K. Nikki Barefoot

Psychological well-being among transgender and genderqueer individuals

ABSTRACT The purpose of this study was to compare psychological well-being among transgender women, transgender men, genderqueer/nonbinary individuals, and their cisgender sexual minority counterparts. A total of 2,932 gender and sexual minority individuals participated in the online study. While controlling for age, race/ethnicity, employment status, education, and relationship status, there was significant variation between gender minority subgroups in depression (p < 0.001); anxiety (p = 0.003); stress (p = 0.004); perceived social support (p < 0.001); self-esteem (p = 0.031); self-perceived need for mental health care (p < 0.001); family history of mental illness (p = 0.003); personal history of mental health concerns (p = 0.003); and being in recovery (p = 0.004). Overall, transgender women had the poorest psychological well-being across the majority of variables. In contrast to their transgender peers, genderqueer/nonbinary–identified individuals did not significantly differ from their cisgender sexual minority counterparts on outcomes; however, they did differ on stressors. Transgender men appeared to fall between transgender women and genderqueer/nonbinary individuals in terms of risk factors and outcomes. The current findings highlight the importance of considering the psychosocial experiences of the various gender minority subgroups, separate from not only their cisgender sexual minority counterparts but also each other.

Barriers to Care and Psychological Distress Differences between Bisexual and Gay Men and Women

The bisexual community may face unique barriers to health care that affect mental health outcomes; however, previous research has not specifically compared bisexual and gay men and women on these factors. This study explored differences between bisexual and gay men and women in barriers to care and psychological distress among a sample of 2,500 bisexual and gay men and women recruited online. Bisexual men and women were more likely to report barriers to care ranging from limited availability of providers to less comfort discussing their sexual orientation with their provider. Differences in specific mental health outcomes centered on sexual orientation, but not gender. Bisexual women reported the highest levels of depression, stress, and anxiety, and bisexual men reported higher levels of anxiety than gay men and gay women. Findings suggest that the sociocultural pressures affecting barriers to care and psychological distress may be disproportionately affecting bisexual individuals, even more so than previously documented sociocultural pressures related to gender.

Variations in psychological distress between gender and sexual minority groups

ABSTRACT The purpose of this study was to compare rates of elevated levels of depression, anxiety, and stress among six different lesbian, gay, bisexual, and transgender (LGBT) subgroups (cisgender lesbians, cisgender gay males, cisgender bisexual females, cisgender bisexual males, transgender females, and transgender males). A total of 2,702 LGBT-identified individuals participated in the online study. While controlling for other demographic factors, rates of elevated levels of depression (p < 0.001), anxiety (p = 0.015), and stress (p < 0.001) all varied significantly between LGBT subgroups. Post-hoc examinations of pairwise differences revealed substantial and unexpected variations, highlighting the importance of separately examining LGBT subgroups when considering mental health outcomes.

Recent Alcohol, Tobacco, and Substance Use Variations Between Rural and Urban Middle and High School Students

ABSTRACT The use of addictive substances by adolescents is a major public health concern; however, rural versus urban variations are poorly understood. The purpose of the current study was to examine rural-urban differences in the prevalence of recent use of 11 substances in grades 6 through 12 in a statewide sample of students from the Georgia Student Health Survey II (N = 513,909). We found that rural-urban differences in substance use depend largely upon grade level, with rural middle school students demonstrating higher rates of alcohol, smoking tobacco, and chewing tobacco use, and urban high school students demonstrating higher rates of illicit drugs.

Psychological Distress and Perceived Barriers to Care for Rural Lesbians

The purpose of the current study was to examine rural lesbians’ experiences of psychological distress and barriers to mental healthcare compared with their nonrural counterparts. A geographically diverse sample of 716 lesbians from across the United States participated in an online study. Results revealed that compared with their nonrural counterparts, rural lesbians experience higher levels of psychological distress. In addition, after controlling for age, race, and education level, rural lesbians were also more likely to report the following barriers to needed mental healthcare: (1) a lack of coverage/financial limitations, (2) a limited availability of providers in their area, and (3) avoidance of care due to fears of discrimination/unfair treatment by a provider. Rural lesbians appear to face greater mental health related vulnerabilities. Implications for research and clinical practice are discussed.

A quantitative comparison of the health-care disclosure experiences of rural and nonrural lesbians.

Concealment of sexual orientation from health-care providers and/or delay of care due to fears of discrimination or maltreatment in the health-care setting can be major risk factors for the health and well-being of lesbians. Given the added vulnerabilities that rural lesbians may face as they interact with the traditional health-care system, the purpose of the current study was to investigate the relation of sexual minority status and rural background to lesbians’ health-care disclosure-related attitudes or beliefs, behaviors, and experiences. A national, diverse sample of 746 lesbians from rural (38.3%) and nonrural (61.7%) backgrounds participated in the current online study. Participants completed a series of demographic questions and the Multidimensional Disclosure to Health Care Providers Scale. A multivariate analysis of covariance was used to investigate rural versus nonrural differences across 5 disclosure indices. Post hoc analyses of covariance were then conducted for each subscale to explore the specific direction of the rural versus nonrural differences. After race or ethnicity and education were controlled for, the results revealed that rural lesbians endorsed fewer attitudes and beliefs that facilitated disclosure to a health-care provider, experienced fewer health-care opportunities in which disclosure could be initiated, reported less communication of their sexual orientation to providers, and reported previously experiencing greater negative reactions to their disclosure by providers when compared to their nonrural counterparts. Rural lesbians appear to face multiple risks related to health-care disclosure. It is important for rural health-care providers to examine their own biases and beliefs and seek out cultural competency training and consultation related to providing affirming care to lesbians in order to facilitate positive disclosure and overall health-care experiences.

The Impact of Rurality on Likelihood of Drunk Driving and Riding With a Driver Under the Influence Among High School Students: Alcohol and Motor Vehicle Risks in Rural Students

PURPOSE The purpose of this study was to examine the importance of rural location in the likelihood of adolescent drunk driving and riding in a vehicle with a driver under the influence while controlling for a variety of student-, school-, and county-level factors. METHODS Data from the 2013 Georgia Student Health Survey (GSHS) II (a statewide assessment of student health in public school students in Georgia) were analyzed using multilevel binary regressions to examine rural-urban differences in prevalence of driving under the influence (11th and 12th graders only; n = 114,907) and riding with a driver under the influence (9th -12th graders; n = 258,610), controlling for school-level race, gender, and income, in addition to county-level education level, unemployment, alcohol use, and smoking. FINDINGS Across geographies, students were twice as likely to report riding with a driver under the influence (10.32%) as driving under the influence (4.16%). While both outcomes were more likely among rural adolescents in unadjusted analyses, in adjusted analyses, rural adolescents were not significantly more likely to drive under the influence (ORadj = 1.19; P = .055), but they were significantly more likely to ride with a driver under the influence (ORadj = 1.18; P = .002). CONCLUSIONS Our findings suggest that riding with a driver under the influence rather than driving under the influence may be a more pressing public health issue for adolescents in rural areas. Future research focused on the formative work necessary to build novel, culturally tailored interventions should be conducted to minimize the associated substantial burden of motor vehicle deaths within rural adolescents.

Discrepancy in Motivation for Weight Loss and Exercise in Rural Patients

OBJECTIVES We explored the extent to which discrepancy between motivation for weight loss and exercise is related to obesity among rural patients with chronic disease, and identified the psychosocial correlates of this discrepancy. METHODS 497 patients with diabetes and/or hypertension were recruited from a network of Federally Qualified Health Centers in the rural South and completed a battery of assessments. RESULTS Most persons in the sample (83.1%) were overweight and 65.0% were obese. For motivation for change, 70.8% reported being in the Action stage or higher for weight loss, whereas only 24.9% reported being in the Action stage or higher for motivation for exercise. When controlling for age, education level, income, sex, and race/ethnicity, individuals who were motivated for weight loss but not exercise were twice as likely to be obese (p = .005). Race and sex were significantly associated with this discrepancy, with African-American patients 1.7 times as likely (p = .05) and women 2.3 times as likely to be discrepant (p = .001). CONCLUSIONS Findings underscore the importance of focusing not simply on weight loss among rural patients with chronic disease, but rather to incorporate specific activities designed to build simultaneous motivation for engaging in exercise.

Cross-Cultural and Cognitive-Affective Models of Suicide Risk

Only a handful of empirical investigations have identified culturally salient markers of suicide risk within samples of African American young adults. To address this gap, our study examined the intercorrelations among cultural congruity, defectiveness schemas, and multiple indices of suicide risk for African American (n = 207) and European American (n = 208) students attending a primary White institution. Cultural congruity was negatively associated with reports of interpersonal and behavioral suicide risk for both African and European American students. However, ethnic differences in the magnitude of these relationships emerged. Specifically, as predicted, for African Americans, lower levels of cultural congruity were more strongly related to greater interpersonal factors associated with a desire to die. Finally, the relationships between cultural congruity and multiple indices of suicide risk were partially mediated by defectiveness schemas for both African and European American students, suggesting a useful intervention target for students. These results also have implications for suicide screening, prevention, and intervention strategies directed toward African American students.