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1.
Med Probl Perform Art ; 38(2): 89-96, 2023 Jun.
Article in English | MEDLINE | ID: covidwho-20243859

ABSTRACT

AIMS: The COVID-19 pandemic negatively affected the performing arts sector by temporarily closing venues. As venues reopened, COVID-19 symptom self-reporting and monitoring were one tool to identify potentially symptomatic cast and crew, who would then undergo contact tracing, testing, or isolation to prevent spreading COVID-19. However, the compliance rates for submitting a COVID-19 self-monitoring checklist among undergraduate performing art majors remain unknown. METHODS: This retrospective medical chart review investigated 282 cast and crew (68 males and 214 females) regarding their daily COVID-19 symptom report documents across the genres of dance, musical theater, and vocal performance throughout the production runs of 11 performances at a midwestern United States university's integrated performing arts campus. Compliance regarding the completion of the COVID-19 symptom checklist was compared between gender identity, performance semester, and performance type throughout the 2020-2021 academic year. RESULTS: There was no statistically significant difference on masking compliance when comparing males (mean 73.6%) and females (73.8%). The completion of the symptom self-reporting during the fall 2020 semester was statistically significantly higher than in the spring 2021 semester (F = 6.065, t = 4.485, df = 229.661, p = 0.014, d = 0.52). Additionally, those participating in musical theater were more compliant than those in vocal performance (F(2,280) = 4.410, p = 0.013, d = 0.031). There was no statistically significant difference between dance and musical theater or vocal performance and dance genres regarding overall compliance. CONCLUSIONS: These findings can help understand the groups of performing artists who would comply with the public health measure of completing a daily symptom checklist for COVID-19 or similar communicable diseases.


Subject(s)
COVID-19 , Humans , Male , Female , Universities , Pandemics , Retrospective Studies , Gender Identity
2.
Z Evid Fortbild Qual Gesundhwes ; 177: 26-34, 2023 Apr.
Article in German | MEDLINE | ID: covidwho-2308898

ABSTRACT

INTRODUCTION: Measures against the COVID-19 pandemic led to restrictions in ambulatory health care in Germany. While the restrictions have been described from claims data, the patients' perspective has been missing. Lesbian, gay, bisexual, trans-, inter- and asexual persons (LGBTIA) might have been particularly affected by these restrictions because of their vulnerability. Thus, our research questions were: 1) How did the restrictions during the pandemic influence primary care and psychotherapy in Germany from the patients' perspective? 2) Are there differences between LGBTIA and cis-heterosexual persons regarding these restrictions? METHODS: We conducted an online survey with two survey waves in March/April 2020 and January/February 2021. Sampling was conducted via multiplicators and via snowball sampling. Amongst others, the survey contained open-ended questions regarding primary care and psychotherapy. From the answers of the first survey wave we constructed quantitative items for the second survey wave. Descriptive and inferential statistical analysis was conducted, including linear regression with R. RESULTS: 6,784 participants took part in the survey (2,641 in the first survey wave), 5,442 of whom identified as LGBTIA. Categories of changes in primary care were: no health care utilization, no changes in primary care, insecurity regarding primary care, and changes in primary care which could be less frequent utilization, differing procedures or changes in ways of communication. In the second wave, LGBTIA participants rated the worsening of primary care during the pandemic as being more pronounced. Regarding psychotherapy, the change can be described as no change in care, changes in the form of therapy, treatment in emergencies only and a longer break from psychotherapy. There was no different rating by LGBTIA persons compared to cis-heterosexual persons in the second survey wave. Telephone and video consultations were more common in psychotherapy than in primary care. DISCUSSION: LGBTIA persons were oversampled, so the sample included more people from urban areas than the German population. Due to the online survey form, older people were underrepresented relative to their numbers in the general German population. CONCLUSION: With respect to future pandemics general practitioners in primary care must be prepared that psychotherapy might be paused and delayed for some time. Video and telephone consultations should be offered to overcome pandemic-related restrictions in the future. General practitioners should know the gender identity and sexual orientation of their patients in order to proactively address health care barriers.


Subject(s)
COVID-19 , Gender Identity , Humans , Female , Male , Aged , Pandemics , COVID-19/epidemiology , COVID-19/therapy , Germany , Communicable Disease Control , Sexual Behavior , Psychotherapy , Primary Health Care
3.
Eat Behav ; 49: 101723, 2023 04.
Article in English | MEDLINE | ID: covidwho-2296084

ABSTRACT

There is a clear association between food insecurity and eating disorder (ED) psychopathology, mainly among samples in the United States and prior to the COVID-19 pandemic. However, Canadians experience food insecurity as well, which may have been heightened by the pandemic and its associated restrictions. The associations between food insecurity and ED psychopathology among Canadians remains underexamined. Therefore, the purpose of this study was to explore associations between food insecurity and ED psychopathology by gender identity among a national sample Canadian adolescents and young adults. Data were collected from 2714 participants aged 16 to 30 years old from across Canada. Participants reported sociodemographic characteristics, ED psychopathology, and food insecurity experienced during the COVID-19 pandemic through an online survey. Descriptive statistics, chi-square tests, ANOVAs, and regression analyses were conducted. Overall, 8.9% of the sample experienced food insecurity, with the highest prevalence among transgender and gender nonconforming individuals. Generally, those with no food insecurity reported the lowest ED psychopathology compared to higher ED psychopathology among those with food insecurity. Several unique differences were observed between cisgender men and cisgender women, while there were no significant associations between food insecurity and ED psychopathology found among transgender and gender nonconforming individuals. Further research is needed to investigate how the relationship between food insecurity and ED psychopathology differs based on gender, and to continue to explore food insecurity experienced beyond the COVID-19 pandemic as food insecurity possesses a considerable health threat to all.


Subject(s)
COVID-19 , Feeding and Eating Disorders , Humans , Male , Female , Young Adult , Adolescent , United States , Adult , Gender Identity , Pandemics , COVID-19/epidemiology , Canada/epidemiology , Feeding and Eating Disorders/epidemiology
4.
JAMA Pediatr ; 177(4): 329-330, 2023 04 01.
Article in English | MEDLINE | ID: covidwho-2293893

ABSTRACT

This Viewpoint discusses how to support patient and clinician safety regarding extreme online threats to gender-affirming care.


Subject(s)
Gender Identity , Transgender Persons , Humans
5.
Child Abuse Negl ; 133: 105866, 2022 11.
Article in English | MEDLINE | ID: covidwho-2286352

ABSTRACT

BACKGROUND: LGBTQ+ youth frequently experience disparities in outcomes related to permanency and overall well-being while in out-of-home care. These negative outcomes often persist after youth have transitioned out of care, particularly in the domains of housing, education, employment, and mental health. Initial research has found that the ongoing COVID-19 pandemic has exacerbated negative physical and mental health outcomes, as well as decreased economic stability among transition age youth. OBJECTIVE: This study seeks to determine if COVID-19 has resulted in unique impacts on foster care alumni, and if these impacts are the same for LGBTQ+ and non-LGBTQ+ transition age youth. PARTICIPANTS AND SETTING: This study used data from the 2020 Jim Casey Youth Opportunities Initiative Opportunity Passport Survey to explore these questions. METHODS: This survey was administered electronically to a national sample of 1223 youth ages 18-26 with lived experience in foster care. RESULTS: Results indicate that relative to non-LGBTQ+ foster care alumni, LGBTQ+ foster care alumni experienced more negative outcomes in housing stability, employment, and mental health/trauma due to COVID-19. No significant differences were found for education-related impacts. Outcomes varied by sex assigned at birth, ethnicity, and sexual orientation, gender identity and expression (SOGIE) of respondents, with female respondents, black, indigenous and other people of color (BIPOC) youth and LGBTQ+ youth being most frequently impacted. CONCLUSIONS: Results indicate that relative to non-LGBTQ+ foster care alumni, LGBTQ+ foster care alumni experienced more negative outcomes in housing stability, employment, and mental health/trauma due to COVID-19. No significant differences were found for education-related impacts. Outcomes varied by sex assigned at birth, ethnicity, and sexual orientation, gender identity and expression (SOGIE) of respondents, with female respondents, BIPOC youth and LGBTQ+ youth being most frequently impacted. Implications for practice and policy are explored.


Subject(s)
COVID-19 , Child, Foster , Adolescent , Adult , COVID-19/epidemiology , Female , Foster Home Care/psychology , Gender Identity , Humans , Infant, Newborn , Male , Pandemics , Young Adult
6.
Cell Rep Med ; 3(4): 100550, 2022 04 19.
Article in English | MEDLINE | ID: covidwho-2257226

ABSTRACT

Policies that require male-female sex comparisons in all areas of biomedical research conflict with the goal of improving health outcomes through context-sensitive individualization of medical care. Sex, like race, requires a rigorous, contextual approach in precision medicine. A "sex contextualist" approach to gender-inclusive medicine better aligns with this aim.


Subject(s)
Biomedical Research , Precision Medicine , Drive , Female , Gender Identity , Humans , Male , Policy
7.
Int J Drug Policy ; 112: 103936, 2023 02.
Article in English | MEDLINE | ID: covidwho-2278703

ABSTRACT

BACKGROUND: The increase in alcohol consumption among young women has been the most striking change in drinking culture in Spain in recent years. This study sets out to examine how images and stories about alcohol consumption are presented on Instagram, the strategies for constructing them, and the impact of social norms, including gender norms, on the strategies of making alcohol consumption visible. METHODS: We have carried out a digital ethnography study in which different research techniques have been applied. We held 13 discussion groups, conducted a three-month period of observation on Instagram, and 38 in-depth interviews of young Spanish men and women between the ages of 15 and 24 (N = 118). RESULTS: The representation of alcohol consumption on Instagram by young people shows fashionable party spaces for shared disinhibition, fun and youth gatherings. This social network permits different types of alcohol advertising and promotion of the image associated with its consumption, and is thus a space that brands and influencers exploit. Young people avoid the diffusion on Instagram of images related to their heavy use of alcohol through particular strategies. They untag, delete or avoid using their smartphone; and they choose the audience to whom images are directed, and the areas of publication. The desire to be posting and exhibiting constantly converges with embarrassment and precaution with (un)known audiences. Gender is a key element for understanding the differences in the way in which posts on Instagram related to drinking and drunkenness affect young people. CONCLUSIONS: Our data show that Instagram fosters the spreading of an ideal model of "alcohol consumption" online that tends to conceal the adverse effects of the substance, and that the online diffusion of behaviour concerning drinking is not gender-neutral.


Subject(s)
Alcoholic Intoxication , Social Media , Male , Adolescent , Humans , Female , Young Adult , Adult , Gender Identity , Alcohol Drinking/epidemiology , Anthropology, Cultural
8.
BMC Womens Health ; 23(1): 84, 2023 02 24.
Article in English | MEDLINE | ID: covidwho-2278625

ABSTRACT

BACKGROUND: College-aged young adults in the US have low utilization and high need for reproductive healthcare. Multiple barriers to reproductive care exist. University Student Health Centers (SHCs) provide varying degrees of reproductive products and services. Recently, California legislated that public university SHCs add medication abortion to their care. METHODS: To examine existing attitudes and barriers to reproductive healthcare for public university students, we conducted an anonymous online survey at a large, diverse, urban coastal California State University. Students were asked about numerous barriers accessing reproductive services in general and at the SHC, which we categorized into three groups: stigma, access and system. Respondents were also asked about knowledge and preferences for accessing and recommending various services. To understand the extent to which inequities exist, we compared differences across racialized/ethnic identity, gender identity, anticipated degree, and living distance from campus using chi-squared tests. RESULTS: The majority of survey (n = 273) respondents experienced stigma and access barriers in general healthcare settings which made obtaining reproductive healthcare for themselves or their partners difficult (stigma barriers 55%; 95% CI 49%-61%; access barriers 68%; 95% CI 62-73%). Notably, students reported statistically significant lower rates of access barriers at the SHC, 50%, than in general reproductive healthcare settings, 68%. There were limited differences by student demographics. Students also reported a high willingness to use or recommend the SHC for pregnancy tests (73%; 95% CI 67-78%), emergency contraception pills (72%; 95% CI 66-78%) and medication abortion (60%; 95% CI 54-66%). Students were less likely to know where to access medication abortion compared to other services, suggesting unmet need. CONCLUSIONS: Our study provides evidence that students face barriers accessing reproductive healthcare and that SHCs are a trusted and accessible source of this care. SHCs have a key role in increasing health, academic and gender equity in the post-Roe era. Attention and financial support must be paid to SHCs to ensure success as state legislatures mandate them to expand reproductive and abortion care access.


Subject(s)
Abortion, Induced , Abortion, Spontaneous , Pregnancy , Young Adult , Humans , Male , Female , Health Services Accessibility , Gender Identity , Students , Surveys and Questionnaires , Reproductive Health
9.
Front Public Health ; 11: 1069357, 2023.
Article in English | MEDLINE | ID: covidwho-2276723

ABSTRACT

Objective: The representativeness of participants is crucial to ensure external validity of clinical trials. We focused on the randomized clinical trials which assessed COVID-19 vaccines to assess the reporting of age, sex, gender identity, race, ethnicity, obesity, sexual orientation, and socioeconomic status in the results (description of the participants' characteristics, loss of follow-up, stratification of efficacy and safety results). Methods: We searched the following databases for randomized clinical trials published before 1st February 2022: PubMed, Scopus, Web of Science, and Excerpta Medica. We included peer-reviewed articles written in English or Spanish. Four researchers used the Rayyan platform to filter citations, first reading the title and abstract, and then accessing the full text. Articles were excluded if both reviewers agreed, or if a third reviewer decided to discard them. Results: Sixty three articles were included, which assessed 20 different vaccines, mainly in phase 2 or 3. When describing the participants' characteristics, all the studies reported sex or gender, 73.0% race, ethnicity, 68.9% age groups, and 22.2% obesity. Only one article described the age of participants lost to follow-up. Efficacy results were stratified by age in 61.9%, sex or gender in 26.9%, race and/or, ethnicity in 9.5%, and obesity in 4.8% of the articles. Safety results were stratified by age in 41.0%, and by sex or gender in 7.9% of the analysis. Reporting of gender identity, sexual orientation or socioeconomic status of participants was rare. Parity was reached in 49.2% of the studies, and sex-specific outcomes were mentioned in 22.9% of the analysis, most of the latter were related to females' health. Conclusions: Axes of social inequity other than age and sex were hardly reported in randomized clinical trials that assessed COVID-19 vaccines. This undermines their representativeness and external validity and sustains health inequities.


Subject(s)
COVID-19 , Clinical Trials as Topic , Diversity, Equity, Inclusion , Female , Humans , Male , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/immunology , Ethnicity , Gender Identity
10.
JMIR Public Health Surveill ; 9: e43786, 2023 03 30.
Article in English | MEDLINE | ID: covidwho-2283842

ABSTRACT

BACKGROUND: The COVID-19 pandemic and related lockdowns have impacted lifestyle behaviors, including eating habits and physical activity; yet, few studies have identified the emerging patterns of such changes and associated risk factors. OBJECTIVE: This study aims to identify the patterns of weight and lifestyle behavior changes, and the potential risk factors, resulting from the pandemic in Canadian adults. METHODS: Analyses were conducted on 1609 adults (18-89 years old; n=1450, 90.1%, women; n=1316, 81.8%, White) of the Canadian COVIDiet study baseline data (May-December 2020). Self-reported current and prepandemic weight, physical activity, smoking status, perceived eating habits, alcohol intake, and sleep quality were collected through online questionnaires. Based on these 6 indicator variables, latent class analysis (LCA) was used to identify lifestyle behavior change patterns. Associations with potential risk factors, including age, gender, ethnicity, education, income, chronic diseases, body image perception, and changes in the stress level, living situation, and work arrangement, were examined with logistic regressions. RESULTS: Participants' mean BMI was 26.1 (SD 6.3) kg/m2. Of the 1609 participants, 980 (60.9%) had a bachelor's degree or above. Since the pandemic, 563 (35%) had decreased income and 788 (49%) changed their work arrangement. Most participants reported unchanged weight, sleep quality, physical activity level, and smoking and alcohol consumption, yet 708 (44%) reported a perceived decrease in eating habit quality. From LCA, 2 classes of lifestyle behavior change emerged: healthy and less healthy (probability: 0.605 and 0.395, respectively; Bayesian information criterion [BIC]=15574, entropy=4.8). The healthy lifestyle behavior change group more frequently reported unchanged weight, sleep quality, smoking and alcohol intake, unchanged/improved eating habits, and increased physical activity. The less healthy lifestyle behavior change group reported significant weight gain, deteriorated eating habits and sleep quality, unchanged/increased alcohol intake and smoking, and decreased physical activity. Among risk factors, body image dissatisfaction (odds ratio [OR] 8.8, 95% CI 5.3-14.7), depression (OR 1.8, 95% CI 1.3-2.5), increased stress level (OR 3.4, 95% CI 2.0-5.8), and gender minority identity (OR 5.5, 95% CI 1.3-22.3) were associated with adopting less healthy behaviors in adjusted models. CONCLUSIONS: The COVID-19 pandemic has appeared to have influenced lifestyle behaviors unfavorably in some but favorably in others. Body image perception, change in stress level, and gender identity are factors associated with behavior change patterns; whether these will sustain over time remains to be studied. Findings provide insights into developing strategies for supporting adults with poorer mental well-being in the postpandemic context and promoting healthful behaviors during future disease outbreaks. TRIAL REGISTRATION: ClinicalTrials.gov NCT04407533; https://clinicaltrials.gov/ct2/show/NCT04407533.


Subject(s)
COVID-19 , Adult , Humans , Female , Male , Adolescent , Young Adult , Middle Aged , Aged , Aged, 80 and over , COVID-19/epidemiology , Pandemics , Bayes Theorem , Cohort Studies , Canada/epidemiology , Communicable Disease Control , Gender Identity , Life Style , Risk Factors
11.
Public Health Rep ; 138(2): 357-368, 2023.
Article in English | MEDLINE | ID: covidwho-2286838

ABSTRACT

OBJECTIVES: COVID-19 surveillance data are rarely collected or disaggregated by gender identity in the United States. We quantified COVID-19 testing experiences and SARS-CoV-2 infection history among transgender and gender-diverse (TGD) people to inform testing strategies and public health responses. METHODS: From June 14 through December 16, 2021, TGD adults enrolled in a US nationwide online survey with optional SARS-CoV-2 antibody testing. We used multinomial regression analyses to identify correlates of suspected and confirmed SARS-CoV-2 infection (vs no known infection). We identified correlates of inability to access COVID-19 testing when needed using generalized linear models for binomial variables. RESULTS: Participants (N = 2092) reported trans masculine (30.5%), trans feminine (27.3%), and nonbinary (42.2%) gender identities. Ten percent of respondents had a confirmed history of SARS-CoV-2 infection, and 29.8% had a history of suspected SARS-CoV-2 infection. Nonbinary gender (adjusted prevalence ratio [aPR] = 1.68; 95% CI, 1.12-2.53), experiencing homelessness (aPR = 1.65; 95% CI, 1.05-2.60), and food insecurity (aPR = 1.45; 95% CI, 1.03-2.04) were associated with confirmed SARS-CoV-2 infection. Food insecurity (aPR = 1.38; 95% CI, 1.10-1.72), chronic physical health condition (aPR = 1.44; 95% CI, 1.15-1.80), chronic mental health condition (aPR = 3.65; 95% CI, 2.40-5.56), and increased anticipated discrimination scores (aPR = 1.03; 95% CI, 1.01-1.05) were associated with suspected SARS-CoV-2 infection. Thirty-four percent (n = 694 of 2024) of participants reported an inability to access COVID-19 testing when needed, which was associated with Latinx or Hispanic ethnicity, inconsistent telephone access, homelessness, disability, and transportation limitations. The majority (79.4%) reported a complete COVID-19 vaccine course at the time of participation. CONCLUSIONS: Inclusion of TGD people in public health surveillance and tailored public health strategies to address TGD communities' social and structural vulnerabilities may reduce barriers to COVID-19 testing.


Subject(s)
COVID-19 , Transgender Persons , Adult , Female , Humans , Male , Gender Identity , COVID-19 Testing , COVID-19 Vaccines , COVID-19/diagnosis , COVID-19/epidemiology , SARS-CoV-2
12.
Soc Sci Med ; 323: 115850, 2023 04.
Article in English | MEDLINE | ID: covidwho-2249445

ABSTRACT

During the COVID-19 pandemic, lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults have experienced pronounced declines in well-being. However, less is known about how changes to daily routines and settings, such as the shift to remote work within many occupations, may be playing a role in well-being outcomes. Drawing on a unique time diary data source (N = 3515 respondents and 7650 episodes) collected between April 2020-July 2021 through online crowdsourcing platforms, we conducted random effects analyses to examine how working from home has been associated with experienced well-being among LGBTQ and cisgender heterosexual workers in the United States during the pandemic. Findings indicate LGBTQ adults felt significantly less stressed and tired while doing paid work at home than while working at a workplace. In addition, working at a workplace, rather than working from home, appeared to be more detrimental to LGBTQ adults' well-being compared to their non-LGBTQ counterparts. Adjusting for work characteristics explained some of the difference, whereas adjusting for family characteristics had little impact on the results. It is possible that for LGBTQ employees, working from home mitigates some of the minority stressors experienced during paid work.


Subject(s)
COVID-19 , Homosexuality, Female , Sexual and Gender Minorities , Transgender Persons , Female , Adult , Humans , United States/epidemiology , Pandemics , COVID-19/epidemiology , Sexual Behavior , Homosexuality, Female/psychology , Gender Identity , Transgender Persons/psychology
13.
Int J Eat Disord ; 56(3): 604-615, 2023 03.
Article in English | MEDLINE | ID: covidwho-2261953

ABSTRACT

OBJECTIVE: Eating disorders (EDs) disproportionately affect sexual and gender minorities, with majority of research conducted among samples in the United States. The purpose of this study was to examine ED psychopathology among adolescents and young adults in Canada with diverse gender and sexual identities. METHOD: Data were collected from 2,714 Canadians, aged 16-30 years old, via an online survey at the end of 2021 during the COVID-19 pandemic. Participants responded to sociodemographic questions (including history of EDs) and reported on eating attitudes and behaviors. Descriptive statistics and multiple modified Poisson and linear regressions were conducted. RESULTS: Over half the sample was heterosexual, 35% were sexual minority cisgender men and women, and 6.5% were transgender and gender non-conforming (TGNC) people. The sample overall reported elevated ED psychopathology based on their eating attitudes and behaviors. TGNC participants reported the most severe ED psychopathology. Generally, sexual minority cisgender women and cisgender men had elevated ED psychopathology compared to their heterosexual counterparts. Regression analyses revealed all gender and sexual minorities reported greater ED psychopathology compared to heterosexual cisgender men. DISCUSSION: The Canadian sample reported elevated ED psychopathology compared to previous studies among various populations. Additional investigations are now needed to observe how ED psychopathology continues to change after the onset of the pandemic. Further research is needed among cisgender men, TGNC people, and sexual minorities to understand the unique stressors they face that lead to high ED psychopathology, and develop appropriate prevention and treatment tools. PUBLIC SIGNIFICANCE: EDs affect people of all gender and sexual identities. People who identify as a gender and/or sexual minority often experience problematic eating attitudes and behaviors, particularly transgender and gender non-conforming people of all sexual identities. More research attention is needed among these populations, especially due to a paucity of research among Canadians, to develop effective diagnostic tools, prevention efforts, and treatment programs specific to gender and sexual identities.


Subject(s)
COVID-19 , Feeding and Eating Disorders , Sexual and Gender Minorities , Male , Adolescent , Young Adult , Humans , Female , United States , Adult , Gender Identity , Pandemics , Canada/epidemiology , COVID-19/epidemiology , Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/epidemiology
14.
BMC Health Serv Res ; 23(1): 168, 2023 Feb 17.
Article in English | MEDLINE | ID: covidwho-2265007

ABSTRACT

BACKGROUND: Sexual and gender minorities (SGM) in the Southern United States face challenges in accessing sexual and gender affirming health care. Alternative care models, like inclusive mobile clinics, help mitigate barriers to care for SGM. There is limited data in the literature on the experience of medical referral processes for SGM individuals accessing services from mobile health clinics. AIMS AND OBJECTIVES: The purpose of this study is to describe the medical referral experiences of SGM clients and their providers at a mobile health clinic in the Southern United States. METHODS: We recruited English-speaking individuals who provided care or received care from the mobile health clinic in South Carolina between June 2019 and August 2020. Participants completed a brief demographic survey and a virtual in-depth, semi-structured individual interview. Data analysis was conducted using an iterative process to generate codes, categories, and themes. Data collection and analysis were terminated once thematic saturation was achieved. RESULTS: The findings from this study indicated that the mobile health clinic had an inconsistent referral process that was largely dependent on providers' knowledge. Furthermore, clients and providers expressed individual barriers to the referral process, such as financial barriers, and opportunities to improve the referral process, such as an opt-in follow-up from the mobile clinic and increased mobile clinic resources. CONCLUSION: The findings in this study underscore the importance of having mobile clinics create a structured referral process that all medical providers are familiar with, and the value of hiring patient navigators that can support and refer clients to care that goes beyond the mobile health clinic setting.


Subject(s)
Mobile Health Units , Sexual and Gender Minorities , Humans , South Carolina , Public Health , Gender Identity , Referral and Consultation
16.
Adm Policy Ment Health ; 50(4): 552-562, 2023 07.
Article in English | MEDLINE | ID: covidwho-2269144

ABSTRACT

The COVID-19 pandemic has negatively impacted numerous people?s mental health and created new barriers to services. To address the unknown effects of the pandemic on accessibility and equality issues in mental health care, this study aimed to investigate gender and racial/ethnic disparities in mental health and treatment use in undergraduate and graduate students amid the COVID-19 pandemic. The study was conducted based on a largescale online survey (N = 1,415) administered during the weeks following a pandemic-related university-wide campus closure in March 2020. We focused on the gender and racial disparities in current internalizing symptomatology and treatment use. Our results showed that in the initial period of the pandemic, students identified as cis women (p < .001), non-binary/genderqueer (p < .001), or Hispanic/Latinx (p = .002) reported higher internalizing problem severity (aggregated from depression, generalized anxiety, intolerance of uncertainty, and COVID-19-related stress symptoms) compared to their privileged counterparts. Additionally, Asian (p < .001) and multiracial students (p = .002) reported less treatment use than White students while controlling for internalizing problem severity. Further, internalizing problem severity was associated with increased treatment use only in cisgender, non-Hispanic/Latinx White students (pcis man = 0.040, pcis woman < 0.001). However, this relationship was negative in cis-gender Asian students (pcis man = 0.025, pcis woman = 0.016) and nonsignificant in other marginalized demographic groups. The findings revealed unique mental health challenges faced by different demographic groups and served as a call that specific actions to enhance mental health equity, such as continued mental health support for students with marginalized gender identities, additional COVID-related mental and practical support for Hispanic/Latinx students and promotion of mental health awareness, access, and trust in non-White, especially Asian, students are desperately needed.


Subject(s)
COVID-19 , Pandemics , Male , Humans , Female , Mental Health , Gender Identity , Students
17.
BMC Public Health ; 23(1): 316, 2023 02 13.
Article in English | MEDLINE | ID: covidwho-2240993

ABSTRACT

BACKGROUND: Intimate partner violence and abuse (IPVA) includes controlling behaviours, psychological, physical, sexual and financial abuse. Globally, surveys and emergency services have recorded an increase in IPVA since restrictions were imposed to limit COVID-19 transmission. Most studies have only included heterosexual women. METHODS: Data from the Global Drug Survey (an annual, anonymous, online survey collecting data on drug use) Special Edition were analysed to explore the impact of COVID-19 on people's lives, including their intimate relationships. Five relationship groupings were created using respondents' lived gender identity: women partnered with men (46.9%), women partnered with women (2.1%), men partnered with men (2.9%), men partnered with women (47.2%), and partnerships where one or both partners were non-binary (1%). Self-reported experience and perpetration of IPVA in the past 30 days before (February) and during COVID-19 restrictions (May or June) in 2020 (N = 35,854) was described and compared for different relationship groupings using Fishers Exact Tests. Changes in IPVA during restrictions were assessed using multivariable logistic regression. RESULTS: During restrictions, 17.8 and 16.6% of respondents had experienced or perpetrated IPVA respectively; 38.2% of survivors and 37.6% of perpetrators reported this had increased during restrictions. Greater proportions of non-binary respondents or respondents with a non-binary partner reported experiencing or perpetrating IPVA (p < .001) than other relationship groupings. 22.0% of respondents who were non-binary or had a non-binary partner, 19.5% of men partnered with men, 18.9% of men partnered with women, 17.1% of women partnered with women and 16.6% of women partnered with men reported experiencing IPVA. Respondents with higher psychological distress, poor coping with pandemic-related changes, relationship tension and changes (increases or increases and decreases) in alcohol consumption reported increased experience of IPVA during restrictions. CONCLUSIONS: This study confirmed that IPVA can occur in all intimate relationships, regardless of gender of the perpetrator or survivor. Non-binary respondents or respondents with non-binary partners reported the highest use and experience of IPVA. Most IPVA victim support services have been designed for heterosexual, cisgender women. IPVA support services and perpetrator programmes must be tailored to support all perpetrators and survivors during the pandemic and beyond, regardless of their sexual or gender identity.


Subject(s)
COVID-19 , Intimate Partner Violence , Humans , Male , Female , Cross-Sectional Studies , Gender Identity , COVID-19/epidemiology , Sexual Partners/psychology , Surveys and Questionnaires , Risk Factors
18.
Am J Drug Alcohol Abuse ; 49(1): 129-139, 2023 01 02.
Article in English | MEDLINE | ID: covidwho-2239122

ABSTRACT

Background: Studies have found changes in substance use during the COVID-19 pandemic in specific populations. Transgender and gender diverse (TGD) individuals have experienced greater distress compared to cisgender individuals during the pandemic; however, there is little research on substance use among TGD individuals during this sensitive time period.Objectives: The objective of this study is to examine distress from COVID-19 and coping via substance use including alcohol, cannabis, tobacco, and non-medical use of prescription drugs (NMUPD) among TGD adults.Method: An online survey assessing substance use, general psychiatric symptoms, and COVID-19 anxiety was completed by 342 TGD individuals (16.4% transfeminine, 19.6% transmasculine, 64.0% Gender Diverse) in June/July 2020. Chi-square and structural equation modeling (SEM) analyses examined the connections between distress, coping, and substance use.Results: Seventy-one percent of participants reported no changes in substance use since the start of the pandemic and 22% reported an increase in substance use. Increased substance use was associated with alcohol (p < .001), cannabis (p < .001), and combustible tobacco (p < .001) use in the prior three months. SEM showed significant direct effects between distress and substance use coping, substance use coping and recent drug use, and an indirect effect of distress on recent drug use through substance use coping (ß = .31, p = .001).Conclusion: Results highlight the risk of substance use to cope with COVID-19-related stress in a large sample of a minoritized population with mental health disparities. Transmasculine and gender diverse participants were especially likely to report using substances to cope.


Subject(s)
COVID-19 , Substance-Related Disorders , Transgender Persons , Humans , Adult , Transgender Persons/psychology , Pandemics , COVID-19/epidemiology , Gender Identity , Substance-Related Disorders/epidemiology
19.
Int J Environ Res Public Health ; 20(1)2022 12 21.
Article in English | MEDLINE | ID: covidwho-2244214

ABSTRACT

BACKGROUND: People who identify as sexual and gender minorities (SGM) experienced disproportionate economic and mental health issues related to COVID-19 when compared to the general population. The purpose of this study was to better understand how COVID-19 has impacted the SGM community and ways to address vaccine hesitancy. METHODS: Three focus groups were conducted with 21 members of the SGM community between 5 November and 10 December 2020. A thematic analysis using the reflexive approach was applied to the transcripts of the focus groups. RESULTS: Four themes emerged: (1) Impact of COVID-19 on the Community, (2) Perceptions of Contact Tracing and Testing, (3) Perceptions of a Potential COVID-19 Vaccine, and (4) Decreasing Vaccine Hesitancy. The most relevant subthemes were that social isolation led to anxiety, stress, and fear in the SGM community during COVID-19; resilience and adaptation were positive outcomes of the pandemic; histories of medical racism contributed to hesitancy to get tested; and specific messaging from trusted messengers may be needed to encourage SGM communities to get vaccinated. These findings support other COVID-19 research on the SGM community during the start of the pandemic. CONCLUSIONS: This study provides insight into the impact of the early stages of COVID-19 on the SGM community, highlighting the unique hurdles faced by SGM individuals with regard to contact tracing and vaccine hesitancy.


Subject(s)
COVID-19 , Sexual and Gender Minorities , Humans , Focus Groups , COVID-19 Vaccines , COVID-19/epidemiology , Sexual Behavior , Gender Identity
20.
Saúde Soc ; 31(4): e220452pt, 2022.
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-2197566

ABSTRACT

Resumo A partir da experiência do projeto Respostas Indígenas à COVID-19 no Brasil: arranjos sociais e saúde global (PARI-c), na região do Alto Rio Negro (AM), buscamos refletir neste artigo sobre as possibilidades e implicações da produção colaborativa de conhecimento com pesquisadoras indígenas, levando em consideração a emergência sanitária, as imobilidades territoriais, as desigualdades sociais e as diferenças epistemológicas e de políticas ontológicas. A partir da ideia de Cestos de conhecimento, pensamos as formas e possibilidades dessa colaboração, à luz de discussões contemporâneas sobre processos de "descolonização" da saúde pública (global, planetária) e do conhecimento em saúde. A base empírica para este artigo é uma descrição da experiência metodológica, de produção de conhecimento, focada em duas faces: o campo e a escrita. Esse material nos permite tecer algumas considerações em torno da relevância e do sentido de formas de geração de "saberes híbridos", para lidar com contextos de crises globais ou sindemias. Estas formas, como veremos, atravessam o realinhamento das alianças e têm na escrita de mulheres um lugar especial de atenção.


Abstract From the experience of the project Indigenous Responses to COVID-19 in Brazil: social arrangements and global health (PARI-c), in the region of Alto Rio Negro (AM), we seek to reflect in this article on the possibilities and implications of collaborative knowledge production with indigenous researchers, taking into account the health emergency, territorial immobilities, social inequalities, and epistemological and ontological policy differences. From the idea of Baskets of knowledge, we think about the forms and possibilities of this collaboration, in the light of contemporary discussions on processes of "decolonization" of public health (global, planetary) and health knowledge. The empirical basis for this article is a description of the methodological experience of knowledge production, focused on two aspects: the field and writing. This material allows us to make some considerations around the relevance and meaning of ways of generating "hybrid knowledge", to deal with contexts of global crises or syndemics. These ways, as we shall see, cross the realignment of alliances and find a special focal point on women's writing.


Subject(s)
Humans , Male , Female , Health of Indigenous Peoples , Community-Based Participatory Research , Gender Identity , COVID-19 , Anthropology , Anthropology, Cultural
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