%0 Journal Article %J Gerontologist %D 2014 %T Physical and mental health of transgender older adults: an at-risk and underserved population. %A Fredriksen-Goldsen, Karen I %A Cook-Daniels, Loree %A Kim, Hyun-Jun %A Erosheva, Elena A %A Emlet, Charles A %A Hoy-Ellis, Charles P %A Goldsen, Jayn %A Muraco, Anna %K Data Collection %K Health Status %K Humans %K Mental Health %K Middle Aged %K Risk Factors %K Transgender Persons %K Vulnerable Populations %X

PURPOSE: This study is one of the first to examine the physical and mental health of transgender older adults and to identify modifiable factors that account for health risks in this underserved population.

DESIGN AND METHODS: Utilizing data from a cross-sectional survey of lesbian, gay, bisexual, and transgender older adults aged 50 and older (N = 2,560), we assessed direct and indirect effects of gender identity on 4 health outcomes (physical health, disability, depressive symptomatology, and perceived stress) based on a resilience conceptual framework.

RESULTS: Transgender older adults were at significantly higher risk of poor physical health, disability, depressive symptomatology, and perceived stress compared with nontransgender participants. We found significant indirect effects of gender identity on the health outcomes via fear of accessing health services, lack of physical activity, internalized stigma, victimization, and lack of social support; other mediators included obesity for physical health and disability, identity concealment for perceived stress, and community belonging for depressive symptomatology and perceived stress. Further analyses revealed that risk factors (victimization and stigma) explained the highest proportion of the total effect of gender identity on health outcomes.

IMPLICATIONS: The study identifies important modifiable factors (stigma, victimization, health-related behaviors, and social support) associated with health among transgender older adults. Reducing stigma and victimization and including gender identity in nondiscrimination and hate crime statutes are important steps to reduce health risks. Attention to bolstering individual and community-level social support must be considered when developing tailored interventions to address transgender older adults' distinct health and aging needs.

%B Gerontologist %V 54 %P 488-500 %8 2014 Jun %G eng %N 3 %R 10.1093/geront/gnt021 %0 Journal Article %J Matern Child Health J %D 2013 %T Health disparities among childrearing women with disabilities. %A Kim, Miok %A Kim, Hyun-Jun %A Hong, Seunghye %A Fredriksen-Goldsen, Karen I %K Adolescent %K Adult %K Behavioral Risk Factor Surveillance System %K Child Rearing %K Child, Preschool %K Chronic Disease %K Disabled Persons %K Female %K Health Behavior %K Health Services Accessibility %K Health Status Disparities %K Health Status Indicators %K Health Surveys %K Healthcare Disparities %K Humans %K Middle Aged %K Mothers %K Prevalence %K Quality of Life %K Socioeconomic Factors %K Washington %K Young Adult %X

This study examines leading health indicators for childrearing women with disabilities, including health-related quality of life, chronic health conditions, adverse and preventive health behaviors, health care access, and social and emotional support. The study analyzes aggregated data from the Washington State Behavioral Risk Factor Surveillance System (n = 28,629). The weighted prevalence of key health indicators of childrearing women with disabilities (aged 18-59) are compared with childrearing women without disabilities. A series of adjusted logistic regression analyses are applied, controlling for confounding variables. When compared to childrearing women without disabilities, childrearing women with disabilities are less likely to have a partner or spouse, report lower income and education levels and are older. Childrearing women with disabilities, compared to childrearing women without disabilities, report significantly lower health-related quality of life including poor general health (adjusted odds ratio[AOR] = 6.85; p < .001), frequent mental distress (AOR = 4.02; p < .001), and frequent poor physical health (AOR = 9.34; p < .001); higher prevalence of chronic health conditions, including arthritis, cardiovascular diseases, diabetes, asthma, high blood pressure and cholesterol, and obesity (the range of AORs = 1.59 to 5.65; p < .001); higher prevalence of adverse health behaviors including smoking (AOR = 2.14; p < .001) and lack of exercise (AOR = 1.61; p < .001); more financial barriers to health care (AOR = 2.11; p < .001) and lack of social and emotional support (AOR = 2.05; p < .001) while controlling for age, education, income, and relationship status. Based on population level data, the study reveals that childrearing women with disabilities experience elevated risks of health disparities across many key health indicators, many of which are preventable and modifiable. These findings underscore the importance of identifying contributing factors and developing interventions to improve the health and quality of life of childrearing women with disabilities.

%B Matern Child Health J %V 17 %P 1260-8 %8 2013 Sep %G eng %N 7 %R 10.1007/s10995-012-1118-4 %0 Journal Article %J Am J Public Health %D 2013 %T Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. %A Fredriksen-Goldsen, Karen I %A Kim, Hyun-Jun %A Barkan, Susan E %A Muraco, Anna %A Hoy-Ellis, Charles P %K Bisexuality %K Chronic Disease %K Confidence Intervals %K Female %K Health Behavior %K Health Services Accessibility %K Health Status Disparities %K Health Surveys %K Homosexuality, Female %K Homosexuality, Male %K Humans %K Logistic Models %K Male %K Mass Screening %K Middle Aged %K Odds Ratio %K Washington %X

OBJECTIVES: We investigated health disparities among lesbian, gay, and bisexual (LGB) adults aged 50 years and older.

METHODS: We analyzed data from the 2003-2010 Washington State Behavioral Risk Factor Surveillance System (n = 96 992) on health outcomes, chronic conditions, access to care, behaviors, and screening by gender and sexual orientation with adjusted logistic regressions.

RESULTS: LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals. Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men. Conclusions. Tailored interventions are needed to address the health disparities and unique health needs of LGB older adults. Research across the life course is needed to better understand health disparities by sexual orientation and age, and to assess subgroup differences within these communities.

%B Am J Public Health %V 103 %P 1802-9 %8 2013 Oct %G eng %N 10 %R 10.2105/AJPH.2012.301110 %0 Journal Article %J Am J Public Health %D 2013 %T Nonresponse to a question on self-identified sexual orientation in a public health survey and its relationship to race and ethnicity. %A Kim, Hyun-Jun %A Fredriksen-Goldsen, Karen I %K Adult %K African Americans %K Asian Americans %K Behavioral Risk Factor Surveillance System %K Continental Population Groups %K Ethnic Groups %K European Continental Ancestry Group %K Female %K Health Surveys %K Hispanic Americans %K Humans %K Male %K Middle Aged %K Self Report %K Sexual Behavior %K Washington %X

We examined whether nonresponse to the survey question on self-identified sexual orientation was associated with race and ethnicity, utilizing Washington State Behavioral Risk Factor Surveillance System data. The results of adjusted multinomial logistic regression indicated that the nonresponse rates of Asian Americans, Hispanics, and African Americans are higher than those of non-Hispanic Whites. Innovative ways of measuring sexual orientation to reduce racially and ethnically driven bias need to be developed and integrated into public health surveys.

%B Am J Public Health %V 103 %P 67-9 %8 2013 Jan %G eng %N 1 %R 10.2105/AJPH.2012.300835 %0 Journal Article %J Gerontologist %D 2013 %T The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors. %A Fredriksen-Goldsen, Karen I %A Emlet, Charles A %A Kim, Hyun-Jun %A Muraco, Anna %A Erosheva, Elena A %A Goldsen, Jayn %A Hoy-Ellis, Charles P %K Aged %K Aged, 80 and over %K Bisexuality %K Cross-Sectional Studies %K Depression %K Female %K Health Behavior %K Health Services Accessibility %K Health Status %K Health Status Indicators %K Homosexuality, Female %K Homosexuality, Male %K Humans %K Logistic Models %K Male %K Mental Health %K Middle Aged %K Minority Health %K Quality of Life %K Resilience, Psychological %K Risk Factors %K Social Stigma %K Social Support %K Socioeconomic Factors %X

PURPOSE: Based on resilience theory, this paper investigates the influence of key health indicators and risk and protective factors on health outcomes (including general health, disability, and depression) among lesbian, gay male, and bisexual (LGB) older adults.

DESIGN AND METHODS: A cross-sectional survey was conducted with LGB older adults, aged 50 and older (N = 2,439). Logistic regressions were conducted to examine the contributions of key health indicators (access to health care and health behaviors), risk factors (lifetime victimization, internalized stigma, and sexual identity concealment), and protective factors (social support and social network size) to health outcomes, when controlling for background characteristics.

RESULTS: The findings revealed that lifetime victimization, financial barriers to health care, obesity, and limited physical activity independently and significantly accounted for poor general health, disability, and depression among LGB older adults. Internalized stigma was also a significant predictor of disability and depression. Social support and social network size served as protective factors, decreasing the odds of poor general health, disability, and depression. Some distinct differences by gender and sexual orientation were also observed.

IMPLICATIONS: High levels of poor general health, disability, and depression among LGB older adults are of major concern. These findings highlight the important role of key risk and protective factors, which significantly influences health outcomes among LGB older adults. Tailored interventions must be developed to address the distinct health issues facing this historically disadvantaged population.

%B Gerontologist %V 53 %P 664-75 %8 2013 Aug %G eng %N 4 %R 10.1093/geront/gns123 %0 Journal Article %J Gerontologist %D 2013 %T Risk and protective factors associated with health-related quality of life among older gay and bisexual men living with HIV disease. %A Emlet, Charles A %A Fredriksen-Goldsen, Karen I %A Kim, Hyun-Jun %K Aged %K Aged, 80 and over %K Aging %K Bisexuality %K Cross-Sectional Studies %K Health Status %K HIV Infections %K Homosexuality, Male %K Humans %K Male %K Mental Health %K Middle Aged %K Prevalence %K Quality of Life %K Risk Factors %K Social Support %K Socioeconomic Factors %K Surveys and Questionnaires %K United States %X

PURPOSE: To identify risk and protective factors associated with mental and physical health-related quality of life, after controlling for key background characteristics, in a population of older gay and bisexual men living with HIV disease. Previous research examining quality of life among persons living with HIV rarely includes older adults.

DESIGN AND METHODS: Survey responses from 226 gay and bisexual men aged 50 and older, and living with HIV disease, which were part of the Caring and Aging with Pride study, were analyzed using multivariate linear regression models.

RESULTS: Findings reveal that comorbidity, limitations in activities, and victimization are significant risk factors for decreased physical and mental health-related quality of life. Stigma and HIV progression did not contribute to the overall outcome variables in multivariate models. Social support and self-efficacy serve as protective factors although social support was only significant with mental health-related quality of life.

IMPLICATIONS: Comorbidity, functional limitations, and lifetime victimization are risks to quality of life among older gay and bisexual men with HIV disease. Self-efficacy and social support represent intrapersonal and interpersonal resources that can be enhanced through interventions to improve health-related quality of life.

%B Gerontologist %V 53 %P 963-72 %8 2013 Dec %G eng %N 6 %R 10.1093/geront/gns191 %0 Journal Article %J AIDS Patient Care STDS %D 2011 %T "You must take the medications for you and for me": family caregivers promoting HIV medication adherence in China. %A Fredriksen-Goldsen, Karen I %A Shiu, Cheng-Shi %A Starks, Helene %A Chen, Wei-Ti %A Simoni, Jane %A Kim, Hyun-Jun %A Pearson, Cynthia %A Zhao, Hongxin %A Zhang, Fujie %K Adult %K Anti-HIV Agents %K Caregivers %K China %K Family %K Female %K Health Knowledge, Attitudes, Practice %K HIV Infections %K Humans %K Incidence %K Interviews as Topic %K Male %K Medication Adherence %K Middle Aged %K Motivation %X

China is experiencing a rapid increase in the incidence of HIV infections, which it is addressing proactively with broad implementation of antiretroviral therapy (ART). Within a cultural context extolling familial responsibility, family caregiving may be an important component to promote medication adherence for persons living with HIV in China. Based on 20 qualitative interviews with persons living with HIV and their family caregivers and a cross-sectional survey with 113 adults receiving HIV care at Beijing's Ditan outpatient clinic, this mixed-methods study examines family caregivers' role in promoting adherence to ART. Building upon a conceptual model of adherence, this article explores the role of family members in supporting four key components enhancing adherence (i.e., access, knowledge, motivation, and proximal cue to action). Patients with family caregiving support report superior ART adherence. Also, gender (being female) and less time since ART initiation are significantly related to superior adherence. Since Chinese cultural values emphasize family care, future work on adherence promotion in China will want to consider the systematic incorporation of family members.

%B AIDS Patient Care STDS %V 25 %P 735-41 %8 2011 Dec %G eng %N 12 %R 10.1089/apc.2010.0261 %0 Journal Article %J Am J Public Health %D 2010 %T Disparities in health-related quality of life: a comparison of lesbians and bisexual women. %A Fredriksen-Goldsen, Karen I %A Kim, Hyun-Jun %A Barkan, Susan E %A Balsam, Kimberly F %A Mincer, Shawn L %K Adolescent %K Adult %K Bisexuality %K Exercise %K Female %K Health Status Disparities %K Homosexuality, Female %K Humans %K Logistic Models %K Mental Health %K Middle Aged %K Obesity %K Poverty %K Quality of Life %K Risk Factors %K Stress, Psychological %K Urban Population %K Washington %K Young Adult %X

OBJECTIVES: We investigated the association of health-related quality of life (HRQOL) with sexual orientation among lesbians and bisexual women and compared the predictors of HRQOL between the 2 groups.

METHODS: We used multivariate logistic regression to analyze Washington State Behavioral Risk Factor Surveillance System population-based data (2003 to 2007) in a sample of 1496 lesbians and bisexual women and examined determinants of HRQOL among lesbians and bisexual women.

RESULTS: For lesbians and bisexual women, frequent mental distress and poor general health were associated with poverty and lack of exercise; poor general health was associated with obesity and mental distress. Bisexual women showed a higher likelihood of frequent mental distress and poor general health than did lesbians. The odds of mental distress were higher for bisexual women living in urban areas as compared with nonurban areas. Lesbians had an elevated risk of poor general health and mental distress during midlife.

CONCLUSIONS: Despite the standard practice of collapsing sexual minority women into a single group, lesbian and bisexual women in this study emerge as distinct groups that merit specific attention. Bisexual women are at elevated risk for poor HRQOL.

%B Am J Public Health %V 100 %P 2255-61 %8 2010 Nov %G eng %N 11 %R 10.2105/AJPH.2009.177329