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1.
Int J Gynaecol Obstet ; 148 Suppl 2: 15-19, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31975403

ABSTRACT

OBJECTIVES: To describe the mechanisms of implementation of Zika virus diagnosis, prevention, and management guidelines in Colombia, and to characterize their influence on efforts to defend sexual and reproductive rights. METHODS: A qualitative study performed between February and April 2018 in three municipalities in Colombia. We conducted 30 semistructured interviews and five focus groups with key informants who played a role during the epidemic. These included decision-makers, program coordinators, healthcare providers, pregnant women diagnosed with Zika virus, and members of affected communities. RESULTS: We identified barriers to and facilitators for the implementation of the national Zika virus response plan. Barriers included a lack of coordination between vector control efforts and in the realms of sexual and reproductive rights. Facilitators included healthcare providers' response to the epidemic, the development of technical skills, and the establishment of coordination and referral networks across different institutions. CONCLUSION: A multidimensional approach that considers healthcare services, gender issues, and the environment is crucial. We highlight the epidemic's effects on women's sexual and reproductive rights, mainly related to inequalities in sexual and reproductive health such as the increased risk of sexually transmitted infections experienced by the poorest and most vulnerable women.


Subject(s)
Reproductive Health , Reproductive Rights , Sexual Health , Zika Virus Infection , Colombia , Epidemics , Female , Focus Groups , Humans , Practice Guidelines as Topic , Pregnancy , Qualitative Research , Women's Health , Young Adult , Zika Virus Infection/diagnosis , Zika Virus Infection/prevention & control , Zika Virus Infection/therapy
2.
Health Promot Int ; 35(1): 27-41, 2020 Feb 01.
Article in English | MEDLINE | ID: mdl-31916577

ABSTRACT

This systematic review sought to evaluate the impact of gender equality on the health of both women and men in high-income countries. A range of health outcomes arose across the 48 studies included. Gender equality was measured in various ways, including employment characteristics, political representation, access to services, and with standard indicators (such as the Global Gender Gap Index and the Gender Empowerment Measure). The effects of gender equality varied depending on the health outcome examined, and the context in which gender equality was examined (i.e. employment or domestic domain). Overall, evidence suggests that greater gender equality has a mostly positive effect on the health of males and females. We found utility in the convergence model, which postulates that gender equality will be associated with a convergence in the health outcomes of men and women, but unless there is encouragement and support for men to assume more non-traditional roles, further health gains will be stymied.

3.
Health Econ ; 29(1): 3-17, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31746116

ABSTRACT

Starting from December 2012, insurers in the European Union were prohibited from charging gender-discriminatory prices. We examine the effect of this unisex mandate on risk segmentation in the German health insurance market. Although gender used to be a pricing factor in Germany's private health insurance (PHI) sector, it was never used as a pricing factor in the social health insurance (SHI) sector. The unisex mandate makes PHI relatively more attractive for women and less attractive for men. Based on data from the German socio-economic panel, we analyze how the unisex mandate affects the difference between women and men in switching rates between SHI and PHI. We find that the unisex mandate increases the probability of switching from SHI to PHI for women relative to men. On the other hand, the unisex mandate has no effect on the gender difference in switching rates from PHI to SHI. Because women have on average higher health care expenditures than men, our results imply a worsening of the PHI risk pool and an improvement of the SHI risk pool. Our results demonstrate that regulatory measures such as the unisex mandate can affect risk selection between public and private health insurance sectors.

4.
Lancet Glob Health ; 8(2): e225-e236, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31879212

ABSTRACT

BACKGROUND: In the context of the Sustainable Development Goals and the shifting global burden of disease, this systematic review analyses the evidence from rigorously evaluated programmes that seek to transform the gendered social norms undermining the health and wellbeing of children, adolescents, and young adults. The aim of this study was threefold: to describe the landscape of gender-transformative programmes that attempt to influence health-related outcomes; to identify mechanisms through which successful programmes work; and to highlight where gaps might exist in implementation and evaluation. METHODS: We systematically reviewed rigorous evaluations published between Jan 1, 2000, and Nov 1, 2018 of programmes that sought to decrease gender inequalities and transform restrictive gender norms to improve the health and wellbeing of 0-24 year olds. We included rigorously evaluated health programmes that met the Interagency Gender Working Group definition of gender-transformative programming, regardless of where in the world they were implemented and what area of health they focused on. FINDINGS: Among 22 993 articles identified by our search, 61 evaluations of 59 programmes met review criteria. Programmes were concentrated in sub-Saharan Africa (25 [42%]), south Asia (13 [22%]), and North America (13 [22%]) and mainly measured health indicators related to reproductive health (29 [48%]), violence (26 [43%]), or HIV (18 [30%]). Programmes most frequently focused on improving the individual power of the beneficiaries, rather than working on broader systems of inequality. 45 (74%) of the evaluations measured significant improvements in health-related and gender-related indicators; however, only ten (16%) showed evidence of, or potential for, broader norm change. These ten programmes worked with sectors beyond health, included multiple stakeholders, implemented diversified strategies, and fostered critical awareness and participation among affected community members. INTERPRETATION: This review can accelerate efforts to improve global health by leading to more strategic investment in programmes that promote gender equality and target restrictive gender norms among young people. Such programmes can lead to a lifetime of improved health and wellbeing by challenging not only attitudes and behaviours related to gender at an early age, but also the gendered systems that surround them. FUNDING: Bill & Melinda Gates Foundation.

6.
Article in English | MEDLINE | ID: mdl-31801219

ABSTRACT

Though sex/gender is an important social determinant of health, sex/gender inequalities have not been considered comprehensively in environmental health research thus far. The aim of this systematic review was to clarify whether sex/gender theoretical concepts were addressed in studies on the impact of residential green space on self-rated health and whether effect modification by sex/gender was observed. Three electronic databases were searched to identify epidemiological studies on perceived or objective residential green/blue space and self-rated health. Necessary for study inclusion was mentioning at least one keyword for sex/gender in title or abstract, adult study participants and data on self-rated health and on availability and/or use of green/blue spaces. Decisive for study inclusion was consideration of sex/gender differences in the impact of perceived or objective residential green/blue spaces on self-rated health in the analysis and presentation of results. Seven studies were included. They presented an overall positive impact of green space on self-rated health. No consistent sex/gender differences in the impact of green space on self-rated health were found in these studies. However, all studies used a binary operationalization male/female without further theoretical foundation. Research quality could be enhanced by integrating sex/gender-theoretical concepts into study design and interpretation of results.

7.
Plast Reconstr Surg ; 144(4): 824-833, 2019 10.
Article in English | MEDLINE | ID: mdl-31568285

ABSTRACT

BACKGROUND: Despite the medical necessity, legislative mandates, and economic benefits of gender-affirming surgery, access to treatment remains limited. The World Professional Association for Transgender Health (WPATH) has proposed guidelines for transition-related surgery in conjunction with criteria to delineate medical necessity. The authors assessed insurance coverage of "top" gender-affirming surgery and evaluated the differences between insurance policy criteria and WPATH recommendations. METHODS: The authors conducted a cross-sectional analysis of insurance policies for coverage of top gender-affirming surgery. Insurance companies were selected based on their state enrollment data and market share. A Web-based search and individual telephone interviews were conducted to identify the policy. Medical necessity criteria were abstracted from publicly available policies. RESULTS: Of the 57 insurers evaluated, bilateral mastectomy (transmasculine) was covered by significantly more insurers than breast augmentation (transfeminine) (96 percent versus 68 percent; p < 0.0001). Only 4 percent of companies used WPATH-consistent criteria. No criterion was universally required by insurers. Additional prerequisites for coverage that extended beyond WPATH guidelines for top surgery were continuous living in congruent gender role, two referring mental health professionals, and hormone therapy before surgery. Hormone therapy was required in a significantly higher proportion of transfeminine policies compared with transmasculine policies (90 percent versus 21 percent; p < 0.0001). CONCLUSIONS: In addition to the marked intercompany variation in criteria for insurance coverage that often deviated from WPATH recommendations, there are health care insurers who categorically deny access to top gender-affirming surgery. A greater evidence base is needed to provide further support for the medical necessity criteria in current use.


Subject(s)
Insurance Coverage/statistics & numerical data , Insurance Coverage/standards , Sex Reassignment Surgery , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Male , Practice Guidelines as Topic , United States , Young Adult
8.
BMJ Glob Health ; 4(5): e001634, 2019.
Article in English | MEDLINE | ID: mdl-31565410

ABSTRACT

Objectives: Working with men/boys, in addition to women/girls, through gender-transformative programming that challenges gender inequalities is recognised as important for improving sexual and reproductive health and rights (SRHR) for all. The aim of this paper was to generate an interactive evidence and gap map (EGM) of the total review evidence on interventions engaging men/boys across the full range of WHO SRHR outcomes and report a systematic review of the quantity, quality and effect of gender-transformative interventions with men/boys to improve SRHR for all. Methods: For this EGM and systematic review, academic and non-academic databases (CINAHL, Medline, PsycINFO, Social Science Citation Index-expanded, Cochrane Library, Campbell Collaboration, Embase, Global Health Library and Scopus) were searched using terms related to SRHR, males/masculinities, systematic reviews and trials (January 2007-July 2018) with no language restrictions for review articles of SRHR interventions engaging men/boys. Data were extracted from included reviews, and AMSTAR2 was used to assess quality. Outcomes were based on WHO reproductive health strategy. Results: From the 3658 non-duplicate records screened, the total systematic reviews of interventions engaging men/boys in SRHR was mapped through an EGM (n=462 reviews) showing that such interventions were relatively evenly spread across low-income (24.5%), middle-income (37.8%) and high-income countries (37.8%). The proportion of reviews that included gender-transformative interventions engaging men/boys was low (8.4%, 39/462), the majority was in relation to violence against women/girls (n=18/39, 46.2%) and conducted in lower and middle-income countries (n=25/39, 64%). Reviews of gender-transformative interventions were generally low/critically low quality (n=34/39, 97.1%), and findings inconclusive (n=23/39, 59%), but 38.5% (n=15/39) found positive results. Conclusion: Research and programming must be strengthened in engagement of men/boys; it should be intentional in promoting a gender-transformative approach, explicit in the intervention logic models, with more robust experimental designs and measures, and supported with qualitative evaluations.

9.
Health Serv Res ; 54 Suppl 2: 1442-1453, 2019 12.
Article in English | MEDLINE | ID: mdl-31663120

ABSTRACT

OBJECTIVE: To examine reported experiences of gender discrimination and harassment among US women. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey of 1596 women, conducted January-April 2017. METHODS: We calculated the percentages of women reporting gender discrimination and harassment in several domains, including health care. We used logistic regression to examine variation in experiences among women by race/ethnicity and sexual orientation/gender identity. PRINCIPAL FINDINGS: Sizable fractions of women experience discrimination and harassment, including discrimination in health care (18 percent), equal pay/promotions (41 percent), and higher education (20 percent). In adjusted models, Native American, black, and Latina women had higher odds than white women of reporting gender discrimination in several domains, including health care. Latinas' odds of health care avoidance versus whites was (OR [95% CI]) 3.69 (1.59, 8.58), while blacks' odds of discrimination in health care visits versus whites was 2.00 [1.06, 3.74]. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) women had higher odds of reporting sexual harassment (2.16 [1.06, 4.40]) and violence (2.71 [1.43, 5.16]) against themselves or female family members than non-LGBTQ women. CONCLUSIONS: Results suggest that discrimination and harassment are widely experienced by women across multiple domains of their lives, particularly those who are a racial/ethnic minority or LGBTQ. Further policy and programmatic efforts beyond current legal protections for women are needed to meaningfully reduce these negative experiences, as they impact women's health care and their lives overall.


Subject(s)
Healthcare Disparities , Sexism , Sexual Harassment , Sexual and Gender Minorities/statistics & numerical data , Women's Health , Adolescent , Adult , Aged , Employment , Female , Healthcare Disparities/ethnology , Healthcare Disparities/statistics & numerical data , Humans , Middle Aged , Patient Acceptance of Health Care , Sexism/ethnology , Sexism/statistics & numerical data , Sexual Harassment/ethnology , Sexual Harassment/statistics & numerical data , Surveys and Questionnaires , Telephone , United States
11.
Surgery ; 166(5): 785-792, 2019 11.
Article in English | MEDLINE | ID: mdl-31375322

ABSTRACT

BACKGROUND: No consensus exists on whether patient-provider race, gender, and language concordance provides benefits to surgical patients. We report a systematic review of the association between patient-provider concordance and patient preferences and outcomes in surgery. METHODS: A systematic review of the literature was performed in Medline and PubMed using defined search terms to identify studies related to patient-provider concordance in surgical patients. We included studies with full manuscripts published in English within the United States (1998 to July 2018). RESULTS: Out of 253 titles screened, 16 studies met inclusion criteria. Five studies had level 4 evidence and 11 studies had level 3 evidence. The majority of patients preferred providers with a similar background (n = 4/6). Race, gender, and language-concordance had no effect on adherence to provider recommendations (n = 3/3). No effect of race concordance on the quality of care was seen (n = 2/3). Gender concordance was associated with improved quality of care (n = 2/3). There were mixed effects of concordance on the effectiveness of communication (n = 2). CONCLUSION: Few studies examine patient-provider concordance. Most patients prioritize culturally, technically, and clinically competent providers over concordance. Future research is needed regarding the influence of concordance on patient outcomes in surgery within specific patient populations and clinical settings.


Subject(s)
Healthcare Disparities/organization & administration , Language , Perioperative Care , Physician-Patient Relations , Quality Improvement , Clinical Competence , Communication , Female , Humans , Male , Patient Preference , Patient Satisfaction , United States
12.
J Health Popul Nutr ; 38(1): 17, 2019 08 07.
Article in English | MEDLINE | ID: mdl-31387643

ABSTRACT

Household nutrition is influenced by interactions between food security and local knowledge negotiated along multiple axes of power. Such processes are situated within political and economic systems from which structural inequalities are reproduced at local, national, and global scales. Health beliefs and food taboos are two manifestations that emerge within these processes that may contribute beneficial, benign, or detrimental health outcomes. This study explores the social dimensions of food taboos and health beliefs in rural Khatlon province, Tajikistan and their potential impact on household-level nutrition. Our analysis considers the current and historical and political context of Tajikistan, with particular attention directed towards evolving gender roles in the wake of mass out-migration of men from 1990 to the present. Considering the patrilieneal, patrilocal social system typical to Khatlon, focus group discussions were conducted with the primary decision-making groups of the household: in-married women, mothers-in-law, and men. During focus groups, participants discussed age- and gender-differentiated taboos that call for avoidance of several foods central to the Tajik diet during sensitive periods in the life cycle when micronutrient and energy requirements peak: infancy and early childhood (under 2 years of age), pregnancy, and lactation. Participants described dynamic and complex processes of knowledge sharing and food practices that challenge essentialist depictions of local knowledges. Our findings are useful for exploring entaglements of gender and health that play out across multiple spatial and temporal scales. While this study is situated in the context of nutrition and agriculture extension, we hope researchers and practitioners of diverse epistemologies will draw connections to diverse areas of inquiry and applications.

13.
Pediatrics ; 144(3)2019 09.
Article in English | MEDLINE | ID: mdl-31427462

ABSTRACT

CONTEXT: Compared with cisgender (nontransgender), heterosexual youth, sexual and gender minority youth (SGMY) experience great inequities in substance use, mental health problems, and violence victimization, thereby making them a priority population for interventions. OBJECTIVE: To systematically review interventions and their effectiveness in preventing or reducing substance use, mental health problems, and violence victimization among SGMY. DATA SOURCES: PubMed, PsycINFO, and Education Resources Information Center. STUDY SELECTION: Selected studies were published from January 2000 to 2019, included randomized and nonrandomized designs with pretest and posttest data, and assessed substance use, mental health problems, or violence victimization outcomes among SGMY. DATA EXTRACTION: Data extracted were intervention descriptions, sample details, measurements, results, and methodologic rigor. RESULTS: With this review, we identified 9 interventions for mental health, 2 for substance use, and 1 for violence victimization. One SGMY-inclusive intervention examined coordinated mental health services. Five sexual minority-specific interventions included multiple state-level policy interventions, a therapist-administered family-based intervention, a computer-based intervention, and an online intervention. Three gender minority-specific interventions included transition-related gender-affirming care interventions. All interventions improved mental health outcomes, 2 reduced substance use, and 1 reduced bullying victimization. One study had strong methodologic quality, but the remaining studies' results must be interpreted cautiously because of suboptimal methodologic quality. LIMITATIONS: There exists a small collection of diverse interventions for reducing substance use, mental health problems, and violence victimization among SGMY. CONCLUSIONS: The dearth of interventions identified in this review is likely insufficient to mitigate the substantial inequities in substance use, mental health problems, and violence among SGMY.


Subject(s)
Crime Victims/psychology , Mental Disorders/prevention & control , Sexual and Gender Minorities/psychology , Substance-Related Disorders/prevention & control , Violence/prevention & control , Health Policy , Healthcare Disparities , Humans , Mental Disorders/psychology , Mental Disorders/therapy , Mental Health Services , Substance-Related Disorders/psychology , Substance-Related Disorders/therapy , United States , Violence/psychology
14.
Int J Equity Health ; 18(1): 114, 2019 07 24.
Article in English | MEDLINE | ID: mdl-31340821

ABSTRACT

BACKGROUND: Although Swedish legislation prescribes equity in healthcare, inequitable healthcare is repeatedly reported in Sweden. Telephone nursing is suggested to promote equitable healthcare, making it just one call away for anyone, at any time, irrespective of distance. However, paediatric health calls reflect that male parents are referred to other health services twice as much as female parents are. Regarding equity in healthcare, telephone nurses have expressed a continuum from Denial and Defence to Openness and Awareness. To make a change, Action is also needed, within organizational frames. The aim here was thus to investigate Swedish Healthcare Direct managers' views on gender (in)equity in healthcare through the application of a conceptual model, developed based on empirical Swedish Healthcare Direct telephone RN data, as a baseline measure at the service's national implementation. METHODS: All Swedish Healthcare Direct managers were interviewed during the period March-May 2012. They were asked how they view equitable healthcare, and how they work to achieve it. A conceptual model for attaining equity in healthcare, including Denial, Defence, Openness, Awareness and Action, was used in a deductive thematic analysis of the interview data. RESULTS: The five model concepts - Denial; Defence; Openness; Awareness and Action - were found in a variety of combinations in the manager interviews. Denial and Defence were mentioned to a higher extent than Openness and Awareness. Several informants denied inequity, arguing that the decision support tool prevented this. However, those who primarily expressed Denial and Defence were also open to learning more on the subject. Action was only mentioned twice in the informants' answers, and then only implicitly. CONCLUSION: Although a majority of the interviewed managers expressed a lack of awareness of (in)equity in healthcare, they also expressed an openness to learning more. While this may reflect a desire to show political correctness, it also points to the need for educational training in order to increase the awareness of (in)equity in healthcare among healthcare managers. Future follow up measurements will reveal if this has happened.


Subject(s)
Community Health Services/organization & administration , Healthcare Disparities/statistics & numerical data , Telenursing/organization & administration , Awareness , Delivery of Health Care/organization & administration , Female , Humans , Male , Socioeconomic Factors , Sweden
15.
Health Soc Work ; 44(3): 149-155, 2019 Aug 02.
Article in English | MEDLINE | ID: mdl-31359065

ABSTRACT

Contemporary research suggests that transgender and gender-nonconforming (TGNC) adults encounter formidable barriers to health care, including access to quality therapeutic interventions. This systematic review is one of the first to specifically explore obstacles to TGNC mental health care. A rigorous literature review identified eight relevant studies: six qualitative designs and two quantitative designs. Thematic synthesis revealed three major barriers to care and five corresponding subthemes: (1) personal concerns, involving fear of being pathologized or stereotyped and an objection to common therapeutic practices; (2) incompetent mental health professionals, including those who are unknowledgeable, unnuanced, and unsupportive; and (3) affordability factors. Results indicate an acute need for practitioner training to ensure the psychological well-being of TGNC clients.

16.
Lancet ; 393(10189): 2440-2454, 2019 06 15.
Article in English | MEDLINE | ID: mdl-31155275

ABSTRACT

Gender is not accurately captured by the traditional male and female dichotomy of sex. Instead, it is a complex social system that structures the life experience of all human beings. This paper, the first in a Series of five papers, investigates the relationships between gender inequality, restrictive gender norms, and health and wellbeing. Building upon past work, we offer a consolidated conceptual framework that shows how individuals born biologically male or female develop into gendered beings, and how sexism and patriarchy intersect with other forms of discrimination, such as racism, classism, and homophobia, to structure pathways to poor health. We discuss the ample evidence showing the far-reaching consequences of these pathways, including how gender inequality and restrictive gender norms impact health through differential exposures, health-related behaviours and access to care, as well as how gender-biased health research and health-care systems reinforce and reproduce gender inequalities, with serious implications for health. The cumulative consequences of structured disadvantage, mediated through discriminatory laws, policies, and institutions, as well as diet, stress, substance use, and environmental toxins, have triggered important discussions about the role of social injustice in the creation and maintenance of health inequities, especially along racial and socioeconomic lines. This Series paper raises the parallel question of whether discrimination based on gender likewise becomes embodied, with negative consequences for health. For decades, advocates have worked to eliminate gender discrimination in global health, with only modest success. A new plan and new political commitment are needed if these global health aspirations and the wider Sustainable Development Goals of the UN are to be achieved.


Subject(s)
Delivery of Health Care , Sexism , Socioeconomic Factors , Female , Humans , Male
17.
JMIR Res Protoc ; 8(6): e14091, 2019 Jun 27.
Article in English | MEDLINE | ID: mdl-31250829

ABSTRACT

BACKGROUND: Public health strategies are urgently needed to improve HIV disparities among transgender women, including holistic intervention approaches that address those health needs prioritized by the community. Hormone therapy is the primary method by which many transgender women medically achieve gender affirmation. Peer navigation has been shown to be effective to engage and retain underserved populations living with HIV in stable primary medical care. OBJECTIVE: This study aims to assess the feasibility and acceptability of an integrated innovative HIV service delivery model designed to improve HIV prevention and care by combining gender-affirming primary care and peer navigation with HIV prevention and treatment services. METHODS: A 12-month, nonrandomized, single-arm cohort study was implemented in Lima, Peru, among adult individuals, assigned a male sex at birth, who identified themselves as transgender women, regardless of initiation or completion of medical gender affirmation, and who were unaware of their HIV serostatus or were living with HIV but not engaged in HIV treatment. HIV-negative participants received quarterly HIV testing and were offered to initiate pre-exposure prophylaxis. HIV-positive participants were offered to initiate antiretroviral treatment and underwent quarterly plasma HIV-1 RNA and peripheral CD4+ lymphocyte cell count monitoring. All participants received feminizing hormone therapy and adherence counseling and education on their use. Peer health navigation facilitated retention in care by visiting participants at home, work, or socialization venues, or by contacting them by social media and phone. RESULTS: Patient recruitment started in October 2016 and finished in March 2017. The cohort ended follow-up on March 2018. Data analysis is currently underway. CONCLUSIONS: Innovative and culturally sensitive strategies to improve access to HIV prevention and treatment services for transgender women are vital to curb the burden of HIV epidemic for this key population. Findings of this intervention will inform future policies and research, including evaluation of its efficacy in a randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT03757117; https://clinicaltrials.gov/ct2/show/NCT03757117. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14091.

18.
Psychiatr Q ; 90(2): 461-469, 2019 06.
Article in English | MEDLINE | ID: mdl-31065921

ABSTRACT

The goal of this study was to examine the demographics sex and marital status of inpatients with schizophrenia and bipolar and compare differences in patients' chances of possessing adequate health coverage to cover hospital expenses. Data from the National Hospital Discharge Survey was extracted and analyzed. For hospital discharges of patients age 18 and older 702,626 hospital discharges were included in the study representing a weighted population of 77,082,738 hospital discharges. Prediction model was applied to test the ability of the independent variables sex and marital status to predict differences in health coverage in multinomial logistic regression (MLR) test. Results indicate that sex and marital status were significant predictors of health coverage type that patient owned. Male, unmarried and with unknown marital status patients were more likely to be either uninsured or publicly insured. Public health policy legislation efforts need to address public-health-insurance provisions that limit the coverage of treatment for psychiatric patients.


Subject(s)
Bipolar Disorder , Healthcare Disparities/statistics & numerical data , Insurance, Health/statistics & numerical data , Marital Status/statistics & numerical data , Medical Assistance/statistics & numerical data , Medically Uninsured/statistics & numerical data , Patient Discharge/statistics & numerical data , Schizophrenia , Adolescent , Adult , Aged , Bipolar Disorder/economics , Bipolar Disorder/therapy , Female , Health Care Surveys/statistics & numerical data , Humans , Male , Middle Aged , Schizophrenia/economics , Schizophrenia/therapy , Sex Factors , United States , Young Adult
19.
Article in English | MEDLINE | ID: mdl-31036795

ABSTRACT

Background: The association between age and health-related quality of life (HRQoL) is still under debate. While some research shows older age is associated with better HRQoL, other studies show no or negative association between age and HRQoL. In addition, while the association between age and HRQoL may depend on race, ethnicity, gender, and their intersections, most previous research on this link has been performed in predominantly White Middle Class. Objective: To explore gender differences in the association between age and mental and physical HRQoL in a sample of economically disadvantaged African American (AA) older adults. Methods: This cross-sectional survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 economically disadvantaged AA older adults (age ≥ 55 years) were enrolled in this study, using non-random sampling. This includes 266 AA men and 474 AA women. The independent variable of interest was age. Dependent variables of interest were physical component scores (PCS) and mental component scores (MCS), two main summary scores of the HRQoL, measured using Short Form-12 (SF-12). Gender was the moderator. Socioeconomic status (educational attainment and financial difficulty) were covariates. Linear regression models were used to analyze the data. Results: AA women reported worse PCS; however, gender did not impact MCS. In the pooled sample, high age was associated with better PCS and MCS. In the pooled sample, a significant interaction was found between gender and age on PCS, suggesting a stronger effect of age on PCS for AA men than AA women. In gender-stratified models, older age was associated with better PCS for AA men but not AA women. Older age was similarly and positively associated with better MCS for AA men and women. Conclusions: There may be some gender differences in the implications of ageing for the physical HRQoL of AA older adults. It is unclear how old age may have a boosting effect on physical HRQoL for AA men but not AA women. Future research should test gender differences in the effect of age on physical health indicators such as chronic disease as well as cognitive processes involved in the evaluation of own's health in AA men and women.


Subject(s)
African Americans , Aging , Quality of Life/psychology , Social Class , Aged , Chronic Disease , Cross-Sectional Studies , Ethnic Groups/psychology , Female , Humans , Linear Models , Los Angeles , Male , Middle Aged , Sex Factors , Vulnerable Populations
20.
Am J Community Psychol ; 63(3-4): 511-526, 2019 06.
Article in English | MEDLINE | ID: mdl-30989666

ABSTRACT

Lesbian, gay, bisexual, transgender, queer, and gender non-conforming (LGBTQ & GNC) youth experience more economic hardship and social stress than their heterosexual and cisgender peers. However, the ways that LGBTQ & GNC youth resist these damaging social factors and the corresponding implications for their health have not been addressed. Data were analyzed from a national participatory survey of LGBTQ & GNC youth ages 14-24 (N = 5,860) living in the United States. Structural equation models indicated that economic precarity was associated with experiences of health problems. This association was mediated by the negative influence of minority stress on health as well as by activism, which had a positive association with health. Findings suggest that minority stress explanations of health inequalities among LGBTQ & GNC youth can benefit from including a focus on economic precarity; both in terms of its deleterious impact on health and its potential to provoke resistance to structural oppression in the form of activism.

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