Kim D. Jaffee

Racial/Ethnic Disparities in the Use of Mental Health Services in Poverty Areas

OBJECTIVES This study examined racial/ethnic disparities in mental health service access and use at different poverty levels. METHODS We compared demographic and clinical characteristics and service use patterns of Whites, Blacks, Hispanics, and Asians living in low-poverty and high-poverty areas. Logistic regression models were used to assess service use patterns of minority racial/ethnic groups compared with Whites in different poverty areas. RESULTS Residence in a poverty neighborhood moderates the relationship between race/ethnicity and mental health service access and use. Disparities in using emergency and inpatient services and having coercive referrals were more evident in low-poverty than in high-poverty areas. CONCLUSIONS Neighborhood poverty is a key to understanding racial/ethnic disparities in the use of mental health services.

Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery.

Background:The transgender community experiences health care discrimination and approximately 1 in 4 transgender people were denied equal treatment in health care settings. Discrimination is one of the many factors significantly associated with health care utilization and delayed care. Objectives:We assessed factors associated with delayed medical care due to discrimination among transgender patients, and evaluated the relationship between perceived provider knowledge and delayed care using Anderson’s behavioral model of health services utilization. Research Design:Multivariable logistic regression analysis was used to test whether predisposing, enabling, and health system factors were associated with delaying needed care for transgender women and transgender men. Subjects:A sample of 3486 transgender participants who took part in the National Transgender Discrimination Survey in 2008 and 2009. Measures:Predisposing, enabling, and health system environment factors, and delayed needed health care. Results:Overall, 30.8% of transgender participants delayed or did not seek needed health care due to discrimination. Respondents who had to teach health care providers about transgender people were 4 times more likely to delay needed health care due to discrimination. Conclusions:Transgender patients who need to teach their providers about transgender people are significantly more likely to postpone or not seek needed care. Systemic changes in provider education and training, along with health care system adaptations to ensure appropriate, safe, and respectful care, are necessary to close the knowledge and treatment gaps and prevent delayed care with its ensuing long-term health implications.

Structural Discrimination is Associated With Smoking Status Among a National Sample of Transgender Individuals

INTRODUCTION Limited evidence suggests that transgender individuals smoke at significantly higher rates than the general population. We aimed to determine whether structural or everyday discrimination experiences predict smoking behavior among transgender individuals when sociodemographic, health, and gender-specific factors were controlled. METHODS Data from the National Transgender Discrimination Survey (N = 4781), a cross-sectional online and paper survey distributed to organizations serving the transgender community, were analyzed in order to determine the association between current smoking and discrimination experiences and other potential predictors. Logistic regression models were used to establish factors that predict smoking. RESULTS Participants reported experiencing both structural (80.4%) and everyday (65.9%) discrimination. Multivariate analyses showed that participants who reported attending some college, graduating college, or having a graduate degree were less likely to smoke compared to those with a high school degree or less. Uninsured participants were more likely to report smoking compared to those with private insurance. Those who used alcohol or drugs for coping were also more likely to smoke. Participants whose IDs and records listed their preferred gender were less likely to smoke (OR = 0.84); those who had experienced structural discrimination were more like to report smoking (OR = 1.65). CONCLUSIONS Further research is needed in order to explore the relationship between smoking and legal transition among transgender individuals. Strategies to prevent smoking and encourage cessation among this vulnerable population are also needed. In addition, comprehensive collection of gender identity data in the context of national surveys, tobacco-related research, and clinical settings is sorely needed. IMPLICATIONS This study establishes a link between experiences of structural discrimination among transgender individuals and smoking status.

Racial Differences in Neighborhood Disadvantage Among Childbearing Women in New York City: 1991-1992

Abstract An ecological framework is utilized in this study to explore the differential neighborhood environments that existed for Black and White childbearing women in New York City during the early 1990s. We examined ecological risk factors for different racial groups in a highly segregated metropolitan city and provide a framework from which we can address issues of oppression and social inequality. This study examines neighborhood conditions and determines the extent to which Black and White women, who gave birth during 1991 and 1992, occupy differing neighborhoods in New York City and in each of the boroughs that comprise New York City-Manhattan, Bronx, Brooklyn, and Queens (excluding Staten Island). High and persistent residential segregation of Blacks and Whites in NYC has put Black women at a clear and significant ecological disadvantage compared to White women regardless of the borough where they lived when they gave birth to their infant. This study found that, when compared to White women, Black women in New York City are at a vast disadvantage regardless of income. In Manhattan and Queens that disparity is the greatest with low income Black women much more likely than low income White women to live in a high poverty neighborhood. Overall, in NYC and across the four boroughs studied, low income Blacks were more likely than Whites to live in neighborhoods characterized by high poverty rates, substance abuse and inadequate health care.