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Roosevelt LK, Kattari L, Yingling C. Affirming Care for Transgender and Gender-Diverse Youth. MCN Am J Matern Child Nurs 2024; 49:66-73. [PMID: 38112665 DOI: 10.1097/nmc.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
ABSTRACT Nurses play a critical role in providing gender-affirming care for transgender and gender-diverse youth. With heightened debate about the clinical care for transgender and gender-diverse youth in the national and global spotlight, now more than ever before nurses must equip themselves with the knowledge and the evidence spanning more than 4 decades that support the clinical use of gender-affirming care for youth and young adults. By exploring gender development and gender-affirming care approaches through the lifespan perspective, this review provides an up-to-date discussion about best practices and clinical implications for providing equitable care for transgender and gender-diverse youth from birth to childhood and through adolescence developmental phases. A transgender and gender-diverse youth's future willingness to access health care is dependent on how positive their interactions are with their care team at this sensitive moment in their life. Nurses must not let political rhetoric impede their practice and ethical guidelines to provide competent, skilled, and unbiased care. Knowledgeable, informed, and empowered nurses can provide life-saving care to transgender and gender-diverse youth and their families.
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Kattari L, Hill H, Shires DA, Prieto LR, Modi IK, Misiolek BA, Kattari SK. Prescription Pain Reliever Misuse Among Transgender and Gender Diverse Adults. Transgend Health 2024; 9:68-75. [PMID: 38312452 PMCID: PMC10835153 DOI: 10.1089/trgh.2022.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Purpose Little is known about the prevalence and risks associated with transgender and gender diverse (TGD) persons' misuse of prescription pain relievers (PPRs). This study explores the relationship between PPR misuse and various sociodemographic identities and experiences of discrimination in health care among TGD adults. Methods TGD participants (n=595) were recruited in 2018 to participate in a cross-sectional statewide trans health survey through convenience sampling. Chi-square tests of independence and logistic regressions were conducted to explore associations between sociodemographics and experiences of discrimination among persons who had ever misused PPRs, or who had misused PPRs in the past year. Results Sociodemographics such as gender identity (odds ratio [OR]=0.44, p=0.01), race/ethnicity (OR=0.14, p<0.001), and sexual orientation influence TGD individuals likeliness of misusing PPRs (OR=0.40, p<0.001). Notably, those who were ever diagnosed with anxiety had a higher likeliness of having lifetime PPR misuse compared with those who were never diagnosed (OR=2.05, p=0.05), and those reporting past-year discrimination within the mental health care setting because of their gender identity were more than twice as likely to report past-year misuse than those who reported not experiencing it (OR=2.43, p=0.004). Conclusion Certain subpopulations of TGD individuals may be at elevated risk of PPR misuse. It is imperative to acknowledge the impact of multimarginalized identities as well as differences across various identities and experiences within the TGD community while working to address non-PPR misuse.
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Affiliation(s)
- Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Haley Hill
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Lucas R Prieto
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Ishaan K Modi
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | | | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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3
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Shires DA, Kattari L, Hosea F, Hirsch J, Mulvaney M, Matthews AK, Thompson HS. Healthcare experiences among Black and White sexual and gender minority cancer survivors: a qualitative study. J Cancer Surviv 2023:10.1007/s11764-023-01504-z. [PMID: 38051422 DOI: 10.1007/s11764-023-01504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The purpose of this study was to explore healthcare experiences of Black and White sexual and gender minority (SGM) cancer survivors across the cancer care continuum. METHODS This was a qualitative analysis of two focus groups and eight individual interviews completed as part of a larger initiative using a community-engaged research approach to reduce cancer disparities in marginalized communities. There was a total of 16 participants in the study (9 were White, 7 were Black) and data were collected between 2019 and 2020. RESULTS Three main themes emerged from the thematic analysis: strategically coming out, provider preferences, and health system challenges. Participants noted that they often came out through their support system, decided to come out based on the relevance of their SGM identity that they perceived, and expressed a desire for privacy. Lack of an accessible and competent PCP was tied to delayed cancer diagnosis and many participants voiced a preference for consistency when they found a provider they liked. CONCLUSIONS Providers across specialties can address barriers for SGM patients by not making assumptions about patient sexual orientation or gender identity. Institutions should systematically collect sexual orientation and gender identity information. Primary care providers should be aware that due to resistance to switching from trusted providers, they may need to take greater initiative to facilitate cancer screenings for their patients when appropriate or take special care when making referrals to ensure they are using SGM-affirming providers. IMPLICATIONS FOR CANCER SURVIVORS SGM cancer survivors often benefit from a cultivating relationship with a trusted PCP or other provider.
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Affiliation(s)
- Deirdre A Shires
- School of Social Work, Michigan State University, 655 Auditorium Road, 122 Baker Hall, East Lansing, MI, 48824, USA.
| | - Leonardo Kattari
- Department of Health and Human Services, University of Michigan - Dearborn, Dearborn, MI, USA
| | - Forrest Hosea
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jen Hirsch
- School of Social Work, Michigan State University, 655 Auditorium Road, 122 Baker Hall, East Lansing, MI, 48824, USA
| | - Megan Mulvaney
- Indiana University School of Public Health, Bloomington, IN, USA
| | | | - Hayley S Thompson
- Office of Cancer Health Equity and Community Engagement, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
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Kattari L, Anderson-Carpenter KD. Effects of psychological distress and life satisfaction on COVID-related traumatic stress: An international, cross-sectional study. J Affect Disord 2023; 328:222-227. [PMID: 36801421 DOI: 10.1016/j.jad.2023.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND This study examines the individual impacts of psychological distress (i.e., depression and anxiety) and life satisfaction on COVID-related traumatic stress in an international sample of heterosexual versus LGBQ+ adults. METHOD Between July and August 2020, a cross-sectional electronic survey (n = 2482) was launched in five countries (India, Italy, Saudi Arabia, Spain, and United States) assessing sociodemographic characteristics as well as psychological, behavioral, and social factors related to health outcomes during the COVID-19 pandemic. RESULTS Significant differences between LGBQ+ participants and heterosexual participants were found for depression (p < .001) and anxiety (p < .001). Depression was associated with COVID-related traumatic stress among heterosexual participants (p < .001) but not LGBQ+ participants. Both anxiety (p < .001) and life satisfaction (p = .003) were also associated with COVID-related traumatic stress in both groups. Hierarchical regression models demonstrated significant effects of COVID-related traumatic stress for adults outside the United States (p < .001); less than full-time employment (p = .012); and for greater levels of anxiety, depression, and life satisfaction, respectively (all ps < .001). LIMITATIONS Given the stigma of being LGBQ+ that remains in many countries, participants in may have been reluctant to identify as a sexual minority and therefore indicated a heterosexual sexual orientation. CONCLUSION The impact of sexual minority stress among LGBQ+ may play a role in COVID-related post-traumatic stress. Large-scale global disasters such as pandemics, contribute to disparities in psychological distress among LGBQ+ individual, however, sociodemographic factors such as country and urbanicity may play mediating or moderating roles.
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Affiliation(s)
- Leonardo Kattari
- Michigan State University, East Lansing, MI, United States of America.
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5
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Kattari L, Brittain DR, Visconti V. HPP Call to Action for LGBTQIA2S+ Health Equity. Health Promot Pract 2023; 24:385-386. [PMID: 37122280 DOI: 10.1177/15248399231157334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Kattari L, Kattari S, Kinney MK, Walls NE. Matchmaking Methodology for Humanizing Transgender and Gender Diverse Health Research. Prog Community Health Partnersh 2023. [DOI: 10.1353/cpr.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Lacombe-Duncan A, Kattari SK, Kattari L, Scheim AI, Misiolek BA. Sexually transmitted infection testing among transgender and non-binary persons: results of a community-based cross-sectional survey. Sex Health 2023; 20:87-91. [PMID: 36347262 DOI: 10.1071/sh22128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Studies show higher rates of sexually transmitted infections (STIs) among transgender (trans) and non-binary (TNB) persons compared with the general population. Scant studies have examined non-HIV STI testing (henceforth referred to as STI testing); fewer inclusive of trans men and non-binary persons. We characterised the prevalence of STI testing and time since last STI test and gender-based differences in these outcomes among TNB persons. METHODS Data were analysed from a 2018 community-based participatory cross-sectional survey (n =528). Prevalence of lifetime STI testing history and time since last STI test were reported overall and compared across genders (trans men, trans women, non-binary assigned female at-birth, non-binary assigned male at-birth) using Chi-squared, then bivariable and multivariable logistic regression analyses to compare lifetime STI testing history (ever vs never) across sociodemographic and health care characteristics. RESULTS Most (n =425; 80.5%) participants reported having ever had an STI test; over half (59.8%) ever tested had tested within the past year. Bivariate analyses showed no significant gender differences in lifetime STI testing history (P =0.298) or time since last STI test (P =0.118). In a multivariable model, higher age, reporting multiple committed partners (vs single/divorced), known HIV status, and ever receiving information about pre-exposure prophylaxis (PrEP) were positively associated with ever having had an STI test, whereas Latinx race/ethnicity (vs white) was negatively associated. CONCLUSIONS Findings showed high rates of lifetime STI testing and recent testing, with no gender-based differences. Never testing rates were concerning considering screening recommendations. Broad based (non-gender specific) TNB-focused interventions may be warranted to increase uptake.
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Affiliation(s)
| | - Shanna K Kattari
- University of Michigan, School of Social Work, Ann Arbor, MI, USA; and University of Michigan, Department of Women's and Gender Studies, Ann Arbor, MI, USA
| | - Leonardo Kattari
- Michigan State University, School of Social Work, East Lansing, MI, USA
| | - Ayden I Scheim
- Drexel University, Dornsife School of Public Health, Philadelphia, PA, USA
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Abstract
A healthy democracy requires civic engagement from citizens. In the current political climate that is hostile toward LGBTQIA2S+ youth, young adults, and individuals of all ages, it is imperative that public health promotion integrate civic education into health education programs to build civic engagement knowledge, skills, and efficacy among young people. In the United States, we are experiencing an alarming increase in state and federal policies designed to censor and erase LGBTQIA2S+ history and visibility, critical race theory, and civic education. Public health practitioners have an opportunity and a responsibility to integrate civic education as a crucial component of health promotion and education not just to advance LGBTQIA2S+ justice but justice and equity in all its forms.
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Kattari SK, Kattari L, Lacombe-Duncan A, Shelton J, Misiolek BA. Differential Experiences of Sexual, Physical, and Emotional Intimate Partner Violence Among Transgender and Gender Diverse Adults. J Interpers Violence 2022; 37:NP23281-NP23305. [PMID: 35271412 DOI: 10.1177/08862605221078805] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Various forms of intimate partner violence (IPV) are unfortunately common amongst adults in the United States, and these rates are devastatingly higher for transgender and gender diverse (TGD) individuals than for the general population. However, the TGD population is not monolithic, and is diverse regarding gender, sexual orientation, age, race/ethnicity, urbanicity, and other sociodemographic categories. This study uses data from the 2018 Michigan Trans Health Survey to explore these within group differences regarding sexual, physical, and emotional forms of IPV using chi-square tests of independence and logistic regressions. Chi square tests of independence found homelessness had significant associations across all outcome variables: "ever experienced physical violence from a partner," "ever experienced forced sex from a partner," "ever been threatened to be outed by a partner," and "ever had gender belittled by a partner." Gender identity and sexual orientation had significant associations with "ever experienced forced sex from a partner," "ever been threatened to be outed by a partner," and "ever had gender belittled by a partner." Urbanicity showed a significant association with "ever being threatened to be outed by a partner." In the logistic regressions, age indicated significantly higher likelihood of IPV physical IPV with each year of age; experiences of homelessness were significantly related to likelihood for all outcomes variables. Gender and sexual orientation were also significant across the models, with differing levels of likeliness depending on identities. Findings demonstrate a need for TGD inclusive programming, and specifically programs that target TGD persons who are older, report additional genders (meaning, multiple identities and/or identities besides transfeminine, transmasculine, or nonbinary), queer sexual orientations, and who are/have experienced homelessness. Programs are needed both in the realms of intimate partner violence prevention work and social services that support survivors of violence, such as mental health clinics, rape crisis centers, and shelters.
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Affiliation(s)
| | | | | | - Jama Shelton
- Hunter College, City University of New York, 366436New York, NY, USA
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Lacombe‐Duncan A, Kattari L, Kattari SK, Scheim AI, Alexander F, Yonce S, Misiolek BA. HIV testing among transgender and nonbinary persons in Michigan, United States: results of a community-based survey. J Int AIDS Soc 2022; 25 Suppl 5:e25972. [PMID: 36225152 PMCID: PMC9557000 DOI: 10.1002/jia2.25972] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Transgender (trans) and nonbinary people (TNB) are disproportionately impacted by HIV. HIV testing is critical to engage TNB people in HIV prevention and care. Yet, scant literature has examined social and structural factors associated with HIV testing among TNB people of diverse genders and in geographies with potentially lower trans acceptance. We: (1) characterized the prevalence of never having been tested for HIV; and (2) identified associated factors, among TNB people in Michigan, United States. METHODS Data were from a community-based participatory cross-sectional survey (n = 539 sexually experienced TNB people). The prevalence of never having had an HIV test was reported overall and compared across socio-demographic, clinical, social and structural factors using bivariable and multivariable logistic regression analyses. RESULTS AND DISCUSSION Approximately one-quarter (26.2%) of participants had never had an HIV test (20.8% transfeminine; 30.0% transmasculine; 17.8% nonbinary assigned male at-birth; and 32.0% nonbinary assigned female at-birth). In a multivariable socio-demographic model, older age (adjusted odds ratio [aOR] for 1-year increase: 0.93, 95% CI: 0.90, 0.96, p<0.001) and Black/African American race (vs. White) (aOR: 0.28, 95% CI: 0.09, 0.86, p<0.05) were associated with increased odds of HIV testing (aORs for never testing). In separate multivariable models controlling for socio-demographics, ever experiencing sexual violence (aOR: 0.38, 95% CI: 0.21, 0.67, p<0.001), not accessed sexual/reproductive healthcare in the past 12 months (aOR: 4.46, 95% CI: 2.68, 7.43, p<0.001) and reporting a very/somewhat inclusive primary care provider (PCP) (aOR: 0.29, 95% CI: 0.17, 0.49, p<0.001) were associated with HIV testing (aORs for never testing). CONCLUSIONS Findings contribute to scant literature about gender-based differences in HIV testing inclusive of transmasculine and nonbinary people. Lack of statistically significant gender differences suggests that broad TNB interventions may be warranted. These could include training healthcare providers in trans-inclusive practices with sexual violence survivors and PCPs in trans-inclusive HIV prevention and care. Findings showing Black participants were less likely to have never had an HIV test suggest the promise of culturally tailored services, though further investigation is needed. Findings identify social and structural factors associated with HIV testing and can inform multi-level interventions to increase TNB person's HIV testing.
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Affiliation(s)
| | - Leonardo Kattari
- School of Social Work, Michigan State UniversityEast LansingMichiganUSA
| | - Shanna K. Kattari
- School of Social Work, University of MichiganAnn ArborMichiganUSA
- Department of Women's and Gender Studies, University of MichiganAnn ArborMichiganUSA
| | - Ayden I. Scheim
- Dornsife School of Public Health, Drexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Flyn Alexander
- School of Social Work, University of MichiganAnn ArborMichiganUSA
| | - Sophie Yonce
- Lyman Briggs College, Michigan State UniversityEast LansingMichiganUSA
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Shires DA, Kcomt L, Kattari L, Liroff M, Lee R. Emergency Clinicians' Comfort Levels in Caring for Transgender Patients. Transgend Health 2022. [DOI: 10.1089/trgh.2021.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Deirdre A. Shires
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Luisa Kcomt
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Meghan Liroff
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Rachel Lee
- Department of Family Medicine, Henry Ford Health System, Detroit, Michigan, USA
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12
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Gerke DR, Call J, Atteberry-Ash B, Katz-Kattari S, Kattari L, Hostetter CR. Alcohol use at the intersection of sexual orientation and gender identity in a representative sample of youth in Colorado. Am J Addict 2021; 31:61-68. [PMID: 34873759 DOI: 10.1111/ajad.13243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/21/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Lesbian, gay, bisexual, and questioning (LGBQ) youth are at greater risk of problematic alcohol use than their heterosexual peers, yet there is a dearth of research examining variability in alcohol use among youth that simultaneously accounts for sexual orientation and gender identity. This paper examines the relationship between alcohol use and intersecting identities of sexual orientation and gender while accounting for this population's disproportionate experiences of depression and dating and sexual violence. METHODS The study used a representative sample (n = 27,621) of high school students. Logistic regressions were used to determine if earlier age at first drink, 30-day alcohol use, and binge drinking were significantly related to intersectional sexual orientation and gender identity. Secondary models added depression, dating violence, and sexual violence to analyses to determine if they explained any of the variance in alcohol use variables in LGBQ and transgender youth. RESULTS Transgender youth who identified as heterosexual or questioning their sexual orientation were at greatest risk for early initiation of alcohol use and binge drinking. These relationships between intersectional identity and alcohol use became nonsignificant when depression, dating violence, and sexual violence were added to the models. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE This is the first study to examine relationships between intersecting identities of sexual orientation and gender identity and alcohol use among youth. Risky alcohol use among transgender youth may be attributed to experiences of depression, dating violence, and sexual violence impacting these populations. Interventions should focus on reducing transgender youth exposure to violence.
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Affiliation(s)
- Donald R Gerke
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Jarrod Call
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | | | - Shanna Katz-Kattari
- School of Social Work & Department of Women's and Gender Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - C Riley Hostetter
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
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13
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LaPlant WG, Kattari L, Ross LK, Zhan J, Druck JP. Perceptions of Emergency Care by Sexual and Gender Minorities in Colorado: Barriers, Quality, and Factors Affecting Identity Disclosure. West J Emerg Med 2021; 22:903-910. [PMID: 35354007 PMCID: PMC8328175 DOI: 10.5811/westjem.2021.3.49423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Expanding on data concerning emergency department (ED) use and avoidance by the sexual minority (those who identify as lesbian, gay, bisexual, queer, other [LGTBQ+]) and gender minority (those who identify as transgender, gender nonconforming, other) community may inform future ED LGTBQ+ training and clinical practice. Investigation objectives included characterizing rates of emergency care avoidance, identifying barriers to emergency care, and assessing emergency care quality and cultural competency for sexual and gender minorities. Methods In this population-based, cross-sectional needs assessment, sexual minority, gender minority, and/or cisgender heterosexual-identified participants were selected based on participants’ subscription to newsletters or social media accounts for One Colorado, an LGBTQ+ advocacy organization. Each participant completed a single digital survey that collected qualitative and quantitative data about ED perception, use, and demographics. Results A total of 477 LGBTQ+ or heterosexual-identified individuals (mean age = 44.3 (standard deviation [SD] = 16.7)) participated in the study. Lifetime emergency care avoidance rates for gender minorities were markedly increased (odds ratio [OR] 3.8, 95% confidence interval [CI], 2.2 – 6.6; P <.001), while avoidance rates for sexual minorities were similar to those of cisgender heterosexual respondents (17% vs 14%; P <.001). Gender minorities were more likely than sexual minorities to both avoid emergency care due to fear of discrimination (43% vs 15%; P =.002) and to have experienced discrimination during their last ED visit (OR 11, [95% CI, 5–24]; P <.001). No significant differences were observed between participants in care avoidance due to financial reasons or prior negative experiences. No cited ED factors that influenced identity disclosure decisions were distinctly predictive. Conclusion Gender minorities are more likely than sexual minorities and heterosexual cisgender individuals to report ED avoidance and discrimination at last ED visit. Future work characterizing deficits in LGBTQ+ ED care might reduce these avoidance and discrimination rates, enhancing the level of patient care provided to this population.
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Affiliation(s)
- William G LaPlant
- Good Samaritan Medical Center, Department of Emergency Medicine, Brockton, Massachusetts
| | - Leonardo Kattari
- Michigan State University School of Social Work, East Lansing, Michigan
| | - Lexie K Ross
- University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer Zhan
- California Hospital Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Jeffrey P Druck
- Public Health Institute California Bridge Program, Oakland, California.,University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
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14
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Atteberry-Ash B, Kattari SK, Harner V, Prince DM, Verdino AP, Kattari L, Park IY. Differential Experiences of Mental Health among Transgender and Gender-Diverse Youth in Colorado. Behav Sci (Basel) 2021; 11:48. [PMID: 33918631 PMCID: PMC8069714 DOI: 10.3390/bs11040048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022] Open
Abstract
Young people experience a variety of mental health concerns, including depression, non-suicidal self-injury, and suicidal ideation. These issues are at even higher rates among transgender and gender-diverse (TGD) young people, due to the additional burden of having to navigate a world in which transphobia impacts them at the individual, organizational, and policy levels. However, much of the extant research focuses only on comparing TGD youth to cisgender counterparts. This study explores the nuance within the TDG youth population regarding mental health, examining how gender, race/ethnicity, and sexual orientation change the likelihood of experiencing each of these mental health concerns. Among a sample of over 400 young people, findings indicate that those TGD young people who do not identify themselves within the masculine/feminine binary and those with marginalized sexual orientations were two to three times more likely to experience adverse mental health outcomes, as compared to their peers who are questioning their gender, and who are heterosexual. The implications for mental health professionals and others who work with young people are to recognize that mental health is not a one-size-fits all model for young TGD people, and that the intersection of multiple marginalized identities, must be addressed in order to improve the mental health of this group of young people. Findings can also be used to better understand issues of stigma, discrimination, and victimization in education, health care, and beyond.
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Affiliation(s)
- Brittanie Atteberry-Ash
- School of Social Work, University of Texas Arlington, 211 S Cooper St., Arlington, TX 76019, USA
| | - Shanna K. Kattari
- School of Social Work and College of Literature, Science, and the Arts Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Vern Harner
- School of Social Work, University of Washington, Seattle, WA 98105, USA;
| | - Dana M. Prince
- The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Anthony P. Verdino
- School of Social Service Administration, University of Chicago, Chicago, IL 60637, USA;
| | - Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, MI 48824, USA;
| | - In Young Park
- Graduate School of Social Work, University of Denver, Denver, CO 80208, USA;
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15
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Guz S, Kattari SK, Atteberry-Ash B, Klemmer CL, Call J, Kattari L. Depression and Suicide Risk at the Cross-Section of Sexual Orientation and Gender Identity for Youth. J Adolesc Health 2021; 68:317-323. [PMID: 32680801 DOI: 10.1016/j.jadohealth.2020.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/23/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Adolescence is a developmental phase in which young people begin to explore their identity and seek to understand how their identity fits into the larger society. Although this is a developmental task for all adolescents, it is especially salient for sexual and gender minority youth. Owing to oppressive social structures and stigmatized identities, adolescents who identify as nonheterosexual or noncisgender are vulnerable to experiencing disproportionate adverse health outcomes. METHODS To further the literature on adolescent mental health among sexual and gender minority youth, this study analyzed a representative statewide sample of high school students (ages 14-18) to analyze how sexual orientation and gender identity are associated with depression and suicidality. RESULTS Results aligned with previous research demonstrating that sexual and gender minority youth were all at a heightened risk for depression. However, transgender youth and youth questioning their sexuality or gender were at especially heightened risk for experiencing depression and suicidality. CONCLUSION The findings of this study indicate a need to target or adapt direct services and programming for sexual and gender minority adolescents.
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Affiliation(s)
- Samantha Guz
- University of Chicago School of Social Service Administration, Chicago, Illinois.
| | - Shanna K Kattari
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | | | - Cary L Klemmer
- University of Southern California Dworak-Peck School of Social Work, Los Angeles, California
| | - Jarrod Call
- University of Denver Graduate School of Social Work, Denver, Colorado
| | - Leonardo Kattari
- University of Michigan School of Social Work, Ann Arbor, Michigan
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16
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Mak J, Shires DA, Zhang Q, Prieto LR, Ahmedani BK, Kattari L, Becerra-Culqui TA, Bradlyn A, Flanders WD, Getahun D, Giammattei SV, Hunkeler EM, Lash TL, Nash R, Quinn VP, Robinson B, Roblin D, Silverberg MJ, Slovis J, Tangpricha V, Vupputuri S, Goodman M. Suicide Attempts Among a Cohort of Transgender and Gender Diverse People. Am J Prev Med 2020; 59:570-577. [PMID: 32798005 PMCID: PMC7508867 DOI: 10.1016/j.amepre.2020.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. METHODS Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. RESULTS During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged <18 years than among those aged >45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2-5 times higher among those with 1-2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. CONCLUSIONS Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings.
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Affiliation(s)
- Josephine Mak
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
| | - Qi Zhang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lucas R Prieto
- School of Social Work, Michigan State University, East Lansing, Michigan
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, Michigan
| | - Tracy A Becerra-Culqui
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Andrew Bradlyn
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Shawn V Giammattei
- The Rockway Institute, Alliant International University, San Francisco, California
| | - Enid M Hunkeler
- Division of Research, Kaiser Permanente, Northern California (emerita), Oakland, California
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California (emerita), Pasadena, California
| | - Brandi Robinson
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, Maryland
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Jennifer Slovis
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Vin Tangpricha
- School of Medicine, Emory University, Atlanta, Georgia; The Atlanta VA Medical Center, Atlanta, Georgia
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, Maryland
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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17
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Kattari SK, Bakko M, Hecht HK, Kattari L. Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults. SSM Popul Health 2020; 10:100525. [PMID: 31872041 PMCID: PMC6909214 DOI: 10.1016/j.ssmph.2019.100525] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 01/26/2023] Open
Abstract
Transgender and nonbinary patients have a wide array of experiences when attempting to access healthcare, including discrimination and having to educate providers about trans people. This study examines the mental health factors connected to transgender and nonbinary patients' experience with providers to determine the likelihood of transgender or nonbinary patients receiving respectful care after a provider knows about the patient's gender identity, and patients' experience of having to educate providers about trans people, controlling for sociodemographic factor. Using data from the 2015 United States Trans Survey (N = 27,715), chi-square tests of independence and multivariate logistic regressions were used to explore the odds of transgender or nonbinary individuals having a positive experience with a doctor or healthcare provider. Of the respondents, 24.31% experienced having to educate a provider about trans people when seeking care, and 62.90% experienced a provider knowing they were transgender or nonbinary and treating them with respect. Those experiencing depression and suicidal thoughts were significantly less likely to have had a provider treat them with respect, and significantly more likely to need to educate their providers. Gender, age, disability status, and educational level were significant across both variables; income was significant regarding having to educate a provider. Healthcare providers need ongoing training and education to improve their care of transgender and nonbinary patients, specifically around acknowledging the multiple backgrounds and experiences of such patients, including those related to mental health, gender, race, age, income, educational level, and disability.
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Affiliation(s)
- Shanna K. Kattari
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Matthew Bakko
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Hillary K. Hecht
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Leonardo Kattari
- Michigan State University School of Social Work, 655 Auditorium Road, East Lansing, MI, 48824, USA
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18
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Kattari L, Cikara L, Ma M, Brooks-Russell A. Community-Driven Approach for Youth Health Survey Administration and Data Utilization. Health Promot Pract 2020; 22:167-169. [PMID: 32111123 DOI: 10.1177/1524839920910696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Large-scale population surveillance systems may fall short in capturing localized data specifically from rural communities. A three-tiered engagement approach is implemented by survey administrators that focuses on supporting communities and schools to better understand the health of youth locally and identify the most effective interventions. This community-driven approach to survey administration addresses the locality gap and evolves a statewide youth survey to better meet the needs of the state and local communities, as well as alleviates survey burden in schools through a unified, strategic approach.
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Affiliation(s)
| | - Lauren Cikara
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ming Ma
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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19
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Kattari SK, Atteberry-Ash B, Kinney MK, Walls NE, Kattari L. One size does not fit all: differential transgender health experiences. Soc Work Health Care 2019; 58:899-917. [PMID: 31618117 DOI: 10.1080/00981389.2019.1677279] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 02/08/2019] [Revised: 08/05/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
Transgender and nonbinary (TNB) adults face a multitude of challenges when attempting to access general health care. Issues include fear of discrimination and encounters with providers who are not familiar with treating the needs of this population. These challenges may result in the delay or denial of medically necessary care. This study explores nuanced experiences of gender identity and sexual orientation around accessing health care. Using a statewide sample of TNB individuals (N = 417), analyses include descriptive statistics and logistic regressions predicting delayed care due to fear of discrimination and having any medical intervention to understand the importance of transgender-inclusive care and other experiences across identities. Findings indicate differential experiences across gender identity, sexual orientation, and age. Access to a trans-inclusive primary care provider was one of the strongest indicators both for not delaying care due to fear of discrimination and having had a medical intervention. Providers should be provided with more nuanced training about being culturally responsive and aware of differences across sexual orientation within the TNB community. This will move toward ensuring not only increased access to needed care and medical interventions, but toward potentially lowering the rate of those who delay access to care due to fear of discrimination.
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Affiliation(s)
- Shanna K Kattari
- University of Michigan School of Social Work , Ann Arbor , Michigan , USA
| | | | - M Killian Kinney
- University of Indiana School of Social Work , Indianapolis , Indiana , USA
| | - N Eugene Walls
- University of Denver Graduate School of Social Work , Denver , Colorado , USA
| | - Leonardo Kattari
- University of Michigan School of Social Work , Ann Arbor , Michigan , USA
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20
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Ghosh TS, Vigil DI, Maffey A, Tolliver R, Van Dyke M, Kattari L, Krug H, Reed JK, Wolk L. Lessons learned after three years of legalized, recreational marijuana: The Colorado experience. Prev Med 2017; 104:4-6. [PMID: 28232101 DOI: 10.1016/j.ypmed.2017.02.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 11/24/2022]
Abstract
In November 2012 Colorado voters approved legalized recreational marijuana. On January 1, 2014 Colorado became the first state to allow legal sales of non-medical marijuana for adults over the age of 21. Since that time, the state has been monitoring potential impacts on population health. In this paper we present lessons learned in the first three years following legal sales of recreational marijuana. These lessons pertain to health behaviors and health outcomes, as well as to health policy issues. Our intent is to share these lessons with other states as they face the prospect of recreational marijuana legalization.
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Affiliation(s)
- Tista S Ghosh
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States; Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
| | - Daniel I Vigil
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Ali Maffey
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Rickey Tolliver
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Mike Van Dyke
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Leonardo Kattari
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States.
| | - Heather Krug
- Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
| | - Jack K Reed
- Colorado Department of Public Safety, Division of Criminal Justice, 700 Kipling Street, Suite 1000, Lakewood, CO 80215, United States.
| | - Larry Wolk
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246, United States; Colorado Department of Public Health and Environment, Laboratory Services Division, 8100 Lowry Boulevard, Denver, CO 80230, United States.
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21
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Abstract
Transgender-inclusive behaviors are actions and communication supporting transgender individuals. Examples include using language not reinforcing the gender binary, asking for and using correct pronouns, creation of spaces that welcome members of the transgender community, and acknowledging cisgender (non-transgender) privilege. A survey was developed measuring this behavior in individuals to examine the impact of transgender-inclusive behavior and the potential effect of interventions on promoting inclusive behavior. Data were collected utilizing an online survey (N = 1,051). The sample was split in half to run two sets of cases in a principal components analysis. Analysis of the full sample showed Cronbach's alpha to be .93 (n = 918). Findings suggest that the Transgender Inclusive Behavior Scale (TIBS) may be a useful instrument for identifying behaviors related to being inclusive of transgender individuals, groups, and communities. It may also be used to measure behavior change before and after transgender-specific educational and behavioral interventions.
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Affiliation(s)
- Shanna K Kattari
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - Ashley A O'Connor
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - Leonardo Kattari
- b Colorado Department of Public Health and Environment , Denver , Colorado , USA
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22
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Seelman KL, Colón-Diaz MJP, LeCroix RH, Xavier-Brier M, Kattari L. Transgender Noninclusive Healthcare and Delaying Care Because of Fear: Connections to General Health and Mental Health Among Transgender Adults. Transgend Health 2017; 2:17-28. [PMID: 28861545 PMCID: PMC5436369 DOI: 10.1089/trgh.2016.0024] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: There are many barriers to reliable healthcare for transgender people that often contribute to delaying or avoiding needed medical care. Yet, few studies have examined whether noninclusive healthcare and delaying needed medical care because of fear of discrimination are associated with poorer health among transgender adults. This study aims to address these gaps in the knowledge base. Methods: This study analyzed secondary data from a statewide survey of 417 transgender adults in the Rocky Mountain region of the United States. Independent variables included noninclusive healthcare from a primary care provider (PCP) and delay of needed medical care because of fear of discrimination. Dependent variables assessed general health and mental health. Results: Transgender individuals who delayed healthcare because of fear of discrimination had worse general health in the past month than those who did not delay or delayed care for other reasons (B=−0.26, p<0.05); they also had 3.08 greater odds of having current depression, 3.81 greater odds of a past year suicide attempt, and 2.93 greater odds of past year suicidal ideation (p<0.001). After controlling for delayed care because of fear of discrimination, having a noninclusive PCP was not significantly associated with either general health or mental health. Conclusion: This study suggests a significant association between delaying healthcare because of fear of discrimination and worse general and mental health among transgender adults. These relationships remain significant even when controlling for provider noninclusivity, suggesting that fear of discrimination and consequent delay of care are at the forefront of health challenges for transgender adults. The lack of statistical significance for noninclusive healthcare may be related to the measurement approach used; future research is needed to develop an improved tool for measuring transgender noninclusive healthcare.
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Affiliation(s)
| | | | - Rebecca H LeCroix
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | | | - Leonardo Kattari
- Colorado Department of Public Health & Environment, Denver, Colorado
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23
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Kattari SK, Walls NE, Speer SR, Kattari L. Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people. Soc Work Health Care 2016; 55:635-650. [PMID: 27351890 DOI: 10.1080/00981389.00982016.01193099] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Using a statewide survey of transgender and gender variant individuals (N = 417), this study examines the association between having a transgender-inclusive provider and three mental health concerns: current experience of depression, lifetime experience of anxiety disorder, and suicidality within the last year. Findings suggest that having a transgender-inclusive provider is associated with decreased rates of depression and suicidality, but not with lifetime experience of having anxiety. Implications for future research and education of providers are discussed.
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Affiliation(s)
- Shanna K Kattari
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - N Eugene Walls
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | | | - Leonardo Kattari
- b Colorado Department of Public Health and Environment , University of Denver , Denver , Colorado , USA
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24
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Kattari SK, Walls NE, Speer SR, Kattari L. Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people. Soc Work Health Care 2016; 55:635-50. [PMID: 27351890 DOI: 10.1080/00981389.2016.1193099] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 03/17/2016] [Accepted: 05/19/2016] [Indexed: 05/28/2023]
Abstract
Using a statewide survey of transgender and gender variant individuals (N = 417), this study examines the association between having a transgender-inclusive provider and three mental health concerns: current experience of depression, lifetime experience of anxiety disorder, and suicidality within the last year. Findings suggest that having a transgender-inclusive provider is associated with decreased rates of depression and suicidality, but not with lifetime experience of having anxiety. Implications for future research and education of providers are discussed.
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Affiliation(s)
- Shanna K Kattari
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - N Eugene Walls
- a Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | | | - Leonardo Kattari
- b Colorado Department of Public Health and Environment , University of Denver , Denver , Colorado , USA
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