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Health Services Research Aug 2023
Topics: Humans; Sexual and Gender Minorities; Gender Identity
PubMed: 37011909
DOI: 10.1111/1475-6773.14158 -
Current Opinion in Psychology Aug 2023
Topics: Humans; Sexual Behavior; Gender Identity
PubMed: 37418831
DOI: 10.1016/j.copsyc.2023.101616 -
Social Science & Medicine (1982) Mar 2024Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) is a new approach to quantitative intersectional modelling. Along with an outcome of...
Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) is a new approach to quantitative intersectional modelling. Along with an outcome of interest, MAIHDA entails the use of two sets of independent variables. These include group demographics such as race, gender, and poverty status as well as strata which are constructs such as Black female poor, Black female wealthy, and White female poor. These constructs represent the combination of the demographic variables. To operationalize the approach, an initial random intercepts model with strata as a level 2 context is specified. Then, another model is specified that includes the strata as well as the demographic variables as level 1 fixed effects. As such, it is argued that MAIHDA uniquely identifies the additive and intersectional effects for any given outcome. In this paper we show that MAIHDA falls short of this promise: the strata are an individual-level composite variable not a level 2 context. Rather than being analogous to neighborhoods as contexts, strata are analogous to socio-economic status which is a combination of individual-level demographic variables, albeit often presented as a group-level characteristic. The result is that the demographic variables are inserted in both level 2 and 1. This duplication across the levels in MAIHDA means that there is a built-in collinearity across the levels and that the models are mis-specified and, therefore, redundant. We conclude that single-level models with the demographic variables and interactions or with the strata as fixed effects are still the more accurate models for quantitative intersectional analyses.
Topics: Female; Humans; Black People; Gender Identity; Multilevel Analysis; Residence Characteristics; Social Class; White
PubMed: 38401177
DOI: 10.1016/j.socscimed.2023.116495 -
Annals of Internal Medicine Jul 2023
Topics: Humans; Transgender Persons; Transsexualism; Health Services Accessibility
PubMed: 37399563
DOI: 10.7326/M23-0704 -
Frontiers in Public Health 2023Given that Indigenous populations globally are impacted by similar colonial global legacies, their health and other disaprities are usually worse than non-indigenous... (Review)
Review
Given that Indigenous populations globally are impacted by similar colonial global legacies, their health and other disaprities are usually worse than non-indigenous people. Indigenous peoples of Australia have been seriously impacted by colonial legacies and as a result, their health has negatively been affected. If Indigenous health and wellbeing are to be promoted within the existing Australian health services, a clear understanding of what preventive health means for Indigenous peoples is needed. The aim of this scoping review was to explore the available literature on the uptake/engagement in health assessments or health checks by Indigenous Australian peoples and to determine the enablers and barriers and of health assessment/check uptake/engagement. Specifically, we aimed to: investigate the available evidence reporting the uptake/engagement of health checks/assessments for Australian Indigenous; assess the quality of the available evidence on indigenous health checks/assessments; and identify the enablers or barriers affecting Indigenous persons' engagement and access to health assessment/health checks. A systematic search of online databases (such as Cinhl, Scopus, ProQuest health and medicine, PubMed, informit, google scholar and google) identified 10 eligible publications on Indigenous preventive health assessments. Reflexive thematic analysis identified three major themes on preventive health assessments: (1) uptake/engagement; (2) benefits and limitations; and (3) enablers and barriers. Findings revealed that Indigenous peoples' uptake and/or engagement in health assessments/check is a holistic concept varied by cultural factors, gender identity, geographical locations (living in regional and remote areas), and Indigenous clinical leadership/staff's motivational capacity. Overall, the results indicate that there has been improving rates of uptake of health assessments by some sections of Indigenous communities. However, there is clearly room for improvement, both for aboriginal men and women and those living in regional and remote areas. In addition, barriers to uptake of health asessments were identified as length of time required for the assessment, intrusive or sensitive questions and shame, and lack of access to health services for some. Indigenous clinical leadership is needed to improve services and encourage Indigenous people to participate in routine health assessments.
Topics: Humans; Female; Male; Australia; Gender Identity; Indigenous Peoples; Databases, Factual; Leadership
PubMed: 37736086
DOI: 10.3389/fpubh.2023.1168568 -
The Lancet. Public Health Feb 2024
Topics: Humans; Gender Identity; Health Inequities; Sexual and Gender Minorities
PubMed: 38307680
DOI: 10.1016/S2468-2667(24)00006-9 -
Clinics in Chest Medicine Sep 2023This review summarizes the evidence of health disparities in cystic fibrosis (CF), an autosomal recessive genetic disorder with substantial variation in disease... (Review)
Review
This review summarizes the evidence of health disparities in cystic fibrosis (CF), an autosomal recessive genetic disorder with substantial variation in disease progression and outcomes. We review disparities by race, ethnicity, socioeconomic status, geographic location, gender identity, or sexual orientation documented in the literature. We outline the mechanisms that generate and perpetuate such disparities across levels and domains of influence and assess the implications of this evidence. We then recommend strategies for improving equity in CF outcomes, drawing on recommendations for the general population and considering approaches specific to people living with CF.
Topics: Humans; Female; Male; Cystic Fibrosis; Gender Identity; Ethnicity
PubMed: 37517835
DOI: 10.1016/j.ccm.2023.03.011 -
Journal of the National Cancer Institute Oct 2023Most case-control studies compare cancer survivors with general population controls without considering sexual orientation or gender identity. This case-control analysis...
BACKGROUND
Most case-control studies compare cancer survivors with general population controls without considering sexual orientation or gender identity. This case-control analysis compared health risk behaviors and health outcomes among sexual and gender minority cancer survivors to those of matched sexual and gender minority participants without cancer (controls).
METHODS
Using data from the 2014-2021 Behavioral Risk Factor Surveillance System, a population-based sample of 4507 cancer survivors who self-identified as transgender, gay men, bisexual men, lesbian women, or bisexual women were 1:1 propensity score matched, using age at survey, race and ethnicity, marital status, education, access to health care, and US census region. Within each sexual and gender minority group, behaviors and outcomes were compared between survivors and participants without cancer, and survivors' odds ratios and 95% confidence intervals calculated.
RESULTS
Gay male survivors had higher odds of depression, poor mental health, limited usual activities, difficulty concentrating, and fair or poor health. Few differences were observed between bisexual male survivors and participants without cancer. Compared with controls, lesbian female survivors had greater odds of overweight-obese status, depression, poor physical health, and fair or poor health. Bisexual female survivors had the highest rates of current smoking, depression, poor mental health, and difficulty concentrating across all sexual and gender minority groups. Statistically significantly different from transgender controls, transgender survivors had greater odds of heavy alcohol use, physical inactivity, and fair or poor health.
CONCLUSIONS
This analysis revealed an urgent need to address the high prevalence of engaging in multiple health risk behaviors and not following guidelines to avoid second cancers, additional adverse outcomes, and cancer recurrences among sexual and gender minority cancer survivors.
Topics: Female; Humans; Male; Cancer Survivors; Gender Identity; Sexual Behavior; Sexual and Gender Minorities; Neoplasms; Health Behavior
PubMed: 37421397
DOI: 10.1093/jnci/djad131 -
Archives of Sexual Behavior Oct 2023
Topics: Humans; Gender Identity
PubMed: 37415026
DOI: 10.1007/s10508-023-02650-2 -
Medical Education Online Dec 2024People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other sexual/gender minorities (LGBTQ+) may experience discrimination when... (Review)
Review
INTRODUCTION
People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other sexual/gender minorities (LGBTQ+) may experience discrimination when seeking healthcare. Medical students should be trained in inclusive and affirming care for LGBTQ+ patients. This narrative literature review explores the landscape of interventions and evaluations related to LGBTQ+ health content taught in medical schools in the USA and suggests strategies for further curriculum development.
METHODS
PubMed, ERIC, and Education Research Complete databases were systematically searched for peer-reviewed articles on LGBTQ+ health in medical student education in the USA published between 1 January 2011-6 February 2023. Articles were screened for eligibility and data was abstracted from all eligible articles. Data abstraction included the type of intervention or evaluation, sample population and size, and key outcomes.
RESULTS
One hundred thirty-four articles met inclusion criteria and were reviewed. This includes 6 (4.5%) that evaluate existing curriculum, 77 (57.5%) study the impact of curriculum components and interventions, 36 (26.9%) evaluate student knowledge and learning experiences, and 15 (11.2%) describe the development of broad learning objectives and curriculum. Eight studies identified student knowledge gaps related to gender identity and affirming care and these topics were covered in 34 curriculum interventions.
CONCLUSION
Medical student education is important to address health disparities faced by the LGBTQ+ community, and has been an increasingly studied topic in the USA. A variety of curriculum interventions at single institutions show promise in enhancing student knowledge and training in LGBTQ+ health. Despite this, multiple studies indicate that students report inadequate education on certain topics with limitations in their knowledge and preparedness to care for LGBTQ+ patients, particularly transgender and gender diverse patients. Additional integration of LGBTQ+ curriculum content in areas of perceived deficits could help better prepare future physicians to care for LGBTQ+ patients and populations.
Topics: Humans; Male; Female; United States; Students, Medical; Gender Identity; Sexual and Gender Minorities; Curriculum; Health Education
PubMed: 38359164
DOI: 10.1080/10872981.2024.2312716