Vincent M. B. Silenzio

Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concerns

Laura Dean, MEd,1 Ilan H. Meyer, PhD,1 Kevin Robinson, MHA, MSW,1 Randall L. Sell, ScD,1 Robert Sember, PhD,1 Vincent M.B. Silenzio, MPH, MD,1 Deborah J. Bowen, PhD,2 Judith Bradford, PhD,2 Esther Rothblum, PhD,2 Scout, MA,2 Jocelyn White, MD,2 Patricia Dunn, MSW, JD,3 Anne Lawrence, M.D., Ph.D.(c),4 Daniel Wolfe,1 Jessica Xavier,5 and With acknowledgment to Darren Carter, MD, Jennifer Pittman, and Ronald Tierney

Sexual Orientation and Risk Factors for Suicidal Ideation and Suicide Attempts Among Adolescents and Young Adults

Same-gender sexual orientation has been repeatedly shown to exert an independent influence on suicidal ideation and suicide attempts, suggesting that risk factors and markers may differ in relative importance between lesbian, gay, and bisexual individuals and others. Analyses of recent data from the National Longitudinal Study of Adolescent Health revealed that lesbian, gay, and bisexual respondents reported higher rates of suicidal ideation and suicide attempts than did heterosexual respondents and that drug use and depression were associated with adverse outcomes among heterosexual respondents but not among lesbian, gay, and bisexual respondents.

Connecting the invisible dots: Reaching lesbian, gay, and bisexual adolescents and young adults at risk for suicide through online social networks

Young lesbian, gay, and bisexual (young LGB) individuals report higher rates of suicide ideation and attempts from their late teens through early twenties. Their high rate of Internet use suggests that online social networks offer a novel opportunity to reach them. This study explores online social networks as a venue for prevention research targeting young LGB. An automated data collection program was used to map the social connections between LGB self-identified individuals between 16 and 24 years old participating in an online social network. We then completed a descriptive analysis of the structural characteristics known to affect diffusion within such networks. Finally, we conducted Monte Carlo simulations of peer-driven diffusion of a hypothetical preventive intervention within the observed network under varying starting conditions. We mapped a network of 100,014 young LGB. The mean age was 20.4 years. The mean nodal degree was 137.5, representing an exponential degree distribution ranging from 1 through 4309. Monte Carlo simulations revealed that a peer-driven preventive intervention ultimately reached final sample sizes of up to 18,409 individuals. The networks structure is consistent with other social networks in terms of the underlying degree distribution. Such networks are typically formed dynamically through a process of preferential attachment. This implies that some individuals could be more important to target to facilitate the diffusion of interventions. However, in terms of determining the success of an intervention targeting this population, our simulation results suggest that varying the number of peers that can be recruited is more important than increasing the number of randomly-selected starting individuals. This has implications for intervention design. Given the potential to access this previously isolated population, this novel approach represents a promising new frontier in suicide prevention and other research areas.

Suicidal ideation among sexual minority veterans: results from the 2005-2010 Massachusetts Behavioral Risk Factor Surveillance Survey.

Suicide is a public health problem disproportionately associated with some demographic characteristics (e.g., sexual orientation, veteran status). Analyses of the Massachusetts Behavioral Risk Factor Surveillance Survey data revealed that more lesbian, gay, and bisexual (i.e., sexual minority) veterans reported suicidal ideation compared with heterosexual veterans. Decreased social and emotional support contributed to explaining the association between sexual minority status and suicidal ideation. More research is needed about suicide risk among sexual minority veterans; they might be a population for outreach and intervention by the Veterans Health Administration.

COMPREHENSIVE CARE OF LESBIAN AND GAY PATIENTS AND FAMILIES

A significant proportion of the population is predominantly gay or lesbian, but the unique health care needs of these patients and their families often are ignored. The most significant health risk for lesbians and gays may be that they avoid routine health care. Families that include gay members may have special needs, largely related to how homosexuality is perceived. Physicians can improve the health care of gay and bisexual men and women and their families by maintaining a non-homophobic attitude, being sure to distinguish sexual behavior from sexual identity, communicating clearly and sensitively by using gender-neutral terms, and being aware of how their own attitudes affect clinical judgment.

Use of personal digital assistants to enhance educational evaluation in a primary care clerkship

Experiences of students using optically scanned cards were compared with those of students using personal digital assistants (PDAs) to log patient encounters in a primary care clerkship. From April to September 2001, students were offered the option of using a PDA in lieu of scanned cards to track clinical encounters. Data obtained from PDA users were compared with those previously obtained from scanned card users. Verbal and written feedback was obtained from all students. Of the 71 students invited to participate, 21 (30%) owned a PDA, and of these, 20 agreed to participate. Eighteen students completed the pilot. One student was unable to participate owing to software installation problems; another student lost data because of improper back-up. Students using the PDAs recorded more encounters per rotation and had fewer missing data when compared with students who used scanned card. Additionally, feedback from students suggested that PDAs offered other important educational benefits.

What Is the Role of Complementary and Alternative Medicine in Public Health

What is the role of complementary and alternative health care and medical practices in the health and well-being of the public? With this extraordinary collection of articles and essays, the Journal explores this question and helps to open a new period in the history of public health. Although long an integral part of the health systems of societies all around the globe, the relationship between public health and traditional or indigenous health practices has not often been a congenial or collegial one. Yet the question of the proper role of complementary and alternative medicine (CAM) in the health of the public remains perhaps the most important one to be asked by readers of the Journal, both supporters and detractors of approaches that are beyond the pale of conventional biomedicine. It is a question with a complex set of answers.

Social structure and depression in TrevorSpace

We discover patterns related to depression in the social graph of an online community of approximately 20,000 lesbian, gay, and bisexual, transgender, and questioning youth. With survey data on fewer than two hundred community members and the network graph of the entire community (which is completely anonymous except for the survey responses), we detected statistically significant correlations between a number of graph properties and those TrevorSpace users showing a higher likelihood of depression, according to the Patient Healthcare Questionnaire-9, a standard instrument for estimating depression. Our results suggest that those who are less depressed are more deeply integrated into the social fabric of TrevorSpace than those who are more depressed. Our techniques may apply to other hard-to-reach online communities, like gay men on Facebook, where obtaining detailed information about individuals is difficult or expensive, but obtaining the social graph is not.

Anthropological Assessment for Culturally Appropriate Interventions Targeting Men Who Have Sex With Men

Although social and cultural factors play a fundamental role in the health of sexual minority populations and the development of culturally appropriate interventions, public health activities and research have sometimes lacked appropriate sophistication or attention to issues of cultural competency. In areas such as HIV prevention for men who have sex with men (MSM), biomedical interpretations of same-sex phenomena should be applied with caution. Communities and societies may broadly understand same-sex desire, attraction, behavior, and identity through age-structured/initiatory, gender-defined, profession/social role-defined, or egalitarian/gay frameworks. When more detailed, locally specific information is required, such as for youth, ethnic minorities, or urban versus rural populations, the approach to rapid anthropological assessment presented can provide nuanced insights for effective health programs targeting MSM.

Suicide Contagion: A Systematic Review of Definitions and Research Utility

Objectives Despite the common use of contagion to analogize the spread of suicide, there is a lack of rigorous assessment of the underlying concept or theory supporting the use of this term. The present study aims to examine the varied definitions and potential utility of the term contagion in suicide-related research. Methods 100 initial records and 240 reference records in English were identified as relevant with our research objectives, through systematic literature screening. We then conducted narrative syntheses of various definitions and assessed their potential value for generating new research. Results 20.3% of the 340 records used contagion as equivalent to clustering (contagion-as-cluster); 68.5% used it to refer to various, often related mechanisms underlying the clustering phenomenon (contagion-as-mechanism); and 11.2% without clear definition. Under the category of contagion-as-mechanism, four mechanisms have been proposed to explain how suicide clusters occurred: transmission (contagion-as-transmission), imitation (contagion-as-imitation), contextual influence (contagion-as-context), and affiliation (contagion-as-affiliation). Contagion-as-cluster both confounds and constrains inquiry into suicide clustering by blending proposed mechanism with the phenomenon to be studied. Contagion-as-transmission is, in essence, a double or internally redundant metaphor. Contagion-as-affiliation and contagion-as-context involve mechanisms that are common mechanisms that often occur independently of apparent contagion, or may serve as a facilitating background. When used indiscriminately, these terms may create research blind spots. Contagion-as-imitation combines perspectives from psychology, sociology, and public health research and provides the greatest heuristic utility for examining whether and how suicide and suicidal behaviors may spread among persons at both individual and population levels. Conclusion Clarifying the concept of “suicide contagion” is an essential step for more thoroughly investigating its mechanisms. Developing a clearer understanding of the apparent spread of suicide-promoting influences can, in turn, offer insights necessary to build the scientific foundation for prevention and intervention strategies that can be applied at both individual and community levels.