Sexual and Gender Identity-Associated Disparities in University Students' Experiences with Inappropriate, Disrespectful, and Coercive Health Care.

IF 3.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH LGBT health Pub Date : 2024-10-10 DOI:10.1089/lgbt.2023.0373
Alison R Walsh, Devon E Spiars, Charisse Loder, Emily Dove-Medows, Claire Kalpakjian, Andrea Hess, Kelsey Postler, Michelle L Munro-Kramer, Susan Ernst
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Abstract

Purpose: Inappropriate, disrespectful, or coercive health care (IDCH) is associated with patient age and sexual orientation and gender identity (SOGI) and can impact healthcare engagement and outcomes. Emerging adulthood is a critical period for establishing trust in health care, yet little is known about university students' IDCH experiences. This study assessed the IDCH prevalence and identified IDCH-SOGI associations in a university student sample. Methods: Using data from the cross-sectional IDC Survey (2021), we quantified the lifetime prevalence of 18 IDCH items in a sample of 3403 university students. Chi-squared and Kruskal-Wallis tests were used to assess bivariate associations between IDCH items and SOGI. We modeled associations between demographic characteristics and two types of provider-sexual misconduct using logistic regression. Results: Statistically significant associations between SOGI and 17 of the analyzed IDCH items were identified. Self-reported IDCH experiences were more prevalent among minoritized SOGI students than heterosexual cisgender students, including receiving inappropriate/harmful treatment and dismissive or biased provider communication. Gender minority and sexual minority cisgender male and female students had significantly higher odds of ever being touched inappropriately during an exam, compared with heterosexual cisgender males (adjusted odds ratios [95% confidence interval]: 3.07 [1.59-5.93], 2.34 [1.24-4.41], and 1.85 [1.16-2.90], respectively). SOGI was not significantly associated with experiencing a provider's sexual advances. Conclusion: University students with historically minoritized SOGIs may be particularly vulnerable to IDCH experiences; research is needed to understand differential experiences within minoritized sexual and gender subpopulations. Patient and provider education about healthcare norms and trauma-centered care could potentially reduce IDCH and its harms.

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大学生在不恰当、不尊重和胁迫性医疗保健经历中与性和性别认同相关的差异。
目的:不恰当、不尊重或胁迫性医疗保健(IDCH)与患者年龄、性取向和性别认同(SOGI)有关,会影响医疗保健参与度和结果。成年期是建立对医疗保健信任的关键时期,但人们对大学生的 IDCH 体验知之甚少。本研究评估了大学生 IDCH 的流行情况,并确定了 IDCH 与性别认同之间的关联。研究方法利用横断面 IDC 调查(2021 年)的数据,我们对 3403 名大学生样本中 18 个 IDCH 项目的终生流行率进行了量化。我们使用卡方检验(Chi-squared tests)和克鲁斯卡尔-瓦利斯检验(Kruskal-Wallis tests)来评估IDCH项目与SOGI之间的二元关联。我们使用逻辑回归法建立了人口统计学特征与两类提供者-性不端行为之间的关联模型。结果在所分析的 IDCH 项目中,有 17 个项目与 SOGI 之间存在统计学意义上的重大关联。与异性恋同性别学生相比,性别少数和性少数同性别学生自我报告的 IDCH 经历更为普遍,其中包括接受不适当/有害的治疗以及医疗服务提供者轻蔑或带有偏见的沟通。与异性恋同性别男生相比,性别少数和性少数同性别男生和女生在考试中曾被不适当触摸的几率明显更高(调整后的几率比[95%置信区间]:3.07 [1.59-5.59]:分别为 3.07 [1.59-5.93]、2.34 [1.24-4.41] 和 1.85 [1.16-2.90])。SOGI与医疗服务提供者的性挑逗没有明显关联。结论具有历史性少数性取向的大学生可能特别容易受到 IDCH 的影响;需要开展研究以了解少数性取向和性别亚群的不同经历。对患者和医疗服务提供者进行有关医疗保健规范和以创伤为中心的护理的教育,有可能减少 IDCH 及其危害。
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来源期刊
LGBT health
LGBT health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -
CiteScore
6.60
自引率
6.20%
发文量
80
期刊介绍: LGBT Health is the premier peer-reviewed journal dedicated to promoting optimal healthcare for millions of sexual and gender minority persons worldwide by focusing specifically on health while maintaining sufficient breadth to encompass the full range of relevant biopsychosocial and health policy issues. This Journal aims to promote greater awareness of the health concerns particular to each sexual minority population, and to improve availability and delivery of culturally appropriate healthcare services. LGBT Health also encourages further research and increased funding in this critical but currently underserved domain. The Journal provides a much-needed authoritative source and international forum in all areas pertinent to LGBT health and healthcare services. Contributions from all continents are solicited including Asia and Africa which are currently underrepresented in sex research.
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