Sexual and Gender Minority Youth (SGMY) & Sexual Health Education in Healthcare
Jane C. Murphy, MPH
CHHS 731-91
Overview
Overview
-Why is this important?
-Variables of interest: age, race,
socioeconomic status, access to healthcare, SGMY or not
-Literature Review
-Examples of Theory & Research
-Gaps in the Literature
-Potential for the Future
U.S. Health in international perspective: shorter lives, poorer health. (Woolf & Aron 2013)
- no federal standard on sexual health education in public schools
-since the 1990s, adolescents in the United States have the highest rates of pregnancy and are more likely to have sexually transmitted infections (STIs)
-the second highest prevalence of HIV infection among the 17 peer countries and the highest
incidence of AIDS
Sex Ed in the USA
LGBT VS. LGBTQIA+
-wide variety of gender identities, sexual orientation, and gender expression
-Lesbian, Gay, Bisexual, Transgender
-Lesbian, Gay, Gender Queer, Gender Fluid, Gender non-conforming, Bisexual, Non-Binary, Transgender, Queer, Questioning, Intersex, Aromantic, Asexual, Demisexual, Pansexual, Two Spirit, and more
CDC Youth Risk Behavior Survey:
Data Summary and Trends Report 2007-2017
SGMY
Literature Review
Literature Review
A
Adolescent Pre-exposure Prophylaxis Administration: An Education Curriculum
for Health Care Providers (Carnevale et al. 2018)
-authors found that clinicians identified two significant barriers to prescribing PrEP to adolescents: the perceived need for a multidisciplinary team and inclusion of behavioral interventions in the visit
-PrEP implementation in a younger population requires a new set of youth-focused guidelines, teaching points, and educational methodologies
-Eight domains were identified as essential for inclusion in the curriculum:
What is PrEP/PEP? - Overview of PrEP - Efficacy & Clinical Trials- PrEP Eligibility- Sexual History Taking in the PrEP Era - Can Adolescents Access PrEP? - How to conduct an Adolescent PrEP Medical Visit- Benefits and Insurance Navigation
-additional research needed on how best to engage the parents of adolescents in the administration of PrEP
B
Examining clinicians’ experiences providing sexual health services for LGBTQ youth: considering social & structural determinants of health in clinical practice (Knight et al. 2014)
-conducted in the province of British Columiba, Canada where same sex marriage was legalized in 2005
-used post-modern and feminist theorectical approaches, looking at forms of social oppression. Study design to understand the extent to which sexual health service provision responds to structural issues that influence LGBTQ youth (e.g. heteronormativity, heterosexism, homophobia and transphobia)
-Three main themes were identified:
1. experiences providing LGBTQ youth sexual health care within the heterosexual status quo
2. reflections on clinical practice and the social determinants of LGBTQ youth sexual health
3. changing practices or reproducing the heterosexualstatus quo: a variety of
responses within day-to-day clinical practice.
1. Experiences providing LGBTQ youth sexual health care within the heterosexual status quo
2. Reflections on clinical practice and the social determinants of LGBTQ youth sexual health
3. Changing practices or reproducing the heterosexual status quo: a variety of
responses within day-to-day clinical practice
C
Managing uncertainty: A grounded theory of stigma in transgender health care encounters (Poteat et al. 2013)
-overall, transgender people on the LGBTQ+ spectrum face more stigma than cisgender people
-care for transgender patients is excluded from medical training so many providers approach medical encounters with transgender patients with ambivalence and uncertainty
-interviews with 55 trans patients and 12 medical providers showed that there is frustration on both ends
-grounded theory was used to reduce bias against current literature
Which theories
have been working?
Examples of Theory
-Grounded theory
-Post-modern and feminist theoretical approaches
-Expert Panels
-Social Cognitive theory
Examples of Research
Examples of Research
The effects of educational curricula &
training on LGBT-specific health issues for
healthcare students & professionals (Sekoni et al. 2017)
1
-a mixed-method systematic review of 16 publications reporting 15 studies were included in the review
-majority of papers were from the USA, only 5 out of 16 studies included input from the LGBT community in the design or facilitation of training
-All reported statistically significant improvement in knowledge, attitude and/or practice post-training
-Two main themes identified from the qualitative studies: the process of changing values and attitudes to be more LGBT inclusive, and the constraints to the application of new values in practice
Schools: A Missed Opportunity
to Inform African American SGMY About Sexual Health Education and Services (Rose & Friedman 2017)
2
-qualitative study examined African American male SGM youths’
perception of school sexual health education and services
-focus group discussion on health information-seeking behaviors, STI information sources, and recommendations for improving the delivery of health information
-small sample size so not generalizable to other ethnic, racial, or sexual minorities; used interpersonal communication and social cognitive theory
-One participant commented, ‘‘I already had sex
by the time I got to [high] school, so my teacher should have
talked to us about more than just abstinence.’’
Where? What? Why?
Gaps in
Literature
-Does parental involvement affect sexual health outcomes? (PrEP, access to healthcare, etc)
-Can researchers compare transgender experience to the cisgender experience regardless of sexual orientation?
-Does socioeconomic status of LGBTQ+ individuals affect their understanding of sexual health?
-How is healthcare different for individuals with intersectional minority identities?
Potential Solutions
-using technology to educate health care providers
-involving the community that is being affected (CAB)
-addressing issues surrounding social norms & practices
Potential Solutions &
Challenges
Challenges
-negative attitudes towards the LGBTQ+ population, in particular transgender individuals
-stigma against teaching sexual health education
-connecting with youth in the ever changing field of communication
References
References
-Carnevale, C., Zucker, J., Womack, J. A., Dixon, J., Cohall, A., Sobieszczyk, M. E., & Gordon, P. (2019). Adolescent Preexposure Prophylaxis Administration: An Education Curriculum for Health Care Providers. Journal of Pediatric Health Care, 33(3), 288–295. doi: 10.1016/j.pedhc.2018.09.007
-CDC. (2018). Youth Risk Behavior Survey: Data Summary & Trends Report 2007-2017. Youth Risk Behavior Survey: Data Summary & Trends Report 2007-2017. Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trendsreport.pdf
-Hart-Cooper, G. D., Allen, I., Irwin, C. E., & Scott, H. (2018). Adolescent Health Providers’ Willingness to Prescribe Pre-Exposure Prophylaxis (PrEP) to Youth at Risk of HIV Infection in the United States. Journal of Adolescent Health, 63(2), 242–244. doi: 10.1016/j.jadohealth.2018.03.016
-Knight, R. E., Shoveller, J. A., Carson, A. M., & Contreras-Whitney, J. G. (2014). Examining clinicians experiences providing sexual health services for LGBTQ youth: considering social and structural determinants of health in clinical practice. Health Education Research, 29(4), 662–670. doi: 10.1093/her/cyt116
-Poteat, T., German, D., & Kerrigan, D. (2013). Managing uncertainty: A grounded theory of stigma in transgender health care encounters. Social Science & Medicine, 84, 22–29. doi: 10.1016/j.socscimed.2013.02.019
-Rose, India D., and Daniela B. Friedman. “Schools: A Missed Opportunity to Inform African American Sexual and Gender Minority Youth About Sexual Health Education and Services.” The Journal of School Nursing, vol. 33, no. 2, 2017, pp. 109–115., doi:10.1177/1059840516678910.
-Sekoni, A. O., Gale, N. K., Manga-Atangana, B., Bhadhuri, A., & Jolly, K. (2017). The effects of educational curricula and training on LGBT-specific health issues for healthcare students and professionals: a mixed-method systematic review. Journal of the International AIDS Society, 20(1), 21624. doi: 10.7448/ias.20.1.21624
-Steinke, J., Root-Bowman, M., Estabrook, S., Levine, D. S., & Kantor, L. M. (2017). Meeting the Needs of Sexual and Gender Minority Youth: Formative Research on Potential Digital Health Interventions. Journal of Adolescent Health, 60(5), 541–548. doi: 10.1016/j.jadohealth.2016.11.023
-Woolf, S. H., & Aron, L. Y. (2013). U.S. health in international perspective: shorter lives, poorer health. Washington, District of Columbia: The National Academies Press.