11 research outputs found
#168_Sexual and reproductive health promotion information for sexual and gender minority youth: A systematic, web-based content analysis
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Relationships of social determinants of health with substance use and psychological distress among a cohort of transgender women and transfeminine nonbinary adults in the Southern and Eastern United States
Background: Transgender women and transfeminine nonbinary adults may be at disproportionate risk of problematic substance use and the co-occurrence of problematic substance use and psychological distress due to a lack of access to economic/social resources and gender affirmation. This dissertation estimated associations between social determinants of health and substance use and co-occurrence with psychological distress, which can inform prevention efforts.Methods: Data from The LITE Study, a longitudinal cohort of transgender women and transfeminine nonbinary adults in the Southern and Eastern United States, were analyzed. Cohort participants (N~1,300) were adults not living with HIV at baseline. Paper one used the baseline sample to estimate latent classes of substance use behavior and examine cross-sectional associations between social determinants of health and latent class membership and between latent class membership and problematic drug use. Paper two assessed associations between baseline social determinants of health and 6-month co-occurrence of problematic drug use and psychological distress. Paper three assessed associations between baseline medical and legal gender affirmation with 12-month problematic drug use and problematic alcohol use.
Results: Paper one: Four classes were identified (âlow/moderate alcohol use,â âproblematic alcohol and cannabis use,â âpoly substance use,â and âopioid and cannabis useâ). Legal and medical gender affirmation, food insecurity, homelessness, and arrest predicted class membership. The âproblematic alcohol and cannabis use,â âpoly substance use,â and âopioid and cannabis useâ had greater odds of problematic drug use compared to the âlow/moderate alcohol useâ class. Paper two: More income, never homelessness, never arrested, more food security, and not experiencing health care discrimination was negatively associated with co-occurrence of problematic substance use and psychological distress. Paper 3: Those who successfully obtained medical gender affirmation had 0.68 times the risk (95% CI 0.47â0.98) of problematic drug use compared to those who unsuccessfully tried to obtain medical gender affirmation.
Conclusions: Access to economic/social resources and gender affirmation was negatively associated with problematic substance use and the co-occurrence of problematic substance use and psychological distress. Increasing access to such resources may improve substance use outcomes. Community-based intervention work is needed to develop culturally sensitive interventions for transgender women and transfeminine nonbinary adults
Ensuring Community Participation During Program Planning: Lessons Learned During the Development of a HIV/STI Program for Young Sexual and Gender Minorities
HIV/STI incidence has shifted to a younger demographic, comprised disproportionately of gay and bisexual men, transgender women, and people of color. Recognizing the importance of community organizing and participatory engagement during the intervention planning process, we describe the steps taken to engage diverse constituents (e.g., youth and practitioners) during the development of a structuralâlevel HIV/STI prevention and care initiative for young sexual and gender minorities in Southeast Michigan. Our multiâsector coalition (MFierce; Michigan Forward in Enhancing Research and Community Equity) utilized a series of community dialogues to identify, refine, and select programmatic strategies with the greatest potential. Evaluation data (NÂ =Â 173) from the community dialogues highlighted constituentsâ overall satisfaction with our elicitation process. Using a case study format, we describe our community dialogue approach, illustrate how these dialogues strengthened our program development, and provide recommendations that may be used in future communityâbased program planning efforts.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138284/1/ajcp12147.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138284/2/ajcp12147_am.pd
Vaping Disparities at the Intersection of Gender Identity and Race/Ethnicity in a Population-Based Sample of Adolescents.
BackgroundTransgender adolescents use vape products (eg, e-cigarettes) at higher rates than cisgender adolescents. Little is known about how these disparities differ from the intersectional perspective of both gender identity and race/ethnicity.MethodsWe examined disparities in past 30-day vaping frequency at the intersection of gender identity and race/ethnicity among adolescents participating in two pooled waves of the population-based California Healthy Kids Survey (N = 953 445; 2017-2019). Generalized linear mixed models included gender identity-by-race/ethnicity interactions and adjusted for potential confounders. Stratified models quantified relationships between gender identity and vaping within race/ethnicity strata and between race/ethnicity and vaping within gender identity strata.ResultsTransgender adolescents of color were more likely to report a higher frequency of vaping than cisgender white adolescents. In models stratified by race/ethnicity, transgender adolescents evidenced greater odds of more frequent vaping than cisgender adolescents of the same race/ethnicity; disparities were greatest between transgender and cisgender Black adolescents (adjusted odds ratio [AOR]: 6.05, 95% CI: 4.76-7.68) and smallest between transgender and cisgender white adolescents (AOR: 1.20, 95% CI: 1.06-1.35). In models stratified by gender identity, disparities were greatest between transgender Black and transgender white adolescents (AOR: 2.85, 95% CI: 2.20-3.70) and smallest between transgender multiracial and transgender white adolescents (AOR: 1.28, 95% CI: 1.05-1.58). Similar, though less consistent, patterns emerged for adolescents of color unsure of their gender identity relative to cisgender white adolescents.ConclusionTransgender adolescents of color may be especially vulnerable to vaping disparities. Future research should identify and intervene on causal mechanisms undergirding disparities.ImplicationsResearch finds that transgender adolescents use vape products at higher rates than their cisgender peers, however, little is known about how patterns of adolescent vaping may differ by both gender identity and race/ethnicity, information needed to inform culturally tailored prevention and control initiatives to decrease adolescent vaping disparities. Our analysis of data from a population-based adolescent health survey finds evidence of magnified disparities in vaping frequency among transgender adolescents of color
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Determinants of HIV Pre-Exposure Prophylaxis (PrEP) Retention among Transgender Women: A Sequential, Explanatory Mixed Methods Study
Transgender women (TW) face inequities in HIV and unique barriers to PrEP, an effective biomedical intervention to prevent HIV acquisition. To improve PrEP retention among TW, we examined factors related to retention using a two-phase, sequential explanatory mixed methods approach. In Phase I, we used data from a trial of 170 TW who were provided oral PrEP to examine predictors of 24-week retention. In Phase II, we conducted 15 in-depth interviews with PrEP-experienced TW and used thematic analysis to explain Phase I findings. In Phase I, more participants who were not retained at 24 weeks reported sex work engagement (18% versus 7%) and substantial/severe drug use (18% versus 8%). In Phase II, participants reported drug use as a barrier to PrEP, often in the context of sex work, and we identified two subcategories of sex work. TW engaged in "non-survival sex work" had little difficulty staying on PrEP, while those engaged in "survival sex work" struggled to stay on PrEP. In Phase I, fewer participants not retained at 24 weeks reported gender-affirming hormone therapy (GAHT) use (56% versus 71%). In Phase II, participants prioritized medical gender affirmation services over PrEP but also described the bidirectional benefits of accessing GAHT and PrEP. TW who engaged in "survival sex work" experience barriers to PrEP retention (e.g., unstable housing, drug use) and may require additional support to stay in PrEP care
School Climate Among Transgender High School Students: An Exploration of School Connectedness, Perceived Safety, Bullying, and Absenteeism
Where You Live Matters: Structural Correlates of HIV Risk Behavior Among Young Men Who Have Sex with Men in Metro Detroit
International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD-AF, ORBIT-AF I, and ORBIT-AF II registries
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia in the world. We aimed to provide comprehensive data on international patterns of AF stroke prevention treatment