older adults lived and the strengths they developed in order to understand their health and to develop tailored and targeted prevention and intervention services.
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Affiliation(s)
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
| | | | - Chengshi Shiu
- School of Social Work, University of Washington, Seattle
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Abstract
Historical, environmental, and cultural contexts intersect with aging, sexuality, and gender across communities and generations. My scholarship investigates health and well-being over the life course across marginalized communities, including LGBTQ (lesbian, gay, bisexual, transgender, and queer) midlife and older adults, native communities experiencing cardiovascular risk, and families in China living with HIV, in order to balance the realities of unique lives in contemporary society. By probing the intersection of age, sexuality, and gender, my analysis is informed by both personal and professional experiences. With the death of my partner occurring at a time of profound invisibility and silence before HIV/AIDS, I found my life out of sync, experiencing a loss without a name. My life was thrust into a paradox: My relationship was defined by a world that refused to recognize it. This essay provides an opportunity for me to weave together how such critical turning points in my own life helped shape my approach to gerontology and how gerontology has informed my work and life. Reflecting on this journey, I illustrate the ways in which historical, structural, environmental, psychosocial, and biological factors affect equity, and the health-promoting and adverse pathways to health and well-being across marginalized communities. Although gerontology as a discipline has historically silenced the lives of marginalized older adults, it has much to learn from these communities. The growing and increasingly diverse older adult population provides us with unique opportunities to better understand both cultural variations and shared experiences in aging over the life course.
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Emlet CA, Fredriksen-Goldsen KI. Green light given to more research on health disparities in LGBT elders. Aging Today 2017; 38:13. [PMID: 29129965 PMCID: PMC5679411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Charles A Emlet
- Charles A. Emlet, Ph.D., M.S.W., A.C.S.W., is a professor of social work at the University of Washington Tacoma, and co-investigator on the Aging with Pride: National Health, Aging, Sexuality and Gender study. Karen I. Fredriksen-Goldsen, Ph.D., is professor and director of Healthy Generations: Hartford Center of Excellence at the University of Washington in Seattle. She leads the Aging with Pride: National Health, Aging, Sexuality and Gender study
| | - Karen I Fredriksen-Goldsen
- Charles A. Emlet, Ph.D., M.S.W., A.C.S.W., is a professor of social work at the University of Washington Tacoma, and co-investigator on the Aging with Pride: National Health, Aging, Sexuality and Gender study. Karen I. Fredriksen-Goldsen, Ph.D., is professor and director of Healthy Generations: Hartford Center of Excellence at the University of Washington in Seattle. She leads the Aging with Pride: National Health, Aging, Sexuality and Gender study
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Abstract
Little is known about how lesbians and gay men perceive the turning points that define their life trajectories. This study uses qualitative interview data to understand which experiences lesbian women and gay men age 50 and older identify as turning points and explore gender differences. In depth, face-to-face qualitative interviews were conducted with a subset of participants (n=33) from the Caring and Aging with Pride survey. The most common turning points identified were relationship and occupation related. Lesbians more frequently identified the break-up of a relationship and occupational and educational related experiences as turning points. Gay men more commonly indicated that the beginning of a relationship and HIV/AIDS related experiences were turning points. The turning points were analyzed according to principles of the life course theory and narrative analysis.
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Affiliation(s)
- Anna Muraco
- Loyola Marymount University, Department of Sociology Mailing address: One LMU Drive, Los Angeles, CA 90045
| | - Karen I Fredriksen-Goldsen
- University of Washington, School of Social Work Mailing address: 4101 15th Ave. NE, Box 354900, Seattle, WA 98105
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Hoy-Ellis CP, Fredriksen-Goldsen KI. Lesbian, gay, & bisexual older adults: linking internal minority stressors, chronic health conditions, and depression. Aging Ment Health 2016; 20:1119-1130. [PMID: 27050776 PMCID: PMC5053828 DOI: 10.1080/13607863.2016.1168362] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 01/30/2016] [Accepted: 03/15/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study aims to: (1) test whether the minority stressors disclosure of sexual orientation; and (2) internalized heterosexism are predictive of chronic physical health conditions; and (3) depression; (4) to test direct and indirect relationships between these variables; and (5) whether chronic physical health conditions are further predictive of depression, net of disclosure of sexual orientation and internalized heterosexism. METHODS Secondary analysis of national, community-based surveys of 2349 lesbian, gay, and bisexual adults aged 50 and older residing in the US utilizing structural equation modeling. RESULTS Congruent with minority stress theory, disclosure of sexual orientation is indirectly associated with chronic physical health conditions and depression, mediated by internalized heterosexism with a suppressor effect. Internalized heterosexism is directly associated with chronic physical health conditions and depression, and further indirectly associated with depression mediated by chronic physical health conditions. Finally, chronic physical health conditions have an additional direct relationship with depression, net of other predictor variables. CONCLUSION Minority stressors and chronic physical health conditions independently and collectively predict depression, possibly a synergistic effect. Implications for depression among older sexual minority adults are discussed.
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Kim HJ, Fredriksen-Goldsen KI. Disparities in Mental Health Quality of Life Between Hispanic and Non-Hispanic White LGB Midlife and Older Adults and the Influence of Lifetime Discrimination, Social Connectedness, Socioeconomic Status, and Perceived Stress. Res Aging 2016; 39:991-1012. [PMID: 27193047 DOI: 10.1177/0164027516650003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 11/16/2022]
Abstract
We assessed factors contributing to ethnic and racial disparities in mental health quality of life (MHQOL) among lesbian, gay, and bisexual (LGB) midlife and older adults. We utilized cross-sectional survey data from a sample of non-Hispanic White and Hispanic LGB adults aged 50 and older. Structural equation modeling was used to test the indirect effect of ethnicity/race on MHQOL via explanatory factors including social connectedness, lifetime discrimination, socioeconomic status (SES), and perceived stress. Hispanics reported significantly lower levels of MHQOL, compared to non-Hispanic Whites. In the final model, the association between ethnicity/race and MHQOL was explained by higher levels of perceived stress related to lower SES, higher frequency of lifetime discrimination, and lack of social connectedness among Hispanic LGB adults. This study suggests that perceived stress related to social disadvantage and marginalization plays an important role in MHQOL disparities among Hispanic LGB midlife and older adults.
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Affiliation(s)
- Hyun-Jun Kim
- 1 School of Social Work, University of Washington, Seattle, WA, USA
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Abstract
PURPOSE This study examines global social networks-including friendship, support, and acquaintance networks-of lesbian, gay, bisexual, and transgender (LGBT) older adults. DESIGN AND METHODS Utilizing data from a large community-based study, we employ multiple regression analyses to examine correlates of social network size and diversity. RESULTS Controlling for background characteristics, network size was positively associated with being female, transgender identity, employment, higher income, having a partner or a child, identity disclosure to a neighbor, engagement in religious activities, and service use. Controlling in addition for network size, network diversity was positively associated with younger age, being female, transgender identity, identity disclosure to a friend, religious activity, and service use. IMPLICATIONS According to social capital theory, social networks provide a vehicle for social resources that can be beneficial for successful aging and well-being. This study is a first step at understanding the correlates of social network size and diversity among LGBT older adults.
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Affiliation(s)
- Elena A Erosheva
- Department of Statistics and School of Social Work, University of Washington, Seattle, WA, USA
| | - Hyun-Jun Kim
- University of Washington, School of Social Work, Seattle, WA, USA
| | - Charles Emlet
- University of Washington, Tacoma, School of Social Work, Tacoma, WA, USA
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Fredriksen-Goldsen KI, Simoni JM, Kim HJ, Lehavot K, Walters KL, Yang J, Hoy-Ellis CP, Muraco A. The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. Am J Orthopsychiatry 2014; 84:653-63. [PMID: 25545433 DOI: 10.1037/ort0000030] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbian, gay, bisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the Health Equity Promotion Model-a framework oriented toward LGBT people reaching their full mental and physical health potential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered.
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Affiliation(s)
| | | | | | - Keren Lehavot
- MIRECC Postdoctoral Fellow, VA Puget Sound Health Care System
| | | | - Joyce Yang
- Department of Psychology, University of Washington
| | | | - Anna Muraco
- Department of Sociology, Loyola Marymount University
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Kim HJ, Fredriksen-Goldsen KI. Living Arrangement and Loneliness Among Lesbian, Gay, and Bisexual Older Adults. Gerontologist 2014; 56:548-58. [PMID: 25213482 DOI: 10.1093/geront/gnu083] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [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: 04/14/2014] [Accepted: 07/14/2014] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY Loneliness is a key health risk for older adults. Utilizing the loneliness model, we examine the relationship between living arrangement and loneliness among lesbian, gay, and bisexual (LGB) older adults, taking into consideration potential correlates including social resources and personal constraints. DESIGN AND METHODS We use data from a national survey of LGB adults aged 50 and older (N = 2,444). Types of living arrangement include living with a partner or spouse, living alone, and living with someone other than a partner or spouse. RESULTS Compared with LGB older adults living with a partner or spouse, both those living alone and living with others reported higher degrees of loneliness, even after controlling for other correlates. The results of a multivariate regression analysis reveal that social support, social network size, and internalized stigma partially account for the relationship between living arrangement and loneliness. IMPLICATIONS Living arrangement was found to be an independent correlate of loneliness among LGB older adults. Targeted interventions are needed to reduce loneliness for those living alone and those living with someone other than a partner or spouse in part by enhancing social resources and reducing risks of internalized stigma. Eliminating discriminatory policies against same-sex partnerships and partnered living arrangements is recommended.
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Affiliation(s)
- Hyun-Jun Kim
- University of Washington, School of Social Work, Seattle, Washington.
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Fredriksen-Goldsen KI, Kim HJ, Shiu C, Goldsen J, Emlet CA. Successful Aging Among LGBT Older Adults: Physical and Mental Health-Related Quality of Life by Age Group. Gerontologist 2014; 55:154-68. [PMID: 25213483 DOI: 10.1093/geront/gnu081] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [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: 04/09/2014] [Accepted: 06/25/2014] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Lesbian, gay, bisexual, and transgender (LGBT) people are a health disparate population as identified in Healthy People 2020. Yet, there has been limited attention to how LGBT older adults maintain successful aging despite the adversity they face. Utilizing a Resilience Framework, this study investigates the relationship between physical and mental health-related quality of life (QOL) and covariates by age group. DESIGN AND METHODS A cross-sectional survey of LGBT adults aged 50 and older (N = 2,560) was conducted by Caring and Aging with Pride: The National Health, Aging, and Sexuality Study via collaborations with 11 sites across the U.S. Linear regression analyses tested specified relationships and moderating effects of age groups (aged 50-64; 65-79; 80 and older). RESULTS Physical and mental health QOL were negatively associated with discrimination and chronic conditions and positively with social support, social network size, physical and leisure activities, substance nonuse, employment, income, and being male when controlling for age and other covariates. Mental health QOL was also positively associated with positive sense of sexual identity and negatively with sexual identity disclosure. Important differences by age group emerged and for the old-old age group the influence of discrimination was particularly salient. IMPLICATIONS This is the first study to examine physical and mental health QOL, as an indicator of successful aging, among LGBT older adults. An understanding of the configuration of resources and risks by age group is important for the development of aging and health initiatives tailored for this growing population.
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Affiliation(s)
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
| | - Chengshi Shiu
- School of Social Work, University of Washington, Seattle
| | - Jayn Goldsen
- School of Social Work, University of Washington, Seattle
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Abstract
Health disparities exist among sexual minority older adults. Yet, health and aging surveys rarely include sexual orientation measures and when they do, they often exclude older adults from being asked about sexual orientation. This is the first population-based study to assess item nonresponse to sexual orientation measures by age and change over time. We compare response rates and examine time trends in response patterns using adjusted logistic regressions. Among adults aged 65 and older, the nonresponse rate on sexual orientation is lower than income. While older adults show higher nonresponse rates on sexual orientation than younger adults, the nonresponse rates have significantly decreased over time. By 2010, only 1.23% of older adults responded don't know/not sure, with 1.55% refusing to answer sexual orientation questions. Decisions to not ask sexual orientation among older adults must be reconsidered, given documented health disparities and rapidly changing social trends in the understanding of diverse sexualities.
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Affiliation(s)
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle, WA, USA
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Abstract
While extensive research has examined associations between marriage, cohabitation, and the health of heterosexual adults, it remains unclear whether similar patterns of health are associated with same-sex partnerships for lesbian, gay, and bisexual (LGB) older adults. This article examines whether having a same-sex partner is associated with general self-reported health and depressive symptoms for LGB older adults. Based on survey data collected from LGB adults 50 years of age and older, having a same-sex partner was associated with better self-reported health and fewer depressive symptoms when compared with single LGB older adults, controlling for gender, age, education, income, sexuality, and relationship duration. Relationship duration did not significantly impact the association between partnership status and health. In light of recent public debates and changes in policies regarding same-sex partnerships, more socially integrated relationship statuses appear to play a role in better health for LGB older adults.
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Muraco A, Fredriksen-Goldsen KI. The highs and lows of caregiving for chronically ill lesbian, gay, and bisexual elders. J Gerontol Soc Work 2014; 57:251-72. [PMID: 24224896 PMCID: PMC4065790 DOI: 10.1080/01634372.2013.860652] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/26/2013] [Indexed: 05/27/2023]
Abstract
This study examines informal caregivers' and LGB care recipients' best and worst experiences of care within their relationship. Communal relationship theory guides the research. The work uses qualitative interview data from a sample of 36 care pairs (N = 72), divided between committed partners and friends, to understand the similarities and differences in the care norms employed in varied relationship contexts. Findings from the study show that relationship context influences the experiences that caregivers and care recipients identify as best and worst, but often focus on the relationship and needs met at bests, and conflict and fear of worsening health as worsts.
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Affiliation(s)
- Anna Muraco
- a Department of Sociology , Loyola Marymount University , Los Angeles , California , USA
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Fredriksen-Goldsen KI. Despite disparities, most LGBT elders are aging well. Aging Today 2014; 35:http://www.asaging.org/blog/despite-disparities-most-lgbt-elders-are-aging-well. [PMID: 25431529 PMCID: PMC4243168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Karen I Fredriksen-Goldsen
- professor and director of Healthy Generations Hartford Center of Excellence in Geriatric Social Work at the University of Washington in Seattle, Wash
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Abstract
This study examines leading health indicators for childrearing women with disabilities, including health-related quality of life, chronic health conditions, adverse and preventive health behaviors, health care access, and social and emotional support. The study analyzes aggregated data from the Washington State Behavioral Risk Factor Surveillance System (n = 28,629). The weighted prevalence of key health indicators of childrearing women with disabilities (aged 18-59) are compared with childrearing women without disabilities. A series of adjusted logistic regression analyses are applied, controlling for confounding variables. When compared to childrearing women without disabilities, childrearing women with disabilities are less likely to have a partner or spouse, report lower income and education levels and are older. Childrearing women with disabilities, compared to childrearing women without disabilities, report significantly lower health-related quality of life including poor general health (adjusted odds ratio[AOR] = 6.85; p < .001), frequent mental distress (AOR = 4.02; p < .001), and frequent poor physical health (AOR = 9.34; p < .001); higher prevalence of chronic health conditions, including arthritis, cardiovascular diseases, diabetes, asthma, high blood pressure and cholesterol, and obesity (the range of AORs = 1.59 to 5.65; p < .001); higher prevalence of adverse health behaviors including smoking (AOR = 2.14; p < .001) and lack of exercise (AOR = 1.61; p < .001); more financial barriers to health care (AOR = 2.11; p < .001) and lack of social and emotional support (AOR = 2.05; p < .001) while controlling for age, education, income, and relationship status. Based on population level data, the study reveals that childrearing women with disabilities experience elevated risks of health disparities across many key health indicators, many of which are preventable and modifiable. These findings underscore the importance of identifying contributing factors and developing interventions to improve the health and quality of life of childrearing women with disabilities.
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Affiliation(s)
- Miok Kim
- Department of Social Welfare, Chonbuk National University, Jeonju, South Korea.
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Fredriksen-Goldsen KI, Espinoza R. Time for Transformation: Public Policy Must Change to Achieve Health Equity for LGBT Older Adults. Generations 2014; 38:97-106. [PMID: 25960600 PMCID: PMC4425261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The marriage equality movement and the Affordable Care Act have enormous potential to reduce health disparities in LGBT elders, but more data and additional policy changes are sorely needed.
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Affiliation(s)
- Karen I Fredriksen-Goldsen
- Professor and director of Healthy Generations at the Hartford Center of Excellence in Geriatric Social Work, University of Washington, in Seattle
| | - Robert Espinoza
- Senior director for Public Policy and Communications at Services & Advocacy for GLBT Elders (SAGE) in New York City
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Fredriksen-Goldsen KI. Promoting Health Equity Among LGBT Mid-Life and Older Adults: Revealing how LGBT mid-life and older adults can attain their full health potential. Generations 2014; 38:86-92. [PMID: 25983387 PMCID: PMC4431582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Fredriksen-Goldsen KI, Hoy-Ellis CP, Goldsen J, Emlet CA, Hooyman NR. Creating a vision for the future: key competencies and strategies for culturally competent practice with lesbian, gay, bisexual, and transgender (LGBT) older adults in the health and human services. J Gerontol Soc Work 2014; 57:80-107. [PMID: 24571387 PMCID: PMC4091982 DOI: 10.1080/01634372.2014.890690] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Sexual orientation and gender identity are not commonly addressed in health and human service delivery, or in educational degree programs. Based on findings from Caring and Aging with Pride: The National Health, Aging and Sexuality Study (CAP), the first national federally-funded research project on LGBT health and aging, this article outlines 10 core competencies and aligns them with specific strategies to improve professional practice and service development to promote the well-being of LGBT older adults and their families. The articulation of key competencies is needed to provide a blueprint for action for addressing the growing needs of LGBT older adults, their families, and their communities.
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Fredriksen-Goldsen KI, Emlet CA, Kim HJ, Muraco A, Erosheva EA, Goldsen J, Hoy-Ellis CP. The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors. Gerontologist 2013; 53:664-75. [PMID: 23034470 PMCID: PMC3709843 DOI: 10.1093/geront/gns123] [Citation(s) in RCA: 249] [Impact Index Per Article: 22.6] [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: 07/09/2012] [Accepted: 08/22/2012] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Based on resilience theory, this paper investigates the influence of key health indicators and risk and protective factors on health outcomes (including general health, disability, and depression) among lesbian, gay male, and bisexual (LGB) older adults. DESIGN AND METHODS A cross-sectional survey was conducted with LGB older adults, aged 50 and older (N = 2,439). Logistic regressions were conducted to examine the contributions of key health indicators (access to health care and health behaviors), risk factors (lifetime victimization, internalized stigma, and sexual identity concealment), and protective factors (social support and social network size) to health outcomes, when controlling for background characteristics. RESULTS The findings revealed that lifetime victimization, financial barriers to health care, obesity, and limited physical activity independently and significantly accounted for poor general health, disability, and depression among LGB older adults. Internalized stigma was also a significant predictor of disability and depression. Social support and social network size served as protective factors, decreasing the odds of poor general health, disability, and depression. Some distinct differences by gender and sexual orientation were also observed. IMPLICATIONS High levels of poor general health, disability, and depression among LGB older adults are of major concern. These findings highlight the important role of key risk and protective factors, which significantly influences health outcomes among LGB older adults. Tailored interventions must be developed to address the distinct health issues facing this historically disadvantaged population.
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