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Kidd KM, Didden E, Harman H, Sequeira GM, Faeder M, Inwards-Breland DJ, Voss RV, Katz-Wise SL. Parents of Gender Diverse Youth: Support Sought, Received, and Still Needed. J Adolesc Health 2024; 74:1078-1087. [PMID: 37715763 PMCID: PMC10947309 DOI: 10.1016/j.jadohealth.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/14/2023] [Accepted: 08/01/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Gender diverse youth (GDY) have improved mental health when affirmed by parents, but little is known about the support parents of GDY seek, receive, and still need. This qualitative study explored experiences of parents of GDY to better understand their support needs. METHODS Parents of GDY submitted videos and were interviewed about their journey supporting their GDY. Data collection continued until thematic saturation was reached. Audio recordings from videos and interviews were transcribed and analyzed via an inductive thematic analysis using the rigorous and accelerated data reduction technique. RESULTS In total, 25 parents of GDY (mean age 15 years, range 6-21 years) from 12 states provided video recordings and interviews; 36% were People of Color and 28% were fathers. We identified four themes and 12 subthemes. Theme 1: support through education included acknowledging ignorance about gender diversity and remedying ignorance. Theme 2: engaging community noted that support was multilayered and based around the family unit and pre-existing community. Theme 3: expanding community included acknowledgement that seeking new community was important for many to reduce feelings of isolation. It also highlighted that "safe spaces" for parents of GDY were not always safe for those of other marginalized groups, particularly People of Color. Theme 4: support in healthcare spaces centered experiences navigating medical and mental healthcare for GDY and feeling supported and unsupported in those spaces. DISCUSSION Parents identified numerous ways they sought, received, and needed support to understand and affirm their GDY. These findings will aid development of targeted support interventions for parents of GDY. Further research is needed to evaluate the impact of these interventions on GDY health.
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Affiliation(s)
- Kacie M Kidd
- Department of Pediatrics, Division of Adolescent Medicine, West Virginia University School of Medicine, WVU Medicine Children's Hospital, Morgantown, West Virginia.
| | - El Didden
- West Virginia University School of Medicine, WVU Medicine Children's Hospital, Morgantown, West Virginia
| | - Hayley Harman
- West Virginia University School of Medicine, WVU Medicine Children's Hospital, Morgantown, West Virginia
| | - Gina M Sequeira
- Department of Pediatrics, Division of Adolescent Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Morgan Faeder
- Department of Psychiatry, University of Pittsburgh School of Medicine, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | | | - Raina V Voss
- Department of Pediatrics, Divison of Adolescent and Young Adult Medicine, Northwestern University Feinburg School of Medicine, Lurie Children's Hospital, Chicago, Illinois
| | - Sabra L Katz-Wise
- Harvard TH Chan School of Public Health, Boston Children's Hospital, Boston, Massachusetts
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2
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Wang YC, Hoatson T, Stamoulis C, Herman J, Reisner SL, Meyer IH, Katz-Wise SL. Psychological Distress and Suicidality Among Transgender Young Adults in the United States. J Adolesc Health 2024; 74:1095-1105. [PMID: 38310507 DOI: 10.1016/j.jadohealth.2023.11.004] [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: 07/01/2022] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Transgender young adults (TYA) are burdened by adverse mental health outcomes. Guided by intersectionality and minority stress frameworks, we compared prevalence of psychological distress and suicidality among TYA of different social identities to inform future interventions. METHODS In this secondary data analysis of 12,738 TYA, ages 18-25 years, from the 2015 United States Transgender Survey, we developed multivariable regression models examining associations between social identities and psychological distress and suicidality, adjusting for relevant covariates. Self-reported identities were used as proxies for minority stress resulting from structural oppressions related to gender binarism, transmisogyny, heterosexism, and racism. RESULTS Overall, 53% met criteria for serious psychological distress, and 66% reported suicidal ideation. Statistically higher odds of serious psychological distress and suicidal ideation and plan were found for TYA assigned male compared to assigned female at birth (adjusted odds ratios [aORs] = 1.14-1.50). Nonbinary TYA assigned male at birth also had lower odds of all outcomes compared to all other TYA (aORs = 0.6-0.7). Compared to White TYA, Latiné/x TYA were more likely to experience serious psychological distress (aOR = 1.19, 95% confidence interval: 1.02, 1.39) and multiracial TYA were more likely to report suicide plan(s) and attempt(s) (aORs = 1.25-1.30). Finally, compared to heterosexual TYA, bisexual/pansexual TYA were more likely to report suicide plan(s) (aOR = 1.28, 95% confidence intervals: 1.04, 1.52), and all sexual minority TYA were more likely to report serious psychological distress and suicidal ideation (aORs = 1.31-2.00). DISCUSSION Results highlight complex associations between intersectional minority stress and mental health outcomes among TYA. Associations between identities and mental health morbidity highlight an urgent need for targeted mental health interventions.
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Affiliation(s)
- Yu-Chi Wang
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Research and Best Practices, GLSEN, New York, New York.
| | - Tabor Hoatson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Catherine Stamoulis
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jody Herman
- The Williams Institute, UCLA School of Law, Los Angeles, California
| | - Sari L Reisner
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Ilan H Meyer
- The Williams Institute, UCLA School of Law, Los Angeles, California
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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3
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Katz-Wise SL, Shah SN, Melvin P, Boskey ER, Grice AW, Kornetsky S, Young Poussaint T, Whitley MY, Stack AM, Emans SJ, Hoerner B, Horgan JJ, Ward VL. Establishing a Pediatric Health Equity, Diversity, and Inclusion Research Review Process. Pediatrics 2024; 153:e2023062946. [PMID: 38651252 DOI: 10.1542/peds.2023-062946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 04/25/2024] Open
Abstract
Equity, diversity, and inclusion (EDI) research is increasing, and there is a need for a more standardized approach for methodological and ethical review of this research. A supplemental review process for EDI-related human subject research protocols was developed and implemented at a pediatric academic medical center (AMC). The goal was to ensure that current EDI research principles are consistently used and that the research aligns with the AMC's declaration on EDI. The EDI Research Review Committee, established in January 2022, reviewed EDI protocols and provided recommendations and requirements for addressing EDI-related components of research studies. To evaluate this review process, the number and type of research protocols were reviewed, and the types of recommendations given to research teams were examined. In total, 78 research protocols were referred for EDI review during the 20-month implementation period from departments and divisions across the AMC. Of these, 67 were given requirements or recommendations to improve the EDI-related aspects of the project, and 11 had already considered a health equity framework and implemented EDI principles. Requirements or recommendations made applied to 1 or more stages of the research process, including design, execution, analysis, and dissemination. An EDI review of human subject research protocols can provide an opportunity to constructively examine and provide feedback on EDI research to ensure that a standardized approach is used based on current literature and practice.
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Affiliation(s)
- Sabra L Katz-Wise
- Divisions of Adolescent/Young Adult Medicine
- Departments of Pediatrics
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Snehal N Shah
- Departments of Pediatrics
- Accountable Care and Clinical Integration
- Office of Health Equity and Inclusion
- Clinical Research Compliance
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Patrice Melvin
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
| | - Elizabeth R Boskey
- Gynecology/Department of Surgery
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Tina Young Poussaint
- Clinical Research Compliance
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Melicia Y Whitley
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
| | - Anne M Stack
- Emergency Medicine
- Departments of Pediatrics
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - S Jean Emans
- Divisions of Adolescent/Young Adult Medicine
- Departments of Pediatrics
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Hoerner
- Office of the General Counsel, Boston Children's Hospital, Boston, Massachusetts
| | - James J Horgan
- Office of the General Counsel, Boston Children's Hospital, Boston, Massachusetts
| | - Valerie L Ward
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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4
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Katz-Wise SL, Ranker LR, Korkodilos R, Conti J, Nelson KM, Xuan Z, Gordon AR. Will all youth answer sexual orientation and gender-related survey questions? An analysis of missingness in a large U.S. survey of adolescents and young adults. Psychol Methods 2024:2024-69792-001. [PMID: 38573664 DOI: 10.1037/met0000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Some researchers and clinicians may feel hesitant to assess sexual orientation and gender-related characteristics in youth surveys because they are unsure if youth will respond to these questions or are concerned the questions will cause discomfort or offense. This can result in missed opportunities to identify LGBTQ+ youth and address health inequities among this population. The aim of this study was to examine the prevalence and sociodemographic patterns of missingness among survey questions assessing current sexual orientation, gender identity and expression (SOGIE), and past change in sexual orientation (sexual fluidity) among a diverse sample of U.S. youth. Participants (N = 4,245, ages 14-25 years; 95% cisgender, 70% straight/heterosexual, 53% youth of color), recruited from an online survey panel, completed the Wave 1 survey of the longitudinal Sexual Orientation Fluidity in Youth (SO*FLY) Study in 2021. Current SOGIE, past sexual fluidity, and sociodemographic characteristics were assessed for missingness. Overall, 95.7% of participants had no missing questions, 3.8% were missing one question, and 0.5% were missing ≥ 2 questions. Past sexual fluidity and assigned sex were most commonly missing. Sociodemographic differences between participants who skipped the SOGIE questions and the rest of the sample were minimal. Missingness for the examined items was low and similar across sociodemographic characteristics, suggesting that almost all youth are willing to respond to survey questions about SOGIE. SOGIE and sexual fluidity items should be included in surveys and clinical assessments of youth to inform clinical care, policy-making, interventions, and resource development to improve the health of all youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
| | - Lynsie R Ranker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
| | - R Korkodilos
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
| | - Jennifer Conti
- Department of Community Health Sciences, Boston University School of Public Health
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health
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5
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Charlton BM, Potter J, Keuroghlian AS, Dalrymple JL, Katz-Wise SL, Guss CE, Phillips WR, Jarvie E, Maingi S, Streed C, Anglemyer E, Hoatson T, Birren B. Development of a mentor training curriculum to support LGBTQIA+ health professionals. J Clin Transl Sci 2024; 8:e44. [PMID: 38476241 PMCID: PMC10928698 DOI: 10.1017/cts.2024.18] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/03/2024] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
While mentors can learn general strategies for effective mentoring, existing mentorship curricula do not comprehensively address how to support marginalized mentees, including LGBTQIA+ mentees. After identifying best mentoring practices and existing evidence-based curricula, we adapted these to create the Harvard Sexual and Gender Minority Health Mentoring Program. The primary goal was to address the needs of underrepresented health professionals in two overlapping groups: (1) LGBTQIA+ mentees and (2) any mentees focused on LGBTQIA+ health. An inaugural cohort (N = 12) of early-, mid-, and late-career faculty piloted this curriculum in spring 2022 during six 90-minute sessions. We evaluated the program using confidential surveys after each session and at the program's conclusion as well as with focus groups. Faculty were highly satisfied with the program and reported skill gains and behavioral changes. Our findings suggest this novel curriculum can effectively prepare mentors to support mentees with identities different from their own; the whole curriculum, or parts, could be integrated into other trainings to enhance inclusive mentoring. Our adaptations are also a model for how mentorship curricula can be tailored to a particular focus (i.e., LGBTQIA+ health). Ideally, such mentor trainings can help create more inclusive environments throughout academic medicine.
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Affiliation(s)
- Brittany M. Charlton
- Harvard Medical School, Harvard Pilgrim Health Care Institute, Harvard T.H.
Chan School of Public Health, Fenway Health, Boston Children’s Hospital, and Brigham and
Women’s Hospital, Boston, MA,
USA
| | - Jennifer Potter
- Harvard Medical School, Beth Israel Deaconess Medical Center, and Fenway
Health, Boston, MA, USA
| | - Alex S. Keuroghlian
- Harvard Medical School, Massachusetts General Hospital, and Fenway
Health, Boston, MA, USA
| | - John L. Dalrymple
- Harvard Medical School and Beth Israel Deaconess Medical Center,
Boston, MA, USA
| | - Sabra L. Katz-Wise
- Harvard Medical School, Boston Children’s Hospital, and Harvard T.H. Chan
School of Public Health, Boston, MA,
USA
| | - Carly E. Guss
- Harvard Medical School and Boston Children’s Hospital,
Boston, MA, USA
| | - William R. Phillips
- Harvard Medical School and Beth Israel Deaconess Medical Center,
Boston, MA, USA
| | - Emeline Jarvie
- Harvard Medical School and Boston Children’s Hospital,
Boston, MA, USA
| | | | - Carl Streed
- Boston University School of Medicine, Boston,
MA, USA
| | - Ethan Anglemyer
- Harvard Medical School and Boston Children’s Hospital,
Boston, MA, USA
| | - Tabor Hoatson
- Harvard Pilgrim Health Care Institute, Boston,
MA, USA
| | - Bruce Birren
- Broad Institute of MIT and Harvard University,
Cambridge, MA, USA
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6
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Godwin EG, Moore LM, Sansfaçon AP, Nishman MM, Rosal MC, Katz-Wise SL. Experiences of cisgender youth with a transgender and/or nonbinary sibling. Fam Process 2024. [PMID: 38171537 DOI: 10.1111/famp.12957] [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: 10/18/2021] [Revised: 10/15/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
While recent research has begun to address the effects of family support on transgender and/or nonbinary youth (TNY), almost no studies have directly examined how cisgender siblings in families with TNY navigate their sibling's gender disclosure and affirmation within both their families and their larger communities. We conducted an exploratory secondary analysis of in-person, semi-structured interviews with 15 adolescent and young adult siblings (age 13-24 years) of TNY from the northeastern United States from the baseline wave of the community-based, longitudinal, mixed methods Trans Teen and Family Narratives Project. Interview transcripts were analyzed using immersion/crystallization and template organizing approaches. Analyses yielded three main themes: gender-related beliefs and knowledge, peri- and post-disclosure family dynamics, and assessing responses to their sibling. Subthemes included anticipation of their sibling's TN identity, expectations post-disclosure, participants' level of involvement in gender-related family processes, perceptions of changes in family relationships, concern for their sibling (including a high degree of attunement to gender-affirming name and pronoun usage), and concern for themselves. Findings from this study suggest the need to engage directly with siblings of TNY to further elucidate their intrapersonal, intra-familial, and extra-familial experiences related to having a TN sibling and determine their unique support needs. Implications for families, clinicians, and communities are discussed.
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Affiliation(s)
- Eli G Godwin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lb M Moore
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Annie Pullen Sansfaçon
- School of Social Work and the Centre for Public Health Research, University of Montréal, Montréal, Quebec, Canada
| | | | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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7
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Kidd KM, Sequeira GM, Katz-Wise SL, Fechter-Leggett M, Gandy M, Herring N, Miller E, Dowshen NL. "Difficult to Find, Stressful to Navigate": Parents' Experiences Accessing Affirming Care for Gender-Diverse Youth. LGBT Health 2023; 10:496-504. [PMID: 37184531 PMCID: PMC10552142 DOI: 10.1089/lgbt.2021.0468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Purpose: Gender-diverse youth (GDY) face significant health disparities, which can be mitigated by gender-affirming medical care. Understanding parents' experiences seeking care for their GDY can identify barriers to care and improve access. This study sought to understand parents' experiences accessing gender-affirming medical care with their GDY. Methods: We asked parents of GDY in the United States to describe their experiences with gender-affirming medical care through a single open-ended item on an online survey disseminated through social media in February of 2020. Open-ended survey responses were analyzed through inductive thematic analysis by two authors using an iteratively developed codebook adjudicated by consensus. This codebook was used to identify key themes. Results: We analyzed 277 responses from majority White (93.9%) parents from 41 U.S. states. Themes included (1) Experiences accessing care: finding a provider, financial and insurance-related considerations, the impact of geography on care access; (2) Experiences receiving care: factors in successful or unsuccessful patient-provider interactions, differing approaches to initiating care, sense of community with other families; and (3) Outcomes related to receiving care: how care for their child was perceived to be lifesaving or helped their child thrive. Conclusions: Parents highlighted how access to gender-affirming medical care improved their GDY's health and wellbeing, and described numerous barriers they experienced with finding and receiving this care. Given the evidence that gender-affirming medical care mitigates health disparities, providers, policymakers, insurance companies, and health systems leaders should urgently address these challenges to ensure equitable receipt of care for all GDY.
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Affiliation(s)
- Kacie M. Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Gina M. Sequeira
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Sabra L. Katz-Wise
- Boston Children's Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Molly Fechter-Leggett
- West Virginia University Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Megan Gandy
- School of Social Work, West Virginia University, Morgantown, West Virginia, USA
| | - Nadeen Herring
- blaq noyz, LLC, Rowan University, Glassboro, New Jersey, USA
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nadia L. Dowshen
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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8
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Katz-Wise SL, Ranker LR, Kraus AD, Wang YC, Xuan Z, Green JG, Holt M. Fluidity in Gender Identity and Sexual Orientation Identity in Transgender and Nonbinary Youth. J Sex Res 2023:1-10. [PMID: 37585555 DOI: 10.1080/00224499.2023.2244926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Changes in sexual orientation identity (SOI) and gender identity (GI) have rarely been studied in transgender and/or nonbinary youth (TNBY), but documenting such changes is important for understanding identity development and gender transition and supporting the needs of TNBY. This study examined the frequency and patterning of changes in GI and SOI across 3 months (T1-T2) and 1.5 years (T1-T4) among 183 TNBY (baseline age 14-17 years; 83.6% White, 16.9% Hispanic/Latinx) who participated in a longitudinal US study. Participants completed online surveys including measures of GI and SOI. The most common gender identity selected at T1 (with or without another gender identity) was nonbinary (56.3%), and more than half (57.4%) of youth identified with a plurisexual identity (e.g., bisexual, pansexual). GI fluidity from T1-T2 was 13.2% and from T1-T4 was 28.9%. It was equally common to move toward a nonbinary gender identity as toward a binary gender identity. SOI fluidity was more common (30.6% from T1-T2; 55.8% from T1-T4) than GI fluidity. Shifts toward plurisexual identities were more common than shifts toward monosexual identities (e.g., straight, gay). Findings highlight the need to assess changes in GI and SOI in research and clinical practice to address the unique needs of TNBY accurately and effectively.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health
| | - Lynsie R Ranker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Community Health Sciences, Boston University School of Public Health
| | - Aidan D Kraus
- Wheelock College of Education and Human Development, Boston University
| | - Yu-Chi Wang
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health
| | | | - Melissa Holt
- Wheelock College of Education and Human Development, Boston University
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9
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Katz-Wise SL, Jarvie EJ, Potter J, Keuroghlian AS, Gums JN, Kosciesza AJ, Hanshaw BD, Ornelas A, Mais E, DeJesus K, Ajegwu R, Presswood W, Guss CE, Phillips R, Charlton BM, Kremen J, Williams K, Dalrymple JL. Integrating LGBTQIA + Community Member Perspectives into Medical Education. Teach Learn Med 2023; 35:442-456. [PMID: 35766109 DOI: 10.1080/10401334.2022.2092112] [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: 01/16/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
ProblemLGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minorities) people have unique health care needs related to their sexual orientation, gender identity and expression, and sex development. However, medical education has historically excluded LGBTQIA + health-related content in formal curricula. It is common for medical students to interact with diverse patient populations through clinical rotations; however, access to and knowledge about LGBTQIA + patients is inconsistently prioritized in medical schools. This is especially true for LGBTQIA + patients with intersecting historically marginalized identities, such as people of color and people with disabilities. Learning from and listening to medically underserved community members can help both medical students and educators better understand the unique health needs of these communities, and address implicit biases to improve health care and outcomes for their patients. Intervention: To address the lack of LGBTQIA + health-related content in medical education and improve access to and knowledge about LGBTQIA + patients, LGBTQIA + community members' perspectives and lived experiences were integrated into undergraduate medical education via four primary methods: Community Advisory Groups, community panel events, standardized patients, and community member interviews. Context: LGBTQIA + community members' perspectives and lived experiences were integrated into medical education at Harvard Medical School (HMS) as part of the HMS Sexual and Gender Minority Health Equity Initiative. Impact: LGBTQIA + community members' perspectives and lived experiences were successfully integrated into multiple aspects of medical education at HMS. During this process, we navigated challenges in the following areas that can inform similar efforts at other institutions: representation of diverse identities and experiences, meeting and scheduling logistics, structural barriers in institutional processes, and implementation of community member recommendations. Lessons Learned: Based on our experiences, we offer recommendations for integrating LGBTQIA + community members' perspectives into medical education. Engaging community members and integrating their perspectives into medical education will better enable medical educators at all institutions to teach students about the health care needs of LGBTQIA + communities, and better prepare medical students to provide affirming and effective care to their future patients, particularly those who are LGBTQIA+.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - E J Jarvie
- Office of Curriculum Services, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Potter
- Division of General Medicine, Beth Israel Lahey Health, Cambridge, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- The Fenway Institute, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jasmine N Gums
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Aiden James Kosciesza
- Klein College of Media and Communication, Temple University, Philadelphia, Pennsylvania, USA
- Department of English, Community College of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brady D Hanshaw
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angel Ornelas
- Department of History, Claremont McKenna College, Claremont, California, USA
| | - Em Mais
- Department of Counseling and Human Services, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Kai DeJesus
- Studies of Women, Gender, & Sexuality, Harvard University, Boston, Massachusetts, USA
- Department of Sociology, Harvard University, Boston, Massachusetts, USA
| | - Rose Ajegwu
- College of Engineering, Northeastern University, Boston, Massachusetts, USA
| | - William Presswood
- Department of Natural and Social Science, Miami Dade College, Miami, Florida, USA
| | - Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Rusty Phillips
- Division of Hospital Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jessica Kremen
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kesha Williams
- Department of Medicine, Fenway Community Health Center, Boston, Massachusetts, USA
| | - John L Dalrymple
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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10
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Murchison GR, Aguayo-Romero RA, Lett E, Katz-Wise SL, Agénor M, Gordon AR. Transgender/nonbinary young adults' exposure to cissexism-related social stressors: Variation across gender groups. Soc Sci Med 2023; 329:116013. [PMID: 37315357 PMCID: PMC10710666 DOI: 10.1016/j.socscimed.2023.116013] [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: 06/08/2022] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Young adults who are transgender and/or nonbinary (TNB) experience discrimination, violence, and other social stressors as a result of cissexism, the system of power relations that marginalizes people whose genders diverge from sociocultural expectations for the sex they were assigned at birth. However, variation in TNB young adults' exposure to social stressors across gender groups, particularly specific nonbinary gender groups (e.g., agender, genderqueer), has not been well characterized. METHODS We analyzed data from an online cross-sectional survey of U.S. TNB young adults (N = 667; ages 18-30 years; 44% White, 24% multiracial, 14% Black, 10% Latinx, 7% Asian, 1% another race/ethnicity), assessing gender non-affirmation; cissexist discrimination, rejection, and victimization; general discrimination; sexual assault victimization; and psychological, physical, and sexual abuse in childhood/adolescence. We used generalized linear models to test for variation in stressors across six gender groups (transgender woman [n = 259], transgender man [n = 141], agender [n = 36], gender fluid [n = 30], genderqueer [n = 51], nonbinary [n = 150]) and compare each group to the full sample. We performed similar analyses among nonbinary gender groups. RESULTS Exposure to stressors was considerable in all groups. Several stressors (e.g., past-year cissexist discrimination) did not vary significantly by gender group. Compared to the full sample, transgender women reported greater lifetime cissexist rejection and lifetime and past-year cissexist victimization. Compared to the full sample, transgender men and women reported greater lifetime cissexist discrimination and lower past-year gender non-affirmation. No stressors varied significantly across nonbinary gender groups. CONCLUSION Among TNB young adults, women, men, and nonbinary people experience distinct patterns of some (though not all) stigma-related stressors. Decisions about (dis)aggregating research participants by gender group, or providing gender-tailored services for TNB people, should account for patterning of pertinent stressors. Efforts to eliminate structural cissexism should address intersections with other systems of power relations, including sexism and binary normativity.
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Affiliation(s)
- Gabriel R Murchison
- Yale School of Public Health, Department of Social & Behavioral Sciences, New Haven, CT, USA
| | - Rodrigo A Aguayo-Romero
- Harvard Medical School, Department of Medicine, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA; Fenway Health, The Fenway Institute, Boston, MA, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, IL, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sabra L Katz-Wise
- Boston Children's Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA, USA; Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA; Harvard Medical School, Department of Pediatrics, Boston, MA, USA
| | - Madina Agénor
- Fenway Health, The Fenway Institute, Boston, MA, USA; Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, USA; Brown University School of Public Health, Center for Health Promotion and Health Equity, Providence, RI, USA
| | - Allegra R Gordon
- Boston Children's Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA, USA; Harvard Medical School, Department of Pediatrics, Boston, MA, USA; Boston University School of Public Health, Department of Community Health Sciences, Boston, MA, USA.
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11
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Freaney C, Isles S, Adler S, Katz-Wise SL. An Examination of Health Care Workers' Education and Training on Their Basic Knowledge, Clinical Preparedness, and Attitudinal Awareness About LGBT Patients. J Homosex 2023:1-16. [PMID: 37289101 DOI: 10.1080/00918369.2023.2221760] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
LGBT individuals experience discrimination in health care settings and report difficulty accessing clinically competent healthcare. This study examined the self-assessed knowledge, clinical preparedness, LGBT health focused education received and attitudinal awareness of health care workers (HCW) (n = 215) toward LGBT patients at an urban hospital in New York City. HCW completed a one-time survey, that included the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale. Forty percent of HCW treated LGB patients and 30% treated transgender patients, 11% and 18% reported they were unaware if their patients were LGB or transgender. Seventy-four percent of HCW received less than two hours of formal education in LGBT health. A slight majority of HCW (51%) reported not receiving adequate clinical training to work with transgender clients. Forty-six percent of HCW reported not receiving adequate clinical training to work with LGB clients. A significant difference in LGBT health knowledge, clinical preparedness, and attitudinal awareness was found by LGBT health education received. HCW that reported more LGBT focused health education reported higher basic LGBT health knowledge, felt more clinically prepared, and reported affirming attitudes regarding LGBT patients. This research suggests that more LGBT health focused education of HCW is needed.
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Affiliation(s)
- Christine Freaney
- Health Promotion and Wellness, Farmingdale State College, Farmingdale, New York, USA
| | - Sheneil Isles
- School of Allied Health, Monroe College, Bronx, New York, USA
| | - Sandy Adler
- School of Allied Health, Monroe College, Bronx, New York, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Harvard University, Boston, Massachusetts, USA
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12
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Katz-Wise SL, Ranker LR, Gordon AR, Xuan Z, Nelson K. Sociodemographic Patterns in Retrospective Sexual Orientation Identity and Attraction Change in the Sexual Orientation Fluidity in Youth Study. J Adolesc Health 2023; 72:437-443. [PMID: 36528519 PMCID: PMC10289118 DOI: 10.1016/j.jadohealth.2022.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This study examined sociodemographic patterns of retrospective fluidity in sexual orientation identity (i.e., any change from one identity to another) and attractions (i.e., any change in attractions to one or more gender(s)) in a large sample of US youth. METHODS Participants were 4,087 youth (58% cisgender girls/women, 38% cisgender boys/men, 5% transgender or nonbinary individuals), ages 14-25 years, from across the United States, who were recruited from an online survey panel. Sexual and gender minorities and people of color were oversampled. Participants completed the Wave 1 survey of the longitudinal Sexual Orientation Fluidity in Youth study, which assessed sociodemographic characteristics and retrospective fluidity in sexual orientation identity and attractions. RESULTS Across the sample, 17% reported a retrospective change in identity and 33% reported a change in attractions. Participants who were most likely to report identity change were in the younger age group (14-17 years), were transgender or nonbinary, had a plurisexual identity (pansexual, queer), and reported attractions to more than one gender. Participants who were most likely to report attraction change were nonbinary, had a plurisexual identity (pansexual, queer, bisexual), and reported attractions to more than one gender. DISCUSSION This study found retrospective changes in sexual orientation identity and attractions were common in this sample of youth, with the prevalence of these changes differing by sociodemographic characteristics. Results from this study inform future research on adolescent health and have implications for supporting and caring for this age group, for whom sexual fluidity is common.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
| | - Lynsie R Ranker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Kimberly Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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13
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Katz-Wise SL, Perry NS, Nelson KM, Gordon AR, Ybarra ML. Sexual Fluidity in Identity and Behavior Among Cisgender Youth: Findings from the Longitudinal Growing up with Media Study. J Pediatr 2023:S0022-3476(23)00114-2. [PMID: 36822509 DOI: 10.1016/j.jpeds.2023.01.020] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/07/2022] [Accepted: 01/12/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES To examine fluidity in sexual orientation identity and behavior among cisgender youth. STUDY DESIGN Data were analyzed from 5 survey waves of the longitudinal US Growing Up with Media Study (2010-2019). Participants were 989 cisgender youth, aged 13-20 years at baseline, who completed online surveys assessing sexual orientation identity and behavior (gender of sexual partners). Amount of change (mobility) and patterns of change across waves were assessed for identity and behavior. RESULTS Consistently heterosexual was the most common sexual orientation identity (89%-97% for boys, 80%-90% for girls), followed by gay (3%) for boys, and bisexual (8%) for girls. Sexual minority identities increased (3%-11% for boys, 10%-20% for girls) over time, same-gender sexual behavior also increased. Girls had more identity mobility than boys; no gender difference was found for behavior mobility. Movement from heterosexual to a sexual minority identity occurred for 9% of girls and 6% of boys; movement from different-gender sexual behavior to same-gender sexual behavior occurred for 2% of girls and boys. CONCLUSIONS Findings highlight the need to assess multiple dimensions and patterns of change of youth sexual orientation in research and clinical care. Recognizing and creating space for conversations about changes in sexual identity and behavior over time will help providers accurately and effectively address the health needs of all patients.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.
| | | | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA.
| | - Allegra R Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
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14
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Abstract
Sexual fluidity research (i.e., change over time in one or more sexual orientation dimensions) has grown exponentially, with advancements in conceptual models, measurement, and understanding of sexual orientation as a construct and developmental process that accommodates potential for change. Sexual fluidity research has also moved beyond samples of white cisgender women to consider the experiences of individuals with other sociodemographic characteristics and has examined change across multiple dimensions of sexual orientation, mechanisms of change, and associations with health outcomes. This review provides a brief narrative of historical conceptualizations of sexual orientation and fluidity and the current state of research on sexual fluidity. Finally, we identify opportunities for future research, policy, and clinical practice.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Kieran P Todd
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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15
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Keuroghlian AS, Charlton BM, Katz-Wise SL, Williams K, Jarvie E, Phillips R, Kremen J, Guss CE, Dalrymple JL, Potter J. Harvard Medical School's Sexual and Gender Minority Health Equity Initiative: Curricular and Climate Innovations in Undergraduate Medical Education. Acad Med 2022; 97:1786-1793. [PMID: 35947484 PMCID: PMC9698138 DOI: 10.1097/acm.0000000000004867] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PROBLEM Sexual and gender minority (SGM) populations face numerous health disparities. Medical school curricula lack adequate educational content preparing students for serving SGM patients, and medical students typically do not experience welcoming, inclusive educational environments conducive to learning about SGM health care. APPROACH In 2018, Harvard Medical School (HMS) launched the 3-year Sexual and Gender Minority Health Equity Initiative to integrate SGM health content throughout the longitudinal core medical curriculum and cultivate an educational climate conducive for engaging students and faculty in SGM health education. The initiative employed innovative strategies to comprehensively review existing SGM health curricular content and climate; integrate content across courses and clerkships; lead with LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minorities) community engagement; adopt an intersectional approach that centers racial equity; cultivate safe, affirming educational environments for LGBTQIA+ and non-LGBTQIA+ students and staff; ensure all graduating students are prepared to care for SGM patients; enhance faculty knowledge, skills, attitudes, and confidence teaching SGM health; evaluate effectiveness and impact of SGM health curricular innovations; prioritize sustainability of curricular innovations; and publicly share and disseminate SGM health curricular products and tools. OUTCOMES Key outcomes of the initiative focused on 5 areas: development of 9 SGM health competencies, stakeholder engagement (HMS students and faculty, national SGM health experts, and LGBTQIA+ community members), student life and educational climate (increased LGBTQIA+ student matriculants, enhanced mentorship and support), curriculum development (authentic LGBTQIA+ standardized patient experiences, clerkship toolkit design), and faculty development (multimedia curriculum on content and process to teach SGM health). NEXT STEPS In addition to refining curricular integration, evaluating interventions, and implementing comprehensive antiracist and gender-affirming educational policies, the next phase will involve dissemination by translating best practices into feasible approaches that any school can adopt to meet local needs with available resources.
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Affiliation(s)
- Alex S. Keuroghlian
- A.S. Keuroghlian is principal investigator, National LGBTQIA+ Health Education Center, The Fenway Institute, and associate professor of psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Brittany M. Charlton
- B.M. Charlton is associate professor, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sabra L. Katz-Wise
- S.L. Katz-Wise is assistant professor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Kesha Williams
- K. Williams is a family medicine physician, Fenway Health, Boston, Massachusetts
| | - E.J. Jarvie
- E.J. Jarvie is a curriculum theme coordinator, Office of Curriculum Services, Harvard Medical School, Boston, Massachusetts
| | - Rusty Phillips
- R. Phillips is a hospitalist, Beth Israel Deaconess Medical Center, and clinical instructor, Harvard Medical School, Boston, Massachusetts
| | - Jessica Kremen
- J. Kremen is a pediatric endocrinologist, Division of Endocrinology, Boston Children’s Hospital, and pediatrics instructor, Harvard Medical School, Boston, Massachusetts
| | - Carly E. Guss
- C.E. Guss is an attending physician, Adolescent and Young Adult Medicine, Boston Children’s Hospital, and assistant professor, Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John L. Dalrymple
- J.L. Dalrymple is associate dean, Medical Education Quality Improvement, and professor, Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Potter
- J. Potter is co-chair, The Fenway Institute, professor of medicine, and advisory dean, Harvard Medical School, Boston, Massachusetts
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16
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Katz-Wise SL, Boskey ER, Godwin EG, Thomson K, Post J, Gordon AR. "We're Moving in the Right Direction. Still a Long Way to Go": Experiences and Perceptions of the Climate for LGBTQ+ Employees at a Pediatric Hospital. J Homosex 2022; 69:2286-2304. [PMID: 34115579 DOI: 10.1080/00918369.2021.1938468] [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] [Indexed: 06/12/2023]
Abstract
A positive LGBTQ+ (lesbian, gay, bisexual, transgender/nonbinary, queer) workplace climate is critical for healthcare employee satisfaction, productivity, and patient care. The current study assessed LGBTQ+ workplace climate among 791 employees from a large urban pediatric hospital. Several workplace climate domains were assessed in an online survey: employee attitudes, training, experiences related to working with LGBTQ+ colleagues, patients and families, and LGBTQ+-specific experiences. For most domains, half or more of respondents perceived an affirming LGBTQ+ climate. LGBTQ+ employees perceived a less affirming climate than cisgender heterosexual employees. LGBTQ+ employees, especially transgender/nonbinary employees, experienced numerous discriminatory situations. Over 90% of participants felt competent and qualified to work with LGB patients/families; 80% felt competent and qualified to work with TNB patients/families. Themes from open-ended survery responses reflected three LGBTQ+ climate components: systemic, interpersonal, and "grassroots" (affinity group) initiatives. Findings inform strategies to improve LGBTQ+ employee experiences and competency caring for LGBTQ+ patients and families.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth R Boskey
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Eli G Godwin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katharine Thomson
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Julian Post
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
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17
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Bosse JD, Katz-Wise SL, Chiodo LM. Sexual and Gender Diverse Young Adults’ Perception of Behaviors that are Supportive and Unsupportive of Sexual Orientation and Gender Identities. Journal of Adolescent Research 2022. [DOI: 10.1177/07435584221124957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To explore specific responses that sexual and gender diverse young adults (SGD YA) perceive to be supportive and unsupportive of sexual orientation and gender identity by caregivers and other adults following identity disclosure. SGD YA ( N = 101), ages 18 to 25 years ( M = 21.2) were predominantly White (83.1%), non-Hispanic (89.1%), assigned female at birth (82.2%). The majority (97.8%) were sexually diverse (e.g., queer, pansexual, lesbian, gay, asexual, bisexual) and half (50%) were gender diverse (e.g. transgender, agender, genderqueer, nonbinary). Participants completed an online survey. This analysis is focused on participants’ responses to open-ended questions regarding responses they perceived to be supportive and unsupportive of their SGD identity/identities. Content analysis of participants’ open-ended survey responses was conducted using a combination of inductive and deductive coding. Six themes emerged for both supportive responses (communication, actions, acceptance, open-mindedness, unconditional love, and advocacy) and unsupportive responses (distancing, hostility, minimizing, controlling, blaming, and bumbling). For some themes, different sub-themes emerged based on identity. Parents/caregivers as well as other adults in the lives of SGD YA can implement specific responses to demonstrate support for sexual orientation and gender identity with the potential to improve the mental health of SGD YA.
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Affiliation(s)
- Jordon D. Bosse
- Northeastern University, Boston, MA, USA
- Massachusetts General Hospital, Boston, USA
| | - Sabra L. Katz-Wise
- Boston Children’s Hospital, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lisa M. Chiodo
- University of Massachusetts, Amherst, USA
- Wayne State University, Detroit, MI, USA
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18
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Shah TN, Parodi KB, Holt MK, Green JG, Katz-Wise SL, Kraus AD, Kim GS, Ji Y. A Qualitative Exploration of How Transgender and Non-binary Adolescents Define and Identify Supports. Journal of Adolescent Research 2022. [DOI: 10.1177/07435584221123123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This qualitative study explored how 249 transgender and non-binary (TNB) adolescents (ages 14–18) described salient supports in their lives, and ways in which key social-ecological contexts could better support TNB adolescents’ wellbeing. Participants were recruited through social media, and completed online surveys; all study procedures were approved by the Boston University Institutional Review Board. Most (84.7%) participants identified as White, and as sexual minorities (96.4%). Modified consensual qualitative research (CQR-M) methods were used to examine TNB adolescents’ responses to two questions: “In your life, which people, if any, would you describe as most supportive, and why?” and “What can individuals/groups within families, schools, and communities do to best support the well-being of transgender and non-binary adolescents?” Results indicated that the most common source of support for TNB participants was peers, followed by family members. Participants also highlighted the centrality of supportive environments that offer access to resources, as well as support derived through policies and practices that reduce stigma. Collectively, results have implications for how individuals and systems can foster wellbeing among TNB adolescents.
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Affiliation(s)
| | | | | | | | | | | | | | - Yujie Ji
- Tufts University, Medford, MA, USA
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19
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Katz-Wise SL, Gordon AR, Sharp KJ, Johnson NP, Hart LM. Developing Parenting Guidelines to Support Transgender and Gender Diverse Children's Well-being. Pediatrics 2022; 150:189276. [PMID: 36045300 DOI: 10.1542/peds.2021-055347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Parents and caregivers' responses to their child's gender identity or expression play a pivotal role in their mental health. Despite increasing visibility of transgender and gender diverse (TGD) children, few scientific resources exist to advise their parents and caregivers. METHODS We used an online Delphi study to generate expert consensus. Expert adult participants (N = 93; 55% cisgender women, 12% cisgender men, 33% gender minority; 83% White race or ethnicity) rated statements describing parenting strategies compiled from a systematic search of community-generated online literature. Participants represented 3 distinct "panels" of expertise: parents and caregivers of a TGD child, TGD persons, and/or professionals working with TGD populations. Statements rated as essential or important by 80% to 100% of each panel were endorsed as a guideline. Three rounds of surveys were used with iterative feedback to develop consensus. RESULTS Of 813 total statements, only 125 were endorsed by all 3 panels. Key domains of consensus included: supportive strategies for parents (eg, open communication, listening), behaviors to avoid (eg, pressuring a child into a gender transition), strategies for navigating healthcare and school systems, and common responses for parents (eg, confusion). Areas of disagreement, in which professional and TGD panels concurred but the parent panel did not, included whether to allow gender identity experimentation during childhood, the value of providing access to gender diverse media, and how to avoid misgendering a child. CONCLUSIONS These consensus-based guidelines offer a unique and needed resource for parents and caregivers and clinicians and can be used to promote the mental health and well-being of TGD children.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Contributed equally as cofirst authors
| | - Allegra R Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.,Contributed equally as cofirst authors
| | - Kendall J Sharp
- Department of Psychology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Laura M Hart
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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20
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Tabaac AR, Godwin EG, Reynolds CA, Katz-Wise SL, Charlton BM. Sexual Minority Men's Perspectives and Experiences of Adolescent Pregnancy Risk and Pregnancy Prevention Behaviors. J Sex Res 2022; 59:886-896. [PMID: 35353659 PMCID: PMC10389053 DOI: 10.1080/00224499.2022.2053043] [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] [Indexed: 06/08/2023]
Abstract
Sexual minority men (e.g., gay, bisexual, queer) are more likely than heterosexual men to be involved in an adolescent pregnancy, but little research has been done on the context surrounding this disparity. To address this gap, and as part of the larger Sexual Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) Study, semi-structured interviews and descriptive surveys were conducted with 10 cisgender sexual minority men, ages 29-49, from across the United States. Interview transcripts were analyzed using immersion/crystallization and template organizing style methods, and themes were organized into a conceptual model describing sexual minority men's debut sexual activity and decision-making experiences during adolescence. This model depicts three themes: 1) partnership and negotiation of sexual experiences, 2) psychological processes related to development, pregnancy, and sexuality, and 3) cultural and environmental contexts. These three themes are contextualized by a throughline of transformative life events (i.e., the existence and chronology of life-impacting events). Findings indicate a complex interplay of psychological (e.g., developmental processes surrounding sexuality and sexual orientation), social (e.g., personal relationships), and policy-level factors (e.g., sex education) influence sexual minority men's sexuality and pregnancy prevention decision-making during adolescence. Care should be taken to consider and include sexual minority men in pregnancy prevention messaging and education.
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Affiliation(s)
- Ariella R. Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Eli G. Godwin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Colleen A. Reynolds
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sabra L. Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Brittany M. Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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21
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Goldblatt AEA, Bankoff SM, Katz-Wise SL, Pantalone DW. A heavy burden: Associations between sexual minority status, mental health, and BMI in women. J Clin Psychol 2022; 78:2180-2196. [PMID: 35881947 DOI: 10.1002/jclp.23423] [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: 08/19/2020] [Revised: 05/20/2022] [Accepted: 07/10/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sexual minority women (SMW) are at increased risk of elevated body mass index (BMI) compared to heterosexual women, increasing their vulnerability to chronic diseases. Nonmonosexual SMW appear to be at additional risk for elevated BMI, likely due to unique sexual minority stressors. METHODS A total of 437 SMW and heterosexual women completed a cross-sectional, online survey including self-report measures of sexual orientation dimensions, weight, psychological distress, and eating behaviors. We investigated relations among these variables to better understand disparities in self-reported BMI based on sexual orientation and sexual orientation discordance (SOD). RESULTS SMW self-reported more psychological distress, more binge eating, and higher BMIs than their heterosexual peers, with nonmonosexual groups of SMW often reporting the highest values. SOD was positively associated with psychological distress. CONCLUSIONS SMW-particularly nonmonosexual SMW-are at increased risk for psychological distress, binge eating, and elevated BMI relative to heterosexual peers. Future research should further elucidate mechanisms for these disparities.
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Affiliation(s)
- Alison E A Goldblatt
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Sarah M Bankoff
- Behavioral Medicine Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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22
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Goldhammer H, Grasso C, Katz-Wise SL, Thomson K, Gordon AR, Keuroghlian AS. Pediatric sexual orientation and gender identity data collection in the electronic health record. J Am Med Inform Assoc 2022; 29:1303-1309. [PMID: 35396995 PMCID: PMC9196694 DOI: 10.1093/jamia/ocac048] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/29/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/14/2022] Open
Abstract
The systematic documentation of sexual orientation and gender identity data in electronic health records can improve patient-centered care and help to identify and address health disparities affecting sexual and gender minority populations. Although there are existing guidelines for sexual orientation and gender identity data among adult patients, there are not yet standard recommendations for pediatric patients. In this article, we discuss methods that pediatric primary care organizations can use to collect and document sexual orientation and gender identity information with children and adolescents in electronic health records. These recommendations take into consideration children's developmental stages, the role of caregivers, and the need to protect the privacy of this information. We also focus on the current limitations of electronic health records in capturing the nuances of sexual and gender minority identities and make suggestions for addressing these limitations.
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Affiliation(s)
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katharine Thomson
- Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Allegra R Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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23
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Affiliation(s)
- Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Suzanne Dahlberg
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Jessica Addison
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
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24
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Katz-Wise SL, Godwin EG, Parsa N, Brown CA, Sansfaçon AP, Goldman R, MacNish M, Rosal MC, Austin SB. Using Family and Ecological Systems Approaches to Conceptualize Family- and Community-Based Experiences of Transgender and/or Nonbinary Youth From the Trans Teen and Family Narratives Project. Psychol Sex Orientat Gend Divers 2022; 9:21-36. [PMID: 35755166 PMCID: PMC9231420 DOI: 10.1037/sgd0000442] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study used family and ecological systems approaches to understand transgender and/or nonbinary (TNB) youths' experiences of their gender identity within family and community contexts. A sample of 33 TNB youth, ages 13-17 years (M = 15.18, SD = 1.24), were recruited from community-based venues in the New England region of the United States to participate in the Trans Teen and Family Narratives Project, a longitudinal community-based mixed methods study. TNB youth in the sample identified as trans girls (n = 12), trans boys (n = 17), and nonbinary (n = 3 assigned female at birth; n = 1 assigned male at birth). Race/ethnicity of the sample was 73% White and 15% mixed race/ethnicity. All participants completed a one-time, in-person semi-structured qualitative interview at baseline about their family and community-based experiences related to their TNB identity. Interviews were audio-recorded and professionally transcribed. Interview transcripts were coded and analyzed using immersion/crystallization and thematic analysis approaches. Eight themes were developed, which correspond to different levels of the ecological systems model: individual-level (identity processes, emotions/coping), family-level (general family experiences, family support), community-level (general community experiences; community support; lesbian, gay, bisexual, transgender, queer (LGBTQ) community), and societal/institutional-level (external forces). Findings emphasize the importance of using family and ecological systems approaches to understanding the family- and community-based experiences of TNB youth and have implications for improving clinical practice with TNB youth and families.
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Affiliation(s)
- Sabra L. Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Eli G. Godwin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA and Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Neeki Parsa
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA
| | - Courtney A. Brown
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA
| | - Annie Pullen Sansfaçon
- Canada Research Chair on transgender children and their families, School of Social Work, University of Montreal, Montreal, Canada
| | - Roberta Goldman
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Melissa MacNish
- SAYFTEE: Supporting Alternative Youth and Families through Education and Empowerment, Boston, MA
| | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
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25
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Pletta DR, Kant JD, Ehrensaft D, MacNish M, Cahill S, Katz-Wise SL. The 2016 United States presidential election's impact on families with transgender adolescents in New England. J Fam Psychol 2022; 36:23-34. [PMID: 34043404 PMCID: PMC8626525 DOI: 10.1037/fam0000873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During and after the 2016 United States (U.S.) presidential election, discriminatory policies and stigmatizing rhetoric have been increasingly directed toward the transgender community at state and national levels. Transgender and/or nonbinary (TNB) adolescents, already at elevated risk for poorer health relative to their cisgender (nontransgender) peers, may have been adversely impacted by the shifting sociopolitical climate. This secondary analysis used qualitative data from the Trans Teen and Family Narratives Project to investigate how perceived shifts in the sociopolitical climate following the 2016 election affected families with TNB adolescents in the New England region of the U.S. (states of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont). Data included two waves of semistructured interviews conducted with TNB adolescents and their caregivers and siblings (N = 20 families, 60 family members). Two coders analyzed transcripts using a thematic analysis approach. Emergent themes included: contemporary life for trans people in America (e.g., being discriminated against and dehumanized), perceptions of the national sociopolitical climate (e.g., anger toward political figures), forms of resistance and advocacy (e.g., confronting misinformation), and factors amplifying or buffering effects of the sociopolitical climate (e.g., the formation of alliances or coalitions within the family). Findings indicate the 2016 election spurred the redefinition of communication boundaries within, and outside, the immediate family, particularly regarding online communication and social media. TNB adolescents and their families anxiously anticipated changes in the sociopolitical climate and their foreseen impact on TNB adolescents' rights and safety. Implications for family therapy, intervention design, and policy reform are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- David R Pletta
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University
| | - Jessica D Kant
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
| | - Diane Ehrensaft
- Department of Pediatrics, University of California, San Francisco
| | | | | | - Sabra L Katz-Wise
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University
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26
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Abstract
Among sexual minorities, bisexual individuals experience higher rates of victimization and symptoms of PTSD than their lesbian and gay peers as well as heterosexual individuals. Despite these disparities, little work has examined factors contributing to PTSD symptoms among bisexual adults. The current study examined the associations between bisexual-specific minority stress and PTSD symptoms in a sample of adults with bisexual orientation and tested social support as a potential mediator of this association. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), ages 18 to 66 years, with bisexual orientation based on identity and/or attraction to multiple genders. Greater anti-bisexual prejudice was associated with greater PTSD symptoms (β = 0.16) and lower social support (β = -.16), while accounting for sociodemographics and sexual identity-based victimization. Social support was associated with lower PTSD symptoms (β = -.25), while accounting for sociodemographics, sexual identity-based victimization, and anti-bisexual prejudice. Mediation analyses indicated that anti-bisexual prejudice was indirectly associated with greater PTSD symptoms through lower social support. Addressing bisexual-specific minority stress and its role in diminishing social support for bisexual individuals represents a critical component of trauma-informed research and intervention development in the bisexual community.
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Affiliation(s)
- Julie M Woulfe
- Syracuse University Barnes Center at the Arch, Syracuse, New York, USA
| | - Ethan H Mereish
- Department of Health studies, American University, Washington, DC, USA
| | - Sabra L Katz-Wise
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachussets, USA
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27
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Parodi KB, Holt MK, Green JG, Katz-Wise SL, Shah TN, Kraus AD, Xuan Z. Associations between school-related factors and mental health among transgender and gender diverse youth. J Sch Psychol 2022; 90:135-149. [PMID: 34969484 DOI: 10.1016/j.jsp.2021.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 05/21/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
Transgender and gender diverse youth (TGD) report high rates of mental health concerns. However, there is reason to expect that among TGD youth there is variation in mental health experiences related to specific aspects of gender identity. Furthermore, although certain school characteristics are related to improved mental health for sexual minority youth, it is unclear whether the same school characteristics are associated with improved mental health for TGD youth and whether gender identity moderates the associations between school characteristics and mental health. Using baseline data from Project AVANT, a longitudinal study of TGD youth ages 14-18 years in the United States (N = 252), we report on several mental health outcomes (i.e., depression, anxiety, nonsuicidal self-injury, and PTSD), with attention to differences by gender identity. Secondly, we examined associations of three protective school-related factors (i.e., school-connectedness, presence of a Gay-Straight or Gender-Sexuality Alliance [GSA], and state mandated protections for sexual and gender minority students) with TGD youth mental health. TGD youth reported elevated levels of anxious and depressive symptoms, with nonbinary youth assigned female at birth reporting higher mean depressive symptoms relative to transgender females. Among the aggregate sample of TGD youth, 69.9% reported clinically significant anxiety, 57.9% reported clinically significant depression, 56.7% reported nonsuicidal self-injury, and 46.4% met screening criteria for posttraumatic stress disorder. Despite a small effect size, greater school-connectedness was significantly associated with fewer mental health concerns and gender identity moderated the association between school-connectedness and number of anxiety symptoms. Gender identity also moderated the association between presence of a GSA and number of anxious symptoms, depressive symptoms, and clinically significant depression, respectively. No significant associations of state-level protections and mental health outcomes were detected. Findings highlight the importance of improving mental health and fostering GSA-engagement and school-connectedness among TGD youth. Implications for school psychologists are discussed.
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Affiliation(s)
- Katharine B Parodi
- Department of Counseling Psychology and Applied Human Development, Boston University, USA
| | - Melissa K Holt
- Department of Counseling Psychology and Applied Human Development, Boston University, USA.
| | - Jennifer Greif Green
- Department of Counseling Psychology and Applied Human Development, Boston University, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, USA; Department of Pediatrics, Harvard Medical School, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, USA
| | - Tanvi N Shah
- Department of Counseling Psychology and Applied Human Development, Boston University, USA
| | - Aidan D Kraus
- Department of Counseling Psychology and Applied Human Development, Boston University, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University, Boston, MA, USA
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28
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Jolly D, Boskey ER, Thomson KA, Tabaac AR, Burns MTS, Katz-Wise SL. Why Are You Asking? Sexual Orientation and Gender Identity Assessment in Clinical Care. J Adolesc Health 2021; 69:891-893. [PMID: 34629230 DOI: 10.1016/j.jadohealth.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Divya Jolly
- Center for Gender Surgery, Department of Plastic and Oral Surgery, Boston, Massachusetts.
| | - Elizabeth R Boskey
- Center for Gender Surgery, Department of Plastic and Oral Surgery, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Katharine A Thomson
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Ariella R Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Maureen T S Burns
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sabra L Katz-Wise
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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29
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Jhe GB, Mereish EH, Gordon AR, Woulfe JM, Katz-Wise SL. Associations between anti-bisexual minority stress and body esteem and emotional eating among bi+ individuals: The protective role of individual- and community-level factors. Eat Behav 2021; 43:101575. [PMID: 34757266 PMCID: PMC8739806 DOI: 10.1016/j.eatbeh.2021.101575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 09/29/2021] [Accepted: 10/08/2021] [Indexed: 11/27/2022]
Abstract
Bisexual individuals experience prejudice specifically related to their bisexual identity, and these experiences may compound extant risk for disordered eating behaviors and body esteem concerns. However, little is known about how sexual minority stress related to bisexual orientation is associated with emotional eating and body esteem. The current study examined the associations between bisexual-specific minority stress and emotional eating and body esteem in a sample of bisexual plus (bi+) adults (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity), and tested the moderating effects of identity centrality, affirmation, and community connectedness as potential protective factors. This study leveraged data from an online survey of 498 adults (77.46% cisgender women; 79.7% White), ages 18 to 64 years (M = 28.5; SD = 9.59). Bisexual-specific minority stress was associated with more emotional eating (β = 0.15, p = .013) and lower body esteem (β = -0.16, p = .005), while controlling for sociodemographic characteristics, body mass index, and heterosexist minority stress. This finding remained the same when sensitivity analyses were conducted with participants who identified specifically as bisexual. Identity centrality and affirmation and community connectedness did not demonstrate moderating effects but they had main effects, such that they were positively associated with body esteem (β = 0.16, p = .001; β = 0.21, p < .001; β = 0.13, p = .004, respectively). Results suggest that anti-bisexual minority stress has a unique association with bi+ individuals' emotional eating and body esteem, and identified potential individual- and community-level protective factors for body esteem. These findings inform future research and interventions for this understudied population.
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Affiliation(s)
- Grace B. Jhe
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America,Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America,Corresponding author at: Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, United States of America. (G.B. Jhe)
| | - Ethan H. Mereish
- Department of Health Studies, American University, Washington, DC, United States of America
| | - Allegra R. Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America,Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States of America
| | - Julie M. Woulfe
- Barnes Center at the Arch, Syracuse University, Syracuse, NY, United States of America
| | - Sabra L. Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America,Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America,Department of Social and Behavioral Sciences, Harvard T. H Chan School of Public Health, Boston, MA, United States of America
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30
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Charlton BM, Reynolds CA, Tabaac AR, Godwin EG, Porsch LM, Agénor M, Grimstad FW, Katz-Wise SL. Unintended and teen pregnancy experiences of trans masculine people living in the United States. Int J Transgend Health 2021; 22:65-76. [PMID: 34651143 PMCID: PMC8040679 DOI: 10.1080/26895269.2020.1824692] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Trans masculine people are more likely than cisgender peers to have a teen or unintended pregnancy, though little is known about the origins of these disparities. AIMS This study aimed to describe teen and unintended pregnancy experiences among trans masculine people in order to elucidate risk factors and pregnancy-related needs. METHODS As a part of the United States-based SexuaL Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) study, in-depth, semi-structured interviews were conducted between March 2017 and August 2018 with 10 trans masculine people, ages 20-59 years, who experienced a teen or unintended pregnancy. Audio-recorded interviews were professionally transcribed, then analyzed using immersion/crystallization and thematic analysis approaches. The themes were contextualized using sociodemographic survey data. RESULTS The four themes that were developed from participants' narratives highlighted: 1) how trans masculine people navigated having a pregnant body (e.g., heightened gender dysphoria due to being pregnant); 2) the importance of the cultural environment in shaping experiences as a trans masculine pregnant person (e.g., pregnancy and gender-related job discrimination); 3) the development of the pregnancy over time (e.g., decision-making processes); and 4) how pregnancy (and gender identity) affected relationships with other people (e.g., adverse family of origin experiences). DISCUSSION This study identified a number of risk factors for teen and unintended pregnancies among trans masculine people including physical and sexual abuse as well as ineffective use of contraception. This research also identifies unique needs of this population, including: relieving gender dysphoria, combating discrimination, and ensuring people feel visible and welcome, particularly in reproductive healthcare spaces. Public health practitioners, healthcare providers, and support networks (e.g., chosen family) can be key sources of support. Attention to risk factors, unique needs, and sources of support will improve reproductive healthcare and pregnancy experiences for trans masculine people.
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Affiliation(s)
- Brittany M. Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Colleen A. Reynolds
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ariella R. Tabaac
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Eli G. Godwin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Lauren M. Porsch
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Madina Agénor
- Department of Community Health, Tufts University, Medford, MA
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Frances W. Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Harvard Medical School, Boston, MA, USA
| | - Sabra L. Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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31
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Garcia Saiz E, Sarda V, Pletta DR, Reisner SL, Katz-Wise SL. Family Functioning as a Protective Factor for Sexual Risk Behaviors Among Gender Minority Adolescents. Arch Sex Behav 2021; 50:3023-3033. [PMID: 34586546 PMCID: PMC9116415 DOI: 10.1007/s10508-021-02079-5] [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: 12/03/2020] [Revised: 04/12/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
Gender minority (GM) youth are more likely to engage in sexual behaviors that increase risk of exposure to sexually transmitted infections, including HIV. However, family functioning may be protective against sexual risk taking. We characterized longitudinal associations between family functioning (family communication and family satisfaction) and sexual risk behaviors across two years in a community sample of 30 GM adolescents, ages 13-17 years. Participants were purposively recruited from community-based venues, through social media, and peer referrals throughout the New England area and completed surveys every 6 months, with measures of family functioning, sexual risk behaviors, risk factors (depressive and anxious symptoms, perceived stress related to parents), and protective factors (social support, gender-related pride, and community connectedness). Results indicated that higher levels of family communication, improved family satisfaction, and increased social support were protective for sexual risk taking, in general, and specifically for condom use for anal/vaginal sex. In contrast, increased depressive symptoms were associated with lower likelihood of anal/vaginal condom use. Associations between family functioning and sexual risk taking were not attenuated by adding risk and protective factors to the model; thus, these factors did not explain the observed associations between family functioning and sexual risk taking. These findings suggest improved family functioning, greater social support, and lower depressive symptoms are associated with reduced sexual risk taking among gender minority youth, thus making these factors an important target for future prevention efforts.
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Affiliation(s)
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - David R Pletta
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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32
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Baker AM, Jahn JL, Tan AS, Katz-Wise SL, Viswanath K, Bishop RA, Agénor M. Sexual Health Information Sources, Needs, and Preferences of Young Adult Sexual Minority Cisgender Women and Non-Binary Individuals Assigned Female at Birth. Sex Res Social Policy 2021; 18:775-787. [PMID: 34484461 PMCID: PMC8414874 DOI: 10.1007/s13178-020-00501-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Young adult sexual minority women (SMW) have unique sexual health needs and higher rates of some poor sexual health outcomes compared to their heterosexual peers. Unequal access to relevant sexual health information may contribute to sexual orientation disparities in sexual health among women, but research on sexual health communication among SMW is sparse. METHODS In-depth interviews conducted in 2016-2017 investigated sexual health communication in a sample of 29 racially/ethnically diverse cisgender women and non-binary individuals assigned female at birth who were between 19 and 36 years of age and identified as a sexual minority. Data were analyzed using a thematic analysis approach that involved inductive and deductive coding to identify themes. RESULTS Three broad themes were identified: 1) sources of sexual health information; 2) sexual health information needs; and 3) preferences for sexual health information delivery. Participants discussed and critiqued the Internet, other mass media, health care providers, school-based sex education, family, and peers/partners as sources of sexual health information. Participants expressed a need for customized, non-heteronormative information pertaining to sexually transmitted infection risk and prevention. They preferred receiving information from health care providers, the Internet, and other mass media, and some also suggested school-based sex education and peer education as methods for delivering information. CONCLUSIONS Participants expressed clear desires for relevant, high-quality sexual health information delivered through a variety of channels, especially the Internet, other mass media, and health care providers. POLICY IMPLICATIONS Findings call for policies that improve provision of sexual health information through health care providers, online resources, and school-based sex education.
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Affiliation(s)
- Allison M. Baker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jaquelyn L. Jahn
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andy S.L. Tan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Sabra L. Katz-Wise
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rachel A. Bishop
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Executive Office of Health & Human Services, Commonwealth of Massachusetts, Boston, MA, USA
| | - Madina Agénor
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Community Health, Tufts University, Medford, MA, USA
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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Bhattacharya N, Budge SL, Pantalone DW, Katz-Wise SL. Conceptualizing relationships among transgender and gender diverse youth and their caregivers. J Fam Psychol 2021; 35:595-605. [PMID: 33119364 PMCID: PMC8081734 DOI: 10.1037/fam0000815] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Family support and acceptance are protective for transgender and gender diverse (TGD) youths' mental health and identity development. Although some studies have examined the role of supportive family relationships for TGD youth, prior research has not fully explored how TGD youth and their caregivers understand or characterize these relationships within the family system. In this qualitative study, we explored perspectives of TGD youth and their caregivers regarding youth-caregiver and caregiver-caregiver relationships within the family system. We recruited a community-based sample of 20 families (20 TGD youth, ages 7 to 18 years, and 34 caregivers) from 3 U.S. geographic regions. TGD youth represented multiple gender identities; caregivers included mothers (n = 21), fathers (n = 12), and 1 grandmother. Each family member completed an individual semistructured interview that included questions about family relationships. Interviews were transcribed verbatim and transcripts were analyzed using a thematic analysis approach. Analyses revealed complex bidirectional family relationships, highlighting 5 contextual factors influencing these relationships: school, community, workplace, religion, and extended family. TGD youths' identity development was inextricably linked to how caregivers respond to, adjust to, and learn from their children, and how caregivers interact with one another. Findings illustrate how caregiver acceptance and family cohesion may be linked and how youth and caregivers identified shared contextual factors impacting the family system. This research highlights the importance of situating TGD youth and caregivers as equal partners in family level approaches to affirm and support TGD identity development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Katz-Wise SL, Sarda V, Austin SB, Harris SK. Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents. PLoS One 2021; 16:e0250500. [PMID: 34077452 PMCID: PMC8171963 DOI: 10.1371/journal.pone.0250500] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Gender minority (GM) adolescents, who have a different gender identity than their sex assigned at birth, may use substances as a coping strategy in response to GM-related stressors. This study examined longitudinal effects of gender minority stressors on substance use in GM adolescents, and related risk factors (internalized transphobia, depressive symptoms, anxious symptoms) and protective factors (resilience, gender-related pride, family functioning, social support, gender-related community connectedness). METHODS Participants were 30 GM adolescents, ages 13-17 years, from the U.S. community-based longitudinal Trans Teen and Family Narratives Project. Participants completed an online survey every 6 months across 2 years (5 waves; data collected 2015-2019). RESULTS Exposure to gender minority stressors was associated with higher odds of alcohol use. Across models, internalized transphobia (risk factor), resilience (protective factor), and gender-related pride (protective factor) were the most significant mediators of associations between gender minority stressors and substance use. Family functioning and social support (protective factors) significantly moderated the association between gender minority stressors and alcohol use, such that family functioning and social support were protective for alcohol use at lower levels of gender minority stress, but not at higher levels. CONCLUSION Results suggest that GM adolescents engage in substance use as a coping strategy in response to gender minority stressors. A number of hypothesized risk and protective factors mediated or moderated these associations. Future interventions with GM adolescents should focus efforts on addressing internalized transphobia as a risk factor and strengthening resilience, gender-related pride, and family functioning as protective factors for substance use.
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Affiliation(s)
- Sabra L. Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America
| | - S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
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Kidd KM, Sequeira GM, Paglisotti T, Katz-Wise SL, Kazmerski TM, Hillier A, Miller E, Dowshen N. "This Could Mean Death for My Child": Parent Perspectives on Laws Banning Gender-Affirming Care for Transgender Adolescents. J Adolesc Health 2021; 68:1082-1088. [PMID: 33067153 PMCID: PMC8041924 DOI: 10.1016/j.jadohealth.2020.09.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Numerous U.S. state legislatures have proposed bills to ban gender-affirming medical interventions for minors. Parents and caregivers play a critical role in advocating for and supporting their transgender and gender-diverse youth (TGDY). We aimed to understand parent and caregiver perspectives about this potential legislation and perceived effects on their TGDY's mental health. METHODS We developed and launched a social-media based, anonymous online survey in February 2020 to assess parent and caregiver perspectives on proposed laws to ban gender-affirming medical interventions for minors. Participants were asked to respond to two open-ended questions about these laws; responses were coded to identify key themes. RESULTS We analyzed responses from 273 participants from 43 states. Most identified as white (86.4%) female (90.0%) mothers (93.8%), and 83.6% of their TGDY had received gender-affirming medical interventions before age 18 years. The most salient theme, which appeared in the majority of responses, described parent and caregiver fears that these laws would lead to worsening mental health and suicide for their TGDY. Additional themes included a fear that their TGDY would face increased discrimination, lose access to gender-affirming medical interventions, and lose autonomy over medical decision-making due to government overreach. CONCLUSIONS In this convenience sample, parents and caregivers overwhelmingly expressed fear that the proposed legislation will lead to worsening mental health and increased suicidal ideation for their TGDY. They implored lawmakers to hear their stories and to leave critical decisions about gender-affirming medical interventions to families and their medical providers.
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Affiliation(s)
- Kacie M. Kidd
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave
| | - Gina M. Sequeira
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave
| | - Taylor Paglisotti
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave
| | - Sabra L. Katz-Wise
- Boston Children’s Hospital, Division of Adolescent/Young Adult Medicine, 300 Longwood Ave, Boston MA 02115
| | - Traci M. Kazmerski
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave
| | - Amy Hillier
- University of Pennsylvania, School of Social Policy & Practice, Colonial Penn Center, 3641 Locust Walk, Philadelphia PA 19104
| | - Elizabeth Miller
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave
| | - Nadia Dowshen
- University of Pennsylvania, School of Medicine, Colonial Penn Center, 3641 Locust Walk, Philadelphia PA 19104
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Silveri MM, Schuttenberg EM, Schmandt K, Stein ER, Rieselbach MM, Sternberg A, Cohen-Gilbert JE, Katz-Wise SL, Blackford JU, Potter AS, Potter MP, Sarvey DB, McWhinnie CM, Feinberg JE, Boger KD. Clinical Outcomes Following Acute Residential Psychiatric Treatment in Transgender and Gender Diverse Adolescents. JAMA Netw Open 2021; 4:e2113637. [PMID: 34152417 PMCID: PMC8218077 DOI: 10.1001/jamanetworkopen.2021.13637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Transgender and gender diverse (TGD) individuals, who have a gender identity that differs from their sex assigned at birth, are at increased risk of mental health problems, including depression, anxiety, self-injurious behavior, and suicidality, relative to cisgender peers. OBJECTIVE To examine mental health outcomes among TGD vs cisgender adolescents in residential treatment. DESIGN, SETTING, AND PARTICIPANTS This cohort study's longitudinal design was used to compare groups at treatment entry and discharge, and 1-month postdischarge follow-up. The setting was an adolescent acute residential treatment program for psychiatric disorders. Participants were TGD or cisgender adolescents enrolled in the treatment program. Statistical analysis was performed October 2019 to March 2021. EXPOSURE Adolescents participated in a 2-week acute residential treatment program for psychiatric disorders. MAIN OUTCOMES AND MEASURES Primary outcomes were depressive (the Center for Epidemiologic Studies Depression Scale [CES-D]) and anxiety (the Multidimensional Anxiety Scale for Children [MASC]) symptoms, and emotional dysregulation (the Difficulties in Emotion Regulation Scale [DERS]), measured at treatment entry and discharge, and postdischarge follow-up. Age of depression onset, suicidality, self-injury, and childhood trauma also were assessed at treatment entry. RESULTS Of 200 adolescent participants who completed treatment entry and discharge assessments, the mean (SD) age was 16.2 (1.5) years; 109 reported being assigned female at birth (54.5%), 35 were TGD (17.5%), and 66 (49.3%) completed 1-month follow-up. TGD participants had an earlier mean (SD) age of depression onset (TGD: 10.8 [2.4] years vs cisgender: 11.9 [2.3] years; difference: 1.07 years; 95% CI, 0.14-2.01 years; P = .02), higher mean (SD) suicidality scores (TGD: 44.4 [23.1] vs cisgender: 28.5 [25.4]; difference: 16.0; 95% CI, 6.4-25.5; P = .001), more self-injurious behavior (mean [SD] RBQ-A score for TGD: 3.1 [2.5] vs cisgender: 1.7 [1.9]; difference: 1.42; 95% CI, 0.69-2.21; P = .001) and more childhood trauma (eg, mean [SD] CTQ-SF score for emotional abuse in TGD: 12.7 [5.4] vs cisgender: 9.8 [4.7]; difference: 2.85; 95% CI, 1.06-4.64; P = .002). The TGD group also had higher symptom scores (CES-D mean difference: 7.69; 95% CI, 3.30 to 12.08; P < .001; MASC mean difference: 7.56; 95% CI, 0.46 to 14.66; P = .04; and DERS mean difference: 18.43; 95% CI, 8.39 to 28.47; P < .001). Symptom scores were significantly higher at entry vs discharge (CES-D mean difference, -12.16; 95% CI, -14.50 to -9.80; P < .001; MASC mean difference: -3.79; 95% CI, -6.16 to -1.42; P = .02; and DERS mean difference: -6.37; 95% CI, -10.80 to -1.94; P = .05) and follow-up (CES-D mean difference: -9.69; 95% CI, -13.0 to -6.42; P < .001; MASC mean difference: -6.92; 95% CI, -10.25 to -3.59; P < .001; and DERS mean difference: -12.47; 95% CI, -18.68 to -6.26; P < .001). CONCLUSIONS AND RELEVANCE This cohort study found mental health disparities in TGD youth relative to cisgender youth, with worse scores observed across assessment time points. For all participants, primary clinical outcome measures were significantly lower at treatment discharge than at entry, with no significant differences between discharge and 1-month follow-up. Given the substantial degree of mental health disparities reported in TGD individuals, these findings warrant focused clinical attention to optimize treatment outcomes in gender minority populations.
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Affiliation(s)
- Marisa M. Silveri
- Neurodevelopmental Laboratory on Addictions and Mental Health, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Eleanor M. Schuttenberg
- Neurodevelopmental Laboratory on Addictions and Mental Health, McLean Hospital, Belmont, Massachusetts
- Adolescent Acute Residential Treatment Program, McLean Hospital, Belmont, Massachusetts
| | - Kaya Schmandt
- Adolescent Acute Residential Treatment Program, McLean Hospital, Belmont, Massachusetts
| | - Elena R. Stein
- Neurodevelopmental Laboratory on Addictions and Mental Health, McLean Hospital, Belmont, Massachusetts
- Adolescent Acute Residential Treatment Program, McLean Hospital, Belmont, Massachusetts
| | - Maya M. Rieselbach
- Neurodevelopmental Laboratory on Addictions and Mental Health, McLean Hospital, Belmont, Massachusetts
- Adolescent Acute Residential Treatment Program, McLean Hospital, Belmont, Massachusetts
| | - Ariel Sternberg
- Adolescent Acute Residential Treatment Program, McLean Hospital, Belmont, Massachusetts
| | - Julia E. Cohen-Gilbert
- Neurodevelopmental Laboratory on Addictions and Mental Health, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sabra L. Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Mona P. Potter
- McLean Anxiety Mastery Program, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Dana B. Sarvey
- Adolescent Acute Residential Treatment Program, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Chad M. McWhinnie
- Adolescent Acute Residential Treatment Program, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jessica E. Feinberg
- Adolescent Acute Residential Treatment Program, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kathryn D. Boger
- McLean Anxiety Mastery Program, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Stark B, Nagle SA, Hunter A, Charlton BM, Katz-Wise SL. Family building desires among transgender and gender expansive adolescents: A longitudinal family-level analysis. Int J Transgend Health 2021; 22:425-439. [PMID: 37808529 PMCID: PMC10553371 DOI: 10.1080/26895269.2021.1896410] [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] [Indexed: 10/10/2023]
Abstract
Introduction Professional societies state that Transgender and gender expansive (TGE) adolescents and their families should be counseled about future family building options prior to initiating gender affirming therapy. While emerging data show that TGE adolescents have diverse desires regarding future family building, little is known regarding how these preferences are developed in a larger ecological context. Aim The current study used Ecological Systems Theory as a framework to describe the family building attitudes of TGE adolescents, their caregivers, and their siblings. Methods Participants were recruited from community-based venues in the New England region of the U.S. to participate in the TTFN Project, a longitudinal community-based mixed methods study. The sample for the current study included 84 family members from 30 families (30 TGE adolescents, 11 siblings, 44 caregivers). All participants completed a semi-structured qualitative interview about family building attitudes and desires for TGE and cisgender adolescents at two waves across 6-8 months. Interview transcripts were analyzed using a combination of immersion/crystallization, thematic analysis, and template organizing style approaches. The Transgender Youth Fertility Attitudes Questionnaire (TYFAQ) was employed to quantitatively describe the family building attitudes of TGE adolescents and their families. Results Eight themes corresponding to the levels of the ecological systems model - individual-level (perceived reproductive potential, reproductive identity), family-level (communication about family building, familial experiences and expectations), community-level (community support and role models; community expectations and norms), and societal/institutional-level (medicalization of family building, external sociopolitical factors) - were developed from the interviews. Results from the TYFAQ indicated that compared to cisgender adolescents, TGE adolescents were less likely to value having biological children and more likely to consider adoption in comparison to their cisgender siblings. Discussion Findings emphasize the importance of using Ecological Systems Theory to understand the family building attitudes and desires of TGE adolescents and their families.
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Affiliation(s)
- Brett Stark
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shea A. Nagle
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Adam Hunter
- Department of Health Policy, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brittany M. Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Sabra L. Katz-Wise
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Shrier LA, Burke PJ, Jonestrask C, Katz-Wise SL. Applying systems thinking and human-centered design to development of intervention implementation strategies: An example from adolescent health research. J Public Health Res 2020; 9:1746. [PMID: 33117757 PMCID: PMC7582103 DOI: 10.4081/jphr.2020.1746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/26/2020] [Indexed: 12/02/2022] Open
Abstract
Introducing innovative health interventions into clinic settings requires a comprehensive and creative approach to multiple implementation challenges. To optimize implementation of a sexual and reproductive health intervention for young women with depression, we applied systems thinking and human-centered design thinking methods to develop tools and strategies to address issues influencing intervention implementation in diverse clinics. We recruited staff from three clinics that provide sexual and reproductive health and behavioral health care to young women. Across five sessions (four video conference calls, one in-person workshop), we used systems mapping to identify key stakeholders and their relationships, processes, and challenges to care; formed clinic staff-investigator design teams; brainstormed about challenges that would influence intervention implementation and considered potential solutions; prioritized implementation challenges; and designed prototypes of solutions. Participants responded positively to the systems thinking perspective and collaborative design thinking process. Findings included generalizable considerations about solving implementation challenges for clinic-based interventions, such as forming a team of champions representing the diverse disciplines involved in and impacted by intervention implementation, and creating multiple tools and strategies for implementation that can be tailored to a given clinic’s culture. Significance for public health Implementing innovative health interventions in clinic systems requires consideration of multiple human, environmental, and process factors. To develop implementation tools and strategies for a sexual and reproductive health intervention for young women with depression, we applied systems thinking to consider clinic system elements and their connections, and human-centered design to tackle challenges with intervention implementation by centering on the clinic staff who would be experiencing these challenges. Using this approach, the investigators and clinic staff efficiently and effectively identified implementation challenges in diverse clinic settings and designed tools and strategies to overcome these challenges. This form of investigator-clinic staff collaboration, attention to system factors, and focus on creative solutions can inform research and care around implementing novel interventions in established clinical systems.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Boston, MA.,Department of Pediatrics, Harvard Medical School in Boston, Boston, MA
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Boston, MA.,Department of Pediatrics, Harvard Medical School in Boston, Boston, MA.,Department of Nursing, Northeastern University, Boston, MA
| | | | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Boston, MA.,Department of Pediatrics, Harvard Medical School in Boston, Boston, MA.,Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Stark B, Nagle SA, Hunter A, Mok-Lin E, Katz-Wise SL. UNDERSTANDING THE INFLUENCE OF GENDER IDENTITY AND SEXUAL ORIENTATION ON THE FUTURE PARENTING DESIRES OF TRANSGENDER AND NON-BINARY ADOLESCENTS IN COMPARISON TO THEIR CISGENDER SIBLINGS. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Budge SL, Orzechowski M, Schams S, Lavender A, Onsgard K, Leibowitz S, Katz-Wise SL. Transgender and Gender Nonconforming Youths’ Emotions: The Appraisal, Valence, Arousal Model. The Counseling Psychologist 2020. [DOI: 10.1177/0011000020945051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Increased scientific understanding explains why transgender and gender nonconforming (TGNC) youth report more mental health concerns than their cisgender peers. However, the emotional processes of TGNC youth have not been assessed beyond mental health diagnoses. Our aim in this study was to investigate how TGNC youth understand, experience, and label their emotional experiences. We conduced a two-tiered qualitative analysis of 20 predominantly White TGNC youths, ages 7–18 years, resulting in the creation of the appraisal, valence, arousal theory of emotions. Within the theory, emotions are categorized in four quadrants: Reflective/Unpleasant, Anticipatory/Unpleasant, Reflective/Pleasant, and Anticipatory/Pleasant. Results indicated that the majority of TGNC youths’ emotions were located in the Reflective/Unpleasant and Reflective/Pleasant quadrants. The current study highlights TGNC youths’ appraisal of emotions and the potential impact on youths’ cognitive and emotional processes. Interventions should attend to pleasant and unpleasant aspects of emotions while also focusing on youths’ understanding of the context of their emotions.
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Affiliation(s)
| | | | | | - Amy Lavender
- University of Wisconsin-Madison, Madison, WI, USA
| | - Kate Onsgard
- University of Wisconsin-Madison, Madison, WI, USA
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Katz-Wise SL, Gordon AR, Burke PJ, Jonestrask C, Shrier LA. Healthcare Clinician and Staff Perspectives on Facilitators and Barriers to Ideal Sexual Health Care to High-Risk Depressed Young Women: A Qualitative Study of Diverse Clinic Systems. J Pediatr Adolesc Gynecol 2020; 33:363-371. [PMID: 32145377 DOI: 10.1016/j.jpag.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/22/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE This study identified clinician and clinic staff perspectives on facilitators and barriers to providing sexual and reproductive health (SRH) care to depressed young women, a population at increased risk for adverse SRH outcomes. DESIGN We conducted in-person semi-structured qualitative interviews, which were audio-recorded, transcribed, and coded by two researchers. We used thematic analysis to identify themes pertaining to care facilitators and barriers within a socio-ecological framework. SETTING This study was conducted in seven diverse clinics in the U.S. New England region. PARTICIPANTS Participants were 28 clinicians and staff (4/clinic), including behavioral health clinicians (n = 9), nurse practitioners (n = 7), nurses (n = 3), medical doctors (n = 3), administrative associates (n = 2), practice managers (n = 2), family planning counselor (n = 1), and medical assistant (n = 1). MAIN OUTCOME MEASURES We queried how clinicians and clinic staff identify and manage depression and sexual risk, and what they perceive as facilitators and barriers affecting provision of ideal SRH care to depressed young women. RESULTS Themes represented facilitators of and barriers to providing ideal SRH care to high-risk depressed young women at five socio-ecological levels: individual (facilitator: trust in providers; barrier: stigma experiences), interpersonal/provider (facilitator: frequent patient-provider communication; barrier: lack of time during clinic visits to build trust), clinic (facilitator: integration of care; barrier: lack of scheduling flexibility), organization/community (facilitator: training for providers; barrier: funding constraints), and macro/societal (facilitator: supportive policies; barrier: mental health stigma). CONCLUSION Optimizing SRH care to high-risk depressed young women necessitates attention to factors on all socio-ecological levels to remove barriers and bolster existing facilitators of care.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.
| | - Allegra R Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Cassandra Jonestrask
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
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Charlton BM, Nava-Coulter B, Coles MS, Katz-Wise SL. Teen Pregnancy Experiences of Sexual Minority Women. J Pediatr Adolesc Gynecol 2019; 32:499-505. [PMID: 31145986 PMCID: PMC6878152 DOI: 10.1016/j.jpag.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/14/2018] [Revised: 04/23/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE Sexual minority women are more likely than heterosexual peers to have a teen pregnancy, though little is known about origins of this disparity. Our objective was to describe teen pregnancy experiences among sexual minority women and elucidate potential risk factors. DESIGN As a part of the SexuaL Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) study, in-depth semistructured interviews and surveys were conducted. SETTING Across the United States. PARTICIPANTS Interviews were conducted with 10 sexual minority cisgender women, ages 21-66 years, who experienced a teen pregnancy. MAIN OUTCOME MEASURES Interview transcripts were analyzed using immersion/crystallization and template organizing style approaches. The themes were contextualized using survey data and organized into a conceptual model. RESULTS AND CONCLUSION Participants first became pregnant between ages 12 and 19 years; all pregnancies were described as unintentional. Half of the pregnancies resulted from sexual assault. Most of the remaining pregnancies resulted from consensual sex with a boyfriend or regular partner with whom the participant reported inconsistent or no contraceptive use. Five primary themes emerged from participants' interviews: (1) sexuality; (2) life history and contextual factors before pregnancy; (3) abuse and assault; (4) reactions to the pregnancy; and (5) pregnancy outcomes. Future research should assess each theme to explore its contribution to the higher burden of teen pregnancies among sexual minority compared with heterosexual women; such data can inform public health prevention campaigns and evidenced-based curricula for health care providers who care for adolescents.
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Affiliation(s)
- Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
| | | | - Mandy S Coles
- Department of Pediatrics, Boston University Medical Center, Boston, Massachusetts
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Guss CE, Woolverton GA, Borus J, Austin SB, Reisner SL, Katz-Wise SL. Transgender Adolescents' Experiences in Primary Care: A Qualitative Study. J Adolesc Health 2019; 65:344-349. [PMID: 31227384 PMCID: PMC6708717 DOI: 10.1016/j.jadohealth.2019.03.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Transgender adults may avoid medical settings due to concerns about discrimination or past experiences of maltreatment. Emerging evidence shows improved outcomes and psychosocial functioning when transgender adolescents receive gender-affirming care, but little is known about transgender adolescents' experiences in primary care. The objective of this study was to learn about the experiences in primary care of transgender and gender nonconforming (TGN) adolescents and their recommendations for primary care practices and clinicians. METHODS Participants were recruited from primary care clinics, gender care clinics, and list serves. Semistructured qualitative interviews were conducted with 20 TGN adolescents aged 13-21 years (75% white/non-Hispanic, average age 16.7 years). Participants answered questions about primary care experiences, how to improve care, suggestions regarding how to ask about gender identity, and recommendations for making offices more welcoming for TGN adolescents. Interviews were transcribed verbatim, coded, and analyzed for themes. RESULTS Overall, participants reported positive experiences in primary care. Most participants commented on distress resulting from being called the incorrect name or the incorrect pronoun. Several concrete recommendations emerged from the interviews, including asking all patients about their gender identity and pronouns at every primary care visit and not asking about gender identity when caregivers are in the room. Participants emphasized the importance of using their affirmed name and pronouns and wanted providers to be knowledgeable about transgender health. CONCLUSION Delivery of primary care services for transgender adolescents may be optimized if offices provide a welcoming environment, use correct names and pronouns, and discuss gender confidentially with patients.
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Affiliation(s)
- Carly E. Guss
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 333 Longwood, Boston, MA, USA 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston MA USA 02115
| | - G. Alice Woolverton
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 333 Longwood, Boston, MA, USA 02115,Suffolk University Department of Psychology, 8 Ashburton Pl, Boston MA USA 02108
| | - Joshua Borus
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 333 Longwood, Boston, MA, USA 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston MA USA 02115
| | - S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 333 Longwood, Boston, MA, USA 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston MA USA 02115,Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA USA 02115
| | - Sari L. Reisner
- Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston MA USA 02115,Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA USA 02115
| | - Sabra L. Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 333 Longwood, Boston, MA, USA 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston MA USA 02115,Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA USA 02115
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44
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Calzo JP, Katz-Wise SL, Charlton BM, Gordon AR, Krieger N. Addressing the dearth of critical gender analysis in public health and medical pedagogy: an interdisciplinary seminar to generate student-created teaching examples. Crit Public Health 2019; 29:18-26. [PMID: 30778277 DOI: 10.1080/09581596.2017.1419166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Gender-based analysis in public health is a systematic examination of how population health is shaped by systems of gender relations, involving policies and laws, programs and services, research priorities, social norms and practices, and public discourse. To address the paucity of critical gender-based analysis training in most public health, medical, and health policy courses, we designed the capstone course in the Women, Gender, and Health (WGH) Interdisciplinary Concentration at the Harvard T.H. Chan School of Public Health. This course enables students to develop brief teaching examples to expose students in non-WGH courses to gender-based analysis (e.g., challenging simplistic conflations of gender and sex). The assignment has yielded 19 teaching examples (several available online at no cost) and offers a model that can be used to address analogous curriculum gaps in relation to other social determinants of health, including racism, social class, sexuality, and immigration.
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Affiliation(s)
- Jerel P Calzo
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.,Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Allegra R Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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45
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Charlton BM, Kahn JA, Sarda V, Katz-Wise SL, Spiegelman D, Missmer SA, Austin SB. Maternal Factors and Sexual Orientation-Related Disparities in Cervical Cancer Prevention. Womens Health Issues 2019; 29:238-244. [PMID: 30639277 DOI: 10.1016/j.whi.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Our objective was to explore how mothers' attitudes and relationships with their daughters may impact the cervical cancer prevention behaviors of daughters with diverse sexual orientations. METHODS We examined 8,143 mother-daughter dyads from the Nurses' Health Study 2 and Growing Up Today Study. During the daughter's adolescence, each mother reported her beliefs about the importance of regular Pap testing for her daughter, the frequency of communication with her daughter about Pap testing, her beliefs about Pap testing and human papillomavirus (HPV) vaccines, and her acceptance of sexual minorities (e.g., bisexuals, lesbians). Mothers and daughters separately reported relationship satisfaction. Log-binomial models were used to examine the longitudinal association between maternal factors and daughter's receipt of a Pap test and HPV vaccination. RESULTS Nearly all maternal factors predicted the daughter's likelihood to have a Pap test and HPV vaccination. Higher levels of acceptance for sexual minorities and better relationship quality were also positively associated with these cervical cancer prevention behaviors. Yet, after adjusting for the maternal factors, there was little attenuation of the existing sexual orientation-related disparities in Pap tests or HPV vaccination. CONCLUSIONS Mothers can play an important role in their daughters' cervical cancer prevention behaviors through novel processes like being more accepting of sexual minorities and having a good relationship quality. However, in this study, maternal factors did not explain much of the sexual orientation-related disparities in cervical cancer prevention. Efforts to ensure a mother is accepting of sexual minorities and has a good relationship quality with her daughter may improve that daughter's reproductive health.
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Affiliation(s)
- Brittany M Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Jessica A Kahn
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Donna Spiegelman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Departments of Biostatistics, Nutrition, and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stacey A Missmer
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Doan Van EE, Mereish EH, Woulfe JM, Katz-Wise SL. Perceived Discrimination, Coping Mechanisms, and Effects on Health in Bisexual and Other Non-Monosexual Adults. Arch Sex Behav 2019; 48:159-174. [PMID: 30105618 PMCID: PMC6349472 DOI: 10.1007/s10508-018-1254-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 06/01/2023]
Abstract
Bisexual individuals experience unique discrimination related to their sexual orientation, which may increase their risk of adverse health outcomes. The study goal was to investigate how bisexual and other non-monosexual individuals experience discrimination, understand how they perceive discrimination to affect their health, and examine the ways in which they cope with discrimination by analyzing responses to open-ended survey questions. The sample included 442 bisexual and other non-monosexual adults, ages 18-68 years (M = 28.97, SD = 10.30), who either reported a bisexual identity or reported attractions to more than one gender. Gender identities included women (n = 347), men (n = 42), and transgender/non-binary individuals (n = 53); 29% of participants were currently located outside of the U.S. Participants completed an online survey, including three open-ended questions regarding their experiences with discrimination, how discrimination affects their health, and methods used to cope with discrimination. Themes related to perceived discrimination included: double discrimination of bisexuals and other non-monosexual individuals by heterosexuals, lesbian and gay individuals; bisexual invalidation and erasure; and sexual victimization. Themes related to the perceived effects of discrimination on health included: impact on mental health; impact on physical health; and effect of discrimination in healthcare. Themes related to coping with discrimination included: social support; resilience; and identity-specific media consumption. Findings demonstrate that bisexual and other non-monosexual individuals' experiences of discrimination can be additive, based on other marginalized facets of identity, including race/ethnicity, gender, and socioeconomic status. Our findings have implications for advancing bisexual health research from an intersectionality framework.
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Affiliation(s)
- Emilie E Doan Van
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Ethan H Mereish
- Department of Health Studies, American University, Washington, DC, USA
| | - Julie M Woulfe
- Division of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Bronx, NY, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Burke PJ, Katz-Wise SL, Spalding A, Shrier LA. Intimate Relationships and Sexual Behavior in Young Women withDepression. J Adolesc Health 2018; 63:429-434. [PMID: 30120062 DOI: 10.1016/j.jadohealth.2018.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/05/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To better understand links between depressive symptoms and high-risk sexual behavior in young women. METHODS We conducted semistructured interviews with young women from three primary care clinics who reported clinically significant depressive symptoms, had penile-vaginal sexual intercourse within the past 6 months, and met at least one sexual risk criterion (N = 16, age 16-23years, racially/ethnically diverse). We transcribed the interview recordings, organized and coded the data, and conducted a directed content analysis. RESULTS Participants described a complex interrelation between depression and intimate relationships and sexual behavior. Depression had negative effects on relationships, sexual motives and experiences (including safety), and feelings about oneself in sexual situations. Participants reported difficulty in developing and maintaining intimate relationships. Although many participants reported less interest in and emotional energy for sex, several were having sex frequently to manage depressive symptoms. Generally, the young women described sex as unsafe (e.g., no condom) owing to impaired judgment, increased impulsivity, apathy, and alcohol. As a result, sometimes their efforts to feel better by having sex led them to feeling worse (e.g., ashamed and worthless). CONCLUSIONS Depressed young women may limit intimate relationships, yet engage in frequent and unsafe sex to cope with their symptoms. Their efforts to feel better may provide only temporary relief or result in feeling worse. Depressed young women would benefit from tailored interventions that identify and counter unhealthy thoughts, attitudes, behaviors, and patterns related to sexual relationships and behavior; minimize factors that impair healthy decision-making; and foster development of alternative affect regulation strategies.
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Affiliation(s)
- Pamela J Burke
- School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Allegra Spalding
- University of Chicago, Masters Program in Social Service Administration, Chicago, Illinois
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Menino DD, Katz-Wise SL, Vetters R, Reisner SL. Associations Between the Length of Time from Transgender Identity Recognition to Hormone Initiation and Smoking Among Transgender Youth and Young Adults. Transgend Health 2018; 3:82-87. [PMID: 29795789 PMCID: PMC5962926 DOI: 10.1089/trgh.2018.0002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose: Gender-affirming medical interventions have been associated with mental health improvements among transgender individuals. However, little is known about optimal timing of these interventions as they relate to stress-sensitive behaviors such as smoking. Methods: We analyzed electronic health record data from transgender youth and young adults to examine whether longer duration from transgender identity recognition to hormone initiation was associated with smoking behaviors. Results: Longer duration from age of identity recognition to age of cross-sex hormone initiation was associated with increased odds of current and lifetime smoking. Conclusion: Future research should investigate other potential risk factors associated with transgender-specific stressors for this population.
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Affiliation(s)
- David D Menino
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ralph Vetters
- Sidney Borum Jr. Health Center, Fenway Health, Boston, Massachusetts
| | - Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,The Fenway Institute, Fenway Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Katz-Wise SL, Ehrensaft D, Vetters R, Forcier M, Austin SB. Family Functioning and Mental Health of Transgender and Gender-Nonconforming Youth in the Trans Teen and Family Narratives Project. J Sex Res 2018; 55:582-590. [PMID: 29336604 PMCID: PMC7895334 DOI: 10.1080/00224499.2017.1415291] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Transgender and gender-nonconforming (TGN) youth are at increased risk for adverse mental health outcomes, but better family functioning may be protective. This study describes TGN youth's mental health and associations with family functioning in a community-based sample. Participants were from 33 families (96 family members) and included 33 TGN youth, ages 13 to 17 years; 48 cisgender (non-transgender) caregivers; and 15 cisgender siblings. Participants completed a survey with measures of family functioning (family communication, family satisfaction) and mental health of TGN youth (suicidality, self-harm, depression, anxiety, self-esteem, resilience). TGN youth reported a high risk of mental health concerns: suicidality (15% to 30%), self-harm (49%), clinically significant depressive symptoms (61%); and moderate self-esteem (M = 27.55, SD = 7.15) and resiliency (M = 3.67, SD = 0.53). In adjusted models, better family functioning from the TGN youth's perspective was associated with better mental health outcomes among TGN youth (β ranged from -0.40 to -0.65 for self-harm, depressive symptoms, and anxious symptoms, and 0.58 to 0.70 for self-esteem and resiliency). Findings from this study highlight the importance of considering TGN youth's perspectives on the family to inform interventions to improve family functioning in families with TGN youth.
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Affiliation(s)
- Sabra L Katz-Wise
- a Division of Adolescent/Young Adult Medicine , Boston Children's Hospital
- b Department of Pediatrics , Harvard Medical School
| | - Diane Ehrensaft
- c Department of Pediatrics , University of California, San Francisco
| | | | - Michelle Forcier
- f Department of Pediatrics, Alpert School of Medicine , Brown University
| | - S Bryn Austin
- a Division of Adolescent/Young Adult Medicine , Boston Children's Hospital
- b Department of Pediatrics , Harvard Medical School
- e Department of Social and Behavioral Sciences , Harvard T. H. Chan School of Public Health
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50
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Charlton BM, Roberts AL, Rosario M, Katz-Wise SL, Calzo JP, Spiegelman D, Austin SB. Teen Pregnancy Risk Factors Among Young Women of Diverse Sexual Orientations. Pediatrics 2018; 141:e20172278. [PMID: 29531127 PMCID: PMC5869338 DOI: 10.1542/peds.2017-2278] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Young women who are sexual minorities (eg, bisexual and lesbian) are approximately twice as likely as those who are heterosexual to have a teen pregnancy. Therefore, we hypothesized that risk factors for teen pregnancy would vary across sexual orientation groups and that other potential risk factors exist that are unique to sexual minorities. METHODS We used multivariable log-binomial models gathered from 7120 young women in the longitudinal cohort known as the Growing Up Today Study to examine the following potential teen pregnancy risk factors: childhood maltreatment, bullying victimization and perpetration, and gender nonconformity. Among sexual minorities, we also examined the following: sexual minority developmental milestones, sexual orientation-related stress, sexual minority outness, and lesbian, gay, and bisexual social activity involvement. RESULTS Childhood maltreatment and bullying were significant teen pregnancy risk factors among all participants. After adjusting for childhood maltreatment and bullying, the sexual orientation-related teen pregnancy disparities were attenuated; these risk factors explained 45% of the disparity. Among sexual minorities, reaching sexual minority developmental milestones earlier was also associated with an increased teen pregnancy risk. CONCLUSIONS The higher teen pregnancy prevalence among sexual minorities compared with heterosexuals in this cohort was partially explained by childhood maltreatment and bullying, which may, in part, stem from sexual orientation-related discrimination. Teen pregnancy prevention efforts that are focused on risk factors more common among young women who are sexual minorities (eg, childhood maltreatment, bullying) can help to reduce the existing sexual orientation-related teen pregnancy disparity.
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Affiliation(s)
- Brittany M. Charlton
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School,,Departments of Epidemiology,,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Margaret Rosario
- Department of Psychology, The Graduate Center, City University of New York, New York City, New York; and
| | - Sabra L. Katz-Wise
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School
| | - Jerel P. Calzo
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, California
| | - Donna Spiegelman
- Departments of Epidemiology,,Biostatistics, Nutrition, and Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts;,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - S. Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School,,Social and Behavioral Sciences, and,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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