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Marie Javier N, Noy R. Affirming Care for LGBTQ+ Patients. Clin Geriatr Med 2024; 40:211-221. [PMID: 38521593 DOI: 10.1016/j.cger.2023.11.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
The lesbian, gay, bisexual, transgender, and queer(LGBTQ +) community is a marginalized minority group who continues to face and experience significant discrimination, prejudice, stigma, oppression, and abuse in various societal domains including health care. The older adult LGBTQ + community is an especially vulnerable group as they have unique minority stressors attributed to intersectional identities of age, ableism, ethnicity, and employment, among other factors. It is critical for health care providers to recognize and mitigate disproportionate care by engaging in strategies that promote inclusion and affirmation of their sexual orientation and gender identity. The biopsychosocial, cultural, and spiritual framework is a useful tool to care for this community in a holistic and compassionate way.
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Affiliation(s)
- Noelle Marie Javier
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, 1070, New York, NY 10029, USA.
| | - Roy Noy
- Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
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2
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Oeser P, Grune J, Dedow J, Herrmann WJ. The 5 C model and Mpox vaccination behavior in Germany: a cross-sectional survey. BMC Public Health 2024; 24:1039. [PMID: 38622587 PMCID: PMC11017625 DOI: 10.1186/s12889-024-18489-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Due to the authorization of the Mpox vaccines, we aimed to identify determinants of the intention to get vaccinated, actively trying to receive vaccination, and for successfully receiving a vaccination in Germany employing the 5 C model of vaccination readiness. METHODS Data stem from a cross-sectional online survey that was available online from August 13, 2022 to August 31, 2022. To assess the influence of the 5 C Model on vaccination behavior, we conducted a multinomial logistic regression. RESULTS 3,338 participants responded to the survey, with 487 already vaccinated and 2,066 intending to receive a vaccination. Confidence and collective responsibility were positively associated with intention to get vaccinated, while complacency was negatively correlated. A higher score on the calculation scale increased the odds of intention to receive vaccination but not with actively having tried to receive a vaccination. Fewer perceived constraints were associated with higher odds to be vaccinated. Patients in practices that focus on HIV treatment were more likely to intend to get vaccinated, to have tried to get vaccinated and to be vaccinated, regardless of indication. While level of education had no impact, having an indication to get vaccinated was a strong predictor of vaccination behavior in all groups. CONCLUSION Future vaccination campaigns should aim to reduce specific constraints of the target group and make vaccines widely available in primary care institutions beyond HIV-focused practices.
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Affiliation(s)
- Philip Oeser
- Institute of General Practice and Family Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Julianna Grune
- Institute of General Practice and Family Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jendrik Dedow
- Institute of General Practice and Family Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolfram Joachim Herrmann
- Institute of General Practice and Family Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Haines HM, Fields EL, Alvarenga A, Yang Y, Shorrock F, Reed C, Armington G, Gaydos CA, Manabe YC, Arrington-Sanders R. Improving Access to Care Through Youth-Focused Virtual Sexual Health Navigation. J Adolesc Health 2024:S1054-139X(24)00119-8. [PMID: 38597840 DOI: 10.1016/j.jadohealth.2024.02.027] [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: 08/08/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Gender and sexually diverse adolescents and young adults in Baltimore City, Maryland, are disproportionately impacted by HIV. The Virtual and Online Integrated Sexual Health Services for Youth program is a health navigation program which combines virtual sexual health service delivery and health navigation to link youth at risk for HIV acquisition to HIV testing/prevention and sexual healthcare services. METHODS Youth between 13 and 26 years old and residing in the Baltimore area were eligible to participate in the program. Demographic and engagement data from 238 youth (average age 21.4, SD = 2.5) who requested navigation were collected and recorded in a Health Insurance Portability and Accountability Act (HIPAA)-secure medical database and examined for associations between demographics, referral source, and the number of navigational services to which they were linked. Focused populations were defined as residents of high HIV prevalence zip codes who identify as sexual and gender diverse youth. RESULTS Receipt of navigational services was significantly associated with self-identifying as sexually diverse. A multivariate regression revealed a significant association between the count of navigational services a youth was linked to and recording one's sexual orientation, identifying as a cisgender male, and residing in a high HIV-prevalence zip code. DISCUSSION Virtual health navigation has the potential to engage priority populations, including sexual and gender diverse youth. By refining linkage and identification approaches to health navigation, future outreach attempts can be tailored to support vulnerable communities, with the potential to improve sexual healthcare access.
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Affiliation(s)
- Haley M Haines
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Errol L Fields
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Aubrey Alvarenga
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Yeng Yang
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Fiona Shorrock
- Johns Hopkins Hospital Children's Center, Baltimore, Maryland
| | - Christopher Reed
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gretchen Armington
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Yukari C Manabe
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Renata Arrington-Sanders
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland; Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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4
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Atarere J, Chido-Amajuoyi O, Onyeaka H, Akpoviroro O, Adewunmi C, Mele AA, Faith CO, Nwani S, Kanth P. Awareness of the causal association between human papillomavirus and anal cancer among US adults. Cancer Causes Control 2024; 35:719-725. [PMID: 38103133 DOI: 10.1007/s10552-023-01830-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/11/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The incidence of anal cancer is on the rise in the US, especially among high-risk groups. This study examined the prevalence and determinants of awareness of the causal relationship between HPV and anal cancer among US adults. METHODS Study data was obtained from the 2017 to 2020 iterations of the Health Information National Trends Survey. The prevalence of awareness that HPV causes anal cancer was estimated among HINTS respondents who were aware of HPV in general. Survey weights were used to provide estimates representative of the adult US population. Multivariable logistic regressions were used to examine the associations between awareness that HPV causes anal cancer and cancer-related behaviors/perceptions and sociodemographic characteristics of respondents. RESULTS Two thousand six hundred and eighty four (27.2%) of the study population were aware that HPV caused anal cancer. Those of gay sexual orientation were more aware than heterosexuals [OR 2.27; 95% CI (1.24, 4.14)]. Compared to respondents with a high school diploma or less, individuals with some college education [OR 1.38; 95% CI (1.03, 1.85)] and those with at least a college degree [OR 1.52; 95% CI (1.17, 1.98)] were more likely to be aware. Participants who had positive cancer information seeking behavior were more aware of the HPV-anal cancer link compared to those who did not [OR 1.57; 95% CI (1.30, 1.89)]. CONCLUSION Population-level awareness that HPV causes anal cancer remains critically low in the US. Sexual orientation, level of education and cancer information seeking behavior are associated with increased awareness of the causal relationship between HPV and anal cancer. Efforts should be directed toward addressing the awareness gap among individuals with lower education levels and promoting curiosity-driven information seeking behaviors.
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Affiliation(s)
- Joseph Atarere
- Department of Medicine, MedStar Health, Baltimore, MD, USA.
| | | | - Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Comfort Adewunmi
- Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Chilota O Faith
- Department of Medical and Laboratory Sciences, Madonna University, Okija, Anambra State, Nigeria
| | - Somtochi Nwani
- Department of Pharmaceutical Sciences, University of Nigeria, Enugu, Nigeria
| | - Priyanka Kanth
- Division of Gastroenterology, Georgetown University, District of Columbia, Washington, DC, USA
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5
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Nicoletti A, Giuliano L, Donzuso G, Cicero CE. Exploring the knowledge, attitudes, and practices on sexual and gender minorities patients: a survey on Italian Neurologists. Neurol Sci 2024; 45:1465-1470. [PMID: 37947982 DOI: 10.1007/s10072-023-07181-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Sexual and gender minorities (SGM) encompass individuals identifying as lesbian, gay, bisexual, transgender, and queer (LGBTQ). SGM patients experience difficulties in accessing healthcare and may face discrimination, impacting their overall health outcomes. Enhancing healthcare professionals' knowledge is the initial step in dismantling these barriers. MATERIALS AND METHODS The study has been conducted on the neurologists of the Italian Society of Neurology (SIN). We utilized a survey instrument comprising 24 Likert-type questions to investigate knowledge, attitudes, and practices concerning sexual orientation and gender identity minorities. Likert scales were assessed with scores 1 and 2 as negative response, 3 as neutral, and 4 and 5 as positive responses. RESULTS A total of 177 neurologists (103 women; 58.2%) participated, with a mean age of 44.3 ± 14.6 years answered the survey. Over half recognized sexual and gender orientation as social determinants of health, yet only a minority acknowledged the elevated prevalence of physical and mental health issues in SGM populations. Nearly, all respondents felt confident in examining a sexual minority patient, while only half felt the same regarding transgender patients. The majority of neurologists expressed a need for more comprehensive training and supervision in treating SGM patients. CONCLUSION To enhance healthcare quality for SGM populations, healthcare professionals must receive appropriate training in how to approach, assess, and treat patients within this demographic.
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Affiliation(s)
- Alessandra Nicoletti
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
| | - Loretta Giuliano
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Giulia Donzuso
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
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Kasdin RG, Sun M, Rice T. Mental health concerns among Asian American Pacific Islander and sexual or gender minority youth amidst growing social violence: A call for the development of best practice guidelines. Asian J Psychiatr 2024; 95:103995. [PMID: 38493751 DOI: 10.1016/j.ajp.2024.103995] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Rachel G Kasdin
- Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Mary Sun
- Brigham and Women's Hospital, Boston, MA, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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7
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Seiger KW, McNamara B, Berrahou IK. Gynecologic Care for Sexual and Gender Minority Patients. Obstet Gynecol Clin North Am 2024; 51:17-41. [PMID: 38267126 DOI: 10.1016/j.ogc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Sexual and gender minority (SGM) people, including lesbian, gay, bisexual, transgender, and queer individuals, are a diverse population with a wide spectrum of gynecologic needs. Institutionalized cisheteronormativity, stigmatization, lack of provider training, and fear of discrimination contribute to health disparities in this patient population. In this article, we review key topics in the gynecologic care of SGM patients and provide strategies to enable gynecologists to provide SGM people with equitable and inclusive full spectrum reproductive health care.
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Affiliation(s)
- Kyra W Seiger
- Yale University School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA
| | - Blair McNamara
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Iman K Berrahou
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, Suite 302 FMB, New Haven, CT 06520-806, USA.
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8
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Eidelberg A, Axelrad J, Chedid V, Ballou S, Cheifetz A, Rabinowitz LG. Sexual Health in Sexual and Gender Minority Patients with Inflammatory Bowel Disease. Dig Dis Sci 2024; 69:743-748. [PMID: 38267727 DOI: 10.1007/s10620-023-08253-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND In recent years, legislation targeting the sexual and gender minority (SGM) community has been passed at an increasingly alarming rate, affecting access to safe and effective gender-affirming care and forcing many SGM patients, including those with inflammatory bowel disease (IBD), to withhold their identities and health concerns. Additionally, SGM patients with IBD may have unique health considerations that have not yet been well-studied OBJECTIVE: This article aims to explore the intersection of IBD and sexual health in patients who identify as SGM and to identify limitations for gastroenterologists in caring for SGM patients. The article also aims to provide suggestions for improvement in SGM-competent care within gastroenterology METHODS: A thorough literature review was conducted regarding sexual health and the SGM community with IBD. This included a review of surgical considerations in SGM patients, sexually transmitted infections (STIs) and prevention, and sexual dysfunction RESULTS: Overall, little is known about the impact of IBD on patients who identify as sexual and gender minorities. Surgery, medications, and STIs continue to be a concern in the SGM community with IBD and these areas represent opportunities to improve SGM-competent IBD care. Additionally, implementation of an SGM-focused curriculum is urgently needed in medical education to improve provider knowledge and care for this unique group of patients CONCLUSIONS: Patients with IBD who identify as SGM experience challenges that are not well described in prior literature. More research is needed and is actively being pursued to guide provider awareness and improve sexual health for this patient population.
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Affiliation(s)
- Andrew Eidelberg
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rabb 4, Boston, MA, 02215, USA.
| | | | | | - Sarah Ballou
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rabb 4, Boston, MA, 02215, USA
| | - Adam Cheifetz
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rabb 4, Boston, MA, 02215, USA
| | - Loren G Rabinowitz
- Department of Medicine and Division of Gastroenterology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rabb 4, Boston, MA, 02215, USA
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Gómez W, Gomez AM, Solis S, Dimonte C, Organista KC. Provider Perspectives on Multi-level Barriers and Facilitators to PrEP Access Among Latinx Sexual and Gender Minorities. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01948-8. [PMID: 38381327 DOI: 10.1007/s40615-024-01948-8] [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: 12/13/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
Although pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention intervention, inequities in access remain among Latinx sexual and gender minorities (LSGM). There is also a gap in the PrEP literature regarding providers' perspective on access inequities. This qualitative case study sought to explore barriers and facilitators to PrEP engagement in a community-based integrated health center primarily serving Latinx populations in Northern California. We conducted in-depth, semi-structured interviews with providers (9/15) involved in PrEP services and engaged in a constructivist grounded theory analysis consisting of memoing, coding, and identifying salient themes. Three participants worked as medical providers, three as outreach staff, and one each in planning, education, and research. The analysis surfaced four themes: geopolitical differences, culture as barrier, clinic as context, and patient strengths and needs. Participants referenced a lack of resources to promote PrEP, as well as the difficulties of working within an institution that still struggles with cultural and organizational mores that deprioritize sexual health. Another barrier is related to sexual health being positioned outside of patients' immediate needs owing to structural barriers, including poverty, documentation status, and education. Participants, however, observed that peer-based models, which emboldened their decision-making processes, were conducive to better access to PrEP, as well as allowing them to build stronger community ties. These data underscore the need for interventions to help reduce sexual stigma, promote peer support, and ameliorate structural barriers to sexual healthcare among LSGM.
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Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street (MC309), Chicago, IL, 60607-7134, USA.
| | | | - Sheilalyn Solis
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Cheryl Dimonte
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street (MC309), Chicago, IL, 60607-7134, USA
| | - Kurt C Organista
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
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10
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Franco-Rocha OY, Lewis KA, Kesler SR, Henneghan AM. An Exploratory Analysis of Contributors to Cognitive Functioning Among Sexual and Gender Minority Individuals Who Had COVID-19. J Homosex 2024:1-16. [PMID: 38305820 DOI: 10.1080/00918369.2024.2309497] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sexual and gender minority (SGM) individuals face mental health disparities. However, research analyzing SGM people's mental health after a COVID-19 diagnosis is scarce. In this secondary analysis of a remote study, we 1) examined associations between cognitive and psychosocial health and 2) explored differences between these health outcomes among SGM (n = 14) and heterosexual cisgender (n = 64) U.S. adults who had COVID-19. We used the Patient Reported Outcome Measures Information System (PROMIS) v2.0 to assess subjective cognition and the BrainCheck cognitive test to analyze objective cognition. We administered the Perceived Stress Scale and PROMIS 57 Profile V.2.0 to measure psychosocial health. SGM COVID-19 survivors had worse scores in depression, anxiety, sleep disturbance, pain, stress, and objective cognition than heterosexual cisgender participants (p-values < .05). Objective cognition was associated with age, SGM classification, racial or ethnic minority classification, income, comorbidities, COVID-19 severity, number of symptoms, and pain (|0.137| < r < |0.373|, p-values < .05). Subjective cognition was associated with comorbidities, number of symptoms, depression, anxiety, sleep disturbance, pain, and stress (|0.158| < r < |0.537|, p-values < .05). Additional studies are needed to expand what is known about post-COVID-19 health disparities and to guide policies and interventions that promote cognitive functioning.
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Affiliation(s)
| | - Kimberly A Lewis
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
- Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
- Department of Oncology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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11
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Segovia M, Sparks PJ. Sexual minorities and sleep health: How does discrimination and stigma influence a sleep disorder diagnosis? Sleep Health 2024; 10:41-47. [PMID: 38151378 DOI: 10.1016/j.sleh.2023.11.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Sleep difficulties are associated with many physical and mental health problems, such as diabetes, hypertension, and depressive symptoms. Sleep can be affected by stressors such as discrimination and stigma, which are disproportionately experienced by sexual and gender minority (SGM) individuals. This research assesses how different characteristics, including discrimination and stigma, sociodemographic characteristics, community connectedness, self-rated good health, and outness levels, influence a sleep disorder diagnosis among SGMs. METHODS We analyzed data from wave 3 of Generations: A Study of the Life and Health of LGB People in a Changing Society. We used bivariate analysis to document the distribution of key variables across SGM status. Next, we conducted logistic regression analyses to measure how each variable influences the likelihood of an SGM individual being diagnosed with a sleep disorder considering experiences of discrimination and stigma. RESULTS We found that feeling stigma was statistically significant in predicting a sleep disorder diagnosis among SGM individuals. However, after controlling for sociodemographic characteristics, community connectedness, self-rated good health, and outness levels, SGM individuals only had increased odds of a sleep disorder diagnosis if they reported higher scores on the Internalized Homophobia Scale. CONCLUSIONS Variation in having a sleep disorder diagnosis differs based on SGM status and could not be explained away with the inclusion of all covariates. Our findings support the need for more research to compare health outcomes between different sexual and gender identities, rather than comparing them with their nonminority counterparts.
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Affiliation(s)
- Michael Segovia
- Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, Texas, USA.
| | - Patrice Johnelle Sparks
- Department of Demography, University of Texas at San Antonio, One UTSA Circle, San Antonio, Texas, USA
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12
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Darrow WW. The City Clinic Cohort Study: Hepatitis B, HTLV-III/LAV, and CDC AIDS Project 24. AIDS Behav 2024; 28:377-392. [PMID: 38236319 DOI: 10.1007/s10461-023-04187-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 01/19/2024]
Abstract
Anticipating the availability of a safe vaccine, scientists at the Center for Disease Control (CDC) planned for a multicenter study of the prevalence, incidence, and efficacy of an experimental vaccine for hepatitis B in 1977, conducted the study among homosexual male volunteers in five collaborating sexually transmitted infection (STI) clinics in the United States from April 1978 through 1980, and concluded that the candidate vaccine was highly efficacious in preventing infections with the hepatitis B virus. Then something completely unexpected and portentous happened. Some successfully vaccinated as well as other homosexual and bisexual men began to show signs and symptoms of a rare cancer, Kaposi's sarcoma, and opportunistic infections typically associated with severe immunodeficiency. As early as October 1983, members of the Hepatitis B study cohort in San Francisco were invited to return to the city STI clinic for further examinations, testing, and confidential interviews about their sexual and other practices. CDC AIDS Project 24 was designed to help describe the natural history of AIDS, define risk factors, and predict future trends. It produced some of the earliest and most convincing scientific evidence about the seriousness and extent of the AIDS epidemic among homosexual and bisexual men in the United States. How the City Clinic Cohort Study came about and evolved is the focus of this commentary.
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Affiliation(s)
- William W Darrow
- Professor Emeritus, Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, 33199, USA.
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13
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Kalwicz DA, Rao S, Modrakovic DX, Zea MC, Dovidio JF, Eaton LA, Holt M, MacGibbon J, Zaheer MA, Garner A, Calabrese SK. The Implications of PrEP Use, Condom Use, and Partner Viral Load Status for Openness to Serodifferent Partnering Among US Sexual Minority Men (SMM). AIDS Behav 2024; 28:524-534. [PMID: 38329558 PMCID: PMC10999131 DOI: 10.1007/s10461-023-04241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
PrEP has been reported to facilitate openness to serodifferent sexual partnerships among sexual minority men (SMM). However, other aspects of a sexual scenario likely come into play, including whether or not condoms are used and whether or not the partner living with HIV has an undetectable viral load. This online survey study evaluated the association between PrEP status and openness to serodifferent partnering, as well as the effects of various sexual scenario variables (condom use and partner's viral load) among 268 HIV-negative SMM in the US. Each participant reported their PrEP status and rated their openness to serodifferent partnering in four sexual scenarios, which varied by condom use (with/without) and partner viral load status (detectable/undetectable). Analyses of covariance (ANCOVAs) were conducted to assess differences in openness to serodifferent partnering by PrEP status in each scenario, adjusting for background characteristics. A two-way repeated measures ANCOVA and a three-way mixed factorial ANCOVA, including PrEP status as a between-subjects variable, were also performed to assess the effects of condom use and partner viral load status on openness. Across all scenarios, current PrEP users expressed significantly greater openness to serodifferent partnering compared to participants who had never used PrEP. Current PrEP users were also more likely than former PrEP users to consider partnering with someone with an undetectable viral load without using condoms. Both PrEP users and PrEP-inexperienced individuals had greater openness to serodifferent partnering with a partner having an undetectable (vs. detectable) viral load, which was magnified by condom use among the latter.
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Affiliation(s)
- David A Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA.
| | - Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Djordje X Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Maria Cecilia Zea
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
- Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Myra A Zaheer
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA
| | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA
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14
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King AJ, Bilardi JE, Maddaford K, Fairley CK, Chow EP, Phillips TR. Sexual health clinic attendees' views on antibiotic post-exposure prophylaxis and vaccinations for sexually transmitted infections prevention: A qualitative study. Prev Med Rep 2024; 38:102628. [PMID: 38375181 PMCID: PMC10874840 DOI: 10.1016/j.pmedr.2024.102628] [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: 10/02/2023] [Revised: 12/19/2023] [Accepted: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
Background The rising prevalence of bacterial sexually transmitted infections (STIs) is cause for concern in the context of antimicrobial resistance and the potential health outcomes of untreated infections. Objective The Community Awareness and Surveillance of Transmission (CAST) study sought sexual health service users' views on reducing the prevalence of STIs. Methods Semi-structured interviews were conducted with sexual health clinic attendees who had received a diagnosis of chlamydia, gonorrhea or syphilis in the previous six months. Participant comments relating to antibiotic post-exposure prophylaxis (APEP) and vaccination were inductively coded, then compared using comparative qualitative data analysis methods described by Miles and Huberman. Findings Twenty-one participants with differing genders, ages, nationalities and sexual orientations, were interviewed. Participants across informant groups expressed concerns about APEP for STI prevention because of potential antimicrobial resistance and personal health impacts. Vaccination against bacterial STIs was more acceptable. Common factors mentioned in relation to both interventions included perception of individual STI risk over time, safety, effectiveness and accessibility. Conclusions The views of sexual health service users support efforts to find alternatives to more frequent use of antibiotics, such as vaccinations against bacterial STIs, to reduce STI incidence and support antimicrobial stewardship.
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Affiliation(s)
- Alicia J. King
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Jade E. Bilardi
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Maddaford
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Eric P.F. Chow
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Tiffany R. Phillips
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
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15
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Yang Y, Ye Z, Li W, Sun Y, Dai L. Efficacy of psychosocial interventions to reduce affective symptoms in sexual and gender minorities: a systematic review and meta-analysis of randomized controlled trials. BMC Psychiatry 2024; 24:4. [PMID: 38166855 PMCID: PMC10762931 DOI: 10.1186/s12888-023-05451-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are more likely than cisgender heterosexuals to experience mental, physical, and sexual health issues. A promising contemporary strategy to address the issue of affective symptoms in sexual and gender minorities (SGM) is psychosocial intervention. OBJECTIVE To systematically evaluate the effect of psychosocial interventions on the improvement of affective symptoms in SGM, and to provide a reference for the implementation of effective psychological interventions for SGM with affective symptoms. METHODS Between the date of database construction until December 10, 2022, a computerized search of the English-language literature published both nationally and worldwide was done. 8 literature databases and 3 additional gray databases were searched. We gathered randomized controlled trials that used psychological interventions for SGM. To evaluate risk bias in included papers in accordance with Cochrane cooperation criteria, we used Review Manager 5.4 software. In conjunction with post-test and follow-up data, mean differences were standardized using Stata 12.0 software. Subgroup analysis was used to investigate the cause of heterogeneity. The study was conducted strictly in accordance with PRISMA guidelines, and it was registered on the PROSPERO platform (CRD42023408610). RESULTS This review covered 18 research, and 14 studies were included in the meta-analysis. A total of 1194 study cases, including 706 cases from the control group and 488 cases from the experimental group, were included in these investigations. Compared to the control group, the psychosocial intervention group had significantly lower levels of depression (standardized mean difference (SMD) = -0.17;95% CI = [-0.30, -0.04]; p = 0.012) and anxiety (SMD = -0.22; 95% CI = [-0.41, -0.04]; p = 0.01), but no significant differences were found for distress (SMD = -0.19; 95% CI = [-0.45,0.07]; p = 0.021). CONCLUSION According to this study, psychosocial interventions helped lessen the symptoms of depression and anxiety in SGM but had no significant effect on their psychological distress. To assess the impact of psychological intervention on SGM, more randomized controlled trials with larger sample sizes and numerous follow-up times should be done.
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Affiliation(s)
- Yawen Yang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Wuhan, Hubei Province, 430074, China
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China
- Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Zhiyu Ye
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Wuhan, Hubei Province, 430074, China
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China
- Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Wentian Li
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Wuhan, Hubei Province, 430074, China
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China
- Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Ye Sun
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China
- Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Lisha Dai
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Wuhan, Hubei Province, 430074, China.
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China.
- Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China.
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16
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Warus J, Hidalgo MA, Belzer M, Olson-Kennedy J. Acute HIV Diagnosis After Initiation of Pre-exposure Prophylaxis in a Young Adult Patient: A Case Report. J Adolesc Health 2024; 74:205-207. [PMID: 37690011 PMCID: PMC10843824 DOI: 10.1016/j.jadohealth.2023.07.013] [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: 12/26/2022] [Revised: 02/27/2023] [Accepted: 07/17/2023] [Indexed: 09/11/2023]
Abstract
Oral pre-exposure prophylaxis (PrEP) in the prevention of human immunodeficiency virus (HIV) infection is highly effective, yet the majority of sexually active adolescents and young adults (AYAs) at highest risk for HIV infection, particularly AYA males who have sex with males, have not been prescribed this medication. Provider hesitancy in prescribing PrEP to at-risk AYA patients is often associated with concerns about patient nonadherence and its effect on inducing HIV medication resistance. This case report has two aims. First, to outline the clinical course for an AYA patient prescribed PrEP for 3 months and then found to have HIV with an M184V resistance mutation and subsequently started on HIV treatment. And second, to illustrate how the benefits of PrEP initiation outweigh its risks by presenting clinical data on resistance patterns to PrEP medications. The patient eventually achieved viral suppression within 5 months of starting HIV treatment which has been sustained up to 2 years. This case illustrates that M184V resistance mutations, although rarely associated with PrEP, are unlikely to impact options for HIV treatment. Providers should recommend and prescribe oral PrEP to AYA patients at risk for HIV infection without concern for nonadherence leading to HIV medication resistance.
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Affiliation(s)
- Jonathan Warus
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.
| | - Marco A Hidalgo
- Division of Internal Medicine-Pediatrics and Preventive Medicine, University of California Los Angeles, Los Angeles, California
| | - Marvin Belzer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Johanna Olson-Kennedy
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
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17
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Crosby B, Gell-Levey IM, Monroe J, Streed CG, Siegel J, Carter EE, Mulkey N, Zumwalt AC. Comparison of faculty and student perceptions of sexual and gender minority content in a preclerkship medical curriculum. BMC Med Educ 2023; 23:973. [PMID: 38115000 PMCID: PMC10731801 DOI: 10.1186/s12909-023-04925-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Sexual and gender minority (SGM) persons experience stark health disparities. Efforts to mitigate disparities through medical education have met some success. However, evaluations have largely focused on subjective perspectives rather than objective measures. This study aimed to quantify Boston University School of Medicine's sexual and gender minority (SGM) education through surveys of course directors (CDs) and medical students regarding where SGM topics were taught in the preclerkship medical curriculum. Responses were compared to identify concordance between faculty intention and student perceptions regarding SGM education. METHODS A cross-sectional survey was distributed to preclerkship CDs and current medical students in Spring 2019 and 2021, respectively, regarding where in the mandatory preclerkship curriculum CDs deliberately taught and where first- and second-year students recalled having learned 10 SGM topic domains. RESULTS 64.3% of CDs (n = 18), 47.0% of the first-year class (n = 71), and 67.3% of the second-year class (n = 101) responded to the surveys. Results indicate that, as anticipated, deliberate SGM teaching correlates with greater student recall as students recalled topics that were reported by CDs as intentionally taught at a significantly higher rate compared to those not intentionally taught (32.0% vs. 15.3%; p < 0.01). Students most commonly recalled learning SGM-related language and terminology, which is likely partly but not entirely attributed to curricular modifications and faculty development made between distribution of the faculty and student surveys, indicating the importance of all faculty being trained in appropriate SGM terminology and concepts. Discordance between faculty intention and student recall of when topics were taught reveals opportunities to enhance the intentionality and impact of SGM teaching. CONCLUSIONS Students perceive and recall SGM content that is not listed as learning objectives, and all faculty who utilize this material in their teachings should receive foundational training and be thoughtful about how information is framed. Faculty who intentionally teach SGM topics should be explicit and direct about the conclusions they intend students to draw from their curricular content.
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Affiliation(s)
- Benjamin Crosby
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Isabelle M Gell-Levey
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Pediatrics & Child Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Janet Monroe
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Carl G Streed
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, MA, USA
| | - Jennifer Siegel
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, MA, USA
- Transgender Health Program, Massachusetts General Hospital, Boston, MA, USA
| | - Erin E Carter
- Division of Urology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Nat Mulkey
- Department of Psychiatry, The University of Vermont Medical Center, Burlington, VT, USA
| | - Ann C Zumwalt
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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18
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Choi SK, Bauermeister J, Tingler RC, Johnson S, Macagna N, Ho K, Hoesley C, Liu A, Kayange N, Palanee-Phillips T, Chariyalertsak S, Gonzales P, Piper JM. A latent trajectory analysis of young sexual and gender minorities' adherence to three rectal microbicide placebo formulations (MTN-035; a randomized crossover trial). BMC Public Health 2023; 23:2464. [PMID: 38066471 PMCID: PMC10709877 DOI: 10.1186/s12889-023-17368-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Rectal microbicides (RM) are biomedical HIV prevention products that aim to prevent or reduce the transmission of HIV and other sexually transmitted infections (STIs). RM modalities may be beneficial for populations who have complex lifestyles, difficulties adhering to pre-exposure prophylaxis (PrEP) regimens, and/or have limited access to care. MTN-035 (DESIRE; Developing and Evaluating Short-Acting Innovations for Rectal Use), a randomized crossover trial, aimed to evaluate the safety and acceptability of, and adherence to, three placebo RM modalities (douche, insert, and suppository) prior to receptive anal intercourse. METHODS We conducted latent trajectory analysis to identify clusters of individuals who shared similar trajectories in acceptability and adherence for each product (douche, insert, and suppository) over time. We analyzed weekly short messaging service (SMS) use reports for each modality as reported by enrolled sexual and gender minority (SGM) participants. RESULTS Two trajectories for each product were identified: a "protocol compliant" trajectory (i.e., at least one product use occasion per week) and "high use" trajectory (i.e., more than three product use occasions per week). Participants with high use were more likely to lack access to PrEP and have higher intentions to utilize RM modalities compared to those who were protocol compliant. CONCLUSIONS This study highlighted high adherence to RM modalities among SGM. As research into viable HIV prevention modalities continues to evolve, tailored intervention strategies are needed to support the uptake of and adherence to alternative prevention modalities that are behaviorally congruent with targeted users. TRIAL REGISTRATION NCT03671239 (14/09/2018).
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Affiliation(s)
- Seul Ki Choi
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Room 235L, Philadelphia, PA, 19104, USA.
| | - José Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Room 235L, Philadelphia, PA, 19104, USA
| | - Ryan C Tingler
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Room 235L, Philadelphia, PA, 19104, USA
| | | | | | - Ken Ho
- Magee-Women's Research Institute, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Craig Hoesley
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Albert Liu
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Noel Kayange
- Johns Hopkins University Research Project, Blantyre, Malawi
| | - Thesla Palanee-Phillips
- Faculty of Health Sciences, School of Public Health, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA
| | - Suwat Chariyalertsak
- Faculty of Public Health, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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19
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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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20
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Astle KN, Hart LA, Holloway J, Medlin CG, Mills AR, Nardolillo JA, Phan T, Wilby KJ. Born This Way: Integrating LGBTQIA+ Identities as Pharmacy Practitioners. Am J Pharm Educ 2023; 87:100122. [PMID: 38097310 DOI: 10.1016/j.ajpe.2023.100122] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/20/2023] [Accepted: 04/11/2023] [Indexed: 12/18/2023]
Abstract
Progression through the profession of pharmacy is filled with many milestones that can contribute to feelings of stress, rejection, and isolation. For Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual+(LGBTQIA+) students and practitioners, these feelings can be compounded by similar issues experienced by their sexual orientation or gender identity. Historically, LGBTQIA+ students, new practitioners, and seasoned professionals alike have lacked visible role models for how to intersect personal and professional identity in the pharmacy profession. In this paper, the authors describe experiences of intersecting personal queer identities with professional pharmacy identities; exploring barriers to integration and developing solutions to overcome these barriers. The authors also share how the formation of a collective of LGBTQIA+ practitioners and educators has led to a unified voice to advocate for the advancement of LGBTQIA+ healthcare in pharmacy education and practice. This manuscript will provide readers with a guide to navigate and address issues with the integration of personal and professional identity to lead to practice that validates personal identity as important, valuable, and affirmed.
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Affiliation(s)
| | - Laura A Hart
- University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA
| | | | | | - Alex R Mills
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, University Ave, MS, USA
| | | | - Tam Phan
- University of Southern Calfornia, Los Angeles, CA, USA
| | - Kyle John Wilby
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, NS, Canada; Editorial Board, American Journal of Pharmaceutical Education, USA
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21
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Curtis MG, Floresca YB, Davoudpour S, Xu J, Phillips G. Patterns of COVID-19 related lifestyle disruptions and their associations with mental health outcomes among youth and young adults. J Mood Anxiety Disord 2023; 4:100029. [PMID: 38125785 PMCID: PMC10732581 DOI: 10.1016/j.xjmad.2023.100029] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The COVID-19 pandemic is a socionatural disaster that has disrupted the lives of individuals, families, and communities. Youth and young adults (YYA) were uniquely vulnerable to the proximal mental health effects of the pandemic; however, few studies have examined the long-term mental health effects of the pandemic. In the present study, we sought to (a) identity distinctive profiles of COVID-related lifestyle disruptions experienced by YYA, (b) investigate sociodemographic characteristics correlates of profile membership, and (c) examine the extent to which profile membership was prospectively associated with changes in depressive and anxiety symptoms. Hypothesis were tested using latent profile analysis with data from 1055 YYA collected across two time-points, 6-months apart. Results produced a three-class model: low- (11%), moderate- (61%), and high-levels of (28%) disruption. Members of the high levels of disruption group were more likely to identify as Black or Latinx American, bisexual/pansexual, or as transgender or gender diverse in comparison to the low levels of disruption group. Inclusion in the high levels of disruption group was associated with increases in depressive and anxiety symptoms from T1 to T2. YYA from multiple marginalize communities (i. e. those who identified as both racial/ethnic and sexual/gender minorities) experienced the greatest levels of lifestyle disruption related to COVID-19. Consequently, disruptive effects of the COVID-19 pandemic prospectively eroded their mental health. YYA are in urgent need of developmentally appropriate resources to effectively recovery from the pandemic.
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Affiliation(s)
- Michael G. Curtis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
| | - Ysabel Beatrice Floresca
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
| | - Shahin Davoudpour
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
| | - Jiayi Xu
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, USA
- Division of Public Health Practice, Department of Preventive Medicine, Feinberg School of Medicine Northwestern University, USA
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22
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Siegel M, Nöstlinger C, Dürrauer F, Kirchner S, Niederkrotenthaler T, Zemp M. [Mental health of sexual and gender minority youth in Austria: scoping review and research agenda based on international evidence]. Neuropsychiatr 2023; 37:196-205. [PMID: 36316573 DOI: 10.1007/s40211-022-00436-x] [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] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
A robust body of international evidence documents that lesbian, gay, bisexual, transgender, and other youth with diverse sexual orientations and/or gender identities (i.e., sexual and gender minority youth) face unique mental health vulnerabilities but are also equipped with unique resources. However, it is unclear to what extent these findings are applicable to sexual and gender minority youth in Austria, because the sociolegal and developmental contexts differ across countries. According to PRISMA guidelines, we conducted a systematic scoping review (1) to identify published studies on the mental health of sexual and gender minority youth in Austria, and, based on this, (2) to derive research recommendations supplemented by international evidence. We searched five scientific databases (PsycInfo, PSYNDEX, PubMed, Scopus, Web of Science; March 2022) and additionally contacted researchers and community leaders to find pertinent studies. Only two published empirical studies on the mental health of sexual and gender minority youth in Austria could be located, reflecting the sparse state of research in Austria. Against this background, we outline a detailed research agenda following a socio-ecological approach. Including sexual orientation and non-binary gender identities in population-based studies to assess onset, prevalence, and trajectory of mental health burdens, as well as conducting targeted, resource-based, and developmentally sensitive research on all levels seem paramount to reduce health disparities and societal stigma and to support sexual and gender minority youth in their development.
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Affiliation(s)
- Magdalena Siegel
- Institut für Klinische und Gesundheitspsychologie, Universität Wien, Wien, Österreich.
| | | | - Flo Dürrauer
- Institut für Klinische und Gesundheitspsychologie, Universität Wien, Wien, Österreich
| | - Stefanie Kirchner
- Abteilung für Sozial- und Präventivmedizin, Medizinische Universität Wien, Wien, Österreich
| | | | - Martina Zemp
- Institut für Klinische und Gesundheitspsychologie, Universität Wien, Wien, Österreich
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23
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Ruiz MJ, Chisholm B, de Martelly V, Chor J. Sexual and Gender Minority Patients' First Pelvic Examination Experiences: What Clinicians Need to Know. J Pediatr Adolesc Gynecol 2023:S1083-3188(23)00447-3. [PMID: 38012980 DOI: 10.1016/j.jpag.2023.11.008] [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: 08/20/2023] [Revised: 11/05/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
STUDY OBJECTIVE The aim of this study was to identify factors that influence the first pelvic exam experiences of sexual and gender minority (SGM) adolescents and young adults who were assigned female at birth (AFAB). METHODS Using purposive sampling, we recruited SGM AFAB individuals, ages 18-24, who had had at least 1 pelvic examination. Semi-structured interviews and an iterative approach allowed for the emergence of factors influencing the first pelvic exam experience. Items included in the final code directory had a Krippendorff's alpha intercoder reliability score greater than 0.7. Interviews were analyzed using ATLAS.ti. RESULTS Thirty participants completed interviews. Fourteen participants identified as bisexual, 2 as gay, 1 as lesbian, 3 as pansexual, 8 as queer, and 2 as straight/heterosexual. Sixteen participants identified as cisgender, 9 as genderqueer/gender nonconforming, and 5 as transgender. Factors influencing the first pelvic exam experience were organized as patient- or clinician-level factors. The patient-level factors of gender identity, sexual orientation, history of sexual trauma, and participant's relationship to their body were central factors influencing the exam experience. Speculum insertion during the exam induced anxiety and pain for some. The clinician-level factors of gender, age, and race or ethnicity influenced the exam experience. Most participants preferred detailed communication. Participants offered recommendations to ensure gender-affirming, patient-centered care during the first pelvic exam. CONCLUSION SGM AFAB individuals identified patient- and clinician-level factors influencing their first pelvic exam experiences. This study underscores the need for changes in medical education and health systems to ensure that SGM AFAB individuals have their needs met and feel comfortable in reproductive health settings.
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Affiliation(s)
- Maria J Ruiz
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Briyana Chisholm
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Victoria de Martelly
- The University of Chicago, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Julie Chor
- The University of Chicago, Department of Obstetrics and Gynecology, Chicago, Illinois.
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Caceres BA, Sharma Y, Levine A, Wall MM, Hughes TL. Investigating the Associations of Sexual Minority Stressors and Incident Hypertension in a Community Sample of Sexual Minority Adults. Ann Behav Med 2023; 57:1004-1013. [PMID: 37306778 PMCID: PMC10653588 DOI: 10.1093/abm/kaac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Sexual minority adults are at higher risk of hypertension than their heterosexual counterparts. Sexual minority stressors (i.e., unique stressors attributed to sexual minority identity) are associated with a variety of poor mental and physical health outcomes. Previous research has not tested associations between sexual minority stressors and incident hypertension among sexual minority adults. PURPOSE To examine the associations between sexual minority stressors and incident hypertension among sexual minority adults assigned female sex at birth. METHODS Using data from a longitudinal study, we examined associations between three sexual minority stressors and self-reported hypertension. We ran multiple logistic regression models to estimate the associations between sexual minority stressors and hypertension. We conducted exploratory analyses to determine whether these associations differed by race/ethnicity and sexual identity (e.g., lesbian/gay vs. bisexual). RESULTS The sample included 380 adults, mean age 38.4 (± 12.81) years. Approximately 54.5% were people of color and 93.9% were female-identified. Mean follow-up was 7.0 (± 0.6) years; during which 12.4% were diagnosed with hypertension. We found that a 1-standard deviation increase in internalized homophobia was associated with higher odds of developing hypertension (AOR 1.48, 95% Cl: 1.06-2.07). Stigma consciousness (AOR 0.85, 95% CI: 0.56-1.26) and experiences of discrimination (AOR 1.07, 95% CI: 0.72-1.52) were not associated with hypertension. The associations of sexual minority stressors with hypertension did not differ by race/ethnicity or sexual identity. CONCLUSIONS This is the first study to examine the associations between sexual minority stressors and incident hypertension in sexual minority adults. Implications for future studies are highlighted.
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Affiliation(s)
- Billy A Caceres
- Columbia University School of Nursing, 560 West 168th Street, Room 603, New York, NY 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA
| | - Yashika Sharma
- Columbia University School of Nursing, 560 West 168th Street, Room 603, New York, NY 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA
| | - Alina Levine
- Department of Biostatistics, Columbia Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Melanie M Wall
- Department of Biostatistics, Columbia Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 West 168th Street, Room 603, New York, NY 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA
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Hua Y, Wang L, Nguyen V, Rieu-Werden M, McDowell A, Bates DW, Foer D, Zhou L. A deep learning approach for transgender and gender diverse patient identification in electronic health records. J Biomed Inform 2023; 147:104507. [PMID: 37778672 PMCID: PMC10687838 DOI: 10.1016/j.jbi.2023.104507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Although accurate identification of gender identity in the electronic health record (EHR) is crucial for providing equitable health care, particularly for transgender and gender diverse (TGD) populations, it remains a challenging task due to incomplete gender information in structured EHR fields. OBJECTIVE Using TGD identification as a case study, this research uses NLP and deep learning to build an accurate patient gender identity predictive model, aiming to tackle the challenges of identifying relevant patient-level information from EHR data and reducing annotation work. METHODS This study included adult patients in a large healthcare system in Boston, MA, between 4/1/2017 to 4/1/2022. To identify relevant information from massive clinical notes, we compiled a list of gender-related keywords through expert curation, literature review, and expansion via a fine-tuned BioWordVec model. This keyword list was used to pre-screen potential TGD individuals and create two datasets for model training, testing, and validation. Dataset I was a balanced dataset that contained clinician-confirmed TGD patients and cases without keywords. Dataset II contained cases with keywords. The performance of the deep learning model was compared to traditional machine learning and rule-based algorithms. RESULTS The final keyword list consists of 109 keywords, of which 58 (53.2%) were expanded by the BioWordVec model. Dataset I contained 3,150 patients (50% TGD) while Dataset II contained 200 patients (90% TGD). On Dataset I the deep learning model achieved a F1 score of 0.917, sensitivity of 0.854, and a precision of 0.980; and on Dataset II a F1 score of 0.969, sensitivity of 0.967, and precision of 0.972. The deep learning model significantly outperformed rule-based algorithms. CONCLUSION This is the first study to show that deep learning-integrated NLP algorithms can accurately identify gender identity using EHR data. Future work should leverage and evaluate additional diverse data sources to generate more generalizable algorithms.
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Affiliation(s)
- Yining Hua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
| | - Liqin Wang
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Vi Nguyen
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Meghan Rieu-Werden
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Alex McDowell
- Health Policy Research Institute, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Dinah Foer
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, USA.
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Wagner AL, Lacombe-Duncan A, Boulton ML. Acceptance of a Future Gonorrhea Vaccine in a Post-Coronavirus Disease 2019 World: Impact of Type of Recommendation and Changing Levels of Trust in Health Institutions and Authorities. Med Clin North Am 2023; 107:e19-e37. [PMID: 38609279 PMCID: PMC10261718 DOI: 10.1016/j.mcna.2023.06.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Widespread uptake of a future gonorrhea vaccine could decrease the burden of disease and limit the spread of antibiotic resistance. However, gonorrhea vaccination will occur in the backdrop of the roll-out of the coronavirus disease 2019 (COVID-19) vaccine, which could have influenced parental perceptions about other, non-COVID-19 vaccines. In an internet-based cross-sectional survey, 74% of parents would get a gonorrhea vaccine for their child, and this was higher among those whose trust in pharmaceutical companies increased since the start of the COVID-19 pandemic. About 60% of adults aged 18 to 45 would receive a vaccine for themselves.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Division of Infectious Disease, Department of Internal Medicine, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Hastings PD, Hodge RT. Considering the experiences and adjustment of sexual and gender minority youths during the COVID-19 pandemic. Curr Opin Psychol 2023; 53:101660. [PMID: 37517165 DOI: 10.1016/j.copsyc.2023.101660] [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: 05/31/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
Sexual and gender minority (SGM) adolescents and emerging adults experienced social and structural inequities and evinced more psychosocial adjustment difficulties than cisgender, heterosexual youths before the onset of the COVID-19 pandemic. The unique array of stressors confronting SGM youths during the pandemic - including separation from affirming and supportive peers, teachers and communities, and mandated co-residence with potentially rejecting family members - may have exacerbated these discrepancies. Conversely, social distancing and remote learning may have reduced direct exposure to discrimination outside the home, and many SGM youths leveraged their personal and social resources to cope with pandemic-related stressors. This review considers the empirical literature on the academic, psychological, and social consequences of the COVID-19 pandemic for SGM youths.
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Affiliation(s)
- Paul D Hastings
- Department of Psychology, University of California Davis, Davis, CA, USA; Center for Mind and Brain, University of California Davis, Davis, CA, USA.
| | - Ryan T Hodge
- Center for Mind and Brain, University of California Davis, Davis, CA, USA; Department of Human Ecology, University of California Davis, Davis, CA, USA
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Shields RK, Suneja M, Shields BE, Tofte JN, Dudley-Javoroski S. Healthcare educational debt in the united states: unequal economic impact within interprofessional team members. BMC Med Educ 2023; 23:666. [PMID: 37710228 PMCID: PMC10503048 DOI: 10.1186/s12909-023-04634-1] [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] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Advancing healthcare access and quality for underserved populations requires a diverse, culturally competent interprofessional workforce. However, high educational debt may influence career choice of healthcare professionals. In the United States, health professions lack insight into the maximum educational debt that can be supported by current entry-level salaries. The purpose of this interprofessional economic analysis was to examine whether average educational debt for US healthcare graduates is supportable by entry-level salaries. Additionally, the study explored whether trainees from minoritized backgrounds graduate with more educational debt than their peers in physical therapy. METHODS The study modeled maximum educational debt service ratios for 12 healthcare professions and 6 physician specialties, incorporating profession-specific estimates of entry-level salary, salary growth, national average debt, and 4 loan repayment scenarios offered by the US Department of Education Office of Student Financial Aid. Net present value (NPV) provided an estimate for lifetime "economic power" for the modeled careers. The study used a unique data source available from a single profession (physical therapy, N = 4,954) to examine whether educational debt thresholds based on the repayment model varied between minoritized groups and non-minoritized peers. RESULTS High salary physician specialties (e.g. obstetrics/gynecology, surgery) and professions without graduate debt (e.g. registered nurse) met debt ratio targets under any repayment plan. Professions with strong salary growth and moderate debt (e.g. physician assistant) required extended repayment plans but had high career NPV. Careers with low salary growth and high debt relative to salary (e.g. physical therapy) had career NPV at the lowest range of modeled professions. 29% of physical therapy students graduated with more debt than could be supported by entry-level salaries. Physical therapy students from minoritized groups graduated with 10-30% more debt than their non-minoritized peers. CONCLUSIONS Graduates from most healthcare professions required extended repayment plans (higher interest) to meet debt ratio benchmarks. For several healthcare professions, low debt relative to salary protected career NPV. Students from minoritized groups incurred higher debt than their peers in physical therapy.
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Affiliation(s)
- Richard K Shields
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 1-252 Medical Education Building, Iowa City, IA, 52242, USA.
| | - Manish Suneja
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Bridget E Shields
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Josef N Tofte
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Shauna Dudley-Javoroski
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 1-252 Medical Education Building, Iowa City, IA, 52242, USA
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Zollweg SS, Belloir JA, Drabble LA, Everett B, Taylor JY, Hughes TL. Structural stigma and alcohol use among sexual and gender minority adults: A systematic review. Drug Alcohol Depend Rep 2023; 8:100185. [PMID: 37663525 PMCID: PMC10474584 DOI: 10.1016/j.dadr.2023.100185] [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] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
Background Sexual and gender minority (SGM) people are more likely than their cisgender, heterosexual counterparts to report negative alcohol-related outcomes. Although the association between individual- and interpersonal-level minority stressors and negative alcohol-related outcomes among SGM people is well-established, structural-level minority stressors are understudied. This systematic review examined structural-level stigma and alcohol-related outcomes among SGM people to inform future research, interventions, and policy. Methods We used five electronic databases to search for studies published between January 2010 and May 2022 that examined associations between structural stigma and alcohol use among SGM adults in the United States. Peer-reviewed, quantitative studies available in English were included. We conducted quality appraisal using the Joanna Briggs Institute checklist. Results The final sample included 11 studies. Overall, there was moderate to strong support for a positive association between structural stigma and negative alcohol-related outcomes among SGM people, with differences by gender, sexual identity, race, and ethnicity. All studies used cross-sectional designs, and nearly half utilized non-probability samples. Transgender and nonbinary people, SGM people of color, and sexual identity subgroups beyond gay, lesbian, and heterosexual were underrepresented. Structural stigma was most commonly measured as a state-level index. Alcohol measures were heterogeneous. Multilevel stigma and resiliency factors were understudied. Conclusions Addressing structural stigma is critical in reducing negative alcohol-related outcomes and inequities among SGM people. Research is needed that includes probability samples, longitudinal designs, and samples that reflect the diversity of SGM people. Future studies should examine the influence of multilevel stigma and resiliency factors on alcohol-related outcomes.
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Affiliation(s)
- Sarah S. Zollweg
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
- National Clinician Scholars Program, David Geffen School of Medicine, University of California, Los Angeles, CA, 1100 Glendon Ave, Suite 900, Los Angeles, CA 90024
| | - Joseph A. Belloir
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
| | - Laurie A. Drabble
- San Jose State University College of Health and Human Sciences, One Washington Square, San Jose, CA, 95192, USA
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., #450, Emeryville, CA, 94608, USA
| | - Bethany Everett
- University of Utah, Department of Sociology, 380 S. 1530 E, Salt Lake City, UT, 84112, USA
| | - Jacquelyn Y. Taylor
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
| | - Tonda L. Hughes
- Columbia University School of Nursing, 560 W. 168th St., New York, NY, 10032, USA
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Anderson JN, Paladino AJ, Robles A, Krukowski RA, Graetz I. "I don't just say, Hi! I'm gay": Sexual Orientation Disclosures in Oncology Clinic Settings Among Sexual Minority Women Treated for Breast Cancer in the U.S. South. Semin Oncol Nurs 2023; 39:151452. [PMID: 37331879 PMCID: PMC10524252 DOI: 10.1016/j.soncn.2023.151452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/17/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES Few studies examine sexual orientation disclosures (SODs) among women with breast cancer; fewer examine the impact of culture and geography on disclosure processes. This study explores how sexual minority women (SMW) in the Southern United States engage in SODs with oncology clinicians. DATA SOURCES We conducted in-depth interviews with SMW (eg, lesbian, bisexual) treated for early-stage (stages I-III), hormone receptor-positive breast cancer (N = 12), using a semistructured interview guide. Participants completed an online survey prior to the 60-minute interview. Data was analyzed using an adapted pile sorting approach and thematic analysis conventions. CONCLUSION Average age of participants was 49.5 years (range: 30-69), all self-identified as cisgender; 83.3% as lesbian, 58.3% were married, 91.7% had completed a 4-year college degree or higher, 66.7% identified as non-Hispanic White, 16.7% as Black, and 16.7% as Hispanic/Latina. Half of the sample had not engaged in SODs with an oncology clinician. Key themes were: (1) religious and political conservatism in the South create SOD barriers; (2) oncologist-specific barriers to SODs; (3) "straight passing" as a discrimination mitigation strategy; and (4) SOD facilitators in oncology settings (ie, strategic disclosures, medical privilege, and lesbian, gay, bisexual, and transgender-friendly branding of oncology centers). IMPLICATIONS FOR NURSING PRACTICE SMW with breast cancer living in the U.S. South navigate unique interpersonal barriers to SODs in oncology settings. Clinicians could encourage SODs by fostering inclusive environments via nonheteronormative language, inclusive intake forms, and respect for SMW's SOD navigation processes. Oncology clinicians require culturally relevant, geographic-specific communication training to facilitate SODs among SMW.
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Affiliation(s)
- Janeane N Anderson
- Assistant Professor, Department of Community and Population Health, College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Andrew J Paladino
- Medical Student, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Andrew Robles
- Early-phase regulatory coordinator, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rebecca A Krukowski
- Professor, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Ilana Graetz
- Associate Professor, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Rankine J, Kidd KM, Sequeira GM, Miller E, Ray KN. Adolescent Perspectives on the Use of Telemedicine for Confidential Health Care: An Exploratory Mixed-Methods Study. J Adolesc Health 2023; 73:360-366. [PMID: 37227338 PMCID: PMC10524174 DOI: 10.1016/j.jadohealth.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Telemedicine can improve access to adolescent health care, but adolescents may experience barriers to accessing this care confidentially. Gender-diverse youth (GDY) may especially benefit from telemedicine through increased access to geographically limited adolescent medicine subspecialty care but may have unique confidentiality needs. In an exploratory analysis, we examined adolescents' perceived acceptability, preferences, and self-efficacy related to using telemedicine for confidential care. METHODS We surveyed 12- to 17-year-olds following a telemedicine visit with an adolescent medicine subspecialist. Open-ended questions assessing acceptability of telemedicine for confidential care and opportunities to enhance confidentiality were qualitatively analyzed. Likert-type questions assessing preference for future use of telemedicine for confidential care and self-efficacy to complete components of telemedicine visits confidentially were summarized and compared across cisgender versus GDY. RESULTS Participants (n = 88) included 57 GDY and 28 cisgender females. Factors affecting the acceptability of telemedicine for confidential care related to patient location, telehealth technology, adolescent-clinician relationships, and quality or experience of care. Perceived opportunities to protect confidentiality included using headphones, secure messaging, and prompting from clinicians. Most participants (53/88) were likely or very likely to use telemedicine for future confidential care, but self-efficacy for completing components of telemedicine visits confidentially varied by component. DISCUSSION Adolescents in our sample were interested in using telemedicine for confidential care, but cisgender and GDY recognized threats to confidentiality that may reduce acceptability of telemedicine for these services. Clinicians and health systems should carefully consider youth's preferences and unique confidentiality needs to ensure equitable access, uptake, and outcomes of telemedicine.
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Affiliation(s)
- Jacquelin Rankine
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Kacie M Kidd
- WVU Medicine Children's, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Gina M Sequeira
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kristin N Ray
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Nouri S, Quinn M, Doyle BN, McKissack M, Johnson N, Wertz M, Tan C, Pantilat SZ, Lyles CR, Ritchie CS, Sudore RL. "We've Got to Bring Information to Where People Are Comfortable": Community-Based Advance Care Planning with the Black Community. J Gen Intern Med 2023; 38:2478-2485. [PMID: 36894819 PMCID: PMC9998020 DOI: 10.1007/s11606-023-08134-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND People identifying as Black/African American are less likely to engage in advance care planning (ACP) compared to their White peers, despite the association of ACP with improved patient and caregiver outcomes. OBJECTIVES Assess facilitators/barriers to ACP in the San Francisco (SF) Black community and co-design/implement/test community-based ACP pilot events. DESIGN Community-based participatory research, including qualitative research, intervention development, and implementation. PARTICIPANTS In partnership with the SF Palliative Care Workgroup (which includes health system, city, and community-based organizations), we formed an African American Advisory Committee (n = 13). We conducted 6 focus groups with Black older adults (age ≥ 55), caregivers, and community leaders (n = 29). The Advisory Committee then selected 5 community-based organizations through a widespread request for proposal. These community-based organizations designed and implemented community-based pilot events to support ACP engagement. MAIN MEASURES Two authors analyzed recorded focus group transcripts using thematic analysis. We assessed pre- vs post-event readiness to engage in ACP (validated ACP Engagement Survey; 1-4 scale, 4 = most ready) using Wilcoxon signed rank tests and assessed event acceptability with open-ended questions. KEY RESULTS Themes included the importance of ACP to the Black community (sub-themes: strengthens families; preserves dignity, particularly for sexual/gender minorities; is tied to financial planning) and facilitators for increasing ACP engagement (sub-themes: culturally relevant materials; events in trusted community spaces including Black-owned businesses). A total of 114 participants attended 5 events; 74% identified as Black, and 16% as sexual/gender minorities. Readiness to engage in ACP was similar pre- vs post-events; 98% would recommend the events to others. CONCLUSIONS Community-based ACP events designed and led by and for the Black community are highly acceptable. Novel insights underscored the importance of financial planning as part of ACP and the role of Black-owned businesses as trusted spaces for ACP-related discussions.
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Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Mara Quinn
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Natalya Johnson
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Molly Wertz
- Molly Wertz Consulting, San Francisco, CA, USA
| | - Charissa Tan
- John A. Burns School of Medicine, University of Hawai'I at Mānoa, Honolulu, HI, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, USA
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Dullius WR, O'Keefe-McCarthy S, McCleary L, Scortegagna SA. Continuing education with a holistic approach to the Brazilian LGBT+ population through use of the m-health App. Nurse Educ Pract 2023; 71:103693. [PMID: 37429221 DOI: 10.1016/j.nepr.2023.103693] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023]
Abstract
AIM This article aims to discuss the development of a continuing education course for health care professionals to provide competent healthcare assistance to the Brazilian LGBT+ population and the implementation of this course using a m-Health solution. BACKGROUND There is a scarcity of continuing education courses in the Brazilian context that update provides evidenced-informed education to ensure health care professional competence in the delivery of health care to LGBT+ individuals. METHODS Based on Bloom's taxonomy, with a main focus on the cognitive domain, the course "Ally: A Holistic Approach to the LGBT+ Individual'' was developed in five months. This was based on the Nurse's Health Education for LGBT Seniors (HEALE), the Curriculum Implementation and Institutional Climate manual, Changes to Improve Healthcare for LGBT People, Gender Nonconforming or Born with DSD" and the National Comprehensive Health Policy for LGBT+ People, among others. RESULTS Comprising six modules: i) human sexuality; ii) equitable care and appropriate terminology; iii) public health policy for the LGBT+ population; iv) cultural skills for health professionals; v) aging and health care for the LGBT+ population; and vi) mental health of LGBT+ people. Content validity indexing was established using an expert panel and was Ally was supported by a m-Health Solution called "Over the Rainbow'' and totals of 60 h of education. CONCLUSIONS This m-Health solution and continuing education course for health professionals can be an opportunity to change health professionals' practice to offer more equitable health care for the LGBT+ population.
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Affiliation(s)
| | | | - Lynn McCleary
- Nursing Department at Brock University, St. Catharines, Canada.
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Shrader CH, Duncan DT, Chen YT, Driver R, Russell J, Moody RL, Knox J, Skaathun B, Durrell M, Hanson H, Eavou R, Goedel WC, Schneider JA. Latent Profile Patterns of Network-Level Norms and Associations with Individual-Level Sexual Behaviors: The N2 Cohort Study in Chicago. Arch Sex Behav 2023; 52:2355-2372. [PMID: 36877319 PMCID: PMC10480356 DOI: 10.1007/s10508-023-02555-0] [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] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Individual-level behavior can be influenced by injunctive and descriptive social network norms surrounding that behavior. There is a need to understand how the influence of social norms within an individual's social networks may influence individual-level sexual behavior. We aimed to typologize the network-level norms of sexual behaviors within the social networks of Black sexual and gender minoritized groups (SGM) assigned male at birth. Survey data were collected in Chicago, Illinois, USA, between 2018 and 2019 from Black SGM. A total of 371 participants provided individual-level information about sociodemographic characteristics and HIV vulnerability from sex (i.e., condomless sex, group sex, use of alcohol/drugs to enhance sex) and completed an egocentric network inventory assessing perceptions of their social network members' (alters') injunctive and descriptive norms surrounding sexual behaviors with increased HIV vulnerability. We used Latent Profile Analysis (LPA) to identify network-level norms based on the proportion of alters' approval of the participant engaging in condomless sex, group sex, and use of drugs to enhance sex (i.e., injunctive norms) and alters' engagement in these behaviors (i.e., descriptive norms). We then used binomial regression analyses to examine associations between network-level norm profiles and individual-level HIV vulnerability from sex. The results of our LPA indicated that our sample experienced five distinct latent profiles of network-level norms: (1) low HIV vulnerability network norm, (2) moderately high HIV vulnerability network norm, (3) high HIV vulnerability network norm, (4) condomless sex dominant network norm, and (5) approval of drug use during sex dominant network norm. Condomless anal sex, group sex, and using drugs to enhance sex were positively and significantly associated with higher HIV vulnerability social network norm profiles, relative to low HIV vulnerability norm profiles. To mitigate Black SGM's HIV vulnerability, future HIV risk reduction strategies can consider using network-level intervention approaches such as opinion leaders, segmentation, induction, or alteration, through an intersectionality framework.
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Affiliation(s)
- Cho-Hee Shrader
- Department of Epidemiology, ICAP at Columbia University, Columbia University, 211 W 117th St APT 3A, New York, NY, 10026, USA.
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Yen-Tyng Chen
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA
| | - Redd Driver
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
| | - Jonathan Russell
- Department of Epidemiology, ICAP at Columbia University, Columbia University, 211 W 117th St APT 3A, New York, NY, 10026, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Raymond L Moody
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Mainza Durrell
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Hillary Hanson
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Rebecca Eavou
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - William C Goedel
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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Yagüe-Pasamón R. [Monkeypox and men who have sex with men: we need to treat it with a destigmatizing perspective.]. Rev Esp Salud Publica 2023; 97:e202307059. [PMID: 37403538 PMCID: PMC10541261] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/24/2023] [Indexed: 07/06/2023] Open
Abstract
Monkeypox is a zoonosis, which is transmitted by direct and close contact, and has recently produced a large epidemic outbreak in non-endemic areas, classified as a Public Health Emergency of international concern by the World Health Organization. The global doubting and delayed response, and the stigmatizing approach to men who have sex with men promoted by public opinion, some scientists, socio-political agents, and the media, could be some of the reasons why the epidemic has not yet been contained. The stigma around the disease produces severe injuries to its victims and obstructs actions aimed at controlling the disease, as occurred with HIV in the past. To limit stigma and contain the outbreak, scientists should lead the diffusion of scientifically validated information, educate the population about prevention, symptoms, how to react in case of suspicion and the importance of not contributing to others' stigmatization. Interventions must also be conducted on victims of stigma to counter act its consequences and encourage their self-efficacy. Public health interventions should be carried out in collaboration with political and social actors to integrate evidence into regulations and procedures and facilitate public health interventions. Experts should also work together with the media to facilitate proper health communication and warn about bad practices. Similarly, the relationship between organizations and health professionals and stigmatized individuals must be improved to optimize their access and retention in health systems. The objective of this study was to review the stigmatizing response of some political agents, the media and social opinion to the Monkeypox epidemic, to highlight the consequences of stigma on the patients and the control of the disease. And to establish a series of recommendations to treat this situation effectively through a non-stigmatizing approach.
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Affiliation(s)
- Rubén Yagüe-Pasamón
- Programa de Doctorado en Ciencias de la Salud y del Deporte; Universidad de ZaragozaUniversidad de ZaragozaZaragozaSpain
- Unidad de Cuidados Intensivos Coronaria; Hospital Universitario Miguel ServetHospital Universitario Miguel ServetZaragozaSpain
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Laffin BE, Bergin KM, Arya V, Black EK, Gebre A, Gillis J, Framp H, Wilby KJ. Developing Research-Informed Guidance on Preparing Pharmacy Students to Care for Diverse Populations. Am J Pharm Educ 2023; 87:100095. [PMID: 37380279 DOI: 10.1016/j.ajpe.2023.100095] [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] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/23/2023] [Accepted: 03/12/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE The purpose of this study was to develop research-informed guidance on how to better prepare students for working with diverse populations through exposure to diversity representation within case-based learning materials. METHODS This was a qualitative interpretive phenomenological study using audio-recorded semi-structured interviews for data collection. Interviews were conducted virtually with 15 recent program alumni from Dalhousie University and 15 members from underrepresented communities in Nova Scotia, Canada. Audio-recordings were transcribed verbatim and framework analysis was used to code and categorize data. Themes were interpreted from categorized data and a conceptual model was developed based on the results. RESULTS The conceptual model highlighted that awareness of diversity and health equity paired with practice and application of learning were perceived to be important for preparing graduates for practice. It was found that awareness could be best achieved through exposure to diversity within cases. To effectively expose students, programs must deliberately identify diverse populations to include, seek perspectives and engagement from those populations when writing cases, ensure conscientious representation of diversity without reinforcing stereotypes, and provide resources for discussion and further learning. CONCLUSION Through the development of a conceptual model, this study provided research-informed guidance representing diversity within case-based learning materials. Findings support the notion that representation of diversity must be deliberate, conscientious, and collaborative with those offering diverse perspectives and lived experiences.
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Affiliation(s)
- Breanna E Laffin
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Kathleen M Bergin
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Vibhuti Arya
- College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA
| | - Emily K Black
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Afomia Gebre
- St. Joseph's Hospital, Hamilton, Ontario, Canada
| | - Jane Gillis
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Heidi Framp
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Kyle John Wilby
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Canada.
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Wilby KJ. Don't Forget About the Identifiers. Am J Pharm Educ 2023; 87:100022. [PMID: 37380257 DOI: 10.1016/j.ajpe.2022.09.003] [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] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/14/2022] [Indexed: 06/30/2023]
Abstract
There has been a sharp increase in curricular programming that addresses the health needs of sexually and gender diverse (LGBTQIA+) individuals. Although this is a positive step forward for the academy, there is a need to address the impact of these sessions on LGBTQIA+ identifying students both inside and outside the classroom. The aim of this commentary is to provide strategies that may help to minimize stress processes for identifying students within and outside the classroom when developing, delivering, and providing feedback on content for LGBTQIA+ health. Eight strategies are proposed based on literature and personal experience when teaching LGBTQIA+ health. Strategies are grouped according to developing content, delivering content, and following up on questions and feedback. Promoting these strategies when developing, delivering, and following up on content for LGBTQIA+ health may reduce stress for identifying students and facilitate the creation of the safe teaching spaces we all aim to achieve.
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Affiliation(s)
- Kyle John Wilby
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
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Medlin CG, Wilby KJ. The Impact of Moving Beyond Intersection to Integration of LGBTQIA+ Identities on Professional Identity Affirmation. Am J Pharm Educ 2023; 87:100024. [PMID: 37380264 DOI: 10.1016/j.ajpe.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/29/2022] [Accepted: 10/26/2022] [Indexed: 06/30/2023]
Abstract
There have been active calls within pharmacy education literature for the profession to work toward dismantling systemic oppression by elevating the voices of commonly underrepresented and marginalized communities, including the lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual(LGBTQIA+) community. There has also been a simultaneously growing interest in understanding how the intersection of one's personal identity with one's professional identity may help to foster greater affirmation within the profession. However, what has not been explored is how intersecting personal and professional identities may enhance the strength of one's LGBTQIA+ identity and therefore result in creating cultures of affirmation in addition to meaningful participation in professional advocacy. We link our lived experiences to a theoretical perspective through the minority stress model to demonstrate how distal and proximal stresses may affect pharmacy professionals' ability to fully integrate their professional and personal identities. Additionally, we call on the academy to strategically address gaps in LGBTQIA+ knowledge, equity, and professional development through research, shifts in culture, and education.
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Affiliation(s)
| | - Kyle John Wilby
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Canada
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Lapping-Carr L, Mustanski B, Ryan DT, Costales C, Newcomb ME. Stress and Depression Are Associated with Sexual Function and Satisfaction in Young Men Who Have Sex with Men. Arch Sex Behav 2023; 52:2083-2096. [PMID: 37253920 PMCID: PMC10691266 DOI: 10.1007/s10508-023-02615-5] [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] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/27/2023] [Accepted: 04/30/2023] [Indexed: 06/01/2023]
Abstract
Prior research suggests that better mental health and higher relationship quality are associated with better sexual function and satisfaction. Such insights can inform intervention development for mental, relationship, and sexual health concerns. This study examined the interactions among these variables in a racially and ethnically diverse group of young men who have sex with men (YMSM) in serious relationships (N = 348). Data were drawn from wave 5 of a longitudinal cohort study. We examined cross-sectional associations between depression and stress (predictors) and sexual function, sexual satisfaction, and anal discomfort (outcomes) and to what extent these associations were moderated by relationship quality. Higher endorsement of depression and stress was associated with worse sexual functioning, lower sexual satisfaction, and more anal discomfort. We also found that fewer negative interactions, stronger commitment, and higher relationship satisfaction were associated with better sexual functioning and higher sexual satisfaction. Higher relationship satisfaction and commitment were found to attenuate the association between stress and sexual satisfaction. Contrary to expectations, higher relationship satisfaction also showed a trend toward exacerbating the association between depression and sexual functioning. These results suggest that, for YMSM, high relationship satisfaction and commitment may protect sexual satisfaction from being negatively impacted by high stress. However, YMSM in highly satisfying relationships may experience poor sexual functioning associated with depression as particularly distressing. This study addressed a major gap in the literature by focusing on mental, relationship, and sexual health in a diverse sample. Future research should examine a wider range of sexual functioning outcomes and include minority stress in study design.
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Affiliation(s)
- Leiszle Lapping-Carr
- Department of Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St Clair St., Suite 1000, Chicago, IL, 60611, USA.
| | - Brian Mustanski
- Department of Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 676 N St Clair St., Suite 1000, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel T Ryan
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cocoa Costales
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Rodrigues TS, Sant'Ana RSE, Zerbinati JP, Souza LN, de Sousa AR, Maheu C, de Godoy S. Approaching sexuality in LGBTQIAP + patients with cancer: scoping review. BMC Public Health 2023; 23:1269. [PMID: 37391788 PMCID: PMC10311796 DOI: 10.1186/s12889-023-16170-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 06/21/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND When individuals in the SGM group are diagnosed with cancer and undergo treatment, they experience changes in physical, mental, sexual and spiritual dimensions, which can negatively impact sexual desire, as well as satisfaction and sexual health as a whole. This study aims to examine the existing scientific literature on how healthcare professionals approach sexuality in cancer patients who belong to the SGM group. The SGM group is particularly vulnerable, and the challenges they face in terms of psychosocial and emotional health are further exacerbated by the oncological treatment they receive. Therefore, specialized attention and support are necessary to address their unique needs. METHOD To conduct this study, a scoping review was performed following the guidelines established by the Joanna Briggs Institute. By synthesizing the available evidence, this study aims to provide insights and recommendations for healthcare professionals to improve the care and support provided to SGM individuals with cancer. Guiding question: "how do health professionals approach sexuality in cancer patients in a minority group?". The search was carried out in PubMed, Science Direct, Scopus, Web of Science, Virtual Health Library, Embase databases and Google Scholar in addition. Specific criteria were used for Evidence source selection, Data mapping, assurance, analysis, and presentation. RESULTS Fourteen publications were included in this review for the final synthesis, which indicated that the approach to the sexuality of sexual and gender minority groups is based on research whose character is limited in terms of producing care and health care that is congruent in gender and sexuality. The analysis of scientific articles showed that one of the biggest challenges and priorities of health services today is to reduce disparities and promote equity in health for SGM people. CONCLUSIONS This study reveals a significant gap in addressing the sexuality of SGM groups within cancer care. Inadequate research impedes the provision of consistent and inclusive care for SGM individuals, which has a negative impact on their overall wellbeing. Reducing disparities and promoting healthcare equity for SGM individuals must be a top priority for health services.
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Affiliation(s)
| | | | - João Paulo Zerbinati
- Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
| | | | | | - Christine Maheu
- Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Simone de Godoy
- University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Ribeirão Preto, Brazil
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Curtis MG, Davoudpour S, Rodriguez-Ortiz AE, Felt D, French AL, Hosek SG, Phillips G, Serrano PA. Predictors of Mpox vaccine uptake among sexual and gender minority young adults living in Illinois: Unvaccinated vs. double vs. single dose vaccine recipients. Vaccine 2023; 41:4002-4008. [PMID: 37236817 PMCID: PMC10206605 DOI: 10.1016/j.vaccine.2023.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The 2022 global outbreak of Monkeypox virus (Mpox), which has primarily spread through the sexual networks of sexual and gender minority (SGM) individuals, has introduced new public health challenges. While an efficacious Mpox vaccine is in active circulation, few Mpox vaccine studies have examined its uptake among SGM groups. The aims of this study were to investigate (a) the prevalence of Mpox vaccine uptake among SGM and (b) the contextual, Mpox-disease specific, and Mpox-vaccine specific factors associated with Mpox vaccine among SGM. METHODS We conducted a cross-sectional survey in Illinois, USA in September 2022; 320 young SGM completed self-administered questionnaires. Multinomial logistic regression was used to assess the contextual, Mpox-disease specific, and Mpox-vaccine specific factors associated with Mpox vaccine uptake. Adjusted Odds Ratios (aORs) and 95 % Confidence Intervals (CI) are reported. RESULTS Approximately 50 % of the SGM participants included in this study had received at least their first dose of the Mpox vaccine. Multinomial regression analysis showed that individuals who had recently experienced food insecurity, had higher degrees of fear of social rejection due to Mpox acquisition, and were more Mpox-vaccine hesitant were more likely to be unvaccinated. Conversely, knowing people who have contracted Mpox, having higher formal educational attainment, having higher degrees of Mpox-related internalized heterosexism, and being more concerned about one's safety regarding Mpox morbidity were more likely to be double-dosers. CONCLUSION Approximately 50 % of the SGMs included in this study received at least their first dose of the Mpox vaccine; however, only one-quarter of participants completed the recommended 2-dose Mpox regimen. Our findings indicate that socioeconomic stability, fear of social rejection due to disease acquisition, and Mpox-specific vaccine hesitancy may be important structural targets to consider when developing vaccine-uptake prevention and intervention strategies tailored to the needs of sexual and gender minorities.
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Affiliation(s)
- Michael G Curtis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States.
| | - Shahin Davoudpour
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - Anthony E Rodriguez-Ortiz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - Dylan Felt
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - Audrey L French
- Division of Infectious Disease, Department of Medicine, John H. Stroger Hospital, Jr., of Cook County Health, Chicago, IL, United States
| | - Sybil G Hosek
- Division of Infectious Disease, Department of Medicine, John H. Stroger Hospital, Jr., of Cook County Health, Chicago, IL, United States; Department of Psychiatry, John H. Stroger Hospital, Jr., of Cook County Health, Chicago, IL, United States
| | - Gregory Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States; Division of Public Health Practice, Department of Preventive Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL, United States
| | - Pedro A Serrano
- Division of Public Health Practice, Department of Preventive Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL, United States; Department of Research, CORE Center of Cook County Health, Chicago, IL, United States
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Gottvall M, Brunell C, Eldebo A, Kissiti R, Mattsson E, Jirwe M, Carlsson T. Nurse education about forced migrants with diverse sexual orientations, gender identities, and gender expressions: An exploratory focus group study. Nurse Educ Today 2023; 128:105880. [PMID: 37356186 DOI: 10.1016/j.nedt.2023.105880] [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] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/27/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND In many countries, forced migrants can seek asylum based on persecution and danger related to self-identifying as having diverse sexual orientations, gender identities, and gender expressions; herein defined as lesbian, gay, bisexual, transgender, queer, or other non-heterosexual orientations, non-cisgender identities, gender expressions and/or reproductive development considered beyond cultural, societal or physiological norms. Nurse education has a significant role in promoting cultural competence among future health professionals. OBJECTIVES To explore the experiences and views regarding education about forced migrants with diverse sexual orientations, gender identities, and gender expressions, among students and lecturers in nurse education. DESIGN Explorative qualitative study with focus group discussions. SETTINGS Swedish nursing programs. PARTICIPANTS Final-year nursing students and lecturers (n = 25 participants) at nursing programs were recruited with convenience and snowball sampling. METHODS Semi-structured digital focus group discussions (n = 9) were audio recorded and transcribed verbatim. Data were analyzed with inductive qualitative content analysis. RESULTS Promoting a broader understanding regarding societal structures and preparing students to provide culturally sensitive care were considered as essential components in nurse education. Challenges and problems involved a need for increased awareness, the associated topics and target populations seldom being addressed, and a need for improvements within clinical placements. Participants suggested the utilization of external resources, presented a range of different specific learning activities that would promote in-depth understanding, and articulated a need for overarching decisions and guidelines regarding mandatory inclusion in nurse education. CONCLUSIONS Students and lecturers describe several challenges and problems that need to be addressed in regard to forced migration, sexual health, and inclusion health. There seems to be a need for utilization of external competence in learning activities as well as establishing clearer guidelines, which may increase the quality of education and better prepare future nurses to support patients with diverse backgrounds and identities.
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Affiliation(s)
- Maria Gottvall
- The Swedish Red Cross University, Huddinge, Sweden; The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Anna Eldebo
- The Swedish Red Cross University, Huddinge, Sweden
| | | | - Elisabet Mattsson
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; The Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Maria Jirwe
- The Swedish Red Cross University, Huddinge, Sweden; The Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Tommy Carlsson
- The Swedish Red Cross University, Huddinge, Sweden; The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Titus AR, Gamarel KE, Thrasher JF, Elliott MR, Fleischer NL. Exploring the Potential for Smoke-Free Laws to Reduce Smoking Disparities by Sexual Orientation in the USA. Int J Behav Med 2023; 30:448-454. [PMID: 35579845 PMCID: PMC9669255 DOI: 10.1007/s12529-022-10099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined associations between smoke-free laws and smoking outcomes in a nationally representative sample of US adults, including exploring whether these associations differed for heterosexual and sexual minority (SM) adults. METHODS We constructed county-level variables representing the percent of the population covered by state-, county-, or city-level smoke-free laws in workplaces and hospitality venues. We combined this information with restricted individual-level adult data with masked county identifiers from the National Health Interview Survey (NHIS), 2013-2018. We used modified Poisson regression to explore associations between each type of smoke-free law and the prevalence ratio (PR) of current smoking, and we used linear regression to explore associations with smoking intensity (mean cigarettes per day). We assessed interactions between smoke-free laws and SM status on the additive scale to determine whether associations were different for SM and heterosexual adults. RESULTS In adjusted models without interaction terms, smoke-free laws in hospitality venues were associated with lower prevalence of current smoking (PR = 0.93, 95% confidence interval (CI) = 0.89, 0.98). Both types of smoke-free laws were associated with lower mean cigarettes per day (workplace law change in mean = - 0.50, 95% CI = - 0.89, - 0.12; hospitality law change in mean = - 0.72, 95% CI = - 1.14,-0.30). We did not observe any statistically significant interactions by SM status, though statistical power was limited. CONCLUSIONS We did not find evidence that smoke-free laws were differentially associated with smoking outcomes for heterosexual and SM adults. Additional studies are needed to further explore the potential for tobacco control policies to address the elevated risk of smoking in SM communities.
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Affiliation(s)
- Andrea R Titus
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Kristi E Gamarel
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - James F Thrasher
- Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Michael R Elliott
- Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Kano M, Tamí-Maury I, Pratt-Chapman ML, Chang S, Kosich M, Quinn GP, Poteat T, Kanetsky PA, Elk R, Boehmer U, Sanchez J, Kamen C, Sanchez NF. Piloting the Sexual and Gender Minority Cancer Curricular Advances for Research and Education (SGM Cancer CARE) Workshop: Research Training in the Service of SGM Cancer Health Equity. J Cancer Educ 2023; 38:1066-1076. [PMID: 36399283 PMCID: PMC9673892 DOI: 10.1007/s13187-022-02233-0] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 06/02/2023]
Abstract
The purpose of this study is to describe the context, curriculum design, and pilot evaluation of the educational program "Sexual and Gender Minority Cancer Curricular Advances for Research and Education" (SGM Cancer CARE), a workshop for early-career researchers and healthcare providers interested in gaining knowledge and skills in sexual and gender minority (SGM) cancer research and healthcare advocacy. A needs assessment of a sample of clinicians and researchers (n = 104) and feedback from an Advisory Board informed the curriculum design of the SGM Cancer CARE workshop. Four SGM-tailored modules, focusing on epidemiology, clinical research, behavioral science and interventions, and community-based participatory approaches, were developed and tested in a 2.5-day virtual format among 19 clinicians and researchers. A fifth module to provide feedback to participants on brief presentations about their SGM cancer research ideas or related efforts was added later. A mixed-methods evaluation comprised of pre- and post-modular online evaluation surveys and virtual focus groups was used to determine the degree to which the workshop curriculum met participant needs. Compared to pre-module evaluations, participants reported a marked increase in SGM cancer research knowledge in post-module scores. Quantitative results were supported by our qualitative findings. In open field response survey questions and post-workshop focus groups, participants reported being extremely pleased with the content and delivery format of the SGM Cancer CARE workshop. Participants did regret not having the opportunity to connect with instructors, mentors, and colleagues in person. The SGM Cancer CARE curriculum was shown to increase the knowledge, skills, and level of preparedness of early-career clinicians and scientists to conduct culturally relevant and appropriate research needed to improve care for SGM persons across the cancer care continuum from prevention to survivorship.
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Affiliation(s)
- Miria Kano
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM, USA.
| | - Irene Tamí-Maury
- Department of Epidemiology, School of Public Health, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Mandi L Pratt-Chapman
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Shine Chang
- Division of Cancer Prevention and Population Sciences, Department of Epidemiology and Cancer Prevention Research Training Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mikaela Kosich
- Biostatistics Shared Resource, The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Gwendolyn P Quinn
- Department of OBGYN, Perlmutter Cancer Center, Grossman School of Medicine, New York University, New York, NY, USA
| | - Tonia Poteat
- Department of Social Medicine, Lineberger Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ronit Elk
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Julian Sanchez
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Charles Kamen
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY, USA
| | - Nelson F Sanchez
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Adler Jaffe S, Jacobson K, Farnbach Pearson AW, Baca LA, Dimauro N, Kano M. "Did I get into the twilight zone somehow?": sexual and gender minority cancer caregiver experiences during COVID. Cancer Causes Control 2023; 34:563-568. [PMID: 37145262 PMCID: PMC10161178 DOI: 10.1007/s10552-023-01708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION The COVID-19 pandemic created new challenges for cancer patients and caregivers. Little is known about the confluence of the pandemic and people with multiple marginalized identities, such as those in the Sexual and Gender Minority (SGM) community. METHODS We conducted a mixed-methods pilot study using semi-structured interviews to elicit experiences of cancer among a diverse population of SGM patients and caregivers and a matched set of cisgender heterosexual (cishet) individuals. Here, we present qualitative findings focused on caregiver experiences as ascertained from the broader study. RESULTS We discovered differences between SGM and cishet caregiving experiences, with SGM caregivers reporting less comfort in the cancer center environment; dissatisfaction with patient-provider communication; feeling excluded from their loved ones' care; and increased social isolation resulting from the caregiver experience. SGM and cishet caregivers described the detrimental impact of the pandemic. CONCLUSION Our data suggest SGM caregivers experience additional burdens to cancer caregiving when compared to cishet peers. Although SGM and cishet caregivers reported challenges stemming from the COVID-19 pandemic, challenges appeared greater and more acute for SGM caregivers. Pandemic-related findings point to overall gaps in SGM cancer caregiver supports that may be remedied by additional research and targeted intervention development.
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Affiliation(s)
- Shoshana Adler Jaffe
- University of New Mexico Comprehensive Cancer Center, 2325 Camino de Salud, Albuquerque, NM, 87131, USA.
| | - Kendal Jacobson
- University of New Mexico Comprehensive Cancer Center, 2325 Camino de Salud, Albuquerque, NM, 87131, USA
| | - Amy W Farnbach Pearson
- University of New Mexico Comprehensive Cancer Center, 2325 Camino de Salud, Albuquerque, NM, 87131, USA
| | - Lila A Baca
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nina Dimauro
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Miria Kano
- University of New Mexico Comprehensive Cancer Center, 2325 Camino de Salud, Albuquerque, NM, 87131, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
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Puttkammer N, Ihnatiuk A, Shapoval A, Kazanzhy A, Secor A, Shotorbani S, McDowell M, Golden M. Profile of partners who completed HIV testing and received a new HIV diagnosis in Ukraine's HIV index testing program: a retrospective cohort study to inform program improvement. BMC Infect Dis 2023; 23:291. [PMID: 37147618 PMCID: PMC10161989 DOI: 10.1186/s12879-023-08281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Approximately one-third of people living with HIV in Ukraine are unaware of their HIV status. Index testing (IT) is an evidence-based HIV testing strategy that supports voluntary notification of partners with HIV risk, so they can receive HIV testing, prevention, and treatment services. METHODS Ukraine scaled up IT services in 2019. This observational study of Ukraine's IT program covered 39 health facilities located in 11 regions with high HIV burden. The study used routine program data from January-December 2020 to describe the profile of named partners and explore index client (IC) and partner factors associated with two outcomes: 1) completing testing; and 2) HIV case finding. Analysis used descriptive statistics and multilevel linear mixed regression models. RESULTS The study included 8,448 named partners, of whom 6,959 had unknown HIV status. Among them,72.2% completed HIV testing and 19.4% of those tested were newly diagnosed with HIV. Two-thirds of all new cases were among partners of ICs who were recently diagnosed and enrolled in care (< 6 months), while one third were among partners of established ICs. In adjusted analysis, partners of ICs with unsuppressed HIV viral load (VL) were less likely to complete HIV testing (adjusted odds ratio [aOR] = 0.11, p < 0.001), but more likely to receive a new HIV diagnosis (aOR = 1.92, p < 0.001). Partners of ICs who cited injection drug use or having a known HIV + partner as their own reason for testing were more likely to receive a new HIV diagnosis (aOR = 1.32, p = 0.04 and aOR = 1.71, p < 0.001 respectively). Involving providers in the partner notification process was associated with completed testing (aOR = 1.76, p = 0.001) and HIV case finding (aOR = 1.64, p < 0.01), compared with notification by ICs. CONCLUSION HIV case detection was highest among partners of recently diagnosed ICs, but IT participation among established ICs still yielded an important share of all newly-identified HIV cases. Areas for improvement in Ukraine's IT program include completing testing for partners of ICs with unsuppressed HIV VL, with history of injection drug use or discordant partnerships. Using intensified follow-up for the sub-groups at risk of incomplete testing may be practical. Greater use of provider-assisted notification could also accelerate HIV case finding.
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Affiliation(s)
- Nancy Puttkammer
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA.
| | - Alyona Ihnatiuk
- International Training and Education Center for Health (I-TECH), 29 Obolonska St., Office 506, Kiev, 04071, Ukraine
| | - Anna Shapoval
- International Training and Education Center for Health (I-TECH), 29 Obolonska St., Office 506, Kiev, 04071, Ukraine
| | - Anna Kazanzhy
- International Training and Education Center for Health (I-TECH), 29 Obolonska St., Office 506, Kiev, 04071, Ukraine
| | - Andrew Secor
- Department of Global Health, University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
| | - Solmaz Shotorbani
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
| | - Misti McDowell
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
| | - Matthew Golden
- Department of Global Health, International Training and Education Center for Health (I-TECH), University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, USA
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Stevens SD. Obesity in Sexual and Gender Minority Populations: Prevalence and Correlates. Curr Obes Rep 2023:10.1007/s13679-023-00499-z. [PMID: 37140879 DOI: 10.1007/s13679-023-00499-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to explore the prevalence and correlates of obesity among members of sexual and gender minority (SGM) populations. RECENT FINDINGS Research overall finds higher rates of obesity among lesbian and bisexual women than heterosexual women, lower rates of obesity among gay and bisexual men than heterosexual men, and inconsistent findings on obesity among transgender individuals. Rates of mental health disorders and disordered eating are high among all SGM groups. Rates of comorbid medical conditions differ among groups. More research needs to be conducted within all SGM groups but particularly among transgender populations. All members of SGM encounter stigma, including when seeking healthcare, and this may lead to individuals avoiding healthcare. Therefore, it is important to educate providers about population-specific factors. This article serves as an overview of important considerations for providers treating individuals within SGM populations.
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Affiliation(s)
- Serena D Stevens
- Cleveland Clinic Bariatric and Metabolic Institute, 9500 Euclid Ave./M61, Cleveland, OH, 44195, USA.
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Franco-Rocha OY, Wheldon CW, Trainum K, Kesler SR, Henneghan AM. Clinical, psychosocial, and sociodemographic factors of sexual and gender minority groups with cancer: A systematic review. Eur J Oncol Nurs 2023; 64:102343. [PMID: 37290162 DOI: 10.1016/j.ejon.2023.102343] [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: 01/31/2023] [Revised: 04/07/2023] [Accepted: 04/29/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Psychosocial health varies depending on demographic and clinical factors and the social context in which individuals grow and live. Sexual and gender minority (SGM) populations experience health disparities due to systemic factors that privilege cisgender and heterosexual identities. We reviewed the literature on the psychosocial, sociodemographic, and clinical factors in SGM groups with cancer and described the associations among these factors. METHODS We conducted a systematic review according to Fink's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in the PubMed, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, and LGBTQ+ Life databases. Quantitative articles published in English or Spanish were included. Grey literature and studies with participants in hospice care were excluded. The quality of the publications was assessed with the Joanna Briggs Institute criticalappraisal tools. RESULTS The review included 25 publications. In SGM groups, systemic cancer treatment was associated with worse psychosocial outcomes; and older age, employment, and higher income were associated with better psychosocial outcomes. CONCLUSIONS SGM groups with cancer are different from their heterosexual cisgender peers in sociodemographic, psychosocial, and clinical factors. Clinical and sociodemographic factors are associated with psychosocial outcomes among SGM individuals with cancer.
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Affiliation(s)
- Oscar Y Franco-Rocha
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Christopher W Wheldon
- Department of Social & Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B, Moore Ave., Ritter Hall Annex 9th Floor, Room 955, Philadelphia, PA, 19122, USA.
| | - Katie Trainum
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Shelli R Kesler
- School of Nursing, Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Ashley M Henneghan
- School of Nursing, Department of Oncology, Dell Medical School, The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
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Walsh AR, Stephenson R. Intimate Partner Violence Perpetration Denial and Underreporting in Cisgender Male Couples. Interv Psicosoc 2023; 32:109-121. [PMID: 37383641 PMCID: PMC10294463 DOI: 10.5093/pi2023a8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/10/2023] [Indexed: 06/30/2023]
Abstract
Intimate partner violence (IPV) perpetrators often deny their actions, limiting opportunities for intervention. Cisgender male couples experience similar IPV rates to mixed-gender couples, yet less is known about how men in same-sex relationships deny or report their IPV behavior. This study aimed to describe perpetration denial across emotional, monitoring/controlling, and physical/sexual IPV, and to identify correlates of perpetration denial, in a convenience sample of male couples (N = 848; United States, 2016-2017). Past-year victimization and perpetration were measured with the IPV-Gay and Bisexual Men (GBM) scale; perpetration deniers were men whose self-reported perpetration contradicted their partner's reported victimization. Individual-, partner-, and dyadic-correlates of perpetration denial, by IPV-type, were identified using actor-partner interdependence models. We identified 663 (78.2%) perpetrators: 527 emotional; 490 monitoring/controlling; 267 physical/sexual. Thirty-six percent of physical/sexual-, 27.7% of emotional-, and 21.43% of monitoring/controlling-perpetrators categorically denied their actions. Depression was negatively associated with denying monitoring/controlling-perpetration (odds ratio 95% confidence interval: 0.91 [0.84, 0.99]) and physical/sexual-perpetration (0.91 [0.83, 0.97]); dyadic differences in depression were associated with emotional-perpetration denial (0.95 [0.90, 0.99]). Recent substance users had 46% lower odds of monitoring/controlling-denial (0.54 [0.32, 0.92]), versus non-users. Partner-race and employment were also significantly associated with emotional perpetration denial. This study highlights IPV denial's complexities, including differences across IPV types. Further investigations into how cisgender men in same-sex couples perceive and report various types of IPV perpetration will provide valuable insight into how an underserved and understudied population experiences IPV.
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Affiliation(s)
- Alison R. Walsh
- University of MichiganCenter for Sexuality and Health DisparitiesAnn ArborUSACenter for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
| | - Rob Stephenson
- University of MichiganCenter for Sexuality and Health DisparitiesAnn ArborUSACenter for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
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Priddle T, Crawford T, Power T. The inclusion and representation of LGBTIQ+ content in undergraduate nurse education: A scoping review. Nurse Educ Today 2023; 124:105771. [PMID: 36889046 DOI: 10.1016/j.nedt.2023.105771] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/11/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The aim of this review was to gain an overview of existing empirical literature examining LGBTIQ+ content in undergraduate nursing curricula. DESIGN An international scoping review was conducted using librarian assisted search strategies. DATA SOURCES The databases CINAHL, SCOPUS and ERIC were searched. A total of 30 studies meeting the eligibility criteria were included in this review. REVIEW METHODS Following a quality appraisal, thematic analysis was conducted to identify six key themes. RESULTS 30 studies spanning 8 countries, across 5 continents were included in this review. 6 themes emerged 1) Level of Knowledge Regarding LGBTIQ+ People and Their Specific Health Needs, 2) Comfort and Preparedness in the Provision of Care to LGBTIQ+ People, 3) Attitudes Toward LGBTIQ+ People, 4) Inclusion of LGBTIQ+ Educational Content, 5) Framing of LGBTIQ+ Educational Content, 6) Pedagogical Strategies to Incorporate LGBTIQ+ Content. CONCLUSIONS Nurse education is dominated by heteronormativity, deficit discourses, stereotypes, binary ideologies and western cultural perspectives. The body of literature surrounding LGBTIQ+ content in nurse education is largely quantitative, insular and contributes to the erasure of unique identities under the LGBTIQ+ umbrella.
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Affiliation(s)
- Tyler Priddle
- Level 8, D18 - Susan Wakil Health Building, The University of Sydney, Gadigal Country, Camperdown, NSW, 2006, Australia.
| | - Tonia Crawford
- Level 8, D18 - Susan Wakil Health Building, The University of Sydney, Gadigal Country, Camperdown, NSW, 2006, Australia.
| | - Tamara Power
- Level 8, D18 - Susan Wakil Health Building, The University of Sydney, Gadigal Country, Camperdown, NSW, 2006, Australia.
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