Transgender and nonbinary (TGNB) adolescents and young adults (AYA) designated female at birth (DFAB) experience chest dysphoria, which is associated with depression and anxiety. Top surgery may be ...performed to treat chest dysphoria.
To determine whether top surgery improves chest dysphoria, gender congruence, and body image in TGNB DFAB AYA.
This is a nonrandomized prospective cohort study of patients who underwent top surgery between December 2019 and April 2021 and a matched control group who did not receive surgery. Patients completed outcomes measures preoperatively and 3 months postoperatively. This study took place across 3 institutions in a single, large metropolitan city. Patients aged 13 to 24 years who presented for gender-affirming top surgery were recruited into the treatment arm. Patients in the treatment arm were matched with individuals in the control arm based on age and duration of testosterone therapy.
Patients in the surgical cohort underwent gender-affirming mastectomy; surgical technique was at the discretion of the surgeon.
Patient-reported outcomes were collected at enrollment and 3 months postoperatively or 3 months postbaseline for the control cohort. The primary outcome was the Chest Dysphoria Measure (CDM). Secondary outcomes included the Transgender Congruence Scale (TCS) and Body Image Scale (BIS). Baseline demographic and surgical variables were collected, and descriptive statistics were calculated. Inverse probability of treatment weighting (IPTW) was used to estimate the association of top surgery with outcomes. Probability of treatment was estimated using gradient-boosted machines with the following covariates: baseline outcome score, age, gender identity, race, ethnicity, insurance type, body mass index, testosterone use duration, chest binding, and parental support.
Overall, 81 patients were enrolled (mean SD age, 18.6 2.7 years); 11 were lost to follow-up. Thirty-six surgical patients and 34 matched control patients completed the outcomes measures. Weighted absolute standardized mean differences were acceptable between groups with respect to body mass index, but were not comparable with respect to the remaining demographic variables baseline outcome measures. Surgical complications were minimal. IPTW analyses suggest an association between surgery and substantial improvements in CDM (-25.58 points; 95% CI, -29.18 to -21.98), TCS (7.78 points; 95% CI, 6.06-9.50), and BIS (-7.20 points; 95% CI, -11.68 to -2.72) scores.
Top surgery in TGNB DFAB AYA is associated with low complication rates. Top surgery is associated with improved chest dysphoria, gender congruence, and body image satisfaction in this age group.
Medication adherence among HIV-infected individuals is critical to limit disease progression and onward transmission. Evidence indicates that among youth living with HIV (YLH), adherence is ...suboptimal and related to co-morbid psychosocial conditions. Cross-sectional data from 212 YLH, ages 16-29, collected between 2011-2014 in Chicago were analyzed to assess the relationship of multiple psychosocial conditions (e.g., depressive symptoms, anxiety symptoms, moderate/heavy marijuana use, moderate/heavy alcohol use, HIV-related stigma) to ART adherence (i.e., a "syndemic.") Adherence was regressed on an index of increasing numbers of psychosocial conditions, controlling for demographic and treatment factors as well as enrollment site. The mean age of participants was 24, 89% were male, 87% black, and 91% behaviorally infected. Psychosocial conditions were prevalent, including 38% and 34% with high depressive and anxiety symptoms, respectively, 54% and 25% with a moderate/high level of marijuana and alcohol use, respectively, and 46% reporting high HIV-related stigma. In regression analysis, the likelihood of ART adherence decreased with the number of syndemic conditions (linear dose response, p = 0.02) as did the odds of viral load suppression (p = 0.008). Interventions to address these conditions in concert with biomedical treatment as prevention for YLH are needed.
The purpose of this study was to determine the existence and strength of association between chest dysphoria and mental health in transmasculine and nonbinary adolescents.
This is a cross-sectional ...cohort study of transmasculine and nonbinary adolescents designated female at birth between 12 and 18 years old. None had undergone prior top surgery. Patients complete the Chest Dysphoria Measure and Youth Inventory-4 (YI-4) upon presentation to our institution. Outcomes were retrospectively reviewed. The primary outcome of interest was the association between chest dysphoria and anxiety and depression symptom severity, as measured by the YI-4.
One hundred fifty-six patients met inclusion criteria. Mean age was 15.3 years (standard deviation SD = 1.7). Most patients identified as transmasculine (n = 132); 18 identified as nonbinary and 6 as questioning. Mean (SD) YI-4 symptom severity scores were 10.67 (6.64) for anxiety and 11.99 (7.83) for depression. Mean (SD) Chest Dysphoria Measure composite score was 30.15 (9.95); range 2–49. Chest dysphoria was positively correlated with anxiety (r = .146; p = .002) and depression (r = .207; p < .001). In multivariate linear regression models, chest dysphoria showed a significant, positive association with anxiety and depression, after accounting for gender dysphoria, degree of appearance congruence, and social transition status.
Chest dysphoria is associated with higher anxiety and depression in transmasculine and nonbinary adolescents designated female at birth. This association is independent of level of gender dysphoria, degree of appearance congruence, and social transition status. Treatment options aimed at alleviating chest dysphoria should be made accessible to adolescents and tailored to individual needs.
The TransLife Care (TLC) project was developed to address the structural factors that act as barriers to HIV care among transgender women of color. The purpose of this study was to evaluate the ...feasibility and initial efficacy of the TLC project; primary HIV care outcomes included linkage to HIV care, engagement in care, retention in care, use of ART and viral suppression among N = 120 participants. In multivariable analysis, receipt of the intervention (versus none), was associated with any HIV care visit (aOR 2.05; 95% CI 1.25–3.37; p = 0.005), more total HIV care visits (aRR 1.45; 95% CI 1.09–1.94; p = 0.011), being retained in care (aOR 1.58; 95% CI 1.03–2.44; p = 0.038), and having a viral load test done (aOR 1.95; 95% CI 1.23–3.09; p = 0.004). We conclude that a structural intervention, designed and delivered by the focus population, that directly addresses social determinants, is feasible and efficacious to promote HIV care engagement among transgender women of color.
Transgender women are disproportionately impacted by HIV infection. We report herein the findings of a pre-post evaluation of the TransLife Care (TLC) project in Chicago, Illinois, on behaviors ...associated with HIV transmission among transgender women. Participants who received any TLC component versus those who did not were compared using mixed-effects logistic regression with random intercepts across follow-up time points. Ninety-seven participants aged 18 to 59 (median age 24) enrolled; 76.3% were transgender women of color. There was a decrease in condomless sex without consistent PrEP use at 8 months, which was not significantly different between those who did and did not receive the TLC intervention, controlling for calendar time. Evidence does not indicate that the TLC reduces condomless sex without PrEP protection among urban transgender women. However, given the preponderance of evidence of the influence of structural barriers on condomless sex, future research should continue to test the efficacy of structural interventions.
The present study investigated the relationship between gender harassment, or acts which convey demeaning attitudes about women, and college adjustment. Additionally, we explored whether Christian ...attribution, or the perception that the perpetrator was motivated by their Christian/Catholic beliefs to harass, moderated the relationship. Two hundred and twenty-three female-identified students attending a Catholic university in a large city completed the Gender Experiences Questionnaire (Leskinen & Cortina, 2014) and a separate measure of the specific dimension of sexuality policing, indicated whether they made a Christian attribution for experienced harassment, and completed the Student Adaptation to College Questionnaire (Baker & Siryk, 1989). Christian attribution was not found to moderate the relationship between gender harassment and college adjustment. However, it was found to moderate the relationship between sexuality policing and college adjustment by potentiating its negative effects at lower levels of harassment. Implications and future directions are discussed.
Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care substance use screening among adolescents is recommended, but not widely ...implemented. The purpose of this study was to describe the distribution and characteristics of adolescent substance use screening in outpatient clinics in a large academic medical center and assess related factors (i.e., patient age, race/ethnicity, gender, and insurance type) to inform and improve the quality of substance use screening in practice.
We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes (e.g., converted open-ended notes to discrete values) to describe screening cases and related characteristics (e.g., which substances screened, how screened). We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multiple logistic regression to identify related factors.
Among 127 records, rates of screening by providers were 72% (each) for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical mnemonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multiple logistic regression models.
Despite recommendations, low rates of structured screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment.
not applicable.
Young men who have sex with men (YMSM), particularly Black YMSM, bear a disproportionate burden of new human immunodeficiency virus (HIV) infections in the United States. Several studies support the ...positive and protective role of religion in health and the prevention of morbidity and mortality. However, little empirical research has been conducted looking at religion with the context of YMSM and HIV prevention. We examined the impact of religious attendance and faithfulness on sexual risk among a community-based sample of 450 YMSM in Chicago ages 16 to 20. Participants were mostly racial/ethnic minorities, that is, Black (53.4%) and Latino (19.9%). Multivariate logistic regression indicated that faithfulness in combination with frequent formal religious attendance was associated with a decrease in reported number of unprotected anal sex acts, including unprotected receptive anal sex with male partners. These association trends were also found for the Black YMSM in our sample, suggesting that religious involvement and faithfulness is a potential protective factor for the acquisition of HIV among this high-risk population.
Objective: The purpose of this study was to describe psychological functioning, parenting stress, and parental support of gender expansiveness in prepubertal gender-expansive children presenting to a ...specialized pediatric gender clinic and to examine relations between parenting factors and child psychological functioning. Method: Standard-of-care questionnaires were completed by parents of all children presenting for services. Data from prepubertal children (i.e., Tanner Stage 1 of pubertal development) seen between August 2013 and April 2018 were extracted from patient charts. Results: Data were analyzed from 71 youth ages 3-11, including 20% (n = 14) ages 5 and younger. Fourteen percent of the sample (n = 10) met diagnostic cutoff criteria for generalized anxiety disorder, and 20% (n = 14) for oppositional defiant disorder. Caregivers reported varying levels of support of their child's gender expansiveness (female caregivers: M = 78.85, SD = 8.68, range = 56-90; male caregivers: M = 77.32, SD = 10.37, range = 53-90), and only 3% (n = 2) of caregivers endorsed parenting stress levels in the high range. Parenting stress significantly predicted higher symptom counts across all 8 diagnoses. Unexpectedly, higher levels of parental support predicted more symptoms of major depressive disorder and dysthymia. Parenting stress was a significant moderator of relations between gender nonconformity and attention-deficit/hyperactivity disorder (ADHD) hyperactive-impulsive type and conduct disorder symptoms; higher levels of gender nonconformity were associated with higher symptom counts at moderate and high levels of parenting stress (but not at low levels of parenting stress). Conclusions: Clinical interventions aimed at reducing parenting stress among caregivers of gender-expansive children may have a positive effect on children's psychological functioning.
Implications for Impact Statement
Higher levels of gender nonconformity were associated with more attention-deficit/hyperactivity disorder (ADHD) hyperactive-impulsive type and conduct disorder symptoms but only at moderate or high (not low) levels of parenting stress. Thus, interventions aimed at reducing parenting stress in caregivers of gender-expansive children may improve children's psychological functioning.
Nigeria has the fourth-largest HIV epidemic globally, yet high levels of social stigma inhibit HIV testing among Nigerian youths and young men who have sex with men (MSM).
To report pilot data from ...iCARE Nigeria (Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents), a combination intervention using social media and peer navigation to promote HIV testing and linkage to care among high-risk youths and young men (hereinafter referred to as young men), including predominantly young MSM.
This nonrandomized controlled study assessed an organizational and community-level 12-month, preintervention-postintervention pilot trial of a combination intervention designed to increase HIV testing uptake, increase the rate of identified seropositive cases, and improve linkage to care among young men, including MSM, using social media outreach and peer navigation. Data were collected from June 1, 2019, to May 30, 2020. Participants were young men aged 15 to 24 years in the city of Ibadan, Nigeria, and surrounding areas. Frequencies and percentages were examined, and a Fisher exact test was used to evaluate outcomes compared with historical surveillance data. Linkage to care was defined as 2 clinic visits, including HIV confirmation, within 2 months of a positive rapid test result.
Four peer navigators conducted social media outreach promoting sexual health and guiding individuals to HIV counseling and rapid testing in clinical, community, or home-based settings.
Primary outcomes included the number of young men tested for HIV at university-based iCARE catchment clinics or by iCARE peer navigators in the community, the postintervention HIV seroprevalence of these groups, and linkage to care of participants diagnosed with HIV infection.
A total of 339 participants underwent testing for HIV (mean SD age, 21.7 1.9 years), with 283 (83.5%) referred through social media. The main referral sources for social media were WhatsApp (124 43.8%), Facebook (101 35.7%), and Grindr (57 20.1%). Regarding testing location, participants chose home (134 39.5%), community-based (202 59.6%), or clinic (3 0.9%) settings. Eighty-six participants reported no prior HIV testing. Thirty-six participants (10.6%) were confirmed as HIV seropositive; among those, 18 (50.0%) reported negative test results within the past year, and 31 (86.1%) were linked to care. In two 6-month follow-up periods, the intervention increased HIV testing by 42% and 31%, respectively, and seroprevalence increased compared with historical trends with odds ratios of 3.37 (95% CI, 1.43-8.02; P = .002) and 2.74 (95% CI, 1.10-7.11; P = .02), respectively.
These findings suggest that use of iCARE Nigeria was associated with increased HIV testing and linkage to care in a high-risk, difficult-to-reach population, making it a promising combination intervention for young MSM.
isrctn.org Identifier: ISRCTN94590823.
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