'I don't want to have to teach every medical provider': barriers to care among non-binary people in the Canadian healthcare system.

It is well-known that trans and non-binary individuals experience worse health outcomes due to experiences of violence and discrimination. For this reason, accessible healthcare for trans and non-binary people is crucial. There is a lack of Canadian literature on the experiences of non-binary people within the healthcare system. This study sought to understand barriers to healthcare among non-binary people living in a mid-sized urban/rural region of Canada. Interviews were conducted between November 2019 to March 2020 with 12 non-binary individuals assigned female at birth, living in Waterloo Region, Ontario, Canada, as a part of a larger qualitative study exploring experiences within the community, healthcare and employment. Three broad themes were developed: erasure, barriers to access to healthcare, and assessing whether (or not) to come out. Sub-themes included institutional erasure, informational erasure, general healthcare barriers, medical transition healthcare barriers, anticipated discrimination, and assessing safety. Policy and institutional changes are needed to increase the safety and accessibility of healthcare services to non-binary individuals.

The effects of base rate neglect on sequential belief updating and real-world beliefs.

Base-rate neglect is a pervasive bias in judgment that is conceptualized as underweighting of prior information and can have serious consequences in real-world scenarios. This bias is thought to reflect variability in inferential processes but empirical support for a cohesive theory of base-rate neglect with sufficient explanatory power to account for longer-term and real-world beliefs is lacking. A Bayesian formalization of base-rate neglect in the context of sequential belief updating predicts that belief trajectories should exhibit dynamic patterns of dependence on the order in which evidence is presented and its consistency with prior beliefs. To test this, we developed a novel 'urn-and-beads' task that systematically manipulated the order of colored bead sequences and elicited beliefs via an incentive-compatible procedure. Our results in two independent online studies confirmed the predictions of the sequential base-rate neglect model: people exhibited beliefs that are more influenced by recent evidence and by evidence inconsistent with prior beliefs. We further found support for a noisy-sampling inference model whereby base-rate neglect results from rational discounting of noisy internal representations of prior beliefs. Finally, we found that model-derived indices of base-rate neglect-including noisier prior representation-correlated with propensity for unusual beliefs outside the laboratory. Our work supports the relevance of Bayesian accounts of sequential base-rate neglect to real-world beliefs and hints at strategies to minimize deleterious consequences of this pervasive bias.

Exploring community enabling factors associated with recent HIV testing in a regional sample of gay, bisexual, and other men who have sex with men.

HIV testing and diagnosis are the gateway into treatment and eventual viral suppression. With gay, bisexual, and other men who have sex with men (GBMSM) persistently over-representing new HIV diagnoses in Canada, combined with the evolving nature of community social connection, an exploration of factors associated with recent HIV testing is warranted. As most studies of GBMSM rely on samples obtained from larger metropolitan regions, examining HIV testing from an under-researched region is necessary. With data collected from an online survey of LGBTQ+ persons 16 or older living, working, or residing in the Region of Waterloo, Ontario, Canada, we used multinomial logistic regression to explore socio-demographic, behavioural, and psychosocial factors associated with recent HIV testing for GBMSM. In the final multivariate multinomial logistic regression model: sense of belonging was associated with more recently testing, as was having an increasing proportion of LGBT friends, app use to find sex partners in the past 12 months, access to the local AIDS service organization, and general sense of belonging to local community, among other. This analysis highlights the continued importance of enabling and need factors when accessing testing, and suggests areas for further testing promotion in physical and virtual spaces frequented by GBMSM.

Individual differences in the perception of probability.

In recent studies of humans estimating non-stationary probabilities, estimates appear to be unbiased on average, across the full range of probability values to be estimated. This finding is surprising given that experiments measuring probability estimation in other contexts have often identified conservatism: individuals tend to overestimate low probability events and underestimate high probability events. In other contexts, repulsive biases have also been documented, with individuals producing judgments that tend toward extreme values instead. Using extensive data from a probability estimation task that produces unbiased performance on average, we find substantial biases at the individual level; we document the coexistence of both conservative and repulsive biases in the same experimental context. Individual biases persist despite extensive experience with the task, and are also correlated with other behavioral differences, such as individual variation in response speed and adjustment rates. We conclude that the rich computational demands of our task give rise to a variety of behavioral patterns, and that the apparent unbiasedness of the pooled data is an artifact of the aggregation of heterogeneous biases.

Experiences of trans patients in primary care settings: findings from The OutLook Study.

BACKGROUND: Relationships between primary care providers (PCP) and trans patients remain important, necessitating discussions about gender identity, health and their intersections. METHODS: Using an online survey, we explored socio-demographic and psycho-social factors associated with: (1) disclosing gender identity; (2) discussing gender identity-related health issues; and (3) comfort sharing gender identity with PCPs, among trans people (n =112) over 16years of age, sampled in Waterloo, Ontario, Canada. Bivariate and multivariate methods using modified Poisson regression generated effect estimates. RESULTS: Age, birth presumed gender, employment status, family support, and transphobia were significantly associated with disclosing gender identity, discussing gender identity-related health issues, and comfortability sharing gender identity with PCPs. CONCLUSION: Increasing PCPs' knowledge of trans-related health issues is stressed to improve access and quality for trans patients.

Multiple conceptions of resource rationality.

Resource rationality holds great promise as a unifying principle across theories in neuroscience, cognitive science, and economics. The target article clearly lays out this potential for unification. However, resource-rational models are more diverse and less easily unified than might appear from the target article. Here, we explore some of that diversity.

Transphobia rather than education predicts provider knowledge of transgender health care.

PURPOSE: Transgender and gender diverse (TGD) patients face significant hurdles in accessing affirming, knowledgeable care. Lack of provider knowledge presents a substantial barrier to both primary and transition-related care and may deter patients from seeking health care. Little is known about factors that affect provider knowledge or whether exposure to TGD health content during training is associated with improved knowledge among providers. Using the TGD Healthcare Knowledge Scale, this study aimed to determine whether prior education on TGD health predicts clinicians' current knowledge regarding health care for TGD patients. METHODS: An online survey examining exposure to TGD content and knowledge of TGD health care was distributed to all primary care providers in an integrated health care system in the Midwestern United States. Multivariable linear regression was used to predict provider knowledge, controlling for demographics, transphobia and other potential confounders. RESULTS: The response rate was 57.3% (n = 223). The mean knowledge score was 7.41 (SD = 1.31) on a 10-point scale. Almost half (48.4%, n = 108) had no formal education on TGD health care, yet half (49.7%, n = 111) of providers reported previously caring for at least one transgender patient. In regression analysis, provider knowledge of TGD health care was associated with transphobia (ß = -0.377, 95% CI = -0.559 to -0.194, p < 0.001), but not with hours of formal education (ß = -0.027, 95% CI = -0.077 to 0.023, p = 0.292) or informal education (ß = -0.012, 95% CI = -0.033 to 0.009, p = 0.259). CONCLUSIONS: Increasing hours of education related to TGD health care may not be sufficient to improve providers' competence in care for TGD individuals. Transphobia may be a barrier to learning that needs to be addressed. Broader efforts to address transphobia in society in general, and in medical education in particular, may be required to improve the quality of medical care for TGD patients.

Primary Care Clinicians' Willingness to Care for Transgender Patients.

Transgender patients report negative experiences in health care settings, but little is known about clinicians' willingness to see transgender patients. We surveyed 308 primary care clinicians in an integrated Midwest health system and 53% responded. Most respondents were willing to provide routine care to transgender patients (85.7%) and Papanicolaou (Pap) tests (78.6%) to transgender men. Willingness to provide routine care decreased with age; willingness to provide Pap tests was higher among family physicians, those who had met a transgender person, and those with lower transphobia. Medical education should address professional and personal factors related to caring for the transgender population to increase access.

Frequent Experience of LGBQ Microaggression on Campus Associated With Smoking Among Sexual Minority College Students.

Introduction: Lesbian, gay, bisexual, or queer/questioning (LGBQ) microaggressions refer to often-unintentional insults, assaults, and invalidations that denigrate sexual minorities. While experiencing hostile discrimination and violence has previously been associated with elevated rates of smoking cigarettes for LGBQ college students, the relationship between LGBQ microaggressions and smoking is unknown. Methods: Data from a national anonymous online survey of sexual and gender minority college students were used to examine the relationship between past month cigarette smoking and interpersonal LGBQ microaggressions. Multivariable logistic regression assessed the relationship between smoking and frequent (chronic) experiences of microaggressions, using a hierarchical procedure to control for demographics, predictors of smoking, and academic factors. Results: Past year frequent LGBQ microaggression was reported by 48% of respondents and was more common among students who smoked in past 30 days. Experiencing past year physical violence was reported by 15% and did not differ by smoking status. Past year frequent experience of microaggressions was associated with increased odds of 1.72 (95% CI 1.03-2.87) for past 30-day smoking after adjusting for age, gender, race, socioeconomic indicators, alcohol misuse, physical violence, as well as academic stress and engagement. Conclusions: The results indicate that frequently experiencing LGBQ microaggressions is a risk factor for LGBQ college students smoking cigarettes. The mechanisms underlying this relationship require additional research, as does identifying positive coping strategies and institutional strategies to address LGBQ microaggressions on campuses. Tobacco control efforts should consider the impact of microaggression on the social environment for the prevention and treatment of tobacco use among LGBQ individuals. Implications: Microaggressions related to sexual minority identity include subtle forms of discrimination experienced during daily interactions that can create hostile and stressful social environments for a socially disadvantaged group. Prior research has demonstrated that LGBQ college students have higher rates of cigarette smoking, and that experiencing identity-based violence is a risk factor. This study revealed that experiencing frequent LGBQ microaggressions on college campus is associated with increased likelihood of current smoking among LGBQ college students.

Primary care providers' willingness to continue gender-affirming hormone therapy for transgender patients.

Background: Most transgender individuals either use or are interested in using gender-affirming hormone therapy (HT). Making gender-affirming HT available in primary care is critical for quality care to this vulnerable population. The barriers that transgender patients experience to accessing this treatment may be exacerbated if primary care providers (PCPs) will not provide it. Little is known about PCPs' willingness to administer HT to transgender patients. Objective: To examine whether PCPs are willing to continue prescribing HT for transgender patients and the factors that predict such willingness. Methods: An online survey of internal and family medicine physicians and residents practising in a large integrated Midwest health system (n = 308); 158 responded to the relevant questions (51.3%). Results: Approximately 50% of respondents were willing to continue HT for transgender patients. Most participants had previously met a transgender person (77%), and approximately half of them had cared for a transgender patient in the past 5 years. Multivariate logistic regression results indicate that attending physicians had lower odds of willingness to continue HT compared with medical residents, and those who reported perceived capability of providing routine care to transgender patients had higher odds of willingness. Conclusions: Only about half of PCPs surveyed were willing to continue HT for transgender patients. Our study indicates that both personal and clinical factors play a role. Future research should address ways to increase PCPs' willingness and comfort related to continuing HT for transgender patients.

Ecological Covariates of Subtle and Blatant Heterosexist Discrimination Among LGBQ College Students.

Sexual minority college students report experiencing interpersonal heterosexism, ranging from subtle insults to blatant physical violence. Such negative experiences can complicate developmental tasks common to adolescence and emerging adulthood. Studies examining the nature of heterosexism on college campuses have focused on blatant manifestations, yet subtle forms are more prevalent. Guided by ecological theory, we investigate the microsystem (e.g., perceived social support from friends, ambient heterosexism on campus), mesosystem (e.g., interaction between social support and ambient heterosexism), and macrosystem level (e.g., knowledge of gay-straight alliances on campus) covariates of interpersonal microaggressions, avoidance behaviors, verbal threats, and physical threats. Participants consisted of 530 self-identified LGBQ college students from 37 states. Regression results suggest that at the microsystem level, ambient heterosexism was positively associated with interpersonal microaggressions, avoidance behaviors, and verbal threats. At the mesosystem level, perceptions of LGBQ student support within one's institution moderated the effects of ambient heterosexism on three types of interpersonal heterosexism. At the macrosystem level, students who reported knowing that their campus had a sexual-orientation inclusive anti-discrimination policy reported encountering fewer verbal threats. Directions for future research and implications for campus programming are discussed.

Academic and social integration on campus among sexual minority students: the impacts of psychological and experiential campus climate.

A heterosexist campus climate can increase risk for mental health problems for sexual minority students; however, the relationship between campus climate for sexual minorities and academic outcomes remains understudied. Using a sample of sexual minority respondents extracted from a campus climate survey conducted at a large university in the Midwest, we examine relationships between multiple dimensions of psychological and experiential campus climate for sexual minorities with academic integration (academic disengagement, grade-point average [GPA]) and social integration (institutional satisfaction, acceptance on campus). We also investigate the protective role of engagement with informal academic and peer-group systems. Findings suggest campus climate affects sexual minority students' integration. In multivariate analyses, perceptions of whether lesbian, gay, and bisexual (LGB) people could be open about their sexual identity was positively associated with acceptance on campus; personal heterosexist harassment was positively associated with academic disengagement and negatively with GPA. Students' informal academic integration (instructor relations) and informal social integration (LGB friends) demonstrated influential main effects but did not moderate any of the climate-outcome relationships. Researchers should further explore the relationships between climate and academic outcomes among sexual minority students, both collectively and among specific sub-groups, and address the role of other protective factors.

Discrimination and depressive symptoms among sexual minority youth: is gay-affirming religious affiliation a protective factor?

Researchers have examined perceived discrimination as a risk factor for depression among sexual minorities; however, the role of religion as a protective factor is under-investigated, especially among sexual minority youth. Drawing on a cross-sectional study investigating campus climate at a large public university in the U.S. midwest, we examined the role of affiliation with a gay-affirming denomination (i.e., endorsing same-sex marriage) as a moderating factor in the discrimination-depression relationship among self-identified sexual minority (n = 393) and heterosexual youth (n = 1,727). Using multivariate linear regression analysis, religious affiliation was found to moderate the discrimination-depression relationship among sexual minorities. Specifically, the results indicated that the harmful effects of discrimination among sexual minority youth affiliated with denominations that endorsed same-sex marriage were significantly less than those among peers who affiliated with denominations opposing same-sex marriage or who identified as secular. In contrast, religious affiliation with gay-affirming denominations did not moderate the discrimination-depression relationship among heterosexual participants. The findings suggest that, although religion and same-sex sexuality are often seen as incompatible topics, it is important when working with sexual minority clients for clinicians to assess religious affiliation, as it could be either a risk or a protective factor, depending on the religious group's stance toward same-sex sexuality. To promote the well-being of sexual minority youth affiliated with denominations opposed to same-sex marriage, the results suggest these faith communities may be encouraged to reconsider their position and/or identify ways to foster youth's resilience to interpersonal discrimination.

Imprecise probabilistic inference from sequential data.

Although the Bayesian paradigm is an important benchmark in studies of human inference, the extent to which it provides a useful framework to account for human behavior remains debated. We document systematic departures from Bayesian inference under correct beliefs, even on average, in the estimates by experimental subjects of the probability of a binary event following observations of successive realizations of the event. In particular, we find underreaction of subjects' estimates to the evidence ("conservatism") after only a few observations and at the same time overreaction after longer sequences of observations. This is not explained by an incorrect prior nor by many common models of Bayesian inference. We uncover the autocorrelation in estimates, which suggests that subjects carry imprecise representations of the decision situations, with noise in beliefs propagating over successive trials. But even taking into account these internal imprecisions and assuming various incorrect beliefs, we find that subjects' updates are inconsistent with the rules of Bayesian inference. We show how subjects instead considerably economize on the attention that they pay to the information relevant to the decision, and on the degree of control that they exert over their precise response, while giving responses fairly adapted to the task. A "noisy-counting" model of probability estimation reproduces the several patterns we exhibit in subjects' behavior. In sum, human subjects in our task perform reasonably well while greatly minimizing the amount of information that they pay attention to. Our results emphasize that investigating this economy of attention is crucial in understanding human decisions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Individual risk attitudes arise from noise in neurocognitive magnitude representations.

Humans are generally risk averse, preferring smaller certain over larger uncertain outcomes. Economic theories usually explain this by assuming concave utility functions. Here, we provide evidence that risk aversion can also arise from relative underestimation of larger monetary payoffs, a perceptual bias rooted in the noisy logarithmic coding of numerical magnitudes. We confirmed this with psychophysics and functional magnetic resonance imaging, by measuring behavioural and neural acuity of magnitude representations during a magnitude perception task and relating these measures to risk attitudes during separate risky financial decisions. Computational modelling indicated that participants use similar mental magnitude representations in both tasks, with correlated precision across perceptual and risky choices. Participants with more precise magnitude representations in parietal cortex showed less variable behaviour and less risk aversion. Our results highlight that at least some individual characteristics of economic behaviour can reflect capacity limitations in perceptual processing rather than processes that assign subjective values to monetary outcomes.

Correlates of HIV testing uptake among kothi-identified men who have sex with men in public sex environments in Chennai, India.

Kothi-identified men who have sex with men in India are highly marginalized and are at high-risk for HIV. This study examines HIV testing among 132 self-reported HIV-negative and unknown serostatus kothis recruited from public sex environments in Chennai, India. Using logistic regression we identified variables associated with HIV testing uptake (i.e., being tested and knowing the result). Sixty-one percent reported HIV testing uptake. At the bivariate level, married men, those with low HIV transmission knowledge, those who engaged in unprotected anal sex and unprotected receptive anal sex were at lower odds of reporting testing uptake. In multivariate analysis, married men and those with low levels of HIV transmission knowledge were at decreased odds of being tested, as were kothis who experienced forced sex. Culturally competent programs engaging married kothis are needed. Interventions to facilitate HIV prevention education and systemic interventions to combat sexual violence may facilitate HIV testing uptake among kothis.

Qualitative research with small connected communities: generating new knowledge while upholding research ethics.

Qualitative researchers have a dual mission: to generate knowledge through rigorous research and to uphold ethical standards and principles. Qualitative researchers often conduct studies with small connected communities in which relationships exist among community members. When engaging such communities, researchers might face ethical issues in upholding confidentiality standards while they work to achieve their dual mandate. Qualitative scholars have paid little attention to the ethical challenges that might arise in this context. Drawing on our experiences conducting studies with such communities, we expand the dialogue concerning qualitative research ethics by making explicit conceptual and practical tensions that emerge at various stages of the research process; articulating our respective reflective processes; and exploring issues associated with strategies for upholding confidentiality. We conclude with lessons learned to guide researchers who might face similar challenges.

Efficient coding of numbers explains decision bias and noise.

Humans differentially weight different stimuli in averaging tasks, which has been interpreted as reflecting encoding bias. We examine the alternative hypothesis that stimuli are encoded with noise and then optimally decoded. Under a model of efficient coding, the amount of noise should vary across stimuli and depend on statistics of the stimuli. We investigate these predictions through a task in which the participants are asked to compare the averages of two series of numbers, each sampled from a prior distribution that varies across blocks of trials. The participants encode numbers with a bias and a noise that both depend on the number. Infrequently occurring numbers are encoded with more noise. We show how an efficient-coding, Bayesian-decoding model accounts for these patterns and best captures the participants' behaviour. Finally, our results suggest that Wei and Stocker's "law of human perception", which relates the bias and variability of sensory estimates, also applies to number cognition.

Gynecological Providers' Willingness to Prescribe Gender-Affirming Hormone Therapy for Transgender Patients.

Purpose: Transgender individuals face barriers to accessing gender-affirming hormone therapy, yet little is known about gynecological providers' willingness to provide such care. Methods: We surveyed gynecological providers in one healthcare system to determine their willingness to prescribe hormone therapy (HT) for transgender patients and factors associated with willingness to both initiate and refill HT. Results: Among respondents (N = 60), 60.3% and 27.6% were willing to refill and initiate HT for transgender patients, respectively. Willingness to refill HT was associated with having met a transgender person and lower transphobia. Unwillingness was associated with lack of transgender health training, lack of staff knowledge about transgender health, and unfamiliarity with transition guidelines. Willingness to initiate HT was associated with younger age and resident status. Unwillingness was associated with unfamiliarity with transition guidelines. Conclusion: While gynecological providers are qualified to prescribe HT for transgender patients, willingness to do so may be influenced by both personal and educational/training factors. Encouraging and training gynecological providers to provide gender-affirming HT will help to increase access for transgender individuals.

Experiences of discrimination and its impacts on well-being among racialised LGBTQ+ newcomers living in Waterloo region, Ontario, Canada.

Discrimination (i.e. racism, homo/bi/transphobia) at both the individual and systemic levels may negatively impact the well-being of racialised LGBTQ+ newcomers living in Waterloo Region, Ontario, Canada. Current research about the experiences of LGBTQ+ newcomers focuses predominantly on homogeneous samples of gay men living in large metropolitan city centres. The present study aims to extend the current literature by exploring the experiences of discrimination and its impacts on well-being among racialised LGBTQ+ newcomers living in a small urban area and representing a variety of intersecting identities (i.e. ethno-racial background, LGBTQ+ identity, newcomer status). Using a qualitative method, 10 individuals were invited to complete a semistructured interview between fall 2019 and summer 2020 about their experiences of discrimination in Waterloo Region, and how such experiences impact their well-being. Using an intersectional lens, a thematic analysis revealed that racialised LGBTQ+ newcomers experienced discrimination before and after settlement in Waterloo Region. Prior to settlement, participants spoke predominantly about experiences of homo/biphobia and the associated feelings of internalised oppression. Alternatively, upon settling in Waterloo Region, experiences of discrimination were predominantly racism, and, in particular, systemic racism, which manifested as an inability to access adequate services and a lack of representation in various spaces throughout Waterloo Region. These results extend previous research by identifying the service barriers experienced by racialised LGBTQ+ newcomers living in a small urban area and can be used to inform best practices for addressing these barriers in Waterloo Region and other small urban areas with similar demographics. Implications and limitations are discussed.