Gender-Based Violence and Suicide Among Gender-Diverse Populations in the United States

OBJECTIVES

Transgender populations report higher suicidal ideation (SI) and suicide attempts than the general population. This study sought to identify predictors of suicide in individuals with diverse gender identities, including transgender women; transgender men; and gender-nonbinary, genderqueer, and crossdressing individuals within various racial/ethnic groups.

METHODS

Secondary analyses were conducted using the United States Transgender Survey (N = 27,204). The dependent variables were SI and suicide attempts in the past 12 months. The independent variables were gender, race, employment status, transactional sex, exposure to violence, and age. Bivariate, multivariable, and nested models were used to examine the association between variables.

RESULTS

Findings reveal transgender women to be more likely to report SI than other gender groups. White and Hispanic/Latino participants were more likely to have SI than Black participants. Transgender men and gender-nonbinary groups were significantly less likely to attempt suicide than transgender women, and crossdressers were not significantly different in suicide attempts than transgender women. Increased exposure to violence was associated with increased SI and suicide attempts. Increased age and part- or full-time employment were associated with decreased SI and suicide attempts. White transgender women were more likely to have attempted suicide than white transgender men and gender-nonbinary groups. Asian and biracial transgender women were more likely to have attempted suicide than the other gender groups.

CONCLUSIONS

Findings illuminate differences in suicide among individuals with diverse racial and gender identities and support the call for continued research on mental health experiences of these populations.HighlightsSuicide ideation and attempts varies by race and gender, including for people with diverse gender identitiesTransgender women and crossdressers are more likely to have attempted suicide than transgender men or gender-nonbinary individualsSuicide ideation and suicide attempts are associated with gender, race, employment, survival and transactional sex, violence exposure, and age.

Perceptions of healthcare accessibility and medical mistrust among Black women living with HIV in the USA

Black women living with HIV in the USA frequently endure structural racism, racial biases and discrimination in healthcare that affect their access to care. To explore their experiences in healthcare settings as they relate to HIV-treatment accessibility and medical mistrust we used intersectionality and structural intersectionality as guiding frameworks. Four focus groups were conducted with 20 low-income Black women living with HIV in a large urban region. Using thematic analysis, we identified four themes: (1) multilevel stigma and discrimination; (2) medical mistrust of providers across multiple settings; (3) varying responses to stigma, discrimination, and medical mistrust; and (4) preferences for patient-provider relationships. Participants described how medical providers, nurses and other healthcare staff perpetuated negative treatment, including multiple forms of discrimination and stigmatisation based on their HIV diagnosis, race, class and gender. The stigma, discrimination and resulting mistrust experienced often caused hurt feelings and decisions to disengage from treatment or remain with providers while feeling unwelcome. Participants described the strong desire to feel seen, supported and validated by healthcare providers. Narratives reveal that feelings of being discriminated against can cultivate mistrust not only towards doctors, but other provider types and settings. Findings can inform care models for low-income Black women living with HIV.

A Systematic Review of Specialty Courts in the United States for Adolescents Impacted by Commercial Sexual Exploitation

Nationwide efforts to enhance services for adolescents experiencing commercial sexual exploitation (CSE) in the judicial system have led to the emergence of specialty courts, including human trafficking and girls' courts. Given that prior research has documented competing stances on the effectiveness of specialty courts for CSE-impacted populations, we conducted a systematic review of the literature to identify key characteristics of programming, profiles of adolescents served, and effectiveness of these courts. To identify relevant research and information, we systematically searched scholarly databases and information sources, conducted reference harvesting, and forwarded citation chaining. Articles presenting primary data with quantitative, qualitative, or mixed methodologies or programmatic descriptions of specialty courts serving adolescents at risk or with confirmed histories of CSE that were published after 2004 were included. We identified 39 articles on 21 specialty courts serving adolescents at risk or with confirmed histories of CSE, including seven specialty courts with evaluation or outcome data. Across specialty courts, adolescents benefited from an increase in linkage to specialized services, improved residential placement stability, and reduction in recidivism-measured by new criminal charges. Specialty court participation was also associated with improved educational outcomes and decreased instances of running away. A lack of empirical data, specifically of evaluation studies, emerged as a weakness in the literature. Still, findings support that specialty courts can be an integral judicial system response to CSE. Multidisciplinary collaboration can help target and respond to the multifaceted needs of adolescents, encourage healthy behaviors, and promote their overall wellness.

"If I start panicking over having enough, then I start eating too much": Understanding the eating behaviors of SNAP recipients in larger bodies during COVID-19

BACKGROUND/OBJECTIVE

Living in a food-insecure household may increase the risk for disordered eating. Though the Supplemental Nutrition Assistance Program (SNAP) was designed to reduce food insecurity, it may increase risk for disordered eating with the frequency in which benefits are distributed. Limited research has explored the lived experiences of managing eating behaviors while on SNAP, particularly among SNAP participants in larger bodies, and during COVID-19. Thus, the purpose of this study is to examine the experiences with eating behaviors among adults with a BMI ≥ 25 kg/m², and who received SNAP benefits during the COVID-19 pandemic.

METHODS

Eligible adults were recruited to participate in a semi-structured interview. Interviews were transcribed verbatim and analyzed using thematic analysis and content analysis.

RESULTS

Participants (N = 16), had a mean (±SD) age of 43.4 ± 10.9 years, and overwhelmingly identified as female (86 %). One-third of the participants were Black. We identified 4 main themes: (1) not having enough money/benefits to cover needs; (2) navigating loss of control and emotional eating; (3) making sure the kids are alright; and (4) still feeling the pressure to manage weight.

CONCLUSION

Managing eating behaviors while also navigating SNAP benefits is complex and may exacerbate risk of disordered eating.

Risk profiles of suicide attempts among girls with histories of commercial sexual exploitation: A latent class analysis

BACKGROUND

Girls impacted by commercial sexual exploitation (CSE) in the juvenile legal system are three times more likely to have suicide attempts than girls without histories of exploitation. Yet, research on risk profiles and correlates that contribute to elevated suicide risk among girls with CSE histories remains scant.

OBJECTIVE

We sought to examine suicide attempts profiles among CSE-impacted girls in the juvenile legal system.

PARTICIPANTS AND SETTING

We partnered with a specialty court for CSE-impacted youth in Los Angeles County.

METHODS

Data were collected from case files of the 360 girls participating in the court from 2012 to 2016. Latent class analysis was used to identify their profiles of risk indicators.

RESULTS

Four risk profiles for suicide attempts emerged: (1) Parental Incarceration (PI; 30 %), (2) Child Welfare Contact (CWC; 25 %), (3) Disruptive Behavior and Sleep Problems (DBS; 25 %), and (4) Pervasive Risk (PR; 22 %). Among youth in the PI group, 5 % had a suicide attempt; however, contrary to our hypothesis, no youth in the CWC group had a suicide attempt. Rates of suicide attempt were significantly higher among youth in the DBS group, as 14 % had a suicide attempt. As hypothesized, youth in the PR were associated with higher risk of suicide attempts, with 28 % reporting a prior suicide attempt.

CONCLUSIONS

Findings underscore the need for standardized suicide screenings and treatment referrals for girls with CSE histories and suggest an important opportunity for multidisciplinary collaboration with courts to improve suicide prevention strategies. The present study also supports the importance of examining risk across the socioecological context.

Perceptions and experiences with eating disorder treatment in the first year of COVID-19: A longitudinal qualitative analysis

OBJECTIVE

The COVID-19 pandemic created significant challenges in accessing and receiving treatment for individuals with eating disorders (EDs). The purpose of this study is to explore perceptions of and experiences with ED treatment during the first year of the pandemic among individuals with past and self-reported EDs in the United States.

METHODS

Online surveys were administered to adults (N = 510) with a past or current self-reported ED at 13 timepoints between April 2020 and May 2021. Using longitudinal qualitative analysis, 5651 free-text responses were examined to capture experiences with ED treatment and generate inferences of change over time.

RESULTS

We categorized results into four sequential, temporal quarters and identified patterns that explained participants' perceptions of facilitators, barriers, and experiences with ED treatment over time: Quarter 1. Treatment Disruption and Reorienting Recovery; Quarter 2. Accumulating COVID-19 Stress and Virtual Treatment Woes; Quarter 3. A Continuation of Inadequate Care; and Quarter 4. Ongoing Adaptation and Adjustment to Uncertainty. Participant experiences were marked by numerous barriers to accessing care, challenges adjusting to virtual treatment, unmet treatment needs, and beginning acceptance of telehealth.

DISCUSSION

Our findings present a timeline to help evaluate challenges related to navigating the switch to virtual care which created significant disruption to ED recovery. Participants spent much of the first year trying to adjust to unemployment, loss of insurance, and lack of access to in-person treatment. Future research should identify additional strategies to improve the receipt and experience of care for EDs.

PUBLIC SIGNIFICANCE

Our findings suggest that individuals with eating disorders were significantly challenged by accumulating COVID-19 stress, worsening symptomatology, and limited access to effective treatment during the first year of the pandemic. This knowledge can guide clinicians, treatment centers, and policy makers in addressing the behavioral health needs of individuals impacted by disordered eating amidst emergent public health crises.

For us by us: Instituting mentorship models that credit minoritized medical faculty expertise and lived experience

The woefully low proportion of scientists and clinicians underrepresented in medicine (UIM), including members of African-American/Black, Hispanic/Latinx, American Indian/Alaska Native or Native Hawaiian/Pacific Islander communities, is well characterized and documented. Diversity in medicine is not only just, but it improves quality and outcomes. Yet, diversity in academic medicine remains stagnant, despite national recognition and urgent calls to improve diversity, equity, and inclusion across health sciences. One strategy that has shown to improve diversity in many sectors is high quality mentoring. While many institutions have adopted mentoring programs, there remains a lack of mentorship that is equitable, individualized, and sets a clear timeline for academic milestones that will position UIM mentees at the optimal trajectory for promotion and retention. A barrier to assembling these programs is the small number of UIM among the senior faculty ranks who are able to serve in this role, given the disproportionate burden to serve on a multitude of academic committees, task forces, and workgroups to fulfill institutional mandates to diversify representation. These time-consuming services, documented in the literature as the "minority tax," are generally uncompensated and unaccounted for in terms of consideration for promotion, leadership positions, and other measures of career advancement. The Justice, Equity, Diversity, and Inclusion Academic Mentors (JAM) Council represents a novel, culturally responsive, and anti-racist approach to achieve a more equitable and inclusive institutional environment. This approach strategically leverages the intergenerational wisdom and experience of senior UIM faculty via time-protected effort with the overall goals of improving rates of promotion, retention, and career satisfaction of early career UIM colleagues. This community case study describes the rationale, resources needed, processes, and proposed workflow required to launch the JAM Council, as well as the major roles and responsibilities for JAM mentors and mentees, which may be considered by academic medical centers focused on improving diversity among the faculty ranks.

Human Trafficking in Correctional Institutions: A Survey of Correctional and Anti-Trafficking Leaders

Growing awareness of the overlap between justice involvement and human trafficking victimization has led to calls for correctional institutions to prevent, identify, and respond to trafficking. However, it is unclear how correctional facilities (i.e., jails and prisons) are responding to such calls to action. To examine current efforts to address human trafficking in U.S. correctional facilities, this study surveyed correctional and anti-trafficking leaders (n = 46) about their perceptions and experiences with human trafficking screening, response, and training in correctional facilities. Although the majority of leaders (89%) agreed individuals in their state's correctional facilities have experienced human trafficking, they generally did not perceive that correctional staff were prepared to respond. Bivariate tests revealed that correctional and anti-trafficking leaders differed on their perceptions regarding correctional staffs' knowledge about human trafficking risk factors (p = .014), identification ability (p = .006), and response knowledge (p = .036), with anti-trafficking leaders perceiving correctional staff to be less prepared in these areas. Approximately 16% of leaders reported strategies to identify and respond to trafficking in correctional facilities, and about 27% reported human trafficking training for corrections staff. To promote a just society, study findings offer preliminary guidance for anti-trafficking correctional initiatives and future research.

Perspectives of Girls and Young Women Affected by Commercial Sexual Exploitation: mHealth as a Tool to Increase Engagement in Care

Objective

We gathered the perspectives of girls and young women affected by commercial sexual exploitation (CSE) to understand the acceptability and feasibility of mobile health (mHealth) for enhancing access and engagement in health and social services during judicial involvement.

Methods

We conducted four focus groups with 14 girls and young women (ages 14 to 21) with self-identified CSE histories.

Results

Participants perceived mHealth as viable for accessing and engaging providers, and health and social services, and navigating judicial systems. Participants expressed that mHealth tools increased self-efficacy and self-navigation of required services. Recommendations to improve mHealth functionality included push-notification appointment reminders, wellness and safety promotion, enhancement of provider communication, peer-to-peer support, and access to health education and community resources.

Conclusions

Findings provide insight for how mHealth may be leveraged to increase self-management skills, fulfill judicial obligations, and improve access and engagement in health and social services for CSE-affected girls and young women.

Collaborative Responses to Commercial Sexual Exploitation as a Model of Smart Decarceration

Historically, youths who are affected by commercial sexual exploitation (CSE) in the United States have been implicated as perpetrators of crime and overrepresented in the juvenile justice system. As an intriguing example of the "smart decarceration" social work grand challenge, policy and practice initiatives have converged to decriminalize cisgender girls and young women experiencing CSE by reframing them as victims of exploitation rather than as criminals. To date, these efforts have largely focused on gender-specific programming for cisgender girls and young women. In this article, the authors describe how federal, state, and local policy and practice innovations have supported reframing CSE as a form of child maltreatment and rerouted girls and young women from the juvenile justice system to specialized services. Using Los Angeles County as a case example, the authors detail how innovative prevention, intervention, and aftercare programs can serve as models of smart decarceration for CSE-affected cisgender girls and young women with the potential to address the needs of youths with diverse gender and sexual identities.

Fierce Autonomy: How Girls and Young Women Impacted by Commercial Sexual Exploitation Perceive Health and Exercise Agency in Health Care Decision-Making

Prior research has examined the high health care needs and vulnerabilities faced by survivors of commercial sexual exploitation (CSE), yet their perspectives are frequently absent. We sought to understand the narratives and views of individuals affected by CSE on their bodies, health, and motivations to seek health care treatment. Twenty-one girls and young women ages 15 to 19 years with self-identified histories of CSE participated in the study. All participants had current or prior involvement in the juvenile justice and/or child welfare systems. Data collection included brief questionnaires, followed by semi-structured individual interviews. The interviews took place between March and July 2017 and were analyzed using iterative and inductive techniques, using the shared decision-making model as a guide. "Fierce Autonomy" emerged as a core theme, depicting how past traumas and absence of control led the girls and young women to exercise agency and reclaim autonomy over decisions affecting their health.

A specialty court for U.S. youth impacted by commercial sexual exploitation

BACKGROUND

Specialty courts have emerged as a model of care for U.S. youth impacted by commercial sexual exploitation (CSE) to ensure comprehensive service provision. However, there is a lack of published research that documents the extent to which these programs achieve this goal.

OBJECTIVE

We sought to understand a specialty juvenile justice court's role in identifying mental health and substance use treatment needs, providing linkages to services, and facilitating stability for youth with histories of CSE.

PARTICIPANTS AND SETTING

We conducted an exhaustive court file review of the 364 participants in a U.S. based juvenile delinquency specialty court for youth affected by CSE. The observation period spanned 2012-2017.

METHODS

The research team systematically transferred data from court files into a secure, electronic database. Descriptive statistics and Chisquared tests were calculated to explore potential associations.

RESULTS

Participation in the specialty court for youth impacted by CSE suggests an increase in identification of mental health and substance use needs and linkages and referrals to mental health and substance use treatment services. In addition, there was increased stabilization as indicated by decreased substantiated child welfare allegations, fewer running away episodes, and placements and criminal involvement.

CONCLUSIONS

Specialty courts that incorporate a multidisciplinary, trauma-informed approach offer a promising intervention model for meeting the high treatment needs of youth impacted by CSE.

Pregnancy Outcomes Among Girls Impacted by Commercial Sexual Exploitation

OBJECTIVE

We measured pregnancy rates and pregnancy outcomes among girls with histories of commercial sexual exploitation (CSE), and then quantified the associations between the outcome of pregnancy with: a) girls' exposure to childhood adversity, and b) their behavioral health. This is the largest study of pregnancy outcomes and associated factors among girls impacted by CSE in the United States.

METHODS

We reviewed court files of participants in a juvenile specialty court for youth impacted by CSE, between 2012 and 2016. We collected data on pregnancy, health, and social factors. Data were updated through 2018 and descriptive statistics were calculated. Two-sample tests for equality of proportions explored associations between pregnancy with adverse childhood experiences and the girls' behavioral health profiles.

RESULTS

Among the 360 biological females, 31% had ever been pregnant. Of the girls ever pregnant, 18% had multiple pregnancies. Outcomes for the 130 reported pregnancies were: 76% live births; 13% therapeutic abortions; 5% miscarriages or stillbirths; and 6% of pregnancies were ongoing at case closure. Parental incarceration and histories of maternal substance abuse were both associated with pregnancy.

CONCLUSIONS

High pregnancy rates among girls with histories of CSE suggest the importance of applying a reproductive justice approach to deliver reproductive education, family planning services, prenatal care, and parenting support to girls impacted by CSE.

Understanding Commercially Sexually Exploited Youths' Facilitators and Barriers toward Contraceptive Use: I Didn't Really Have a Choice

STUDY OBJECTIVE

Because of the high reproductive health risks that commercially sexually exploited youth (CSEY) face, we sought to understand facilitators and barriers related to their use of condoms and hormonal contraception. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted semistructured interviews with 21 female CSEY. Interviews were audio-recorded, transcribed, and coded for emergent themes. Participants were enrolled through group homes and a juvenile specialty court serving CSEY.

RESULTS

Overall, CSEY reported relatively easy access to hormonal contraception and condoms, expressing a strong preference for condoms as their primary form of contraception. Most respondents described an aversion toward hormonal birth control, attributed to personal experiences and peer accounts of side effects. Many also shared a common belief that hormonal methods are "unnatural," cause infertility, and have low efficacy. Although youth expressed a preference for condom use, they also reported frequent unprotected sex. Furthermore, there were notable barriers to hormonal contraception and condom use that were specific to youths' sexual exploitation, primarily because of their lack of control while trafficked.

CONCLUSION

Although participants noted relatively easy access to contraception, a number of barriers to condom and hormonal contraceptive use exist. Many of these barriers align with youth identified in other at-risk adolescent populations, however, CSEY also face a number of barriers that might be attributable to their unique experience of commercial sexual exploitation. Contraceptive education that dispels prevailing myths, sets clear expectations regarding side effects, and emphasizes autonomy is most likely to resonate with their world view and experiences.