Psychological and neighborhood factors associated with urban womens preventive care use.

Women are more likely than men to forego care-including preventive care. Understanding which factors influence womens preventive care use has the potential to improve health. This study focuses on the largely understudied areas of psychological barriers (depression) and neighborhood factors (support and stressors) that may be associated with womens preventive care use through secondary analysis of the Chicago Community Adult Health Study. Across models, 30-40% of the variance in preventive care adherence was explained by the neighborhood. Depressive symptoms were not associated with preventive care use when neighborhood factors were included. However, stratified models showed that associations varied by race/ethnicity. Previous research has tended to focus on individual determinants of care, but this study suggests that barriers to care are far more complex. Efforts aimed at improving care utilization need to be multipronged and interventions need to take an individuals demographics, mental health, and context into account

Research on alcohol and other drug (AOD) use among sexual minority women: A global scoping review

Until the 1980s, the limited research on alcohol and other drug (AOD) use among sexual minority women (SMW) focused on alcohol and used samples recruited from gay bars, resulting in inflated estimates of hazardous drinking. Over the past several decades the number of AOD studies with SMW has increased dramatically. To characterize this literature, we conducted a scoping review to answer the following questions: What do we know, and what are the gaps in research about AOD use among SMW? We searched multiple electronic databases (Medline [PubMed], CINAHL, PsycInfo, and Web of Science) for peer-reviewed research articles about AOD use among adult SMW published between January 1, 2000 and May 31, 2017. After duplicates were removed the search identified 4,204 articles. We reviewed the titles and abstracts and removed articles that did not meet inclusion criteria. We used full-text review of the remaining 229 articles to make a final determination regarding inclusion and we retained 181 articles for review. Although the quantity of AOD research with SMW has grown substantially, the great majority of studies have been conducted in the United States (US) and most focus on hazardous drinking; relatively little research has focused on other drugs. In addition, although there has been marked improvement in theories and methods used in this research, many gaps and limitations remain. Examples are the lack of longitudinal research; reliance on samples that tend to over-represent white, well-educated, and relatively young women; sparse attention to mechanisms underlying the disproportionately high rates of AOD use among SMW; and the absence of intervention research. In general, more high-quality research on SMW\u27s use of AODs is needed, but gaps and limitations are particularly large in non-western countries. Addressing these research gaps and limitations is essential for providing information that can be used to develop more effective prevention and early intervention strategies, as well as for informing policies that can help to reduce risky drinking and drug misuse among SMW

Perceived psychosocial impacts of legalized same-sex marriage: A scoping review of sexual minority adults’ experiences

A growing body of literature provides important insights into the meaning and impact of the right to marry a same-sex partner among sexual minority people. We conducted a scoping review to 1) identify and describe the psychosocial impacts of equal marriage rights among sexual minority adults, and 2) explore sexual minority women (SMW) perceptions of equal marriage rights and whether psychosocial impacts differ by sex. Using Arksey and O’Malley’s framework we reviewed peer-reviewed English-language publications from 2000 through 2019. We searched six databases (PubMed, PsycINFO, CINAHL, Web of Science, JSTOR, and Sociological Abstracts) to identify English language, peer-reviewed journal articles reporting findings from empirical studies with an explicit focus on the experiences and perceived impact of equal marriage rights among sexual minority adults. We found 59 studies that met our inclusion criteria. Studies identified positive psychosocial impacts of same-sex marriage (e.g., increased social acceptance, reduced stigma) across individual, interpersonal (dyad, family), community (sexual minority), and broader societal levels. Studies also found that, despite equal marriage rights, sexual minority stigma persists across these levels. Only a few studies examined differences by sex, and findings were mixed. Research to date has several limitations; for example, it disproportionately represents samples from the U.S. and White populations, and rarely examines differences by sexual or gender identity or other demographic characteristics. There is a need for additional research on the impact of equal marriage rights and same-sex marriage on the health and well-being of diverse sexual minorities across the globe

Associations between individual and couple-level minority stressors and relationship stress in queer women’s interracial/interethnic couple relationships

Intimate relationships provide protections against excess stress. Little research has investigated this in same-sex/gender couples, and particularly interracial/interethnic same-sex/gender couples. In a sample of N = 215 women in same-sex/gender couple relationships, 43% if whom were in interracial/interethnic relationships, we examined differences in general stressors and both individual- and couple-level minority stressors. Women in interracial/interethnic couple relationships reported higher levels of individual-level childhood stress, microaggressions, stress related to race/ethnicity, and couple-level expectations and stereotypes. We also examined the associations between stressors and relationship outcomes and whether these associations differed comparing women in monoracial and interracial/interethnic couple relationships. We found multiple sources of general stressors and individual- and couple-level stressors that were associated with poorer relationship outcomes but found few differences by whether couples were monoracial or interracial/interethnic. Our findings have implications for couple-level interventions and highlight the importance of taking intersectional approaches to research on same-sex couples, as well as the importance of examining multiple sources and levels of stress

The LGBTQIA+ Social-Ecological Model

This paper presents an adapted version of Bronfenbrenner's social ecological model that is responsive to the unique stressors and contexts experienced by LGBTQIA+ people

Cultivating dependence, denial, and self-blame: The use and effects of coercive tactics in intimate partner violence

Little research has investigated coercive tactics in intimate partner violence, and even less has examined coercive tactics among LGBTQIA+ relationships despite their higher rates of intimate partner violence. Abusers may consciously exploit these tactics to ensure dependence and enable continued abuse. To demonstrate this, I use research on abusers’ controlling and coercive tactics and delineate the predictable effects on victims such as lowering their awareness of the violence, decreasing the likelihood of disclosure, and locating blame for the abuse in the victim. In doing so, I also marshal the limited research on coercive tactics in LGBTQIA+ relationships to broaden understanding of coercive tactics in relationships outside of solely heterosexual couples. Abusive relationships in which coercive tactics are used to establish and maintain control may lead to worse mental and physical health outcomes for the victim and may be more violent than bi-directional violence and other forms of intimate partner violence. These dynamics may have unique and pernicious effects on LGBTQIA+ couples. Understanding the patterns of coercive behaviors may help abused partners decrease self-blame and understand the broader context in which they and their abuser are situated which is vital to better understand the dynamics of violence and to end violence

Psychological and Neighborhood Factors Associated with Preventive Care Use by Women in Chicago

Given that half of all deaths in the United States are caused by modifiable health behaviors, improving use of preventive care could save more than 2 million life years annually. Women are more likely than men to forego care -including preventive care, with 60% of women foregoing care compared to 50% of men. In 2014, only 30% of women in the US were up to date on preventive screenings; this rate was even lower among women living in Illinois (21.8%). Understanding which factors influence women’s preventive care use has the potential to improve women’s health. Much of the literature on barriers to preventive care has focused on demographic and practical barriers to preventive care use. In particular, race/ethnicity, low SES, lower levels of education, not having insurance, and transportation barriers have been identified as significant barriers to preventive care use. However, these factors do not explain all of the variance in preventive care use, and little is known about the psychological and contextual factors that may be barriers to women’s use of preventive care. One potential psychological barrier to preventive care use may be depression. Depression affects 9% of the US population, and women are almost twice as likely to be diagnosed with depression as men. People with depression use more healthcare, are 2.5 times more likely to visit the emergency department, and have double the healthcare costs compared to non-depressed people. Yet, individuals with depression are also significantly less likely to have insurance, more likely to live in poverty, less likely to have a primary care physician, and have higher rates of chronic health conditions. Although people who are depressed are more likely to seek care from their primary care physician than from a mental health professional, actual utilization of preventive care by people with depression is not well-understood. Further, much of the focus on preventive care use has been on the individual, yet both individual processes and the social context in which these individual processes occur affect health behaviors and disparities in health care. One contextual factor that is associated with health and is implicated in health disparities is the neighborhood in which individuals live. Neighborhood factors are strongly associated with health and healthcare use, especially among women. The focus of this dissertation is the largely understudied areas of psychological barriers (depression) and neighborhood factors (support and stressors) that may be associated with women’s preventive care use through a secondary analysis of the Chicago Community Adult Health Study (CCAHS; N = 3,105). The dataset combines biomedical data, interview data, and objective community-level data and is the most comprehensive existing secondary dataset on Chicagoans’ health; women comprise 60% (n = 1,870) of the total sample. Hierarchical logistic regressions were used to test the hypothesis that depression and neighborhood factors (stress and support) are associated with lower adherence to both sex-specific (pap tests, mammograms, and breast exams) and general preventive care (checkups, blood pressure and cholesterol checks) and further that neighborhood factors will moderate the relationship between depression and adherence to preventive care. Results showed that overall, the rates of depression in this sample were high, and varied by race/ethnicity. Almost 25% of the sample had probable depression, which is more than triple the rate of current depression (8.2%) among women in the National Comorbidity Study (NCS). The rates were significantly higher among Latinas and African American women. In unadjusted analyses, women with higher levels of depressive symptoms had significantly lower likelihood of being adherent to sex-specific preventive care (pap smears, mammograms, and breast exams), and this was particularly true among African American women. However, when demographic factors were included in the model, the association between depression and sex-specific preventive care disappeared. Counter to expectations, depressive symptoms were not associated with adherence to general preventive care in analyses with all race/ethnic groups combined. Among Latinas, higher levels of perceived neighborhood support were associated with increased likelihood of adherence to sex-specific preventive care. Among African American women, depression was significantly associated with lower likelihood of adherence to sex-specific care, however this association disappeared when demographic factors were added into the model

LGBTQ Health and Well-Being in China: A Trend Analysis of English- and Chinese-Language Research, 2011–2018

Purpose: Research on LGBTQ populations has dramatically increased in both Western and non-Western countries over the past several decades. Attempts to synthesize this research have largely focused on studies conducted in the West. We conducted a review of LGBTQ research in China to elucidate trends and gaps in the literature and to provide a foundation for future research. Methods: We searched the literature to identify studies that focused on LGBTQ people in China using PsycINFO and reviews of article titles and abstracts in 15 English-language LGBTQ-specific journals published between 2011–2018. We used the Wanfang database to identify Chinese-language LGBTQ research articles published in any journal between 2011– 2018. Each article was coded by topic, study type, province, and sample. Results: These searches yielded 798 LGBTQ research studies conducted in China between 2011–2018. HIV/AIDS, sexuality, and LGBTQ-specific issues (e.g., coming out) have been most frequently studied. Most of the articles focused on sexual minority men (69.5%), with smaller proportions focused on sexual minority women (15.5%) or transgender individuals (2.6%). The disparity was reduced after excluding studies on HIV or other sexually transmitted infections. The geographic distribution of studies was uneven; most were conducted in economically developed areas. Conclusion: This study identified gaps and trends in LGBTQ research in China and highlighted priority and under-researched topics to guide future LGBTQ research. More research on these understudied populations and topics will contribute to understanding of LGBTQ populations

Relationship of Religiosity and Spirituality to Hazardous Drinking, Drug Use, and Depression Among Sexual Minority Women

Using data from Wave 3 of the Chicago Health and Life Experiences of Women (CHLEW) study (N = 699), we explored whether religiosity and spirituality were associated with risk of hazardous drinking, drug use, and depression among sexual minority women (SMW; i.e., lesbian, bisexual) and possible differences by race/ethnicity. Participants were more likely to endorse spirituality than religiosity, and endorsement of each was highest among African American SMW. We found no protective effect of religiosity or spirituality for hazardous drinking or drug use. An association initially found between identifying as very spiritual and past-year depression disappeared when controlling for help-seeking. Among SMW with high religiosity, African American SMW were more likely than White SMW to report hazardous drinking. Latina SMW with higher spirituality were more likely than White SMW to report drug use. Results suggest that religiosity and spirituality affect subgroups differently, which should be considered in future research on resiliency among SMW