Delaware journal of public health最新文献

Gender-affirming care (GAC) for youth is a medically necessary, evidence-based practice endorsed by major health organizations to support transgender and gender-diverse individuals. In Delaware, proposed legislation threatens to restrict access to GAC despite clear evidence that such care improves mental health outcomes and reduces suicide risk. This article outlines the components of GAC, examines the impact of legal and political threats, and argues for sustained protections to safeguard the health of Delaware's youth and public health systems.

The recent surge in anti-LGBTQ+ legislation across the United States has far-reaching consequences that extend beyond civil rights, posing a significant but underrecognized threat to public mental health-particularly for LGBTQ+ individuals living with or at risk for HIV. This article explores how such legislation operates as a form of structural trauma, exacerbating minority stress, anticipatory grief, and psychological distress among clients in HIV care. Drawing on clinical experience, trauma-informed practice, and existing literature, it demonstrates how discriminatory policies compromise mental health, disrupt care engagement, and deepen medical mistrust. Through composite case vignettes and evidence-based analysis, the article highlights the role of the mental health clinician as both a therapeutic and systemic advocate. It concludes with urgent recommendations for culturally competent care, trauma-informed public health systems, and policy advocacy to resist harm and promote resilience among LGBTQ+ populations. Ultimately, the piece calls for a unified public health response that affirms identity, fosters healing, and safeguards the dignity and well-being of marginalized communities.

Objective: This article details the results of focus groups with providers who work with LGBTQ+ youth experiencing or at risk of experiencing homelessness in Delaware.

Methods: Researchers interviewed 16 service providers in four focus groups held between May 24, 2023 and June 5, 2023. Providers included housing support specialists, social workers, community health workers, school counselors, mental health care providers, and other community-service-based practitioners. Data were collected through semi-structured interviews conducted via Zoom, and the authors utilized inductive coding to identify emerging themes.

Results: Throughout Delaware, there are limited housing and public health supports in place for LGBTQ+ youth experiencing homelessness. Even when services are available, LGBTQ+ young people may have difficulty accessing them due to age restrictions, shelter segregation by sex or gender, or safety concerns. Providers working with this population face challenges including limited funding and staff, and a lack of specialized training. Changes at the local and state level-including increased funding, enhanced access to specialized training, and greater inclusivity on administrative forms-are important first steps to ensuring providers can adequately provide services to LGBTQ+ youth experiencing homelessness.

Conclusions: LGBTQ+ youth are more likely to experience homelessness than their cisgender and heterosexual peers and yet face greater barriers to housing services throughout Delaware. The unique needs of this population necessitate specialized services and programs to ensure all young people have access to basic needs such as housing.

Policy implications: The provider perspectives in this paper offer a firsthand account of the challenges of serving this population and opportunities for improvement in policy creation and program administration.

Objective: To investigate mental health and substance use disparities by sexual orientation and gender identity among Delaware youth.

Methods: Data were from the Delaware School Surveys (DSS) administered to 8th and 11th graders (n=17,361; ages 12-17 years old) in 2022, 2023, and 2024. Frequency statistics were used to summarize sexual orientation and gender identity composition, including frequency of youth who were lesbian, gay, bisexual, transgender, and other minoritized sexual and gender identities (LGBT+). Using logistic regression, we tested associations between LGBT+ status and odds of reporting psychological distress, anxiety, underage drinking, cigarette smoking, vaping, marijuana use, and prescription drug misuse.

Results: Around one in four (25-26%) Delaware youth identified as LGBT+, including 6-7% of youth who were transgender or nonbinary. Rates of lifetime mental health symptoms and underage substance use were elevated among LGBT+ youth for every health outcome. For 8th grade LGBT+ youth relative to cisgender heterosexual youth, odds were elevated by 269% for psychological distress, 276% for anxiety, 91% for drinking, 141% for cigarette smoking, 121% for vaping, 98% for marijuana use, and 86% for prescription drug misuse. In 11th grade LGBT+ youth relative to cisgender heterosexual youth, odds were elevated by 228% for psychological distress, 240% for anxiety, 33% for drinking, 71% for cigarette smoking, 51% for vaping, 57% for marijuana use, and 70% for prescription drug misuse.

Conclusions: Mental health and substance use disparities between LGBT+ youth and cisgender heterosexual youth highlight an alarming public health crisis in Delaware. With growing numbers of youth identifying as LGBT+ and persistent health disparities, state policy and clinical practice must be attuned to the needs and lived experiences of LGBT+ youth to identify and eliminate drivers of these disparities. Schools, healthcare, and policy provide important avenues for intervention.

Background: The "Food is Medicine" (FIM) model bridges healthcare and food access to mitigate chronic health conditions and address social determinants of health.

Objectives: This study assesses the impact of the Feeding Families (FF) program, a FIM initiative by Westside Family Healthcare in Delaware, which was conducted between February 2023 and February 2024 and designed to support individuals with diabetes, hypertension, and obesity.

Methods: We employed a quasi-experimental design to evaluate the implementation and effectiveness of the program over 12 months. The FF program provided participants with nutrient-dense food, bi-weekly nutrition counseling, and behavioral support. Data on body mass index (BMI), glycated hemoglobin (A1C), and fruit and vegetable intake were collected from 43 participants at baseline, midpoint, and endpoint. Participant knowledge, dietary behaviors and food insecurity, changes in goal setting, consumption of sodium, sugar, and fats were also assessed.

Results: Participants demonstrated significant reductions in BMI and improved dietary behaviors, including decreased consumption of sodium, sugar, and fats. While changes in A1C levels were not statistically significant, the overall trend indicated improvement. The program also led to modest enhancements in food security.

Conclusion: The Feeding Families program contributes to improving health outcomes among populations with chronic diseases, particularly in reducing BMI and promoting healthier dietary behaviors around sodium, sugar, and fat consumption.

Policy implications: The Feeding Families program demonstrates the potential of integrating tailored nutrition, behavioral support, and healthcare services to manage chronic conditions through 'Food Is Medicine' best practices, and its impact on BMI, salt, sugar and fat reduction among other benefits. Delaware should prioritize FIM, including establishing Medicaid waivers for funding.

A psychologist shares his observations shadowing resident, fellow and attending physicians, and the unexpected impacts on culture, health, and wellbeing.