Unmet Healthcare Need Due to Cost Concerns among U.S. Transgender and Gender-Expansive Adults: Results from a National Survey

2021 ◽  
Author(s):  
Luisa Kcomt ◽  
Kevin M Gorey ◽  
Betty Jo Barrett ◽  
Dana S Levin ◽  
Jill Grant ◽  
...  
Keyword(s):  
Regression Models ◽  
Healthcare Access ◽  
The United States ◽  
Transgender Women ◽  
Logistic Regression Models ◽  
The Past ◽  
Patient Protection ◽  
And Gender ◽  
Healthcare Need ◽  
Transgender Men

Abstract This study examines past-year unmet healthcare need due to cost experienced by transgender and gender-expansive (TGE) adults in the United States in the context of the Patient Protection and Affordable Care Act (ACA). It also aims to estimate the importance of having health insurance among TGE Americans (transgender men, transgender women, nonbinary/genderqueer people, and cross-dressers). Data were from the 2015 U.S. Transgender Survey (N = 19,157 adults, aged 25 to 64 years). Multivariable logistic regression models were used to determine the adjusted odds ratios (AOR) and 95 percent confidence intervals (CI) of TGE individuals’ past-year unmet healthcare need due to cost. Although the majority (86.8 percent) reported seeing a doctor or healthcare provider in the past year, 32.1 percent reported past-year unmet healthcare need due to cost. One in six respondents (17.1 percent) was uninsured and almost one-third (29.8 percent) were at/near poverty. The prevalence of unmet healthcare need was greater among the uninsured (65.1 percent) than among the insured (25.2 percent). Compared with transgender women, nonbinary/genderqueer people (AOR = 1.31, 95% CI [1.18, 1.46]) and transgender men (AOR = 1.30, 95% CI [1.18, 1.42]) had greater odds of unmet healthcare need due to cost. Social workers can lobby to fully enact the ACA by underscoring affordability and availability as important dimensions of healthcare access for TGE populations.

Comparing the Health of Transgender Women, Transgender Men, and Gender Non-Conforming Individuals Using Population-Level Data

2020 ◽  
Vol 1 (1) ◽  
pp. 43-62 ◽  
Author(s):  
Arryn A. Guy ◽  
Wren Yoder ◽  
Kelly Manser ◽  
Stephen D. Ramos ◽  
Steve N. Du Bois
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Healthcare Access ◽  
Population Level ◽  
Transgender Women ◽  
Level Data ◽  
Race Ethnicity ◽  
And Gender ◽  
Mental And Physical Health ◽  
Transgender Men

Converging evidence indicates transgender and gender non-conforming (TGNC) individuals generally experience poorer health than their cisgender counterparts. Less is known about TGNC health across gender identity subgroups. Extant work has yielded mixed findings, precluding conclusions regarding the comparative health of transgender women, transgender men, and gender non-conforming individuals. Additionally, this work is limited methodologically, e.g., utilizing convenience samples and operationalizing “transgender” differently across studies. This study aims to improve upon these limitations, and more broadly add to the literature on within-group health differences among TGNC individuals. We used 2016 U.S. population-level data (N = 1,117), conducting MANCOVA (multivariate analysis of covariance) and logistic regression to compare the health of transgender women, transgender men, and GNC individuals. Health outcomes of mental and physical health, substance use, and healthcare access/utilization were selected based on empirical and theoretical support for their relevance to TGNC health. We also completed interaction analyses to test the intersectional effects on health of gender identity and emergent sociodemographic variables, e.g. race/ethnicity. Across TGNC subgroups, individuals reported similar alcohol use, mental health, and healthcare access/utilization. Transgender men reported worse physical health than their counterparts, and GNC individuals reported lower smoking prevalence than their counterparts. Interaction analyses by race/ethnicity indicated Hispanic transgender women reported worse physical health than other Hispanic TGNC individuals, while Black transgender men, Multiracial GNC individuals, and Hispanic transgender women reported worse mental health than some of their intra-racial/ethnic TGNC counterparts. Findings add to the growing literature on TGNC health and highlight TGNC subgroups that may be vulnerable regarding mental and physical health.

Hearing Gender: Voice-Based Gender Classification Processes and Transgender Health Inequality

2019 ◽  
Vol 84 (5) ◽  
pp. 801-827 ◽  
Author(s):  
Danya Lagos
Keyword(s):  
Gender Identity ◽  
Transgender Women ◽  
Gender Classification ◽  
Logistic Regression Models ◽  
Self Rated Health ◽  
And Gender ◽  
Original Survey ◽  
Average Marginal Effects ◽  
Ethnicity And Gender ◽  
Transgender Men

This study examines the link between self-rated health and two aspects of gender: an individual’s gender identity, and whether strangers classify that person’s voice as male or female. In a phone-based general health survey, interviewers classified the sex of transgender women ( n = 722) and transgender men ( n = 446) based on assumptions they made after hearing respondents’ voices. The flawed design of the original survey produced inconsistent sex classification among transgender men and transgender women respondents; this study repurposes these discrepancies to look more closely at the implications of voice-based gender classification for the health of transgender men and women. Average marginal effects from logistic regression models show transgender men who are classified as women based on their voices are more likely to report poor self-rated health compared to transgender men who are classified as men. Conversely, transgender women who are classified as men are less likely to report poor self-rated health than are transgender women who are classified as women. Additionally, Black transgender men are more likely than any other group to be classified inconsistently with their gender identity, suggesting a link between race/ethnicity and gender perception.

scholarly journals Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys

BMJ ◽  
2019 ◽  
pp. l2219 ◽  
Author(s):  
David Hammond ◽  
Jessica L Reid ◽  
Vicki L Rynard ◽  
Geoffrey T Fong ◽  
K Michael Cummings ◽  
...  
Keyword(s):  
United States ◽  
Regression Models ◽  
Smoking Prevalence ◽  
The United States ◽  
Close Monitoring ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Nicotine Concentration ◽  
The Past ◽  
The Us

Abstract Objective To examine differences in vaping and smoking prevalence among adolescents in Canada, England, and the United States. Design Repeat cross sectional surveys. Setting Online surveys in Canada, England, and the US. Participants National samples of 16 to 19 year olds in 2017 and 2018, recruited from commercial panels in Canada (n=7891), England (n=7897), and the US (n=8140). Main outcome measures Prevalence of vaping and smoking was assessed for use ever, in the past 30 days, in the past week, and on 15 days or more in the past month. Use of JUUL (a nicotine salt based electronic cigarette with high nicotine concentration) and usual vaping brands were also assessed. Logistic regression models examined differences in vaping and smoking between countries and over time. Results The prevalence of vaping in the past 30 days, in the past week, and on 15 days or more in the past month increased in Canada and the US between 2017 and 2018 (P<0.001 for all), including among non-smokers and experimental smokers, with no changes in England. Smoking prevalence increased in Canada (P<0.001 for all measures), with modest increases in England, and no changes in the US. The percentage of ever vapers who reported more frequent vaping increased in Canada and the US (P<0.01 for all), but not in England. The use of JUUL increased in all countries, particularly the US and Canada—for example, the proportion of current vapers in the US citing JUUL as their usual brand increased threefold between 2017 and 2018. Conclusions Between 2017 and 2018, among 16 to 19 year olds the prevalence of vaping increased in Canada and the US, as did smoking in Canada, with little change in England. The rapidly evolving vaping market and emergence of nicotine salt based products warrant close monitoring.

785 Reported Restful Sleep Predicting Emotional Distress: Does Exercise (and its modalities) moderate?

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A305-A306
Author(s):  
Jesse Moore ◽  
Ellita Williams ◽  
Collin Popp ◽  
Anthony Briggs ◽  
Judite Blanc ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Aerobic Exercise ◽  
Regression Models ◽  
Regression Analyses ◽  
Logistic Regression Models ◽  
The Past ◽  
Strengthening Exercise ◽  
Waking Up ◽  
The Relationship ◽  
Age And Sex

Abstract Introduction Literature shows that exercise moderates the relationship between sleep and emotional distress (ED.) However, it is unclear whether different types of exercise, such as aerobic and strengthening, affect this relationship differently. We investigated the moderating role of two types of exercise (aerobic and strengthening) regarding the relationship between ED and sleep. Methods Our analysis was based on data from 2018 National Health Interview Survey (NHIS), a nationally representative study in which 2,814 participants provided all data. Participants were asked 1) “how many days they woke up feeling rested over the past week”, 2) the Kessler 6 scale to determine ED (a score &gt;13 indicates ED), and 3) the average frequency of strengthening or aerobic exercise per week. Logistic regression analyses were performed to determine if the reported days of waking up rested predicted level of ED. We then investigated whether strengthening or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Logistic regression analyses were performed to determine if subjective reporting of restful sleep predicted level of ED. We investigated whether strengthening exercise or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Results On average, participants reported 4.41 restful nights of sleep (SD =2.41), 3.43 strengthening activities (SD = 3.19,) and 8.47 aerobic activities a week (SD=5.91.) We found a significant association between days over the past week reporting waking up feeling rested and ED outcome according to K6, Χ2(1) = -741, p= &lt;.001. The odds ratio signified a decrease of 52% in ED scores for each unit of restful sleep (OR = .48, (95% CI = .33, .65) p=&lt;.001.) In the logistic regression model with moderation, aerobic exercise had a significant moderation effect, Χ2(1) = .03, p=.04, but strengthening exercise did not. Conclusion We found that restful sleep predicted reduction in ED scores. Aerobic exercise moderated this relationship, while strengthening exercise did not. Further research should investigate the longitudinal effects of exercise type on the relationship between restful sleep and ED. Support (if any) NIH (K07AG052685, R01MD007716, K01HL135452, R01HL152453)

The Past Is Prologue: Criminal Specialization Continuity in the Delinquent Career

2018 ◽  
Vol 17 (4) ◽  
pp. 335-353 ◽  
Author(s):  
Matt DeLisi ◽  
Ramate Bunga ◽  
Mark H. Heirigs ◽  
Jacob H. Erickson ◽  
Andy Hochstetler
Keyword(s):  
Logistic Regression ◽  
Regression Models ◽  
Specific Form ◽  
Theoretical Research ◽  
Logistic Regression Models ◽  
Aggravated Assault ◽  
The Past ◽  
California Youth Authority ◽  
Important Evidence ◽  
Robust Evidence

The versatility/specialization debate in criminology has important theoretical, research, and juvenile/criminal justice ramifications. Although offenders are mostly versatile, there is important evidence of specialization, but much of this evidence is derived from highly technical statistical approaches. Drawing on data from a cohort of serious delinquents committed to the California Youth Authority, logistic regression models revealed robust evidence for criminal specialization net the effects of behavioral and demographic controls. Prior homicide was associated with a 1,467% increased likelihood of being currently adjudicated for a homicide offense. Similar prior–current involvement in robbery (294% increased likelihood), aggravated assault (200%), burglary (148%), and drug sales (736%) was found. Logistic regression with odds ratios provides intuitive, valuable estimates of specialization in offending whereby prior involvement in a specific form of delinquency dramatically increases the likelihood of current involvement in the same form of crime.

scholarly journals Understanding the Association Between Spontaneous Quit Attempts and Improved Smoking Cessation Success Rates: A Population Survey in England With 6-Month Follow-up

2019 ◽  
Vol 22 (9) ◽  
pp. 1460-1467 ◽  
Author(s):  
Claire Garnett ◽  
Lion Shahab ◽  
Tobias Raupach ◽  
Robert West ◽  
Jamie Brown
Keyword(s):  
Regression Models ◽  
Population Survey ◽  
Adult Population ◽  
Success Rates ◽  
Logistic Regression Models ◽  
The Past ◽  
Quit Attempt ◽  
Quit Attempts ◽  
Adjusted Model

Abstract Introduction Almost half of smoking quit attempts are “spontaneous” (initiated as soon as the decision to quit has been made) and are associated with increased success rates. This study aimed to assess to what extent other factors may account for this association. Methods Data were used from respondents to a survey representative of the adult population in England from 2006 to 2016. We included 2018 respondents who were current smokers at baseline and had attempted to quit between baseline and 6-month follow-up. Logistic regression models assessed the association between quit success and spontaneous quit attempts while adjusting for smoking, sociodemographic, and quit attempt characteristics. Results Spontaneous quit attempts were associated with greater odds of quit success (OR = 1.31, 95% CI = 1.07 to 1.60) but the association was not significant in the fully adjusted model (ORadj = 1.19, 95% CI = 0.95 to 1.49). In this adjusted model, those who attempted to quit without cutting down first (ORadj = 3.08, 95% CI = 2.46 to 3.88) and were male (ORadj = 1.44, 95% CI = 1.16 to 1.80) had greater odds of success; although a greater number of attempts in the past 6 months, stronger urges to smoke (strong vs. none), higher daily cigarette consumption, and lower social grade (E vs. AB) were associated with lower odds of success (ORadj range = 0.32–0.98, p &lt; .030). Quit attempts made without cutting down first were correlated with spontaneous quit attempts (r = .150, p &lt; .001) and appeared to account for the diminished association between spontaneous quitting and success (ORadj = 1.18, 95% CI = 0.96 to 1.46). Conclusions The increased success rate of spontaneous quit attempts appears to be because spontaneous quit attempts are more likely to be made without cutting down first. Implications The apparent benefit of spontaneous over planned quit attempts may be attributable to the former being more likely to involve quitting without cutting down first (ie, abrupt cessation) than cutting down first (ie, gradual cessation) and so this may be a more useful target for advice to improve the chances of successful quitting.

Transgender and Nonbinary Gender Policy in the Public Sector

2019 ◽  
Author(s):  
Nicole M. Elias
Keyword(s):  
The United States ◽  
Physical And Mental Health ◽  
Public Agencies ◽  
Transgender People ◽  
The Public ◽  
Gender Policy ◽  
The Past ◽  
Government Documents ◽  
Nonbinary Gender ◽  
And Gender

Our understanding and treatment of gender in the United States has evolved significantly over the past four decades. Transgender individuals in the current U.S. context enjoy more rights and protections than they have in the past; yet, room for progress remains. Moving beyond the traditional male–female binary, an unprecedented number of people now identify as transgender and nonbinary. Transgender identities are at the forefront of gender policy, prompting responses from public agencies at the local, state, and federal levels. Because transgender individuals face increased rates of discrimination, violence, and physical and mental health challenges, compared to their cisgender counterparts, new gender policy often affords legal protections as well as identity-affirming practices such as legal name and gender marker changes on government documents. These rights come from legal decisions, legislation, and administrative agency policies. Despite these victories, recent government action targeting the transgender population threatens the progress that has been made. This underscores the importance of comprehensive policies and education about transgender identities to protect the rights of transgender people.

scholarly journals The Prevalence of Vaping and Smoking as Modes of Delivery for Nicotine and Cannabis among Youth in Canada, England and the United States

2019 ◽  
Vol 16 (21) ◽  
pp. 4111 ◽  
Author(s):  
Fathima Fataar ◽  
David Hammond
Keyword(s):  
Regression Models ◽  
Online Survey ◽  
The United States ◽  
Cannabis Use ◽  
Medical Cannabis ◽  
Logistic Regression Models ◽  
Canadian Youth ◽  
Patterns Of Use ◽  
Country Differences ◽  
The U.S

Background: Vaping has become an increasingly common mode of administration for both nicotine and cannabis, with overlap among users, devices, as well as nicotine and cannabis companies. There is a need to understand patterns of use among youth, including the way nicotine and cannabis are administered. Methods: Data are from Wave 2 of the ITC Youth Tobacco and Vaping survey, an online survey conducted in 2018 among 16–19 year-olds recruited from commercial panels in Canada (n = 3757), England (n = 3819), and the U.S. (n = 3961). The prevalence of past 30-day vaping nicotine, non-nicotine and cannabis substances, as well as cannabis modes of use was examined. Logistic regression models examined between country differences in prevalence. Results: Past 30-day cannabis use was highest among Canadian youth (16.6%), followed by youth in the U.S. (13.8%) and England (9.0%). Vaping e-cigarettes was substantially more prevalent than vaping cannabis in all three countries. All forms of cannabis use were higher among Canadian and U.S. youth compared to England (p < 0.001 for all). Past 30-day cannabis users in the U.S. were more likely to report vaping cannabis oil (30.1%), and consuming solid concentrates such as wax and shatter (30.2%), compared to cannabis users in Canada (18.6% and 22.9%) and England (14.3% and 11.0%; p < 0.001 for all). Conclusions: Youth are administering cannabis and nicotine using a wide diversity of modes. Cannabis users in the U.S.—where an increasing number of states have legalized medical and non-medical cannabis—reported notably higher use of more potent cannabis products, including cannabis oils and extracts.

Correlates of Perceived HIV Prevalence and Associations With HIV Testing Behavior Among Men Who Have Sex With Men in the United States

2014 ◽  
Vol 10 (2) ◽  
pp. 90-99 ◽  
Author(s):  
Darcy White ◽  
Rob Stephenson
Keyword(s):  
United States ◽  
Logistic Regression ◽  
Hiv Testing ◽  
Regression Models ◽  
Binary Logistic Regression ◽  
The United States ◽  
Hiv Prevalence ◽  
Logistic Regression Models ◽  
Sex With Men ◽  
Hiv Testing Behavior

As the rate of HIV infection continues to rise among men who have sex with men (MSM) in the United States, a focus of current prevention efforts is to encourage frequent HIV testing. Although levels of lifetime testing are high, low levels of routine testing among MSM are concerning. Using data from an online sample of 768 MSM, this article explores how perceptions of HIV prevalence are associated with HIV testing behavior. Ordinal logistic regression models were fitted to examine correlates of perceived prevalence, and binary logistic regression models were fitted to assess associations between perceived prevalence and HIV testing. The results indicate that perceptions of higher prevalence among more proximal reference groups such as friends and sex partners are associated with greater odds of HIV testing. Perceptions of HIV prevalence were nonuniform across the sample; these variations point to groups to target with strategic messaging and interventions to increase HIV testing among MSM.

Ethnicity Significantly Influences Incidence Patterns and Predicts Mortality: Adult Hodgkin Lymphoma (HL) In the United States (US)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2683-2683
Author(s):  
Andrew M Evens ◽  
Eileen Shiuan ◽  
Soyang Kwon ◽  
Leo I Gordon ◽  
Brian Chiu
Keyword(s):  
Mortality Rate ◽  
Conflicts Of Interest ◽  
The United States ◽  
Annual Percent Change ◽  
Black Females ◽  
The Past ◽  
Seer Data ◽  
Black Populations ◽  
And Gender ◽  
The Impact

Abstract Abstract 2683 Background: Pediatric HL studies have suggested survival differences based on ethnicity. However, little data is available regarding the impact, if any, of ethnicity on incidence patterns, disease histology, and/or survival among adult HL. Methods: We examined data for 13 US SEER areas, several of which contain large Hispanic and Black populations. Case information was obtained from the 11/2009 SEER data submission released April 2010. We analyzed incidence, HL histology, and mortality rates according to ethnicity, age, and gender. We also examined incidence patterns across the past four decades. All analyses used SEER*Stat. Results: A total of 16,783 HL cases were diagnosed among residents in the 13 SEER registry areas during 1992–2007, with non-Hispanic Whites contributing the largest number (n=11,890), followed by Hispanics (n=2,190), and Blacks (n=1,724). Consistent with SEER 9 results (1973 data), Whites show a continued bimodal age-incidence curve (6.0/100,000 ages 25–29, 2.5/100,000 ages 50–54, and 4.5/100,000 age 75–79). However, Blacks have a much less apparent bimodal pattern (4.5/100,000 ages 25–29, 2.6/100,000 ages 50–54, and 3.0/100,000 ages 75–79), while Hispanics are distinctly not bimodal with a small increase at 20–24 (2.4/100,000) followed by an exponential-like increase with peak HL incidence at ages 80–84 (7.0/100,000). Moreover, among persons >65 years, HL is currently significantly more common in Hispanics than Whites (4.7-7.0/100,000 vs 3.9–4.5/100,000, respectively, p<0.05). With gender, HL is more common in males than females, regardless of ethnicity. Interestingly, the male excess, however, does not occur until ages 30–34 (all ethnicities). Furthermore, from 1975–2007, HL incidence increased in Black females (annual percent change (APC) = 2.5; p<0.05) and White females (APC = 0.4; p<0.05). According to histology, both nodular sclerosis and mixed cellularity are more common in Whites followed by Blacks and Hispanics, while in persons age 60–84, both histologies are significantly more common in Hispanics compared with Whites and Blacks. Over the past 20 years, mortality has declined within each race by 10.3%–13.7% (p<0.05). However, age-specific ethnic survival disparities are apparent (Figure 1). For ages 65–84, Hispanics have a significantly increased mortality rate compared with Whites/Blacks (p<0.05). Conversely, among ages 20–44, Hispanics have a lower mortality rate versus Whites and Blacks. Conclusions: Multiple important epidemiologic and mortality differences are evident across and within ethnicities in adult HL. *Both sexes (1992-2007). Rates are per 100,000. Mortality source: US Mortality Files, National Center for Health Statistics, CDC. Accessed August 12th, 2010. Disclosures: No relevant conflicts of interest to declare.

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