The Experts below are selected from a list of 43635 Experts worldwide ranked by ideXlab platform
Bryn S Austin - One of the best experts on this subject based on the ideXlab platform.
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Social epidemiology of depression and anxiety by gender identity
Journal of Adolescent Health, 2016Co-Authors: Sabra L Katzwise, Allegra R Gordon, Heather L Corliss, Sari L Reisner, Bryn S AustinAbstract:Abstract Purpose This study investigates depression and anxiety in gender minority (i.e., transgender and/or gender nonconforming) compared with nongender minority (cisgender) young adults. Methods Data were from the Growing Up Today Study, a national cohort of U.S. young adults. A two-step method (maternal-reported natal sex in 1996 cross-classified with participant-reported current gender identity in 2010) was used to identify gender minority and nongender minority respondents (n = 7,831; mean age = 26 years). Differences in past week depressive symptoms and anxious symptoms were examined cross-sectionally by gender identity. Gender minority and nongender minority respondents were compared using age-adjusted logistic regression models. Results In gender minorities, the prevalence of depressive and anxious symptoms meeting clinical cutoffs was 52% and 38%, respectively, compared with nongender minorities (27% and 30% in females and 25% and 14% in males; p Conclusions Gender identity is an understudied Social Determinant of mental health. Surveillance efforts to monitor mental health disparities should include survey questions to assess gender identity in epidemiologic research. Research and interventions to understand and ameliorate mental health disparities by gender identity are needed.
Sari L Reisner - One of the best experts on this subject based on the ideXlab platform.
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integrated and gender affirming transgender clinical care and research
Journal of Acquired Immune Deficiency Syndromes, 2016Co-Authors: Sari L Reisner, Asa Radix, Madeline B DeutschAbstract:Transgender (trans) communities worldwide, particularly those on the trans feminine spectrum, are disproportionately burdened by HIV infection and at risk for HIV acquisition/transmission. Trans individuals represent an underserved, highly stigmatized, and under-resourced population not only in HIV prevention efforts but also in delivery of general primary medical and clinical care that is gender affirming. We offer a model of gender-affirmative integrated clinical care and community research to address and intervene on disparities in HIV infection for transgender people. We define trans terminology, briefly review the Social epidemiology of HIV infection among trans individuals, highlight gender affirmation as a key Social Determinant of health, describe exemplar models of gender-affirmative clinical care in Boston MA, New York, NY, and San Francisco, CA, and offer suggested "best practices" for how to integrate clinical care and research for the field of HIV prevention. Holistic and culturally responsive HIV prevention interventions must be grounded in the lived realities the trans community faces to reduce disparities in HIV infection. HIV prevention interventions will be most effective if they use a structural approach and integrate primary concerns of transgender people (eg, gender-affirmative care and management of gender transition) alongside delivery of HIV-related services (eg, biobehavioral prevention, HIV testing, linkage to care, and treatment).
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Social epidemiology of depression and anxiety by gender identity
Journal of Adolescent Health, 2016Co-Authors: Sabra L Katzwise, Allegra R Gordon, Heather L Corliss, Sari L Reisner, Bryn S AustinAbstract:Abstract Purpose This study investigates depression and anxiety in gender minority (i.e., transgender and/or gender nonconforming) compared with nongender minority (cisgender) young adults. Methods Data were from the Growing Up Today Study, a national cohort of U.S. young adults. A two-step method (maternal-reported natal sex in 1996 cross-classified with participant-reported current gender identity in 2010) was used to identify gender minority and nongender minority respondents (n = 7,831; mean age = 26 years). Differences in past week depressive symptoms and anxious symptoms were examined cross-sectionally by gender identity. Gender minority and nongender minority respondents were compared using age-adjusted logistic regression models. Results In gender minorities, the prevalence of depressive and anxious symptoms meeting clinical cutoffs was 52% and 38%, respectively, compared with nongender minorities (27% and 30% in females and 25% and 14% in males; p Conclusions Gender identity is an understudied Social Determinant of mental health. Surveillance efforts to monitor mental health disparities should include survey questions to assess gender identity in epidemiologic research. Research and interventions to understand and ameliorate mental health disparities by gender identity are needed.
Gala True - One of the best experts on this subject based on the ideXlab platform.
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screening for housing instability providers reflections on addressing a Social Determinant of health
Journal of General Internal Medicine, 2019Co-Authors: Manik Chhabra, Anneliese E Sorrentino, Meagan Cusack, Melissa E Dichter, Ann Elizabeth Montgomery, Gala TrueAbstract:Background The Veterans Health Administration (VHA) has a long history of addressing Social Determinants of health, including housing. In 2012, the VA integrated a two-question Homelessness Screening Clinical Reminder (HSCR) into the electronic medical record in outpatient clinics to identify Veterans experiencing housing instability and ensure referral to appropriate services. Objective This study explores perspectives of VA clinical providers regarding administration of the HSCR, their role in addressing housing status, and how a patient's housing status impacts clinical decision-making. Design We conducted a qualitative study using in-depth semi-structured interviewing. Participants Twenty-two providers were interviewed (20 physicians and two nurse practitioners) between March and September 2016. Approach Interviews were conducted with Veterans Health Administration (VHA) physician and non-physician practitioners who had administered the HSCR and documented at least five positive screens between 2013 and 2015. Our interview guide investigated provider experiences with administering the HSCR and addressing affirmative responses. The guide also elicited details about how patients' housing instability was identified (if at all) prior to implementation of the screening reminder, and how practices changed following implementation of the HSCR. Transcripts were analyzed using a modified grounded theory approach. Key results Providers reported that the HSCR prompted them to incorporate patient housing status into routine assessment, which they typically did not do prior to its implementation. Providers discussed adverse impacts of housing instability on patients' overall health and described how they factored patients' housing instability into clinical decision-making. Although providers viewed the health system as having an important role in addressing housing concerns, there were mixed opinions on whether it was the role of providers to directly administer the screening. Conclusions Integration of a screener for housing instability into the electronic medical record increased provider attention to housing instability into the Social history, and positive responses commonly impacted plans of care.
Ann Elizabeth Montgomery - One of the best experts on this subject based on the ideXlab platform.
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screening for housing instability providers reflections on addressing a Social Determinant of health
Journal of General Internal Medicine, 2019Co-Authors: Manik Chhabra, Anneliese E Sorrentino, Meagan Cusack, Melissa E Dichter, Ann Elizabeth Montgomery, Gala TrueAbstract:Background The Veterans Health Administration (VHA) has a long history of addressing Social Determinants of health, including housing. In 2012, the VA integrated a two-question Homelessness Screening Clinical Reminder (HSCR) into the electronic medical record in outpatient clinics to identify Veterans experiencing housing instability and ensure referral to appropriate services. Objective This study explores perspectives of VA clinical providers regarding administration of the HSCR, their role in addressing housing status, and how a patient's housing status impacts clinical decision-making. Design We conducted a qualitative study using in-depth semi-structured interviewing. Participants Twenty-two providers were interviewed (20 physicians and two nurse practitioners) between March and September 2016. Approach Interviews were conducted with Veterans Health Administration (VHA) physician and non-physician practitioners who had administered the HSCR and documented at least five positive screens between 2013 and 2015. Our interview guide investigated provider experiences with administering the HSCR and addressing affirmative responses. The guide also elicited details about how patients' housing instability was identified (if at all) prior to implementation of the screening reminder, and how practices changed following implementation of the HSCR. Transcripts were analyzed using a modified grounded theory approach. Key results Providers reported that the HSCR prompted them to incorporate patient housing status into routine assessment, which they typically did not do prior to its implementation. Providers discussed adverse impacts of housing instability on patients' overall health and described how they factored patients' housing instability into clinical decision-making. Although providers viewed the health system as having an important role in addressing housing concerns, there were mixed opinions on whether it was the role of providers to directly administer the screening. Conclusions Integration of a screener for housing instability into the electronic medical record increased provider attention to housing instability into the Social history, and positive responses commonly impacted plans of care.
M Emiley P H Chang - One of the best experts on this subject based on the ideXlab platform.
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capsule commentary on lee et al health literacy as a Social Determinant of health in asian american immigrants findings from a population based survey in california
Journal of General Internal Medicine, 2015Co-Authors: M Emiley P H ChangAbstract:Lee and colleagues used population-based data from the California Health Interview Survey (CHIS) to assess the relationship between self-rated health (SRH), depressive symptoms and health literacy among five Asian American immigrant groups.1 Controlling for English proficiency and duration of U.S. residence, health literacy levels for Chinese, Korean, and Vietnamese immigrants were lower than for non-Latino whites. Health literacy was positively associated with SRH among Chinese and Koreans and negatively associated with depressive symptoms among Koreans and South Asians. These findings support the use of brief health literacy screens in routine clinical care.2 This study disaggregated Asian Americans by ethnicity to identify groups disproportionately affected by poor health literacy, which may help focus community-based interventions. However, use of the two-item health literacy measure in CHIS limits interpretation; the mechanisms linking health literacy, SRH, and depressive symptoms for these groups remain unclear and it is possible that they are inadequately captured by items focusing on reading. Language is an incomplete explanation. While a previous study showed that limited English proficiency patients with language-concordant physicians reported fewer problems with medical comprehension compared to patients with language-discordant physicians,3 the current analysis adjusted for English language proficiency and the surveyed South Asians had high levels of English proficiency. The cross-sectional study design also leaves the possibility of reverse causation, that individuals with depression have lower health literacy. Paasche-Orlow and Wolf suggest that health literacy influences three points in health care: access and utilization, patient–provider relationship, and self-care.4 A subsequent path analysis study confirmed an indirect pathway from health literacy to health status via knowledge and self-efficacy.5 Health literacy reflects the ability to not only obtain information, but also to use it appropriately. Culture can influence expectations for communication, beliefs about patients’ role in decision making, and motivation to seek help for depressive symptoms. Investigating the relationship between these factors and health literacy may help explain why the association between health literacy and outcomes differed between ethnic groups, and inform interventions to improve the health of Asian American patients.