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American Journal of Preventive Medicine Oct 2023Adverse childhood experiences portend vulnerability to numerous physical and mental health concerns across the lifespan. Separate bodies of work suggest that both...
INTRODUCTION
Adverse childhood experiences portend vulnerability to numerous physical and mental health concerns across the lifespan. Separate bodies of work suggest that both lesbian, gay, bisexual, and queer individuals and military veterans are more likely to report adverse childhood experiences than their non-lesbian, gay, bisexual, and queer and non-veteran counterparts, respectively. Although lesbian, gay, bisexual, and queer veterans experience health disparities compared with non-lesbian, gay, bisexual, and queer veterans, the prevalence of adverse childhood experiences among individuals with both lesbian, gay, bisexual, and queer and veteran identities is yet unknown.
METHODS
Participants were U.S. military veterans (N=14,461) from 18 states that included Sexual Orientation and Gender Identity and adverse childhood experiences modules in the 2019 and 2020 Behavioral Risk Factor Surveillance System survey. Multivariable logistic regression was used to determine the odds of adverse childhood experiences reported by lesbian, gay, bisexual, and queer veterans compared with those reported by non-lesbian, gay, bisexual, and queer veterans. Analyses were conducted in 2023.
RESULTS
While accounting for sociodemographic factors, lesbian, gay, bisexual, and queer veterans were more likely to report living with someone who experienced mental illness (AOR=2.17, 95% CI=1.35, 3.51), emotional abuse (AOR=1.58, 95% CI=1.11, 2.25), and sexual abuse (AOR=2.21, 95% CI=1.29, 3.76) than non-lesbian, gay, bisexual, and queer veterans.
CONCLUSIONS
With past work indicating that childhood abuse experiences are especially predictive of adverse health in adulthood, these findings suggest that a higher prevalence of adverse childhood experiences among lesbian, gay, bisexual, and queer veterans may contribute to health disparities among this population.
Topics: Female; Humans; Male; Child; Gender Identity; Veterans; Adverse Childhood Experiences; Sexual Behavior; Sexual and Gender Minorities
PubMed: 37037327
DOI: 10.1016/j.amepre.2023.04.001 -
Journal of Urban Health : Bulletin of... Dec 2023US correctional facilities operate under a binary interpretation of gender, which can yield inherent risks and conflicts for incarcerated transgender people. We... (Review)
Review
US correctional facilities operate under a binary interpretation of gender, which can yield inherent risks and conflicts for incarcerated transgender people. We conducted a scoping literature review on challenges unique to transgender individuals within US correctional settings. Online databases were searched to identify papers that addressed the challenges of incarcerated transgender adults age 18 + within US correctional institutions. A concurrent analysis of legal literature was reviewed with key policy recommendations extracted. A total of 33 papers (21 scientific studies and 12 legal analyses) met criteria for inclusion. Of the 21 scientific studies, the majority of papers (n = 14) focused on transgender women and most (n = 13) utilized qualitative methods. Emerging themes revealed challenges in key domains of violence, health, healthcare access, housing, and a pervasive culture of transphobia. Legal analyses supported policy changes such as implementing case-by-case housing classification systems, providing all forms of gender-affirming care, and safeguarding gender expression. Transgender persons face distinct obstacles while incarcerated in US correctional facilities and are in need of expanded protections. Working in tandem with efforts to decarcerate and reduce criminal legal involvement, widespread institutional policy change, such as redefining housing assignment policies, ensuring gender-affirming healthcare, and expanding transgender-specific competency trainings for correctional staff, is necessary.
Topics: Adult; Humans; Female; Adolescent; Transgender Persons; Prisons; Gender Identity; Delivery of Health Care; Criminals
PubMed: 37851317
DOI: 10.1007/s11524-023-00794-z -
Annals of Work Exposures and Health Nov 2023While sex is a biological attribute associated with physical and physiological features, gender refers to socially constructed roles, behaviors, expressions, and...
While sex is a biological attribute associated with physical and physiological features, gender refers to socially constructed roles, behaviors, expressions, and identities. On the biological side, males and females differ concerning hormonal and anatomical differences, and It is therefore plausible occupational exposure may act differently on males and females. In contrast, gender may influence the work organization, work environment conditions and exposures, and employment conditions, leading people of different genders to perform different jobs or job tasks, be exposed to different stressors, and work under different employment terms. Traditionally, occupational exposures have been assessed without considering how exposures may differ by sex or gender. Early research focused on occupations that primarily employed men. However, women have entered occupations historically dominated by men, leading to emerging exploration of gender differences in exposure. Some women-dominated occupations have become the focus of intensive research activity. In the Annals, the number of articles including sex and gender issues has increased dramatically over time, with only two published prior to 1980, and 70 in the 2010s, and with a special issue dedicated to Gender, Work, and Health in 2018 where the editors highlighted a need to improve assessment of gender and sex identities to allow for more nuanced knowledge to elucidate the role of work organization and contextual factors about gender, work exposures, and health. Females, on average, have different body dimensions than males, which affects how well workplaces and personal protective equipment (PPE) fit females, and there remains a need for further improvements to ensure that females are protected equally well. On the other hand, females tend to comply more frequently with PPE requirements than men highlighting the need for gender-specific initiatives in order to increase PPE performance and compliance. In conclusion, there is still work to do in order to fill in the existing knowledge gap with regard to sex, gender, and work, but there are promising initiatives and the field is progressing.
Topics: Humans; Male; Female; Occupational Exposure; Workplace; Occupations; Sex Factors; Gender Identity
PubMed: 37812681
DOI: 10.1093/annweh/wxad063 -
Autism : the International Journal of... Oct 2023Research about autism is mostly about boys and men, even though many autistic people are girls, women, and transgender/nonbinary. We wanted to learn more about how... (Review)
Review
Research about autism is mostly about boys and men, even though many autistic people are girls, women, and transgender/nonbinary. We wanted to learn more about how gender interacts with language skills in autistic people, so we reviewed existing research articles on this topic. We also wanted to know how this previous research talked about gender. Included articles had to measure language skills for autistic people of different genders. They also had to be published between 2000 and 2021. Twenty-four articles met these requirements. We found that autistic girls showed better language skills than autistic boys but worse skills than nonautistic girls. This may be one reason that autistic girls are underdiagnosed compared to autistic boys. If we compare autistic girls to nonautistic girls instead, we can see more language differences and possible areas to target in interventions. This study supports the need to create diagnostic and support measures for autism that take gender into account. Also, only one article mentioned autistic people who are transgender or nonbinary. Researchers who want to learn more about gender and autism need to understand gender diversity and recognize that many autistic people are transgender or nonbinary.
Topics: Humans; Male; Female; Autistic Disorder; Autism Spectrum Disorder; Language; Gender Identity
PubMed: 36737874
DOI: 10.1177/13623613221151095 -
Journal of Breast Imaging Jul 2023The number of individuals identifying as lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) has doubled over the past 10 years, and this figure continues to... (Review)
Review
The number of individuals identifying as lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) has doubled over the past 10 years, and this figure continues to rise. The LGBTQ+ community is diverse, encompassing a vast array of differences in gender identity and sexual orientation. Additionally, it is inclusive of people from all races, ethnicities, religions, and socioeconomic backgrounds. This intersectionality of identities and experiences impacts both access to health care and its delivery. Barriers to care for this population are multifactorial and include stigma, discrimination, bias, limited role models, issues with insurance coverage, lack of education and training for health care providers, and lack of research on LGBTQ+ health-related issues. Specific to breast cancer, the screening recommendations for this group are influenced not only by risk but also by gender-affirming hormonal and surgical therapies. This article will provide an overview of the LGBTQ+ population, review breast cancer screening compliance and recommendations, summarize the multitude of health disparities, and offer potential interventions to improve care delivery at the individual, facility, organizational, and health policy levels.
Topics: Female; Humans; Male; Cultural Competency; Gender Identity; Homosexuality, Female; Sexual and Gender Minorities; Sexual Behavior
PubMed: 38416897
DOI: 10.1093/jbi/wbad012 -
Integrative and Comparative Biology Jul 2023Fieldwork is considered an integral component of research within conservation biology and ecology. Oftentimes, institutions and researchers share resources on general...
Fieldwork is considered an integral component of research within conservation biology and ecology. Oftentimes, institutions and researchers share resources on general safety when collecting data in field settings. Despite an increasing awareness, there has been a lack of transparency and communication in terms of the hazards associated with fieldwork. These include but are not limited to an increased risk of sexual harassment and assault. These risks are compounded particularly for those from marginalized racial, sexual, and gender identities. In addition to this lack of acknowledgment, the added risks to those who identify as lesbian, gay, bisexual, transgender (trans), and/or queer or members of other marginalized sexualities and gender identities (to reflect the "+" in LGBTQ+) are often overlooked. We have found that there is not only a lack of data on sexual orientation and gender identities of researchers and the barriers they may face as field-based scientists, but also a lack of awareness of how we can support those from these marginalized groups within our disciplines. Creating a SAFE and INCLUSIVE community for those with marginalized identities is key to sustaining the diversity within our discipline. Here, we outline a series of recommendations that can be utilized to address the harassment, homophobia, and transphobia that our LGBTQ+ colleagues face. These recommendations range from what can be applied at the local level (within a lab group), at the department level, at the institutional level as well at specific field sites.
Topics: Animals; Male; Female; Humans; Gender Identity; Sexual and Gender Minorities
PubMed: 37248053
DOI: 10.1093/icb/icad038 -
Journal of Advanced Nursing Apr 2024To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such... (Meta-Analysis)
Meta-Analysis Review
AIM
To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research.
DESIGN
Scoping review.
METHODS
The PRISMA (Preferred Reporting Items for Systematic and Meta-Analysis) Extension for Scoping Reviews was adopted.
DATA SOURCES
Systematic literature search was conducted through PubMed, CINAHL and Web of Science databases. Boolean operators were used to identify moral distress literature which included gender and/or race data and published between 2012 and 2022.
RESULTS
After screening and full-text review, 73 articles reporting on original moral distress research were included. Analysis was conducted on how gender and race were incorporated in research and interpretation of moral distress experiences among healthcare professionals.
IMPACT
This study found that while there is an upward trend in including gender and race-disaggregated data in moral distress research, over half of such research did not conduct in-depth analysis of such data. Others only highlighted differential experiences such as moral distress levels of women vis-à-vis men. Only about 20% of publications interrogated how experiences of moral distress differed and/or explored factors behind their findings.
CONCLUSION
There is a need to not only collect disaggregated data in moral distress research but also engage this data through gender and race-based analysis. Particularly, we highlight the need for intersectional analysis, which can elucidate how social identities and categories (such as gender and race) and structural inequalities (such as those sustained by sexism and racism) interact to influence moral experiences.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE
Moral distress as experienced by healthcare professionals is increasingly recognized as an important area of research with significant policy implications in the healthcare sector. This study offers insights for nuanced and targeted policy approaches.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution.
Topics: Male; Humans; Female; Gender Identity; Health Personnel; Morals; Stress, Psychological
PubMed: 37849045
DOI: 10.1111/jan.15901 -
Palliative & Supportive Care Oct 2023The study aims to describe inadequate, disrespectful, and abusive palliative and hospice care received by lesbian, gay, and bisexual (LGB) patients and their...
OBJECTIVES
The study aims to describe inadequate, disrespectful, and abusive palliative and hospice care received by lesbian, gay, and bisexual (LGB) patients and their spouses/partners due to their sexual orientation or gender identity.
METHODS
A national sample of 865 healthcare professionals recruited from palliative and hospice care professional organizations completed an online survey. Respondents were asked to describe their observations of inadequate, disrespectful, or abusive care to LGB patients and their spouses/partners.
RESULTS
There were 15.6% who reported observing disrespectful care to LGB patients, 7.3% observed inadequate care, and 1.6% observed abusive care; 43% reported discriminatory care toward the spouses/partners. Disrespectful care to LGB patients included insensitive and judgmental attitudes and behaviors, gossip and ridicule, and disrespect of the spouse/partner. Inadequate care included denial of care; care that was delayed incomplete, or rushed; dismissive or antagonistic treatment; privacy and confidentiality violations; and dismissive treatment of the spouse/partner.
SIGNIFICANCE OF RESULTS
These findings provide evidence of discrimination faced by LGB patients and partners while receiving care for serious illness. Hospice and palliative care programs should promote respectful, inclusive, and affirming care for the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, including policies and practices that are welcoming and supportive to both employees and patients. Staff at all levels should be trained to create safe and respectful environments for LGBTQ patients and their families.
Topics: Humans; Female; Male; Palliative Care; Gender Identity; Sexual Behavior; Sexual and Gender Minorities; Attitude of Health Personnel
PubMed: 37435654
DOI: 10.1017/S1478951523001037 -
Endocrinology and Metabolism Clinics of... Dec 2023Social and health disparities among transgender people may result in increased rates of incarceration, particularly among Black transgender women. The World Professional... (Review)
Review
Social and health disparities among transgender people may result in increased rates of incarceration, particularly among Black transgender women. The World Professional Association for Transgender Health states that all recommendations for gender-affirming care made in the Standards of Care-8 be applied equally to people living in institutions. Understanding the structural challenges to gender-affirming care in the corrections environment will allow the endocrinologist to navigate the complex correctional health care system. The barriers to gender-affirming care and surgery will be highlighted in this article.
Topics: Humans; Female; Transgender Persons; Gender Identity; Delivery of Health Care; Prisoners
PubMed: 37865481
DOI: 10.1016/j.ecl.2023.05.007 -
JAMA Network Open Oct 2023Physician burnout disproportionately affects women physicians and begins in training. Professional coaching may improve well-being, but generalizable evidence is lacking. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Physician burnout disproportionately affects women physicians and begins in training. Professional coaching may improve well-being, but generalizable evidence is lacking.
OBJECTIVE
To assess the generalizability of a coaching program (Better Together Physician Coaching) in a national sample of women physician trainees.
DESIGN, SETTING, AND PARTICIPANTS
A randomized clinical trial involving trainees in 26 graduate medical education institutions in 19 states was conducted between September 1, 2022, and December 31, 2022. Eligible participants included physician trainees at included sites who self-identified as a woman (ie, self-reported their gender identity as woman, including those who reported woman if multiple genders were reported).
INTERVENTION
A 4-month, web-based, group coaching program.
MAIN OUTCOMES AND MEASURES
The primary outcomes were change in burnout (measured using subscales for emotional exhaustion, depersonalization, and personal achievement from the Maslach Burnout Inventory). Secondary outcomes included changes in impostor syndrome, moral injury, self-compassion, and flourishing, which were assessed using standardized measures. A linear mixed model analysis was performed on an intent-to-treat basis. A sensitivity analysis was performed to account for the missing outcomes.
RESULTS
Among the 1017 women trainees in the study (mean [SD] age, 30.8 [4.0] years; 540 White participants [53.1%]; 186 surgical trainees [18.6%]), 502 were randomized to the intervention group and 515 were randomized to the control group. Emotional exhaustion decreased by an estimated mean (SE) -3.81 (0.73) points in the intervention group compared with a mean (SE) increase of 0.32 (0.57) points in the control group (absolute difference [SE], -4.13 [0.92] points; 95% CI, -5.94 to -2.32 points; P < .001). Depersonalization decreased by a mean (SE) of -1.66 (0.42) points in the intervention group compared with a mean (SE) increase of 0.20 (0.32) points in the control group (absolute difference [SE], -1.87 [0.53] points; 95%CI, -2.91 to -0.82 points; P < .001). Impostor syndrome decreased by a mean (SE) of -1.43 (0.14) points in the intervention group compared with -0.15 (0.11) points in the control group (absolute difference [SE], -1.28 (0.18) points; 95% CI -1.63 to -0.93 points; P < .001). Moral injury decreased by a mean (SE) of -5.60 (0.92) points in the intervention group compared with -0.92 (0.71) points in the control group (absolute difference [SE], -4.68 [1.16] points; 95% CI, -6.95 to -2.41 points; P < .001). Self-compassion increased by a mean (SE) of 5.27 (0.47) points in the intervention group and by 1.36 (0.36) points in the control group (absolute difference [SE], 3.91 [0.60] points; 95% CI, 2.73 to 5.08 points; P < .001). Flourishing improved by a mean (SE) of 0.48 (0.09) points in the intervention group vs 0.09 (0.07) points in the control group (absolute difference [SE], 0.38 [0.11] points; 95% CI, 0.17 to 0.60 points; P < .001). The sensitivity analysis found similar findings.
CONCLUSIONS AND RELEVANCE
The findings of this randomized clinical trial suggest that web-based professional group-coaching can improve outcomes of well-being and mitigate symptoms of burnout for women physician trainees.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT05222685.
Topics: Female; Humans; Male; Adult; Mentoring; Physicians, Women; Gender Identity; Anxiety Disorders
PubMed: 37792378
DOI: 10.1001/jamanetworkopen.2023.35541