LGBT Health in the Midlands: A Rural/Urban Comparison of Basic Health Indicators

Research into the health and wellbeing of rural lesbian, gay, bisexual, and transgender (LGBT) populations is limited. A community-based participatory research (CBPR) approach was used to develop an online survey for LGBT Nebraskans. The 770 participants replied to an array of questions on social determinants of health and basic health outcomes. Only significant differences in having health insurance were found between urban and rural participants. Social determinants of health were explored. Results of this study suggest that regional culture may be more salient to health for lesbian, gay, bisexual, and transgender persons living in the Midwest than rural or urban residence.     

Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization

To determine the independent predictors of attempted suicide among transgender persons we interviewed 392 male-to-female (MTF) and 123 female-to-male (FTM) individuals. Participants were recruited through targeted sampling, respondent-driven sampling, and agency referrals in San Francisco. The prevalence of attempted suicide was 32% (95% CI = 28% to 36%). In multivariate logistic regression analysis younger age (<25 years), depression, a history of substance abuse treatment, a history of forced sex, gender-based discrimination, and gender-based victimization were independently associated with attempted suicide. Suicide prevention interventions for transgender persons are urgently needed, particularly for young people. Medical, mental health, and social service providers should address depression, substance abuse, and forced sex in an attempt to reduce suicidal behaviors among transgender persons. In addition, increasing societal acceptance of the transgender community and decreasing gender-based prejudice may help prevent suicide in this highly stigmatized population.     

Intimate Partner Violence Among Sexual Minorities in Japan: Exploring Perceptions and Experiences

Using qualitative interviews (n = 39) and participant observation (n = 54), this study documents perceptions and experiences of violence between lesbian, gay, bisexual, transgender, and intersex intimate partners in Japan, thereby providing exploratory, formative data on a previously unexamined issue. Results indicate that intimate partner violence (IPV) is experienced physically, sexually, and psychologically in all sexual minority groups. Participants perceived the violence to be: a) very similar to heterosexual IPV against women; b) more likely perpetrated and experienced by lesbians, bisexual women, and transgender persons compared to gay and bisexual men and intersex persons; c) the cause of several negative physical and mental health outcomes; and d) largely unrecognized in both sexual minority communities and broader Japanese society.     

Resilience to Discrimination and Rejection Among Young Sexual Minority Males and Transgender Females: A Qualitative Study on Coping With Minority Stress

Sexual minority and transgender status is associated with mental health disparities, which have been empirically and theoretically linked to stressors related to social stigma. Despite exposure to these unique stressors, many sexual minority and transgender individuals will not experience mental health disorders in their lifetime. Little is known about the specific processes that sexual minority and transgender youth use to maintain their wellbeing in the presence of discrimination and rejection. Semistructured interviews were conducted with 10 sexual minority males and transgender females aged 18–22 years, who currently met criteria for an operationalized definition of resilience to depression and anxiety. Data were analyzed qualitatively, yielding information related to a wide variety of problem-solving, support-seeking, and accommodative coping strategies employed by youth in the face of social stigma. Results are discussed in light of their clinical implications.     

Sense of Community Belonging and Health in Canada: A Regional Analysis

This article investigates the association between sense of community belonging and health among settlements of different size and across the urban to rural continuum in Canada. Using data from the recent 2007/08 Canadian Community Health Survey (CCHS), the objective is to identify the major health, social and geographic determinants of sense of community belonging and to consider policy options aimed at improving sense of belonging among certain segments of the population. The research found a significant and consistent association between sense of belonging and health, particularly mental health, even when controlling for geography and socio-economic status. At the same time, sense of community belonging improved progressively across the urban to rural continuum with remarkably high levels of belonging evident in the outer most regions of Canada. Despite the health deficit that exists in rural and small-town Canada, the paper postulates that these communities are able to overcome health challenges to create conditions conducive to a positive sense of belonging. Overall, sense of belonging was also found to be highest among seniors, people residing in single-detached homes and among couples with children and was lowest among youth, residents of high-rise apartments and among single-parents. Finally, in the context of addressing deficiencies in sense of belonging, the paper examines several recent policy developments aimed at improving mental health services in Canada.     

Health Care Issues Among Lesbian,Gay, Bisexual,Transgender and Intersex (LGBTI) Populations in the United States: Introduction

ABSTRACT

This supplemental issue of the Journal of Homosexuality presents research that explores a variety of health care issues encountered by lesbian, gay, bisexual, transgender and intersex (LGBTI) population groups in the United States over the 10-year period from 1993 to 2002.

Topics include access to health care, utilization of care, training of medical and mental health providers, and the appropriate preparation of clinical offices and waiting areas. Authors used a variety of community-based public health research methods, including participant and provider surveys and retrospective chart reviews of patients, to develop this body of research, providing a recent-historical perspective on the complex health care and health-related needs of sexual and gender minorities. Particularly for transgender and intersex populations, the state of research describing their health care needs is in its infancy, and much remains to be done to design effective medical and mental health programs and interventions.     

Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma

ABSTRACT

LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.     

Is the Lack of Specific Lesbian,Gay, Bisexual,Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) people frequently report negative health care encounters. Medical professionals may inadequately manage LGBTQ persons’ health if they have not received training in this area. An anonymous survey measuring efficacy in health situations among LGBTQ persons was answered by 166 medical students across all years of a UK university. Results show that 84.9% of participants reported a lack of LGBTQ health care education, with deficits in confidence clarifying unfamiliar sexual and gender terms, deciding the ward in which to nurse transgender patients, finding support resources, and discussing domestic abuse with LGBTQ patients. Most participants reported that they would not clarify gender pronouns or ask about gender or sexual identity in mental health or reproductive health settings. Participants reported infrequently observing doctors making similar inquiries. Participants held positive attitudes toward LGBTQ patients, with attitude scores positively correlating with LGBTQ terminology knowledge scores (r_s = 0.5052, p < .01). Addressing gender identity and sexuality issues within medical curricula may remove barriers to accessing health care and improve encounters for LGBTQ patients.     

Health care issues among lesbian, gay, bisexual, transgender and intersex (LGBTI) populations in the United States: Introduction

This supplemental issue of the Journal of Homosexuality presents research that explores a variety of health care issues encountered by lesbian, gay, bisexual, transgender and intersex (LGBTI) population groups in the United States over the 10-year period from 1993 to 2002. Topics include access to health care, utilization of care, training of medical and mental health providers, and the appropriate preparation of clinical offices and waiting areas. Authors used a variety of community-based public health research methods, including participant and provider surveys and retrospective chart reviews of patients, to develop this body of research, providing a recent-historical perspective on the complex health care and health-related needs of sexual and gender minorities. Particularly for transgender and intersex populations, the state of research describing their health care needs is in its infancy, and much remains to be done to design effective medical and mental health programs and interventions.     

Health Selection,Migration, and HIV Infection in Malawi

Despite its importance in studies of migrant health, selectivity of migrants—also known as migration health selection—has seldom been examined in sub-Saharan Africa (SSA). This neglect is problematic because several features of the context in which migration occurs in SSA—very high levels of HIV, in particular—differ from contextual features in regions that have been studied more thoroughly. To address this important gap, we use longitudinal panel data from Malawi to examine whether migrants differ from nonmigrants in pre-migration health, assessed via SF-12 measures of mental and physical health. In addition to overall health selection, we focus on three more-specific factors that may affect the relationship between migration and health: (1) whether migration health selection differs by destination (rural-rural, rural-town, and rural-urban), (2) whether HIV infection moderates the relationship between migration and health, and (3) whether circular migrants differ in pre-migration health status. We find evidence of the healthy migrant phenomenon in Malawi, where physically healthier individuals are more likely to move. This relationship varies by migration destination, with healthier rural migrants moving to urban and other rural areas. We also find interactions between HIV-infected status and health: HIV-infected women moving to cities are physically healthier than their nonmigrant counterparts.     

Transgender youth: invisible and vulnerable

This study used three focus groups to explore factors that affect the experiences of youth (ages 15 to 21) who identify as transgender. The focus groups were designed to probe transgender youths' experiences of vulnerability in the areas of health and mental health. This involved their exposure to risks, discrimination, marginalization, and their access to supportive resources. Three themes emerged from an analysis of the groups' conversations. The themes centered on gender identity and gender presentation, sexuality and sexual orientation, and vulnerability and health issues. Most youth reported feeling they were transgender at puberty, and they experienced negative reactions to their gender atypical behaviors, as well as confusion between their gender identity and sexual orientation. Youth noted four problems related to their vulnerability in health-related areas: the lack of safe environments, poor access to physical health services, inadequate resources to address their mental health concerns, and a lack of continuity of caregiving by their families and communities.     

The Interaction of Same-Sex Marriage Access With Sexual Minority Identity on Mental Health and Subjective Wellbeing

Previous psychological and public health research has highlighted the impact of legal recognition of same-sex relationships on individual identity and mental health. Using a sample of U.S. sexual minority (N = 313) and heterosexual (N = 214) adults, participants completed a battery of mental health inventories prior to the nationwide legalization of same-sex marriage. Analyses of covariance (ANCOVAs) examining identity revealed sexual minority participants living in states where same-sex marriage was banned experienced significantly higher levels of internalized homonegativity than sexual minority participants living in states where same-sex marriage was legal, even after controlling for state-level political climate. Mental health ANCOVAs revealed sexual minority participants residing in states without same-sex marriage experienced greater anxiety and lower subjective wellbeing compared to sexual minority participants residing in states with same-sex marriage and heterosexual participants residing in states with or without same-sex marriage. Implications for public policy and future research directions are discussed.     

Mental Health of Transgender People in Hong Kong: A Community-Driven,Large-Scale Quantitative Study Documenting Demographics and Correlates of Quality of Life and Suicidality

A community-driven survey of 106 transgender people (the first such survey in Hong Kong) showed that: (1) more than half the sample (50.9%) had a university degree or higher qualification; (2) despite this, 43.4% had a monthly income below HK$6,000 (about USD$775); (3) 66% reported “fair” or “poor” quality of life; (4) 67% of the sample (87.1% of respondents aged 15–24 years) had contemplated suicide; and (5) 20.8% of the sample (35.5% of respondents aged 15–24 years) had attempted suicide. It was found that (1) those who were single, had a lower monthly income, and identified as transgender women reported lower quality of life; and (2) those who were younger and on a lower income expressed higher suicidality. The findings suggest that service providers and policy makers urgently need to address the mental health needs of transgender people, particular younger transgender people.     

Health Care Needs and Care Utilization Among Lesbian,Gay, Bisexual,and Transgender Populations in New Jersey

The purpose of this study was to explore prevalent health issues, perceived barriers to seeking health care, and utilization of health care among lesbian, gay, bisexual, and transgender (LGBT) populations in New Jersey. A cross-sectional online survey was administered to 438 self-identified LGBT people. Results identified health needs, which included management of chronic diseases, preventive care for risky behaviors, mental health issues, and issues related to interpersonal violence. Barriers to seeking health care included scarceness of health professionals competent in LGBT health, inadequate health insurance coverage and lack of personal finances, and widely dispersed LGBT inclusive practices making transportation difficult. There is a need for better preparation of health care professionals who care for LGBT patients, to strengthen social services to improve access and for better integration of medical and social services.     

Coming Out as Transgender: Navigating the Social Implications of a Transgender Identity

ABSTRACT

This study examines transgender coming-out narratives. Most previous studies of coming out as transgender have relied on psychological stage models of identity development, with little empirical verification. This study uses identity theory to reframe transgender coming out as a primarily external, ongoing, and socially situated process. The data were collected from 20 transgender people residing in the Minneapolis-St. Paul, Minnesota metro area through interviews and focus groups. The analyses reveal that coming out as transgender requires navigating others’ gender expectations, others’ reactions, and the threat of violence. The results indicate that transgender individuals do not simply decide to “come out of the closet” and then stay out. Rather, they make strategic decisions regarding the enactment of gender and gender identity disclosure based on specific social contexts. Coming out as transgender is best conceptualized as an ongoing, socially embedded, skilled management of one’s gender identity.     

Health Needs and Experiences of a LGBT Population in Georgia and South Carolina

ABSTRACT

The 2016 Municipal Equality Index rated Augusta, the largest city in the Central Savannah River Area (CSRA), as one of the least lesbian, gay, bisexual, and transgender (LGBT) friendly cities in America. To understand the context of our region in relation to LGBT wellness, we conducted the first LGBT health needs assessment of the CSRA, assessing physical and mental health status and health care needs and experiences in the community. Participants (N = 436) were recruited using venue and snowball sampling and completed an anonymous online survey. Overall, the health problems experienced (i.e., obesity, depression) were not uniformly experienced across sexual orientation and gender identity; some groups experienced significantly higher rates of these conditions than others. Similarly, transgender individuals in particular reported higher rates of negative experiences with health care providers. Regional and national dissemination of these findings is critical to reducing health disparities and improving wellness of our local LGBT community.     

Sense of Place and Health in Hamilton, Ontario: A Case Study

The concept of sense of place has received considerable attention by social scientists in recent years. Research has indicated that a person's sense of place is influenced by a number of factors including the built environment, socio-economic status (SES), well-being and health. Relatively few studies have examined sense of place at the neighbourhood level, particularly among communities exhibiting different levels of SES. This article investigates sense of place among three neighbourhood groups in Hamilton, Ontario representing areas of low, mixed and high SES. It analyses data from a 16-point sense of place scale derived from the Hamilton Household Quality of Life Survey carried out in 2010-2011 among 1,002 respondents. The paper found that sense of place was highest among residents of the high SES neighbourhood group as well as among home owners, people residing in single-detached homes, retired residents and those living in their neighbourhood for more than 10?years. From a health perspective, the paper found that a strong association existed between sense of place and self-perceived mental health across the three neighbourhood groups. Furthermore, by way of regression modeling, the paper examined the factors influencing health-related sense of place. Among the sample of respondents, a strong connection was found between housing, particularly home ownership, and high levels of health-related sense of place.     

The South Carolina LGBT Needs Assessment: A Descriptive Overview

Limited quantitative information exists about the demographics and needs of lesbian, gay, bisexual, and transgender (LGBT) persons in South Carolina, a predominately rural Southern state. Responses to a needs assessment survey (n = 715) were analyzed to understand the diversity and needs of members of the LGBT community in SC. The purpose was to inform future programming and guide the development of a more comprehensive portfolio of services to be offered by a local LGBT community center. Findings suggest that a diverse LGBT community exists in SC and needs include increased programming for community members as well as efforts to provide policy-level support and increased acceptability and understanding of LGBT persons in South Carolina.     

[The mechanism and policy of the new stage of labor force migration in rural areas].]

The dynamics of rural labor migration in various countries are explored, with emphasis on the policies required to control such migration flows. The economic structure and conditions of rural and non-rural regions and their effect on migration are described. Factors affecting the decision to migrate are also examined. Data are from published U.N. sources.     

Residential independence among older persons: community and individual factors

The objective of this study is to evaluate an expanded version of the resource model of living arrangements among older persons. This expanded model includes community-level measures of geriatric health services and housing market conditions. We employ the first two waves of the National Survey of Families and Households to test static and longitudinal fixed effects models of residential living arrangements. We find that residing in areas with higher levels of geriatric health care services increases the likelihood of residential independence, net of other contextual factors and individual characteristics. Our results show that housing market conditions are not related to levels of or changes in residential independence when control variables are included in the models. The results for the individual-level resource variables show that persons with greater economic resources, more children, and better functional status are better able to maintain independence and are less likely to die or live in a nursing home. This study shows the utility of expanding on micro-level approaches to understanding community living arrangements among older persons. Future investigations should include measures of the policy environment, transportation constraints and opportunities, and a more complete array of indicators of health and social services oriented toward helping elderly persons maintain their independence.