A comparison of health disparities among transgender adults in Colorado (USA) by race and income

Transgender individuals face heightened risks for discrimination, harassment, and violence that impact their psychosocial well-being and physical health. However, few studies have thoroughly examined the general physical and mental health of transgender adults or within-group health differences by race/ethnicity and income. To that end, after controlling for health insurance status, age, and engagement in exercise, this study asks: (a) Are transgender people of color more likely than White transgender individuals to experience poor health outcomes? and (b) Is lower annual household income among transgender adults associated with poorer health outcomes? The study analyzes secondary data from a survey of transgender adults (N = 417) in one state in the western United States using multiple linear regression and logistic regression models. Results showed that transgender people of color had significantly greater odds than their White counterparts of having arthritis/rheumatoid arthritis/gout/lupus/fibromyalgia, or asthma but lower odds of being told by a provider that they had depression. Having a lower income was significantly associated with worse general health as well as multiple indicators of poor physical and mental health, including depression, anxiety, and suicidal ideation. We discuss implications for health care delivery for transgender people and for future research.     

Strategies used by transmasculine and non-binary adults assigned female at birth to resist transgender stigma in healthcare

Abstract

Background: Transgender stigma is rampant within healthcare systems in the United States. Transgender adults assigned female at birth – including those identifying as transmasculine or non-binary – face unique barriers, such as stigma when accessing sexual and reproductive healthcare labeled as being for “women.” However, transgender and non-binary people are not passive victims to this stigma, and the medical community would benefit from understanding the actions this population takes to resist and reduce transgender stigma in healthcare. Yet, little research has attempted to understand such actions.

Aims: This qualitative study aims to explore how transmasculine and non-binary adults are actively resisting and reducing the impact of transgender stigma in healthcare.

Methods: In-depth semi-structured interviews were conducted with 25 transmasculine and non-binary adults assigned female at birth who were living in a metropolitan area in the mid-Atlantic United States. The research team analyzed qualitative interview data using content analysis.

Results: The 25 participants ranged in age from 21 to 57, with an average age of 33?years old. Six themes were identified related to resisting and reducing transgender stigma in healthcare: (a) using social support; (b) persistence to meet one’s own needs; (c) avoiding mainstream healthcare; (d) advocacy; (e) doing one’s own research; and (f) strategic disclosure of transgender/non-binary identity. We detail how privilege and intersectionality connect to the use of these strategies.

Discussion: Findings indicate there is value in using peer advocates and peer health literacy; in developing and nurturing support groups related to transgender/non-binary health; in developing “allies” employed within the healthcare system; in creating and maintaining lists of culturally responsive health providers and resources about navigating the healthcare system; and in offering trainings related to self-advocacy and health-related activism. These findings can be used to inform future health prevention and intervention efforts with transmasculine and non-binary adults.     

Vaginal bleeding and spotting in transgender men after initiation of testosterone therapy: A prospective cohort study (ENIGI)

Abstract

Background: Previous studies have cross-sectionally described amenorrhea in cohorts of transgender men on intramuscular or subcutaneous testosterone injections. It remains uncertain which testosterone preparations most effectively suppress vaginal bleeding and when amenorrhea occurs after testosterone initiation.

Aim:To investigate the clinical effects of various testosterone preparations on vaginal bleeding and spotting in transgender men.

Methods: This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Data on the persistence and intensity of vaginal bleeding and spotting, serum sex steroid levels and body composition were prospectively and cross-sectionally assessed in 267 transgender men during a three-year follow-up period, starting at the initiation of various testosterone preparations.

Results: After three months of testosterone, 17.9% of transgender men reported persistent vaginal bleeding and 26.8% reported spotting. The percentages reporting vaginal bleeding and spotting decreased over the first year of testosterone (bleeding 4.7% and spotting 6.9% at 12?months, respectively), with no participants reporting vaginal bleeding or spotting after 18?months of testosterone. Factors associated with vaginal bleeding or spotting included lower serum testosterone levels and being on testosterone gel as compared to injections (e.g., esters or undecanoate preparations). If vaginal bleeding persisted, starting progestogens at three months resulted in a decrease in the intensity of vaginal bleeding and spotting.

Discussion: Transgender men and hormone-prescribing providers can be reassured that vaginal bleeding and spotting usually stop within three months after testosterone initiation. If not, serum testosterone levels should be measured and testosterone dose adjusted to achieve serum testosterone levels in the physiologic male range. Adding a progestin can be considered after three to six months if bleeding persists. Providers should be aware that cessation of bleeding can be more difficult to achieve in transgender men with lower serum testosterone levels or those on testosterone gel.     

Differences in smoking attitudes of adolescents and young adults

This study employed the Theory of Planned Behavior to examine the differences between adolescent (n = 182) and young adults (n = 209) in their intention to smoke and examined possible differences. Analysis showed that young adults had more positive self-reported attitudes toward smoking than adolescents, had higher intentions to smoke, lower perceived behavioral control over smoking and perceived they were more informed about smoking. The Theory of Planned Behavior provided good prediction of intention for both young adults (R2 = .70, attitudes, information, and past behavior significant) and adolescents (R2 = .68, attitudes, past behavior significant). For both samples attitudes were the strongest predictor of intentions to smoke. Implications for understanding intention toward smoking between adolescents and young adults are discussed.     

Family and psychosocial predictors of obsessive compulsive disorder in a community sample of young adolescents

A two-stage epidemiologic study conducted between 1986 and 1988 in the southeastern United States investigated family and psychosocial predictors of obsessive compulsive disorder (OCD) and subclinical OCD in young adolescents. In the first stage, a life-event schedule and a family adaptability and cohesion scale were administered to a community sample of 3,283 adolescents. In stage two, the Schedule for Affective Disorders and Schizophrenia in School Age Children and the Children's Global Assessment Scale were administered to 488 mother-child pairs. In multivariable models family cohesion was the only significant correlate of OCD (odds ratio=0.95, 95% confidence interval 0.91–0.98). Gender, race, age, socioeconomic status, guardian status, adaptability, undesirable life events and desirable life events were not found to be significant predictors of OCD in models adjusting for cohesion. Note of the above variables were significantly associated with subclinical OCD. However, separate analyses of the 41 individual life events indicated seven specific events were significantly associated with OCD or subclinical OCD. These findings are at odds with the theory that overinvolvement of family members is a risk factor for OCD, though an association with overly rigid family structure cannot be eliminated based on these data. Further exploration of family characteristics is warranted.     

Investigating the relationship between past contraceptive behaviour,self‐efficacy,and anticipated shame and guilt in sexual contexts among Norwegian adolescents

What are the relationships between self‐efficacy when communicating to the partner about use of contraception, stopping undesired intercourse, and perceived self‐conscious emotions in sexual contexts? How does past contraceptive behaviour influence perceived self‐efficacy? These research questions were studied among 399 10th grade students with coital experience in the county Nordland in Norway. Two dimensions of perceived emotional responses were identified in a hypothetical situation related to communicating to the partner about use of contraception, namely Shame and Emotional intimacy. Two dimensions were also identified with regard to anticipated emotional responses in a hypothetical situation related to stopping undesired intercourse: Guilt and responsibility and Emotional intimacy. Most of the boys and girls reported that they would react with positive emotions in both hypothetical situations. Path models were constructed with the affective dimensions and self‐esteem as mediating variables between past contraceptive behaviour and contextual self‐efficacy. Past behaviour influenced communication self‐efficacy indirectly via Shame, and Shame had a direct effect upon self‐efficacy. Guilt and responsibility had a direct effect upon stop‐self‐efficacy. Copyright © 2006 John Wiley & Sons Ltd.     

Suicide among adolescents and young adults: a cross-national comparison of 34 countries

Few cross-national reports have examined suicide rates among adolescents and young adults. A survey of suicides among 15-24-year-olds in 34 of the wealthiest nations demonstrated that 15,555 youths killed themselves in a 1-year study period. Thirty-four percent of these suicides were firearm-related. Finland led the participating nations in total and firearm-related suicide rates. An association was found between divorce rates and youth suicide rates, firearm-related suicide among youths, and suicide rates among young males. For a smaller sample of countries, an association was found between firearm availability and firearm-related suicide rates among youths and suicide rates among young males.     

Forgiveness in adolescents, young, middle-aged, and older adults

The evolution of the propensity to forgive an offense was studied in a sample of 236 people from various age groups. The effect of a number of circumstances connected with the offense was considered: intent to harm, severity of consequences, cancellation of consequences, social proximity to the offender, apologies from the offender, and the attitude of others. The method was an application of information integration theory. A global increase in the propensity to forgive from adolescence to old age was observed. Several interactions between age and circumstances were found: (a) The effect of the cancellation factor was higher in young adolescents and in the very old than in the middle-aged, (b) the attitude of others and the restoration of harmony factors were important only in adolescents. Finally, the structure of the Forgiveness schema was shown to be an additive one, regardless of the age of the participants.     

Cigarette smoking and depressive symptoms: a longitudinal study of adolescents and young adults

Cigarette smoking and depressive symptoms have been shown to be related in previous research. This paper examined the relationship between cigarette smoking and depressive symptoms in a longitudinal sample of 688 adolescents and young adults through surveys conducted over 13 yr. The results indicate that a history of earlier cigarette smoking in adolescence predicts later depressive symptoms in the late twenties. The study also suggests that depressive symptoms during adolescence predict cigarette smoking in the late twenties but not above and beyond prior smoking. These results help clarify and expand current knowledge on the links between cigarette smoking and depression. The results point to several clinical implications for treatment of both cigarette smoking and depressive symptoms among both adolescents and young adults.     

Reactive and proactive control in incarcerated and community adolescents and young adults

This study compared the cognitive control skills of male incarcerated adolescents (n = 44), male control adolescents (n = 33), male incarcerated young adults (n = 41), and male control young adults (n = 35) using the AX-continuous performance test (AX-CPT). This test measures proactive control (the ability to maintain a mental representation of goal-related information in preparation for a behavioral response) and reactive control (the ability to activate goal-related information in response to an external trigger). Incarcerated individuals had more difficulty implementing proactive control, whereas control individuals had more difficulty implementing reactive control. Adolescents had more difficulty with both reactive and proactive control compared with young adults, suggesting that both skills improve with age. Additional analyses indicated that the effect of age on proactive control was due to the presence of attention-deficit/hyperactivity disorder, whereas the effect of age on reactive control appeared to be a natural developmental trend that could not be explained by other variables. These findings are considered in relation to the dual mechanisms of control theory [Braver, T. S., Gray, J. R., & Burgess, G. C. (2007). Explaining the many varieties of working memory variation: Dual mechanisms of cognitive control. In A. R. A. Conway, C. Jarrold, M. J. Kane, A. Miyake, & J. N. Towse (Eds.), Variation in Working Memory. New York: Oxford University Press.].     

Relationships between mind-wandering and attentional control abilities in young adults and adolescents

Recent findings suggest that mind-wandering—the occurrence of thoughts that are both stimulus-independent and task-unrelated—corresponds to temporary failures in attentional control processes involved in maintaining constant task-focused attention. Studies supporting this proposal are, however, limited by a possible confound between mind-wandering episodes and other kinds of conscious experiences, such as external distractions (i.e., interoceptive sensations and exteroceptive perceptions). In the present study, we addressed this issue by examining, in adolescents and young adults, the relations between tasks measuring attentional control abilities and a measure of mind-wandering that is distinct from external distractions. We observed (1) that adolescents experienced more frequent external distractions, but not more mind-wandering, than young adults during the Sustained Attention to Response Task (SART) and (2) that, in young adults, the influence of external distractions on SART performance was fully accounted for by attentional control abilities, whereas mind-wandering was associated with decreases in SART performance above and beyond what was explained by attentional control abilities. These results show that mind-wandering cannot be entirely reduced to failures in the ability to maintain one's attention focused on task, and suggest that external distractions rather than mind-wandering are due to attentional control failures.     

The symptomatic expression of major depressive disorder in adolescents and young adults

Data from the Oregon Adolescent Depression Project were used to examine the symptomatic expression of major depressive disorder (MDD) as a function of age and gender. The objective was to investigate the phenomenological nature of MDD among a cohort of adolescents as they progressed into early adulthood. The analyses were based on 564 participants who had experienced MDD in their lifetime. No systematic differences in the relative rate of occurrence of specific symptoms across episodes and only minor symptom differences between male and female participants were found. Age did not significantly influence the symptom picture. Stability of specific symptoms and episode severity across episodes was low. The results are discussed within the context of a stressor-symptom matching model.     

Constructing a short form of the Smoking Consequences Questionnaire with adolescents and young adults

The goal of the present studies was to construct and validate a short form of the 50-item Smoking Consequences Questionnaire (SCQ; T.H. Brandon & T. B. Baker, 1991), a measure of smoking outcome expectancies. In Study 1, a 21-item short form (S-SCQ) was derived from a sample of 107 young adults previously treated for substance abuse. In Study 2, the measure was cross-validated on 125 adolescents in treatment for substance abuse. Confirmatory factor analyses revealed good model fit and factorial invariance for the 4 S-SCQ subscales across both samples. Validation analyses on each sample found that subscale scores generally correlated significantly with smoking-related variables. The present studies provide initial evidence for the utility of the S-SCQ when used with young adults and adolescents.     

Barriers and facilitators of physical activity and sport participation among young transgender adults who are medically transitioning

Background: Transgender people (those who feel incongruence between the gender they were assigned at birth and their gender identity) engage in lower levels of physical activity compared to cisgender (non-transgender) people. Several factors have been shown to affect physical activity engagement in the cisgender population; however, the physical activity experiences of young transgender adults have not been explored. It is therefore the aim of the current study to understand what factors are associated with physical activity and sport engagement in young transgender adults who are medically transitioning.

Method: Semi-structured interviews were conducted with 14 young transgender adults (18–36 years) who had initiated their medical transition at a transgender health service in the United Kingdom. The data were analyzed using thematic analysis.

Results: Two main themes were identified: (1) barriers and (2) facilitators to physical activity and sport. Overall, the young transgender adults were insufficiently active due to inadequate changing facilities, body dissatisfaction, fears surrounding “passing” and not being accepted by others. At the same time, participants were motivated to engage in physical activity to increase their body satisfaction and gender congruence. However, participants felt there was a lack of safe and comfortable spaces to engage in physical activity and sport.

Conclusion: Young transgender adults who are medically transitioning experience several barriers to physical activity and sport, despite being motivated to be physically active. Initiatives to facilitate young transgender adults' ability to put their motivations into practice (i.e. to be more physically active) are needed.     

Changes in the parental bond and the well-being of adolescents and young adults

Changes in the parental bond and the well-being of adolescents and young adults were investigated in this longitudinal study among Dutch youngsters aged 12 to 24 years (their ages ranged from 15 to 27 years when they were assessed for the second time three years later, and from 18 to 30 years when assessed for the third time). A total of 1,078 adolescents/young adults (459 males and 619 females) participated. We found a curvilinear pattern in the bond between daughters and their parents. For most of the boys, there was a deterioration in the parental bond during the transition from early to midadolescence, which does not subsequently improve. The general conclusion, however, is that adolescents and young adults maintain a rather good and reasonably stable relationship with their parents. Parents prove to be of lasting importance for the well-being of their growing children. For adult children, the parental bond appears to be as important for their well-being as having a partner or a best friend.     

Socialization and development of the work ethic among adolescents and young adults

Work ethic is part of a broader field of attitudes, identified as cultural conservatism. The results of this longitudinal study—three repeated measurements with 620 adolescents and one of their parents as participants—show that parents' social economic status and educational level are associated with their cultural conservatism, and with the educational level and cultural conservatism of their children. During adolescence, parents effectively transfer their own cultural (non-)conservatism to their children. These socialization factors of adolescent cultural conservatism and adolescent educational level are important determinants of their work ethic. Lower educational level and higher cultural conservatisms of adolescents predict a stronger work ethic. Work ethic is a stable type of attitude, with work ethic at a younger age strongly predicting work ethic at a later age.