Julie A. Honnold

Experiences of Transgender-Related Discrimination and Implications for Health: Results From the Virginia Transgender Health Initiative Study

OBJECTIVES We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. METHODS In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). RESULTS Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). CONCLUSIONS Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers.

Age and Environmental Concern: Some Specification of Effects.

Abstract Two major explanations of the well-documented inverse relationship between age and environmental concern have been suggested: 1) the differences are due to the socio-biological process of aging, or 2) important historical events have affected birth cohorts differently. Palmores (1978) method is used in this study to distinguish possible aging, cohort, and (additionally) period effects explaining time series differences by age groups in the General Social Survey data. The analysis suggests that the decline in environmental concern among most age groups can be accounted for by period effects, but that an aging effect is important among young adults. Implications for environmental education are discussed.

Transgender Health Care Access in Virginia: A Qualitative Study

ABSTRACT We explored health care access experiences of 32 male-to-female (MtF) and 15 female-to-male (FtM) transgender people of different ethnicities in Virginia using data from focus groups conducted in 2004. Victimization associated with social stigmatization played a dominant role in participants’ lives, manifested by discrimination; violence; and health care provider insensitivity, hostility, and ignorance of transgender health. Access to transgender-related medical services that would allow participants to pass in their chosen genders was their highest medical priority. Faced with barriers to access, hormonal self-medication was common, and silicone injections were reported by both MtF and FtM participants. Due to economic vulnerability, sex work was reported as a source of income by both MtFs and FtMs. MtFs expressed concern over confidentiality of HIV testing and additional discrimination if testing positive. FtMs expressed difficulty accessing gynecological care due to their masculine gender identities and expressions. Cultural and technical competency training for providers and implementation of local programs in transgender hormonal therapy are recommended to improve transgender health care access.

Using Social Network Analysis to Enhance Nonprofit Organizational Research Capacity: A Case Study

As donor agencies become more specific in funding requirements, research that can demonstrate the collaborative efforts of a nonprofit agency with its organizational neighbors and how those efforts pay off in terms of capacity and provision of services is highly useful. Recognizing these benefits, a local funding agency in Virginia commissioned a study to look at the ways in which social network analysis (SNA) can enhance the data resources available to nonprofits for funding and grant requests. In this article, we present a case study of a network of 52 nonprofit organizations to illustrate the viability of SNA in terms of funding and research needs specific to nonprofit organizations. We discuss the outcomes of the case study in terms of how the visual and metric outputs of SNA can be used by nonprofits to enhance the accomplishment of their organizational missions and strengthen their grant requests.

Improving the accuracy of identifying lesbians for telephone surveys about health.

Knowledge about the health status and health care needs of lesbians is limited by the lack of population-based studies, although recent survey methods research offers suggestions that may be relevant to involving lesbians in more rigorous studies. To explore the transferability of findings about the general population to research on lesbian health, focus groups were conducted in 1997-1998 with self-identified lesbians in five U.S. urban areas. Videotaped telephone interviews stimulated discussion about methods for enhancing participation of lesbians in random digit dial telephone surveys. Results are useful for developing improved practices for conducting health surveys with lesbians.

Attitude toward Homosexuality and Attention to News about AIDS.

Using data from random sample telephone interviews of adults in the Richmond, Virginia, metropolitan area, we tested a path analytic model predicting attention to news about AIDS. We hypothesized that negative attitudes toward homosexuality would act as a barrier to attention to news about AIDS. We found that lower attention to news about AIDS was predicted by negative attitudes toward homosexuality, conservative AIDS policy attitudes, lower perceived risk of getting AIDS, in addition to being male, older, white, and better educated (adjusted R2 = .17). The model predicted media attention better for men (adjusted R2 = .18) than for women (adjusted R2 = .07).

Socialization and demographic determinants of mortality expectations

Since subjective life expectancy (SLE) has been found related to a variety of personal orientations, the clarification of its determinants should facilitate understanding of social behavior. A theoretical model is presented which includes sociodemographic and socialization predictors. It was hypothesized that SLE would vary with exposure to early death among near relatives, family size, and desired longevity (DL). Exposure and DL were expected to vary with socioeconomic status (SES), age, and ethnic membership. Results from a sample of 513 students (18–29 years of age) indicated that the mean SLE of females exposed to same-sex early death was markedly lower than that of males or of females exposed to opposite-sex death. Among respondents with death exposure, family size was inversely related to SLE. SES had a direct effect on the dependent variable; the effects of age and ethnic membership were indirect. While death socialization attenuates SLE, it does not affect DL. It was suggested, therefore, that increased exposure to early death could heighten personal frustration, especially among females.

SUPPORT FOR RESOURCE CONSERVATION: A PREDICTION MODEL*

Normative support is created for social movements in a variety of ways. In previous studies of the diffusion of environmentalism, the complexity of this process has not been recognized. By synthesizing Smelsers (1962) collective behavior theory, Olsons (1971) theory of collective action and generalizations from diffusion research, we develop a theoretical model of support for resource conservation which includes socioeconomic status and aspiration, need identification, perceived problem immediacy, assessment of problem solubility and perceived personal efficacy. To provide a preliminary test of the theoretical model, survey data were gathered from a sample of 485 undergraduate students. The six measured predictors explained 25 percent of the variance in support for resource conservation. The results suggest that the internal logic of conservationism may be self-defeating, and that therefore the diffusion of support for voluntary resource conservation will probably not be extensive.

“I Have Never Slept with a Man, and There Is No Star Rising in the East”: Lesbians, Bisexual Women, and Pregnancy Before Insemination

The National Lesbian Health Care Survey (NLHCS) was the first major survey of lesbian and bisexual womens health and mental health, and was conducted in 1984–1985 with 1,927 participants from all U.S. states and several territories. The NLHCS included an open-ended item, about what had prevented respondents from becoming pregnant, that was never transcribed or analyzed, yet that reflected historical trends of that time. The survey was conducted immediately prior to the era when donor insemination was becoming available to lesbians and bisexual women in some urban clinics. Many respondents at the time wrote that they could not have children without heterosexual intercourse, feared losing custody of children in a homophobic or biphobic society, or knew that their family of origin or society in general would not accept their children. This article examines themes about lesbians, bisexual women, and pregnancy from this time period.