Experiences of Transgender and Gender Nonbinary Patients in the Emergency Department and Recommendations for Health Care Policy, Education, and Practice.

BACKGROUND: Transgender and gender nonbinary (trans/NB) individuals face many barriers to accessing health care in the United States due to systemic and clinician discrimination. Such experiences can lead to avoidance or delays in seeking care. These issues are relevant for emergency department (ED) clinicians and staff because trans/NB patients may use the ED in times of crisis. OBJECTIVES: The purpose of this study was to qualitatively explore experiences of trans/NB individuals accessing health care in the ED and provide recommendations for improvements. METHODS: This study involved semi-structured qualitative interviews with nine trans/NB individuals living in Arkansas about their experiences when visiting local EDs. RESULTS: Interviews revealed four main themes: 1) system and structural issues; 2) interactions with clinicians/staff influence care received; 3) perceptions of clinician knowledge and education about trans/NB health; and 4) impact on future health and health care access. Participants recommended education for current and future ED clinicians and staff to improve knowledge of best practices for trans/NB health care. Recommendations were also made to improve ED policy for inclusive and affirming intake processes, intake forms, and electronic health record (EHR) documentation, including documentation and use of patients' chosen name and pronouns. CONCLUSION: The negative experiences and discrimination reported by trans/NB patients in ED visits underscores the importance of improving ED clinician knowledge of gender-affirming care practices, ED intake policies and practices, and EHR documentation in EDs.

Community engagement and its impact on child health disparities: building blocks, examples, and resources.

National attention to racial and ethnic health disparities has increased over the last decades, but marked improvements in minority health, especially among children, have been slow to emerge. A life-course perspective with sustained community engagement takes into account root causes of poor health in minority and low-income communities. This perspective involves a variety of primary care, public health, and academic stakeholders. A life-course perspective holds great promise for having a positive impact on health inequities. In this article we provide background information on available tools and resources for engaging with communities. We also offer examples of community-primary care provider interventions that have had a positive impact on racial and ethnic health disparities. Common elements of these projects are described; additional local and national resources are listed; and future research needs, specifically in communities around issues that are relevant to children, are articulated. Examples throughout the history of pediatrics show the potential to eliminate racial and ethnic health disparities not only for children but also for all populations across the life course.

Self-reported sugar-sweetened beverage intake among college students.

OBJECTIVE: To characterize sugar-sweetened beverage intake of college students. RESEARCH METHODS AND PROCEDURES: Undergraduates in an urban southern community campus were surveyed anonymously about sugared beverage consumption (soda, fruit drinks, energy drinks, sports drinks, sweet ice tea) in the past month. RESULTS: Two hundred sixty-five undergraduates responded (66% women, 46% minority, 100% of volunteers solicited). Most students (95%) reported sugared beverage intake in the past month, and 65% reported daily intake. Men were more likely than women to report daily intake (74% vs. 61%, p = 0.035). Soda was the most common sugar-sweetened beverage. Black undergraduates reported higher sugared beverage intake than whites (p = 0.02), with 91% of blacks reporting sugar-sweetened fruit drink intake in the past month and 50% reporting daily consumption. Mean estimated caloric intake from combined types of sugar-sweetened beverages was significantly higher among black students than whites, 796 +/- 941 vs. 397 +/- 396 kcal/d (p = 0.0003); the primary source of sugar-sweetened beverage calories among blacks was sugared fruit drinks (556 +/- 918 kcal/d). Younger undergraduates reported significantly higher intake than older students (p = 0.025). DISCUSSION: Self-reported sugar-sweetened beverage consumption among undergraduates is substantial and likely contributes considerable non-nutritive calories, which may contribute to weight gain. Black undergraduates may be particularly vulnerable due to higher sugared beverage intake. Obesity prevention interventions targeting reductions in sugar-sweetened beverages in this population merit consideration.

Prostate cancer in Arkansas.

Prostate cancer is the most common cancer affecting men and the second leading cause of cancer deaths in U.S. males. Nationally, black men have greater prostate cancer incidence/mortality than other men. This study used focus group discussions to examine knowledge, beliefs and attitudes about prostate cancer in black and white male populations in urban and rural areas of Arkansas. The study found a general lack of knowledge about prostate cancer and its symptoms, screening and treatment. There were also subtle differences among the groups that could impact the development of interventions and policies, thus decreasing prostate cancer mortality in Arkansas.

On any Saturday--a practical model for diabetes education.

PURPOSE: Patient self-management is an important part of treating chronic diseases. However, many primary care physicians face barriers in offering office-based diabetes education. This paper will discuss a practical program of community-based diabetes education that can be easily modified for a practitioner's office. PROCEDURE: Half-day diabetes education workshops geared toward local health care providers and patients with diabetes and their families were conducted in two rural communities in Arkansas. Participants were surveyed with respect to the effectiveness of the program and how they would use what they learned in the program. FINDINGS: Thirty-one health care providers and 59 patients with diabetes and their families attended. Program evaluation scores were between 4.1 and 5 on a 5-point Likert scale. One third of the patients commented that they had a better understanding of diet and medication use. Feedback from community health care providers noted that attendance in local diabetes support groups increased after the workshops. CONCLUSIONS: Diabetes complications have a large impact on the health of the population and a growing economic impact on the health care industry. Although there are many barriers to diabetes education and control, a practical half-day diabetes workshop on any Saturday can be effectively developed and implemented.