First name
Nadia
Last name
Dowshen

Title

Sexual Behaviors Associated with HIV Transmission Among Transgender and Gender Diverse Young Adults: The Intersectional Role of Racism and Transphobia.

Year of Publication

2022

Date Published

06/2022

ISSN Number

1573-3254

Abstract

HIV prevalence and engagement in sexual behaviors associated with HIV transmission are high among transgender people of color. Per intersectionality, this disproportionate burden may be related to both interpersonal and structural racism and transphobia. The goal of this study was to estimate the association between interpersonal and structural discrimination and sexual behaviors among transgender and gender diverse (TGD) U.S. young adults. We used logit models with robust standard errors to estimate the individual and combined association between interpersonal and structural racism and transphobia and sexual behaviors in a national online sample of TGD young adults of color (TYAOC) aged 18-30 years (N = 228). Racism was measured at the interpersonal and structural level using the Everyday Discrimination Scale and State Racism Index, respectively. Transphobia was measured at the interpersonal and structural level using the Gender Minority Stress Scale and the Gender Identity Tally, respectively. We found that interpersonal racism was associated with transactional sex, and interpersonal transphobia was associated with alcohol/drug consumption prior to sex and transactional sex among TYAOC. We also found evidence of a strong joint association of interpersonal and structural racism and transphobia with alcohol/drug consumption prior to sex (OR 3.85, 95% CI 2.12, 7.01) and transactional sex (OR 3.54, 95% CI 0.99, 12.59) among TYAOC. Racism and transphobia have a compounding impact on sexual behaviors among TYAOC. Targeted interventions that reduce discrimination at both the interpersonal and structural level may help reduce the HIV burden in this marginalized population.

DOI

10.1007/s10461-022-03701-w

Alternate Title

AIDS Behav

PMID

35661016

Title

Developing a Consensus for Adolescent and Young Adult mHealth HIV Prevention Interventions in the United States: A Delphi Method Study.

Year of Publication

2022

Number of Pages

e25982

Date Published

07/2022

ISSN Number

2561-326X

Abstract

BACKGROUND: Engaging adolescents and young adults (AYAs) who are at elevated risk for HIV acquisition or who are living with HIV in health care has posed a major challenge in HIV prevention and care efforts. Mobile health (mHealth) interventions are a popular and accessible strategy to support AYA engagement despite barriers to care present along the HIV care continuum. Even with progress in the field of mHealth research, expert recommendations for the process of designing, evaluating, and implementing HIV-related mHealth interventions are underdeveloped.

OBJECTIVE: The aim of this study was to compile expert recommendations on the development, evaluation, and implementation of AYA-focused HIV prevention and care mHealth interventions.

METHODS: Experts from adolescent mHealth HIV research networks and investigators of recently funded HIV mHealth projects and programs were identified and invited to complete a series of electronic surveys related to the design, implementation, and evaluation of HIV-related mHealth interventions. A modified Delphi method was used to ask experts to score 35 survey items on a 4-point Likert scale from not important to very important and encouraged experts to leave additional comments in textboxes. Responses were reviewed by the researchers, a team of 4 HIV mHealth intervention experts. The average importance ratings from survey responses were calculated and then categorized as retained (high importance), flagged (mid-level importance), or dropped (no/low importance). Additionally, thematic analysis of expert comments helped modify survey items for the next survey round. An evaluation of the level of agreement among experts on the most important items followed each round until consensus was reached.

RESULTS: Of the 35 invited experts, 23 completed the first survey representing a variety of roles within a research team. Following two rounds of Delphi surveys, experts scored 24 of the 28 (86%) survey items included in round two as important to very important. The final consensus items included 24 recommendations related to the mHealth intervention design process (n=15), evaluation (n=2), and implementation (n=7). The 3 survey items with the highest average scores focused on the design process, specifically, (1) the creation of a diverse team including researchers, app software developers, and youth representation; (2) the importance of AYA-focused content; and (3) the value of an iterative process. Additionally, experts highlighted the importance of establishing the best ways to collect data and the types of data for collection during the evaluation process as well as constructing a plan for participant technology disruption when implementing an mHealth intervention.

CONCLUSIONS: The modified Delphi method was a useful tool to convene experts to determine recommendations for AYA-focused HIV prevention and care mHealth interventions. These recommendations can inform future mHealth interventions. To ensure the acceptability, feasibility, and efficacy of these AYA HIV prevention interventions, the focus must be on the specific needs of AYAs by including representation of AYAs in the process, including consistent and relevant content, ensuring appropriate data is collected, and considering technology and health accessibility barriers.

DOI

10.2196/25982

Alternate Title

JMIR Form Res

PMID

35819824

Title

Multicenter Analysis of Cardiometabolic-Related Diagnoses in Transgender and Gender Diverse Youth: a PEDSnet study.

Year of Publication

2022

Date Published

08/2022

ISSN Number

1945-7197

Abstract

CONTEXT: Studies on cardiometabolic health in transgender and gender diverse youth (TGDY) are limited to small cohorts.

OBJECTIVE: To determine the odds of cardiometabolic-related diagnoses in TGDY compared to matched controls in a cross-sectional analysis, using a large, multisite database (PEDSnet).

DESIGN: Electronic health record data (2009-2019) were used to determine odds of cardiometabolic-related outcomes based on diagnosis, anthropometric and laboratory data using logistic regression among TGDY youth vs. controls. The association of gender affirming hormone therapy (GAHT) with these outcomes was examined separately among TGDY.

SETTING: Six PEDSnet sites.

PATIENTS OR OTHER PARTICIPANTS: TGDY (n=4,172) were extracted from PEDSnet and propensity-score matched on 8 variables to controls (n=16,648).

INTERVENTION(S): N/A.

MAIN OUTCOME MEASURE(S): Odds of having cardiometabolic-related diagnoses among TGDY compared to matched controls, and among TGDY prescribed GAHT compared to those not prescribed GAHT.

RESULTS: In adjusted analyses, TGDY had higher odds of overweight/obesity (1.2 [95% confidence interval 1.1-1.3]) than controls. TGDY with a testosterone prescription alone or in combination with a gonadotropin releasing hormone agonist (GnRHa) had higher odds of dyslipidemia (1.7 [1.3-2.3], 3.7 [2.1-6.7], respectively) and liver dysfunction (1.5 [1.1-1.9], 2.5 [1.4-4.3]) than TGDY not prescribed GAHT. TGDY with a testosterone prescription alone had higher odds of overweight/obesity (1.8 [1.5-2.1]) and hypertension (1.6 [1.2-2.2]) than those not prescribed testosterone. Estradiol and GnRHa alone were not associated with greater odds of cardiometabolic-related diagnoses.

CONCLUSIONS: TGDY have increased odds of overweight/obesity compared to matched controls. Screening and tailored weight management, sensitive to the needs of TGDY, are needed.

DOI

10.1210/clinem/dgac469

Alternate Title

J Clin Endocrinol Metab

PMID

35945152

Title

Pediatric Provider Perspectives on Laws and Policies Impacting Sports Participation for Transgender Youth.

Year of Publication

2022

Date Published

2022 Apr 01

ISSN Number

2325-8306

Abstract

<p>Since May 2021, numerous state legislatures in the United States have introduced bills to restrict the participation of transgender and gender diverse (trans) youth in gender-segregated sports in a manner consistent with their gender identity. The purpose of this study was to understand how medical providers of pediatric gender-affirming care for trans youth view these legislative efforts and how they believe these bills will affect their practice and patients. In March 2021, we recruited participants using listservs known to be frequented by providers of gender-affirming medical care to complete a survey about bills that restrict trans youths' participation in sex-segregated sports. Eligible participants were over the age of 18, currently worked as a physician, nurse practitioner, or physician's assistant, and provided gender-affirming care to trans youth under the age of 18 in the United States. We analyzed the responses of 103 providers from all 50 states and the District of Columbia. Most participants identified as White (77%), cisgender women (70%), and specialized in pediatric care (52%). The most salient theme, described by nearly all participants, was that legislation banning trans youth from sports participation would lead to worsening discrimination and stigmatization. Other themes included worsening mental and physical health of trans youth, forced changes to clinical practice, politicization of trans youth, and efforts required to stop these bills. Providers of gender-affirming care in this study overwhelmingly opposed legislation that bans trans youth from sports participation citing the severe consequences to the well-being of trans youth. More research is needed to examine stakeholder's opinions regarding legislation that does not ban but otherwise restricts sports participation by trans youth.</p>

DOI

10.1089/lgbt.2021.0392

Alternate Title

LGBT Health

PMID

35363079

Title

Adolescent Perceptions of Menstruation on Twitter: Opportunities for Advocacy and Education.

Year of Publication

2022

Date Published

2022 Mar 10

ISSN Number

1879-1972

Abstract

<p><strong>PURPOSE: </strong>While some adolescents celebrate menstruation as a rite of passage, others seek discretion due to stigma. Many youth have used Twitter to combat stigma and raise awareness about other culturally taboo topics, but previous work has not explored youth conversations regarding menstruation. This study aims to assess whether Twitter can provide useful insights into how youth perceive menstruation.</p>

<p><strong>METHODS: </strong>The team searched 162,316,839 tweets of 71,443 users of the age range 13-25&nbsp;years in the Health Language Processing Twitter Youth Cohort for tweets that matched menstruation-related keywords: a pad, my pad, my period, her period, your period, tampon, diva cup, menstruate, that time of the month. Twelve codes emerged using a grounded theory approach and were sorted into three themes.</p>

<p><strong>RESULTS: </strong>Analysis was conducted on 10,000 tweets. Three themes emerged, including menstrual health, menstrual stigma, and menstrual positivity. Tweets related to menstrual health included physical complications, sexual/reproductive health, health education, and LGBTQ health. Tweets that addressed menstrual stigma included inconvenience/limitations, shame/stereotypes, religion/alternate perceptions, access/affordability, and self-depreciation/harm. Tweets related to menstrual positivity included awareness/community, strength/resilience, and environment/sustainability.</p>

<p><strong>DISCUSSION: </strong>This study provides insights into youth perceptions about menstruation. There was overwhelming emphasis placed on the negative expectations and shame around menstruation. A significant minority of tweets were directly or indirectly related to advocacy or education, which supports the potential use of Twitter as a platform to improve public health messaging, transform health outcomes, and promote equity among youth who menstruate.</p>

DOI

10.1016/j.jadohealth.2022.01.224

Alternate Title

J Adolesc Health

PMID

35283044

Title

Characterizing Health Inequities for the U.S. Transgender Hispanic Population Using the Behavioral Risk Factor Surveillance System.

Year of Publication

2021

Number of Pages

275-283

Date Published

2021 Oct

ISSN Number

2688-4887

Abstract

<p>This study aims to describe health inequities experienced by transgender Hispanic (TH) individuals in the United States. This retrospective case-control study used the Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 to 2018. Propensity score matching and logistic and negative binomial regression were used to compare TH survey respondents with other relevant populations across the following outcomes: health care access, health risk factors, self-reported chronic conditions, and perceived health status. Relative to transgender White (TW) respondents, TH respondents (=414) were less likely to report having health insurance (odds ratio [OR]: 0.35, &lt;0.001), a regular provider (OR=0.40, &lt;0.001), and were more likely to report cost barriers to care (OR=1.85, &lt;0.001) and HIV risk factors (OR=2.41, &lt;0.001). Similar results were found when comparing outcomes with cisgender White respondents. TH respondents reported fewer days of poor health (rate ratio [RR]=0.67, &lt;0.001), activity limited days (RR=0.64, =0.011), and were less likely to report depression (OR=0.44, &lt;0.001) than TW respondents. Relative to cisgender Hispanic (CH) respondents, TH respondents experienced more cost barriers (OR=1.56, =0.003), higher HIV risk (OR=3.38, &lt;0.001), and more activity limited days (RR=2.93, &lt;0.001). Our results demonstrate that TH individuals may be less likely to have access to health care and have poorer health-related quality-of-life when compared with either CH or TW individuals. It is vital that additional research further elucidate the challenges faced by this multiply marginalized population including racism and transphobia. Further health care solutions should be responsive to the unique challenges of the TH population at the individual and institutional level.</p>

DOI

10.1089/trgh.2020.0095

Alternate Title

Transgend Health

PMID

34993300

Title

Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences.

Year of Publication

2021

Number of Pages

e32708

Date Published

2021 Nov 15

ISSN Number

2561-6722

Abstract

<p><strong>BACKGROUND: </strong>Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking.</p>

<p><strong>OBJECTIVE: </strong>The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality.</p>

<p><strong>METHODS: </strong>Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses.</p>

<p><strong>RESULTS: </strong>Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P&lt;.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents' concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing.</p>

<p><strong>CONCLUSIONS: </strong>Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety.</p>

DOI

10.2196/32708

Alternate Title

JMIR Pediatr Parent

PMID

34779782

Title

"These Laws Will Be Devastating": Provider Perspectives on Legislation Banning Gender-Affirming Care for Transgender Adolescents.

Year of Publication

2021

Date Published

2021 Oct 06

ISSN Number

1879-1972

Abstract

PURPOSE: The standards of care for transgender and gender diverse youth (TGDY) experiencing gender dysphoria are well-established and include gender-affirming medical interventions. As of July 2021, 22 states have introduced or passed legislation that bans the provision of gender-affirming medical care to anyone under the age of 18 even with parent or guardian consent. The purpose of this study is to understand what providers who deliver gender-affirming medical care to TGDY think about this legislation.

METHODS: In March 2021, we recruited participants via listservs known to be frequented by providers of gender-affirming medical care. Eligible participants were over the age of 18, currently working as a physician, nurse practitioner, or physician's assistant, and providing gender-affirming care to TGDY under the age of 18 in the U.S.

RESULTS: We analyzed the responses of 103 providers from all 50 states and DC. Most participants identified as white (77%), cisgender women (70%), specializing in pediatric care (52%). The most salient theme, described by nearly all participants, was the fear that legislation banning gender-affirming care would lead to worsening mental health including increased risk for suicides among TGDY. Other themes included the politicization of medical care, legislation that defies the current standards of care for TGDY, worsening discrimination toward TGDY, and adverse effects on the providers.

CONCLUSIONS: Providers of gender-affirming care overwhelmingly opposed legislation that bans gender-affirming care for TGDY citing the severe consequences to the health and well-being of TGDY along with the need to practice evidence-based medicine without fear.

DOI

10.1016/j.jadohealth.2021.08.020

Alternate Title

J Adolesc Health

PMID

34627657

Title

Behavioral Health Diagnoses in Youth With Gender Dysphoria Compared with Controls: A PEDSnet Study.

Year of Publication

2021

Date Published

2021 Sep 24

ISSN Number

1097-6833

Abstract

<p><strong>OBJECTIVE: </strong>To assess the odds of a psychiatric or neurodevelopmental diagnosis among youth with a diagnosis of gender dysphoria compared with matched controls in a large electronic health record dataset from six pediatric health systems, PEDSnet. We hypothesized that youth with gender dysphoria would have higher odds of having psychiatric and neurodevelopmental diagnoses than controls.</p>

<p><strong>STUDY DESIGN: </strong>All youth with a diagnosis of gender dysphoria (n=4,173 age at last visit 16.2 + 3.4) and at least one outpatient encounter were extracted from the PEDSnet database and propensity-score matched on 8 variables to controls without gender dysphoria (n=16,648, age at last visit 16.2 + 4.8) using multivariable logistic regression. The odds of having psychiatric and neurodevelopmental diagnoses were examined using generalized estimating equations.</p>

<p><strong>RESULTS: </strong>Youth with gender dysphoria had higher odds of psychiatric (OR: 4.0 [95% CI: 3.8, 4.3] P &lt; .0001) and neurodevelopmental diagnoses (1.9 [1.7, 2.0], p&lt;0.0001). Youth with gender dysphoria were more likely to have a diagnosis across all psychiatric disorder sub-categories, with particularly high odds of mood disorder (7.3 [6.8, 7.9], p&lt;0.0001) and anxiety (5.5 [5.1, 5.9], p&lt;0.0001). Youth with gender dysphoria had a greater odds of autism spectrum disorder (2.6, [2.2, 3.0], p&lt;0.0001).</p>

<p><strong>CONCLUSIONS: </strong>Youth with gender dysphoria at large pediatric health systems have greater odds of psychiatric and several neurodevelopmental diagnoses compared with youth without gender dysphoria. Further studies are needed to evaluate changes in mental health over time with access to gender affirming care.</p>

DOI

10.1016/j.jpeds.2021.09.032

Alternate Title

J Pediatr

PMID

34571022

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