Assessing access to care for transgender and gender nonconforming people: A consideration of diversity in combating discrimination

Cruz, Taylor M.

doi:10.1016/j.socscimed.2014.03.032

Cited by 262 publications

(246 citation statements)

References 28 publications

Supporting

Mentioning

233

Contrasting

Unclassified

Order By: Relevance

“…27 Consideration of psychosocial history is crucial when providing clinical care to FTM patients, many of whom have had negative experiences accessing health care. 24,28 A gender minority stress model has been applied in order to understand the gender-related stressors faced by FTM people. 29,30 Social stressors such as experiences of discrimination in the health care system (enacted stigma) lead to the expectation of negative experiences in health care (anticipated stigma).…”

Section: Overview Of Key Clinical Concernsmentioning

confidence: 99%

Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

et al. 2015

View full text Add to dashboard Cite

Guidelines for cervical cancer screening have evolved rapidly over the last several years, with a trend toward longer intervals between screenings and an increasing number of screening options, such as Pap/HPV co-testing and HPV testing as a primary screening. However, gynecological recommendations often do not include clinical considerations specific to patients on the female-to-male (FTM) spectrum. Both patients and providers may not accurately assess risk for HPV and other sexually transmitted infections, understand barriers to care, or be aware of recommendations for cervical cancer screening and other appropriate sexual and reproductive health services for this patient population. We review the evidence and provide guidance on minimizing emotional discomfort before, during, and after a pelvic exam, minimizing physical discomfort during the exam, and making adaptations to account for testosterone-induced anatomical changes common among FTM patients.

show abstract

Section: Overview Of Key Clinical Concernsmentioning

confidence: 99%

Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

et al. 2015

View full text Add to dashboard Cite

show abstract

“…16 While the passage of the Affordable Care Act (ACA) makes it illegal for insurance companies to deny individuals on the basis of preexisting conditions and gender identity, 17 the limited availability of transgendercompetent providers, [18][19][20] and the still limited coverage for many gender affirming surgeries, 21,22 may force some transgender people to pay out-of-pocket for a provider outside their plan, leading to high healthcare expenditures even for the insured. 23,24 Due to the many challenges surrounding affordability and access to healthcare for transgender people, along with the disproportionate prevalence of poverty and unemployment in this population, inadequate insurance coverage and lack of financial resources remain primary barriers to accessing healthcare among transgender people.…”

Section: Introductionmentioning

confidence: 99%

Geographic and Individual Differences in Healthcare Access for U.S. Transgender Adults: A Multilevel Analysis

et al. 2016

View full text Add to dashboard Cite

Purpose: To identify geographic and individual-level factors associated with healthcare access among transgender people in the United States. Methods: Multilevel analyses were conducted to investigate lifetime healthcare refusal using national data from 5831 U.S. transgender adults. Hierarchical generalized linear models examined associations between individual (age, gender, race, income, insurance, and healthcare avoidance) and state-level factors (percent voting Republican, percent same-sex couple households, income inequality, and transgender protective laws) and lifetime refusal of care. Results: Results show that individual-level factors (being older; trans feminine; Native American, multiracial, or other racial/ethnic minority; having low income; and avoiding care due to discrimination) are positively associated with care refusal (all P-values <0.05). Adjusting for individual-level factors, variation was observed across U.S. states, with a greater proportion of states in the Southern and Western United States with transgender residents at increased odds of experiencing care refusal, relative to other regions of the United States. When adjusting for state-level factors, the percentage of the state population voting Republican was positively associated with care refusal among the transgender adults sampled (P < 0.01). Conclusion: Transgender adults surveyed reported differential access to healthcare by geographic region. Identifying geographic and individual-level factors associated with healthcare barriers allows for the development of targeted educational and policy interventions to improve healthcare access for transgender people most in need of services.

show abstract

“…Our findings also suggest a need to fully theorize the potential role of GNC stigma on LGBQ women's health care access. Cruz 29 has theorized transgender and/or gender non-conformity stigma as a barrier to access of care. Specifically, not being seen as transgender or gender non-conforming, also known as "passing," may prevent outward experiences of discrimination.…”

Section: Discussionmentioning

confidence: 99%

Correlates of clinical breast examination among lesbian, gay, bisexual, and queer women

Lacombe‐Duncan

Logie

2016

Can J Public Health

View full text Add to dashboard Cite

OBJECTIVES: Lesbian, gay, bisexual, and queer (LGBQ) women have increased risk of breast cancer yet lower use of early detection screening than heterosexual women. This lower use may be due in part to sexual stigma. The study purpose was to explore correlates of past two-year clinical breast examination (CBE) among LGBQ women to better understand screening disparities, particularly among gender non-conforming LGBQ women. METHODS:A cross-sectional Internet-based survey was conducted with LGBQ women in 2011-2012. We conducted multivariate logistic regression to assess the associations between individual, social/structural and health care factors and past two-year CBE among LGBQ women (n = 414), including a subsample of gender non-conforming LGBQ women (n = 148). RESULTS:In multivariate analyses, significant correlates of past two-year CBE among the full sample included sexually transmitted infection knowledge (OR: 1.12, 95% CI: 1.05, 1.19), sexual risk practices (OR: 0.92, 95% CI: 0.87, 0.98), past two-year Papanicolaou test (OR: 8.36, 95% CI: 4.24, 16.45), having a regular source of health care (OR: 4.84, 95% CI: 2.60, 9.01), and health care provider knowing one's sexual orientation (OR: 3.60, 95% CI: 2.29, 5.81). Among gender non-conforming LGBQ women, perceived gender non-conformity stigma (OR: 0.85, 95% CI: 0.74, 0.99) and belief that one's health care provider is uncomfortable with one's sexual orientation (OR: 0.33, 95% CI: 0.11, 1.00) were also associated with lower screening.CONCLUSION: These findings enhance understanding of individual, social/structural, and health care factors correlated with CBE among LGBQ women. More research is needed to understand the complex interplay of these factors to inform multi-level interventions to address screening disparities for diverse LGBQ women. Studies show that despite their increased risk of breast cancer, LGBQ women access early detection screening, including mammography and clinical breast examination (CBE), less than heterosexual women. 5,6 While controversies exist regarding optimal breast cancer screening modalities, age at which to start screening, and screening frequencies, 7 it is generally believed that breast cancer screening improves early detection and treatment, ultimately reducing breast cancer mortality. 8 Thus, improving accessing of screening among LGBQ women is an important public health priority.Most studies that focus on LGBQ women and breast cancer have described differences in disease prevalence 2,3 or use of mammography or CBE among LGBQ women compared to heterosexual women. 5,6 Social ecological models (e.g., Andersen's Model 9 ) suggest that multi-level (individual, social, structural) factors influence health care utilization. Yet studies that have examined correlates of LGBQ women's use of mammography or CBE are often limited to socio-demographic factors and overlook social/structural (e.g., stigma) and health care (e.g., having a regular source of health care) factors.Stigma is a fundamental cause of population health inequities...

show abstract

Assessing access to care for transgender and gender nonconforming people: A consideration of diversity in combating discrimination

Cited by 262 publications

References 28 publications

Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

Geographic and Individual Differences in Healthcare Access for U.S. Transgender Adults: A Multilevel Analysis

Correlates of clinical breast examination among lesbian, gay, bisexual, and queer women

Contact Info

Product

Resources

About