Collaborating for consensus: Considerations for convening Coalition stakeholders to promote a gender-based approach to addressing the health needs of sex workers

Women involved in sex work experience myriad challenges, such as poverty, illiteracy, low social status and gender inequity, as they struggle to access healthcare. These challenges place them at high risk for poor health outcomes. The purpose of this article is to describe the formation of a strong cross-system Coalition representing both the criminal justice and healthcare systems to address the health needs of sex workers in Delaware. The Delaware Coalition for Health and Justice implemented a Coalition-building strategy to design interventions and streamline systems to promote health and reduce criminal justice contact for sex workers. The sequential intercept model was utilized to organize Coalition membership and build consensus among varied stakeholders. The model assisted the Coalition in understanding differing primary objectives for key system programs, recognizing the limitations and barriers of each stakeholder group, sharing findings and discovering opportunities for partnership, and engaging stakeholders in designing and providing a comprehensive “systems” approach. This work suggests that aligning the criminal justice, healthcare, and community social services in a systemic process to build consensus can result in the implementation of effective systems change initiatives that address gender disparities and promote the health of justice-involved women.     

SAME‐SEX EXPERIENCE AND MENTAL HEALTH DURING THE TRANSITION BETWEEN ADOLESCENCE AND YOUNG ADULTHOOD

Previous research has demonstrated that people who report same‐sex experience tend to have poorer mental health than heterosexual people in adolescence and adulthood. Yet, little is known about how same‐sex experience is associated with changes in mental health between the two life stages. Using data from the National Longitudinal Study of Adolescent Health (n = 12,056), this study assesses patterns of same‐sex experience between adolescence and young adulthood and their consequences for changes in depressive symptoms, binge drinking, and drug use. Compared to people with no same‐sex experience, those who report such experience only in adolescence show greater levels of mental health problems in adolescence, but they do not show any worse mental health changes during the transition into young adulthood. People who develop their first same‐sex experience in young adulthood, however, tend to show worse changes, consistent with the argument that entry into a stigmatized role is psychologically harmful. Among females, those who report same‐sex experience in both life stages also show worse mental health changes, indicating that the continuity in minority status contributes to their cumulative disadvantage. However, these differences are modest, and substantial amounts of variations in mental health changes are observed within each group. Findings are used to address the dynamic aspect of mental health disparity linked to sexuality.     

The mental health of African-American and Caucasian-American women who are homeless.

1. Nurses can use research findings to educate other health professionals about homeless subcultures with attention to specific cultural and socioeconomic needs, as well as to develop interventions for homeless women. 2. Minority women are more susceptible to homelessness as they experience increased poverty levels and are often single mothers. Of all minority women, African-American women are the most vulnerable to physical and psychological illness. 3. In this study, 75% of the subjects had scores on a psychological assessment test that indicated they needed additional psychological testing.     

Meeting immigrant health challenges: An integrated model in New York City

New York City has traditionally been the portal to America for millions of foreign‐born immigrants. Current immigration echoes this past. Each year, tens of thousands of immigrants and migrants enter New York City. These individuals and families come from diverse cultures and health care systems which continue to impact on their health care needs. How can New York's health care system provide culturally sensitive and epidemiologically informed health services to these immigrants? In 1990, with a grant from the Aaron Diamond Foundation, an interdisciplinary group of professionals established the New York Task Force on Immigrant Health. This paper will describe the work of this unique multi‐disciplinary organisation as it seeks to address issues of health status and service delivery to immigrant populations. The paper will discuss specific issues and strategies with respect to a) the development of data bases, b) ethnographic investigations, c) cross‐cultural and structural barriers to care, d) the creation and analysis of models to integrate traditional and Western bio‐technical health care, and e) the informing and transforming of public policy and programs to result in more linguistically appropriate, culturally sensitive and effective health and social services. The successes of the New York Task Force on Immigrant Health, in a relatively brief period of time, provide both a model and a stimulus for other localities and nation‐states interested in preventing illness and improving the health status of their diverse populations.     

Mental health and substance use of sexual minority college athletes

ABSTRACT

Objective: Assess the mental health and substance use of sexual minority collegiate student-athletes in the United States, as compared with heterosexual college students and heterosexual student-athletes. Participants: Undergraduate students (N = 196,872) who completed the American College Health Association's National College Health Assessment (Fall 2008–Fall 2012 administrations). Methods: Written cross-sectional survey. Results: Sexual minority student-athletes had a higher risk of experiencing mental health difficulties than their heterosexual athlete peers. There were no significant differences in mental health between sexual minority male athletes and nonathletes. Sexual minority female athletes appeared to fare better than nonathlete peers. Substance use was greater among sexual minority students (athlete and nonathlete) and was mediated by mental health. Conclusions: Participation in athletics does not appear to be associated with an elevated risk of negative mental health outcomes for sexual minority participants; however, there are disparities in mental health outcomes by sexual orientation regardless of athletics participation.     

A participatory evaluation framework in the establishment and implementation of transdisciplinary collaborative centers for health disparities research

ObjectiveWe describe the formulation and implementation of a participatory evaluation plan for three Transdisciplinary Collaborative Centers for Health Disparities Research funded by the National Institute of Minority Health and Health Disparities.MethodsAlthough different in scope of work, all three centers share a common goal of establishing sustainable centers in health disparities science in three priority areas – social determinants of health, men’s health research, and health policy research.ResultsThe logic model guides the process, impact, and outcome evaluation. Emphasis is placed on process evaluation in order to establish a “blue print” that can guide other efforts as well as assure that activities are being implemented as planned.ConclusionWe have learned three major lessons in this process: (1) Significant engagement, participation, and commitment of all involved is critical for the evaluation process; (2) Having a “roadmap” (logic model) and “directions” (evaluation worksheets) are instrumental in getting members from different backgrounds to follow the same path; and (3) Participation of the evaluator in the leadership and core meetings facilitates continuous feedback.     

Single motherhood and children's health

This analysis employs the recently released Hispanic Health and Nutrition Examination Survey (hispanic HANES) and the National Health and Nutrition Examination Survey II (NHANES) to determine the effect of a mother's marital status on her report of her child's health for Mexican-American, black, and non-Hispanic white children aged 6 months to 11 years. The results reveal that single mothers report poorer overall physical health for their children than do mothers in intact marriages. Several social and cultural factors, including marital status, acculturation, and income, affect the accuracy of mother's assessments. The analysis also documented the extensive dependence of single mothers, especially minority-group mothers, on public programs. In summary, a mother's report of her child's health is the result of a complex interaction of cultural, demographic, and social class factors. This analysis revealed that marital status operates differently for 3 racial and ethnic groups, and that poverty and the stresses associated with single motherhood decrease levels of reported health for children. Analysis of a matched sample of Mexican-American children and their mothers revealed that, net of physician's assessment of a child's health, a mother's depression score is among the most significant predictors of her assessment of her child's health.     

Ethnic and class factors affecting mental health clinic service

Service delivery by a mental health clinic to clients from an older suburban catchment area containing both lower and middle class blacks and whites was studied. The epidemiologic method was employed, relating service delivery to the characteristics of the various population groups within the catchment. The findings indicate that low service rates for blacks were not related to ethnicity alone, but to the combination of black ethnicity and low social status; however, middle class blacks and middle class whites who entered treatment received similar service. Poor blacks had higher admission rates than poor whites with similar need indicators. In continued treatment, poor blacks received lowest service rates while minority status poor whites living in a predominantly black area received highest service rates. Social class mediated black service utilization. Severity of illness, interacting with social class and minority status mediated white service utilization. Outreach is suggested not only for poor blacks but also for poor whites, especially those living in areas in which they represent an ethnic minority.     

Whose knowledge is valued: a critical study of knowledge in elementary school textbooks in China

This study critically examines knowledge in elementary school textbooks in China. Language analysis and story‐line analysis are used to examine how the knowledge related to minority groups and how the knowledge related to the Han group are introduced and interpreted. This study finds that the Han knowledge dominates elementary school textbooks in China and that minority knowledge and culture are under‐represented, which demonstrates that the dominant Han group’s knowledge is seen as the ‘truth’ while minority knowledge is seen as backward. Moreover, through the dominant Han group’s selection and construction of school knowledge, the Han group reproduces its ideology and legitimates its hegemonic control over minority groups. Minority knowledge and culture are, therefore, subjugated.     

Stress,Stigma, and Sexual Minority Status: The Intersectional Ecology Model of LGBTQ Health

One of the four overarching goals of Healthy People 2020 is to achieve health equity, eliminate health disparities, and improve the health of all groups, including the health of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) populations. In 2011, the Institute of Medicine (IOM) released a report that drew attention to the unique health disparities experienced by sexual minorities and underscored the need for a comprehensive approach to sexual minority health research. This article proposes a new model of LGBTQ health to help measure, explore, explain, and predict the impact of sexual minority status on health outcomes. The Intersectional Ecology Model of LGBTQ Health (IEM) demonstrates how the relentless hypervigilance of LGBTQ individuals in a heteronormative society impacts health outcomes through the primary vehicles of stigma and chronic, elevated stress. The purpose of the IEM is to guide future research and enhance public health practice for LGBTQ populations.     

Marital trajectories and mental health

This study expands the marital status and mental health literature by examining several dimensions of marital trajectories, including the number and type of prior marital losses and duration in current status. Data are drawn from the Piedmont Health Survey of the National Institute of Mental Health Epidemiologic Catchment Area Study, collected in 1982-83 (n = 2,158). Results indicate that number of prior losses moderates the health-enhancing effect of being currently married; higher order marriages are associated with worse mental health. Although results vary across the mental illnesses examined (depression, anxiety, and substance use), the negative effect of multiple loss also is observed for the currently divorced and widowed. There is less evidence that the type of prior loss (i.e., divorce or widowhood) moderates the effect of current marital status on mental health; however, some support is found among the presently widowed. The analyses of duration in current status suggest that the rate of decline in symptoms of anxiety following one's most recent loss varies by marital history among the currently widowed.     

Oral health among student veterans: Effects on mental and physical health

Abstract

Objective: The purpose of this study was to explore differences in oral health among students by military service status in postsecondary settings. Participants: Secondary data were obtained from the American College Health Association’s 2011–2014 National College Health Assessment II. Method: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with maximum likelihood multiple logistic regression. Results: Service member and veteran students are at greater risk for neglecting health behaviors associated with positive oral health, including that they were less likely to get dental exams and that those who deployed in the past were the least likely to be practicing good oral health. Conclusions: The results suggest that improving oral health will contribute to improving health and mental health outcomes in this population, and provide important information for health specialists working with service members and veterans on college campuses.     

Referrals, language proficiency, and enrolment for children's mental health services

Alberta Health Services maintains a database of children, adolescents and adults referred to the child and adolescent mental health and psychiatry intake service. In this study, we sought to systematically assess the impact, if any, of English language proficiency on enrolment of children for mental health services. Specifically, we assessed the extent to which children referred for mental health services were enrolled. In doing so, we categorized our sample (12,143) as English Proficient (EP), or Less English Proficient (LEP). Overall, we found that LEP children were significantly less likely to be enrolled compared to EP children. This disparity in enrolment was only present when other variables were not taken into account. English Proficiency is an important factor for some subgroups.     

Race and psychological distress: the South african stress and health study

We analyze data from the South African Stress and Health Study, a nationally representative in-person psychiatric epidemiologic survey of 4,351 adults conducted as part of the World Mental Health Survey Initiative between January 2002 and June 2004. All blacks (Africans, Coloreds, and Indians) initially report higher levels of non-specific distress and anger/hostility than whites. Access to socioeconomic resources helps explain differences in non-specific distress between Coloreds and whites and Indians and whites. However, only when social stressors are considered do we find few differences in psychological distress (i.e., non-specific distress and anger/hostility) between Africans and whites. In addition, self-esteem and mastery have independent effects on non-specific distress and anger/hostility, but differences between Coloreds and whites in feelings of anger/hostility are not completely explained by self-esteem and mastery. The findings contribute to the international body of work on social stress theory, challenge underlying assumptions of the minority status perspective, and raise a series of questions regarding mental health disparities among South Africans.     

Minority Stress,Emotion Regulation,and the Parenting of Sexual-Minority Youth

ABSTRACT

Despite increasing societal acceptance of sexual-minority individuals, there are still gay, lesbian, and bisexual (GLB) adolescents who experience negative mental health outcomes. Minority stress theory posits that stigma-related stress associated with sexual-minority status drives increased risk among GLB individuals. Furthermore, recent evidence suggests that minority stress impacts emotion regulation (ER), identified as a particularly important risk factor for sexual-minority youth (SMY). Current research has identified some aspects of parenting contribute to GLB youth's mental health. We review the literature in these areas, and also integrate research from the broader developmental field on families and emotion socialization in order to identify the need for studies of parenting that go beyond existing data on parental acceptance and supportiveness of youth's sexual orientation. Limitations of the current literature and directions for future research are discussed, with specific focus on implications for interventions with SMY and their families.     

The relationship between medical education and trans health disparities: a call to research

According to the National Transgender Discrimination Survey, 28% of trans respondents reported postponing medical care due to discrimination, and 28% reported being harassed by providers when they did seek out care. Scholars have proposed that what is taught (or not) in medical schools might play a role in the unequal health care experienced by many trans people. As medical education becomes a site of intervention for reducing transgender health disparities, it presents opportunities for sociologists to study and explain the processes by which medical training creates, reinforces, and potentially challenges stigma‐related health disparities. In this paper, we propose three areas of inquiry that might help explain this situation: the hidden curriculum, patient health movements and consumerism, and medical competency. By employing these concepts, we argue that sociologists can develop more comprehensive explanations for the relationship between medical education and transgender health inequalities and offer solutions to address this disparity.     

Multicultural Competence in Nevada Human Services

SUMMARY

A survey of 300 Nevada mental health, child welfare, early childhood, and parole workers provided baseline information concerning multicultural competence for use in planning diversity programs. A modified version of the Multicultural Counseling Inventory yielded data on awareness, knowledge, skills, and relationship. Significant findings emerged for gender, educational level, practice field, and minority status. Women scored higher than men on the total and three subscales. Workers with graduate degrees scored higher than BA level workers on the total and two subscales. Early childhood workers scored highest on the total; youth parole scored lowest. Minority workers scored higher than non-minority workers in awareness.     

How local health departments work towards health equity

BackgroundHealth inequities are exacerbated when health promotion programs and resources do not reach selected populations. Local health departments (LHDs)¹ have the potential to address health equity via engaging priority populations in their work. However, we do not have an understanding of what local agencies are doing on this front.MethodsIn the summer of 2016, we collaborated with informants from thirteen LHDs across North Carolina. Via semi-structured interviews, the research team asked informants about their LHD’s understanding of health equity and engaging priority populations in program planning, implementation, and evaluation.FindingsAll informants discussed that a key function of their LHD was to improve the health of all residents. LHDs with a more comprehensive understanding of health equity engaged members of priority populations in their organizations’ efforts to a greater extent than LHDs with a more limited understanding. Additionally, while all LHDs identified similar barriers to engaging priority populations, LHDs that identified facilitators more comprehensively engaged members of the priority population in program planning, implementation, and evaluation.ConclusionsLHDs are ideally situated between the research and practice worlds to address health equity locally. To promote this work, we should ensure LHDs hold an understanding of health equity, have the means to realize facilitators of health equity work, and recognize the complex context in which health equity work exists.     

A survey of Colorado's migrant farmworkers: access to health care

This report utilizes data collected in a 1986 sample survey of 329 adult (18 to 50 years old) migrant farmworkers in Colorado to determine their health needs, health services utilization, and overall access to care. Health needs include selected indices of medical, dental, nutrition, and reproductive health. About 1/4 of the population had no usual source of health care. Upstream states such as Colorado are responsible as the primary providers of health services for those who either have no source of health care at their home base or experience a variety of barriers in their attempts to access services. Women are most likely to have had a medical visit over the past 12 months and are more likely to have experienced hospitalization. Unfortunately, although their contact with medical professionals is more frequent, the family planning needs of women are not being met. A large disparity exists between ideal family size and number of pregnancies and live births. The findings of this survey document the inferior health status of the migrant farmworker population in Colorado. Hunger, poverty, and environmental hazards increase the risk of illness, while at the same time, barriers to care often prevent migrants from accessing needed health services. Recommendations include 1) promoting and funding family planning and reproductive health services for migrant farmworker women and their partners, 2) incorporating trained family planning promoters in the migrant health delivery system, 3) maintaining successful models of restorative dental care for adults, 4) increasing access to services in nontraditional settings, 5) increasing use of ancillary personnel to provide services, especially dental services, 6) maintaining outreach programs in the available food programs, and 7) encouraging migrant health programs to provide leadership in the development of alternative food sources.     

Examples of best practice: ‘All together we are the city’: a workshop developed by the Muslim Minority Education Project in Greece

There is a significant population of Muslim citizens in Greece, sometimes referred to as the Muslim minority, who live in the geographical region of Thrace. For many years, little attention was devoted to the educational needs of this group, and there was consequently a high percentage of school failure and early school leaving. The poorly functioning collaboration between the teachers of the majority and the teachers of the minority, weak communication between minority schools and mainstream schools and the lack of teacher‐training in intercultural education were key reasons for this. Recently, significant educational initiatives have taken place in the field of Muslim minority education within the framework of a broad educational project, entitled ‘The Muslim Minority Education Project’. The aims of the project are to improve the educational provision for students from this Muslim minority and to promote the principles and philosophy of intercultural education.