Natalie Ingraham

At the Intersection of Public Health and Fat Studies: Critical Perspectives on the Measurement of Body Size

Public health and fat studies intersect around documenting varied body sizes, and both disciplines claim that body size is relevant to their research. However, current body size measures are problematic, and nonstigmatizing measures of body size are needed. In particular, means of documenting lived body size that are decoupled from health are desirable for both disciplines. This commentary aims to begin conversations about social justice–oriented means of documenting body diversity, to critically discuss how these measures are used, and potential next steps for body size measurement.

Prior Family Planning Experiences of Obese Women Seeking Abortion Care

BACKGROUND The prevalence of obesity among women of reproductive age calls for research focused on strategies that ensure obese women receive high-quality reproductive health care. This study adds to this literature on service delivery by exploring obese womens experiences receiving or avoiding family planning care. METHODS We included 651 women seeking abortion care who completed iPad surveys about their previous family planning experiences. FINDINGS One quarter were classified as obese, with almost 5% morbidly obese. Only 1% of obese women reported avoiding family planning care. More than 12% of morbidly obese women reported not having their family planning needs met (Pap smears, sexually transmitted infection testing, or ultrasonography). This is compared with only 2% among overweight and obese women and 0% among normal and underweight women. Almost 10% of obese and morbidly obese women reported that at least one of the previous family planning clinics they had visited was not prepared to provide care for heavier women and around 25% of obese women reported at least one item in the clinic (such as blood pressure cuffs and examination gowns) was not adequate for their size. RESULTS Contrary to expectations, we did not find that obese women avoided family planning care. However, morbidly obese women reported not having all of their family planning needs met when they attended care. Family planning providers should ensure that their facilities have the capacity to meet the family planning needs of obese women and that they have adequate equipment to care for this population of women.

Counting Trans* Patients A Community Health Center Case Study

With the Affordable Care Act revolutionizing the US health care system, the importance of collecting clinical, demographic, operational, and utilization data has exponentially increased for community health centers (CHC). Data collection of gender and gender identity presents a unique set of challenges for medical settings. One central challenge is the conflict between, on one hand, the need to know and use patients’ preferred names, gender identities, and pronouns to establish trust and safety and, on the other hand, institutional requirements to know and use patients’ legal names and gender markers with insurance companies and pharmacies. This essay examines how a communitybased LGBTQ community health center, Lyon-Martin Health Services, collects and reports data about gender identity and how this process has changed over time. Lyon-Martin strongly supports the use of the two-step gender data collection method, which allows clinicians to have necessary information related to patients’ anatomy-based health care while simultaneously honoring and respecting patients’ gender identity and preferred pronouns. Collecting precise information about patient sex and gender is vital to providing not only respectful care but also medically appropriate care. The ability to quantify and justify the services provided by CHCs is a key part of keeping clinics open and thriving, from securing grant support to implementing internal quality improvement efforts to provide the best care for trans* patients. The shift toward electronic medical records and electronic practice management systems is also highlighted, including billing and clinical practice challenges due to narrowed gender options written into practice-management and billing software.

Women’s Health and Mindfulness (WHAM): A Randomized Intervention Among Older Lesbian/Bisexual Women

Introduction. Lesbian and bisexual (LB) women have higher body weight than heterosexual women. Interventions focused on health and well-being versus weight loss may be more likely to succeed among LB women. This article describes effects of Women’s Health and Mindfulness, a 12-week pilot intervention addressing mindfulness, healthy eating, and physical activity, on outcomes associated with chronic disease risk among overweight and obese LB women older than 40 years. Method. Eighty women were randomized, using a stepped-wedge design, to either an immediate- or a delayed-start intervention group; the delayed-start group served as the control. Eligible participants were aged 40 years or older, identified as LB, and had a body mass index of 27 or greater. We compared differences in biological markers of chronic disease, mindfulness, nutrition, and physical activity between immediate- and delayed-start intervention groups. Results. We observed clinically significant improvements in low-density lipoprotein cholesterol but no change in hemoglobin A1c. We found evidence of intervention effects on improved mindfulness and mindful eating scores and on nutrition (improved vegetable intake). Conclusions. The Women’s Health and Mindfulness pilot intervention appears to have initiated positive behavioral and physical health changes in this population. Refinements to the intervention model, such as extended intervention duration, and longer term follow-up are warranted to determine sustained effects.

Queering pornography through qualitative methods

Abstract This study explores the meanings of participation for members of the queer pornography community in the San Francisco Bay Area of California by utilizing a mix of qualitative research methods. Research questions sought to grasp the shared values and beliefs of the participants, including factors that might influence identification with this community and its activist roots. Prior research has examined queer porn with regard to the race and gender diversity of performers (Hernandez & Tester, 2004), and the queering of specific sex acts such as penetration (Day, 2009). But a more empirical exploration, including examining the discourse on definitions of both queer pornography and the queer pornography community has not yet been done. Nor have issues of identity making or identify affirmation through participation in queer pornography been addressed (DeGenevieve, 2007; Jacobs, 2007). These unexplored aspects of pornography research and the unique characteristics of the queer pornography community demanded the flexibility in methodology and data analysis offered by qualitative research. A combination of ethnography and narrative analysis was used to investigate participants’ experiences of participation in queer pornography.

Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative Study

BACKGROUND Little research documents the self-identified reproductive health priorities and health care experiences of lesbian, gay, bisexual, transgender, queer (LGBTQ)-identified individuals who may be in need of services. METHODS We conducted in-depth interviews with a diverse sample of 39 female-assigned-at-birth individuals (ages 18-44) who also identified as lesbian, bisexual, queer, and/or genderqueer, or transmasculine. Interviews were primarily conducted in person in the Bay Area of California, and Baltimore, Maryland, with 11 conducted remotely with participants in other U.S. LOCATIONS We asked participants about their current reproductive health care needs, topics they felt researchers should pursue, and past reproductive health care experiences. Data were analyzed using a framework method, incorporating deductive and inductive thematic analysis techniques. RESULTS Reproductive health care needs among participants varied widely and included treatment of polycystic ovary syndrome and irregular menses, gender-affirming hysterectomies, and fertility assistance. Many faced challenges getting their needs met. Themes related to these challenges cross-cutting across identity groups included primary focus on fertility, provider lack of LGBTQ health competency relevant to reproductive health priorities and treatment, and discriminatory comments and treatment. Across themes and identity groups, participants highlighted that sexual activity and reproduction were central topics in reproductive health care settings. These topics facilitated identity disclosures to providers, but also enhanced vulnerability to discrimination. CONCLUSIONS Reproductive health priorities of LGBTQ individuals include needs similar to cisgender and heterosexual groups (e.g., abortion, contraception, PCOS) as well as unique needs (e.g., gender affirming hysterectomies, inclusive safer sex guidance) and challenges in pursuing care. Future reproductive health research should pursue health care concerns prioritized by LGBTQ populations.

Inclusion of LGBTQ persons in research related to pregnancy risk: a cognitive interview study

Introduction Recently, researchers have begun considering whether and how to include lesbian, gay, bisexual, transgender and queer (LGBTQ) people in research about abortion and contraception care. Including LGBTQ people in research about abortion and contraception care, as well as the risk for unintended pregnancy more broadly, requires accurate assessment of risk for unintended pregnancy, which involves different considerations for LGBTQ people. Methods We created a survey with existing sexual orientation and gender identity measures, new reproductive anatomy questions to guide skip patterns, gender neutral terminology in sexual and behavioural risk questions, and existing contraception and pregnancy intentions questions that were modified to be gender neutral. We then assessed the appropriateness of these measures through cognitive interviews with 39 individuals aged 18–44 years who were assigned female at birth and identified as LGBTQ. Participants were recruited in the San Francisco Bay Area of California, Baltimore, Maryland and other cities. Results Existing demographic questions on sexual orientation and gender identity were well received by participants and validating of participant reported identities. Participants responded positively to new reproductive anatomy questions and to gender neutral terminology in sexual behaviour and pregnancy risk questions. They felt skip patterns appropriately removed them out of inappropriate items (eg, use of contraception to avoid unintended pregnancy); there was some question about whether pregnancy intention measures were widely appropriate or should be further restricted. Conclusions This study provides guidance on ways to appropriately evaluate inclusion of LGBTQ people in abortion and contraception research.

Two Tailored Provider Curricula Promoting Healthy Weight in Lesbian and Bisexual Women.

PURPOSE Provider curricula to reduce potential weight bias or stigma in treating lesbian and bisexual (LB) women who are overweight or obese were pilot-tested in two unique settings. Trainings used LB cultural competency and motivational interviewing techniques to improve provider-patient interactions. METHODS Two training formats were used: Clinic Format and Academic Format. Clinic Format training was pilot tested at Lyon-Martin Health Services, a Program of HealthRight360, a community health center serving women, lesbians, and transgender people in San Francisco and in two community settings. Academic Format training was pilot tested by the Mautner Project of Whitman-Walker Health with physicians, medical residents, and students at Georgetown, George Washington, Howard, and Vanderbilt Universities. Both programs measured provider knowledge and attitude change. RESULTS Both programs saw significant percentage point gains in knowledge about LB womens avoidance of health care based on body size. Participants in the Academic Format program saw the greatest gain in knowledge about understanding health care avoidance (30 percentage point increase), whereas Clinic Format program participants gained most in understanding how to appropriately discuss weight loss with patients (23 percentage point increase). CONCLUSIONS Both programs increased provider knowledge about the barriers to health care facing LB women who are overweight and obese, reducing the potential for future negative interactions. However, the two programs differed in how they conceptualized the relationship between weight and health, likely contributing to differences in knowledge gain among participants at each site. Future studies should test differences between the two formats across site type or staff baseline knowledge differences.