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False beliefs about sexual risk, poor physician-patient communication impede STD screening in young women

A study found that one in four clinicians surveyed will disregard screening guidelines for chlamydia and/or gonorrhea if a patient is asymptomatic.

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Despite record high rates of new cases of sexually transmitted diseases (STDs), young women who are sexually active often don’t talk to their clinicians about sex and STD risk, and many aren’t being tested for infection or disease as guidelines recommend, according to new research from Quest Diagnostics, a provider of diagnostic information services.

The findings from a new survey -“Young Women and STDs: Are Physicians Doing Enough to Empower their Patients and Protect their Health?” – suggest that lack of direct communication between clinicians and patients – and false beliefs about STD risk held by both groups — may contribute to STD prevalence.

The survey examined the perceptions of young women 15-24 years of age, mothers of young women in this age group, and primary care, OB/GYN, and other specialty physicians regarding sexual activity, sexual health, and knowledge of and screening for STDs (also known as sexually transmitted infections or STIs). The results of the 2017 survey were also compared to those of previous research by Quest in 2015 involving similar populations.

Medical guidelines from the Centers for Disease Control and Prevention recommend annual laboratory testing for chlamydia and gonorrhea for all sexually active women under the age of 25. According to the Centers for Disease Control and Prevention (CDC), cases of sexually transmitted disease are at an all-time high, with more than two million cases of chlamydia, gonorrhea and syphilis reported in the United States in 2016. Young adults make up about half of STD cases.

“We know that people often think of STDs as something that happens ‘to others’ and, frequently, health care providers have similar beliefs and don’t view their patients as being at risk,” said Lynn Barclay, president and CEO, American Sexual Health Association. “Testing is crucial in young women because STDs are very common, often without symptoms, and undetected infections like chlamydia can lead to problems including infertility.”

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Among the key findings:

  • Young women may not understand their STD risk: A little more than half of young women (56%) say they are sexually active and of those who are, 56 percent say they have been tested for an STD. Young sexually active women cite “not feeling at risk” (62%) and “being asymptomatic” (55%) as reasons for not testing, although STDs often lack symptoms. Of women who are sexually active, 86 percent and 88 percent said they aren’t at risk for chlamydia or gonorrhea, respectively.
  • Many young women are uncomfortable talking to their clinician about sex and STDs: Fifty-one percent of young women say they don’t want to bring up for discussion the topics of sex or STDs with their clinicians.
  • Young women may fail to be truthful with their clinician: Twenty seven percent of sexually active young women admit they don’t always tell the truth about their sexual history to their clinician. For the youngest sexually active women (15-17 years of age), forty-three percent aren’t always truthful.
  • Women don’t recall having a clinician ask about STD screening: 49 percent of young women claim their clinician has never asked if they want STD testing, and less than one in four sexually active women has asked their healthcare professional for an STD test.

In addition, the survey responses of young women suggest rates of STD screening by clinicians have declined, particularly among those 15-17 years of age. Based on the comparison of responses of sexually active women 15-17 between 2015 and 2017, STD testing by clinicians for chlamydia and gonorrhea has decreased by 9 percent and 11 percent, respectively.

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The survey also found gaps in care by some physicians.

Clinicians may also be uncomfortable discussing STDs, with one in four (24%) primary care physicians agreed with the statement, “I am very uncomfortable discussing STI risk with my female patients.”

One in three primary care physicians rely on symptoms to diagnose an STD: Twenty-seven percent reported that they could accurately diagnose STD patients “based on their symptoms,” even though CDC notes, “STDs do not always cause symptoms, so it is possible to have an infection and not know it.”

Undiagnosed women are much more likely than men to suffer long-term health impacts from STDs, including infertility and pelvic inflammatory disease.
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Also, one in four physicians will disregard screening guidelines if a patient is asymptomatic: Only seventy-four percent of primary care doctors said they would order chlamydia testing of an asymptomatic, sexually active female patient. Only seventy-two percent would order testing for gonorrhea for such an asymptomatic patient.

Annual screening for chlamydia and gonorrhea for men who do not have sex with other men is not currently guideline recommended, although, like women, they may not have symptoms and can unknowingly transmit infection to a partner. Undiagnosed women are much more likely than men to suffer long-term health impacts from STDs, including infertility and pelvic inflammatory disease.

“Our findings suggest that discomfort with frank conversations about sexual activity and false beliefs about risk are key barriers to STD testing, and could be driving some of the increase in STD cases of young women,” said Damian P. Alagia, III, MD, FACOG, FACS, medical director of woman’s health, Quest Diagnostics. “Half of all new STD cases are acquired by young people between the ages of 15-24, and one in four sexually active adolescents has a sexually transmitted disease. Our hope in sharing this survey’s findings with clinicians and the general public is that it prompts open dialogue about reproductive health and STD risk, which is absolutely critical to reversing the trajectory of high STD rates in the US.”

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The research was conducted by Aurora Research & Consulting on behalf of Quest Diagnostics in December, 2017. A total of 4,742 study respondents, comprised of 3,414 young women between the ages of 15-24, of whom 1,500 self-identified as sexually active; 1,016 mothers of young women in that age group; and 312 primary care, OB/GYN and specialty physicians were surveyed. Most clinician survey data presented in this report was of responses of 100 primary care physicians. Each respondent completed 15-30 minute online surveys regarding perceptions and knowledge of STDs and chlamydia and gonorrhea testing. Strengths of the research include the large number of respondents and the research’s national scale, while limitations include self-reported data and a lack of direct comparability between study populations. The 2017 research was complemented by results of a survey of similar cohort of patients and healthcare practitioners performed in 2015.

Health & Wellness

LGBT adolescents more likely than other kids their age to try to kill themselves

A study found that sexual minority youth were 3.5 times as likely to attempt suicide as their heterosexual peers. Meanwhile, transgender adolescents were 5.87 times more likely, gay and lesbian adolescents were 3.71 times more likely and bisexual youth were 3.69 times more likely than heterosexual peers to attempt suicide.

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LGBT youth have higher risk for suicide attempts.

This is according to “Estimating the Risk of Attempted Suicide Among Sexual Minority Youths: A Systematic Review and Meta-analysis”, a study done by Ester di Giacomo, MD; Micheal Krausz, PhD; Fabrizia Colmegna, MD; Flora Aspesi, MD; and Massimo Clerici, PhD and which was published in JAMA Pediatrics.

For this study, the researchers pooled data from 35 earlier studies to show that sexual minority youth were more than three times as likely to attempt suicide as heterosexual peers. Transsexual youth were at highest risk, nearly six times as likely to attempt suicide as heterosexual peers, researchers reported.

“Adolescents facing ‘non-conventional’ sexual identity are at risk of higher self-threatening behaviors, independent of bullying and other risk factors,” Dr.di Giacomo, the study’s lead author, was quoted as saying by Reuters Health. “I think that a difficulty in self-acceptance and social stigmatization might be keys for understanding such elevation in the risk of self-threatening behaviors.”

This may be because many LGBT youth have trouble accepting who they are because of the way they are seen by others, di Giacomo added.

The study noted that “suicide is the second-leading cause of death among adolescents” and that “sexual minority individuals are at a higher risk of suicide and attempted suicide.”

Thirty-five studies reported in 22 articles that involved a total of 2 ,378,987 heterosexual and 113, 468 sexual minority adolescents (age range: 12-20 years) were included in the analysis. The study found that sexual minority youth were 3.5 times as likely to attempt suicide as their heterosexual peers. Meanwhile, transgender adolescents were 5.87 times more likely, gay and lesbian adolescents were 3.71 times more likely and bisexual youth were 3.69 times more likely than heterosexual peers to attempt suicide.

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Since the findings suggest that youths with non-heterosexual identity have a significantly higher risk of life-threatening behavior compared with their heterosexual peers, the researchers stressed that “public awareness is important, and a careful evaluation of supportive strategies (e.g. support programs, counseling, and de-stigmatizing efforts)… be part of education and public health planning.”

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Health & Wellness

Sexual minority adults are poorer than their straight peers

Researchers found that sexual minority women were more likely to be near poor, receive public assistance and report economic hardship in the past year. In addition, sexual minority women were less likely to graduate from college and were twice as likely to be unemployed, compared to heterosexual women.

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Sexual minorities in have fewer economic resources than their straight peers and the gap is more pronounced among women. This is according to a new study by the Williams Institute at UCLA School of Law.

The report, “Sexual orientation and sex differences in socioeconomic status: a population-based investigation in the National Longitudinal Study of Adolescent to Adult Health,” appears in the Journal of Epidemiology and Community Health and is co-authored by Kerith J. Conron, Blachford-Cooper Distinguished Scholar and Research Director at the Williams Institute, along with Shoshana K. Goldberg, Research Assistant Professor at the University of North Carolina-Chapel Hill, and Carolyn T. Halpern, Professor, Department of Maternal and Child Health, University of North Carolina-Chapel Hill.

Researchers analyzed data gathered from 14,051 participants in the National Longitudinal Study of Adolescent to Adult Health in the US, and they found that sexual minority women were more likely to be near poor, receive public assistance and report economic hardship in the past year. In addition, sexual minority women were less likely to graduate from college and were twice as likely to be unemployed, compared to heterosexual women.

Among women, sexual orientation inequities in homeownership were more pronounced for whites than racial minorities. However, rates of homeownership were the lowest for Black and Latina sexual minority women and were the highest for heterosexual white women.

“Socioeconomic status is a major contributor to health and disease throughout a person’s life,” said Conron said lead author Kerith Conron, Blachford-Cooper Distinguished Scholar and Research Director at the Williams Institute. “Understanding the extent and nature of sexual orientation differences in socioeconomic status is essential to reducing health inequities, particular as the population of sexual minorities grows and ages.”

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Fewer sexual orientation differences in economic status existed for men. Sexual minority men were more likely than their straight peers to have a college education. Yet, they earned less and were more likely to report economic hardship in the past year than straight men, which could indicate that sexual minority men face wage discrimination.

In addition, socioeconomic status among men differed by race. White sexual minority men were less likely than white heterosexual men to be among the highest earners. But Black and Latino sexual minority men did better economically than their Black and Latino heterosexual peers.

“These patterns suggest that multiple forms of inequality, as well as factors that promote resilience, must be considered in analyses of the diverse LGBT community,” said Conron. “Moreover, findings emphasize the need to include LGBT measures in large surveys conducted by the US Census Bureau, including the American Community Survey and the Survey of Income and Program Participation, in order to better track, understand, and respond to observed economic inequities.”

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Health & Wellness

Female to male trans adolescents report highest rate of attempted suicide at 50.8%

A study found that almost 14% of adolescents reported a previous suicide attempt, with disparities by gender identity in suicide attempts. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%).

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 Nearly 14% of adolescents reported a previous suicide attempt, with female to male adolescents reporting the highest rate of attempted suicide at 50.8%.

This is according to “Transgender Adolescent Suicide Behavior“, a study done by Russell B. Toomey, Amy K. Syvertsen and Maura Shramko, and released in Pediatrics. The study eyed to examine prevalence rates of suicide behavior across six gender identity groups: female; male; transgender, male to female; transgender, female to male; transgender, not exclusively male or female; and questioning. A secondary objective was to examine variability in the associations between key sociodemographic characteristics and suicide behavior across gender identity groups.

Data from the “Profiles of Student Life: Attitudes and Behaviors” survey (N = 120 617 adolescents; ages 11–19 years) were used to achieve the study objectives. Data were collected over a 36-month period: June 2012 to May 2015. A dichotomized self-reported lifetime suicide attempts (never versus ever) measure was used. Prevalence statistics were compared across gender identity groups, as were the associations between sociodemographic characteristics (i.e. age, parents’ highest level of education, urbanicity, sexual orientation, and race and/or ethnicity) and suicide behavior.

The study found that almost 14% of adolescents reported a previous suicide attempt, with disparities by gender identity in suicide attempts. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%).

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Identifying as non-heterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (i.e. non-binary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts.

According to the researchers, “Suicide prevention efforts can be enhanced by attending to variability within transgender populations, particularly the heightened risk for female to male and non-binary transgender adolescents.”

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Health & Wellness

Trans-inclusive policies on college campuses improve the well-being of trans students

New report provides recommendations to institutions of higher education regarding the creation of trans-inclusive communities.

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report by the Williams Institute at UCLA School of Law finds that transgender-inclusive policies and support systems on college campuses provide transgender students a greater sense of belonging and more positive perceptions of the campus environment.

The report reviews previous research on the experiences of transgender students and presents new findings from interviews, surveys and focus groups conducted with transgender students.

“The majority of transgender students arrive at college having endured harassment and bullying in secondary school, which research shows have a negative impact on their academic performance and mental health. This cycle may be compounded by further adverse treatment and institutional invisibility at college,” said author Abbie E. Goldberg, former visiting scholar at the Williams Institute at UCLA School of Law. “However, through relatively small changes, faculty and administrators can make a world of difference in the lives of transgender young adults.”

The current research focused on the institutional structures and interpersonal interactions at colleges and universities that either enforce biases or serve as sources of support for transgender students. The report concludes with ten recommendations to institutions of higher education on how to create more transgender-inclusive campus communities.

Key recommendations include:

  • Colleges and universities should explicitly include gender identity and expression in their nondiscrimination policies.
  • College curricula should address gender identity and specifically transgender identities and experiences.
  • Students should be provided with education/training to enhance their understanding and acceptance of gender diversity.
  • Faculty/staff should be exposed to mandatory training on gender identity issues.
  • Students should be able to list their preferred name on campus records and alternatives to male/female should be provided.
  • All university literature and publications should use gender-inclusive language.
  • Gender-inclusive or single-stall restrooms should be readily available on campus.
  • Universities should provide trans-inclusive/trans-accommodating housing options.
  • Counseling and health services staff should receive training on trans-inclusive and trans-affirming practices and health insurance coverage should be inclusive of trans students.
  • Trans-specific spaces and/or groups should be created with sufficient resources to support programming and events.
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“A growing body of research indicates that gender, including gender identity, expression and gender norms, plays a key role in academic, health and economic outcomes,” said Kerith J. Conron, the Blachford-Cooper Distinguished Scholar and Research Director at the Williams Institute. “Colleges should engage students and faculty in conversations about gender and examine policies, including those related to information systems, through a comprehensive gender lens. This would have the potential to improve campus safety and promote academic success for all students.”

READ THE REPORT HERE.

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Health & Wellness

Report identifies unique challenges for LGBT community facing Alzheimer’s and other dementias

Despite recent advances in LGBT rights, LGBT older people are often marginalized and face discrimination. They are twice as likely to age without a spouse or partner, twice as likely to live alone and three to four times less likely to have children.

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LGBT and Dementia – a new issues brief developed by the Alzheimer’s Association and SAGE – outlines the unique issues that arise when Alzheimer’s disease, sexual orientation, and gender identification and expression intersect, allowing advocates and care providers to better meet the needs of LGBT elders and their caregivers facing dementia.

“Living with Alzheimer’s or another dementia is not easy for anyone,” said Sam Fazio, Ph.D., director of quality care and psychosocial research, Alzheimer’s Association. “But LGBT individuals can often face additional challenges that need to be considered and addressed to ensure this population gets respectful and competent care.”

It is estimated that there are 2.7 million LGBT people over age 50 living in the US alone, and that number is increasing rapidly as baby boomers age and more people self-identify as LGBT. New research presented at the 2018 Alzheimer’s Association International Conference found that about one in 13 lesbian, gay or bisexual (LGB) seniors in the US are living with dementia. Dementia rates for the LGB population are 7.4 percent, compared to about 10 percent for the general population.

“While the LGBT community faces similar health concerns as the general public, LGBT people who receive a dementia diagnosis and LGBT caregivers face uniquely challenging circumstances,” said SAGE CEO Michael Adams. “This brief shines a light on these challenges, so we can begin taking steps to address them and improve the care and support LGBT people receive.”

Despite recent advances in LGBT rights, LGBT older people are often marginalized and face discrimination. They are twice as likely to age without a spouse or partner, twice as likely to live alone and three to four times less likely to have children – greatly limiting their opportunities for support. There’s also a lack of transparency as 40 percent of LGBT older people in their 60s and 70s say their healthcare providers don’t know their sexual orientation.

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The brief identifies seven areas which can create unique or additional challenges for LGBT individuals living with dementia and their caregivers. They include:

  • Stigma
  • Social isolation
  • Poverty
  • Health disparities
  • Sexuality and sexual expression
  • Barriers to utilizing existing services
  • Living with HIV/AIDS

According to the brief, LGBT individuals may not reach out for services and support because they fear poor treatment due to their LGBT identity, because they fear the stigma of being diagnosed with dementia, or both. Several studies document that LGBT elders access essential services, including visiting nurses, food stamps, senior centers, and meal plans, much less frequently than the general aging population.

The Institute of Medicine identified the following pressing health issues for LGBT people: lower rates of accessing care (up to 30 percent); increased rates of depression; higher rates of obesity in the lesbian population; higher rates of alcohol and tobacco use; higher risk factors of cardiovascular disease for lesbians; and higher incidents of HIV/AIDS for gay and bisexual men. Risk factors for heart disease — including diabetes, tobacco use, high blood pressure and high cholesterol — are also risk factors for Alzheimer’s and stroke-related dementia.

Among the recommendations for organizations and service providers, the Alzheimer’s Association and SAGE suggest:

  • Expand your definition of family.
  • Educate yourself and your staff on LGBT cultural competency.
  • Find or create support groups specifically for LGBT people.
  • Partner with local LGBT community groups and political organizations.
  • Help LGBT people and their families with legal and financial planning.
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Health & Wellness

6 Ways you’re wrecking your mental health

In recent years, the stigma surrounding mental health has started to lift, allowing us to finally have open conversations about our well-being. However mentally healthy you may be or think you are, it’s crucial that you do what you can to take care of yourself.

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Like physical health, we all have a state of mental health, with some people being deemed relatively healthy and others requiring professional help. In recent years, the stigma surrounding mental health has started to lift, allowing us to finally have open conversations about our well-being. However mentally healthy you may be or think you are, it’s crucial that you do what you can to take care of yourself.

Keeping that in mind, here are six mental health mistakes to avoid.

1. Lack Of Physical Activity

Everyone knows that exercise helps us to stay physically fit, but what many people don’t realize is that it can prevent stress and anxiety too. In fact, experts believe that a simple thirty-minute walk can have an effect, with more physical activities having a bigger and better outcome. Because of this, it’s vital that you make time to exercise for at least thirty minutes every single day.

2. Not Getting Enough Sleep

While it’s important to stay active, this doesn’t mean sacrificing sleep in the process. When you have a rough nights sleep, it can leave you feeling cranky, emotional, and stressed, and this will start to cause damage unless you get into a proper routine and stick to seven or eight hours a night. To help you ensure this, you should keep your room dark and cool, with no electronics.

While you should certainly distance yourself from people that make you feel bad, you shouldn’t isolate yourself from everyone you know.
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3. Associating With Negative People

Regardless of the state of your mental health, associating with people that make you feel bad about yourself will always cause some damage. If the person making you feel this way is a family member or spouse, then you should consider family counseling and couples therapy retreats to deal with your issues. For those that aren’t family, you may want to distance yourself.

4. Isolating Yourself From Friends

While you should certainly distance yourself from people that make you feel bad, you shouldn’t isolate yourself from everyone you know. Even introverted people need social interaction now and then, or you’ll start to feel lonely, depressed, and may even develop social anxiety. If you start to spend lots of time alone, arrange to meet up with friends after work or give your mom a call.

5. Refusing To Get Help

No matter what people tell you, there’s nothing wrong with asking for help when you need it. In fact, that’s the very best thing you can do. With that in mind, it’s crucial that you speak to a doctor, counsellor, or therapist when you start to notice problems with your mental health. They’ll be able to offer advice on ways to boost your mental health, including possible treatment options.

6. Self-Medicating With Substances

Drinking, smoking, and taking drugs may offer a temporary release from your mental health issues, but they are far from a cure. In fact, all they’re ever going to do is make your problems worse, while adding an addiction to the mix. Instead of trying to handle things yourself, speak to a professional for support and advice on proper treatment methods.

Mental health is not something that should be taken lightly, so avoid making the mistakes listed above.

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