Cisgender Adults Research Articles

Bias-Motivated Physical or Verbal Violence Among Men Who Have Sex with Men: Findings from the Lisbon Cohort of MSM

Abstract Introduction Victimization based on sexual orientation or gender identity is a cause for concern. Bias-motivated violence affect not only the individuals targeted but also their communities and societies as a whole. Objective To estimate the proportion of bias-motivated victimization among cisgender men who have sex with men (MSM) and to compare sociodemographic and behavioral characteristics and HIV and syphilis test results between victims and non-victims. Methods We used data from the baseline visit of 2811 adult cisgender MSM from July 2017 to December 2020 in the Lisbon Cohort of MSM. Victimization was defined as self-reported lifetime or recent (in the previous 12 months) experience of physical or verbal violence motivated by sexual orientation or gender identity. Rapid HIV and syphilis tests determined serostatus. We conducted descriptive statistics to summarize the sociodemographic and behavioral characteristics and the prevalence of victimization and compared groups using the Student t-test or Mann–Whitney U test and chi-square test, as appropriate. Results Overall, 40.3% of participants reported lifetime bias-motivated physical or verbal violence, and 11.7% reported recent victimization. Recent victimization contexts more frequently reported were street/neighborhood (67.9%) and workplace/school (35.5%). Victimization was associated with younger age (mean age: 26.5 vs 30.2, p-value < 0.001), being born in Brazil or other American countries, or being 14 or younger at their anal intercourse with a man debut (19.5% vs. 11.0%, p-value < 0.001). Lifetime victimization was not significantly associated with reactive results for HIV (p-value = 0.135) or syphilis (p-value = 0.760). Conclusion The violence motivated by sexual orientation or gender identity was quite frequent in this community. The occurrence of violence based on sexual orientation or gender identity in the Lisbon Cohort of MSM was associated with adverse social conditions and health risk behaviors. Policy Implications Raising awareness about bias-motivated violence as a hate crime may deter potential aggressions. Primary violence prevention should tackle specificities of sexual and gender minorities.

Assessing a Couples-Based, Digital HIV Serostatus-Neutral Intervention (Para Ti, Para Mí, Para Nosotros) for Adult Cisgender Sexual Minority Male Couples in Lima, Peru: Protocol for a 6-Month Pilot Randomized Controlled Trial.

HIV disproportionately affects sexual minority men (SMM; eg, gay, bisexual, and other men who have sex with men) in Lima, Peru; epidemiological data estimate that 32% to 39% of new HIV infections occur among adult cisgender SMM within primary partnerships (ie, male couples). Most HIV prevention-care research in Lima, Peru, has focused on SMM as individuals and not couples. To help address this critical gap in prevention care, we developed Para Ti, Para Mí, Para Nosotros (P3): a couples-based, digital HIV serostatus-neutral intervention (DHI) for adult cisgender SMM couples in Lima, Peru. The P3 DHI is designed to facilitate couples with skill-building, communication, decision-making, and working together to form and adhere to a detailed prevention care plan that aligns with their explicit sexual agreement. The P3 DHI is theoretically informed, self-guided, directed, sequential, and fully automated. This pilot randomized controlled trial (RCT) aims to examine the preliminary effects of P3 on couples' formation and adherence to a detailed prevention care plan containing evidence-based strategies that also aligns with their explicit sexual agreement over time. In addition, the feasibility of enrollment and retention and couples' acceptability of P3 will be assessed. The research implements a prospective, 6-month pilot RCT with a 3-month delayed control condition. After baseline, 60 enrolled SMM couples will be randomized to 1 of 2 conditions. Couples randomized to the unmatched, delayed control condition will receive access to the P3 DHI to use during the last 3 months of the trial after the 3-month assessment. Couples randomized to the immediate intervention condition will immediately receive access to the P3 DHI for 6 months. Study assessments will occur at baseline and months 3 and 6. Descriptive, comparative, qualitative, and longitudinal analyses using generalized linear mixed-effect, multilevel, and actor-partner interdependence models will be conducted to address the specific aims. The 6-month pilot RCT is ongoing. Recruitment, enrollment, and data collection began in January 2023 and ended in April 2024. A total of 74 adult cisgender SMM couples met all inclusion criteria, provided consent, and were enrolled in the pilot RCT. Retention was 92% (68/74) at month 6. Data are currently being analyzed to address the 3 specific aims regarding feasibility, acceptability, and preliminary efficacy. Findings from this research will reveal whether couples deemed the P3 DHI to be acceptable. Findings will also highlight the preliminary efficacy of the P3 DHI on couples managing their vulnerability to HIV and other sexually transmitted infections (STIs) over time via alignment of their prevention-care plan and sexual agreement. Trial findings will help shape the future direction of the P3 DHI while addressing the existing gap in prevention and care services for couples in the local context. ClinicalTrials.gov NCT05873855; https://clinicaltrials.gov/study/NCT05873855. DERR1-10.2196/63106.

Comparison of Sexual Violence Perpetration Rates by Among Gay, Lesbian and Heterosexual Cisgender Adults

Comparison of Sexual Violence Perpetration Rates by Among Gay, Lesbian and Heterosexual Cisgender Adults

Inequities in Self-Reported Social Risk Factors by Sexual Orientation and Gender Identity

Sexual minority (ie, people who self-identify as gay, lesbian, bisexual, and other nonheterosexual identities) and gender minority (ie, people who self-identify as transgender, nonbinary, or other noncisgender identities) adults report worse health outcomes compared with heterosexual and cisgender adults, respectively. Although social risk factors (SRFs; eg, housing instability) are associated with health outcomes, little is known about the prevalence of SRFs among sexual and gender minority adults. To examine differences in the prevalence of SRFs by sexual orientation and gender identity among adults. This cross-sectional study used Behavioral Risk Factor Surveillance System data collected from January 2022 to February 2023 for adults aged 18 years or older residing in 22 US states. Self-reported sexual orientation and gender identity. Outcome measures were dissatisfaction with life, lack of emotional support, social isolation, employment loss in the past 12 months, Supplementary Nutrition Assistance Program participation in the past 12 months, insufficient food, inability to pay bills, inability to pay utilities, lack of transportation, and stress. Survey weights were applied. Multivariable linear regression models were used to measure the association between sexual orientation and gender identity for each outcome. The study sample comparing outcomes by sexual orientation included 178 803 individuals: 84 881 men (48.5%; 92.9% heterosexual; 7.1% sexual minority) and 93 922 women (51.5%; 89.4% heterosexual; 10.6% sexual minority). The study sample comparing outcomes by gender identity included 182 690 adults (99.2% cisgender; 0.8% gender minority). Of sexual minority women, 58.1% reported at least 1 SRF compared with 36.5% of heterosexual women. Sexual minority women were significantly more likely to report social isolation (difference, 7.4 percentage points [PP]; 95% CI, 4.9-10.0 PP) and stress (difference, 12.2 PP; 95% CI, 9.8-14.7 PP) compared with heterosexual women. A greater proportion of sexual minority men (51.1%) reported at least 1 SRF than heterosexual men (34.0%); the largest magnitudes of inequity were in dissatisfaction with life (difference, 7.9 PP; 95% CI, 5.8-10.1 PP) and stress (difference, 6.7 PP; 95% CI, 4.5-8.9 PP). Of gender minority adults, 64.1% reported at least 1 SRF compared with cisgender adults (37.1%). Gender minority adults were significantly more likely to report social isolation (difference, 14.8 PP; 95% CI, 9.9-19.7 PP) and stress (difference, 17.0 PP; 95% CI, 11.9-22.1 PP). In this cross-sectional study, sexual and gender minority adults were significantly more likely to report multiple SRFs. These findings suggest that policies and community-based systems to advance socioeconomic equity among sexual and gender minority adults are critical.

Differences in cardiovascular risk factors associated with sex and gender identity, but not gender expression, in young, healthy cisgender adults.

Sex differences exist in cardiovascular disease risk factors including elevated blood pressure and arterial stiffness, and decreased endothelial function in males compared to females. Feminine gender expression may be associated with elevated risk of acute coronary syndrome. However, no study has investigated the associations between sex, gender identity, and gender expression and cardiovascular disease risk factors in young adults. One hundred and thirty participants (22 ± 3 years) underwent assessments of hemodynamics, arterial stiffness [pulse wave velocity (PWV)], and brachial artery endothelial function (flow-mediated dilation; %FMD). Participants completed a questionnaire capturing sex category (50 male/80 female), gender identity category (49 men/79 women/2 non-binary), and aspects of gender expression assessed by the Bem Sex Role Inventory-30 (39 androgynous/33 feminine/29 masculine/29 undifferentiated). Sex/gender identity category groups were compared using unpaired t-tests and gender expression groups compared using one-way ANOVAs. Resting systolic and mean arterial pressure (p < 0.01) were elevated in males vs. females. Central PWV was elevated in males [median (interquartile range): 6.4 (1.8) vs. 5.8 (2.2) m/s, p = 0.02]; however, leg and arm PWV were not different between sexes. %FMD was elevated in males vs. females, after accounting for a larger baseline artery diameter in males (8.8 ± 3.3% vs. 7.2 ± 3.1%, p = 0.02); since the majority of participants were cisgender, the same results were found examining gender identity (men vs. women). There were no differences across gender expression groups (p > 0.05). Sex/gender identity category, but not gender expression, influence cardiovascular risk factors (blood pressure, arterial stiffness, endothelial function) in cisgender adults; further research is needed in gender-diverse populations.

The Effects of Speaker Head Posture on Auditory Perception of Vocal Masculinity

ObjectiveThe purpose of this study was to investigate the impact of head position on listeners’ perception of vocal masculinity. MethodsTwelve cisgender women were recorded reciting two voiced sentences with varying head positions: baseline, flexed, and extended. Voice samples were cropped and fundamental frequency (fo) was resynthesized to control for any changes in fo across conditions. Twelve cisgender adults were recruited as listeners. Listeners were presented with 144 paired comparisons of speaker samples and were prompted to select the sample that sounded more masculine in each presented pairing. Ratings of masculinity were analyzed using Thurstone’s law of comparative judgment. A repeated measures analysis of variance (ANOVA) assessed the effects of head positioning, followed by Dunnett’s post hoc tests. ResultsThe ANOVA showed a statistically significant effect of head position on listener perceptions of masculinity: speech in the flexed position was perceived as statistically more masculine than that in the baseline condition. ConclusionsThe results of this study support the use of head posture manipulation to achieve increased vocal masculinity, which adds to the limited research related to voice masculinization strategies for those seeking gender-affirming voice care.

Dysmenorrhea-Related Impact on Functioning Scale: Development and Measurement Properties for Cisgender Women and Transgender Men

ObjectivesTo develop the Dysmenorrhea-related Impact on Functioning Scale (DIFS) to assess the impact of dysmenorrhea on functioning in cisgender women and transgender men and to evaluate its measurement properties. MethodsMixed and online design study conducted with adolescents and adult cisgender women and transgender men with dysmenorrhea. We developed the DIFS based on the International Classification of Functioning, Disability, and Health. Content validity was assessed with experts and people with dysmenorrhea. Item Response Theory developed the DIFS total score. Structural validity was assessed by exploratory and confirmatory factor analysis and internal consistency by Cronbach’s α and McDonald’s Ω. Construct validity and test-retest reliability were assessed by correlation between DIFS and World Health Organization Disability Assessment Schedule and intraclass correlation coefficient, respectively. Measurement error was also assessed. ResultsA total of 3335 people participated in the study. The DIFS is a 15-item instrument divided into “Bodily Functions” and “Daily Activities and Social Participation” sections and “Functioning” as a general factor. Internal consistency (α and Ω > 0.7) and test-retest reliability (intraclass correlation coefficient > 0.9) were adequate. No systematic error was found. Correlation was positive and strong between World Health Organization Disability Assessment Schedule and “Functioning” (r = 0.62, P ≤ .05). For the DIFS total score, higher scores indicate a greater impact of dysmenorrhea on functioning, and 44 points is the cutoff point for classifying the person with a significant impact of dysmenorrhea on functioning. ConclusionsDIFS showed excellent measurement properties for assessing the impact of dysmenorrhea on functioning for cisgender women and transgender men.

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data, 2010–23

Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa. Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors. We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV. Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates. UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health.

Autobiographical memory phenomenology in transgender and cisgender individuals

ABSTRACT Transgender individuals face challenges to identity as they transition from their sex assigned at birth to their affirmed gender. Memories may support a sense of self through the recall of events with more phenomenological detail than others, making them feel closer to the current self. Autobiographical memories of 90 transgender and 90 cisgender adults were compared on self-reported memory phenomenology. Memory phenomenology was more variable in transgender individuals, with a larger difference between phenomenological ratings of recent and distant memories. Memory phenomenology specifically varied in relation to the timing of coming out to a parent. High points reported after this time were rated with higher phenomenological quality and these ratings were linked to positive well-being. Results affirm the relevance of phenomenological continuity to the identity of transgender individuals, suggesting that events from before coming out are recalled with less phenomenological quality than events after coming out.

COVID-19 vaccination initiation and completion in a multicenter cohort study of insured US transgender and cisgender adults

PurposeTransgender and gender-diverse (TGD) people may have been disproportionately impacted by the COVID-19 pandemic, yet little is known about vaccination status in this population. This multicenter cohort study of insured adults examined the rates of COVID-19 vaccine initiation and completion in TGD persons compared to matched cisgender persons. MethodsA cohort of TGD persons and matched cisgender persons enrolled in Kaiser Permanente health plans in Northern and Southern California between 12/1/2020 and 7/31/2021 were analyzed. COVID-19 vaccination initiation and completion rates were compared across groups using Cox regression models. ResultsAmong transmasculine persons, the HR (95 % CI) estimates for COVID-19 vaccination initiation and completion were, respectively, 1.35 (1.30–1.40) and 1.78 (1.71–1.85) compared with cisgender women and 1.34 (1.29–1.40) and 1.81 (1.73–1.88) compared with cisgender men. Among transfeminine persons, the corresponding HRs (95 % CIs) for vaccination initiation and completion were 1.35 (1.30–1.40) and 1.78 (1.71–1.85) compared with cisgender women and 1.34 (1.29–1.40) and 1.81 (1.73–1.88) compared with cisgender men. ConclusionFindings from this cohort of insured adults demonstrated that TGD persons initiated and completed COVID-19 vaccination at higher rates compared to matched cisgender persons. Further work is needed to understand vaccination rates and determinants in the broader TGD populations.

Characteristics and Outcomes Among US Commercially Insured Transgender Adults With Cirrhosis: A National Cohort Study.

The National Institute on Minority Health and Health Disparities has noted that transgender individuals experience unique health disparities. We sought to describe the landscape of transgender patients with cirrhosis. We identified all transgender and cisgender adults in Optum's deidentified Clinformatics Data Mart Database between 2007 and 2022 using validated billing codes and calculating age-standardized prevalence of cirrhosis among cisgender vs transgender adults. Among those with incident cirrhosis diagnoses, we calculated age-standardized incidence densities of liver-related outcomes (decompensation, transplantation, hepatocellular carcinoma) and all-cause mortality. We examined 5-year survival using inverse probability treatment weighting to balance transgender and cisgender populations on demographic and clinical characteristics. Among 64,615,316 adults, 42,471 (0.07%) were transgender. Among 329,251 adults with cirrhosis, 293 (0.09%) were transgender. Trans- (vs cis-) genders had higher prevalence of cirrhosis (1,285 [95% confidence interval (CI) 1,136-1,449] per 100,000 vs 561 [559-563] per 100,000). Among adults with cirrhosis, trans- (vs cis-) genders had higher proportions of anxiety (70.7% [56.9-86.9] vs 43.2% [42.7-43.8]), depression (66.4% [53.3-81.7] vs 38.4% [37.9-38.9]), HIV/AIDS (8.5% [3.9-16.1] vs 1.6% [1.5-1.7]), and alcohol (57.5% [46.0-71.1] vs 51.0% [50.5-51.6]) and viral (30.5% [22.8-39.8] vs 24.2% [23.9-24.5]) etiologies, although etiologies had overlapping CIs. Trans- (vs cis-) genders had similar incidence densities of death (12.0 [95% CI 8.8-15.3] vs 14.0 [13.9-14.2] per 100 person-years), decompensation (15.7 [10.9-20.5] vs 14.1 [14.0-14.3]), and liver transplantation (0.3 [0.0-0.8] vs 0.3 [0.3-0.4]). In inverse probability treatment weighting survival analysis, transgender and cisgender individuals had similar 5-year survival probabilities (63.4% [56.6-71.1] vs 59.1% [58.7-59.4]). Trans- (vs cis-) gender adults have double the prevalence of cirrhosis, and the majority have a diagnosis of anxiety and/or depression. These results are informative for researchers, policymakers, and clinicians to advance equitable care for transgender individuals.

Autism traits in transgender and gender-diverse adults seeking gender-affirming medical treatment

Background Prior research has indicated a common overlap between autism traits and gender identity diversity, but studies including nonbinary/genderqueer (NBGQ) adults in clinical settings are lacking. This study therefore compared autism traits in transgender and gender-diverse (TGD) adults seeking gender-affirming medical treatment (GAMT) with autism traits in cisgender adults. It further assessed differences in autism traits among TGD subgroups, considering sex assigned at birth (comparing adults assigned male at birth (AMAB) and female at birth (AFAB)) and gender identity (comparing NBGQ adults with binary transgender and cisgender adults). Aim The primary aim of the study was to investigate autism traits in TGD adults seeking GAMT, contrasting them with cisgender adults from the general population. Additionally, the study aimed to assess potential differences in autism traits within and between TGD subgroups, considering sex assigned at birth and gender identity. Methods The study sample included 424 TGD adults referred to a gender identity clinic in the Netherlands (Mdn age = 22.59, 54.2% AFAB) and an age-matched sample of 424 cisgender adults from the Netherlands and Flanders. Autism traits were assessed using the Social Responsiveness Scale for Adults (SRS-A). Results TGD adults reported significantly more autism traits on the SRS-A compared to cisgender adults. TGD adults AFAB displayed significantly more autism traits than both TGD adults AMAB and cisgender men and women. However, TGD AMAB and cisgender men did not differ significantly in autism traits. In the TGD group, 65 (15.3%) identified with a NBGQ identity, and this TGD subgroup reported significantly more autism traits compared to binary identifying TGD and cisgender adults. Conclusion & discussion The study confirmed a higher prevalence of autism traits in TGD adults, specifically in those AFAB and those identifying as NBGQ, emphasizing the need for personalized clinical approaches in GAMT for autistic individuals.

ART coverage and viral suppression among female sex workers living with HIV in eThekwini, South Africa: Baseline findings from the Siyaphambili study.

In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban (South Africa) were enrolled into the Siyaphambili Study, a sequential multiple assignment randomized trial. Baseline viral load and CD4 were assessed, and an interviewer-administered survey was conducted, capturing socio-demographic, reproductive and sexual history and behaviors, vulnerabilities, substance use, mental health, and stigma. We assessed baseline determinants of viral suppression (<50 copies/mL) using bivariate and multivariable robust poisson regression, considering associations across the individual, network, environmental and macrostructural levels. From June 2018 -March 2020, 1,644 women were screened, with 1,391 eligible FSW living with HIV enrolled. The analyses were conducted among the 1,373 participants with baseline data. Overall, 65% (889/1,373) of participants were reported to be on antiretroviral therapy and 38% (520/1,373) were virally suppressed. In the multivariable model, FSW who experienced a lack of housing in the prior six months were less likely to be virally suppressed (aPR: 0.72, 95%CI 0.56-0.91), while older FSW (aPR: 1.46 95%CI: 1.16-1.83 for 30-39 years old vs. 18-29 years old; aPR: 2.15 95%CI: 1.64-2.80 for 40+ years vs. 18-29 years old) and FSW reporting hormonal or long-acting contraception use were more likely to be virally suppressed (aPR: 1.19 95% CI: 1.00-1.43). We found vulnerability to be high among FSW living with HIV in South Africa and identified individual and structural determinants associated with viral suppression. Taken together these results suggest optimizing HIV treatment outcomes necessitates supporting younger sex workers and addressing housing instability. Trial registration: NCT03500172.

Drug use and condomless sex among sexual minority men in relationships: Whether relationship quality is a risk or protective factor depends upon what they believe their partners do

Sexual minority male (SMM) couples tend toward behavioral similarity around cannabis use, illicit drug use, and sex with casual partners. Similarity in these behaviors may contextualize associations with relationship quality. This study tested the hypotheses that perceptions of partner (cannabis and illicit) drug use and sexual behavior would predict personal drug use and sexual behavior as well as moderate the association between relationship quality and these health outcomes. Recruitment via social networking applications yielded a sample of 5511 cisgender SMM aged 18–85 (M = 38.21, SD = 12.16) who were in a relationship with an adult cisgender male main partner. Respondents completed an online survey assessing their own cannabis use, illicit drug use, and condomless anal sex (CAS) with casual partners during the past 30 days as well as their belief about their partner's engagement in these behaviors. Three subscales of the Perceived Relationship Quality Components (PRQC) scale assessed relationship quality. Across the observed range of PRQC scores participants who reported their partner used cannabis, used other illicit drugs, and had recent CAS with a casual partner were more likely to report engaging in these activities themselves. Among participants who indicated their partner did not engage in these activities, relationship quality was negatively associated with personal cannabis use (OR = 0.985, p < 0.001), illicit drug use (OR = 0.973, p < 0.001), and CAS with casual partners (OR = 0.979, p < 0.001); meanwhile, among those who reported their partner engaged in these behaviors – relationship quality was positively associated with the odds of these behaviors (OR = 1.018, p < 0.001; OR = 1.015, p < 0.001; OR = 1.019, p = 0.015 for cannabis, illicit drug use and CAS with casual partners respectively). These findings suggest that perceptions of a partner's behavior contextualize associations between relationship quality and personal behavioral risk. Results emphasize the importance of integrating components that support relationship quality into behavioral health interventions for SMM couples and SMM in relationships.

Disparities in positive mental health of sexual and gender minority adults in Canada.

The goal of this study was to examine potential disparities in positive mental health (PMH) among adults in Canada by sexual orientation and gender modality. Using 2019 Canadian Community Health Survey (CCHS) Annual Component data (N = 57 034), we compared mean life satisfaction and the prevalence of high self-rated mental health (SRMH), happiness and community belonging between heterosexual and sexual minority adults, and between cisgender and gender minority adults. We used 2019 CCHS Rapid Response on PMH data (N = 11 486) to compare the prevalence of high psychological well-being between heterosexual and sexual minority adults. Linear and logistic regression analyses examined the between-group differences in mean life satisfaction and the other PMH outcomes, respectively. Sexual minority (vs. heterosexual) adults reported lower mean life satisfaction (B = -0.7, 95% CI: -0.8, -0.5) and were less likely to report high SRMH (OR = 0.4, 95% CI: 0.3, 0.5), happiness (OR = 0.4, 95% CI: 0.3, 0.5), community belonging (OR = 0.6, 95% CI: 0.5, 0.7) and psychological well-being (OR = 0.4, 95% CI: 0.3, 0.6). Differences were not always significant for specific sexual minority groups in sexstratified analyses. Gender minority adults reported lower mean life satisfaction and were less likely to report high SRMH and happiness than cisgender adults. Future research could investigate how these PMH disparities arise, risk and protective factors in these populations, how other sociodemographic factors interact with sexual orientation and gender identity to influence PMH and changes in disparities over time.

“Establishing Policy Is Just Step One of Twenty”: How Educational Policy Protections, District Practices, and Leadership Matter to Trans PK–12 School Workers

Background/Context: While trans adults in the U.S. and Canada report higher levels of discrimination and harassment than cisgender adults, but the existing literature lacks comprehensive descriptions of trans school workers’ believes about what would improve working conditions, satisfaction, and safety. Purpose: We interrogate systemic forces shaping PK-12 trans educators’ workplace experiences through two research questions: (1) What educational reforms did trans PK–12 workers believe would improve working conditions? (2) Did greater policy, organizational, and leadership support contribute to improved job satisfaction and safety? Research Design: The critical quantitative study employed cross-sectional, online survey data from 341 trans school workers in Canada and the United States. We used frequencies to descripe respondents’ rankings of reforms and logistic regression analysis to examine whether respondents’ reports of greater policy protections, organizational supports, and affirming leadership constributed to greater workplace safety and satisfaction. Conclusions/Recommendations: Trans workers reporting safer, more satisfactory school workplaces also indicate their workplaces have multiple tools across socio-ecological systems to disrupt cisnormativity. Policy protections topped workers’ rankings of beneficial reforms, but logistic regression analysis revealed policies mitigated only the most egregious physical safety concerns. Greater organizational supports and affirming leaders consistently contribute to satisfaction and safety. Policies, organizational practices, and leadership approaches working in tandem contribute to safe, satisfying workplaces for PK-12 trans school employees.

Promoting diverse perspectives: Addressing health disparities related to Alzheimer's and all dementias.

Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participantsare primarily well-resourced, non-Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowledge gap about Alzheimer's-related risk factors in those other groups. The Alzheimer's Association hosted a virtual conference on June 14-16, 2021, supported in part by the National Institute on Aging (R13 AG072859-01), focused on health disparities. The conference was held entirely online andconsisted of 2 days of core programming and a day of focused meetings centered on American Indian and Alaska Natives and on LGBTQIA+ populations. Over 1300 registrants attended discussionsfocused on the structural and systemic inequities experienced across diverse groups, as well as ways to investigate and address these inequities.

Temporal Trends in Mental Health in the United States by Gender Identity, 2014-2021.

Objectives. To examine the temporal trends in the transgender-cisgender mental health disparity in the United States. Methods. We used 2014-2021 US Behavioral Risk Factor Surveillance System Survey data with logistic and ordinary least squares regression to document temporal trends in the transgender-cisgender disparity in self-reports of the number of poor mental health days in the past month and frequent mental distress. Results. In 2014, cisgender individuals reported a mean average of 3.68 (95% confidence interval [CI] = 3.65, 3.70) poor mental health days compared with a mean average of 5.42 (95% CI = 4.68, 6.16) poor mental health days among transgender respondents. The size of this disparity adjusted by differences in observable characteristics increased by 2.75 days (95% CI = 0.58, 4.91) over the sample period. In 2014, 11.4% (95% CI = 11.3%, 11.5%) of cisgender adults reported frequent mental distress compared with 18.9% (95% CI = 15.9%, 22%) of transgender adults. By 2021, 14.6% (95% CI = 15.9%, 22%) of cisgender adults and 32.9% (95% CI = 30.7%, 35.1%) of transgender adults reported frequent mental distress. Conclusions. Policies are needed to address the worsening mental health of transgender and gender-nonconforming people in the United States. (Am J Public Health. 2024;114(5):523-526. https://doi.org/10.2105/AJPH.2024.307603).

Exploring men's health in medium and high complexity care in Brazil: A deductive thematic analysis of social determinants.

Men's health is influenced by a complex interplay of social, economic, and cultural determinants. Understanding how these aspects affect the health of adult cisgender men in medium and high-complexity healthcare settings is essential for improving healthcare services and promoting better health outcomes. This study aimed to analyze the health status of adult cisgender men in medium and high-complexity healthcare settings based on social determinants and conditioners. This study employed a qualitative design involving 45 adult cisgender men receiving care in medium/high complexity services in Bahia, Brazil. Semi-structured interviews were conducted from July 2019 to February 2020, and data were interpreted based on Dahlgren and Whitehead's Model of Social Determinants of Health using deductive thematic analysis. Proximal determinants included biological aspects, preventive behaviors, lifestyle/social life, and aging processes. Intermediate factors included work conditions, access/utilization of healthcare services/medications, and psychosocial factors. Macro determinants involved income distribution, power dynamics, resource allocation, health inequalities/iniquities, morbidity, culture, political decisions, environmental factors, and structural elements. The health status of men in medium/high complexity care was profoundly influenced by structural social determinants. These determinants impacted healthcare attention, service organization, cultural influences, the reproduction of hegemonic masculinity patterns, lifestyle, social support, and socioeconomic conditions necessary to realize the right to health. Nursing practices should conduct comprehensive assessments that extend beyond physical health indicators.

The impact of COVID-19 and long COVID on sexual function in cisgender women.

Research suggests that COVID-19 impairs sexual function in men, but little is known about the impact of COVID-19 (or long COVID) on sexual function in women. We sought to compare the sexual function of cisgender women who had never had COVID-19, who had COVID-19 but not long COVID, and who had long COVID, and assessed whether long COVID symptoms and/or emotional distress mediate the relationship between COVID-19 history and sexual function. In total, 2329 adult cisgender women were recruited online as study participants. Half of these women reported having had COVID-19, and the other half reported never having had COVID-19. Of those who had COVID-19, 25% (n= 170) reported having long COVID. We compared the mean Female Sexual Function Index (FSFI) scores by using t-tests for each of the primary comparison categories (never COVID vs COVID and only COVID vs long COVID). Four path models were used to test the hypotheses that (1) long COVID symptoms or (2) depression, anxiety, and/or stress assessed with the subscales of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) mediated the relationship between COVID-19 and sexual function. Sexual function was measured with the FSFI, long COVID symptoms were assessed using the Centers for Disease Control working symptom set, and emotional distress was measured with the DASS-21. In total, 1313 participants provided data suitable for analysis. The never-COVID group (n= 645, 49.1%) had higher scores on the Desire, Arousal, Lubrication, and Satisfaction subscales of the FSFI (mean [M] [SD] FSFI total Mnever COVID = 27.98[4.84] vs MCOVID = 27.05[5.21]) than the combined only-COVID (n= 498, 37.9%) and long-COVID (n= 170, 12.9%) groups. The FSFI subscale scores were significantly higher in the only-COVID group than in the long-COVID group for the Arousal, Lubrication, and Orgasm and lower for the Pain subscales and higher for overall sexual function (FSFI total Monly COVID = 27.49[5.00] vs Mlong COVID = 25.77[5.61]. None of the proposed mediation models had adequate model fit. Clinicians treating cisgender women who have COVID-19 should consider proactively discussing sexual function with their patients and offering available resources. In this study we used a large and diverse sample, but this sample did not include transgender or gender-diverse persons. This study was also correlational; as such, causal conclusions cannot be drawn. Further, the mechanism of action remains unexplained. The study findings suggest the following: (1) COVID-19 infection is associated with impaired sexual function in cisgender women, and (2) that women with long COVID experienced incrementally more impaired sexual function than women with COVID-19 who did not develop long COVID.