Discrimination In Health Care Research Articles

Establishing Healthcare Discrimination: An Analysis of Scandinavian Equality Boards

Discrimination in healthcare is a pervasive issue faced by patients, affecting their access to treatment and overall well-being. This article examines the forms of healthcare discrimination recognised by Scandinavian equality boards through a comparative analysis of their decisions. While social science studies have established the existence of discrimination based on ethnicity, race, gender, sexuality, and age, proving such discrimination in legal terms poses significant challenges. An analysis of board decisions reveals that patients face barriers in establishing legally actionable discrimination, as perceived discriminatory conduct may not meet the criteria for legal claims. Additionally, equality boards are often hesitant to intervene in medical decision-making processes, further complicating the path to legal recourse. Lack of evidentiary support, especially in cases of unconscious bias, makes it difficult for some patients to substantiate claims of discrimination. The findings underscore the complexities of addressing healthcare discrimination through legal means. To effectively combat discrimination, there is a need to clarify the goals of discrimination law in the healthcare context and consider its future application within the broader context of human rights and equality.

Reimagining Healthcare: What an Ideal Healthcare System Looks Like for Transgender and Nonbinary Individuals

Research is clear that transgender and nonbinary (TNB) individuals face a myriad of barriers accessing and participating in the healthcare system and these barriers often lead to negative health outcomes. In this study, in collaboration with the largest statewide LGBTQ+ advocacy organization, we conducted seven focus groups with TNB individuals representing urban, suburban, and rural areas to assess what the ideal health system would look like. From these focus groups, four themes were identified: (a) addressing discrimination and invisibility in healthcare and healthcare provider training, (b) access to care, (c) medical cost and insurance, and (d) access to resources and information. Several subthemes were identified under each main category.

Abstract PO2-09-11: Breast Cancer Care Disparities in Sexual Minority Women: An Analysis of the National Institutes of Health All of Us Research Program

Abstract Background. Currently, sexual orientation data is not collected, nor is the language to study sexual orientation data defined by any national cancer database. Due to this limitation, little is known about breast cancer (BC) disparities in sexual minority women (SMW) despite several studies showing increased lifestyle risk factors. Our objective was to study this question in the All of Us database. Methods. We analyzed data from the All of Us research program, a national open enrollment database that registers diverse subjects through associated healthcare electronic medical records and collects survey data. We aimed to compare risk factors, as well as preventative and procedural healthcare utilization differences between SMW and straight women (StW) as they relate to BC care. Results were expressed as odds ratios (OR) with a 95% confidence interval [CI]. Results. Of 229,917 cisgender women who answered the sexual orientation question, 27,302 (11.9%) selected “non-straight orientation, prefer not to answer, or skipped” and thus were defined as SMW. In total, 6,905 (3.0%) women had received a BC diagnosis, including 423 (6.1%) SMW. SMW were less likely to have a BC diagnosis than StW (OR 0.48 [0.43-0.53]). Among all women, there were significant differences in frequency and types of visits and procedures performed. SMW women were less likely to undergo annual history and physical examination (0.79 [0.73-0.85]), mammography (0.61 [0.53-0.69]), and breast biopsy (0.55 [0.41-0.72]), as well as being less likely to undergo breast surgeries (mastectomy 0.53 [0.30-0.93]; lumpectomy 0.53 [0.38-0.74]). Survey data revealed differences in several lifestyle factors that relate to BC risk development. While StW were more likely to answer yes to being an “alcohol participant” (0.79 [0.77-0.82]), SMW reported higher rates of alcohol intake on a daily, weekly, and monthly basis, as well as being more likely to consume 6 or more drinks in one sitting. SMW also showed significantly increased history of smoking/nicotine usage. There were also significant differences in healthcare access and utilization: StW were more likely to receive health advice from a primary care provider (0.65 [0.65-0.69]), while SMW were more likely to utilize urgent and emergency care (1.44 [1.34-1.54]). SMW were also more likely to report being unable to afford care (1.82 [1.72-1.93]), medication (1.69 [1.61-1.76]), specialty care (1.98 [1.89-2.08]), and follow-up care (1.85 [1.75-1.95]), as well as to delay care due to cost concerns about the copay (2.13 [2.02-2.23]), deductible (1.64 [1.56-1.73]), paying out of pocket (1.70 [1.63-1.77]) or because they were nervous (2.80 [2.69-2.91]). SMW reported being more likely to experience healthcare discrimination based on questions about healthcare provider interactions (Table 1). Conclusions.Although likelihood of a breast cancer diagnosis in the All of Us database is significantly higher in StW than SMW, discrimination, lack of access, and underutilization of preventative and screening services by SMW likely creates an underrepresentation of the true number of SMW with BC. Further studies on characteristics at diagnosis, treatments, and survival are needed to address how these disparities affect BC outcomes in SMW. Table 1: Survey answers among sexual minority women (SMW) compared to straight women (StW) reporting on discrimination from healthcare provider interactions in the All of Us database. SMW: sexual minority women; StW: straight women; OR: odds ration; Lower 95 CI: lower 95% confidence interval; Upper 95 CI: upper 95% confidence interval; Sig. *: statistically significant with p < 0.05; OR>1: SMW most likely to answer; OR <1 StW most likely to answer. Citation Format: Lucas Houser, Collin Dougherty, Sean Figy, Jessica Maxwell, Juan Santamaria-Barria. Breast Cancer Care Disparities in Sexual Minority Women: An Analysis of the National Institutes of Health All of Us Research Program [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-09-11.

Social Support Is Protective Against the Effects of Discrimination on Parental Mental Health Outcomes.

Discrimination, or unfair treatment based on individual characteristics such as gender, race, skin color, and or sexual orientation, is a pervasive social stressor that perpetuates health disparities by limiting social and economic opportunity and is associated with poor mental and physical health outcomes. The purpose of the present study is to (1) examine the association between maternal experiences of discrimination and paternal experiences of discrimination; (2) explore how discrimination relates to parental (maternal and paternal) stress and depressive symptoms; and (3) examine whether social support exerts protective effects. The sample was 2,510 mothers and 1,249 fathers from the Child Community Health Network study. Linear regression models were conducted to explore associations between maternal and paternal discrimination. In addition, mediation analyses were conducted to explore if social support functioned as a mediator between discrimination on parental stress and depressive symptoms. Most mothers (40.3%) and fathers (50.7%) identified race as the predominant reason for discrimination. Experiencing discrimination was significantly related to stress and depressive symptoms for both parents, and all forms of social support mediated these relationships. Our findings suggest that social support can act as a protective factor against the negative association between discrimination and both stress and depressive symptoms. These findings highlight the need to integrate social support into existing interventions and include fathers in mental health screenings in primary-care settings. Finally, we briefly describe the role of nurses and other allied health professionals in addressing discrimination in health care and health policy implications.

Representation of Women Among Individuals With Mild Variants in ABCA4-Associated Retinopathy

Previous studies indicated that female sex might be a modifier in Stargardt disease, which is an ABCA4-associated retinopathy. To investigate whether women are overrepresented among individuals with ABCA4-associated retinopathy who are carrying at least 1 mild allele or carrying nonmild alleles. Literature data, data from 2 European centers, and a new study. Data from a Radboudumc database and from the Rotterdam Eye Hospital were used for exploratory hypothesis testing. Studies investigating the sex ratio in individuals with ABCA4-AR and data from centers that collected ABCA4 variant and sex data. The literature search was performed on February 1, 2023; data from the centers were from before 2023. Random-effects meta-analyses were conducted to test whether the proportions of women among individuals with ABCA4-associated retinopathy with mild and nonmild variants differed from 0.5, including subgroup analyses for mild alleles. Sensitivity analyses were performed excluding data with possibly incomplete variant identification. χ2 Tests were conducted to compare the proportions of women in adult-onset autosomal non-ABCA4-associated retinopathy and adult-onset ABCA4-associated retinopathy and to investigate if women with suspected ABCA4-associated retinopathy are more likely to obtain a genetic diagnosis. Data analyses were performed from March to October 2023. Proportion of women per ABCA4-associated retinopathy group. The exploratory testing included sex ratio comparisons for individuals with ABCA4-associated retinopathy vs those with other autosomal retinopathies and for individuals with ABCA4-associated retinopathy who underwent genetic testing vs those who did not. Women were significantly overrepresented in the mild variant group (proportion, 0.59; 95% CI, 0.56-0.62; P < .001) but not in the nonmild variant group (proportion, 0.50; 95% CI, 0.46-0.54; P = .89). Sensitivity analyses confirmed these results. Subgroup analyses on mild variants showed differences in the proportions of women. Furthermore, in the Radboudumc database, the proportion of adult women among individuals with ABCA4-associated retinopathy (652/1154 = 0.56) was 0.10 (95% CI, 0.05-0.15) higher than among individuals with other retinopathies (280/602 = 0.47). This meta-analysis supports the likelihood that sex is a modifier in developing ABCA4-associated retinopathy for individuals with a mild ABCA4 allele. This finding may be relevant for prognosis predictions and recurrence risks for individuals with ABCA4-associated retinopathy. Future studies should further investigate whether the overrepresentation of women is caused by differences in the disease mechanism, by differences in health care-seeking behavior, or by health care discrimination between women and men with ABCA4-AR.

Engaging Sexual and Gender Minority (SGM) Communities for Health Research: Building and Sustaining PRIDEnet

Lesbian, gay, bisexual, transgender, queer, intersex, asexual, aromantic, and other sexual and/or gender minority (LGBTQIA+) communities are underrepresented in health research and subject to documented health disparities. In addition, LGBTQIA+ communities have experienced mistreatment, discrimination, and stigma in health care and health research settings. Effectively engaging LGBTQIA+ communities and individuals in health research is critical to developing representative data sets, improving health care provision and policy, and reducing disparities. However, little is known about what engagement approaches work well with LGBTQIA+ people. This paper describes the development of PRIDEnet (pridenet.org), a national network dedicated to catalyzing LGBTQIA+ community involvement in health research and built upon well-established community-engaged research (CEnR) principles. PRIDEnet’s relationship building and digital communications activities engage thousands of LGBTQIA+-identified people across the country and offer multiple low-threshold ways to participate in specific studies and shape research. These activities comprise a CEnR infrastructure that engages LGBTQIA+ people on behalf of other projects, primarily The PRIDE Study (pridestudy.org) and the National Institutes of Health’s All of Us Research Program (joinallofus.org/lgbtqia). Our impact, results, and lessons learned apply to those engaging communities underserved in biomedical research and include: the importance of building adaptable infrastructure that sustains transformational relationships long-term; implementing high-touch activities to establish trust and broad-reach activities to build large data sets; nurturing a team of diverse professionals with lived experiences that reflect those of the communities to be engaged; and maintaining CEnR mechanisms that exceed advice-giving and result in substantive research contributions from beginning to end.

COVID-19 and Immigrant Status: A Qualitative Study of Malawian Immigrants Living in South Africa

Migration to South Africa is motivated by the pursuit of employment, safety, and improved living conditions. However, immigrants encounter significant challenges, such as restricted access to essential services, which were exacerbated by the COVID-19 pandemic. This paper investigates the impact of the COVID-19 pandemic on Malawian immigrants in South Africa, addressing the lack of attention given to this immigrant population by highlighting their vulnerabilities. Using a qualitative exploratory and descriptive approach, in-depth interviews were conducted with 24 Malawi immigrants who were over 18 years old and had established residency in South Africa before the onset of the COVID-19 pandemic. Five key stakeholders were also interviewed for additional perspectives and to ensure triangulation and improve data reliability. The interviews were transcribed verbatim and analyzed using thematic analysis strategies and coding with Nvivo12 software. The study highlighted the exacerbated struggles of Malawian immigrants in South Africa amid the COVID-19 pandemic, uncovering systemic discrimination in healthcare, marked by longer wait times and reluctance from health workers to treat undocumented immigrants. The study also revealed a dire security situation, with immigrants living in high-crime areas and feeling particularly targeted due to their foreign status, a situation worsened by the pandemic’s economic effects. Additionally, the economic downturn induced by COVID-19 significantly impacted employment opportunities, with many immigrants facing prolonged unemployment and job losses, especially in sectors where they traditionally found work. The detailed accounts of participants highlight not only the multifaceted challenges imposed by the pandemic but also the critical need for inclusive policies and support systems that ensure healthcare access, safety, and economic resilience for immigrants, particularly during global health emergencies. Future research should focus on effective interventions for socioeconomic integration and well-being, particularly for immigrants from other African countries.

Factors Associated With COVID-19 Vaccination Among Racial/Ethnic Minority Groups With HIV in South Florida.

Racial/ethnic minority groups with HIV in the United States are particularly vulnerable to COVID-19 consequences and can significantly benefit from increased uptake of COVID-19 vaccines. This study identified factors associated with full COVID-19 vaccination among people with HIV. Ryan White HIV/AIDS Program in Miami-Dade County, FL. Data were collected from 299 Ryan White HIV/AIDS Program adult clients during January-March 2022 using a cross-sectional phone survey. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). All analyses were weighted to be representative of the race/ethnicity and sex distribution of clients in the Ryan White HIV/AIDS Program. Eighty-four percent of participants were fully vaccinated with a primary vaccine series; stratified by race/ethnicity, the percentages were 88.9% of Hispanic, 72.0% of black/African American, and 67.5% of Haitian participants. Fully vaccinated participants were less likely to be black/African American than Hispanic (aOR = 0.18; 95% CI: 0.05 to 0.67) and more likely to not endorse any misconceptions about COVID-19 vaccines (aOR = 8.26; 95% CI: 1.38 to 49.64), to report encouragement to get vaccinated from sources of information (aOR = 20.82; 95% CI: 5.84 to 74.14), and to perceive that more than 50% of their social network was vaccinated (aOR = 3.35; 95% CI: 1.04 to 10.71). Experiences of health care discrimination, structural barriers to access vaccines, and recommendations from HIV providers were not associated with full vaccination. These findings highlight the importance of delivering accurate and positive messages about vaccines and engaging social networks to promote COVID-19 vaccination among people with HIV. This information can be leveraged to promote uptake of subsequent boosters and other recommended vaccines.

Direct and vicarious exposure to healthcare discrimination and erasure among transgender and gender independent individuals: Testing the indirect effect of mistrust in healthcare on utilization behaviors

RationaleDirect exposure to gender identity-related discrimination and erasure among the transgender and gender independent (TGI) population are associated with healthcare underutilization, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the United States (U.S.). Although the impacts of direct exposure to healthcare discrimination and erasure may have on TGI individuals are known, exposure to such harm vicariously (i.e., through observation or report) is underexplored. ObjectiveThe present study examined the relationships among direct and vicarious gender identity-related healthcare discrimination and erasure exposure and past-year healthcare utilization. MethodGender identity-based mistrust in healthcare was also assessed, as a mechanism through which direct and vicarious gender identity-related healthcare discrimination and erasure predict healthcare utilization behaviors among a sample (N = 385) of TGI adults in the U.S., aged 18 to 71 recruited online. ResultsResults indicated direct lifetime and vicarious healthcare discrimination and erasure exposure significantly predicted past-year healthcare underutilization when participants anticipated encountering gender identity-related healthcare discrimination. Mediational analyses indicated that higher levels of exposure to direct lifetime and vicarious healthcare discrimination and erasure were related to higher levels of mistrust in healthcare, through which past-year underutilization was significantly related. ConclusionsThese findings are vital to informing healthcare practice and policy initiatives aimed at ensuring the barriers that deleteriously influence the accessibility of healthcare among TGI individuals are ameliorated.

Investigating the Potential Double-Edged Score of Immigration-Related Stress, Discrimination, and Mental Health Access.

Prior work has suggested that discrimination and immigration-related stress may impede mental health care seeking and utilization among Latinx populations. These effects may be more nuanced as both discrimination and immigration-related stress may increase symptomology, particularly post-traumatic stress disorder (PTSD) and depression. Both symptoms may, in turn, prompt attempts to seek care. The current study examined the direct effects of discrimination and immigration-related stress on care access, as well as potentially indirect effects with PTSD and depression symptoms as mediators. Interviews and online surveys were completed with 234 Latinx residents of the Midwest, assessing everyday discrimination, discrimination in healthcare, PTSD symptoms, depression symptoms, current mental health utilization, and previous unsuccessful attempts to seek care. Direct effects of discrimination and immigration-related stress were largely unrelated to care access variables. Discrimination in healthcare settings predicted both unsuccessful attempts to seek care and current use, but this effect was positive. The indirect effect was largely supported, but only for PTSD symptoms and not depression. Results indicate that further investigation is necessary to understand the direct effects of discrimination on care access. Further, discrimination and immigration-related stress may indirectly prompt attempts to seek mental health care.

Association between experiencing low healthcare quality and developing dementia.

Low healthcare quality has been found to predict the development of a number of illnesses in older adults. However, it has not been investigated as a determinant of dementia. Thus, the goal of this study was to assess whether experiencing low healthcare quality is associated with developing dementia in people aged 60 and older. Participants in the Health and Retirement Study, without dementia and aged 60 and older at baseline, were followed from 2006 to 2019. Experiencing low healthcare quality was assessed at baseline through questions about healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression was used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors. Among the 3795 participants included in the cohort, 700 developed dementia. Experiencing low healthcare quality was associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27-2.21, p-value <0.001; fully adjusted HR: 1.50, 95% CI: 1.12-2.01, p-value: 0.006). Healthcare discrimination and dissatisfaction with the healthcare quality received were independently associated with increased dementia risk. As predicted, experiencing low healthcare quality was associated with greater dementia risk. To date, most measures to reduce dementia have focused on individual-level behaviors. Our findings suggest that implementing structural changes to improve healthcare quality delivery for older persons could reduce dementia prevalence.

Perceived discrimination in health care in Germany– results of a population survey

BackgroundIt has consistently been shown that perceived discrimination is associated with adverse health outcomes. Despite this uncontested relevance, there is a lack of research on the experiences of discrimination in health care. Therefore, the following research questions were addressed: (1) How often do people in Germany report having been discriminated in health care due to different reasons? (2) Which socio-demographic groups are most afflicted by perceived discrimination in health care?MethodsAnalyses are based on a cross-sectional online survey conducted in Germany. An adult population sample was randomly drawn from a panel which was recruited offline (N = 2,201). Respondents were asked whether they have ever been discriminated in health care due to the following reasons: age, sex/gender, racism (i.e. migration history, religion, language problems, colour of skin), health issues or disability (i.e. overweight, mental illness/addiction, disability), socio-economic status (SES, i.e. income, education, occupation).Results26.6% of the respondents reported discrimination experiences. Perceived discrimination due to health issues or disability was most frequent (15%), followed by age (9%) and SES (8.9%). Discrimination due to racism and sex/gender was less frequently reported (4.1% and 2.5%). Younger age groups, women, and 2nd generation migrants as well as respondents with low income and low education were more likely to report any kind of discrimination in health care. Two groups were found to be at special risk for reporting discrimination in health care across different reasons: women and younger age groups. Discrimination due to racism was more prevalent among respondents who have immigrated themselves than those who were born in Germany but whose parents have immigrated. Discrimination due to SES was significantly associated with (low) income but not with education.ConclusionsMore than a quarter of the adult population in Germany reported experiences of discrimination in health care. Such experiences were more frequent among lower SES groups, migrants, women, and younger people. Results underline the necessity of interventions to reduce the magnitude and consequences of discrimination in health care. Future studies should apply an intersectional approach to consider interactions between social inequality indicators regarding discrimination and to identify risk groups that are potentially afflicted by multiple discrimination.

The Effects of Previous Experiences of Healthcare Discrimination on HIV Intervention Outcomes.

Although several healthcare interventions have been developed to address HIV among young Black/African American men who have sex with men (YBMSM), the HIV epidemic in the United States continues to disproportionately burden this population. The current study examines previous healthcare discrimination and how it affects HIV intervention delivery. One hundred seventy-two YBMSM participated in the Peer Promotion of Wellness and Enhanced Linkage to Resources (PPOWER) project, which used a short, multi-faceted, community-level intervention based on Community Peers Reaching Out and Modeling Intervention Strategies (Community PROMISE). Data were collected at baseline, a 45-day follow up, and a 90-day follow up. Generalized Estimating Equations (GEE) were used to examine the effects of previous healthcare discrimination on outcomes related to HIV testing, alcohol and drug use, and sexual behaviors. Previous healthcare discrimination was found to moderate the relationship between time and intentions to test for HIV, perceptions of sexual risk, problem marijuana use, and problem other drug use, such that those who had experienced more healthcare discrimination showed greater improvements over time compared to those who had experienced less healthcare discrimination. The results of the current study suggest that a community-level peer intervention, in combination with a component to promote cultural competency and address prior experiences of discrimination in healthcare settings, may be highly effective for people who have experienced a barrier in their continuum of care as a result of racial discrimination.

Psychological Distress Mediates the Relationship Between HIV-Related Stigma and Prescription Opioid Misuse Among Chinese People Living with HIV.

Prescription opioid misuse (POM) among people living with HIV (PLWH) is a serious concern due to risks related to dependence and overdose, and PLWH may be at higher risk for POM due to psychosocial stressors including psychological distress. However, scant POM research has examined the role of HIV-related stigma (e.g., internalized stigma, enacted stigma) in POM among PLWH. Guided by minority stress theory, this study examined a hypothesized serial mediation among enacted stigma, internalized stigma, psychological distress, and POM within a sample of Chinese PLWH with pain symptoms enrolled in a wave (between November 2017 and February 2018) of a longitudinal cohort study in Guangxi (n = 116). Models were tested individually for six enacted stigma experiences, controlling for key demographic and health-related variables (e.g., CD4 + count). Results showed HIV-related workplace discrimination was the most common stigma experience (12%,) and 10.3% of PLWH reported POM. Indirect effect analyses showed that internalized stigma was indirectly associated with POM through psychological distress. Internalized stigma and psychological distress mediated the association between workplace discrimination and POM. Family discrimination, gossip, and healthcare discrimination were directly associated with POM. This study suggests that Chinese PLWH may engage in POM to cope with psychological distress that is rooted in HIV-related stigma and highlights the important context of workplace discrimination for PLWH. Implications for interventions to reduce POM among PLWH are discussed.

Impact of disability-based discrimination in healthcare on parents of children with medical complexity.

To qualitatively assess the impact of disability-based discrimination in healthcare on the parents of children with medical complexity (CMC). In this qualitative study, we conducted in-depth, semi-structured interviews with the parents of CMC. Data collection and analysis occurred iteratively; constant comparison methods were used to identify themes describing the impact of disability-based discrimination in pediatric healthcare on the parents of CMC. Thirty participants from 15 US states were interviewed. Four themes were developed regarding the impact of disability-based discrimination in healthcare on parents. The themes were: (1) discrimination leads to a loss of trust in healthcare providers; (2) discrimination increases the burden of caregiving; (3) discrimination impacts parental well-being; and (4) racism and poverty-based discrimination amplifies disability-based discrimination. The experience of discrimination toward their child results in loss of trust and therapeutic relationship between provider and parent, causes increased burden to the family, and contributes to decreased parental well-being. These experiences are magnified in minoritized families and in families perceived to have a lower socioeconomic status based on insurance type.

Prescription Pain Reliever Misuse Among Transgender and Gender Diverse Adults.

Little is known about the prevalence and risks associated with transgender and gender diverse (TGD) persons' misuse of prescription pain relievers (PPRs). This study explores the relationship between PPR misuse and various sociodemographic identities and experiences of discrimination in health care among TGD adults. TGD participants (n=595) were recruited in 2018 to participate in a cross-sectional statewide trans health survey through convenience sampling. Chi-square tests of independence and logistic regressions were conducted to explore associations between sociodemographics and experiences of discrimination among persons who had ever misused PPRs, or who had misused PPRs in the past year. Sociodemographics such as gender identity (odds ratio [OR]=0.44, p=0.01), race/ethnicity (OR=0.14, p<0.001), and sexual orientation influence TGD individuals likeliness of misusing PPRs (OR=0.40, p<0.001). Notably, those who were ever diagnosed with anxiety had a higher likeliness of having lifetime PPR misuse compared with those who were never diagnosed (OR=2.05, p=0.05), and those reporting past-year discrimination within the mental health care setting because of their gender identity were more than twice as likely to report past-year misuse than those who reported not experiencing it (OR=2.43, p=0.004). Certain subpopulations of TGD individuals may be at elevated risk of PPR misuse. It is imperative to acknowledge the impact of multimarginalized identities as well as differences across various identities and experiences within the TGD community while working to address non-PPR misuse.

Transgender and gender diverse people with endometriosis: A perspective on affirming gynaecological care.

Transgender and gender diverse people presumed female at birth experience gynaecological conditions, such as chronic pelvic pain at elevated rates, estimated to impact between 51% and 72% of this population, compared to rates of up to 26.6% in cisgender women. The negative impact of these conditions is likely amplified due to limited access to safe and affirming healthcare. Despite this high prevalence rate, there is limited research investigating the prevalence, presentation or management options for trans and gender diverse people with endometriosis. Cisgender women with endometriosis report barriers to accessing care, with lengthy times to diagnosis and limited treatment options available. However, barriers for trans and gender diverse individuals are enhanced by physician bias and lack of education in gender-affirming care. This is reflected in stories of discrimination and denial of basic healthcare. A healthcare environment built on the presumption that gynaecological patients are women, others trans and gender diverse patients, which can result in avoidance of needed medical care. A lack of knowledge of gender-affirming care alongside healthcare provider bias highlights a need for gender-affirming care and bias reduction training in undergraduate healthcare provider curricula. Research to date assessing current curriculum in Australia and Aotearoa (New Zealand) shows limited inclusion of lesbian, gay, bisexual, trans, queer, intersex, asexual and other related identities content as a whole with gender-affirming care being among the least-frequently addressed topics. This review will detail barriers to accessing gender-affirming healthcare specific to gynaecology, interweaving the experiences of a non-binary individual seeking access to gender-affirming endometriosis care.

Screening for health literacy, social determinants, and discrimination in health plans.

Health inequities are frequently driven by social determinants of health (SDOH) and structural determinants of health. Our pilot sought to test the feasibility of screening for health literacy (HL) and perceived health care discrimination (PHD) through a live telephonic-facilitated survey experience with managed care patients. Cross-sectional study. Newly enrolled Medicare Advantage patients were screened for self-reported PHD, HL, and multiple SDOH using validated screening tools. Response rates for both HL and PHD screens were analyzed. A χ2 test for association between response to PHD screen and patient race was conducted. A weighted logistic regression model was used to understand how HL is associated with SDOH and demographic factors (age, gender, race/ethnicity, andincome). HL and PHD screening questions have different levels of feasibility. Administering the HL screen did not present a challenge, and patients felt comfortable responding to it. On the other hand, the PHD question had a lower response rate among patients, and some concierge advocates felt uncomfortable asking patients the question. Based on the self-reported HL data collected, low/limited HL is associated with patients who were Black, were low income, reported loneliness or isolation, or reported food insecurity. It is important to note that the study's findings are limited by the small sample size and that study results do not imply causality. It is feasible to collect self-reported HL data through a live telephonic format at the time of patient enrollment into a health plan. Health plans can leverage such screenings to better understand patient barriers for health equity-oriented interventions.

The impact of perceived healthcare discrimination on health outcomes among patients with prostate cancer across racial and ethnic groups.

The impact of perceived healthcare discrimination on health outcomes among patients with prostate cancer across racial and ethnic groups.

Attitudinal Disposition of Correctional Officers’ Towards an Inmates with Mental illness in Agodi Prison, Oyo State, Nigeria

There is a frequently higher prevalence of mental health problems among the incarcerated population in Nigeria. However, their mental health is often neglected, leading to a complex interplay of issues that hinder effective rehabilitation and integration of offenders into society. This study examined the attitudinal disposition of correctional officers towards the mental health of an inmate in Agodi correctional home, Ibadan. This is a cross-sectional study design and a stratified random sampling technique were used to select 200 correctional officers. A socio-demographic questionnaire and questions focusing on the stigmatization of inmates living with mental health. The Pearson Product Moment Correlation was used to test the generated hypotheses at a 0.05 significance level. Findings revealed that there was a significant relationship between counselling service and inmate mental health (r = .621, n= 200, p &lt; .05), there was a significant relationship between rehabilitation program and inmate mental health (r = .642, n= 200, p &lt; .05), there was a significant relationship between welfare service and inmate mental health (r = .716, n= 200, p &lt; .05), there was a significant relationship between correctional officers attitude and inmates mental health (r = .731, n= 200, p &lt; .05). This study underscored the potential consequences of negative attitudes, such as stigmatization, discrimination, and inadequate provision of mental health care, which can impede the rehabilitation and successful reintegration of inmates into society. Therefore, a comprehensive understanding of the attitudinal disposition of correctional officers towards inmates with mental illness is imperative.